Abnormality

Question 1

Schizophrenia and Psychotic disorders

Answer 1

Include a range of psychotic disorders that affect all aspects of a person’s thinking, emotions, actions, along with a major break from reality.

The personal, social and occupational functioning deteriorate because of disturbed thought process, unusual emotions and motor abnormalities.

Question 2

DSM definition

Answer 2

Schizophrenic spectrum and psychotic disorders as sharing one or more of the following: e.g. delusions, hallucinations, disorganised thoughts or negative symptoms e.g. loss of speech

Question 3

When diagnosed?

Answer 3

DSM: two symptoms for at least one month one must be delusions, hallucinations or disorganised thoughts/speech

Question 4

Types of Psychotic Disorders

Answer 4

Schizotypal: difficulty developing emotionally meaningful relationships with others and showing extreme coldness and flat affect

Substance induced psychotic disorder: a psychiatric disorder featured by delusions and/or hallucinations during or soon after substances intoxication or withdrawal

Question 5

Case Study

Answer 5

Conrad, male aged 23.

First episode aged 22 while on holiday, later diagnosed with schizo-affective disorder.

At first he was reluctant to seek treatment as he was unsure of recovery. He spent eight months following diagnosis in a psychiatric hospital. Conrad eventually found the right drug treatment but struggles with maintaining a healthy weight.

Question 6

Delusional Disorder (inc. types and diagnosis)

Answer 6

Characterised by persistent delusions but whose other behaviours are ‘normal’. There is an absence of the other psychotic symptoms of schizophrenia such as hallucinations, disorganised speech or negative symptoms.

Types:
Erotomaniac: belief that another person is in love with them
Grandiose: they are convinced they have a great unrecognised skill or status
Jealous: belief their partner is being unfaithful

Symptoms for at least one month and be unrelated to physiological effects of substance use.

Question 7

Freeman Aim

Answer 7

To investigate the use of virtual reality in assessing symptoms of shizophrenia

Question 8

Freeman Procedure

Answer 8

• 200 non-clinical participants
• Multiple measures: level of paranoia, emotional distress as well as social/cognitive traits. Simulator-sickness questionnaire was given before and after the simulation.
• Participants entered a 4 min virtual reality journey of either a library or underground train scene where the person walks/rides in the presence of other neutral avatars.
• After completion, persecutory thinking was measured alongside a VAS and an assessment of immersion in the environment

Question 9

Freeman results

Answer 9

Those who scored highly on the assessment of paranoia experienced high levels of persecutory ideation during VR.

Question 10

Gottesman and Shields Aim:

Answer 10

Genes or particular combinations of genes are passed on to offspring which may cause the disorder to develop.

Carry out a twin study to look at the genetic inheritance of schizophrenia. Symptoms of schizophrenia e.g. psychosis have known genetic origins and are known as ‘endophenotypes’ meaning it is possible to inherit them.

Question 11

Gottesman and Shields Procedure:

Answer 11

• 57 pairs of twins were used - 24 sets of MZ twins and 33 DZ twins.
• Researchers interviewed the patients alongside their twins, some of whom also had a diagnosis of schizophrenia.
• Participants also undertook cognitive tests e.g. object sorting.
• Case summaries of each participant were also independently evaluated by external judges.

Question 12

Gottesman and Shields Findings

Answer 12

50% MZ twins shared schizophrenia status - DZ twins, 9%.

For MZ twins, if the illness of one twin was severe, the other twin was much more likely to have schizophrenia.

Question 13

Biochemical (dopamine hypothesis) explanation of Schizophrenia

Answer 13

• Brains of those with schizophrenia produce more dopamine than those without. Hypothesis identified a link between excessive amounts of dopamine and positive symptoms of schizophrenia.
• Supported by drug trials w/ participants diagnosed with and without schizophrenia. Amphetamines and cocaine are known to produce excess dopamine - increase in dopamine correlates with an increase in the reporting of hallucinations and delusions.
• Patients with Parkinson’s disease are often treated with synthetic form of dopamine, if their dosage is too high, it creates symptoms such as hallucinations.

Question 14

Test for Dopamine Hypothesis

Answer 14

• Lindstroem et al. gave 10 people with schizophrenia and 10 people without L-Dopa (drug to increase dopamine) and found that those with schizophrenia absorbed the drug quicker.

Question 15

Cognitive explanation of Schizophrenia

Answer 15

FRITH

Schizophrenia involves an abnormality of self-monitoring. Believed schizophrenia sufferers have problems with meta-representation e.g. failing to recognise hallucinations are just inner speech resulting in them attributing what they hear to someone else.

Also believed schizophrenia may be caused by a cognitive impairment which explains symptoms like disorganised thoughts.

An additional aspect was the patients may have a less developed TOM and so may develop delusions to try understand others’ actions.

