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Psychology
Healthy Module: G543
Living
Stress
Dysfuncti
onal
Behaviour
Disorders
Contents
Objectives for the Health and Clinical Psychology module
6
What is Health Psychology? Careers in Health Psychology
7
Unit G543: Health and Clinical Psychology
Exemplar exam paper
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Theories of Adherence
Reasons for Non- Adherence (Bulpitt et al. 1988)
Measures of Non Adherence ( Lustman et al. 2000)
Improving Adherence using Behavioural Methods (Watt et al. 2003)
Summary of the theories/studies of adherence
Comprehension questions for theories of adherence
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Introduction
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PART C STRESS
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Introduction
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PART E DISORDERS
Introduction
Characteristics of Disorders
Anxiety Disorders e.g. phobias.
Affective Disorders e.g. depression.
Psychotic Disorders e.g. schizophrenia.
Summary of the characteristics of disorders
Comprehension questions for characteristics of disorders
Part A exam question
161
Part B exam question
162
Evaluation sheet of characteristics of disorders theories
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1. Hospitals and Health authorities may deal with specific problems identified by
health care agencies or professional. They may also work in government health dept. or
any health-care charities or organisations
2. Clinical setting Usually within the Health service. They may see patients with
depression, relationship problems, learning disabilities and serious mental illnesses.
They would assess a patient using methods such as interviews observations and
psychometric tests which may lead to a therapy regime such as counselling or Cognitive
Behavioural Therapy
3. Research Within this sector, a health psychologist would remain as an academic and
drive progress in the field, and apply psychological research to; the promotion and
maintenance of health, the prevention and management of illness, the identification of
psychological illness, the improvement of the health-care system and the formulation
of health policy
Healthy Living this area considers theories that might explain health behaviours
such as health belief model and then looks at health promotion campaigns. It also looks
at adherence: understanding why people adhere to medical advice and why it is
important adhere to ensure the long-term health of society.
2.
Stress this area examines what will reduce stress and teach stress-management
techniques. Problems associated with measuring stress are also examined as this
affects validity.
3.
4.
Disorders This section looks at three types of disorder in more detail examining
the characteristics of psychotic affective and anxiety disorders. Then identifies one
disorder and looks at it in greater depth from the Cognitive, Biological and behavioural
point of view, along with research supporting these explanations.
Evaluation
Think!
about the study/approach/ method/issues/debates you have
just covered.
Approach/Perspective
Issues -
Ecological Validity (how realistic is it; can the findings be applied to everyday life?)
Longitudinal and snapshot (is the study conducted over a long period or one point in time?)
Qualitative and Quantitative data (is the data descriptive or numerical?)
Usefulness (how is the research/theory/model useful in terms of how it explains human
behaviour?)
Application (how can the results of the research/theory/model be applied in everyday life
settings?)
Debates
Determinism and Free will (does this study/perspective suggest we have
freewill or that our behaviour/experience is determined?)
Reductionism and Holism (do the results of the study focus on one single level of
explanation, ignoring others or do they consider many explanations?)
Nature and Nurture (is this characteristic/behaviour due to genetics or
learning?)
Ethnocentrism (can this behaviour be considered to be biased towards one ethnic group or
society?)
Approach bias (does the study support the beliefs of a specific approach?)
Psychology as a Science (is the method used within the study rigorous, ie. objective, reliable,
falsifiable?)
** There will be 4 questions for each topic on the exam paper. You are to chose and
answer 2 questions per topic **
How to answer a part (a) 10 mark Forensic/Health & Clinical psychology exam question
Once you choose your 2 X questions per topic, you are to answer the 10 mark
questions using PEC format. Each question will usually ask you to either Outline,
Describe or Identify.
P (point, ie. describe/outline the main research/technique)
E (example, ie. give examples of the features of the research/technique being
asked about)
C (conclusion, ie. summarise the research/technique)
For each question you are to spend 12 mins and write approximately side A4
0 marks
1-2 marks
3-5 marks
6-8 marks
9-10 marks
No or irrelevant answer
There are very few psychological terms. The
description of the study is limited, mainly inaccurate
or lacks detail. The study has not been linked to the
question, or the model. The answer doesnt have a
structure and contains many spelling errors.
There is basic use of psychological terms. The
description of the study is generally accurate, and
makes sense, is usually made relevant to the question,
but it lacks detail. There is some elaboration (using
examples), but the study isnt linked to the question
very clearly. The answer has some structure and
organisation. It is mostly grammatically correct, but
there are some spelling errors.
The use of psychological terms is mainly accurate. The
description of the evidence is mainly accurate,
relevant and reasonably detailed. The elaboration
(explanations, use of examples) is good. It has been
made clear how the study is relevant to the question.
The answer has good structure and organisation. The
answer is mostly grammatically correct and there are
very few spelling errors.
There are lots of psychological terms and they are
used accurately. The description of the study is
accurate, relevant, makes sense and is very detailed.
There are a lot of elaborations (explanations, using
examples) and the study is clearly related to the
question. The answer is well structured and organised.
The answer is grammatically correct and has very few
spelling errors.
Checklist
There are a lot of psychological terms used
accurately
The description of the cause/study is
accurate
There are lots of examples from a
study/studies
There are explanations of key points to
show you understand what you have written
The answer is clearly related to the
question (use the words in the question in
your answer to help you)
There are no spelling errors and it is
grammatically correct
The answer is well structured and easy to
read
NB. This question assesses your A01 skills (knowledge & understanding). There are
NO marks rewarded for A02 skills (evaluation).
How to answer a part (b) 15 mark Forensic/Health & Clinical psychology exam question
For this part of the question, you will be required to demonstrate your evaluative
skills (A02 & A03) by outlining a number of evaluative points covering a range of issues
in CREEC or CREECC format.
Claim
Reason
Evidence
Evaluative
comment
Conclusion
Reason
Evidence
Evaluative
comment
Countercomment
Conclusion
For each question you are to spend 18 mins and write approximately 1 side A4
0 marks
1-3 marks
4-7 marks
8-11 marks
12-15
marks
No or irrelevant answer
Few evaluative points. There is no evidence of an
argument. There is no structure- it looks
disorganised. There are very few examples from
studies. There are very few conclusions, and very
little summary of the issues or arguments. Very
little of the answer is related to the question.
The argument and organisation are limited. Some
points are related to the question. There is
evidence of an argument, and this shows
understanding. There are some evaluation points.
Valid conclusions summarise the argument.
There are some evaluation points, and these cover a
range of issues. The argument is well organised, but
may lack balance or development. The answer is
related to the specific question. Good use of
examples. The argument is competent and
understanding is good. Valid conclusions summarise
the arguments effectively.
There are many evaluative points covering a range
of issues. The argument is well organised, balanced,
and developed. The answer is clearly related to the
Checklist
Use technical terms
Cover a range of evaluation points (at least 4)
Include strengths and weaknesses (2 of each)
Organise your work so it is easy to read- use
connectives
Form an argument- do you agree or disagree?
Use lots examples from relevant studies
Relate the answer to the question (use the
words in the question)
Write a conclusion that summarises what you
have said clearly.
Theories of health belief help explain individual reasoning behind these decisions. This
involves considering the benefits and barriers) of adopting a health behaviour( The health
belief model) , considering how you feel personally in terms of controlling your health
behaviours (Locus of control) and whether or not you are confident that you can carry out
certain health behaviours (Self-efficacy).
Psychologists are also interested in what makes health communication persuasive. In
todays society, people are encouraged from a very young age to eat a healthy diet and live
an active life and this is done by using different Methods of health promotion.
This was not always the case. Smoking for example was once
looked upon as a glamorous habit and film actors were used to
promote smoking. The beautiful Betty Grable, America's
favourite pin-up girl up to 1972, appeared in 84 films and her
"million dollar legs," were insured. Her picture appeared on the
packets of cigarettes she smoked. She died of lung cancer aged
56.
The media are used today to encourage people to give up
smoking or to not start in the first place.
Fear arousal, such as images of cancerous mouths are now used
on cigarette packets to warn individuals of the dangers of smoking. Legislation has also
been introduced to ban smoking in all public and work places.
Finally, maintaining good health often involves adhering (sticking to/following) a healthy
lifestyle or to medical advice from a doctor or health worker. Medical regimes may involve
eating a healthy diet, exercising regularly or taking medication to treat an illness.
Research shows that individuals struggle to Adhere to medical regimes.
Psychologists are thus interested in reasons for non adherence. Some people do not
follow medical advice because they believe that they have good reason not to. Side
effects of medication are often a reason cited for non adherence.
Psychologists also need to be
confident that they can measure
adherence in individuals. These
methods vary from self- reports
to bio-chemical analysis which
involves a physiological approach
such as analysing the level of
medication in blood or urine.
GRIFFITHS (1994) studied cognitive styles - the way regular gamblers have of
thinking about gambling, weighing the odds and explaining away losses, that is quite
different from non-gamblers. This highlights how cognitive processes affect
behaviour. Thus with the health belief models a persons thoughts affect whether
they change their lifestyles for the better, have self-belief so they feel they can
change their lifestyles and shows us that these cognitive thoughts can be altered so
a person can have more self-efficacy.
