Health and Clinical Psychology
1. Healthy Living
Theories of Health Belief
Health Belief Model - Becker
Aim: To use the HBM to explain mothers' adherence to a drug regimen for their asthmatic children.
Participants: 111 Mothers resposible for administering athsma mediacation to their children.
Procedure: Each mother was interviewed on their health beliefs and attitudes and about athsma and its consequences. Compliance was checked by a covert blood sample from their children.
Findings: There was a positive correlation between a mother's belief about her child's susceptability to athsma attacks. Futhermore, demographic factors such as the greater the mother's education and and if they were married were found to positively correlate with adherence to the medical regimen.
Conclusion: The HBM is a useful model to predict and explain different levels of cimpliance with medical regimens.
Becker - Evaluation
+ Self-report allows you to gether large amounts of data quickly and effectively.
- Social desiriability bias may occur, for example mothers may have lied about their adherence to medical regimes for their athsmatic children to appear in a more socially acceptable light.
- Protection from harm was breached as the children of the mothers were had covert blood samples taken. This may have caused the children some discomfort.
- Informed Consent was not gathered as the mothers were not aware of the covert blood sample being taken.
- Deception also occured as the moters, again, were not aware of the blood sample being taken from their child.
Ethnocentrism: The HBM was developed in the 1960s to understand why individuals did not go for free screening programmes in the USA, it is heavily based on westurn cultures and western ideals. The model may not be applicable to those from different cultures.
Locus of Control - Rotter
Locus of Control: Considers where people believe the control of their health is located: within themselves or within others.
Aim: To find out whether locus of control affects our health beliefs.
- Internal locus of control: an individual has control of their health themselves.
- External locus of control: you do not have control of your health.
Method: Reviewing research.
Procedure: Rotter reviewed several pieces of research, which had all investigated an individuals perception of the extent to which they could control the outcome of their behaviour.
Findings: Participants with an internal locus of control were more likely to show behaviours that would allow them to cope with potential threats, than participants with an external locus of control.
Conclusion: Rotter concluded that locus of control would affect many of our behaviours, not just health behviours.
Rotter - Evaluation
Reductionist: Does not take take into account external factors such as environment as to why people do/don't adopt health behaviours, only takes into consideration locus of control.
Validity: Low in validity as Rotter only reviewed research that had been previously conducted.
Self-efficacy - Bandura and Adams
Self-efficacy: How effective a person believes they can be in changing their behaviour will influence their tendency to try to change their behaviour.
Aim: To assess the self-efficacy to patients undergoing systematic desensitiastion for their fear of snakes.
Methodology: Quasi-experiment - 10 snake-phobic patients 9 females & 1 male who replied to a newspaper advert.
Procedure: Participants were given a series of pre-test assessments such as efficacy expectations (how well they would be able to interact with the snakes). They then underwent systematic desensitisation which ranged from looking at a picture of snake to handling a live snake. Participants were then given a post-test assessment where they were again measured on belief of self-efficacy in coping.
Findings: Those with higher levels of post-test self efficacy were found to correlate with higher levels of interactions with snakes.
Conclusion: Desensitiastion enhanced self-efficacy levels, which in turn led to the belif that the particpant was able to cope with the phobic stimulus (snakes).
Bandura and Adams - Evaluation
+ High in ecological validity as the I.V occurs naturally.
- Time consuming and expensive to conduct.
Ethnocentrism: Bandura's theory of self-efficacy was developed with western cultures in mind, in other cultures around the world different factors may have more of an influence on whether an individual adopts a health behaviour other than self-efficacy.
Individual vs. Situational:
- Situational - For example if you come from a unhealthy background you may be given little encouragement to adopt a health behaviour
- Individual - The emotional strength of the individual may also play a vital role in an indivduals self-efficacy.
Media Campaigns - Cowpe
Aim: To test the effectieveness of a media campiagn for the prevention and cures of chip pan fires.
Methodology: Quasi-experiment where a media campaign was shown in 10 UK regional TV areas from 1976 to 1984.
Participants: Those living in the TV areas.
Procedure: Each region was hown a TV advert for the initial cause of the fire and how to put it out. 3 areas (Granada, Harlech and Tyne Tees) were shown reminders one year later.
- Between 1976 and 1982 there was a percentage decline in chip pan fires ranging from 7% in the Central area to 25% in the Granada area.
- A questionnaire showed an increase in the awareness of chip-pan fires from 62% in the Yorkshire TV area to 90% after the first adverts.
