A2 Psychology Revision Notes

Alexander Hunter

Clinical Psychology Revision Notes

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Definitions: Clinical Psychology Clinical psychology deals with understanding and treating a mental disorder. It is particularly concerned with understanding how we can define behaviour as abnormal and how abnormal behaviour is classified and diagnosed as a mental disorder. Statistical Definition of Abnormality This definition of abnormality refers to how frequently it occurs. According to this definition, anything that occurs relatively rarely can be thought of as abnormal. This is most useful when dealing with human characteristics that can be reliably measured e.g. intelligence, anxiety and depression. Diagnosis is therefore made for those people outside the normal distribution (standard deviation). However statistical infrequency on its own criterion for diagnosis, but may play a part in it. Social Norm definition of Abnormality This definition refers to exhibiting behaviours which most people believe are not normal in society. People normally conform to social norms, but when they deviate from them it can attracts our attention and is often perceived to be weird. The problem is that some people are simply eccentric whilst others may face a genuine problem. Nevertheless, deviation from social norms proves useful as a basis for diagnosing antisocial personality disorder psychopaths who are impulsive, aggressive etc. Schizophrenia Schizophrenia has no single defining characteristic. It is instead, a cluster of symptoms, some of which appear at first glance appear to be unrelated to others. Symptoms often include delusions, hallucinations, disorganised speech, disorganised behaviour, catatonic behaviour, poorer social levels, no major changes in mood. It is believed that 1% of the population suffer from schizophrenia and it is equally recurring in both men and women. It is however more prevalent in families and people of a lower socio-economic status. Reliability Reliability means consistency. A system can be said to be reliable if those who use it continuously arrive at the same diagnosis. Reliability can be tested through seeing if different clinicians arrive at the same diagnosis for the same person. This is known as inter-rater reliability. Test-reliability can be used to see if patients consistently are judged to have the same diagnosis. Validity Validity concerns measuring exactly what it set out to measure e.g. within clinical psychology, if the diagnostic system successfully identifies a condition. Different forms of validity exist predictive validity (where identifies a condition will respond in a particular way to a treatment), criterion validity (where the diagnosis agrees with a diagnosis made in a different way) and construct validity (the extent that a particular category of mental disorder exists). Primary Data and Secondary Data Primary data is the data collected by researchers conducted studies. These may be case studies or experiments in to psychological phenomenon. Secondary data is the information taken from studies that have been carried out already by other people.
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Methodology: a)Describe what is meant by Primary and Secondary Data in doing research. Primary Data: -Original data collected by those who witnessed an event first hand or who collected data themselves for a specific purpose. -Examples include results from questionnaires or experiments which can be quantitative or qualitative. -Data can be used to generate statistics and can be gathered from experiments, even observations. Secondary Data: -Second-hand analysis of pre-existing data. Analysed in other ways. Gathered prior to primary to gather knowledge of subject. -Builds a study with greater and further detail. -Interprets, analyses, evaluates, explains or comments. b)Evaluate the use of primary and secondary data in doing research. Primary Data: +Reliable as the researcher can replicate procedures to check results as they know the procedures and how data was collected and analysed. +More up-to date and new data. +It is taken directly from a study or theory. -Researchers may be subjective. -Research is made from scratch. This is time consuming and is difficult to find a large enough sample. Secondary Data: +Saves time and expense. +Larger database than individual researcher could hope to collect. +Only way to examine large scale trends of the past. -Researcher cannot personally check data so it is unethical. -There is no knowledge of collection. It is not accurate and there is a risk of error. -The research may be out of date. c)Explain how issues of validity and reliability arise in clinical psychology. -Reliability is consistency in other words similar results on a consistent basis. Examples in clinical psychology include inter-rater reliability which can be measured by the consistency of diagnoses from a professional. Test-retest reliability is another measure of testing reliability.