MILGRAM (1963) looked at behavioural study of obedience and that people act a
certain way depending on a given situation and this can be related to health with the
Health belief model: the social situation has an effect on whether people will adopt a
behaviour which will benefit them.
BEHAVIOURIST psychologists will try to look at the behaviour of people and their
environments and work out what sort of backgrounds or circumstances make someone
make healthy choices as opposed to those who do not.
COGNITIVE psychologists will try to study the thought processes of people. Their
beliefs - how they weigh up the odds, what are the pros and cons of making changes
to their lifestyle who has strong internal belief and faith in themselves. There are
compelling and logical arguments for adopting a healthy lifestyle, however many of us
choose to ignore them. Why?
The main approach in this area is Cognitive psychology. It is interested in how people
think about health behaviours. There are many compelling and logical arguments for
adopting a healthy lifestyle, however many of us choose to ignore them.
19
Background- The Health Belief Model (HBM) is a tool that scientists use to try and predict
health behaviours. Originally developed in the 1950s, it is based on the theory that a person's
willingness to change their health behaviours is primarily due to the following factors:
Perceived Susceptibility - an individual's assessment of their risk of getting the condition. People
will not change their health behaviours unless they believe that they are at risk.
Perceived Severity - an individual's assessment of the seriousness of the condition, and its
potential consequences. The probability that a person will change his/her health behaviours to
avoid a consequence depends on how serious he or she considers the consequence to be.
Perceived Benefits - an individual's assessment of the positive consequences of adopting a
behaviour. It's difficult to convince people to change a behaviour if there isn't something in it for
them.
Perceived Barriers - an individual's assessment of the influences that facilitate or discourage
adoption of the promoted behavior) One of the major reasons people don't change their health
behaviours is that they think that doing so is going to be hard. Sometimes it's not just a matter
of physical difficulty, but social difficulty as well. Changing your health behaviours can cost
effort, money, and time.
The health belief model incorporates two more elements into its estimations about what it
actually takes to get an individual to make the leap. These two elements are cues to action and
self efficacy.
Cues to action are external events that prompt a desire to make a health change. They can be
anything from a blood pressure van being present at a health fair, to seeing a condom poster on a
train, to having a relative die of cancer. A cue to action is something that helps move someone
from wanting to make a health change to actually making the change.
Other constructs or mediating factors to consider, which were added later were; Demographic
variables (such as age, gender, ethnicity, occupation) Socio-psychological variables (such as
social economic status, personality, coping strategies) Health motivation (whether an individual is
driven to stick to a given health goal) Self-efficacy to be discussed separately.
20
Aim:
To use the health belief model to explain mothers adherence for their asthmatic children
Approach/Perspective (if any): Cognitive but includes social factors with demographic variables,
such as family size, education, occupation etc..
Type of Data: Quantitative
Method: A correlation between beliefs reported during interviews and the compliance with selfreported administration of asthma medication
Details: 117 mothers originally asked, 111 eventually agreed to take part. Respondents ranged in
age from 17 to 54 years and all but 7 were black. The children's ages ranged between 9 months
and 17 years.
The interview schedule, which required about 45 minutes to complete, dealt with the mother's
general health motivations and attitudes and her views about various aspects of asthma and its
consequences. Most questions were designed to provide measures of the HBM's dimensions.
They were asked questions regarding their perception of their childs susceptibility to illness and
asthma, beliefs about its seriousness its interference with education and its interference with
their activities, whether it caused embarrassment or interfered with mothers activities. They
were also questioned about their faith in doctors and the effectiveness of the medication.
A covert evaluation of compliance was also made by drawing blood by finger stick and testing it
for the presence of theophylline, a substance basic to all of the drugs prescribed for asthma by
the cooperating physicians. Such objective verification of compliance was ultimately available for
80 (72 percent) of the 111 mothers. Their reports of medication administration were compared
with laboratory findings for the 80 children; a correlation of 0.913 was obtained, arguing for the
validity of the mother's statement as an additional indicator of compliance
Results;
A positive correlation between a mothers belief about her childs susceptibility to asthma attacks
and compliance to medical regimen was found.
There was also a positive correlation was also between the mothers perception of the childs
having a serious asthma condition and her administering the medication as prescribed.
Mothers who reported that their childs asthma interfered with the mothers activities also
complied with the medication.
Costs negatively correlated with compliance (e.g. disruption of daily activities, inaccessibility of
chemists, the child complaining, and the prescribed schedule).
The demographic variable of marital status and education level correlated with compliance as
follows:
Married mothers were more likely to comply.
The greater the mothers education the more likely she would be to adhere.
Conclusions:The HBM is a useful model to predict and explain different levels of compliance with
medical regimens
21
Evaluation: Issues
Evaluation: Debates
22
People with a strong internal locus of control believe that the responsibility for
whether or not they get rewards/punishments ultimately lies with themselves.
Internals believe that success or failure is due to their own efforts. In contrast,
externals believe that things in life are controlled by luck, chance, or powerful
others. Therefore, they see little impact of their own efforts to change things.
Translated for health this means a person with high LOC will try to eat five portions
of fruit and veg a day and follow health advice but low LOC will they believe their
health is in someone else hands (doctors, parents fate religion) and fate will decide
whether they lice or die.
Therefore: Is Locus of Control a stable, underlying personality construct, (Nature)
or
23
Is Locus of control largely learned? (Nurture) There is evidence that, at least to some
extent, LOC is a response to circumstances. Some psychological and educational
interventions have been found to produce shifts towards internal locus of control (e.g.,
outdoor education programs.
Aim
Examines the degree by which individuals believe their health is controlled by
internal or external factors
Approach/Perspective
Cognitive Method
Review of six pieces of research into individuals perceptions of ability to control
outcomes based on reinforcement
Results
In the review Ps with internal LOC were more able to show behaviours that would
enable them to cope with a threat than those with an external LOC
Conclusions
Rotter concluede that LOC would effect many of out behaviours, not just health.
Also included summary by James et al. (1965) which found that smokers who give up
and did not relapse had a higher level of internal LOC than those who did not.
However, for women, where there was no significant difference between internal and
external LOC in those giving up instead other factors such as weight gain were
influential in giving up smoking. (Therefore indicating that LOC a factor in health
behaviours but other factors play a part).
Examples are: In health if a person gets ill do they believe they can control it, beat it.
Survive it. Many studies have shown that people who beat cancer have internal LOC
Wallston- Kaplon (1970) Internal LOC live longer after lung transplant.
24
Evaluation: Issues
Evaluation: Debates
Self-efficacy beliefs are cognitions that determine whether health behaviour change will
25
be initiated, how much effort will be expended, and how long it will be sustained in the
face of obstacles and failures. Self-efficacy influences the effort a person puts into
changing risk behaviour and the persistence to continue striving despite barriers and setbacks
that may undermine motivation.
Bandura points to four sources affecting self-efficacy;
Experience - "Mastery experience" is the most important factor deciding a person's selfefficacy. Simply put, success raises self-efficacy, failure lowers it.
Modeling - a.k.a. "Vicarious Experience" -If they can do it, I can do it as well. This is a
process of comparison between oneself and someone else. When people see someone succeeding
at something, their self-efficacy will increase; and where they see people failing, their selfefficacy will decrease. Modeling is a powerful influence when a person is particularly unsure of
him- or herself.
Social Persuasions
Social persuasions relate to encouragements/discouragements. These can have a strong
influence most people remember times where something said to them significantly altered
their confidence. While positive persuasions increase self-efficacy, negative persuasions
decrease it.
Physiological Factors
In unusual, stressful situations, people commonly exhibit signs of distress; shakes, aches and
pains, fatigue, fear, nausea, etc. A person's perceptions of these responses can markedly alter
a person's self-efficacy. If a person gets 'butterflies in the stomach' before public speaking,
those with low self-efficacy may take this as a sign of their own inability, thus decreasing their
self-efficacy further, while those with high self-efficacy are likely to interpret such
physiological signs as normal and unrelated to his or her actual ability. Thus, it is the person's
belief in the implications of their physiological response that alters their self-efficacy, rather
than the sheer power of the response.
Aim:
To assess the self-efficacy of patients undergoing systematic desensitisation.
Approach: Cognitive
Type of Data: Quantitative and Qualitative
Method: A controlled quasi-experiment with patients with snake phobias.
26
A key concept Bandura identified as affecting behaviour is the efficacy expectation. This is
the belief that a person can successfully do whatever is required to achieve a desired
outcome. The key factors which affect a persons efficacy expectation are:
Previous Experiences how successful were you in the past e.g. quitting smoking
Vicarious experiences The success of others
Verbal persuasion Others telling you, you can do it
Emotional arousal Too much anxiety (pressure) can reduce a persons self-efficacy
In addition, cognitive appraisal of a situation might also effect expectations of personal
efficacy. Factors such as social, situational and temporal circumstances are contextual
factors that could influence such an appraisal. This means a persons self-efficacy can alter
depending on the situation. Bandura cites the example of public speaking, and how the time,
audience, subject matter and type of presentation might all influence perceived coping
capabilities that represent self-efficacy. It is not simply down to personality traits.
Details: 10 snake phobic patients who replied to an advertisement in a paper (self-selected). 9
females and one male aged 1957 years.
Pre-test assessment each patient was assessed for:
efficacy expectations (how much they thought they would be able perform different
behaviours with snakes-again self-report).
