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Flashcards in Individual differences Deck (228):
1

What is anti-psychiatry?

This was a movement associated with Szasz and Laing that rejected the medical model of psychopathology. Instead they proposed that people had 'problems with living' rather than psychological disorders.

2

What is psychosis?

This refers to a state when the individual appears to have lost contact with reality. It occurs in disorders such as schizophrenia and bipolar depression. The individual does not have insight into their condition.

3

What do anti-psychiatrists believe?

That there is no such thing as 'abnormality'; some see it as a sane reaction to an insane world, and psychiatry was seen as a political tool to label and control 'difficult' people. Their alternative suggestion was that the legal system should be used to control violent or antisocial behaviour, but otherwise people should not be forced to undergo psychiatric diagnosis and treatment.

4

What is a psychiatrist?

A person who has completed their medical training and then specialised in psychopathology.

5

What is a psychologist?

These clinical psychologists have completed a psychology degree and then specialised in the study of psychological disorders.

6

What are some ways of defining abnormality?

1. Deviation from social norms
2.Failure to function adequately
3. Deviation from ideal mental health

7

What is deviation from social norms?

Whether written into the legal system or implicit, i.e. generally accepted but not legally binding, social norms allow for the regulation of normal social behavior. One approach to defining abnormality, therefore, is to consider deviations from social norms as an indication of abnoramlity.

8

What is the limitation of defining abnormality as deviation from social norms?

1. It doesn't take into account the importance of the context of behaviour
2. Behaviour that deviates from social norms is not always a sign of psychopathology
3. This definition is open to abuse, particularly as a means of political control, when norms are dictated by the ruling party.
4. Social norms vary over time
5. Cultural relativity

9

What is cultural relativity?

The idea that some aspects of psychology vary from culture to culture. SO patterns of infant attachment might vary across different cultures and definitions of abnormality such as DSN are certainly culture-specific.

10

What is meant by failure to function adequately?

This definition of abnormality focuses on the everyday behaviour of an individual. When someone deviates from the normal pattern of behaviour (going to work, getting washed etc.) we might argue that they are failing to function adequately. Failure to function adequately is a general sign of disorder, and not itself specific to any condition.

11

What characteristics of abnormal behaviour in relation to FFA definition did Rosenhan and Seligman (1989) suggest?

1. Observer discomfort when another's behaviour causes discomfort and distress to the observer
2. Unpredictability; FF can involve behaviour that is unpredictable and sometimes uncontrolled
3. Irrationality: FFA can involve behaviours that look irrational and are hard to understand.
4. Maladaptiveness; this is central to the FFA definition; it refers to behaviour that interfers with a person's usual daily routine.

12

What are the limitations of the failure to function adequately definition of abnormality?

1. It does not take into account context, hunger strikes etc.
2. Doesn't take into account economic conditions, prejudice or discrimination that might affect people's ability to function
3. Psychological disorders may not prevent a person from functioning adequately.
4. Cultural dimension; standard patterns of behaviour will vary from culture to culture

13

What is psychopathy?

A term used to refer to an apparent lack of empathy and understanding of others. People with high levels of psychopathy exploit others with no guilt or remorse.

14

What is self-actualisation?

This refers to our motivation to achieve our full potential as individuals

15

What is autonomy?

The ability to function as an independent person, taking responsibility for one's actions.

16

What is deviation from ideal mental health?

Jahoda introduced the first systematic approach in 1956, listing a number of characteristics she felt indicated ideal mental health. Deviations from these ideals would be defined as abnoramlity;
1. Individual should be in touch with their own identity and feelings
2. Should be resistant to stress
3. Should be able to focus on the future and self-actualisation
4. Should function as autonomous individuals
5. Have an accurate perception of reality
6. Show empathy and understanding towards others.

17

What are the limitations to the deviation from ideal mental health definition of abnormality?

1. The characteristics listed are rooted in Western societies and a Western view of personal growth and achievement- cultural relativity
2. Very few people would match the criteria laid down by Jahoda and so by definition the majority of the population would be classified as abnormal.

18

What is the disease model?

This is the idea that psychological disorders can be seen as similar to physical illnesses and diseases. Each disorder has its own distinct symptoms and is separate from all others. However, it is likely that psychological disorders will often overlap with each other.

19

What is a syndrome?

A cluster of physical or psychological symptoms that regularly occur together is referred to as a specific syndrome

20

What is the DSM-IVR:?

The Diagnostic and Statistical Manual of Mental Disorders. A system used by psychiatrists to diagnose and classify psychological disorders.

21

What is the global assessment of functioning scale?

One of the scales used in the DSM-IVR system. It assesses the impact of the disorder on the individual's everyday life. In this sense it has elements of the FFA definition of abnormality.

22

What is the dominant approach to psychopathology?

The biological approach

23

What elements is the diseasemodel made up of?

1. Abnormality is associated with certain signs or symptoms.
2. Signs and symptoms that regularly occur together are referred to as syndromes.
3. The disease model assumes that the various syndromes represent distinctive disorders that can be considered independently of one another. It then tries to develop explanations and treatments for each seperate disorder.

24

What are the two widely used systems in psychiatry for defining and classifying psychopathology into separate syndromes?

The International Statistical Classification of Diseases (ICD) is used mainly in Europe, while the American-Based Diagnostic and Statistical Manual of Mental Disorders (DSM) has a more international usage. Bother follow the approach of categorising different disorders, but differ in some particulars.

25

How does the DSM-IVR system define abnormality?

After using signs and symptoms to identify the particular syndrome, it also takes into account social and environmental problems that might influence the disorder. Finally, it useds a global assessment of functioning scale to rate the impact of the disorder on the patient's daily life; this is closely related to deviation from social norms and failure to function adequately approach. However, the global rating is secondary to the main aim of identifying the disorder through signs and symptoms.

26

What are the issues with the medical disease model of psychopathology?

1. There can be significant disagreements between psychiatrists when symtpoms overlap, or illnesses themselves occur together.
2. The medical model of psychopatholgy emphasises the biological aspects of disorders, and the possible role of psychological factors in causing psychopathology is minimised.
3. Labelling patients is a serious ethical issue that might lead to people being stigmatised.

27

What is cognitions?

This term refers to the cognitive processes underlying behaviour. It can include attention, perception and memory, and more complex thought processes such as reflection and problem solving.

28

What is cognitive neuroscience?

This is an area of research that investigates the brain mechanisms underlying cognitive processes such as perception, language and memory.

29

What is the biological approach?

THis studies the relationship between behaviour and the body's various physiological systems. THe most important of these is the nervous system, especially the brain. The brain is the focus for most biological psychologists as it is the processing centre controlling all complex behaviour. This means that in theory all behaviour, normal and disordered, can be related to changes in brain-activity.

30

What is the nature-nurture debate?

For at least the last century psychologists have argued over whether behaviour is influenced more by our genetic inheritance (nature) or by environmental factors such as upbringing and socialization (nurture.)

