AS Psychology/ Individual Differences - Unit 2



AS Psychology: Unit 2 PSYA2

(May Exam)

Individual Differences Booklet 2 (of 2):

Treating Psychological Abnormality

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Treating Psychological Abnormality

Treatments fall into two main areas: biological therapies and psychological therapies.

Biological Treatments and Therapies

Biological/medical therapies dominate the diagnosis and treatment of psychopathology. Medically trained psychiatrists and doctors are responsible for treating the majority of people with psychological disorders and therefore physical treatments based on the biological approach are by far the most common. There are two main areas here: drugs and electro-convulsive therapy (or ECT).

1, Drugs

Drugs are often used in the treatment of psychological disorders. They are used to treat directly the symptoms of a particular disorder. There are 2 main types of drugs used in the treatment of mental illness:

1, Anti-depressants

2, Anti-anxiety drugs

AO2 Evaluation of Drug Treatments:

2, Electro-Convulsive Therapy (or ECT)

AO1 Description of ECT:

Electro-Convulsive Therapy (or ECT) involves passing a small electric current through the brain which causes the equivalent of a seizure similar to an epileptic seizure.

ECT starts with the patient lying down on a bed and being given muscle relaxant drugs. The patient is then attached to a machine by placing electrodes against the temples of their head. They can be placed against both sides of the head (bilateral) or just to one (unilateral ECT).

A small amount of electrical current of 70-150 volts is then passed through the brain for 0.04 – 1 seconds. This produces a generalised convulsion in the patient which lasts up to a minute, affecting the entire brain. This process is usually repeated 3 times per week for up to 4 weeks.

As time has passed, ECT has been the subject of much controversy and is now recommended only for the most severe forms of depression. In around 50% of cases of severe depression that have proved resistant to drug and other therapies, ECT can be effective as a form of treatment.

AO2 Evaluation of ECT:

How could informed consent be gained in an ethical manner for these types of patients?

Exam-style Questions:

1, (a) Identify two drugs used in the treatment of psychological disorders. (2 marks)

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1, (b) Explain how these drugs might be used to treat psychological disorders. (4 marks)

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2, Outline two limitations of using drugs to treat a psychological disorder. (2 + 2 marks)

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3, Explain how ECT might be used to treat psychological disorders. (6 marks)

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4, Outline and evaluate one biological (medical) treatment of psychological disorders.

(8 marks)

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Psychological Therapies

Psychological therapies try to treat psychological abnormalities such as depression or anxiety disorders by trying address mental and/or behavioural issues (as opposed to the physical methods employed by biological treatments). There are three main areas here: psychoanalysis, systematic desensitisation and cognitive-behaviour therapy (CBT).

Therapies based on the Psychodynamic Approach:

The idea that underpins the pysychodynamic approach is that abnormality is caused by unconscious processes. Therefore, a general aim of psychoanalysis is to try to make the unconscious conscious or to undo unconscious forces that are causing problems (such as repression) through therapeutic regression.

Psychoanalysis

Examples of Psychoanalysis are:

1. Free Association

2. Dream analysis

1, Free Association

The client is encouraged to express anything that comes into their mind. This could begin with an account of what happened on the way to the therapist’s consulting room with the trail of thought being followed. The intention is for the therapist to help the client (patient) identify thoughts extending back to the client’s childhood. The client must not hold back or censor material at all in doing this in an attempt to lower ego defence mechanisms to access repressed material.

In this form of psychoanalysis, the analyst must remain faceless and ‘anonymous’ often achieved by the patient (or client) lying on a couch with the analyst sitting out of view. The analyst should not show emotion or talk about themselves at all. This is because the aim of the therapy is to encourage the patient to talk through repressed feelings, particularly those concerning childhood (repression) with the analyst acting almost as a ‘blank screen’ onto which the patient can express their feelings.

Jacobs (1984) describes the working alliance between therapist and client during psychoanalysis as two adults co-operating to understand the ‘child’ in the client. The role of the therapist is to intervene occasionally to encourage detail and some reflection on a particular experience. Freud’s free association was referred to as the ‘talking cure’.