Conclusion: The advertising proved effective as shown by the reduction in chip pan fires.
Methods of Health Promotion
Cowpe - Evaluation
+ High in ecological validity as the I.V occurs naturally.
- Difficult to establish cause and effect due to lack of control of extraneous variables, i.e did the advertisement campaign really have an effect of health behaviours or was it something else?
Reliability: Cowpe's study can be seen as being low in reliability as it is not possible to know exactly how many people were exposed to the advertising campaign. This means that it is hard to replicate.
Ethnocentrism: Only individuals from 10 UK TV regions were used in Cowpe's study. This means that we cannot generalise the results gathered to those who live in different TV regions or in different countries as they may have behaved differently to the advertisement campaign. This makes Cowpe's study low in generalisability.
Legislation - Dannenburg
Aim: To review the impact of passing a law requiring cycle helmet wearing in children under 16.
Sample: Children from 47 different schools in Howard County. Two control groups from Baltimore and Montgomery County, all three counties were in Maryland, USA.
Procedure: Questionnaires were sent out to 7322 children in Howard, Baltimore and Montgomery County containing a variety of information on helmets.
- Response rates were between 41% and 53% between the counties.
- Reported helmet usage had increased in Howard county compared to the other two counties.
Conclusion: The Howard County legislation on cycle helmets did show a large increase in the reported usage rate of cycle helmet wearing.
Dannenburg - Evaluation
+ High in ecological validity as the I.V occurs naturally and is not manipulated by the researchers.
- In Dannenburg's study it was impossible to control extraneous variables which may have had an impact on the increase of cycle helmets being worn by those under 16, such as type of bike used etc.
Reductionism: Dannenburg's study can be considered to be be reductionist as it only considers the law being passed in Howard County as a cause for the increase in cycle helmets being worn. Dannenburg does not takes other factors into consideration such as the type of bike and whether or not the child's parents force them to wear a helmet.
Ethnocentrism: Can be considered to be ethnocentric as only children from three counties in Maryland were used in Dannenburg's study. This means that the results cannot be applied to those who live in other counties in the United States or are from different countries or cultures.
Fear Arousal - Janis and Feshbach
Aim: To study the motivational effects of fear arousal in health promotion.
Participants: The entire freshmen year of a large Connecticut high school.
Method: Laboratory experiment.
Procedure: 4 groups of participants, 3 were given a 15 minute lecture on tooth decay and oral hygiene. They were given a questionnaire one week before and after the lecture on oral hygiene.
- Group 1 - Stong fear appeal
- Group 2 - Moderate fear appeal
- Group 3 - Minimal fear appeal
- Group 4 - Control group - Given a lecture on the human eye.
Findings: The strong fear arousal group showed a net increase in conformity to good dental practices of only 8% whilst the minimal fear arousal group saw an increase of 36%.
Conclusion: Janis and Feshbach conlcuded that relatively low fear arousal is likely to be the optimal level for promoting health.
Janis and Feshbach - Evaluation
+ Highly controlled, allows for the control of extraneous variables - high in reliability.
- Demand characteristics may have affected the results in the study as students may have managed to work out the aims of the experiement.
Ethnocentrism: Only students from a large Connecticut high school used, results cannot be generalised to others across the USA or indeed the world.
Reductionism: Janis and Feshbach's study can be considered to be reductionist as it only assumes that fear arousal is the reason for individuals adopting health behaviours. Other factos such as peer pessure may have made students change their dental habits after witnessing the lecture.
Features of Medical Adherence
Reasons for non-adherence - Bulpitt
Aim: To review research on adherence in hypertensive patients.
Method: Review article.
Procedure: Previous research analysed to identify the physical and psychological effects of drug treatments on an individual's life.
- Anti-hypertensive drugs have many side effects including sleepiness, dizziness and lack of sexual functioning.
- A study by CURB found that 8% of males stopped taking anti-hypertensive medication because of sexual reasons.
- Another study found that 15% of patients stopped taking the medication for other reasons.
Conclusion: When taking medication, if the costs outweigh the benefits of treating mainly asymptomatic problems, such as hypertension, the patient is less likely to adhere to the treatment.
Bulpitt - Evaluation
Holism: Bulpitt's study can be considered to be holistic as it considers a variety of resons why individuals do not adhere to medical regimens such as sleepiness, tiredness, impared cognitive functioning and lack of sexual functioning.
Measures of non-adherence - Becker
- Becker's study which aimed to use the Health Belief Model to explain why mother's adhered to a medical regimen for their athsmatic children, used physiological measures as a measure of non-adherence.
