Clinical Psychology Flashcards
(274 cards)
1
Q
What is Clinical Psychology?
A
A branch of psychology concerned with assessing and treating mental illness and psychological problems.
2
Q
THE 4 Ds
A
3
Q
What are the 4 Ds of diagnosing mental disorders?
A
- Danger.
- Dysfunction.
- Distress.
- Deviance.
4
Q
What is deviance?
A
When behaviours and emotions are viewed as unacceptable.
> regarded as abnormal/defy social norms.
5
Q
What is distress?
A
When someone’s own behaviours or emotions upset them (for an extended period of time).
> anxiety, fear, confusion.
6
Q
What is dysfunction?
A
When behaviours prevent someone from doing everyday tasks/satisfying social and occupational roles.
7
Q
What is danger?
A
When someone’s behaviour puts themself or others at risk of harm.
> subjective—drinking + smoking vs bungee jumping.
8
Q
What do the 4 Ds do?
A
Assist the accuracy and reliability of diagnoses.
9
Q
THE DSM
A
10
Q
What is the DSM?
A
A handbook used to help the diagnosing of mental disorders.
11
Q
How many versions are there?
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5.
12
Q
Why was it created?
A
- To create a common system for diagnosing disorders.
- Originally published to help the armed forces correctly diagnose servicemen.
13
Q
What are some facts about the DSM 1?
A
- Was dominated by Freud’s psychodynamic theory.
> was a leading form of clinical psychology. - Used as a manual for military doctors in the US army.
14
Q
What are some facts about the DSM 2?
A
- Bandura challenged the psychodynamic approach.
- Thomas Szasz argued that MH was a myth.
- Rosenhan’s study exposed it as unreliable.
15
Q
What are some facts about the DSM 3?
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- It had a better biological understanding of MH.
- Had a strong focus on observation due to the biological approach.
- More scientific.
16
Q
What are some facts about the DSM 4?
A
- People became more aware of how MH was different in different cultures.
- Followed 5 axes.
17
Q
What were the 5 axes?
A
- Mental health conditions.
- Personality disorders.
- Medical conditions.
- Psychosocial and environmental problems.
- Daily functioning.
18
Q
What are some facts about DSM 5?
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- No axes.
- Has 3 sections.
- More research into different disorders.
19
Q
What are the 3 sections?
A
- Introduction + directions on how to use the manual.
- All known disorders + diagnostic criteria.
- Conditions that require further research.
> Caffeine use disorder.
> Internet gaming disorder.
20
Q
THE ICD
A
21
Q
What is the ICD?
A
The international classification of disease.
22
Q
How many versions are there?
A
11.
23
Q
What are some facts about the ICD?
A
- It’s free and available for everyone.
- Contains all known disorders and diseases.
- Created by the world health organisation.
24
Q
RELIABILITY AND VALIDITY OF DIAGNOSES
A
25
How do we know if a diagnosis is reliable?
More than one psychologist agrees on the diagnosis.
26
How do we know if a diagnosis is valid?
The diagnostic criteria will measure the disorder it claims to.
27
How can patient factors affect reliability?
- May provide inaccurate information to the clinician.
> memory problems, denial or shame.
- May not think a symptom is notable.
> could be normal to them.
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How can clinician factors affect reliability?
- Unstructured interviews may lead to focus on a certain symptom.
- May already be set on a diagnosis.
- Different clinicians may have different training backgrounds.
> psychodynamic vs medical.
29
What are the different types of validity?
- Predictive.
- Concurrent.
- Etiological.
30
What’s concurrent validity?
When there is a broad agreement about which symptoms mean which disorder.
> cross-checking with another diagnostic tool.
31
What’s etiological validity?
When people with the same disorder have the same causal factors.
> genetics.
32
What is predictive validity?
When a diagnosis can lead to the prediction of future symptoms and the prediction of the effect of treatment.
33
How can implicit biases affect the validity of diagnoses?
Clinicians may be more likely to diagnose women with depression because it’s more common among women.
34
**CLASSIC STUDY**
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Who created this classic study?
Rosenhan
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What were the aims of this study?
1. To see what it was like to be institutionalised.
2. To see if the DSM had good reliability when distinguishing the ‘sane’ from the ‘insane’.
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What was the procedure?
- 8 pseudo patients chosen (5M + 3F).
> one was Rosenhan himself.
- Each patient went to a different psychiatrist.
> Reported the same symptom of hearing a voice saying ‘hollow’, ‘empty’, ‘thud’.
> Bar that symptom, everything else was normal.
- Covert observation—staff and doctors didn’t know.
- As soon as they were admitted, they acted how they normally would—stopped showing abnormal symptoms.
> took part in activities + spoke to staff.
- Patients took notes.
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What were the results of this study?
- All patients were admitted.
- All but one was diagnosed with schizophrenia.
> Diagnosed with manic depression.
- Average stay was 19 days.
- A lot of the actual patients were suspicious of the pseudo patients’ sanity.
- Staff dehumanised the patients.
> Ignored them + invaded their privacy.
-Taking notes was seen as normal behaviour in the hospital.