31

What assumptions does the biological approach make?

1. As all behaviour is associated with changes in brain function, psychopathology will be caused by changes in either the structure or function of the brain.
2. The development of the body, including the brain, is heavily influenced by genetics, and biological psychologists tend to assume that most behaviours,normal and disorders, involve a component inherited from the biological parents. Very much on the nature side of the nature-nurture debate.

32

Why does the biological approach not assume everything is genetic?

Brain activity is affected by all sorts of factors, including our envionment and our experiences. Everyday experiences can affect brain chemistry, and this in turn can lead to psychopathologies such as depression. So, while depression is associated with reduced serotonin activity and therefore a biological cause, the reduction can be caused by environmental factors and is not necessarily genetic etc.

33

What experiment did Watson et al (1998) do on social isolation?

He found that isolating monkeys from their social groups leads to reduced activity of brain serotonin and also to a state that looks very much like depression.

34

What are the strengths of the biological approach?

1. Use of brain scanning and other modern techniques has identified biological aspects of many psychopathologies.
2. Research into behavioural genetics has identified a genetic or inherited, component in many pscyhopathologies.
3. Drug treatment which targets the biological bases of disorders can be very effective

35

What are the issues with the biological approach?

1. It is heavily reductionist. A full picture requires a study of both biology and environmental influences.
2. Although a genetic component has been identified in many disorders, in no case does this component provide a complete explanation. So even when there is evidence for a genetic influence, it is assumed that this must interact with non-genetic environmental factors.
3. Drug treatments are not effective for all people, and are sometimes largely ineffective.

36

What has depression been associated with?

Lowered levels of brain serotonin

37

What has schizophrenia been associated with?

Overactiity of the neurotransmitter dopamine

38

What is reductionism?

This is the attempt to explain behaviour by reducing it to the smallest possible elements. There are many types of reductionism, but biological reductionism is the most common.

39

What is Diathesis-stress?

This refers to a model that explains behaviour through an interaction between nature and nurture. For example, a vulnerability to depression is inherited, but the condition is only triggered if severe life stress is encountered.

40

What is psychodynamic?

Approaches to understanding behaviour that emphasise the balance between conscious and unconscious processes, and the significance of early development.

41

What is repression?

One of Freud's most important defence mechanisms. Material that is too threatening to be deal with consciously is repressed into the unconscious.

42

What is the psychodynamic approach?

This approach assumes that adult behaviour reflects complex dynamic interactions between conscious and unconscious processes, many of which have their origins in development from birth onwards. THere are a number of different psychodynamic approaches, but all have their origins in the work of Sigmund Freud.

43

What were the two key elements in Freud's work on abnormality?

His model of human personality and his detailed theory of psychosexual development in childhood.

44

What three interacting elements did Freud propose that personality was made up of?

The Id, The Ego and the superego

45

What is the id?

This is the reservoir of unconscious and instinctual psychic energy that we are born with. The most important aspect of psychic energy is the libido or life instincts, but this energy may also be directed into aggression. The id operates on the pleasure principle and constantly tries to gratify these instincts through sex and other forms of pleasureable activity, but may also lead to aggression and violence.

46

What is the ego?

This represents our conscious self. It develops during early childhood and regulates interactions with our immediate environment. It also tries to balance the demands of the id for self-gratification with the moral rules imposed by the superego or conscience. The ego operates on the reality principle, in that it constantly balances the demands of the real world against the instinctive drives of the id.

47

What is the superego?

This is our personal moral authority, or conscience. It develops later in childhood through identification with one or other parent, at which point the child internalises the moral rules and social norms of society.

48

How may the ego influence the development of psychological disorders according to Freud?

If the ego fails to balance the demands of the id and superego, conflicts may arise and psychological disorders may result. Dominance of id impulses may lead to destructive tendencies, pleasurable acts and uninhibited sexual behaviour. If the morality of the superego dominates, the individual may be unable to experience any form of pleasureable gratification.

49

Why does Freud focus on the early years as the source of adult disorders?

As the id is present from birth while the ego and superego develop through the early childhood years, such conflicts are particularly likely at this time when the ego is undeveloped.

50

What is the reality principle?

The ego operates on the reality principle, trying to balance id and superego in the face of the demands of the real world.

51

What is intra-psychic?

In Freud's model, the psyche, or mind, is made up of the id, ego and superego. Conflict between these components (i.e. intra-psychic) can lead to anxiety.

52

What is ego-defence mechanism?

These protect our conscious self from the anxiety produced by intra-psychic conflict. THese can include mechanisms such as repression, displacement, and denial.

53

What is displacement?

This occurs when an unacceptable drive such as hatred is displaced from its primary target to a more acceptable target.

54

What is denial?

This occurs when an individual refuses to accept that a particular event has happened.

55

How do ego-defence mechanisms lead to abnoramlity?

There are a number of ego defence mechanisms and one of the aims of psychodynamic therapy is to break through these defences to reveal the underlying conflicts. Defence mechanisms protext our conscious self from the anxiety produced by unconscious intra-psychihc conflict. If they are unsuccessful this anxiety may reveal itself through clinical disorders such as phobias and generalised anxiety.

56

What are erogenous zones?

In Freud's theory, the instinctual energy of the id is focused on different parts of the body (the erogenous zones) at different psychosexual stages.

57

What is meant by fixated?

In Freud's theory of psychosexual stages, failure to resolve one of the stages may lead to fixation at that stage. The characteristics of, e.g. the oral stage, may then show themselves in adult behaviour such as smoking.

58

What is the oedipus complex?

During the phallic stage of psychosexual development boys develop love for their mother, leading to fear of the father. To resolve this fear the boy identifies with the father, leading to development of the superego or conscience.

59

What is the electra complex?

The equivalent in girls to the Oedipus complex in boys. It is less detailed in Freud's theory than the Oedipus complex, leading to criticism of the phallocentric nature of Freud's work.

60

What is psychosexual development?

According to Freud's theory, the child goes through a series of stages where the instinctive energy of the id looks for gratification in different bodily areas: the so called erogenous zones. If the developing child is either deprived or over-gratified at a particular stage they may become fixated at this stage and this will have effects on their adult behaviour.

61

What are the stages of psychosexual development?

The oral stage, the anal stage, the phallic stage, the latency state.

62

What is the oral stage?

This lasts from birth to about 18 months. id impulses are satisfied by feeding, and so the mouth is the focus of this stage. Activities include sucking initially,a nd then biting.

63

What does fixation at the oral stage led to?

It may produce an adult gaining pleasure from oral gratification through activities such as smoking, drinking or eating. As this stage also involves complete dependency of the infant, the fixated adult may also show overdependence in their relationships.

64

What is the anal stage?

From 18 months to about 3 years of age, gratification focuses on the anus. Key activities revolve around retaining and expelling faeces. This is a significant stage in Freudian theory as for the first time that child can exert some control over its environement. They can show obedience or disobedience by expelling or retaining faeces.

