Health and Clinical Psychology

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  • Created on: 04-06-15 14:40

Health Belief Model- K/S: Becker

Model that predicts why people adopt health behaviours. Beliefs will either encourage or prevent us from adopting healthy behaviours. Factors in HBM that influence our decisions: perceived threat- directly influenced by perceived seriousness and perceived susceptibility (how vulnerable you think you are to illness/ disorder), cost vs benefits, cues to action (internal/ external factors at appropriate time) and demographics (age, gender, social group, etc). 


Aim: use HBM to explain mothers adherance to drug regimen for asthmatic children. Method: correlation/ self report. Participants: 111 mothers responsible for administering asthma medication to their children. Procedure: each mother interviewed about health beliefs, attitudes and about asthma and its consequences. Compliance checked through blood sample taken under pretence that it was for medical rather than research reasons. Findings: positive correlation between mother's beliefs about child's susceptibility to asthma attacks and compliance. Demographic factors (such as mothers being more educated and and married) found to correlate positively with compliance to child's medical regimen. Conclusions: HBM is useful to predict and explain different levels of compliance to medical regimens.

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Locus of Control- K/S: Rotter

People either have internal locus of control (LOC) - they believe own behaviour or actions directly impact on own behaviours and life, or an external LOC- believe life and behaviours are outside own control + led instead by chance/ fate. Extent to which one's perception of how far own actions determine events of their life/ behaviours. Internal LOC = more likely to alter behaviours to become healthier- believe changes will directly affect overall outcome in life- more controll. External LOC = may not try as hard as believe own actions make no difference- no controll over outcomes of life, decided by uncontrollable external force. Internal LOC = more likely to be males, older people, people with high positions in organisational structures + those with past success. 


Aim: to find out whether LOC affects our health beliefs. Method: Reviewing research. Procedure: reviewed research into individuals perception of extent to which they could control outcome of their behaviour. Findings: participants with internal LOC were more likely to show behaviours that would allow them to cope with potential threats than those with external LOC. Conclusion: LOC would affect many behaviours, just not health behaviours.

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Self Efficacy- K/S: Bandura

Learning from consequences of behaviour. If people believe they will be successful at changing health behaviours, will positively impact on their ability to change. Internal belief impacts on ability to become healthier- may not be concious decision. Low self-efficacy = low confidence in fact that own actions in a situation will be successful- may give them low motivation. Diminished motivation may make them less likely to attempt to improve health behaviours, meaning low self-efficacy will impact negatively on attempt to become healthier. Cognitive approach + behaviourism (Social Learning Theory) as level of self-efficacy we have depends on: 'Vicarious Experiences'- seeing others do something successfully, 'Verbal Persuasion'- being told you can do something, and 'Emotional Arousal'- worry/ stress could lower self-efficacy.


Aim: assess SE of patients undergoing systematic desensitisation (SD) for fear of snakes. Method: quasi experiment- 10 snake phobic patients who replied to newspaper advert. Procedure: pps given pre-test assessments such as efficacy expectations (how well they expected to interact with snakes). Underwent SD- ranged from looking at picture of snake to handling live snake. Pps given post test assessment- again measured on self-efficacy in coping. Findings: higher levels of post-test SE found to correlate with higher levels of interactions with snakes. Conclusion: SD enhanced SE levels- led to belief that pps was able to cope with phobic stimulus (snakes).

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Media Campaigns- K/S: Cowpe

Aim to raise awareness about particular health behaviour, eg smoking, drink driving, healthy eating etc. Effectiveness = limited. Shown on TV, magezines, radio etc. Attitude change doesn't always lead to behavioural change. YALE MODEL OF COMMUNICATION: Valid communicator (trustworthy), believable message (clear), accessible method of communication, message aimed at target audience (audience sympathetic and knowledgable) and situation message is received in must be taken into account (eg doctors, home, cinema, etc).

Cowpe- Chip Pan Fires

Aim: test effectiveness of media campaign aimed to reduce chip pan fires. Method: Quasi experiment. Procedure: two 60 second TV adverts shown in 10 UK regions. Showed the cause of chip pan fires and how to put them out. 2 DV's number of chip pan fires reported + 2 quantitative consumer attitude surveys. Results: 12% reduction in chip pan fires in these regions, if area received more than one channel- less impact, questionnaires showed increased awareness- 62%- 96%. Conclusions: media campaigns can be effective in increasing awareness and changing behaviour. Most efffective= info on what to do rather than what to think or what to be scared of.

