Clinical Flashcards
What are the 3 types of Symptoms of Schizophrenia?
- Positive
- Negative
- Cognitive
What is Psychosis?
A general term for disorders that involve a loss of contact with reality
What is Schizophrenia marked by?
•Periods of remission where the patient has no symptoms •Followed by relapses where their symptoms reoccur
What is Schizophrenia?
- A psychotic disorder
* Where their ability to perceive, process + respond to environmental stimuli is impaired
What are Positive Symptoms in Schizophrenia?
Strange additions to normal behaviours
What are Negative Symptoms in Schizophrenia?
Loss of normal characteristics
What are Cognitive Symptoms in Schizophrenia?
Issues to do with information processing
What are the 4 Types of Positive Symptoms in Schizophrenia?
- Delusions
- Hallucinations
- Disorganised thinking/speech
- Abnormal motor behaviour/disorganised behaviour
What are Delusions as a Type of Positive Symptoms in Schizophrenia?
Bizarre beliefs which persist
What are the Different Types of Delusions as a Type of Positive Symptoms in Schizophrenia?
- Delusions of reference
- Delusions of grandeur
- Delusions of persecution
- Thought insertion
- Thought broadcasting
What are Delusions of Reference as a Type of Delusion as a Type of Positive Symptoms in Schizophrenia?
Patient believes that other peoples behaviour is directed specifically at them
What are Delusions of Persecution as a Type of Delusion as a Type of Positive Symptoms in Schizophrenia?
Believes that one is being plotted or conspired against
What is Thought Broadcasting as a Type of Delusion as a Type of Positive Symptoms in Schizophrenia?
Belief that others can hear their thoughts
What is Thought Insertion as a Type of Delusion as a Type of Positive Symptoms in Schizophrenia?
Person believes that their thoughts have been implanted by some kind of external force
What are the Cultural Differences of Delusions as a Type of Positive Symptoms in Schizophrenia?
- Delusions reflect pre-dominant themes + values of a persons culture
- In industrially advanced countries (America) patients delusions focus on sinister uses of tech - e.g. patients may report that they’re being spied on by their TV
- In Nigeria, mental illness is believed to be caused by evil spirits, so delusions may be in the form of witches
- So delusions differ according to the patient’s culture
- In some African cultures hallucinations are not seen as a sign of mental illness
- So different cultures may diagnose disorders differently
What are Hallucinations as a Type of Positive Symptoms in Schizophrenia?
- Perception of stimuli not actually present
- It can be visual, auditory, or olfactory
- Sometimes they will comment on the individuals character, usually in an insulting manner or they may give a command
What are the Cultural Differences of Hallucinations as a Type of Positive Symptoms in Schizophrenia?
- People from different cultures may interpret the voices that they hear differently
- Luhmann (2015) - found in some cultures the voices heard were harsh + critical, but in others they were seen as kind
- So symptoms of schizophrenia may vary from cultures
What is Disorganised Thinking/Speech as a Type of Positive Symptoms in Schizophrenia?
- Underlying with conscious thought that has an effect on a person’s language
- Patient’s speech is jumbled due to loose associations in thoughts - where 1 idea constantly triggers another, so they jump from topic to topic
What is Abnormal Motor Behaviour/Disorganised Behaviour as a Type of Positive Symptoms in Schizophrenia?
Agitated movement - such as repeating movements over and over again
What are the 6 Types of Negative Symptoms in Schizophrenia?
- Lack of energy + movement
- Social withdrawal
- Flatness of emotion
- Not looking after appearance + self
- Lack of pleasure in everyday things
- Speaking little
How do the Negative Symptoms in Schizophrenia Link to Psychology as a Science?
They are more objective as they may be more directly observable
What are the 3 Types of Cognitive Symptoms in Schizophrenia?
- Difficulties in concentrating + paying attention
- Problems with working memory
- Difficulties with executive functioning
What are the 3 Features of Schizophrenia?
- Onset
- Prevalence
- Prognosis
What is Onset as a Feature of Schizophrenia?
- Between late teens + mid 30s
- Peak onset is early to mid 20s in males, and late 20s for females
- The episodes develop gradually over time + may not be obvious at first
What is Prevalence as a Feature of Schizophrenia?
- Refers to how common a disorder is
- It is a universal illness
- The likelihood of developing schizophrenia is between 0.7 and 1%
- This is influenced by racial/ethnic background, residence + birth country
- People who experience social problems (poverty + unemployment) are more likely to develop schizophrenia
What is Prognosis as a Feature of Schizophrenia?
- Refers to likely course of the disease
- 25% of people who had a schizophrenic episode recover
- 50% of people have recurrent episodes
- 25% of people experience schizophrenic symptoms continually
- Life expectancy for person w/ schizophrenia is 10 years less than the average
- Males show higher proportion of negative symptoms + have longer duration of the disorder - these factors are associated w/ a poor prognosis
How does Onset as a Feature of Schizophrenia Link to Developmental Psychology?
Schizophrenia is triggered by some aspect of development during the years of late teens and mid 30s - either biological or social
How does Prevalence as a Feature of Schizophrenia Link to Individual Differences?
People who experience social problems such as poverty and unemployment are more likely to develop schizophrenia
How does Prognosis as a Feature of Schizophrenia Link to Individual Differences?
Males show more negative symptoms + have a longer duration of the disorder - these factors are associated with poor prognosis
How does Prognosis as a Feature of Schizophrenia Link to Cultural Differences?
The WHO international pilot study of schizophrenia suggests - patients w/ this disorder in developing countries have more positive prognosis than do patients in Western industrialised societies
How does Prevalence as a Feature of Schizophrenia Link to Cultural Differences?
Prevalence varies according to countries
What is a Neurotransmitter?
Chemicals that allow neurons to communicate with one another which allows our brains to think and feel so that our bodies are able to do things
What is Dopamine?
Neurotransmitter associated with functions, including motivation and feeling pleasure
What is the Dopamine Hypothesis?
Suggest that schizophrenia can be explained by changes of dopamine functioning in the brain
How can Schizophrenia be Explained by High Levels of Dopamine?
- Low levels of beta hydroxylase, so excess dopamine builds up in the synapses
- Excess dopamine receptors at synapses in the brain
- Due to hyper sensitivity of certain dopamine receptors
How are Low Levels of Serotonin Related to Schizophrenia?
Irregular serotonin activity = negative symptoms of schizophrenia
How are Low Levels of Dopamine Related to Schizophrenia?
Low levels of dopamine in mesocortical pathway = negative symptoms
How are High Levels of Dopamine Related to Schizophrenia?
High levels of dopamine in mesolimbic pathway = positive symptoms
What are Neurotransmitters (which aren’t serotonin or dopamine) Which have a Influence on Schizophrenia?
- GABA
* Glutamate
What are the Strengths of the Theory of Neurotransmitters as an Explanation for Schizophrenia?
- Explains positive + negative symptoms - increase of dopamine in mesolimbic pathway accounts for positive symptoms, decrease of dopamine in mesocortical pathway accounts for negative symptoms
- Backed up by evidence from drug treatment - antipsychotic medications for work by blocking dopamine receptors
- Testable evidence that excess dopamine plays a role in schizophrenia - people given Levodopa experience schizophrenic-like symptoms (e.g. hallucinations)
- PET scans in investigating dopamine levels in patients provide an objective measure of neurotransmitter functioning in areas of the brain
What are the Applications of the Theory of Neurotransmitters as an Explanation for Schizophrenia?
Many antipsychotic medications used to treat schizophrenia work by blocking dopamine receptors
What are the Weaknesses of the Theory of Neurotransmitters as an Explanation for Schizophrenia?
- It’s reductionist - Ignores other factors that may influence whether someone develops schizophrenia - biological, psychological + social factors
- Cannot prove that excess dopamine causes schizophrenia, instead it may be a symptom of schizophrenia
- Not all patients with schizophrenia respond to the drugs - Friedhoff (1980) found that some patients show no improvement after taking dopamine antagonists
- PET scans show that blocking dopamine receptors doesn’t always remove the symptoms
What did Brown and Birley (1968) Find which Suggests the Theory of Neurotransmitters as an Explanation for Schizophrenia
is Reductionist?
- Found that 50% of schizophrenic patients reported a major life event in the 3 weeks prior to the relapse
- Suggesting that social conditions may trigger relapse
What did Owen (1978) Show which Supports the Theory of Neurotransmitters as an Explanation for Schizophrenia?
- Post-mortem examinations of the brains of people with schizophrenia
- Showed that they had a higher density of dopamine receptors in the cerebral cortex
What does it mean if Schizophrenia is Genetic?
- People who are genetically related to schizophrenics should be more likely to have schizophrenia themselves
- The chances of them having schizophrenia is higher
What are the 3 Types of Research that have Investigated the Role of Genetics in Schizophrenia?
- Family studies
- Adoption studies
- Twin studies
What are Family Studies as a Type of Research that has Investigated the Role of Genetics in Schizophrenia?
- Investigate whether close biological relatives also have schizophrenia
- Problematic as the closer the relative the more likely they are to share the same environment
- So it’s difficult to separate out the effects of nature with nurture
What are Adoption Studies as a Type of Research that has Investigated the Role of Genetics in Schizophrenia?
- Useful as a genetic factor can be looked for in adopted children who have been apart from their biological parents
- Allows effects of nature to be separated from nurture which controls extraneous variable of environment
- The adopted children whose biological parents are schizophrenic have a higher risk of developing schizophrenia
What are Twin Studies as a Type of Research that has Investigated the Role of Genetics in Schizophrenia?
- Schizophrenia in MZ and DZ twins can be compared
- If a twin has schizophrenia then the concordance rate between MZ twins should be 100% whereas it should be lower in DZ twins as they only share 50% of their genetic material
What are Dizygotic (DZ) Twins?
- Non-identical
* Share 50% of their genes
What are Monozygotic (MZ) Twins?
- Genetically identical
* Share 100% of their genes
What were the Results from Gottesman and Shield’s (1966) Study which related to Twin Studies?
- Concordance rates for schizophrenia were higher in females compared to males for MZ and DZ twins
- Concordance rates higher for MZ+DZ twins for severe schizophrenia compared to mild
- Concordance rates for severe schizophrenia was much higher in MZ twins (75%) compared to DZ twins (22%)
What were the Conclusions from Gottesman and Shield’s (1966) Study which related to Twin Studies?
- Schizophrenia does have a biological basis, developing it is influenced by a persons gene
- However, not totally caused by genes as concordance rate for MZ weren’t 100% •Therefore genes are a risk factor for developing it but environmental triggers are necessary
What did Gottesman and Shield’s (1966) Investigate which related to Twin Studies?
Whether schizophrenia has a genetic basis for looking at concordance rates for schizophrenia and MZ and DZ twins
What are the Strengths of Genes as an Explanation for Schizophrenia?
- Evidence from Twin studies suggest that there is a significant genetic factor in schizophrenia (e.g. Gottesman + Sheild)
- Biological approach to explaining schizophrenia is associated with the medical profession + has scientific status + credibility
What are the Weaknesses of Genes as an Explanation for Schizophrenia?
- Research methods used to establish genetic links e.g. twin studies have flawed methodologies - as don’t take account that genes may function differently in different environments
- Reductionist as environmental factors may be involved in the development of schizophrenia - e.g. concordance rate in MZ twins for Schizophrenia is only around 40-50%, so if the illness was purely down to genetics, we’d expect the rate to be 100%
- Confusion as to which genes are responsible for predisposing a person to schizophrenia as there could be many, Wright (2014) suggested that 700 genes have been linked to schizophrenia
What are the Individual differences in the Genetic Explanation of Schizophrenia?
- Symptoms of schizophrenia are very diverse and not the same for everyone
- Biological view is unlikely to be a complete one as there are likely to be different factors associated with developing the disorder that may account for the various subtypes and presentation of symptoms
What is the Issue and Debate of Nature-Nurture in the Genetic Explanation of Schizophrenia?
- Diathesis-stress model argue that schizophrenia develops in those who have a biological predisposition to developing illness due to genetic’s (neurochemical or neuroanatomical factors)
- But who also have some sort of environmental trigger - suggest the cause is a combination of factors
What does the Diathesis-Stress Model of Schizophrenia Suggest about the Genetic Explanation?
A genetic disposition which becomes apparent when the individual becomes stressed by factors in their environment
How is Developmental Psychology Linked to the Genetic Explanation of Schizophrenia?
- Schizophrenia can be explained through the process of development
- Thomas (2010) suggests schizophrenia stems from abnormalities in early brain development
- Prenatal exposure to infection or lack of nutrition have been linked with schizophrenia (Opler and Susser (2005))
- Schizophrenia develops in late adolescence and early adulthood
What are the Similarities between the Neurotransmitter Explanation for Schizophrenia and the Genetic Explanation for Schizophrenia?
- Both reductionist
- Both are biological explanations in terms of the medical model
- Both have research evidence to support their theories
What is the Cognitive Explanation of Schizophrenia?
- Explain human behaviour in terms of information processing
- So, explains the symptoms of schizophrenia in terms of the patients thought processes
- Cognitive impairments play an important role in the development and maintenance of schizophrenia
What are the 2 Cognitive Factors which may Explain Schizophrenia?
- Problems with attention
* Problems with memory
What are the Problems with Attention as a Cognitive Factor which may Explain Schizophrenia?
