PSYCHOLOGY - PSYCHOLOGICAL PROBLEMS

Javid has schizophrenia, a mental problem. In the past he may have been called ‘a lunatic’, resulting in people treating him in a negative way. Nowadays he would be said to have a mental health problem – a label that causes others to treat him more favourably as they view him as having a problem that can be treated.

What is meant by the phrase ‘lessening of social stigma’ in relation to mental health? Refer to Javid in your answer. [4 marks]

The phrase relates to the idea that if people, such as Javid, are given a label like schizophrenic then people may discriminate against them due to the negative expectations that such a label brings. The label acts as a stigma. Referring to Javid as having mental health problems means he is less likely to be stigmatised as people will see him as having an illness that can be treated. So the new label lessens social stigma.

Describe how the incidence of significant mental health problems changes over time. [3 marks]

It is reported that for adults in the UK in 2007, 24% were accessing treatment, whereas In 2014 this had risen to 37%. MIND estimates that by 2030 approximately two million more adults in the UK will have mental health problems than there were in 2013.

More women than men are treated for mental health problems and this gender gap is widening.

Briefly outline two cultural variations in beliefs about mental health problems. [4 marks]

In India and Africa, more people report hearing voices and they regard it as a positive experience, whereas In the Western world ‘hearing voices’ is categorised as an auditory hallucination and is seen as a symptom of schizophrenia.

Another example of a cultural difference is eating disorders, which for many years have been quite rare outside the Western world.

Explain how increased challenges of modern living, such as isolation, have led to mental health problems. [2 marks]

Lower income households are more likely to have mental health problems compared to higher income households. Also social isolation for people living in cities is a problem.

What type of distribution is displayed in the graph? [1 mark]

A normal distribution.

What is the relationship between performance and anxiety shown in the graph. [3 marks]

Too little or too much anxiety has a negative effect on performance which is why the performance scores are very low at each end of the graph. A moderate amount of anxiety leads to the best performance so most people (the mode/median/mean) have scores in the middle of the anxiety scale.

Give the graph a suitable title. [1 mark]

A graph showing the relationship between performance and anxiety

Explain why mental health problems may have a negative impact on relationships. [3 marks]

Mental health problems often affect a patient’s ability to talk to others as someone who is depressed may become very focused on themselves and find it difficult to understand what other people are feeling. Mental health problems are also isolating as patients tend to avoid being with other people because they feel bad about themselves and may fear being judged.

Explain the effect that mental health problems can have on a person’s physical well-being. [3 marks]

Your psychological state has an impact on your physical well-being. For example, people who are stressed often get more colds and other illnesses. Usually the immune system can cope in keeping the invaders at bay but, if you are anxious or stressed, your body produces a hormone called cortisol. This hormone prevents the immune system functioning as well as it should and physical illness is more likely.

Describe the effects that significant mental health problems can have on society. [4 marks]

One aspect of mental health problems that may affect society is the link between mental health and crime. Research does indicate an increased risk of violence amongst mentally disturbed patients, perhaps as much as four times greater than in the ‘normal’ population.

The effect on society is also financial. Looking after people with mental health problems costs a considerable amount of money. A recent government report, the McCrone report, suggests that the direct cost of mental health in England is about £22 billion a year.

John: I am worried about Ivy as she hasn’t seemed like her normal self lately. She usually loves playing hockey with her friends but last time she played she looked bored and had to go home early as she felt tired and ‘flat’.

Daisy: I agree, I watched a TV programme about someone with depression and they acted in a similar way to Ivy.

Identify two symptoms of depression. Refer to Ivy’s behaviour in your answer. [4 marks]

One symptom is loss of interest in pleasurable activities such as playing hockey with her friends, which does not make Ivy happy like it normally does.

Another symptom is reduced energy levels as she felt tired which would have a knock-on effect on her social life if she does not have the energy to do activities involving other people.

John: I am worried about Ivy as she hasn’t seemed like her normal self lately. She usually loves playing hockey with her friends but last time she played she looked bored and had to go home early as she felt tired and ‘flat’.

Daisy: I agree, I watched a TV programme about someone with depression and they acted in a similar way to Ivy.

Which type of depression is Ivy experiencing? Explain your answer. [3 marks]

Unipolar depression, as she only is experiencing one extreme emotional state which is low mood. If she had bipolar depression she would have periods of mania and normal mood but this is not the case as she just appears to be unhappy.

Distinguish between depression and sadness. [3 marks]

Depression is characterised by an abnormally low mood and low energy levels whereas sadness is a normal human emotion. It is a natural reaction to certain experiences such as the death of a beloved pet. In contrast, depression is deeper and stops the ability to function.

