Treatments for dysfunctional behaviour

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

Background: Fear loud noises is common in young children but for some it impacts on normal life. Lucy, the girl in this study, could not go to parties and school trips or anywhere where fireworks may go off.

Sample: Lucy was a 9 year old girl of loaw average intelligence (IQ 97). She showed as averagely depressed, fearful and anxious when she was tested and therefore it was felt her fear of noise was not part of a wider condition and could be treated.

Method: Systematic desensitisation was used and written up as a case study.

Procedure: Lucy was taught to relax and then she created a hierarchy of feared noises including doors banging, cap-guns popping, balloons bursting and unexpected explosions of party poppers. Imagining herself at home with her toys, on her bed and deep breathing was used to control her fear. She also used a fear thermometer, rating her from 1 to 10. As she was given the feared object, she paired it with the relaxation and imagery she had learn until she was calm.

Results: Balloon bursting was the first fear to be tackled and by the fourth session, Lucy could bear it being popped 10 metres away quite calmly. In the fifth session she was able to pop the balloon herself. The other feared objects were then introduced and by the tenth session her fear thermometer scores had dropped from 7/10 to 3/10 for balloon popping and fear of the cap-gun from 8/10 to 5/10.

Evaluation: Systematic desensitisation seems to be highly replicable with many different patients and condition. Giving the patient control over timing increased the effectiveness, which is interesting because it introduces a cognitive component to a behavioural theory. Free will vs. determinism could be used because this study suggests our conscious control can be used to treat fears and phobias. Reductionism could be explored because it reduces a phobia to a learned response. Psychology as a science - this could be a demonstration of a scientific approach to a treatment. A very useful treatment with many applications.

Aim: To compare drug treatment or therapy alone, with a combination of drugs and therapy for depression in women.

Background: Following the early enthusiasm for anti-depressants, many clinicians realised they did not alleviate all the symptoms of depression. One hypothesis is that adding therapy to a drug regimen will build a relationship which in turn would improve adherence to medication. Similarly, including the patients family helps patients to stay on the drugs long enough for them to work.

Sample: Various samples of women and men with depression from 1974 to 1992 who met the DSM criteria for a major depressive episode.

Method: A review of many studies which had mainly two conditions, either drug and placebo or therapy and placebo or therapy plus drugs. Some would have been matched pairs designs. 

Procedure: Depression was analysed using inventories such as the Beck Depression Inventory (BDI) and patients were tested before and after the treatment. Each study followed differing procedures depending on their focus, e.g. one study looked at life events using the Bedford College Life Events and Difficulties Schedule (LEDS).

Results: Very little evidence was found to support the effectiveness of combination therapy over either therapy or drug therapy alone for women patients. Some evidence would seem to support the ideaa that seeing a therapist reguarly helps both men and women stick to their medication. Women planning pregnancies should use therapy alone as this was as effective as drugs.

Evaluation: A huge amount of data is evaluated but all from differing methodologies and scales so it is hard to determine reliability. People become depressed for many different reasons and so the routes to recovery are likely to be qually as varied. Individual vs. situational explanations of behaviour - are some people more likely to have depression because of their personalities or is it caused by environmental influences. Ethnocentrism - is this a disease of developed countries? Is our tendency to label it as an illness correct? Not particularly useful because it is not conclusive, although failure to find differences between men and women might reduce stereotyping women as neurotic.

Aim: To test whether patients with bipolar affective disorder could be helped with cognitive therapy (CT) to prevent relapses. 

Background: Beck's cognitive therapy (CT) seeks to help the patient overcome difficulties by identifying and changing dysfunctional thinking, behaviour and emotional responses. Therapy may consist of testing the assumptions which one makes and identifying how certain of one's usually unquestioned thoughts are disorted, unrealistic and unhelpful. Beck initially focused on depression and developed a list of 'errors' in thinking that he propsed could maintain depression, including exaggerating megatives and minimising of positives.

Sample: 103 patients with Bipolar 1 disorder according to DSM-IV, who experienced frequent relapses despite using mood stablisers, were invited to take part. They were averagely affected by their illness with no extreme sufferers in the sample.

Method: A single- blind randomised controlled study with an independant measures design.

Procedure: Patients were randomised into a CT group or control group by computor program. Both the control and CT groups received mood stabilisers and regular psychiatric follow-up. Also, the CT group received an average of 14 sessions of CT during the first 6 months and two booster sessions in the second 6 months. Independant assessors, blind to the conditions, assessed the patients at 6month intervals against the DSM-IV criteria for a relapse, and monthly for depression scores, and quesionnaires about levels of social functioning.

Results: During the 12 month program, the CT group had significantly fewer bipolar episodes, days in a bipolar episode and number of admissions for this type of episode. The CT group also had significantly higher social functioning. During these 12 months, the CT group showed fewer mood symptoms on the monthly mood questionnaires. Furthermore, there was significantly less fluctuation in manic symptoms in the CT group. The CT group also coped better with the manic prodromes (early warning of an episode) at 12 months.

Evaluation: There was no control fro the amount of attention received by the CT group or medication prescribed, or any control over sleep routines. This was a well-conducted study, free from experimenter bias in its analysis. Freewill vs. determinism - this study raises the question that if a patient can use cognitive control to improve symptoms, does that mean that mental illnesses are always under our control? This study shows that psychology can be scientific in the way the research is conducted. The study shows a clear benefit for using CT with pharmacotherapy with moderately affected patients suffering from bipolar disorder.