- People with schizophrenia have attentional processes which work in a different way
- They don’t have normal functioning of these filtering processes, leading them to pay too much attention to irrelevant stimuli
- Preventing them from making sense of the world in the way that most people can
What does Frith (1979) Suggest which Supports the Problems with Attention as a Cognitive Factor which may Explain Schizophrenia?
- Inability to filter out unnecessary cognitive noise created by internal information processing
- Patient is unable to self monitor effectively, resulting in hallucinations or delusions as they don’t realise that their thoughts are self generated
- Patient experiences their own internal thought as an external voice
- Which explains the symptoms of hallucinations and delusions
What does Hemsley (1993) Suggest which Supports the Problems with Memory as a Cognitive Factor which may Explain Schizophrenia?
- People with schizophrenia aren’t able to activate relevant schemas
- They experience sensory overload, so they are unable to predict what will happen next, their concentration is poor + they attend to irrelevant aspects of the environment
- Their poor integration of memory + perception leads to disorganised thinking and behaviour
What are the Problems with Memory as a Cognitive Factor which may Explain Schizophrenia?
- There is a substantial breakdown in the relationship between memory and perception in schizophrenics
- Which is linked to schemas, as relevant schemas are not triggered in people w/ schizophrenia
What is the Research by McGuigan (1966) which Supports the Cognitive Explanation for Schizophrenia?
- Found that the larynx of patients with schizophrenia was active during the time they were experiencing auditory hallucinations
- Suggesting that they mistook their own inner speech for that of someone else
What is the Research by McGuire (1996) which Supports the Cognitive Explanation for Schizophrenia?
Found schizophrenics to have reduced activity in the parts of the brain involved in monitoring inner speech
What is the Research from PET Scans which Supports the Cognitive Explanation for Schizophrenia?
- Show under activity in the frontal lobe of the brain of people suffering from schizophrenia
- Which is linked to self monitoring
- Providing biological support for this explanation
What are the Strengths of the Cognitive Explanation for Schizophrenia?
- It explains some of the key problems associated with schizophrenia, e.g. it explains the symptom of delusions + hallucinations + disorganised behaviour
- It is supported by research evidence
- Useful in developing effective treatments which have helped many people with mental disorders by alleviating the symptoms and improving their lives - e.g. Morrison (2014) found that cognitive therapy reduced psychiatric symptoms + is safe for people with schizophrenia
- It is less reductionist as it includes the idea that delusions are triggered by strange sensory experiences that arise from biological problems, suggesting a complex interaction between biological and cognitive causes of schizophrenia
What are the Weaknesses of the Cognitive Explanation for Schizophrenia?
- Difficult to find out whether the cognitive problems are a cause of their disorder or an affect, As they may play a role in causing schizophrenia or schizophrenia itself may cause the cognitive problems
- It is reductionist as it underestimates genetic factors, stressful life events and social factors in the development of schizophrenia
- Many brain-damaged patients have problems with attention or the relationship between memory and perception, but they failed to develop the symptoms of schizophrenia, which challenges the cognitive explanations
What are the Similarities between the Genetic Explanation and the Cognitive Explanation for Schizophrenia?
- Both supported by research evidence
- Both look at human body as part of the explanation, as 1 looks at memory and the other looks at genes
- Both reductionist as they underestimate the other factors into schizophrenia - such as social and environmental
What are the Differences between the Genetic Explanation and the Cognitive Explanation for Schizophrenia?
- Cognitive explanation can be more useful as it leads directly to treatment
- Cognitive looks at memory + attention as part of the explanation, whereas genetic looks at the biological inherited genes as part of the explanation
- Genetic can show cause + effect link between genes + schizophrenia, whereas the cognitive symptoms shown may be a symptom of schizophrenia rather than a cause
What is the Health and Care Professions Council (HCPC)?
- Clinical practitioners must register with this
* It sets standards which practitioners must meet in order to remain registered with the HCPC
What are the 7 Standards Set Out by the HCPC for Clinical Practitioners?
- Character
- Health
- Standards of proficiency
- Standards of conduct, performance + ethics
- Standard for continuing personal development
- Standards of education and training
- Standards for prescribing
What is Character as a Standard Set Out by the HCPC for Clinical Practitioners?
- Registrants provide credible character references from people who have known them for at least three years
- Considering any criminal convictions and their character traits
What is Health as a Standard Set Out by the HCPC for Clinical Practitioners?
- Provide info every two years when they re-register about their general health
- Provide info on any health issues that they have only if it’s likely to affect their ability to practice safely
What are the Standards of Profficiency as a Standard Set Out by the HCPC for Clinical Practitioners?
- There are a set of specific expectations for practitioners psychologists
- E.g. professional autonomy + accountability, delivery of strategies for meeting health + social care needs
- Specific requirements within each standard to be demonstrated by practitioners in different areas of psychology
What are Standards of Conduct, Performance and Ethics as a Standard Set Out by the HCPC for Clinical Practitioners?
- List of 14 guidelines that practitioners must adhere to in their clinical practice
- Including points such as maintaining confidentiality in work with service users, referring on to others when necessary, and only acting within the limits of their own knowledge
What are Standards for Continuing Personal Development as a Standard Set Out by the HCPC for Clinical Practitioners?
- Professionals expected to take part in + document regular training that they undertake to develop their own practice
- Including training events, evidence on how they’ve changed their practice, and an evaluation of the effectiveness of these changes
What are Standards of Education + Training as a Standard Set Out by the HCPC for Clinical Practitioners?
•Set of minimum levels of qualification specified before people can register to practice in
different areas of health + care professions
•Registrants must be able to evidence at least a master degree with bps qualification in the area of practice they will be working in
•HCPC sets out standards for training courses
What are Standards for Prescribing as a Standard Set Out by the HCPC for Clinical Practitioners?
- These standards set out safe practice for prescribing medication by health and care professionals
- Including the required knowledge and training to be able to prescribe within professional practice
What are the 2 Treatments which can Help People with Schizophrenia?
- Drug treatment
* Cognitive treatment
What is Drug Treatment for Schizophrenia Based on?
- The medical model of mental disorder
- Where mental disorders are seen as an illness + assumed they have biological causes
- Treatments are physical in nature
What are the Drugs used in Treatment for Schizophrenia Known as?
Anti-psychotic drugs
How does the Dopamine Hypothesis Explains how Drug Treatments for Schizophrenia Work?
Schizophrenia results from abnormally high levels of dopamine
How did the 1st Anti-Psychotic Drug (Phenothiazine) Explain how Drug Treatments for Schizophrenia Work?
- Blocking receptors for dopamine
- So, effects of dopamine aren’t picked up by the Brain
- However, there were side effects - shaking, muscle tremors, jerky movement
What are the New Drug Treatments for Schizophrenia and How do they Work?
- Clozapine - acts by blocking serotonin receptors
* Olanzapine + risperidone - have fewer side effects + more effective - known as ‘atypical’ drugs
What are the Strengths of Drug Treatment for Schizophrenia?
- Effective in reducing symptoms + more effective than any other form of therapy as reduces symptoms quickly
- Useful w/ assistance of antipsychotic drugs
- Allowed patients to live relatively normal lives - prior to phenothiazine, schizophrenia was considered untreatable
- Appropriate as it has more of genetic basis - main drugs used to treat schizophrenia block dopamine receptors, so appropriate to use as they target parts of physiological system that function abnormally in Schizophrenia
What did Meltzer (2004) Find which Supports that Drug Treatment is Effective in Reducing Symptoms of Schizophrenia?
Haloperidol gave significant improvements in all areas of functioning compared to placebo
What are the Weaknesses of Drug Treatment for Schizophrenia?
- It’s reductionist - ignores psychological + social factors
- Effectiveness + usefulness of drug therapy is limited - it is palliative - it suppresses the symptoms of the disorder without addressing the underlying causal processes - patients have to take drugs for many years
- Unethical - drugs often produce side effects + some patients unable to give consent + may lead to addiction + dependency
- Relapse is a problem - drugs don’t offer a long term cure as they don’t address the cause of the problem
- Some patients are resistant to drugs
- Most common drugs aren’t effective in treating the negative symptoms of schizophrenia
How is Drug Treatment for Schizophrenia an Issue of Social Control?
- Drug treatment can be looked down on in society as it’s considered that you need to alter their behaviours to become more ‘normal’ - social norms in society
- Cannot assume everyone has same symptoms + severity of symptoms due to labelling them ‘schizophrenic’
- Pharmaceutical drug company’s want money
Why is Drug Treatment the Most Common Biological Treatment for Schizophrenia?
- Dopamine hypothesis is widely accepted explanation for schizophrenia
- Suggests that schizophrenia may result from high levels of dopamine
- So, it follows the most common form of biological treatment for schizophrenia is drug therapy
What does the Cognitive Model of Abnormality Assume?
- Mental disorder is created by errors in thinking
* Thoughts influence emotions + feelings
What do Cognitive Behavioural Therapies Attempt to do?
Attempt to change maladaptive behaviour by changing the way people think
What does the Cognitive Behavioural Therapy Assume?
- Patients have irrational thoughts + beliefs about themselves + the world
- Thoughts + beliefs are negative, self-defeating + contribute to development of mental disorders
How do Therapists using Cognitive Behavioural Therapy Try to Change the Patients Behaviour?
- Focusing on the present symptoms
- Looking at how the person thinks about how an event affected them - what they felt + how they behaved
- Challenge negative thoughts + change them for more realistic + positive thoughts
- Person will feel better + behaviour will change
What is the Aim of Cognitive Behavioural Therapy when Treating Schizophrenia?
Reduce the stress felt by the patient with schizophrenia + allow them to help them mange + understand their symptoms
What are the 3 Techniques Used in Cognitive Behavioural Therapy for Schizophrenia?
- Belief modification
- Focusing + reattribution
- Normalising the experiences of the person w/ schizophrenia
What is Belief Modification as a Technique Used in Cognitive Behavioural Therapy for Schizophrenia?
Delusional thinking is challenged
What is Focusing + Reattribution as a Technique Used in Cognitive Behavioural Therapy for Schizophrenia?
- To help w/ hallucinations (auditory)
* Therapist aims to show that the voices are self-generated + don’t need to be feared
What is Normalising the Experiences of the Person with Schizophrenia as a Technique Used in Cognitive Behavioural Therapy for Schizophrenia?
Psychotic symptoms are looked at as more normal to reduce the fear related to them
What are the Strengths of Cognitive Behavioural Therapy as a Treatment for Schizophrenia?
- Useful as effective in treating - patients show increase in coping skills + decreased hallucinations + delusions
- Most ethical - empowers patients by educating them in self-help strategies + they have more control over the process - allows patients to be more independent
- Strategies learned cab be incorporated into a patients life - so it’s a useful treatment
What are the Weaknesses of Cognitive Behavioural Therapy as a Treatment for Schizophrenia?
- Reductionist - doesn’t address the underlying cause of the mental disorder as it overlooks biological causes
- Not effective - patient suffering severe schizophrenia may lack problem solving skills + don’t have an insight into their condition
- Effectiveness is hard to judge - control treatments are sometimes given by non-experts, so the use of inadequate control treatment conditions may explain some of the findings
What did Sensky (2000) Find which Supports that Cognitive Behavioural Treatment is Effective in Treating Schizophrenia?
- He compared CBT w/ non-specific ‘befriending interventions’ for patients w/ schizophrenia
- Found that CBT was more effective in reducing both positive + negative symptoms of schizophrenia
How does Cognitive Behavioural Therapy Link to the Issue of Social Control?
- CBT can be seen as an agent of social control, so patients thoughts may be changed to fit into social norms
- Superficial way of trying to get patients to act normally without actually addressing the problem
- But, by alleviating the symptoms, it makes the patient much more independent
What are 2 Similarities Between Cognitive Behavioural Therapy and Drug Treatment as Treatments for Schizophrenia?
- Both supported by research evidence - e.g. Sensky, Meitzar
- Both are useful as they allow people to live independent lives
- Both ignore social factors
What are 2 Differences Between Cognitive Behavioural Therapy and Drug Treatment as Treatments for Schizophrenia?
- Drug Therapy is more reductionist than CBT, as it focuses purely on biological treatment , where CBT looks at cognitive + behavioural
- CBT can be considered more ethical than drug therapy
What is a Review Article?
Summarises previously published studies
Why are Review Articles Useful?
- Looks at recent major advances + discoveries
- Looks at significant gaps in research
- Looks at current debates
- Looks at ideas of where research might go next
What are the Strengths of Review Articles?
- Generate new ideas about where research should go next
- Can close significant gaps in research
- Draws together wide body of data
- Includes recent major developments
What are the Weaknesses of Review Articles?
Has practical problems - validity and reliability may be interpretative if original studies had flaws
What is the Aim of the Contemporary Study for Schizophrenia by Carlsson (2000)?
Review research to investigate:
•Use info on psychosis + neurotransmitter functioning to produce new antipsychotic drugs that are more effective w/ fewer side-effects
•Show neurotransmitter functioning in specific brain areas
•Investigate neurotransmitter functioning + psychosis, beyond the dopamine hypothesis
What is the Procedure of the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Literature review
- Methods + findings of studies to do w/ neurotransmitter interactions in schizophrenia are analysed
- Including studies using rodents to test neurotransmitter functioning + related brain structure functioning, studies on people w/ acute schizophrenia + people with schizophrenia in remission, studies which used brain scans to investigate psychosis
What were the Key Points about Dopamine from the Literature Review of the Contemporary Study for Schizophrenia by Carlsson (2000)?
