IB HL2 Abnormal Psychology Review

How and why can bio treatments be used to treat one disorder? (Topics)

Topics:

• Selective Serotonin Reuptake Inhibitors (SSRI’s) - Drug Therapy

• SSRI’s effect in PFC and cognitive reappraisal

How and why can bio treatments be used to treat one disorder? (studies)

Drug Therapy

• CAPS PTSD Drug Trial Study (Marshall et al. 2001)

• Ipser et. al 2006 study

• Reappraisal War Veteran Study (MacNamara et al., 2016)

Examine how and why cognitive treatments can be used to treat one disorder (Topics)

Topics:

• VRET

• Imagination Therapy

Examine how and why cognitive treatments can be used to treat one disorder (Studies)

• Vietnam War Vets VRET Study (Rothbaum et al, 2001)

• CAPS Imagination Therapy (Felmingham et al, 2007)

Examine how culture may influence the treatment of disorders (Topics)

Cultural attitudes towards drug therapy and internal model of illness

• Cultural attitudes towards drug therapy

• Cultural factors influencing the patient’s internal model of illness

Examine how culture may influence the treatment of disorders (Studies)

• Southeast Asian Depression Study (Kinzie et al. 1987)

• Cultural Differences in Ideologies for Treating Depression (Jimenez et al, 2012)

Examine how the effectiveness of treatment for disorders is determined (Topics)

Topics:

• Clinical Trials

• Meta Analyses

Examine how the effectiveness of treatment for disorders is determined (Studies)

• CAPS PTSD Drug Trial Study (Marshall et. al 2001)

• VRET vs Anxiet Disorders (Parsons and Rizzo, 2008)

Point Paragraph 1 (Concept 7)

• What are treatments, how drug treatments help PTSD (PFC, Serotonin)

• What is Drug Therapy, give example (SSRI)

• How SSRI’s Work (Prevent reuptake of excess serotonin, allowing for more to be binded to post-synaptic nerves, emphasizing serotonin’s effects (excitatory, stimulating effect, negating effects of PTSD)

• How is effectiveness measured?: Response Rate (50% decrease in scores of PTSD), Remission (few to no symptoms), Relapse (do they get symptoms after treatment subsides?)

• Side effects: undesirable secondary effect of the drug must be considered

• How are they done?: Usually a Clinical Drug Trial, to have the placebo group; 3 things necessary for clinical drug trial: placebo group, random allocation, double-blind

Evidence & Evaluation 1: (Concept 7)

Marshall et al. 2001:

• Clinical Drug Trial (True Lab)

• 551 Patients w/ PTSD

• 12 Weeks long, 3 groups: 20mg, 40mg, Placebo

• Results: Percentage of patients that had improvement was: 62%, 54%, 37% with paroxetine groups having 50% reduction in symptoms while placebo only had 30%

• No difference based on trauma type

  Evaultation:

• Area of Uncertainty: 12 weeks not a long time, longitudinal effects not shown, hard to conclude effectiveness over time

• Internal Validity: Usage of a placebo, limiting the confounding variable of differing lifestyles of participants being the reason for variations in scores

Point Paragraph 2: (Concept 7)

The Role of SSRIs in PFC and Cogntive Reappraisal

• Why is PFC important? Serotonin receptors concentrated there, showing serotonins impact in this part of brain

• PFC helps with cognitive reappraisal (regulate emotions to stressful stimuli)

• SSRIs reduce symptoms of PTSD by imporving function and activities in the PFC which enables cognitive reappraisals and limits activation of amygdala, which gives stress response

Evidence and Evaluation 2: (Concept 7)

MacNamara et al. 2016

• 34 US War Veterans (17 w/ PTSD, 17 w/o) , 2 fMRI scans 12 weeks apart

• 17 w/ PTSD given paroxetine

• During each scan, had to do an emotion regulation task (shown 64 unpleasant pictures, 32 neutral, had to 1) Look - at the picture, 2) Maintain - View the picture and experience it naturally, 3) reappraise - look at the pictures and cognitvely reappraise to reduce negative effects of the picture

• Severity of PTSD measured using CAPS (clinician-administered PTSD Scale) scores.

• Results: 70% of PTSD group had at least a 50% decrease in symptoms, left dorsolateral PFC activation increased with SSRIs and the right dorsolateral PFC activation decreased. The less the right dorsolateral PFC activated, the more symptoms of PTSD were reduced.

  Evaluation:

• Temporal Validity, done in 2016, findings still applicable to today

• Population Validity - Decreases bc only 34 ppl

Point Paragraph 1: (Concept 8)

Exposure Therapy:

• What is Cognitive Behavioral Therapy (CBT) and what is an example (Exposure Therapy)

• What is exposure Therapy

• Virtual reality exposure therapy, what is it? how does it work?

• Therapist can see the environment and guide patient through it, can control the environment

• Eventually reduces emotional arousal, eventually leading to new connections, addressing negative cognitive appraisals bc they learn to cope with triggers

• May also change the structure and functioning of parts of the brain, like vmPFC and amygdala

Evidence and Evaluation 1 (Concept 8):

Rothbaum et al, 2001: VRET Study

• Correlational

• 10 Vietnam War vets, 8-16 VRET treatments across 5-7 weeks

• Used CAPS to measure PTSD, all had reduction in symptoms 6 weeks post-treatment ranging from 15% to 67%

Evaluation:

• Ecological Validity - Although artificial, the researchers mimicked environment’s smells, sounds, and sights to ensure ecological validity

• Internal Validity - Increased bc they followed up 6 months later

Point Paragraph 2 (Concept 8):

VRET isnt the only type of exposure therapy:

• Imagination Therapy (same as VRET but instead of Virtual Reality, they use Imagination)

• Used in conjunction with Cognitive Restructuring (change a persons negative appraisal to their trauma)

• Helps to improve function in important areas of the brain that are correlated with PTSD like the PFC and the amygdala

Evidence and Evaluation 2 (Concept 8):

Felmingham et al. 2007

• 8 Participants (5 females, 3 males) experiencing PTSD bc of Car accident or assault

• 8 Weeks of CBT (Imagination Therapy and Cog Restructuring)

• After 8 weeks - 30% reduction in CAPS scores

• Participant brain function was also measured by having to look at a range of fearful and neutral facial expressions, which highlighted a positive correlation between CAPS scores and amygdala activation, when CAPS scores decreased, so did amygdala activation

Evaluation:

• Population Validity - Decreaes bc only 8 People

• Temporal Validity - 2007, Relatively recent, making finding still applicable to today

Point Paragraph 1 (Concept 9):

Cultural attitudes towards drug therapy and internal models of illness:

• Influences how a mental disorder is experienced, presented, and perceived, it can also influence treatment through cultural attitudes towards treatments and cultural attitudes to etiologies of disorders

Cultural attitudes towards treatments:

• Why is drug therapy a desirable form of treatment? (fast easy, cheap, self administered,)

• Most drugs developed in the West by Western Pharmaceutical companies, which is why drug therapy is more accepted in the West

• Cultural differences in ideologies towards drug treatments can affect an individual’s compliance to taking their medication, leading to a good rapport not being established between the patient and doctor, resulting in the patient not taking the treatment seriously or following through with treatment

• Psychologists need to be culturally competent (understanding patient’s cultural needs) and be aware of cultural stigma that comes with diagnoses and drug treatments bc they can influence the behavior of patients

Evidence and Evaluation 1 (Concept 9)

Kinzie et al, 1987: Depressed Southeast Asian Study

• 41 Depressed Southeast Asian Patients who were doing long-term depression treatment at US Clinics, they were all described Tricyclic antidepressants (TCA)

• Blood levels were taken to examine amount of medication in the bloodstream, 61% of patients were found to not be taking their medication

• After a doctor-patient discussion about the problems and benefits of antidepressants, rates of compliance drastically improved.

Evaluation:

• Area of Uncertainty - Dont know if it was the fact that patients were embarrased they got caught not taking meds from a doctor bc doctor is a higher authority figure in a medical setting

• Population Validity - Decreases bc there is only 41 participants

Point Paragraph 2: (Concept 9)

Cultural Factors that influence the patient’s internal model of illness:

• The Internal model of illness (perception of illness and treatment) influences Three Factors: How patients interpret symptoms, how favorably they view treatments, and the extent to which they believe the treatment targets the cause

• Therapist must take the internal model of illness into account to see if they should Change the patients internal model of illness to fit the therapy or to change the therapy to fit the model of illness

Evidence and Evaluation 2 (Concept 9)

Jimenez et al. 2012

• Questionnaires, 2000 U.S participants all over 65 years old

• Grouped by ethnicity: Non-latino whites, african americans, Asian-americans, and Latinos

• Asked a variety of mental healthy related questions

  Results:

• AA believed depression caused by stress or worry and were more likely to seek spiritual advice, Latinos were more likely to opt for medication

• AA were more likely to speak to a family member about problems, non-latino whites more likely to seek help from psychiatrist, Asian-Am more likely to not speak at all or to someone else that is asian

Evaluation:

• RM - Decreased because no cause and effect can be reported due to it being a correlational study

• Temporal Validity - done less than 15 years ago, but it was pre-covid, so it may need to be revisited as many cultural beliefs were challenged as individuals lost people to covid

Point Paragraph 1 (Concept 10):

Clinical Trials:

• To understand why treatment is effective, the mechanisms of treatment must be studied

• Three ways of assessing effectiveness of treatment in abnormal psych: Randomized Control Trials (CRTs), Qualitative Research Studies, and Meta-analyses

• This is important bc ineffective treatment can be detrimental to a patient, challenges in doing this include different operationalizations and the consideration of the differences of St and LT effectiveness

• Clinical Trials are used on people seeking treatment for a certain disorder (psychological or biological)

  • They’re true experiments

  • Must have Random allocation, be double-blind, and have a placebo

  • Can be done for psychotherapies but its more difficult to have a placebo

Evidence and Evaluation 2 (Concept 10)

Marshall et al. 2001

• Clinical Drug Trial (True Lab)

• 551 Patients w/ PTSD

• 12 Weeks long, 3 groups: 20mg, 40mg, Placebo

• Results: Percentage of patients that had improvement was: 62%, 54%, 37% with paroxetine groups having 50% reduction in symptoms while placebo only had 30%

• No difference based on trauma type

  Evaultation:

• Area of Uncertainty: 12 weeks not a long time, longitudinal effects not shown, hard to conclude effectiveness over time

• Internal Validity: Usage of a placebo, limiting the confounding variable of differing lifestyles of participants being the reason for variations in scores

Point Paragraph 2 (Concept 10):

Meta-Analyses:

• gathers data from many studies and includes all the data in a statistical analysis

• Effect size is measured (trend in data) which shows the strength of the effects of the independent variable on the dependent variable, the closer to one the stronger the relationship and vice versa

Evidence and Evaluation 2 (Concept 10):

Parsons and Rizzo, 2008:

• 21 studies (over 300 participants) that used VRET to treat anxiety disorders

• Found a significant effect in using VRET to treat a range of anxiety-related disorders, including PTSD and phobias

• results showed an effet size of 0.87 for PTSD