Clinical Characteristics of Phobic Disorders
You need to know 8 marks worth of information about this.(4 points with examples).
- DSM and ICD are diagnostic systems used world wide
- Both list similar characteristics
- Persistent, prolonged and excessive
- Irrational thoughts
- Anxiety response (physical symptoms)
- Avoidance behaviour
- Disruption of daily functioning
REMEMBER: 5 characteristics and link to examples.
Issues surrounding classification and diagnosis
This could be a 24 mark question so you need to know 24 marks worth of AO1 and AO2 information.
- Reliability - consistency of a measuring instrument. Inter-rater reliability (two assessors give similar scores). Research - Skyre et al - SCID inter-rater agreement of +0.72. Kendler et al - low reliability in face-to-face interviews - may be due to over-exaggeration in patients. (issue with diagnosis)
- Comorbidity - extent to which two conditions co-occur. Research - Eysenck - up to 66% of patients with one anxiety disorder were diagnosed with another. (issue with diagnosis and classification)
- Concurrent validity - comparing one method with one that has previously been validated - research - Mattick and Clarke - SPS correlated well with other standardised measures. (issue with diagnosis)
- Gender and culture bias - unintentional tendency to make certain kinds of diagnosis. Research - Worrel & Remer - women more likely to be diagnosed with specific phobia due to stereotypes. (issue with diagnosis).
- Conclusion - Kobak et al - reliability improved by computerised scales. Helmberg et al - decreases validity.
This could be a 24 mark question so you need to know 24 marks worth of AO1, AO2 research and AO2 Commentary
- Genetics - people have a hereditory predispostion. famil y studies - research - Ost - 64% of blood phobics with at least one relative with same condition. Twin studies - research - Torgersen - 31% concordance rate in 13 MZ twins for panic disorder vs. 0% in 16 DZ twins. Kendler et al - 722 female twins, significantly higher concordance for agoraphobia for MZ than DZ. Commentary - cannot prove genetics is sole cause, methodological issues - mainly self-report unreliable, not many twin studies, adoption better but even fewer, Torgersen - small sample, Kendler - female only pps.
- Preparedness - innately programmed to fear dangerous stimuli - Ohman et al - paired pics with electric shocks, pics were either harmful e.g snakes or harmless e.g houses. It took up to 5 times longer to see a feared response from the harmless stimuli compared to a feared reaction from first viewing of harmful. Commentary - explains harmful but not harmless, study shows ease of developing phobia, were they afraid of the pics of shocks?
- Biochemical - dysfunction in neurones GABA which reduces anxiety. Research - Vyas et al - chronic stress can lead to too much glutamate which causes perminent damage in the hippocampus and amygdala. Commentary - most research is animal based, BZs are successful treatment which mimic GABA, unclear whether low levels of GABA causes phobias or the other way around.
Again this could be a 24 mark question so you need to know 24 marks worth of AO1, AO2 research and AO2 commentary.
- Cognitive - irrational thinking maintains phobias. Research - Stopa & Clarke - videotaped conversations and found that social phobics had more negative self-evaluative thoughts and systematically underestimated performance. Tomarken et al - snake phobics over estimated amount of snakes in a pic compared to non-phobics. Commentary - explains how phobias are maintained not acquired, unclear whether irrational thoughts cause phobias or the other way around, deterministic, regarded as superior to behaviourist, difficult to analyse someones thoughts, CBT is a successful treatment based on this theory.
- Behaviourist - classical conditioning - phobia developed through association. Research - Watson & Rayner - conditioned little Albert to fear white rabbits using CC. Commentary - Sue et al - phobics do often recall a specific incident, however not everyone can, ethics in little Albert study.Operant - maintained through this. Research - Mowrer - two process theory, Commentary - mainly animal research. SLT - observing and immitating a role model - Ost & Hugdahl - boy who witnessed his grandfather be violently sick and dieing and then developed a phobia or vomiting. Commentary - case study, systematic desensitisation is a successful treatment that came from this theory.
Again 24 marks worth of AO1, AO2 research and AO2 commentary is needed
- Antidepressants - rebalance and alter chemicals and neurotransmitters in the brain, reducing serotonin levels (SSRI's). Research - Katzeinick et al - improved levels of anxiety compared to a placebo. Aouzierate et al - SSRI's provide relief for social phobia in 50-80% of cases. Commentary - side effects including drowsiness and dizziness, treat the symptoms but not the cause.
- Anti-anxiety drugs - help to relax the body, BZs e.g Valium and Librium. Research - Gelernter et al - BZs more effective than placebo. Hildalgo et al - BZs more effective than antidepressants. Commentary - work well when combined with psychological treatments, are found to be effective, cost vs. benefits e,g side effects, addiction & dependency
- Psychosurgery - aims to treat behaviour which no pathological cause has been found. It is presumed that a part of the brain is not functioning and so if the connection to this part is severed, symptoms can be relieved. Research - Ruck et al - studied 26 patients, all had been suffering for 5 years or more. After capsulotomy was performed, assessments were conducted before operations and an average anxiety score of 22. was round but after operation an average score of 4.6 was found. Commentary - cost vs, benefits e.g serious surgery, consequences of surgery, the negative symptoms of the surgery were greater than expected, long term cure.
Again 24 marks
- Systematic Desensitisation - counter-condtion the client, two versions, 3 stages. Research - McGrath et al - effective in 75% of specific phobia cases. Menzies & Clarke - in vivo works best. Ohman et al - does not work for phobias with an underlying cause. Klein et al - no difference in effectiveness between SD and psychotherapy. Commentary - mainly suited for those who can learn and use the relaxation techniques, ethics - can be psychologically harmful, do long term benefits outweigh short term benefits?, relatively fast, can be self administered - proven more successful in social phobia - Humphrey.
- CBT - combo of behavioural and cognitive, explores the irrational nature and perception, both therapy sessions and homework. Research and Commentary - client focused, Black - meta-analysis and found that CBT and CBT combined with medication had no difference, Spence et al - assessed value of CBT in treating children with social phobia and was found to be effective one year on, techniques can be used throughout life, Kvale et al - CBT resulted in 77% of dental phobics regularly visiting a dentist 4 years on. Little side effects, works particularly wekk for agoraphobia and social phobia, needs client motivation.
- Psychotherapy - uncover real reasons for irrational fear, methods such as dream analysis and word association. Research & Commentary - not much research into effectiveness of therapy, most comes from case studies, although they are detailed and rich in information they cannot be generalised, combination of psychotherapy and behavioural techniques was successful (Wolitz & Eagle), not possible to evaluate this therapy in the same way as others, unconscious thoughts cannot be measured or tested.