Explain how the International Classification of Diseases is used to diagnose unipolar depression. [4 marks]

The ICD lists symptoms of unipolar depression and it is up to clinicians to identify symptoms in a patient. In order for a diagnosis to be made the clinician must have noted two out of the three key symptoms – low mood, loss of interest and reduced energy levels.

In addition, two other symptoms must have been observed such as a reduced energy level, change in sleep patterns or ideas of self-harm.

Symptoms should be present all or most of the time, and for longer than two weeks

Describe two characteristics of depression. [4 marks]

One characteristic is a low mood. This is a depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad) or observation made by others (e.g. appears tearful).

A second characteristic is a reduced energy level, making the person lethargic. This has a knock-on effect, with sufferers tending to withdraw from work, education and social life.

A study was carried out to see whether eating foods that raise serotonin levels would decrease depression. A group of 80 patients diagnosed with depression were recruited for the study and their depression level was measured at the start of the study. Half of the patients were given a high serotonin diet for six months. At the end of six months all patients’ depression levels were measured again.

1. Identify a sampling method that could be used in this study and explain one strength of using this method. [3 marks]

Opportunity sampling could be used. This is a very convenient sampling method as you just use the most readily available group of people, which in this case could have been the patients at a particular clinic.

A study was carried out to see whether eating foods that raise serotonin levels would decrease depression. A group of 80 patients diagnosed with depression were recruited for the study and their depression level was measured at the start of the study. Half of the patients were given a high serotonin diet for six months. At the end of six months all patients’ depression levels were measured again.

Explain how the participants could have been allocated to each condition. [3 marks]

Randomisation could be used. All 80 of the participants’ names could have been placed in a hat and then 40 could have been picked out to go in each condition.

A study was carried out to see whether eating foods that raise serotonin levels would decrease depression. A group of 80 patients diagnosed with depression were recruited for the study and their depression level was measured at the start of the study. Half of the patients were given a high serotonin diet for six months. At the end of six months all patients’ depression levels were measured again.

Identify one extraneous variable that could affect the outcome of the study and explain how it could be controlled. [3 marks]

The participants might have taken other drugs or food that would affect their serotonin levels. To deal with this, the patients’ diets and drug habits would need to be monitored, maybe by asking all participants to keep a record of what they ate or by using only patients in hospital.

Explain what is meant by the term ‘serotonin’. [2 marks]

Serotonin is a neurotransmitter. It regulates mood, and low levels are associated with depression.

With reference to depression, explain what is meant by an ‘imbalance of neurotransmitters’. [4 marks]

An ‘imbalance of neurotransmitters’ means that these biochemical substances are not present in the right quantities at the synapse – there is either too much or too little. In the case of depression, levels of serotonin in the synaptic cleft are too low, which means that mood-relevant information is not passed to the postsynaptic neuron. The effect is a lower mood.An ‘imbalance of neurotransmitters’ means that these biochemical substances are not present in the right quantities at the synapse – there is either too much or too little.

In the case of depression, levels of serotonin in the synaptic cleft are too low, which means that mood-relevant information is not passed to the postsynaptic neuron. The effect is a lower mood.

Describe and evaluate the biological explanation of depression. Refer to the influence of nature in your answer. [9 marks]

The biological explanation of depression focuses on physical influences (usually determined by nature). This means that the explanation suggests that depression isn’t caused by other people or influences on the way we think, instead it is caused by inherited genes that produce imbalanced levels of the neurotransmitter serotonin. Messages travel along a neuron electrically and are transmitted chemically across the synapse via neurotransmitters. Low levels of serotonin mean less stimulation of the postsynaptic neuron, resulting in a low mood. This affects memory, sleep and appetite, which is linked to the characteristics of depression, e.g. lack of concentration, disturbed sleep and reduced appetite.

One strength of the biological explanation of depression is that it has supporting research evidence. McNeal and Cimbolic found lower levels of serotonin in people with depression. This suggests that there is a link between low levels of serotonin and depression which supports the biological explanation.

One weakness is low levels of serotonin could be an effect of being depressed. Thinking sad thoughts and having difficult experiences could cause low serotonin levels. Therefore, low levels of serotonin may be an effect of psychological experiences rather than the cause, so may not be biological (due to nature).

Another weakness is that depression may not be solely caused by abnormal levels of neurotransmitters. Some people with low levels of serotonin don’t have depression and some people with depression don’t have low levels of serotonin. This means that the neurotransmitter (nature) explanation isn’t enough on its own.

A magazine article explained depression as being like seeing a glass as half empty instead of half full.

