Health & Clinical
Psychology

Healthy Living

Stress

Dysfunctional Behaviour Disorders

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Contents

• Objectives for the Health and Clinical Psychology module 6 • What is Health Psychology? Careers in Health Psychology 7 • Unit G543: Health and Clinical Psychology 8 • Exemplar exam paper 9

PART A – INFORMATION TO HELP EVALUATE STUDIES • Evaluation sheet for the theories/studies of Health Psychology 10 • Guide for answering part A & part B exam questions 11

PART B – HEALTHY LIVING • Introduction to Healthy Living 14

• Theories of Health Belief 17 • Compliance with a Medical Regime for Asthma (Becker 1978) 18 • Internal versus External Locus of Control (Rotter 1966) 21 • Analysis of Self-Efficacy Theory of Behavioural Change (Bandura and Adams 1977) 23 • Summary of the health belief theories 26 • Comprehension questions for theories of health belief 27 • Part A exam question 28 • Part B exam question 29 • Evaluation sheet of health belief theories/studies 30

Introduction to Health Promotion 31 • Theories of Health Promotion • Chip pan fire prevention (Cowpe 1983) 32 • Legislation-Bicycle helmet laws and educational campaigns (Dannenberg et al. 1993) 34 • Effects of Fear arousal (Janis & Feshbeck 1953) 37 • Summary of the health promotion studies 41 • Comprehension questions for health promotion 42 • Part A exam question 43 • Part B exam question 44 • Evaluation sheet of health promotion theories/studies 45

Introduction to Theories of Adherence 46 • Theories of Adherence • Reasons for Non- Adherence (Bulpitt et al. 1988) 47 • Measures of Non –Adherence ( Lustman et al. 2000) 49 • Improving Adherence using Behavioural Methods (Watt et al. 2003) 51 • Summary of the theories/studies of adherence 53 • Comprehension questions for theories of adherence 54 • Part A exam question 55 • Part B exam question 56 • Evaluation sheet of theories of adherence theories/studies 57
PART C – STRESS
Introduction 58

• Theories of Causes of Stress 62 • Measurement of Stress Response (Johansson 1978) 63 • Comparison of Two Methods of Stress Measurement (Kanner 1981) 66 • The Effect of Control on Reducing Stress (Geer and Meisel 1972) 68 • Comprehension questions for causes of stress 70 • Summary of the theories/studies of causes of stress 71 • Part A exam question 72 • Part B exam question 73 • Evaluation sheet of causes of stress theories/studies 74

Introduction to Theories of Measuring Stress 75 • Theories of Measuring Stress • Physiological Measures (Geer & Maisel 1973) 76 • Self-Report (Holmes & Rahe 1967) 78 • Combined Approach (Johannson 1978) 81 • Summary of the theories/studies of measuring stress 84 • Comprehension questions for methods of measuring stress 85 • Part A exam question 86 • Part B exam question 87 • Evaluation sheet of methods of measuring stress theories/studies 88

Introduction to Theories of Managing Stress 89 • Theories of Managing Stress • Stress Inoculation Therapy (Michenbaum 1975) 90 • Biofeedback and Reduction of Tension Headaches (Budzynski 1973) 93 • Social Relationships and Cancer Survival (Waxler-Morrison 2006) 96 • Summary of the theories/studies of managing stress 99 • Comprehension questions for managing stress 100 • Part A exam question 101 • Part B exam question 102 • Evaluation sheet of managing stress theories/studies 103

PART D – DYSFUNCTIONAL BEHAVIOUR • Introduction 104
Introduction to theories diagnosing dysfunctional behaviour 105 • Diagnosis of Dysfunctional Behaviour • Categories of Dysfunctional Behaviour (DSMI/ICD ) 108 • Definitions of Dysfunctional Behaviour (Rosenhan and Seligman 1995) 112 • Sex Biases in Diagnosis of Disorders (Ford and Wediger 1989) 116 • Summary of the theories/studies of dysfunctional behaviour 118 • Comprehension questions for diagnosis of dysfunctional behaviour 119 • Part A exam question 120 • Part B exam question 121 • Evaluation sheet of diagnosis of dysfunctional behaviour theories/studies 122

Introduction to theories explaining dysfunctional behaviour 123 • Theories Explaining Dysfunctional Behaviour • Behavioural : Study of Classical conditioning(Watson and Raynor 1920) 124 • Biological : Twin studies (Gottesman and Shields 1991) 127 • Cognitive : Interviews with people with depression (Beck et al. 1974) 129 • Summary of the theories/studies explaining dysfunctional behaviour 131 • Comprehension questions for explaining dysfunctional behaviour 132 • Part A exam question 133 • Part B exam question 134 • Evaluation sheet of the explanations of dysfunctional behaviour theories/studies 135

Introduction to treatments of dysfunctional behaviour 136 • Theories of Treatments of Dysfunctional Behaviour • Successful Treatment of a Noise Phobia (McGrath 1990) 137 • Treatment of Social Phobia with Phenelenzine (Leibowitz 1988) 139 • Treatments for panic attacks (Ost & Westling 1995) 141 • Summary of the theories/studies of dysfunctional behaviour 143 • Comprehension questions for treatment of dysfunctional behaviour 144 • Part A exam question 145 • Part B exam question 146 • Evaluation sheet of treatment of dysfunctional behaviour theories/studies 147

PART E – DISORDERS • Introduction 150 • Characteristics of Disorders • Anxiety Disorders– e.g. phobias. 154 • Affective Disorders– e.g. depression. 156 • Psychotic Disorders– e.g. schizophrenia. 158 • Summary of the characteristics of disorders 159 • Comprehension questions for characteristics of disorders 160 • Part A exam question 161 • Part B exam question 162 • Evaluation sheet of characteristics of disorders theories 163

Introduction to explanations of an Anxiety disorder 164 • Explanations of an Anxiety Disorder • Behavioural Explanation: Study of Classical conditioning (Watson and Raynor 1920) 165 • Biological Explanation :Types of Phobia and biological predisposition to them 168 (Ohman et al 1975) • Cognitive Explanation : Generalised Anxiety Disorder (Di Nardo 1998) 171 • Summary of the theories/studies of an Anxiety disorder 173 • Comprehension questions for explanations of an anxiety disorder 174 • Part A exam question 175 • Part B exam question 176 • Evaluation sheet of Explanations of an anxiety disorder theories/studies 177

Introduction to treatments of an Anxiety disorder 178 • Treatments of an Anxiety Disorder • Successful Treatment of a Noise Phobia (McGrath 1990) 181 • Treatment of Social Phobia with Phenelenzine (Leibowitz 1988) 183 • Treatments for panic attacks (Ost & Westling 1995) 185 • Summary of the theories/studies of treatments of an Anxiety disorder 188 • Comprehension questions for treatments for an anxiety disorder 189 • Part A exam question 190 • Part B exam question 191 • Evaluation sheet of treatments for an anxiety disorder theories/studies 192

Health and Clinical Psychology

Objectives for this part of the module

Candidates should: - • Be able to describe and evaluate the areas in the light of psychological theories, studies and evidence; • Always seek to apply psychological methods, perspectives and issues; • Actively seek to apply theory and evidence to the improvements of real-life events and situations; • Explore social, moral cultural and spiritual issues where applicable; • Consider ways in which the core areas of psychology (cognitive psychology, developmental psychology, physiological psychology, social psychology and the psychology of individual differences), studied in the AS course, can inform our understanding of Psychology and Health

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What is Health Psychology?

Health psychology is a relatively new area of psychology encompassing not only dysfunctional behaviour, but also the whole area of human health. Health can be considered to be a lack of illness, both physical and mental and can relate to many aspects of the mind and body. On the physical side health psychology is not only to do with aspects of health such as physical trauma or reduction in disease but also health behaviours such as eating well, not drinking to excess and unhealthy behaviours such as smoking or becoming stressed.

|[pic] |Being psychology it relies on empirical research to support theories and models of health interventions and |
| |promotions. Once health has been researched then the applications can be fully explored, such as legislation and |
| |health promotion. All this should make for a healthier society which means less public spending on health and people |
| |living longer. |

In studying the mind, health psychology looks at mental health, hence clinical psychology and this examines the diagnoses, causes and treatments of a wide range of dysfunctional behaviours and requires an individual differences approach to each therapy which accounts for our human uniqueness and ensures the therapies meet our needs.

Careers in Health & Clinical Psychology

Health psychology is a relatively new pathway within psychology and as such is still continuing to develop in terms of career options. As health psychologist you would work in:

1. Hospitals and Health authorities – may deal with specific problems identified by health care agencies or professional. They may also work in government health dept. or any health-care charities or organisations

2. Clinical setting – Usually within the Health service. They may see patients with depression, relationship problems, learning disabilities and serious mental illnesses. They would assess a patient using methods such as interviews observations and psychometric tests which may lead to a therapy regime such as counselling or Cognitive Behavioural Therapy
3. Research – Within this sector, a health psychologist would remain as an academic and drive progress in the field, and apply psychological research to; the promotion and maintenance of health, the prevention and management of illness, the identification of psychological illness, the improvement of the health-care system and the formulation of health policy
Unit G543: Health and Clinical Psychology

There are many areas of health psychology that cannot be covered in this course for example: disability and it’s affect on the family; management of illness and pain and improving communication between patient and health practitioner the areas therefore that are covered are

1. Healthy Living – this area considers theories that might explain health behaviours such as health belief model and then looks at health promotion campaigns. It also looks at adherence: understanding why people adhere to medical advice and why it is important adhere to ensure the long-term health of society.

2. Stress – this area examines what will reduce stress and teach stress-management techniques. Problems associated with measuring stress are also examined as this affects validity.

3. Dysfunctional behaviour – this area examines how society defines dysfunctional behaviour as this seems to predict how it is treated. This section looks at different approaches explanations and treatments for dysfunctional behaviour.

4. Disorders – This section looks at three types of disorder in more detail examining the characteristics of psychotic affective and anxiety disorders. Then identifies one disorder and looks at it in greater depth from the Cognitive, Biological and behavioural point of view, along with research supporting these explanations.

Evaluation

about the study/approach/ method/issues/debates you have just covered.

Ψ Approach/Perspective -Physiological, Social, Cognitive, Ind diffs, Developmental, Behaviourist, Psychodynamic ← Methods –Design- Independent/ Repeated measures (adv/disadv) Type of study (eg experiment, self-report, observation, case study – adv/disadv) Participants (representative?) setting, controls Ψ Issues - Ecological Validity (how realistic is it; can the findings be applied to everyday life?) Longitudinal and snapshot (is the study conducted over a long period or one point in time?) Qualitative and Quantitative data (is the data descriptive or numerical?) Usefulness (how is the research/theory/model useful in terms of how it explains human behaviour?) Application (how can the results of the research/theory/model be applied in everyday life settings?) Ethics (consent/informed consent, deception, withdrawal, debriefing, confidentiality, protection of participants, observation without consent) Generalisability (can these findings be applied to all individuals/situations?) Reliability (is the method used within the research/theory/model consistent?) Validity (is the method used within the research/theory/model measuring what it is supposed to?)

Ψ Debates – Determinism and Free will (does this study/perspective suggest we have freewill or that our behaviour/experience is determined?) Reductionism and Holism (do the results of the study focus on one single level of explanation, ignoring others or do they consider many explanations?) Nature and Nurture (is this characteristic/behaviour due to genetics or learning?) Individual and situational explanations (can this behaviour be explained by the situation/environment or is it due to personal characteristics?) Ethnocentrism (can this behaviour be considered to be biased towards one ethnic group or society?) Approach bias (does the study support the beliefs of a specific approach?) Psychology as a Science (is the method used within the study rigorous, ie. objective, reliable, falsifiable?)
GUIDANCE NOTES FOR ANSWERING 10 & 15 MARK
FORENSIC/HEALTH & CLINICAL PSYCHOLOGY
EXAM QUESTIONS

** There will be 4 questions for each topic on the exam paper. You are to chose and answer 2 questions per topic **

How to answer a part (a) 10 mark Forensic/Health & Clinical psychology exam question

• Once you choose your 2 X questions per topic, you are to answer the 10 mark questions using PEC format. Each question will usually ask you to either “Outline”, “Describe” or “Identify”. ➢ P (point, ie. describe/outline the main research/technique) ➢ E (example, ie. give examples of the features of the research/technique being asked about) ➢ C (conclusion, ie. summarise the research/technique)

• For each question you are to spend 12 mins and write approximately ½ side A4

• The mark scheme for Part (a)
|0 marks |No or irrelevant answer |
|1-2 marks |There are very few psychological terms. The description of the |
| |study is limited, mainly inaccurate or lacks detail. The study |
| |has not been linked to the question, or the model. The answer |
| |doesn’t have a structure and contains many spelling errors. |
|3-5 marks |There is basic use of psychological terms. The description of |
| |the study is generally accurate, and makes sense, is usually |
| |made relevant to the question, but it lacks detail. There is |
| |some elaboration (using examples), but the study isn’t linked |
| |to the question very clearly. The answer has some structure and|
| |organisation. It is mostly grammatically correct, but there are|
| |some spelling errors. |
|6-8 marks |The use of psychological terms is mainly accurate. The |
| |description of the evidence is mainly accurate, relevant and |
| |reasonably detailed. The elaboration (explanations, use of |
| |examples) is good. It has been made clear how the study is |
| |relevant to the question. The answer has good structure and |
| |organisation. The answer is mostly grammatically correct and |
| |there are very few spelling errors. |
|9-10 marks |There are lots of psychological terms and they are used |
| |accurately. The description of the study is accurate, relevant,|
| |makes sense and is very detailed. There are a lot of |
| |elaborations (explanations, using examples) and the study is |
| |clearly related to the question. The answer is well structured |
| |and organised. The answer is grammatically correct and has very|
| |few spelling errors. |

• NB. This question assesses your A01 skills (knowledge & understanding). There are NO marks rewarded for A02 skills (evaluation).
How to answer a part (b) 15 mark Forensic/Health & Clinical psychology exam question

• For this part of the question, you will be required to demonstrate your evaluative skills (A02 & A03) by outlining a number of evaluative points covering a range of issues in CREEC or CREECC format.

➢ Example CREEC format Example CREECC format

|Claim |The sample used by the researchers in the fear arousal|
| |study lacked generalisibility |
|Reason |This is because the researchers used opportunity |
| |samples of students to carry out the research |
|Evidence |Janis and Fleshbeck used psychological students to |
| |carry out their research into fear arousal and oral |
| |hygiene |
|Evaluative |The problem with this is that psychology students who |
|comment |are getting credit for their degrees are more likely |
| |to show uncharacteristic behaviour by perhaps being |
| |more willing to comply and give the researchers what |
| |they want, being familiar with fear arousal from their|
| |own reading and this may unconsciously affect their |
| |answers. This is called demand characteristics. |
|Conclusion |Therefore, we should be cautious when applying the |
| |findings from students to actual fear arousal |

• For each question you are to spend 18 mins and write approximately 1 side A4

• The mark scheme for Part (b)
|0 marks |No or irrelevant answer |
|1-3 marks |Few evaluative points. There is no evidence of an argument. |
| |There is no structure- it looks disorganised. There are very|
| |few examples from studies. There are very few conclusions, |
| |and very little summary of the issues or arguments. Very |
| |little of the answer is related to the question. |
|4-7 marks |The argument and organisation are limited. Some points are |
| |related to the question. There is evidence of an argument, |
| |and this shows understanding. There are some evaluation |
| |points. Valid conclusions summarise the argument. |
|8-11 marks |There are some evaluation points, and these cover a range of|
| |issues. The argument is well organised, but may lack balance|
| |or development. The answer is related to the specific |
| |question. Good use of examples. The argument is competent |
| |and understanding is good. Valid conclusions summarise the |
| |arguments effectively. |
|12-15 marks |There are many evaluative points covering a range of issues.|
| |The argument is well organised, balanced, and developed. The|
| |answer is clearly related to the question, and the examples |
| |are relevant and effective. Valid conclusions summarise the |
| |issues effectively, and shows thorough understanding. |

Topic 1 -Healthy Living

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1. Theories of health belief • The health belief model • Locus of control • Self-efficacy

2. Methods of Health promotion • Media campaigns • Legislation • Fear Appeals

3. Features of adherence to medical regimes • Reasons for non-adherence • Measures of non adherence • Improving adherence using behavioural methods

Topic 1 – Healthy Living

|Healthy living refers to the way people live their lives. A health |[pic] |
|behaviour is something you do to improve your health. A lifestyle is a | |
|pattern of health behaviours. Psychologists are interested in the reasons | |
|behind why some people choose to be healthy and others choose not to. Some| |
|people eat their five portions of fruit and vegetables a day and go to the| |
|gym 3 times a week. Some go to the gym but don’t eat their five a day. | |
|Some do neither!! Why is this? | |

Theories of health belief help explain individual reasoning behind these decisions. This involves considering the benefits and barriers) of adopting a health behaviour(The health belief model) , considering how you feel personally in terms of controlling your health behaviours (Locus of control) and whether or not you are confident that you can carry out certain health behaviours (Self-efficacy).

Psychologists are also interested in what makes health communication persuasive. In today’s society, people are encouraged from a very young age to eat a healthy diet and live an active life and this is done by using different Methods of health promotion.

This was not always the case. Smoking for example was once looked upon as a glamorous habit and film actors were used to promote smoking. The beautiful Betty Grable, America's favourite pin-up girl up to 1972, appeared in 84 films and her "million dollar legs," were insured. Her picture appeared on the packets of cigarettes she smoked. She died of lung cancer aged 56.

The media are used today to encourage people to give up smoking or to not start in the first place.
Fear arousal, such as images of cancerous mouths are now used on cigarette packets to warn individuals of the dangers of smoking. Legislation has also been introduced to ban smoking in all public and work places.

Finally, maintaining good health often involves adhering (sticking to/following) a healthy lifestyle or to medical advice from a doctor or health worker. Medical regimes may involve eating a healthy diet, exercising regularly or taking medication to treat an illness. Research shows that individuals struggle to Adhere to medical regimes.

Psychologists are thus interested in reasons for non adherence. Some people do not follow medical advice because they believe that they have good reason not to. Side effects of medication are often a reason cited for non adherence.

|[pic] |Psychologists also need to be confident that they can |[pic] |
| |measure adherence in individuals. These methods vary from | |
| |self- reports to bio-chemical analysis which involves a | |
| |physiological approach such as analysing the level of | |
| |medication in blood or urine. | |

|When individuals do not adhere to medical advice, health workers and psychologists try |[pic] |
|to come up with ways to improve adherence. | |
|Simple measures such as pill boxes help with adherence, especially amongst the elderly.| |

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WHAT DO WE KNOW FROM AS?
Several studies or theories from AS Psychology explain why individuals might choose a healthy lifestyle or not and believe that they have the ability change things:

• GRIFFITHS (1994) studied cognitive styles - the way regular gamblers have of thinking about gambling, weighing the odds and explaining away losses, that is quite different from non-gamblers. This highlights how cognitive processes affect behaviour. Thus with the health belief models a person’s thoughts affect whether they change their lifestyles for the better, have self-belief so they feel they can change their lifestyles and shows us that these cognitive thoughts can be altered so a person can have more self-efficacy.

• BANDURA (1961) was more interested in SITUATIONAL explanations, particularly the idea that we might learn to behave in certain ways. His "Bashing Bobo" experiment looked at how we learn to be aggressive, but his Social Learning Theory (SLT) might help explain lots of other behaviours such as how in copying role models we will eat the right or wrong foods or exercise or not? If it worked for them it may work for us?

• MILGRAM (1963) looked at behavioural study of obedience and that people act a certain way depending on a given situation and this can be related to health with the Health belief model: the social situation has an effect on whether people will adopt a behaviour which will benefit them.

HOW CAN WE APPLY THE APPROACHES AND PERSPECTIVES TO HEALTHY LIVING?

• BEHAVIOURIST psychologists will try to look at the behaviour of people and their environments and work out what sort of backgrounds or circumstances make someone make healthy choices as opposed to those who do not.

• COGNITIVE psychologists will try to study the thought processes of people. Their beliefs - how they weigh up the odds, what are the pros and cons of making changes to their lifestyle – who has strong internal belief and faith in themselves. There are compelling and logical arguments for adopting a healthy lifestyle, however many of us choose to ignore them. Why?

• BIOPSYCHOLOGISTS will be more interested in the brain structure and genetics of individuals and whether this links with them having certain personalities, temperaments or abilities which makes them more prone to being overweight, or have the type of personality which enables them to make life changes and believe they can carry them through.

Theories of Health Belief

The Theories/Studies

1. Becker (1978) - Compliance with a Medical Regime for Asthma
2. Rotter (1966) - Internal versus External Locus of Control
3. Bandura and Adams (1977) - Analysis of Self-Efficacy Theory of Behavioural Change

The main approach in this area is Cognitive psychology. It is interested in how people think about health behaviours. There are many compelling and logical arguments for adopting a healthy lifestyle, however many of us choose to ignore them.