A2 Psychology Revision Notes

Alexander Hunter

-Reliability can then be measured by the PPV (No. of patients who receive same diagnoses) or the Kappa figure. -Pontizovsky et al. (2006) looked at the agreement between diagnosis and release of patients from an Israeli psychiatric hospital using the ICD system. The PPV for mood disorders was 94.2%, meaning that 94.2% of patients had the same diagnosis on release as when they were admitted. The Kappa figure was 0.68. The PPV for psychotic patients was 83.8%. Good kappa figure shows reasonably good reliability for diagnosis. -Nicholls et al. (2000) shows neither ICD-10 nor DSM-IV demonstrates good inter-rater reliability for diagnosis of eating disorders. 81 ppts were diagnosed with either ICD-10m or DSM-IV. Over 50% could not be diagnosed from the DSM criteria. Reliability was 0.64, but this was higher because most could not rate their diagnosis. Using ICD there was 0.36 reliability. The Great Ormond street system emerged as having a reliability of 0.88. -Validity is the extent that something measures what it sets out to measure. So a diagnosis system si valid if it correctly identifies a condition. -Predictive Validity where a system responds a particular way to a treatment. -Criterion Validity Diagnosis agrees with a diagnosis made in another way. -Construct Validity The extent to which a particular disorder actually exists. Allardyce et al. (2007) investigated this: -Although delusions and hallucinations are rare they are fairly common. No clear cut off point between schizophrenia. -Schizophrenia has range of symptoms, many of which overlap. Meaning another disorder can be wrongly identified. -Unclear if patients who suffer from negative symptoms have same condition as those suffering positive symptoms. -The criterion validity of some disorders is moderately good. Sanchez-Villegas et al. (2008) found 68% were correctly identified with depression again, whilst 81% previously undiagnosed were also diagnosed. The remaining 19% were classed as having some other form of diagnoses. This has also been tested further by David Rosenhan. d)Describe and evaluate two research methods used in the study of schizophrenia, including one study for each of the two research methods to illustrate the use of the relevant method. Twin Studies and Case Studies Using Twin Studies to study Schizophrenia -Identical or Monozygotic twins share 100% of their genes. Fraternal twins or dizygotic twins only share 50% of genes. -So 2 different typed of twin study comparing the similarity of MZs and DZs reared together, so have experienced a similar environment. -If genes control the characteristic being studied, then MZs should be more similar than DZs. Gottesman (1991) conducted a study of this type and found that for an identical twin of a patient suffering schizophrenia the risk was 48%, whilst for DZs was just 17%. -If genetic factors are important, then the results of one twin will be similar to the other giving a positive correlation. The closer the correlation coefficient to 1, the more similar the twins. This ensures a characteristic is referred to as concordance rate. -Genes can also be investigated when comparing the similarity of identical twins who have grown up in the same family or different environments. -If those who have grown up together are more alike than those who grew up apart, then it supports the role of the environment. -Conversely if the twins remain similar when reared apart it supports the role of genes. Evaluation +Twins provide a perfect way of controlling for genetic inheritance as MZs always share 100% and DZ share 50%, a naturally occurring manipulation of an independent variable, yet both have the same environmental experience (control of confounding variables) so nature vs nurture. +With increasing numbers of multiple births, it is possible to replicate the findings of twin studies with large samples in many different world cultures, increasing the reliability and generalisability of the findings. +Supported by many studies such as Gottesmann 91991) ad Gottesmann & Shields (1966). -Degree of similarity between the environments of MZ and DZ twins. Because both types of twin pair are born at the same time into the same environment it is assumed that each member of a twin pair is exposed to exactly the same set of environmental influences, regardless of zygosity. However, this not strictly true: -MZ twins can experience differences in terms of environmental experiences, even in the womb -MZ twins are typically closer than DZ twins, their parents are more likely to dress them similarly and they are always the same sex; all these factors mean that people will treat them more similarly and therefore it may not be right to assume that both MZ and DZ twin pair share equally similar environments; MZ environments may be more similar than DZs -Even though genetically identical, MZ twins are not exactly the same; -their fingerprints are different. -One twin is typically larger and more robust than the other; first observable in his difference is first observable during pre-natal development. -Genes turn on and off at different point in life and in interaction with differing environmental experiences (epigenetic modification); meaning the environment can trigger the action of the schizophrenic genes. -The validity of the findings of twin studies still rely on the validity and reliability of the measures used to diagnose schizophrenia the DSM and ICD in itself is not a reliable or valid tool. -In studies of separated twins, often the environments that they are placed in are actually more similar than the researches say.

A2 Psychology Revision Notes

Alexander Hunter

-Boklage (1977)noted that if MZ twins were both right handed, the concordance rate for schizophrenia was 92% but if one was right handed and the other left-handed, the concordance rate was only 25%. Gottesman & Shields (1966) Aim: To investigate the relative importance of genetic and environmental influences on schizophrenia by comparing MZ and DZ twins. Procedure. -Collected secondary data from hospital records of twins from the Maudsley and Bethlem Royal Joint Hospital. From a sample of 392 patients with twins of the same sex, born between 1893 and 1945 that had survived to age 15 (from a total of about 45,000 psychiatric patients) 57 twin pairs were selected aged between 19 64yrs (average age 37). Following info obtained: -Case histories based on a self-report questionnaire and interview with the twins and their parents to provide a record of verbal behaviour -A personality test and A test used to measure disordered thinking conducted on twins and parents. Findings: Analysis of the data has looked for similarities between each client and their twin. Concordance was assessed in three different ways: Grade 1: both client and co-twin have been hospitalised and diagnosed with schizophrenia. 42% MZ and 9%DZ Grade 2: both client and co-twin have had psychiatric hospitalisation but the co-twin has a different diagnosis. 12%MZ and 9%DZ Grade 3: The co-twin has some psychiatric abnormality (e.g. out-patient care, GP care, neurotic or psychotic personality profile or being abnormal on interview) 25%MZ and 27%DZ. Concordance rate for schizophrenia in twins of schizophrenics was 48% in MZs but just 17% in DZs. Conclusion: +Genes appear to play an important role in schizophrenia because the concordance rate is higher in MZ twins than DZ twins. (MZ twins are at least 48 times more likely to have schizophrenia than someone in the general population) +There is some evidence to suggest that there is a set of genes responsible but not one in particular. -Environmental factors must also be important. The Diathesis model suggests that individuals have a genetic predisposition for schizophrenia which is in part triggered from the environment. It could be that particular genes lowers the threshold for coping with stress. -Gottesman (1991) went on to investigate the influence of genes on schizophrenia by combining the results of 40 investigations spanning over 60 years. Using Case Studies in Schizophrenia -Psychologists and Psychiatrists frequently record case studies e.g Carol (Bradshaw, 1998). -Its purpose is to illustrate conditions like schizophrenia and give a detailed account of the experience of having and treating the condition. This is useful in educating people about the condition. -Cases like Carols bring schizophrenia to life much more vividly than lists of symptoms and diagnostic procedures. -Cases like Carols illustrate one way in which schizophrenia can be treated and are therefore very valuable in training of therapists. -They are useful providing we consider their purpose where the case study method is very limited in its status as evidence that a phenomenon can be true the case of Carol suggests CBT can be effective in treating schizophrenia. -However evidence remains limited as the case of Carol has no way of knowing what would have become of Carol if she had not had CBT. But due to the fact we know little about Carol, we dont know how typical a person she is. -Case studies cannot be generalised every single study is unique and has its own methods. Evaluation +Allow very detailed accounts to be collected, and gain valuable information about schizophrenia. +Ethical naturally occurring. Providing subjects privacy is kept then there are no issues with case studies. -Time Consuming Take a long time. And extremely expensive. -Not generalisable every case is different. -Different researchers have different interpretations very subjective. -Does not measure a genetic or environmental link. Carol (Bradshaw 1998) Case History -Carol is a 26 year old white American Female from a Conservative Christian Family. She had suffered from Schizophrenia for 7 yrs. -She experienced voices making negative comments and she said Im no good + Ill always be this way. -For the first 3 months, the therapist focused on gaining trust and rapport with Carol, letting her decide on length of sessions, which ran from 15mins to an hour. -Over the next 2 months, therapy went under a socialisation phase. The emphasis here was using CBT and understanding her symptoms. For the next year the therapist focused on increasing Carols activity levels. -She was set goals and encouraged to rediscover her hobbies prior to schizophrenia and was also taught stress management. -Next sixth months focused on dealing with stressful situations and recognising challenging negative cognitions e.g. Im no good -Carol resumed socialising and began volunteer work. The end-phase of therapy focused on Carols anxiety about relapsing. Results -At the end of therapy and one year on Carol was greatly improved on measures of symptoms and social functioning. -She was able to return to education and paid work, and at 4 year follow-up had no readmission to hospital.

