Evaluations for Psychopathology

Behavioural approach to explaining phobias - EVALU

Diathesis-stress model - according to the two-process model of phobias, an association between a NS + fearful experience will result in a phobia. However, Di Nardo found that not everyone bitten by a dog develops a phobia of dogs. This could be explained using the diathesis-stress model, that we inherit a genetic vulnerability for developing mental health disorders. However, it only manifests itself if triggered by an event.

The importance of classical conditioning - support for the approach, people with phobias do recall a specific event when their phobia appeared (Sue et al 1994). This therefore supports the first part of the two-process model (classical conditioning and the inititation - a phobia being acquired through association.)

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Evaluation of SD - Research has found SD is effective for a range of phobic disorders. For example, McGrath found that about 75% of patients with phobias respond to SD.It has also been found that it is more successful when used in vivo (Choy et al, 2007.) Therefore, it is an effective treatment for phobias in a large % of cases. However, it is not appropriate for all phobias - Ohman et al suggests it is better for phbias that are acquired through as a result of personal experience rather than one that has underlying revolutionary survival components (e.g. fear of the dark, heights.)
Evaluation of flooding - for patients who choose flooding and stick with it as a treatment, it appears to be effective and is relatively quick (compared to CBT.) Choy et al reported that SD and flooding were both effective but flooding more-so. However, flooding is not for every patient and can be a highly traumatic procedure. Patients are made aware of this beforehand but may quit during the treatment which reduces the ultimate effectiveness of the therapy.

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Research Support - Ellis claimed a 90% success rate for REBT. However, he recognised it wasnt always effective and suggested this could be because some clients did not put their revised beliefs into action. Cuijpers carried out a review of 75 studies found that CBT was superior to no treatment.
Support for behavioural activation - the belief that changing behaviour can go some way to alleviating depression is supported by a study on the beneficial effects of exercise. Babyak et al (2000) studied 156 adult volunteers diagnosd with major depressive disorder. They were assigned to 3 different groups; aerobic exercise, drug treatment or both.Those in the exercise group had significantly lower relapse rates than those in the medication group. This therefore supports the idea that behavioural activation helps depression to a certain extent.

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Family & twin studies - Nestadt et al identified 80 patients with OCD and 343 of their first-degree relatives and compared them with 73 control patients without mental illness and 300 of their relatives. Found that people with a first-degree relative with OCD had a 5x greater risk of having the illness at some point of their lives, compared with the general population.
A meta-analysis of 14 twin studies of OCD found that identical twins are more than twice as likely to develop OCD if their co-twin has it than non-identical twins. (Billett et al 1998)
However, these concordance rates are never 100%

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Effectiveness - Soomro et al reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective than placebos in reducing the symptoms of OCD up to 3 months after treatment (short term.) However, one of the isues regarding this is that most studies are only of 3-4 months' duration, and therefore little long term data exists (Koran et al)
Side effects - All drugs have side effects, some more severe than others. Nausea, headaches and insomnia are common side effects of SSRI's (Soomro et al.) Whereas, the possible side effects of BZs include increased aggressiveness and long-term impairment of memory - there are also problems with addiction, so use is limited to a max of 4 weeks.
Not a lasting cure - Koran et al (2007) suggested that although drug therapy may be more commonly used, CBT should be tried first. Drug therapy may require little effort and be relatively effective in the short-term, it does not provide a lasting cure. Patients relapse within a few weeks if medication is stopped (Maina et al).

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