Question 16

Frith supporting procedure

Answer 16

Frith tested abnormality of self-monitoring with schizophrenic patients by asking if items read out loud were done so by themselves, an experimenter or a computer. Schizophrenic patients with incoherent speech performed worst at the task. Delusional thinking may arise from misinterpretation of perception.

Question 17

Biochemical treatment of schizophrenia

Answer 17

Typical: Chlorpromazine reduce dopamine activity by blocking dopamine receptors. Reduces positive symptoms e.g. hallucinations and has calming effect.

Atypical: Clozapine block dopamine production and act on others e.g. serotonin. These are better for negative symptoms + treatment resistant

Question 18

Research into effectiveness of drugs

Answer 18

Research into the effectiveness of drugs via randomised control trials, double-blind placebo controlled shows that 50% of those taking antipsychotic medication show significant improvement after 4-6 weeks - 30-40% show partial improvement and a small minority show 0 improvement (treatment-resistant schizophrenia).

Question 19

ECT

Answer 19

ECT is a procedure done under general anaesthesia.

The treatment involves passing electricity through the brain to induce a brief seizure.

Patients undergo a course of ECT ranging from 6-12 sessions, often being given twice a week or at longer intervals to prevent relapse.

It is applied to the non-dominant hemisphere to reduce memory loss.

Rarely used as there is little evidence that it is more effective than other forms of therapy.

Question 20

Token economy (Paul and Lentz) Aim

Answer 20

Investigated the effectiveness of a token economy on managing symptoms of schizophrenia. Token economy is based on the behaviourist principles of positive reinforcement for encouraging desirable behaviours. Believes symptoms occur as a result of a learned response - focuses on helping patients unlearn symptoms.

Question 21

Paul and Lentz procedure

Answer 21

84 individuals from a psychiatric institution participated.

Over four and a half years, Paul and Lentz used an independent measures design to compare the outcomes of three different treatments: milieu therapy, traditional hospital management and a token economy.

Patients were given ‘tokens’ as a reward for appropriate behaviours e.g. self-care. The tokens could be exchanged for luxury items like clothing and cigarettes. Behaviour was monitored through time-sample observation, standardised questionnaire and individual interviews.

Question 22

Paul and Lentz findings

Answer 22

Positive and negative symptoms were reduced.

Most effective reduction was found in catatonic behaviour and less successful for hallucinations/delusions.

97% of the token economy group were able to live independently in the community for 1.5-5 years compared to 71% in the milieu group and 45% in the hospital group.

Question 23

Cognitive-behavioural therapy (Sensky) Definition and Aim

Answer 23

CBT is a talking therapy designed to help people change through recognising thoughts which underlie their behaviours.

Sensky used a RCT to compare the effectiveness of CBT with ‘befriending’ (one-to-one discussions about hobbies, sports, current affairs) with schizophrenia patients.

Question 24

Sensky procedure

Answer 24

90 patients diagnosed with treatment-resistant schizophrenia.

Received an average of 19 sessions of CBT or befriending.

Randomly allocated and independent measures used.

Intervention delivered by experienced nurses. CBT treatment followed stages, first discussing emergence of their disorder before tackling specific symptoms. Patients kept voice diaries to record what they were hearing to generate coping strategies.

Ppts assessed by blind raters prior to treatment, at treatment completion and at a nine month follow-up. A number of standardised, validated assessment scales were used.

Question 25

Sensky findings

Answer 25

Both groups showed a significant reduction in positive and negative symptoms. However, at the follow-up, the CBT group continued to improve in reduction of positive symptoms.

Question 26

Define abnormal affect disorder

Answer 26

Abnormal affect disorders are classified as ‘mood disorders’ in the DSM-V.

This distinguishes them from brief feelings of sadness or joy.

Characteristics

Emotions are amplified beyond the normal ups and downs, in either extremely negative or positive directions which can persist for long periods of time.

Individuals may experience strong feelings of despair and emptiness or anger or euphoria.

Disorders of abnormal affect significantly impair the individual’s ability to function normally.

Question 27

Unipolar depression

Answer 27

Type of affective disorder characterised by sadness and hopelessness for an extended period of time ranging from mild to moderate or severe.

This includes a lack of pleasure in most activities, weight changes, changes in sleep patterns, psychomotor agitation, fatigue, feelings of worthlessness and reduction in ability to concentrate.

To be diagnosed, you must have ⅝ symptoms for at least two weeks:
Weight loss/gain
Insomnia/hypersomnia
Loss of energy/tiredness
Agitated depression
Loss of interest in previously enjoyed activities
Guilt
Reduced ability to think/concentrate
Suicidal thoughts

Question 28

Mania (bipolar):

Answer 28

Affective disorder characterised by episodes that alternate between mania and depression that cannot be accounted for.