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**FOLLOW UP STUDY**
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What was the aim of this study?
To see if the tendency towards diagnosing the sane as insane could be reversed.
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What was the procedure?
- Another hospital didn’t believe that the results of the first study could happen/be found in their hospital.
- Rosenhan told them that over the next 3 months 1 or more pseudo patients would try to gain access to the hospital.
42
What were the results?
- 193 patients tried to gain access—none ended up being pseudo patients.
- 41 were suspected fake by at least 1 staff member.
- 23 suspected fake by at least 1 psychiatrist.
- 19 suspected fake by psychiatrist and 1 other staff member.
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**SCHIZOPHRENIA**
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What is schizophrenia?
A chronic mental health condition where you see, hear or believe things that aren’t real.
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What are positive symptoms?
Symptoms that are additional to behaviour.
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What are negative symptoms?
Symptoms that show a lack of normal functioning.
47
Give some positive symptoms.
- Hallucinations.
> Visual or auditory.
- Delusions.
- Thought insertions—thoughts are put there by someone else.
- Thought withdrawal.
- Disorganised speech and behaviour.
48
Give some negative symptoms.
- Apathy—loss of interest in normal goals/interests.
- Lack of speech.
- Social withdrawal.
- Flat emotions.
> Immobile face, lifeless eyes, tone less speech.
49
Give some statistics of schizophrenia.
- In men symptoms show during teens-20s.
- In women symptoms show during 20s-30s.
- Affects 1% of the population.
- More common in those of a lower class.
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What are the 5 types of schizophrenia?
1. Paranoid.
2. Disorganised.
3. Residual.
4. Catatonic.
5. Undifferentiated.
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What’s the paranoid type?
Delusions of control and auditory hallucinations.
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What is the disorganised type?
Disorganised speech and behaviour, and flat emotions.
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What is the catatonic type?
- Apathy.
- Bizarre postures.
- Excessive motor activity.
Repetition of others’ words (echolalia).
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What’s the residual type?
When they portray few symptoms but have history of schizophrenia.
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What’s the undifferentiated type?
When people have symptoms that aren’t fully formed or specific enough to permit diagnosis.
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How is schizophrenia diagnosed?
- Clinicians look for at least 2 symptoms.
- Symptoms must be present for 6 months.
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What are the biological explanations for schizophrenia?
- Neurotransmitters.
- Genetics.
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What are the neurotransmitters associated with schizophrenia?
- Dopamine.
- Serotonin.
- Glutamate.
59
How does dopamine affect schizophrenia?
- Schizophrenics have an abnormal number of D2 receptors at the synapse.
- Increased dopamine in the mesolimbic pathway in the brain causes positive symptoms.
- Decreased dopamine in the mesocortical pathway in the brain causes negative symptoms.
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How does serotonin affect schizophrenia?
- Increased serotonin leads to positive and negative symptoms.
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How does glutamate affect schizophrenia?
- It controls memory and learning.
- Reduced glutamate=increased dopamine.
62
Where does evidence of the neurotransmitters hypothesis come from?
- **Lieberman** —75% of schizophrenics show new symptoms/increased symptoms after taking amphetamines.
- **Randrup and Munkvad** —Raised dopamine levels in rats brains (injected amphetamines).
> Showed psychotic behaviour—aggression and isolation.
- **Post-mortems** —High density of dopamine receptors.
63
Give some strengths of this?
- Clearly scientific.
- Continues to generate research using objective methods—PET scans, animal studies.
- Possible to test.
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Give some weaknesses.
- Doesn’t adequately explain types of schizophrenia.
- Can’t explain why some aren’t helped by antipsychotic drugs.
- Reductionist.
- Unknown whether schizophrenia causes increased neurotransmitters or whether increased neurotransmitters cause schizophrenia.
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What is the treatment for this theory?
Antipsychotic drugs.
66
What are the 2 types of antipsychotics?
1. Atypical.
2. Typical.
67
What are typical antipsychotics and what do they do?
- Chloraprozamine + Haloperidol.
- Block the action of dopamine.
68
What are atypical antipsychotics and what do they do?
- Clozapine + Risperidone.
- Blocks both serotonin and dopamine.
69
Why are antipsychotics bad?
They have lots of negative side effects.
70
How do genetics link to schizophrenia?
- Thought that schizophrenia runs in families.
- Occurs in 10% of people with a close relative with the condition.
- Identical twins have a 40-65% risk.
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What is the problem with the genetic explanation?
No singular gene has been identified with causing schizophrenia.
72
What research backs up this explanation?
- **Gottesman and Shields** —Twin studies.
> MZ + DZ twins.
> 75% concordance for identical twins.
- **Sullivan** —Meta-analysis
> 81% heritability.
- **Heston** —Adoption studies.
> Those who had biological mothers with schizophrenia were more prone to it—10%.
> Shows its not environment.
73
Give some strengths of these studies.
- **Gottesman and Shields**
> Replicates other studies—reliable.
- **Heston**
> Ensured the separation at birth—reliable.
- Common finding occurred between multiple studies.
74
Give some weaknesses of this explanation.
