Clinical and Health Psychology<br />Disorders<br />
Make a list of as many mental disorders as you can think of.<br />Eg Multiple personality disorder<br />        Post traum...
Read the syllabus requirements in the booklet you have been given + the first column on p122 in your textbook<br />Set up ...
Categories of Disorders<br />
Neurotic disorders such as phobias or depression affect 1:6 in the population<br />The stimulus  e.g. snakes or buttons wi...
Definition of a Phobia<br />
DSM-IV<br />Marked or persistent fear that is excessive or unreasonable<br />Exposure to phobic stimulus provokes immediat...
<ul><li>Estimated that 11m people suffer from a mood disorder with depression affecting around 1 in 20 people.
Distinction between reactive and endogenous depression
Mood change – usually to depression but sometimes to elation
Bipolar disorder – moods fluctuate between </li></ul>  depressive episodes and manic episodes<br /><ul><li>Dysthymia – chr...
SAD ( seasonal affective disorder) depression experienced in winter</li></ul>An Affective Disorder - Depression<br />
DSM IV (single episode depression)<br />5 + of the following:<br /><ul><li>Insomnia most nights
Fidgeting or lethargy
Tiredness
Feelings of worthlessness or guilt
Reduced ability to concentrate
Recurrent thoughts of death</li></ul>ICD – 10<br /><ul><li>Depressed Mood
Loss of interest and enjoyment
Reduced energy</li></ul>Other common symptoms include:<br />Marked tiredness after only slight effort<br />Reduced self es...
<ul><li>Psychosis general term for disorders characterised by a loss of contact with reality
Sufferers become more confused and disorientated and withdraw from outside world
Research shows a link between drug use and schizophrenia ( Moore et al 2007)
Schizophrenia has positive and negative symptoms. Positive symptoms include: delusions, auditory hallucinations and though...
<ul><li>Affects an estimated 1 m people in the UK or 1 in a 100.
Usually appears in the teenage years
Men have the highest risk before 25, women have the highest risk after 25</li></ul>A Psychotic Disorder Schizophrenia<br />
Schizophrenia - Characteristics<br />DSM IV<br />2 + of the following:<br /><ul><li>Delusions
Hallucinations
Disorganised speech
Disorganised behaviour
Negative symptoms</li></ul>Plus<br /><ul><li>Social Occupation dysfunction
At least 6 months duration
No other explanation for symptoms</li></ul>ICD 10<br /><ul><li>Thought echo, thought insertion or withdrawal or broadcasting
Delusions of control
Hallucinatory voices
Persistent delusions or hallucinations
Incoherent speech
Catatonic behaviour
Negative symptoms such as marked apathy
Reduction in overall quality of some aspects of personal behaviour,.</li></li></ul><li>Find the similarities and differenc...
Behavioural Explanations <br />Behaviourists argue that abnormal behaviour is<br />learnt in the same way that all behavio...
Classical Conditioning can explain the development of phobias:<br />
Watson and Raynor conditioned an 11 month old<br />child Albert to have a phobia of white rats by<br />pairing playing wit...
Operant conditioning is learning from the<br />consequences of actions.<br />Actions which have a good outcome through pos...
Positive Reinforcement<br />  If someone is rewarded for showing a phobic reaction this could perpetrate the behaviour. E....
There are 4 elements to SLT<br />Observation of behaviour<br />Imitation of observed behaviour<br />The people we are most...
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  1. 1. Clinical and Health Psychology<br />Disorders<br />
  2. 2. Make a list of as many mental disorders as you can think of.<br />Eg Multiple personality disorder<br /> Post traumatic stress disorder<br />Look at the “Pause for thought” on p122 of the A2 textbook. Think about your response to that question<br />Disorders - starter<br />
  3. 3. Read the syllabus requirements in the booklet you have been given + the first column on p122 in your textbook<br />Set up a spider diagram on A4 or A3 paper to plot this topic.<br />Syllabus Requirements<br />
  4. 4. Categories of Disorders<br />
  5. 5. Neurotic disorders such as phobias or depression affect 1:6 in the population<br />The stimulus e.g. snakes or buttons will provoke a panic attack<br />The person realises that this fear is irrational<br />The fear may result in the person’s everyday life being disrupted, for example not being able to wear clothes with buttons or taking a long route to avoid the advertising hoarding with the picture of the snake on it.<br />An Anxiety Disorder - Phobias<br />
  6. 6. Definition of a Phobia<br />
  7. 7. DSM-IV<br />Marked or persistent fear that is excessive or unreasonable<br />Exposure to phobic stimulus provokes immediate anxiety response<br />The person recognises the fear as excessive<br />The phobic situation is avoided<br />The phobia disrupts the person’s everyday life<br />The phobia has lasted more than 6 months in a person under 18<br />ICD -10<br />The anxiety must manifest itself in psychological or physiological symptoms and not be linked to delusions<br />The anxiety must be restricted to the presence of a particular object or situation<br />The phobic situation is avoided wherever possible<br />Phobias - Characteristics<br />
  8. 8. <ul><li>Estimated that 11m people suffer from a mood disorder with depression affecting around 1 in 20 people.