Mania may include feelings of euphoria, rage or irritability for a long period of time.

Behavioural symptoms include becoming easily distracted, having racing thoughts, sudden interest in new activities, overconfidence, speaking quickly, sleeping less, engaging in risky behaviours.

Question 29

Measures: Beck Depression Inventory

Answer 29

• Psychometric test
• 21 item self-report measure
• assesses the attitudes and symptoms of depression.
• Each item has at least four statements (four point scale 0-3)
• Respondee must choose one that best fits how they have been feeling as of recent.
• The total score determines the severity of the disorder: 10 is the minimum for mild depression, 19-29 for moderate, and 30 or more for severe there are a total of
• Two revised versions since
• An example statement is:

Satisfaction:
I get as much satisfaction out of things as I used to (0)
I don’t enjoy things the way I used to (1)
I don’t get real satisfaction out of anything anymore (2)
I am dissatisfied and bored with everything (3)

Question 30

Biological: genetic (Oruc et al.) Aim

Answer 30

Believed depression has a genetic basis and looked at the link between bipolar and first relatives. First degree relatives share 50% of DNA.

Question 31

Oruc et al. procedure

Answer 31

A sample of 42 participants with a diagnosis of bipolar disorder were drawn from two psychiatric hospitals in Croatia. Control group of 40 ppts also included.

Information collected from ppts and family members alongside medical records.

Sixteen of the bipolar group had at least one first relative diagnosed with a major affective disorder.

DNA testing was conducted to test for polymorphisms in serotonin receptor 2c (5-HTR2c) and the serotonin transported (5-HTT) genes.

Question 32

Oruc et al. findings

Answer 32

There were no significant associations in the sample. Polymorphisms in these genes could be responsible for an increased risk of developing bipolar disorder in females.

Question 33

Biological (Neurochemical) - Schildkraut

Answer 33

Schildkraut (1965) suggested too much noradrenaline causes mania and too little causes depression. Serotonin was also found to exist in low levels for both depression and mania. Both serotonin and noradrenaline imbalances are involved in affective disorders.

Question 34

Cognitive (Beck)

Answer 34

Depression is due to faulty processing of information resulting in cognitive distortion.

Beck developed the cognitive triad (negative views about the world - obstacles blocking happiness, about oneself - worthless and not capable of being happy, about the future - anticipation of failure or rejection) these are a constant loop in the sufferers mind.

Negative views form a reality for that person leading to them spiraling into lower moods.

Cognitive distortion: distortion of thoughts automatic process which occurs as a result of earlier life processes, developed through schemas.

Question 35

Learned helplessness/attributional style (Seligman) aim

Answer 35

Seligman investigated how well attributional style could predict depressive symptoms.

Question 36

Seligman procedure

Answer 36

51 patients with bipolar or unipolar from the same outpatient clinic participated in the study during a depressive episode. They were compared to a 10 ppt control group.

First they completed the BDI and then the Attributional Style Questionnaire consisting of 12 hypothetical good and bad events. The participants made attributions for each one and rated each on a seven-point scale for internality, stability and globality.

Question 37

Seligman findings

Answer 37

The bipolar and unipolar participants had more pessimistic, negative attributional styles then the control group. The more severe the BDI score the worse the pessimism on the ASQ.

Question 38

Biological: chemical/drugs: MAO

Answer 38

MAOIs inhibit the work of the enzyme monoamine oxidase which is responsible for breaking down/removing neurotransmitters like norepinephrine, serotonin and dopamine. MAOIs prevent them from being broken down allowing them to remain at high levels in the brain.

They have numerous side effects and may cause issues with withdrawal.

Question 39

Biological: chemical/drugs: SSRIs

Answer 39

SSRIs, such as Prozac are a newer antidepressant that stops serotonin being reabsorbed and broken down allowing it to remain at higher levels in the brain. They are the most prescribed and have less side effects.

Question 40

Electro-convulsive Therapy

Answer 40

ECT is a procedure done under general anaesthesia.

The treatment involves passing electricity through the brain to induce a brief seizure.

Patients undergo a course of ECT ranging from 6-12 sessions, often being given twice a week or at longer intervals to prevent relapse.

It is applied to the non-dominant hemisphere to reduce memory loss.

Rarely used as there is little evidence that it is more effective than other forms of therapy.

Question 41

Cognitive Restructuring (Beck)

Answer 41

Talking therapy - one-to-one interaction between patient and therapist. Focuses on identifying and questioning illogical thinking.

1. Explain theory of depression to help understand way of thinking
2. Observe and record thoughts to identify irrational beliefs
   3.Challenge negative thoughts and replace with positive thoughts
3. Completes once patient can restructure thoughts or once there is reduction in depressive symptoms

Question 42

Rational Emotive Behavioural Therapy (Ellis)

Answer 42

Based on stoicism (affected by their own perception). A person is depressed as a result of their perceptions towards things. Focuses on the ABC model:
A: Activating event
B: Belief about A
C: Consequences of B

Question 43

REBT procedure

Answer 43

Ellis believes the most important aspect is the beliefs as negative beliefs lead to depression.

