Human Relationships

Abnormal PsychologyLearning Outcomes

To what extent do biological, cognitive and sociocultural factors influence abnormal behaviour?BIOLOGICALNumberger and Gershon (1982) used 7 twin studies on major depressionMZ twins had 65% concordance rate, 14% for DZ twins. Supports genetic predisposition hypothesis.Important to consider interaction with environment skillComorbidity with anxiety, eating disorders, etc., makes conclusions difficult

Depression etiology: Catecholamine hypothesis asserts that noradrenaline is influential in depression. Janowsky et al. (1972) used a drug that decreased noradrenaline and induced depression in minutesDrugs that increase noradrenaline reduce depression symptoms Cortisol hypothesis states that stress predisposes an individual to disordersHigh levels of cortisol are found in those with depressionCortisol may influence the release of neurotransmitters

CognitionBeck (1976) Cognitive theory of depressionNegative cognitive triad. Negative views of self, world and futureDepression is caused by inaccurate cognitive responses. Negative thinking and schemas. Contrary to other models where negative thinking is a symptom.Related to diathesis-stress model. Negative (depressogenic) schemas are the diathesis, negative life events are the stresses that active schemas.

SocioculturalBrown & Harris (1978) Social factors in depression.Aim: how depression could be linked to social factors and stressful life eventsProcedure: 458 women were surveyed about stress and depression, interviewed about particular events/copingResults: 8% had been depressed in past year, 90% of depressed had experienced negative life event. Working class had higher rate than middle class with children. Lack of support, 3 young children, unemployment were identified as vulnerabilities. Implications: demonstrated social factors involved in depression and need to be considered. Gender biased sampleEvaluation: generally supported that social stressors (war, poverty, urbanisation, unemployment) play a role in mental health. Cultural expectations are also important.

Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour.

Seligman and Maier (1967)learning to be depressed: electrical shocks on dogs affecting their ability to jump over barriersAims; learn that when dogs were exposed to electrical shocks they could neither control nor escape from, they later failed to learn to escape from shocks when such escape was easily availableProcedure; Some dogs were able to control electrical pulses by pushing panels on near their head, while other dogs were not. Dogs who were able to control the shock became progressively faster at pushing the panel, showing that they were learning avoidance. All dogs were then put in a chamber where they were able to jump over a barrier to escape the shocks (which were administered 10 seconds after a light flashed, warning the dogs of the impending shock).Results; While dogs in the "escape group" (able to push panels to stop pulses) got faster at pushing the panels, the no-escape group eventually stopped pushing the panels at all. Results showed that all dogs who were previously able to escape the shocks eventually learned to jump the barrier, while 80% of the no-escape dogs were failed to do so. Dogs in the control group (no previous shock therapy) reacted almost identically to escape-group dogs.Implications/Concerns While this shows that in dogs, learned helplessness can lead to failure to learn new behaviors (this can lead to depression in humans), it has all sorts of ethical concerns with using dogs as test subjects.

Examine the concepts of normality and abnormality.NormalityJahoda (1958) Mental health model of normality.Criteria for normal mental health are: absence of mental illness, realistic self-perception and contact with reality, strong sense of identity and positive self-esteem, autonomy and independence, ability to maintain healthy interpersonal relationships, ability to cope with stress, capacity for growth.Deviations would be abnormal. Most people would be abnormal. Mental health is more difficult to establish than physical health.Focus is on the Western ideal

Abnormality An abnormality is difficult to define and diagnose because it is subjective and is based on symptoms instead of biological tests. Rosenhahn & Seligman (1984) Suggest seven criteria for abnormalSuffering experience of stress or discomfortMaladaptiveness engaging in behaviours that make life more difficultIrrationality incomprehensible or unable to communicate in a reasonable mannerUnpredictability acting ways that are unexpected for self or buy othersVividness/unconventionality experiences that are different from mostObserver discomfort acting in a way that is difficult to watch or embarrassingViolation of standards breaking accepted moral/ethical standards of a culture

Discuss validity and reliability of diagnosis.Diagnosis is based on the ABCS, as well as the classification systems such as the DSMIV andthe ICD. The reason for the lack of validity and reliability of diagnosis has to do with the lack ofscientific evidence in diagnoses, the cultural aspects that can contribute to the lack of reliability, as well as the psychiatrists attitude and prejudices