  9. 9. Distinction between reactive and endogenous depression
  10. 10. Mood change – usually to depression but sometimes to elation
  11. 11. Bipolar disorder – moods fluctuate between </li></ul> depressive episodes and manic episodes<br /><ul><li>Dysthymia – chronic depression
  12. 12. SAD ( seasonal affective disorder) depression experienced in winter</li></ul>An Affective Disorder - Depression<br />
  13. 13. DSM IV (single episode depression)<br />5 + of the following:<br /><ul><li>Insomnia most nights
  14. 14. Fidgeting or lethargy
  15. 15. Tiredness
  16. 16. Feelings of worthlessness or guilt
  17. 17. Reduced ability to concentrate
  18. 18. Recurrent thoughts of death</li></ul>ICD – 10<br /><ul><li>Depressed Mood
  19. 19. Loss of interest and enjoyment
  20. 20. Reduced energy</li></ul>Other common symptoms include:<br />Marked tiredness after only slight effort<br />Reduced self esteem and confidence<br />Pessimistic view of future<br />Ideas of self harm or suicide<br />Reduced appetite<br />Disturbed sleep<br />Depression - Characteristics<br />
  21. 21. <ul><li>Psychosis general term for disorders characterised by a loss of contact with reality
  22. 22. Sufferers become more confused and disorientated and withdraw from outside world
  23. 23. Research shows a link between drug use and schizophrenia ( Moore et al 2007)
  24. 24. Schizophrenia has positive and negative symptoms. Positive symptoms include: delusions, auditory hallucinations and thought disorder. Negative symptoms include the loss of motivation, emotional response and pleasure</li></ul>A Psychotic Disorder - Schizophrenia<br />
  25. 25. <ul><li>Affects an estimated 1 m people in the UK or 1 in a 100.
  26. 26. Usually appears in the teenage years
  27. 27. Men have the highest risk before 25, women have the highest risk after 25</li></ul>A Psychotic Disorder Schizophrenia<br />
  28. 28. Schizophrenia - Characteristics<br />DSM IV<br />2 + of the following:<br /><ul><li>Delusions
  29. 29. Hallucinations
  30. 30. Disorganised speech
  31. 31. Disorganised behaviour
  32. 32. Negative symptoms</li></ul>Plus<br /><ul><li>Social Occupation dysfunction
  33. 33. At least 6 months duration
  34. 34. No other explanation for symptoms</li></ul>ICD 10<br /><ul><li>Thought echo, thought insertion or withdrawal or broadcasting
  35. 35. Delusions of control
  36. 36. Hallucinatory voices
  37. 37. Persistent delusions or hallucinations
  38. 38. Incoherent speech
  39. 39. Catatonic behaviour
  40. 40. Negative symptoms such as marked apathy
  41. 41. Reduction in overall quality of some aspects of personal behaviour,.</li></li></ul><li>Find the similarities and differences between the following:<br />Similarities and Differences<br />
  42. 42. Behavioural Explanations <br />Behaviourists argue that abnormal behaviour is<br />learnt in the same way that all behaviour is learnt <br />There are 3 learning theories that provide us with<br />explanations for phobias:<br />Classical conditioning<br />Operant conditioning <br />Social Learning theory<br />These may operate alone or in conjunction with each<br />other to explain the development of a phobia<br />Explanations for an Anxiety Disorder – Phobias<br />
  43. 43. Classical Conditioning can explain the development of phobias:<br />
  44. 44. Watson and Raynor conditioned an 11 month old<br />child Albert to have a phobia of white rats by<br />pairing playing with the rat with a loud noise ( a<br />metal sheet being hit by a hammer). Albert then<br />generalised this fear to other white fluffy<br />objects such as a rabbit’s tail and Father Xmas’<br />Beard.<br />Watson and Raynor (1920) – Little Albert and the White Rat<br />
  45. 45. Operant conditioning is learning from the<br />consequences of actions.<br />Actions which have a good outcome through positive reinforcement (reward),will be repeated<br />Actions where there is negative reinforcement (the removal of something bad), will be repeated<br />Actions where there is no reinforcement tend to die out or be extinguished<br />Operant Conditioning - Skinner<br />
  46. 46. Positive Reinforcement<br /> If someone is rewarded for showing a phobic reaction this could perpetrate the behaviour. E.g. A child who is frightened by a barking dog may get cuddles from their parents and continues with this response every time they see a dog. The pattern of behaviour becomes entrenched and is by definition unreasonable<br />Negative reinforcement<br /> When we get anxious around phobic stimuli heights, needles etc we avoid them. This prevents the anxiety and acts as negative reinforcement. Again the behaviour becomes entrenched.<br />Operant Conditioning and Phobias<br />