A2 Psychology Revision Notes _______________________________________________ Content:

Alexander Hunter

a)Describe both the Statistical definition of abnormality and the social norms definition of abnormality Statistical Definition of Abnormality This definition of abnormality refers to how frequently it occurs. According to this definition, anything that occurs relatively rarely can be thought of as abnormal. This is most useful when dealing with human characteristics that can be reliably measured e.g. intelligence, anxiety and depression. Diagnosis is therefore made for those people outside the normal distribution (standard deviation). However statistical infrequency on its own criterion for diagnosis, but may play a part in it. Social Norm definition of Abnormality This definition refers to exhibiting behaviours which most people believe are not normal in society. People normally conform to social norms, but when they deviate from them it can attracts our attention and is often perceived to be weird. The problem is that some people are simply eccentric whilst others may face a genuine problem. Nevertheless, deviation from social norms proves useful as a basis for diagnosing antisocial personality disorder psychopaths who are impulsive, aggressive etc. b)Evaluate the Statistical definition of abnormality and social norms in terms of suitability as definitions of abnormality. Statistical Definition of Abnormality: +Useful in finding differences between people, by measuring how they differ from normal. -However some may simply be geniuses it doesnt necessarily mean they are abnormal. -Statistical infrequency not sufficient on its own in defining behaviour as abnormal. -Some mental illnesses are naturally common so the people who dont have it are abnormal? Depression. Deviation from Social Norms: +Useful in diagnosing and defining some mental disorders. -How do you define social norms? What might be abnormal in one culture might be perfectly normal in another. -Many diagnoses are made largely on social unacceptability. -Leads to problems of personal liberty and social control lives are often restricted after diagnosis in order to maintain social control. It can also lead to cruel and unusual punishment such as dangerous electricity treatments in 1970s and 1990s. -Cultural variations- different ethnic, regional and socio-economic groups have different beliefs on norms. Littlewood & Lipsedge (1997) demonstrate this with the case of Calvin. He was described as eccentric but his dress was culturally normal. c)Using the findings of studies, describe and evaluate reliability, validity and cultural issues with regard to the diagnosis of disorders (including use of Diagnostic and Statistical Manual) (DSM). SEE ABOVE. d)For Schizophrenia and Unipolar Depression, describe the features and symptoms. Schizophrenia -About 1% of the population suffer from schizophrenia. It is equally occurring in men and women, although symptoms appear earlier in men. -Schizophrenia is more prevalent in lower socio-economic groups and in urban areas. Symptoms interfere with everyday tasks. -Many believe it affects long-term prospects although Hopper et al. (2007) concluded more than 50% live a normal life. -Men often suffer more serious symptoms than women do. Below are the symptoms (there are both positive and negative): A) 2 Characteristic Symptoms for at least a month: -Hallucinations (usually auditory or somatic) -Delusions (often linked to hallucinations) -Disorganised speech - jumping from one conversations topic to another apparently at random - or incoherence -Disorganised or catatonic behaviour -Negative symptoms - affective flattening (apparent lack of emotion), alogia (apparent inability or unwillingness to speak), or avolition (apparent inability or unwillingness to direct own activities) B) Social & occupational dysfunction - For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset C)Continuous signs of disturbance for at least 6 months. D)No major changes in mood (depression or elation). E) No evidence of organic factors (drugs) or any medical conditions. F)History of a developmental disorder (e.g. Autism), prominent delusions or hallucinations must be present for a month. Unipolar Depression -Depression is relatively common and 20% of us will experience at one point In our life-time. -Women are twice as likely to suffer from depression than men, and lower socio-economic groups are more vulnerable. -It is a mood disorder. Many studies have been conducted with most targeted at working class women e.g. Brown et al. (1986). A)Five or more of the following symptoms have been present for the same two week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure: -Depressed mood most of the day and nearly every day. -Diminished interest or pleasure in all, or almost all activities of the day, nearly every day. -Significant weight loss when not dieting or weight gain, or loss of appetite.