1. Becker (1978) - Health Belief Model: Compliance with a medical regime

|Background- The Health Belief Model (HBM) is a tool that scientists use to try and predict health behaviours. Originally developed in the 1950s, it is |
|based on the theory that a person's willingness to change their health behaviours is primarily due to the following factors: |
|Perceived Susceptibility - an individual's assessment of their risk of getting the condition. People will not change their health behaviours unless |
|they believe that they are at risk. |
|Perceived Severity - an individual's assessment of the seriousness of the condition, and its potential consequences. The probability that a person will|
|change his/her health behaviours to avoid a consequence depends on how serious he or she considers the consequence to be. |
|Perceived Benefits - an individual's assessment of the positive consequences of adopting a behaviour. It's difficult to convince people to change a |
|behaviour if there isn't something in it for them. |
|Perceived Barriers - an individual's assessment of the influences that facilitate or discourage adoption of the promoted behavior) One of the major |
|reasons people don't change their health behaviours is that they think that doing so is going to be hard. Sometimes it's not just a matter of physical |
|difficulty, but social difficulty as well. Changing your health behaviours can cost effort, money, and time. |
|The health belief model incorporates two more elements into its estimations about what it actually takes to get an individual to make the leap. These |
|two elements are cues to action and self efficacy. |
|Cues to action are external events that prompt a desire to make a health change. They can be anything from a blood pressure van being present at a |
|health fair, to seeing a condom poster on a train, to having a relative die of cancer. A cue to action is something that helps move someone from |
|wanting to make a health change to actually making the change. |
|Other constructs or mediating factors to consider, which were added later were; Demographic variables (such as age, gender, ethnicity, occupation) |
|Socio-psychological variables (such as social economic status, personality, coping strategies) Health motivation (whether an individual is driven to |
|stick to a given health goal) Self-efficacy to be discussed separately. |
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|Aim: |
|To use the health belief model to explain mothers’ adherence for their asthmatic children |
|Approach/Perspective (if any): Cognitive but includes social factors with demographic variables, such as family size, education, occupation etc.. |
|Type of Data: Quantitative |
|Method: A correlation between beliefs reported during interviews and the compliance with self-reported administration of asthma medication |
|Details: 117 mothers originally asked, 111 eventually agreed to take part. Respondents ranged in age from 17 to 54 years and all but 7 were black. The |
|children's ages ranged between 9 months and 17 years. |
|The interview schedule, which required about 45 minutes to complete, dealt with the mother's general health motivations and attitudes and her views |
|about various aspects of asthma and its consequences. Most questions were designed to provide measures of the HBM's dimensions. |
|They were asked questions regarding their perception of their child’s susceptibility to illness and asthma, beliefs about its seriousness it’s |
|interference with education and its interference with their activities, whether it caused embarrassment or interfered with mothers activities. They |
|were also questioned about their faith in doctors and the effectiveness of the medication. |
|A covert evaluation of compliance was also made by drawing blood by finger stick and testing it for the presence of theophylline, a substance basic to |
|all of the drugs prescribed for asthma by the cooperating physicians. Such objective verification of compliance was ultimately available for 80 (72 |
|percent) of the 111 mothers. Their reports of medication administration were compared with laboratory findings for the 80 children; a correlation of |
|0.913 was obtained, arguing for the validity of the mother's statement as an additional indicator of compliance |
|Results; |
|A positive correlation between a mother’s belief about her child’s susceptibility to asthma attacks and compliance to medical regimen was found. |
|There was also a positive correlation was also between the mother’s perception of the child’s having a serious asthma condition and her administering |
|the medication as prescribed. |
|Mothers who reported that their child’s asthma interfered with the mothers activities also complied with the medication. |
|Costs negatively correlated with compliance (e.g. disruption of daily activities, inaccessibility of chemists, the child complaining, and the |
|prescribed schedule). |
|The demographic variable of marital status and education level correlated with compliance as follows: |
|Married mothers were more likely to comply. |
|The greater the mother’s education the more likely she would be to adhere. |
|Conclusions:The HBM is a useful model to predict and explain different levels of compliance with medical regimens |
|Evaluation: Issues |Evaluation: Debates |
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2. Rotter (1966) - Internal versus External Locus of Control

|Background: Locus of Control is considered to be an important aspect of personality. The concept was developed originally Julian Rotter in the 1950s|
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|Locus of Control is a simple reductionist theory and refers to an individual's perception about the underlying main causes of events in his/her |
|life. Or, more simply: |
|Do you believe that your destiny is controlled by yourself or by external forces (such as fate, god, or powerful others)? |
|Rotter's view was that behaviour was largely guided by "reinforcements" (rewards and punishments) and that through these; individuals come to hold |
|beliefs about what causes their actions. A locus of control orientation is a belief about whether the outcomes of our actions are contingent on what|
|we do (internal control orientation) or on events outside our personal control (external control orientation)." |
|Thus, locus of control is conceptualised as referring to a unidimensional continuum, ranging from external to internal: |
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|External Locus of Control |
|Individual believes that his/her behaviour is guided by fate, luck, or other external circumstances |
|Internal Locus of Control |
|Individual believes that his/her behaviour is guided by his/her personal decisions and efforts. |
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|People with a strong internal locus of control believe that the responsibility for whether or not they get rewards/punishments ultimately lies with |
|themselves. Internals believe that success or failure is due to their own efforts. In contrast, externals believe that things in life are controlled |
|by luck, chance, or powerful others. Therefore, they see little impact of their own efforts to change things. Translated for health this means a |
|person with high LOC will try to eat five portions of fruit and veg a day and follow health advice but low LOC will they believe their health is in |
|someone else hands (doctors, parents fate religion) and fate will decide whether they lice or die. |
|Therefore: Is Locus of Control a stable, underlying personality construct, (Nature) or |
|Is Locus of control largely learned? (Nurture) There is evidence that, at least to some extent, LOC is a response to circumstances. Some |
|psychological and educational interventions have been found to produce shifts towards internal locus of control (e.g., outdoor education programs. |
|Aim |
|Examines the degree by which individuals believe their health is controlled by internal or external factors |
|Approach/Perspective |
|Cognitive - |
|Method |
|Review of six pieces of research into individuals perceptions of ability to control outcomes based on reinforcement |
|Results |
|In the review P’s with internal LOC were more able to show behaviours that would enable them to cope with a threat than those with an external LOC |
|Conclusions |
|Rotter concluede that LOC would effect many of out behaviours, not just health. |
|Also included summary by James et al. (1965) which found that smokers who give up and did not relapse had a higher level of internal LOC than those |
|who did not. |
|However, for women, where there was no significant difference between internal and external LOC in those giving up instead other factors such as |
|weight gain were influential in giving up smoking. (Therefore indicating that LOC a factor in health behaviours but other factors play a part). |
|Examples are: In health if a person gets ill do they believe they can control it, beat it. Survive it. Many studies have shown that people who beat |
|cancer have internal LOC |
|Wallston- Kaplon (1970) Internal LOC live longer after lung transplant. |
|Evaluation: Issues |Evaluation: Debates |
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3. Bandura and Adams (1977)- Analysis of Self-Efficacy Theory of Behavioural change

|Background: Self efficacy looks at a person's belief in his/her ability to make a health related change. It may seem trivial, but faith in your |
|ability to do something has an enormous impact on your actual ability to do it. Thinking that you will fail will almost make certain that you do. In |
|fact, in recent years, self efficacy has been found to be one of the most important factors in an individual's ability to successfully negotiate |
|health changes. |
|Self-efficacy beliefs are cognitions that determine whether health behaviour change will be initiated, how much effort will be expended, and how long|
|it will be sustained in the face of obstacles and failures. Self-efficacy influences the effort a person puts into changing risk behaviour and the |
|persistence to continue striving despite barriers and setbacks that may undermine motivation. |
|Bandura points to four sources affecting self-efficacy; |
|Experience - "Mastery experience" is the most important factor deciding a person's self-efficacy. Simply put, success raises self-efficacy, failure |
|lowers it. |
|Modeling - a.k.a. "Vicarious Experience" -“If they can do it, I can do it as well.” This is a process of comparison between oneself and someone |
|else. When people see someone succeeding at something, their self-efficacy will increase; and where they see people failing, their self-efficacy will|
|decrease. Modeling is a powerful influence when a person is particularly unsure of him- or herself. |
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|Social Persuasions |
|Social persuasions relate to encouragements/discouragements. These can have a strong influence – most people remember times where something said to |
|them significantly altered their confidence. While positive persuasions increase self-efficacy, negative persuasions decrease it. |
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|Physiological Factors |
|In unusual, stressful situations, people commonly exhibit signs of distress; shakes, aches and pains, fatigue, fear, nausea, etc. A person's |
|perceptions of these responses can markedly alter a person's self-efficacy. If a person gets 'butterflies in the stomach' before public speaking, |
|those with low self-efficacy may take this as a sign of their own inability, thus decreasing their self-efficacy further, while those with high |
|self-efficacy are likely to interpret such physiological signs as normal and unrelated to his or her actual ability. Thus, it is the person's belief |
|in the implications of their physiological response that alters their self-efficacy, rather than the sheer power of the response. |
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|Aim: |
|To assess the self-efficacy of patients undergoing systematic desensitisation. |
|Approach: Cognitive |
|Type of Data: Quantitative and Qualitative |
|Method: A controlled quasi-experiment with patients with snake phobias. |
|A key concept Bandura identified as affecting behaviour is the efficacy expectation. This is the belief that a person can successfully do whatever is|
|required to achieve a desired outcome. The key factors which affect a person’s efficacy expectation are: |
|Previous Experiences – how successful were you in the past e.g. quitting smoking |
|Vicarious experiences – The success of others |
|Verbal persuasion – Others telling you, you can do it |
|Emotional arousal – Too much anxiety (pressure) can reduce a person’s self-efficacy |
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|In addition, cognitive appraisal of a situation might also effect expectations of personal efficacy. Factors such as social, situational and temporal|
|circumstances are contextual factors that could influence such an appraisal. This means a person’s self-efficacy can alter depending on the |
|situation. Bandura cites the example of public speaking, and how the time, audience, subject matter and type of presentation might all influence |
|perceived coping capabilities that represent self-efficacy. It is not simply down to personality traits. |
|Details: 10 snake phobic patients who replied to an advertisement in a paper (self-selected). 9 females and one male aged 19–57 years. |
|Pre-test assessment each patient was assessed for: |
|avoidance behaviour towards a boa constrictor. |
|fear arousal with an oral rating of 1–10.(self-report) |
|efficacy expectations (how much they thought they would be able perform different behaviours with snakes-again self-report). |
|Systematic desensitisation – a standard desensitisation programme was followed where patients were introduced to a series of events involving snakes |
|and at each stage were taught relaxation. |
|Post-test assessment. Each patient was again measured on behaviours and belief of self-efficacy in coping |
|Results: Higher levels of post-test self-efficacy were found to correlate with higher levels of behaviour with snakes. |
|Conclusions: Desensitisation enhanced self-efficacy levels, which in turn lead to a belief that the participant was able to cope with the phobic |
|stimulus of a snake |

|Evaluation: Issues |Evaluation: Debates |
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Summary: Health Belief theories

• A person’s lifestyle choices may be healthy or not healthy. They may choose to give up smoking, eat healthily or exercise regularly.

• There are many theories that would explain such choices, and the ones we have looked at concentrate on the logical cognitive approach to such behaviour.

• All the theories are linked, in that they are individual perceptions based on previous information which might affect a person’s Locus of Control, their self-efficacy, and how susceptible they think they are to ill-health.

• These cognitive theories successfully explain how individuals might adopt one or more behaviour, but not necessarily all of them.

Comprehension questions for theories of health belief

1.Becker (1978) - Compliance with a Medical Regime for Asthma

• What is costs/benefits analysis? • What are demographic variables? • Why is the health belief model not reductionist? • What did Becker find in his research on parents of children with asthma • How did Becker improve the validity of the experiment?

2.Rotter (1966) Internal versus External Locus of Control

• What are the two loci of control according to Rotter? • What did Rotter find out about people who felt they had control over the situation? • What did the research from James et al. find out? • Is Locus of control nature or nurture? • Describe an example of how LOC can explain a health behaviour?

3.Bandura and Adams(1977) Analysis of Self-Efficacy Theory of Behavioural Change

• What does self-efficacy mean? • What are the three factors that influence self-efficacy? • What factors might influence cognitive appraisal of a situation and affect expectations of personal efficacy? • Who were the participants in Bandura’s study on self-efficacy? • What are the conclusions in Bandura’s study?
Part A exam question for theories of health belief

• Describe self efficacy as a theory of health belief (10 marks)

Linking sentence _____________________________________________________

Linking sentence _____________________________________________________

Part B exam question for theories of health belief

• Discuss theoretical approaches to beliefs about health (15 marks)

Linking sentence _____________________________________________________
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Evaluation sheet for the Theories of Health Belief

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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Health Promotion

The Theories/Studies

1. Cowpe (1983) - Chip pan fire prevention
2. Dannenberg et al, (1993) - Legislation-Bicycle helmet laws and educational campaigns
3. Janis & Feshbeck, (1953) - Effects of Fear arousal.

The main approach in this area is Cognitive psychology as it explores how communication can be made persuasive enough for people to think differently about their health. The Behavioural approach is also important as the reason behind change could be argued to be due to imitation and social learning theory via media campaigns and fear arousal.

1.Cowpe (1989) - Media Campaigns: Chip-Pan Fire Prevention

|Background: Television, adverts, posters and leaflets are all common means of getting health messages across to the public. |
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|Scottish media campaign on drink-driving showed that the numbers of people drinking at home between Aug 2006 and Dec 2006 did not change significantly.|
|There was, however, a gradual decline amongst those who claimed to drink at home at least once a week from73% to 71% not a great change but a move in |
|right direction. Some campaigns do not work as they result in change of attitude which does not result in a behavioural change. |
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|Occasionally campaigns in areas of health and safety can show effectiveness, e.g Cowpe chip pan research. |
|Aim: |
|To test the effectiveness of an advertising campaign that demonstrated a procedure, provided information, challenged perceptions about lack of ability |
|to cope and encouraged preventative actions. |
|Approach/Perspective : |
|Cognitive |
|Behavioural |
|Type of Data: Quantitative data (stats from fire brigade of actual fires) |
|Method: A quasi-field experiment (longitudinal) where a media campaign (12 week) was shown in 10 regional television areas from 1976 to 1984. An |
|analysis of the number of chip pan fires reported between 1976 and 1982 plus two quantitative consumer surveys in 1976 and 1983 were used to gather the|
|data. (Repeated measures design and P’s were interviewed after each campaign (condition) |
|Details: The campaigns were shown on television. Providing both information and fear arousal. |
|There were two 60-second commercials, one called ‘in-attendance’ and one called ‘overfilling’. |
|These showed the initial cause of the fire and the actions required to put it out. |
|Slow motion and real time for effect |
|Three areas were shown reminders one year later. The number of reported chip pan fires was analysed for each area |
|Results; |
|The net decline in each area over the twelve-month period of the campaign was between 7% and 25%. |
|The largest reduction was during the campaign. |
|Overlap’ areas (areas that received two of the television stations) showed less impact. |
|The questionnaires showed an increase in the awareness of chip pan fire advertising from 62% to 90% |
|People mentioning chip pan fires as a danger in the kitchen also increased in the questionnaires from 12% to 28% |
|Conclusions: |
|The advertising proved effective as shown by reduction in chip pan fires. |
|The behaviour change is seen most during the campaign and reduces as time passes after the end of the campaign. Thus there is a need to repeat |
|periodically. |
|The viewer is less likely to be influenced by the campaign if overexposed to it, as in the overlap areas. |

|Evaluation: Issues |Evaluation: Debates |
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2. Dannenberg et al (1993)-Bicycle Helmet Laws and Educational Campaigns

|Background: Legislation is a law, or a set of laws that have been enacted by a legislative body, which in our case is the Parliament at Westminster. |
|[pic] |
|New laws are debated and passed by the British Parliament for a number of reasons, including being part of the Government of the day’s manifesto |
|promises, or as a reaction to unfolding situations, for example terrorism or a natural disaster. |
|Health can be promoted through this manner for example, on the 1st July 2007 legislation was passed to ban smoking in all enclosed public places and |
|workplaces in the UK. On the 1st October 2007 the legal age for buying cigarettes increased to 18. |
|Legislation varies from country to country or state to state in the US in 2007 the max blood alcohol level in the UK was 80mg per 100ml of blood. But |
|the royal society for prevention of accidents think it should be lowered particularly in young drivers as an increase of just 20mg per 100ml has been |
|shown to substantially increased the risk of accidents in young drivers and legislation could reduce this risk. |
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|The problem with any legislation is that it needs to be effective, would the laws be obeyed if there was no chance of being caught? The police in 2007|
|needed evidence not just a suspicion that they had been drinking to do a breathalyser. |
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|How effective has the bam on smoking in public places been? What were its aims? Has they been achieved? |
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|A study by Dannenburg looked at legislation in Maryland USA to see how legislation would compel young cyclists to wear helmets. |
|Aim: To review the impact of the passing of a law promoting cycle helmet wearing in children |
|Approach/Perspective: |
|Cognitive |
|Behavioural |
|Type of Data: |
|Quantitative ( self-report questionnaires) |
|Method: Natural (quasi) field experiment as a law was passed in Howard County, requiring children under 16 to wear helmets (Maryland, USA.) Children |
|from 47 schools in Howard County, and two control groups from Montgomery County and Baltimore County, all in Maryland USA, They were aged 9–10 years, |
|12–13 years and 14–15 years. In Montgomery County there was already a campaign to promote helmet use. |
|Independent design with each child naturally falling into one of the three counties. (7332 children questioned) |
|Details: A questionnaire was sent using a four point Likert scale that asked about: |
|bicycle use. |
|helmet ownership. |
|awareness of law. |
|sources of information about helmets. |
|peer pressure. |
|Parents were asked to help the children complete to gain consent. |
|Results; |
|Responses to questionnaires were about 50% across the three counties. |
|Helmet ownership was higher amongst cycle owners and highest in younger age groups. |
|In Howard County (the one with the law), reported usage had increased. |
|Howard County – 11.4% to 37.5%. |
|Montgomery County – 8.4% to 12.6%. |
|Baltimore County – 6.7% to 11.1%. |
|Conclusions: |
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|Legislation has more effect than educational campaigns alone. Although a slight rise in that county it was not significant from area where there was |
|no campaign. |
|This study was correlated with an observational study by Cote et al. in 1992, which found similar rates of cycle helmet usage. |
|While not everyone adheres to the law (some people still drink and drive) adherence cuts deaths and injuries significantly. In Maryland it is claimed |
|that wearing helmets will prevent 100 deaths and 56,000 hospitalisations each year. |

|Evaluation: Issues |Evaluation: Debates |
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3. Janis & Feshbeck (1953) - Effects of Fear Arousal

Both the risks of smoking and drink driving have addressed by fear arousal tactics. Putting graphic images on packets of cigarettes and media campaigns that focus on the severe health implications have been tried. On the whole they have little impact.

Why?
Psychologists suggest we become desensitised, we feel that it will happen to others, not us.

Activity -
Consider the following images
[pic] [pic] [pic] [pic]

[pic] [pic]

[pic] [pic] [pic]

[pic] [pic] [pic]

They are all examples of different levels of fear appeals in relation to oral hygiene.

Using the following grid - decide what pictures fit into these categories.
You can only place a picture in one category

|Minimal Fear |Moderate Fear |Strong Fear |
|Appeal |Appeal |Appeal |
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|Which of these levels of fear arousal would be most effective in getting you to improve your oral hygiene? |
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3. Janis & Feshbeck (1953) - Effects of Fear Arousal
|Aim: To investigate the consequences on emotions and behaviour of fear appeals in communications |
|Approach/Perspective: Cognitive and behavioural |
|Type of Data: quantitative and qualitative |
|Method: lab experiment-independent design, with three experimental groups and one control group. |
|Details: |
|Participants were 9th Grade students aged 14.0 to 15.11 years, mean age 15 years |
|A questionnaire was given one week before the lecture on health to ascertain dental practices. |
|A fifteen minute illustrated lecture was presented to each group. |
|3 groups had a lecture on dental hygiene and the control group had a lecture on the human eye. |
|Gp1. lecture had strong fear appeal, emphasising painful consequences of poor dental hygiene, such as tooth decay and gum disease and statements such|
|as ‘This could happen to you!’. Gp2. moderate fear with little info on consequences factual statements. Gp3 minimal fear appeal, neutral info on |
|tooth decay and function rather than consequences. Gp4. functioning of human eye. |
|Immediately after the lecture a questionnaire was given asking for emotional reactions to the lecture. |
|One week later a follow-up questionnaire asked about longer term effects of the lecture. |
|Results: The amount of knowledge on dental hygiene didn’t differ between the three experimental groups. |
|The strong fear-appeal lecture was generally seen in a more positive light. |
|The strong fear-appeal group showed a net increase in conformity to dental hygiene of 8% (measured by comparing the no. of recommended dental |
|practises shown before and after lecture -such as brushing for 3 mins) |
|The net increase in the moderate fear group was 22%. |
|The net increase in the minimal fear group was 36%. |
|The control group showed 0% change |
|Conclusions: |
|Fear appeals can be helpful in changing behaviours, but it is important that the level of fear appeal is right for each audience. Note the minimal |
|fear group was most effective. |
|There is several studies which used fear arousal. Leventhal et al. (1967) on smokers who found that high fear arousal was more effective than middle |
|or lower contradictory to Fleshbeck. |

|Evaluation: Issues |Evaluation: Debates |
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Summary: Methods of Health Promotion

• There may be ethical considerations in dictating or compelling behaviours for an individual’s own benefit and perhaps individuals should make their own choices when it comes to health.

• It seems that a variety of health promotion methods can be effective in ensuring healthy lifestyles, and one could argue that governments have a duty of care to ensure that their citizens are as healthy as possible.