27
Evaluation: Issues
Evaluation: Debates
28
A persons lifestyle choices may be healthy or not healthy. They may choose to
give up smoking, eat healthily or exercise regularly.
There are many theories that would explain such choices, and the ones we have
looked at concentrate on the logical cognitive approach to such behaviour.
All the theories are linked, in that they are individual perceptions based on
previous information which might affect a persons Locus of Control, their selfefficacy, and how susceptible they think they are to ill-health.
These cognitive theories successfully explain how individuals might adopt one or
more behaviour, but not necessarily all of them.
29
What did Becker find in his research on parents of children with asthma
What did Rotter find out about people who felt they had control over the
situation?
31
Introduction
32
Issue:
Issue:
Debate:
Study 1
Researcher/s:
______________________
Study 2
Researcher/s:
______________________
Study 3
Researcher/s:
______________________
Key assumption:
______________________
Key assumption:
______________________
Key assumption:
______________________
Health Promotion
The Theories/Studies
1. Cowpe (1983) - Chip pan fire prevention
2. Dannenberg et al, (1993) - Legislation-Bicycle helmet laws and educational
campaigns
3. Janis & Feshbeck, (1953) - Effects of Fear arousal.
The main approach in this area is Cognitive psychology as it explores how communication
can be made persuasive enough for people to think differently about their health. The
Behavioural approach is also important as the reason behind change could be argued to be
due to imitation and social learning theory via media campaigns and fear arousal.
34
There were two 60-second commercials, one called in-attendance and one called
overfilling.
These showed the initial cause of the fire and the actions required to put it out.
Three areas were shown reminders one year later. The number of reported chip
pan fires was analysed for each area
35
Results;
The net decline in each area over the twelve-month period of the campaign was
between 7% and 25%.
The largest reduction was during the campaign.
Overlap areas (areas that received two of the television stations) showed less impact.
The questionnaires showed an increase in the awareness of chip pan fire advertising
from 62% to 90%
People mentioning chip pan fires as a danger in the kitchen also increased in the
questionnaires from 12% to 28%
Conclusions:
The advertising proved effective as shown by reduction in chip pan fires.
The behaviour change is seen most during the campaign and reduces as time
passes after the end of the campaign. Thus there is a need to repeat periodically.
The viewer is less likely to be influenced by the campaign if overexposed to it, as
in the overlap areas.
Evaluation: Issues
Evaluation: Debates
36
New laws are debated and passed by the British Parliament for a number of reasons,
including being part of the Government of the days manifesto promises, or as a reaction
to unfolding situations, for example terrorism or a natural disaster.
Health can be promoted through this manner for example, on the 1 st July 2007
legislation was passed to ban smoking in all enclosed public places and workplaces in the
UK. On the 1st October 2007 the legal age for buying cigarettes increased to 18.
Legislation varies from country to country or state to state in the US in 2007 the max
blood alcohol level in the UK was 80mg per 100ml of blood. But the royal society for
prevention of accidents think it should be lowered particularly in young drivers as an
increase of just 20mg per 100ml has been shown to substantially increased the risk of
accidents in young drivers and legislation could reduce this risk.
The problem with any legislation is that it needs to be effective, would the laws be
obeyed if there was no chance of being caught? The police in 2007 needed evidence not
just a suspicion that they had been drinking to do a breathalyser.
How effective has the bam on smoking in public places been? What were its aims? Has
they been achieved?
A study by Dannenburg looked at legislation in Maryland USA to see how legislation
would compel young cyclists to wear helmets.
Aim: To review the impact of the passing of a law promoting cycle helmet wearing in
children
Approach/Perspective:
Cognitive
Behavioural
37
Type of Data:
Quantitative ( self-report questionnaires)
Method: Natural (quasi) field experiment as a law was passed in Howard County,
requiring children under 16 to wear helmets (Maryland, USA.) Children from 47 schools
in Howard County, and two control groups from Montgomery County and Baltimore
County, all in Maryland USA, They were aged 910 years, 1213 years and 1415 years.
In Montgomery County there was already a campaign to promote helmet use.
Independent design with each child naturally falling into one of the three counties.
(7332 children questioned)
Details: A questionnaire was sent using a four point Likert scale that asked about:
bicycle use.
helmet ownership.
awareness of law.
peer pressure.
38
Evaluation: Issues
Evaluation: Debates
39
40
They are all examples of different levels of fear appeals in relation to oral hygiene.
Using the following grid - decide what pictures fit into these categories.
You can only place a picture in one category
Minimal Fear
Appeal
Moderate Fear
Appeal
Strong Fear
Appeal
Which of these levels of fear arousal would be most effective in getting you to
improve your oral hygiene?
41
42
Participants were 9th Grade students aged 14.0 to 15.11 years, mean age 15
years
A questionnaire was given one week before the lecture on health to ascertain
dental practices.
3 groups had a lecture on dental hygiene and the control group had a lecture on
the human eye.
Gp1. lecture had strong fear appeal, emphasising painful consequences of poor
dental hygiene, such as tooth decay and gum disease and statements such as This
could happen to you!. Gp2. moderate fear with little info on consequences factual
statements. Gp3 minimal fear appeal, neutral info on tooth decay and function
rather than consequences. Gp4. functioning of human eye.
Immediately after the lecture a questionnaire was given asking for emotional
reactions to the lecture.
One week later a follow-up questionnaire asked about longer term effects of the
lecture.
Results: The amount of knowledge on dental hygiene didnt differ between the three
experimental groups.
The strong fear-appeal lecture was generally seen in a more positive light.
The strong fear-appeal group showed a net increase in conformity to dental hygiene
of 8% (measured by comparing the no. of recommended dental practises shown
before and after lecture -such as brushing for 3 mins)
The net increase in the moderate fear group was 22%.
The net increase in the minimal fear group was 36%.
The control group showed 0% change
Conclusions:
Fear appeals can be helpful in changing behaviours, but it is important that the level of
fear appeal is right for each audience. Note the minimal fear group was most effective.
There is several studies which used fear arousal. Leventhal et al. (1967) on smokers who
found that high fear arousal was more effective than middle or lower contradictory to
Fleshbeck.
43
44
What was the aim of Cowpes research on chip pan fire prevention?
How long were the adverts shown for and what were they called?
47
Study 1
Researcher/s:
______________________
Study 2
Researcher/s:
______________________
Study 3
Researcher/s:
______________________
Key assumption:
______________________
Key assumption:
______________________
Key assumption:
______________________
Issue:
Issue:
Issue:
Debate:
48
This area highlights that there are many factors which contribute to a persons adherence
to a medical regime which range from social (the factors in a persons life) to cognitive,
irrational thought processes about the drugs or therapies. Similarly when measuring
adherence this section looks at the social, and physiological methods employed and
examines which is more valid and reliable. Lastly, this section examines ways to improve
adherence which is important to improve health and save the NHS costs. Here it examines
a behavioural approach to encouraging adherence.
49
50
Evaluation: Issues
Evaluation: Debates
51
Conclusions: Measuring GHb in patients with diabetes indicates their level of adherence
to prescribed medical regimes. Greater adherence was shown by patients who were less
depressed, and previous research has suggested that reducing depression may improve
adherence in diabetic patients.
Evaluation: Issues
Evaluation: Debates
53
54
Results;
38% more parents were found to have medicated their children the previous day when
using the Funhaler compared to the existing
Conclusions:
Previous research had given reasons for non-adherence in children with asthma as
boredom, forgetfulness and apathy. The Funhaler set out to remedy this by reinforcing
correct usage of the inhaler with a toy that spins and a whistle that blows. This did
improve the adherence to the medication. So by making the medical regime fun, the
adherence, certainly in children, can be improved
Evaluation: Issues
Evaluation: Debates
55
It would be possible to use the HBM to explain why people do not adhere and also to
improve adherence.
This section has only touched on the plethora of idea, models and research into
adherence. Given the high cost of medication that is prescribed and NOT taken, in
addition the health costs of people not adhering to their regimes, the importance of
this area of health psychology can be seen not only in healthier patients, but less
wastage of resources.
56
What did they find that supported the health belief Model?
What is GHb?
57
What are the strengths and weaknesses of using self-report to measure health
behaviour?
Introduction
58
Conclusion
59
60
Study 1
Researcher/s:
______________________
Study 2
Researcher/s:
______________________
Study 3
Researcher/s:
______________________
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Topic 2 Stress
Work
Lack of control
Physiological measures
Self report
Combined approach
Cognitive
Behavioural
Social
62
Topic 2 Stress
The first big question is what is
stress anyway? It is a term we
read about in the papers almost
daily. As a society we are
supposedly suffering from this
thing, it costs the country millions
of pounds a year in days off work
and stress related illness not to
mention broken marriages,
arguments and neglected children.
We tend to think of stress as something `out there`. Subjectively it feels as if there is
just too much to do, or too much being expected of us. We feel unable to cope and if it
goes on for too long we may even become ill.
50 years ago the term was not really used. People would get tired, they might have been
unhappy, but they probably would not have said they were stressed. Nowadays, however,
psychologists are interested in: What causes stress? Does the situations we are in cause
us to feel stressed or the people we are? How can we measure stress? By filling in
questionnaires or doing interviews can we get an objective measure or are only scientific
measurements a true and valid measure, and finally in order to safeguard peoples health
we need to investigate, How can we reduce or manage stress? If we make different
choices in life, can we reduce stress? And what techniques do psychologists favour when
helping people overcome stress. We might also ask whether stress is always a bad thing.