- PET scans provide evidence to show high levels of dopamine related to psychosis - e.g. Abi-Dargham (1998) + Breier (1997)
- Supporting the dopamine hypothesis
- However interactions with other neurotransmitters (e.g. noradrenaline, serotonin, acetylcholine, glutamate, + GABA) may be related w/ schizophrenia
What were the Key Points about Glutamate from the Literature Review of the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Low levels of glutamate play a role in schizophrenia
- Lodge (1989) - shows that PCP can induce psychosis by inhibiting the action of glutamate in the brain
- Glutamate failure in cerebral cortex may lead to negative symptoms of schizophrenia, •Glutaminergic in the basal ganglia could be responsible for positive symptoms
What were the Key Points about Dopamine and Glutamate from the Literature Review of the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Some research has found an interaction between dopamine and glutamate
- Reduced levels of glutamate is associated with increased dopamine release
What were the Key Points about Serotonin from the Literature Review of the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Serotonin may be implicated in schizophrenia
- Serotonin levels are related to dopamine
- Clozapine works by reducing dopamine and serotonin levels in the brain
- NMDA antagonists, which limit glutamate, seem to stimulate serotonin levels
What were the 2 Main Theories About the Causes of Schizophrenia from the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Whether high levels of dopamine (hyperdopaminergia) cause schizophrenia
- Whether low levels of glutamate (hypoglutamatergia) cause schizophrenia
What was the Conclusions from the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Glutamate deficiency may explain increased dopamine responsiveness
- Glutamate deficiency should be studied
- Increased serotonin activity is found in people w/ schizophrenia - dopamine + serotonin contribute to the positive + negative symptoms
- More focus on other neurotransmitters is needed (e.g. GABA, acetylcholine, etc)
- May be different subpopulations of those w/ schizophrenia, where it’s caused by different abnormal levels of different neurotransmitters - this has implications for treatment
What are the Strengths of the Secondary Data from the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Provides an overview of key findings in the area
- generate new ideas about where research should go next
- Closes significant gaps in research
- Draws together wide body of data - allowing a large amount of info to be brought together quickly
- Because of the extensive nature of material covered, the conclusion drawn is likely to be valid
- Ethical - no direct ethical issues
What are the Weaknesses of the Secondary Data from the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Studies rely on secondary data from many other studies
- The validity and reliability of Carlsson’s study may be affected by any research issues in the original studies
- So, any conclusions from his study may be problematic
What are the Strengths of the Original 33 Studies from the Contemporary Study for Schizophrenia by Carlsson (2000)?
- High reliability - studies cited by Carlsson are lab experiments - many are animal + PET scans using standardised procedures + controlled
- High validity - Carlsson considered glutamate as a possible contribute to schizophrenia (another hypothesis), he argues both hypotheses may be true + research should continue in both (evidence seems to suggest this), he questions the validity of the dopamine hypothesis he himself developed in 1950s, Sendt (2012) literature review supports Carlsson’s findings
What are the Weaknesses of the Original 33 Studies from the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Low generalisability - some findings come from animals - so may not generalise to humans, culture may influence the type of auditory hallucinations (Luhrman, 2015), may be time locked (1999/2000) so research may no longer be representative of state of scientific ideas
- Unethical - issues of deception + risk as patients don’t know if they’re being given the real drug or placebo, studies use humans - with or without schizophrenia being given amphetamines or PCP or other drugs that increased psychotic symptoms
What are the Applications from the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Useful in developing antipsychotic drugs
- Glutamate antipsychotics are still in development (Papanastasiou et al, 2013) could bring relief to people who don’t respond well to typical antipsychotics
- Improved dopaminergic drugs that have fewer side-effects based on better understanding of dopamine pathways + new atypical drugs that affect other neurotransmitters, like serotonin and glutamate
What are the Issue and Debates about Psychology as a Science in the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Use of scientific methods- e.g. PET scans
- High validity - looks at a wide range of studies
- Uses animal studies which aren’t generalisable
- Not valid data - review article uses secondary data which might have flaws
- High validity + credibility- Breier et al (1997) produced objective data
What are the Issue and Debates about Practical Issues in the Design and Implementation of Research in the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Difficult to study functioning of neurotransmitter in the brain
- So, neurotransmitters which are easiest to study (dopamine + serotonin) tend to be most researched and others which are important tend to be ignored
What are the Issue and Debates about Reduction in the Contemporary Study for Schizophrenia by Carlsson (2000)?
- This research is purely biological as only focuses on neurotransmitters, so it ignores social + cognitive factors
- But, research uses many different studies to draw its conclusions (rodent studies, PET scans), as it generates such a wide range of evidence it can be considered somewhat holistic, also looked at many different neurotransmitters
What are the Issue and Debates about an Understanding of How Psychological Understanding has Developed Over Time in the Contemporary Study for Schizophrenia by Carlsson (2000)?
- Further research suggested by the article will lead to more changes
- Methods of investigating neurotransmitters have become more sophisticated overtime
- Further research found that there is an interaction between dopamine + glutamate, as reduced level of glutamate is associated with increased dopamine levels
What are the Issue and Debates about the Use of Psychological Knowledge Within Society in the Contemporary Study for Schizophrenia by Carlsson (2000)?
- The research suggests areas for further research which can be used to inform further treatments for schizophrenia
- Future research as different sub populations have abnormal levels in different transmitters, not just dopamine
What is the Aim of the Longitudinal Study for Schizophrenia by Sensky (2000)?
Compare cognitive behavioural therapy (CBT) w/ non-specific ‘befriending interventions’ for patients w/ schizophrenia in effectively reducing positive symptoms of schizophrenia
What is the Design of the Longitudinal Study for Schizophrenia by Sensky (2000)?
- Randomised controlled design
- Patients allocated to one of two groups: A cognitive behavioural therapy group or an non-specific befriending control group
What were the Participants of the Longitudinal Study for Schizophrenia by Sensky (2000)?
- 90 patients - 57 from clinics in Newcastle, Cleveland and Durham and 33 from London
- They had a diagnosis of schizophrenia that had not responded to medication
- Aged 16 to 60 years
What were the Results of the Longitudinal Study for Schizophrenia by Sensky (2000)?
- Both interventions resulted in significant reductions in positive and negative symptoms and depression
- At the 9 month follow-up evaluation, patients who had received cognitive therapy showed greater improvements on all measures
What were the Conclusions of the Longitudinal Study for Schizophrenia by Sensky (2000)?
CBT is effective in treating negative + positive symptoms of schizophrenia that are resistant to standard antipsychotic drugs, w/ its efficiency sustained over 9 months of follow-up
What was the Procedure for the
Cognitive Behavioural Therapy Group of the Longitudinal Study for Schizophrenia by Sensky (2000)?
- Normal routine of CBT used - engaging with patient, examining antecedents of psychotic disorder, developing a normalising rationale + treatment of other disorders
- Specific techniques for positive symptoms of schizophrenia used
- Patients helped to change their beliefs + taught coping strategies to deal with the voices
What was the Procedure for the Befriending Group of the Longitudinal Study for Schizophrenia by Sensky (2000)?
- Patients had same time allocation at the same intervals as the patients in the CBT
- Therapists were empathetic + non-directive
- No attempt at therapy, the sessions focused on hobbies, sports + current affairs
What was the Procedure for Assessing the Patients of the Longitudinal Study for Schizophrenia by Sensky (2000)?
- Assessed by blind raters at baseline, after treatment (lasting up to 9 months), and a 9 month follow-up evaluation
- Assessed using comprehensive psychiatric rating scale, the scale for assessment of negative symptoms and a depression rating scale
- Patients continued to received routine care throughout the study
- Patients received a mean of 19 individual treatment sessions over 9 months
What does Diagnosis Involve?
- Clinician assessing a patient •Decides whether they show evidence of mental disorder
- Decides whether their symptoms match those in a checklist of the features + symptoms of a mental disorder
Why is it Hard to Define Abnormal Behaviour in an Objective and Scientific Way?
- No clear dividing line separating normal + abnormal behaviour
- Concept of abnormality can change over time
- Concept of abnormality can change between societies/cultures
- Many different types of behaviour can be considered abnormal
What are the 4 D’s of Diagnosis?
- Deviance
- Distress
- Dysfunction
- Danger
What is Deviance as 1 of the 4 D’s of Diagnosis?
- Behaviours/emotions that are unusual in society
* Behaviour must be statistically rare + disapproved of by most in society
What is Distress as 1 of the 4 D’s of Diagnosis?
Extent to which the individual finds their behaviour and/or emotions upsetting
What is Dysfunction as 1 of the 4 D’s of Diagnosis?
Extent to which the behaviour interferes with the persons day-to-day life
What is Danger as 1 of the 4 D’s of Diagnosis?
Behaviour which could harm others or the individual
What is the Issue and Debate of Issues of Social Control in the Diagnosis of Mental Disorders?
- Clinicians have a lot of power and influence in the diagnosing of mental health problems
- This has implications for patients who are labelled as mentally ill
- As it’s possible to treat patients against their will if their sectioned by the mental health act + considered at risk to themselves or others
- But, antipsychotic medication is critical for alleviating the distress associated with schizophrenia + enabling quality of life to be restored
What are the Strengths of the 4 D’s of Diagnosis?
- Useful - they have practical applications in helping professionals decide whether a patient symptoms need a clinical diagnosis
- Holistic way to assess someone’s mental health - cover a wide range of symptoms
- Davis (2009) - suggests a 5th D needs to be added - duration to increase validity
What are the Weaknesses of the 4 D’s of Diagnosis?
- Low validity - as diagnosis may not be accurate
- Low reliability - if used by 2 professionals, may not get same diagnosis - reducing scientific status of diagnosis
- Subjectivity in the application of the 4 D’s - E.g. dysfunction is subjective as individual may not think they have a problem + their unusual behaviour may suit them
- Distress + danger is subjective + difficult to measure - not all mental disorders are distressing
- Model criticised for being incomplete - Davis (2009) suggests that duration needs to be added
What is the Issue and Debate of Practical Issues in the Design and Implementation of Research in the Diagnosis of Mental Disorders?
- Issues of reliability + validity- diagnosis process conducted through unstructured or semi-structured interviews
- When gathering highly sensitive data about someone’s mental health - there are problems with the self-report method
What is the Issue and Debate of Psychology as a Science in the Diagnosis of Mental Disorders?
- Diagnosing disorders relies on unstructured/semi-structured interviews
- Involving the clinicians subjective interpretation of data
- Which reduces scientific status of the diagnosing of mental illness as it’s objective, lacks reliability and validity
Why are Classification Systems used by Practitioners?
To help them make diagnosis + establish appropriate treatment regimes
What is the Aim of Classification Systems?
Provide clear + measurable criteria for diagnosis, which can be used in the same way by all practitioners - increasing the reliability of diagnosis
What is the Medical Model of Abnormality?
- Biological approach assuming that the major source of abnormal behaviour is a form of medical illness
- Believes that the best treatment for mental disorders is biological - e.g. drug treatment
What are the Strengths of the Medical Model of Abnormality?
- Scientific + objective approach to diagnosis - has a lot of scientific credibility
- It group symptoms together + classifies them into a syndrome - so, their cause can be discovered + treated
What are the Limitations of the Medical Model of Abnormality?
- Limited - criticised for just focusing on the symptoms + not causes of this disorder - e.g. the model was criticised by anti-psychiatry movement in the 1960s
- Symptoms cannot be easily measured, so clinician must make a subjective judgement
What was the Anti-Psychiatry Movement in the 1960’s which Criticised the Medical Model of Abnormality?
- Thomas Szasz + R.D. Laing suggested that psychiatric symptoms is an understandable reaction to coping with a sick society
- They felt that mental hospitals were not designed to cure people + they function as a prison, where disruptive people could be removed from society
- Concerned that diagnosis could be used as an agent of state control + diagnosis results in labelling + could be used to medicalise social problems
- Concerned about controversial medical practices in psychiatry - e.g. use of lobotomies as a treatment
What are the 2 Major Classification Systems?
- ICD 10
* DSM-5
What is the Purpose of the DSM-5 and the ICD 10?
- Diagnostic tool is designed to enable practitioners to identify + treat particular disorders
- To provide a standardised, criterion based system to allow for accurate diagnosis of mental disorders
Why are the DSM and ICD Regularly Reviewed and Updated?
- To take into account new research
- To take account of peoples changing cultural views
- To show that psychological understanding changes and develops over time
What are the Similarities Between the DSM and ICD?
- Both regularly updated
- Both attempt to make diagnosis accurate across cultures
- Both rely on checklists + can be criticised for being reductionist
- Both criticised as use the medical model
- Both designed to enable practitioners to identify + treat particular disorders
- Both include categories of mental disorders based on characteristic patterns of symptoms
What are the Differences Between the DSM and ICD?
- DSM less reductionist than ICD - so it’s more holistic than ICD
- ICD used in many countries in the world, but DSM used in America
- ICD is free + an open resource, but DSM generates profits for the American psychological Association
- DSM only deals w/ mental conditions, but ICD also diagnoses physical illness
What is the Issue and Debate of Reductionist vs Holistic in the Classification Systems?