Comprehension questions for Health Promotion

1.Cowpe (1983)- Chip pan fire prevention

• What was the aim of Cowpe’s research on chip pan fire prevention? • How long were the adverts shown for and what were they called? • How did they measure the success of the adverts? • What happened in ‘overlap’ areas? • Was the experiment thought to be effective, explain your answer?

2.Dannenberg et al, (1993)- Legislation-Bicycle helmet laws and educational campaigns

• What type of experiment was Dannenberg’s study? • Who were the sample and from where? • How did Dannenberg collect his data? • What did Dannenberg find? • What other study showed concurrent-validity with these results?

3.Janis & Feshbeck, (1953) -Effects of Fear Arousal

• What type of research did Janis and Feshbech carry out? • What did the strong fear-arousal lecture contain? • Which group showed most increase in dental hygiene practices? • What did the control group experience? • When was the durability of the change in behaviour assessed?

Part A exam question for methods of health promotion

• Describe one piece of research into media campaigning as a method of health promotion (10 marks)

Linking sentence _____________________________________________________

Linking sentence _____________________________________________________

Part B exam question for methods of health promotion • Discuss the ecological validity of research into methods of health promotion (15marks)

Linking sentence _____________________________________________________
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Evaluation sheet for Methods of Health Promotion

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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| |Researcher/s: |Researcher/s: |Researcher/s: |
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Features of Adherence to Medical Regimes

The Theories/Studies

1. Bulpitt et al. (1988) - Reasons for non- adherence
2. Lustman et al. (2000) - Measures of non –adherence
3. Watt et al. (2003)- Improving adherence using behavioural methods

This area highlights that there are many factors which contribute to a person’s adherence to a medical regime which range from social (the factors in a person’s life) to cognitive, irrational thought processes about the drugs or therapies. Similarly when measuring adherence this section looks at the social, and physiological methods employed and examines which is more valid and reliable. Lastly, this section examines ways to improve adherence which is important to improve health and save the NHS costs. Here it examines a behavioural approach to encouraging adherence.

1.Bulpitt et al. (1988) - Reasons for Non-Adherence

|Background: People do not arrive at medical appoints, do not follow treatment programmes and frequently do not take medication WHY? Variety of reasons |
|People simply believe not in best interest- so stop, when begin to feel better stop prescribed course, feel logical explanation for not continuing, |
|althou’ docs would not prescribe surplus medicine. |
|We need to consider why people do not adhere to medical advice, and this looks at patients who have made a rational decision not to adhere. This means |
|there is a logical decision not to listen to medical advice. It may be linked to the HBM whereby the costs outweigh the benefits, and the rational |
|decision is not to continue with the medicine. |
|There are cases in the media where patients have refused potentially life-saving treatments as the costs to their quality of life outweigh the |
|less-than certain odds, of prolonging life. Who is to say that is irrational? |
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|Bulpitt’s study examined how males with hypertension (high blood pressure) weighed up the costs of the medication and it’s side effects to the benefits|
|of taking the medication for their health. |
|Aim: To review the research on adherence in hypertensive (high blood pressure) patients |
|(adhere- means to stick to, remain, hold fast) |
|Approach/Perspective : Cognitive and Social |
|Type of Data: Qualitative approach |
|Method: Review Articles |
|Procedure: Research was analysed to identify the physical and physiological effects of new drug treatments on a person’s life. These included work, |
|hobbies and physical well-being. |
|Results; Drug did reduce headaches and depression compared to old drug but -side –effects were: reduced circulation of blood leading to erectile |
|dysfunction, sleepiness, dizziness and also affected cognitive functioning, which affected work and hobbies. |
|Curb ( 1985) 85 males discontinued because of sexual problems General medical council|
|found 15% males withdrew due to side effects |
|Conclusions: |
|When costs side effects outweigh benefits less likely to adhere to treatments |
|Study in using qualitative approach gives insight into patients’ beliefs about medication and how they weigh up the outcomes, confirming the |
|cost-benefit analysis that patients undertake before deciding to adhere to medical advice. |

|Evaluation: Issues |Evaluation: Debates |
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2. Lustman et al.(2000) - Measures of Non-Adherence

|Background: Diff ways of measuring adherence and as in all psychological research no perfect method. |
|Self –report- can lead to social desirability bias (not admit to not taking medicine.(SUBJECTIVE) |
|Therapeutic outcomes- doc assess effect of medicine on p health (rough and ready measurement of adherence) (SUBJECTIVE) |
|Pill and bottle counts and less reliable (SUBJECTIVE) |
|Mechanical methods- device for measuring how much medicine dispensed from container (SUBJECTIVE) just because pill left bottle doesn’t mean been taken.|
|Record no. of repeat prescriptions |
|Biochemical methods- blood or urine tests (OBJECTIVE- reliable) but unlikely happen every day in everyday life. |
|Study by Chung and Naya (2000) (Track cap)found that mechanical method was effective however, need to consider whether being told compliance was being |
|assessed may have influenced patients. |
|Lustman showed how physical measurements such as blood sugar levels can indicate adherence to regime necessary to control diabetes. |
|Glycohaemoglobin ( haemoglobin with glucose attached to it, GHb)levels will show the amount of glucose in the blood. The regime a diabetic has to adopt|
|changing diet and administering insulin by injection should keep GHb levels normal. Therefore adherence can be measured by measuring GHb levels. |
|Aim: To assess the efficacy of the anti-depressant fluoxetine in treating depression, by measuring glycemic control |
|Approach/Perspective: Physiological and social |
|Type of Data: quantitative data (psychometric test and blood tests) |
|Method: A randomised controlled double-blind study (neither patients nor experimenters know which is experimental group and which is control gp) |
|Details: 60 patients with type 1 or type 2 diabetes and diagnosed with depression .Patients were randomly assigned to either fluoxetine or placebo |
|groups. Patients were assessed for depression using psychometric tests. Their adherence to their medical regimen was assessed by measuring their GHb |
|levels, which indicated their glycemic control |
|Results; |
|Patients given the fluoxetine reported lower levels of depression. Patients given the fluoxetine had lower levels of GHb, which indicated their |
|improved adherence |
|Conclusions: Measuring GHb in patients with diabetes indicates their level of adherence to prescribed medical regimes. Greater adherence was shown by |
|patients who were less depressed, and previous research has suggested that reducing depression may improve adherence in diabetic patients. |

|Evaluation: Issues |Evaluation: Debates |
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3. Watt et al. (2003) - Improving Adherence using behavioural methods

|Background: Many ways to improve adherence: | |
|Reduce the costs so don’t outweigh the benefits. |Watt et al study used behaviourism and reinforcement for correct |
|Study demographic variables of HBM (e.g. differences in males and females.) |adherence thus a funhaler with a whistle and spinner were used to|
|How do perceptions of seriousness and susceptibility influence adherence |reward children for using inhaler correctly |
|Locus of control may influence (externals feel life mapped out and medicines have no | |
|influence) | |
|Emphasizing key info, and repeating instructions and not using medical jargon (Ley | |
|1973) worked for elderly. | |
|(Lewin 1992) give patients info and instructions | |
|Behavioural strategies- use of reinforcement for correct adherence. | |

|Aim: Funhaler spacer – improving adherence without compromising delivery. To see if using funhaler would improve children’s adherence to taking |
|medication for asthma. |
|Approach/Perspective: Behavioural perspective. |
|Type of Data: Quantitative data through self-report |
|Method: Field and quasi (children with asthma) The experiment set up two conditions, and then used self-report to measure the adherence rates. |
|Research: 32 Australian children (10 males and 22 females) aged from 1.5 to 6 years, mean age 3.2 years. They had all been diagnosed with asthma and |
|prescribed drugs delivered by pressurised metered dose inhaler (pMDI). The parents gave informed consent. |
|Each child was given the Breath-a-Tech to use for one week, and a questionnaire given for the parents to complete. In the second week, the children used |
|the Funhaler, and the parents were given a matched questions questionnaire after the second week. |
|Results; |
|38% more parents were found to have medicated their children the previous day when using the Funhaler compared to the existing |
|Conclusions: |
|Previous research had given reasons for non-adherence in children with asthma as boredom, forgetfulness and apathy. The Funhaler set out to remedy this |
|by reinforcing correct usage of the inhaler with a toy that spins and a whistle that blows. This did improve the adherence to the medication. So by |
|making the medical regime fun, the adherence, certainly in children, can be improved |

|Evaluation: Issues |Evaluation: Debates |
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Summary: Features of Adherence to Medical Regimes

• Why do we adhere or not? There are many reasons.

• There are also many ways to improve adherence?

• It would be possible to use the HBM to explain why people do not adhere and also to improve adherence.

• This section has only touched on the plethora of idea, models and research into adherence. Given the high cost of medication that is prescribed and NOT taken, in addition the health costs of people not adhering to their regimes, the importance of this area of health psychology can be seen not only in healthier patients, but less wastage of resources.

Comprehension questions for Adherence

1.Bulpitt et al. (1988) - Reasons for non- adherence

• What method did Bulpitt use for his research? • What were his findings? • What did they find that supported the health belief Model? • What were the general medical council’s findings? • Is this a situational explanation or individual?

2.Lustman et al. (2000) - Measures of non –adherence

• What is GHb? • Lustman used a double blind study what does this mean? • What two methods were used to test for depression? • What were the findings? • What assumption is made about depression and adherence in this study?

3.Watt et al. (2003)-Improving adherence using behavioural methods

• Who was the sample used in this study? • What technique did Watt et al. use to improve adherence? • What approach is this based on? • What are the strengths and weaknesses of using self-report to measure health behaviour? • What were the conclusions of the study?

Part A exam question for Adherence to Medical Regimes

• Describe one way to measure non-adherence to medical advice (10 marks)

Linking sentence _____________________________________________________

Linking sentence _____________________________________________________

Part B exam question for Adherence to Medical Regimes

• Assess the reliability of research into non-adherence to medical advice (15 marks)

Linking sentence _____________________________________________________
Linking sentence _____________________________________________________
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Evaluation sheet for Features of Adherence to Medical Regimes

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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Topic 2 – Stress

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1. Causes of stress and supporting evidence • Work • Hassles and life events • Lack of control

2. Methods of measuring stress • Physiological measures • Self report • Combined approach

3. Techniques for managing stress • Cognitive • Behavioural • Social

Topic 2 – Stress

|The first big question is what is stress anyway? It is a term|[pic] |
|we read about in the papers almost daily. As a society we are| |
|supposedly suffering from this thing, it costs the country | |
|millions | |
|of pounds a year in days off work and stress related illness | |
|not to mention broken marriages, arguments and neglected | |
|children. | |

We tend to think of stress as something `out there`. Subjectively it feels as if there is just too much to do, or too much being expected of us. We feel unable to cope and if it goes on for too long we may even become ill.

50 years ago the term was not really used. People would get tired, they might have been unhappy, but they probably would not have said they were stressed. Nowadays, however, psychologists are interested in: What causes stress? Does the situations we are in cause us to feel stressed or the people we are? How can we measure stress? By filling in questionnaires or doing interviews can we get an objective measure or are only scientific measurements a true and valid measure, and finally in order to safeguard people’s health we need to investigate, How can we reduce or manage stress? If we make different choices in life, can we reduce stress? And what techniques do psychologists favour when helping people overcome stress. We might also ask whether stress is always a bad thing. Is a lack of stress stressful?!

The stress experience is made up of stressors and the stress response.
Stressors = Stimuli that require a person to make some form of adaption or adjustment. These may be external such as life threatening events such as an earthquake, life events such as work, divorce or the minor hassles of day to day life such as being stuck in a traffic jam or not finding a parking space, or internal, such as our feelings and thoughts and our ability to cope with them, whether we feel in control of the situation. Stress is therefore, the result of a mismatch between the demands of the situation and our ability to cope with them.

Lazarus and Folkman (1984) defined stress as:-

“A pattern of negative physiological states and psychological responses occurring in situations where people perceive threats to their well being which they may be unable to meet.”

Stress consequently brings about a stereotyped set of biological and psychological responses, this is the stress response. We are programmed to respond physically to stress by producing adrenaline, which results in symptoms such as increased heart rate and respiration and the closing down of functions not immediately vital such a digestion (hence we often lose our appetite when stressed).

The Body’s Stress Response

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The problem with this is, in today’s society when stressors happen on a daily basis, such as financial worries or work worries that the constant production of adrenaline can attack our immune system and reduce our ability to fight of disease. The UK and Health and Safety Executive suggest that approx 1.4 million working days per year are lost due to work-related stress! Therefore this topic introduces some of the influences that psychologists have used to explain stress. In particular the causes of stress, methods for measuring stress and how to manage it, in the hope that if we can understand health behaviours and their antecedents, we can help people lead healthier lives, enhancing their quality of life and also save society the cost of health care lost productivity

WHAT DO WE KNOW FROM AS?
Several studies or theories from AS Psychology may explain why individuals suffer stress: • BANDURA (1961) was more interested in SITUATIONAL explanations, particularly the idea that we might learn to behave in certain ways. This can be applied to feeling stressed as here it is shown that situations; life events and hassles bring about stress and our lack of control as an individual over the situation causes us to feel stressed.

• GRIFFITHS (1994) studied cognitive styles – the way people perceive an event may affect whether they get stressed from it.

HOW CAN WE APPLY THE APPROACHES AND PERSPECTIVES TO CRIME?

• BEHAVIOURIST psychologists will try to look at the behaviour of people who suffer from stress and discover what actions trigger stress, and then use various techniques to overcome the stressful situation such as desensitization or flooding.

• COGNITIVE psychologists will try to study the thought processes of people who suffer from stress - how they weigh up the odds, cope with stress or how it affects their everyday life.

• BIOPSYCHOLOGISTS will be more interested in the genes and biological make up; are some people more prone to stress and how then does the stress affect them physiologically.

• A theme that comes out of this unit is INDIVIDUAL vs SITUATIONAL Are some people born with the propensity to get more stressed about life’s events and thus their health suffers or is the situation people find themselves in no matter who they are, that will cause stress.

Causes of Stress and supporting evidence

The Theories/Studies
1. Johansson (1978) - Stress in the Workplace
2. Kanner (1981) - Hassles and life events
3. Geer and Meisel (1972) - Lack of control

The first two studies examine the social influences in explaining what causes stress which obviously stem from the social approach to psychology. However, only taking this view would be reductionist, as the last study demonstrates, how we as individuals view the stressors and feel about our ability to cope with them is explained in terms of the cognitive and individual approaches. Therefore, when determining causes it is not only the stressors in our lives, but the situation we are in and the person we are, which can affect out stress levels.

1. Johansson (1978) - Stress and the Work place

|Background: Stress is a biological response to an external stressor/s | |
|Biological response to the fight or flight mechanism. The bodies stress response | |
|causes an increase in blood pressure, reduction in blood flow to the peripheral blood| |
|vessels (hand and feet) and an increase in adrenaline, noradrenalin and | |
|corticosteroids to be released into the blood stream. Over a long period of time | |
|this stress response causes the body’s immune systems to eventually break down. | |

|Why is understanding stress useful: |
|Causes psychological problems like anxiety and depression. |
|Causes everyday physical illness like cough and colds by lowering the effectiveness of the immune system. |
|Can cause heart disease and stroke by increasing build up of cholesterol. |
|May lead to illnesses like cancer |
|Causes millions of lost sick days from work |
|Causes accidents and injuries at work due to loss of concentration |

|Aim: |
|To measure the psychological and physiological stress response in two categories of employees. |
|Approach/Perspective: |
|Cognitive |
|Physiological |
|Individual differences |
|Type of Data: |
|Quantitative – |
|Qualitative - |
|Method: |
|A quasi-experiment where workers were defined as being at high risk (of stress) or in a control group. |
|An independent design with participants already working in one of the two categories, so no manipulation of the independent variable. |
|Details: |
|24 workers at a Swedish sawmill. The researchers identified a high-risk group of 14 “finishers” in a Swedish sawmill. Their job was to finish off the |
|wood at the last stage of processing timber. The work was machine-paced, isolated, very repetitive yet highly skilled, and the finishers’ productivity |
|determined the wage rates for the entire factory |
|The 14 “finishers” were compared with a low-risk group of 10 cleaners, whose work was more varied, largely self-paced, and allowed more socialising |
|with other workers |
|Levels of stress-related hormones (adrenaline and noradrenaline) in the urine were measured on work days and rest days They also gave self-reports of |
|mood and alertness plus caffeine and nicotine consumption. Body temperature was measured at the time of urine collection. Self-rating scales of words |
|such as ‘sleepiness’, ‘wellbeing’, ‘irritation’ and ‘efficiency’ were made on scales from none to maximal (the highest level the person had ever |
|experienced). Records were kept of stress-related illness and absenteeism |
|Results; |
|The high-risk group of 14 finishers secreted more stress hormones (adrenaline and noradrenaline) on work days than on rest days, and higher levels than|
|the control group. The high-risk group of finishers also showed significantly higher levels of stress-related illness such as headaches and higher |
|levels of absenteeism than the low-risk group of cleaners |
|In the self-report, the high risk group felt more rushed and irritated than the control group. They also rated their well-being as lower than the |
|control group. |
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|Conclusions: |
|A combination of work stressors- especially repetitiveness, machine-pacing of work and high levels of responsibility – lead to chronic (long-term) |
|physiological arousal. This in turn leads to stress-related illness and absenteeism. |
|If employers want to reduce illness and absenteeism in their workforce, they need to find ways of reducing these work stressors, for example by |
|introducing variety into employees’ work and by allowing them to experience some sense of control over the pace of their work. |
|Evaluation: Issues |Evaluation: Debates |
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2.Kanner et al.(1981) Daily Hassles & Uplifts- Comparisons of two methods of stress measurement.

|Background: Life event scales (SRRS) were devised to demonstrate how major life events such as death, divorce, unemployment and severe illness can be |
|used to calculate levels of stress and consequently to predict illness (Holmes and Rahe 1967 -see measurements of stress for more details). However |
|even when we do not have extreme stressors like these we still end up feeling stressed! |
|Some researchers have suggested that daily hassles lead to more stress, that is, minor hassles can combine to become one large stress, and that these |
|are a better predictor of health problems than life events. Daily hassles are ‘irritating, frustrating, distressing demands that to some degree |
|characterise everyday transactions with the environment’ (Kanner 1981) – i.e. the straw that broke the camel’s back! |
|Aim: To compare the Hassles and Uplift Scale and the Berkman Life Events Scale as predictors of psychological symptoms of stress |
|Approach/Perspective : Cognitive and Social |
|Type of Data: Quantitative |
|Method: Longitudinal study using self-report and psychometric tests. 100 middle-aged adults in California (mostly white, with adequate or above income,|
|protestant and with at least 9th grade education). Repeated design as participants completed both self-reports. |
|Procedure: All tests were sent out by post one month before the study began. The participants were asked to complete: |
|The Hassles rating every month for nine months. |
|The Life Events rating after ten months. |
|The Hopkins Symptom Checklist (HSCL) and the Bradburn Morale Scale every month for nine months. To assess their psychological symptoms of stress (Nine |
|subjects dropped out) |
|Results: It was found that the Hassles Scale was a better predictor of psychological and physiological symptoms than were the life events scores. |
|Hassles also seemed to be consistent month on month. Life events for men correlated positively with hassles and negatively with uplifts. For women, |
|the more life events they reported, the more hassles and uplifts reported. Hassle frequency correlated positively with psychological symptoms on the |
|HSCL The more hassles the participant reported the more symptoms they reported. |
|Conclusions: |
|It was concluded that the assessment of daily hassles and uplifts may be a better approach to the prediction of stress and ill health than the life |
|events approach. Hassles contribute to psychological symptoms whatever life events have happened. |

|Evaluation: Issues |Evaluation: Debates |
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3.Geer and Maisel (1972)- The Effect of control in reducing stress reactions

|Background: |
|Numerous studies show that job stress is far and away the major source of stress for American adults and that it has escalated progressively over the |
|past few decades. Increased levels of job stress as assessed by the perception of having little control but lots of demands have been demonstrated to be |
|associated with increased rates of heart attack, hypertension and other disorders. In New York, Los Angeles and other municipalities, the relationship |
|between job stress and heart attacks is so well acknowledged, that any police officer who suffers a coronary event on or off the job is assumed to have a|
|work related injury and is compensated accordingly (including a heart attack sustained while fishing on vacation or gambling in Las Vegas). Geer and |
|Maisel wanted to investigate the idea that one of the most stressful things we can experience is that feeling of having absolutely no control over our |
|situation. |
|Aim: To see if perceived control or actual control can reduce stress reactions to averse stimuli - photos of crash victims. |
|Approach/Perspective: Physiological |
|Type of Data: Quantitative |
|Method: |
|Laboratory experiment 60 psychology undergraduates from New York University. Independent design as participants were randomly assigned to one of three |
|conditions. Their stress levels were measured using galvanic skin response and heart- rate electrodes |
|Details: |
|Group 1: were given control over how long they looked at the images for. They could press a button to terminate the image and were told a tone would |
|precede each new image. |
|Group 2: Were warned the photos would be 60 seconds apart they would see the picture for 35 seconds and a 10 second warning tone would precede each |
|photo. The group had no control but did know what was happening. |
|Group 3: were told that from time to time they would see photos and hear tones but were not given timings or any control. |
|Procedure: each participant was seated in a sound proofed room and wired up to the GSR and ECG machines. The machine was calibrated for 5 minutes while |
|the participant relaxed and a baseline measurement was then taken. Instructions were read over an intercom. Each photo was preceded with a 10 second |
|tone and then flashed up for 35 seconds (only the one group could terminate the photo and move on). |
|The GSR was taken at the onset of the tone and during the second half of the tone and in response to the picture. |
|Results; |
|ECG recordings were discarded as they appeared inaccurate. |
|Group 2 showed most stress. |
|Group 1 showed least stress. |
|Conclusions: |
|That having control over your environment can reduce stress responses. |

|Evaluation: Issues |Evaluation: Debates |
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Summary: Causes of Stress

• Each of us would probably realise that a cause of Stress for one person may not be a cause of stress for another.