  47. 47. There are 4 elements to SLT<br />Observation of behaviour<br />Imitation of observed behaviour<br />The people we are most likely to copy are similar to us and/or powerful and influential.<br /> People of the same sex, parents, siblings, peers and celebrities are the most influential role models<br />The behaviour we observe and imitate has to be reinforced.<br />Social Learning Theory – Bandura (Bobo Doll experiments)<br />
  48. 48. If a child sees their mother being frightened of injections, they are likely to copy that fear response. If they then get rewarded with cuddles and a fuss this will reinforce the fear response.<br />Bandura and Rosenthal (1966) found that p’s would develop a fear reaction to a buzzer if they witnessed someone showing pain when the buzzer sounded. The research was carried out using confederates who pretended to be shocked at the sound of the buzzer.<br />SLT - Phobias<br />
  49. 49. Strengths<br /><ul><li>It is scientific with testable concepts.
  50. 50. It is supported by empirical evidence such as Little Albert and the Bandura study
  51. 51. If behaviour is learned it can be unlearned and therefore anxiety disorders are treatable</li></ul>Limitations<br /><ul><li>It is reductionist because it ignores both the influence of cognition (thinking) and biology
  52. 52. There are some aspects of anxiety disorders that cannot be explained by learning theory, such as individual differences in susceptibility to acquiring disorders
  53. 53. There are ethical issues in both studies such as Little Albert and in treatments such as aversion therapy</li></ul>Strengths and limitations of the behavioural explanation<br />
  54. 54. 2. Biological Explanations<br />There is no doubt that some of the symptoms of<br />anxiety disorders such as increased heart rate<br />and blood pressure are biological.<br />There is also some evidence that there are both<br />evolutionary and genetic explanations for anxiety<br />disorders.<br />Explanations for an Anxiety Disorder – Phobias<br />
  55. 55. The evolutionary argument proposes that we have a biological preparedness which allows us to acquire phobias of some things such as snakes, spiders, heights more readily than others<br />Evolutionary theory suggests that behaviours that aid survival tend to evolve over time as people with this behaviour in their genes survive and those without die out.<br />People who have a phobic response to something dangerous, such as snakes, are more likely to avoid them and therefore survive to pass on their genes<br />Evolutionary explanations for phobias<br />
  56. 56. Ohman et al <br />Wanted to see if phobias of snakes could be more easily conditioned than phobias of faces/houses<br />Lab experiment<br />Results showed p’s were more likely to show fear reactions to snakes supporting the theory of biological preparedness<br />Bennet-Levy & Martineau<br />Investigated what characteristics of animals humans are predisposed to fear<br />Correlation using self -report rating scales<br />One scale rated fear of various animals<br /> One scale rated 4 characteristics: ugliness, sliminess, speediness and how suddenly the animal moved<br />Results showed a correlation between the 4 characteristics and levels of fear supporting the idea of biological preparedness<br />Evidence for Biological Preparedness<br />
  57. 57. Twin studies<br />Skyre et al (2000) studied concordance rates in 23 pairs mz and 38 pairs same sex dz twins<br />Identical twins more likely to share phobias<br />This effect was greater for agoraphobia<br />-Twin studies usually involve small samples<br />Family Studies<br />Harris et al (1983) found that where there was a mother/father/sibling with agoraphobia the risk of illness was twice that of the control group<br />Solyam et al (1974) found that 31% of phobics had a mother who suffered some kind of phobia and 55% had mothers and 24% had fathers with other anxiety disorders.<br />- Problems in families could be a result of SLT<br />Evidence from Twin and Family studies<br />
  58. 58. Strengths<br /><ul><li>Evidence from twin & family studies as well as other research, supports this explanation
  59. 59. This explanation is ethical because people are not blamed for their disorder
  60. 60. Biological therapies can help to relieve the fear response</li></ul>Limitations<br /><ul><li>Biological explanations are reductionist, focusing only on the role of nature
  61. 61. Biological explanations are deterministic, phobic responses are determined by our genes
  62. 62. Biological therapies raise ethical concerns. Drugs can only suppress symptoms rather than cure the disorder and may cause addiction