For a classification system to be reliable, it should be possible for different clinicians, using the same system, to arrive at the same diagnosis for the same individualsFor a classification system to be valid ,it should be able to classify a real pattern ofsymptoms which can then lead to an effective treatmentThe classification system is descriptive and does not identify any specific causes fordisorders so its hard to make a valid diagnosis for psychiatric disorders because there are no objective physical signs of such disorders

Rosenhan (1973)Aim: Test the reliability of psychiatric diagnosesMethod:Field experimentDescription: five men and three women who were normal went to 12 different psychiatric hospitals to get admission by stating that they had been hearing voices.7 of them = diagnosed with schizophrenia and it took an average of 19 days before they were discharged and seven of them were labeled as schizophrenic in remission. Also,Rosenhan wanted to see if abnormal patients would be able to be classified as abnormal and out of 41 of these abnormal patients, 19 were suspected to be frauds by some of the psychiatristsConclusion: Not possible to distinguish between sane and insane in psychiatric hospitals and theres a lack of scientific evidence on which medical diagnoses can be made.Strengths: Gives insight to the lack of reliability in psychiatric diagnosesLimitations: Ethical issues such as deceit to the psychiatrists

Lipton and Simon (1985):Randomly selected 131 patients at a NY hospital and tested them to arrive at a diagnosis. This diagnosis was then compared with the original diagnosis. 89 originally diagnosed with schizophrenia, and only 16 received the same diagnosis. 50 were diagnosed with mood disorder, and only 15 had originally been diagnosed with mood disorders.Lack of scientific evidence and the diagnoses may be influenced by the attitudes and prejudices of the psychiatrist

Discuss cultural and ethical considerations in diagnosis (for example, cultural variation, stigmatization).Cultural considerationsAn individuals behaviour is governed to an extent by the culture they are brought up in.There are likely to be different perceptions of behaviour in different cultures, different cultural norms.A tendency to favor ones own cultural view of the world.Studies on psychological disorders originated from the west, hence the tendency that the diagnosis system favor the western culture.

Erinosho &amp Ayonrinde NigeriaYoruba Tribe study[A]Investigate the cultural differences in criteria of normality and abnormality.[P]Participants were tribesmen from the Yoruba tribe in Nigeria.Information of patients with schizophrenia were presented to people of the Yoruba Tribe.[F]Only 40% of the tribesmen from the Yoruba tribe identified the patients as mentally ill.30% of the tribesmen said they would marry such person.This maybe due to the cultural differences between the tribesmen and the westernized world (see Binities study).[C]Shows the importance of an emic approach in studies.The ability to identify the definition of abnormality in different cultures can only be done in culture specific approach in studies.

Binitie Schizophrenia in Nigeria[A]Investigate the cultural differences in criteria of normality and abnormality.[P]Participants were Nigerians living in the city.Information of patients with schizophrenia were presented to the participants.[F]Most participants correctly identified the patients as mentally ill.31% showed aggressive response to such patients e.g. suggesting that they should be expelled or shot.[C]Shows how western culture has influenced the judgement of normality (compared with Yoruba tribe study).

Conclusion; Seems that Schizophrenia is a western model, Tribal Nigerians did not see hallucination as something negative.Cultural relativism suggests that abnormality is subjective cross culturally.Hallucinations and cultural perspectives was also investigated in theKasamatsu & Hirai Monk Serotonin Study. Hallucination is seen to be a spiritual experience by Japanese monks.Ethical considerationsEthical concerns regarding diagnosis mainly surround the issue of Labeling and its consequences.After diagnosis, the patient will inevitably be labeled with the diagnosed illness.Labeling will cause Stigmatisation.Where the patient will have a negative persona attached to them because they are labeled as mentally ill.

Describe symptoms and prevalence of one disorder from two of the following groups:Symptoms of DepressionPhysiological: fatigue, loss of energy, significant weight change, loss of appetite, headaches, painCognitive: Feeling worthless, excessive guilt, difficulty concentrating, negative attitude to world/self/future, feeling a lack of controlEmotional: Distress, sadness, anhedonia (not feeling positive feelings), loss of interest in outside activitiesBehavioural: Disturbed sleep patterns, self-destructive behaviour, suicidal ideation, and avoidance of social company.