• Some people in high-powered jobs seem to thrive on the pressure, while others would seem to burn out and show signs of physical and /or mental illnesses.

• Individual differences are a major problem for any researcher looking at stress.

• Cultural norms and expectations can influence how stressful events might be: this means that ethnocentrism is also an issue psychologists need to consider.

Comprehension questions for Causes of Stress

1.Johansson (1978) - Stress in the Workplace

• What are stressors? • What does adrenaline attack? • Where did Johansson carry out his research? • What type of experiment did Johansson carry out? • What happened to the adrenaline levels of the high-risk group throughout the day?

2.Kanner (1981) – Daily hassles and life events

• What are daily hassles?

• Who were the sample and what limitations does this impose on the result • What issues might arise with it being self-report? • What were the three variables correlated? • What are the strengths and weaknesses of the longitudinal method?

3.Geer and Meisel (1972) - Lack of control

• What was the aim of Geer and Meisel’s research? • Group 2 was yoked to Group 1. What does this mean? • Who was the sample in this study and what limitations could they impose on study? • How the stress measured and what was good and bad about this method? • Why was each recording performed in a sound and electrically-shielded room?

Part A exam question for Causes of Stress

• Describe one piece of research which considers work as a source of stress (10 marks)

Linking sentence _______________________________________________

Linking sentence ______________________________________________

Part B exam question for Causes of Stress

• Discuss problems of conducting research into the causes of stress (15 marks)

Linking sentence_______________________________________________
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Evaluation sheet for the Causes of Stress

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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Methods of Measuring and Stress

The Theories/Studies

1. Geer & Maisel (1973) Physiological Measures
2. Holmes & Rahe (1967) Self-report
3. Johannson (1978) Combined approach

There are various ways in which psychologists measure stress which we have touched on in the last section: using physiological measures to assess the biological reaction; asking people to assess their own stress levels or stressors is also used. Of course there are methodological problems with both of these. Here we are going to look at them in more detail, examining the physiological approach against the social approach, investigate their methodological issues and then ask whether a better way may be to combine them to create a more holistic approach.

1.Geer and Maisel (1972)-Physiological Measurements of Stress.

|Background: Physiological measures of stress can overcome the subjectivity of the self-report by relying on scientific measurements of hormones, |
|chemicals, heart rate and blood pressure etc. the main problem with these is the validity. How can we be sure that we are truly measuring stress levels. |
|Think about other factors which can cause physiological changes which can mimic stress reactions, caffine, recreational drugs or alcohol. |
|Stress can be measured physiologically by any device that measures levels of arousal. |
|Adrenaline causes increased blood pressure which can be measured. Goldstein (1992) found that paramedics had higher blood pressure during ambulance runs |
|compared to at home. |
|Galvanic Skin Response (GSR) measures the electrical resistance of the skin which is an indicator of the level of arousal in the nervous system. Good for|
|labs but not normal life. |
|Sample tests of Blood or Urine which can test the hormone level on the body secreted through these. Lundenberg (1976) commuters on train higher levels of|
|hormone secreted on crowded short journey than long less crowded ride. |
|Aim: To see if perceived control or actual control can reduce stress reactions to aversive stimuli (photos of crash victims). |
|Approach: Physiological |
|Type of Data: Quantitative |
|Method: Laboratory experiment 60 psychology undergraduates from New York University. Independent design as participants were randomly assigned to one of |
|three conditions. |
|Details: Each participant was seated in a sound-shielded room and wired up to galvanic skin response (GSR) and heart-rate monitors. The machine was |
|calibrated for 5 minutes while the participant relaxed and a baseline measurement was then taken. Instructions were read over an intercom. Each photo |
|was preceded with a 10 second tone and then flashed up for 35 seconds (only the one group could terminate the photo and move on). The GSR was taken at |
|the onset of the tone and during the second half of the tone and in response to the picture. |
|Group 1: were given control over how long they looked at the images for. They could press a button to terminate the image and were told a tone would |
|precede each new image. |
|Group 2: Were warned the photos would be 60 seconds apart they would see the picture for 35 seconds and a 10 second warning tone would precede each |
|photo. The group had no control but did know what was happening. |
|Group 3: were told that from time to time they would see photos and hear tones but were not given timings or any control. |
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|A Beckman Model RB polygraph was used to collect psycho-physiological data. |
|The data was converted from a voltmeter to a printout. |
|Each recording was performed in a sound and electrically-shielded room to ensure no audio or visual input from the projector would interfere with the |
|data collection. |
|The heart monitors were attached in standard positions, and the GSR electrodes were placed between the palm and forearm of the participants’ |
|non-preferred arm e.g. left arm for right-handed people. |
|Results; The predictability group (Group 2) were most stressed by the tone as they knew what was coming, but did not have control over the photograph. |
|The control group (Group 1) were less stressed by the photograph than the predictability group and no-control group (Groups 1 and 2) as they had control.|
|Conclusions: Participants showed less GSR reaction, indicating less stress, when they had control over the length of time they could look at the |
|disturbing photographs. It is likely that being able to terminate aversive stimuli reduces the stressful impact of those stimuli. |
|Evaluation: Issues |Evaluation: Debates |
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2. Holmes and Rahe (1967) Self–Report Measures: Life Events as Stressors.

|Background: Self-report methods include questionnaires, interviews and diary keeping. |
|Holmes and Rahe used self-report measure with their Social Readjustment Rating Scale (SRRS). This looked at life events that have occurred in a |
|person’s life and rates their importance. The readjustments need to cope with these life events causes stress, so the more life events you have to cope|
|with the more stressed you are. |
|Aim: Creating a method that estimates the extent to which life events are stressors |
|Approach: Social |
|Type of Data: Quantitative |
|Method: In the correlation there was an independent design. A questionnaire designed to ascertain how much each life event was considered a stressor |
|with 394 participants’ 179 males and 215 females, from a range of educational abilities, races and religions. |
|Details: |
|Holmes and Rahe examined the medical records of 5,000 patients (all American service men). From these, they put together a list of 43 life events |
|which seemed to precede (come before) illness. |
|394 subjects (179 males and 215 females) from range of educational abilities and ethnic groups and religions took part. |
|Each participant was asked to rate the series of 43 life events. Rating should be based on personal experience and perceptions of other people’s |
|experience. The amount of readjustment and the time it would take people to readjust were to be considered |
|They were told that ‘marriage’ had been given an arbitrary value of 50. The participants then had to give a number to each of the other life events, |
|indicating how much readjustment they’d involve relative to marriage. |
|Death of a spouse was judged (on average) to require twice as much readjustment as marriage. |
|The resulting values became the weighting (numerical value) of each life event. |
|The amount of life stress a person has experienced in a given period (e.g. 12 months) is measured by the total number of life change units (LCUs). |
|These units are calculated by adding the mean values (in the right hand column of the table on the next page) associated with the events the person has|
|experienced during that time. The ranks (left hand column) simply denote the order in which the life events appear in the SRRS. |

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|Results: Correlations between groups were tested and found to be high in all but one group. |
|Males and females agreed. Participants of different ages, religions, educational level agreed. |
|There was less correlation between white and black participants. |
|Conclusions: The events chosen are mostly ordinary (although some are extraordinary. E.g. going to jail, but they do pertain to the |
|western way of life). There is also some socially desirable events which reflect western values of materialism, success and conformism. |
|The degree of similarity between groups is impressive and shows agreement in general at what constitutes a life event and how much they |
|cause stress. |
|Holmes and Rahe concluded that stress could be measured objectively as an LCU score. This, in turn, predicts the person’s chances of |
|becoming ill (physically and / or mentally) following the period of stress. Stress and illness are not just correlated. Stress actually|
|makes us ill. |
|Evaluation: Issues |Evaluation: Debates |
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3.Johansson et al.(1978) Combined Approach: Measurement of Stress Response.

|Background: The combined approach used both physiological and self-report can give us the objectivity of scientific measurements and rich qualitative |
|data that helps understand behaviours such as stress. |
|Aim: To measure the psychological and physiological stress response in two categories of employees. |
|Approach: Physiological and Cognitive (psychological) |
|Type of Data: Quantitative and Qualitative |
|Method: A quasi-experiment where workers were defined as being at high risk (of stress) or in a control group. An independent design with participants|
|(24) already working in one of the two categories, so no manipulation of the independent variable. The high-risk group (14 ) were classified as having |
|jobs which were repetitive and constrained, little control of pace or work routine, more isolated and having more responsibility |
|Details: Each participant was asked to give a daily urine sample when they arrived at work and at four other times during the day so that their |
|adrenaline levels could be measured This is a physiological measure. Body temperature was also measured at the same time. These measures gave an |
|indication of how alert the participants were |
|These measures were combined with a self-report where each participant had to say how much caffeine and nicotine they had had since the last urine |
|sample. They also had to rate a list of emotions and feelings such as sleepiness, wellbeing, calmness, irritation and efficiency. These were on a |
|continuum from minimum to maximum and on a mm scale. The score was how many mm from the minimum base point they had marked themselves to be feeling. |
|The baseline measurements were taken at the same time on a day when the workers were at home. |
|This combined method of physiological measures and self-reports gave some good qualitative and quantitative data, which enabled Johansson et al. to |
|compare the two groups, but have some understanding of the impact of higher stress levels on the participants |
|Results; The high-risk group had adrenaline levels twice as high as their baseline and these continued to increase throughout the day. |
|The control group had a peak level of 1 ½ times baseline level in the morning and this then declined during the rest of their shift. |
|In the self-report, the high-risk group felt more rushed and irritated than the control group. They also rated their wellbeing lower than the control |
|group. |
|Conclusions: The repetitive, machine-paced work, which was demanding in attention to detail and was highly mechanised, contributed to the higher stress|
|levels in the high-risk group. |
|Evaluation: Issues |Evaluation: Debates |
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Activity

Fill in the following table: -

| |Explanation |Strengths |Limitations |
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Summary: Measurements of Stress

• As with measuring any behaviour, each method has its strengths and weaknesses, yet if psychology aspires to be accepted as a science we must acknowledge the objectivity of scientific methods.

• Just measuring chemicals or physiological responses will yield less information than the more qualitative data that self-report techniques can give us.

• Rich qualitative data can help us understand behaviours such as stress.

• Perhaps the combined approach is the most useful, though it may be most costly in terms of resources and time.

Comprehension questions for Measurements of Stress

1.Geer & Maisel (1973) - Physiological Measures

• What is a galvanic skin response? • What is the link between stress and galvanic skin response? • Why were the heart rate monitors placed in a standard position? • What are the strengths of obtaining Objective data? • What variables could affect the validity of the results?

2.Holmes & Rahe (1967) - Self-report

• What are the strengths and limitations of using self-report? • Consider why these may be particularly relevant to asking people about their stress? • Consider how valid these results will be? • How will individual /situational debate link with this method?

3.Johannson (1978) - Combined approach

• What is the combined approach when measuring stress? • Which two measures did Johansson use? • How valid were these results? • How does this methods link to the reductionism/holism approach?

Part A exam question for Measurements of Stress • Outline one piece of evidence which suggests that stress can be caused by hassles and/or life events (10 marks)

Linking sentence_______________________________________________

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Part B exam question for Measurements of Stress • Evaluate the reliability of methods of measuring stress (15marks)

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Evaluation sheet for Measurements of Stress

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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Techniques for Managing Stress and Supporting Evidence

The Theories/Studies
1. Cognitive: SIT (Michenbaum 1975)
2. Behavioural: Biofeedback. (Budzynski 1973)
3. Social: social support (Waxler-Morrison 2006)

The social, behavioural and cognitive approaches all view the physiological symptoms of stress as emerging because of different stressors. Therefore, we will examine three techniques for managing stress, each based on one of the above approaches. All have credence and all have been validated by empirical research although there are others which are just as reputable.

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1. Meichenbaum (1975) - Cognitive: Stress Inoculation Therapy

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|Background: Meichenbaum’s assumption is that stress is caused by faulty processing of information. Therefore, stress inoculation therapy assumes that |
|people sometimes find situations stressful because they think about them in catastrophising ways and the aim of the therapy is thus to train people to |
|cope more effectively with potentially stressful situations. |
|SIT is a psychotherapy method intended to help patients prepare themselves in advance to handle stressful events successfully and with a minimum of |
|upset. The use of the term "inoculation" in SIT is based on the idea that a therapist is inoculating or preparing patients to become resistant to the |
|effects of stressors in a manner similar to how a vaccination works to make patients resistant to the effects of particular diseases. |
|It is similar to hardiness and has three stages. |
|1. Cognitive preparation (or conceptualisation) involves the therapist and patient exploring the ways in which stressful situations are thought |
|about. Typically, people react to stress by offering negative self-statements like 'I can't handle this'. This makes the situation worse. A key part |
|of what needs to be communicated in the SIT conceptualization stage is the idea that stressors are creative opportunities and puzzles to be solved, |
|rather than mere obstacles. Patients are helped to differentiate between aspects of their stressors and their stress-induced reactions that are |
|changeable and aspects that cannot change, so that coping efforts can be adjusted accordingly. |
|2. Skill acquisition and rehearsal, attempts to replace negative self-statements with incompatible positive coping statements. These are then learned |
|and practised. A variety of emotion regulation, relaxation, cognitive appraisal, problem-solving, communication and socialization skills may be |
|selected and taught on the basis of the patient's unique needs. |
|3. Application and follow through involves the therapist guiding the person through progressively more threatening situations that have been rehearsed|
|in actual stress-producing situations. The patient may be encouraged to use a variety of simulation methods to help increase the realism of coping |
|practice, including visualization exercises, modeling and vicarious learning, role playing of feared or stressful situations, and simple repetitious |
|behavioural practice of coping routines until they become over-learned and easy to act out. Initially the person is placed in a situation that is |
|moderate to cope with. Once this has been mastered, a more difficult situation is presented. |
|Technique |
|Strengths |
|Limitations |
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|Cognitive Behavioural Technique |
|Gets people to analyse and evaluate the effectiveness of their coping strategies |
|Teaches new coping strategies e.g. positive visualisation /relaxation |
|Effects can be long lasting |
|Good if stressor is specific e.g. exams |
|Can be generalised to new situations |
|Improves perceived control and self efficacy |
|Non -invasive |
|Time consuming |
|Needs high levels of commitment |
|Therapists are expensive |
|Not effective with very high levels of stress or more generalised stress |
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|Aim: Standard behavioural measures have tried to help people become desensitised to stress. Meichenbaum compared these standard behavioural methods |
|with cognitive ones. Cognitive therapy sessions aimed at enabling people to identify their stressors and change their mental processes when under |
|stress rather than just their behaviours. |
|Approach/Perspective: Cognitive |
|Type of Data: Qualitative |
|Method: It was a field experiment with participants put into three groups, SIT, standard desensitisation and a control group. Each participant was |
|tested using a test anxiety questionnaire and grade averages before and after treatment. It was a blind situation in that the people assessing them did|
|not know which condition they had been in. Matched pairs design with random allocation to groups and gender controlled in each group. |
|Details: 21 students ages 17 – 25 responded to an advert about treatment of test anxiety. |
|The SIT group received 8 therapy sessions giving them insight into their thoughts before tests. They were then given some positive statements to say |
|and relaxation techniques to use in test situations. The systematic desensitisation groups were also given 8 therapy sessions with only progressive |
|relaxation training whilst imaging stressful situations. The control group were told they were on a waiting list for treatment. |
|Results; Findings: performance in tests in the SIT group improved the most although both therapy groups showed improvement over the control groups |
|The significant difference was between the two therapy groups and the control group. |
|Participants in the SIT group showed more reported improvement in their anxiety levels, although both therapy groups showed overall improvement |
|compared to the control group. |
|Conclusions: Conclusions: that SIT is an effective way of reducing anxiety in students who are prone to anxiety in test situations and more effective |
|than simply behavioural techniques when cognitive component is added in. |

|Evaluation: Issues |Evaluation: Debates |
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2.Budzynski et al (1970)-Behavioural: Biofeedback

|Background: A different approach to stress reduction is seen in biofeedback, which has a behavioural perspective. One aspect of the behavioural approach |
|is the idea that consequences of behaviour can lead to it being repeated or not (reinforcement). If something is pleasurable or rewarding we are more |
|likely to repeat it. |
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|Simply put, biofeedback is a means for gaining control of our body processes to increase relaxation, relieve pain, and develop healthier, more comfortable |
|life patterns. |
|Biofeedback gives us information about ourselves by means of external instruments. Using a thermometer to take our temperature is a common kind of |
|biofeedback. Clinical biofeedback follows the same principle, using specialized instruments to monitor various physiological processes as they occur. |
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|Moving graphs on a computer screen and audio tones that go up and down "reflect" changes as they occur in the body system being measured. Biofeedback |
|training familiarizes us with the activity in our various body systems so we may learn to control this activity to relieve stress and improve health. |
|Trying to change physiological activity without biofeedback is like playing darts while blindfolded - we can't see whether we are hitting the mark or not. |
|Biofeedback lets us know precisely when we are changing our physiologies in the desired direction. |
|Biofeedback is not a treatment. Rather, biofeedback training is an educational process for learning specialized mind/body skills. Learning to recognize |
|physiological responses and alter them is not unlike learning how to play the piano or tennis - it requires practice. Through practice, we become familiar |
|with our own unique psychophysiological patterns and responses to stress, and learn to control them rather than having them control us. |
|By giving visible or audible feedback on the state of the body it is assumed that we would be more likely to repeat the method of reducing stress. This is |
|the method used by Budzynski et al.’s (1970) research on patients with tension headaches. These headaches are thought to be caused by sustained contraction|
|of the scalp and neck muscles. Which is associated with stress, therefore by relaxing the muscles (reducing the stress response), the headaches should be |
|reduced. |

|Technique |
|Strengths |
|Limitations |
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|Biofeedback |
|Become aware of physiological response (e.g. heart rate) – machines can be used to provide feedback |
|Learn to control this response (e.g. deep breathing) |
|Apply this control in everyday situations |
|Non-invasive |
|No side effects (compared to drugs) |
|Gives individual control over stress response |
|Reduction in blood pressure etc can be long term |
|May need expensive equipment and trained staff |
|Requires effort and commitment from patient – not easy to learn |
|Behavioural techniques are based on studies with animals e.g. rats and may not generalise to human learning |
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|Aim: to see if biofeedback techniques work and help reduce tension headaches or whether the effect is due to the placebo effect. The placebo effect is a|
|positive psychological effect that can occur even when there is no actual treatment. |
|Approach/Perspective : Behavioural |
|Type of Data: Quantitative |
|Method: Experimental method with patients trained in the laboratory. Data was collected using muscle tension measurements (EMG) with an electromyography,|
|a machine which gives feedback by a graph by applying electrodes to the muscles. Patients were also given a psychometric test for depression (MMPI) and |
|asked to complete questionnaires on their headaches. It was an independent measures design with participants randomly assigned to one of three groups. |
|Details: Participants: 18 replied to a newspaper advert in the USA. They were screened by telephone and then had psychiatric and medical examinations to|
|ensure there were no other reasons for their headaches. There were 2 males and 16 females aged 22-44 with a mean age of 36. |
|Group A had real biofeedback training with relaxation using the EMG |
|Group B had biofeedback training but with false (pseudo) feedback |
|Group C were used as a control group |
|Procedure: all groups kept a diary of their headaches for two weeks, rating them from 0 mild to 5 severe. Groups A and B were told to practice |
|relaxation after the training for 15 – 20 mins each day. |
|Results: After 3 months group A’s muscle tension was significantly lower than the other two groups. Reporting of headaches in group A also fell |
|significantly compared to their base line which it did not in the other two groups. |
|Follow up: after 18 months where 4 were contacted, 3 reported very low headache activity and the fourth reported some reduction. |
|Conclusions: Biofeedback is an effective way to reduce stress levels by reducing tension therefore effective method of stress management. |
|Relaxation techniques are more effective than just being monitored but better with biofeedback. |
|Evaluation: Issues |Evaluation: Debates |
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3.Waxler-Morrison et al (1993) - Social: Relationships and Cancer survival

|Background :The last technique is less of an intervention than a social situation. Having close friends and family on whom you can count has far-reaching|
|benefits for your health. It doesn't take a scientific study to show that surrounding yourself with supportive family, friends and co-workers can have a |
|positive effect on your mental well-being, but there's plenty of research to confirm it. A strong social support network can be critical to help you |
|through the stress of tough times, whether you've had a bad day at work or a year filled with loss or chronic illness. |
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|Support networks are used for a variety of problems: slimming clubs, Alcoholics Anonymous, cancer clubs are all ways in which people with problems can |
|increase their social support. |
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|Waxler-Morrison et al’s (1993) research into women with breast cancer and their survival rates showed that support networks can increase the positive |
|outcome of survival after breast cancer. Sklar and Amisman (1981) reviewed a large body of literature which concluded that cancer growth is amplified by |
|stress and therefore it could be determined that by reducing this stress with social support this must have positive outcomes for those suffering from |
|cancer. |
|However, as we have seen there are always many factors involved in human behaviour and taking the reductionist approach of only giving one explanation or|
|assuming one technique is responsible is too simplistic and doesn’t encompass the complexities of humans and our activities. |
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|Technique |
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|People with strong support networks suffer less stress and have better health |
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|Specific support networks can be set up e.g. cancer clubs, self-help groups |
|Effects can be long lasting |
|Good if stressor is specific e.g. cancer/bereavement |
|Improves perceived control and self efficacy |
|Non –invasive |
|Inexpensive often relies on volunteers |
|People may resist being helped in this way |
|Dependent on quality and availability of support network |
|Can’t necessarily be generalised to new situations |
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|Aim: To look at how a woman’s social relationships influence her response to breast cancer and survival. |
|Approach: Social |
|Type of Data: Quantitative and Qualitative |
|Method: A quasi-experiment with women who were diagnosed with breast cancer. Using questionnaires and some (18) interviews, plus examination of medical|
|records. The women naturally fitted into categories based on their existing social support networks |
|Details: 133 women under 55 years who were referred to a clinic in Vancouver with breast cancer |
|Patients were mailed a self-administered questionnaire to gather information on their demography and existing social networks. Questions included their|
|educational level, who they were responsible for (e.g. children), contact with friends and family, perception of support from others, and a |
|psychometric test of social networks that combined martial status, contact with friends and family and church membership. |
|Details of their diagnosis were taken from their medical records between June 1980 and May 1981, survival and recurrence rates were checked in their |
|medical records in January 1985. |
|Results: Six aspects of social network were significantly linked with survival. These were: marital status, support from friends, contact with friends,|
|total support, social network and employment. |
|The qualitative data from the interviews showed that practical help such as childcare, cooking and transport to hospital were the concrete aspects of |
|support. |
|Married women who survived tended to report supportive spouses. Jobs were seen as important, even if they were not financially important, as they were |
|a source of support and information. |
|Conclusions: The prospective aspect of the study: choosing a sample, assessing social networks and then waiting to see outcomes for patients, removed |
|the biases of retrospective studies. |
|Several characteristics of the women’s social networks, including marriage and employment status are significantly related to survival, so the |
|conclusion is that the more social networks and support, the higher the survival rate of women with breast cancer. Although it is acknowledged that the|
|main factor influencing survival is still the state of cancer at the time of diagnosis, with nodal status and clinical stage of cancer being |
|significantly linked with survival |
|Evaluation: Issues |Evaluation: Debates |
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Summary: Managing Stress

• Remember stress is not necessarily a bad thing! Stress is blamed for a whole range of physical illnesses and psychological disorders. It is said to be costing industry vast sums of money in absence from work and poor performance at work. Stress is now pictured almost exclusively in negative terms. But, it is important to remember that the stress response is a valuable survival mechanism which motivates people. It warns of a threat in the environment and galvanises the individual to take action and deal with the situation. But, many of the techniques of stress management are designed to calm people down and subdue the stress response.