Is a lack of stress stressful?!
The stress experience is made up of stressors and the stress response.
Stressors = Stimuli that require a person to make some form of adaption or adjustment.
These may be external such as life threatening events such as an earthquake, life events
such as work, divorce or the minor hassles of day to day life such as being stuck in a
traffic jam or not finding a parking space, or internal, such as our feelings and thoughts
and our ability to cope with them, whether we feel in control of the situation. Stress is
therefore, the result of a mismatch between the demands of the situation and our ability
to cope with them.
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Lazarus and Folkman (1984) defined stress as:A pattern of negative physiological states and psychological responses
occurring in situations where people perceive threats to their well being which
they may be unable to meet.
Stress consequently brings about a stereotyped set of biological and psychological
responses, this is the stress response. We are programmed to respond physically to
stress by producing adrenaline, which results in symptoms such as increased heart rate
and respiration and the closing down of functions not immediately vital such a digestion
(hence we often lose our appetite when stressed).
The Bodys Stress Response
The problem with this is, in todays society when stressors happen on a daily basis, such as
financial worries or work worries that the constant production of adrenaline can attack
our immune system and reduce our ability to fight of disease. The UK and Health and
Safety Executive suggest that approx 1.4 million working days per year are lost due to
work-related stress! Therefore this topic introduces some of the influences that
psychologists have used to explain stress. In particular the causes of stress, methods for
measuring stress and how to manage it, in the hope that if we can understand health
behaviours and their antecedents, we can help people lead healthier lives, enhancing their
quality of life and also save society the cost of health care lost productivity
64
GRIFFITHS (1994) studied cognitive styles the way people perceive an event may
affect whether they get stressed from it.
COGNITIVE psychologists will try to study the thought processes of people who
suffer from stress - how they weigh up the odds, cope with stress or how it affects
their everyday life.
BIOPSYCHOLOGISTS will be more interested in the genes and biological make up;
are some people more prone to stress and how then does the stress affect them
physiologically.
A theme that comes out of this unit is INDIVIDUAL vs SITUATIONAL Are some
people born with the propensity to get more stressed about lifes events and thus their
health suffers or is the situation people find themselves in no matter who they are,
that will cause stress.
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Details:
24 workers at a Swedish sawmill. The researchers identified a high-risk group of 14
finishers in a Swedish sawmill. Their job was to finish off the wood at the last stage of
processing timber. The work was machine-paced, isolated, very repetitive yet highly
skilled, and the finishers productivity determined the wage rates for the entire factory
The 14 finishers were compared with a low-risk group of 10 cleaners, whose work was
more varied, largely self-paced, and allowed more socialising with other workers
Levels of stress-related hormones (adrenaline and noradrenaline) in the urine were
measured on work days and rest days They also gave self-reports of mood and alertness
plus caffeine and nicotine consumption. Body temperature was measured at the time of
urine collection. Self-rating scales of words such as sleepiness, wellbeing, irritation and
efficiency were made on scales from none to maximal (the highest level the person had
ever experienced). Records were kept of stress-related illness and absenteeism
Results;
The high-risk group
of 14 finishers
secreted more
stress hormones
(adrenaline and
noradrenaline) on
work days than on
rest days, and
higher levels than
the control group.
The high-risk group
of finishers also
showed significantly
higher levels of
stress-related
illness such as
headaches and
higher levels of
absenteeism than
the low-risk group
of cleaners
In the self-report, the high risk group felt more rushed and irritated than the control
group. They also rated their well-being as lower than the control group.
Conclusions:
A combination of work stressors- especially repetitiveness, machine-pacing of work and
68
Evaluation: Debates
69
Aim: To compare the Hassles and Uplift Scale and the Berkman Life Events Scale as
predictors of psychological symptoms of stress
Approach/Perspective : Cognitive and Social
Type of Data: Quantitative
Method: Longitudinal study using self-report and psychometric tests. 100 middle-aged
adults in California (mostly white, with adequate or above income, protestant and with at
least 9th grade education). Repeated design as participants completed both self-reports.
Procedure: All tests were sent out by post one month before the study began. The
participants were asked to complete:
The Hopkins Symptom Checklist (HSCL) and the Bradburn Morale Scale every
month for nine months. To assess their psychological symptoms of stress (Nine
subjects dropped out)
70
Results: It was found that the Hassles Scale was a better predictor of psychological
and physiological symptoms than were the life events scores. Hassles also seemed to
be consistent month on month. Life events for men correlated positively with hassles
and negatively with uplifts. For women, the more life events they reported, the more
hassles and uplifts reported. Hassle frequency correlated positively with psychological
symptoms on the HSCL The more hassles the participant reported the more symptoms
they reported.
Conclusions:
It was concluded that the assessment of daily hassles and uplifts may be a better
approach to the prediction of stress and ill health than the life events approach. Hassles
contribute to psychological symptoms whatever life events have happened.
Evaluation: Issues
Evaluation: Debates
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72
Details:
Group 1: were given control over how long they looked at the images for. They could press
a button to terminate the image and were told a tone would precede each new image.
Group 2: Were warned the photos would be 60 seconds apart they would see the picture
for 35 seconds and a 10 second warning tone would precede each photo. The group had no
control but did know what was happening.
Group 3: were told that from time to time they would see photos and hear tones but were
not given timings or any control.
Procedure: each participant was seated in a sound proofed room and wired up to the GSR
and ECG machines. The machine was calibrated for 5 minutes while the participant
relaxed and a baseline measurement was then taken. Instructions were read over an
intercom. Each photo was preceded with a 10 second tone and then flashed up for 35
seconds (only the one group could terminate the photo and move on).
The GSR was taken at the onset of the tone and during the second half of the tone and in
response to the picture.
Results;
ECG recordings were discarded as they appeared inaccurate.
Group 2 showed most stress.
Group 1 showed least stress.
Conclusions:
That having control over your environment can reduce stress responses.
Evaluation: Issues
Evaluation: Debates
73
Each of us would probably realise that a cause of Stress for one person may not be a
cause of stress for another.
Some people in high-powered jobs seem to thrive on the pressure, while others would
seem to burn out and show signs of physical and /or mental illnesses.
Individual differences are a major problem for any researcher looking at stress.
Cultural norms and expectations can influence how stressful events might be: this
means that ethnocentrism is also an issue psychologists need to consider.
74
What happened to the adrenaline levels of the high-risk group throughout the day?
75
Who were the sample and what limitations does this impose on the result
Who was the sample in this study and what limitations could they impose on study?
How the stress measured and what was good and bad about this method?
Describe one piece of research which considers work as a source of stress (10
marks)
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The heart monitors were attached in standard positions, and the GSR electrodes
were placed between the palm and forearm of the participants non-preferred arm
e.g. left arm for right-handed people.
Results; The predictability group (Group 2) were most stressed by the tone as they
knew what was coming, but did not have control over the photograph.
The control group (Group 1) were less stressed by the photograph than the
predictability group and no-control group (Groups 1 and 2) as they had control.
Conclusions: Participants showed less GSR reaction, indicating less stress, when they
had control over the length of time they could look at the disturbing photographs. It
is likely that being able to terminate aversive stimuli reduces the stressful impact of
those stimuli.
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Evaluation: Issues
Evaluation: Debates
Aim: Creating a method that estimates the extent to which life events are stressors
Approach: Social
Type of Data: Quantitative
Method: In the correlation there was an independent design. A questionnaire designed
to ascertain how much each life event was considered a stressor with 394
participants 179 males and 215 females, from a range of educational abilities, races
and religions.
83
Details:
Holmes and Rahe examined the medical records of 5,000 patients (all American
service men). From these, they put together a list of 43 life events which seemed
to precede (come before) illness.
394 subjects (179 males and 215 females) from range of educational abilities and
ethnic groups and religions took part.
Each participant was asked to rate the series of 43 life events. Rating should be
based on personal experience and perceptions of other peoples experience. The
amount of readjustment and the time it would take people to readjust were to be
considered
They were told that marriage had been given an arbitrary value of 50. The
participants then had to give a number to each of the other life events, indicating
how much readjustment theyd involve relative to marriage.
Death of a spouse was judged (on average) to require twice as much readjustment
as marriage.
The resulting values became the weighting (numerical value) of each life event.
The amount of life stress a person has experienced in a given period (e.g. 12
months) is measured by the total number of life change units (LCUs).
These units are calculated by adding the mean values (in the right hand column of
the table on the next page) associated with the events the person has
experienced during that time. The ranks (left hand column) simply denote the
order in which the life events appear in the SRRS.
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Evaluation: Issues
Evaluation: Debates
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Aim: To measure the psychological and physiological stress response in two categories of
employees.
Approach: Physiological and Cognitive (psychological)
Type of Data: Quantitative and Qualitative
Method: A quasi-experiment where workers were defined as being at high risk (of stress)
or in a control group. An independent design with participants (24) already working in one
of the two categories, so no manipulation of the independent variable. The high-risk group
(14 ) were classified as having jobs which were repetitive and constrained, little control
of pace or work routine, more isolated and having more responsibility
Details: Each participant was asked to give a daily urine sample when they arrived at work
and at four other times during the day so that their adrenaline levels could be measured
This is a physiological measure. Body temperature was also measured at the same time.
