psychology revision

1. Psychology Revision Clinical Psychology

3. What is Abnormality? Deviation from the statistical norm. If most people can do something, it seems logical to assume those who can�t must be abnormal. It provides a clear cut-off point for those who are �different.� However, being �different� does not classify abnormality. It can be a good thing to deviate, e.g., �gifted & talented� people deviate from the statistical norm in a �good� way. Sometimes statistics can change, e.g., IQ levels have increased over the past 100 years, this implies that someone with a certain score 100 years ago would now be regarded as mentally retarded. Homosexuality is statistically abnormal but this does not mean that homosexuality should be categorised as a form of mental illness. Statistics aren�t always a valid measure of something (e.g. Intelligence). One score may not accurately reflect behaviour or cognition; it may also be necessary to use more than one measure (& more than one score) to get an accurate gauge of statistical average behaviour/attitudes.

4. What is abnormality? Personal Suffering/Distress It is good because it takes into account the subjective nature of suffering: it is different for everybody However, some people may not be aware of their condition People have different ideas about what it is to �suffer�: it is therefore very hard to measure & quantify & so too subjective to be of much value Some may exaggerate symptoms when defining mental health It relies on the sufferer to show signs of their condition Psychopaths may feel no distress whatsoever but are nevertheless regarded as having a clinical condition Failure to function adequately Maladaptiveness of behaviour when the behaviour is not adapted well to a situation then it will cause abnormality Condition is often very obvious However, it is based on value judgements - too subjective Society may be the problem, not the individual

5. What is abnormality? Absence of normality Deviation of the expected - the mental health criteria Jahoda (1958) wrote criteria for ideal mental health: Freedom from mental illness Self-actualisation Autonomy Mastery of the environment However, these are based on value judgements Values change all the time Highly context-significant It is difficult to keep with definite characteristics People have different ideas about self-actualisation/none at all

6. Problems with defining abnormality The problems with all of these definitions is that there is no one, shared characteristic implying that no one definition is enough There�s no fixed point between normal and abnormal - a continuum

7. Classification Systems Advantages Allows people to get treated more effectively due to more minority groups: not �lumping� people together A way of investing different situations Allows people to �pool� information and research that group The first step towards diagnosis > treatment

8. Validity Aeitological Validity That people with a particular disorder have the same causal factors Concurrent Validity When you have on-set of symptoms, you have associated conditions e.g. age of onset, social factors Predictive Validity Whether the results match up with what�s predicted

9. Validity The Diagnosis should be a genuine & accurate reflection of the condition diagnosed. This is not as straightforward as it seems Rosenhan (1973) �Being Sane in Insane Places� is a classic study which shows the problems of validity with regard to clinical conditions. (NB., One Flew Over The Cuckoo�s Nest). Bi-Polar Disorder (manic depression) is often misdiagnosed as Schizophrenia because the symptoms can be very similar. Different types of conditions may often have similar symptoms, e.g., paranoia is associated with schizophrenia & substance abuse

10. Reliability Both physical and clinical conditions are not as easy to diagnose as you may expect Reliability for angina and tonsillitis is lower than that of schizophrenia Cooper et al. (1972) showed psychologists had different diagnoses for the same conditions when watching a video clip of patients. Americans were twice as likely to diagnose schizophrenia than British, who diagnosed bipolar disorder more often. This proves that a classification system relies on more than just symptoms Spitzer & Williams (1985) found that psychologists agreed on a diagnosis only 50% of the time Zigler & Phillips (1961) found that agreement for clinical categories was 54-84% e.g. personality disorders

11. Reliability Kendell (1975) found only a 33-57% agreement about more specific definitions Davison & Neale (1994) Psychosexual conditions are more reliable (92%) because it is easier to diagnose unlike any other disorder. For somatoform disorders it drops to 0.54% Fallek & Moser (1975) found a 66% concordance rate with the post mortem and the cause of death on the certificate A problem with a lot of diagnoses is that they are nebulous (vague)

12. Interviews Often the diagnosis takes place through a clinical interview, which are unstructured so the same questions aren�t asked each time so different conclusions can be drawn through the different information Self-report is also another unreliable method to diagnose conditions These methods lack objectivity so reliability and validity are harder Doctors may not be given the same information each time and in the same manner Doctors also only spend a short amount of time with each patient, so accurate diagnosis is difficult Some people may exaggerate symptoms to get a result (e.g. faster cure, sick leave etc.)

