- When psychologists describe symptom of a disorder:
-
Affective Symptoms: emotional elements, fear, sadness, anger
-
Behavioral Symptoms: observational behavior, crying, physical withdrawal
-
Cognitive Symptoms: ways of thinking, pessimism, personalization, self image
-
Somatic Symptoms: physical symptoms, facial twitching, stomach cramping
- If it is accurate, several clinicians (using the same system) can have the same diagnosis for the same individual
- For classification systems to be valid, it should classify real pattern symptoms leading to effective treatment
- Classification is descriptive, does not identify any specific causes for disorders
- Difficult to make diagnosis for psychiatric disorders because there are no objective physical signs of the disorders
- Some psychiatrists introduce their own classification systems
- Great ormond street children's hospital developed own diagnostic for children with reliability of 88%
- DSM IV system was 64% reliability
- ICD 10 system was 36% reliability
-
Beck et al 1962: agreement on diagnosis for 153 patients were 54% between 2 psychiatrists
-
Cooper et al 1972: NY psychiatrists were twice as likely to diagnose schizophrenia than London psychiatrists, who were twice as likely to diagnose mania or depression when shown same videotaped clinical interviews
-
Di Nardo et al 1993: studying the reliability of DSM III for anxiety disorders
- 2 clinicians separately diagnosed 267 individuals seeking treatment for anxiety and stress disorders
- 80% reliability for obsessive compulsive disorder
- 57% reliability for assessing generalized anxiety disorder
- Maybe because problems arise with interpreting how excessive a persons worries are
Paragraph 2
-
Confirmation Bias: Clinicians have expectations about the person who is consulting them
- They have an assumption that they must have a problem in order for them to be there
- They may overreact to see abnormality when ever people consult them
-
Tversky 1973: However there is no valid positive correlation between the number of assessment techniques used and the accuracy of the diagnosis
-
Aim: to text the reliability of psychiatric diagnoses
-
Method: field experiment- 5 men, 3 female (all researchers) tried to gain admission to 12 different psychiatric hospitals complaining that they have been hearing voices that were unclear, unfamiliar, of the same sex with the words "empty" or "thud".
-
Results: 7 were diagnosed as suffering from schizophrenia, and had been admitted to psychiatric wards. The researchers said the were fine, with no long experiencing symptoms, and it took them averagely 19 days before they were discharged, and 7 of them the psychiatric classification of the time of discharge was "schizophrenia in remission", meaning that schizophrenia may come back
- Research 2
-
Aim: to text the reliability of psychiatric diagnoses
-
Method: telling the staff at psychiatric hospital that pseudo-patients would try to gain admittance
-
Result: no pseudo-patients appear, but 41 patients were judge with great confidence to be pseudo-patients by at least 1 member of staff, and 19 patients were suspected of being frauds by one psychiatrist and another member of staff
-
Conclusion: very inaccurate to diagnose a patient with schizophrenia when they were only told one symptom.
- Problems as to why people can be classified as normal when they're not
- Not possible to distinguish between san and insane in psychiatric hospitals
- Raise issue of treatments
- NEED TO CRITIQUE THIS RESEARCH STUDY
-
Lipton and Simon 1985: selected 131 patients in NY hospital to conduct various assessment procedures before diagnosing each person
- 16 received the same diagnosis on re-evaluation from the original 89 diagnoses of schizophrenia
- 15 received the same diagnosis on re-evaluation from the original 50 diagnoses of mood disorder
- Different chances of receiving the same diagnosis leading to same / different treatment- suggesting lack of validity, due to bias in diagnosis
-
Aim: testing social perception, whether labeling a person as a patient status would lead to discrimination
-
Method: showing a videotape of a man telling an older man about his job experience, and the viewers were told beforehand that the man was a job applicant, and the other group of viewers were told beforehand that the man was a patient
-
Result: job applicant was thought to be conventional looking, attractive. Patient was described as tight, defensive, dependent, frightened
-
Evaluation: use any evaluation of lab studies
Paragraph 3
Cultural bias in diagnosis
- Diagnosis can be influenced by attitudes and prejudge of the psychiatrists
- They may expect a certain group of people to be more prone to depression
- Therefore higher chance of getting depression
-
Overpathologization: same symptoms being interpreted as something else if they were presented by different person that is in a specific group
- Different cultures and beliefs towards a certain problem may be different in different cultures
- Real differences between cultures in the symptomology of disorders
-
Kleinmann 1984- studying the somatization of symptoms in Chinese depressive patients (bodily symptoms of psychological dysfunction)
- Impossible to compare depression cross-culturally because it may be experienced with different symptoms / behaviors
- Depression means:
- Lower back pain (China)
- Guilt and existential anxiety (Western cultures)
- Difficult for clinicians to accurately diagnose and suggest treatments
- How to avoid cultural influence:
- Make effort to learn about culture of the patient
- Bilingual patients should be studied in both languages
- Ensure the patient understands the diagnostic procedures
- Make sure they understand that the symptoms are described differently in different cultures
- Jenkins-Hall and Sacco 1991 - Racial/ ethnic discriminations affecting validity of a diagnosis
-
Aim: how people may judge others based on race
-
Method: European American therapists being asked to watch a video of a clinical interview and to evaluate the female patient. They were given 4 conditions to represent the possible combinations of race and depression
- African American and non depressed
- European American and non depressed
- African American depressed
- European American depressed
-
Results: same rating for European and American, rating of African American woman with more negative terms, as they think that the AA is less socially competent than the European Woman
-
Conclusion: diagnosis will allow the patient to have a label that may be unnecessary and incorrect due to racial discrimination by psychiatrists
- ADD TO CONCLUSION – PROJECT INTO THE FUTURE
Discuss cultural and ethical considerations in diagnosis
- Many researches are done to discover treatments for abnormal psych
- However its important to have cultural and ethical considerations
- Respect the participants
- Shouldn't feel distressed after experiment
- Ecological validity, may only occur in one culture but not others
- First ethical considerations will be looked at, then cultural considerations
Paragraph 1
ETHICS: wrong diagnosis may lead people into having stigma and self fulfilling prophecy
-
Szasz: people who are different are stigmatized
- Psychiatric diagnosis provides patient with a new identity
- e.g. the patient is now schizophrenic
- The DSM IV now calls it "individual with schizophrenia" after Szasz criticized the action of giving people labels such as mentally ill, criminal, foreigner to socially exclude people
- Label for life
- Even if they don’t have any symptoms, the label "disorder in remission" remains
Scheff 1966: effects of labels: self fulfilling prophecy
- People act as they are expected to
- Increasing their own role as mentally ill patient, and this may increase their symptoms
-
Aim: testing social perception
-
Method: showing a video tape of a younger man telling an older man about his job experience. One group of participants were told that he is a job applicant, another group of participants were told that he is a patient
-
Results: those who were told he was job applicant- attractive, conventional-looking, and those who were told he was a patient - tight, defensive, dependent, frightened of his own aggressive impulses
-
Conclusion: power of schema processing is very important in judging someone, and those that are labeled as mentally ill will often endure prejudice and discrimination
Paragraph 2
Ethics: Psychiatrists having conformation bias and racial discrimination
-
Confirmation Bias: when clinicians have expectations about the person consulting them
- Institutionalization: affect validity of a diagnosis
- Rosenhan's study of pseudo-patients were admitted into mental wards, but it was very hard to convince the staff that it was an experiment and that they could not leave
- One extreme case of a patient requiring 52 days before convincing the staff that he's fine
- Behavior of the patients were regarded as symptoms of schizophrenia
- They were never asked why they were writing notes- instead they noted them as "patient engages in writing behavior"
- This implicates paranoia behavior, and pacing corridors out of boredom meant nervousness and agitated behavior
- Patients may feel powerlessness and depersonalization
- Lack of rights, constructive activity, choice, privacy
- Physical differences are not always found in the brains of people whose behavior is abnormal, and treatment based on this assumption will be inappropriate.
- There is little evidence for these claims and therefore physical intervention can be the wrong treatment for some patients.
- If abnormal behavior is not a symptom of mental illness, classification will produce misunderstanding and potentially dangerous treatments.
- Drugs do not always work as predicted, and often have side effects, psychosurgery can cause more harm than good
- Jenkins-Hall and Sacco 1991 - Racial/ ethnic discriminations affecting validity of a diagnosis
-
Aim: how people may judge others based on race
-
Method: European American therapists being asked to watch a video of a clinical interview and to evaluate the female patient. They were given 4 conditions to represent the possible combinations of race and depression
- African American and non depressed
- European American and non depressed
- African American depressed
- European American depressed
-
Results: same rating for European and American, rating of African American woman with more negative terms, as they think that the AA is less socially competent than the European Woman
-
Conclusion: diagnosis will allow the patient to have a label that may be unnecessary and incorrect due to racial discrimination by psychiatrists
Paragraph 3
Cultural bound syndrome and cultural blindness
- Conceptions of abnormality differ between cultures
- Affects validity of diagnosis of mental disorders
- Some disorders can be universal, present in all cultures
-
Culture-bound syndromes: Some abnormalities / disorders are culturally specific
- E.g. shenjing shuairuo (neurasthenia) accounts for more than half of psychiatric outpatients in china
- It is listed in the CCMD-2 (chinese classification of mental disorders), but its not in the DSM IV used in the western world
- However neurasthenia may be similar in the DSM IV, but it may be known as mood disorder and anxiety disorder
- American Psychiatric Association (APA) : formally recognize culture-bound syndromes through a separate list in the appendix of DSM IV
-
Fernando 1988: many of these special conditions occur quite frequently
- If they are limited to other cultures, they will not be admitted into mainstream western classification, and the possibility of misdiagnosis and improper treatment still exists
- Depression - common in Western Culture- is absent in Asian cultures
- Asian people live in extended family: ready access to social support
-
Rack 1982: Asian doctors state that depression is equally common in asians, however asians consult doctors for physical problems, rarely emotional distress.