- Reductionist—reduces schizophrenia down to just genetics.
- Some people with schizophrenia don’t have family members with the condition.
- Ignores that environmental factors can contribute.
75
What is the non-biological explanation for schizophrenia?
The social explanation.
76
What are the social risk factors for schizophrenia?
- Social adversity.
- Urbanicity.
- Social isolation.
- Immigration/minority group status.
77
What evidence is there that shows immigration and minority is a risk?
- There is a high incidence rate among African-Caribbean and black immigrants.
- Immigrant populations are disadvantaged.
> Education, class, housing, discrimination.
78
What is the social-drift hypothesis.
The development of schizophrenia leads to movement into the lower class—not the other way round.
79
Give some strengths of this explanation.
- Enables suggestions for improving mental health of children in minority communities.
- **Pedersen and Mortensen**
> Longer urban living creates a greater probability of schizophrenia.
80
Give some weaknesses of this explanation.
- Not actually a cause of schizophrenia.
> Only triggers/elicits it in those with a genetic predisposition.
- Evidence can be biased.
> Lower classes are more likely to be diagnosed.
> Greater intervention.
- Hard to pin point specific social factors.
81
What is the treatment for this explanation?
Care in the community.
82
What are the aims of this treatment?
- To avoid institutionalisation.
- To rehabilitate patients in society.
83
How does it work?
- Treatment is provided while the patient is living at home or in sheltered accommodation.
- Those who need hospitalisation are admitted—only short-term.
> Only used as a last resort.
84
What are some arguments for this treatment?
- Helps them learn independence.
- Improves their quality of life.
- Reduces their symptoms.
- Allows them to function as normally as possible.
85
What are some arguments against this treatment?
- Chronic underfunding.
- Overstretched staff.
> May affect recovery.
- Lack of coordination between different services.
> Different advice, methods or quality of care from different people.
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**CONTEMPORARY STUDY**
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Who is this study by?
Carlsson et al.
88
What were the aims of this study?
- To review studies into the relationship between neurotransmitters and schizophrenia.
- To produce drugs that reduce relapse of symptoms and negative side effects.
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What research does this study review?
- Research from sources investigating neurochemical levels in schizophrenia patients.
- Studies into psychosis inducing drugs.
> Amphetamines and Angel Dust (PCP).
- Effectiveness of drugs in treating schizophrenia.
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What were the results?
- PCP acts as an antagonist of glutamate.
> reduces glutamate action.
- Clozapine is highly effective.
- Evidence supports the role of low glutamate levels and psychotic symptoms.
91
What did they conclude?
- Further research needs to be conducted to develop better results.
- Schizophrenia may have different types that are caused by neurotransmitters other than dopamine.
92
Give some strengths.
- It’s scientific.
- Secondary data allowed more information to be brought together quickly.
- **Sendt et al** —Agreed with Carlsson—Reliability.
- Few/no ethical problems—secondary data.
93
Give some weaknesses.
- Citing of animal studies—can’t be generalised to humans—bad ethics.
- Difficult to know how useful the data is.
- Validity issues—PET scans—stressful and affect normal functioning.
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What does an agonist do?
Increases activity/activates the receptor.
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What does an antagonist do?
Limits/decreases activity—blocks the receptor.
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**CULTURE AND MENTAL HEALTH**
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Give a way that culture doesn’t affect diagnoses.
If mental disorders are clearly defined with specific symptoms and features.
> Schizophrenia presents the same all over the world.
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Give a way that culture does affect diagnosis.
If disorders have different symptoms.
> Symptoms are often interpreted and reported differently.
99
How is schizophrenia across different countries (america, japan, nigeria)?
- **America** —focus on technology and surveillance—being spied on.
- **Japan** —Social conformity—delusions are often public humiliation and slander.
- **Nigeria** —Believed that mental health is caused by spirits—delusions of witches and
ancestral ghosts.
100
How is schizophrenia similar across cultures?
- Similar prevalence.
- Similarity in symptoms outweigh the differences.
101
How can normality vary across different cultures?
- Behaviours that are normally symptoms of schizophrenia in Western cultures can be considered signs of spiritual exaltation in developing countries.
> e.g. In Western culture, if someone claimed to be a God they’d be delusional.
> In India—considered to be a spirit medium—a human incarnation of a Hindu God.
102
How can cultural attitudes to mental disorders differ?
- Different attitudes may affect whether people seek help and receive diagnoses.
- Particular disorders may have particular meanings to different cultures.
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How can experience and expression of symptoms differ from culture to culture?
- Different cultures may react in different ways.
- If different symptoms aren’t accounted for it can cause diagnostic system bias.
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How can diagnostic processes differ from culture to culture?
- Some cultures encourage the hiding or denial of problems.
- Some cultures show more tolerance.
- Significant differences in the extent to which ethnic minorities use mental health services.
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How can language affect diagnoses?
- May be language assumptions.
> Interpreters can unconsciously change information that being provided.
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How can a difference in backgrounds affect diagnoses?
- May feel more comfortable talking to their own culture—talk more freely.