Prevalence of DepressionPrevalence is the percentage of a population affected by a disorder during a specific time. The IB does not differentiate prevalence and incidenceNational Institute of Mental Health currently reports a 12-month prevalence of 6.7% in US adults.16.5% lifetime (13.2% males, 20.2% females [Kessler et al. 2005]) Women are 70% more likely to experience depression than menBlacks are 40% more likeAge is a major factor: 18-25 year is 200% more like than someone over 60 for 12-month period.Variations across culturesAndrade and Caraveo (2005) found 3% in JapanPoongothai et al. (2009) found 15.9% in South India

Analyse etiologies (in terms of biological, cognitive and/or sociocultural factors)Affective disorders: DepressionDepression etiology: serotoninSerotonin hypothesis suggests that low levels of serotonin causes depression (Coppen, 1967). Selective Serotonin Reuptake Inhibitors block reuptake to increase serotonin in the system. Prozac, Paxil, Zoloft all do this. Effexor & other new drugs are dual reuptake inhibitors (Serotonin Norepinephrine Reuptake Inhibitors).Henninger et al. (1996) reduced serotonin and did not find increase in depressionKirsh et al. (2002) found that 80% of the response in studies may be the placebo effectThere is a link between depression and serotonin, but may only be a correlation and not the cause. Depression etiology: GeneticsNumberger and Gershon (1982) used 7 twin studies on major depressionMZ twins had 65% concordance rate, 14% for DZ twins. Supports genetic predisposition hypothesis.Important to consider interaction with environment skillComorbidity with anxiety, eating disorders, etc., makes conclusions difficultSullivan et al. (2000) used meta-analysisMZ twins are 2x as likely as DZ twins to develop depressionStrong genetic contribution (31-42%) Environment is important to account depressionThere is a genetic component to depressionmust be viewed as an interaction with the environment/cognition to account for depression.

Depression etiology: CognitionBeck (1976) Cognitive theory of depressionNegative cognitive triad. Negative views of self, world and futureDepression is caused by inaccurate cognitive responses. Negative thinking and schemas. Contrary to other models where negative thinking is a symptom.Related to diathesis-stress model. Negative (depressogenic) schemas are the diathesis, negative life events are the stresses that active schemas.Boury et al. (2001) found a correlation between automatic negative thoughts and severity of depression. Duration of depression also influenced by thoughtsEvaluation: used in Beck Depression Inventory and part of CBT treatment. Effectively describes characteristics of depression. Causal link to depression is hard to estimate.

Depression Etiology: SocioculturalPoverty or living in a violent relationship are linked with depression. Women may experience more stress raising childrenBrown & Harris (1978) Social factors in depression.Aim: how depression could be linked to social factors and stressful life eventsProcedure: 458 women were surveyed about stress and depression, interviewed about particular events/copingResults: 8% had been depressed in past year, 90% of depressed had experienced negative life event. Working class had higher rate than middle class with children. Lack of support, 3 young children, unemployment were identified as vulnerabilities. Implications: demonstrated social factors involved in depression and need to be considered. Gender biased sampleEvaluation: generally supported that social stressors (war, poverty, urbanisation, unemployment) play a role in mental health. Cultural expectations are also important.

Discuss cultural and gender variations in prevalence of disorders.Prevalence of DepressionPrevalence is the percentage of a population affected by a disorder during a specific time. The IB does not differentiate prevalence and incidenceNational Institute of Mental Health currently reports a 12-month prevalence of 6.7% in US adults.16.5% lifetime (13.2% males, 20.2% females [Kessler et al. 2005]) Women are 70% more likely to experience depression than menBlacks are 40% more likeAge is a major factor: 18-25 year is 200% more like than someone over 60 for 12-month period.Variations across culturesAndrade and Caraveo (2005) found 3% in JapanPoongothai et al. (2009) found 15.9% in South IndiaCultural Variation in PrevalenceWeisman et al. (1996) studied 10 countries19% in Lebanon, Paris 16.4%, 2.9% in Korea, 1.5% in Taiwan. Women higher than men in all countries.Cultural differences, stigma, methodology may account for differencesMarsella et al. (2002) argues that depression started as a topic of Western medicine.Rates are increasing throughout the world. May be most common psychiatric problem in world. Why cultural variations?Dutton (2009) found that differences could be due to stress, living standards or reporting bias.War, discrimination, unstable politics, crime, etc. differ.Sartorius et al. (1983) found differences in stigma of disorders.More likely to find physical pain in Middle East or China. Neurasthenia more common in China.Marsella (1995) asserts that urban life has increased stress. May be a cause of increase in depression.