Explain how this article relates to the psychological explanation of depression. Refer to negative schemas in your answer. [3 marks]

Having negative schemas means that you are more likely to interpret information about yourself and your life in a negative way. This means you would see the glass as half empty because that is a negative view. So the psychological explanation is that the preference for negative interpretations is what leads to depression because the world looks less good because of your negative schemas.

What is meant by a ‘negative schema’ in relation to depression? [2 marks]

A negative schema means you are likely to interpret all information about the world and yourself in an unfavourable way and have a ‘glass is half empty’ way of thinking, which makes a person depressed.

With reference to an example, explain how attributions could cause depression. [4 marks]

Attribution is the process of explaining causes of behaviour. When we observe someone else’s behaviour, we unconsciously think of explanations for their behaviour, i.e. we attribute causes. We also know ourselves in this way. Some people have a depressive or negative attributional style. For example, a person who bakes a cake for their child’s birthday and when they cut a slice it’s still uncooked in the middle and they think to themselves that everything they do goes wrong. Such attributions make it difficult to see that things can change and there is hope, so the result is depression.

Outline and evaluate the psychological explanation of depression. [9 marks]

: Depression may be caused by irrational thinking. When a person is depressed they focus on the negative and ignore positives. This is partly due to negative schemas. Having a negative self-schema means you are likely to interpret all information about yourself in a negative way. Attributions also create depression. Seligman proposed that some people have a negative attributional style. If people make negative internal, stable and global attributions they are more likely to become depressed. The result is depression. Seligman also proposed the idea of learned helplessness – that we learn this negative attributional style through experiences where escape from negative experiences was not possible so you learn to give up. The result is again depression.

One strength of this explanation is there is support for learned helplessness. Seligman has demonstrated the process of learned helplessness where dogs learned to react to challenge by ‘giving up’. Therefore, this research supports his explanation of depression due to negative attributions.

Another strength is that irrational thinking is a cognitive explanation which leads to ways of treating depression through cognitive behavioural therapy. People learn to replace irrational thinking with rational thinking to help relieve depression. Therefore, the explanation leads to successful ways to help people with depression.

On the other hand, one weakness is that negative beliefs may simply be realistic rather than depressing. Alloy and Abramson found that depressed people gave more accurate estimates of the likelihood of a disaster than ‘normal’ people. They suggested that depressed people may be ‘sadder but wiser’. This means that a negative attributional style may sometimes be a good thing.

Emma is unsure about whether to continue taking antidepressants to treat her depression. She has been taking them for two months and they haven’t made a difference. Her friend Nelly suggests that something as complex as depression is more than just a chemical imbalance in her brain so taking pills won’t fix it, especially as they can make you feel sick and give you problems with your sleep.

Briefly evaluate antidepressants as a treatment for depression. Refer to the above conversation between Emma and Nelly in your answer. [5 marks]

Nelly’s friend says that something as complex as depression is more than just a chemical imbalance in the brain, which suggests that antidepressants are a reductionist approach as there may be other psychological causes they do not treat.

Another issue is that these drugs have side effects such as sickness and sleep problems which could discourage Emma from taking them in the long term.

Their effectiveness is also questionable, which could explain why they haven’t made a difference to her after two months. Research suggests they may not be any better than a placebo, so perhaps Emma would be better off getting some alternative treatment for her illness.

What is meant by an ‘antidepressant medication’? [2 marks]

Antidepressant medications are a group of drugs which increase the production of serotonin and/or noradrenaline, and reduce symptoms of depression.

Distinguish between reductionism and holism in relation to antidepressant medication. [4 marks]

Reductionism refers to the belief that human behaviour is best explained by breaking it down into smaller constituent parts. Holism refers to the belief that our understanding of human behaviour is more complete if we consider the ‘bigger picture’ rather than focusing on the constituent parts.

The use of an antidepressant medication suggests that neurotransmitters are the only factor that causes depression. In other words, this reduces depression to the action of neurotransmitters alone and doesn’t consider other factors. A more holistic approach would focus on the whole person using a combined form of therapy.

Outline and evaluate antidepressant medication as a therapy for depression. [9 marks]

Low levels of serotonin may cause depression, therefore increasing serotonin levels may alleviate the symptoms of depression. SSRIs are a type of antidepressant that selectively target serotonin at the synapse and aim to increase amounts in the synapse. Serotonin is stored at the end of a transmitting (presynaptic) neuron in sacs called vesicles. The electrical signal travelling through the neuron causes the vesicles to release serotonin into the synaptic cleft. Serotonin locks into the postsynaptic receptors, chemically transmitting the signal from the presynaptic neuron. Normally serotonin is taken back into the presynaptic neuron, broken down and reused. SSRIs block this reuptake so when new serotonin is released it adds to the amount held in the synaptic cleft which increases the amount of serotonin and raises a person’s mood.