65

What does fixation at the anal stage led to?

Fixation at this stage may lead to an obsession with hygeine and cleanliness, and perhaps obsessive-compulsive disorder.

66

What is the phallic stage?

After the anal stage, and lasts until age 4-5, where the focus is on the genitals and gratification comes through genital stimulation. This is the key stage in sexual development as gender differences are noticed and psychosexual development differs between the sexes. The most important feature of this stage is the Oedipus complex. In the Electra complex, freud proposed that the girl realises she has no penis, which produces a state of penis envy, which leads her to develop more affection for the father.

67

What is the latency period?

During the period from 4-5 up to puberty psychosexual development enters a latent period, to re-emerge at puberty. At puberty, sexual feelings become less focused on the self and instead are directed at potential partners.

68

What are neurotic disorders?

Now largely discarded, this term refers to disorders such as anxiety and depression where the person has insight into their condition. It is contrasted with psychotic disorders such as schizophrenia, where insight is lost.

69

What are the strengths of the psychodynamic approach?

1. It was the first to emphasise the significance of unconscious processes and repressed material influencing our behaviour- This is now widely accepted
2. He was also the first to suggest how our adult behaviour could be influenced by early childhood experiences, supported by the work of Ainswroth, on early attachment styles and later adult relationships

70

What are the weaknesses of the psychodynamic approach?

1. He overemphasised infantile sexuality to the exclusion of other aspects of development.
2. He did not study children directly, but developed his theory largely on the case studies with adults, and linked their disorders to their early childhood experiences.
3. Most of his concepts and theories are impossible to test using conventional scientific methodology.
4. His theory is clearly related to the historical and cultural period, for instance its phallocentric nature.

71

What is the behavioural approach?

This approach to psychopathology emphasises the role of learning and experience in causing psychological disorders. Behaviourists deal with three main forms of learning: classical conditioning, operant conditioning, and social learning.

72

What study did Watson and Rayner (1920 Do on classifcal conditioning?

They classically conditioned an 11-month-old child- little albert- to fear fluffy animals. They did this by pairing presentation of a tame white rat with a sudden loud noise. The noise caused fear, an unconditioned reflex equivalent to salvation in Pavlov's experiment, while the rat was the equivalent of the bell. Eventually he was conditioned to associate the rat with ear. He also became afraid of other fluffy objects, similiar to the white rat such as a rabbit and white dog; this is known as stimulus generalisation.

73

How has classifcal conditioning been used to account for the development of phobias?

Phobias are characterised by extreme fear of certain objects or situations. One simple explanation of phobias is that a traumatic experience, especially early in life, leads to the conditioning of fear to that particular object or situation. This fear then generalises to similiar objects or situations. THis leads to the adult having a general phobia of, say, all spiders or all enclosed spaces/

74

Why is classical conditioning not enough to explain phobias?

It soon became clear that many people with phobias had not actually experienced traumatic encounters with, for instance, spiders or enclosed space.

75

What concept did Seligman (1971) propose to explain phobias?

He proposed the concept of preparedness. Preparedness is the idea that our evolutionary history has prepared humans to be sensitive to biologically-relevant stimuli such as dangerous animals and situations. So even today we are more likely to be phobic of spiders than, for example tulips.

76

What did Ohman et al (2000) demonstrate about classical conditioning in relation to phobias?

They showed experimentally that fear in human participants can be conditioned to pictures of spiders but not to pictures of flowers.

77

What is stimulus generalisation?

A phenomenon in which a response to one stimulus can be elicited by a similar stimulus.

78

What are schedules of reinforcements?

In operant conditioning , the pattern of rewards and punishments can be used to 'shape' behaviour. Continous reinforcement is when every response is rewarded and leads to rapid learning. However,t he response rapidly fades or extinguishes when reinforcement is withdrawn. Occasional rewards (intermitten schedules) lead to slower learning, but the behaviour persists for much longer when reinforcement is withdrawn.

79

What is social learning theory?

Based largely on Bandura's work, this is an extension of operant conditioning theory that focuses on learning through observation and imitation of others. Vicarious learning and reinforcement are key components of social learning theory.

80

What is vicarious learning?

This is an important part of social learning theory, and refers to learning through observing the consequences of behaviour in others. Observed behaviour that is reinforced is more likely to be imitated.

81

How can social learning explanations be applied to the developments of disorders?

It can be applied to areas such as eating disorders, these are found mainly in young women and one popular hypothesis is that observation and imitation of slim models and film stars play an important role. Operant conditioning can also contribute to the persistence of disorders, such as depression and anorexia, which may attract more attention, which, if rewarding, will reinforce the behaviour and make it more likely to continue.

82

What are the strenghts of the behavioural approach?

1. It can provide convincing explanations of some psychological disorders, including the role of classical conditioning in phobias and social learning in eating disorders.
2. Treatments based on this approach can be effective

83

What are the weaknesses of the behavioural approach?

1. It is reductionist, as it ignores cognitive and emotional contributions to the development of psychopathology.
2. It ignores any genetic contribution
3.Heavily deterministic, viewing human behaviour as simply a product of stimuli. THere is no role for conscious choice.

84

What is the cognitive approach?

In relation to abnoramlity, the cognitive approach emphasis the role of cognitive processes (beliefs, thoughts, perceptions) in causing psychological disorders.

85

What is schemata?

Organised systems of knowledge that we use to understand and interpret the world.

86

What are negative automatic thoughts?

In the cognitive approach to depression negative schemata lead to NATs. Examples of NATs include cognitive biases such as minimisation and selective abstraction.

87

What are cognitive biases?

In the cognitive approach to abnormality biases are irrational and maladaptive thoughts that can lead to depression. They include the tendencies to maximise failures and minimise successes.

88

Who were the pioneers of the cognitive approach and what were they influenced by?

Aaron Beck (1963) and Albert Ellis (1962), were heavily influenced by their backgrounds as therapists. DIsappointed in what they saw as the ineffectiveness of psychodynamic and humanistic approaches, they were also influenced by the behavioural approach and the cognitive revolution in psychology that occurred in the 1960's

89

Why did the focus turn towards critical cognitive processes in the 1960's?

It was fuelled by the development of computers as information processors, providing a model of how the human brain might work.

90

How did Beck and Ellis develop the cognitive approach to abnormality?

As a combination of behaviourism and cognitive models of psychopathology.

91

What assumptions does the cognitive approach make?

1. Human behaviour is heavily influenced by schemata. Many of these schemata relate to how we see ourselves.
2. Schemata develop on the basis of early experience. Traumatic or unhappy experiences early in life may lead to the development of negative schemata.
3. Negative schemata, or core beliefs as they are sometimes called, when actived lead to negative automatic thoughts. In this approach, NATs are misplaced and dysfunctional.

92

What is minimisation?

The bias towards minimising success in life.

93

What is maximisation?

