IB Psychology Abnormal Studies

Rosenhan 1973 Study

[A] To investigate reliability and validity of diagnosis in psychiatric hospitals

[M]

-8 (was 9 but one was rejected for falsifying information) pseudo patients

- Called different psychiatric hospitals in different states for appointment; then claimed to hear voices

-Diagnosed, and admitted. Then told to act normal

-Made notes of events

[R]

-All admitted

-All treated with disrespect by staff members (e.g. being ignored when asking "Pardon me, Mr. X, could you tell me when I will be presented at the staff meeting?"

[C]

-Displayed lack of validity and reliability in diagnosis

-Displayed labelling

Rosenhan 1973 Evaluation

Study Evaluation:

- Field experiment; high ecological validity

- Used deception

- Used 5 different states; generalisability for USA

Idea Evaluation:

- DSM-II used; old, and now it is improved

- Psychiatrists tend to want to play it safe; worse to miss out on diagnosis

Rosenhan II Study

[A] To investigate reliability and validity of diagnosis in psychiatric hospitals

[M]

- Told psychiatric hospitals that they would be sending pseudo patients to appointments in the next 3 months, and to scale out of ten the likelihood that the patient was fake

- Sent no pseudo patients

[R]

- Out of 193, 41 were confidently believed to be pseudo, 23 were suspected by psychiatrist and 19 were suspected by psychiatrist AND member of staff

[C]

-Demonstrates lack of reliability and validity in diagnosis

-Demonstrates labelling and generalised ideas associated with mental disorders

Rosenhan II Evaluation

Study Evaluation;

- Field; high ecological validity

- Deception

Idea Evaluation;

- Displays need for individual approach, looking at specific symptoms

- Ethical issue of misdiagnosis of people with actual mental disorders

Jahoda 1958 Study

- Attempt to diagnose "normal" behaviour

- Used 6 different categories

1) Strong sense of identity

2) Personal growth

3) Cope with environment

4) Accurate perception of reality

5) Control of behaviour

6) Being independent

Jahoda 1958 Evaluation

- Too idealistic; most couldn't achieve those

- Reductionist approach; can't base mental health off of 6 points

- Cultural factors; collectivist cultures would strive for communal growth, not personal

Rosenhan and Seligman 1989 Study

- Defining abnormality as the violation of the acceptable limits of social standards (Failure to Function Adequately)

-Characteristics include;

1) Suffering

2) Malaptiveness (behaviour that is harmful to individual)

3) Unpredictability

4) Unconventionality

5) Irrationality

6) Observer Discomfort

7) Violation of social standards

Rosenhan and Seligman 1989 Evaluation

- Subjective in nature, leading to bias

- Who diagnoses

- Observer discomfort; discrimination

- Not quantifiable

Nicholls et al 2000 Study

[A] To investigate inter-rater reliability between different diagnostic systems

[M]

- Two practitioners diagnosed 81 children with eating disorders, using either DSM-IV. ICD or GOSH system

-Tested correlation between practioners

[R]

-0.88 inter-rater reliability for GOSH

-0.64 for DSM-IV

-0.36 for ICD

[C]

-GOSH had more greater reliability of diagnostic tools

Nicholls et al (2000) Evaluation

- GOSH is specialised for children; may explain why

- Perhaps suggests need for more individual specific approach

Beck's Self Report Inventory

- Used 21 worded self report to measure level of severity of depression

- Questions 1-15 measured emotion symptoms, whilst 16-21 measured physical symptoms

- Each scaled 0-3

Beck's Self Report Inventory Evaluation

- Self report; better for revealing symptoms? Or allows demand characteristics?

- Quantifying qualitative entity; reductionist

- Answers overlap "I'm sad all the time", "I'm so sad I can't stand it"

Jacobs et al (1998)

- Investigated Indian women in London GP

- Doctors weren't likely to diagnose if patients didn't disclose ALL symptoms

-Demonstrates lack of patient centred approach

Bugra et al (1997)

- Used focus group interviews of Punjabi women in London

- Displayed that older women used terms like "weight on heart" and "pressure on the mind" to describe symptoms of depression

-Demonstrates need of culture relativism in diagnosis

Karasz (2005) Study

[A] To investigate cultural differences in diagnosis

[M]

-In New York, 36 South Asian Americans and 37 European Americans

- Vignette describing symptoms of depression

[R]