One weakness is SSRIs can have serious side effects. The side effects include nausea, insomnia, and, most seriously, suicidal thoughts. Side effects mean that people stop taking the drugs, which reduces the effectiveness of the drug therapy.

An additional weakness of antidepressant medication is that the evidence for the effectiveness of them is questionable. Asbert found that the serotonin levels of depressed people may not actually be that different from the normal population. This suggests that the effectiveness of the drug may not be related to serotonin. It may be a placebo effect.

A further weakness of antidepressant medication is that it is a reductionist approach to the treatment of mental illness. Antidepressant medication targets serotonin (and sometimes noradrenaline) so focuses on only one kind of factor. This suggests that other treatments are not necessary but a more successful treatment might include both biological and psychological approaches (a holistic approach).

A study was carried out to see which technique proved most effective at treating depression – 200 patients with depression were treated with one of four techniques. The table below displays the number of patients who showed an improvement in their symptoms after 6 weeks.

What percentage of those given technique 1 showed an overall improvement in their symptoms? Show your workings. [2 marks]

25/50 × 100 = 50%

A study was carried out to see which technique proved most effective at treating depression – 200 patients with depression were treated with one of four techniques. The table below displays the number of patients who showed an improvement in their symptoms after 6 weeks.

Which of the four techniques was the most effective treatment for depression? [2 marks]

Technique 2 was most effective as 75% improved. E

ffectiveness:

Technique 1 = 25/50 × 100 = 50%

Technique 2 = 30/40 × 100 = 75%

Technique 3 = 10/30 × 100 = 33%

Technique 4 = 48/80 × 100 = 60%

A study was carried out to see which technique proved most effective at treating depression – 200 patients with depression were treated with one of four techniques. The table below displays the number of patients who showed an improvement in their symptoms after 6 weeks.

Calculate the percentage of patients who didn’t improve from any of the four techniques. Show your workings and round your answer up to the nearest whole number. [4 marks]

44% did not improve.

25 + 10 + 20 + 32 = 87 (total of patients who did not improve)

50 + 40 + 30 + 80 = 200 (overall number of patients)

87/200 × 100 = 43.5% rounded up = 44%

Explain how CBT improves mental health. [4 marks]

CBT focuses on what a client thinks. Negative, irrational or faulty thinking causes depression because people tend to catastrophise and think in all-or-nothing terms. The aim for the therapist is to therefore change this to rational thinking to reduce depression. Disputing can be used to challenge the client’s irrational thoughts and then more rational thinking leads to greater self-belief and self-liking.

CBT also aims to change behaviour indirectly, for example by using behavioural activation where a pleasant activity is planned each day. This creates more positive emotions and mood.

Explain one criticism of using CBT to treat depression. [4 marks]

One weakness is that some people are not willing to spend the considerable amount of time and thought that is required for successful CBT. Typically, a client will spend months meeting with their therapist once a week, and also doing homework in between sessions. Taking medication such as SSRIs is much quicker and you just have to remember to take the pill. CBT involves a willingness to think about yourself and also to be prepared to change. This means that many people drop out of CBT treatments or fail to engage sufficiently to gain any benefits.

Describe and evaluate CBT as a therapy for depression. [9 marks]

One key element of CBT is that it focuses on what a client thinks. Good mental health is the result of rational thinking. Poor mental health, such as depression, results from negative, irrational or faulty thinking. The aim of therapist is to change this to rational thinking to reduce depression. More rational thinking leads to greater self-belief and self-liking. Any negative emotions experienced are recorded in a ‘thought diary’, where the client also records the ‘automatic’ thoughts created by these emotions. The client rates how much they believe in these thoughts. A rational response to the automatic thoughts is then recorded and rated. CBT also aims to change behaviour indirectly, for example by using behavioural activation where a pleasant activity is planned each day. This creates more positive emotions and mood.

One strength of using CBT to treat depression is that it has lasting effectiveness. The ‘tools’ learned in CBT to help challenge irrational thoughts can help the client deal with future episodes of depression. Therefore, this therapy offers a long-term solution where they can draw on the skills they have learned in the future.

One weakness is that it takes a long time and thought for CBT to be successful. Therapy takes months, homework is expected so a lot of effort is needed in comparison to just taking a pill. This means that many people drop out or fail to engage enough for it to work.

Another strength of CBT is that it is holistic. CBT focuses on treating the whole person and what they think/feel. This may be preferable to drug treatment because it deals with the core symptoms of depression (e.g. feeling sad).

In order to test the effectiveness of antidepressants, a sample of undergraduates who had depression were either given an antidepressant or a placebo (a pill that did nothing). All assumed they were taking an antidepressant. Mood was measured before the study and again six months later to get a mood improvement score.

