G543 Health and Clinical Studies (stress, dysfunctional behaviour, disorders: depression)

Health and Clinical studies for stress, dysfunctional behaviour and disorders (an affective disorder: depression)

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Aim: To measure the psychological and physiological stress response in two categories of employees.

Methodology: A quasi-experiment. Data were collected through physiological measures of chemicals in urine and self-report of mood.

Participants: 24 workers at a Swedish sawmill: 14 finishers (repetitive, machine-paced work, wages relied on quick working) and 10 maintenance workers and cleaners.

Design: Independent measures design.

Procedure: Each participants gave a daily urine sample four times throughout the day and once when they arrived at work. They also gave self-report of mood and alertness, plus cafffeine and nicotine consumption. Their baseline measurements where taken on a day when they were at home. Catecholamine (adrenaline) levels were measured in the urine as was body temperature.

Findings: In the first urine samples of the day, the high-risk group had adrenaline levels twice as high as their baseline and this continued to rise throughout the day. The control group had a peak level of one and a half times their baseline but this decreased throughout the day. The high-risk group described themselves as more irritated than the control group.

Conclusions: The repetitive, machine-paced work which was demanding in attention to detail and highly mechanised, contributed to the higher stress levels in the high-risk group.

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Aim: To compare the Hassles and Uplifts Scale and the Berkman Life Events Scale as predictors of psychological symptoms of stress.

Methodology: A repeated design in that each participant completed the Hassles rating scale and the Life Events scale. They then assessed their psychological symptoms of stress using the Hopkins Symptom Checklist (HSCL) and the Bradburn Morale Scale.

Participants: 100 people who had previously completed a health survey in 1965. They were from California, were mostly white, protestant, with adequate or above income and at least 9th grade education. 

Design: Repeated measures design.

Procedure: The participants were asked to complete the hassles rating, the HSCL and the Bradburn Morale Scale every month for 9 months and the life events rating after 10 months.

Findings: For women, the more life events they reported, the more hassles and uplifts they reported. For men, the more life events they reported, the more hassles and fewer uplifts they reported. 

Conclusions: Hassles are a more powerful predictor of psychological symptoms than life events.

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Geer and Maisel

Aim: To see if perceived control or actual control can reduce stress reactions to aversive stimuli.

Methodology: Lab experiment, in which participants were shown images of dead car-crash victims, and their stress levels were measured by galvanic skin response (GSR) and heart-rate electrodes.

Participants: 60 psychology students from New York University.

Design: Independent measures (three groups). Group 1: actual control, actual predictability. Group 2: no control, actual predictability. Group 3: no control or predictability.

Procedure: Each participants had a soundproofed room and their GSR machine calibrated for 5 minutes so that a baseline measurement could be taken.

Findings: The heart-rate monitors proved inaccurate and so the data from these were discarded. The predictability only group (Group 2) showed the most stress because they knew what was coming but couldn't control it. Group 1 showed the least stress because they could terminate the photo themselves.

Conclusion: Participants showed less GSR reaction, indicating less stress, when they had control over the length of time they looked at the disturbing pictures. It is likely that being able to terminate this reduces their stressful impact.

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Holmes and Rahe

Aim: To create a method that estimates the extent to which life events are stressors.

Methodology: A questionnaire design to ascertain how much each life event was felt to be a stressor.

Participants: 394 subjects from a range of backgrounds.

Procedure: Each participant was asked to rate a series of 43 life events. Marriage was given an arbitrary rating of 50 and each event was to be judged as requiring more or less readjustment.

Findings: The final SRRS (social readjustment rating scale) was completed based on the mean scores allocated by the participants. Correlations were high between every group except white/black.

Conclusions: These events are mostly ordinary (some are extraordinary, such as going to jail, but are all Westernised). There are also some socially desirable events which reflect the western values of materialism, success and conformism.

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Stress Inoculation Therapy (SIT) - links to Meiche

There are three components of SIT:

1. The patients with the stress have to become aware of the thoughts they have in a stressful situation. 

2. The coping strategies are put in place that patients are taught to enable them to restructure their thoughts. They are taught to relax when they become tense, they imagine themselves in situations that cause them stress and learn how to relax. They then learn self-instructions that will help them to relax rather than be stressed.

3. Finally the person puts what they have learnt into practice in a real-life stressful situation. 

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Aim: To compare SIT with standard behavioural systematic desensitisation and a control group on a waiting list.

Methodology: A field experiment where students were assessed before and after treatment using self-report and grade averages. 

Participants: 21 students who responded to an advert for treatment of test anxiety.