-SA; social problem, needing self-management

-E; biological problem, "hormonal imbalance", "neurological problem"

[C] Displays difference in idea of etiology and treatment in different cultures

Karasz (2005) Evaluation

-Only New York; ungeneralisable

-Small sample size

Brown and Harris (1978)

[A] To investigate social and cultural factors on depression in women

[M]

-458 women in South London surveyed on daily life, depressive episodes and life events

- Each rated on severity

[R]

-Large effect of occupation of humans in mothers

-Working class x4 more likely to become depressed than middle class

-37 women became depressed in last year; 33 of which experienced adverse life event (death, domestic abuse)

-30% had adverse effect, but no depression

[C]

-Identified main factors

1) Protective factors; supportive husband

2) Vulnerability factors; significant adverse life event

3) Provoking agent; contributes to acute stress

-Displayed link of social status and depression

Brown and Harris (1978) Evaluation

- Only correlational, other factors cannot be controlled so have factors

- Only females; ungeneralisable to men

- Used semi-structured interview; helping to get understanding on personal situation

Jenkins-Hall and Sacco (1991) Study

- Presented videotapes of therapy sessions to European Americans

- Used videotapes with varying people; black/white, male/female, depressed/not depressed symptoms

-White psychiatrist more often misdiagnosed false-positive with black patient

Jenkins-Hall and Sacco (1991) Evaluation

- Confidentiality

- European Americans; ungeneralisable

Nolen-Hoeksema (2001) Study

- Proposed that women are 2 times more likely to develop depression

- Women have same stressors as men, but due to biological responses, women are more vunerable

- Women are also more likely to report symptoms and seek help

Nolen-Hoeksema (2001) Evaluation

- Other factors; stigmatisation of mental disorder is arguably less acceptable in men- keeping up "manly" persona

- Women have less power than men; glass ceiling (Women still receive half as much as men in UK)

Marsella et al (1995) and (2002) Study

(1995)

-Depression prevalence is seemingly increasing globally; worst challenge to psychiatrists

-Suggested to be due to poverty, war, natural disasters etc.

(2002)

-Urbanisation also increasing stress, causing increased likelihood of depression

-Crowds, poor working condition, discrimination

-Weaken any support against depression

Kessler et al (1993)

Prevalence in genders for major depression

-Female (27.3%)

-Male (12.7%)

Evaluation:

-Only figures; may be other factors involved, such as stigma reducing people wanting to admit

Sartorius et al (1983)

- Found substantial cultural differences in stigma of mental health problems (e.g. Middle East)

- Stigma seemingly led to increased descriptions of physical symptoms than psychological

Weisman et al (1996) Study

[A] To investigate the prevalence of depression in different countries

[M] Investigated cross-cultural data from 10 countries, comparing prevalence rates of depression

[R]

-Beirut 19%

-Taiwan 1.5%

-Paris 16.4%

- Generally, Asian countries had lower rates of depression

[C]

-Different levels of acceptance in different cultures

-Beirut had been at war for 15 years

-Interestingly, women had higher rates than men in all countries

Weisman er al (1996) Evaluation

- Used many countries; generalisability

- Men may be less accepted when admitting

Charney and Weismann (1988)

- Found depression to affect 15% of people in USA at some point in their lives

- Affects women more than men

- Appeared to start around age 13

- Results in 3x more women than men

Drewnowski et al (1988)

- Telephone survey with sample of 1007 students in USA

- Found 1% of women classified as Bulimic

- Found 0.2% of men classified as Bulimic

Fairburn and Beglin (1908)

- Found that Bulimia affected 1-2% of women in UK and USA

-APA estimated 1-3% of young females suffer from Bulimia

-Seems to occur less in men

Keel and Klump (2003)

-Used meta-analysis of research on Bulimia Nervosa

- From 1970 to 1973, there was an increase of patients diagnosed with Bulimia

- Diagnostic tools became more stringent, leading to more diagnosis'

- Self-reports found tended to produce higher estimates of Bulimia prevalence than structures interviews (suggesting for diagnosis tool?)

