Paper 2: Abnormal Psychology

Psychology IB paper 2 abnormal SL/HL. APFC stands for Aims, Procedure, Findings and Conclusion.

What defines a mental disorder?

A clinically significant disturbance in an individual’s cognition, emotional regulation, and behaviour. It is usually associated with impairment in important areas of functioning and emotional distress.

Give two examples of diagnostic manuals used to classify mental disorders.

Diagnostic and Standard Manual of Mental Disorders (DSM) and International Classification of Disease (ICM)

What are the symptoms of OCD?

Obsessions- persistent, unwanted and distressing (intrusive) thoughts. Could relate to cleanliness, morality, bad things happening to self/family/friends.

Compulsions- rituals that people feel obligated to carry out to provide temporary relief from the obsessions. This could include cleaning, checking, reciting, tapping a number of times, etc.

What statistics can be used in an essay introduction about OCD?

OCD affects around 1.2% of adults in the UK

What are two tools used for diagnosing OCD?

Y-BOCS and MOCI

Y-BOCS

The Yale-Brown Obsessive Compulsive Scale (completed by a clinician)

MOCI

The Maudsley Obsessive-Compulsive Inventory (collects self report data)

What is the “worry circuit“

A neural network connecting the orbitofrontal cortex and the caudate nucleus (part of the basal ganglia). This region sends impulses to the thalamus which triggers further thinking about these impulses. The pathways are rich in serotonin receptors. It is thought that people with OCD have less serotonin than healthy people.

What is the role of serotonin and how do serotonin levels differ in people with OCD compared to healthy people?

Serotonin is a mood-stabilising “happy“ neurotransmitter. It has roles in happiness, sexual behaviour, hunger, sleep and regulation of body temperature.

People with OCD have depleted levels of serotonin in their brain.

Give two biological treatments for OCD

SSRI medication and electroconvulsive therapy. (nb. can also use SARI medication)

How do SSRIs work?

Selective Serotonin Reuptake inhibitors block the transporter molecules or ‘pumps‘ on the presynaptic cell membrane, meaning that there is more serotonin available in the synapse ready to bind to receptors on the postsynaptic cell.

Give an example of an SSRI

Fluoxetine (ie Prozac)

Positives of SSRIs (crit thinking):

They are effective after a couple of weeks.

Writing/receiving a prescription and taking a drug is minimally invasive and takes up less of the clinician and patient’s time than therapy.

Negatives of SSRIs (crit thinking):

Reported side-effects of SSRIs include nausea, shakiness, feelings of anxiety, stomach aches and indigestion (according to the NHS).

Tolerance can be built up, meaning that dosages must be increased over time.

The patient may become dependant.

They don’t address situational causes of OCD.

What is the study for SSRIs

Issari et al (2016)

Issari et al (2016) APFC:

A: Provide evidence to support the use of SSRIs in OCD treatment.

P: meta-analysis of 17 randomised placebo-controlled trials including over 3000 participants.

F: After just 2 weeks, Y-BOCS scores were significantly lower for the SSRI group than the placebo group.

C: Positive gains are seen early on in SSRI treatment. This was surprising as previous research suggested they take effect more slowly.

Issari et al (2016) critical thinking:

• Were the effects longer lasting?

• If the effects lasted longer, how was dosage changed?

• Placebo was used, and large sample size- pos!

• Although SSRIs have been shown to be effective for some, at least 30% of patients showed no significant improvement

How does electroconvulsive therapy work?

An electric current is sent through the brain, causing a brief surge of electrical activity known as a seizure (under general anaesthetic)

Positives of electroconvulsive therapy (crit thinking):

It has shown to be effective as a last-ditch attempt at a cure where other first-line treatments such as drugs and talking therapies have failed (see Wang et al study)

Negatives of electroconvulsive therapy (crit thinking):

• It was used unethically during the 1950s-70s without anaesthetic on non-consenting patients

• It may have a side effect of short-term memory loss

• Fears about ECT have been reinforced through its portrayal in media

• Scientists are still unsure how it actually operates, some professionals say it should not be used

What is the study for electroconvulsive therapy?

Wang et al (2014)

Which research method is used by Wang et al (2014)?

Case study

Wang et al (2014) APFC:

A: To investigate the effectiveness of ECT for severe OCD

P: Researchers investigated the courses, effects and after- information about 3 ECT patients (who had received 8, 3 and 4 courses respectively).

F: In all cases the patients’ OCD and depression symptoms improved and remained stable at regular follow-ups

C: ECT may play an effective role at treating severe OCD

Wang et al (2014) critical thinking:

• Very small sample size

• Only applicable to severe cases

What are two psychological treatments for OCD?

CBM therapy and ERP therapy

What is ERP therapy?

Exposure Response Prevention: a clinician draws up a hierarchy of the patient’s fears and gradually exposes them to each fear in a controlled setting, moving up the hierarchy until the fear is eradicated or lessened. It’s similar to systematic desensitization, a treatment plan for people with phobias.

What is CBM therapy?

Cognitive Bias Modification targets attentional biases (OCD patients’ tendency to pay more attention to stressful stimuli) and interpretational biases (tendency to interpret ambiguous stimuli in a negative light) by ‘training‘ OCD patients to fill in gaps with positive words, cuing them to anticipate positive outcomes from situations

What studies can be used for psychological treatments for OCD?

ERP: Eddy et al (2004), CBM: Williams and Grisham (2013)

Which study can be used in an essay about ERP therapy?