13. Classification Systems General Problems Creates a circular argument Do symptoms classify the illness or does the illness classify the symptoms They may not help if there�s no treatment available Mental health is a continuum, and there is no clear cut-off point, so conditions will not fall into a particular category Goffman argues that classifying people stigmatises them It attaches a negative label, to which people will make assumptions which is unfair Scheff believes that this will induce self-fulfilling prophecy, whereby people will live up to their label Heather introduce the concept of institutionalisation, believing that people can become dependant on their surroundings

14. Classification Systems General Problems Szasz thought that classifying people often caused them to medicalize behaviour meaning they will use drug treatment for all behaviour, when really the people are just unpredictable people who have problems with living. By classifying them, society is trying to �control� unpredictable people. It is easier to blame an individual than to blame society. Blaney (1975) however, believed labelling people was quite humane. It�s not saying that you are bad, but merely allowing you to know it�s not your fault Sometimes however, the condition can be used as a scapegoat for people who do not take responsibility

15. Classification Systems General Problems R.D. Laing thought that schizophrenia is not a breakdown, it�s a break-through. To deal with it rationally, and confronting it is better than just labelling it as a �disorder� It has focus more in the individual, and not the cause (e.g. families) It diagnoses the symptoms and not the individual It should not be diagnosed due to social norms McCrae and Costa (1992) introduced a theory of 5-factor analysis: Agreeableness & Openness to experience/Not Stable/Neurotic Conscientious/un-conscientious However this approach only applies to personality, and there is not clear cut-off point It ignores social facilities, subjective distress and biological factors

16. International Classification of Disease (ICD) ICD This involves one broad category, and describes symptoms It matches references between causes It is more 1-dimensional than the DSM It links class and culture, looking at a variety of cultures, not like DSM, which is westernised However, this can cause a lot of �cultural baggage� to be carried

17. Diagnostic & Statistical Manuel of Mental Disorders (DSM) DSM is the US method of diagnosing mental disorders (NB., Western psychiatric bias). It is a multi-axial system � there are 5 axis. For a diagnosis to be made the patient must meet criteria on at least the first 3 axis (although all 5 are considered). Evaluation of DSM DSM is continually updated to take into account new research & changes in cultural attitudes, this helps to improve reliability & validity. The inter-rater & test-retest reliability of some disorders is now very good; however, other disorders remain low, notably childhood disorders The multi-axial nature of DSM improves validity because diagnosis is not based on one aspect or feature of behaviour/cognition, social factors & level of personal functioning is also considered, for example. DSM has been prone to cultural/social bias, e.g., homosexuality was on DSM until 1980, now Maths phobia is on DSM.

18. Cultural factors affecting the diagnosis of clinical conditions Cultural ideas differ in some cultures, and between some cultures Banyard (1996) found that 5% of the UK population is black, but 25% of psychiatric patients are black This could be due to racism, or that it�s harder to be a minority group therefore more conditions arise, or diagnoses could be culturally biased (made by white, middle-class Drs) Lilwood (1992) believed axis V (G.A.S. (1-100)) placed too much emphasis on the nuclear family. Different families have different cultural traditions, and behaviour is different for different cultures Davidson and Neale (1994) found that Asian-American women are seen as more subservient/withdrawn. Emphasis may be placed on a disorder, but their culture may make their behaviour normal to them It can be bad to acknowledge some cultural differences O�Conner (1989) found native Americans get lower IQ scores than white Americans. This is because the IQ test is designed from a western perspective. Western influences often emphasise the importance of the individual, and not the importance of teamwork, which is favoured in other cultures

19. The importance of cultural factors with classification Rack (1982) found that rates of depression are very low in Asian countries, which would suggest that aetiological factors are restricted to western cultures ? status anxiety? Too much choice? However, he realised that rates were actually similar, but those in more eastern cultures are more reluctant to seek help for depression due to the stigma attached to depression as a mental illness. In China, it was found that people only went to seek help for mental disorder when the symptoms are undeniably clear Cochrane (197) discovered that black people were between 2 and 7 times more likely to be admitted to an institute with schizophrenia. If you were white, you were also more likely to be admitted with less severe symptoms. Symptoms are more recognizable in white people so they are more likely to be admitted early ? white psychiatrists have similar cultural frames of reference. It could also relate to the access of healthcare. There is less understanding because few doctors are black/Asian. This could be due to social drift ? when you slide down the �social ladder� when you�re mentally ill. People with a lower SES are less likely to be registered with a GP. Ethnic minority groups are usually lower un the SES ? language problems?