The bias towards maximising the importance of even trivial failures.

94

What is selective abstraction?

A bias towards focusing on only the negative aspects of life and ignoring the wider picture.

95

What is all or nothing thinking?

A tendency to see life in terms of black and white and ignoring the middle ground.

96

What is a negative triad?

In Beck's model of depression, the negative triad of cognitive biases are pessimistic thoughts about the self, the world, and the future.

97

What is Beck's (1979) cognitive model of depression?

It invovles 3 negative schemata- called the negative triad. A negative view of the self, or the world and the future. These are reflected in the attributions that depressed people make. Attributions refer to our interpretion of why things happen. In this mode, depression attributes of negative events are internal, global and stable, whilst for positive events tend to be external, specific and unstable.

98

What are the three dimensions to attributes?

1. Can be internal or external, i.e. the cause is seen as internal to the person (it's my fault) or due to external circumstances.
2. Can be specific or global, i.e. the cause may be specific to a particular event, or apply to all events.
3. Can be stable or unstable, i.e. the invididual consistently makes the same types of attribution, or they can very over time and situation.

99

What is Ellis' ABC model (cognitive approach)?

Ellis considers that activating certain events (A) in an individual's life have consequences (C) such as feelings and actions. However, these consequences are affected by beliefs (B) about these events. Rational beliefs are likely to be confirmed by events, and even negative events will lead to appropriate negative emotions. Irrational beliefs, can lead to inappropriate negative emotions when things go wrong. Beliefs are an important cognitive component in how we see the world, and can be affected by the same cognitive biases that are central to Beck's model.

100

What are the strenghts of the cognitive model?

1. Clear evidence for cognitive biases and dysfunctional thinking and beliefs in depression and anxiety disorders.
2. Therapy based on this model can be very effective

101

What are the weaknesses of the cognitive model?

1. The idea of schemata and how they develop is rather vague. Likewise, it is not clear how irrational thoughts should be defined.
2. Takes no account of biological or genetic factors
3. In some cases disorders such as depression may lead to dysfunctional thinking rather than the other way round.
4. Sometimes negative thoughts reflect an accurate review of the world, and it is these life circumstances that needs to be targeted, not cognitive biases.

102

What is depressive realism?

This refers to the fact that beliefs and thoughts of the depressed person can be a rational reflection of reality rather than irrational and maladaptive.

103

What is electroconvulsive therapy (ECT)?

A treatment for severely depressed patients who have proved resistant to other forms of psychological and biological treatments. It involves passing a small current through the brain to cause epileptic like electrical discharges

104

What is psychosurgery?

A now extremely rare biological treatment for psychological disorders that involves systematically damaging the brain

105

What is a lesion?

To deliberately and systematically damage parts of the brain, as in psychosurgery.

106

What is a frontal lobotomy?

A psychosurgical operation used as a treatment for schizophrenia in the 40's and 50's. It was of doubtful effectiveness and disappeared with the introduction of drug therapy.

107

What treatment options are derived from the biological approach to abnormality?

Pscyhosurgery, Electroconvulsive therapy (ECT), and drugs.

108

What is psychosurgery?

The term refers to systematically damaging the brain in order to change behaviour.

109

How has psychosurgery been used in the past?

In the 1950's the amygdala was lesioned in over-aggressive people to reduce levels of violent. The frontal lobotomy was used in the 40's and 50's as a treatment for schizophrenia. It involved cutting pathways between higher and lower centres in the brain. There was no evidence that it improved the specific symptoms of schizophrenia, but it could make patients more manageable.

110

How is psychosurgery used today?

Nowadays it is extremely rare. It is occasionally used for conditions such as severe depression and OCD that have been proved resistant to all other treatments. Areas to be damaged are precisely localised using brain scans, and limited amounts of tissue destroyed using electrical current or small radioactive pellets.

111

What is the evaluation of psychosurgery?

1. It is rare now so it is hard to judge its effectiveness
2. It did not target the specific symptoms of schizophrenia when used for that, but made patients more manageable
3. Major ethical issues; damage to the brain is irreversible and the consequences unpredictable.
4. People with severe disorders are unlikely to fully understand the procedure and be able to give informed consent.

112

What is electroconvulsive therapy (ECT)?

It involves passing a small electric current through the brain. This causes the equivalent of a seizure as seen in epilspy, with violent electrical discharges in the brain and behavioural convulsions.

113

When was electroconvulsive therapy (ECT) introduced?

It was introduced in the 1930's and originally tested as a treatment for schizophrenia. It then became apparent that ECT could be an effective therapy for some forms of severe depression and it became a popular antidepressant treatment by the 1950's/

114

How does electroconvulsive therapy (ECT) work?

We do not know how ECT works, but it is likely that the electrical discharge will have an effect on the activity of a number of brain neurotransmitters.

115

How is electroconvulsive therapy (ECT) used today?

Nowadays its use in the UK is recommended only for the most severe forms of depression that have proved resistant to alternative psychological and drug therapies. In around 50% of these cases it can be effective when all other treatments have filed.

116

What is the evaluation of electroconvulsive therapy (ECT)?

1. It is a violent electrical assault on the brain. It is never given once only, ut in a series of sessions. Research suggests that this can lead in some cases to long-term memory impairment.
2. Individuals with severe depression may not fully grasp the nature and consequences of ECT and so cannot give fully informed consent.
3. It can be an effective antidepressant treatment for patients unresponsive to other therapies.

117

What is chlorpromazine?

The first antipsychotic drug used as a treatment for schizophrenia. Introduced in 1952 it rapidly became the treatment of choice for the disorder.

118

What are antipsychotics?

The name given to drugs used in the treatment of schizophrenia. Examples include chlorpromazine and clozapine.

119

What is clozapine?

A recently introduced antipsychotic drug used in the treatment of schizophrenia. It has fewer side effects than older drugs such as chlorpromazine.

120

What are monoamine-oxidase inhibitors?

MAOI's are a class of antidepressant drugs. THey raise levels of serotonin and noradrenaline in the brain.

121

What is tricyclic antidepressants?

A class of antidepressant drugs, working by raising brain levels of the neurotransmitters serotonin and noradrenaline.

122

What is the monoamine theory of depression?

The brain neurotransmitters serotonin and noradrenaline are known jointly as monoamines. The theory relates depression to reduced levels of these neurotransmitters.

123

What are SSRIs?

Selective serotonin reuptake inhibitors. These newer antidepressant drugs, such as prozac, specifically increase brain serotonin levels.

124

What is a placebo?

An inactive substance given to a patient who believes it to be an active drug. Controlled studies of drug treatment for anxiety and depression show that up to 30% of people respond to the placebo alone.

125

What is psychological dependence?

When people become psychologically dependent on a drug treatment, feeling that they cannot cope without the treatment although there is no physical dependence.

126

When was schizophrenia first diagnosed?

In the early years of the twentieth century when it was recognised as a severe psychologial disorder that required treatment.