These measures gave an indication of how alert the participants were
These measures were combined with a self-report where each participant had to say
how much caffeine and nicotine they had had since the last urine sample. They also had
to rate a list of emotions and feelings such as sleepiness, wellbeing, calmness, irritation
and efficiency. These were on a continuum from minimum to maximum and on a mm
scale. The score was how many mm from the minimum base point they had marked
themselves to be feeling. The baseline measurements were taken at the same time on a
day when the workers were at home.
This combined method of physiological measures and self-reports gave some good
qualitative and quantitative data, which enabled Johansson et al. to compare the two
groups, but have some understanding of the impact of higher stress levels on the
participants
Results; The high-risk group had adrenaline levels twice as high as their baseline and
these continued to increase throughout the day.
The control group had a peak level of 1 times baseline level in the morning and this
then declined during the rest of their shift.
In the self-report, the high-risk group felt more rushed and irritated than the control
group. They also rated their wellbeing lower than the control group.
Conclusions: The repetitive, machine-paced work, which was demanding in attention to
detail and was highly mechanised, contributed to the higher stress levels in the high-risk
group.
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Evaluation: Issues
Evaluation: Debates
88
Activity
Fill in the following table: Explanation
Strengths
Limitations
Self-Report
Physiological
Combined
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As with measuring any behaviour, each method has its strengths and
weaknesses, yet if psychology aspires to be accepted as a science we must
acknowledge the objectivity of scientific methods.
Perhaps the combined approach is the most useful, though it may be most
costly in terms of resources and time.
90
Consider why these may be particularly relevant to asking people about their
stress?
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The social, behavioural and cognitive approaches all view the physiological
symptoms of stress as emerging because of different stressors. Therefore, we
will examine three techniques for managing stress, each based on one of the
above approaches. All have credence and all have been validated by empirical
research although there are others which are just as reputable.
95
1.
96
Technique
Cognitive Behavioural
Technique
Gets people to analyse
and evaluate the
effectiveness of their
coping strategies
Teaches new coping
strategies e.g. positive
visualisation /relaxation
Strengths
Limitations
Time consuming
Needs high levels of
commitment
Therapists are expensive
Not effective with very
high levels of stress or
more generalised stress
Aim: Standard behavioural measures have tried to help people become desensitised to
stress. Meichenbaum compared these standard behavioural methods with cognitive ones.
Cognitive therapy sessions aimed at enabling people to identify their stressors and
change their mental processes when under stress rather than just their behaviours.
Approach/Perspective: Cognitive
Type of Data: Qualitative
Method: It was a field experiment with participants put into three groups, SIT,
standard desensitisation and a control group. Each participant was tested using a test
anxiety questionnaire and grade averages before and after treatment. It was a blind
situation in that the people assessing them did not know which condition they had
been in. Matched pairs design with random allocation to groups and gender controlled
in each group.
Details: 21 students ages 17 25 responded to an advert about treatment of test
anxiety.
The SIT group received 8 therapy sessions giving them insight into their thoughts
before tests. They were then given some positive statements to say and relaxation
techniques to use in test situations. The systematic desensitisation groups were also
given 8 therapy sessions with only progressive relaxation training whilst imaging
stressful situations. The control group were told they were on a waiting list for
treatment.
Results; Findings: performance in tests in the SIT group improved the most although
both therapy groups showed improvement over the control groups
The significant difference was between the two therapy groups and the control
group.
Participants in the SIT group showed more reported improvement in their anxiety
levels, although both therapy groups showed overall improvement compared to the
control group.
Conclusions: Conclusions: that SIT is an effective way of reducing anxiety in students
who are prone to anxiety in test situations and more effective than simply behavioural
techniques when cognitive component is added in.
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Evaluation: Issues
Evaluation: Debates
98
Moving graphs on a computer screen and audio tones that go up and down "reflect" changes
as they occur in the body system being measured. Biofeedback training familiarizes us with
the activity in our various body systems so we may learn to control this activity to relieve
stress and improve health. Trying to change physiological activity without biofeedback is
like playing darts while blindfolded - we can't see whether we are hitting the mark or not.
Biofeedback lets us know precisely when we are changing our physiologies in the desired
direction.
Biofeedback is not a treatment. Rather, biofeedback training is an educational process for
learning specialized mind/body skills. Learning to recognize physiological responses and
alter them is not unlike learning how to play the piano or tennis - it requires practice.
Through practice, we become familiar with our own unique psychophysiological patterns and
responses to stress, and learn to control them rather than having them control us.
By giving visible or audible feedback on the state of the body it is assumed that we would
be more likely to repeat the method of reducing stress. This is the method used by
Budzynski et al.s (1970) research on patients with tension headaches. These headaches are
thought to be caused by sustained contraction of the scalp and neck muscles. Which is
associated with stress, therefore by relaxing the muscles (reducing the stress response),
the headaches should be reduced.
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Technique
Strengths
Biofeedback
Become aware of
physiological response
(e.g. heart rate)
machines can be used to
provide feedback
Learn to control this
response (e.g. deep
breathing)
Apply this control in
everyday situations
Limitations
Non-invasive
No side effects
(compared to drugs)
Gives individual control
over stress response
Reduction in blood
pressure etc can be long
term
Aim: to see if biofeedback techniques work and help reduce tension headaches or whether
the effect is due to the placebo effect. The placebo effect is a positive psychological
effect that can occur even when there is no actual treatment.
Approach/Perspective : Behavioural
Type of Data: Quantitative
Method: Experimental method with patients trained in the laboratory. Data was collected
using muscle tension measurements (EMG) with an electromyography, a machine which gives
feedback by a graph by applying electrodes to the muscles. Patients were also given a
psychometric test for depression (MMPI) and asked to complete questionnaires on their
headaches. It was an independent measures design with participants randomly assigned to
one of three groups.
Details: Participants: 18 replied to a newspaper advert in the USA. They were screened
by telephone and then had psychiatric and medical examinations to ensure there were no
other reasons for their headaches. There were 2 males and 16 females aged 22-44 with a
mean age of 36.
Group A had real biofeedback training with relaxation using the EMG
Group B had biofeedback training but with false (pseudo) feedback
Group C were used as a control group
Procedure: all groups kept a diary of their headaches for two weeks, rating them from 0
mild to 5 severe. Groups A and B were told to practice relaxation after the training for 15
20 mins each day.
Results: After 3 months group As muscle tension was significantly lower than the other
two groups. Reporting of headaches in group A also fell significantly compared to their
base line which it did not in the other two groups.
Follow up: after 18 months where 4 were contacted, 3 reported very low headache activity
and the fourth reported some reduction.
Conclusions: Biofeedback is an effective way to reduce stress levels by reducing tension
therefore effective method of stress management.
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Relaxation techniques are more effective than just being monitored but better with
biofeedback.
Evaluation: Issues
Evaluation: Debates
101
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Technique
Strengths
Specific support
networks can be set up
e.g. cancer clubs, selfhelp groups
Limitations
Aim: To look at how a womans social relationships influence her response to breast cancer and
survival.
Approach: Social
Type of Data: Quantitative and Qualitative
Method: A quasi-experiment with women who were diagnosed with breast cancer. Using
questionnaires and some (18) interviews, plus examination of medical records. The women naturally
fitted into categories based on their existing social support networks
Details: 133 women under 55 years who were referred to a clinic in Vancouver with breast cancer
Patients were mailed a self-administered questionnaire to gather information on their
demography and existing social networks. Questions included their educational level, who they
were responsible for (e.g. children), contact with friends and family, perception of support from
others, and a psychometric test of social networks that combined martial status, contact with
friends and family and church membership.
Details of their diagnosis were taken from their medical records between June 1980 and May
1981, survival and recurrence rates were checked in their medical records in January 1985.
Results: Six aspects of social network were significantly linked with survival. These were:
marital status, support from friends, contact with friends, total support, social network and
employment.
The qualitative data from the interviews showed that practical help such as childcare, cooking
and transport to hospital were the concrete aspects of support.
Married women who survived tended to report supportive spouses. Jobs were seen as
important, even if they were not financially important, as they were a source of support and
information.
Conclusions: The prospective aspect of the study: choosing a sample, assessing social networks
and then waiting to see outcomes for patients, removed the biases of retrospective studies.
Several characteristics of the womens social networks, including marriage and employment
status are significantly related to survival, so the conclusion is that the more social networks
and support, the higher the survival rate of women with breast cancer. Although it is
acknowledged that the main factor influencing survival is still the state of cancer at the time
of diagnosis, with nodal status and clinical stage of cancer being significantly linked with
survival
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Evaluation: Issues
Evaluation: Debates
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It is perhaps one of the joys of being human, that no one can explain our
behaviour; we are complex animals and we need to have a variety of tools at
our disposal to explain, measure and treat atypical behaviour. However, we
would have to ask: is being stressed atypical?
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What were the findings and how did they know SIT was effective?
What is pseudo-biofeedback?
How did Budzynski overcome the ethical problem of treating only one group?
How was the information gathered and how might this affect the validity of
the study?
This was a prospective study what does this mean and why does this remove
bias?