2, Dream Interpretation (Psychoanalytic therapy)

Freud referred to dreams as the ‘royal road to the unconscious’. He argued that during dreams the normal barriers (ego defence mechanisms) to unconscious material were lifted and much of the imagery of dreams was symbolic of unconscious material. Therefore, by analysing the content of people’s dreams the therapist might be able to identify significant conflicts repressed into the unconscious.

Many objects in dreams are argued to be symbolic of other things. For example, objects such as swords, snakes or trains represent the penis and cupboards and tunnels represent the vagina. These symbols might tell the therapist something about aspects of the client’s psychosexual development. By identifying symbolic ideas from the clients’ unconscious, the client can then start working through these issues with the therapist.

AO2 Evaluation of Psychoanalysis:

Exam-style Questions:

1, Outline how psychoanalysis is used to treat psychological disorders. (6 marks)

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2, Helen is referred to a psychoanalyst to cure her fear of commitment in personal relationships. Explain how her analyst might approach this problem. (4 marks)

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3, Outline and evaluate how psychoanalysis is used to treat psychological disorders.

(12 marks)

Therapies based on the Behavioural Approach:

The idea that underpins the behavioural approach to abnormality is that abnormal behaviour is learnt in the same that we learn normal behaviour. Therefore, behaviourists suggest that just as someone might learn to be abnormal through a process of classical or operant conditioning, so too can they then be treated by learning to be normal.

1, Systematic Desensitisation (Behavioural therapy)

Systematic desensitisation (SD) is a form of therapy developed by Behavioural Psychologists to treat psychological abnormalities step by step (systematically). It is a form of counter-conditioning (reverse learning) where the therapist attempts to replace the client’s fear response with an alternative and harmless response.

SD involves using a hierarchy of increasingly fearful situations. The client is taught deep relaxation techniques (alternative harmless responses intended to eventually replace the fear response). The client firstly learns to associate (classical conditioning) the pleasant relaxation with the least fear-provoking situation at the bottom of the hierarchy (e.g. with a spider phobia this might be seeing a picture of a spider) and once this is achieved, the client is encouraged, step by step to progress up the hierarchy, associating the relaxed response with the fearful situation at each stage until they associate the most fearful situation at the top of the hierarchy (e.g. finding a tarantula in their bed) with the relaxed response.

This process is demonstrated in the famous case of ‘Little Peter’ in treating his phobia:

2, Aversion Therapy (Behavioural therapy)

As opposed to systematic desensitisation which aims to replace an undesirable association (such as a phobia), aversion therapy aims to associate an undesirable association (such as an addictive behaviour) with an unpleasant stimulus. It has a controversial history in that it was used in the 1950s to try and ‘cure’ homosexuality by pairing electric shocks with pictures of naked men. It was assumed homosexuals would learn to associate naked men with the fear of electric shocks. However, despite being ethically and scientifically unsound, there was never any evidence that it worked.

Nowadays, aversion therapy is sometimes used as therapy for addictions such as smoking. One way of doing this is by making the smoker feel sick using pills, simultaneously with their smoking. Through _____________ conditioning the feeling of sickness is associated with smoking and should act to prevent the person from smoking in the future.

AO2 Evaluation of Behavioural Therapies:

Exam-style Questions:

1, James is afraid of flying. Just thinking about flying causes him distress and even going to the airport is a problem. In order to overcome this fear, he consults a behavioural psychologist who feels that he may benefit from systematic de-sensitisation.

(a) Which approach to psychopathology would be most likely to advocate the use of

systematic de-sensitisation?

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(1 mark)

(b) Explain how systematic de-sensitisation might be carried out to overcome James’ fear.

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(6 marks)

2, Discuss the use of behavioural therapies in treating psychological disorders.

(12 marks)

Therapies based on the Cognitive Approach

The notion that underpins the cognitive approach is that psychological disorders result from irrational and dysfunctional thoughts. The aim of cognitive therapy then (more often referred to as cognitive-behavioural therapy) is to challenge these irrational thought processes and by replacing them with more rational ones, the psychological disorder can be dealt with.

Cognitive Behavioural Therapy (CBT)

Two examples of the cognitive behavioural therapy (CBT) are;

a) Beck’s cognitive therapy for depression.

b) Ellis’s rational-emotive therapy (RET).