127

What are the key symptoms of schizophrenia?

Hallucinations and delusions, a loss and insight and contact with reality.

128

How was the drug chlorpromazine introduced as a treatment for schizophrenia?

In 1952 Laborit, a French doctor, decided to try out the drug which had just been introduced as a sedative given before operations on his surgical patients. He found that it significantly reduced post-operative stress, and then suggested to psychiatrist colleagues that they try te drug on patients with schizophrenia. It significantly reduced symptoms such as hallucinations, delusions and thought disorder. It rapidly took over from frontal lobotomy as the treatment of choice for schizophrenia, and the age of mass drug therapy for psychological disorders had begun.

129

How do antipsychotics such as chlorpromazine work?

At the time chlorpromazine was introduced little was known about brain chemisty, and it wasn't until the early 1970's that the relationship between chloropromaxine and the neurotransmitter dopamine was discovered. Chlorpromazine and other antipsychotics act by reducing dopamine activity in the brain, and this led to the long-lasting model that linked schizophrenia to raised levels of dopamine activity.

130

How are the newer drugs for treatment of schizoprhenia different from chlorpromazine?

They are effective as chloropromazine with fewer side effects. They have also been shown to act in some patients resistent to chlopromazine. These new drugs, such as clozapine, seem to act on a wide range of neurotransmitters in the brain, such as dopamine and serotonin,a nd this may account for their different pattern of actions.

131

What are the strengths of using drug treatment for schizophrenia?

1. Drugs can be effective in suppressing the symtpoms of schizophrenia and many people are able to live normal lives because of drug therapy.
2. They can effectively suppress the symptoms.
3. As knowledge of the action of these drugs in the brain has increased, it has contributed to biological models of schizophrenia and our understanding of the disorder.

132

What are the weaknesses of using drug treatment for schizophrenia?

1. It is only effecitve in 50-60% of paitnets, so do not work in 40-50% of patients.
2. They do not cure the disorder, and symptoms will return in about 80% of patients who come off the drugs. Drug treatment for schizophrenia is for life.
3. All drugs used in treating schizophrenia have unpleasant side effects
4. Ethical issues involving informed consent and the extent to which a person with hallucinations and delusions can give htis.

133

What are some of the unpleasant side effects of drugs used for the treatment of schizophrenia?

Long-term treatment with classic drugs such as chlorpromazine often led to movement disorders resembling Parkinson's disease. Clozapine lowers the number of white blood cells, part of our immune defense system, and levels have to be carefully monitored during treatment.

134

What is depression?

Depression, along with anxiety, is the most common of the psychological disorders, characterised by sad, depressed mood and symptoms such as sleeplessness and loss of appetite.

135

When did effective drug treatment for depression develop?

It developed rapidly in the 1960's with the introduction of two groups of drugs:
Monoamine-oxidase inhibitors (MAOIs)
Tricyclic Antidepressants

136

How do drug treatments for depression work?

Little was known about the action of these drugs in the brain but by the 1970's it has been established that both groups of drugs raised levels of the neurotransmitters serotonin and noradrenaline. These discoveries led to the monoamine theory of depression, a strictly biological explanation that related depression to low levels of brain serotonin and noradrenaline.

137

What serious side effects could both MAOIs and tricyclics have?

MAOIs interact badly with various food groups and other medications while long-term use of tricyclics was associated with heart problems.

138

When were SSRIs introduced?

In the 1990's. These were the selective serotonin reuptake inhibitors of which the most famous is Prozac. As their name implies these drugs selectively raise levels of sertonin in the brain and were considered to be more effective and also safer that MAOIs and tricyclics in the treatment of depression.

139

What are the concerns with using SSRIs to treat depression?

Subsequent research suggests that SSRIs are sometimes no more effective than the earlier drugs, and have also been associated with outbursts of violence and suicides. While some of these reports are anecdotal, these are concerns over the increasing prescribing of Prozac and other SSRIs to young people.

140

What are the strengths of drug treatment for depression?

1. Our increasing knowledge of the action of antidepressants on neurotransmitters has contributed to the development of biological models of depression, in particular the roles of serotonin and noradrenaline.

141

What are the weaknesses of drug treatment for depression?

1. The highest estimates suggest that only 60-70 % of depressed people respond. Even less impressive when you consider that 30% respond to the placebo.
2. They do not cure depression; they do not change any life circumstances, daily stressors or cognitive biases that may also be involved.
3. Psychological and physical dependence
4. Range of unpleasant side effects
5. Ethical issues with informed consent

142

What is physical dependence?

When people become physically dependent on the drug, meaning that when the drug is withdrawn they go into a withdrawal syndrome with unpleasant physical symptoms. It implies that the body, especially the brain, has adapted to the presence of the drug.

143

What are benzodiazepines?

A group of drugs including the anti-anxiety agents librium and valium, and the sleeping drug Mogadon. They are also called 'minor tranqualisers'

144

What are anti-anxiety drugs?

(also known as anxiolytics or minor tranquilizers) they include the most prescribed drugs over the last 40 years, Librium and Valium. These come from a group called the Benzodiazepines (also known as BZs) and are used in the treatment of general anxiety, stress and sleep disorders.

145

What is the prolonged use of benzodiazpines associated with?

Psychological and physical dependence, and also with side effects such as drowsiness and memory impairment.

146

What is lithium?

This is an unusual drug in that it is used for one specific condition, bipolar depression. It can stabilise the condition, but can also have severe side effeccts, such as heart and digestive problems.

147

What is bipolar depression?

(previously called manic depression) THis is a disorder where the person has periods of clinical depression followed by periods of mania or hyperactivity.

148

What are the strengths of drug therapy?

1.Drugs can be effective in a range of psychological disorders and many people are able to live normal lives through drug therapy
2. The increasing use of antidepressants and anti-anxiety drugs has generally lessened the stigma associated with drug therapy
3. It is a fundamental part of the biological.medical approach, so its use confirms the view of the person as a patient which takes away individual responsibility for the disorder.

149

What are the weaknesses of drug therapy?

1. There are some disorders such as phobias, panic and eating disorders for which there is no consistently effective drug therapy
2. The drugs only treat the symptoms of a disorder, via their effect on the biological changes in te brain. THey are therefore a highly reductionist treatment that ignores any cognitive, emotional or environmental influences.
3 Most drugs have problems of side effects and dependence, which needs to be carefully managed.
4. As part of the biological/medical apporahc it can lead to stigmatising the person as a schizophrenic or depressive etc.

150

What does Freud's psychoanalytical model assume is the origins of psychological disorders?

That adult neuroses such as anxiety and depression are rooted in early childhood experience. The adult is protected from the conflicts that lie at the root of these problems by ego defence mechanisms, therefore they are not consciously accessible to the individual concerned.

151

What is the aim of psychoanalytic therapy?