Nurnberger and Gershon (1982)

[A] To investigate the possible biological etiologies of depression

[M] Reviewed results of 7 twin studies, looking at concordance rates for depression among twins

[R]

-65% MZT

-14% DZT

-Correlation

[C]

-Displayed genetic factor of predisposition to depression

Fernald and Gunmar (2009)

[M] Investigated cortisol levels of children in Mexico who wished to participate in the Poverty Alleviation Programme

[R]

-High levels of cortisol for those who weren't able to participate in programme

-If mothers were depressed, higher cortisol

-Programme included advice about good mothering, helped reduce stress of those who otherwise may have developed depression

Beck (1976)

-Cognitive triad (self, world and future) underlies information processing style

-Negative core beliefs can result in;

1) Over generalisation (I will always fail)

2) Selective abstraction (focus on negative)

Beck (1983)

-Two types of negative schemas that affect core beliefs

1) Sociotropy; failed relationships

2) Autonomy; failed achievements

Seligman and Maier (1967)

[A] To investigate learned helplessness

[M]

- Dog enclosed, with floor lined with electrodes

- Experimenter would activate floor, triggering the dog to jump over the low wall to the side of no electrodes

- Raised wall; couldn't jump over

- Continued electrocuting

- Lowered wall again

[R]

- Dog attempted to jump over raised wall; failed

- Gave up, even when wall was lowered

[C]

- Learned helplessness

[E]

- Low in ecological validity

- Ethical issues; harming dog & no right to withdraw

- Animal experiment can give us insight to human behaviour

- No confounding variables due to control

Hiroto (1974)

[A] To investigate learned helplessness in humans

[M]

-Participants were separated into 3 groups

1) Exposed to loud noise they could not stop

2) Exposed to loud noise they could stop

3) No noise

-Participants then introduced to box with a handle, and exposed to loud noise

[R]

1) Passive, did nothing with handle

2) Used handle

3) Used handle

[C]

- Group 1 learned helplessness

[E]

- Unethical; potentially harmful loud noise

- Low ecological validity

[A]

- Gives insight to why domestic abuse victims stay with partner, but also suffer depression

Boury et al (2001)

[A] To investigate the credibility of Beck's triad

[M]

-Investigated model to find correlation between amount of negative automatic thoughts and severity of depression

[R]

-Significant correlation found

-Duration of repression was also influenced by negative automatic thoughts

[C]

-Automatic negative thoughts can affect cognition

-Beck's triad is a useful model when investigating depression

[E]

-Correlational, not causational

Elkin et al (1989)

[A] US National Institute of Mental Health initiated comparison of Beck's Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy (IPT) and Biomedical therapy

[M]

-Used Imipramine as antidepressant

-Used placebo for control

-60 patients randomly allocated into the 4 groups over 16 weeks

-Areas of changed were assessed (e.g. depressive symptoms, overall symptoms, functioning)

[R]

-Improvements

Antidepressants = 57%

IPT = 55%

CBT = 51%

Placebo = 29%

-18 month follow up; psychotherapies favoured, with less relapse than drugs

[C]

-Long term results suggest psychotherapies are better

[E]

-Allows psychiatrists to understand complexity for diagnosis

-Eclectic approach is favoured

Lewisohn et al (2001)

[A] To investigate the relation between negative thought patterns and depression

[M]

-Questionnaire given to 1500 teenagers to score severity of depressive thoughts

[R]

-High scorers were more likely to develop depression after stressful life event later in life

[C]

-Could suggest causational relationship

[E]

-Self reports are unreliable; can lead to demand characteristics

Kendler et al (2006)

[A] To investigate the genetic link between depression

[M]

-Phoned 42,000 MZT and DZT twins

-Tested for depression using either DSM-IV or if they had already been diagnosed

[R]

-Concordance rates

MZT = 0.38

DZT = 0.14

[C]

- Not entirely genetic due to the concordance rate not being 1, but suggests there is a genetic factor

[E]

-Important to not be reductionistic

Kirsch et al (2002)

[A] Investigate publications researching effectiveness of SSRI on depression

[R]

-Found bias; if pooled together, placebo effect accounted for 80% of antidepressant response

-Found 57% failed to display significant difference between placebo and antidepressant

[C]

-Doubt of drug companies and serotonin hypothesis

[E]

-Displays possible corruption in drug companies; unethical for patients

Kendler et al (1991)

[A] To investigate genetic factors of Bulimia Nervosa

[M]

-Phoned 2163 female twins in longitudinal study

-Found concordance rates between MZT and DZT

[R]