- e.g. physical problems such as tiredness, sleep disturbance, appetite disturbance
- They think that depression is not the responsibility of the doctor, and instead the family should be the one helping out
-
Cultural Blindness: identifying symptoms of a psychological disorder if they are not the norm in the clinicians' own culture
-
Cochrane and Sashidharan 1995: common assumption that behavior of white population are normative
- Deviation from this by another ethnic group reveals racial or cultural pathology
-
Rack 1982: when a member of a minority ethnic group exhibits sets of symptoms similar to British-born patient, they are assumed to be suffering from the same disorder
- e.g., it may be common in a culture/ ethnic group to see or hear a deceased relative during the bereavement period
- However under the DSM IV, this behavior may be misdiagnosed as a symptom of psychotic disorder
- How psychologists can avoid cultural bias influencing a diagnosis
- Clinicians should make an effort to learn about culture of the person being assessed
- Professional development, consultation with colleagues, direct discussion with individual
- Evaluation of bilingual patients in both languages
- By bilingual clinician / trained mental health interpreter
- Patients may use second language as a form of resistance to avoid intense emotional responses
- Diagnosis should be modified to ensure that the person understands the requirements of the task
- Symptoms of disorder are often discussed with local practitioners
- Symptoms may be described differently in different countries
Paragraph 4:
Reporting bias, somatic vs. emotion
- Reporting Bias makes cross-cultural comparison difficult
- Figures of diagnosis and patients are based on hospital admissions
- May not effect true prevalence rates for particular ethnic groups / particular disorders
- Low admission rates in minority ethnic groups may reflect cultural beliefs about mental health
-
Cohen 1988: In India, mentally ill people are cursed and looked down upon
-
Rack 1982: In China, mental illness carries great stigma
- Chinese would therefore be careful to label people with mental disorder
- Only when thinking and emotion is so impaired that individuals are out of contact with reality, then they will diagnose them with mental disorder
- Low admission rates: reflect minority's lack of mental health care
- Real differences between cultures in the symptomology of disorders
- Marsella 2003
- depression takes primarily affective form in individualistic cultures
- Feelings o loneliness and isolation dominate
- In collectivists societies, somatic (physiology) symptoms such as headaches are dominant
- Depressive symptoms patterns are different between cultures,
- Studying somatization of symptoms in Chinese depressive patients
- Impossible to compare depression cross-culturally because they experience different symptoms of behavior
- Depression may mean lower back pain in China, and guilt and existential anxiety in western cultures
- Difficult for clinicians to accurately diagnose and suggest treatments
- Difficult to classify such different behaviors and symptoms as belonging to the same psychological disorder
Conclusion
- Importance in correct diagnosis of symptoms with regards to cultural considerations
- All researches should be ethical
- Adverse effects may be using drugs that are unnecessary
- People may be stigmatized - affects their future
Evaluate psychological research (through studies and theories) relevant to the study of abnormal behavior
Introduction
- Different types of psychological research studies used to study abnormal behavior
- When researchers are gathering the symptoms of a disorder, they look for
- Affective symptoms (emotional elements), fear, sadness, anger
- Behavioral symptoms (observational behaviors) crying, physical withdrawal from others
- Cognitive symptoms: ways of thinking, pessimism, personalization, self image
- Somatic symptoms: physical symptoms, facial twitching, stomach cramping
- Or using the DSM (Diagnostic and Statistical Association) and ICD (international classification of diseases)
- Focus on research studies related to the reliability and validity of different etiologies of abnormal behaviors
Paragraph 1
- Gathering qualitative data
- Can be in depth or very brief
- A positive attitude may help get more information off the patient as they are more comfortable to talk about their problems, making it easier to diagnose them
- It may be influenced by the researcher themselves, where some patients may feel more comfortable speaking to their own race, etc.
- May lead to sensitive and distressing problems
- counseling service provided by the British government
- Helps people get better from abnormal behavior
- Writes people treatment plans to help them recover
Paragraph 2
- PET or CAT (especially in cases of schizophrenia or Alzheimer's disease)
- Artificial environment, therefore the participants may act differently
- Act under demand characteristics
- Expensive, requires expert
- Ethical findings on abnormalities in the brain
- Useful, because you can look at brain activity to see to what extent brain activity has effects on abnormal behavior
-
Aim: whether schizophrenic patients had differences in dopamine levels
-
Method: PET scan of 10 patients with schizophrenia and 10 healthy controls. Inject patients with I-DOPA, which is used in production of dopamine
-
Results: I-DOPA was taken up more quickly in patients with schizophrenia, suggesting that more dopamine was used for production
- Evaluation of Lindstroem:
- Not easy to find out levels of neurotransmitters accurately- lots of experiments have been done to see If the levels go up or down when something changes, but it doesn’t show accurate amount of change
- Scans are open to interpretation
- Given us an insight into schizophrenia
- Now we can deal with those patients easier knowing that they have different dopamine levels
Paragraph 3
- Observations being faulty
- Confirmation Bias- when doctors know that they are having a patient, they may already think that they have a problem, therefore they will look at them differently and consider them as people with mental problems
-
Rosenhan: this research shows that the "patients" who were emitted into psychiatric hospitals could not leave even though they have told the doctors that it was an experience
- The nurses and doctors thought that it was part of their symptoms as a schizophrenic
- When the researchers were taking notes of the experiment, the nurses made observations and noted them as "writing behavior", and they are making assumptions that they have mental problems
- Naturalistic observations
- Demand characteristics influences observation if the people know that they are being looked at, therefore they may act upon self-fulfilling prophecy
- Many researches may lead help find out different abnormalities of people
- Important to remember the accuracy and reliability of the data
Discuss the interaction of biological, cognitive, and sociocultural factors in abnormal behavior
Introduction
- what is abnormal behavior, and how it can be looked at under biological, cognitive, and sociocultural viewpoints
- Its hard to diagnose and fully diagnose a person as there may be: cultural differences, different cultural beliefs, cultural bound syndromes
- Hard to classify abnormal, some say abnormal is something away from the normal, so someone who is 2 meters tall is abnormal?
- Picture is still mysterious
- Must not always separate all 3 sections, we should combine it all to look because a mind functions together, not separated
Paragraph 1
- Biological factors influencing abnormal behavior
- The way that our brain is mapped out based on genetics and neurotransmitters, it may affect the way that we think about our human body
- People in different cultures may think of their bodies differently
- Genetics (brand of biology studying the heredity and variation of organisms)
-
Aim: whether genetics had an effect of bulimia nervosa in families
-
Method: gathering data of 2000 female twins
-
Results: concordance rate of 23% in MZ twins, and 9% in DZ twins. In all studies, higher concordance rate in MZ than DZ twins, but it varies from 23% - 83%
-
Conclusion: genetics may have an effect on people getting bulimia. However people may be secretive when asked about bulimia, therefore self-reporting data is not reliable
-
Strober 2000: first-degree relatives of woman with bulimia are 10 times more likely than average to develop the disorder
- Problems with twin research and family researches:
- May be because they were raised in the same environment,
- Unethical, may have joined twins of families together that didn’t expect so
- Useful to study, similar genetics
- Generalized
- The fact that MZ twins had higher concordance rates of chances of having bulimia is between 23% to 83%, it shows that it may not be too reliable
-
Aim: investigating levels of noradrenaline and serotonin in patients suffering from major depression
-
Method: brain scans to check levels of noradrenaline and serotonin
-
Results: abnormal levels of noradrenaline and serotonin in patients suffering from depression
- Abnormal level of neurotransmitters may not cause depression,
- However it may indicate that depression may influence the production of neurotransmitters
- Drugs are extensively used to cure patients nowadays
- SSRI is used to cure depression -
- Increase serotonin levels without messing up levels of noradrenaline
- Diathesis stress model - you may have the genetic predisposition, but you must have the environment to trigger it
- People may have genetic predisposition to bulimia, but they must be triggered and affect by the environment too
Paragraph 2
- Cognitive factors influencing abnormal behavior
- The way that people think affecting their behavior (schemas)
- psychological disturbances come from irrational and illogical thinking
- Alloy et al: 1999
-
Aim: whether cognitive patterns may affect one's thinking
-
Method: following a sample of young American's in their twenties for 6 years, and they had to take a thinking style test, then they were placed in "positive thinking group" and "negative thinking group"
-
Results: 1% of the people in the positive thinking group developed depression, and 17& of the people in the negative thinking group developed depression
-
Conclusion: link between cognitive style and development of depression, and that identification of negative thinking patterns may eventually help prevent depression
- The way that we think of ourselves may be affected by the levels of serotonin and dopamine in our brains
- Some countries may not think that depression is common, and that depression is more of somatic problems
- Therefore they would not consider of the importance of thinking "positively" to cure and decrease the chances of depression
Paragraph 3
- Viewpoint on the perfect body image
- Perfect body figure has changed from large bodies and curvy bodies to thin
- Increase in cultural emphasis on thinness as an ideal body shape in Europe, US, Japan
- Sanders and Bazalgette 1993:
-
Aim: the influence of media in dolls towards chilren
-
Method: analyse and create life size figures of Barbie, Sindy, and Little Mermaid
-
Results: the dolls all had tiny hips and waists, and exagerrated inside leg measurements
-
Conclusion: at a young, children are already influenced and have a pressure towards their ideal shape, and allows their dolls to be their models, and this may increase their thought towards the need of dieting.