Design: Matched-pairs design with random allocation to the SIT therapy group, the waiting list control group or the standard systematic desensitisation group. Although randomly allocated, gender was controlled to be equal in each group and also anxiety levels were matched.

Procedure: Each participants did an IQ test and answered the Anxiety Adjective Checklist. The SIT group had eight therapy sessions using the 'insight' approach. They were then given some positive statements to say and relaxation techniques to use in test situations. In the systematic desensitisation group, they were given eight therapy sessions with progressive relaxation training which they practised at home. The control group were on a waiting list.

Findings: Participants in the SIT groups showed more reported improvement in their anxiety levels, although both therapy groups showed overall improvement compared with the control group.

Conclusions: SIT is a more effective way of reducing anxiety in students because it adds a cognitive component to the therapy.

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Budzynski et al

Aim: To see if previous research on biofeedback as a method of reducing tension headaches was due to the placebo effect or whether biofeedback was an effective method of reducing tension headaches.

Methodology: Lab experiment. Data were collected through an EMG feedback machine with electrodes on the muscles producing a graph of muscle tension. Participants had to complete a questionnaire about their headaches.

Participants: 18 people who replied to an advertisement, from Colorado. 

Design: Independent measures, with three groups. Group A had biofeedback sessions with relaxation training and EMG feeback. Group B had pseudofeedback. Group C were on a waiting list.

Procedure: For 2 weeks, patients kept a record of their headaches, and rated them from 0-5. They also tests for depression, hysteria and hypochondria. Groups A and B had 16 sessions of training. Both groups were told to practise relaxation at home. Group C were told they would begin training in 2 months. Each participants recorded their headache activity and after 3 months they completed the self-report tests again.

Findings: Group A's muscle tesnsion was significantly lower than Group B's by the end of training and was still lower 3 months later. The tests showed high levels of hysteria, depression and hypochondriasis for all groups at the beginning. Group A showed a significant reduction in hypochondriasis. Drug usage in Group A dropped more than Group B.

Conclusions: Biofeedback is an effective way of training patients to relax. Relaxation is also more effective than just being monitored but is better when with biofeedback.

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Waxler-Morrison et al

Aim: To look at how a women's social relationships influence her response to breast cancer and survival.

Methodology: A quasi-experiment with women who were diagnosed with breast cancer. The information was gathered using 18 interviews and questionnaires, and examination of medical records.

Participants: 133 pre-menopausal women, attending a breast cancer clinic in Vancouver.

Design: Independent design of women with different levels of existing social networks.

Procedure: The questionnaire included questions on their educational level, who they were responsible for (i.e. children), contact with friends and family, perception of support from others.

Findings: The six aspects of social network significantly linked with survival were: marital status, support from friends, contact with friends, total support, social network and employment.

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DSM-IV: compiled by over 1000 people. Empirical research used to support criteria. Main diagnostic tool in the USA. Multi-axial tool (more holistic than ICD) including global functioning. Classifications e.g. dementia, learning disorders. Only mental disorders.

ICD-10: published by World Health Organisation (WHO). Used around the world. Physical and mental disorders. Checklist style diagnosis (more reductionist than DSM). Categories e.g. dementia, schizophrenia.

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Rosenhan and Seligman

Statistical infrequency (difficult to use alone, may include behaviours such as high IQ)

Deviation from social norms (if society does not approve of a behaviour it could be seen as dysfunctional: differences between societies)

Failure to function adequately (e.g. OCD, agoraphobia)

Deviation from ideal mental health (Jahoda's ideal mental health: you should have a positive view of yourself, be capable of some personal growth, be independent and self-regulating, have an accurate view of reality, be resistant to stress, be able to adapt to your environment.)

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Ford and Widiger

Aim: To find out if clinicians were stereotyping genders when diagnosing disorders.

Methodology: A 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 was the diagnosis made by clinician.

Participants: A final sample of 354 clinical psychologists randomly selected from the National Register in 1983.

Design: An independent design as each participant was given a male, female or sex-unspecified case study.

Procedure: Participants were randomly provided with one of nine case histories. Case studies of patients with antisocial personality disorder (ASPD) or histrionic personality disorder (HPD) or an equal balance of symptoms from both disorders were given to each therapist. 

Findings: Sex-unspecified case histories were diagnosed most often with borderline personality disorder. ASPD was correctly diagnosed 42% of the time in males and 15% in females. Females with ASPD were misdiagnosed with HPD 46% of the time.