Eddy et al (2004)

Which study can be used as supporting research for the benefits of self-directed ERP?

Amir (2015)

What were the findings of Amir’s study?

All completers of a 7-week sERP course significantly reduced their Y-BOCS scores from an average of 29/40 to 15.5/40

Eddy et al (2004) APFC:

A: To investigate the effectiveness of ERP on OCD.

P: A meta-analysis

F: ERP led to a clinically significant improvement for about 68.8% of patients who completed the programme, compared with 56.6% Cognitive Therapy (CT) patients who made a comparable level of improvement. However, CT had a higher recovery rate of 49.8% compared with 38.2% for ERP.

C: ERP was deemed most effective at reducing symptoms, but CT patients were more likely to make a full recovery.

What research method was used by Eddy (2004)?

Meta-analysis (nb you CANNOT use this in a research methods question)

Eddy et al (2004) critical thinking:

What study can be used in an essay about CBM therapy?

Williams and Grisham (2013)

Williams and Grisham (2013) AP:

A: To investigate the effectiveness of CBM on OCD

P: A volunteer sample of 89 adults with O/C symptoms did a task that involved imagining themselves in 164 situations targeting OCD core beliefs. They completed a self-report questionnaire measuring the severity of their symptoms. Then participants in the positive condition, all scenarios had positive endings while in the control condition there was a mix. Participants had their interpretational bias measured.

Behavioural tasks: imagining a loved one in a car crash and rating their distress.

Contamination task: number of wipes used on mouse/keyboard covertly counted.

Perfectionism: they were given very little time to write up the procedure for the next participant and asked to rate their faith in the writing.

Williams and Grisham (2013) FC:

F: A significant difference in interpretational bias between conditions (p < 0.01). Participants in positive condition had a clear shift towards a positive bias, but only to do with the statements relating to OCD and not general bias.

C: The task targeted the participants’ core OCD beliefs and not just general bias. Severity of symptoms beforehand was not a factor in effectiveness. CBM therapy would be an effective treatment for anyone with mild or severe OCD symptoms.

Williams and Grisham (2013) crit thinking:

• The therapy is usually conducted over weeks or months, not a single session as in this study: low ecological validity?

• Only short-term effects were measured

• The tasks were not individualised to the participants’ own OCD symptoms as they would be in real CBM

• The participants had not received a diagnosis of OCD, so generalisations should be made cautiously

What research method did Williams and Grisham (2013) use?

Lab experiment

Give an example of how mental illness may be perceived in other cutures.

In India, mentally ill people may be thought of as cursed. In other cultures, schizophrenia may be interpreted as a sign of spirit possession.

What key aspects of culture may affect perception and treatment of disorders?

Stigma, awareness, interpretation of symptoms, help-seeking behaviour, social support, treatment approaches, language and communication

Give a statistic to show that some cultures are more likely to pursue drug treatments than others.

In China, less than 6% of people pursue drug treatments for mental health symptoms.

Give an example of a cultural preference for/against a particular medication

People of Asian heritage are less likely to be prescribed clomipramine because they are at risk of unpleasant side effects, which has been linked to a genetic polymorphism causing it to be metabolised more slowly

Which two studies can be used in an essay about cultural differences in OCD treatment?

Nicolini (2017) and Williams et al (2012)

What research method was used by Nicolini (2017)?

Literature review (nb. that this therefore cannot be used in a research methods question)

Nicolini (2017) APFC:

A: investigate the influence of cultural diversity on manifestations of OCD and identify factors of cultural diversity that significantly impact OCD symptoms.

P: review of literature using keywords related to OCD, culture, cultural identity, and religion. The review covered ten years and focused on studies examining the relationship between culture and OCD across different countries and regions. 

F: OCD symptoms did not significantly vary across cultures. However, religion affected the content/severity of obsessions. For example: US: Christian obsessions related to sin, guilt, and morality were frequently reported. India: Hindu obsessions related to purity, pollution, and religious rituals were more common. Saudi Arabia: Muslim obsessions related to religious rules and rituals, such as cleanliness and prayer, were frequently observed. 

The review also highlighted the importance of considering other cultural factors, such as educational background, access to health services, and food, in understanding the influence of culture on OCD and its treatment. 

C: Cultural diversity does not seem to alter the main symptoms of OCD. However, cultural factors like religion and religiosity can impact the content and severity of OCD symptoms. 

Nicolini (2017) critical thinking:

• Comprehensive research, thorough literature review spanning 10 years increases validity

• Including only research from the most recent decade is a strength (higher temporal validity) and a weakness (excludes older studies that could provide valuable insight)

Which research method was used by Williams et al (2012)?

Questionnaire

Williams at al (2012) APFC:

A: Examine the barriers that prevent African Americans with OCD from receiving treatment

P: 71 AA adults with OCD took the Barriers to Treatment Participation Scale and Barriers to treatment questionnaire (BTPS, BTQ).

F: 6 of the 7 major barriers were cost, stigma, fear of therapy, feeling it wouldn’t help, feeling no need, and logistic issues. Compared to European American online sample (n=108) there were unique concerns including not knowing where to find help and fears of discrimination.

C: Fear of shame in requesting treatment differs between cultures, along with many other barriers.

Williams et al (2012) critical thinking:

• Only includes one culture

• Doesn’t consider religions aspects

• Validity of questionnaire as a method?

• Doesn’t say what treatment participants ultimately received

• High temporal validity