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Legislation- K/S: Dannenberg

Law passed by governing bodies. May exist to promote or protect public's health through changing health attitudes and behaviours, eg legal age to buy cigarettes to 18 years or no smoking in public buildings. Controls health behaviours such as drink driving- effectiveness of enforcing laws to change certain health behaviours can be questioned. Changing a law can force people to adhere to particular behaviours.

Dannenberg- Bicycle Helmets

Method: quasi experiment with self report questionnaires. Sample: 7,000+ children from 3 countries in Maryland, USA. Procedure: 3 groups: 1- law was introduced, 2- no law but educational campaign, 3- no law + no educational campaign. Questionnaire was to measure child's present helmet uses with that of year before. Results: law introduced- greatest improvement in wearing helmet (4%- 47%), no law introduced and no educational campaign- least improvement. Conclusions: legislation can be effective in changing health behaviours compared to educational campaigns and doing nothing. However, still showed majority didn't wear helmets even after law was passed- shows how legislation may not be the best way to change health behaviours. 

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Fear Arousal- K/S: Janis and Feshback

Scaring people to make them more aware of consequences of bad health behaviour. May not be as effective in making individual change bad health habits. Most effective campaigns = minimal fear arousal + present health info in serious and frank way. Use of tar filled lungs on cigarette packages to create fear and effect health behaviour for smoking. 

Janis + Feshback 

Aim: see motivational effects of fear arousal in health promotion communications. Method: lab experiment. Sample: freshman class of students. Procedure: 4 groups- strong fear appeal on dental hygiene, moderate fear appeal, minimal fear appeal, and control lecture on human eye. Questionnaire given 1 week before, immediately after and 1 week after. Findings: minimal = 36% change from previous oral hygiene, moderate = 22% change, strong = 8% chnage, control = 0% change. Strong fear group had higher levels of fear arousal and anxiety immediately after lecture. Conclusions: if fear is strongly aroused but not relieved by reassurance, audience may ignore threat. Better to provide someone with info on what to do to change health behaviour rather than telling them what to be scared of.

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Reasons for Non-adherence- K/S: Bulpitt

When patients do not take medication or follow medical advice. Costs of taking medication may be greater than benefits of taking it, eg; side effects, not seeing improvement from treatment and forgetting to take medication. May stop taking medication when they start to feel better, even if course of treatment is not finished- rational decision has been make to stop, have evaluated perceived seriousness and vulnerability of threat. 


Aim: review research on adherence in hypertensive patients. Method: review article of research into problems with taking drugs for high blood pressure. Procedure: identify physical and psychological effect of drug treatment on patients life- eg; work, physical wellbeing, hobbies, etc. Results: anti-hypertension medication can have many side effects- physical reactions (sleepiness, dizziness and lack of sexual functioning), cognitive functioning (work and hobbies). 8% of males stop taking the drug due to sexual problems. 15% withdrew because of side effects. Conclusions: side effects of treatment and not seeing improvement from treatment may make individual rationally non-adhere to medical regimen. May not adhere to medicine because of cost vs benefit analysis where costs outweigh benefits- supports Health Belief Model.

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Measures of Non-adherence- K/S: Lustman

Subjective measures (self-reports, qualitative data)- asking patient, medical practitioner or patients family about extent of adherence. Can be influenced by demand characteristics, social desirability or people may simply not know- can't monitor patient 24/7. Objective measures (quantitative data)- quantity accounting/ pill counting (pill being gone does not necessarily mean has been taken), record number of repeat prescriptions- assume patient is taking meds they collect. Physiological measures- blood sugar levels (diabetes), blood + urine tests, reliable measures, unlikely to be practical to measure long term adherence.


Aim: assess efficacy of anti-depressant 'fluoxetine' in treating depression. Sample: 60 pps, self selected with diabetes + depression- USA. No history of other mental disorders. Procedure: randomly assigned to drug or placebo group. Double blind. Psychometric tests over 8 weeks- daily doses of fluoxetine + GHb levels monitored- GHb levels show adherence as it would indicate glycemic control. If drug taken then depression would be lower, so they would also take insulin for diabetes meaning blood sugar would be close to normal. Results: patients given fluoxetine reported lower levels of depression- also had lower levels of GHb- showed improved adherence. Conclusions: measuring GHb in patients with diabetes indicated levels of adherence to medical regimes- adherence can be measured covertly through effects on other illness.