Conclusions: Practitioners are biased by stereotypical views of genders, as there was a clear tendency to diagnose females with HPD even when their case histories were of ASPD. There was also a tendency not to diagnose males with HPD. The characteristics of HPD (a pattern of excessive emotional behaviour and attention-seeking) could be seen as gender specific.

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Watson and Raynor

Aims: 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 will have on the fear response.

Methodology: A case study on Little Albert.

Proedure: Session 1: The rat and the steel bar were presented together. Albert jumped and fell forward at the shock of the noise. Session 2: The rat alone was enough to provoke crying and crawling away (fear response). Session 3: Other similar objects were presented which provoked a similar response. Session 4: After 5 days Albert was brought back, where the response was similar to the rat, rabbit and dog. Session 5: 1 month later Albert was tested with similar object stimuli which showed the fear response.

Conclusions: Time does not remove the fear response. It is possible to condition fear through classical conditioning. Transference of the fear can be made to similar objects. Albert was taken out of the experiment after session 5 so Watson and Raynor could not de-condition him.

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Gottesman and Shields

Aim: To review research on genetic transmission of schizophrenia.

Methodology:  A review of three adoption and five twin studies into schizophrenia between 1967 and 1976. 

Procedure: The incidence of schizophrenia in adopted children and monozygotic twins was made by comparing biological parents and siblings and adoptive parents and siblings in the adoption studies. In the twin studies the concordance rates of when both twins were diagnosed with schizophrenia was compared. 

Findings: All three adoption studies found an increased incidence of schizophrenia in adopted children with a schizophrenic biological parent, whereas normal children fostered to schizophrenic parents and adoptive parents of schizophrenic children showed little evidence of schizophreia. All twin studies found a higher concordance rate for schizophrenia in monozygotic than dizygotic twins.

Conclusions: There is obviously a significant genetic input into the onset of schizophrenia, but with concordance rates less than 100% there must be some interaction with the environment.

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Beck et al (1)

Aim: To understand cognitive distortions in patients with depression.

Methodology: Clinical interviews with patients who were undergoing therrapy for depression.

Participants: 50 patients diagnosed with depression.

Design: Independent design as the patients were matched with a group of 31 non-depressed patients undergoing psychotherapy.

Procedure: Face-to-face interviews as well as diaries of their thoughts.

Findings: Certain themes appeared in the depressed patients that did not appear in the non-depressed patients. These were 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. Some patients felt themselves unlovable and alone. 

Conclusions: Even in mild depression, patients have cognitive distortions that deviate from realistic and logical thinking. These distortions related only to depression.

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Aim: To treat a girl with specific noise phobia using systematic desensitisation.

Methodology: A case study of Lucy, aged 9, who had a fear of sudden loud noises.

Procedure: Lucy was brought to the therapy session and the programme was explained to her and her parents. Lucy made a hierachy of feared noises. She was taught breathing and relaxation, and told to imagine herself at home with her toys. She had a hypothetical 'fear thermometer'. As she had the stimulus of the loud noise, she paired it with relaxation, deep breathing and imagining herself at home, which would naturally lead to her to feel calm.

Findings: At the end of the first session Lucy cried when the balloon was burst at the other end of the corridor and had to be taken away. By the end of the fourth session, Lucy was able to endure a balloon being burst 10 metres away with mild anxiety. In the fifth session she held a deflated balloon. At the end of the session she could pop a balloon herself. By Lucy's last session (10) her fear thermometer had gone from 7/10 to 3/10 for balloons and 9/10 to 3/10 for party poppers.

Conclusions: It appears that noise phobias in children are amenable to systematic desensitisation.

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Karp and Frank

Aim: To compare drug treatment and non-drug treatments for depression.

Methodology: A review article of previous research, concentrated on women with depression.

Procedure: Depression was analysed using a variety of depression inventories, and patients were tested generally prior to treatment, after treatment and in some cases after a period of time as a follow up. Some health practitioner assessments of symptoms were also used by some of the research.

Findings: Many studies found that adding psychological treatments to drug therapy did not increase the effectiveness of the drug therapy. Occasionally studies did show less attrition when combination therapies were used. This means that people were more likely to continue with treatment if cognitive therapy was given in addition to drug therapy.

Conclusions: Although it would seem logical that two treatments are better than one, the evidence does not show any better outcomes for patients offered combined therapy as opposed to only drug therapy, showing the effectiveness of drug therapy on depression.

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Beck et al (2)

Aim: To compare the effectiveness of cognitive therapy and drug therapy.

Methodology: Controlled experiment with participants allocated to one of two conditions.