  63. 63. Psychological therapies can be just as effective as biological treatments</li></ul>Strengths and limitations of biological explanations<br />
  64. 64. 3. Cognitive Explanations<br />The cognitive explanation suggests that<br /> anxiety disorders are caused by maladaptive thinking<br />Cognitive explanations can address some of the<br /> limitations of behavioural explanations, for<br /> instance why some people are more susceptible<br /> to acquiring anxiety disorders than others<br />Eysenck (1992) has suggested that people with anxiety disorders suffer from attentional bias <br />(the tendency to attend more than most people to threatening stimuli)<br />Explanations for an Anxiety Disorder – Phobias<br />
  65. 65. Bradley et al (1999)<br />Tested the idea of attentional bias<br />Lab experiment<br />Exposed 14 GAD sufferers and 33 control ps to slides of happy or threatening faces<br />Results showed the GAD group responded with greater vigilance to all the faces<br />DiNardo<br />Tested whether excessive worry is a symptom of GAD<br />Quasi experiment<br />The frequency of the symptom “excessive worry” was measured and correlated with the % of the time the p experienced it<br />Excessive worry indicating attentional bias was more common in the GAD patients<br />Evidence for the Cognitive Explanation<br />
  66. 66. Strengths<br />Is useful because it considers the role of thoughts and beliefs<br />Links to the behavioural explanation in assuming that anxiety is a learned response<br />Is supported by research evidence<br />Cognitive therapies are successful in treating anxiety disorders<br />Limitations<br />Reductionist because it fails to recognise the role of biology<br />Faulty cognition may be a consequence of the disorder rather than a cause<br />Strengths and limitations of cognitive explanations<br />
  67. 67. Read p128-9 “Treatments for an anxiety disorder – phobias” in your textbook and briefly summarise the arguments.<br />Treatments for phobias<br />
  68. 68. Behaviourists argue that if a phobia is learned behaviour then the treatment will consist of unlearning the behaviour<br />This is generally done by using classical conditioning. The phobic stimulus is paired with a stimulus which leads to a “no fear response”<br />Behavioural Treatments<br />
  69. 69. Technique was developed by Joseph Wolpe to treat individuals suffering from phobias involving excessive fear of certain stimuli (e.g. Snakes and spiders)<br />Stage one;<br /> Provide clients with relaxation training in which they learn how to engage in deep muscle relaxation.<br /> Systematic Desensitisation<br />
  70. 70. Stage two<br /> Clients construct a fear hierarchy with the assistance of their therapist.<br />A fear hierarchy consists of a list of situations/objects that produce fear in the client; starting with those that cause only a small amount of fear, and increasing to one that causes the most.<br />For example, if you have a phobia of spiders, you would start with a tiny spider 50 feet away, and increase the size whilst decreasing the distance.<br />Systematic Desensitisation contd.<br />
  71. 71. Arachnophobia- a fear hierarchy<br />
  72. 72. The patient imagines the least feared item and practices the relaxation technique until he/she feels no fear of it.<br />When the client can imagine the least feared items in the fear hierarchy staying relaxed and without experiencing fear, he/she moves onto the next item.<br />Eventually, the client can confront the most feared object or situation in the fear hierarchy without fear, at which point they are regarded as cured.<br />
  73. 73. Can you make your own fear hierarchy?<br />
  74. 74. McGrath – The treatment of a girl with a specific noise phobia.<br />Read the study p119<br />Make notes on the key evaluation points of the study<br />Key Study<br />McGrath<br />
  75. 75. Strengths<br />+The basic ingredients of systematic desensitisation (muscle relaxation; fear hierarchy; association of phobic stimuli with relaxation responses) can easily be manipulated to test success.<br />+ The evidence supports its effectiveness. The study by McGrath and other research shows that individuals treated with systematic de-sensitisation improved more than those receiving no treatment (Choy et al.)<br />Limitations<br />- Only relevant to anxiety disorders. Even within the anxiety disorders, it can only be used when the stimuli producing a client’s anxious state can be identified. It wouldn’t be effective to use systematic de-sensitisation with someone suffering from GAD, because that involves excessive worrying about numerous situations<br />- Many of the phobias treated are relatively trivial. They don’t have the crippling effects on everyday life of other mental disorders such as depression or schizophrenia. However, this is arguable.<br />Evaluation of Behavioural Treatments<br />