20. The importance of cultural factors with classification Brislin (1993) thought that there are at least 3 possible ways in which culture influences clinical conditions: The form the symptoms take (how they show themselves) Different cultures have different ways of manifesting symptoms E.g. 1920s ? schizophrenics heard voices through the radio, 1950s ? they heard voices through the TV, 1960�s ? space, 1980s ? microwaves Triggers (precipitatory factors) in different societies are different Haughton (1972) found that primitive African tribes with problems would talk to a witch doctor, who would try and find out who cast a spell on them, Often illness was caused by stress, so the poor relationships were improved, therefore reliving stress Prognosis in different cultures is different Kleinman & Lin (1988) thought it would be better to have schizophrenia in non-westernised countries because the lifestyle is much simpler. Non-westernised cultures have a higher emphasis on family values, so there is less chance of social isolation, and you can fit into society better with their support Self-worth ? can be low due to poor social interaction, with which drugs can�t helps therefore there's lower self-worth in cultures where society isolates those with mental problems

21. The importance of cultural factors with classification Culture bound syndromes When we define mental illness, it�s usually done by a middle-class, white person, so anything that�s not usual to this culture will be ignored, or unclassified, so they are often under-diagnosed Fernando (1991) thought that many illnesses classified using western classification systems don�t recognize other forms of abnormality; they don�t accept forms that go against the paradigm ? ethno-centric bias Some conditions are diagnosed more frequently in one gender than another, which suggests a gender-bias in diagnosis. However, this could be due to the socialization of women/men, and their willingness to see the doctor. There may also be some genuine biological factors in diagnosis HISTRIORIC PERSONALITY DISORDER ? extrovert, OTT: associated with women, �drama queen� DEPENDANT PERSONALITY DISORDER ? �clingy�, attached: associated with women NARCISSISTIC PERSONALITY DISORDER ? Obsessive vanity: associated with men OBSESSIVE COMPULSIVE DISORDER ? diagnosed more in men These prove how our socialized impressions of men and women give us pre-conceptions of their roles. Some of these conditions may be diagnosed if the behaviour is away from our socialized norm

22. The importance of cultural factors with classification Too much emphasis on differences in cultures may mean that if one culture suffers from a problem, they will all be ignored ? �it�s a part of their culture�, which could lead to under-diagnosis However, there is an over-diagnosis in some cultures (e.g. black people and schizophrenia) With these problems it�s often easy to avoid the importance of diagnosis

23. Approaches & clinical psychology The Biomedical Model

24. Outline of biomedical approach Clinical conditions can be understood in the same way as physical disorders. Emphasis on biological/physiological explanations, e.g., genes, neurotransmitters (serotonin, dopamine hypothesis, brain structure). Focus is on physiological aspects of mental disorder rather than behavioural, cognitive, emotional or social aspects. Clinical conditions can be treated physically because they are physical in cause, I.e., through chemotherapy (drugs), ECT, psychosurgery.

25. Evaluation of biomedical model Evidence for biological explanations from twin studies, e.g., Gottesman & concordance for MZ twins & schizophrenia. Evidence for dopamine hypothesis, serotonin levels in depression. Biological treatments for clinical conditions can be very effective, e.g., anti-depressants, anti-psychotics, ECT for severe clinical depression. Side-effects of drug treatments, problems of dependency. Treats symptoms not underlying cause of problem. Problems of cause and effect, i.e., is schizophrenia caused by too much dopamine or does the condition itself lead to too much dopamine being produced? I.e., behaviour may affect biology, not the other way around. Concept of �no blame� i.e., person cannot help their condition because it is physical and beyond their control BUT does this remove personal �responsibility� from person with illness to the health care professional. Biomedical explanations ignore contributions made by social & psychological factors.

26. Behavioural model Clinical disorders are explained as patterns of learned maladaptive behaviour. Focus is on observable behaviour as opposed to physiological, emotional, cognitive or social factors. We learn maladaptive behaviours through processes of classical and operant conditioning and social learning theory. Mental disorders can be treated using behavioural therapies which aim to replace maladaptive behaviour with adaptive behaviour through classical & operant conditioning � e.g., flooding, aversion therapy, token economies.

27. Evaluation of behavioural model There is lots of empirical evidence to support the concepts behind behavioural model � although a lot of this research has been done on animals. Behavioural techniques have proved effective in treating some types of disorders, even some of the behavioural aspects of schizophrenia. Avoids labelling person, I.e, they have not got an �illness� but maladaptive behaviour, it is the behaviour, not the person, that is the problem. This approach simply focuses on the outward manifestation of the problem � the behaviour, not the underlying cause of this behaviour. This can lead to symptom substitution � where one symptom or behaviour is treated but re-emerges or manifests itself as another type of maladaptive behaviour. It underestimates the complexity of humans, we are simply �learning machines� at the mercy of our environment, cognitive factors (mental processes) intervene between stimulus & response. It seems unlikely that complex clinical conditions can be learned.