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Improving Adherence- K/S: Watt

Medical practitioner could improve adherence through emphasising key info, treating instructions and not using medical jargon. Could provide info- patients more likely to adhere if they have info and intructions to follow. Behaviourist method- classical conditioning + operant conditioning could be used- making medical regimes more fun (reinforcement) or associating treatment with something positive may allow better adherence. 


Aim: using 'Funhaler' to see if this could improve adherence to asthmatic medication in children. Method: field experiment/ self-report. Sample: 32 Australian children with asthma. Procedure: pps had 1 week using traditional 'Breath-a-tech-' inhaler, then 1 week using 'Funhaler'. 'Funhaler'- inhaler with incentive toys (spinner + whistle) that function best when correct breathing technique is used. Self-report questionnaire with matched questions at end of each week completed by mothers. Results: 38% more parents medicated child previous day using 'Funhaler' compared to traditional inhaler. Conclusions: 'Funhaler' improved adherence to asthma medication. Adherence in children will improve when regimen is made fun (reinforcement). Supports behaviourist approach.

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Work Place Stress- K/S: Johansson

Task related factors- info overload, info under-load, and pace of a machine. Interpersonal factors- role ambiguity or role conflict. Environmental factors- heat, noise, lighting, etc.

Johansson- Measurement of stress response

Aim: measure + compare physiological measures of stress with psychological measures of stress in 2 different types of employees working in a Sweedish sawmill. Method: quasi experiment. Sample: 24 workers- 14 high- risk job, 10 low risk job. Procedure: high-risk group = machine paced and repetitive, called finishers, isolated from other workers. Low risk group = more varied, self-paced and allowed more time to socialise with other workers. Physiological measures = urine samples to measure adrenaline and body temp. Self-report measures = mood, alertness, caffine and nicotine intake. Pps gave daily urine samples 4 times per day. Results: high-risk group = higher adrenaline levels that increased throughout the day. Self-report revealed high-risk group felt more irritated and rushed than low risk group. Conclusions: repetitive, demanding work has higher impact on stress.

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Hassles and Life Events- K/S: Kanner

Social Readjustment Rating Scale (SRRS)- examine events + experiences in our life which cause stress, life of major + minor events + gave each a rank and mean value, 300 life change points or more were more susceptible to physical and mental illness. EG; death of spouse is mroe likely to be more stressful than starting school- dependent on individual differences. Other stressors: moving house, having children, marriage, etc. Daily hassles have more effect on stress levels since they are constant- eg getting ironing done on time.


Aim: compare daily hassles + uplifts scale vs major life events scale to test whether hassles were greater cause of stress. Method: self-report. Sample: 100 pps- 52 women, 48 men. Procedure: pps would complete the hassles rating scale and life events scale. Assessed their psychological sympotoms of stress using Hopkins symptom checklist and Bradburn Morale scale of well-being. Results: male = +ive correlation between life events and hassles, -ive correlation with uplifts. Women = more life events they report, the more hassles and uplifts they reported. Hassles often correlated with psychological stress symptoms, therefore hassles = more powerful predictor of stress.

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Lack of Control- K/S: Geer and Maisel

Links to Locus of Control theory- people with internal LOC will see life events as being something they can control. Poeple may experience stress when they feel they have little or no control over a situation. Amount of perceived control we have makes difference on whether we feel stressed- perceived control = thinking we have control even when we don't. More control we have, less stressful it is. Lack of control makes people feel like situation is out of their hands + could spiral downwards and cause stress- no ability to change this + don't feel they can deal with things.

Geer + Maisel

Aim: does lower stress result from ability to predict occurrence of unpleasant stimuli or related to controlling behaviour itself. Method: lab experiment. Sample: 60 psychology undergraduates, USA. Procedure: pps shown photos of dead car crash victimes- stress levels measured by Galvanic skin response (GSR). Baseline measurement taken when pps relaxed. Photograph preceded by 10-second tone then flashed up. Group 1= had button to change picture if they wished. Group 2 (predictability) = unable to terminate or control picture but knew about relationship between tone and picture. Group 3 = no control + no idea how long picture would be there. Results: ability to predict didn't seem to prevent stress response- being able to stop it did. Group 1 showed less stress, group 3 showed most stress.