It is based on the psychodynamic approach to psychopathology. To uncover the repressed material and help the client come to an understanding of the origins of their problems. There are traditionally several techniques available to the therapist: free association, dream analysis and projective tests.

152

What are neuroses?

Relatively mild mental illnesses theat do not have a biological cause.

153

What is manifest content?

Dream imagery as reported by the dreamer. To uncover the meaningful, latent, content, the therapist uses the dream work.

154

What is dream work?

The processes that distort the underlying meaning of a dream (the latent content) into the manifest content reported by the dreamer. It includes processes such as displacement and symbolisation.

155

What is free association?

A technique used in Freudian psychoanalysis, also referred to as the talking cure. THe client is encouraged to express anything that comes into their mind. Each incident may then, through free association of ideas, lead to other thoughts and memories perhaps extending back into childhood. The client must not censor the material at all, and in this freewheeling way ego defences may be lowered and repressed material accessed.

156

What is the role of the therapist during free association?

To intervene occasionally, perhaps to encourage some reflection on a particular experience. In addition, during the free association, the therapist will be identifying key themes and ideas that can be analysed further during the therapeutic process.

157

What did Freud introduce free association?

To try and get around the defences put up by the ego and so bring to the surface material from the unconscious.

158

What is dream analysis?

Technique used in Freudian psychoanalysis. The therapist uses the dream work to interpret the manifest content of the dream and uncover the latent content. Processes such as displacement and symbolisation distort the latent content into the manifest content.

159

Why did Freud believe dream analysis could be helpful?

He referred to dreams as the 'royal road to the unconscious'. He felt that during dreams the normal barriers to unconscious material was lifted and the symbolic imagery of dreams was a reflection of this unconscious material. Therefore by analysing the content of dreams that therapist might be able to identify significant conflicts repressed into the unconscious.

160

What did Freud believe that dreams were?

For Freud, dreams were essentially wish fulfilment, but the wishes, often sexual or aggressive from the id, were too threatening to be consciously acknowledged.They were therefore distorted and reflected in the imagery of the dream.

161

What assumptions did Freud make about the underlying meaning of dreams?

1. Dreams have an obvious content that the client can recall. He referred to this as the manifest content.
2. Beneath the manifest content lies the actual meaning of the dream that could only be revealed through the therapist's interpretation. Freud referred to this as the latent content.
3. The dream work was the process by which the latent content was distorted into the manifest content. This can happen through various processes, such as displacement and symbolisation.

162

What is the therapist's role during dream analysis?

To use their understanding of how the dream work operates to interpret the symbolism of the dream. Putting together the themes that gradually emerge through the continuing processes of free association and dream analysis regular anxieties and conflicts emerge. THe client can then work through these issues with the therapist, identifying and hopefully resolving the source of their current anxieties.

163

What is a projective test?

Although not part of Freud's original therapeutic techniues, projective tests are used in a variety of psychodynamic approaches. In these tests the client is required to project or impose their own thoughts and associations on some particular stimulus material. The most famous is the Rorscharch ink blot test. They are asked what the shape means to them, and by repeating this with a sequence of different blots particular themes and anxieties may emerge.

164

What are the strenghts of using therapies based on the psychodynamic approach?

1. These therapies accept that human beings are complicated and that many adult disorders may have their roots in childhood and in repressed material. This is almost certainly true.
2. Brief psychodynamic therapy has been introduced in which both the therapist and the client agree that there will only be a fixed number of sessions.

165

What are the weaknesses of using therapies based on the psychodynamic approach?

1. Because of the need to identify the roots of psychopathology it can be very long lasting and therefore expensive.
2. It depends upon the client developing insights into their condition. It is therefore not suitable for those people who mgiht be unable or unwilling to analyse their lives in this way.
3. As they require insight, they are not suitable for all disorders, particularly psychosis.
4. Ethical issues in confrotning clients with perhaps distressing meterial during the course of analysis. It is important that such issues are worked through with the client to a satisfactory conclusion.

166

What did Eysenck (1952) conclude about psychodynamic therapies?

That not only did these therapies not work, but they were actually worse than no treatment at all. However, Eysenck's work itself has been heavily criticised and over the last 50 years a number of more controlled studies have looked at the effectiveness of psychodynamic therapies, which suggest that such therapies can be effective for depression and for anxiety disorders.

167

What did Freud himself believe was the aim of psychodynamic therapies?

He spoke more in terms of reducing unhappiness rather than 'curing it'. His aim was to convert misery into everyday unhappiness. Giving clients an understanding of their condition may itself be beneficial without actually providing them with a complete cure.

168

What is behaviour therapy?

Behavioural therapeutic techniques based on the principles of classical conditioning. They include systematic desenitsation and aversion therapy

169

What is behaviour modification?

Behavioural therapeutic techniques based on the principles of operant conditioning. Examples include token economics.

170

What is systematic desensitisation?

Behaviour therapy technique where people with phobias are gradually desensitised to the phobic object or situation. This is done by using gradual exposure from the least up to the most feared situation.

171

What is flooding?

Behaviour therapy techniue where people with phobias are exposed to the feared object or situation, without the possibility of escape, until the fear response extinguishes.

172

What is aversion therapy?

Behaviour therapy technique where undesirable behaviour is paired with an unpleasant stimulus.

173

What is counter-conditioning?

A process underlying systematic desensitisation in which the conditioned response of fear to an object or situation is replaced through counter conditioning by relaxation.

174

What are the therapies which are based on the behavioural approach?

Behaviour therapies, which include systematic desensitisation, flooding, and aversion therapy.
and behaviour modification, which includes token economy.

175

What does the behavioural approach assume is the cause of disordered behaviour?

That it is learnt through classical and operant conditioning (including social learning). Therefore the approach to therapy is to try and alter behaviour using the principles of conditioning.

176

What does behaviour therapy refer to?

Techniques based on classical conditioning

177

What does behaviour modification refer to?

Therapies based on operant conditioning and social learning.

178

What is the aim of behaviour therapy?

To remove or extinguish the conditioned association between fear and the situation or object.

179

Who introduced systematic desensitisation?

It was introduced by Wolpe in 1958. It is the most popular form of behaviour therapy.

180

How does systematic desensitisation work?

It is a form of counter-conditioning, where the therapist attempts to replace the fear response by an alternative and harmless response. THis involves using hiierarchy of increasingly fearful situations.

181

What are the steps involve in systematic desensitisation?

1. The therapist would ask the person to list situations from the least to the most fearful
2. The therapist trains the client in deep relaxation techniques. Relaxation is the alternative harmless response to the feared situation and the aim of the procedure is to replace the fear response with relaxation. - Reciprocal Inhibition
3. The therapist asks the client to visualise the least feared situation, whilst simultaneously performing their deep relaxation procedure.
4. Once the client feels comfortable at that level, they are asked to imagine the next situation in the hierarchy. The same procedure is repeated.
5. Over a series of sessions the client will cope with every level of the hierarchy, although they can of course stop at any time and restart at a lower level. Eventually they can cope with the most feared situation.