28. The cognitive model This approach aims to explain specific features of clinical conditions, rather than the illness in its entirety, e.g., cognitive approach can explain symptoms of schizophrenia such as thought insertion, or poverty of speech & thought The cognitive approach focuses on cognitive processes such as memory, distorted/irrational thinking & other perceptual problems, rather than biological, behavioural, emotional or social problems. Cognition can affect physiological functioning & vice versa. If symptoms of mental illness are cognitive in nature, then treatment should involve tackling cognition, i.e., challenging irrational beliefs, distorted thinking. E.g., Ellis� ABCDE paradigm: A=activating experience B=belief C=consequences D=Disputing belief E=effects of successfully disputing belief. Beck�s cognitive triad=Negative view of self; Negative view of future; Negative view of world Beck argued that automatic negative thoughts overwhelmed people with clinical problems. Mental illness can be explained by negative self-schemas which often develop early in childhood. The role of the cognitive therapist is to suggest to the client new ways of interpreting situations perceived as negative.

29. Evaluation of cognitive model There is much scientific support for this approach, e.g., Gustafson (1992) found that maladaptive thinking processes were displayed in many people with psychological disorders, such as depression, anxiety & sexual disorders. There is also a lot of support for Beck�s & Ellis�s cognitive model of mental illness. There is little empirical support for the concept of schemas in relation to mental illness. The cognitive model emphasises the role of individual & being self-sufficient (the individual can almost think themselves better); therefore, it tends to devalue social support systems and places �responsibility� for issues with the individual, not the social environment. Cognitive-behavioural therapy has been shown to be very effective with a range of disorders, especially clinical depression, but also schizophrenia. Treatment, like the behaviourist approach, is practical & problem-solving in nature, but is also empowering for the individual as they can learn to control the excessively negative thoughts & emotions which can detrimentally affect their lives. Between 50-60% of depressed clients treated with cognitive therapy show total remission of symptoms (Hollon et al., 1993) Improvements in self-concept produced by cognitive therapy correlate with lifting of depression (Pace & Dixon, 1993). However, the demand for cognitive therapy to treat clinical depression often outstrips the supply of trained psychology professionals. Like the biological model there are problems with cause & effect, i.e., maladaptive thinking processes may be the result and not the cause of the psychological disorder, e.g., low serotonin levels may lead to depressed thoughts, or depressed thoughts may result in lower serotonin.

30. The psychodynamic model The focus is on early relationships, especially with parents, and how this can affect mental health & well-being in later adult life. Early traumatic experiences are associated with later mental health problems. These early experiences are retained in our unconscious mind & affect our later conscious feelings, motives & relationships. We often use defence mechanisms to prevent use from confronting these traumatic experiences, which often result from conflicts between the demands of the id, ego & superego. Freud used the term �hydraulic model� to explain his concept of personality; we often bury trauma, conflict & repressed emotions but this can lead to a build up of pressure (hence term hydraulic) & tension which needs to be vented in some way, I.e., we have to figuratively �blow off steam� in some way. Treatment involves uncovering these unconscious elements through psychoanalysis in order to achieve catharsis � the safe release of this unconscious tension/psychic energy.

31. Evaluation of the psychodynamic model Some aspects of Freudian theory have support, especially notion of importance of early childhood experience, e.g., Brown & Harris. However, many other aspects of theory have little scientific support & are difficult to test empirically because they are subjective & revolve around the unconscious (NB., just because something cannot be scientifically tested does not mean it is not necessarily correct.) Freud�s theory was based on a limited & atypical sample. Freud was instrumental in changing the way we think about mental illness and psychoanalysis (and Brief Dynamic Therapy) have been shown to be effective in treating some forms of mental illness (and are better than treatment at all). Psychoanalysis can take months or even years, and therefore can be expensive.

32. The Humanistic Model People have a basic tendency to grow & fulfil their potential: to self-actualise Problems arise when a person cannot realise their full potential and is prevented from doing so because of the demands/constraints of society & family etc. People cannot self-actualise because they make personally inappropriate life-choices which prevent them from exercising their potential & being true to themselves. Where incongruence exists, a large gap between self-concept and ideal self, a lack of self-esteem can result and this can prevent an individual from making life choices that they want to. Incongruence can result through a lack of unconditional positive regard and a sense of doing things to get positive regard from others. Hence there is a strong association between mental health and having a healthy self-image and strong sense of self-esteem. The primary concern of this approach, like the psychodynamic approach, is on emotion, as opposed to biology, cognition or behaviour. People are essentially future-orientated, and under the right circumstances will make the best choices for themselves. The aim of this approach is to help people make the right choices and so fulfil their human potential. Therapists (practising person-centred therapy) need to exhibit three core characteristics to help their clients achieve this: Empathy, Congruence/Genuineness, Unconditional Positive Regard/Non-Judgemental.