- May perceive different ethnic and cultural groups differently.
107
Give 2 culture-bound mental disorders.
- Taijin Kyofusho.
- Hwa-byung.
108
What is Taijin Kyofusho?
It is the individual’s intense fear that their body, its parts, and its functions are displeasing, embarrassing, or offensive to others.
> Essentially social anxiety.
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What are the origins of it?
- A childhood of social inhibition or shyness.
- Stressful or humiliating experiences.
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What are the emotional symptoms?
- Emotional distress.
> shame, embarrassment, anxiety, fear.
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What are the physical symptoms?
- Blushing.
- Improper facial expressions.
- Sweating.
- Trembling.
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What is Hwa-byung?
Intense anger (“fire illness”).
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Who does it typically occur in?
- Korean middle aged women.
> typically in traditional families.
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What is the cause of this illness?
Build up of anger.
> triggered by external, intra-family events.
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What are the physical symptoms?
- Sleeplessness.
- Dizziness.
- Headaches.
- Hot and cold flushes.
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What are the psychological/emotional symptoms?
- Anxiety.
- Depression.
- Feelings of hatred.
- Shame.
- Paranoia.
- Irritability.
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**CASE STUDIES**
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Give some negative features of case studies.
- Based off of one individual or a small group of people.
- Longitudinal.
- Hard to generalise the results.
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Give some positive features of case studies.
- Collect in depth, detailed data.
- Use a range of methods—interviews + questionnaires.
- Collect mainly qualitative data.
120
Who is the case study study by?
Lavarenne et al.
121
What were the aims of this study?
- To see whether the group could develop a sense of connectedness among isolated individuals.
- To give insight into how the individuals formed boundaries to support them in their illness.
122
What was the procedure?
- A therapy group of 6—met regularly.
- All members were vulnerable to psychosis.
- Leader of the session was a therapist—made notes on emotions, thoughts, behaviour and verbal content.
123
Which 2 members did they focus on?
- Earl.
- Dan.
124
What did they find/discover about Earl?
- He was a new member.
- Had been living in a basement—0 electricity—had been eating soup and crackers only.
- A member gave out a Christmas card.
> He rejected it—represents fear of annihilation.
- He discussed a multinational oil project—seen as an attempt to hold the pieces of himself together—identified boundaries.
125
What did they find/discover about Dan?
- Silent for the first 6 months.
- Now he wouldn’t stop talking.
- Told an outer-body experience he had—scared he wouldn’t be able to get his spirit back into his body.
> could be due to demands from his girlfriend—defining boundaries between them.
126
What did they conclude?
- All the members were working to hold themselves together.
- Interactions with the other members threatened boundaries—caused them to cut off human relations.
- The group were able to wrestle with their fragile egos.
127
What is Unipolar Depression also known as?
- Major depressive disorder.
- Clinical depression.
128
Give some statistics/features of Unipolar Depression.
- Affects 7% of the American and UK population.
- More common in low income households.
- Women are 2-3x more likely to develop depression.
- It’s co-morbid with many other disorders—highly prevalent.
129
What is the diagnostic criteria?
- 5 or more symptoms have to be present for a 2 week period.
- Represent a change from normal previous functioning.
130
What are the symptoms?
- Depressed mood/
- Diminished interest in most activities.
- Significant weight loss or gain (without dieting).
- Insomnia or hypersomnia.
- Fatigue/lethargy.
- Worthlessness or guilt.
- Lack of ability to think or concentrate—and indecisiveness.
- Recurrent thoughts of death.
131
What are the behavioural characteristics?
- Reduced activity levels.
- Trouble relaxing—psychomotor agitation.
- Withdrawal/isolation.
- Disruption to eating and sleeping.
- Aggression + self-harm.
132
What are the emotional characteristics?
- Low mood.
- Anger.
> more common than positive emotions.
> focused at others or themselves.
- Low self-esteem.
133
What are the cognitive characteristics?
- Poor concentration.
> Indecisiveness.
- Dwelling on the negative.
> Hard to see the positive side of things.
- Absolutist thinking.
> Thinking that everything is bad.
134
What is the biological explanation of Unipolar Depression?
- The monoamine hypothesis.
135
What does the monoamine hypothesis suggest?
- Depression results from an imbalance in monoamine neurotransmitters.
136
Which monoamine neurotransmitters does this explanation focus on?
- Serotonin.
- Noradrenaline.
137
How do serotonin levels affect depression?
- Serotonin calms the brain.
> low levels lead to depression—calming effect isn’t present.
138
How do noradrenaline levels affect depression?
- Low levels cause drowsiness, lethargy, and lack of concentration.
139
How do serotonin and noradrenaline interact?
- Serotonin controls noradrenaline levels.
> too low=depression.
> too high=mania.
140
Which gene regulates serotonin?
5-HTT gene.
141
What does this gene explain?
That people with an under active version of this gene are more vulnerable to depression.
142
What is the treatment for this biological explanation?
Drug therapy (antidepressants).
143
How does this medication work?
- They restore the neurotransmitters imbalance—to reduce symptoms.
> Agonists.