Write a null hypothesis for this study. [2 marks]

There is no difference in the mood improvement scores of participants given antidepressants and those given a placebo.

In order to test the effectiveness of antidepressants, a sample of undergraduates who had depression were either given an antidepressant or a placebo (a pill that did nothing). All assumed they were taking an antidepressant. Mood was measured before the study and again six months later to get a mood improvement score.

Identify one ethical issue in this study and explain how it could be dealt with. [2 marks]

Deception is an ethical issue as the participants all thought they were being given antidepressants. This could have been dealt with by telling them at the start of the study that some participants would receive a placebo (just debriefing them at the end of the study would not be a sufficient way to deal with this deception).

In order to test the effectiveness of antidepressants, a sample of undergraduates who had depression were either given an antidepressant or a placebo (a pill that did nothing). All assumed they were taking an antidepressant. Mood was measured before the study and again six months later to get a mood improvement score.

This study used an independent groups design. Explain one weakness of using this type of design in this study. [3 marks]

There are participant variables in independent groups design which means that individual differences could have affected the results and therefore affected any conclusions drawn. In this case the patients in one group might have been more depressed than the other group and that might explain poorer improvement in one group.

Outline the method Wiles used in her study into the effectiveness of CBT. [3 marks]

The study recruited 469 participants from Bristol, Exeter and Glasgow belonging to 73 different GP practices. The study involved patients who had treatment-resistant depression, i.e. they had been taking antidepressant medication for more than six weeks and still showed symptoms of clinical depression. Patients were randomly allocated to one of two conditions where they either took antidepressants only or antidepressants and CBT. Improvement was assessed by measuring symptoms of depression using the Beck Depression Inventory.

Explain what Wiles’ study shows about the effectiveness of CBT. [3 marks]

The study shows that CBT is effective in treating patients who do not respond to antidepressants. This is because those taking antidepressants and CBT continued to show much greater levels of recovery and a greater chance of remission than those in the antidepressant only group. This shows that CBT is a useful addition to treatment. CBT plus antidepressant medication is more effective in reducing depressive symptoms than antidepressant medication alone.

Describe and evaluate Wiles’ study into the effectiveness of CBT. [9 marks]

randomly allocated to one of two conditions where they either took antidepressants only or antidepressants and CBT. Improvement was assessed using the Beck Depression Inventory (BDI) before and after treatment. After six months the number who had more than 50% reduction in symptoms was about 20% for usual care and about 50% for usual care and CBT. After 12 months those having usual care and CBT continued to show greater levels of recovery. This shows that CBT plus antidepressant medication is more effective in reducing depressive symptoms than medication alone.

One strength of the study is that extraneous variables were carefully controlled. The two groups had the same average depression score at the start and participants were randomly allocated to groups through a computer. This means that we can conclude that changes in the dependent variable (reduction in symptoms) were not affected by extraneous variables.

One weakness is the use of self-report methods to determine levels of depression. Some people might have underestimated how sad they feel and others might have overestimated. This questions the validity of the information collected about depression.

Another strength of the study is that it is focused on developing a useful therapy. The study shows that a more holistic approach to treating depression is more successful than antidepressant medication alone which is reductionist. Such real-world usefulness is one of the main reasons for conducting research.The study recruited 469 participants from Bristol, Exeter and Glasgow belonging to 73 different GP practices. The study involved patients who had treatment-resistant depression, i.e. they had been taking antidepressant medication for more than six weeks and still showed symptoms of clinical depression. Patients were

Gary loves to drink alcohol because of the ‘high’ that it gives him. His job has been difficult recently so having a few drinks helps him forget the negative events of the day. He tried stopping this habit but he found he was constantly craving a drink.

Distinguish between dependence and addiction. Refer to Gary’s behaviour in your answer. [4 marks]

Dependence relates to doing something because you rely on it and you want to avoid withdrawal symptoms. Gary is dependent on alcohol as he uses it to help him deal with his difficult job (reliance) and also finds he constantly craves a drink when he stops drinking alcohol (withdrawal).

Addiction includes dependence but also has additional characteristics as well. Gary also loves drinking, which suggests that he is also addicted to alcohol as it gives him a buzz and helps him escape from the reality of his job.

Using an example, explain what is meant by ‘dependence’ (3 marks)

Dependence is indicated either by a compulsion go keep taking a drug or continue a behavior (psychological dependence), or it is indicated by withdrawal symptoms (physical dependence).

For example a person may become dependent on pain medication. The pain they experience makes it impossible to lead a normal life without the medication. There is a psychological reliance on the substance/activity. The person may also have a physical dependence on the pain medication and experience withdrawal symptoms if they stop taking it.