- DSM and ICD rely on checklists
- Can be criticised for being reductionist
- But, DSM takes account of psychological factors + disability, so it’s less reductionist than the ICD
What is the Issue and Debate of How Psychological Understanding has Changed Over Time in the Classification Systems?
- Late 19th Century - Kraeplin argued that pychiatric disorders are physical in nature + should be studied as a branch of medical science + it is possible to classify specific mental health disorders by their symptoms, diagnose them + predict their course
- Both DSM + ICD are regularly updated
What is the Issue and Debate of Psychology as a Science in the Classification Systems?
- Reliable - rely on standardised checklists of observable behaviour - used in the same way by all clinicians
- But, there will always be an element of subjectivity when interpreting the diagnostic criteria
What is the Issue and Debate of Practical Issues in the Classification Systems?
- DSM +ICD are regularly updated
* So, they show that psychological understanding changes and develops over time
What is the Issue and Debate of Cultural Differences in the Classification Systems?
- DSM and ICD attempt to make diagnosis accurate across cultures
- But, some argue that they still have a western bias
When was the DSM 5 Published?
May 2013
What does the DSM-5 Assess Individuals In Terms Of?
- The type of disorder from which they suffer - e.g. psychotic disorders
- Psychological + contextual factors - as it can influence the well-being of the individual - e.g. unemployment
- Disability - looks at overall level of functioning of the individual
- Co-existing factors - e.g. medical conditions
What does the DSM-5 Assessment of an Individual Involve?
- Clinical interviews
- Observations of the client
- Medical records of the client
- Focuses on assessing patients along the spectrum
What is the Issue and Debate of Developmental Psychology in the Classification Systems?
- Latest version of DSM reflects developmental + lifespan considerations
- Reflects developmental processes that occur early in life (e.g. schizophrenia) and those that are more commonly developed during adolescence (e.g. depression)
- Highlighting understanding that some psychiatric illnesses occur during certain periods of our development
How does the DSM 5 Manual Divide into 3 Sections?
- 1 - Intro to manual w/ instructions on its use
- 2 - Contains classification of the main mental health disorders - e.g. OCD, schizophrenia, bipolar, anxiety, etc
- 3 - Contains other assessment measures to aid diagnosis - cultural formulation interview guide to help diagnose individuals from a different culture from the clinician + includes other conditions that are being assessed for possible future diagnosis
When is Diagnosis is Considered to be Reliable?
- If different practitioners arrive at same diagnosis of a patient
- When clinicians agree on a diagnosis there is high inter-rater reliability for the system of diagnosis
What is the Evidence from Spitzer and Williams (1985) that Suggests that Diagnosis is Low in Reliability?
- Reviewed process of diagnosis
* Suggested that experienced psychiatrists only agree on diagnosis about 50% of the time
What is the Evidence from Hiller et al (1992) that Suggests that Diagnosis is Low in Reliability?
Argued reliability is in doubt for some disorders related to schizophrenia
What is the Evidence from Brown (2002) that Suggests that Diagnosis is High in Reliability?
- Tested reliability + validity of DSM-5 diagnosis for anxiety + mood disorders
- Found them to be good to excellent
What is the Evidence from Jacobsen et al (2005) that Suggests that Diagnosis is High in Reliability?
- Through a random sample of Danish in-patients + outpatient’s w/ a history of schizophrenia
- Showed that ICD 10 is a reliable measure of schizophrenia + compares well in terms of reliability with the DSM-111-R
What is the Evidence from Pederson (2001) that Suggests that Diagnosis is High in Reliability?
- Found 71% of psychiatrists agreed with the ICD 10 definition of depression when assessing 116 patients
- This indicates high inter-rater reliability
What are the Improvements in Reliability of Diagnosis?
- Improved w/ the use of standardised interview schedules specifying symptoms to ask about + giving instructions as to how to rate their severity
- DSM + ICD have specific diagnostic operational criteria for diagnosis to increase objectivity + reliability - e.g. clear definitions are given for each disorder + a list of symptoms
What are the Possible Patient Factors that Impact on Reliability of Diagnosis?
- Patients may give different psychiatrists slightly different info
- E.g. lack of standardisation in assessment + interview techniques
- Leading to different practitioners giving different diagnoses to the same person
What are the Possible Clinician Factors that Impact on Reliability of Diagnosis?
- Practitioners using the classification systems aren’t completely objective
- Practitioner may not use the categories of the classification system correctly or they may gather insufficient info
What is the Evidence from Ward (1962) that Suggests that Diagnosis is Low in Reliability?
- Studied 2 psychiatrists diagnosing the same patient
- Found that disagreement occurred because of the inconsistency of info provided by the patient (5%), psychiatrists interpretation of symptoms (32.5%), inadequacy of the classification system (62.5%)
What does the Validity of Diagnosis Refer to?
The extent to which a diagnosis is accurate
What is Concurrent Validity in Diagnosis?
- Compares evidence from different diagnostic tests to see if they agree
- The DSM + ICD seem to have good concurrent validity
What is Aetiological Validity in Diagnosis?
- Exists when the diagnosis reflects known causes
* E.g. cause of disorder may be due to a problem w/ damage to a particular area of the brain
What is Predictive Validity in Diagnosis?
- Future course of the disorder is known and can be applied to the person
- So, the diagnosis can be checked against the outcome to see if it’s valid
What are Possible Factors that Impact on Validity of Diagnosis?
- Implicit bias in clinician as the beliefs of them mean that they arrive at an inaccurate diagnosis
- Patient may not disclose all info as they may be embarrassed or they don’t remember all details - so, clinician not able to arrive at an accurate diagnosis
- Interviews are subjective - producing findings that the clinician expects to find
- If the classification system is biased then diagnosis will not be valid
What is the Evidence from Cochrane et al (1995) that Suggests that Diagnosis is Low in Validity?
- Blames classification systems used in Britain
- Argues that they lead practitioners to take on a Eurocentric bias
- So, they cannot take into account the normal behaviours of other cultures as they are based on European ideas
What is the Evidence from Littlewood (1992) that Suggests that Diagnosis is Low in Validity?
- Questions international validity of DSM-5
* Suggests that the assumptions it makes about nuclear family life aren’t applicable to all cultures
What is Implicit Bias in Diagnosis?
Positive or negative attitudes that a person may hold at an unconscious level
What did David Rosenhan Suggest about Diagnosis?
- Diagnosis was not accurate
- Being given a psychiatric diagnosis would negatively affect a persons life
- As, they would be left with a psychiatric label which others could judge them negatively on + misinterpret their behaviour
What was the Aim of the Classic Study 1 by Rosenhen (1973)?
- See if psychiatrists could differentiate between sane + insane people
- Investigate life for patients in psychiatric hospitals
- Raise awareness about conditions in psychiatric hospitals
Who were the Participants of the Classic Study 1 by Rosenhen (1973)?
Hospital staff and patients
What was the Method of the Classic Study 1 by Rosenhen (1973)?
- Field experiment with participant observation
- Participant observation by 8 sane people (a student, 3 psychologists, a painter, housewife, psychiatrist, paediatrician)
What was the Independent Variable of the Classic Study 1 by Rosenhen (1973)?
Symptoms (lack of symptoms)
What was the Dependent Variable of the Classic Study 1 by Rosenhen (1973)?
Diagnosis they’re given
What was the Procedure of the Classic Study 1 by Rosenhen (1973)?
- Phoned 12 psychiatric hospitals giving a false name + address •All complained of hearing unclear voices saying “hollow, empty, thud” - chose these words as they aren’t associated with a particular disorder
- Apart from hearing voices, the pseudo patients behaved normally
- Once admitted, they stopped simulating any symptoms + took part in ward activities -took notes of their experiences in the hospital
- They had daily visitors who found that they were acting normally
What were the Results of the Classic Study 1 by Rosenhen (1973)?
- All admitted to hospital + all but 1 diagnosed with schizophrenia
- Normal behaviour was misinterpreted - writing notes described as “patient engaged in writing behaviour”, arriving early for lunch described as “oral acquisitive syndrome”
- No staff suspected that they were sane
- Average stay in hospital was 19 days, shortest stay = 7 days, longest stay= 52 days
- Given a total of 2100 medication tablets
- 35/119 real patient has voiced their suspicions about the pseudo patients
- Nurses stayed in ward offices 90% of the time, each real patient spent less than seven minutes per day with psychiatric staff + patients treated with no respect
What was the Conclusion of the Classic Study 1 by Rosenhen (1973)?
- Psychiatrist couldn’t detect sanity
- The psychiatric hospitals weren’t useful for people with mental disorders
- Diagnostic labels change the perception of the person so that all their behaviour was in interpreted within the context of the label - lead to self-fulfilling prophecy as the person is treated in a way that is consistent with the label which confirms the validity of the label
What was the Aim of the Classic Study 2 by Rosenhen (1973)?
See if the hospitals who had been told they were going to be approached by pseudo patients would be able to tell the sane from insane people
What was the Procedure of the Classic Study 2 by Rosenhen (1973)?
- A teaching + psychiatric hospital was informed that over the next 3 months 1 or more pseudo patients were trying to get admitted to their hospital
- Each staff member was asked to write the likelihood that the patients who sought to be admitted were pseudo patience
- In reality, no pseudo patients were admitted
- Staff members rated new patients on a scale of 1 to 10 as ‘how likely to be a fraud’, where 193 patients were assessed
What were the Results of the Classic Study 2 by Rosenhen (1973)?
- 41/193 rated as pseudo patient by at least 2 members of staff
- 23/193 rated as pseudo patient by at least 1 psychiatrist
- 19/193 rated as pseudo patient by a psychiatrist + 1 other member of staff
What were the Conclusions of the Classic Study 2 by Rosenhen (1973)?
- The staff were unable to detect insanity
* This confirmed Rosenhan’s initial results that there is poor validity in the diagnosis process
What was the Aim of the Classic Study 3 by Rosenhen (1973)?
Investigate patient/staff contact
What was the Procedure of the Classic Study 3 by Rosenhen (1973)?
- In 4 of the hospitals, pseudo patients asked a member of staff when they will be eligible for ground privileges
- Avoided asking the same member of staff more than once a day
- Rosenhan compared responses given to the patients to those given to a student at Stanford university
What were the Results of the Classic Study 3 by Rosenhen (1973)?
- 71% psychiatrists ignore + 4% stop and talk
- 88% nurses ignore + 0.5% stop and talk
- But, 0% faculty at the Uni ignore + 100% stop and talk
What was the Conclusion of the Classic Study 3 by Rosenhen (1973)?
- Psychiatric patients are treated differently to non-psychiatric patients
- Patients are powerless while on the mental ward
- Lack of eye contact between staff + patients depersonalises the patients
What is Depersonalisation?
Where people aren’t treated as unique individuals, worthy of respect
How was the Classic Study by Rosenhen (1973) High in Generalisability?
- Study took place in a range of hospitals
- 12 hospitals across the USA
- So, the results are generalisable to the USA of 1960s
How was the Classic Study by Rosenhen (1973) Low in Generalisability?
- Sample was very small and was unrepresentative - only 12 hospitals
- May not generalise outside the USA as there may be cultural differences
- May not generalise to current times
How was the Classic Study by Rosenhen (1973) High in Reliability?
- Certain aspects were standardised
- E.g. All pseudo patients presented with the same single symptom of hearing voices saying “hollow, empty thud”
- All pseudo patients behaved normally as soon as they’re admitted to hospital + said they didn’t have symptoms
- Questions asked by pseudo patients and controls were standardised
How was the Classic Study by Rosenhen (1973) Low in Reliability?
- It was a field experiment
- Variables such as patient-staff interactions couldn’t be standardised
- So, research couldn’t be repeated in a consistent way
- Study used participant observation so this is low reliability - as participant observers find it difficult to observe all details + may get distracted or over-involved
What were the Applications for the Classic Study by Rosenhen (1973)?
- Highlighted danger of labelling
- People recognise that hospitals may not be the best place to treat mental illness
- Reduce abuse of power in mental institutions by staff (e.g. CCTV)
- Number of criteria used to diagnose mental illness increased - diagnosis now more accurate/valid, as a diagnosis of schizophrenia cannot rely on only 1 symptom
How was the Classic Study by Rosenhen (1973) High in Validity?
- High ecological validity
- Pseudo patients able to gather 1st-hand data about the treatment of the patients
- Setting (hospital) + tasks (hospital activities, life as a patient) are true to life
- Process of being admitted to hospital, interactions with staff, discharge + experience of life in a hospital was true
- Covert observation increases validity as reduces demand characteristics - nurses + doctors likely to act as they normally would
How was the Classic Study by Rosenhen (1973) Low in Validity?
- Low ecological validity
- Lack of control is due to nature of research (field experiment) - so, impossible to standardise things such as patients/staff interactions or reactions of other patients
- Observer bias may reduce validity - Rosenhan had strong opinions about psychiatry + the medical model - his opinions may have influenced his observations
How was the Classic Study by Rosenhen (1973) Ethical?
- Raised awareness of poor conditions in psychiatric hospitals
- Confidential - names of individual doctors/nurses were not published
How was the Classic Study by Rosenhen (1973) Unethical?