-Concordance rates

MZT = 23%

DZT = 9%

[C]

-Genetic factor, but not whole cause

[E]

-Genetic factors cause predisposition

-Natural study; high ecological validity

-Reductionistic

-Only women; ungeneralisable

Bruch (1962)

- Claimed that patients with eating disorders suffer from cognitive delusion that they are fat

- When patients evaluate body size, they're influenced by emotional appraisal rather than perception

Fairburn (1997)

-Suggested that people with eating disorders had distorted weight related schema and low self-esteem (Weight related schema)

-Body image issues due to high status given to those who are thin

-Obsession with weight loss control becomes major way of maintaining self-worth

Fallon and Rozin (1985)

[A] Investigated gender factors in body dysmorphia

[M]

-Showed 9 pictures of ranging body shapes to 475 US undergraduates

-Asked to indicate;

1) Most similar to their own

2) Most ideal

3) Shape opposite sex would be attracted to

[R]

-Women indicated body shape was heavier than ideal

-They were thinner than one they selected was close to them

-Men chose similar figures for the 3

[C]

-Men more satisfied with body shape?

-Body image perceptions led to pressure to lose weight

-May be linked to higher prevalence in women than men of Bulimia Nervosa

[E]

-Heteronormative; what about other sexualities?

-Link to media and body image standards

-Can't assume all men don't suffer from body image issues

Dittmar (2006)

[A] To study the influence of thin Barbie doll body on eating disorders. Estimated that 42% of UK women owned Barbie doll

[M]

- 162 British girls (aged 5-8) divided into 3 groups, displaying images in a storybook of;

1) Barbie doll

2) Emme (realistic)

3) Control (flowers, balloons)

-Asked to rate self-esteem

-Coloured silhouette of their body shape and what they wanted to be

[R]

-Barbie group were most dissatisfied with body

[C]

-Barbie offers young children unrealistic body standards

-Sociocultural dimension to BN

[E]

-Other cultures?

-Gender bias; same with boys?

Levine et al (1994)

[A] Investigate relationship between sociocultural factors and eating disorders

[M]

-Interviewed 385 girls (aged 10-14) in USA

-Asked about eating behaviour, body satisfaction, attitudes of family and friends

[R]

-Majority discussed standards set by media of the importance to be thin

-Found two factors for seemingly disturbed eating patterns

1) media 2) criticism by family

[C]

-SC factors can affect body image

[E]

-Important not to be reductionistic

-Only girls; gender bias

-Only USA; ungeneralisable

Jaegar et al (2002)

[A] To investigate cultural factors with body

dissatisfaction

[M]

-1751 female medical and nursing students from 12 nations were given 10 body silhouettes

-Measured BMI, body dissatisfaction and dieting behaviour

[R]

-Most extreme in Northern Mediterranean countries

-Westernisation led to increased body dissatisfaction

-Diet was independent of BMI

[C]

-Media encourage dissatisfaction of body shape

[E]

-Only focused on SC factors; reductionistic

-Only female;gender bias

Minuchin et al (1978)

[A] To investigate the effect of family on eating disorders

[R]

-Identified 4 main feautures

1) Enmeshment (over-involvement)

2)Over-protectiveness (no room for independence)

3) Rigidity (no change allowed, no room for self-differentiation)

4) Conflict avoidance (No discussion of opinions)

[C]

-Displayed role of family in predisposition for eating disorders

[E]

-Reductionistic; other factors?

-Not all families are like this

Neale et al (2011)

[A] To investigate relapse rates in antidepressants

[M]

-Meta-analysis of published studies on outcome of antidepressants vs placebo

-Focused on:

1) People who stayed on antidepressants

2) Placebo group

3) Antidepressants then placebo

[R]

-Placebo group had 25% higher risk of relapse

-Group 3 had 42% risk of relapse

[C]

-Antidepressants are effective, and have reduced relapse rates

-However, create dependence, which would result in even higher relapse rate when off them

[E]

-Meta-analysis reduces risk of experimental errors

Butler and Beck (2000)

-Reviewed 14 meta-analysis that investigated CBT

-Concluded that 80% of adults benefited, compared to controls

-More effective than drug therapies, and had lower relapse rate

-Suggests proposition that depression has a cognitive basis

Kyuken et al (2008)

[A] To investigate effectiveness of MBCT

[M] 123 participants with history of 3+ depressive episodes were split into two groups:

1) CBT + antidepressants

2) Antidepressants

- 15 month period, reducing medication

[R]

1) Reported higher quality of life, 75% stopped taking medication

2) Higher rate of relapse (60% compared to 47%)

[C]

-Eclectic approach more effective

[E]

-No placebo group

-Synergistic effects?