The goal is to help individuals create and maintain rational patterns of thinking. This means changing thoughts which lead to negative behaviour.

A REBT therapist forcefully questions irrational beliefs to try to reformulate them. This enables the patient to recognise that they choose how to think and feel about setbacks. Ellis then expanded the ABC model to include:

D: disputing the irrational beliefs

E: the effect of successful disruption of the irrational beliefs

Question 44

Ellis support

Answer 44

Researchers looking into effectiveness found group given REBT had significant improvements over the baseline and control groups

Question 45

Impulse Control Disorder Definition

Answer 45

An impulse control disorder where the person feels a compulsion to carry out a certain behaviour, rather than take a substance (e.g., alcohol, food, cigarettes, etc.). Types of behaviours could include gambling, stealing and pyromania.

Question 46

Definitions (Griffiths)

Answer 46

All addictions have a number of common characteristics including:

salience: activity takes over as most important thing in their life

mood modification: experience creates a buzz

tolerance: increasing amounts needed to fulfil

withdrawal: unpleasant feelings when stopped

conflict: between them and others

relapse: return to addiction years after controlling

Question 47

Kleptomania

Answer 47

Inability to resist stealing objects not needed for personal use or for their monetary value.

Individuals may feel tension before and pleasure afterwards.

Characterised by intrusive thoughts and urges to steal, which affects the person’s ability to concentrate. They may feel guilt and shame and the inability can lead to arrest, prosecution and loss of employment.

Question 48

Pyromania

Answer 48

Impulse to start fires.

Diagnosis requires individuals to have deliberately and intentionally set fires on more than one occasion. They feel tense before and pleasure when setting a fire or participating in the aftermath. Those with pyromania are fascinated with fire and accelerants (e.g. gasoline). They cannot resist starting a fire, set off fire alarms or watch fires burning. It may lead to employment in the fire service.

Question 49

Burton et al

Answer 49

distinguished between fire-setting, arson and pyromania:

Fire-setting: includes both the accidental and intentional setting of fires.

Arson: a subtype of fire-setting, is a criminal act in which one willfully and maliciously sets fire to, or aids in setting fire to, a structure, dwelling, or property of another.

Pyromania: a psychiatric diagnosis. Individuals with pyromania engage in intentional and pathological fire setting, but do not always commit the crime of arson.

Question 50

Gambling

Answer 50

non-substance addictive disorder: difficulty controlling impulses to gamble. Gambling stimulates the brain’s reward centre in a similar way to substance abuse. Involves problematic behaviours such as difficulty withdrawing, lying to conceal involvement, loss of relationships - has a devastating impact on the individual.

Question 51

Measures: Kleptomania Symptom Assessment Scale (K-SAS)

Answer 51

A self-report measure to assess the kleptomania symptoms in a patient.

There are 11 items with a self-rated scale which measures impulses, thoughts, feelings and behaviours related to stealing.

The individual answers are based on the past seven days.

Each item is rated on either a 5 point scale or six point scale (0=none, 4/5 = severe).

The higher the score, the more severe the symptoms.

There are four main sections:

Urges/impulses to steal

Thoughts of stealing

Emotional distress prior/after the act

Distress/impairment due to Kleptomania

Example question:

During the past week, how many hours were you preoccupied with your urges to steal?

Question 52

Biochemical: dopamine

Answer 52

Dopamine is linked to impulse control disorders. It is known as the ‘happy chemical’ as its release is triggered by rewarding stimuli. When they become compulsive, dopamine levels are reduced. A deficiency in dopamine can lead to compulsions and addictions (this is called reward deficiency syndrome)

So, for example, when someone with kleptomania steals something, their reward centres are stimulated and release dopamine.

Question 53

Behavioural: positive reinforcement

Answer 53

Operant conditioning: Positive reinforcement: using rewards to increase the frequency of a behaviour. For gamblers, the enjoyment of winning acts as a positive reinforcer and for pyromaniacs and kleptomaniacs the thrill acts as a reward. Gambling is also explained through schedules of reinforcement whereby the gambler is compelled to continue playing in hopes of winning the next game.

Question 54

Cognitive: feeling-state theory (Miller)

Answer 54

Intense positive feelings link with specific behaviours such as gambling which creates a state-dependent memory or a ‘feeling-state’.

To regenerate the feeling, the person compulsively repeats the behaviour - this re-enactment creates the impulse-control disorder.

The intense feeling-state experienced is all the emotions, thoughts and physiological arousal, and this leads to impulse-control problems and causes obsessions.