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Introduction
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Categorising
Definitions
Biases in diagnosis
Biological
Behavioural
Cognitive
Biological
Behavioural
Cognitive
110
This
as a
has
No psychologist can say for certain what causes dysfunctional behaviour; the evidence may
point to factors that may cause a disposition or tendency towards a disorder but all humans
are unique, complex individuals and therefore, not everyone behaves in the same way.
The first section of the course consequently examines dysfunctional behaviour, how to
categorise dysfunctional behaviour so it can be diagnosed, what the definitions of
dysfunctional behaviour are then examining the biases in diagnosis that exist, which
further confound the issue and reflect societys views on dysfunctional behaviour.
Psychologists from various approaches will have their own explanations for dysfunctional
behaviour, for example behaviourists would consider the causes to be learned behaviour and
the second section will look at three explanations: the biological, which is the genetic
explanation, the behavioural explanation as in classical conditioning and the cognitive
explanation such as maladaptive thoughts.
It follows therefore, that the treatments recommended by each approach will be based on
the assumptions of that approach, if the cause is biological it follows that the treatment
should be biological, thus the third section will examine a biological treatment, where drug
therapy was used, a behavioural treatment which involved desensitisation and cognitive
therapy which is a cognitive treatment.
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Several studies or theories from AS Psychology explain why individuals might suffer because
of dysfunctional behaviour:
One of the themes that comes from this unit is NATURE vs NURTURE. Are some people
born with the predisposition to suffer from dysfunctional behaviours or are the situations
people experience causes them to suffer from for example, depression, or anxieties.
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Theories/Studies
DSMI/ICD Categories of Dysfunctional Behaviour
Rosenhan and Seligman (1995) Definitions of dysfunctional Behaviour
Ford and Wediger (1989) Sex Biases in Diagnosis of Disorders
This section examines how dysfunctional behaviour is categorised and defined in order to
help practitioners identify behaviours and consequently enable patients to get the help that
is necessary. However, it highlights the reductionist nature of categorizing, and illustrates
how taking holistic approach which takes into consideration individual differences and
cultural diversity needs to be considered. The study then draws attention to how culture is
affected when diagnosing by demonstrating that biases occur because of preconceived ideas
about the nature of men and women, which ultimately affects the reliability of the methods
used.
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In most instances more than one of these elements has to occur at the same time and over a
prolonged period of time. In order therefore, to standardize the description and interpretation
of mental disorders, diagnosis and classification systems were set up.
At present there are two established classification systems for mental disorders: The
International Classification of Diseases (ICD-10) published by the World Health Organization
(WHO) and the classification system of the American Psychiatric Association (APA), the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Aim:
To compare the two ways of categorising dysfunctional behaviour
Approach/Perspective:
Type of Data:
Qualitative
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The ICD-10 was used in 40 countries to see if it improved psychiatric diagnosis across
cultures, however, it is only a snap shot of dysfunctional behaviour and definitions and
criteria must continue to be revised.
Version 10 of the ICD was first published in 1992, and was a revision of previous
versions. The ICD-8 was used as the basis for much cross-cultural collaboration in the
1980s, with the aim of refining the definitions for disorders in the 10th version. This
allowed for inconsistencies and ambiguities to be removed and resulted in the clear set
of criteria now found in ICD-10.
The draft in 1987 was used in 40 countries to see if this improved psychiatric diagnoses
across cultures. Of course ICD-10 is only a snapshot of the field of dysfunctional
behaviour, and as cultures change so revision of definitions and criteria must continue to
take place.
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Evaluation: Issues
Evaluation: Debates
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118
How do we decide what is normal or abnormal, and whether the behaviour constitutes a
psychological disorder (e.g. depression, schizophrenia, phobias, post traumatic stress
disorders, eating disorders etc.) Rosenhan and Seligman (1995)
Limitations: The cut off points are rather arbitrary. How can someone with an IQ of 70 be
considered normal, whilst a person with an IQ of 1 point difference (69) be considered
abnormal?
It ignores desirability of behaviour, in terms of IQ we might accept that someone has an
abnormally low IQ, but we would probably all wish to have a high IQ and wouldnt label that
as abnormal.
Some disorders, for example depression, are statistically very frequent, but still classified
as abnormal.
Way 2: Deviation from Social Norms
Every society or culture has standards of acceptable behaviour/norms. Behaviour that
deviates, (moves away) from these norms is considered abnormal. Social norms are approved
and expected ways of behaving in a particular society or social situation. For example, in all
societies there are social norms governing dress for different ages, gender and occasion
Cultural and historical relativism: - what is statistically frequent and acceptable in one
culture and time period is not necessarily the norm in another. For example, arranged
119
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6.Master of your own environment: Normal people can meet demands within different
situations and are able to adapt to changing circumstances.
Evaluation: Issues
Evaluation: Debates
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8. Antisocial (behavioural pattern of disregard for, and violation of, the rights of
others that begins in childhood or early adolescence and continues into adulthood)
9. Borderline personality disorder (a condition in which a person makes impulsive actions,
and has an unstable mood and chaotic relationships)
Results; Sex-unspecified case histories were diagnosed most often with borderline
personality disorder.
ASPD was correctly diagnosed 42% of the time in males and 15% of the time in females.
Females with ASPD were misdiagnosed with HPD 46% of the time, whereas males were only
misdiagnosed with HPD 15% of the time.
HPD was correctly diagnosed in 76% of females and 44% of males.
Conclusions: Practitioners are biased by stereotypical views of genders as there was a clear
tendency to diagnose females with HPD (histrionic personality disorder) even when their case
Evaluation: Issues
Evaluation: Debates
histories were of ASPD (antisocial personality disorder).
There was also a tendency not to diagnose males with HPD, although this was not as great as the
misdiagnosis of women
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Diagnosing often depends on how society views any particular disorder at any one time,
and the biases inherent in that society.
There are dysfunctional behaviours that cause distress to patients and their families,
and which can be treated to facilitate a better quality of life.
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What are the current diagnostic manuals used in the USA and the UK?
What are the four definitions of abnormality according to Rosenhan and Seligman?
What does Jahoda suggest you should have for ideal mental health?
What factors affect the reliability and validity of defining dysfunctional behaviour?
Ford and Widiger believed that histrionic personality disorder was seen as more likely in
women. How can this be explained?
What did Ford and Widiger find out about bias in diagnosis?
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Details: Alberts baseline reactions to the stimuli were noted. He showed no fear when
presented with a rat, a rabbit, a dog, a monkey, a mask with hair. When Albert was 11
months old the experiments started.
Session One: Albert was presented with a rat. Just as he reached for it, a steel bar
behind him was hit. This procedure was repeated. Findings: The first time the steel bar
was struck when Albert touched the rat, he jumped and fell forward. The second time he
began to whimper. A fear response had been conditioned
Session Two: The following week the rat alone was presented. Then three presentations
were made with the rat and the loud noise. This was followed with one presentation of
just the rat. Then two more presentations with the rat and the noise were made. Finally
the rat alone was presented. Findings: Albert reacted to the rat alone by immediately
crying, turning to the left and crawling quickly away from the rat. The conditioning of a
fear response was evident and so it is possible to condition fear through classical
conditioning.
Session Three: Albert was brought back five days later and given toy blocks (a neutral
stimulus) to play with. Presentations were then made of: the rat, a rabbit, a dog, a Santa
Claus mask etc. Findings: After each presentation of the blocks, Albert played with them
happily. The other stimuli produced negative responses of crying, moving away from the
stimulus and crawling away. Transference of the fear had been made to other similar
objects
Session Four: Albert was then taken to a well-lit lecture theatre to see if the response
was the same as it was in the small room used up till now. In the different room the fear
reaction was slight, until the bar was hit. Then the fear reaction increased.
Session Five: One month later Albert was tested with various stimuli. Albert continued to
show fear reactions. Findings: Time had not removed the fear response
Conclusions:
Session 2 After five paired presentations the conditioning of a fear response was
evident and so it is possible to condition fear through classical conditioning.
Session 3 and 4 Transference of the fear had been made to other similar objects,
although it appeared the less like the original stimulus the objects were (e.g. the cotton
wool), the less negativity was shown.
Session 5 Time had not removed the fear response.
Unfortunately Albert was taken out of the hospital on the day of Session 5, so Watson
and Rayner were never able to carry out their aim of trying to find ways of removing a
phobia in the laboratory. We dont know if Albert had a fear of furry animals for the
rest of his life!
Research by Mary Cover Jones on Little Peter, (Jones, 1924) did show how a fear of
rabbits could be overcome using a treatment of systematic desensitisation.
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nature-nurture debate thus the focus is on the individual not the situation in
explaining behaviour. Consequently the explanation of dysfunctional behaviour would be
that something in our biology is the fundamental cause of our behaviour. This could be a
genetic cause or a malformation of brain structures
Details: The incidence of schizophrenia in adopted children and monozygotic twins was
extrapolated from the research.
Results;
All adoption studies found an increased incidence of schizophrenia in adopted
children with a schizophrenic biological parent.
Kety found that biological siblings of children with schizophrenia showed a much
higher percentage of schizophrenia.
All twin studies found a higher concordance rate for schizophrenia in monozygotic
(MZ) than dizygotic (DZ) twins.