Design: Independent measures with random allocation to the cognitive or drug conditions.

Participants: 44 patients diagnosed with depression.

Procedure: Patients assessed with three self reports before treatment using Beck Depression Inventory, Hamilton Rating Scale and Rasking Scale. For 12 weeks, patients either had a 1 hour cognitive therapy session twice a week or 100 Imipramine tablets.

Findings: Both groups showed significant decrease in depression stymptoms. The cognitive treatment group showed significantly greater improvements on self-reports and observer based ratings: 80% compared with 20% of those with drug therapy. The drop out rate was lower in the cognitive therapy group.

Conclusions: Cognitive therapy leads to better treatment of depression, shown by fewer symptoms reported and observed, and also better adherence to treatment.

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Characteristics of an anxiety disorder: phobia

  • Marked and persistent fear that is excessive or unreasonable
  • Exposure to phobic stimulus provoke immediate anxiety response
  • The person recognises the fear as excessive
  • The phobic situation is avoided
  • The phobia disrupts a person's normal life
  • The phobia has lasted more than 6 months in people under 18
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Characteristics of an affective disorder: depressi

Five or more of the following symptoms:

  • Insomnia most nights
  • Fidgeting or lethargy
  • Tiredness
  • Feelings of worthlessness or guilt
  • Less ability to concentrate
  • Recurrent thoughts of death
  • Depressed mood
  • Loss of interest and enjoyment
  • Reduced energy
  • Reduced self-esteem and self-confidence
  • Reduced appetite
  • Ideas of self-harm or suicide
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Characteristics of a psychotic disorder: schizophr

Two or more of the following:

  • Delusions
  • Hallucinations
  • Disorganised speech/behaviour
  • Negative symptoms
  • Thought echo, thought insertion or withdrawal and broadcasting
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Lewinsohn et al. (1)

Aim: To compare the amount of 'positive reinforcement' received by depressed and non-depressed participants.

Design: A longitudinal study over 30 days.

Participants: 30 participants; 10 diagnosed with depression, 10 diagnosed with another disorder and 10 'normal'.

Method: A quasi-experiment. Participants were asked to check their mood daily using the depression adjective checklist which included emotions such as happy, active, blue and lucky. The participants ticked the ones they felt that day. Then they were asked to complete the pleasant activities scale rating 320 activities such as talking about sports, meditating or doing yoga. These were rated for pleasantness and frequency (positive reinforcement).

Findings: There were significant positive correlations between mood ratings and pleasant activities, with involvement in more pleasant activities being correlated with more positive mood ratings. Individual differences showed that there is more to depression than reinforcement from pleasant activities.

Conclusions: There seems to be a link but further research is needed to identify the individual characteristics that make some people more influenced by pleasant activities than others.

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Wender et al

Aim: To investigate the contribution of genetic and environmental factors in the aetiology of mood disorders.

Participants: Adoptive and biological relatives of 71 adult adoptees with a mood disorder and 71 adult adoptees who were psychiatrically normal.

Methodology: Psychiatric evaluations of the relatives were made by independent blind diagnoses of mental hospital and other official records.

Results: There was an eight fold increase in unipolar depression among the biological relatives and a fifteen fold increase in suicide.

Conclusions: There is a significant genetic link between unipolar depression and suicide.

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The original learned helplessness of model of depression was based on animal learning studies, where dogs would be given electric shocks. The behaviours learnt included not trying to escape and passively enduring the shocks. Seligman related this to depression in humans. The core depressive symptom is the expectationt hat whatever you do, nothing will change. The symptoms are similar: passivity, lowered aggression, loss of appetite. The causes (uncontrollable negative events) and successful therapies (drug therapy) are the same.

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Lewinsohn (2)

Aim: To evaluate the efficacy of a 'coping with depression' course.

Methodology: A longitudinal study.

Participants: 59 adolescents with a diagnosis of depression, from Oregon, self-selected.

Design: Independent measures. Group 1: adolescent only, Group 2: adolescent and parent, Group 3: waiting list.

Procedure: The participants were assessed by interviews when it started and finished, and at 1, 6, 12 and 24 month intervals when it finished. Therapy was detailed manuals, homework and handouts. They learnt relaxation methods. Parents were taught how to reinforce expected positivity in their depressed children.

Findings: At the end of the treatment only 52% of Group 2 were diagnosed with depression, and 57% of Group 1. Group 3 showed little change. 

Conclusion: This shows the efficacy of a 'coping with depression' course where the adolescents and parents are involved.

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A brilliant set of cards, thank you :-)

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