• Stress is also motivational, without a bit of stress in our lives many of us would not perform at our best. E.g. Stage fright and performance anxiety often bring out the best in people.

• It appears that there is no one cause of stress and no uniform reaction to stress; it is difficult to measure it accurately, and there are many stress reduction techniques, all of which can claim some success, as least on the participants in the supporting research.

• It is perhaps one of the joys of being human, that no one can explain our behaviour; we are complex animals and we need to have a variety of tools at our disposal to explain, measure and treat atypical behaviour. However, we would have to ask: is being stressed atypical?

Comprehension questions for Managing of Stress

1.Michenbaum (1975) Cognitive :SIT.

• What was the design in Michenbaum’s study? • What is the assumption of the cognitive approach adopted by Michenbaum? • What are the three stages of the stress inoculation therapy? • Explain what the happened to the group who underwent systematic desensitisation? • What were the findings and how did they know SIT was effective?

2.Budzynski (1973) Behavioural : Biofeedback.

• Which two approaches are combined in biofeedback? • What was the aim of Budzynski et al.’s research? • What does the term ‘placebo’ mean? • What is pseudo-biofeedback? • How did Budzynski overcome the ethical problem of treating only one group?

3.Waxler-Morrison (2006) Social: social support.

• How was the information gathered and how might this affect the validity of the study? • What is an advantage and disadvantage of the kind of data collected? • This was a prospective study what does this mean and why does this remove bias? • What were the results? • How would it be suggested that someone manage stress on a daily basis?
Part A exam question for Managing of Stress • Describe one cognitive technique for managing stress (10 marks)

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Part B exam question for Managing of Stress • Discuss whether stress should be managed by treating the individual or their situation (15 marks)

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Evaluation sheet for Managing of Stress

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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Topic 3 – Dysfunctional Behaviour

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1. Diagnosis of dysfunctional behaviour • Categorising • Definitions • Biases in diagnosis

2. Explanations of dysfunctional behaviour • Biological • Behavioural • Cognitive

3. Treatments of dysfunctional behaviour • Biological • Behavioural • Cognitive

Topic 3 – Dysfunctional Behaviour

It is important to note firstly that psychology is a science that looks at trends, not certainties, so for every piece of evidence that appears to explain human behaviour, there is probably another that refutes it. This is the case when studying dysfunctional behaviour, which is a more up to date term for what was called mental illness. Thus, if someone is not able to function as a human being and given the label dysfunctional and it carries fewer stigmas than the label abnormal. However, as we have previously seen labelling someone has ethical issues because of the stickiness of the label which can lead to discrimination, therefore the diagnosis needs to valid and safe.

No psychologist can say for certain what causes dysfunctional behaviour; the evidence may point to factors that may cause a disposition or tendency towards a disorder but all humans are unique, complex individuals and therefore, not everyone behaves in the same way.

The first section of the course consequently examines dysfunctional behaviour, how to categorise dysfunctional behaviour so it can be diagnosed, what the definitions of dysfunctional behaviour are then examining the biases in diagnosis that exist, which further confound the issue and reflect society’s views on dysfunctional behaviour.

Psychologists from various approaches will have their own explanations for dysfunctional behaviour, for example behaviourists would consider the causes to be learned behaviour and the second section will look at three explanations: the biological, which is the genetic explanation, the behavioural explanation as in classical conditioning and the cognitive explanation such as maladaptive thoughts.

It follows therefore, that the treatments recommended by each approach will be based on the assumptions of that approach, if the cause is biological it follows that the treatment should be biological, thus the third section will examine a biological treatment, where drug therapy was used, a behavioural treatment which involved desensitisation and cognitive therapy which is a cognitive treatment.
WHAT DO WE KNOW FROM AS?

Several studies or theories from AS Psychology explain why individuals might suffer because of dysfunctional behaviour:

• FREUD (1909) introduced the idea of people having unconscious motivations. In particular, he suggested people can behave in a dysfunctional way because of underlying unconscious emotional issues that were not dealt with as a child. Thus leading to phobias as seen by Little Hans. • MAGUIRE (2000) looked at how the brain changes structure depending on what we use it for. If taxi drivers develop unusual hippocampi after spending years memorising routes and distances, maybe individuals' brains will change after years of being depressed or phobic. • GRIFFITHS (1994) studied cognitive styles - the way regular gamblers have of thinking about gambling, weighing the odds and explaining away losses, that is quite different from non-gamblers. Maybe this different way of thinking has caused individuals to behave in a dysfunctional manner. • ROSENHAN (1954) studied the reliability of diagnosing dysfunctional behaviour and highlighted a disadvantage of being diagnosed that is the stickiness of labelling.

HOW CAN WE APPLY THE APPROACHES AND PERSPECTIVES TO DYSFUNCTIONAL BEHAVIOUR?

• BEHAVIOURIST psychologists will try to look at the behaviour of individuals and their environments and work out what sort of backgrounds or circumstances may cause dysfunctional behaviour; • COGNITIVE psychologists will try to study the thought processes of people with dysfunctional behaviour – are they different from a normal person? What is there thinking? how do they weigh up actions to be taken and cope with stressors - that makes them different from everybody else; • PSYCHODYNAMIC psychologists argue that the dysfunctional behaviour stems from unconscious, unresolved emotional; • BIOPSYCHOLOGISTS will be more interested in the brain structure of patients, and ask questions like: do people suffer from depression because of a biological predisposition and what drugs can help make their lives more normal.

One of the themes that comes from this unit is NATURE vs NURTURE. Are some people born with the predisposition to suffer from dysfunctional behaviours or are the situations people experience causes them to suffer from for example, depression, or anxieties.

Diagnosis of Dysfunctional Behaviour

The Theories/Studies
1. DSMI/ICD – Categories of Dysfunctional Behaviour
2. Rosenhan and Seligman (1995) – Definitions of dysfunctional Behaviour
3. Ford and Wediger (1989) – Sex Biases in Diagnosis of Disorders

This section examines how dysfunctional behaviour is categorised and defined in order to help practitioners identify behaviours and consequently enable patients to get the help that is necessary. However, it highlights the reductionist nature of categorizing, and illustrates how taking holistic approach which takes into consideration individual differences and cultural diversity needs to be considered. The study then draws attention to how culture is affected when diagnosing by demonstrating that biases occur because of preconceived ideas about the nature of men and women, which ultimately affects the reliability of the methods used.

1.DSM / ICD - Categories of Dysfunctional Behaviour.

|Background: The definition of a mental disorder is important for investigation to enable a practitioner to identify and treat a particular disorder but |
|it also helps for health care as well as for health care and the insurance industry (especially health insurance and pension insurance). The following |
|elements are of particular importance for the definition of a mental disorder: |
|Personal harm and suffering |
|Abnormality (statistical, social, individual) |
|Limitations or disabilities in what a person can perform |
|Danger for others or the individual him/herself |
|In most instances more than one of these elements has to occur at the same time and over a prolonged period of time. In order therefore, to standardize |
|the description and interpretation of mental disorders, diagnosis and classification systems were set up. |
|At present there are two established classification systems for mental disorders: The International Classification of Diseases (ICD-10) published by the|
|World Health Organization (WHO) and the classification system of the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of |
|Mental Disorders (DSM-IV). |
|Aim: |
|To compare the two ways of categorising dysfunctional behaviour |
|Approach/Perspective: |
|Type of Data: |
|Qualitative |
|The Diagnostic and Statistical Manual of Mental disorders (DSM-IV) |
|This was compiled by over 1000 mental health professionals who collaborated to produce a practical guide to clinical diagnosis and help improve |
|reliability of mental health diagnosis not just in US but around world This resulted in a simpler classification using criteria sets. The DSM is a |
|diagnostic tool designed to enable practitioners to identify a particular disorder and therefore treat the disorder. It is updated regularly, with the |
|current version being DSM-IV. |
|It is complex with a range of Axis (variables to consider, alongside features of mental health there is social, physical and environmental issues also. |
|This classification system of the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), consists |
|of five axes of disorders. The five axes of DSM-IV are: |
|Axis I - Clinical Disorders (all mental disorders except Personality Disorders and Mental Retardation) |
|Axis II - Personality Disorders and Mental Retardation |
|Axis III – Etc.. |
|The are 16 main categories of clinical disorders (Axis I) according to DSM-IV the ones we are concerned with are: |
|5.Schizophrenia and Other Psychotic Disorders |
|6.Mood Disorders |
|7.Anxiety Disorders |
|Here there is some acknowledgement of individual differences as no individual is the same and thus, the features of their illness may not be the same. |
|Also this manual attempts to highlight ethnic diversity and how a clinician from one culture may find it more difficult diagnosing someone from another |
|culture. |
|The classification of disorders can change with time; for example, until 1973 homosexuality was perceived as a mental disorder. As society became more |
|enlightened it was removed from the DSM-II and replaced by the category ‘sexual orientation disturbance’. Again this changed to ‘ego-dystonic |
|homosexuality’ in the DSM-III in 1980. In the DSM-III-Revised in 1987 a category of ‘sexual disorder not otherwise specified’ was introduced, and this |
|has continued in the DSM-IV. |
|The criteria here include ‘persistent and marked distress about one’s sexual orientation’. So it would appear now that society is not labelling |
|homosexuality as a disorder, but that distress about one’s sexuality may lead to a disorder or to a diagnosis of a disorder. Newer disorders such as |
|eating disorders are included as they become more identifiable in society. Bulimia was introduced as a disorder in DSM-III in 1980. Binge-eating |
|disorder (BED) was introduced in 1994 into the 4th edition of DSM. The criteria for disorders such as anorexia can change over time; denial of having |
|the disorder is now a criterion included in DSM-IV, and the body mass index (BMI) for anorexia was changed to allow for cross-cultural consistency. |
|International Classification of Diseases and Related Health Problems (ICD-10) |
|This manual is published by the World Health Organisation (WHO) and is used in many countries throughout the world in diagnosing both physical and |
|mental conditions. |
|It was set up to track and diagnose diseases and mental health issues world-wide and consists of 10 main groups, the most notable for us are: |
|F2 Schizophrenia, schizotypal and delusional disorders |
|F3 Mood [affective] disorders |
|F6 Disorders of personality and behaviour in adult persons. |
|In addition, there is a group of “unspecified mental disorders”. |
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|The ICD-10 was used in 40 countries to see if it improved psychiatric diagnosis across cultures, however, it is only a snap shot of dysfunctional |
|behaviour and definitions and criteria must continue to be revised. |
|Version 10 of the ICD was first published in 1992, and was a revision of previous versions. The ICD-8 was used as the basis for much cross-cultural |
|collaboration in the 1980s, with the aim of refining the definitions for disorders in the 10th version. This allowed for inconsistencies and ambiguities|
|to be removed and resulted in the clear set of criteria now found in ICD-10. |
|The draft in 1987 was used in 40 countries to see if this improved psychiatric diagnoses across cultures. Of course ICD-10 is only a snapshot of the |
|field of dysfunctional behaviour, and as cultures change so revision of definitions and criteria must continue to take place. |
|ICD-11 should be drafted by 2008 |
|Thus the major difference between ICD-10 and DSM-IV is that DSM a multi-axial tool. Clinicians have to consider if a disorder is from Axis 1 (clinical |
|disorders) and/or Axis 2 (personality disorders). Then the general medical condition of the patient is considered, plus any social and environmental |
|problems. This makes DSM more holistic in relation to diagnosing than the reductionist approach of the criteria based ICD. Many clinicians would use the|
|two diagnostic tools side by side. |

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|Evaluation: Issues |Evaluation: Debates |
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2. Rosenhan and Seligman (1995) Definitions of Dysfunctional Behaviour.

|Background: |
|Culture refers to all ways of thinking, feeling and acting that people learn from other members of society. Different cultures will shown cross-cultural |
|differences in beliefs, traditions, norms etc. and may have different views on defining and classifying abnormality. For example, in the West Indies it is |
|perfectly acceptable to admit to hearing voices, it is considered a religious experience, people pray and God answers them. In Britain, hearing voices is |
|considered a symptom of schizophrenia. |
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|Subculture: - This refers to a social group within a society e.g. gender, social class, age and ethnic groups. The dominant culture within a society is |
|likely to be seen as the norm and subcultures as abnormal. The frequency of mental disorders can vary in relation to subcultures. For example, |
|schizophrenia is between twice and eight times more prevalent in lower socio-economic groups in society. Rack (1984) found that African Caribbean’s in |
|Britain are sometimes diagnosed as mentally ill, on the basis of behaviour which is perfectly normal within their subculture (hearing voices and smoking |
|marijuana (cannabis psychosis)). Women are also more likely than men to be diagnosed with clinical depression. Some mental disorders have been found to be |
|specific to certain cultures. The term given to these disorders is Culture Bound Syndromes (CBS), for example PMT and Anorexia Nervosa are particularly |
|Western disorders. |
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|Abnormality is difficult to define. Views of abnormality change across cultures vary within cultures over time and vary from group to group (e.g. Chavs and |
|Goths) within the same society (cultural relativism). It is essential to examine views of abnormality as they form the basis for defining and identifying |
|psychological disorders. |
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|How do we decide what is ‘normal’ or ‘abnormal’, and whether the behaviour constitutes a psychological disorder (e.g. depression, schizophrenia, phobias, |
|post traumatic stress disorders, eating disorders etc.) Rosenhan and Seligman (1995) |
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|Aim: How can we define abnormality or normality? |
|Approach/Perspective: |
|Type of Data: |
|Way 1: Statistical Infrequency |
|A norm is a standard or rule that regulates behaviour in a social setting e.g. it is the norm in our society to be polite and say please and thank you. |
|Norms are socially acceptable or ‘normal’ standards of behaviour. Abnormality is defined as moving away from the norm, non-compliance with society’s norms |
|and values. In statistical terms human behaviour is abnormal if it falls outside the range that is typical for most people, in other words the average is |
|‘normal’. Things such as height, weight and intelligence fall within fairly broad areas. People outside these areas might be considered abnormally tall or |
|short, fat or thin, clever or unintelligent etc. In statistical terms they are abnormal because their behaviour has moved away from the norm. |
|Example: - The Normal Distribution Curve for IQ -This is calculated using psychometric intelligence tests. The norm for IQ is 100. Anything between 70 and |
|130 is considered normal for IQ, an IQ of less than 70 or more than 130 is statistically infrequent and therefore considered abnormal |
|Mark on the graph the norm or average IQ score and the cut off points for abnormality (e.g. 100, 70 and 130). |
|Limitations: The cut off points are rather arbitrary. How can someone with an IQ of 70 be considered normal, whilst a person with an IQ of 1 point |
|difference (69) be considered abnormal? |
|It ignores desirability of behaviour, in terms of IQ we might accept that someone has an abnormally low IQ, but we would probably all wish to have a high IQ |
|and wouldn’t label that as abnormal. |
|Some disorders, for example depression, are statistically very frequent, but still classified as abnormal. |
|Way 2: Deviation from Social Norms |
|Every society or culture has standards of acceptable behaviour/norms. Behaviour that deviates, (moves away) from these norms is considered abnormal. Social|
|norms are approved and expected ways of behaving in a particular society or social situation. For example, in all societies there are social norms governing|
|dress for different ages, gender and occasion Cultural and historical relativism: - what is statistically frequent and acceptable in one culture and time |
|period is not necessarily the norm in another. For example, arranged marriages are statistically frequent in India, Marijuana smoking is statistically |
|frequent in Jamaica. |
|However, it is difficult to use on its own, as this might encompass behaviours such as exceptionally high IQ, or stamp collecting. So it is quite limited. |
|Other behaviours might be quite common, such as depression diagnoses but it could be argued that this illness is dysfunctional. There has to be more to it |
|than just numbers. |
|Way 3: Failure to Function Adequately |
|Perhaps a more useful definition is that if a person is not functioning in a way that enables them to live independently in society then they are |
|“dysfunctional”. There are several ways a person might not be functioning well. These might be dysfunctional behaviours such as obsessions in obsessive |
|compulsive disorder, where a person cannot leave the house due to the rituals they need to undertake before they can leave. If a person is distressed by |
|their behaviour, not being able to go out of the house is distressing for agoraphobics. If the person observing the patient is uncomfortable this could be |
|dysfunctional behaviour, such as when a person is talking to themselves whilst sitting next to you on the bus. Unpredictable behaviour, where a person might |
|have dramatic mood swings or sudden impulses can also be seen as dysfunctional. Irrational behaviour, where a person might think they are being followed, or |
|people are talking about them could also lead to a failure to function adequately. This failure to function adequately might be the most useful definition of|
|the four. However, there are problems with this, in that the context of the behaviour might influence our view on it. We probably all talk to ourselves at |
|times. Maybe a person who has been involved in a fire will obsessively check appliances before leaving the house. It can be quite a subjective view as to |
|whether a person is not functioning adequately. |
|Way 4: Deviation from Ideal Mental Health |
|So far we have outlined definitions of abnormality. This definition instead attempts to define normality, and assumes that absence of normality indicates |
|abnormality. However, normality is as difficult to define as abnormality. Jahoda (1958) approached this problem by identifying various factors that were |
|necessary for ‘optimal living’ (maximising enjoyment for life). The presence of these factors indicates psychological health and well-being. |
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|Jahoda’s 6 elements of Optimal Living |
|1.Positive view of self: Well adjusted individuals have high self-esteem and self acceptance. |
|2.Personal Growth and Development: This refers to developing talents and abilities to the full. |
|3.Autonomy: The ability to act independently and make your own decisions. |
|4.Accurate view of reality: Seeing the world as it really is without distortions (lack of paranoia). |
|5.Positive Relationships: Normal people can form close, satisfying relationships with other people, both giving and receiving affection. They do not make |
|excessive demands to satisfy their own needs. Mentally ill people may be self-centred and look for affection, but are never able to find it. |
|6.Master of your own environment: Normal people can meet demands within different situations and are able to adapt to changing circumstances. |

|Evaluation: Issues |Evaluation: Debates |
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3. Ford and Widiger (1989) Biases in Diagnosis-Sex bias in the diagnosis of disorders

|Background: Boverman (1970)found that mental health professionals used different adjectives to describe normal male and female (submissive and |
|concerned with appearance) which makes any female not fitting with this to be abnormal! This stereotypical view of genders is one way in which |
|diagnosis can be biased. |
|Aim: To find out if clinicians were stereotyping genders when diagnosing disorders |
|Approach/Perspective (if any): Individual differences |
|Type of Data: Quantitative |
|Method: Self-Report where health practitioners were given scenarios and asked to make diagnoses based on the information. The independent variable was |
|the gender of the patient in the case study and the dependent variable the diagnosis made by the clinician |
|Details: 354 clinical psychologists from 1127 randomly selected from the National Register, with a mean 15.6 years clinical experience. 266 |
|psychologists responded to the case histories. |
|An independent design as each participant was given either a male, female or sex-unspecified case study. Participants were randomly provided with one |
|of nine case histories. Case studies of patients with anti-social personality disorder (ASPD) or histrionic personality disorder (HPD) or an equal |
|balance of symptoms from both disorders were given to each therapist. Each case study was male, female or sex-unspecified. Therapists were asked to |
|diagnose the illness in each case study by rating on a 7-point scale the extent to which the patient appeared to have each of nine disorders |
|Dystheymic (form of mild depression) |
|Adjustment (stress-related disorder due to social/emotional issues) |
|Alcohol abuse |
|Cycothymic disorder (type of depression resulting in frequent mood disorders) |
|Narcissistic (a personality disorder in which people have inflated sense of self and little regard for other’s feeling’s. Underpins lack of |
|self-esteem) |
|Histrionic (personality disorder whereby suffer shows excessive emotionality and attention seeking. Can include inappropriate seductive bahvaiour) |
|Passive-aggressive (personality trait manifested negatively, eg. learned helplessness) |
|Antisocial (behavioural pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues |
|into adulthood) |
|Borderline personality disorder (a condition in which a person makes impulsive actions, and has an unstable mood and chaotic relationships) |
|Results; Sex-unspecified case histories were diagnosed most often with borderline personality disorder. |
|ASPD was correctly diagnosed 42% of the time in males and 15% of the time in females. Females with ASPD were misdiagnosed with HPD 46% of the time, |
|whereas males were only misdiagnosed with HPD 15% of the time. |
|HPD was correctly diagnosed in 76% of females and 44% of males. |
|Conclusions: Practitioners are biased by stereotypical views of genders as there was a clear tendency to diagnose females with HPD (histrionic |
|personality disorder) even when their case histories were of ASPD (antisocial personality disorder). |
|There was also a tendency not to diagnose males with HPD, although this was not as great as the misdiagnosis of women |

|Evaluation: Issues |Evaluation: Debates |
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Summary: Diagnosis of Dysfunctional Behaviour

• It is clear that diagnosing and categorising dysfunctional behaviour is not an exact science. • Diagnosing often depends on how society views any particular disorder at any one time, and the biases inherent in that society. • There are dysfunctional behaviours that cause distress to patients and their families, and which can be treated to facilitate a better quality of life.