- They block reuptake of monoamines.
- Prescribed starting at the lowest dose.
> Taken for 7 days before any benefit is felt.
> For recurrent depression, they’re taken indefinitely.
- Other medication can be taken alongside them to enhance effects.
144
What are the different types of antidepressant?
- SSRI.
- Tricyclics.
- MAOIs.
145
How do SSRIs work + what side effects do they have?
- Block the reuptake of serotonin.
> Serotonin is left in the synapse to have an effect for longer.
- Safer than others + have less negative side effects.
> headaches, weight gain, lethargy, nausea.
146
Give 2 examples of SSRIs.
- Fluoxetine.
- Citalopram.
147
How do MAOIs work + what side effects do they have?
- Stop the enzymes that break down amine neurotransmitters.
- Usually prescribed as a last resort—if the other antidepressants have no effect.
> have serious side effects.
> irreversible high blood pressure.
148
Give 2 examples of MAOIs.
- Tranylcypromine.
- Phenelzine.
149
How do Tricyclics work + what side effects do they have?
- Block the reuptake of serotonin and noradrenaline.
> cause them to remain in the synapse for longer.
- Not normally a first choice.
> severe side effects.
> constipation, blurred vision, memory loss.
> overdose leads to psychosis and comas.
- Older drug.
150
Give 2 examples of Tricyclics.
- Imipramine.
- Amoxapine.
151
What is the non-biological explanation for depression?
The cognitive explanation.
152
What does this explanation suggest?
Depression is due to faulty and dysfunctional thinking.
> Focusing on destructive thoughts rather than positive thoughts leads to depression.
153
How does it suggest we can overcome depression/depressive thoughts?
By learning to use more appropriate cognitions.
> Thinking more positively.
154
What is the first part of Beck’s cognitive model?
The cognitive triad.
155
What does the cognitive triad suggest?
Suggests there are 3 areas where there are automatic negative thoughts.
> The self, the world, the future.
156
What does the future aspect of the triad suggest?
The sufferer of depression thinks that life will always be that way.
> Nothing will improve.
157
What’s the second part of Beck’s cognitive model?
Faulty thought patterns.
158
What do these faulty thought patterns suggest?
The possible negative side is thought about more in every situation.
> Always pessimistic.
159
What’s the final part of Beck’s cognitive model?
Schemas.
160
What does the schema suggest?
A new situation is interpreted via a person’s existing schema.
> Existing information changes how they view a situation.
161
What does the cognitive model suggest is the way to treat depression?
To think of alternative positive thoughts when interpreting events.
162
What does Ellis’ A.B.C model show?
That unreasonable, self-defeating thoughts can lead to maladaptive behaviour (leads to depression).
163
What is the A in the model.
Activating event.
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What does it show?
Irrational thoughts are triggered by an event or situation.
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What is the B in the model?
Beliefs.
166
What does it show?
A person’s beliefs about the event causes the depression—not the event itself.
167
What is the C in the model?
Consequence.
168
What does it show?
The emotions that are caused by A and B together are explained.
> Depression—isolation, anxiety, worthlessness.
169
Give some strengths about this non-biological explanation.
- Johnathan Evans—supports Beck.
> measured self-beliefs of 12,000 pregnant women.
> more negative beliefs=more likely to become depressed.
> the faulty cognitions occurred before depression.
- Jacobs—summarised research on the cognitive model.
> 8/14 studies show links between negative self-perception and depression.
> Even if cognitions aren’t the problem it still leads to effective therapy—validity.
170
Give some weaknesses of this non-biological explanation.
- Doesn’t explain the gender differences in depression.
> Women are more likely to suffer—doesn’t give any evidence of a more negative schema in women.
- Reductionist—ignores biological explanation.
> Places the cause of depression within the individual—blaming them.
> Involves changing cognitions—not dealing with the triggering events.
- Not all aspects of depression can be explained.
> it’s complex—many symptoms and features.
> individual differences in symptoms and their severity.
> Beck and Ellis can’t explain all of it.
171
What’s the treatment for the non-biological explanation?
Cognitive Behavioural Therapy.
172
Who proposed CBT?
Beck.
173
What does CBT aim to do?
Teach patients to rethink and challenge negative cognitions.
174
What are some facts about CBT?
- It’s a brief therapy—usually weekly 1 hour sessions for around 3 months.
- Can be group, one-to-one or online.
175
What are the 4 phases of CBT?
1. Schedule activities that you used to enjoy—do them.
2. Record thoughts about the event—negative thoughts will be challenged by the therapist,
3. The cause of the negative thinking is identified by the therapist.
4. The negative thoughts are changed—tested out in real life situations.
176
What needs to be established between patient and therapist before the treatment starts?
- Trust.
- Medications.
- Hobbies.
- Symptoms.
- Aims for the therapy.
177
How do they gather information?
- Interviews.
- Questionnaires.
178
What are the 3 processes involved in CBT?
1. Behavioural activation.
2. Graded task assignment.
3. Thought catching.
179
What’s behavioural activation?
The patient draws up a list of activities they previously liked.
> takes part in them—overcoming obstacles.