  76. 76. There are 3 main types of drugs used to treat phobias:<br /> <br />Tranquillisersare very effective at relieving anxiety, but can be addictive after only four weeks regular use. These drugs should be only used for short periods, perhaps to help during a crisis. They should not be used for longer-term treatment of anxiety.<br /> <br />Antidepressants can help to relieve anxiety as well as the depression for which they are usually prescribed. Some even seem to have a particular effect on individual types of anxiety. Can take 2 to 4 weeks to work and some can cause nausea, drowsiness, dizziness, dry mouth and constipation.<br />Beta blockers are usually used to treat high blood pressure.  In low doses, they control the physical shaking caused by anxiety Most commonly used for social phobia.<br />Biological Treatments for Phobias<br />
  77. 77. Leibowitz – To see if the drug phenelzine can help treat patients with social phobia<br />Read the study p129<br />Make notes on the key evaluation points of the study<br />Key Study<br />Leibowitz<br />
  78. 78. Strengths<br />Limitations<br />Evaluation of Biological Treatments<br />
  79. 79. Read p120 and make notes on<br />Ellis –the ABC approach<br />Beck et al – Comparing pharmacotherapy and cognitive therapy<br />Evaluate the study by Beck et al.<br />Cognitive Treatments<br />Beck<br />
  80. 80. Strengths<br />Limitations<br />Evaluation of Cognitive treatments<br />
  81. 81. Treatments- Similarities and Differences<br />
  82. 82. (a) Outline one explanation of an anxiety disorder of your choice. [10]<br />(b) Evaluate explanations of anxiety disorders. [15]<br />Sample Exam question<br />
  83. 83. Outline one explanation of an anxiety disorder of your choice.<br />This question asks for an explanation of an anxiety<br />disorder. It only requires one explanation i.e biological,<br />behaviourist, for one identified anxiety disorder e.g.<br />phobias, OCD, PTSD. <br />The explanation would apply the assumptions of the<br />approach to the disorder, showing the cause of the<br />disorder. For example biological explanations could<br />include genetic explanations for instance<br />preparedness. A behavioural explanation would<br />concentrate on the learning of the disorder, for instance<br />classical or operant conditioning .<br />Other psychological explanations including<br />cognitive (faulty thinking such as Ellis or Beck) or even<br />Psychodynamic unresolved conflicts such as Little Hans<br />and the unresolved oedipus complex- (although not on the<br />specification) would be appropriate.<br />For 9-10 marks <br />Correct and comprehensive use of psychological<br /> terminology. <br />Description of evidence is accurate, relevant, coherent and<br /> detailed. <br />Elaboration/use of example/quality of description is very good<br />The ability to interpret/explain the evidence selected in the context<br /> of the question is very good. <br />The answer is competently structured and organised. <br />Answer is mostly grammatically correct with occasional<br /> spelling errors. <br />Evaluate explanations of anxiety disorders.<br />This question requires strengths and weaknesses of at least<br />two explanations of anxiety disorders; behavioural, biological<br />and/or cognitive as mentioned on the spec. <br />The strengths and weaknesses could include; <br /><ul><li>empirical evidence in support
  84. 84. reductionism
  85. 85. determinism
  86. 86. effectiveness of treatments supporting original explanation
  87. 87. Also some comparisons/contrasts would also be creditworthy</li></ul>For 12-15 marks <br />Many evaluative points covering a range of issues. <br />The argument is competently organised, balanced and well developed.<br />The answer is explicitly related to the context of the question.<br />Effective use of examples.<br />Valid conclusions that effectively summarise issues <br />Argument is highly skilled and shows thorough understanding. <br />How to answer<br />
  88. 88. Choose one disorder from the list below and design a leaflet to be given out by a Youth Counselling service to inform young people about the characteristics of the disorder and the treatment available.<br />Anxiety disorders – phobias, OCD, PTSD<br />Affective disorders – depression, bipolar disorder, SAD<br />Psychotic disorders - schizophrenia<br />Disorders - Putting it all together<br />

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