- A covert blood sample was obtained from the mother's children to check compliance.
Becker (Adherence) - Evaluation
- Advantages and Disadvantages of using physiological measures for measures of non-adherence?
+ Provides objective scientific data.
- May not be always possible to gather a urine or blood sample.
- Advantages and disadvantages of using self-report for measures of non adherence?
+ Qualitative data can be obtained which provides an insight into thoughts, felling etc.
- Social desirability bias may occur.
In Becker's study the blood sample was taken covertly from the children, this raises both informed consent and deception as the mothers were not aware of the blood sample being taken.
Improving Adherence - Watt
Aim: To see if using a Funhaler could improve children's adherence to taking asthma medication.
Method: Field experiment
Participants: 32 Australian children with a mean age of 3.2 years.
Procedure: Each participant was given a standard asthma inhaler for the first week, and the parents were given a questionnaire to complete on adherence rates. The second week the participant used the Funhaler and the parents filled out another questionnaire on adherence rates.
Findings: 60% more children took the recommended 4 cycles of asthma medication per day when using the Funhaler compared to the standard inhaler.
Conclusion: Making a medical regimen fun can improve adherence in children as it provides positive reinforcement for correct usage.
Watt - Evaluation
+ High in ecological validity as the experiment was conducted in real life environments.
- Hard to replicate exactly as it is impossible to control extraneous variables, this makes the study low in reliability.
Ethnocentrism: Watt's study can be see as being ethnocentric as only participants from Australia were used in the study. This means that the results gathered cannot be applied to other children from different countries and cultures. Low in generalisability.
Reductionism: Watt's study can be seen as being reductionist as it only takes into consideration the asthma pump as being responsible for a child's adherence to their asthma medication. Other factors such as their parents and the environment that they were in at the time may have had an affect on their adherence levels.
Exam Questions for Healthy Living
(a) Describe self-efficacy as a theory of health belief. (10)
(b) Discuss theoretical approaches to beliefs about health. (15)
(a) Describe one piece of research into media campaigning as a method of health. (10)
(b) Discuss the ecological validity of research into methods of health promotion. (15)
(a) How can fear arousal be used as a method of health promotion? (10)
(b) Assess the effectiveness of methods of health promotion. (15)
(a) Discuss one reason why people do not adhere to medical requests. (10)
(b) Discuss the problems psychologists might have when carrying out studies on adherence to medical requests. (15)
(a) Describe one way to measure non-adherence to medical advice. (10)
(b) Assess the reliability of research into non-adherence to medical advice. (15)
Causes of Stress
Causes of Stress - Work - Johansson
Aim: To investigate whether work stressors increase stress-related physiological arousal and stress related illness.
Participants: 24 workers at a Swedish Sawmill. 14 were 'finishers' who had to work at a set pace and whose jobs were complex. The other 10 workers were the control group. These workers were either cleaners or maintenance workers.
Procedure: Each participant was asked to give a daily urine sample to measure levels of stress related hormones (adrenaline and non-adrenaline). Their body temperature was checked and they were asked to complete a self-report on mood,alertness and caffeine consumption. This was repeated 5 times during the day.
Results: The high-risk group of 14 'finishers' secreted more stress hormones on work days than on rest days, and higher levels than the control group. The finishers also showed higher levels of stress-related illness such as headaches than the control group.
Conclusion: High risk jobs that require skill and demand responsibility, cause people to feel more stressed than jobs which are less demanding and do not require much skill.
Johansson - Evaluation
+ High in ecological validity as the I.V occurs naturally, i.e. they were either 'fininshers' or cleaners before the study took place.
- Difficult to replicate due to lack of control over extraneous variables, low in reliability.
Ethnocentrism: All of the participants used in Johansson's study were from a sawmill in Sweden. This can be considered to be ethnocentric as the results gathered from Johansson's study cannot be applied to those in different countries and cultures.
Usefulness: Johansson's study can be considered to be useful as it allows us to determine which employees in a company may be at risk from stress related illnesses. This means that they can be identified and given treatment.
Nature vs. Nurture: Johansson's study supports the nurture side of the debate as it suggests that stress is caused by the type of job that an individual does and not other factors such as genetics which are innate.
Causes of Stress - Daily Hassles - Kanner
Aim: To compare hassles and uplifts and life events as predictors of psychological symptoms of stress.
Methodology: Self-report - Repeated measures design in that each participant completed the Hassles Rating Scale and the Life Events Scale.