180
What’s graded task assignment?
The patient engages in increasing rewarding activities.
> to boost motivation.
181
What’s thought catching?
The patient is taught to replace negative thoughts with more realistic positive ones.
> taught coping strategies too.
182
How is the CBT carried out?
- A plan is developed of strategies going forward.
- The patient is asked to experiment with alternate thoughts.
- Words and meanings are focused on—to uncover core beliefs.
- Each problem is broken down by the therapist—downward arrow technique (starting at the base).
183
Give some strengths of this non-biological treatment.
- Addresses the cause.
- Long-lasting effects—effectiveness found after 18 months.
- Helps prevent relapse.
- Can learn skills and techniques they can apply themselves—without the therapist.
- Can be used alongside drug therapy—gives the motivation to attend the CBT.
184
Give some weaknesses of this non-biological treatment.
- Not useful for severe depression.
- Can cause dependence on the therapist.
- Some patients may only be able to benefit with the addition of drug therapy—defeats the purpose.
- High drop out rates—can’t see real effectiveness.
185
**INTERVIEWS**
186
Who conducted this study of interviews?
Vallentine et al.
187
What was the aim of this study?
To test the usefulness of psycho-educational material provided via group work for offender patients.
> In a high-security psychiatric hospital.
188
What was the sample?
- 42 males.
- 80% of the sample had been diagnosed with depression (ICD-10).
189
What was the procedure like?
- 4 groups—20 sessions over 3 years.
- CORE-OM used to assess effectiveness of therapies.
- Self-concept questionnaire used to measure self-esteem.
- Semi-structured interviews
> assess participants’ experience of the group—what was gained, how could it improve.
- Interviews were analysed.
190
What were the findings?
- There was no significant difference between the groups pre and post-test.
- Significant changes across CORE-OM.
- Questionnaires showed more reliable change—over 50% reported improved self-esteem.
- Interviews data was analysed into 4 categories.
191
What 4 categories was the data analysed into?
1. What patients valued—and why.
2. What they found helpful about the group.
3. Clinical implications—identified by patients.
4. What they found difficult and unhelpful.
192
What did they conclude?
- Further attention needs to be payed—absence of reliable change.
- Patients valued a sense of hope and empowerment.
193
Who conducted the Contemporary study?
Williams et al.
194
What were the aims of this study?
- To investigate the impact of a week long, internet cognitive bias modification therapy (CBM-I).
> on negative thinking bias and depression.
- To see if combining CBT and CBM online would be effective.
195
What is some background on the nature of this study?
- Waiting lists are an issue.
> patients can’t get in-person therapy for months.
- Those with severe depression struggle to leave the house.
- Some people are too busy to attend sessions.
196
What was the sample like?
- Sydney Australia.
- 69 participants—ended on only 42.
197
What was the method like?
- Participants completed an online screening questionnaire and a telephone diagnostic interview.
> BDI-II used to measure depression.
- Participants were split into 2 groups—intervention (38) and wait-list (31)
- No significant differences were found between the groups in the base line measures.
> depression symptoms, anxiety and negative thinking.
- The treatment programmes were explained.
- Intervention did 7 days CBM-I.
> wait-list=no treatment.
- Intervention did 10 weeks iCBT.
> wait-list=no treatment.
- Wait-list group did only the 10 weeks of iCBT—no CBM-I.
- Questionnaires completed after each round of treatment.
198
How was the CBM-I carried out?
- 1 week of 20 minute sessions.
- Patients are presented with ambiguous scenarios—to be resolved in a positive manner.
- Aims to train the patient to think positive everyday.
199
How was the iCBT carried out?
- 6 online sessions—showcasing CBT.
- Includes regular homework assignments.
- Examine pre-existing negative thinking patterns.
200
What were the results of this study?
- After the CBM-I BDI-II score went down.
> not much for wait-list.
- After iCBT BDI-II score dropped significantly.
> not much for wait-list.
- Average distress score from intervention group dropped 12 points.
> 4 for wait-list.
- Intervention quality was rated good or excellent by 84%.
201
What did they conclude?
- Online CBM-I can lead to a significant reduction in depressive symptoms in just 1 week.
- Combined intervention (iCBT + CBM-I) was more effective.
> iCBT is a useful addition.
202
What is Cognitive Bias Modification?
- Individuals are presented with scenarios.
> always resolved positively.
- Aims to train patients to automatically bias their thoughts positively.
- Known as bottom-up approach.
> modifies the biases directly and straight away.
203
What types of interviews can be conducted in clinical psychology?
- Structured.
- Unstructured.
- Semi-structured.
204
What are the 6 steps in the interview process?
1. Establish rapport—ability to freely share feelings.
2. Explain the project + the aims.
3. Informed consent.
4. Conduct interview.
5. End the interview.
6. Take notes.
205
Give some strengths of interviews.
- The interviewer can explain questions and explore other issues in depth.
- Interviews aren’t as limiting as questionnaires—aren’t forced to pick answers—increased validity.
- Interviewer and interviewee can build trust—leads to more honesty.
206
Give some disadvantages of interviews.