- Hospital staff deceived
- No consent given
- No right to withdraw
- Participants didn’t know they were part of the study
- No protection of other patients - staff are wasting time on pseudo patients instead of looking after genuinely ill people
- No protection - undermine confidence of doctors + nurses
What is the Issue and Debate of the Use of Psychology in Social Control in the Classic Study by Rosenhen (1973)?
- Labelling behaviours as abnormal leads to diagnosis, which pathologies the behaviour
- Those in anti-psychiatry movement would argue that this forces people to conform to the standards set by society + if they don’t then they must receive treatment that will normalise their behaviour
- Argued that if we don’t label the behaviour as abnormal than people would be free to behave how they like
- E.g. in Rosenhan’s research - pseudo patients were treated for schizophrenia with tablets for their ‘symptoms’
What is the Issue and Debate of Psychology as a Science in the Classic Study by Rosenhen (1973)?
- Field experiment so lack of controls - e.g. standardisation reduces reliability
- Low validity - participant observation means that there is observer bias - e.g. Rosenhan had strong opinions about medical model
- Mainly qualitative data (pseudo patients experience) reduces scientific status
- Covert observations increase validity as demand characteristics are reduced
What is the Issue and Debate of How Psychological Understanding has Changed over Time in the Classic Study by Rosenhen (1973)?
- When Rosenhan’s pseudo patients were incorrectly diagnosed with schizophrenia, the classification system in use was the DSM 11, which didn’t use a criterion based system for diagnosis
- Currently the DSM-5 + ICD 10 give very specific symptoms which means that diagnosis should be both more reliable (consistent between clinicians) and more accurate
What is the Issue and Debate of the Use of Psychological Knowledge in Society in the Classic Study by Rosenhen (1973)?
- More respect for patients
- More validity of diagnosis - criterion based system
- Awareness of the dangers of labelling
- Recognition that hospitals aren’t necessarily the best place to treat mental illness - move to care in the community
How can Individual Differences be Linked to the Diagnosing of Mental Disorders?
- Different people may react differently to practitioners
- Different people may show different symptoms - e.g. different hallucinations, different levels of distress + dysfunction
How can Developmental Psychology be Linked to the Diagnosing of Mental Disorders?
Schizophrenia usually develops in a persons late teens/early 20s, after an apparently normal childhood
What is the Issue and Debate of Socially Sensitive Research in the Classic Study by Rosenhen (1973)?
- Studying mental health issues is socially sensitive research
- Involving labelling people with an illness in order to investigate treatment
- Rosenhan able to provide an account of the quality of care in psychiatric hospitals
- But, Spitzer criticised the study as sensationalist + causing harm to the psychiatric profession by casting doubt on the treatment of mental health
What is Obsessive Compulsive Disorder (OCD)?
- An anxiety disorder
- Causing distress and has a major impact on the patient’s functioning
- Characterised by the presence of obsessions and/or compulsions
What are Obsessions in OCD?
Persistent, irrational, unwanted thoughts
What are Examples of Common Obsessions in OCD?
- Afraid of hurting themselves
- Afraid of hurting others
- Unwanted sexual thoughts, images, or urges
- Contaminated or contaminating someone else
- Fear of not having done a specific act that could result in harm
What are Compulsions in OCD?
- Tasks that people do to relieve themselves of the obsessions
- The person feels driven to perform these tasks
- This makes them feel less anxious or distressed
- They can be mental or physical
- They are extreme beyond reason or they are not realistically connected with what they are meant to stop
What are Examples of Common Compulsions in OCD?
- Cleaning or washing
- Checking that you haven’t made a mistake
- Ordering or arranging things in a particular way
- Repeated checking behaviours
People with OCD may have a Tic Disorder, What are Examples of this?
- Eye blinking
- Facial grimacing
- Shoulder shrugging
- Head jerking
- Repeated clearing of the throat, sniffing, or grunting sounds
What is the OCD cycle?
- Starts with obsessions
- Which causes strong feelings of anxiety - the person feels compelled to act + remove the discomfort
- So, compulsions occur as a result
- Leading to a feeling of relief from the anxiety
- But, the obsessive response has been strengthened for the future
What is the 5 Diagnostic Criteria for OCD listed by the DSM-5?
- Obsessions cannot be ignored/suppressed + cause anxiety
- Obsessions and compulsions are time-consuming - they take up more than 1 hour per day
- Symptoms cannot be explained by substance use, another medical condition or mental disorder
- Clinician determine if individual has fair or poor insight into the disorder, recognising that their obsessive compulsive beliefs are not true or if they have poor insight, true
- Find out if the individual has a current or past history of a tic disorder
What are the Onset Features of OCD?
- The age of onset is late teens + early 20s
* But, in 25% of male sufferers, it is before the age of 10
What are the Prevalence Features of OCD?
- The prevalence rate is between 1.1 and 1.8% of the population
- In adults, OCD is more common in females
- In children, OCD is more common in males
What are the Prognosis Features of OCD?
- Symptoms develop gradually but they can be extreme
- 70% of people experience a chronic and lifelong course
- 5% have episodic symptoms
- But, the content of obsessions doesn’t determine prognosis
What are Factors Associated with a Good Prognosis in OCD?
- Milder symptoms
- Brief duration of symptoms
- Good functioning before full onset
What are the Risk Factor Features of OCD?
- Family history - having a family member w/ the disorder can increase the risk of developing OCD
- Stressful life events - people who have experienced traumatic or stressful events have an increased risk of getting OCD
How does the Issue and Debate of Individual Differences Link to the Features of OCD?
- Everyone doesn’t necessarily develop the same symptoms - cultural differences, males + females differ in symptoms/features
- Not everyone responds to treatment in the same way
- Genetic + environment factors can affect a persons risk of developing OCD
How does the Issue and Debate of Culture + Gender Link to the Features of OCD?
- Females + males are diagnosed differently depending whether they are a child or adult
- OCD occurs across cultures at a similar rate, show a similar age at onset + show similar structure of symptoms
- But, there are cultural differences in how some of these symptoms can be expressed
What are Examples of the Symptoms of OCD?
- Current or past history of tic disorder can affect severity of disorder
- Obsessions cannot be ignored or suppressed
- Obsessions + compulsions consume at least 1 hour per day + have a great impairment to daily life
What are Examples of the Features of OCD?
- Risk is higher for people with higher negative emotionally
- In adults, OCD is more common in females
- The prevalence rate is between 1.1 and 1.8% of the population
What did OCD-UK Suggest which provides Evidence for the Features of OCD?
OCD affects about 1.2% of the population
What did Grohol (2005) Suggest which provides Evidence for the Features of OCD?
Suggest about 2.3% of US population has OCD in one year
What did Sasson et al (1994) Suggest which provides Evidence for the Features of OCD?
Estimates that about 2% of people have OCD worldwide
What are the 2 Explanations of the Causes of OCD?
- Biological explanation
* Cognitive explanation
What does the Biological Explanation for the Causes of OCD Suggest?
Neuro-circuitry in the brain is not working correctly
What is the Thalamus which Relates to the Biological Explanation for the Causes of OCD Suggest?
- Contains primitive checking + cleaning behaviours hardwired in the brain
- If this is overactive, it triggers a compulsion to engage in these behaviours
What is the Orbitofrontal Cortex which Relates to the Biological Explanation for the Causes of OCD Suggest?
- Alerts the brain to potential worries in the environment
* If overactive, the person would experience anxiety
What is the Cingulate Nuclei which Relates to the Biological Explanation for the Causes of OCD Suggest?
Connect the orbitofrontal cortex to the thalamus
How do the Brain Structures Relate to the Biological Explanation for the Causes of OCD Suggest?
- Basal ganglia malfunctions
- So, thalamus becomes overactive, causing compulsions to occur - so cleaning + checking behaviours are more likely
- Overactive thalamus causes a cascade reaction in the orbitofrontal cortex, then this becomes overactive
- Orbitofrontal cortex alerts the brain when something seems odd, causing anxiety which leads to the obsessions in OCD
What is the Basal Ganglia which Relates to the Biological Explanation for the Causes of OCD Suggest?
- Aims to inhibit the thalamus
- If not working properly, it can’t inhibit the thalamus
- Thalamus becomes overactive, causing compulsions to occur
What are the Strengths for the Biological Explanation for OCD?
- A lot of supporting evidence
- Brain scans show differences in brain structures + functioning between people who have OCD + healthy controls
- High scientific credibility - brain scans are a scientific way of investigating OCD + many studies of brain activity have come up with similar findings
- Surgical reasoning of the cingulate gyrus has been used as treatment for OCD - so, it’s correct that OCD result from faulty feedback loop between thalamus + orbitofrontal cortex - since breaking the loop can cure OCD
What are the Limitations for the Biological Explanation for OCD?
- It’s reductionist - doesn’t fully explain OCD -surgery sometimes doesn’t work as OCD is more complex than this theory suggests
- Difficult to show cause+effect - differences in brain activity in people with OCD may be a symptom of their OCD rather than the cause
- Brain activity + thoughts are related, so can’t say if brain activity altered the thoughts or the thoughts altered the brain activity as they cannot be separated
- Support for the biological link comes from genetic link as it suggests that physiological factors underlie the development of the disorder in many people - e.g. twin studies
How does the Issue and Debate of Reductionism Relate to the Biological Explanation of OCD?
- Isolating mental health to biological processes in the brain simplifies a complex behaviour
- This may not be an appropriate way to view mental disorders
How does the Issue and Debate of Psychology as a Science Relate to the Biological Explanation of OCD?
- Use of brain imaging helps investigate relationship between brain structures + behaviour
- It’s very scientific + adds reliability to the findings
- This increases the scientific credibility of the theory
How does the Issue and Debate of Individual Differences Relate to the Biological Explanation of OCD?
- Some people have a family heredity risk, but some don’t
- Some people respond to surgery, but some don’t
- People suffering from OCD can develop different individualised symptoms
How does the Issue and Debate of Nature vs Nurture Relate to the Biological Explanation of OCD?
- Supports the nature side of the debate - as it looks at structure + functioning of the brain and is supported by genetic factors
- But, the concordance rate in MZ twins was not 100% for OCD, so it is not a full exclamation
How does the Evidence from Menzies (2007) Support the Biological Explanation for OCD?
- Brain scans show differences in brain structure
- Found that people suffering from OCD had a different amount of grey matter in orbitofrontal cortex to those without OCD
How does the Evidence from Whiteside et al (2004) Support the Biological Explanation for OCD?
- Brain scans show differences in brain functioning between people who have OCD + healthy controls
- In patients with OCD, the cingulate gyrus, basal ganglia + orbitofrontal cortex are active when at rest - they become more active as OCD symptoms are stimulated
How does the Evidence from Salloway + Duffy (2002) Support the Biological Explanation for OCD?
Found that PET scans of OCD patients had increased activity in the prefrontal cortex
How does the Evidence from McGuire et al (1994) Support the Biological Explanation for OCD?
- When people w/ OCD are shown objects that bring on their symptoms
- There is an increase in activity in the orbitofrontal cortex + caudate nucleus
How does the Evidence from Feng (2007) Support the Biological Explanation for OCD?
- He bread mice to show symptoms consistent with OCD (excessive grooming + anxious behaviour) when a targeted gene is missing
- This gene is associated with planning + initiation of action
- Showing a link to formation of compulsions
- Genetic explanation for OCD can be used to support the wider biological explanation in general
How does the Evidence from Van Grootheest et al (2005) Support the Biological Explanation for OCD?
Found from a review of 70 studies that the concordance rates for MZ twins was between 27 to 47%, which is higher than for DZ twins
How does the Evidence from Carey + Gottesman (1981) Support the Biological Explanation for OCD?
Found 87% concordance rate in MZ twins for obsessive symptoms + features compared to 47% for DZ twins
How does the Evidence from Kireev et al (2013) Challenge the Biological Explanation for OCD?
- OCD is more complex than this theory suggests
* He suggests that the functions usually performed by the cingulate gyrus can be taken over by other areas of the brain
How does the Cognitive Explanation Explain Behaviour in General?
- Thoughts lead to emotions
* Which in turn trigger behaviours
What does the Cognitive Explanation for OCD Look at?
The role that thoughts play in the disorder
What does the Cognitive Explanation for OCD Suggest?
- It is the thought processes of people that explain OCD
* As, people who suffer from OCD have obsessive thoughts
What are the 5 Beliefs that Researchers Suggest are Important in the Development and Maintenance of Obsessions in the Cognitive Explanation for OCD?
- Tendency to overestimate the likelihood of danger
- Exaggerated responsibility that 1 is responsible for preventing misfortunes
- Belief that certain thoughts are very important + should be controlled
- Belief that someone having a thought or urge will increase the chances that it will come true
- Belief that 1 should always be perfect + mistakes are unacceptable
What are the 3 Ways that the Cognitive Explanation Explains OCD?
- People with OCD misinterpret their thoughts, due to false beliefs
- OCD is due to memory problems
- OCD sufferers may be hypervigilant
How can the Cognitive Explanation Explain OCD in terms of Misinterpreted Thoughts due to False Beliefs?
- Individuals prone to developing OCD exaggerate the thought + respond as if it was a real threat
- Causing high level of anxiety + guilt
- People interpreting intrusive thoughts as catastrophic will believe that thinking holds truth + will be distressed, so they practice ritual behaviours
- People who fear their own thoughts attempt to neutralise feelings by avoiding situations and engaging in rituals
- The anxiety produced by the thoughts lead to the compulsive behaviours seen in OCD
Why do People Attach Exaggerated Danger to Their Thoughts in the Cognitive Explanation for OCD in terms of Misinterpreted Thoughts due to False Beliefs?