Participants: 100 people who had previously completed a health survey in 1965. They were all from California, mostly white and protestant.
Procedure: Participants were asked to complete:
- The Hassles and Uplifts Scale for 9 months.
- The Life Events rating after 10 months.
- The HSCL (Hopkins Symptom Checklist) and the Bradburn Morale Scale every month for 9 months.
Findings: Hassles were consistent from month to month. For women the more life events they reported the more hassles and uplifts they reported. Hassles frequently correlated positively with the psychological symptoms on the HSCL.
Kanner - Evaluation
+ Allows for comparison between two sets of data to be made, for example, hassles and uplifts.
- However, it does not allows for the feeling, thoughts and emotions to be gathered from participants and the reasons behind the hassles to be recorded.
Ethnocentric: 100 participants were used from California. This can be considered to be ethnocentric as the results gathered from these individuals cannot be applied to those who live in different countries and come from different cultures. Furthermore, the hassles and uplifts scale, the Berkman life events scale and the HSCL were created in western cultures to western ideals. The hassles which they feature may not apply to those from different countries and cultures.
CoS - Lack of Control - Geer and Maisel
Aim: To see if perceived control or actual control can reduce stress reactions to adverse stimuli.
Method: Laboratory experiment - Participants had their stress levels measured by GSR and heart rate through ECG monitoring (however ECG data obtained was discarded).
Sample: 60 psychology students from New York University.
Procedure: Participants were randomly assigned to 1 of 3 conditions and shown images of dead car crash victims. Group 1, given control of how long they saw the images, could terminate it at a press of a button and knew when the next image would appear. Group 2 had no control of the image, however they did know when the image was going to appear through a series of tones. Group 3 had no control over the images and were not given any timings.
Results: Group 2 showed most stress with the tone, as they knew what was coming but did not have control over the photograph. Group 1 experienced less stress in response to the photograph than Groups 2 and 3.
Conclusion: Having control over adverse stimuli reduces their stressful impact.
Geer and Maisel - Evaluation
Ethics: Breaks protection from harm as participants are shown images of dead car crash victims. This may cause psychological harm and distress amongst participants.
Ecological Validity: Low in ecological validity as in a 'real life' situation, you would not be presented with images of dead car crash victims and so your stress reactions may be different.
Ethnocentrism: Only students from New York University were used in Geer and Maisel's study. This means that the results gathered cannot be applied to those from different countries and cultures as they may have different methods of coping with stress. Furthermore, students are often placed in stressful situations, such as exams, and may be more adapt to dealing with stress. This means that the results gathered may not be applicable to all ages as some may be better at dealing with stress than others.
5. Measuring Stress
Physiological Measures - Geer and Maisel
In Geer and Maisel's study into control/ perceived control over adverse stimuli and stress reactions, physiological meausres were used to measure participant's reactions to being shown photograhphs of dead car crash victims.
Participant's stress levels in Geer and Maisel's study were measured by GSR and ECG. However the data gathered by the ECG was discarded as it appeared innacurate.
G&M (Physiological Measures) - Evaluation
Validity: One issue with using physiological measures is that they lack validity, as we cannot be sure that we are actually measuring a stress reaction or something else. For example in Geer and Maisel's study, other factors such as medical conditions, may have caused reactions that simulated stress reactions in response to the photographs of car crash victims.
Psychology as a Science: Physiological measures provide evidence for the Psychology as a Science argument. Physiological measures provide an objective means to measure stress reactions as they are not affected by researcher bias and provide quantitative data which allows for statistical comparisons to be made.
Self-report - Kanner
Kanner's study into hassles and uplifts and life events as predictors of stress used the self-report method to gather dtat from participants.
100 participants from California were used in Kanner's study and each were sent tests to complete in the post. These were:
- The Hassles and Uplifts Scale
- The Berkman Life Events Scale
- HSCH (Hopkins Symptom Check List)
- Bradburn Morale Scale
Kanner (Self-report) Evalutation
Validity: The self-report method for measuring stress can be seen as lacking validity. This is because social desirability bias may occur where individuals lie to appear in a more socially acceptable light. For example in Kanner's study, participants may have lied whilst completing the various scales such as the Hassles and Uplifts Scale so that they would not appear to extreme or socially unacceptable.
Easy and Cheap to Conduct: Using the self-report method to measure stress is a relatively cheap and easy way to obtain data. Questionnaires can be sent out via the post, as was seen in Kanner's study, which allows for large amounts of data to be obtained relatively cheaply and quickly.