182

What is an alternative to visualising fearful situations during systematic desensitisation?

An alternative is to use real examples, for instance pcitures of small spiders, through life-like models, up to handling real spiders. It is unclear whether this more realistic approach is actually more effective than visualisation.

183

what does flooding assume?

That very high levels of fear and anxiety cannot be sustained and will eventually fall, meaning that the fear response disappears.

184

What happens if the flooding session ends too soon?

If it ends too soon, when anxiety levels are still high, it may have the opposite of the desired effect, in that the phobia will be reinforced rather than extinguished.

185

What issue is specific to flooding?

It that it is clearly a highly threatening and stressful procedure. Ideally it should only be carried out by trained therapists and with medical supervision available.

186

Why does aversion therapy have a controversial history?

It was used in the 1950's to try and 'cure' homosexuality by pairing electric shocks with pictures of naked men. It was assumed that homosexuals would learn the association between the fear of the electric shock and hte pictures. However, besides being ehtically and scientifically unsound, there was never any evidence that it worked.

187

How is aversion therapy used nowadays?

It is sometimes used as a therapy for addictive states. The idea behind the procedure is to pair an unpleasant or punishing stimulus with, for instance, smoking or drinking. One way to do this is to make the person feel sick using pills, simultaneously with their smoking. Through classical conditioning the feeling of sickness is associated with smoking and should act to prevent smoking in the future.

188

What are the strengths of behavioural therapies?

1. Systematic desensitisation in particular can be extremely effective in the treatment of simple phobias. Success rates of between 60-90% have been reported for spider phobics and blood injection phobics (Bawlow et al, 2002). Despite the emphasis on symptoms, there is no evidence that imporvement is temporary.

189

What are the weaknesses of the behavioural therapies?

1. It assumes that all behaviour is learned through relatively simple conditioning principles, meaning that therapy targets these learnt associations, with no attempt to address any deeper psychological or emotional issues related to the disorder i.e. focuses just on symptoms.
2. Significant ethical issues, in relation to flooding and aversion therapy, in that clients are subjected to intense fear and axiety. Even systematic desensitisation requires the client to visualise or experience feared situations. THere should be careful monitoring to ensure there are no long-term negative consequences for the client.

190

What does behaviour modification attempt to do?

They attempt to change a person's voluntary controlled behaviour rather than the reflextive behaviours involved in classical conditioning.

191

What is token economy?

It is a straightforward version of increasing desirable behaviours by reward or positive reinforcements. It is used mainly in psychiatric hospitals, where tokens are given as rewards for improved behaviour. Tokens can then be exchanged for sweets, cigarettes, etc. The aim is to reduce levels of antisocial behaviour by substituting desirable responses such as good hygeine and clieanliness.

192

What is the main problem with token economy?

It is simply a way of modifying behaviour, but not directly addressing symptoms. In a ward of patients with schizophrenia general behaviour might improve and they would be easier to manage, ut their specific psychotic symptoms are not being targeted.

193

How can social learning theory aid operant conditioning techniques?

It adds a cognitive element, in that observationa nd imitation of models is an important feature. When a model is rewarded for certain behaviour the observer is more likely to imitate.

194

What did Bandura (1969) discover about social learning theory in treatment of abnormality?

He has demonstrated the importance of social learning theory in normal development. It has also been established that phobic people can benefit from observing a model coping effectively with the phobic situation. It has also proved useful in helping people deal with social anxiety.

195

What are the strengths of behaviour modification?

1. Rewards are an effective way of changing behaviour, and the token economics are a useful way of improving antisocial behaviour. They may help the patient become more receptive to psychological therapies.
2. Social learning theory includes cognitive processes such as observation and imitation, and emphasises the role of models in changing behaviour. ALthough based on conditioning principles, it takes a more complext view of human behaviour than either classical or operant conditioning.

196

What are the weaknesses of behaviour modification?

1. Token cconomics are usually set in highly structures institutions. A key problem is whether the behavioural improvement generalises to the outside world when the patient returns to the community, and rewards are less consistent.
2. Token economics follow the very mechanistic approach of treating patients as stimulus-response machines; this is a highly reductionist approach to complex behaviours
3. It is based simply on learning principles and ignore any genetic or biological factors in psychological disorders.

197

What is the aim of cognitive therapy?

TO challenge irrational and dysfunctional thought processes, which the cognitive approach links to psychological disorders.

198

What are the two main examples of the cognitive approach?

1. Beck's cognitive therapy for depression
2. Ellis' s rational-emotive therapy (RET)
Although developed independently they follow the same assumptions and share many similarities.

199

What did Beck (1976) believe cause negative thoughts?

He believed that negative schemata lead to pssimistic thoughts about the self, the world and the future. These in turn lead to cognitive biases, which in turn maintain the negative thoughts.

200

What is the aim of Beck's cognitive therapy?

To challenge irrational cognitions and replace them with more realistic appraisals.

201

What is reality testing?

A technique used in cognitive-behavioural therapy. THe thearapist encourages the client to compare their irrational cognitions against the real world.

202

What steps does Beck's cognitive therapy use to challenge negative thoughts and showing them to be irrational and unrealistic?

1. The therapist helps the client identify particular negative thoughts. To do this the client is encouraged to keep a record of their thoughts and anxieties and perhaps a diary. These can then be reviewed with the therapist and negative automatic thoughts recognised.
2. Using this material the therapist challenges the dysfunctional cognitions by drawing attention to positive incidents or examples, however trivial, which contradict the client's negative assumptions.
3 This is a form of reality testing, akey component in cognitive therapy.

203

How does Beck use behavioural techniques to encourage more positive behaviour in his cognitive therapy?

For instance, in severe depression the person may find it difficult to do anything at all. Beck would encourage them to set a list of small goals to be achieved. These could be as trivial as actually getting out of bed and making a cup of tea. However, in theory these small achievements should help the depressed person develop a sense of personal effectiveness.

204

How can training in problem solving skills be used in Beck's cognitive therapy?

Another aspect of cognitive therapy can be training in problem solving skills, if there are particular situations that trigger negative thoughts. Generally, clients can be taught relaxation techniques to reduce anxiety in stressful situations. However, behavioural change without cognitive change is unlikely to alter the depressed state.

205

How does Ellis believe that people maintain negative beliefs?

Ellis believs that people maintain negative and self-defeating beliefs by constantly telling themselves how inadequate they are, and constantly looking for conforming evidence that they are inadequate.

206

How is Ellis rational-emotive behavioural therapy are similar to Beck's cognitive therapy?

In that the therapist and the client work together to identify situations and the negative reactions they produce. The therapist then helps the client rational the situation, giving the client a more realistic perspective.

207

How is Ellis' rational-emotive behavioural therapy different to Beck's cognitive therapy?

Ellis developed a more confrontational approach to therapy than Beck, challenging the client's self-defeating beliefs in intense debates.