Comprehension questions Diagnosis of Dysfunctional Behaviour

1.DSMI/ICD – Categories of Dysfunctional Behaviour

• What are the current diagnostic manuals used in the USA and the UK? • Who published the ICD? • What is the major difference between ICD-10 and DSM-IV? • Name and advantage and disadvantage to giving an individual diagnosis? • When using these is the diagnosis reliable?

2.Rosenhan and Seligman (1995) – Definitions of dysfunctional Behaviour

• What are the four definitions of abnormality according to Rosenhan and Seligman? • What does Jahoda suggest you should have for ideal mental health? • How might a person be considered to function inadequately? • Which culture is more likely to be diagnosed with dysfunctional behaviour according to The Mental Health Act Commission’s ‘Count Me In Census’ (2005)? • What factors affect the reliability and validity of defining dysfunctional behaviour?

3.Ford and Widiger (1989) – Sex Biases in Diagnosis of Disorders

• Who were the sample and how ere they selected? • Ford and Widiger believed that histrionic personality disorder was seen as more likely in women. How can this be explained? • What were the three research conditions? • What did Ford and Widiger find out about bias in diagnosis? • What was Ford and Widiger’s conclusion?

Part A exam question for Diagnosis of Dysfunctional Behaviour

• Describe how gender biases diagnoses of dysfunctional behaviour (10 marks)

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Part B exam question for Diagnosis of Dysfunctional Behaviour • Evaluate the effectiveness of diagnosing dysfunctional behaviour (15 marks)

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Evaluation sheet for Diagnosis of Dysfunctional Behaviour

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Explanations of Dysfunctional Behaviour

The Theories/Studies
1. Watson and Raynor (1920) – Behavioural - Little Albert (Classical conditioning)
2. Gottesman and Shields (1991) - Biological – Twin studies (Genetic)
3. Beck et al. (1974) - Cognitive – Interviews with people with depression (Maladaptive thoughts)

There are different explanations for human behaviour, and as you will know from AS these are based on approaches such as the cognitive, biological, psychodynamic approach and perspectives such as the behaviourist perspective. Basic assumptions about behaviour should be transferable to any behaviour, including therefore dysfunctional behaviour (remember little Hans and psychodynamic behaviour). This section looks at the cognitive, biological and behaviourist approach to explaining dysfunctional behaviour and what evidence there is for supporting these assumptions.

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‘Little Albert’ and ‘Classical Conditioning.’

1. Watson and Raynor (1920) - Classical conditioning

|Background: Behaviourism is a school of thought in psychology that assumes that learning occurs through interactions with the environment. (The |
|nurturist argument that believes behaviour has little to do with the individual but more to do with the situation they are in) One of the best-known |
|aspects of behavioural learning theory is classical conditioning. Discovered by Russian physiologist Ivan Pavlov, classical conditioning is: ‘a learning|
|process that occurs through associations between an environmental stimulus and a naturally occurring stimulus’ |
| |
|- The unconditioned stimulus is one that unconditionally, naturally, and automatically triggers a response. E.g. when you smell one of your favourite |
|foods, you may immediately feel very hungry, the smell of the food is the unconditioned stimulus. |
|- The unconditioned response is the unlearned response that occurs naturally in response to the unconditioned stimulus. In our example, the feeling of |
|hunger in response to the smell of food is the unconditioned response. |
|- The conditioned stimulus is previously neutral stimulus that, after becoming associated with the unconditioned stimulus, eventually comes to trigger a|
|conditioned response. In our earlier example, suppose that when you smelled your favourite food, you also heard the sound of a whistle. While the |
|whistle is unrelated to the smell of the food, if the sound of the whistle was paired multiple times with the smell, the sound would eventually trigger |
|the conditioned response. In this case, the sound of the whistle is the conditioned stimulus. |
|- The conditioned response is the learned response to the previously neutral stimulus. In our example, the conditioned response would be feeling hungry |
|when you heard the sound of the whistle. |
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|Behaviourists believe we are born as blank slates and all behaviour is learnt. Any dysfunctional behaviour is learnt by operant conditioning, classical |
|conditioning (rewards and punishments) and social learning (Bandura and the Bobo doll). Therefore, this places the responsibility on us not to teach |
|dysfunctional behaviour. Obviously this is a simplistic explanation for complex behaviours and this section is will only examine and concentrate on the |
|classical conditioning explanation of phobia acquisition. |
|Aim: To see if it is possible to induce a fear of a previously unfeared object through classical conditioning. |
|To see if the fear will be transferred to other similar objects. To see what effect time has on the fear response. To see how possible it is to remove |
|the fear response in the laboratory. |
|Approach/Perspective: |
|Behavioural |
|Type of Data: |
|Quantitative |
|Method: A case study undertaken on one boy: ‘Little Albert who was 8 months old and lived in the hospital with his mother, a nurse. He was ‘stolid and |
|unemotional’. A single subject design. |
|Details: Albert’s baseline reactions to the stimuli were noted. He showed no fear when presented with a rat, a rabbit, a dog, a monkey, a mask with |
|hair. When Albert was 11 months old the experiments started. |
|Session One: Albert was presented with a rat. Just as he reached for it, a steel bar behind him was hit. This procedure was repeated. Findings: The |
|first time the steel bar was struck when Albert touched the rat, he jumped and fell forward. The second time he began to whimper. A fear response had |
|been conditioned |
|Session Two: The following week the rat alone was presented. Then three presentations were made with the rat and the loud noise. This was followed with |
|one presentation of just the rat. Then two more presentations with the rat and the noise were made. Finally the rat alone was presented. Findings: |
|Albert reacted to the rat alone by immediately crying, turning to the left and crawling quickly away from the rat. The conditioning of a fear response |
|was evident and so it is possible to condition fear through classical conditioning. |
|Session Three: Albert was brought back five days later and given toy blocks (a neutral stimulus) to play with. Presentations were then made of: the rat,|
|a rabbit, a dog, a Santa Claus mask etc. Findings: After each presentation of the blocks, Albert played with them happily. The other stimuli produced |
|negative responses of crying, moving away from the stimulus and crawling away. Transference of the fear had been made to other similar objects |
|Session Four: Albert was then taken to a well-lit lecture theatre to see if the response was the same as it was in the small room used up till now. In |
|the different room the fear reaction was slight, until the bar was hit. Then the fear reaction increased. |
|Session Five: One month later Albert was tested with various stimuli. Albert continued to show fear reactions. Findings: Time had not removed the fear |
|response |
|Conclusions: |
|Session 2 – After five paired presentations the conditioning of a fear response was evident and so it is possible to condition fear through classical |
|conditioning. |
|Session 3 and 4 – Transference of the fear had been made to other similar objects, although it appeared the less like the original stimulus the objects |
|were (e.g. the cotton wool), the less negativity was shown. |
|Session 5 – Time had not removed the fear response. |
|Unfortunately Albert was taken out of the hospital on the day of Session 5, so Watson and Rayner were never able to carry out their aim of trying to |
|find ways of removing a phobia in the laboratory. We don’t know if Albert had a fear of furry animals for the rest of his life! |
|Research by Mary Cover Jones on Little Peter, (Jones, 1924) did show how a fear of rabbits could be overcome using a treatment of systematic |
|desensitisation. |
|Evaluation: Issues |Evaluation: Debates |
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2. Gottesman and Shields (1991) – A review of recent adoption twin and family studies of schizophrenia

|Background: The biological approach would favour the nature side of the of the nature-nurture debate thus the focus is on the individual not the |
|situation in explaining behaviour. Consequently the explanation of dysfunctional behaviour would be that something in our biology is the fundamental |
|cause of our behaviour. This could be a genetic cause or a malformation of brain structures |
|[pic] |
|Aim: To review research into genetic transmission of schizophrenia |
|Approach/Perspective: Biological |
|Type of Data: |
|Method: |
|A review of adoption and twin studies into schizophrenia between 1967 and 1976. |
|3 adoption studies by Kety, Wender and Rosenthal |
|5 twin studies by Kringlen et al. and Gottesman and Shields. |
|In total there were 711 participants in the adoption studies. In the twin studies a total of 210 monozygotic (identical) twin pairs and 319 dizygotic|
|(non-identical) twin pairs were studied. |
|Details: The incidence of schizophrenia in adopted children and monozygotic twins was extrapolated from the research. |
|Results; |
|All adoption studies found an increased incidence of schizophrenia in adopted children with a schizophrenic biological parent. |
|Kety found that biological siblings of children with schizophrenia showed a much higher percentage of schizophrenia. |
|All twin studies found a higher concordance rate for schizophrenia in monozygotic (MZ) than dizygotic (DZ) twins. |
|In Gottesman and Shield’s own study the rate was 58% for identical twins, and 12% for non-identical twins. |
|Conclusions: |
|There is obviously a heavy genetic input into the onset of schizophrenia. |
|Concordance rates less than 100% show there must be some interaction with the environment. |

|Evaluation: Issues |Evaluation: Debates |
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3. Beck et al (1974) Cognitive - Interviews with Patients Undergoing Therapy for Depression

|Background: The cognitive approach sees behaviour as being the consequence of some internal processing of information. Much like a computer, we take in |
|the information, process it and respond in some way. If however, there is a problem with the circuit boards in a computer the response may not be what |
|we would expect and this is the same for humans. If something goes wrong with information that we attend, how we perceive it or store it, then the |
|response may not be what everyone expects which leads to the label of dysfunctional behaviour. Beck (1967) is one of the founders of the cognitive |
|approach and had much to say about how faulty thinking can influence our behaviours. |
|Aim: To understand cognitive distortions in patients with depression. |
|Approach: Cognitive |
|Type of Data: Qualitative |
|Method: |
|Clinical interviews with patients who were undergoing therapy for depression. |
|Independent design as the patients were compared with a group of 31 non-depressed patients undergoing psychotherapy, matched for age, sex, and social |
|position. |
|50 patients diagnosed with depression |
|16 men and 34 women. |
|age range from 18–48 with median age of 34. |
|Face-to-face interviews with retrospect reports of patients’ thoughts. Some patients kept diaries of their thoughts and brought these to the therapy |
|sessions. Records of the verbalisations of the non-depressed patients were kept to compare with the depressed patients. |
|Results; |
|Certain themes appeared in the depressed patients, e.g. low self-esteem, self-blame, overwhelming responsibilities and desire to escape, anxiety caused |
|by thoughts of personal danger, and paranoia and accusations against other people. |
|Depressed patients had stereotypical responses to situations. |
|Depressed patients regarded themselves as inferior to others |
|Some patients felt themselves unlovable and alone. |
|Self-blame was shown even when blame couldn’t be apportioned to the person. |
|These distortions tended to be automatic, involuntary, plausible and persistent |
|Conclusions: |
|In depression, and even mild depression, patients have cognitive distortions that deviate from realistic and logical thinking |

|Evaluation: Issues |Evaluation: Debates |
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Summary: Explanations of Dysfunctional Behaviour

• The different approaches’ assumptions influence their explanations of the causes of dysfunctional behaviour.

• The biological explanation is the most commonly used in our society; as this reflects the emphasis on mental health being a medical problem

• The prescription of anti-depressants, tranquilisers and antipsychotic drugs reflects this view; these are now more often seen as short-term fixes that need to be combined with other talking therapies such as CBT to address the underlying problems.

Comprehension questions for Explanations of Dysfunctional Behaviour

1.Watson and Raynor (1920) - Little Albert

• What theory did Watson and Rayner support? • What were the four aims of Watson and Rayner’s research on Little Albert? • Identify the conditioned and unconditioned stimulus and the conditioned and unconditioned response? • What is meant by the term generalization in this study? • Why were Watson and Rayner unable to test the last question?

2. Gottesman and Shields (1991) – Twin studies

• What method did Gottesman and Shields use? • How did they use concordance rates in the study? • What are retrospective reports and how do they affect the validity of the study? • What were the findings from the twin studies Gottesman and Shields reviewed? • What were the conclusions?

3. Beck et al. (1974) – Interviews with people with depression

• Who were the patients in Beck’s study on cognitions in dysfunctional behaviour? • What was the aim of the study? • How did the patients report their cognitions? • What did Beck find out about the cognitions of patients with depression?

Part A exam question for Explanations of Dysfunctional Behaviour

• Outline a biological explanation of dysfunctional behaviour (10 marks)

Linking sentence _________________________________________________

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Part B exam question for Explanations of Dysfunctional Behaviour • To what extent are explanations of dysfunctional behaviour reductionist? (15 marks)

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Evaluation sheet for the Explanations of Dysfunctional Behaviour

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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| |Researcher/s: |Researcher/s: |Researcher/s: |
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Treatments of Dysfunctional Behaviour

The Theories/Studies
1. McGrath (1990) – Successful Treatment of a Noise Phobia
2. Leibowitz (1988) -Treatment of Social Phobia with Phenelenzine
3. Ost & Westling (1995) -Treatments for panic attacks

There many treatments for dysfunctional behaviour from all of the approaches however, the three treatments covered in this section reflect the three approaches examined in the explanation of dysfunctional behaviour section. This section therefore, looks at the cognitive, biological and approaches and the behaviourist perspective to treating dysfunctional behaviour.

[pic]

1. McGrath (1990) – Successful Treatment of a Noise Phobia: Behavioural

|Background: Behaviour is learnt and has little to do with the individual but instead the situation they are in. Classical conditioning theory, look at |
|previous notes. |
|Aim: To treat a girl with specific noise phobias using systematic desensitisation. |
|Approach/Perspective : Behavioural |
|Type of Data: |
|Method: A case study that details the treatment of a noise phobia in one girl. A single participant design. |
|Details: A nine-year-old girl called Lucy, who had a fear of sudden loud noises, including: balloons, party poppers, guns, cars backfiring and |
|fireworks. . She had lower than average IQ, and was not depressed, anxious or fearful (tested with psychometric tests), so only had one specific |
|phobia. |
|Lucy was brought to the therapy session and told what would happen. Her parents gave consent for further sessions. |
|At the first session, Lucy constructed a hierarchy of feared noises. |
|Lucy was taught breathing and imagery to relax, and was told to imagine herself at home on her bed with her toys. She also had a hypothetical ‘fear |
|thermometer’ to rate her level of fear from 1-10. As she was given the stimulus of the loud noise, she had paired her feared object (the loud noise) |
|with relaxation, deep breathing and imagining herself at home with her toys. This would naturally lead her to feel calm. |
|She then associated the noise with feeling calm. So after four sessions she had learned to feel calm when they noise was presented. |
|She did not need to imagine herself at home with her toys any more. |
|Results; At the end of the first session, Lucy was reluctant to let balloons be burst. At the end of the first session, Lucy was reluctant to let |
|balloons be burst even at the far end of the corridor. When the therapist burst the balloon anyway Lucy cried and had to be taken away. She was |
|encouraged to breathe deeply and relax. |
|By the end of the fourth session, Lucy was able to signal a balloon to be burst 10 metres away. , with only mild anxiety. |
|On the fifth session, Lucy was able to pop the balloons herself. |
|Over the next three sessions, Lucy was able to pull a party popper if the therapist held it. |
|By the tenth and final session, Lucy’s fear thermometer scores had gone from 7/10 to 3/10 for balloon popping, from 9/10 to 3/10 for party poppers and |
|from 8/10 to 5/10 for the cap gun. |
|Conclusions: It appears that noise phobias in children are amenable to systematic desensitisation The important factors appear to have been giving Lucy|
|control to say when and where the noises were made, and the use of inhibitors of the fear response, which included relaxation, conservation and a |
|playful environment |
|Evaluation: Issues |Evaluation: Debates |
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2.Leibowitz (1988) - Treatment of Social Phobia with Phenelenzine: Biological

|Background: Biological treatments are often the first treatments offered for dysfunctional behaviour, often because diagnosis is made by medical |
|practitioner and the medical approach supports the use of drug therapy. One of the benefits of psychopharmocotherapy is the speed of the effects, some |
|drugs almost instantaneous results. However, other therapies are now used to supplement the biological therapy such as cognitive which can bring about |
|longer lasting change and without the side effects that drug therapy may incur. |
|Aim: To see if the drug phenelzine can help treat patients with social phobia. |
|Approach/Perspective : Biological |
|Method: A controlled experiment where patients were allocated to one of three conditions, and treated over eight weeks. They were assessed for social |
|phobia on several tests such as Hamilton Rating Scale for Anxiety and the Liebowitz Social Phobia Scale. This had common manifestations of social |
|phobia and patents rated 1–4 for the fear produced and 1–4 for the steps taken to avoid the phobic situation. |
|Details: An independent design with patients being allocated randomly to one of four groups. |
|One group was treated with phenelzine, and one given a matching placebo. A second treatment group was given atenolol and another placebo group was |
|given a matching placebo. |
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|80 patients meeting DSM criteria for social phobia aged 18–50 years. They were medically healthy and had not received phenelzine for at least two weeks|
|before the trial. Each was assessed to see that there were no other disorders and each signed a consent form before the research. |
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|Patients were assessed at the beginning, and then given their drug or placebo, with gradual increases in dosage of phenelzine or atenolol in the |
|treatment groups. |
|Each patient was then reassessed on the Hamilton Rating Scale for Anxiety and the Liebowitz Social Phobia Scale. |
|Independent evaluators were used to carry out clinical assessments in a double blind situation. |
|Results; |
|After eight weeks significant differences were noted for the phenelzine groups, with better scores on the tests for anxiety compared to the placebo |
|groups. There was no significant difference between the patients taking atenolol and those taking a placebo |
|Conclusions: |
|Phenelzine but not atenolol is effective in treating social phobia after eight weeks of treatment. |
|Evaluation: Issues |Evaluation: Debates |
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3.Ost & Westling (1995) - Treatments for Panic Attacks: Cognitive

|Background: Cognitive Behavioural uses cognitive approach to restructure thoughts as well as behaviourism (relaxation) the way the person behaves. Does|
|not look at the Cause but focuses on the present symptoms. How the person thinks about an event and its effect on what they did. If negative thought |
|can be reinterpreted then the person will feel better and the behaviour will change. |
|Aim: To compare cognitive behaviour therapy (CBT) with applied relaxation as therapies for panic disorder. |
|Approach/Perspective Cognitive |
|Method: A longitudinal study with patients undergoing therapy for panic disorder. Independent design experiment with participants randomly allocated to|
|one of two conditions, cognitive or drug therapy. The patients with DSM diagnosis of panic disorder, with or without agoraphobia. Recruited through |
|referrals from psychiatrists and newspaper advertisements. |
|26 females and 12 males, mean age 32.6 years (range 23–45 years). From a variety of occupations and some married, some single and some divorced |
|38 patients were diagnosed with moderate to severe depression were assessed using Beck’s Depression Inventory and two other rating scales. |
|Details: Pre-treatment: baseline assessments of panic attack, using a variety of questionnaires (e.g. the Panic Attack Scale, Agoraphobic Cognitions |
|Questionnaire, etc.) Patients recorded details of every panic attack in a diary. |
|Each patient was then given 12 weeks of treatment (50–60 minutes per week), with homework to carry out between appointments. |
|Applied relaxation was used to identify what caused panic attacks, and then relaxation training started with tension-release of muscles. This was |
|gradually increased so that by session 8 rapid relaxation was used and patients were able to practise their techniques in stressful situations. |
|CBT was used to first identify the misinterpretation of physical symptoms and then to generate an alternative cognition in response. For example, not |
|to feel panic when something stressful happened, but to come up with an alternative explanation (e.g. my heart racing is not a heart attack but a |
|normal physical reaction to stress and it will slow down in a minute). This was then tested in situations where participants had panic situations |
|induced, but were not allowed to avoid them, so that eventually they had to accept that their restructured thoughts were right. Patients were then |
|reassessed on the questionnaires. |
|After one year a follow up assessment using the questionnaires was carried out. The therapy session were prescribed and controlled and observed to |
|ensure reliability. |
|Results; |
|Applied relaxation showed 65% panic-free patients after the treatment, 82% panic-free after one year. |
|CBT showed 74% panic-free patients after the treatment and 89% panic-free after a year. |
|These differences were not significant. |
|Complications such as generalised anxiety and depression were also reduced to within the normal range after one year. |
|Conclusions: Both CBT and applied relaxation worked at reducing panic attacks, but it is difficult to rule out some cognitive changes in the applied |
|relaxation group even though this is not focused on in this research. |
|Evaluation: Issues |Evaluation: Debates |
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Summary: Treatments of Dysfunctional Behaviour

• The treatments of dysfunctional behaviour are not limited to those in this booklet; there are other approaches beyond the specification, such as humanistic client-centred therapy and psychodynamic therapies. Who can forget the case of Little Hans and Freud in the AS course?