Combined Approach - Johansson
Research into stress ideally combines both physiological and self report methods. Johannson's study into work stressors uses both physiological and self-report methods.
Physiological - A urine sample was obtained from participants throughout the duration of the study. This measered daily levles of stress hormones, adrenaline and non-adrenaline.
Self-report - Participants were also asked to complete a self-reprt throughout the duration of the study on mood, alertness, caffiene and nicotine consumption.
Johansson (Combined Approach) Evaluation
Validity: The combined approach can be seen as being high in concurrent validity as two types of research methods are used. For example in Johansson's study, physiological measures (urine samples) and a self-report (questionnaires) were used. This increases the overall validity of the approach.
Time Consuming: The combined approach can be seen as being time consuming and expensive to conduct as two research methods are being used as opposed to one.
Cognitive - Meichenbaum (SIT)
Aim: To compare Stress Inoculation Therapy (SIT) with systematic desensitisation and a control group on a waiting list.
Method: Field-experiment - Participants were assessed before and after treatment using self-report.
Sample: 21 students aged 17-25 who responded to an advert for treatment for test anxiety.
Procedure: Each participant was tested using an IQ test and were assessed for anxiety using self-report. Participants were randomly allocated to 1 of 3 conditions: SIT therapy (focuses on restructuring faulty thoughts that contribute to stress), systematic desensitisation or were told they were on a waiting list for treatment.
- SIT Group - received 8 therapy sessions. They were given positive statements to say to reduce stress and relaxation techniques to use in test situations.
- Systematic Desensitisation Group - received 8 sessions.
- Control Group - Told they were on a waiting list and would receive therapy in the future.
Findings: Participants in the SIT group showed more reported improvement in their anxiety levels, although both therapy groups showed overall improvement compared to the control.
Meichenbaum - Evaluation
Psychology as a Science: Meichenbaum's SIT therapy attempts to recorrect faulty cognitive thinking patterns to reduce stress. It focuses on thinking patterns which cannot be observed. This lowers the validity of SIT.
Easy to Conduct: SIT is a relatively easy stress managing therapy to conduct and does not require expensive equipment such as Behavioural methods of managing stress.
Reductionist: Only considers faulty cognitions as being responsible for stress, does not consider, biology, environment ect.
Behavioural - Budzynski (Biofeedback)
Aim: To review previous research on the affects of biofeedback on the reduction of tension headaches.
Methodology: Laboratory experiment, electrodes were placed on participants muscles and they were then monitored using an EMG feedback machine.
Participants: 18 Americans who responded to a Colorado newspaper article. They were given medical examinations to ensure that the headaches were not caused by a medical concern.
Procedure: Three groups: Group A - received biofeedback with relaxation training. Group B - received relaxation training with pseudo-feedback. Group C - waiting list.
Participants kept a record of their headaches for 2 weeks. Groups A and B were given 16 sessions of relaxation training. Group A were told that the 'clicks' of the biofeedback machine would reflect their muscle tension, whilst Group B were just told to focus on the varying clicks.
Findings: At the end of the training, Group A's muscle tension was significantly lower than group B's. Group A also reported significantly less headaches than Groups B and C.
Budzynski - Evaluation
Usefullness: Biofeedback can be seen as being useful as it has been proven to work and proven to reduce tnesion headaches. However it can be impractical to conduct as it required an EMG, feedback machine, to give feeckback on indiduals stress levels.
Psychology as a Science: Biofeedback provides evidence for psychology as a science as it studies observable behavoir through the use of scientific equipment such as EMG machines. This provides us with qualitative data which is objective and allows for statistical comparisons between variables to be made.
Social Support - Waxler-Morrison
Aim: To look at how a woman's social relationships influence her response to breast cancer and survival.
Participants: 133 women referred to a clinic in Vancouver with confirmed diagnosis of breast cancer.
Methodology: Quasi-experiment, information gathered using questionnaires, interviews and medical records.
Procedure: Questionnaires gathered information on existing social networks, who they were responsible for. Survival rates were checked in 1985.
Findings: The 6 aspects of social network significantly linked with survival were: marital status, support from friends, contact with friends, total support, social network and employment.
Data from interviews showed that practical help such as childcare, cooking, and transport to hospital was the concrete aspect of support.
Conclusion: The more social networks and support, the higher the survival rate of women with breast cancer.
Waxler-Morrison - Evaluation
Usefulness: Social support can be seen as a useful method to manage stress as it has been proven to work. For example, Waxler-Morrisons study into social networks and breast caner survival rates highlighted 6 key areas of social support that were linked with breast cancer survival. These included, marital status and contact and support with friends.