A2 Psychology Revision Notes

Alexander Hunter

-Insomnia or Hypersomnia nearly every day. -Psychomotor agitation or retardation nearly every day. -Fatigue or loss of energy every day. -Feelings of worthlessness or inappropriate guilt. -Diminished ability to think or concentrate. -Recurrent thoughts of death, or suicide planning/attempt. B)Symptoms cause clinically significant distress or impairment in social, occupational areas of functioning. C)Not due to substance abuse or another medical disorder. D)Symptoms not related to bereavement and not diagnosed as a mixed episode. e)For Schizophrenia describe + evaluate two explanations from two different approaches in Unit 1 + 2. Biological Explanation Genetic Vulnerability: -It has long been perceived that Schizophrenia runs in families + there is strong evidence for a genetic link from family studies. -Family studies look at the degree of genetic similarity between different relatives and the likelihood of their sharing schizophrenia. -We share 100% of our genes with an identical twin and 50% with a parent. -Gottesman (1991) combined the results of 40 European studies to examine whether genetic similarity to a patient with schizophrenia was associated with a risk of developing it. The greater the genetic similarity of relatives, the more likely they were to have a diagnosis. -For an Identical twin of a patient suffering schizophrenia the risk was 48%, whilst non-identical was 17%.. -For a child of one parent with a diagnosis the risk was 6% but if both parents had it the risk rose to 46%. -These finding s from Gottesman suggest that schizophrenia is partly genetic in origin, but not as high if it was entirely genetic. -Genes still play an important role even when there is no family history element because mutations of the genes occur. Xu et al. (2008) examined the genetic make-up of 1,077 people, including 152 with schizophrenia and their parents and found 10% of the patients but only 2% of the control group had a mutation that distinguished their DNA from their parents. This suggests 10% of schizophrenic cases can be explained by mutation. -Brown et al. (2002) found the risk of the child going on to develop schizophrenia increases with the age of their father when they were conceived. -However, there are very few statistical relationships to link specific genes that cause it directly. -Brain development through either male/female development is linked e.g. Lewine et al. (1990) Biochemical Factors: -This is particularly relevant to the dopamine hypothesis. This concerns the effect of the neurotransmitter dopamine. This stems from studies of drugs, which act as dopamine agonists. This means drugs like speed prevent the breakdown of dopamine and lead to increase of levels. Schizophrenic behaviours are then exhibited such as hallucinations. -Dopamine levels are higher in patients with schizophrenia. Lindstroem et al. (1999) radioactively labelled L-DOPA, which is used to produce dopamine in the brain. The schizophrenic patients took up the dopamine far quicker than the control group from the PET scans results. -However dopamine hypothesis only explains positive symptoms of schizophrenia, not the negative ones and Depatie & Lal, 2001 found some drugs that acts as dopamine agonists do not induce the symptoms of schizophrenia. Evaluation +Significant evidence from studies help to support the theories of both genes and the dopamine hypothesis. +Biology is a known cause of schizophrenia it has always been observed to run in families. -Ignores the influence of the environment to some extent. Some people with no family link develop schizophrenia. -Dopamine hypothesis only explains positive symptoms of schizophrenia. -Some drugs that acts as dopamine agonists dont induce symptoms of schizophrenia. -Results from twin studies suggest that it is not entirely genetic. -Too many theories under one approach not simplistic enough to say it is biological. Cognitive Explanation -A number of cognitive factors are associated with schizophrenia. Frith (1992) specifically is interested in two cognitive abilities: -Metarepresentation Ability to reflect on our thoughts, behaviour and experience. It is the mental ability that allows self-awareness of our intentions and foals. It also allows us to interpret the actions of others. Problems in our Metarepresentation would seriously disrupt our ability to recognise ones own actions and thoughts as being carried out by me rather than someone else. -Central Control The ability to suppress our automatic responses to stimuli while we perform actions that reflect our wishes and intentions. -Positive symptoms of schizophrenia such as delusions and hallucinations can be neatly explained by Metarepresentation problems. Many schizophrenic patients report hearing voices. Frith suggest the failure of Metarepresentation means the patient is unable to distinguish speech heard externally from a thought generated in their own mind. They therefore think something and cannot tell if they or someone else said it. -The common delusion of thought insertion (thoughts from someone else), can be explained in the same way e.g. persecution can be explained by Metarepresentation failure because we require Metarepresentation to make judgements about other peoples intentions. -Frith (1992) explained negative symptoms in terms of problems with central control. Frith proposes Is either willed or stimulus-driven.