33. Evaluation of the Humanistic model Numerous studies have supported a link between parenting style, self-esteem and mental health. Research has shown that children with higher self-esteem have improved self-concept which has also been associated with greater achievement (or actualisation). [Lau & Pun, 1999; Burnett, 1999.] However, it is generally argued that the humanistic approach does not lend itself to scientific (empirical) research easily, thus the scientific evidence supporting this approach can be limited. Related to the above point, the concepts in the humanistic approach, e.g., self-actualisation & self-concept, can be quite vague/nebulous and subjective, making them hard to quantify and measure objectively (key features of scientific study). Many people never self-actualise but still some to be perfectly happy. Person-centred therapy, with its emphasis on personal growth, rather than illness, avoids the problem of labelling or stigmatising an individual. However, it has been argued that this approach is often overly optimistic about the human condition and experience. It is also a reflection of the American culture it emerged from, i.e., it focuses on the individual which may be a good thing in some respects � but it disregards social and environmental factors which may be beyond the control of the individual, e.g., jobs, housing. The humanistic approach requires a certain amount of personal insight, in order to be able to talk about one�s own experiences and choices; in many cases people suffering from more profound clinical condition have limited or no insight into their condition. Person-centred therapy concentrates on the individual not the problem. However, while this might be a good thing most of the time, there are some situations where the problem may need addressing, e.g., a neurochcemical imbalance. Rogers did not explain in the same detail as alternative theories, e.g., cognitive, social learning theory, exactly how parenting, self-esteem and mental health are linked. This apporach may be useful for people to whom spirituality is important.

34. The Social Model The development of diagnostic categories, such as schizophrenia, anxiety disorders, affective disorders, and the actual process of diagnosis is rooted in social processes, e.g., making judgements about what is and is not abnormal. Social factors, such as poor relationships & family communication (expressed emotion), low socio-economic status & related issues, may predispose or precipitate a clinical problem. The emphasis is on social explanations of disorders rather than on individual emotional experiences, or other psychological & biological factors. E.g., feminists emphasise the role of the relative social power of ment & women in the development of mental disorders in women. Clinical problems can be treated using social, as well as psychological & biological interventions. E.g., care-in-the community programmes, drop-in centres, social skills training and help with day-to-day living. Traditionally people suffering from mental health problems where placed in mental institutions, where, as Goffman (1968) argues, they would be subject to social control and become �institutionalised�. R.D. Laing famously suggested mental illness was a fairly �rational� response to the sense of alienation felt by many and to the intense pressure of family life & society: people are obsessed with maintaining the �status quo� and strive to maintain their own definition of reality: �Madness need not be breakdown�it may also be breakthrough� Thomas Szasz, The Myth of Mental Illness, argued that mental illness is better viewed as a problem in living, which is socially expressed, rather than an mental illness; he argued against the �medicalisation� of what he regarded as essentially social problems. He suggested clinical diagnosis is a form of symbolic recapture, where society tries to predict an individual�s behaviour, yet because mentally ill people are unpredictable society tries to label & stigmatise such people in order to make them more controllable, I.e., they are hospitalised or given chemotherapy to make them more pliable and predictable.

35. Evaluation of the Social Model Social explanations provide a contrast with the individual explanations offered by other biological & psychological perspectives. There is some evidence to suggest a link between social factors, e.g., social relationships & socio-economic status and mental illness, e.g., Brown & Harris (1978); Expressed emotion and rates of relapse for schizophrenia (Brown, 1973) [NB., this only supports factors to do with relapse and not causation.] Consider evidence for & against social drift & social causation as explanations of clinical disorders. Care-in-the-community is seen as a better, more effective and ethical treatment of mental illness than other treatments, such as hospitalisation and chemotherapy, as it avoids the problems associated with institutionalisation and subsequent labelling and stigmatisation and the problems of dependency and side effects of some drug therapies. Patients in care-in-the-community programmes are often happier and make better progress than long-term hospitalised patients (Hogarty, 1993). Care-in-the-community allows patients to retain family & friendship ties & support more easily. However, care-in-the community programmes, drop-in centres, 24 hour helplines etc.are often not well-funded (mental illness is often not seen as a funding priority), or coordinated and there is often a lack of expert/skilled mental health practitioners available. If the social environment is the cause of the problem and cannot be influenced then other forms of treatment might be more effective. Evidence shows that the supportive atmosphere of half-way houses aids recovery from schizophrenia. Lack of continuity in who deals with patient may lead to problems. If patients are in the community it may be more difficult to ensure compliance with drug therapies due to lack of control. This can in turn lead to the �revolving door syndrome.� The presence of support in the community does not mean patients will use it. Social explanations are often regarded as merely incidental to, or amplifications of other biological/psychological explanations, not as explanations in themselves (per se). They are usually incorporated into a diatheis-stress explanation of mental illness (I.e, there is an underlying biological or psychological cause which requires some kind of external/social trigger in order for the disorder to manifest itself and develop.