Although the above examples were developed independently, they follow the same assumptions and share the same similarities.

1, Beck’s Cognitive Therapy for depression

Beck (1976) believed that negative schemata lead to pessimistic thoughts about the self, the world and the future (these factors contribute to the negative cognitive triad). These in turn lead to cognitive biases (e.g. minimisation, maximisation etc...) which in turn maintain the negative thoughts. The aim of Beck’s approach is to challenge these irrational cognitions and replace them with more realistic appraisals.

Firstly, the therapist must help the client identify particular negative thoughts (e.g. “I have never had a successful relationship and I never will”). To do this, the client is encouraged to keep a record of their lives including their thoughts and anxieties. These thoughts and anxieties can then be reviewed and negative automatic thoughts recognised. Using the record/diary, the therapist then challenges the client’s dysfunctional cognitions by drawing attention to positive examples or incidents that contradict the clients negative assumptions. This is known as ‘REALITY TESTING’.

Along with challenging the client’s negative thoughts and showing them to be irrational and unrealistic, Beck also uses behavioural techniques to encourage more positive behaviour. In severe depression, the client may find it impossible to do anything at all, as a result Beck would encourage them to set a small list of goals to be achieved (e.g. getting out of bed). In theory, these small achievements should help the client develop a sense of personal effectiveness.

Despite incorporating behavioural techniques as well as cognitive ones, the focus of this Beck’s therapy is very much on cognitive restructuring. The behavioural change without cognitive change is unlikely to alter the depressed state.

2, Ellis’ Rational-Emotive Behavioural Therapy (REBT)

Rational-Emotive Behavioural Therapy (REBT) was developed by Ellis (1957) and is based on the idea that many problems are actually the result of irrational thinking.

The ABC model developed by Ellis helps to demonstrate the idea that beliefs are the main influence behind our emotional well-being. A specific event can activate irrational thoughts and these in turn lead to negative emotions and maladaptive behaviours. These irrational thoughts need to be challenged and rationalised.

ABC Module (before REBT): ABC Module (after REBT):

(Negative) Activating Event (A) (Negative) Activating Event (A)

(Irrational) Belief (B) (Rational) Belief (B)

Consequence (C) Consequence (C)

Unhealthy Negative Emotion Healthy Negative Emotion

As it is not the negative event itself that causes unproductive behaviour, REBT attempts to change individual’s self-defeating thoughts. The client and the therapist work together to identify situations and negative reactions they produce so that the therapist can then help the client rationalise the situations, giving the client a more realistic perspective. During therapy, the client is encouraged to dispute their thoughts using the following techniques:

a) Logical disputing: self-defeating beliefs do not follow logically from the information available, (e.g. “does thinking this way make sense?”).

b) Empirical disputing: self-defeating beliefs may not be consistent with reality, (e.g. “Where is the proof that this belief is accurate?”)

c) Pragmatic disputing: emphasises the lack of usefulness of self-defeating beliefs. (e.g. “How is this belief likely to help me?”)

Effective disputing changes self-defeating beliefs into more rational beliefs, the individual can move from catastrophising (“I have really let my family down”) to more rational interpretations of events, (“I may have failed but if I work harder next time I will do better”). (See ABC model on previous page). This REBT process has also been used extensively in the treatment of depression but also in the treatment of anxiety-related disorders where anxious thoughts are seen to be driving the disorder. Ellis’ REBT is a more confrontational approach to therapy than Beck, challenging the client’s self-defeating beliefs in intense debates as opposed to the calmer ‘reality testing’ favoured by Beck.

AO2: Evaluation of CBT

Exam-style Questions:

1, Claire constantly worries that she will be unable to finish a task. She thinks that if she does not complete it perfectly, it will not be worth doing. These thoughts are so bad that she finds it difficult to start anything and her work is suffering.

1, (a) Outline what is involved in Cognitive Behavioural Therapy.

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(3 marks)

(b) Why might Cognitive Behavioural Therapy be appropriate for Claire?

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(2 marks)

2, Discuss the use of Cognitibe Behavioural Therapy in treating psychological disorders.