A2 Psychology Revision Notes

Alexander Hunter

-Whenever we want to achieve something we suppress brain systems responsible for stimulus-driven behaviour and activate those responsible for willed behaviour. Schizophrenics are unable to do this, and occasionally speech in schizophrenia sometimes includes clanging, in which patient takes words and goes off tracks repeating words associated that rhyme are or relevant. -Bental et al. (1991) provides supportive evidence for Friths model. Bental carried out a study where ptps either read out a category of words or thinking a category items themselves. One group had a diagnosis of schizophrenia whilst the control did not. A week later they were given a list of words and asked to identify which they had read, which were new and which they thought of themselves. The schizophrenia group did significantly worse, suggesting they struggled to distinguish between the words they had come up with themselves and those they heard. This supports Friths idea that people with schizophrenia have Metarepresentation problems; most would be able to identify the words they thought themselves. Evaluation +Frith has support from Bental et al. and his ideas are relevant to schizophrenia sufferers. +Explains both positive and negative symptoms. -Ignores the influence of biology, solely focusing on a lack of Metarepresentation and central control. -Ignores the effect of the environment. -Conceptually weak does not explain Schizophrenia, solely the symptoms does not tackle the causes. -Little support for his model. f) For Unipolar Depression describe + evaluate two explanations from two different approaches in Unit 1 + 2. Biological Genetic Vulnerability -Long been observed that sufferers of depression does run in family, however the environment plays a part. -Strong evidence from twin studies to show that there is some genetic element to depression. In one study McGuffin et al. (1996) studied 214 pairs of twins, of whom one or both was being treated for major depressive disorder. Of the identical twins, 46% shared major depressive disorder whilst 20% of fraternal twins shared major depression. This greater correlation in identical twins suggests there is some genetic element. -New research now concerns particular genes that influence interaction with the environment. The serotonin transporter gene is of particular interest as it is responsible for producing serotonin in the brain. -The gene comes in three forms, varying in the length of its two strands: long-long, long-short and short-short. It is believed that the short form leads to insufficient serotonin production. -Wilhelm et al. (2006) recruited 165 ppts from an Australian teaching programme and followed them up for 25 years. -Every 5 years the teachers were interviewed about positive and negative life events and assessed for major depression using interviews. -By the end of the study, 149 ppts were still alive, well and contactable. Of these 127 consented to have genetic material taken by blood test or mouth swab. The associations between major depression, life events or serotonin transporter gene type were calculated; -53/127 (42%) were diagnosed with depression at some point over 25 years. Negative life events were strongly associated with major depression, with 68% suffering reporting one major event. -Variations in serotonin transporter gene alone were not associated with depression; however were there were negative life events and the short-form of the gene, ppts were particularly vulnerable to depression. -This suggested variations in serotonin transporter gene did not link directly to major depression but instead appear to affect the individuals response to life events with those with short form of the genes being particularly susceptible. Evaluation: +Support from Wilhem et al. (2006) to support the theory as well as from observed links within families. +Takes the environment into consideration, not solely focusing on the biological aspect. +Clear gene associated with the diagnosis and experience of depression. -Not a complete explanation for schizophrenia ignores the role of monamines and biochemical factors, but rather concerns the genes. -Twin study evidence shows it is not entirely genetic. -Too many explanations form one approach this explanation is by no means concrete. Cognitive The Cognitive Model of Depression(The main way of treating and explaing depression) -Beck (1976) saw depression as the result of patterns of negative thinking. He identified 3 types of negative thinking found in depression: -Negative Automatic Thinking. -Selective attention to the negative. -Negative self-schemas. -The cognitive triad of negative automatic thoughts consist of a negative view of self, negative view of world and negative view of future. -Becks second form of negative thinking involves attending to negative aspects of a situation and ignoring the positive aspects. This causes us to overestimate the downside of any situation and reach the most negative possible conclusion. E.g Half empty not half full. -The third involve negative self-schemas. Our self-schema contains all our negative information about poursleves, including beliefs, feelings etc. This acquired though criticism from our parents. When we meet a new situation we interpret using relevant schemas and our self schema. If our beliefs about and feelings towards ourselves are negative, then so will any interpretation we make about ourselves in a new situation e.g. meet someone we fancy who is nice. We interpret them being nice to us as feeling sorry for us because you feel ugly, unloved etc. -Koster et al. (2005) found people selectively attend to negative stimuli. 15 depressed and 15 matched non-pressed students were identified and given a selective attention task. They were presented with positive, negative and neutral words for 1.5 seconds on a computer screen. a second after each word they saw a square on either the left or right