- Less people with abnormal problems because e.g. they are in China, they will consider people as depressed when they have somatic problems rather than emotional problems because in China, people think that having mental problems is a great stigma
- Social origins of depression in women
-
Aim: finding out the social origins of depression in women
-
Results: 29/32 women who became depressed had experienced severe life event, but 78% of those who did experience a severe life event did not become depressed
- Life events resembling previous experiences would most likely lead to depression
- Evaluation of Brown and Harris
- People had different coping abilities of their events
Conclusion
- link biological, cognitive and sociocultural together
- We cannot always be certain of the statistics due to cultural issues
Describe symptoms and prevalence of one disorder from two of the following groups: anxiety disorders, affective disorders, eating disorders
- Affective Disorder: dysfunctional Moods - Depression
- Most common psychological disorder
- Low moods and low levels of self esteem
- Lack motivation
- Guilt and sadness
- Lack of enjoyment or pleasure in familiar activities of company
- Lack of initiative
- Faulty attribution to blame
- Suicidal thoughts
- Irrational hopelessness
- Difficult to make decisions
- Loss of energy
- Insomnia
- Weight loss / gain
- Hypersomnia
- Diminished sexual desire (libido)
- Think that everything is black and they will never be happy again
- Drugs and different kinds of therapy
- Looking at the following for treatments and cures
- Biological factors (genetic make up and biochemical factors)
- Cognitive factors (thoughts of hopelessness, pessimistic thinking patterns, feels of low self esteem)
- Social factors (stress of poverty, loneliness, or troubled personal relationship)
- Diagnosed when one experiences 2 weeks of either depressed mood / loss of interest and pleasure
- Diagnosis requires at least 4 additional symptoms (insomnia, appetite disturbances, loss of energy, worthlessness, thoughts of suicide, difficulty concentrating)
-
Charney and Weismann: Affects around 15% of the world at some time in their life
-
Department of health : depression in 1980's accounted for 1/4 of all psychiatric hospital in UK
- 2-3 more times more common in woman than in men
- More frequent in members of lower socio-economic groups
- Most frequently amongst young adults
-
Levav: prevalence rate to be above in Jewish males
- No difference in prevalence between Jewish men and women
- Some groups may be more vulnerable to depression
- Indicates problem in making a reliable diagnosis
- Difficult for clinician to find out if people are suffering from a major depressive disorder or "the blues" (state of depression)
- Recurrent disorder
- 80% subsequent episode, lasting 3-4 months
- Average number of episodes: 4
- 12% of depression becomes a chronic disorder which lasts of 2 years
- Development and course of disorder reflects complex interaction between several biological and psychological factors
- Negative events, neurotransmitters, hormones --> depression
- Could be long term problem
- Continuing source of stress, disappointment
- Stress and depression association
- Many people with stress do not develop depressive disorder
- Individual differences in vulnerability
- Not possible for any doctor / psychologist to find THE cause of depression in anyone
- Treatment aims to alleviate the symptoms
- Eating Disorder: eating patterns leading to insufficient or excessive intake of food - Bulimia
-
National Institute of Mental Health: 2-3 % of women and 0.02-0.03% of men have been diagnosed with bulimia
-
Frude: female:male ratio of bulimia sufferers is roughly 10:1
- Binge eating - most common disorder affecting 2 % of all adults
- Similar prevalence rates from US is found in Japan, Norway and some European countries
- More than 5 billions individuals have eating disorder (bulimia/ anorexia) in USA
-
Keel: 40% college women 0 Isolated episodes of binge eating and purging
- Preoccupation with eating
- Idealization of thinness
- Fear of becoming fat
- Usually in late teens / early twenties
- Increasing incidences of eating disorders
- Greater medical and public awareness of eating disorders may have resulted in increase reportings of eating disorder cases
- Common to believe its more common in industrialized countries
- Appropriate studies have not been conducted in developed countries
- Tehran, Iran - 3.2%
- Body dissatisfaction and a desire to be thin
- 5.79% Japan 15-29 years old women
- Binge eating, then compensatory method to prevent weight gain - induced vomiting, excessive exercise, laxative abuse
- In order to diagnose bulimia nervosa- binge eating compensatory behaviors must occur at least twice a week for 3 months averagely
- Consume more in a binge than average eating for a persons
-
Ego-dystonic: Feeling disgust and guilt and they cannot control it
- Person obsessed with not being fat - binge episode will produce panic and intense regret
- Vomiting can be effective in reversing the feelings
- Afraid of weight gain
- Self esteem dependent on maintaining a certain weight
- Highly dissatisfied and have distorted sense of own body
- Patients recognize their behavior causes stress for those they love - shameful
- Shame regarding wasting food
- Average BMI
- Repeating vomiting may lead to swollen salivary glands, erosion of tooth enamel
- Loss of stomach acid through vomiting (high in potassium)
- Electrolyte imbalances, causing problems for heart, kidneys, intestines
- Extreme loss of potassium - heart failure
- Feeling inadequacy, guilt, shame
- Excessive exercise
- Negative self image
- Perfectionism
- Perceive events more stressfully than normal
Analyze etiologies (in terms of biological, cognitive, and sociocultural factors) of one disorder from two of the following groups: anxiety disorders, affective disorders, eating disorders
Analyze etiologies (in terms of biological, cognitive, and sociocultural factors) of affective disorders
Introduction
- Most common psychological disorder
- Low moods and low levels of self esteem
- Lack motivation
- Guilt and sadness
- Causes related to Bio, Cog, Socio all related
-
Charney and Weismann: Affects around 15% of the world at some time in their life
Paragraph 1 - Biological
- Genetic predisposition can explain depression
-
Nurnberger and Gershon: results of 7 twin studies, results show that concordance rate for major depressive disorder was consistently higher for depression is higher in MZ twins than DZ twins
- Supports that genetic factors might predispose people to depression
- MZ twins concordance- 65%
- Far below 100%, therefore it indicates that depression is a result of genetic predisposition - genetic vulnerability
- DZ twins - 14%
- Environment events and psychological character play a role in depression
- Problems with twin research and family researches:
- May be because they were raised in the same environment,
- Unethical, may have joined twins of families together that didn’t expect so
- Useful to study, similar genetics
- Generalized
- Long term stress --> depression as they have predisposition making them more vulnerable, therefore more likely to develop depression compared to those that don’t have the genetic predisposition
-
Duenwald 2003: short variant of 5HTT gene - higher risk of depression
- 5HHT may be associated with a higher risk of depression
- Role in serotonin pathways
- Involved in controlling mood, emotions, aggression, sleep, anxiety
- Finding of possible correlation between gene and depression does not indicate the CAUSE since the data is a correlation
-
Caspi et al 2003: result indicates that genetic factors moderate responses to environmental factors
- Warn that speculation about clinical implications of these findings are premature
- Neurobiology suggests - depression caused by a deficiency in neurobiological systems
- Neurotransmitters and hormones
- Catecholamine Hypothesis: depression is associated with low levels of noradrenaline
- Attempt to identidy how biochemical changes induces depression
-
Aim: whether neurotransmitters had effect on depression
-
Method: participants were a drug called physostigmine
-
Results: they felt depressed and self-hate, suicidal wishes within minutes of taking the drug
-
Conclusion: drugs that reduce neurotransmitter (physostigmine) produces depress-like symptoms
-
Evaluation: depressed moods that are induced by drugs suggests that cases of depression may be because of neurotransmission disturbances
- Drugs that increase availability of noradrenaline - more effect in reducing symptoms of depression
-
Rampello et al: depressive patients have imablance of several neurotransmitters
- Noradrenaline, serotonin, dopamine, acetycholine
- Serotonin hypothesis: depression is associated with low levels of serotonin
-
Burns: through years of research in brain serotonin metabolism, he has no evidence that depression results from deficiency of brain serotonin
- Not possible to measure brain serotonin levels in living humans
- Cannot test theory
-
Lacasse and Leo: no evidence that depression is caused by a simple neurotransmitter deficiency
- Shows that modern neuroscience is complex, poorly understood
- Citizen serotonin theory because drugs that affect serotonin levels are heavily advertised and most prescribed drugs for depression
- However there are people who get better from the drugs..