For example, if a person’s feeling-state about starting a fire is “I am a powerful human being” combined with the feelings, arousal and memory of setting a fire, then this could create a compulsion for fire-setting behaviour.

Question 55

Biochemical (Grant et al.) Aim

Answer 55

Grant et al. investigated if opiates may be successful in treating gambling disorders.

Question 56

Grant et al. procedure

Answer 56

284 ppts. Double-blind. Participants took either a 16 week course of the opiate nalmefene or 18 week course of naltrexone (work by reducing urge to gamble) or a placebo. They assessed gambling via the Y-BOCS.

Question 57

Grant et al. findings

Answer 57

The opiate groups produced a significant reduction in symptoms. Participants with a family history of alcoholism and those with the highest dose of opiates showed the greatest reduction.

Question 58

Covert sensitisation (Glover)

Answer 58

Classical conditioning: unpleasant stimulus paired with undesirable behaviour to change the behaviour. The addictive/impulsive behaviour is paired with an unpleasant image or experience. For example, pairing the experience of gambling with the idea of losing.

Question 59

Glover procedure

Answer 59

Glover used covert sensitisation to treat 56-year-old kleptomaniac.

As she imagined approaching the item to steal, she would imagine vomiting which attracted the attention and disgust of those around her. This was used to create unplesant associations with stealing.

She underwent four sessions at two-week intervals. The first two sessions focused on teaching muscle relaxation to ensure immersion. She practised this as homework. The final session practised replacing the item and the sickness going away.

Question 60

Glover findings

Answer 60

She had a decreased desire and avoidance of stealing.

Question 61

Imaginal desensitisation (Blaszczynski and Nower)

Answer 61

The technique involves teaching a brief progressive muscle relaxation procedure.

1. visualize themselves being exposed to a situation that triggers the drive to carry out their impulsive behaviour
2. contemplating acting on their urge
3. leaving the situation in a state of continued relaxation without having acted upon their urge.

The sessions are recorded to assist the patient with practising the technique outside.

The aim is to reduce the strength of compulsions by reducing arousal. Clients report a better ability to control impulses.

Question 62

Impulse control therapy (Miller)

Answer 62

Aim is to establish healthy behaviours. It involves changing impaired thoughts about behaviour, that are linked to the feeling-state explanation.

Question 63

Impulse control therapy (Miller) PROCEDURE

Answer 63

The process is as follows:

Aspect of behaviour which produces the most intense feelings is identified

Positive feelings are identified (measured via positive feelings scale)

The client forms an image linking the behaviour, feelings and sensations

Performing eye movement desensitisation and reprocessing exercises (therapist directs their eye movement in a pattern)

Setting homework and follow-up sessions which are done until the drive towards the compulsive behaviour is reduced.

Question 64

Impulse control therapy (Miller) supporting evidence

Answer 64

Supporting evidence in the case of John who had a gambling problem and lost more than $1,000,000. Positive feelings were identified (rated 10 highest). He followed the process and in his follow-up interview (3 months) he reported his compulsion had not returned.

Question 65

Define Anxiety Disorder

Answer 65

Anxiety disorders are characterised by persistent, frequent worry and apprehension about a perceived threat in the environment, even though the threat is minor or non-existant and causes little to no harm. Panic attacks are a very common feature of anxiety disorders.

Question 66

What can anxiety be?

Answer 66

Anxiety can occur in either many different stimulus (Generalised Anxiety Disorder) or they can be specific occurring only in relation to a particular stimulus (Phobia)

Question 66

Characteristics of Anxiety disorders

Answer 66

Alarm about surroundings

Avoidance Behaviour

Panic attacks

May develop gradually or very quickly as a result of a particular experience

Interferes with everyday activities

Duration of 6 months or more

Question 67

Case study: Little Albert

Answer 67

Little Albert was a 11-month old baby who was conditioned by Watson and Raynor to have a phobia of white rats. This was done using classical conditioning by hitting a metal bar behind Albert when presented with a white rat. Albert developed a fear which became generalised over time to include white objects and anything with fur (e.g. Santa’s beard).

Question 68

Agoraphobia

Answer 68

fear of public places - characterised by a fear of two or more of: standing in line or being in a crowd, being in open scales, using public transport, being outside the home by oneself, being in enclosed spaces.

Question 69

Haemophobia

Answer 69

blood phobia also extends to needles, injections or medical procedures. Avoid hospitals etc. Known to experience an increase in heart rate when they see blood and a drop in blood pressure, leading to fainting.

Question 70

Zoophobia

Answer 70

fear of animals (often dog, insect, bird and spider)- could be a select few or a lot. Individuals avoid contact with these animals and experience distress/panic attacks if faced with them.

Question 71

Koumpounophobia

Answer 71

button phobia: the irrational fear of buttons: cannot touch buttons, look at them, or wear them: Saavedra and Silverman.