A2 Psychology Revision Notes

Alexander Hunter

of the screen. Their task was to press q if the square was on the left and 5 if it was on the right. How long they took to identify the square was a measure of attention to the words. The longer it took to locate, the harder they found it to disengage their attention fro the word. It took an average of 12ms to disengage from word loser when depressed compared to 2ms when not depressed. This shows that depressed people do attend to negative stimuli as Beck proposed. -Mezulis et al. (2006) examined the origins of cognitive vulnerability. Beck believed negative thinking was acquired from parental criticism. They followed up 289 American children from infancy to 11 years. Cognitive style, life events and parenting style were measured by using standard questionnaires. In addition, 120 of the children were filmed receiving feedback on a task from parents. If Beck were correct about origins of depression, negative cognitive style was strongly associated with maternal anger during feedback task in conjunction with negative life events in childhood. Paternal behaviour was not associated negative cognitive style. Evaluation +Environment/Mind focused Considers other aspects from genetics. +CBT is an effective treatment for it and stems from this theory. +Widely accepted as the firm root of depression. +Deals with both causes and symptoms of depression. -Ignores genetic factors which are so clear. -Only parents blamed for the negative thoughts this is a little ignorant and refuted by Mezulis. -Not a comprehensive and complete explanation of depression. g) For Schizophrenia describe + evaluate two treatments from two different approaches in Unit 1 + 2. Biological Antipsychotics -Standard procedure to treat schizophrenia is through antipsychotics which can be divided into first or second generation drugs. -First antipsychotics were phenothiazines which worked by blocking receptors on synapse that absorb dopamine, reducing dopamine. -Second Antipsychotics such as Clozapine have fewer side effects and deals effectively in blocking psychotic symptoms. -They can be taken in tablet or syrup form. Injections are also available for those at high risk. -Some antipsychotics can cure symptoms in a matter of weeks whilst others are on them for life. Evaluation +Strong evidence that it effectively reduces symptoms of schizophrenia. +Cheaper than therapies such as CBT, and tackle the symptoms of schizophrenia much more simply. +Schooler et al. (2005) found 75% reduction in symptoms, and lower relapses for second generation. -Some antipsychotics have side effects and first generation drugs may cause relapse. -0.05% of patients can develop neuroleptic malignant syndrome, of which 10% of sufferers can develop long-term neurological problems. -Tardive Dyskenisia repetitive involuntary facial movements and of limbs. NICE (2002) says second generation most effective. Cognitive CBT -CBT is based on the idea that most unwanted thinking patterns, and emotional and behavioural reactions are learnt over a long period of time. -The CBT approach to treatment differs slightly from conventional CBT methods. The aims of this therapy are as follows: -Challenge and modify delusory beliefs, help identify delusions, challenge delusions + test reality of evidence + recognize delusions -Most people will require between eight to 20 sessions of CBT over the space of six to 12 months. CBT sessions usually last for about an hour. -This type of treatment has been shown to be effective for reducing the positive symptoms of schizophrenia, for reducing relapse and for enhancing recovery when schizophrenia is diagnosed early. -Chadwick & Lowe (1993) significant reductions in delusions in 10 out of 12 patients -Normalising strategies where patient is taught to understand the nature of schizophrenic Symptoms -Challenge catastrophising beliefs about schizophrenia -Help patient feel that symptoms are understandable and normal -Helps 70% of patients although other 30% may deteriorate (Kingdon & Turkington, 1996) Evaluation +Shown to be very effective Supported by Turkington et al. (2002), Bradshaw (1998) and NICE (2002) who suggested it should be made available. +Patients have good insight into their psychopathology and awareness of importance of taking medication. -Often become very attached to therapist. -Very expensive and very time consuming can take a number of years. -Not very rational to teach patients to see life through rose coloured spectacles -Doesnt work for everybody h) For Depression describe + evaluate two treatments from two different approaches in Unit 1 + 2. Biological -ECT is not considered a first line treatment but may be prescribed in cases where other treatments have failed. -ECT works by using an electrical shock to cause a seizure (a short period of irregular brain activity). -This seizure releases a rush of chemical neurotransmitters and temporarily alters function (eg. perception/memory etc) -ECT is given up to 3 or 4 times a week and usually for a maximum of 12 treatments.