- However its not possible to identify precisely factors involved in imbalance
- Research so far is on process of neurotransmission rather than the neurotransmitters itself
- Cortisol Hypothesis: depression is associated with high levels of cortisol
- Cortisol: hormone of the stress system, involved in fear and anxiety reactions
- High levels of cortisol in patients with depression
- Possible link between long term stress and depression
- High levels of cortisol may be because of lower density of serotonin receptors, and it weakens the function of receptors for noradrenaline
- Shows how complex brain chemistry is
- Depression treatments remain problematic
- Relationship between stress and depression - not well known
- Not one to one relationship
- People do develop depression without being previously stressed, and people who develop stress do not necessarily develop depression
- Stress hormones affect behavior by regulating efficiency of certain neural pathways (related to serotonin, noradrenaline, and dopamine)
- Long term depression --> structural change in the brain, e.g. hippocampus - which loses many neurons if depression happens for a long time
- Decrease stress hormone in the hippocampus and prefrontal cortex of suicidal victims
- High prevalence of depression amongst people with Cushing's syndrome (excessive production of cortisol)
- When given drug to normalize cortisol, their depression disappears
- Evidence of link between cortisol and depression
Paragraph 2- Cognitive
- People who feel depressed think depressed thoughts
- Depressed mood leads to cognitive symptoms
- Depressed cognitions, cognitive distortions, irrational beliefs produce disturbance of mood, self criticism, pessimism
- Ellis: cognitive style theory
- Psychological disturbances come from irrational and illogical thinking
- People have faulty inferences about the meaning of an event, drawing false conclusions
- e.g. "My work must be perfect" "Since I did not receive the highest grade I am stupid"
- Beck: cognitive distortions and biases in information processing
- Based on schema processing
- Stored schemas about self interfere with information processing
- (Schemas influence the way people make sense of information)
- He observed depressive patients have the following negative cognitive thoughts
- Overgeneralization based on negative events
- Non-logical inference about self
- Dichotomous thinking - black and white thinking, selective recall of negative consequences
- Negative schemas activated by stressful events
- Depressed person overreacts
- Related to the way they appraise situations
- Tendency to have negative expectations about their future
- Positive link between negative cognitions and depression
-
Blackburn: depressed people experience a number of disturbances in thought process
- Alloy et al 1999
-
Aim: whether participants cognitive is affected by the way they think
-
Method: longitudinal study prospective study (participants chosen on a basis of variable (in this case negative and positive thinking, then are followed to see effects in the long term) on a sample of young americans in their twenties for 6 years. 1 group of positive thinking group, the other negative.
-
Results: after 6 years, 1% of those in positive thinking group had developed depression, and the negative thinking group at 17%.
- Not clear whether depression is caused by depressive thinking, or depressive thinking causes depression.
Paragraph 3 Sociocultural
-
Brown and Harris: finding the social origins of depression in women
- 29/32 women who became depressed had experienced a severe life event
- 78% of those who did experience a severe life event did not become depressed
- Life events that resembled previous experiences were more likely to lead to depression
-
Vulnerability model: based on a number of factors that could increase the likelihood of depression
- 1/5 women reported that a similar severe life event had previously resulted in depression
-
Diathesis Stress Model: depression is a result of hereditary predisposition, with precipitating events in the environment
-
Murphy et al 1967: looking at cultural considerations linked to depression to identify common symptoms of depression in 30+ countries
- Symptoms were: sad, loss of enjoyment, anxiety, tension, lack of energy, loss of interest, inability to concentrate, ideas of insufficiency, inadequacy, worthlessness, loss of sexual interest, loss of appetite, weight reduction, fatigue, self accusatory ideas
-
Prince: no depression in Africa and various regions of Asia - rates of reported depression rose with westernization in the former colonial
- However depression in non-modernized countries may find it different to express depression, and escapes attention of a person from another culture
-
Kleinman: China somatization is a typcical channel of expression of a basic component of depressive experience
- Chinese had body as a medium of their distress
-
Marsella: affective symptoms (sadness, loneliness, isolation) are typical of individualistic cultures
- Collectivists: cultures which are larger, more stable social networks they support the individual more (where one persons identity is more linked to the group), somatic symptoms such as headaches are common
- Cross cultural research - identical core of symptoms present in depression in many cultures
- Depression is not the same in all countries
- Each culture doesn’t create its own distinct patterns of ab. Behavior, but the clinician working with a cultural diverse client needs to combine sensitivity with cross- cultural competence
- Develop ability to adapt quickly and realistically to different cultural settings
Conclusion:
- Many factors would affect depression, there isn't one cause
- Socio, bio, cog must all interact
- We cannot always be certain of the statistics due to cultural issues
No one single cause. We are all unique. Influences on us vary profoundly from person to person. Huge array of variables that can affect behavior. Treatment successes have helped professionals to build a clearer picture of factors that influence the development of these illnesses but etiologies are complex and multi-faceted. Professionals need to be flexible and open-minded and provide a range of treatments and therapies to help someone back to a state of mental health effectively and to use an eclectic approach.
Analyze etiologies (in terms of biological, cognitive, and sociocultural factors) of eating disorders
Introduction
- Very common disorder
- Preoccupation with eating, idealization of thinness, fear of becoming fat
- Usually in early twenties and late teens
- Increasing numbers of people with disorders
Paragraph 1- biological
-
Kendler et al: support for genetic diathesis for eating disorders
- Studied 2000 female twins - concordance rate of 23% in MZ twins, 9% in DZ twins
- Higher concordance rates in MZ than DZ for all studies
- Rates vary from 23-83 % - both method in which data was gathered and varied definitions of disorder
- Highly secretive nature of bulimia - self reporting is not reliable
-
Strober - first degree relatives of women with bulimia nervosa are 10times more likely than average to develop the disorder
- Problems with twin research and family researches:
- May be because they were raised in the same environment,
- Unethical, may have joined twins of families together that didn’t expect so
- Useful to study, similar genetics
- Generalized
- The fact that MZ twins had higher concordance rates of chances of having bulimia is between 23% to 83%, it shows that it may not be too reliable
Paragraph 2- Cognitive
- Body image distortion hypothesis (bruch)
- Many eating disorder patients suffer from delusion that they are fat
- They overestimate their body size
- Degree of distortion varies with contextual factors - including precise nature of instructions given to subjects
- May reflect their emotional appraisal rather than perceptual
-
Slade & Brode: those suffering from eating disorder are uncertain about size and shape,
- When told ot make judgements, they have mistake on over estimating their body
-
Aim: discovering whether there are gender difference in perception of body images
-
Method: showing US graduates figures of their own sex, and then told to choose figures that looked most like: their own shape, their ideal figure, and the figure that would be most attractive to opposite sex.
-
Results: men chose similar body shapes, whilst female chose ideal and attractive body tshapes that were much thinner than the shape they chose to represent themselves
- Women chose thinner shapes for all 3 choices to men
- Polivy and Herman- Cognitive Disinhibition
- Dichotomous thinking - all or nothing approach to judging themselves
- Follow strict diet rules to reach the weight that they feel is ideal
- When breaking their own rules, they binge eat
- Thoughts about eating act to release all dietary restrictions
- Told dieters and non dieters to take part in taste test. Before the test, they were given a chocolate milkshake, and after drinking it, they were given 3 types of ice cream to sample, and they could eat as much as they wanted. Dieters ate more than non dieters
- 3/4 women diet at some point of our lives
- 1/33 women suffer from bulimia, why do we not see more bulimic women?
- Difficult to establish cause and effect, since distorted eating patterns result in distorted thinking? Or vice versa
Paragraph 3- Sociocultural
- Perfect body image changed over years in West
- Used to be curvy as ideal, now its thin
- Media, female sex symbols influences people
- Film stars - representation of ideal body for people to compare
- People always compare themselves to others, - affects self esteem
- Television, billboards, magazines expose people to beautiful people
- Making people look real, normal, most importantly, attainable
- Hard to attain standards of beauty
- Current media ideal thinness is achievable by less than 5% of the female population
- Eating disorder begins when young women feels over weight and feels the need to go on diet
- Media reflects and helps to shape a strong cultural pressure towards thinness
- Rise in eating disorder in europe, US, and Japan - frequently attributed to increase in this cultural emphasis on thinness as ideal body image
- Woman are more likely than men / women to get targeted on magazines and media to promote thinness
- Representation of children's fashion to be thin
- Sanders and Bazalgette 1993:
-
Aim: the influence of media in dolls towards chilren
-
Method: analyse and create life size figures of Barbie, Sindy, and Little Mermaid
-
Results: the dolls all had tiny hips and waists, and exagerrated inside leg measurements
-
Conclusion: at a young, children are already influenced and have a pressure towards their ideal shape, and allows their dolls to be their models, and this may increase their thought towards the need of dieting.