McDermut et al (2001)

[A] Investigated effectiveness of group therapy on depression

[M]

-Meta-analysis of 48 studies between 1970-1988

-78% of participants were women

-Mean age of 44

[R]

-45 studies reported that group psychotherapy was effective for reducing symptoms

-19 weeks showed that psychotherapy was more effective than no therapy

-9 studies showed that individual and group therapy were equally effective

[C]

-Empirical support that group therapy is effective for relieving depressive symptoms

[E]

-Meta-analysis did not include factors such as severity of depression

-Truax (2001) : group therapy should only be used when clients are positive

Bolton et al (2003)

[A] To investigate the role of group therapy on depression in Rural Uganda

[M]

-Emic approach, interviewed local people to get better understanding of triggers for depression

-Trained local people to run group therapy sessions

-30 villages selected, (15 for women, 15 for men)

-Split into intervention and control group

-Used locally adapted Hopkins Symptom Checklist

-8-12 participants in each village

-Groups led by same sex, who had 2 weeks of IPT

-Reviewed each participant symptoms. then facilitated group discussion

-Investigated

1) Grief 2) Disputes 3) Role transitions 4) Deficits

[R]

-Average reduction in depression severity was 17.47 for intervention groups, 3.55 for control

-Afterwards, Intervention group met 6.5% of depressive criteria, whilst control met 54.7% of criteria (beginning was I-86% and C-90%)

[C]

-Group therapy was highly effective

[E]

-Demand characteristics?

-Emic approach; useful

What is diagnosis?

Identifying and classifying abnormal behaviour on basis of symptoms

What is the DSM-V?

-Developed by APA

-Manual list of symptoms of disorders

-Doesn't identify etiologies

What is the ICD-10?

-International Classification of Diseases

-Published by WHO

-Includes reference to etiologies

Validity

Receiving correct diagnosis and treatment

Reliability

Clinicians have same correct diagnosis continuously

Depression

Symptoms:

A-distress

B-disturbed sleep

C-feelings of worthlessness, negative attitudes

P- fatigue and loss of energy

Bulimia Nervosa

Symptoms:

A- fear of becoming fat

B-self-starvation, inducing vomiting and diarrhoea

C-distorted image of body

P-digestive problems, nutritional deficiencies

Prevalence

Percentage of individuals affected by specific disorder

Concordance rate

The presence of the same trait in both members of a pair of twins

Tricyclics

-They increase the levels of both norepinephrine (noradrenaline) and serotonin by interfering with the reuptake of the neurotransmitters.

-Tricyclic drugs have many side effects. These include dry mouth, cardiovascular problems, weight gain, constipation, blurred eyesight, sexual dysfunction, and disorientation

SSRIs

-Affect the reuptake pumps responsible for serotonin, as opposed to earlier antidepressants, which affect other neurotransmitters as well,

-SSRIs have fewer side effects. SSRIs are less toxic than other antidepressants and thus overdose is not as common.

MAO inhibitors

-MAO inhibitors increase the availability of serotonin by inhibiting the action of monoamine oxidase, an enzyme that normally breaks down neurotransmitters in the synaptic cleft.

CBT

1) Identify and correct faulty thinking patterns

2) Increase rewarding activity and learn problem solving strategies

IPT

-Interpersonal psychotherapy (IPT) is based on the premise that depression arises from and leads to interpersonal difficulties.

Stages of treatment:

1)First stage: identification of the client's major problem areas and creation of treatment contract

2)Intermediate stages: working through the identified problems with the therapist.

3)Termination stages: consolidation of what has been learned and looking forward to how the techniques learned in therapy can be applied in the future.

MBCT

Mindfulness based cognitive treatment -Aim of group-based therapy is to prevent relapse

How it works

-Based on Buddhist mediation

-Helps people focus on intrusive thoughts and how to prevent negative thoughts

-Teaches people signs of depression