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DSM /ICD Characteristics: Phobias (Anxiety)

Anxiety: An unpleasant emotion characterised by a general sense of danger, dread and physiological arousal

Examples of an anxiety disorder include: Phobias, OCD and Social Anxiety Disorder

A phobia is a persistent and irrational fear of a particular object or situation. Many people with a phobia will go out of their way to avoid the object /situation, even if it is inconvenient to. When confronted with a phobia there is an instant response (much like a panic attack). Reactions to a confrontation with phobias may include sweating, crying and intense fear

The DSM criteria for diagnosis of a phobia:

  • Marked and persistent fear that is excessive or unreasonable
  • Exposure to phobic stimulus provokes immediate anxiety response
  • Recognition that the fear is excessive
  • Stimulus is avoided and disrupts the person's life
  • Phobia has lasted more than 6 months in people under the age of 18 years
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DSM /ICD Characteristics: Schizophrenia (Psychotic

Schizophrenia: Split brain. Schizophrenia is classed as a psychotic disorder because of the vast array of symptoms that can be present depending on the type of schizophrenia

Symptoms of schizophrenia:

  • Delusions of Grandeur; Beliefs that they are someone grand or famous such as Elvis Presley
  • Delusions of Persecution; Beliefs that people are plotting against them, that they are being spied on or talked about
  • Disorganised Speech; Inappropriate speech, for example, "It's raining...fruit trees in summer"

There are 2 types of symptoms of schizophrenia:

  • Positive symptoms are generally things that have been 'added' to what we might consider a 'normal' life experience, for example delusions. These are not part of a normal life and are 'added' to life
  • Negative symptoms are generally things that have been taken away from what we might consider a 'normal' life experience, for example a lack of pleasure of speech. These are things that have been 'subtracted' from life
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DSM /ICD Characteristics: Depression (Affective)

Depression is generally seen as a mood state characterised by a sense of inadequacy, despondency and pessimism

According to the DSM patients must have 5 or more of the following symptoms:

  • Insomnia (most nights)
  • Fidgeting
  • Tiredness
  • Feelings of worthlessness
  • Less ability to concentrate
  • Recurrent thoughts of death

Patients are usually diagnosed on the basis of one or more interviews with a therpaist. Interviews are usually semi structured in nature and could consist of a structured clinical interview for the DSM

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Biological Explanation of Phobias: Bio Preparednes

Biological preparedness is the idea that we are biologically predisposed to acquire phobias of things that were dangerous to primative humans (snakes) in order to increase our chances of survival. Therefore, if you had a phobia of heights and you avoided cliff faces, you would live to see another day and pass on your genese (hopefully)

Ohman's study:

Aim: To see if phobias of snakes could be more easily conditioned that phobias of snakes and houses

Participants: 64 paid volunteers, aged 20-30. 38F, 26M. All psychology students in Sweden

Method: Lab exp, participants linked to machine that showed pics and electrocute are some imageds. Fear was measured by GSR (skin conductance). IM, 3 groups (houses, snakes, faces)

Findings: Snake group average skin conductance of 0.062 and 0.048 for houses and faces

Linking Sentence: Study indicates that we have a bio preparedness to develop phobias of certain objects that may cause us danger (eg. snakes)

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Biological Treatments of Phobias: Drugs

Drug treatment is the most common form of biological therapy involved in the treatment of phobic disorders. Anti-anxiety drugs are medications that relieve anxiety by slowing down the central nervous system by reducing the activity of the brain. They have been found to be effective, but dont treat the underlying cause of the anxiety disorder

How do MAOIs work? MAOIs balance brain chemicals (neurotransmitters). When these chemicals are in balance the symptoms are reduced. When anxiety occurs there may be a decrease in the amount of monoamines released from the brain

Leibowitz's study:

Aim: To see if the drug phenelzine can help treat patients with social phobia

Participants: 80 participants, aged 18-50 who all met DSM criteria for social phobia

Method: Lab exp over 8 weeks, using IM design being randomly alloacted to 1 of 4 groups. P's assessed at beginning of study and then given drug or placebo with gradual increases and assessed at end of study

Findings: After 8 weeks, significant differences between scores of phenalzine and atenolol group

Linking Sentence: Study shows that phenelzine can be an effective treatment and therefore is possible to biologically treat phobias

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Behavioural Explanation of Phobias: Conditioning

Operant Conditioning: Phobic behaviour is a form of negative reinforcement because it removes the person from the feared situation. The person feels better when they are away from the feared object and therefore they are more likely to continue their avoidant behaviour to avoid anxiety

Classical Conditioning: According to CC, a phobia can be created when a neutral stimulus becomes associated with something frightening

Watson & Raynor's study:

Aim: To assess if a baby could be emotionally conditioned to produce a fear response to a previously neutral stimulus

Participant: One baby boy, 8 months old called Little Albert. Baby of a wet nurse

Procedure: Initial testing; LA fearr tested byy response to rabbit. Did not fear them. Steel bar was hit behind head to induce fear response when saw white rat, he whimpered. Conditioning; Bar hit several times in presence of rat and became more fearful of it (crawled away). Testing; LA whimpered and crawled away when saw rat alone. Also feared dog. Retesting and reconditioning; LA saw rat but turned away, so bar was struck and crawled away. Sam reaction when saw rabbit

Linking Sentence: Study shows that CC can induce fear responses to neutral objects with fear