Distinguish between substance misuse and substance abuse (3 marks)

Substance misuse occurs when a person uses a drug in the wrong way or for the wrong purpose whereas substance abuse occurs when someone uses a drug for a bad purpose, i.e to get ‘high’ rather than as a ‘real’ form of medication. The difference therefore is the person’s intentions when using a substance.

Explain how the International Classification of Diseases is used to diagnose addiction. (4 marks)

The International Classification of Diseases (ICD-10) has a category called ‘Mental and behavioral disorders due to psychoactive substance abuse disorders’. A diagnosis of addiction is usually made only if three or more characteristics have been present together at some time during the previous year.

There are six characteristics of addiction, this includes persisting despite harm, so the individual continues to take the substance despite clear evidence of harmful consequences.

Another characteristic is a difficulty in controlling use, where the individual may have difficulty stopping usage and/or limiting the levels of use.

Darren and his identical twin James' lives have turned out in a very different way. Darren is an alcoholic whilst his brother is not. Although they both went to the same schools when they were younger, Darren ended up being badly bullied, something that his mum reckoned had a profound effect on him. Sadly, alcoholism runs in their family and she feels that the bullying Darren experienced triggered his urge to drink.

Use the biological explanation of addiction to explain Darren's alcoholism. [4 marks]

The biological explanation suggests that addiction is due to hereditary factors. The fact that alcoholism runs in their family suggests Darren's alcoholism is inherited - however, his identical twin James did not inherit it despite having the same genes.

The diathesis explanation would suggest that both Darren and James would have inherited a vulnerability to addiction but the reason why Darren became an alcoholic and James didn't is because Darren was bullied in school.This negative experience acted as a trigger for Darren's alcoholism. Although his brother had the same genes and vulnerability level, James' life experiences were more positive, which is why his life turned out in a different way.

Explain how genetic vulnerability can influence addiction. (3 marks)

Very few genes have an all or nothing effect on behavior. One gene does not make the difference to whether for example you become addicted to alcohol or not. Multiple genes are involved and, moreover, genes do not cause the disorder they simply create a vulnerability, i.e they increase the likelihood of an addiction. The diathesis-stress explanation proposes that a genetic vulnerability (nature) is only expressed if a person’s life stresses ad experiences (nurture) act as a trigger.

Describe the conclusion of one study that investigated alcohol abuse (2 marks)

The Kaia study suggests that alcoholism is related to hereditary factors. The data from the study supports the idea of a vulnerability because identical (MZ) twins were more likely to both be alcoholic than non-identical (DZ) twins. The increased social problems among alcoholic twins suggests that there are environmental factors that contribute to alcoholism.

Outline and evaluate the biological explanation of addiction. Refer to Kaij's twin study of alcohol abuse in your answer. [9 marks]

Kaij wanted to see whether alcoholism was hereditary. Male twins from Sweden were identified from twins registered with the temperance board. Twins and close relatives were interviewed, to collect information about drinking habits. 48 of the twins were identified as MZ and 126 as DZ. It was found that 61% of the MZ twins were both alcoholic whereas only 39% of the DZ twins were. Twins with social problems were overrepresented among the temperance board registrants. This shows alcohol abuse is related to genetic factors but it is a vulnerability because, if it was entirely genetic, we would expect all MZ twins to be the same. If it was entirely due to environment we would expect no difference between MZ and DZ twins.

One weakness of Kaij's twin study is that there were flaws in the design of the study. Temperance board data only includes drinkers who made a public display of their alcohol abuse. This means that the results lack validity.

One strength is support from later research. Kendler et al. conducted a well-controlled study using a similar but larger sample of over 2,500 twins. It was found that MZ twins were more likely to both be alcoholics than DZ twins.Research generally supports the view that genetic factors have a major influence on alcoholism for both males and females (Prescott et al.).

Another weakness with biological explanations of addiction is that they may be misleading. People assume that if you inherit certain genes, then addiction is inevitable but this is not the case as nurture also plays a role. It is therefore very important to fully understand the implications of genetic research.

A psychologist conducted a study to see whether exposure to films that glorify addiction was more likely to cause people to smoke. They selected twenty films that showed addiction in a positive light and asked people to indicate which films they had seen and also to say if they smoked and how many cigarettes a day on average. They found that the more of the selected films that people had seen, the more cigarettes they smoked.

1. Identify the two co-variables in this correlational study. [2 marks]

Number of films watched and number of cigarettes smoked

A psychologist conducted a study to see whether exposure to films that glorify addiction was more likely to cause people to smoke. They selected twenty films that showed addiction in a positive light and asked people to indicate which films they had seen and also to say if they smoked and how many cigarettes a day on average. They found that the more of the selected films that people had seen, the more cigarettes they smoked.