Nature vs. Nurture: Supports the nurture side of the argument as it focuses on the environment (individuals around you) as a means to reduce stress.
Psychology as a Science: Social support does not support Psychology as a Science as it uses the self-report method to collect data from individuals. This lacks validity as social desirability may occur.
Exam Questions on Stress
(a) Describe one piece of research which considers work as a source of stress. (10)
(b) Discuss problems of conducting research into the causes of stress. (15)
(a) Outline one piece of evidence which suggests that stress can be caused by hassles and/or life events. (10)
(b) Evaluate the reliability of methods measuring stress. (15)
(a) Describe one physiological measure of stress. (10)
(b) Assess the validity of different methods of measuring stress. (15)
(a) Describe self-report as a method of measuring stress. (10)
(b) Compare different measures of stress. (15)
(a) Outline a cognitive technique for managing stress. (10)
(b) Compare techniques for managing stress. (10)
Categorising Disorders - DSM/ICD
The DSM manual is published by the American Psychiatric Association and is a multi-axial diagnostic system. The DSM considers a wide variety of factors when diagnosing a disorder, these include physical health of the individual, social and environmental problems. The DSM features 5 main categories of behaviour and illnesses, these include: major clinical syndromes (schizophrenia, mood disorders) and general medical conditions.
The ICD is published by the World Health Organisation and is used throughout the world for diagnosing mental and physical health. Each disorder in the ICD has a description of the main features, and any important associated features. It also indicates how many of each features are required to make an accurate diagnosis.
Evaluation of Categorising Disorders - DSM/ICD
Advantages of Categorising Disorders
- Platform for discussion of new developments in illnesses.
- Highly objective, more than 1000 specialised individuals gathered to compile the DSM.
- Regularly reviewed and updated giving a forum for psychiatrists to come together to discuss and share new issues or problems as they arise.
Disadvantages of Categorising Disorders
- Ethnocentric - some illnesses might be looked upon differently in different cultures, developed in western cultures.
- Open to clinician bias which makes categorising disorders less valid.
- There is a wide range of individual differences in mental health and each case may be different.
Definitions of Dysfunctional Behaviour - Rosenhan
Statistical Infrequency - A behaviour is classified as abnormal if it is rare and not often seen in society.
Deviations from Social Norms - A person's behaviour is classified as abnormal if it violates the unwritten rules about what is acceptable or expected in a particular social group.
Failure to Function Adequately - A person is considered abnormal if they are unable to cope with the demands of everyday life and live independently in society.
Deviation from Ideal Mental Health - Rather than defining what is dysfunctional, we define what is normal/ideal and anything that deviates from this is regarded as dysfunctional. Jahonda (1958) identified 6 characteristics, including: resistant to stress, a positive view of one's self and being able to adapt to your environment.
Definitions of Dysfunctional Behaviour - Evalu.
- Does not consider the desirability of behaviours, eg. high intelligence.
- Some behaviours are regarded as abnormal even though they are quite frequent, i.e depression.
Deviation from Social Norms
- Social norms change between cultures and over time. Consequently so do people's assumptions of abnormality, i.e. homosexuality.
Failure to Function Adequately
- Difficult to define what 'functioning' is an 'adequately' as some behaviours can cause failure to function are not seen as necessarily bad.
- Most people fail to function adequately at some time , but are not considered 'abnormal', i.e bereavement.
Deviation from Ideal Mental Health
- Jahoda's ideal mental health image is heavily based on western cultures.
- The boundaries that stipulate what 'ideal mental health' is are not clearly defined.
Biases in Diagnosis - Ford & Widiger
Aim: To find out if clinicians were stereotyping genders when diagnosing disorder.
Participants: 354 clinical psychologists selected randomly from the national register.
Procedure: Participants were randomly provided with one of nine scenarios and then asked to make a diagnosis.
- Case studies of patients with antisocial personality disorder (ASPD) or histrionic personality disorder (HSP) or an equal balance of symptoms were given to each clinician.
- The clinicians were told that the patients was either male, female or the gender was unspecified.
- They had to make a diagnosis and rate it on a 7 point scale the extent to which they displayed various different disorders.
Results: Borderline personality disorder was the diagnosis made most often across all three case studies when sex was unspecified. ASPD was diagnosed correctly 42% of the time in males but only 15% of the time in females. Females with ASPD were misdiagnosed with histrionic personality disorder 46% but males only 15% of the time.