- May be difficult for the interviewer not to influence the interviewee’s answers—particular emphasis or tone—researcher bias.
- Difficult for the interviewer to avoid interpreting answers—lack of objectivity.
- Difficult to test semi- and unstructured interviews for reliability—different questions each time.
- Social desirability—face-to-face can make people feel uncomfortable—feel judgement.
> especially when discussing socially sensitive matters.
207
**HCPC GUIDELINES**
208
What are the 4 ethical principles psychologists have to follow?
1. Respect.
2. Responsibility.
3. Competence.
4. Integrity.
209
What does **respect** involve?
Providing privacy, confidentiality and informed consent.
210
What does **responsibility** involve?
Ensuring clients are kept out of harm or distress and debriefing patients.
211
What does **competence** involve?
The psychologist must be aware of ethics and have up-to-date knowledge.
212
What does **integrity** involve?
The psychologist must maintain professional boundaries, be honest and avoid deception.
213
Why are the HCPC Guidelines important?
- All professionals in clinical practice muse register with HCPC.
- It monitors a variety of professions.
- It had specific standards professionals must demonstrate to remain registered.
214
What are the 7 standards?
1. Proficiency.
2. Conduct, performance and ethics.
3. Continuing professional development.
4. Education and training.
5. Prescribing.
6. Character.
7. Health.
215
What are standards of proficiency?
Must be able to demonstrate professional autonomy and accountability throughout their practice.
216
What are standards of conduct, performance and ethics?
Maintaining confidentiality and acting only within the limits of their knowledge.
> referring to others/help when necessary.
217
What are standards for continuing professional development?
Taking part in regular training and keeping up to date with clinical practices.
218
What are standards of education and training?
- The psychologist must have a masters (or doctorate) in their area.
- HCPC Guidelines set out standards for training that must be met.
219
What are standards for prescribing?
Having knowledge and training to prescribe medication.
220
What are standards of character?
- Credible character references must be provided in order to register with the HCPC Guidelines.
> from people who have known them for at least 3 years.
- Criminal convictions and cautions are considered.
221
What are standards of health?
- Must re-register general health every 2 years.
- Must provide any information on issues that are likely to affect their abilities.
- Must limit or stop work if their health is impairing their abilities.
222
Why are these standards put into place?
- Helps assess suitability for the role.
- Protects the public.
- Ensures good practice.
223
What happens if they don’t adhere to the guidelines?
Prosecution and fines.
224
Give some strengths of the HCPC Guidelines.
- They’re specific.
- They make it easy to see if someone meets or fails—measurable.
- Re-registration is needed every 2 years.
- Prevents danger.
- The practitioner knows what’s expected.
225
Give some weaknesses of the HCPC Guidelines.
- Guidelines can be too vague—may not think they’re crossing boundaries.
> grey areas—can clients be your friends? how far should you go to protect a client?
- Can intrude into members’ private lives.
- Limits social life.
> limited on social media.
- Informed consent could lead the patient to refuse beneficial treatment.
- Patients may not provide accurate information.
226
**GROUNDED THEORY**
227
What is Grounded Theory?
A way of analysing qualitative data that involves finding a theory from the data—not using existing theories.
228
What is the purpose of Grounded Theory?
To generate a useful theory from the data to help better explain it.
229
How does it work?
- Opposite direction of science theories.
> avoids adopting theories before looking at the data.
230
How is it carried out?
- Takes in text and identifies the idea—coding.
- Groups the data together.
- Groups concepts into similarities and differences—starts to develop theory.
231
What types of thinking does grounded theory use?
- Deductive.
- Inductive.
232
What does deductive thinking involve?
- Deducing what with arise from the theory.
> e.g. ‘all men are mortal, henry is a man, henry is mortal.’
- If claims are true—conclusion must also be true.
233
What does inductive thinking involve?
- Forming ideas from empirical evidence.
- Specific observations are carried out—general theory is made.
- e.g. ‘most dogs have 4 legs, Rex is a dog, he will probably have 4 legs.’
234
Who conducted a study using grounded theory?
Coldwell et al.
235
What did he aim to test/prove?
How people with psychosis positively contribute to their family.
236
Why did he conduct this study?
- Schizophrenia takes the view that the individual isn’t contributing to society or family.
> no studies have looked into the contribution that people with psychosis make.
- Was interested in what factors can help or hinder contribution.
237
How did he conduct this study?
- Interviewed 6 people with a schizophrenia diagnosis.
- Interviewed 6 people with family that had a schizophrenia diagnosis.
238
What did they find?
There were psychological rewards from contributing.
> it should be encouraged.
239
How did they collect data?
- Semi-structured interviews.
> 90 mins + face-to-face.
> taped interviews.
- Grounded theory.
> identified themes were explored in follow up interviews.
240
What themes were identified?
- Practical support.
- Emotional support.
- Personal enhancement.
241
What did they conclude?
- People with psychosis positively contribute to family.
242
Give some strengths of the study.
- Good validity.
> coding was done carefully.
> participants’ thoughts and feelings are used to drive analysis.