- Social parenting pressure to be thin
- Less people with abnormal problems because e.g. they are in China, they will consider people as depressed when they have somatic problems rather than emotional problems because in China, people think that having mental problems is a great stigma
Conclusion:
- Many factors would affect bulimia, there isn't one cause
- Socio, bio, cog must all interact
- We cannot always be certain of the statistics due to cultural issues
No one single cause. We are all unique. Influences on us vary profoundly from person to person. Huge array of variables that can affect behavior. Treatment successes have helped professionals to build a clearer picture of factors that influence the development of these illnesses but etiologies are complex and multi-faceted. Professionals need to be flexible and open-minded and provide a range of treatments and therapies to help someone back to a state of mental health effectively and to use an eclectic approach.
Explain cultural and gender variations in disorders
- Men are being under pressure nowadays
- Ideal image of "worked out" male figure appears in many commercials - strong demand for mirror image for sex appeal
-
Mori Survey- adult males in UK - 1/3 of men had been on diet, and that 2/3 believe a change In shape will make them more sexually attractive
- Growing emphasis on ideal male shape will lead to increase in number of men suffering from eating disorders
- Current media ideal thinness is achievable by less than 5% of the female population
- Woman are more likely than men / women to get targeted on magazines and media to promote thinness
- Fallon and Rozin:
-
Aim: discovering whether there are gender difference in perception of body images
-
Method: showing US graduates figures of their own sex, and then told to choose figures that looked most like: their own shape, their ideal figure, and the figure that would be most attractive to opposite sex.
-
Results: men chose similar body shapes, whilst female chose ideal and attractive body tshapes that were much thinner than the shape they chose to represent themselves
- Women chose thinner shapes for all 3 choices to men
-
Williams and Hargreaves 1994 -Women are 2-3 times more likely to become clinically depressed than men
- More likely to experience several episodes of depression
- Women are naturally more emotional than men, therefore more vulnerable to emotional upsets because of hormonal fluctuations - no validity
-
Murphy et al 1967: looking at cultural considerations linked to depression to identify common symptoms of depression in 30+ countries
- Symptoms were: sad, loss of enjoyment, anxiety, tension, lack of energy, loss of interest, inability to concentrate, ideas of insufficiency, inadequacy, worthlessness, loss of sexual interest, loss of appetite, weight reduction, fatigue, self accusatory ideas
-
Prince: no depression in Africa and various regions of Asia - rates of reported depression rose with westernization in the former colonial
- However depression in non-modernized countries may find it different to express depression, and escapes attention of a person from another culture
-
Kleinman: China somatization is a typical channel of expression of a basic component of depressive experience
- Chinese had body as a medium of their distress
-
Marsella: affective symptoms (sadness, loneliness, isolation) are typical of individualistic cultures
- Collectivists: cultures which are larger, more stable social networks they support the individual more (where one persons identity is more linked to the group), somatic symptoms such as headaches are common
- Cross cultural research - identical core of symptoms present in depression in many cultures
- Depression is not the same in all countries
- Each culture doesn’t create its own distinct patterns of ab. Behavior, but the clinician working with a cultural diverse client needs to combine sensitivity with cross- cultural competence
- Develop ability to adapt quickly and realistically to different cultural settings
Discuss the extent to which biological, cognitive, and sociocultural factors influence abnormal behavior
Introduction
- what is abnormal behavior, and how it can be looked at under biological, cognitive, and sociocultural viewpoints
- Its hard to diagnose and fully diagnose a person as there may be: cultural differences, different cultural beliefs, cultural bound syndromes
- Hard to classify abnormal, some say abnormal is something away from the normal, so someone who is 2 meters tall is abnormal?
- Picture is still mysterious
- In order to diagnose and treat a person with mental health issues we need to better understand the causes or etiologies of those issues. There are many different explanations for conditions like, for example, depression and eating disorders. Despite the variety of theories and the conflicting evidence that exists about what causes certain illnesses, there are a number of successful, tried and tested treatments based on certain theories. An example of this would be drug treatments, including SSRIs like Prozac for the treatment of major depression. However, not only do many of these treatments spark controversy, there is also no one simple explanation for any type of mental health issue and psychologists/psychiatrists need to take a multi-axial approach to diagnosing and treating people who need help. This multi-axial approach has developed from the recent trend towards a more hollistic view of care, which comes from a greater appreciation of how these factors combine to affect a state of mental health. In order to effectively support people, professionals must appreciate the wide-ranging influences on a person’s behavior, which encompass socio-cultural, cognitive and biological factors. They need to investigate the many facets of their lives, relationships and health which could have a bearing on their mental state. Researchers need to be aware of the diathesis-stress relationship of the various influences or causes when seeking to explain why one person develops a particular condition and why another person does not.
Paragraph 1
- Biological factors influencing abnormal behavior
- Biological factors influencing bulimia– develop the explanation first BEFORE describing a study.
- Twin, family research supports notion that bulimia could be inherited. Still in early stages. Twins share 100% of the genes, families also share a percentage of their genes, so it makes sense to suppose that if there is a higher concordance rate between twins and family members, then genetics could well be a determining factor.
- Genetics (brand of biology studying the heredity and variation of organisms)
-
Aim: whether genetics had an effect of bulimia nervosa in families
-
Method: gathering data of 2000 female twins
-
Results: concordance rate of 23% in MZ twins, and 9% in DZ twins. In all studies, higher concordance rate in MZ than DZ twins, but it varies from 23% - 83%
-
Conclusion: genetics may have an effect on people getting bulimia. However people may be secretive when asked about bulimia, therefore self-reporting data is not reliable
-
Strober 2000: first-degree relatives of woman with bulimia are 10 times more likely than average to develop the disorder
- Problems with twin research and family researches:
- May be because they were raised in the same environment,
- Unethical, may have joined twins of families together that didn’t expect so
- Useful to study, similar genetics
- Generalized
- The fact that MZ twins had higher concordance rates of chances of having bulimia is between 23% to 83%, it shows that it may not be too reliable
-
Aim: investigating levels of noradrenaline and serotonin in patients suffering from major depression
-
Method: brain scans to check levels of noradrenaline and serotonin
-
Results: abnormal levels of noradrenaline and serotonin in patients suffereing from depression
- Abnormal level of neurotransmitters may not cause depression,
- However it may indicate that depression may influence the production of neurotransmitters
- Neurotransmitters – the efficacy of certain drug treatments that act on the process of neurotransmission strongly supports the idea that certain conditions are caused by imbalances of these chemicals in our nerves. SSRIs like Prozac are widely prescribed for people with major depression and have without doubt helped many people to live happier, healthier lives.
- Are these imbalances a cause or a symptom?
- Weight gain/loss is symptom of depression and serotonin plays a part in controlling appetite so could contribute to this effect. This could also contribute to eating disordered behaviour.
Psychomotor agitation, fidgeting are a symptoms of depression which could have a biological cause.
- Diathesis stress model – Current ideas err towards the fact that you may have the genetic predisposition to a particular condition, but it will only emerge if one is exposed to certain environmental stimuli. So despite the success of certain treatments like SSRIs, many believe that they do not necessarily deal with the real cause of a condition which could be socio-cultural or due to cognitive dissonance. Biological explanations are often considered too reductionist.
- Also why is it that certain conditions are experienced more by one cultural group/gender than another? For example, Latah, Koro – cultural bound syndromes. Why, according to the statistics, do more women experience depression, EOs than men? Does this emerge from biology or culture?
- Drugs are extensively used to cure patients nowadays
- SSRI is used to cure depression -
- Increase serotonin levels without messing up levels of noradrenaline
- Drug treatments work, which supports the idea of neurotransmission imbalance. Abnormal level of neurotransmitters may not cause depression, According to Burns, there is inadequate evidence to support the idea that this is the cause. Lacasse and Leo agree, stating that the brain is far more complex and misunderstood for the cause to be merely an imbalance of this kind.
Paragraph 2
- Cognitive factors influencing abnormal behavior
- Cognitive factors influencing abnormal behavior
- The way that people think affecting their behavior (schemas)
- psychological disturbances come from irrational and illogical thinking
- People who have depression and bulimia think depressed thoughts and have distorted cognitions. Suicidal ideation, guilt, “weight of the world” on their shoulders. Bulimics often are described as having dichotomous thinking processes and as “musturbators” …”everything must be perfect”, “ I must be or behave like this”. Depressed moods can lead to cognitive symptoms.
- Cognitive theorists like Ellis and Beck believe that cognitive distortions and irrational beliefs can lead to depressed or anxious moods.
- The way that we think of ourselves may be affected by the levels of serotonin and dopamine in our brains or do our thinking styles affect the levels of neurotransmitters in our brains? We do not know for sure.
- There is a wealth of evidence to support the idea that (CBT) Cognitive Behavioural Therapy helps people to become well. This is a form of psychotherapy that challenges a person’s beliefs, helping them to rationalize distorted cognitions. If it works for many, this suggests that by changing the way we think we can “feel” better, so cognitive distortions can be a contributory cause. However this therapy does not work for everyone, which suggests the causes of a condition for some is more complex.
- People in some cultures may not think that depression is common, and that depression is more related to somatic problems. Therefore they would not consider of the importance of thinking "positively" to cure and decrease the chances of depression.