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Cognitive Management of Stress- K/S: Meichenbaum

Human mind like a computer- input, process, output. Faulty thinking distorts processing of info. Processing can be altered to mangage stress. Stress Inoculation Therapy (SIT) focusses on cognitive aspect of stress- getting person to think about maladaptive nature of self-statements + changing maladaptive statements with positive, coping statements + relaxation. Process of Inoculation: conceptualisation- talks to person about stress experiences such as how they would normally cope + identify negative thought patterns, skill acquisition- replacement of negative thought patterns with positive ones- leaning techniques to manage stress (cog and beh skills), application + follow through- applied new skills under supervision through progressively more threatening situations- prepared for real life situations.


Aim: compare group of anxious students receiving SIT with group treated by desensitisation + control group waiting for therapy. Method: field experiement. Sample: 21 volunteers. Procedure: pps pretested for anxiety levels by lab-based tests, IQ test + questionnaire. Received 8 sessions of treatment- control group told they were on waiting list. DV- grade averages, IQ + digital performance tests + self-report post treatment. Single blind- assessers didn't know pps group. Results: 2 groups both improved- neither significantly better. SIT showed most +ive change on self-report anxiety test. Conclusion: cognitive therapy most helpful in test anxiety situations.

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Behavioural Management of Stress- K/S: Budzynski

Behavioural = mind is blank slate at birth, all behaviour is learnt. Biofeedback = control of physiological functions through cognitive processing, eg if we notice our heart rate increasing we can slow it down by thinking about it. Functions of different body systems can be monitored by machines. If behaviour is abnormal, person can adjust behaviour accordingly so levels become normal.


Aim: test effectiveness of biofeedback techniques in reducing tension headaches. Method: lab experiment. Sample: 18 patient volunteers- screened for tension headaches only, no other problems. Procedure: Group A- biofeedback sessions that included relaxation training and EMG feedback- 16 sessions, twice per week for 8 weeks. Group B- relaxation training + pseudo-feedback. Group C- told they were on a waiting list. Patients kept headache diary + rated them on scale of 1 (mild) - 5 (severe) for 2 weeks. Results: group A = muscle tension significantly lower than group B be end of training. Group A reported fewer headaches. Psychometric test on depression showed reduction in all groups, but group A showed significant reduction in hypochondria. Conclusions: biofeedback = effective way of training patients to relax + reduce tension headaches. Relaxation techniques = more effective than just monitoring.

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Social Management of Stress- K/S: Waxler + Morriso

Suggests behaviour relates to + is influenced by people around us. Looks at relationships. Stress when individuals cannot turn to others for help/relaxation- face stress alone. Social support = network of people (family, friends, neighbours, colleagues). Provide positive feedback and emotional support. Honest confrontation + support throughout recovery as may be unmotivated/ discouraged. Social support system may include several people needing help so can help each other reduce stress, relax + motivate. Emotional support = empathy, love and trust. Instrumental support = financial. Informational support = those concerned on providing additional infol. Appraisal support = feedback from those who are close + who are more likely to understand.

Waxler & Morrison- Social relationships and cancer survival                                     Aim:look at predictors of cancer survival including social support from friends and family. Method: quasi experiment + self-report (interviews, questionnairs + medical records). Sample: 133 women diagnosed with cancer. Procedure: women complete questionnaire to obtain demographics and psychological data (eg how many friends or dependents they had). Clinical factors taken from medical records. Survival calculated from time of diagnosis. 18 patients interviewed in detail to understand effects of psychological factors. Results: 6 aspects of social networks linked with survival = marital status, support from friends, contact with friends, total support, social network + employment. Interviews showed- practical help = concrete support. Conclusions: more social networks + support = higher survival rate from breast cancer.

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Measuring Stress- Physiological Measures- G&M

Geer & Maisel's = Key Study. 

Used physiological measures- to measure participants reactions to being shown photographs of dead car crash victims. 

Stress levels measured by GSR (Galvanic Skin Response) and heart rate electrodes- data from heart rate electrodes was discarded as it appeared to be inacurate. 