Ford and Widiger - Evaluation
Usefulness: Ford and Widiger's study can be considered useful as it highlighted biases in diagnosis.
Ecological Validity: Only case studies were given to the clinical psychologists in Ford and Widiger's study. Low in ecological validity as under normal circumstances psychologists would meet patients face to face in order to diagnose illnesses.
Deterministic: Biases in diagnosis regarding gender can be considered to be deterministic as, in some cases, your illness has already been diagnosed because of your gender.
Individual: The individuals gender has a direct influence on the diagnosis given.
Explanations of Dysfunctional Behaviour
Behavioural Explanation - Watson & Raynor
Aim: To investigate whether a human baby could develop a fear it did not have previously.
Participants: A young child named 'Little Albert', a nurse's child at a local children's home.
- 'Little Albert' was presented with a white rat at 11 months old and initially showed no fear and reached out to the rat. At this point researches struck a metal bar above his head making a loud noise, 'Albert' jumped at the noise.
- He reached out to the rat and the researcher struck the metal bar once again.
- This was repeated a number of times.
- He demonstrated various degrees of fear response and negativity when presented with a range of furry stimuli such as a rabbit and a fur coat.
- The results after one week demonstrated that 'Little Albert' had acquired a fear of rats as a learnt emotional response.
Conclusion: The researchers concluded that it is possible to classically condition the emotional response of fear. However as 'Little Albert' has removed from the study, there was no means to determine whether his fear of rats diminished over time.
Watson and Raynor - Evaluation
Ethics: Protection from harm was broken as Albert was not protected from psychological or physical harm that may have occurred during the study. However consent from his mother was gained.
Psychology as a Science: Supports this debate as a laboratory experiment was used in Watson and Raynor's study where observable behaviour was observed.
Reductionist: Doesn't take into account individual differences, the behaviourist approach assumes that every individual responds in the same way to conditioning.
Biological Explanation - Gottesman and Shields
Aim: To review research done on whether schizophrenia is passed on genetically or not.
Participants: 711 different participants from adoption studies. 210 identical (MZ) and 319 non-identical (DZ) twins in the twin studies.
Method: A review of adoption and twin studies into schizophrenia between 1967 and 1976.
Procedure: The occurrence of schizophrenia in adopted and MZ twins was obtained from the research. This was done by comparing biological parents and siblings and adoptive parents and siblings in the adoption studies.
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 showed little evidence of schizophrenia.
All twin studies found a higher concordance rate for schizophrenia in MZ twins than in DZ twins. In Gottesman and Shield's own study in 1972, concordance rates were 58% in MZ twins meaning if one twin had schizophrenia, there was a 58% chance the other twin would have it, compared with a 12% concordance rate in DZ twins.
Conclusion: There is a significant genetic input into the onset of schizophrenia, but with concordance rates of less than 100% there must some interaction with the environment involved.
Gottesman and Shields - Evaluation
Review: Gottesman and Shield's study reviewed previous research intro adoption and twin studies into schizophrenia. Since these studies had been conducted by different researchers under different conditions, it is difficult to determine whether they are high in validity, reliability, ecological validity etc.
Nature vs. Nurture: Supports the nature side of the debate as Gottesman and Shields assume that schizophrenia is an illness that is passed on genetically.
Psychology as a Science: Quantitative data was obtained in Gottesman and Shields's study. This allows for statistical comparisons to be made between two or more sets of data.
Reductionism: The biological explanation for dysfunctional behaviour can be seen as being reductionist as it only takes biological factors into account as be responsible for dysfunctional behaviour. However Gottesman and Shields did conclude that environmental factors must have had an influence on the development of schizophrenia in their study as MZ twins did not have a concordance rate of 100% when the other twin had schizophrenia.
Cognitive Explanation - Beck
Aim: To understand cognitive distortions in patients with depression.
Methodology: Clinical interviews with patients who were undergoing therapy for depression.
Participants: 50 patients diagnosed with depression, most were judged to be middle or upper class.
Procedure: Face-to-face interviews with retrospective reports of patients' thoughts before the session as well as spontaneous reports of thoughts during the session.
Records were kept of the non-depressed patients' verbalisations to compare with those of the depressed patients.
Findings: Certain themes appeared in the depressed patients that did not appear in the non-depressed patients. These were low self-esteem, self-blame and anxiety. Depressed patients also regarded themselves as inferior to others in their social or occupational groups, for example: less attractive, less intelligent, less successful as a parent.