- The way that people think affecting their behavior (schemas)
- psychological disturbances come from irrational and illogical thinking
- Alloy et al: 1999
-
Aim: whether cognitive patterns may affect one's thinking
-
Method: following a sample of young American's in their twenties for 6 years, and they had to take a thinking style test, then they were placed in "positive thinking group" and "negative thinking group"
-
Results: 1% of the people in the positive thinking group developed depression, and 17& of the people in the negative thinking group developed depression
-
Conclusion: link between cognitive style and development of depression, and that identification of negative thinking patterns may eventually help prevent depression
Paragraph 3
Sociocultural viewpoints. Is the difference in the incidence of certain mental illnesses between men and women or people from different cultures due to differences in the status and treatment of women or men or specific cultural groups in certain parts of the world? An explanation of gender differences could be due to the fact that the figures come from medical data and women are more likely to go and see a doctor than men.
Perhaps women are more ready and willing to admit to needing help and therefore seek it out more readily. Are cultural/gender differences in the “experience” of a condition to do with levels of access to health care facilities, education and awareness, media influence?
The media also may play a part in cognitive distortions regarding body image.
- Viewpoint on the perfect body image
- Perfect body figure has changed from large bodies and curvy bodies to thin
- Increase in cultural emphasis on thinness as an ideal body shape in Europe, US, Japan
- Sanders and Bazalgette 1993:
-
Aim: the influence of media in dolls towards chilren
-
Method: analyse and create life size figures of Barbie, Sindy, and Little Mermaid
-
Results: the dolls all had tiny hips and waists, and exagerrated inside leg measurements
-
Conclusion: at a young, children are already influenced and have a pressure towards their ideal shape, and allows their dolls to be their models, and this may increase their thought towards the need of dieting.
- If the media is a key factor to explain why certain conditions like eating disorders develop, one could ask why is it that only certain people experience EOs, when we are all exposed to very similar media influences? This supports the notion of a genetic predispostion and a biological influence.
- Less people with abnormal problems because e.g. they are in China, they will consider people as depressed when they have somatic problems rather than emotional problems because in China, people think that having mental problems is a great stigma
- Data comes mainly from medical data and for sure attitudes towards mental illness vary from culture to culture, Certain parts of the world will have more discriminatory attitudes towards mental illness and people may not want to be stigmatized.
- China, for example – mental health issues often related to a somatogenic explanation – one related to key themes in Chinese medicine of Yin and Yang and “balance” . (Kleinman 1982)
- Marsella (1979) – argued that affective symptoms of lonliness, isolation, sadness are symptoms of Western civilizations.
- Social origins of depression in women
-
Aim: finding out the social origins of depression in women
-
Results: 29/32 women who became depressed had experienced severe life event, but 78% of those who did experience a severe life event did not become depressed
- Life events resembling previous experiences would most likely lead to depression
- Evaluation of Brown and Harris
- People had different coping abilities of their events
- Life events resembling previous experiences would most likely lead to depression. However not all the women who d experienced traumatic life events developed depression. Suggests innate predisposition.
Conclusion
- link biological, cognitive and sociocultural together
- We cannot always be certain of the statistics due to cultural issues
No one single cause. We are all unique. Influences on us vary profoundly from person to person. Huge array of variables that can affect behavior. Treatment successes have helped professionals to build a clearer picture of factors that influence the development of these illnesses but etiologies are complex and multi-faceted. Professionals need to be flexible and open-minded and provide a range of treatments and therapies to help someone back to a state of mental health effectively and to use an eclectic approach.
Evaluate psychological research relevant to the study of abnormal behavior
Introduction
- Different types of psychological research studies used to study abnormal behavior
- When researchers are gathering the symptoms of a disorder, they look for
- Affective symptoms (emotional elements), fear, sadness, anger
- Behavioral symptoms (observational behaviors) crying, physical withdrawal from others
- Cognitive symptoms: ways of thinking, pessimism, personalization, self image
- Somatic symptoms: physical symptoms, facial twitching, stomach cramping
- Or using the DSM (Diagnostic and Statistical Association) and ICD (international classification of diseases)
- Focus on research studies related to the reliability and validity of different etiologies of abnormal behaviors
Paragraph 1
- Gathering qualitative data
- Can be in depth or very brief
- A positive attitude may help get more information off the patient as they are more comfortable to talk about their problems, making it easier to diagnose them
- It may be influenced by the researcher themselves, where some patients may feel more comfortable speaking to their own race, etc.
- May lead to sensitive and distressing problems
- counseling service provided by the British government
- Helps people get better from abnormal behavior
- Writes people treatment plans to help them recover
Paragraph 2
- PET or CAT (especially in cases of schizophrenia or Alzheimer's disease)
- Artificial environment, therefore the participants may act differently
- Act under demand characteristics
- Expensive, requires expert
- Ethical findings on abnormalities in the brain
- Useful, because you can look at brain activity to see to what extent brain activity has effects on abnormal behavior
-
Aim: whether schizophrenic patients had differences in dopamine levels
-
Method: PET scan of 10 patients with schizophrenia and 10 healthy controls. Inject patients with I-DOPA, which is used in production of dopamine
-
Results: I-DOPA was taken up more quickly in patients with schizophrenia, suggesting that more dopamine was used for production
- Evaluation of Lindstroem:
- Not easy to find out levels of neurotransmitters accurately- lots of experiments have been done to see If the levels go up or down when something changes, but it doesn’t show accurate amount of change
- Scans are open to interpretation
- Given us an insight into schizophrenia
- Now we can deal with those patients easier knowing that they have different dopamine levels
Paragraph 3
- Observations being faulty
- Confirmation Bias- when doctors know that they are having a patient, they may already think that they have a problem, therefore they will look at them differently and consider them as people with mental problems
-
Rosenhan: this research shows that the "patients" who were emitted into psychiatric hospitals could not leave even though they have told the doctors that it was an experience
- The nurses and doctors thought that it was part of their symptoms as a schizophrenic
- When the researchers were taking notes of the experiment, the nurses made observations and noted them as "writing behavior", and they are making assumptions that they have mental problems
- Naturalistic observations
- Demand characteristics influences observation if the people know that they are being looked at, therefore they may act upon self-fulfilling prophecy
- Many researches may lead help find out different abnormalities of people
- Important to remember the accuracy and reliability of the data
Examine biomedical, individual, and group treatment approaches to treatment
Biomedical Approaches to Treatments of depression
- Assumption that the problem is based on biological malfunctioning
- Drugs used to restore biological system
- Depression - involves imbalance in neurotransmission, drugs are used to restore appropriate chemical balances in the brain
- Not all patients respond the same way
- Psychoactive drugs used for large proportion of prescriptions
- Drugs typically operate by affecting transmission in the nervous system of neurotransmitters for
- Dopamine, serotonin, noradrenalin, or GABA
- Increase / decrease levels of available neurotransmitters available in the synaptic gap
- Depending on which neurotransmitters they affect, and whether they enhance / diminish effectiveness, they can have calming or energizing effects on different kinds of behavior
- Different methods of action of difference drugs mean that they produce difference side effects
- Antidepressant drugs elevate mood of people with depression
- SSRI - most common group of drugs (selective serotonin re-uptake inhibitors), increasing level of available serotonin by preventing re-uptake in the synaptic gap
- Most common SSRI - fluoxetine / brand name: Prozac
- SSRI's are effective and safe, but have side effects such as vomiting, nausea, insomnia, sexual dysfunction and or headaches
-
Lacasse and Lee, and Kirsch et al: critical towards over-prescription of SSRI's like Prozac
-
Harriman: use of such drugs may increase suicide risk in the first few weeks of treatment
- Evidence for the effectiveness of biomedical treatments in relieving symptoms of mental disorder
- Serious side effects at times (ECT)
- Concerns that drugs may be over-used
- Increasingly safe and effective with new treatments like TMR
- Even those that realize that biology is the cause of mental problem. They do not always support biological interventions because they feel that psychological methods are appropriate in some cases
- Biological therapies are rarely supported as the only treatment
- Biological therapies may be used to support the patients in a state of mind that enables them to receive psychological therapy
- e.g. depressive patients may receive drugs so that they are in the state of mind to believe that they can benefit from psychological treatments
- Use of biological therapies shows that there is relationship between biological dysfunction and mental dysfunction
- Biological therapies provide invaluable and life saving tool in the treatment of mental disorder
- Improvement in existing method and better alternatives are constantly being researched
- Unlikely and probably undesirable for biological treatments to be the only help that sufferers are given
- Combination of appropriate somatic and psychological therapies help provide the most favorable outcomes to the alleviation of mental distress
- Serotonin hypothesis: inadequate amount of serotonin available in the synaptic gap between neurons for effective transmission to occur
- Medications to increase serotonin available
- Medication would prevent the reuptake of serotonin, making it stay in the synaptic gap for longer, and that would increase its efficiency of the serotonin that is present
- SSRI's are the drugs that increase the amount of serotonin available
- Treats symptoms but it does not cure the disorder, and there are significant side effects
- Sexual problems, dry mouth, insomnia, and increase in suicidla thoughts
- Side effects outweight benefits of the medication, because drugs may sometimes be seemed as more helpful for more serious cases of depression
- Only symptoms are treated because depressive episodes usually recur, patients need to continuously take the medication
- Unless medication is used with therapy, it is unlikely that disorder disappears forever
- 2 ways to see how well the drugs work
- Compare drug with placebo when prescribed to patients with depression
- Compare with other forms of therapy
- Difficulty in looking at this research is that many studies show that medication is no better than placebos is usually not published
- Ethical problem with research, as researchers are lying to patients about the treatment they are receiving, as it is deceptive, and it may be dangerous if the patient is having frequent suicidal thoughts