Explain one strength of using correlational analysis in this investigation. [2 marks]

Correlations are useful at the start of the research process to see if two variables are related so that then researchers can do further investigations into the impact of watching films that glorify addiction on people smoking.

A psychologist conducted a study to see whether exposure to films that glorify addiction was more likely to cause people to smoke. They selected twenty films that showed addiction in a positive light and asked people to indicate which films they had seen and also to say if they smoked and how many cigarettes a day on average. They found that the more of the selected films that people had seen, the more cigarettes they smoked.

Describe the type of correlation the researchers found. [2 marks]

A positive correlation as both variables increased together - the more films people watched about glorifying addiction, the more they smoked.

What is meant by the term 'peer influence'? [2 marks]

Peer influence concerns the effect that our peers have on us. Peers are people who, for example, share our interests and are of similar age, social status and background to ourselves.

Explain one way the psychological explanation of addiction can be evaluated. [4 marks]

One strength of peer influence as an explanation of addiction is that there is research support. Simons-Morton and Farhat reviewed 40 studies into the relationship between peers and smoking and found that all but one showed a positive correlation between the two factors. A correlation does not mean that the peer influence caused the addictive behaviour but at the very least it suggests that peer influences are a risk factor. This shows a strong relationship between peers and addiction.

Outline and evaluate the psychological explanation of addiction. Refer to nurture in your answer. [9 marks]

Peers are people who are equal in terms of, for example, age and they can also influence a person to become addicted. Bandura's social learning theory states we learn how to behave and think by observing what others do and we imitate them, especially if they are rewarded, because we want to be accepted by them. This is an example of a nurture influence - the influence of experience coming from the social environment. Furthermore, adolescents may feel 'pressure' to conform to the social norms of their peer group, another environmental/social influence. Finally, peers influence addictive behaviour because they provide opportunities for an individual to smoke or use alcohol.

One strength of peer influence as an explanation of addiction is that there is research support. Simons-Morton and Farhat reviewed 40 studies and found that all but one showed a positive correlation between peers and smoking. This shows a strong relationship between peers and addiction.

A further strength of the peer influence explanation is its real-world application. Social norms programmes have had more success than just teaching resistance skills (Hansen and Graham). Thus there is a value in peer influence explanations.

In contrast to this, one weakness is peers may not be influencers. Individuals may be actively selecting others who are like them rather than conforming to social norms. This means that addictive behaviours shared within a friendship group happen as a consequence of addiction rather than the group causing the addiction through social norms and group pressure.

Annie takes her netball career seriously, which is why she knows she must cut out fast food from her diet. She recognises that she has an addiction and so is willing to try aversion therapy even though she has heard that it can be painful.

1. Briefly explain how aversion therapy would be used to treat Annie's addiction to fast food. [3 marks]

One way would be to give her electric shocks whenever she ate fast food or looked at pictures of fast food. Eventually she would associate the pain of the shocks with the fast food, which would discourage her from eating it in the future. Fast food would therefore become the conditioned stimulus and pain would be the conditioned response.

Annie takes her netball career seriously, which is why she knows she must cut out fast food from her diet. She recognises that she has an addiction and so is willing to try aversion therapy even though she has heard that it can be painful.

Briefly evaluate aversion therapy. Refer to the above item in your answer. [4 marks]

Annie has heard that aversion therapy is unpleasant as the electric shocks are painful. This means that many patients give up before the therapy has had any effect on their behaviour. This makes the therapy ineffective unless you are very strong-willed.

The long-term benefits are questionable. In a long-term follow-up McConaghy et al. found aversion therapy was no more effective than a placebo. So even if Annie found a dislike of fast foods while doing the therapy, she might find this disappeared in the long run, which limits the effectiveness of the therapy.

Briefly explain why aversion therapy could be used as a holistic treatment for addiction. [2 marks]

Aversion therapy can be combined with CBT for greater effectiveness. Aversion therapy deals with the addictive behaviour directly, but other issues can be addressed by CBT such as how a person feels/thinks. This is therefore a better way to treat the whole person rather than simply discourage the addiction.