Conclusion: Even in mild depression, patients have cognitive distortions that deviate from realistic and logical thinking.
Beck - Evaluation
Validity: The findings of Beck's study lack validity as we can only infer what individuals are thinking.
Usefulness: Beck's study can be considered to be useful as he identified a number of symptoms that depression sufferers display. This could aid the diagnosis of depression in the future.
Self-report: Social desirability may have occurred which reduces the overall validity of the study, however self-report allows us to gather participants own opinions and thoughts.
Treatments of Dysfunctional Behaviour
Behavioural Treatment - McGrath
Aim: To treat a girl with specific noise phobias using systematic desensitisation.
Participants: A 9 year old girl with a fear of sudden noises, i.e party poppers. She had a lower than average I.Q, however she had no other psychological problems.
Procedure: 'Lucy' was brought to therapy sessions and constructed a hierarchy of noises that she feared. She was taught breathing techniques and had a hypothetical fear thermometer to rate her level of fear from 1-10.
- 1st session - She cried and had to be taken home when a balloon was popped.
- 5th Session - She was now able to pop the balloon herself and use a cap gun.
- 10th Session - 'Lucy's' fear ratings on her hypothetical fear thermometer was significantly less by the tenth session than they were at the start of the systematic desensitization.
Conclusion: McGrath concluded that noise phobias in children are able to be managed through systematic desensitisation.
McGrath - Evaluation
Usefulness: The behavioural treatment of dysfunctional behaviour can be seen as being useful as it has been proven to work as McGrath's study provides evidence for this. Through systematic desensitization, 'Lucy' was able to dramatically reduce her fear reaction to previously phobic responses.
Cost effective: Behavioural treatment can also be considered to be cost effective to conduct as no equipment is needed, such as feedback machines or ECG monitoring equipment.
Reductionist: The behavioural treatment of dysfunctional behaviour can be seen as being reductionist as it only seeks to reduce the stress, however it doesn't deal with the cause of the stress in the first place.
Sample: Only one participant was used in McGrath's study. Results can't be generalised to the wider population.
Biological Treatment - Leibowitz
Aim: To see if the drug phenelzine can help treat patients with social phobia.
Methodology: A controlled experiment - participants were treated over 8 weeks. They were assed on social phobia through several rating scales.
Participants: 80 participants aged 18-50 years old, meeting DSM criteria for social phobia.
Procedure: Participants were randomly allocated to 1 of 4 groups. One was given phenelzine and the other given a matching placebo. The other groups were given either atenolol or an atenolol placebo.
Findings: After 8 weeks of treatment, significant differences were noted for the phenelzine groups as they had reported lower levels of anxiety than the placebo group.
Conclusion: Phenelzine is effective in treating social phobia.
Leibowitz - Evaluation
Usefulness: One of the benefits of the biological treatments to dysfunctional behaviour is that treatments work almost instantaneously. For example pills taken may begin to have an effect immediately whilst other treatments such as systematic desensitisation take a while for their effects to be felt.
However it can also be argued that the biological apprach has limited used in treating dysfunctional behaviour as they only offer short term release from symptoms as they do nothing to attack the underlying problem.
Cognitive Treatment (CBT) - Ost and Westling
Aim: To compare cognitive behavioural therapy (CBT) with applied relaxation as therapies for panic disorder.
Method: Longitudinal study, participants randomly assigned to applied relaxation or CBT.
Participants: 38 participants with DSM diagnosis of panic disorder. Recruited through newspaper advertisements and psychiatrist referrals.
Procedure: Baseline assessments of panic attacks were taken through questionnaires. Patients also kept a record of every panic attack they had. Each patient was then given 12 weeks of treatment. CBT was used to identify the misinterpretation of physical symptoms and then to generate an alternative cognition in response. Applied relaxation focused on muscle relaxation training.
Findings: Applied relaxation showed that 82% of patients were panic free after one year whilst CBT showed that 89% of patients were stress free after one year. These differences were not significant.
Conclusion: Both CBT and applied relation worked at reducing panic attacks.
Ost and Westling - Evaluation
Usefulness: CBT is becoming increasingly popular as has proved successful in tackling a wide variety of dysfunctional behaviour. It can be seen as being useful as it has been proven that changing faulty cognitions allows individuals to address dysfunctional behaviour.
Reductionism: Can be considered to be reductionist as it only considered faulty cognitions as being responsible for dysfunctional behaviour. Furthermore, it doesn't deal with the root cause of the behaviour, it just enables individuals to restructure their cognitions to avoid such behaviours.