Psychology Revision: Summer A2Section A: Psychopathology

Candidates should be familiar with the following:- Clinical characteristics of the chosen disorder

Definition of a phobia: A persistent, disproportionate and irrational fear of an object of situation which disrupts everyday life. - The object/situation can present little or no danger at all, and even though the individual will recognise the fear as unjustified, they will react to the perceived threat with: hyperventilation, palpitations, choking sensations, flushes, sweating, feeling faint or muscle tension.

Key characteristics: Extreme fear which is disproportionate to the danger, avoidance of the object/situation.

To diagnose: Fear must be unreasonable relative to the danger posed by the object/situation, it must be triggered immediately upon expose, and it must interfere with everyday functioning.

Specific Social AgoraphobiaStrong fear and avoidance of a particular object or situation. Sometimes simply anticipating exposure can bring on a panic attack.

An extreme fear of embarrassment or humiliation in social situations. Can be specific or generalised.

A fear of having a panic attack in public; particularly regarding public transport and busy places like shopping centres.

E.g. claustrophobia, arachnophobia

Specific: Fear of public speakingGeneral: Fear of starting conversations.

Agoraphobia as a complication of panic attack, or less commonly, agoraphobia without panic attacks, fearing the environment outside an individual’s home.

- Issues surrounding the classification and diagnosis of their chosen disorder, including reliability and validity

Reliability of testing for a phobia: - Inter-rater reliability (similar scores between researchers).

- Three clinicians assessed 54 patients using a structured clinical interview. There was high inter-rater agreement, so diagnosis of phobia’s using this method is reliable. This could be because the interview required intensive training on the part of the clinicians, and the interview itself took hours to complete.

- Test-retest reliability (same results when test is repeated). - MDC = Munich Diagnostic Checklist (self-administered short questions to diagnose a phobia).

Examination of the MDC has shown good test-retest reliability for specific phobias. - Kendler (1999) assessed phobias using face to face and telephone interviews, and found long

term reliability (8 years) of using these methods is low. Could be due to participants having poor recall of their fears.

Reliability of diagnosing abnormalities: - Rosenhan study when students attempted to gain admission to hospitals claiming they could hear voices in their heads. They were diagnosed with schizophrenia and during their stay in hospital none of the staff recognised that they were not ill, although several of the genuine patients were suspicious.

Validity: to what extent do classification systems measure what they claim to measure?- Social and animal phobias often are accompanied by other abnormalities (comorbidity) so the DSM is not useful when recommending a treatment (DSM won’t identify a cause or which abnormality needs treating first).

When looking at the validity of different methods of diagnosis, one could consider:Concurrent validity Construct validity

Compares one method with a previously validated method, e.g. the Social Phobia Scale has high concurrent validity compared with other methods of diagnosing social phobias.

Does the concept match the specific measurement? Foe example, the Social Phobia and Anxiety Inventory correlates well with behavioural measures of a social phobia (e.g. public speaking).

Cross Cultural Validity:What is considered a phobia in one culture might be considered less serious in another. For example, in Japan there is a social phobia or embarrassing other people, but in England we would not diagnose an individual with this condition as having a phobia. Therefore culture has an effect on the diagnosis of phobias. Similarly, a phobia can be diagnosed if it interferes with everyday functioning and causes an extreme fear. Different cultures have different ideas of what makes normal functioning and what constitutes and extreme fear.

- Biological explanations of their chosen disorder, for example, genetics, biochemistry

GeneticsResearch suggests genetics may lead to the development of phobias. No specific gene has been identified yet, but patients with phobias share certain genetic anomalies.

Freyer (1995) found individuals who had close relatives with specific phobias were more likely to have a specific phobia themselves.

No concordance for social phobias. If they share the same environment they could have learned the behaviours

Torgesen (1983) investigated twins where at least one twin was agoraphobic and found there was a higher likelihood of both twins having a phobia in identical twins than fraternal twins. Few twin studies so hard to generalise.

It is not clear exactly what is passed on in the genes that causes a phobia to develop. Perhaps some people inherit a genetic over-sensitivity of the nervous system which leaves them sensitive to a range of stimuli. Interactionism (nature = genetic over-sensitivity, nurture = environmental trigger)

NeurophysiologyIndividuals who have high levels of physiological arousal are more vulnerable to the development of phobic disorders as they are argued to be particularly sensitive to their external environment.

Lader and Matthews (1968) found an association between arousal levels and patients suffering from panic disorder with agoraphobia.

Correlation, not causation. Does arousal lead to development of a phobia or does a phobia lead to high levels of arousal?

Evolutionary TheoryPhobias are developed to objects/situations that were potential sources of danger thousands of years ago. Those who developed these phobias would have avoided the harmful object/situation and therefore would be favoured by evolution.

Humans have a ‘preparedness’ to be sensitive to certain stimuli. We aren’t born with the phobia; instead we a born with an innate tendency to acquire the phobia quickly to harmful objects/situation.

Humans are more likely to be conditioned to stimuli like snakes which are ‘fear-relevant’ than stimuli like flowers which are ‘fear irrelevant’. Ethical implications of conditioning fears into humans.

Monkeys readily acquire fears of toy snakes and crocodiles but could not be conditioned to fear a toy rabbit. Because the monkeys had never seen a snake or a crocodile before, their fear cannot be explained by prior learning. Can’t generalise from animals to humans.

Fears acquired under lab conditions can easily be removed, so they are unlike the phobias that people acquire in the real world.

- Biological therapies for their chosen disorder, including their evaluation in terms of appropriateness and effectiveness

Benzodiazepines (BZs) Antidepressants (MAOIs & SSRIs) Beta-Blockers PsychosurgeryFunction Treat the physical symptoms

of a phobia, e.g. slow activity of sympathetic nervous system to reduce anxiety.