(12 marks)

Treatments and Therapies:

Extension Material

Biological Treatment: Drugs

Useful terms used in describing drug treatments:

Dopamine and Serotonin are both neurotransmitters which have been associated with a number or behaviours.

High levels of dopamine have been linked to schizophrenia. Low levels of serotonin are related to depression and high levels have been linked to anxiety.

Biological Therapy: Electro-Convulsive Therapy (ECT)

Below are some statements about ECT. Which ones are True (T) and which are False (F)?

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|Statements; |T or F? |

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|ECT is only done unilaterally. | |

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|ECT always involves electrodes being placed on either side of a person’s | |

|head. | |

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|The electrical current that is applied is moderately strong (about 100 | |

|volts). | |

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|The duration of the shock lasts for about half a second. | |

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|Patients are usually given ECT once a week. | |

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|The reason why ECT works is not known. | |

| | |

Behavioural Therapy: Systematic Desensitisation (SD)

• Step 1: Patient is taught how to relax their muscles completely. (A relaxed state is incompatible with anxiety).

• Step 2: Therapist and patient together construct a desensitisation hierarchy – a series of imagined scenes, each more causing a little more anxiety than the previous one.

• Step 3: Patient starts at the bottom of the desensitisation hierarchy, visualising the anxiety evoking event while engaging in completing the relaxation response.

• Step 4: Once the patient has mastered the first step in the hierarchy (i.e. they can remain relaxed while imagining it), they are ready to move onto the next and they can gradually work their way through the desensitisation hierarchy in this manner.

• Step 5: Patient eventually masters the feared situation that caused them to seek help in the first place.

Activity: Using your knowledge of how systematic desensitisation (SD) works, imagine you are a behavioural therapist and try to put together a desensitisation hierarchy for a patient of yours suffering from a fear of flying in aeroplanes to use:

Situation 4:

(most fearful)

Situation 3:

Situation 2:

Situation 1:

(least fearful)

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Specification:

• Biological treatments and therapies: including Drugs and Electro-Convulsive Therapy (ECT)

• Psychological therapies: including Psychoanalysis, Systematic desensitisation and Cognitive-Behavioural Therapy (CBT)

Key skills covered in this booklet:

• Communication: C2.1a, C3.1a,

• ICT: ICT2.1

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ECT can be an effective treatment:

This means that there is evidence to suggest ECT can work in treating severe forms of depression and in those cases it can actually be life-saving. Evidence to support this comes from Corner (2002) who found that 60-70% of ECT patients’ symptoms improve after treatment. This is positive as it suggests ECT can be useful when other therapies have failed and when the depression is so severe it could lead to suicide, the ECT might be life-saving.

Depression may be based on a perfectly rational and accurate perception of reality:

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However, there are conditions where CBT seems less effective:

This means that CBT has been suggested to be less effective than other treatments I treating some specific disorders. For example, behavioural therapies might be more effective in treating phobias, while more severe conditions such as schizophrenia might be dealt with better through antipsychotic drugs than CBT. This is a problem because it suggests CBT is not always the best therapy for all conditions.

CBT has been shown to be effective for a variety of situations:

This means that CBT has generally done well in outcome studies (studies designed to measure responses to treatment). For example, Engels et al (1993) concluded CBT is an effective treatment for a range of clinical disorders such as obsessive-compulsive disorder and social phobia as well as other disorders (and non-clinical problems such as stress). This is positive because it suggests CBT can be useful to more people than many other treatments.

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AO2

AO1

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There are major ethical issues related to behavioural therapies:

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Little Peter (Jones, 1924):

Little Peter was a two-year old who had an extreme fear of rabbits,

rats, fur coats and feathers amongst other things. In all other

respects, Little Peter was considered well-adjusted. Jones,

supervised by Watson, put a rabbit in a wire cage in front of Peter

while he ate his lunch. Over a series of sessions, Jones gradually

brought the rabbit closer and closer. After 17 steps, gradually

breaking down Peter’s barriers, Peter ate his lunch with one hand

while he stroked the rabbit he once had an extreme fear of (now on

his lap) with the other hand. This is an early example of systematic desensitisation.