A2 Psychology Revision Notes

Alexander Hunter

-Before each treatment, an intravenous line is attached and through it the patient will be given an anaesthetic (to induce sleep) and a muscle relaxant. An electrical shock is applied to the patients head (via electrodes). The shock will last only 1 or 2 seconds (high voltage / low amperage) and will make the brain have a seizure. -This seizure is controlled by the medicines to stop/reduce the body having a grand muscular spasm. -The somewhat dazed patient will then wake up within 5 to 10 minutes after the treatment. -Side effects may result from both the anaesthesia and the ECT. -Common side effects include temporary short-term memory loss, confusion, paranoia, nausea, muscle aches and headache. -Some people may have longer-lasting/permanent problems with memory/paranoia. -Nowadays, rare cases result in death. (In the past it was often caused by poor calibration of the shock, coupled with a lack of muscle relaxants) Evaluation +ECT can have an immediate beneficial effect +Significant benefit of ECT over placebo +Huge research shows no damage to brain after ECT +Eranti et al. (2007) found ECT effective in short-term but not long term. -Risk of cognitive impairment -Lisanby et al. (2000) found ECT affects memory, and findings have led NICE stating ECT is only appropriate if other treatments have failed. -Unscientific -Risk of becoming used for social control? Cognitive CBT (Cognitive-Behavioural Therapies) -Most commonly used form of psychological therapy and is effective in treating depression. -Most people will require between eight to 20 sessions of CBT over the space of six to 12 months. CBT sessions usually last for about an hour. -CBT helps patients to identify irrational and unhelpful thoughts and try to change them. Therapists may draw diagrams for patients to show them how they can change their thinking, behaviour and emotions. -The rationale of CBT is that our thoughts affect our feelings and behaviour, and so by changing our thoughts we can make ourselves feel better. -(BABCP) British Association for Behavioural& Cognitive-Behavioural Therapies (2002) the aims of CBT in treating depression are: -Re-establish previous levels of activity, a social life, challenge patterns of negative thinking, and spotting early signs of depression. -Therapy is collaborative the patient and therapist agree on what they should change. The therapist argues with the patient to make them see the positive sides of change and dealing with Evaluation +Much support e.g. Butler et all (2006)from 16 meta-analyses concluded CBT is best way of treating depression. +Little evidence of Side Effects. -Holmes (2002) found CBT less effective than antidepressant drugs + other therapies, ineffective in long-term + ineffective with complex problems. -NICE recommends psychodynamic therapies for more complex causes of depression. -Does not deal with causes, just the symptoms. -Expensive and very time consuming. h) Describe and Evaluate one treatment/therapy from each of the following appraches: i)Social Approach Community Care. -IN the 70s + 80s emphasis on treatment changed, with a variety of community-based care programmes established. In theory this freed up money for smaller number of patients to receive better quality in-patient care. -Most patients suffer from schizopnhrenia, who dont need to be hospitalised but can receive care and support in community: -Sheltered accommodation with 24hr care, work and employment opportunities in sheltered social firms and businesses, specialist mental health outreach teams to provide long-term support and in patient hospital care when required.# Hospital space is still available, but in general the patient prefers living in the community although it can cause stress. Evaluation +Has the potential to enhance quality of life and reduce symptoms for patients with schizophrenia e.g. Trauer et al. (2001) Quality of life better. +Leff (1997) found symptom severity was far lower than hospitalised patients. +Ideal from of care for sufferers. -Underfunded by government money saved when shutting down hospitals. -Shepherd (1998) No money invested in 80s when hospitals shut down. -Does little to actually deal with the symptoms or causes of schizophrenia but rather causes of schizophrenia. ii)Cognitive CBT (See Above) iii)Psychodynamic - Dream Analysis -Many patients bring dreams that they consider to be important to their psychoanalyst, who then analyse them. -Therapists are informed by a range of theories and different theories suggest interpreting in different ways. Freud believed many dreams represent wishes, which are particularly satisfied by a dream. -The process of dreamwork is where what we wish for is transformed into something else, so that the dream is not too exciting and we can sleep.

A2 Psychology Revision Notes

Alexander Hunter

-A therapist may interpret a dream as being about something that we wish for with something in the dream representing the wish. -A patient might dream of being aggressive to an older man or woman and this might be interpreted as being angry towards parents. -The analyst would normally see the client 3 times a week and a session lasts 50 minutes and would cost at least 50 making this one of the most expensive therapies. Evaluation +Gottdiener & Haslam (2002) found psychodynamic treatment was as effective as CBT with 67% patients improving significantly (schizophrenia) +Gottdiener (2006) found that evidence is strong enough o use psychodynamic theory like dream analysis to treat schizophrenia. +Comprehensive treatment for sufferers of depression (Champion 2000) -Extremely expensive and long-term. -Impossible to prove Freudian theory Is it genuine? -NICE (2002) comment that it is appropriate to make use of psychodynamic therapy but it is not an appropriate treatment. -Interpretations are too subjective. Each analyst has his own interpretation on an issue. -Biological/Learning/Social treatments are better at dealing with problems in general. iv)Biological Use of Drugs/ECT (See Above) v) Learning Token Economy -A token economy programme involves a system of rewards being set up for desired behaviour, sometimes with punishments to discourage behaviour which is undesirable. -Rewards are usually tokens (hence the name!) or points, and these can be periodically exchanged for something that the individual wants (the economy part of the name). This is secondary reinforcement. -Generalisation is part of learning theory principles and is important when talking about token economies. -The idea is that desired behaviour, once reinforced and established in an institution, would be generalised to outside the institution so that appropriate behaviour would be established. Evaluation +There needs to be no delay between the desired behaviour and the reward. +Anyone can give the tokens +Clear rules mean staff know when to award a token, so the programme is relatively easy to administer. + can be administered by anyone (with training) and tokens and rewards are relatively cheap, so the programme is not expensive and there are more benefits than costs. +Has been found to be successful by many studies, even thought there tends to be 10 20 % of people who do not respond well to TEPs. +Ayllon and Milan (1979) reviewed a number of programmes and found that they worked for clear behaviour e.g. the general keeping of rules and control over interpersonal aggression. +Milby (1975) found that programmes were successful in psychiatric hospitals and helped in preparing someone to leave hospital BUT we do not know if the effects worked long term. -In the 1970a when TEPs were evaluated to see if they worked, it was concluded that they did not! -Staff are not committed to the programme, so they do not focus on it sufficiently -Inconsistent rewards are given for the same behaviour -There is a failure to plan for transferring to the home environment or any environment outside the institution. - Learning may not transfer to the home environment, so there might be recidivism. - Programmes have to be carefully planned and controlled, and there are many areas where problems can occur such as lack of consistency from staff. _________________________________________________ Studies in Detail Rosenhan (1973), Goldstein (1988) and Brown et al. (1986) Please see above Rosenhan (1973) On being sane in insane places Aim: To tell how well psychiatrists could distinguish real patients with schizophrenia from pseudopatients who faked a single symptom. This provided a measure of the validity of the DSM-II system for diagnosis. Procedure: -Rosenhan himself + 7 volunteers, 5 of whom were doctors or psychologists (3 women + 5 men), arrived at a range of 12 hospitals, reporting hearing voices saying empty, hollow and thud. Once admitted they then acted normally co-operating with staff + seeking release. -When asked they reported no further symptoms. The pseudopatients recorded responses from doctors and nurses when they spoke. -In a follow up procedure staff at another hospital were informed that one or more pseudopatients would present over the next 3 months. Staff at the hospital rated all new patients on a 1-10 scale for how likely each admission was a pseudopatient. -In reality no pseudopatients approached them in this time; the aim was to see how many real patients were wrongly identified as pseudo. Results: -All 8 ppts admitted to hospitals with the average stay being 19 days (range 7-52 days). -Every case released with schizophrenia in remission. IN 30% of cases real patients made comments to the effect they were normal. -Never at any time did the nurse or doctor notice there was nothing wrong. Perhaps unsurprising considering 71% of doctors + 88% of nurses ignored them when they tried to speak.