With reference to an example of an addiction, explain the way aversion therapy works as a therapy for addiction. [4 marks]

Aversion therapy is based on the principles of classical conditioning. The aim is that an addict will associate their addiction with something unpleasant and then will avoid the addictive substance. In treating alcoholism, the alcoholic is given a drug that causes them to vomit, for example the drug Antabuse. Just before the patient vomits, they are given an alcoholic drink. Treatment involves several repetitions to strengthen the association between the neutral stimulus (alcohol) and the unconditioned stimulus (Antabuse). After repeated pairing, the alcohol becomes a conditioned stimulus causing vomiting (the conditioned response). After conditioning, alcohol is associated with something unpleasant and thus avoided

Outline and evaluate aversion therapy as a method to improve mental health. [9 marks]

Aversion therapy is where the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. It uses classical conditioning which is learning by association. The stimulus becomes associated with the discomfort, which means it is avoided in the future. If the stimulus is related to an addiction, this means the individual should avoid the addictive substance or behaviour in the future. In a smoking addiction the unconditioned stimulus is intensive smoking which creates feelings of disgust and nausea. These feelings are then associated with 'normal' smoking so that when the smoker looks at a cigarette they feel nausea (now a conditioned response).

One weakness is addicts may abandon therapy as it's unpleasant. Many addicts drop out before the treatment is completed as the aversive stimulus has to be negative. This problem means it is difficult to assess the effectiveness of the treatment because, in research studies, the participants who stay in a study tend to be the ones who cope well.

Another weakness is that benefits of aversion therapy seem to be short term rather than long term. In a long-term follow-up McConaghy et al. found aversion therapy was no more effective than a placebo. Covert sensitisation was better. This suggests aversion therapy lacks effectiveness.

There are positives to aversion therapy as it can be combined with CBT in a holistic way. Aversion therapy gets rid of the immediate urge to use the addictive substance whilst CBT provides longer-lasting support with a person's feelings/thinking. This provides a longer-term solution to the addiction.

A researcher accessed the NHS database for all of the patients who had sought help to stop smoking. 50% of those who had used CBT had stopped for more than a year, 30% of those who had attended a self-help group had stopped for a year and 10% of those in a control group who had no treatment had also stopped for a year.

1. Put the results in a suitable table. [2 marks]

A researcher accessed the NHS database for all of the patients who had sought help to stop smoking. 50% of those who had used CBT had stopped for more than a year, 30% of those who had attended a self-help group had stopped for a year and 10% of those in a control group who had no treatment had also stopped for a year.

Identify whether primary or secondary data used in the study. Explain your answer. [2 marks]

Secondary, as the researcher did not collect the data themselves for this study but used data collected by the NHS database for their own purposes.

A researcher accessed the NHS database for all of the patients who had sought help to stop smoking. 50% of those who had used CBT had stopped for more than a year, 30% of those who had attended a self-help group had stopped for a year and 10% of those in a control group who had no treatment had also stopped for a year.

Identify one ethical issue in this study and explain how it would be dealt with. [3 marks]

Confidentiality is an issue here. This could be dealt with by not revealing the identities of the participants in the study when the results were published in order to preserve their anonymity.

Explain what is meant by a 'self-help group'. [2 marks]

Self-help groups are composed of people who share the same problems and regard each other as 'peers'. The 12-step programme is a peer-sharing model where peers offer help and support to each other so it's an example of a 'self-help' approach.

Explain how a self-management programme can be used to improve mental health. [4 marks]

Addiction is a mental health problem. One of the ways that has been used to help people with addictions is a self-management programme such as the 12-step recovery programme developed by Alcoholics Anonymous (AA). This programme focuses on giving control to a higher power and letting go of your own will. The person accepts things they have done, and the members of the group and the higher power listen to the confession to accept the 'sinner'. Recovery is a lifelong process where the group supports each other.

Outline and evaluate a self-management programme for addiction. [9 marks]

Alcoholics Anonymous (AA) has developed a self-management programme called the 12-step recovery programme. One key element is giving control to a higher power and letting go of your own will. The person accepts things they have done, and most importantly shares their sense of guilt about their addiction with others. By sharing guilt the higher power and the others in the group forgive the 'sinner’. This forgiveness means the sinner can forgive themselves. Recovery is a lifelong process where the group supports each other. They can call other members in case of relapse. Some programmes avoid the religious element of surrendering to a high power.

One weakness is poor quality research on the effectiveness of the 12-step programme. The AA reported in 2007 that 33% of its 8000 North American members have remained sober for ten years or more but this doesn't include how many left without success. This suggests that it is difficult to get clear evidence on effectiveness.

Another weakness is that the 12-step programme may only be effective for certain types of people. Dropout rates are high, suggesting that the self-help approach is demanding, requiring high motivation. This means such self-management programmes may offer a limited approach.

However, one strength is that the 12-step recovery programme focuses on the whole person. Many steps are concerned with emotions, particularly guilt, together with providing social support to help a person cope with their emotions. This can be contrasted with more reductionist programmes, such as aversion therapy which just target stimulus-response links.