Because of false beliefs learned earlier in life
How can the Evidence from Sher et al (1989) Show that the Cognitive Explanation Explains OCD in terms of Memory Problems?
Found that people with OCD had poor memories for their actions
How can the Evidence from Trivedi (1996) Show that the Cognitive Explanation Explains OCD in terms of Memory Problems?
- Found people suffering from OCD had low confidence in their memory ability
- Also, their non-verbal memory was impaired
How can the Evidence from Woods et al (2002) Show that the Cognitive Explanation Explains OCD in terms of Memory Problems?
- He conducted a meta-analysis
* Found that patients with OCD had slightly worse memories for recalling stimuli
How can the Cognitive Explanation Explain OCD in terms of Hypervigilance?
- They have attentional bias, so they’re overly sensitive to threat
- They use rapid eye movement to scan the environment + attend selectively to threat related stimuli
- So, they feel very anxious
- The threat perceived become the basis of their obsessions
- The compulsive behaviours are designed to reduce their anxiety
How can the Case Study from Rachman (2004) Show that the Cognitive Explanation Explains OCD in terms of Hypervigilance?
- Female patient had severe fear of diseases
- Had catastrophic thoughts about the probability of harm
- She overestimated the seriousness of contact with anyone
- When in public she rapidly scanned the environment + people on the lookout for evidence of blood
- Her hypervigilant scanning meant that she could recall the blood related items she had encountered over many years
How can the Evidence from Williams et al (1997) Show that the Cognitive Explanation Explains OCD in terms of Hypervigilance?
Suggested that OCD sufferers suffer from hypervigilance, so they have an attentional bias + become very anxious
How can the Evidence from Van Balkom et al (1996) Support the Cognitive Explanation for OCD?
- Found that therapy based on the cognitive explanation was as affective as drug treatment
- This supports the cognitive theory because if OCD were purely biological, then the biological treatment should work better than the cognitive treatment
What are the Strengths of the Cognitive Explanation for OCD?
- Backed up with supporting evidence - which gives it scientific credibility
- Therapy based on the cognitive explanation has been successful as a treatment for OCD
- Cognitive biases (hypervigilance) give a good account of individual differences in susceptibility to OCD - the cognitive approach is easily adapted to individuals’ unique symptoms
What are the Limitations of the Cognitive Explanation for OCD?
- Reductionist - it ignores the role of biology + learning in the development of faulty cognitions
- Doesn’t prove a cause+effect link - doesn’t show that the faulty cognitions are the cause of OCD, instead they could be a symptom - If the cognitive model was complete, treatments would always be useful
How does the Issue and Debate of Comparisons Between Ways of Explaining Behaviour Using Different Themes Relate to the Cognitive Explanation for OCD?
- OCD can be considered from a biological point of view + also a cognitive point of you
- Both approaches have different strengths and weaknesses
How does the Issue and Debate of Nature vs Nurture Relate to the Cognitive Explanation for OCD?
- Everyone may have similar biological structures in common with people, but no one is exactly the same
- Menzies (2007) provides biological support
- Trivedi (1996) provides cognitive support
- Interactive effect which causes OCD, as the brain is shaped by its environment + the environment is shaped by the brain of the person experiencing it
What are the 2 types of treatment for OCD?
- Drug treatment
* Cognitive behavioural therapy (CBT)
When is drug treatment most commonly used as a type of treatment for OCD?
When cognitive behavioural therapy doesn’t work
How do Antidepressants as a type of drug treatment work to treat OCD?
- They raise serotonin levels
- By blocking it’s reuptake from the synapse back into the releasing neurone
- So, more serotonin is available for longer
What are Examples of Antidepressants as a type of drug treatment that work to treat OCD?
- Fluoxetine
* Sertraline (SSRI - selective serotonin re-uptake inhibitor)
How long does it take for Antidepressants as a type of drug treatment to work to treat OCD?
- Up to 12 weeks for drugs to be effective
* But, some people don’t respond to medication
How do Anti Anxiety Drugs as a type of drug treatment work to treat OCD?
- Increasing the effectiveness of GABA in regulating anxiety
* GABA lowers physiological arousal + returns body to a resting state
What are Examples of Anti Anxiety Drugs as a type of drug treatment that work to treat OCD?
- They’re called benzodiazepines
* E.g. Valium
How do Beta Blockers as a type of drug treatment work to treat OCD?
- Block the stress hormone that are released into the bloodstream by adrenal glands
- They prevent this physiological response (e.g. increased heart rate) from occurring
- They feel less stressed, so they have fewer obsessional thoughts + less compulsive behaviour
What are Examples of Beta Blockers as a type of drug treatment that work to treat OCD?
Propranolol
What are the Strengths of Drug Treatment for OCD?
- It’s useful - as it can be used to treat cases of OCD which have not responded to CBT
- There’s empirical evidence to show that drug treatment can be effective in OCD - e.g. Soomro (2007) - there’s scientific credibility
- Drug treatment can be combined with CBT which may raise the effectiveness of CBT
- Modern drug therapy with psychological therapy has reduced the need to resort to neurosurgery which was unethical
What are the Weaknesses of Drug Treatment for OCD?
- Drug treatments alone cannot treat most people with OCD
- Lasts for 12 months before medication can be reduced or discontinued
- May increase the patient’s anxiety
- Can cause side-effects (e.g. nausea + headaches) - limiting the usefulness of drugs as people don’t want to take them
- Can relapse if treatment is stopped
- There’s individual differences in the way that people respond to drugs
- Have to be sensitive to individual differences
How does the Finding Soomro et al (2007) of Support the use of Drug Treatment for OCD?
Found that antidepressants were more effective than placebo in reducing the symptoms of OCD
How does the Finding of POTS (2004) Support the use of Drug Treatment for OCD?
Drug treatment can be combined with CBT and has been shown to raise the effectiveness of CBT
How does the Finding of Koran et al (2002) Support the use of Drug Treatment for OCD?
- Antidepressant medication did have long-term affects compared to a placebo
- It was effective at preventing relapse over an 80 week trial
How does the Finding of Ravizza et al (1995) Challenge the use of Drug Treatment for OCD?
SSRIs were not effective for 40% of people
How does the Finding of Brody et al (1998) Challenge the use of Drug Treatment for OCD?
Differences in the metabolism in the right compared to the left orbitofrontal cortex predicts whether a person will respond better to drugs or CBT
How does the Finding of Goodman et al (1993) Challenge the use of Drug Treatment for OCD?
- Prescribing drugs to patients, needs to be tailored to individual needs
- Especially important with patients with refractory OCD
- E.g. may be given a combination of SSRI drug with an antipsychotic drug
What is Refractory OCD?
OCD that is very difficult to treat
What are the 2 components of CBT as a type of treatment for OCD?
- Cognitive component
* Behavioural component
What does the Cognitive Component of CBT focus on as a type of treatment for OCD?
- Changing thought processes
* Helping people to deal with obsessions found in OCD
What does the Behavioural Component of CBT focus on as a type of treatment for OCD?
Changing actions/behaviours
What are people encouraged to do in CBT as a type of treatment for OCD?
Focus on their thoughts, and emotional + behavioural responses to those thoughts
What is the aim of the cognitive component in CBT as a type of treatment for OCD?
Change the beliefs that they trigger
How does the Cognitive component in CBT start as a type of treatment for OCD?
- Start with thoughts that are least anxiety provoking
* Client encouraged to test the beliefs that the thoughts activate until they don’t generate anxiety
How is cognitive distortion of Catastrophing addressed in CBT as a type of treatment for OCD?
- Person predicts a negative outcome
* Then, jump to the conclusion that if the negative outcome did happen, it would be a catastrophe
What is Habituation Training (Franklin et al 2000) in the Cognitive component of CBT as a type of treatment for OCD?
- Client thinks repeatedly about their obsessive thoughts
- By deliberately thinking about obsessions, they’ll become less anxiety provoking
- With the consequence that compulsive behaviour is not required to reduce high levels of anxiety
What is the most common Behavioural therapy used as a part of CBT as a type of treatment for OCD?
Exposure and response prevention therapy (ERPT)
What does ERPT focus on in the Behavioural component of CBT as a type of treatment for OCD?
The compulsions found in OCD
What is ERPT in the Behavioural component of CBT as a type of treatment for OCD?
- Exposes clients to objects/situations that cause anxiety
- Requires the client to resist performing the compulsive behaviour
- The therapist helps the person develop ways in which they can resist performing the compulsive behaviours
What are the steps involved in ERPT in the Behavioural component of CBT as a type of treatment for OCD?
- Informing clients about exposure + response prevention, and what therapy involves
- Using exposure hierarchy - starting with mildly anxiety raising situations + goes to the highest level of anxiety
- Repeated exposure to situations that cause high anxiety, until anxiety reduces
- Getting the client to resist from performing the compulsive behaviour
What are Clients in ERPT in the Behavioural component of CBT asked to do outside of therapy as a type of treatment for OCD?
Practice exposing themselves to feared situations + reframing from the compulsive behaviour
How does the finding from Franklin et al (2005) support ERPT in the Behavioural component of CBT as a type of treatment for OCD?
- After ERPT, clients showed between 55% and 75% improvement
* The improvement lasts for 5 to 6 years
What are the Strengths of CBT as a type of treatment for OCD?
- Supported by evidence which shows that it’s effective in reducing the symptoms of OCD
- Doesn’t have any side-effects
- Has lower relapse rates than medication
- Ethical form of treatment - patients are empowered as they are taught techniques which they can use on their own
How does the Issue and Debate of Social Control link to CBT as a type of treatment for OCD?
CBT empowers a patient - implying that they are less controlled by others in society
How does the finding by NICE (2006) support CBT as a type of treatment for OCD?
- CBT is endorsed by the National Institute for health and clinical excellence
- So, it’s effective in reducing symptoms of OCD
What are the Weaknesses of CBT as a type of treatment for OCD?
- Limited treatment which should ideally be used in combination with other forms of therapy
- Difficult to disentangle which of the benefits from CBT are due to the cognitive or behavioural component
- Individual differences means that therapy needs to be tailored to the needs of the particular person - can be ineffective
- ERPT wouldn’t be effective for clients that don’t have compulsions
How does the finding of Masellis et al (2003) not support CBT as a type of treatment for OCD?
- Found that up to 44% of clients only suffer from obsessions
- Up to 75% had co-morbid depression, which lessons effects of ERPT
- So, ERPT may not be effective
What is Relapse Rate?
Recurrence of their disorder/disease
What are the Similarities between CBT and Drug Treatment as treatments for OCD?
- Both useful and effective as treatment for OCD
* Both have supporting evidence to show treatment is effective - drug treatment = Soomro (2007), CBT = NICE (2006)
What are the Differences between CBT and Drug Treatment as treatments for OCD?
- CBT more ethical - it empowers patients as they’re taught techniques which they can use on their own + has lower relapse rate
- Individual differences
- Drug treatment with CBT combined as effective - POTS (2004)
What is the Aim of the Contemporary Study by POTS (2004) for OCD?
Compare 3 treatments to see which is most effective in treating young people w/ OCD:
•CBT on its own
•An SSRI (sertraline) on its own
•CBT + sertraline combined
What was the Type of Sample used in the Contemporary Study by POTS (2004) for OCD?
- Volunteer sample
- All diagnosed using DSM-IV
- Study ran across 3 centres in the USA
What were the Participants in the Contemporary Study by POTS (2004) for OCD?
- 112 participants
- All American
- 92% white
- Aged 7-17 years - average age of 11
How was the Severity of the Participants’ Symptoms Measured in the Contemporary Study by POTS (2004) for OCD?
- A standardised test - the Children’s Yale-Brown Obsessive Compulsive Scale
- Only those with a score of 16 or above on the scale were included
Which Children were Excluded from the Contemporary Study by POTS (2004) for OCD?
- Children who were comorbid w/ other disorders (e.g. Tourette’s)
- This would avoid interaction effects - to control confounding variables
Why were children with ADHD required to be on stimulant medication + stable in the Contemporary Study by POTS (2004) for OCD?
To ensure that their ADHD wouldn’t affect the treatment for OCD
Why were no children on anti-obsessional medication at the start of the Contemporary Study by POTS (2004) for OCD?
- To ensure that any in the Ps was due to the treatments offered in the study
- Controlling confounding variables
What were the 4 Conditions of the Contemporary Study by POTS (2004) for OCD?
- Drugs only
- Placebo pill only
- CBT only
- CBT + drug treatment
How were the children allocated to the Conditions in the Contemporary Study by POTS (2004) for OCD?
Randomly, using a computerised system
How were the children assessed at the start of treatment of the Contemporary Study by POTS (2004) for OCD?
- They were interviewed
* The baseline measure was taken using the CY-BOCS using independent evaluators
How long did the Contemporary Study last by POTS (2004) for OCD?
12 weeks
Why did each child have a specialist psychiatrist assigned to them for the duration of the Contemporary Study by POTS (2004) for OCD?
- To monitor their progress
* To provide them with support
What was the Procedure for the Drugs only and Placebo conditions of the Contemporary Study by POTS (2004) for OCD?