Question 72

BIPI

Answer 72

a questionnaire that has 18 situations involving blood and injections.

The self-report asks the individual to evaluate different reactions they might have including cognitive, physiological and behavioural responses.

They rate them on a 4 point scale (0= never, 3= always)

Example:

When I see blood on my arm or finger from pricking myself with a needle (Rate 0-3) :

• I don’t think I will be able to bear the situation
• I think I am going to faint
• I think that something bad is going to happen to me

Question 73

GAD-7

Answer 73

Measures generalised anxiety disorder.

Seven item screening test questionnaire measures the severity of anxiety including feeling nervous, anxious or on edge, being so restless that it is hard to sit still and feeling afraid as if something awful might happen.

Participants score 0-3 for each item based on how frequent they experience the symptoms (0= not at all, 3=nearly every day).

A score out of 21 is generated and the higher the score the more severe the GAD. 0-5 mild, 6-10 moderate, 11-15 moderately severe and 15-21 severe anxiety.

Example:

Feeling nervous, anxious or on edge

0 - Not at all

1 - Several days

2 - More than half of the days

3 - nearly every day

Question 74

Behavioural (classical conditioning, Watson)

Answer 74

Classical conditioning. A phobia is acquired through a process of association. Develops as the neutral stimulus is paired with a frightening experience. If enough pairings occur or the initial UCS is very frightening the person will end up with a fear of the NS. The NS then becomes the CS.

Question 75

Watson supporting example

Answer 75

He was not fearful of the rat beforehand. They presented Albert with the rat and loudly hit a metal bar behind Albert which was the unconditioned stimulus (US) as it produced an unconditioned response of fear (UCR). When Albert reached for the rat, they would hit the loud metal bar. Repeated pairing led to a fearful response (crying, trying to move away) to just the white rat. The rat became a CS producing a CR of fear.

Question 76

Psychoanalytic (Freud)

Answer 76

Anxiety and fear results from impulses of the id, when it is being denied or repressed.

The phobic object symbolises the conflict typical of the stage.

A fear is repressed into the unconscious to protect the ego.

The phobia can be a redirected fear during an intensely frightening experience (e.g. a physical attack) onto an object.

Question 77

Freud supporting example

Answer 77

Little Hans: Five years old.

At three, Hans developed an intense interest in his penis. He frequently played with his penis resulting in his mother threatening to cut it off.

Around this time he was also separated from his mother and witnessed a distressing event of a horse dying in the street. After this, his horse phobia emerged.

Conflict emerged at this time between Hans and his father who denied him from getting into his parents’ bed in the mornings to sit with his mother.

Freud believed the object (the horse) represented Hans’ father. The anxiety was related to castration and the banishment of Hans from his parents’ bed.

Question 78

Biomedical/genetic (Ost)

Answer 78

Born genetically prepared/set up to fear certain objects for survival

Question 79

Ost procedure

Answer 79

140 blood phobic or injection phobic patients compared to samples of patients with other phobias.

Participants underwent a screening interview and completed a self-report on their phobia and its history. They also did a behavioural test where they watched a surgery video and had their gaze tracked.

Then completed a questionnaire on their thoughts during the video and had their blood pressure + heart rate monitored.

Question 80

Ost findings

Answer 80

Ost found that blood-phobic subjects had more first degree relatives with the same phobia compared to injection-phobic participants (49% vs 27%).

Participants with blood phobia and injection phobia had a history of fainting when exposed to their respective phobic stimuli (70% blood phobics and 56% of injection phobics).

These results are much higher than those participants with other specific phobias or anxiety.

Concluded that there appears to be a strong genetic link and more likely to lead to a strong physiological response (fainting).

Question 81

Cognitive (DiNardo et al.)

Answer 81

We have irrational thoughts about an object due to a previous experience that we believe will be repeated.

Question 82

Cognitive (DiNardo et al.) Procedure

Answer 82

37 women, student population, fearful or non-fearful.

Self-report (of fear of dogs) and behavioural test (approached by and had to touch dog) they monitored heart rate and rated anxiety

Participants discussed unpleasant encounters with dogs. They also discussed the expectation of harm upon encountering a dog and the likelihood of harm.

Question 83

DiNardo results

Answer 83

Dog-phobic group rated fear higher than non-dog phobic

56% of people dog phobic could recall frightening past experience with a dog. However, 66% of the group with no dog phobia also had memories of being bitten by dogs and yet had not developed any anxiety about seeing dogs in the future.

Question 84

DiNardo conclusions

Answer 84

This shows that not everyone who is exposed to conditioning would end up developing a phobia, and it may be explained more through our thought processes after an event than the event itself.

Question 85

Systematic Desensitisation (Wolpe)

Answer 85

Behavioural therapy based on classical conditioning.