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Measuring Stress- Self-Report K/S: Kanner

Kanner used the self-report method to gather data from participants in a study into hassles and uplifts and life events as predictors as predictors of stress.

Kanner's participants were all sent 4 self-report scales to complete: 1: The Hassles and Uplifts Scale, 2: The Berkman Life Events Scale, 3: Hopkins Symptom Check List, and 4: Bradburn Morale Scale.

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Measuring Stress- Combined Approach- K/S: Johansso

Johansson's study into stress in the work place (a Sweedish sawmill) includes both physiological measures and self-report measures, which is ideal.

Physiological = urine samples collected from each participant daily throughout the study which was used to measure the stress hormones adrenaline and non-adrenaline.

Self-report = participants recorded their mood, alertness, and caffine and nicotine consumption throughout the duration of the study.

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Categorising dysfunctional behaviour (No Study)

Categorising = necessary so professionals are able to diagnose + give correct treatment.

DSM IV: (diagnostic and statistical manual of mental health). 1: American- set up by team of mental health professionals + approved by Americal Psychiatric Association. 2: Categorising system to improve reliability of mental health diagnosis. 3: Only mental health disorders- contains almost 400. 4: Book has axis- patient must meet number of criteria before being diagnosed with disorder, axis 1: major clinical syndromes- all mental disorders, axis 2: personality disorders and mental retardation, axis 3: general medical conditions- physical illnesses present symptoms from axis 1 + 2, axis 4: psychological and environmental problems- events over past year (eg divorce), and axis 5: global assessment of functioning scale- assessed psych, social and occupational functioning. 

ICD-10: (international classification of disease + related health problems). 1: Global health agency (W.H.O), 2: Both physical and mental health diagnosis criteria, 3: Two sets of diagnostic criteria for each disorder in book- one for practitioners use of judgement, other more strict guidelines, 4: Divided into 11 blocks of axis, eg; i) organic, including symptematic, mental disorders (eg Dementia in Alzheimer's disease), vii) disorders of adult personality and behaviour (eg paranoia), and x) behavioural emotional disorders- onset usually occuring in childhood or adolescence (eg Conduct disorder).

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Definitions of Dysfunctional Behaviour- K/S: Rosen

Necessary to define dysfuncional behaviour (DB) in order for it to be effectively recognised + treated. Each individual is different- useful to have universal definitions. Behaviour = B.

Rosenhan + Seligman- Definitions

Statistical Infrequency: abnormality = any B not seen frequently in society. Difficult to use on its own- might incompass exceptionally high IQ or stamp collecting as abnormal. Some B's seen as abnormal may be quite common so wouldn't be classed here, eg substance abuse. Deviation from Social Norms: abnormality = a B society doesn't approve of. Makes some B's abnormal in some societies and not in others. Sense of 'rightness'- what society says is right and everyone else is wrong. Would mean societies aren't wouldn't be changed by forward thinking. Deviation from Ideal Mental Health: if you lack one thing, eg health, then you must have the opposite, eg illness. Logical, but what defines ideal health? Jahoda 1958 = positive view of self, capable of some personal growth, independent and self regulating, accurate view of reality, resistant to stress, + be able to adapt to environment. More relevant when considering what DB is. Cultural bias + subjective view of clinitian. Failure to Function Adequately: person is dysfunctional if they cannot function in a way that allows them to live in society independently. Several ways in which a person may not be functioning well, eg 1: DB's eg OCD, 2: B distressful to the person, 3: B distressful to those around them, 4: unpredictable B, and 5: irrational B.

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Biases Diagnosis of dysfunctional behaviour- K/S:

May be biasses when diagnosing DB, especially in gener + culture. Cultural biasses = different beliefs in different cultures, not all disorders occur in every part of world- differ in beliefs, values + norms- cannot make absolute statement on what is abnormal. Gender biasses = different traits linked to different genders. Men = more aggressive, territorial, disregard for safety. Women = imaptient, emotional + sensitive to critisism. Genders viewed differently in society so abnormality also different. Histrionic Personality Disorder (HPD) + Antisocial Personality Disorder (APD)= normally have gender biasses. HPD = uncomfortable being ignored, seek approval from others, flirting or behaving privocatively, dramatic and over emotional. APD = linked with criminal B- act impulsively, without considering consequences, put own needs before others- selfish + hard.     Ford & Widiger                                                                                                               Aim: are clinitians stereotyping gender in diagnosis? Method: self-report. Sample: 354 clinitians. Procedure: pps randomly assigned 1 of 9 case histories, patients symptoms either HPD, APD or equal of both. Diagnosed illess on 7 point rating scale- extent to which patients appeared to have each of 9 disorders- eg adjustment, alcohol abuse, histrionic, etc. Results: gender unspecified = most often diagnosed as borderline personality disorder. APD correctly diagnosed 42% of time in males + 15% in females. Females with APD misdiagnosed as HPD 46%. Males only misdiagnosed with HPD 15%. HPD correctly diagnosed in females 76%, males 44%. Conclusions: practitioners showed clear gender bias in diagnosis, especially clear reluctance to diagnose males with HPD.

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Behaviourist Explanation of DB- K/S: Watson & Rayn

Assumption: mind = blank slate when born- all behaviour learnt through life experiences. Implied DB develops over period of time. Experiences with environment are reason DB's may exist. Operant Conditioning = B learnt through reinforcement. Social Learning Theory = B learnt through imitation. Classical Conditioning = learn through association/ pairing- DB can be learnt this was too- learn to associate one stimulus with something considered an abnormal behaviour. 

Watson & Raynor - conditioned emotional reactions:

Aim: investigate possibility of creating fear through classical conditioning + see whether fear could be generalised to similar objects. Method: controlled lab experiment- case study. Sample: 11 month old boy (named Little Albert for study). Procedure: Albert feared noise of hammer striking metal bar but didn't fear rat, rabbit, dog, etc. Session 1: presented with rat alone- noise occured as soon as he reached for rat + repeated. 1st time he jumped + fell, 2nd time started to wimper. Session 2: witnessed rat + noise 7 times- immediately cried + crawled away from rat alone on final time. Session 3: focussed on if fear was generalised- presented with rat, rabbit, dog, cotton wool, etc. Results: Albert continued to show fearful reactions 1 month after conditions. Conclusions: possible to create fear using classical conditioning + fear response can be generalised to similar stimuli. Behaviourists are correct that DB can be learnt.

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Biological Explanation of DB- K/S: Gottesman & Shi

Suggests genetic makeup/ structure of brain can lead individual to have DB's. EG: explanation for schizophrenia = enlarged brain ventricles, promlems during pregnancy or birth, genes + high levels of dopamine could lead to disorder. Twin study: monozygotic twins- identical + share 100% of genes, dizygotic twin- not identical + share 50% of genes. DB cured by biological treatments such as drug therapy. Combinations of certain genes may make some people more vulnerable to schizophrenia but won't always develop symptoms- some people with schizophrenic parents more likely to develop.

Gottesman & Shields                                                                                                       Aim: review research on family, twin, + adoption studies to test for evidence of schizophrenia. Method: review article of 2 adoption + 5 twin studies between 1947-1976. Sample: 711- adoption studies. 210 monozygotic twins, 317 dizygotic twins. Procedure: concordance rates + incidence of schizophrenia in parents + children in biological + adoptive families. Results: adoptive = increased incidence in adopted children with schizophrenic biological parent. Normal children adopted by schizophrenic parents + adoptive parents of schizophrenic children showed little evidence of schizophrenia. Twins = high concordance rate in monozygotic twins. Conclusions: supports nature side of nature/ nurture debate. Evidence that biological approach is correct in saying genes are responsible for DB + not environment, therefore can be cured using biological treatments (eg drugs).

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Cognitive Explanation of DB- K/S: Beck

Thinking, expectations + attitudes direct B. Brain acts like computer- input, process, output. DB caused by inappropriate/ faulty thought processes. Issue is not problem itself, but way you think about it. Cognitive triad: overgeneralisations, negative views on world, self + future (eg one person doesn't like my dress, therefore no one will like my dress). Faulty thinking patterns can be treated through cognitive treatments (eg CBT)- changing way person may think will change their B.


Aim: understand how people with depression think + how their thinking differs from normal people. Method: clinical interviews in matched pairs design. Sample: 50 patients with depression, 31 non-depressed people in control group. Procedure: used association, formal analysis + diaries of thoughts to collect data. Before session- retrospective reports of thoughts. During session- spontaneous reports. Results: themes present in depresses patients that weren't evident in non-depressed patients (eg low self-esteem, self-blame, desire to escape, paranoia). Stereotypical responses to situations even where inappropriate, feeling unable and alone. Conclusions: those who suffered from depression had cognitive distortions that deviated from realistic, logical thinking. Provides evidence that cognitive approach is correct in explaining DB to be result of irrational + illogical thinking patterns.