• Within the approaches that have been covered, there are many more treatments, for example there are biological treatments such as electroconvulsive therapy.

• Similarly there are many therapeutic techniques based on the assumptions of operant conditioning, such as token economies, and on classical conditioning such as flooding, in addition to Mc Grath’s systematic desensitization described here.

Comprehension questions for Treatments for Dysfunctional Behaviour

1. McGrath (1990) – Successful Treatment of a Noise Phobia

• Which Behaviourist theory is this technique based upon? • Who was the participant in McGrath’s study on systematic desensitization? • What is systematic desensitization? • How many sessions did Lucy have to have before she became less fearful? • What was Lucy able to do by the end of her treatment?

2. Leibowitz (1988) Treatment of Social Phobia with Phenelenzine

• Which approach did Leibowitz use to treat social phobias? • How were the participants assessed for social phobia? • Why did Leibowitz use a placebo group? • What design did Leibowitz use? • Which approach has treatments that remove the basis of the fear rather than treating the symptoms?

3. Ost & Westling (1995) Treatments for panic attacks

• What does the cognitive approach suggest as a way to treat anxiety disorders? • How were the patients assessed before treatment? • Which two therapies did Ost and Westling compare? • What did Ost and Westling find? • How did Ost and Westling explain the similarity in findings between the two therapy groups?

Part A exam question Treatments for dysfunctional Behaviour • How could dysfunctional behaviour (either affective or anxiety or psychotic) be treated cognitively? (10 marks)

Linking sentence _____________________________________________

Linking sentence ______________________________________________

Part B exam question for Treatments of Dysfunctional Behaviour • Assess the effectiveness of treatments of dysfunctional behaviour (15 marks)
Linking sentence_______________________________________________
Linking sentence__________________________________________________
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Evaluation sheet for Treatments of Dysfunctional Behaviour

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Causes and Treatments of Dysfunctional Behaviour
Activity

The following table has a list of psychiatric disorders or dysfunctional behaviour. Can you identify: • What may be the cause of the behaviour? • How could it be treated? • Which psychological approach each one could be based on?

|Dysfunctional behaviour |Causes |Ways to treat it |Approach/ Perspective |
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|Depression | | | |
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|Schizophrenia | | | |
|Obsessive compulsive disorder | | | |
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|Anxiety disorder | | | |
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|Agoraphobia | | | |
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|Panic disorders | | | |
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|Bipolar disorder | | | |
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|ADHD | | | |
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|Compulsive eating | | | |
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|Kleptomania | | | |
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|Aspergers syndrome | | | |

Activity

1. Make a list of the strengths and weaknesses of each of the treatments

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2. Now highlight the similarities between the treatments.
3. What is the responsibility on the part of the patient?
4. Consider how the approach each treatment adopts might limit the effectiveness of the treatment.

Topic 4 - Disorders

Disorders refers to mental health problems that can affect an individual at some point, or on a continuous basis through their life
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Psychologists and Psychiatrists are interested in what types of mental health issues affect individuals and the impact these disorders can have on their lives. To be clear on what mental health issue a person is showing symptoms of a psychologist will look at the type of disorder and The Characteristics of Disorders.

These characteristics help diagnose the disorder and also allow the psychologist/psychiatrist to decide on a course of action to help the individual overcome or alleviate their problem. Very generally speaking, there are three types of disorders:
1. Anxiety Disorders such as phobias, panic disorder, post-traumatic stress disorder and generalised anxiety disorders are typified by a continuous feeling of fear and anxiety. This can have a huge impact on everyday life and make daily functioning difficult.
2. Affective Disorders refer to the disabling moods that individual’s experience which causes disruption to their social, family and work lives. Examples are depression, bipolar disorder and dysthymia.
3. A Psychotic Disorder relates to the concept of psychosis which is the general term for disorders that are characterised by a loss of contact with reality. This can be very confusing and frustrating for the individual and can lead to a withdrawal from society. Schizophrenia is the most frequently reported psychotic disorder in psychological literature.

The second section of Disorders will focus on Explanations of a disorder. We can choose from either an anxiety or an affective or a psychotic disorder. We are focusing on an anxiety disorder (phobias and generalised anxiety disorders).

To fully understand an anxiety disorder, psychologists try to explain them from various perspectives:
A Behavioural Explanation for a phobia would suggest that an individual has been conditioned (classical conditioning) to fear that object or they are imitating the behaviour of a role model (social learning theory) who has demonstrated that phobia.

A Biological Explanation of a phobia suggests that people are biologically prepared to fear some objects more than others. For example more people are scared of snakes than grass. This suggests a process of evolution that has resulted in fear of objects that can harm you. This allows for the survival of our species.

A Cognitive Explanation for generalised anxiety disorder focuses on thinking patterns and excessive worrying patterns. Worrying too much about something may result in anxiety, even when in reality there is no reason to worry. Worrying about dangerous or threatening phenomenon makes sense but worrying about things that do not pose a threat creates unnecessary anxiety.

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After diagnosing a disorder, the Psychologist or Psychiatrist then needs to decide on the best treatment for the patient – hence the Treatments for Disorders section (we will focus again on phobias and generalised anxiety disorder). Treatments for disorders often leads to disagreements between clinical staff as there are various treatments based on psychological theory to choose from, such as: • Behavioural Treatments focus on unlearning a phobia and to do this classical conditioning or systematic desensitisation is often used. • Biological Treatments might be used to treat a phobia. This usually involves the use of psychopharmocotherapy or drug therapy. Other therapies may be used to enhance the drug treatment such as cognitive therapy. • Cognitive Treatments often involve cognitive behavioural therapy (CBT) which involves getting individuals to restructure how they think about whatever it is they have a phobia for.

WHAT DO WE KNOW FROM AS?
Several studies or theories from AS Psychology explain why individuals might suffer from a disorder. Find studies from AS that can link with this topic.

HOW CAN WE APPLY THE APPROACHES AND PERSPECTIVES TO DISORDERS?

BEHAVIOURIST

COGNITIVE

PSYCHODYNAMIC

BIOPSYCHOLOGISTS

Characteristics of Disorders

Three categories of disorder 1. Anxiety – e.g. phobias, post traumatic stress disorder, obsessive-compulsive disorder 2. Affective – e.g. depression, bipolar, cyclothymic disorder 3. Psychotic – e.g. schizophrenia, delusional disorder, substance - induced psychotic disorder

The main approaches in this area are behaviourism, biological psychology and cognitive psychology. Disorders can be described in terms of classical conditioning and social learning (behaviourism) or in terms of instinct (biological) or by studying thinking patterns (cognitive).

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1. Characteristics of Disorders: Anxiety Disorders

These are when someone has a continuous feeling of fear and anxiety which is disabling – it stops the sufferer leading a normal life. They can be triggered by something that seems trivial to others; or even be triggered by a non existent threat that seems real to the person concerned. There are many different types of anxiety disorder including panic disorder, generalised anxiety, post traumatic stress, and phobia.
Anxiety disorders give a continuous feeling of fear and anxiety which is disabling and can impose on daily functioning. They can be triggered by something that may seem trivial to others; they may even be triggered by non-existent threats that nevertheless seem very real to the person. In the UK in 2000 the Office of National Statistics reported that 1 adult in 6 in the UK had a neurotic disorder anxiety or depression. Anxiety disorders encompass many different disorders including panic disorders, OCD, Phobias, Post Traumatic Stress Disorder and other generalised anxiety disorders.

PHOBIAS

Phobias essentially have a definite, persistent fear of a particular object or situation. A stimulus such as a snake, dog, and a man’s beard will provoke an immediate response, which may be similar to a panic attack. The individual may experience physical symptoms such as shortness of breath or palpitations, and may feel intense terror and may begin to lose control. Even though the individual knows that the fear is irrational they can still not control the immense terror the stimulus produces. This response alone is not enough to be actually diagnosed with a phobic disorder, if the fear disrupts the individuals day to day life, the disorder may be diagnosed.

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There are many different types of anxiety disorder including panic disorder, generalised anxiety, post traumatic stress, and phobia.

2. Characteristics of Disorders: Affective Disorders

Affective means to do with moods. It is normal for moods to change. The problem for affective disorders is that the changes are extreme, and damaging to the person who suffers from them. Depression is when someone feels very down. Mania is when that person feels elated. Sometimes the two alternate – this is called bipolar, where the sufferer swings from one to the other, sometimes with quiet periods of normality in between, sometimes in rapid succession, and sometimes having combinations of the two together. Although bipolar disorder is extreme there are milder, but problematic affective disorders such as dysthymia – a persistent depression which can cause poor appetite, or overeating, insomnia, or low energy, low self esteem, poor concentration or struggling to make decisions, and feelings of hopelessness.
Cyclothymia is a milder former of bipolar disorder where the sufferer fluctuates between irritable or elated (hypomania) or dysthymic.

To recap we all have different moods; sometimes we are happy and sometimes we are sad, and these are natural responses to events in our lives. However, you will see that the characteristics of mood or affective disorders are disabling moods. This means that the disorder prevents the individual from leading a normal life, at work socially or within their family, which would cause them to be diagnosed with depression or bipolar disorder.

An example of affective disorder is Depression.

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| |Depression is more than just feeling ‘cheesed off’. There is reduced concentration, |
| |disturbed sleeping, low self esteem, pessimism, disturbed eating, sometimes ideas of |
| |self harm – in children there is sometimes irritability rather than sad moods |

Symptoms of Depression

|Emotional |Physiological/behavioural |Cognitive Symptoms |
|Sadness |Sleep disturbance |Poor concentration, Indecisiveness |
|Depressed Mood |Appetitive Disturbance |Sense of worthlessness or guilt, Poor Self esteem |
|Anhedonia – (loss of pleasure in usual |Psychomotor retardation or agitation |Hopelessness, Suicidal Thoughts |
|activities) |Catatononia – |Delusions and hallucinations with depressing themes. |
|Irritability |Fatigue and loss of energy. | |

Different types of depression

• Bipolar – mood fluctuates between manic episodes and depressive episodes, these periods are often separated with periods of ‘normality’. Some individuals experience symptoms very rapidly or very slowly and can the cycle between mania, normality and depression can be sometime days, weeks to month and sometimes years.

• Dysthymia- mood disorder, not considered to be as severe as major depression, but can be thought of a chronic depression. Diagnosed if have 3 or more symptoms, including depressed mood. Duration – 2 YEARS! Must never have been without the symptoms

• Melancholic – no pleasure, depressed mood, worse in morning, weight loss.

• Psychotic – Delusions and hallucinations'

• Catatonic – Catelepsy- trance like, disturbance in speech.

• Atypical – Weight gain, hypersommia,

• Postpartum – Major depression within 4 week of delivery of child.
3. Characteristics of Disorders: Psychotic Disorders

Psychosis is the general term for disorders that involve a loss of contact with reality. It covers many disorders, which may involve delusions (hallucinations that cause a person to lose their sense of what is really happening in their life). It can therefore lead to withdrawal from the outside world as the person becomes more confused and disorientated. Psychotic disorders tend to be characterised by delusions and disorganised speech or behaviour, they include all types of schizophrenia; schizoaffective disorders and brief psychotic disorders. Symptoms can be positive with distorted thinking and can be negative where normal behaviour such as showing emotion and speaking fluently are absent.
[pic],
Schizophrenia

|Positive Symptoms – present symptoms |Negative Symptoms – considered to be the loss or absence of normal |
| |characteristics. |
|Delusions |Losing emotional responses |
|Auditory hallucinations |Inability to feel pleasure |
|Disorganised speech |Lack of motivation |
| |Disorganised aspect |

Summary: Characteristics of a Disorder

• The DSM and the ICD have shown how the characteristics of disorders are identifies and categorised, so it fairly easy to see the characteristics of each type of disorder. Some people in high-powered jobs seem to thrive on the pressure, while others would seem to burn out and show signs of physical and /or mental illnesses.

• What is also clear is that there is room for misdiagnosis, as some people may show all the characteristics, or may show some to a greater or lesser degree.

• Diagnosis is not simply a checklist of disorders to be ticked against a patient’s symptom.

• There is room for disagreement; biases by cultures or practitioners may unwittingly lead to misdiagnosis or even diagnosis where there should not be one.

Comprehension questions for Characteristics of Disorders

1. Anxiety Disorders – eg. phobias, post traumatic stress disorder.

• What are the general characteristics of a phobia? • Which of the following is NOT a DSM-IV characteristic of a phobia? ➢ Marked and persistent fear that is excessive or unreasonable. ➢ Exposure to phobic stimulus provokes immediate feelings of guilt and worthlessness. ➢ The person recognizes the fear as excessive. ➢ The phobia has lasted more than 6 months in people under 18 years of age. • Which of the following is NOT an ICD-10 characteristic of a phobia? ➢ The psychological and physical response must be primarily anxiety. ➢ The anxiety is restricted to the phobic situation or object. ➢ The person with the phobia sleeps whenever possible.

2. Affective Disorders – eg. depression, bipolar, cyclothymic disorder

• What are some of the general characteristics of depression? • Which of the following are DSM-IV characteristics of depression? ➢ insomnia most nights ➢ fidgeting or lethargy ➢ delusion of control ➢ marked and persistent fear that is excessive or unreasonable ➢ disorganised speech ➢ recurrent thoughts of death. • Which of the following are ICD-10 characteristics of depression? ➢ loss of interest and enjoyment ➢ The psychological and physical response must be primarily anxiety. ➢ thought echo or broadcasting ➢ persistent hallucinations ➢ reduced concentration ➢ ideas of guilt and unworthiness.

3. Psychotic Disorders – eg. schizophrenia, delusional disorder.

• What are the general characteristics of schizophrenia? • Which of the following are ICD-10 symptoms of schizophrenia? ➢ Delusion of control. ➢ Increased tiredness. ➢ Reduced self esteem and self confidence. ➢ Ideas of guilt and unworthiness. ➢ Thought echo or broadcasting. ➢ Bleak and pessimistic views of the future. ➢ Trance-like behaviour. ➢ Reduced appetite. • Can you give some examples of positive and negative symptoms of schizophrenia?

Part A exam question for Characteristics of Disorders • Describe the characteristics of a psychotic disorder (10 marks)

Linking sentence __________________________________________________

Linking sentence __________________________________________________

Part B exam question for Characteristics of Disorders • Evaluate difficulties when identifying characteristics of psychological disorders(15 marks)

Linking sentence_______________________________________________
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Evaluation sheet for Characteristics of Disorders

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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| |Researcher/s: |Researcher/s: |Researcher/s: |
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| |Key assumption: |Key assumption: |Key assumption: |
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Explanations of Anxiety Disorders - Phobias

Three Explanations of an Anxiety Disorder 1. Watson & Raynor (1920) – Behavioural: Conditioned Emotional reaction 2. Ohman et al (1975) – Biological: Types of Phobia and biological predisposition to them 3. Di Nardo (1998) – Cognitive: Generalised Anxiety Disorder

The main approaches in this area are behaviourism, biological psychology and cognitive psychology and psychodynamic theory. Disorders can be explained in terms of classical conditioning and social learning (behaviourism) or in terms of instinct (biological) or by studying thinking patterns (cognitive).

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In your exam, there will be questions on explanations of anxiety or affective or psychotic disorders. You only need to focus on one type- as such we will focus on anxiety
(phobias and generalised anxiety disorder).

So, in the exam you need to answer the question in relation to anxiety disorders.

1. Behavioural Explanations
Phobias are seen as learnt behaviour, either through classical conditioning, operant conditioning or social learning theory.

Classical Conditioning – Watson & Rayner (1920) conditioned a baby boy known as Little Albert to fear white rats. For several weeks, Albert played happily with a white rat showing no fear. One day, while he was playing with the rat, the experimenters struck a steel bar with a hammer close to Albert’s head. Albert was very frightened by the noise. This was repeated each time he reached for the rat. Albert then developed an intense fear of white rats (and Dr. Watson!).

1. Watson & Raynor (1920) – Behavioural: Conditioned Emotional reaction

|Aim: To see if it is possible to induce a fear of a previously unfeared object through classical conditioning. |
|To see if the fear will be transferred to other similar objects. To see what effect time has on the fear response. To see how possible it is to |
|remove the fear response in the laboratory. |
|Approach/Perspective : Behavioural |
|Method: |
|A case study undertaken on one boy: ‘Little Albert who was 8 months old and lived in the hospital with his mother, a nurse. He was ‘stolid and |
|unemotional’. A single subject design. |
|Details: |
|See notes on previous study on Little Albert in Dysfunctional |
|Conclusions: |
|Session 2 – After five paired presentations the conditioning of a fear response was evident and so it is possible to condition fear through classical|
|conditioning. |
|Session 3 and 4 – Transference of the fear had been made to other similar objects, although it appeared the less like the original stimulus the |
|objects were (e.g. the cotton wool), the less negativity was shown. |
|Session 5 – Time had not removed the fear response. |
|Unfortunately Albert was taken out of the hospital on the day of Session 5, so Watson and Rayner were never able to carry out their aim of trying to |
|find ways of removing a phobia in the laboratory. We don’t know if Albert had a fear of furry animals for the rest of his life! |
|Research by Mary Cover Jones on Little Peter, (Jones, 1924) did show how a fear of rabbits could be overcome using a treatment of systematic |
|desensitisation. |
|Notes: Operant conditioning also provides am explanation for acquiring and reinforcing a phobic behaviour. i.e Child in bed hears thunder runs to |
|parents room, safe and comforting. Next time thunder comes what are they going to do? Stay lonely in bed or go to parents for comfort. Realise get |
|cuddles if frightened of thunder so continue to show fear. Behaviour becomes entrenched and fear reaction becomes an automatic response. |
|SLT- Bandura discovered p’s would develop fear of buzzer if saw someone else in pain when it sounded. |

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2.Ohman et al (1975) – Biological: Types of Phobia and biological predisposition to them

|Background: based on assumption that a disorder has a biological cause. Mental disorders are same as physical disorders just located in diff place in |
|the body. Mental disorders can be treated in same way as physical illness, mainly with drugs. |
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|This explanation sees phobias as serving an evolutionary purpose – so for example a fear of snakes helps people to save their lives. This even |
|introduces a genetic element. |
|Ost (1992) found 64% of people with blood and injection phobia had a first degree relative who shared the same disorder. Seligman’s research on |
|preparedness suggests many phobias may have originally been based on instinctive responses to danger, to things that could threaten human survival. This|
|is because we have evolved with a fear of things that could harm us,(simplified evolutionary theory). |
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|Ohman set out to show how easier to induce phobias of snakes rather than non-threatening items such as faces or houses and Ohman 1975 was more able to |
|use classical conditioning to cure people with fears of houses and flowers than of spiders or snakes, - this could be taken as supporting Seligman’s |
|preparedness theory. |
|Aim: To see if phobias of snakes could be more easily conditioned than phobias of faces or houses, indicating a biological preparedness to develop |
|phobias of certain objects |
|Approach: Behaviourist |
|Method: Laboratory experiment, with participants linked to a machine that would present pictures and then deliver shocks after some of them. |
|Their fear reaction was measured by skin conductance. |
|Independent design with participants being in one of three conditions. Electric shocks were given after presentation of snakes, houses or faces.64 paid |
|volunteers aged 20–30 years. |
|There were 38 females and 26 males and they were all psychology students from the University of Uppsala in Sweden |
|Details: |
|Each participant was wired up to a machine that would measure their skin conductance. |
|They were given a shock at a level that they as an individual rated as definitely uncomfortable but not painful. |
|Pictures were presented on coloured slides for 8 seconds and, if they were going to be given a shock, it occurred immediately as the picture was shown. |
|Participants were seated comfortably and told that they would experience a number of shocks and that they would see three different types of pictures: |
|snakes, human faces and houses. |
|The order of the pictures was randomised. |
|32 participants received shocks after the snakes and of the other 32, 16 received shocks after pictures of houses, and 16 received shocks after pictures|
|of human faces |
|Results; |
|All participants had a similar measure of skin conductance prior to the conditioned stimulus (shock) being presented. |
|After the presentation of the shocks with the pictures the responses were as follows: |
|Participants shown snakes had on average .062 conductance to the snakes and .048 conductance to the houses and faces. |
|The higher the conductance the more they were sweating, which is a physiological response to fear. |
|The control groups who were shocked after faces or houses showed only .037 conductance to their conditioned stimuli (houses or faces) and .030 to the |
|neutral stimuli that didn’t appear with shocks. |
|N.B. the unit of measurement was micro mhos, which is a measure of conductance of electricity. |
|Conclusions: |
|Participants were more likely to show fear reactions to snakes than houses or faces. This shows a biological preparedness to develop phobias to objects |
|that may cause us danger, such as snakes. |
|For genetic explanation it is important to realise that people do not inherit a specific gene for an illness, such as depression, rather, people inherit|
|the vulnerability to it. |