36. Therapies & Treatment The Medical Model This states the idea that mental problems are caused by physical malfunctions ? treatment must be physical also Psycho-surgery Surgical processes to alter psychological malfunction Freeman and Watts (1942) developed modern frontal lobotomy, but lack of scientific nature, unpredictability and it�s side effects meant that it was not done Psycho-surgery is now used, and is treatment for conditions like OCD, depression and violent behaviour

37. Therapies & Treatment Chemotherapy Use of drugs to treat psychological conditions Used to treat schizophrenia and steroid abuse Drugs are used to block dopamine receptors (post-synaptic sites) in the brain SSRI � Serotonin levels are affected to treat depression They often have unpleasant side effects With drugs there�s often a strong chance of relapse They can take up to 4 weeks to work Electronic Compulsive Therapy (ECD) Electrodes are attached at 110V for 30s � 4 mins through temples Treats depression, bipolar disorder and OCD Used on 20,000 people p.y Much quicker than drugs therapy High success rate, but the treatment is very unpleasant

38. Therapies & Treatment The Social Approach Community Psychology Good mental health from correct interaction with community environment Against institutionalisation because it prevents people from interacting with others in a �normal� way ? we shouldn�t marginalize people Emphasises the environment as the cause and treatment from mental problems Half-way houses A good way of receiving support and treatment, without becoming institutionalised Home care They can remain with their families, and still receive treatment But this can cause pressure for the family, and may cause stress ? more problems develop 24-hour care A telephone service that allows people to have someone to talk to all the time ST Inpatient care A �drop-in� program in hospitals for mental health care

39. Therapies & Treatment The Cognitive Approach Believes that mental problems come from maladapted thought processes Aim is to change self-defeating assumptions Rational-emotive therapy To find flaws in their thinking, and break the cycle of poor thinking Attribution Therapy Finds the flaws in attributive thinking ? internalising things can cause distress Cognitive behavioural therapy Change behaviour through changing thinking about that behaviour Self-efficacy We look at other people and believe that we can do something

40. Therapies & Treatment The Humanistic Approach Believe that mental problems stem from issues with personal growth This approach focuses more on the individual, and their view on the world Therapists needs to act genuinely, and with unconditional positive regard, as well as accurate, empathic understanding Self-actualisation is important ? being able to focus on the present and the goals in life The emphasis needs to be on freewill etc. to develop p. growth, so structure needs to be free Existential Therapy �logo� therapy for those with anxiety disorders and phobias If you can wish the worst case of your fear upon yourself, then you cannot over-anticipate the problem Client-centred therapy Healthy people are aware of behaviour, and are good and centre effective Therapist will give the opportunity for these things to happen It relies on the assumption that people are essentially �good�

41. Therapies & Treatment The psycho-dynamic Approach Hypnosis Although Freud did not agree with hypnosis, it is believed that it can help to uncover thoughts from the unconscious Free association The ego acts as a censor to the information, so free association can get past this by not allowing the ego to cover information before it leaves the unconscious This is the most widely used therapy Dream interpretation The dreams offer a solution in terms of dreams being �unconscious wish fulfilment They can help offer information from the unconscious

42. Therapies & Treatment The Behavioural Approach Shaping Rewarding behaviour as it gets closer to the desired outcome Can be used to improve social interaction in autistic children and schizophrenics TEP Tokens act as secondary reinforcers, and research has proven that both animals and humans will continue behaviour for reinforcement at a later time It has been proved useful in personal care and social development, particularly in institutional environments However, it can make participants dependant on tokens Aversion Therapy Works by associating negative stimuli with a new response Uses the principles of classical conditioning E.g. alcohol with vomiting ? vomiting negative ? drinking = negative

43. Summary: Medical Allows research to be carried out ? animal/twin studies The fact they�re treated with drugs means the cause must be biological Treats the symptoms and not the cause Cause and effect ? circular arguments (symptoms cause condition or condition cause symptoms?) Medical label stigmatises them ? used as an excuse because it removes responsibility