A2 Psychology Revision Notes

Alexander Hunter

-IN the follow up study, 193 genuine patients presented themselves and in 41 cases staff were confident to say they were pseudopatients. Conclusions: -Reveals two major weaknesses in the psychiatric system at the time 1st the environment has a major impact on the process of diagnosis, with hospital staff being unable to tell who was mentally healthy or not. 2nd, once labelled with something like schizophrenia, patients find it very hard to escape the label and be judged as normal. Evaluation: +Ecologically valid took place in the natural setting. +Highlighted major problems with the psychiatric system and taught hospital staff to be more alert. +Study replicated so therefore reliable. +Generalisable to states across the USA took place over 5 different states. +The design was not overly complicated making it possible to replicate and thus increase reliability. -Validity of results reduced as doctors misinformed of pseudopatients. -Study took place over 30 years ago and based on DSM-II which has since changed making it very unreliable. Goldstein (1988) Aim: Compare the course of schizophrenia in men and women for the first ten years of the condition, in particular with regard to hospitalisation. Procedure: -90 patients took part in the study, 32 women and 58 men. Most receiving treatment at a private hospital in New York. -All hospitalised with a diagnosis of schizophrenia for the 1st or 2nd time at the start of study. -Diagnosis was confirmed by 2 independent psychiatrists. -Mean age of ppts was 24 years. Majority were white and middle class. -Course of schizophrenia was measured by the number of hospitalisations and length of hospitalisations over 10 years. Patients were also assessed retrospectively for their functioning during childhood + adolescence. Results: -Men hospitalised an average of 2.24 times a year over 10 years compared to 1.12 times for women. -Mean no. of days spent in hospital for men was 417.83 compared to 205.81 for women. Both significant difference at p<0.05 -Differences were sharper in the first 5 years of the disorder, and there was a strong association between level of functioning in childhood + adolescence + the course of condition. -Typically worse for males than females, statistically accounting 50% of the difference in the course of schizophrenia for men + women. Conclusions: -Men with schizophrenia are typically admitted more times to hospital + spend more time there than women. This appears to be related to worse functioning before the onset of schizophrenia in men. Evaluation: +Findings support that women with schizophrenia have it less severely than men. +Angermeyer (1987) A German study obtained the same result with a larger sample. +Reliability of the hypothesis of her study was checked by expects who were not aware of the aim. +Study supports DSM-II used as evidence to support reliability of DSM-II. -Findings may have been affected by the samples age limit of 45. Some studies have shown that for 9% of women experience more severe course of schizophrenia after the age of 45. The results may only be valid if considering women under 45. -There are several limitations that might prevent generalisation of the results: - Limited area choice - Limited sample size (around New York) - Similar background of participants - Study was carried out in 70s/80s using DSM-III. Brown et al. (1986) Aim: To test whether self-esteem + social support affected the likelihood of suffering depression in the year following a stressful life event. Procedure: -Design was prospective. 400 women, mostly working class, all with children living at home + a husband in manual occupation. -All from Islington, North London + recruited through GPs + interviewed. Initial interview assessed mental health, self-esteem _ social support using a range of standard interview schedules. -1 year on 353 ppts consented to be re-interviewed. These 2nd interviews re-assessed the same variables + looked for major stressful life events that had taken place in the previous year. This was done using Life Events + Difficulties Schedule (LEDS) interview. -Social support was re-assessed with particular regard to support received during stressful life events in previous year. -50 ppts showed signs of depression in 1st interview were not included in analysis, as researchers wanted new cases. Results: -91% of ppts (29/32) who experienced depression during the year between 2 interviews had experienced a severely stressful life event, as compared to 23% who did not suffer depression. -Low self-esteem did not make the women more vulnerable to depression unless there was a stressful life event, but it did make depression more likely where such a life event took place.

A2 Psychology Revision Notes

Alexander Hunter

-General level of social support assessed at first interview wasnt associated with depression; however, in those who suffered a stressful life event, women who received good crisis support from husband or partner were less likely to suffer depression. Conclusion: -Both low self-esteem + lack of social support make it more likely that stressful life events will lead to depression. -However there is no evidence from this study that either factor led to depression in the absence of stressful life events. Evaluation: +Findings support theory that women are more prone to depression. +Natural Experiment stressful life events naturally occurring. High ecological validity. +Large Sample size to begin with. +Ethically sound No guidelines broken at any point. -Sample gradually grew smaller as participants dropped out,. -Not generalisable Only women and all working class (But this was a specific aim of the study). _________________________________________________ Key Issue and Practical Key Issue See Issues and Debates