Unlearn phobic reactions and turn the stimulus to become neutral.

Place fearful feelings associated with phobic stimulus directly in conflict with feelings of deep relaxation - reciprocal inhibition.

Question 86

Systematic Desensitisation (Wolpe) Procedure

Answer 86

1. Patient is taught muscle relaxation and breathing exercises.
2. A fear hierarchy created with the most feared item/experience at the top down to the least feared at the bottom.
3. The patient works their way up the hierarchy practising the relaxation techniques at each level till they reach the highest fear.
4. Fear and calm are incompatible, the fear eventually becomes unlearned.

Question 87

Applied Tension (Ost et al.)

Answer 87

This involves tensing the muscles in the body to raise blood pressure and makes it less likely the person will faint. Developed to help people who have a phobia of blood and/or needles and faint at the sight of them.

Question 88

Ost et al. procedure

Answer 88

30 patients from same hospital who had a phobia of blood, wounds and injuries.

Independent measures:
Applied tension: 5 sessions
applied relaxation (9 sessions)
Combined: ten sessions.

Before treatment, they were assessed via self-report and behavioural/physiological measures to assess tendencies for fainting.

Applied tension taught patients to tense their arm, chest and leg muscles until they experienced a feeling of warmth rising to their face. They were exposed to videos of blood donations + photos of wounds and had to apply the technique.

Compared with patients using applied relaxation and a combination of applied tension and applied relaxation.

After completion and six months later they were given same measures to evaluate changes.

Question 89

Ost et al. findings

Answer 89

73% of all participants showed noticeable improvement - tension 50% of time, so more appropriate.

Question 90

Cognitive-behavioural therapy (Ost and Westling)

Answer 90

This therapy is where the patient and therapist identify faulty thinking about the object/experience that the patient has a phobia about.

Question 91

Ost and Westling procedure

Answer 91

12 weekly sessions comparing CBT with applied relaxation.

38 ppts with panic disorder.

The patients were assessed before, after and at one year.

The applied relaxation group received standardised deep muscle relaxation training and the CBT group received training on restructuring thoughts associated with panic attacks. They practised coming up with these alternative thoughts between sessions.

In order to draw a comparison, they were rated using a self-report scale as well as through self-observation of panic attacks

Question 92

Ost and Westling findings

Answer 92

Both the CBT and the applied relaxation group had a reduction in symptoms, however there was no significant difference, showing CBT is effective.

Question 93

OCD

Answer 93

Obsessive compulsive disorder is a mental health condition where you have recurring thoughts and repetitive behaviours that you cannot control

Question 94

DSM Diagnosis

Answer 94

The DSM-V diagnosis for OCD requires:

• Presence of obsessions and/or compulsions
• Suppress unwanted thoughts by performing behaviours
• Behaviours carried out to relieve anxiety
• Extremely time-consuming

Question 95

Obsessions

Answer 95

thoughts that are persistent, worrying, intrusive and disturbing. Common examples include: fear of illness or infection, strong desire for order and symmetry

Question 96

Compulsions

Answer 96

behaviours that are repetitive and give temporary relief to the anxiety/obsessions. Engaging in these compulsions is a means of suppressing obsessions. Examples: frequent and excessive handwashing; checking repeatedly e.g. checking front door is locked 20 times before leaving home.

Question 97

Hoarding disorder

Answer 97

a disorder where the sufferer excessively collects things and has extreme trouble getting rid of them. They will collect things regardless of their material or sentimental value.

Question 98

Body dysmorphic disorder (BDD)

Answer 98

A disorder where the sufferer has persistent negative thoughts about their appearance, often involving some kind of fault or defect around the face and head. May include repetitive mirror-checking, grooming and comparison to others.

Question 99

Examples and case studies (‘Charles’ by Rappaport)

Answer 99

Charles was 14 years old, diagnosed with OCD who spent 3+ hours showering plus at least another two getting dressed.

He had elaborate repetitive routines. He had to leave school because the rituals made it impossible for him to attend on time. He had received some treatments but was obsessed with the thought he had something sticky on his skin. He was given clomipramine which relieved his symptoms, however after a few years, he developed a tolerance for his medication causing him to relapse.

Question 100

Maudsley Obsessive-Compulsive Inventory (MOCI)

Answer 100

Assess OCD symptoms.

Self-report questionnaire using a forced choice ‘true’ or ‘false’ format.

There are 30 items leading to a total score between 0 and 30. The 30 items are divided into 4 sub-scales (symptoms): Checking, Cleaning/washing, Slowness, Doubting. Takes about 5 mins to complete.

Example:

I frequently have to check things several times

Question 101

Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

Answer 101

Measure the nature and severity of symptoms.

It involves a semi-structured interview, taking about 30 minutes and involves a checklist of different obsessions and compulsions, with a 10-item severity scale.