In Gottesman and Shields own study the rate was 58% for identical twins, and 12%
for non-identical twins.
Conclusions:
There is obviously a heavy genetic input into the onset of schizophrenia.
Concordance rates less than 100% show there must be some interaction with the
environment.
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The biological explanation is the most commonly used in our society; as this
reflects the emphasis on mental health being a medical problem
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What were the four aims of Watson and Rayners research on Little Albert?
Identify the conditioned and unconditioned stimulus and the conditioned and
unconditioned response?
Why were Watson and Rayner unable to test the last question?
What are retrospective reports and how do they affect the validity of the
study?
What were the findings from the twin studies Gottesman and Shields reviewed?
What did Beck find out about the cognitions of patients with depression?
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Conclusion
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Theories/Studies
McGrath (1990) Successful Treatment of a Noise Phobia
Leibowitz (1988) -Treatment of Social Phobia with Phenelenzine
Ost & Westling (1995) -Treatments for panic attacks
There many treatments for dysfunctional behaviour from all of the approaches
however, the three treatments covered in this section reflect the three approaches
examined in the explanation of dysfunctional behaviour section. This section
therefore, looks at the cognitive, biological and approaches and the behaviourist
perspective to treating dysfunctional behaviour.
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Lucy was brought to the therapy session and told what would happen. Her parents gave consent for
further sessions.
At the first session, Lucy constructed a hierarchy of feared noises.
Lucy was taught breathing and imagery to relax, and was told to imagine herself at home on her bed
with her toys. She also had a hypothetical fear thermometer to rate her level of fear from 1-10.
As she was given the stimulus of the loud noise, she had paired her feared object (the loud noise)
with relaxation, deep breathing and imagining herself at home with her toys. This would naturally
lead her to feel calm.
She then associated the noise with feeling calm. So after four sessions she had learned to feel calm
when they noise was presented.
She did not need to imagine herself at home with her toys any more.
Results; At the end of the first session, Lucy was reluctant to let balloons be burst. At
the end of the first session, Lucy was reluctant to let balloons be burst even at the far
end of the corridor. When the therapist burst the balloon anyway Lucy cried and had
to be taken away. She was encouraged to breathe deeply and relax.
By the end of the fourth session, Lucy was able to signal a balloon to be burst 10
metres away. , with only mild anxiety.
On the fifth session, Lucy was able to pop the balloons herself.
Over the next three sessions, Lucy was able to pull a party popper if the therapist held
it.
By the tenth and final session, Lucys fear thermometer scores had gone from 7/10 to
3/10 for balloon popping, from 9/10 to 3/10 for party poppers and from 8/10 to 5/10
for the cap gun.
Conclusions: It appears that noise phobias in children are amenable to systematic
desensitisation The important factors appear to have been giving Lucy control to say
when and where the noises were made, and the use of inhibitors of the fear response,
which included relaxation, conservation and a playful environment
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Conclusions:
Phenelzine but not atenolol is effective in treating social phobia after eight weeks of
treatment.
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Results;
Applied relaxation showed 65% panic-free patients after the treatment, 82% panic-free after
one year.
CBT showed 74% panic-free patients after the treatment and 89% panic-free after a year.
These differences were not significant.
Complications such as generalised anxiety and depression were also reduced to within the
normal range after one year.
Conclusions: Both CBT and applied relaxation worked at reducing panic attacks, but it is
difficult to rule out some cognitive changes in the applied relaxation group even though this is
not focused on in this research.
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Within the approaches that have been covered, there are many more
treatments, for example there are biological treatments such as
electroconvulsive therapy.
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How many sessions did Lucy have to have before she became less fearful?
Which approach has treatments that remove the basis of the fear rather than
treating the symptoms?
What does the cognitive approach suggest as a way to treat anxiety disorders?
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How did Ost and Westling explain the similarity in findings between the two
therapy groups?
Introduction
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Introduction
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Dysfunctional
behaviour
Causes
Ways to treat it
Approach/
Perspective
Depression
Schizophrenia
Obsessive
compulsive
disorder
Anxiety disorder
Agoraphobia
Panic disorders
Bipolar disorder
ADHD
Compulsive eating
Kleptomania
Aspergers
syndrome
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Activity
1. Make a list of the strengths and weaknesses of each of the treatments
Strengths
Weaknesses
Behavioural
therapy
Drug treatments
Cognitive therapy
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Topic 4 - Disorders
Disorders refers to mental health problems that can affect an individual at some point,
or on a continuous basis through their life
Psychologists and Psychiatrists are interested in what types of mental health issues
affect individuals and the impact these disorders can have on their lives. To be clear on
what mental health issue a person is showing symptoms of a psychologist will look at the
type of disorder and The Characteristics of Disorders.
These characteristics help diagnose the disorder and also allow the
psychologist/psychiatrist to decide on a course of action to help the individual overcome
or alleviate their problem. Very generally speaking, there are three types of disorders:
1.
Anxiety Disorders such as phobias, panic disorder, post-traumatic stress
disorder and generalised anxiety disorders are typified by a continuous feeling of
fear and anxiety. This can have a huge impact on everyday life and make daily
functioning difficult.
2.
Affective Disorders refer to the disabling moods that individuals experience
which causes disruption to their social, family and work lives. Examples are
depression, bipolar disorder and dysthymia.
3.
A Psychotic Disorder relates to the concept of psychosis which is the general
term for disorders that are characterised by a loss of contact with reality. This can
be very confusing and frustrating for the individual and can lead to a withdrawal
from society. Schizophrenia is the most frequently reported psychotic disorder in
psychological literature.
The second section of Disorders will focus on Explanations of a disorder. We can
choose from either an anxiety or an affective or a psychotic disorder. We are focusing
on an anxiety disorder (phobias and generalised anxiety disorders).
To fully understand an anxiety disorder, psychologists try to explain them from various
perspectives:
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A Behavioural Explanation for a phobia would suggest that an individual has been
conditioned (classical conditioning) to fear that object or they are imitating the
behaviour of a role model (social learning theory) who has demonstrated that phobia.
A Biological Explanation of a phobia suggests that people are biologically prepared to
fear some objects more than others. For example more people are scared of snakes
than grass. This suggests a process of evolution that has resulted in fear of objects
that can harm you. This allows for the survival of our species.
A Cognitive Explanation for generalised anxiety disorder focuses on thinking patterns
and excessive worrying patterns. Worrying too much about something may result in
anxiety, even when in reality there is no reason to worry. Worrying about dangerous or
threatening phenomenon makes sense but worrying about things that do not pose a
threat creates unnecessary anxiety.
Biological Treatments might be used to treat a phobia. This usually involves the
use of psychopharmocotherapy or drug therapy. Other therapies may be used to
enhance the drug treatment such as cognitive therapy.
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COGNITIVE
PSYCHODYNAMIC
BIOPSYCHOLOGISTS
Characteristics of Disorders
Three categories of disorder
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PHOBIAS
Phobias essentially have a definite, persistent fear of a particular object or
situation. A stimulus such as a snake, dog, and a mans beard will provoke an
immediate response, which may be similar to a panic attack. The individual may
experience physical symptoms such as shortness of breath or palpitations, and may
feel intense terror and may begin to lose control. Even though the individual knows
that the fear is irrational they can still not control the immense terror the stimulus
produces. This response alone is not enough to be actually diagnosed with a phobic
disorder, if the fear disrupts the individuals day to day life, the disorder may be
diagnosed.
There are many different types of anxiety disorder including panic disorder,
generalised anxiety, post traumatic stress, and phobia.
Fidgeting or lethargy
disorder is extreme there are
Tiredness
milder, but problematic affective
Depressed mood
Reduced energy
bipolar disorder where the sufferer
Disturbed sleep
natural responses to events in our
Reduced appetite.
lives. However, you will see that the
characteristics of mood or affective
disorders are disabling moods. This means that the disorder prevents the individual
from leading a normal life, at work socially or within their family, which would cause
them to be diagnosed with depression or bipolar disorder.
Symptoms of Depression
Emotional
Sadness
Depressed Mood
Anhedonia (loss of
pleasure in usual activities)
Irritability
Physiological/behavioural
Sleep disturbance
Appetitive Disturbance
Psychomotor retardation or
agitation
Catatononia
Fatigue and loss of energy.
Cognitive Symptoms
Poor concentration,
Indecisiveness
Sense of worthlessness or guilt,
Poor Self esteem
Hopelessness, Suicidal Thoughts
Delusions and hallucinations with
depressing themes.
Bipolar mood fluctuates between manic episodes and depressive episodes, these
periods are often separated with periods of normality. Some individuals experience
symptoms very rapidly or very slowly and can the cycle between mania, normality and
depression can be sometime days, weeks to month and sometimes years.
Schizophrenia
Positive Symptoms present
symptoms
Delusions
Auditory hallucinations
Disorganised speech
Negative Symptoms
considered
to beof
DSM-IV
Classification
the loss or absence
of normal -Two or more of the
Schizophrenia
characteristics.
following
Losing emotional
responses
Delusions
Inability to feel
pleasure
Hallucinations
Lack of motivation
ICD-10 Classification of
Schizophrenia
Delusions of control
Hallucinatory voices
Persistent delusions
Summary: Characteristics of a
Disorder
Persistent hallucinations
Catatonic behaviour
pressure, while others would seem to burn out and show signs of physical
and /or mental illnesses.