44. Summary: Behavioural Allows to treat behaviour, not label the person Scientific ? research can be carried out, and can be falsified Animal experiments are hard to generalize to humans Treats the symptoms and not the cause Symptom substitution ? the real cause will emerge later in other forms Ethical concerns about reconstructing behaviour to fit in with social norms

45. Summary: Cognitive Lots of scientific research Can be tested and retested Focuses on the individual Problem solving and practical Ignores social factors, and may convince people that they can �think themselves better�

46. Summary: Psycho-dynamic Despite not being proven, it can still work and has been proved to be effective in some cases Retrospective ? need to look at the past before resolving problem so it lacks predictive validity

47. Summary: Humanistic Too optimistic about human nature Too reliant on personal growth ? some people with depression appear to have everything they want but are still unhappy ? too materialistic Not scientific Not empirically testable ? cannot observe things like self-actualisation

48. Summary: Social Helps people live better together Combines with medication to help solve problems ? needs social skills to integrate Very difficult to get trained professionals ? expensive Families can be a part of the problem!

49. Effectiveness of Therapies Judged on: Observation of behaviour Recidivism � how often people have to go back for treatment Self-report Meta-analysis � look at other research to find a trend Smith (1980) found that all therapies worked, but May found that chemotherapy works the best. It�s found that experienced therapists are better than less experienced therapists ? the therapies must help This is because experienced therapists adopt a multi-model approach: bio psychosocial People who aren�t qualified, yet have good personal skills can be just as effective ? psycho-therapies (talking) are merely placebo

50. Clinical Conditions Schizophrenia The fragmentation of personality � not different personalities 5 types: Disorganized Schizophrenia Speech/behaviour is disorganized Neologisms � made-up words �Word salad� � mixed-up words in sentences Thought-blocking Personal hygiene affected Catatonic Schizophrenia Alternating between high excitement and immovable state (catatonic state) ? one of these �states� may dominate Inappropriate emotional responses Flattening affect (�bluntening� of emotion) �waxy� movement 0 can move a limb and it would stay there

51. Clinical Conditions Schizophrenia Paranoid Schizophrenia Hallucinations Delusional thinking (of grandiose, prowess etc) Not disorganized Undifferentiated schizophrenia Patient has symptoms from all forms of schizophrenia Not clearly categorized Residual Schizophrenia Some signs still remain, but not overtly schizophrenic Reliability Hard to categorize people with all the different symptoms Harder to have predictive validity ? prognosis would be different for sub-types, and the patient may show signs of more than one type

52. Clinical Conditions Schizophrenia There is another method of classification Positive Schizophrenia When things are added to the personality e.g. delusions Associated with dopamine receptors Negative schizophrenia When things are taken away e.g. flattened emotions Associated with structural abnormalities of the brain (bigger ventricles) Positive schizophrenia can also be sub-divided Delusions and hallucinations Disorganized behaviour

53. Clinical Conditions Schizophrenia Causes [Biological] Genetic Causes Family Studies Children of 2 schizophrenic parents have 46% chance of inheriting schizophrenia This may also be due to environmental learning Twin Studies Gottesman (1991) believed MZ twins had 48% concordance, whereas this is only 17% in DZ twins (concordance relates to both twins getting the disorder) However, identical twins also share very similar environments Biological Causes Chemicals One theory is that dopamine is over-active in the synapses, which may explain type one positive symptoms of schizophrenia Symptoms of acute paranoid schizophrenia are similar to those of amphetamine psychosis, which is caused by amphetamines over stimulating dopamine receptors Anti-schizophrenic drugs (e.g. chlorpromazine) work by blocking post-synaptic receptors sites for dopamine, reducing it�s activity. Post-mortems and PET scans have found more dopamine and dopamine receptor sites in schizophrenics However, the dopamine hypothesis may be an over-simplified account of schizophrenia � new schizophrenia drugs work by affecting other neurotransmitters, like Serotonin

54. Clinical Conditions Schizophrenia Causes [Biological] Biological Causes Brain structural causes Enlarged ventricles are fluid filled cavities in the brain. Reserch has found that these are larger in schizophrenics due to brain cell loss. Cell loss in the temporal lobes of the brain (cognitive and emotional functions) have been associated with negative symptoms. However, this may be a symptom, and not a cause Brain area activity is also found to be different for schizophrenics. When given problem solving activities, schizophrenics brain scans have shown unusual prefrontal activation of the cortex. This method cannot yet predict the presence of schizophrenia.