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Behavioural Treatments of Phobias: Sys Des

Systematic Desensitisation involves relaxation training and the construction of a fear hierachy. Clients are taught breathing techniques and then create a fear hierachy, ranking fearrful situations from least to most frightening (pic of spider, touching spider, holding spider etc). Eventaully you participate in each scenario while using relaxation technique to get rid of phobia

McGrath's study:

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

Participant: Lucy, a 9 year old girl with a fear of loud noises such as ballons popping and guns

Method: Case study. Constructed a fear hierachy and taught breathing techniques with therapist. Rated fears on 'hypothetical fear thermometer' to rate fears out of 10. Paired stimulus with relaxtion technique to feel calm

Findings: After 10th session, her fear thermometer had gone from 7/10-3/10 for balloons popping and 9/10-3/10 for party poppers

Linking Sentence: Study suggests that phobias cann be treated with SD and should be tailored to the indiviudal

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Cognitive Explanation of Phobias

Early experience - Formation of dysfunctional beliefs - Critical life events - Assumptions activated - Biased information processing - Symptoms of psychological disorder

This links to phobias as we may have an early life experience that forms our dysfunctional beliefs (eg. snow will harm us). They will then experience a critical life event that activates the assumption (eg. they get hit by a snowball). From this point on all info related to snow will be processed biased. This could also link to depression where patients may only process info that fits into their schema and ignore anything that doesn't (eg. getting info back on a test and only focusing on the bad things, despite doing well overall)

Yun's study:

Aim: To investigate the role of cognitive processes in anxiety disorders and find out how anxious patients interpret the physical symptoms of anxiety

Method: Questionnaires measured interpretations oof anxiety. G1 all had anxiety, G2 had depression, G3 control group (no psychological difficulties)

Findings: G1 wer more likely to interpret the symptoms (eg. increased heart rate) as dangerous

Linking Sentence: Negative thoughts about physical symptoms of anxiety play an important role in the maintenance of the anxiety disorder

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Cognitive Treatments of Phobias: CBT

There are 4 stages of CBT: Assessment stage, you and your therapist get to know each other and form a treatment plan. Cognitive stage, you and your therapist work to understand your thoughts and discuss past events. Behaviour stage, you and your therapist work to find new patters of thinking and apply new patterns to new behaviours. Learning stage, you and your therapist work to make sure that our changes are permanent and can cope with future events

Ost & Westling's study:

Aim: To compare CBT with applied relaxation as therapies for panic disorder

Participants: 38 participants who responded via newspaper advert. 26F and 12M aged 23-45 years

Method: Longitudinal study with IM design being randomly assigned to cognitive or relaxation group. P's given 12 weeks of treatment to treat panic disorder.

Findings: % of patients panic free from CBT after treatment =  74% and 89% after 1 year. 65% after applied relaxtion and 82% after 1 year

Linking Sentence: This study shows that CBT can be used to treat phobias and works by changing the thought processes

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Diagnosis of Dysfunctional Behaviour: DSM

The DSM &ICD are the two most widely used systems of classifications

The DSM contains a description of mental health disorders, their symptoms and other information to help diagnosis (eg. number of symptoms). These are called operational diagnostic criteria. It also lists known causes of the disorder, age at onset and prognosis

Each progressive version of the DSM has tightened up the criteria for diagnosing disorders, for example, tend to specify how long symptoms are required for diagnosis

A few of the major categories of the DSM are:

  • Mood disorders, eg. bipolar
  • Sleep disorders, eg. narcolepsy
  • Anxiety disorders eg. phobias, OCD

The DSM uses a multiaxial or multidimensional approach to diagnosing. It takes into consideration general medical conditions, psychological and environmental problems. This is rated on 5 seperate axes that broadens the amount of information gathered

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Diagnosis of Dysfunctional Behaviour: Definitions

Labelling a person as abnormal implies something needs changing and therefore we must be careful when we label people

Statistical Infrequency: A person's behaviour or thinking is classified as abnormal if it is rare or statistically unusual

Deviation from Social Norms: A person's thinking is classified as abnormal if it violates the 'unwritten' rules about what is expected or acceptable behaviour in particular social groups

Failure to Function Adequately: A person is considered abnormal if they are unable to cope with the demands of everyday life. They may be unable to perform te behaviours neccessary for everyday life (eg. holding down a job)

Deviation from Ideal Mental Health: Rather than defining what is abnormal, we define what is normal and anything that deviates from this is regarded as abnormal. This requires us to decide on characteristics that we consider necessary to mental health

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Diagnosis of Dysfunctional Behaviour: Biases

There are likely to be a number of possible issues that may cause bias, and the most likely is stereotyping that could be associated with gender, age or ethnicity. A bias diagnosis could be due to previous experiences

Ford & Widiger's study:

Aim: To assess the effects of sex of patient on diagnosis of antisocial personality disorder

Participants: 354 psychologists, responded to a questionnaire from SE USA. 76% M and mean age was 47

Method: Self report used in exp with IM design. Health practicioners were given 1 of 9 scenarios about individuals and had to make a diagnosis based on info from scenario. IV = gender of individuals, DV = diagnosis

Findings: Scenario where the sex of study was unspecified were often diagnosed with borderline personality disorder. ASPD was correctly diagnosed 42% in males and 15% in females

Linking Sentence: Study indicates that the diagnostic system can be biased by stereotypes of the practitioners which could be related to gender, social class, ethnicity

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