AO2

Psychoanalysis is effective:

Psychoanalysis raises major ethical issues:

This means that because psychoanalysis aims to bring often very painful memories from earlier life into the conscious mind, this can mean there is a lack of protection from harm. For example, some childhood sexual abuse cases can be very traumatic to recall, not only for the individual in therapy themselves but for the whole family. This is a problem as it may be very traumatic for the participants involved.

Critics claim psychoanalysis plants ‘false memories’ in patients:

This means that some critics have argued that, instead of helping patients to ‘recover repressed’ memories, therapists often unwittingly plant ‘false memories’ in patients minds by misinterpreting dreams or encouraging inaccurate recall. For example, Loftus (1995) has shown that many people struggle to accurately recall memories from early life. This is a problem as the therapy may be based on unreliable memories.

Recap key features of abnormality according to the behavioural approach:

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2, Anti-anxiety Drugs (Benzodiazepines)

Often also referred to as minor tranquilisers, benzodiazepines (BZs)

include Librium and Valium. These anti-anxiety drugs are used to

treat a range of anxiety disorders and sleep disorders.

GABA is a neurotransmitter that is the body’s natural form of anxiety relief and has a general ‘quietening’ effect on many of the neurons in the brain. BZ’s therefore work by enhancing the activity of GABA and thus reducing anxiety.

Recap key features of abnormality according to the cognitive approach:

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AO1

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Recap key features of the psychodynamic approach:

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Behavioural therapies less successful for more complex disorders:

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ECT raises major ethical issues.

This means that ECT might not only fail to protect patients from psychological harm (in the form of memory damage), but also that it is often difficult to gain full informed consent. For example, ECT is now only recommended for severely depressed people and they may not fully grasp the nature and consequences of ECT and so cannot give their full informed consent. This is a problem as it goes against the ethical guidelines if true full informed consent cannot be gained.

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Systematic desensitisation extremely effective treating simple phobias:

This means that SD has been shown to an extremely successful therapy for spider phobics and blood injection phobics amongst other ‘simple’ phobias. Evidence to support this comes from Barlow et al (2002) who found success rates of between 60 and 90 per cent for these types of phobias. This is positive because despite the emphasis on symptoms rather than causes of the phobias as such, there is no evidence that this success is temporary.

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ECT can cause serious damage to the patient:

This means that there are a number of reported harmful side effects of ECT. For example, impaired memory, headaches, cardiovascular changes. This is a problem because ECT may be doing more harm than good in trying to treat psychological disorders.

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Drugs can have side effects:

This means drugs can have negative unintended effects on the patient. For example, drowsiness, dizziness, insomnia, nausea, sexual dysfunction, or, more seriously, suicidal thoughts or aggressive tendencies. This is a problem as it can mean drugs are doing more harm than good and can lead to patients not taking their medications.

Drugs are effective (the drugs do work!):

This means drugs’ effectiveness has been assessed by comparing outcomes when some anxious patients are given a drug and others are given a placebo (a substance that has no medical effects on the body) but patients do not know whether it is the real thing or the placebo.

Evidence from Kahn et al (1986) using nearly 250 patients in this way over 8 weeks found that BZs were significantly superior to placebos in treating anxiety disorders. This is positive as it suggests drugs are effective over and above the effects of just thinking you are taking something that will improve your anxiety levels.

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Treating the symptoms, not the problem:

This means drugs may be very effective at treating symptoms, but this lasts only as long as the drugs are taken. For example, as soon as you stop taking the drugs, the effectiveness ceases. This is a problem because it may not be appropriate simply to put a temporary “bandage” on the problem and so it may be preferable to seek a treatment that addresses the problem itself rather than dealing only with the symptoms.

1, Anti-depressants

Most commonly used to treat depression, anti-depressants (e.g. Prozac)

work by raising levels of serotonin in the brain (as low levels of serotonin

had been linked with an increased likelihood of depression).

In normal brains, serotonin is constantly being released from the nerve endings, stimulating the adjacent neurons. However, sometimes the mechanism fails and the serotonin is reabsorbed into the nerve ending before it can stimulate the neighbouring neuron. Prozac works by reducing the rate of re-absorption meaning that serotonin levels don’t drop and the patients mood can remain consistent.

Prozac is usually taken over the course of weeks, months or even years and is successful in treating conditions other than depression including obsessive-compulsive disorder.

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