55. Clinical Conditions Schizophrenia Causes [Psychological] Psychodynamic Freud argued that schizophrenia could be due to regression to a state of narcissism in the early oral stage, where no ego is developed to test reality. Psychotic thoughts are similar to those irrational thoughts first presented by the id. Psycho-analysis would not help treat this condition because a patient in psychosis does not have the necessary attachment to reality. Existential The idea that people withdraw from reality as a response to the pressures of life becoming unbearable (Laing) Some psychiatrists believe that this can be a positive journey of self-discovery Labelling theory Scheff (1966) argues that schizophrenia, once diagnosed, becomes a self-fulfilling prophecy. The reactions of other people in society become internalised, and help reinforce the idea Szasz takes this idea further, and believes we create the label schizophrenia to control people who are different as a form of social control Cognitive theory Frith (1979) believed that there was problems with short-term memory and the brains capacity for information with schizophrenics. An attentional-filter mechanism in the brain means that information going into the brain �overloads� sufferers from schizophrenia, causing the cognitive distractibility

56. Clinical Conditions Schizophrenia Causes [psychological] Social factors Family stresses Reichmann proposed the idea of a �schizophrenogenic mother� who can aggravate symptoms of schizophrenia Also, in families where the is a high amount of expressed emotion, symptoms seem to develop more frequently in people prone to schizophrenia However, this research is correlational, so perhaps the schizophrenia causes the stress and not vice versa Environmental stresses Schizophrenia is found to be 8x more likely in families of a lower social-economic status However, this could be a cause, or an effect of the social drift with people with schizophrenia Viruses Viruses may also trigger schizophrenia (e.g. influenza) This can be particularly important during the pregnancy, when there can be damage to the placenta

57. Clinical Conditions Depression Unipolar depression has a prevalence rate of 5%, and occurs twice as often in men as in women It can be affected by age, gender, social class and marital status Symptoms [Unipolar] Emotional intense feelings of sadness or guilt lack of enjoyment of pleasure in things previously enjoyed Cognitive frequent negative thoughts faulty attribution of blame (blaming themselves) Motivational passivity difficulty in making and initiating decisions Somatic Loss of energy or restlessness disturbance of appetite, weight and sleep

58. Clinical Conditions Depression Bipolar depression is less common as Unipolar It involves the symptoms of Unipolar depression, combined with mania or hypomania There is around a 1% prevalence of bipolar disorder Symptoms [Bipolar] Emotional Abnormally euphoric elevated or irritable mood increased pleasure in activities

59. Clinical Conditions Depression Symptoms (Bipolar) Motivational increase in goal-directed activity increase in pleasurable activities with a high risk of danger Cognitive inflated self-esteem or grandiose racing ideas and thoughts distractibility of attention Somatic decreased need for sleep psychomotor agitation more talkative rapid, pressured speech

60. Clinical Conditions Depression Causes Biological Genetics McGuffin (1993) found that MZ twins have a 52% concordance for unipolar depression, and 80% concordance for bipolar The concordance is still not 100%, so there are a lot of other factors that help contribute Chemicals The most popular theory is about serotonin and noradrenaline levels. These are responsible for the parts of the brain controlling mood and emotion.This can be found by the effect of anti-depressant drugs, which increase their usage.

61. Clinical Conditions Depression Causes Learning Looks at the role of punishment and reinforcement Depressives may suffer from a lack of positive reinforcement, leading to �sad� behaviour. This behaviour is then reinforced by the attention that it brings. This can lead to a �vicious circle� whereby depressives are ignored, creating more negative reinforcement. Seligman (1975) proposed the idea of learned helplessness, where dogs no longer attempted to get out of the way of shocks after repeated shock treatment, because they learnt to be helpless.

62. Clinical Conditions Depression Causes Cognitive Based on the theory of learned helplessness, it was proposed that depressed people get trapped into a cycle of negative thinking They believe they cannot help themselves out of a situation. They see: causes as internal, situations as stable (unlikely to change), failure as global (not specific to one thing) Aaron Beck (1967) devised the �cognitive distortion model�, which implied that certain types of maladaptive thinking mean some people are �prone� to depression. Beck's cognitive errors are: 1. Over-generalising 2. Selective Abstraction 3. Excessive responsibility 4. Self-reference 5. Catastrophizing 6. Dichotomous thinking Although these problems may not entirely cause depression, these factors may help maintain it.

63. Clinical Conditions Depression Causes Psychoanalytic Focuses on the unconscious of the condition Depressives turn their angry and aggressive drive inwards onto themselves Environmental Life events depression occurs mostly after major life events, which also links to the idea of continual stress and hassle Socio-economic background It is more common in women, and may be caused by the variations brought about as the seasons change These environmental factors could be triggers to a wider susceptibility to depression