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Behaviourist Treatment of DB- K/S: McGrath

DB's developed through operant/ classical conditioning + therefore can be treated in same way. Phobias can be treated through treatment based on classical conditioning: Systematic Desensitisation (SD)- phobia introdruced grandually until patient is completely relaxed at each stage before moving on. Patient becomes too stressed, go back a stage. Phobic stimulus can be paired with something pleasant/ relaxing to counter fear reaction. 

McGrath- successful treatment of noise phobia

Aim: to treat a girl with severe noise phobia using SD. Method: case study. Sample: 9-year-old Lucy- low to average intelligence. Fear of sudden, loud noises- no other disorders. Procedure: 1st session- constructed heirachy of feared noises- balloons + party poppers most prominent. 2nd session- taught breathing + imagery to relax (imagining herself at home with toys). 3rd session- given stimulus of noise, paied feared object with relaxation + imagery. Association between noise + feeling calm. Results: learnt to feel calm when noise was presented + had no need for imagery after 4 sessions. Final session- Lucy showed fear thermometer scores had gone from 7/10 --> 3/10 for balloons, and 9/10 --> 5/10 for party poppers. Conclusions: study showed effectiveness of SD on curing a phobia. DB can be learnt + unlearnt- phobia was unlearnt by associating phobic object with something calm and relaxing. 

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Biological Treatment of DB- K/S: Kane

Neurotransmitter- chemical that transmits signal from neuron to cell over synapse- released + diffuse across synapse + binds to receptors on other side. Schizophrenia- higher levels of certain neurotransmitters (eg Dopamine). Dopamine- high levels effect cognition + stops person being able to distinguish between whats real + whats not. Fluphenazine- block dopamine receptors in brain to prevent overly high levels. Drugs attempt to address effects of hormone/ chemical imbalances. 

Kane - Fluphenazine vs Placebo in schizophrenic patients

Aim: carry out 1 year, double blind research study to see effectiveness of fluphenazine as treatment for schizophrenia. Method: longitudinal study. Sample: 28 pps diagnosed with schizophrenia- no drug abuse or other medical conditions. Procedure: pps randomly assigned + given drugs or placebo. Removed if they 'dropped out', had toxic side effects or relapsed. Assessed on whether they had psychotic episode (relapse in remission from schizophrenia). Results: placebo = 7/17 relapsed by 19th week. 7/17 dropped out by 21st week. Drug treatment groups = no relapses, 1 drop out. Conclusions: fluphenazine is a successful drug treatment for schizophrenia. 

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Cognitive Treatment of DB- K/S: Beck

Cognitive therapy attempts to change irrational thinking- shifting patients negative views to positive. CBT = Cognitive Behavioural Therapy: trains person to think different + change behaviours for better. Focusses on thinking, not behaviour. ABC: Activating events- actual event + patients immediate interpretations of event. Beliefs about event- evaluation can be rational or irratinal. Consequences: how they feel + what they do/ other thoughts. Therapist would never comment on beliefs, only work with patient to see if beliefs can be reality tested so they can realise consequences of faulty cognitions.                                                                                Beck                                                                                                                               Aim: compare effectiveness of cognitive therapy vs drug therapy. Method: controlled experiment. Sample: 44 pps diagnosed with moderate - severe depression. Procedure: patients assessed with 3 self-reports pre-treatment: Beck Depression Inventory, Hamilton rating scale + Rasking Scale. Cog group- 1 hour cog therapy sessions twice per week for 12 weeks. Drug group- 100 capsules, prescribed by visiting doctor for 20 mins per week. Results: significant decrease in depression symptoms on all 3 rating scales. Cog treatment group showed significantly greater improvements on self-reports + observer based ratings. 5% drop out rate for cogn therapy, 20% in drug therapy. Conclusions: cognitive therapy = better treatment of depression- fewer symptoms reported + observed + better adherence to treatment. Allows patient to dicuss thoughts + feelings, shifting negative thoughts to positive + logical proved effective.

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