Obsessive categories include contamination and aggressive.

Compulsion categories include counting, and washing.

Individuals can rate the time they spend on obsessions, how hard they are to resist and how much distress they cause.

Scores range from 0 (no symptoms) to 40 (severe symptoms). Those above 16 are in the clinical range.

Question 102

Genetic Matthiessen et al.

Answer 102

OCD occurs due to faulty inherited genes that affect the synapses in the brain.

Matthiessen et al. conducted a study with 1406 ppts analysing genes that may be linked to OCD.

Genes, such as PTPRD, SLITRK3, were implicated with both being related to the regulation of synapses in the brain. Other studies identified DRd4 as being an influence as it is related to the uptake of dopamine.

Question 103

Biochemical Leckman et al.

Answer 103

Oxytocin dysfunction - increase worries and fear of certain situations/stimuli with the belief that survival could be threatened. Leckman et al. found that some forms of OCD were related to oxytocin dysfunction.

Question 104

Neurological

Answer 104

Abnormalities of brain structure and function. Specifically, defects in the basal ganglia may cause OCD.

The basal ganglia and two associated regions (orbitofrontal cortex and anterior cingulate gyrus) work together to check warning messages, in individuals with an impaired function, it does not work as it should, meaning the basal ganglia continuously receives worrying messages.

Question 105

Cognitive

Answer 105

Obsessive thinking is based on faulty reasoning that causes compulsive behaviours as the person attempts to alleviate their obsessions.

For example, the thought that hands are covered in harmful germs that could kill is due to errors in thinking. These thoughts worsen under stressful conditions. Compulsive behaviours attempt to alleviate the unwanted thoughts.

Question 106

Behavioural

Answer 106

Operant Conditioning. Faulty thinking leads to compulsive behaviour which reduces/alleviates the obsessive thoughts for a time and acts as the negative reinforcer of the behaviour (as something unpleasant is removed). Also positive reinforcement e.g. the reward of knowing hands are clean.

Question 107

Psychodynamic

Answer 107

Symptoms develop as a result of an internal conflict between the id and the ego.

OCD develops due to difficult experiences in childhood during the psychosexual stages of development.

These difficult experiences/situations have led the person to develop OCD as an ego defence mechanism.

The obsessive thoughts which come from the id disturb the rational part of the self, the ego, to the extent that it may lead to compulsive cleaning and tidying rituals later in life, in order to deal with the earlier childhood trauma.

Question 108

Biomedical (SSRIs)

Answer 108

If OCD is caused by low serotonin levels, then drugs can be used to increase serotonin in the brain.

Works by increasing the amount of serotonin, a natural substance in the brain that is needed to maintain mental balance. This seems to then cause a lessening of anxiety experienced by the patient and therefore they do not need to engage in the OCD behaviours in order to relieve their anxiety (such as hand washing). A higher level dose tends to be given to OCD patients as it proves more effective.

Question 109

Cognitive (Lovell et al.):

Answer 109

Cognitive behavioural therapy is designed to help people change their behaviour through recognising thoughts which underlie their negative behaviours.

Lovell et al. compared telephone versus face to face treatment of CBT for OCD.

72 ppts randomised control trial underwent ten weekly sessions of therapy either delivered face-to-face or over the phone.

Change was measured via the Y-BOCS, BDI and a client satisfaction questionnaire.

Question 110

Lovell et al. Findings

Answer 110

Both showed a significant improvement in symptoms, however there were no significant differences found at six months. Concluded both face to face and telephone treatment are equally as effective in treating OCD

Question 111

Exposure and response prevention (Lehmkuhl et al.):

Answer 111

A therapy that encourages you to face your fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralising’ them with compulsions. Case study with a 12 year old boy, called Jason, who had OCD and autism. He spent hours engaging in compulsive behaviours and reported severe anxiety when prevented from completing rituals.

Question 112

ERP Procedure

Answer 112

ERP consists of: 1. Gathering information about existing symptoms 2. Therapist-initiated ERP and 3. Generalisation and relapse training. Jason attended 50 minute CBT sessions over 16 weeks. Used exposure response prevention:

Exposure: getting Jason to touch objects he felt were contaminated and produced feelings of anxiety (elevator buttons, door handles, etc…) He touched them until his anxiety levels dropped - the exposures became increasingly difficult.

Response prevention: reducing the anxious response by using coping statements (e.g. I know that nothing bad will happen).

Question 113

Lehmkuhl et al. results

Answer 113

After therapy, Jason’s Y-BOCS score dropped from 18 to 3 and at a three month check up his score remained low with both parents reporting a significant improvement.

Question 114

Learned Helplessness

Answer 114

An individual feels they do not have control over a situation because they have had negative experiences of that situation in the past. This gives them a sense of hopelessness as they feel they cannot escape, which leads to depression.