Both increase levels of serotonin. MAOIs prevent its breakdown, SSRIs prevent serotonin reuptake.

Reduce the activity of adrenalin and noradrenalin, so heart beats slower, blood pressure is lower and patient feels calmer and less anxious.

Operations are performed on the limbic system (region associated with emotions) to treat anxiety.

Positives - More effective than both placebos and antidepressants in treating anxiety.

- SSRIs shown to reduce anxiety levels significantly more than placebos.

- Few if any side effects

Negatives - Side effects include increased aggression and long term memory impairment.- Addictive even in small doses. Recommended for four weeks (not treating phobias in long term).

- Link between SSRIs and increased suicide risk.- SSRIs take four weeks to have an effect so patients stop taking them.- MAOIs have a long list of related side effects such as insomnia and dizziness.- MAOIs require strict dietary restrictions, otherwise they can be lethal.

- Appear highly effective in research, but Turner (1994) found no difference between B.B and placebo groups in terms of heart rate etc.

- Irreversible- Any lasting damage may leave patients with lower quality of life than before the operation.- Unethical, suitable only as a last resort.

General comments- Only treating the symptoms of phobias, so are not recommended as the

primary form of treatment.- Can be useful when a panic disorder accompanies a phobia (e.g. with

agoraphobia).- Cognitive therapies would be more effective because they would directly

treat the cause of the phobia, not the symptoms. - Ethical issue with drug treatments: most patients are not informed about the

comparative success of drugs versus placebos, so they expose themselves to unpleasant side effects even though the benefits of the drugs may be slim.

- Psychological explanations of their chosen disorder, for example, behavioural, cognitive, psychodynamic and socio-cultural

Cognitive‘Catastrophic thoughts explanation’ – a person with a phobia thinks that something dreadful will happen if they encounter the feared object/stimulation, e.g. ‘if I see a snake, it will bite me and I will die’. This negative thought pattern is often accompanied by others, such as believing other people must think badly of them.

Menzies & Clark (1995) – people with phobias believe negative events are much more likely to happen than those without phobias.

Gournay (1989) – phobics are more likely than normal people to overestimate risks. This suggests they may be cognitively predisposed to develop phobias.

Useful because psychologists can find out what types of thoughts people with phobias have, which has led to the development of treatments which try to change how such people think.

Psychodynamic explanations disagree that the focus should be on thought. They would argue the true cause lies within the unconscious mind, so focus should be on unlocking that.

BehaviouristPhobias are learnt from the environment (classical conditioning).

Little Albert – case demonstrates it is possible to condition a fear of a previously neutral stimulus. Cannot generalise from one case study. Latter research failed to replicate the findings. Ethical issue – conditioning fear in a young child.

Bagby (1922) – A young woman developed a fear of running water after she was trapped by rocks near a waterfall.

DiGallo (1997) – Nearly 20% of people who have been in bad traffic accidents develop a fear of travelling (don’t want to travel in a car, frightened of travelling at medium speeds, prefer to stay at home instead of travelling to see friends).

General comments:- Some people have phobias of things they have never encountered- Falls on nurture side of nature/nurture debate- Too reductionist. Phobias are complex and it is too simplistic to explain them

in terms of classical conditioning. - Difficult to test behaviourist explanations experimentally because it is highly

unethical to cause extreme fear in participants.

PsychodynamicThe source of the fear is repressed into the unconscious and the fear is displaced onto a harmless external object, which is why the fear is seen as irrational. It is less threatening for an individual to have a phobia than it is to have distressing thoughts and conflicts.

Little Hans – fear of his father was repressed and displaced onto a harmless external object (horse). Unrepresentative, lacks scientific rigour as it is highly subjective (explanation depends on interpretation of symbols). Both Freud and Hans’ father interpreted the evidence according to their expectation about the origins of the phobia.

- Very difficult to investigate psychodynamic approach because it focuses on the unconscious mind.

- This approach can explain agoraphobia as the result of separation anxiety experienced as a child. Unconsciously the person thinks that separation anxiety is less likely if the person is at home all the time.

o Bowlby (1973) found that agoraphobics often had early experiences of family conflict.

o No other evidence supports this explanation.

- Psychological therapies for their chosen disorder, for example, behavioural, psychodynamic and cognitive-behavioural, including their evaluation in terms of effectiveness and appropriateness.

Systematic desensitisation Flooding Cognitive Behavioural TherapyMethod A stepped approach of increasingly

‘frightening’ tasks, teaching people relaxation techniques they can use when they feel anxious.

Patient is presented with their phobic item/situation in a repeated, intensive way so they ‘unlearn’ their associated negative feelings.

Aims to change distorted thinking patterns associated with the phobic item/situation, coupled with behavioural therapy.

Research Lang & Lazovic (1963) – Group 1 had SD for snake phobia, Group 2 no SD. Group 1 showed less fear of snakes than 2. 6 months later Group 1 still showed reduced fear of snakes.

Study found CBT reduced children’s fear of the dark, and three years later improvement had been maintained.

Negatives Effectiveness of behavioural therapies may rely on clients following instructions for technique practice at home. Treatment failures may have more to do with lack of commitment than the technique itself.

Don’t know which bit of the therapy worked; cognitive or behavioural?- Could change have been caused by another factor, e.g. medication?

Ethics Protection from psychological harm; forcing someone to face a phobia that intensively could cause trauma. However, end result may justify the means.

Comparisons Research was SD vs no treatment; any therapy would be more effective than no therapy.

Psychodynamic approach argues that to cure a phobia the true cause must be unlocked from the unconscious mind.

-Research was CBT vs no treatment; any therapy would be more effective than no therapy.-C vs B = little difference in effectiveness.

Comments Behavioural therapy treats the symptoms, not the cause.