- Children attended weekly sessions for 6 weeks, then attended every other week (9 sessions in total)
- Dose established +changed during sessions
- Parents would monitor that children took their medication + kept a medication diary
- Any adverse reactions would result in the medication being changed or stopped
How many sessions did the CBT group have in the Contemporary Study by POTS (2004) for OCD?
14 clinical sessions over the 12 week period
What were the 4 Components in the CBT group of the Contemporary Study by POTS (2004) for OCD?
- Psychological training
- Cognitive training
- Mapping OCD target symptoms
- Exposure + response ritual prevention
What did each CBT session consist of for the CBT group in the Contemporary Study by POTS (2004) for OCD?
- Goal setting
- Review of the previous week
- Therapist assistant practice
- Homework
- Monitoring
What was the Combined condition of the Contemporary Study by POTS (2004) for OCD?
- Drugs and CBT in conjunction
* Sessions were time linked and provided simultaneously
When were the Participants Assessed in the Contemporary Study by POTS (2004) for OCD?
At baseline, 4 weeks, 8 weeks, 12 weeks
Who Assessed the Participants in the Contemporary Study by POTS (2004) for OCD?
Independent evaluators trained to a reliable standard
How did the authors ensure the assessment was reliable in the Contemporary Study by POTS (2004) for OCD?
- Evaluators carefully trained
* Evaluation process was strictly supervised + reviewed
How many of the original participants completed the Contemporary Study by POTS (2004) for OCD?
97 out of 112
What is CY-BOCS in the Contemporary Study by POTS (2004) for OCD?
Children’s Yale-Brown obsessive compulsive scale
How was the progress of participants measured in the Contemporary Study by POTS (2004) for OCD?
- Looked at how much the participants improved on the CY-BOCS over the 12 week period
- Gathered quantitative data
What does Remission mean?
Where the person has no signs + symptoms of the disorder
How did the authors define ‘entering remission’ in the Contemporary Study by POTS (2004) for OCD?
A drop below 10 on the CY-BOCS
What were the Results of the Contemporary Study by POTS (2004) for OCD?
- All conditions showed improvement at 12 weeks as measured on CY-BOCS, but placebo improvement wasn’t significant
- In CBT alone condition, 39.3% entered remission, compared to 21.4% in the drugs alone condition
- Combination treatment (drugs + CBT) was most effective in reducing symptoms
What was the Conclusion of the Contemporary Study by POTS (2004) for OCD?
- CBT lead to more improvements than drugs - so, should be the 1st line of treatment
- Drugs may compensate for less effective therapy, but minimal gain if CBT is effective
- Drugs require careful monitoring, as SSRI’s are linked to suicidal ideation in young people
- But, drug treatment was well tolerated
- Early intervention effective for children and young people with OCD
How was the Contemporary Study by POTS (2004) for OCD High in Generalisability?
- Large sample - 112 children + low dropout rate
- Representative of target population - young people w/ OCD
- Analysis of sample showed there was no difference in groups - so, any difference in group would be down to the IV
How was the Contemporary Study by POTS (2004) for OCD Low in Generalisability?
- Excluded children who were co-morbid
- Not generalisable to adults - Ps only aged 7-17 years
- Conducted in USA - may not be generalisable to non-western societies - as, other societies may respond differently to CBT and other medication
How was the Contemporary Study by POTS (2004) for OCD High in Reliability?
- The evaluators who assessed the children symptoms had been trained to a reliable standard
- The scale used to assess their symptoms was a standardised measure
- All participating centres (3) used the CBT manual in order to maintain consistency in treatment
How was the Contemporary Study by POTS (2004) for OCD Low in Reliability?
- This study was conducted over 3 centres, but 1 centre had better results on the CBT only condition
- This may be due to the therapist effect, as 1 therapist may have been more proficient at CBT than the others
How did the Contemporary Study by POTS (2004) for OCD have Useful Applications?
- Provides strong evidence about the most effective treatment for OCD in children + young people
- Shows value of clinical treatments - cause + effect
- Show usefulness of psychological therapies
- SSRI’s can lead to suicidal ideation in some individuals which needs to be taken into account
- Findings have shown effectiveness of CBT + sertraline combined - but individual differences mean therapies need to be tailored to the person
How was the Contemporary Study by POTS (2004) for OCD High in Ecological Validity?
- Study conducted over a long period of time - 12 weeks
* Studying people in their real life
How was the Contemporary Study by POTS (2004) for OCD High in Validity?
- The assessment scale (CY-BOCS) had been validated as an accurate measurement of OCD symptoms
- Ps randomly allocated into conditions - can infer cause-and-effect
- The assessors were blind to the condition that the Ps were in - so, they couldn’t be biased in the evaluation of improvements
- Ps in placebo condition were unaware that the drug wasn’t active, as was the therapist - this controlled for demand characteristics
How was the Contemporary Study by POTS (2004) for OCD Ethical?
- All Ps + 1 of their parents gave full written consent
- Volunteer sample - Ps wanted to do the study
- Each participant was assigned psychiatrist to monitor and support them
- Those in the drug treatment condition were regularly checked + dosages changed as necessary - protecting them from harm
How was the Contemporary Study by POTS (2004) for OCD Unethical?
- Use of deception in placebo condition
- But, this was necessary in order to ensure validity of the study
- Everyone in placebo condition was offered therapy on completion of the study
How does the Issue and Debate of Practical Issues Relate to the Contemporary Study by POTS (2004) for OCD?
- Could have problems with attrition - but, there is actually a low dropout rate
- Training of assesses to a reliable standard is costly and time-consuming
- Longitudinal study - carried out over 12 weeks = time-consuming + expensive
- There are difficulties in recruiting Ps w/ similar symptoms of OCD - but when tested, all groups are homogeneous
- Volunteer sample - Ps may be more motivated, so CBT results may be better than in the general population + didn’t have co-morbid Ps, so don’t know how effective for children with multiple issues
How does the Issue and Debate of Reductionism Relate to the Contemporary Study by POTS (2004) for OCD?
- Less reductionist as it looks a different treatments to explain OCD - cognitive, behavioural + medication
- So, more holistic
- But, it ignore social + environmental factors
How does the Issue and Debate of Comparisons Between Ways of Explaining Behaviour using Different Themes Relate to the Contemporary Study by POTS (2004) for OCD?
- Comparison of explanations + treatment for OCD
- CBT assumes faulty thinking
- Drug treatment assumes faulty brain functioning
- The study took account of different explanations
How does the Issue and Debate of Psychology as a Science Relate to the Contemporary Study by POTS (2004) for OCD?
- Drug treatment is objective - controls (e.g. evaluators + ADHD medication) - controlled confounding variables
- The children’s version of the Yale-Brown obsessive compulsion scale is standardised to give quantitative data that is objective - therefore, it’s scientific
How does the Issue and Debate of Culture Relate to the Contemporary Study by POTS (2004) for OCD?
- OCD occurs in most cultures, but POTS study can only be applied to children in the USA
- E.g. children were 92% white
- So, lacks cultural variety
How does the Issue and Debate of Issues of Social Control Relate to the Contemporary Study by POTS (2004) for OCD?
- OCD is distressing for the sufferer, so change may be in their best interest
- However, drug treatment may be criticised for trying to correct someone’s behaviour to go along with social norms
How does the Issue and Debate of the Use of Psychological Knowledge within Society Relate to the Contemporary Study by POTS (2004) for OCD?
- POTS gives treatment for OCD that’s effective
- This helps patients that suffer
- Leading to the relief of symptoms + helped them lead relatively normal lives
How does the Issue and Debate of Issues Relating to Socially Sensitive Research Relate to the Contemporary Study by POTS (2004) for OCD?
- Mental health is a sensitive issue
- Issues of abnormality - once labelled, it’s hard to get rid of that label
- From POTS - CBT is the 1st treatment that should be used + its socially acceptable
How does the Issue and Debate of an Understanding of How Psychological Research has Developed Overtime Relate to the Contemporary Study by POTS (2004) for OCD?
- Practice changed as a result of POTS study
- Before 2004, CBT wasn’t routinely used for children - but, this study has helped change this
- So that CBT is now the 1st line of treatment that OCD, + shows that CBT and drug treatment are very effective in combination
- So, we are using less drastic measures like drugs with side-effects or brain surgery to help relieve OCD
What is the Aim of Valentine et al (2010) study which uses clinical interviewing?
Study the usefulness of psycho education within group work for offender patients in a high security forensic hospital setting
What were the Participants of Valentine et al (2010) study which uses clinical interviewing?
- 42 males
- Detained in Broadmoor high security hospital
- Most received a diagnosis of schizophrenia
- They were part of a program that aimed at helping them understand and cope with their illness
What is the Method of Valentine et al (2010) study which uses clinical interviewing?
- Participants interviewed using a semistructured interview technique
- This was to understand their experience better + get info as to how the group could be improved in the future
- Group run for 20 sessions over a 3-year period
- Psycho education program considered symptoms, treatment options and coping mechanisms
- Then, a content analysis was conducted on the data gathered to pick out key themes in the responses
What were the Key Themes Identified in the Data of Valentine et al (2010) study which uses clinical interviewing?
- What participants valued + why
- What was helpful about the group
- Clinical implications
- What was difficult/unhelpful about the group
What were the Results of Valentine et al (2010) study which uses clinical interviewing?
- Patients valued knowing and understanding their illness
- Group sessions allowed them to understand their symptoms + how other peoples experiences were similar
- Increased confidence in dealing with illness, making them more positive about the future
- Patients valued the group + would recommend it
What were the Conclusions of Valentine et al (2010) study which uses clinical interviewing?
- There were positive + negative changes in measures taken after psycho education group
- Qualitative data showed how Ps valued knowledge about their illness which gave them power
- So, semi-structured interviews are useful in gathering detailed rich data which can be used to inform future practice
How is Valentine et al (2010) study which uses clinical interviewing Low in Generalisability?
- Ps very severe + had complex needs
- This is shown as they were in a high security institution
- So, can’t generalise the findings to another population
How is Valentine et al (2010) study which uses clinical interviewing Low in Reliability?
- Semi structured interviews used - so, questionnaires are not standardised
- E.g. some questions weren’t standardised
- So, difficult to replicate
How is Valentine et al (2010) study which uses clinical interviewing High in Reliability?
- Some questions were standardised- e.g. pre-post test scores
- Researchers recorded their interviews to allow them to play back + check accuracy of data
- So, they can also get other researchers to check the data, which increases interrater reliability
What are the Applications for Valentine et al (2010) study which uses clinical interview?
- Data can inform future practice
* Results showed that Ps did benefit from psycho educational program, as valued knowledge about illness
How is Valentine et al (2010) study which uses clinical interviewing High in Validity?
- Semi structured interviews allowed more detailed data to be gained from patients
- Info from patients interviews allowed them to fully express their own point of view, helping the researchers to understand their perspective more clearly
How is Valentine et al (2010) study which uses clinical interviewing Ethical?
- Ps allowed to withdraw from the study/request for their data not be included
- Ps gave consent
How is Valentine et al (2010) study which uses clinical interviewing Unethical?
- Ps still vulnerable + not easy for them to refuse consent/withdraw from study
- Given confinement
How do Individual Differences Relate to Valentine et al (2010) study which uses clinical interviewing?
- Different insight into their illness
- So, may respond differently to the programme from each other
- Usefulness of programme may not apply to everyone
What is the Inductive Approach in Qualitative Data?
- Observing or analysing something
* Then, drawing a set of principles from it or a model of how things might be from the data
What is the Deductive Approach in Qualitative Data?
- Researcher specifies themes they’ll search for
- Going from a theory to predict what might happen
- Using the data to test against the theory
- Starts with a hypothesis
What is the Grounded Theory?
- A way of analysing qualitative data
- Finding theory from the data, the theory is grounded in the data
- This theory is analysed using the inductive method
What is the Aim of the Grounded Theory?
- Retain the richness of the data
- Produce coding that captures those meaning in a manageable form
- Show new ways of understanding behaviour, including shared meanings between people
What are the Stages of Grounded Theory?
- Coding is done
- Codes collected into concepts, which groups data together
- Concepts grouped into similarities and differences, theory starts to develop
- Theory comes from collecting the categories together, it’s about forming a model that can explain the data
What are the Strengths of Grounded Theory?
- Rich + detailed data collected - showing new ways of understanding behaviours
- Able to develop a theory to explain the data - uses specific terms to explain how it’s done and is explicit in its guidance
- Theory should have high validity - as, evidence is integrated into the theory
What are the Weaknesses of Grounded Theory?
•Low validity - if the data gathered to develop the theory was problematic
•Time-consuming to gather + analyse data
•Theory may be based on a subjective opinion - researchers may be biased in the way they interpret data
•Researchers may force data to support the theory - so, may miss crucial evidence that contradicts the concepts they believe
- as, they selectively sampling data as a theory begins to emerge
What are the Strengths of Thematic Analysis?
- Flexible way of analysing qualitative data + doesn’t always need a theory to drive the analysis
- Maintains richness in data + summarising a large amount of qualitative data in a manageable way
- Allows insight into data which isn’t always anticipated by the researcher + yield more detailed and meaningful info than quantitative data
What are the Weaknesses of Thematic Analysis?