-
Cuijpers: meta-analysis of studies comparing effectiveness of various treatments for depression
- Psychotherapy groups do significantly better than control groups (placebo group)
- Medication is more effective than psychotherapy when improving symptoms, esp. when SSRI's used
- Best results are when there is a combination of medication and psychotherapy
Individual Therapies
- Therapist works one on one with client
- Mostly includes cognitive therapy, where therapist changes clients negative thinking patterns
- More personal than drug therapy, and the person may feel more like a patient
- Highly individualized to meet the need of the client
- Most commonly used and research shows it has positive effect
Group Therapies
- Group of clients meet with one or more therapists
- e.g. group of woman who have experienced sexual abuse in childhood, and now suffer from depressive episodes
- Useful for some groups to come together to share experiences in group sessions
- Talk about private matters that they kept secret - helps recovery
- Allows therapist to counsel several clients at a time
- Advantages to group therapy:
- Less expensive
- Support group for the client and diminishes the role of therapist
- Client is less dependent on the therapist
- Helps clients realize they're not alone - clients usually feel that they are stressed because they are outside the norm with unique and insurmountable problems
- Since many disorders are either caused by / promote poor social skills, group therapy allows clients to role-play and develop social skills in a safe, supportive environment
- Disadvantages to group therapy:
- Unwilling to disclose personal information to the group
- Confidentiality (despite requirements set by therapists)
- Group dynamics - individual feeling that they are not heard in the group / others getting higher priority from the therapist
Evaluate the use of biomedical, individual, and group approaches to the treatment of one disorder
Cultural Considerations in Treatment
- Culture of the client plays significant role in success of therapy
- Therapeutic approach may not always be appropriate
- Mutlaq and Chaleby 1995
- Problems with Group therapy in Arab cultures
- Strict gender roles
- Deference to members in the group based on age / tribal status
- Misperception that therapy session is another social activity
- Therapists use western psychotherapy and indigenous healing practices to treat clients
- Indigenous healing practices: encompass therapeutic beliefs and practices rooted into a given culture
- Research dealing with indigenous healing in non-western countries has identified several commonalities among indigenous practices
- Reliance on family and community networks
- Incorporation of traditional, spiritual, and religious beliefs as part of the treatment
- Malaysia - incorporates religion into psychotherapy
- Integrating religious beliefs and behaviors such as prayer and focusing on versus of the Koran that address "worry" could make psychotherapy culturally relevant
- During therapy with Chinese clients, verses from Taoist writings highlighting main principles such as restricting selfish desires, learning how to be content, learning to let go, are read and reflected by client
- Chinese Taoist cognitive psychotherapy is more effective in long term reduction of anxiety disorders than treating patients with medications
- Community psychologists go beyond traditional focus of responding to a person's distress on an individual level
- They include analysis of psychological health at community level
-
Miller - community based treatment to complement tradition therapy
-
Ecological model - emphasis on the relationship of people and the setting they live in
- Identify natural occurring resources in the community to promote healing and healthy adaptations
- enhancing the coping strategies enabling an individual and community to respond effectively to stressful events and circumstances
- Development of collaborative, culturally grounded community interventions that actively involve community members in the process of solving own problems
-
Hodges and Oei: applicability of CBT to Chinese culture
- Distance between therapist and client allows CBT to be more effective in Chinese culture
- Clients are likely to accept the therapists interpretations and advice about cognition
Essay >>
- Most treatments appear to have some positive effect
- Non-specific factors may play a role, as we see in the placebo effect – any treatment may be better than none
- Some approaches work better for some problems
- It is likely that an eclectic approach tends to work because causation is so complex (the interaction of biological, cognitive and sociocultural factors) – a diverse approach is more likely to work because so many factors contribute to the etiology of a disorder –> there is no one cause
- Even if a treatment approach appears to have more limitations than strengths, this does not mean it cannot be effective for some individuals
Who decides if the therapy is successful?
- Therapist – will they tell the truth?
- Client- will they tell the truth?
- Family – will they tell the truth?
There are limitations to outcome studies
- No patient is alike
- No treatment is alike in terms of procedures (tailored to the patient) or efficacy
Meta-analysis of 475 studies carried out by Smith et al. (1980)
- Meta-analysis indicated that most therapeutic approaches appeared to produce improvement
-
Smith et al: overall, most therapeutic approaches seemed to have improvements, but when the results were broken down into types of disorders, there were significant differences between the efficiency of the treatment
- All methods are effective to some extent, and it may not be a specific kind of therapy that makes a difference, but that non specific factors may play a role
- When results divided amongst disorders – significant differences between efficiency of treatment appeared
Biomedical approach to treating depression
Strengths
Statement: antidepressant drugs can alleviate symptoms of depression and provide effective long-term control for mood disorders
Evidence
Antidepressant drugs significantly help 60-80% of people (Bernstein et. al. 1994)
Evidence
Meta-analysis by Arrol et al. (2005)
- Focus: review of 12 efficacy studies on the role of antidepressants in primary care practices
- Studies were random clinical trials (RCT) comparing a tricyclic antidepressant (TCA), an SSRI, or both, with a placebo
- Targeted adults with mild and major depression
- Both SSRIs and TCAs were significantly more effective than taking a placebo when prescribed by a primary care physician
- Antidepressants effective for reducing range of depressive symptoms
- Many of these studies had design flaws
- For example:
- All of the SSRI versus placebo experiments had commercial ties
- TCAs could take as long as 2 weeks to become effective – those patients could take lower doses
Limitations
Statement: Side-effects must always be considered and can be a major drawback
Evidence
SSRIs can cause vomiting, nausea, insomnia, sexual dysfunction or headaches
Statement: drugs may reduce the symptoms of a psychological disorder but they do not constitute a cure
Discuss: why is this a limitation?
Statement: There is a huge market for anti-depressant drugs and drug companies may not be making all data from efficacy trials available to physicians and the public
Evidence and argument
- 291 million pounds per year spent on anti-depressants in the UK
- Times reports that SSRIS account for 16 million prescriptions a year.
- In Japan, after 2001, SSRI use has increased to 25 million US dollars per month.
- Is this because they are effective or because they are over-used and part of a trend? Are pharmaceutical companies simply cashing in? Evidence indicates that there are alternatives and though drugs can be effective, they should not be considered the only viable form of treatment (connect to evidence on the efficacy of anti-depressants)
- Turner et al (2008)
- Examined experiment results for 74 registered FDA studies of 12 antidepressants tested on 12, 564 subjects
- 23 studies (31% of the total number) were not published
- Paxil had some of the worst ratings
- 7 trials with positive outcomes were published
- 5 with negative outcomes were not
- This does not mean that antidepressants don’t work – it just means doctors must have all the facts if in order to decide on the best course of treatment
- If facts are hidden, then treatment is affected
Statement: Drugs are not effective in all cases
Evidence
A study by Kirsch and Sapirstein (1998)
- Analysed 19 studies, covering 2318 patients treated for depression with Prozac (an SSRI)
- Prozac only 25% more effective than placebos
- No more effective than other drugs, such as tranquillizers
Evidence
- Up to 40% of depressed persons fail to respond to an antidepressant
- Supported by Lambert (2008)
- Antidepressants effective for only 56-60% of patients using them
Statement: Symptoms of depression can also be alleviated by other means
Evidence
Study by Kirsch et. al. (2008)
- Review of 47 clinical trials published by the US Food and Drug Administration on the effectiveness of anti-depressants
- Findings:
- medical treatment not more effective than a placebo
- Depressed patients can improve without biochemical treatment
Evidence
Study by Blumenthal etl al. (1999) indicated that exercise was equally as effective as SSRIs in treating depression in an elderly group of patients
Evidence
Study by Leuchter and Witte (2002)
- Scanned the brains of patients receiving drug treatments and those of patients receiving a placebo
- Findings:
- Within 48 hours patients on drugs showed increased activity in the prefrontal cortex
- Within 1-2 weeks, patients on placebos showed decreased activity in that area
- However, both groups showed equal rates of improvement in mental health
- The placebo was as effective as the drugs and more effective than no treatment
- More research is needed to know why the placebo works
Evidence
Study by Elkin et. al. (1989)
28 clinicians were working with 280 patients diagnosed with major depression
- Individuals were randomly assigned to treatment groups
- Interpersonal therapy (IPT)
- Cognitive-behavioral therapy (CBT)
- Other forms of therapy
- Antidepressant drug (Imipramine)
- Control group = placebo + weekly therapy sessions
- the placebo/drug group was a double-blind design, so that neither the patient nor the doctor knew which was the drug group and which the placebo group
Results:
- Over 50% of patients in the CBT, IPT and Drug groups recovered:
- 29% in the placebo group recovered
Conclusions:
- all treatments produced positive results
- CBT and IPT work equally as well as drugs
Individual approach to treating depression
Strengths
Statement: CBT is just as effective as drugs as a treatment for patients with depression
Evidence
Study by Elkin et al. (1989)
28 clinicians were working with 280 patients diagnosed with major depression
- Individuals were randomly assigned to treatment groups
- Interpersonal therapy (IPT)
- Cognitive-behavioral therapy (CBT)
- Other forms of therapy
- Antidepressant drug (Imipramine)
- Control group = placebo + weekly therapy sessions
- the placebo/drug group was a double-blind design, so that neither the patient nor the doctor knew which was the drug group and which the placebo group
Results:
- Over 50% of patients in the CBT, IPT and Drug groups recovered:
- 29% in the placebo group recovered
Conclusions:
- all treatments produced positive results
- CBT and IPT work equally as well as drugs
Evidence
Study by DeRubeis et. al. (2005)
- Comparison of CT and antidepressant drugs in a randomized placebo controlled experiment including moderately and severely depressed patients
- 1 group was given Paxil; 1 group was given CT; 1 group was given a drug placebo
- after 8 weeks positive symptom reduction found in
- 50 % of Paxil group
- 43% of CT group
- 25% of placebo group
- Moderate and severe cases responded better to both drugs and CT than a placebo
- CT just as effective as drugs when administered by a qualified therapist
- APA and NIMH recommend that severely depressed patients need drug treatments. This study’s results do not support that.