Activity

Fred Flintstone has a phobia of dinosaurs - explain in your own words how this phobia could be explained in terms of biology

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3.Di Nardo (1998) – Cognitive: Generalised Anxiety Disorder

|Background: Cognitive explanations see the origin of phobias in faulty thinking – concern about some issues that are threatening is perfectly |
|rational, but excessive and disproportionate anxiety is not. So a bad experience may lead to negative thoughts which lead to fear, so the negativity |
|and the fear feed on themselves leading to poor thinking and an inability to cope properly when parallel situations crop up subsequently. |
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|DiNardo (1988) studied people who had a traumatic experience with dogs; some developed a phobia of dogs, others did not. Those who developed phobias|
|were more likely to believe that they would have a similar negative experience in the future. |
|Phobias can be maintained or made worse by the way people think about their situation. A high level of anxiety may lead to catastrophising – |
|imagining the worst possible outcome of every situation whilst ignoring the possibility of positive outcomes. |
|Di Nardo found only half people who had had a traumatic experience with dog develop a phobia therefore, they must interpret the event differently |
|from those with phobias. (Faulty thinking pattern.) |
|Aim: To assess whether ‘excessive worry’ is a symptom of General Anxiety Disorder (GAD) |
|Approach/Perspective: Cognitive |
|Method: Quasi-experiment covering three clinics in the USA. Independent design. Patients with and without diagnoses of GAD. |
|Procedure |
|Patients were interviewed twice to assess the reliability of using two different structured interviews. The frequency of the symptom ‘excessive |
|worry’ was analysed along with the percentage of day for which the patient said they displayed the symptom. |
|Results; |
|Significantly more patients with GAD reported excessive worry than non-patients. |
|More patients without GAD reported no-excessive worry. |
|Patients with GAD reported excessive worry for 59.1% of the day compared with 41.7% of non-GAD patients. |
|Conclusions: |
|Excessive worry, which indicates faulty thinking, is found in more GAD patients. Its absence can be used to rule out a diagnosis of General Anxiety |
|Disorder. Patients with GAD spend more time each day worrying. |

|Evaluation: Issues |Evaluation: Debates |
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Summary: Explanations of Disorders

• As you can see there are many different approaches to explaining anxiety disorders

• Each approach has some relevance to our understanding

• It might be useful to adopt an eclectic approach and use parts of each of these to fully understand phobias.

• Psychodynamic and social may have different explanations

• All the explanations have their strengths and weaknesses, some are better at explaining some disorders than others.

• It is important to remember that human behaviour, including dysfunctional behaviour has MANY causes, some of which we still have to identify.

Comprehension questions Explanations of Disorders

1. Watson & Raynor (1920) – Conditioned Emotional reaction

• How would the behavioural approach explain how phobias develop? • What was Albert’s first response to the rat? • Explain whether this fits in with the situational or individual debate? • This approach is thought of as highly scientific. Why? • Think of a negative issue for this study and explain it?

2. Ohman et al (1975) – Types of Phobia and biological predisposition to them

• What is biological preparedness? • What were the phobic objects to be conditioned in Ohman et al’s study on phobias and preparedness? • What were the three conditions of the study? • How did the researchers measure the fear reaction? • Explain whether this fits in with the situational or individual debate?

3. Di Nardo (1998) – Generalised Anxiety Disorder (Cognitive Explanation)

• How does this explanation explain a phobia? • What is GAD? • What was Di Nardo’s aim? • What did he conclude? • Think of a debate which links to this study?

Part A exam question for Explanations of Disorders • Outline a behavioural explanation of one Disorder (either affective or anxiety or psychotic) (10 marks)

Linking sentence __________________________________________________

Linking sentence __________________________________________________

Part B exam question for Explanations of Disorders • Compare explanations of the disorder you referred to in part (a) (15 marks)

Linking sentence_______________________________________________
Linking sentence__________________________________________________
Linking sentence_______________________________________________
Linking sentence______________________________________________
Linking sentence _________________________________________________

Evaluation sheet for Explanations of an Anxiety Disorder

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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Treatments for an Anxiety Disorder - Phobias

Three treatments for an Anxiety Disorder

1. McGrath (1990) – Successful Treatment of a Noise Phobia
2. Ost & Westling (1995) -Treatments for panic attacks
3. Leibowitz (1988) -Treatment of Social Phobia with Phenelenzine

The main approaches in this area are behaviourism, biological psychology and cognitive psychology and psychodynamic theory. Disorders can be treated in terms of unlearning behaviours or systematic desensitisation (behaviourism) or through drug treatments (biological) or cognitive behavioural therapy (cognitive).

|[pic] |Treatments of disorders can be a very contentious issue in that |
| |different psychologists define treatment differently. There is also the |
| |issue of whether or not treatments are a cure for mental illness or |
| |whether they are just a means of helping individuals to cope with their |
| |day to day lives. |
| |Depending on the explanation for a phobia, the treatment will vary. |
| |Issues to look out for here are ethics and reductionism, ie. ethically |
| |is the chosen treatment the correct one for the individual and does it |
| |fully treat the condition or does it focus on one explanation for a |
| |phobia (reductionism) |

In your exam, there will be questions on explanations of anxiety or affective or psychotic disorders. You only need to focus on one type- as such we will focus on anxiety (phobias).

So, in the exam you need to answer the question in relation to anxiety disorders.

1. Behavioural Treatments

Behavioural treatment would consist of trying to ‘unlearn’ behaviours – so that if two stimuli are seen as linked together but are not connected causally, then the impression of a connection should be broken.

The following techniques are just for interest- you only need to be familiar with systematic desensitisation

Sometimes ‘flooding’ is used. This means directly exposing the patients to the object, or situation they fear. E.g. if you fear heights, then you would be taken to the top of a tall building , and encouraged to stay there – the idea being that as you stayed there you would realise there was no basis to your fear and therefore the fear would disappear.
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Another therapy is Implosion Therapy. This is where the patient imagines the fear situation – it is the same idea as flooding, only it is in the mind, not physical exposure.

Aversion therapy tries to get rid of ‘maladaptive’ behaviours by linking them to painful experiences. E.g. putting a chemical into cigarettes to make you sick when you smoke so that you associate smoking with being sick and therefore stop smoking. Another example is of homosexuals being shown pictures of naked men and then blasted with electric shocks so that instead of being aroused by the stimulus they would associate it with pain and be ‘cured’. The problem with aversion therapy is that it causes a great deal of pain, but generally speaking does not change the behaviour.

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Token Economies are exactly what they claim to be – when a patient behaves in an approved way, s/he is given a token, such as a plastic disc that can then be exchanged for a privilege, and this reinforces ‘appropriate’ behaviour. The problem is that patients may act to get the token, thence the privilege, rather than genuinely have changed their behaviour.

Sometimes patients are ‘desensitised’. They are taught relaxation techniques then they construct a fear hierarchy, - what are they just afraid of, and what they are most terrified of, then with the help of the therapist the patient confronts each item in the hierarchy whilst in the state of deep relaxation. This way the association between the object, or situation, and fear, is broken, and the patient has been counter-conditioned.

Systematic desensitisation is the behavioural treatment that we will focus on

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1.McGrath (1990) – Successful Treatment of a Noise Phobia - Behaviourist

|Background Behaviourists suggest that treatment consist of un-learning behaviours in this case CC where pairing two stimuli together would result|
|in a ‘no-fear’ response. And there is generally a lot of evidence to suggest that systematic desensitisation works. |
|Aim: To treat a girl with specific noise phobias using systematic desensitisation. |
|Approach/Perspective (if any): Behavioural |
|Method: A case study that details the treatment of a noise phobia in one girl. A single participant design. |
|Details: |
| |
|See details of study In Treatments of Dysfunctional Behaviour |
|Results; At the end of the first session, Lucy was reluctant to let balloons be burst. At the end of the first session, Lucy was reluctant to let|
|balloons be burst even at the far end of the corridor. When the therapist burst the balloon anyway Lucy cried and had to be taken away. She was |
|encouraged to breathe deeply and relax. |
|By the end of the fourth session, Lucy was able to signal a balloon to be burst 10 metres away. , with only mild anxiety. |
|On the fifth session, Lucy was able to pop the balloons herself. |
|Over the next three sessions, Lucy was able to pull a party popper if the therapist held it. |
|By the tenth and final session, Lucy’s fear thermometer scores had gone from 7/10 to 3/10 for balloon popping, from 9/10 to 3/10 for party |
|poppers and from 8/10 to 5/10 for the cap gun. |
|Conclusions: |
|It appears that noise phobias in children are amenable to systematic desensitisation The important factors appear to have been giving Lucy |
|control to say when and where the noises were made, and the use of inhibitors of the fear response, which included relaxation, conservation and a|
|playful environment |

|Evaluation: Issues |Evaluation: Debates |
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2. Leibowitz (1988) -Treatment of Social Phobia with Phenelenzine – Biological Treatments

|Background: Biological treatments are often the first treatments offered for dysfunctional behaviour, often because diagnosis is made by |
|medical practitioner and the medical approach supports the use of drug therapy. One of the benefits of psychopharmocotherapy is the speed of |
|the effects, some drugs almost instantaneous results. However, other therapies are now used to supplement the biological therapy such as |
|cognitive which can bring about longer lasting change and without the side effects that drug therapy may incur. |
|Aim: To see if the drug phenelzine can help treat patients with social phobia. |
|Approach/Perspective : Biological |
|Method: A controlled experiment where patients were allocated to one of three conditions, and treated over eight weeks. They were assessed |
|for social phobia on several tests such as Hamilton Rating Scale for Anxiety and the Liebowitz Social Phobia Scale. This had common |
|manifestations of social phobia and patents rated 1–4 for the fear produced and 1–4 for the steps taken to avoid the phobic situation. |
|Details: |
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|See details of study In Treatments of Dysfunctional Behaviour |
|Results; |
|After eight weeks significant differences were noted for the phenelzine groups, with better scores on the tests for anxiety compared to the |
|placebo groups. There was no significant difference between the patients taking atenolol and those taking a placebo |
|Conclusions: |
|Phenelzine but not atenolol is effective in treating social phobia after eight weeks of treatment. |

|Evaluation: Issues |Evaluation: Debates |
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3. Cognitive Treatments

Cognitive treatment looks at the way a person is thinking, and tries to get the patient to see the errors in thinking that will help bring about a cure to the disorder itself. It also extensively uses relaxation techniques for some disorders. Cognitive Behavioural Therapy gets the patients to identify problem feelings, thoughts, and behaviours then progress to identifying the distortions involved and to generate alternative thoughts and responses, while identifying the dysfunctional beliefs and schemas that give rise to the distortions. CBT is usually a highly successful therapy.

CBT has been used to treat panic attacks. Panic attacks are sudden surges of overwhelming anxiety and fear. The first symptoms of a panic attack are likely to be feeling flushed or hot, sweaty palms, a feeling that you can’t catch your breath or you are breathing too fast. When you are breathing in this way what you are doing is reducing the amount of carbon dioxide that is in your lungs which creates these symptoms which can be terrifying.

|[pic] |These may include: |
| |A thumping heartbeat |
| |Trembling |
| |Tingling in hands, arms and face |
| |Dizziness |
| |A feeling you are about to die |
| |Chest pain |
| |Breathlessness |
| |Feeling unable to swallow |
| |Blurred vision |
| |Intense fear |
| |Cold hands and feet |

3. Ost & Westling (1995) -Treatments for panic attacks

|Background: Cognitive Behavioural uses cognitive approach to restructure thoughts as well as behaviourism (relaxation) the way the person |
|behaves. Does not look at the Cause but focuses on the present symptoms. How the person thinks about an event and its effect on what they did. If|
|negative thought can be reinterpreted then the person will feel better and the behaviour will change. |
|Aim: To compare cognitive behaviour therapy (CBT) with applied relaxation as therapies for panic disorder. |
|Approach/Perspective:Cognitive |
|Method: A longitudinal study with patients undergoing therapy for panic disorder. Independent design experiment with participants randomly |
|allocated to one of two conditions, cognitive or drug therapy. The patients with DSM diagnosis of panic disorder, with or without agoraphobia. |
|Recruited through referrals from psychiatrists and newspaper advertisements. |
|26 females and 12 males, mean age 32.6 years (range 23–45 years). From a variety of occupations and some married, some single and some divorced |
|38 patients were diagnosed with moderate to severe depression were assessed using Beck’s Depression Inventory and two other rating scales. |
|Details: |
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|See details of study In Treatments of Dysfunctional Behaviour |
|Results;Applied relaxation showed 65% panic-free patients after the treatment, 82% panic-free after one year. |
|CBT showed 74% panic-free patients after the treatment and 89% panic-free after a year. |
|These differences were not significant. |
|Complications such as generalised anxiety and depression were also reduced to within the normal range after one year. |
|Conclusions: Both CBT and applied relaxation worked at reducing panic attacks, but it is difficult to rule out some cognitive changes in the |
|applied relaxation group even though this is not focused on in this research. |

|Evaluation: Issues |Evaluation: Debates |
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Summary: Treatments for Disorders

• Treatment of Disorders is a contentious issue in that different psychologist define treatment differently. Is the treatment a cure for the mental illness or management of the symptoms’ to enable the person to live a relatively normal life!

• Different approaches take different views:

1. Biologists try to manage the symptoms through physical measures

2. Behaviourists suggest re-learning behaviour thereby curing the symptoms with no concern for the cause.

3. Cognitive behavioural therapists try to cure by restructuring patients thinking.

• The way the approach explains the disorder will lead to a treatment and each treatment has strengths and weaknesses in terms of appropriateness and effectiveness.

• You must consider the ethical implications of the treatments and the reductionist nature of them.

• Each of these approaches is reductionist, except perhaps CBT which is in keeping with their assumptions about behaviour, reducing their explanation down to one factor, and treating one factor.

• Again it may be useful to adopt an eclectic approach and use parts of these theories to fully understand phobias and as before it is important to realise that human behaviour including disorders has many causes. Some of which we still have to identify.

• It is clear that there is still someway to go to ensure that effective treatment is available to everyone with a disorder.

• None of the researchers’ are claiming 100% success rate, and so the final decision must be left to the practitioner to decide the best way to help patients with a mental disorder.

Comprehension questions Treatments for Disorders

1. McGrath (1990) – Successful Treatment of a Noise Phobia

• Think of 2 strengths and 2 limitations to using behavioural treatments? • Link a debate with this study and explain it?

2. Ost & Westling (1995) -Treatments for panic attacks

• Think of 2 strengths and 2 limitations to using cognitive treatments? • Link a debate with this study and explain it?

3. Leibowitz (1988) -Treatment of Social Phobia with Phenelenzine

• Think of 2 strengths and 2 limitations to using biological treatments? • Link a debate with this study and explain it?

Part A exam question for Treatments for Disorders • How could a psychological disorder (either affective or anxiety or psychotic) be treated biologically? (10 marks)

Linking sentence __________________________________________________

Linking sentence __________________________________________________

Part B exam question for Treatments for Disorders • Compare approaches to treating the disorder you referred to in part (a) (15 marks)

Linking sentence_______________________________________________
Linking sentence__________________________________________________
Linking sentence_______________________________________________
Linking sentence______________________________________________
Linking sentence _________________________________________________

Evaluation sheet for Treatments of an Anxiety Disorders

|Overview of topic: __________________ |Study 1 |Study 2 |Study 3 |
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Module: G543

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Think!

|Checklist |( |( |( |
|There are a lot of psychological terms used | | | |
|accurately | | | |
|The description of the cause/study is accurate | | | |
|There are lots of examples from a study/studies | | | |
|There are explanations of key points to show you | | | |
|understand what you have written | | | |
|The answer is clearly related to the question (use | | | |
|the words in the question in your answer to help | | | |
|you) | | | |
|There are no spelling errors and it is | | | |
|grammatically correct | | | |
|The answer is well structured and easy to read | | | |

|Claim |The sample used by the researchers in the fear arousal study |
| |lacked generalisibility |
|Reason |This is because the researchers used opportunity samples of |
| |students to carry out the research |
|Evidence |Janis and Fleshbeck used psychological students to carry out |
| |their research into fear arousal and oral hygiene |
|Evaluative |The problem with this is that psychology students who are |
|comment |getting credit for their degrees are more likely to show |
| |uncharacteristic behaviour by perhaps being more willing to |
| |comply and give the researchers what they want, being familiar |
| |with fear arousal from their own reading and this may |
| |unconsciously affect their answers. This is called demand |
| |characteristics. |
|Counter-comment|On the other hand Janis and Feshbeck need the convenience of |
| |the opportunity sample to complete their work in limited time |
| |and budget. Also it gives results that can then be replicated |
| |using other participants in the future. |
|Conclusion |Therefore, we should be cautious when applying the findings |
| |from students to actual fear arousal |

|Checklist |( |( |( |
|Use technical terms | | | |
|Cover a range of evaluation points (at least 4) | | | |
|Include strengths and weaknesses (2 of each) | | | |
|Organise your work so it is easy to read- use | | | |
|connectives | | | |
|Form an argument- do you agree or disagree? | | | |
|Use lots examples from relevant studies | | | |
|Relate the answer to the question (use the words in | | | |
|the question) | | | |
|Write a conclusion that summarises what you have said| | | |
|clearly. | | | |

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Most life events were judged to be less stressful than getting married.

But 6, including death of a spouse, divorce and personal injury or illness were rated as more stressful.

Holmes and Rahe found that people with high LCU scores for the preceding year were likely to experience some sort of physical illness the following year.

For example, someone scoring over 300 LCU s had about an 80% chance of becoming ill.

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DSM-IV Classification for specific phobia • Marked and persistent fear that is excessive or unreasonable • Exposure to phobic stimulus provokes immediate anxiety response • The person recognises the fear as excessive • The phobic situation is avoided • The phobia disrupts the person’s normal life • The phobia has lasted more than 6 months in people under 18 years of age.
ICD-10 Classification for a specific phobia • The psychological or autonomic symptoms must be primary manifestations of anxiety, and not secondary to other symptoms such as delusions. • The anxiety must be restricted to the presence of the particular phobic object or situation. • The phobic situation is avoided wherever possible

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DSM-IV Classification of single-episode depression • Five or more of the following symptoms • Insomnia most nights • Fidgeting or lethargy • Tiredness • Feeling of worthlessness or guilt • Less ability to concentrate • Recurrent thoughts of death • These symptoms are not caused by medication, or situations such as bereavement, and they are enough to hinder the person from important day-to-day.
ICD-10 Classification of depression • Depressed mood • Loss of interest and enjoyment • Reduced energy • Other common symptoms are: • Marked tiredness after only slight effort • Reduced concentration and attention • Reduced self-esteem and self-confidence • Ideas of guilt and unworthiness • Bleak and pessimistic views of the future • Ideas or acts of self harm or suicide • Disturbed sleep • Reduced appetite.

ICD-10 Classification of Schizophrenia • Thought echo, thought insertion or withdrawal broadcasting. • Delusions of control • Hallucinatory voices • Persistent delusions • Persistent hallucinations • Incoherence or irrelevant speech • Catatonic behaviour • Negative symptoms such as marked apathy • A significant and consistent in the overall quality of some aspects of personal behaviour.

DSM-IV Classification of Schizophrenia -Two or more of the following • Delusions • Hallucinations • Disorganise speech and Disorganised behaviour • Negative symptoms
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• Social occupational dysfunction, at least 6 months duration – no other explanation can be found- such as medication, or developmental disorders.

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UCS = Unconditioned stimulus
UCR = Unconditioned response (Natural)
CS = Conditioned stimulus
CR = Conditioned response (Manipulated)

UCS (Noise) UCR (Fear)

UCS (Noise) + CS (Rat) UCR (Fear)

- .QR§ÁÂÅÆÈÉqrîáÑÁ´¦–´‰yjQj>¦>$jh— ÿB*[pic]OJ[?]QJ[?]U[pic]^J[?]ph0jh5,F5?>*[pic]CJOJQJU[pic]aJmHnHu[pic]h— ÿ5?>*[pic]CJOJQJaJh!,èh— ÿ5?CJHOJQJaJHh— ÿ5?CJOJQJaJh‰ àh— ÿ5?CJ`OJQJaJ`h— ÿB*[pic]OJ[?]QJ[?]^J[?]phh— ÿ5?CJHOJQJCS (Rat) CR (Fear)

This explanation sees the origin of phobias as through linking two things together even though there is no logical, nor causal connection between them.

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