What is also clear is that there is room for misdiagnosis, as some people may
show all the characteristics, or may show some to a greater or lesser degree.
Delusion of control.
Increased tiredness.
Reduced self esteem and self confidence.
Ideas of guilt and unworthiness.
Thought echo or broadcasting.
Bleak and pessimistic views of the future.
Trance-like behaviour.
Reduced appetite.
Can you give some examples of positive and negative symptoms of schizophrenia?
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1. Behavioural Explanations
Phobias are seen as learnt behaviour, either through classical conditioning, operant
conditioning or social learning theory.
Classical Conditioning Watson & Rayner (1920) conditioned a baby boy known as
Little Albert to fear white rats.
For several weeks, Albert played happily with a white rat
showing no fear. One day, while he was playing with the rat,
the experimenters struck a steel bar with a hammer close to
Alberts head. Albert was very frightened by the noise. This
was repeated each time he reached for the rat. Albert then
developed an intense fear of white rats (and Dr. Watson!).
UCR (Fear)
UCR (Fear)
CR (Fear)
This explanation sees the origin of phobias as through linking two things together
even though there is no logical, nor causal connection between them.
Conclusions:
Session 2 After five paired presentations the conditioning of a fear response was
evident and so it is possible to condition fear through classical conditioning.
Session 3 and 4 Transference of the fear had been made to other similar objects,
although it appeared the less like the original stimulus the objects were (e.g. the
cotton wool), the less negativity was shown.
Session 5 Time had not removed the fear response.
Unfortunately Albert was taken out of the hospital on the day of Session 5, so
Watson and Rayner were never able to carry out their aim of trying to find ways of
removing a phobia in the laboratory. We dont know if Albert had a fear of furry
animals for the rest of his life!
Research by Mary Cover Jones on Little Peter, (Jones, 1924) did show how a fear of
rabbits could be overcome using a treatment of systematic desensitisation.
Notes: Operant conditioning also provides am explanation for acquiring and reinforcing
a phobic behaviour. i.e Child in bed hears thunder runs to parents room, safe and
comforting. Next time thunder comes what are they going to do? Stay lonely in bed or
go to parents for comfort. Realise get cuddles if frightened of thunder so continue to
show fear. Behaviour becomes entrenched and fear reaction becomes an automatic
response.
SLT- Bandura discovered ps would develop fear of buzzer if saw someone else in pain
when it sounded.
Evaluation: Issues
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Each participant was wired up to a machine that would measure their skin
conductance.
They were given a shock at a level that they as an individual rated as definitely
uncomfortable but not painful.
Pictures were presented on coloured slides for 8 seconds and, if they were going
to be given a shock, it occurred immediately as the picture was shown.
Participants were seated comfortably and told that they would experience a
number of shocks and that they would see three different types of pictures:
snakes, human faces and houses.
32 participants received shocks after the snakes and of the other 32, 16 received
shocks after pictures of houses, and 16 received shocks after pictures of human
faces
Results;
All participants had a similar measure of skin conductance prior to the conditioned
stimulus (shock) being presented.
After the presentation of the shocks with the pictures the responses were as follows:
Participants shown snakes had on average .062 conductance to the snakes and .048
conductance to the houses and faces.
The higher the conductance the more they were sweating, which is a physiological
response to fear.
The control groups who were shocked after faces or houses showed only .037
conductance to their conditioned stimuli (houses or faces) and .030 to the neutral
stimuli that didnt appear with shocks.
N.B. the unit of measurement was micro mhos, which is a measure of conductance of
electricity.
Conclusions:
Participants were more likely to show fear reactions to snakes than houses or faces.
This shows a biological preparedness to develop phobias to objects that may cause us
danger, such as snakes.
For genetic explanation it is important to realise that people do not inherit a specific
gene for an illness, such as depression, rather, people inherit the vulnerability to it.
Activity
Fred Flintstone has a phobia of dinosaurs - explain in your own words how this phobia
could be explained in terms of biology
Explanation
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Results;
Significantly more patients with GAD reported excessive worry than non-patients.
More patients without GAD reported no-excessive worry.
Patients with GAD reported excessive worry for 59.1% of the day compared with
41.7% of non-GAD patients.
Conclusions:
Excessive worry, which indicates faulty thinking, is found in more GAD patients. Its
absence can be used to rule out a diagnosis of General Anxiety Disorder. Patients
with GAD spend more time each day worrying.
Evaluation: Issues
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As you can see there are many different approaches to explaining anxiety
disorders
It might be useful to adopt an eclectic approach and use parts of each of these to
fully understand phobias.
All the explanations have their strengths and weaknesses, some are better at
explaining some disorders than others.
What were the phobic objects to be conditioned in Ohman et als study on phobias
and preparedness?
What is GAD?
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1. Behavioural Treatments
Behavioural treatment would consist of trying to unlearn behaviours so that if two
stimuli are seen as linked together but are not connected causally, then the impression
of a connection should be broken.
The following techniques are just for interest- you only need to be familiar with
systematic desensitisation
Sometimes flooding is used. This means directly exposing the patients to the object, or
situation they fear. E.g. if you fear heights, then you would be taken to the top of a tall
building , and encouraged to stay there the idea being that as you stayed there you
would realise there was no basis to your fear and therefore the fear would disappear.
Another therapy is Implosion Therapy. This is where the patient imagines the fear
situation it is the same idea as flooding, only it is in the mind, not physical exposure.
Aversion therapy tries to get rid of maladaptive behaviours by linking them to painful
experiences. E.g. putting a chemical into cigarettes to make you sick when you smoke so
that you associate smoking with being sick and therefore stop smoking. Another example
is of homosexuals being shown pictures of naked men and then blasted with electric
shocks so that instead of being aroused by the stimulus they would associate it with pain
and be cured. The problem with aversion therapy is that it causes a great deal of pain,
but generally speaking does not change the behaviour.
Token Economies are exactly what they claim to be when a patient behaves in an
approved way, s/he is given a token, such as a plastic disc that can then be exchanged
for a privilege, and this reinforces appropriate behaviour. The problem is that patients
may act to get the token, thence the privilege, rather than genuinely have changed their
behaviour.
Sometimes patients are desensitised. They are taught relaxation techniques then they
construct a fear hierarchy, - what are they just afraid of, and what they are most
terrified of, then with the help of the therapist the patient confronts each item in the
hierarchy whilst in the state of deep relaxation. This way the association between the
object, or situation, and fear, is broken, and the patient has been counter-conditioned.
Results; At the end of the first session, Lucy was reluctant to let balloons be
burst. At the end of the first session, Lucy was reluctant to let balloons be burst
even at the far end of the corridor. When the therapist burst the balloon anyway
Lucy cried and had to be taken away. She was encouraged to breathe deeply and
relax.
By the end of the fourth session, Lucy was able to signal a balloon to be burst 10
metres away. , with only mild anxiety.
On the fifth session, Lucy was able to pop the balloons herself.
Over the next three sessions, Lucy was able to pull a party popper if the therapist
held it.
By the tenth and final session, Lucys fear thermometer scores had gone from
7/10 to 3/10 for balloon popping, from 9/10 to 3/10 for party poppers and from
8/10 to 5/10 for the cap gun.
Conclusions:
It appears that noise phobias in children are amenable to systematic desensitisation
The important factors appear to have been giving Lucy control to say when and where
the noises were made, and the use of inhibitors of the fear response, which included
relaxation, conservation and a playful environment
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Results;
After eight weeks significant differences were noted for the phenelzine
groups, with better scores on the tests for anxiety compared to the placebo
groups. There was no significant difference between the patients taking
atenolol and those taking a placebo
Conclusions:
Phenelzine but not atenolol is effective in treating social phobia after eight
weeks of treatment.
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3. Cognitive Treatments
Cognitive treatment looks at the way a person is thinking, and tries to get the patient to
see the errors in thinking that will help bring about a cure to the disorder itself. It also
extensively uses relaxation techniques for some disorders. Cognitive Behavioural
Therapy gets the patients to identify problem feelings, thoughts, and behaviours then
progress to identifying the distortions involved and to generate alternative thoughts
and responses, while identifying the dysfunctional beliefs and schemas that give rise to
the distortions. CBT is usually a highly successful therapy.
CBT has been used to treat panic attacks. Panic attacks are sudden surges of
overwhelming anxiety and fear. The first symptoms of a panic attack are likely to be
feeling flushed or hot, sweaty palms, a feeling that you cant catch your breath or you
are breathing too fast. When you are breathing in this way what you are doing is
reducing the amount of carbon dioxide that is in your lungs which creates these
symptoms which can be terrifying.
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The way the approach explains the disorder will lead to a treatment and each
treatment has strengths and weaknesses in terms of appropriateness and
effectiveness.
You must consider the ethical implications of the treatments and the reductionist
nature of them.
Again it may be useful to adopt an eclectic approach and use parts of these
theories to fully understand phobias and as before it is important to realise that
human behaviour including disorders has many causes. Some of which we still have
to identify.
None of the researchers are claiming 100% success rate, and so the final decision
must be left to the practitioner to decide the best way to help patients with a
mental disorder.
Compare approaches to treating the disorder you referred to in part (a) (15
marks)
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