- Hard to find themes in data that aren’t driven by the questions asked by the researcher in the interview
- Unscientific - themes are highly dependent on the subjective opinion of the researcher - so, can lead to researcher bias
How does Thematic Analysis Take Place?
- Familiarise with data
- Generate codes
- Look for themes in codes
- Review the themes
- Define + name the themes
- Produce the report
What are the different methods for researching mental health?
- The use of longitudinal methods
- The use of cross-sectional methods
- The use of cross-cultural methods
- The use of meta-analysis
- The use of primary and secondary data
What is a way to explore the causes of mental health problems?
- Investigate impact of different treatment methods
* Find out how disorders progress in patients
What is the use of longitudinal methods as a method for researching mental health?
- Takes place over a long period
- Involves comparing a sample group with their own performance overtime
- So, developmental changes can be seen through patterns of measurement
What would the use of longitudinal methods as a method for researching mental health allow?
Psychologists to see if there is any reduction in the symptoms to help them to assess how effective the treatment is
How are measurements taken in the use of longitudinal methods as a method for researching mental health?
How the symptoms present themselves over a time period at certain intervals
What is the study of POTS (2004) as an example of the use of longitudinal methods as a method for researching mental health?
- Compared the use of CBT with the use of sertraline in children with OCD
- Study lasted for 12 weeks, patients assessed at weeks: 4, 8 and 12
- Showed change and development in OCD symptoms overtime
What is the study of Sensky (2004) as an example of the use of longitudinal methods as a method for researching mental health?
- Compare that CBT vs befriending for schizophrenia
- Treatment lasted 9 months + patients assessed 9 months after treatment ended
- Found that CBT is effective in treating negative and positive symptoms in schizophrenia that are resistant to drugs
What is the study of Meltzer (2004) as an example of the use of longitudinal methods as a method for researching mental health?
- A 6 week study that compared placebo, 4 new drugs + haloperidol
- Found that haloperidol was better than placebo in improving positive + negative symptoms of schizophrenia
- So, study showed change + development in schizophrenia
What are the Strengths of the longitudinal method as a method for researching mental health?
- High validity - participant variables are controlled for - as, same Ps used
- High reliability - reliable way to measure the effect of time on behaviour - enabling clinicians to evaluate the effectiveness of treatments in terms of improving the quality of a patient’s life
What are the Weaknesses of the longitudinal method as a method for researching mental health?
- Low validity- Ps may drop out, reducing the sample size
- May be factors which affect individuals development, making it hard to draw conclusions
- Take a long time + can be expensive
- By the time data can be used to draw conclusions in the study, the data may be irrelevant
What is the use of cross-sectional methods as a method for researching mental health?
- Useful when researchers want to take a quick snapshot of behaviour in a given population in a set period of time
- Uses a large sample
- Conclusions are drawn from the data gathered
What is the study of Luhrmann (2015) as an example of the use of cross-sectional methods as a method for researching mental health?
- The aim was to compare auditory hallucinations in the USA, India and Ghana
- It was an interview based study
What are the Strengths of the cross-sectional method as a method for researching mental health?
- Data gathered quickly - so, conclusion can be drawn + acted on more rapidly
- High validity - results more likely to be valid, as they will be reported at the same time when they have most application
- Can be economical - as, it requires less commitment in terms of time from a researcher compared to the longitudinal design
What are the Weaknesses of the cross-sectional method as a method for researching mental health?
- Not good for finding out the cause of something like a mental disorder as they’re descriptive research
- There might be a cohort effect - as, the study looks at different people at the same moment in time + those people will belong to a different cohort
- They’re unlikely to include any historical info about a patient, or info about the future - this is because they’re a snapshot
What is Cohort Effect?
The difference in social and cultural groups that change with age and time
What is Culture?
The way a group of people share their decisions + behaviour, such as sharing norms in society
What is the use of cross-cultural methods as a method for researching mental health?
- Carried out by researchers who want to compare some behaviour or attitudes in different cultures - similarities + differences
- Universality can be studied - if a result is found in many different cultures, then it may be in our nature
What are the Strengths of the cross-cultural method as a method for researching mental health?
- It identifies elements of abnormal behaviour that can be attributed to biological factors
- They aid clinicians understanding of the cultural factors they should consider when diagnosing + treating patients from different cultural groups
- Allows researcher to gain an understanding of how culture plays a role in the validity and reliability of diagnosis in clinical psychology
What are the Weaknesses of the cross-cultural method as a method for researching mental health?
- In conducting research across cultures, there is likely to be a conflict between the cultures
- So, conclusions drawn may lack validity if the interpretation of the patient’s behaviour doesn’t consider their cultural background
What is the study of Luhrmann (2015) as an example of the use of cross-cultural methods as a method for researching mental health?
- Found that Ps in the USA were more likely to report negative commands
- Whereas, patients from India + Ghana were more likely to report rich relationships with their voices
What is the use of meta-analysis as a method for researching mental health?
- Using the findings of different studies - secondary data
- Findings are analysed
- Focuses on effect sizes
How have meta-analysis as a method for researching mental health been used in clinical psychology?
To find out about the effectiveness of therapies and treatments across different patient groups
What are the Strengths of the meta-analysis as a method for researching mental health?
- Conclusions drawn from a huge sample and different areas
- Results can be generalised to a larger population due to the large sample
- More data used - so, there is likely to be more precision in the analysis
- Quick and cost-effective
- Research generally focuses on using peer-reviewed publications - so, data has been scrutinised
What are the Weaknesses of the meta-analysis as a method for researching mental health?
- Researchers don’t gather data directly - so, may be on identified issues of reliability + validity in the methods of data gathering
- Low validity due to publication bias
- E.g. research that produce null effects may not be published + therefore would be ignored by meta analysis
What is the study of Carlsson (2000) as an example of the use of meta-analysis as a method for researching mental health?
- Used meta analysis in combining the results are various neurotransmitters studies
- To investigate the role of neurotransmitters including dopamine, serotonin and glutamate in schizophrenia
What is the use of primary data as a method for researching mental health?
Gathered first-hand from source directly by researcher
What is the use of secondary data as a method for researching mental health?
Data already gathered by others to use for future research
What is the study by Rosenhan (1973) as an example of the use of primary data as a method for researching mental health?
Gathered primary data from first-hand observations
What is the study by Lavarenne et al (2013) as an example of the use of primary data as a method for researching mental health?
Used data from one of the group sessions, which were primary data
What is the study by Carlsson (2000) as an example of the use of secondary data as a method for researching mental health?
- The use of meta analysis/secondary data for neurotransmitter functioning
- E.g. studies w/ rodents, studies that used brain scans, studies on people w/ acute schizophrenia + people w/ schizophrenia in remission
What is the study by Gottesman and Shields (1966) as an example of the use of secondary data as a method for researching mental health?
- Used secondary data for their twin studies
* E.g. hospital notes
What are the Strengths of the primary data as a method for researching mental health?
- More credible than secondary data - as, they’re gathered for the purpose with chosen research method, design etc
- Operationalisation is done with research in mind, so there’s likely to be validity with regard to the aim
What are the Strengths of the secondary data as a method for researching mental health?
- Cheap - as, data is already collected
- Can be large quantities of data, so there might be detail
- Can be from different sources - so, there is a possibility of comparing data to check for reliability + validity
What are the Weaknesses of the primary data as a method for researching mental health?
- Expensive - as, data gathered from the start
* Limited to time, place and number of participants
What are the Weaknesses of the secondary data as a method for researching mental health?
- When analysed originally, there may have been subjectivity
- Likely to be gathered to suit another aim, so may not be valid for the study
- May have been gathered some time before, so not in a relevant time period
What are case studies as a method for researching mental health?
- Studying individuals or small groups with a unique characteristic or experience
- Often evidence gathered will be qualitative, allowing an in-depth analysis of the group
- Researchers triangulate the data to draw conclusions
What are case studies in relation to clinical psychology as a method for researching mental health?
- Case studies may be of people with rare symptoms or individual taking part in a specific therapy
- A full understanding of the patient’s problems can be assessed + all the factors that may have an affect on them can be taken into account
What was the aim of the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health?
- Investigate how CBT can be used to treat a woman with schizophrenia
- An attempt to use psychotherapy to treat schizophrenia where drug treatment had previous been preferred
What was the procedure of the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health?
- Carol had 3 years of CBT + follows up her progress 6 months and a year after therapy
- Carol symptoms were measured on 4 scales: roll functioning scale (RFS), goal attainment scale (GAS), hospitalisation, global pathology index (GPI)
- Carol had three stages of treatment
What was the 1st stage of Carols treatment in the procedure of the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health?
- Development of rapport - honest + trusting communication
- CBT sessions lasted for 15mins to 1hour
- Carol + therapist often went for a walk
- They shared their love of baseball
What was the 2nd stage of Carols treatment in the procedure of the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health?
- Understanding CBT - took 2months
- Carol was educated in CBT, schizophrenia and treatment
- The focus was on improving ways of coping with stress
- The ABC model (Ellis, 1957) was used
What was the treatment part in the procedure of the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health?
- 1st year - focus on managing anxiety + therapy was on faulty attributions
- A weekly activity schedule gave her structure after leaving the hospital - Carol recited what she did during the day to help therapist recognise signs of stress
- Middle phase - 16months of building more strategies to cope with stressful situations - e.g. the use of a ‘stress thermometer’ + the use of meditation
- End phase - 3months - Carol developed plants to maintain the treatment without therapist - e.g. she wrote cue cards w/ coping strategies
What were the Results of the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health?
- Carol improved in psychosocial functioning, achievement of goals, reduction of symptoms, little distress + never re-hospitalised
- After 1 year - RFS was stable at 27, whereas at the start she scored 6
- At end of study - GPI score of 1 indicated that there were few symptoms present
- GAS increased from 19.85 to 80.15 - shows that treatment goals had been attained - goals were: starting a college course, taking a volunteer job + going out once a week w/ friends
What was the Conclusion of the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health?
- Improved in Carols functioning in all 4 measures after a 3 year course of CBT - so, CBT can be successful in treating schizophrenia
- Bradshaw + Roseborough (2004) carried out a meta-analysis of case studies of 22 patients - they suggested that 86% improved their psychosocial functioning + 82% had reduced severity of symptoms - this supports CBT as an effective treatment for Schizophrenia
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health Low in Generalisability?
- Unusual case - Carol is much younger than most females with schizophrenia, comes from a supportive background + has no family history of mental illness
- She is female + the disorder presents differently in males
- Her type of schizophrenia (undifferentiated type) isn’t the only type of schizophrenia - CBT may not be affective with other types
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health Low in Reliability?
- Many details of the study are hard to replicate
- E.g. the rapport between Carol + her therapist
- Case study - can’t replicate the study in the exact same way
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health High in Reliability?
- CBT follows standard procedure by Aaron Beck
- The measures used (e.g. GAS, GPI, RFS) are well established tools by psychiatrists
- Carols symptoms were checked against DSM-IV
- The same measures used at start of study, 3x during therapy + 2x afterwards = test- retest reliability
What were the Applications in the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental healthy?
- Promotes the use of CBT to help treat patients with schizophrenia
- So, clients lower their dependency on antipsychotic drugs (biological treatment/side-effects/compliance)
- But, treatment of CBT is only available to 10% of sufferers in the UK
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health High in Ecological Validity?
- Real patient receiving real treatment was used
* E.g. CBT and coping methods
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health High in External Validity?
- Supported by other case studies in the meta analysis - Bradshaw + Roseborough (2004)
- 86% improved psychosocial functioning and 82% had to reduce symptoms
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health High in Internal Validity?
- Use of scales to accurately measure her progress increases internal validity - e.g. GAS, GPI, RFS
- Gained quantitative data - e.g. her scores on RFS, GPI and GAS
- Gained qualitative data -e.g. her walks, volunteer job, change in self-esteem + view of herself with someone in the future
- Real changes are seen over a period of 4 years
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health Low in Internal Validity?
- All the clients were taking antipsychotic medication alongside CBT
- So, this could be the real reason there was improvement in the study which supported the case study of Carol
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health Ethical?
- Bradshaw respected the young woman’s dignity + privacy by concealing her real identity + using the pseudonym ‘Carol’ instead
- At the end of study, Carol was much healthier + could give full informed consent for her data to be used
- Her therapist developed rapport by being genuine + having empathy
- CBT helped her live a less stressful life as improvement was still in evidence a year after therapy
- Carol was empowered - using a stress thermometer + a pat on the back technique - allowed her to feel in control of her treatment
How was the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health Unethical?
- There are issues of consent
- As, Carol was in too bad a state at the start of study to consent to share details of her progress with the researcher
- So, consent was obtained from family and therapist instead
How was Carol described in the study by Bradshaw (1998) as an example of the use of case studies as a method for researching mental health Ethical?
•She was a good student, shy but with several friends
•But, when she started to experience hallucinations, she withdrew from people + acted in a bizarre manner
•She was hospitalised + diagnosed with
undifferentiated type schizophrenia using the DSM-IV
How are Peer Reviews Effective?
- It helps to maintain standards within that area of research
- It can attract funding
How can Peer Reviews be Criticised?
- The actual findings may not be relevant by the time it’s published
- There are practical issues - peer review can involve many amendments, so may be costly + take a long time
- Some research is never published - as, research with null findings isn’t published - there is a publication bias for positive outcomes, leading to a distorted view of a subject area