208

What is a serious issues for both approaches to cognitive therapy?

That some negative thoughts are based on a rational and accurate perception of reality, and that dealing with this depressive realism is just as important as correcting dysfunctional thoughts.

209

What are the strengths of cognitive behavioural therapy?

1. As a combination of behavioural and cognitive elements, it is a structured approach to therapy but acknowledges that complex cognitive processes are important in psychological disorders.
2. It is effective as a treatment for depression and social anxiety. There is evidence that the beneficial effects of CBT in depression may last longer than those of antidepressant drugs.
3. SOme therapists believe that where the person with psychosis has some insight into their condition, CBT can have beneficial effects in coping with the disordrs.
4. Courses are generally limited to a number of sessions over a few weeks, so is less time consuming and more cost effective than psychoanalytic therapies.
5. It is not as probing as psychoanalysis which might be unpleasant or even damaging.

210

What are the weaknesses of cognitive-behavioural therapies?

1. Sometimes depression is perfectly rational and an accurate perception of reality, and it is important that the therapist acknowledges this.
2. Behavioural therapies are more effective in treating phobias, whilst more severe conditions such as schnizophrenia aren't suited to CBT.
3. The cognitive approach ignores genetic and biological factors
4. The idea of scehmata lacks detail, and there is no clearly described mechanism for how negative schemata develop in the first place.
5. SOme people might still find the self-monitoring and analysis associated with CBT threatening.

211

How can the comparative effectiveness of different techniques be used to evaluate the underlying approaches?

If one type of therapy is consistently more effective than any others, then this would suggest that the underlying approach, whether biological, cognitive, behavioural or pscyhodynamic, is perhpas the most valid.

212

What are the practical difficulties with comparing therapies in the same study?

1. Large numbers of participants required, who have to be diagnosed with the same psychologial disorder and the same level of severity.
2 There needs to be careful assessment of patients before and after treatment, and some agreement on how long the study should last.
3. When drug therapy is one of the comparisons, there should be a placebo control group.

213

What research study did Elkin et al (1989) conduct on different treatment approaches?

THis was a study across several treatment centres. In all 240 patients with depression were treated with either CBT, psychotherapy or antidepressant drugs. There was also a placebo control group. Treatment lasted for 16 weeks.

214

What were the findings of Elkin et al (1989) study on different treatment approaches?

1. There was a large placebo effect of 35-40%
2. All therapies were significantly more effective than placebo and overall had similar levels of effectiveness
3. Drugs tended to be the most effective therapy for severe depression
4. The individual therapist was a significant factor in the effectiveness of psychotherapy.
5. Across all treatment groups, 30-40% of patients did not respond to therapy. It is a common finding in studies of effectiveness that no treatment is ever 100% effective.

215

What were the conclusions of Elkin et al (1989) study on different treatment approahces?

The conclusions were that drugs, CBT and psychotherapy are all more effective than placebo in treating depression. Also note that the follow-up was only 16 weeks. Ideally patients should be followed up for 6-12 months.

216

What evidence did Bechdolf et al (2006) find about CBT?

There is evidence that the therapeutic effect of CBT in anxiety conditions in longer lasting than the effect of drugs.

217

What study did Davidson et al (2004) do on different treatment approaches?

295 patients with generalised social anxiety were treated with with CBT, with the SSRI antidepressant fluoxetine, or with combined CBT+fluoxetines The findings were:, the overall placebo effect was 19%, all therapies were effective over and above the placebo effect, and after 14 weeks there were no differences between the therapy groups. THe combined therapy was not superior to either therapy alone. 40-50% of patients did not respond to therapy.

218

What were the conclusions of Davidson et al (2004) study on different treatment approahces?

The conclusions were that drugs and CBT are equally effective in treating social anxiety, and combining them does not improve their effectiveness. However many patients do not respond to either treatment.

219

What are the methodological points that not to be considered with studies comparing different treatment approaches?

1.The participants
2. The length of the study
3. A control group
4. Measurement of improvement

220

How should the methodological points of the participants be considered with studies comparing different treatment approaches?

The seperate patient groups to be given the different treatments should be matched in terms of the severity of the disorder. It would also be desirable if they were matched on other characteristics, such as age, gender and socioeconomic status. This is rarely possible, but these factors have been shown to influence, for instance, depression.

221

How should the methodological points of the length of the study be considered with studies comparing different treatment approaches?

The length of the study should be sufficient for treatment effects to be observable. Even with drugs effects can take weeks to develop. Ideally observation should continue for at least a year to check that any improvement is sustained and not temporary.

222

How should the methodological points of the control group be considered with studies comparing different treatment approaches?

There should be a non-treated group to control for the specific effects of treatment. With drugs this is a placebo group given a non-active substance they think is the drug. FOr psychological therapies it is more difficult. Often an 'interaction' condition is used where participants talk to the therapist but there is no attempt to apply specific techniues such as CBT or free association. THis controls of the effects of being given attention by a therapist.

223

How should the methodological points of the measurement of improvement be considered with studies comparing different treatment approaches?

Measurement of improvement should be consistent and thorough across the groups. Questionnaires can be given to participants, and there should also be ratings of clinical improvement by qualified staff; these staff should not know what treatment group the participant is in to prevent bias and investigator effects.

224

What ethical issue is specific to studies evaluating treatment?

There is a non-treated control group used, and therefore if treatments are effective, the control group is being denied help. As a control group is essential to measure improvement this is unavoidable, and is justified by the hope of identifying the most effective treatment.

225

How can we decide which is the most appropriate treatment for abnormality?

In terms of general effectiveness, no one therapy is consistently the best, particularly in relation to depression and anxiety. However, there are other considerations that can help us decide which treatment to use;
1. The accessibility and the speed of action
2. Duration of action
3. Ethical issues

226

How can the accessibility and the speed of action help us to decide which is the most appropriate treatment?

i.e. how easy it is to provide treatment and how quickly it works. Drug therapy stands out. Drugs are readily available for most disorders, and although it usually takes a few days for the therapeutic effect to appear, this is faster than CBT, behavioural and psychodynamic therapies.

227

How can the duration of action help us to decide which is the most appropriate treatment?

There is some research evidence (Otto et al, 2000) that the benefits of CBT last longer than those of drugs and that overall therefore treatment with CBT is more cost effective. For some conditions, though, notably schizophrenia, drug therapy has to be life-long in order to suppress symptoms and there is no reliable alternative.

228

How can the ethical issues help us to decide which is the most appropriate treatment?

All therapeutic drugs used to treat psychological disorders have side effects to a greater or lesser degree. THese may be cognitive, for instance memory loss or confusion, or physical ranging from dry mouth to the severe moment problems found with classical antipsychotics. Patient compliance- the extent to which patients stay on the treatment programme- can be seriouslly affected by these side effects. There are also potentially traumatic effects of deep psychoanalysis revealing repressed material and the stressful effects of behavioural therapies.