Statement: CBT is also effective when combined with drugs
Evidence
Study by Riggs et al. (2007)
- Aimed to investigate effectiveness of CBT in combination with either a placebo or an SSRI
- Procedure
- Double-blind; 126 adolescents; aged 13-19; presented with depression + substance use disorder + conduct disorder
- Subjects randomly distributed into 2 groups: CBT + placebo; CBT + SSRI
- 67% of CBT + placebo group judged as ‘very much improved’ or ‘much improved’
- 76% of CBT + SSRI group judged as ‘very much improved’ or ‘much improved’
- Treatment with drugs and CBT is effective but treatment with placebo and CBT almost as effective
Limitations
The following can be worked into one paragraph where limitations are discussed in general. Don’t just list the statements. Discuss their significance
Statement: Depression is increasing – why is this so when so much treatment is available?
Statement: one complication in the study of any treatment is that there are no studies that compare all available treatments – this is not practical. We don’t have all the information that we need.
Statement: CBT can focus on symptoms rather than causes
Statement: Therapist has control over what constitutes acceptable thinking patterns; such subjectivity can lead to ethical concerns. The relationship with the therapist is vital.
Group Approach to treating depression
Strengths
Statement: A therapy group is beneficial for the individual
Evidence
Jacobsen et al. (1989) found that GT in the form of ‘couples’ therapy was most successful in women suffering from depression related to marital distress
Evidence
Study by Toseland and Siporin (1986)
- Reviewed 74 studies comparing individual and group treatment
- Findings:
- In 75% - Group treatment (GT) as effective as individual treatment (IT)
- Remaining 25% - GT was more effective than IT
- IT was never found to be more effective than GT
- In 31% GT was more cost-effective than IT
Evidence
Study by McDermut et al.
- A meta-analytic review of the effectiveness of group psychotherapy in treating depression, examining 48 studies
- Findings
- 43 showed statistically significant reductions in depressive symptoms
- ** results are different to the Toseland and Siporin (1986) study – likely due to the fact that many more variables are involved in group therapy than in individual therapy because of group dynamics (such as characteristics that should be excluded from the group, group cohesion and confidentiality. Thus the reliability of the data decreases )**
Statement: Group therapy is more cost-effective
Evidence
Study by Toseland and Siporin (1986)
- Reviewed 74 studies comparing individual and group treatment
- Findings:
- In 31% GT was more cost-effective than IT
Limitations
Statement: many more variables are involved in group therapy than in individual therapy because of group dynamics Thus the reliability of the data decreases
Evidence
Yalom (2005)
- Obtaining scientific data to assess effectiveness of group data is problematic
- Group dynamics have more variables than individual therapy such as:
- If you don’t feel that you belong, atmosphere can be detrimental, or an obstacle to healing
- Personality clashes
- Should certain characteristics be excluded?
- Substance abusers
- Specific conditions
- Might be broken by some members
- Reluctance to speak freely
- Relationship with therapist
- Must find the right person
- Also therapist is the outsider – can lead to trust issues
Statement: Depression is increasing – why is this so when so much treatment is available?
Statement: one complication in the study of any treatment is that there are no studies that compare all available treatments – this is not practical. We don’t have all the information that we need.
Discuss the use of eclectic approaches to treatment
Use of eclectic approaches
- Common for many approaches to treatment being used at the same time
- Usually positive effect when people take action to cope with / change behavior
- Drugs, group sessions, therapy sessions - positively contribute to increase mental health
- Commonly go to therapist who practices an eclectic approach to therapy
- Approach that incorporates principles or techniques from various systems or theories
- Strengths and limitations to various therapies, therefore they tailor sessions to then need of the individual / group
Intro
Paragraph 1 (for)
- Helps people get better quickly
- Broader theoretical base
- More sophisticated approach than single theory
- e.g. beck & ellis's theory
- Not biased towards a certain treatment - they can select different treatments
-
Butler et al: reviewing several meta-analysis of efficacy studies for CBT
- CBTis effective for depression
- Effect is not usually greater than medication alone
- Outcomes are better when CBT combines with medication
- Multi-axial diagnosis: eclectic approach to treatment
- Multidisciplinary
- Multilayered
- Multidimensional
- Multifaceted
- e.g. depressive suicidal client - obtains CBT (which may take a long time because then they can allow further discussion about his/her cognitive process), then drug therapy may be used to lessen symptomology of disorder
- Once client is stabilized, CBT may still be used
- When the client is more self reliant, group therapy may be used to develop strategies to avoid future relapse and increases support
Paragraph 2 (for)
- Patient may enter a group / individual therapy without being medicated
- But its rare that a person suffering from significant problems have only 1 treatment - a multidisciplinary team (involving at least one therapist and one medical professional) work together to combine skills to aid patients progress.
- Person may be dependent on the medication, and they may relapse if they stop taking it
- Person's thinking may be disordered, and they will have very negative thoughts.
- When CBT is successful, it teachers people the kind of skills they need in order to function without further use of medication
- CBT may take too long, therefore with drugs as well, they may recover at a faster rate
- Sometimes considered irresponsible to use medication without therapy or therapy without medication
- Medication is often fastest way to see results, for them to realize their own state, and once they know the state they're in, psycho therapy may begin
- Drug therapies alone have significant relapse rates (back to the disorder)
- Client will show symptoms of the disorder after being "symptom free"
-
Klerman: combination of psychotherapy and drugs is usually more successful than psychotherapy / drugs alone
Paragraph 3 (against)
- Difficult to judge value of each treatment in the eclectic approach
- Different people react differently to situation
- People eventually get better anyway - eysenck
- Spontaneous remission alone was responsible for individuals improved conditions
-
Rush et al: higher relapse rate for those being treated with drugs will arise compared to patients in a cognitive therapy program that can learn skills to cope with depression that the patients given drugs don’t learn
-
Hollon and Beck: cognitive therapies are more effective than drug treatment alone at preventing relapse or recurrence (except when drug treatment is continued for long term)
Paragraph 4 (against)
- Clinicians may not be as focused and detailed in finding the cause because they can just keep trying different approaches
- They may have no clear direction for treatment, just labeling themselves as eclectic
- Requires knowledge and skill to deliver eclectic approaches effectively
- Culture differences making it hard for eclectic approach
- Mutlaq and Chaleby 1995
- Problems with Group therapy in Arab cultures
- Strict gender roles
- Deference to members in the group based on age / tribal status
- Misperception that therapy session is another social activity
- Costly to approach so many different techniques
Discuss the relationship between etiology and therapeutic approach in relation to one disorder
Etiology and treatment
- Contemporary abnormal psych: takes on biomedical, individual or group therapy approaches, depending on the disorder
- Multifaceted approach to treatment is most efficient
- Biopsychosocial approach to treatment includes drug treatment, individual therapy (cognitive therapy like CBT), or group therapy (CBT again, or family therapy)
- Consider the individual as a person suffering from problems rather than patient
- "client" replaces "patient"
- Biomedical approaches to treatment are based on assumption that biological factors are involved in the psychological disorder
- Doesn't mean that biological factors cause the psychological disorder - but it is associated with changes in brain chemistry - neurotransmitters and hormones
- Drugs used to treat various disorders based on theories of the brain chemistry involved
- However there is true understanding of the link between neurotransmitters and their symptoms
- Nor why some drugs work in some cases but not all
- Not all clients respond to the same drugs
- Clinicians must find appropriate drug and dosage per person, and they must be prepared to find replacements for the drugs