- Grounded theory uses specific terms to explain process.
- Grounded theory allows rich and detailed data to survive analysis—no detail lost.
243
Give some weaknesses of this study.
- Can’t code and categorise qualitative data without a theory already in mind.
- Not appropriate to ignore previous research to generate new theories.
> original question must have come from previous research.
- Engaged theory uses existing theories to help analysis.
- Can’t generalise findings using grounded theory.
> comes from specific culture, at a specific time, with specific people.
244
**KEY QUESTION**
245
What is the clinical key question?
What are the issues surrounding mental health in the workplace?
246
What are some statistics for mental health in the workplace?
- 1 in 5 take time off for stress.
- 1 in 4 resign because of stress.
- 600k people suffer from work related stress, depression or anxiety.
- 12.8 million working days are lost due to these issues.
- Poor workplace mental health costs the UK £26 billion a year.
247
What are the 6 causes of work-related stress (AO1)?
- Demands of the job.
- Control over work.
- Support.
- Relationships at work.
- Role in the organisation.
- Change.
248
What are some ways to combat these issues (AO2)?
- Stress management seminars.
- Free yoga and mindfulness classes.
- Standing desks.
- Exercise encouragement—free/reduced gym membership.
- Clubs.
- Outside areas—garden.
249
What did Gray’s 1999 study suggest?
- Excessive work place stress is the cause of:
> fatigue, impaired judgement and decision making, exhaustion and aggression.
> accidents at work.
- 88% of company managers (270) said that stress levels were moderate to high.
250
What did Brown’s 1986 study suggest?
- Social support at work is important—it helps prevent depression.
> 44% of women who had no support developed depression.
251
What does the diathesis-stress model explain?
That environment is important in the development of depression.
252
What treatments can be used for work-place mental health?
- CBT—can be group.
- Drug therapies.
253
**TYPES OF STUDIES**
254
What are Longitudinal Studies?
Studies that take place over a long period of time.
255
What does this research involve?
Comparing a group with their own performance over time.
256
Give some strengths of Longitudinal Studies.
- Only way of being able to reliably measure the effect of time on behaviour.
> can see if treatments are actually able to improve patients in the long term.
257
Give some weaknesses of Longitudinal Studies.
- Research has to go on for a long period of time.
> patients may drop out.
> patients may not be able to be contacted.
- By the time all the data is collected the study/data may be irrelevant.
> outdated.
258
What are Cross-Sectional Studies?
- Studies that look at data from a population at one specific point in time.
259
What does the research involve?
Using a large group of people of the target population.
> then drawing conclusions from gathered data.
260
Give some strengths of Cross-Sectional Studies.
- Data is drawn together quickly.
> conclusions can be drawn and acted on quickly.
- Results are more valid.
> reported at the time.
261
Give some weaknesses of Cross-Sectional Studies.
- Comparisons are made between different groups.
> Individual differences are likely to have significant effect on conclusions.
- Cohort effects.
> results are applicable to a particular time or situation.
262
What are Cross-Cultural Studies?
Compare behaviour across cultures.
263
What does this research involve?
- Taking samples from different cultural groups.
> consider how culture impacts behaviour.
264
Give some strengths of Cross-Cultural Studies.
- Allows researchers to gain an understanding of how culture can affect validity and reliability of diagnosis.
- Identify areas of mental health that can be caused biologically.
> identifying behaviour that’s unaffected by cultural variation.
- Improve generalisability of research.
265
Give some weaknesses of Cross-Cultural Studies.
- Researchers may find it difficult to recognise and understand differing experiences and behaviours of people in other cultures.
- Some symptoms of mental health issues can be perceived as different things in other cultures.
> hearing voices in parts of Asia is interpreted as communicating with ancestors—seen positively.
266
What is Meta-Analysis?
Examining data from independent studies on the same subject to determine overall trends.
> using secondary data.
267
Give some strengths of Meta-Analysis.
- Conclusions from large samples can be drawn quickly and cost effectively.
- No ethical issues—the research isn’t carried out first-hand.
268
Give some weaknesses of Meta-Analysis.
- Researchers have no involvement in gathering the data.
> issues of validity and reliability.
- Publication bias.
> validity issues.
269
What is Primary Data?
- Information/data that is gathered by the researchers themselves.
270
Give some strengths of Primary Data.
- First-hand.
> gains credibility and respect.
- The researcher can replicate the procedure to check results.
> reliable.
271
Give some weaknesses of Primary Data.
- Researchers may be subjective in the types of data they look for.
> may look for data that fits their hypothesis.
- Data must be gathered from scratch.
> costly and time consuming.
- Ethical considerations.
272
What’s Secondary Data?
- Second-hand analysis of pre-existing (primary) data.
273
Give some strengths of Secondary Data.
- Saves time and expense.
- Provides a larger database.
- For some studies (e.g.historical) it’s the only resource.
274
Give some weaknesses of Secondary Data.
- Researcher can’t personally check the data.
> reliability issues.
- Researcher may have no knowledge if how the data was collected,
- Data may be originally gathered for a different purpose than it’s used for.
> credibility.