Gender variation in prevalenceNolen-Hoeksema (2001) found that women are twice as likely as men to develop depression. No single variable can account for difference.Lifetime prevalence in the US is 21.3% for women and 12.7% for men. (Kessler et al. 1993). Women more likely to seek help and report symptoms.Piccinelli & Wilkinson (2000) found that gender differences are genuine. Not a product of different diagnostic procedures. Explaining gender variationMay be due to different sex hormones (oestrogen & progesterone) and the effect on mood.Weiss et al. (1999) found that women are more likely to give experienced early trauma. Disrupts HPA-axis and disrupts stress responseNolen-Hoeksema (2001) asserts that women respond to the stressor differently than men. Biological factors, coping styles, self-concepts. Diathesis-stress model. May also be socio-cultural because women have less power. Could lead to a feeling of less control or diminished status. Also supported by Brown and Harris (1978). Role strain hypothesis suggests that social roles and culture contribute to the ratio. Lack of employment/equality, marriage roles (Bebbington, 1998).

Examine biomedical, individual and group approaches to treatment.Depression Treatment: BiomedicalAssumes that restoring the biological system with drugs will treat problem. Most common drug treatment for depression is SSRI. SSRIs are drugs that interfere with the serotonin reuptake. Take up to two weeks to see relief of symptoms. Block the reuptake process of serotonin during neurotransmission. Increases amount of serotonin in synaptic gap. Have fewer side effects than previous drugs. May cause headaches, nausea, agitation, sleeplessness, sexual problemsNeale et al. (2001) conducted meta-analysis of antidepressants vs. placebos Three groups: only placebo, only anti-depressant, switch to placeboPlacebo only had 25% risk of relapse, 42% for switch. Drugs interfere with natural regulation of brain.

Depression Treatment: IndividualThe most commonly used individual treatment is Cognitive Behavioural Therapy (CBT)Related to Becks (1976) cognitive theory of depression. Faulty thinking includes: arbitrary inference, selective abstraction, overgeneralisation, exaggeration, personalisation, dichotomous thinking. Aims to change negative thinking patternsUses 12 to 20 weekly sessions and daily exercises to help identify automatic negative thoughts/patterns and change themStep 1: identify and correct faulty cognition (reality testing and cognitive restructuring)Step 2: increase activity and learn alternative problem solving strategies (increase rewarding acitivites).Teasdale (1997) states that teaching the ability to think about own thoughts is important in CBT.

Depression Treatment: GroupTherapist will meet with a group (family, same disorder)Generally less expensive. Couples therapy has been most successful with women suffering depression related to marital stressToseland & Siporin (1976) reviewed 74 studies comparing individual and group treatment. Group as effective as individual 75% studies, more in 25%. McDermut et al. (2001) looked at 48 studies. 43 showed reduction after group therapy, 9 showed no difference between group/individual.8 found CBT more effectiveYalom (2005) identifies factors to consider in group therapyGroup cohesion, exclusion, confidentiality and relationships with therapist.

Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder.Evaluation of Biomedical TreatmentDrugs are common for treating severe depressionTreat symptoms but do not cure. Side effects and studies with high rates of placebo effect indicate that biomedical approach may not be effective. Long term impact on brain is unknown.Leuchter et al. (2001) Changes in brain function during treatment with placebo.Examined brain function of 51 with depressionReceived placebo or medication, double-blindEEG used to measure brain functionResults showed increase in prefrontal cortex for placebo group immediately, slower for SSRI, both improved.Belief in treatment may be enough to have brain heal itself.Kirsh et al. (2008)Meta-analysis of clinical trialsUsed clinical trials of 6 most used anti-depressants 1987-1999. FDA analysed. SSRI was below recommended criteria for clinical significance.Highest effect was found in the most severe cases of depression.Placebo may account for the observed effect in the clinical trials.

Evaluation of Individual TreatmentCBT effectively treats patients with depression. Superior to no treatment or placebo. CBT to be as effective as IPT or AD.Riggs et al. (2007) studied CBT with SSRI or placebo.Randomised double blind 126 12-19 y-o.Depression, substance use conduct disorders.67% of CBT + placebo and 76% of CBT + SSRI improved after 4 months. Decrease in depression and other problems.CBT is cost-effective because short durationEffective for mild depression, no negative effects found, CBT + AD (anti-depressant) more effective in chronic cases or childhood trauma vs. drugs aloneCriticised for focusing on symptoms, not causes

Evaluation of Group TreatmentSegal, Williams & Teasdale (2001) Mindfulness-based cognitive therapy (MCBT) to treat depressionGoal is to prevent relapse after successful treatment. Based in Buddhist meditation and relaxation to focus so negative thoughts can be observed and reduced. Teach people to recognise signs of depression and adopt decentred perspective of negative thoughts so they are not central to self-concept or thought to represent reality. Kuyuken et al. (2008) randomised to controlled trial of MBCT and anti-depressant medication.Aim: investigate effectiveness of MBCT with anti-depressantProcedure: 123 participants with at least three depressive episodes, 15 month study. One group used anti-depressant alone, other used MBCT & AD (decreasing)Results: relapse of 60% in control, 47% in experimental- 75% stopped taking medication. Implications: MBCT group reported higher quality of life (enjoyment and physical well-being), more positive effects.

Discuss the use of eclectic approaches to treatment.Depression Treatment: Eclectic Antidepressants are the most common treatmentEffective, but take time and dropout is high Keller et al. (2004) found that 50-60% improved with first antidepressant, only 1 in 3 will have complete recovery. Relapse is common, but combining with therapy reduces riskKlerman et al. (1974) treatment of depression by drugs and/or psychotherapyAim: test efficacy of drugs/psychotherapy alone/combinedProcedure: 150 females with depression in 4 groups- AD, therapy, AD + therapy, placeboResults: relapse highest for placebo group (36%), 12% for AD, 16.7% for therapy, 12.5% for AD + therapy. Why use eclectic treatmentPampallona et al. (2004) meta-analysis of efficacy of drug treatment alone versus drug treatment and psychotherapy in depressionAim: analyse whether combining AD and therapy was more effective in treatment of depressionProcedure: 16 randomised, controlled studies with 932 taking AD only and 910 combinedResults: patients in combined treatment improved significantly more than drug alone. Greater effect over time (>12 weeks) and lower dropout.Eclectic treatments may be helpful because individuals may dropout drug treatment when beginning to feel better. May also be due to side effects, combining benefits of AD and therapy generally leads to greater improvement (Pampallona et al., 2004) psychotherapy also heals keeps patients in treatment.

Discuss the relationship between etiology and therapeutic approach in relation to one disorder.Etiology & depression treatmentThere are no simple explanations for the etiology of depression (or other psychological disorders). Logically we want use a treatment for the cause for the best outcome. Serotonin hypotheses (Coppen, 1967) relates los serotonin to depression. Use of SSRI. Henninger et al. (1996) reduced serotonin in healthy individuals and did not see increase in depression. Depression treatment often involves the use of anti-depressantsInterferes with neurotransmission and shows effect. Some question the use of SSRIs because it disrupts brain. Serotonin system is complex and is little long term info is known. Do not cure depression and have side effects, placebo may be as effective, psychotherapy is as effective. Elkin et al. (1989) Controlled outcome study of treatment for depression. 280 patients randomly assigned to AD + clinical management, placebo + clinical management, CBT or IPT 16 week treatment. Tested at beginning, after 6 weeks and after 6 monthsResults showed that therapy and drug groups had reduction in depression in over 50% only 29% placebo. No difference in effectiveness of the AD CBT or IPT. Most severe cases had most improvement with AD.