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» A-Level Clinical Psychology Complete Notes
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Posted on: May 3rd, 2011

1. Describe & evaluate two ways in which psychologists have defined abnormality. (12)

2. Critically consider both practical & ethical considerations for adopting classification systems for mental disorder (12)

3. Discuss cultural & subcultural differences in definitions, classification & diagnosis of abnormality (12)

4. Describe & evaluate the evidence that schizophrenia is a genetic disorder (14)

5. Discuss the influence of genetic &/or neurological factors on mental illness (24)

6. a) Describe the main symptoms one mental disorder (6)

   b) Discuss social/psychological explanations given for the cause of this disorder (8)

7. Describe & evaluate two psychological therapies (12)

8. a) Describe the DSM classification system (AO1-6)

   b) Discuss cultural factors affecting diagnosis of mental health issues (AO1-6  AO2-6)

9. Describe the recent developments in social approaches to abnormality (eg care in the community) (8)

10. Compare & contrast the cognitive & psychodynamic approaches to mental disorders (12)

11. a) State two definitions of abnormality (AO1-2)

     b) For one definition, give two advantages & two disadvantages of using this method (A02-4)

12. Compare and contrast the biological and learning approaches to abnormality (12)

STATISTICAL DEFINITION OF ABNORMALITY: where abnormality is behaviour that is rare. If behaviour is infrequent (statistically) within a population (if the behaviour falls in the top or bottom 2.5% of a normal distribution graph) it is considered to be abnormal eg. Having an IQ of below 70.

SOCIAL NORM DEFINITION OF ABNORMALITY: When a person’s behaviour or beliefs go against what is regarded as acceptable and expected within a particular society they may be judged as ‘abnormal’ eg. Talking to one self. When abnormality is based on what society sees as desirable behaviour.

SCHIZOPHRENIA: a very serious mental illness that can affect the way someone thinks, feels and speaks (disruption in cognition, emotion and language) to such a degree that they lose focus on reality. The diagnosis of schizophrenia, according to DSM-IV, requires at least 1-month duration of two or more positive symptoms, unless hallucinations or delusions are especially bizarre, in which case one alone suffices for diagnosis. Schizophrenia has been classified into five main subtypes – paranoid, disorganised, catatonic, residual & undifferentiated.

RELIABILITY: A measure of whether replications would produce similar results, if they do then the test is reliable. Usually greater control over variables enhances reliability as the study will be more replicable.

VALIDITY: A valid test is one that measures what it claims to measure. There are many different types of validity including population, construct, ecological and face. ? Face validity – simply whether the measure appears to test what it claims to test and does it make common sense ie. can we see real life examples. ? Ecological validity – the extent to which a test measures a real-world phenomena ie. Will the results generalise to a real life situation.

PRIMARY DATA: original data that has been collected by those who witnessed an event first-hand or who collected data themselves for a specific purpose eg. Results from a questionnaire or conducting a tally of observed behaviours.

SECONDARY DATA: second-hand analysis of pre-existing (primary) data. It is the analysis of data that was collected by someone else usually involving interpretation, evaluation and commentary.


13. a) Describe one therapy from the Cognitive approach (6)

     b) Evaluate the therapy given in the previous question (6)

14. Describe the main features/symptoms of phobic disorder (4)

15. Outline primary and secondary data (4)

16. Discuss issues of validity and reliability in clinical psychology (8)

17. Discuss two research methods used to study schizophrenia (12)

18. Outline and discuss one key issue in Clinical psychology (14)


Clinical psychology is the branch of applied psychology that deals with understanding mental health and mental disorders. This area of Psychology is about diagnosing, explaining and treating mental illness such as anorexia nervosa. Clinical psychology is sometimes referred to as ‘abnormal psychology’ as it is concerned with the study of behaviour that is not regarded as ‘normal’ behaviour ie. The person’s behaviour is outside the range of what we see as typical of people with good mental health.

A key are in Clinical Psychology is defining abnormality and diagnosing mental illness. Defining abnormality poses a variety of difficulties such as distinguishing between abnormality and eccentricity for example. It is also difficult to develop a definition which is culturally neutral, consistent over time and objective. Definitions of abnormality include:

• Deviation from social norms – which is based on what society sees as desirable behaviour. • Statistical infrequency – where abnormality is behaviour that is rare. • Failure to function adequately – where an individual will be assessed on a range of criteria such as whether they contribute to the larger social group.

DSM (Diagnostic Statistic Manual) is used as a diagnostic tool to assess a person for a mental disorder, it takes a multi-axial approach to assessment whereby the symptoms of the condition are noted, plus how long the person has been experiencing them, information about their general health, any social or psychological problems. The patient will also be assessed on their ability to cope with everyday life.

An important area in Clinical Psychology is explaining psychological disorders as trying to understand the causes of a condition can then help in identifying the best treatment. Explanations and treatments stem from the different approaches in Psychology. In line with the assumptions within the approach explanations for psychological disorders focus on nature or nurture (and occasionally a combination of both).

Approach Examples of Treatment Social Care in the Community Cognitive Rational Emotive Therapy Learning/Behaviourism Systematic Desensitisation, Aversion therapy, Flooding, Token economy Biological Chemotherapy (drug treatment), Psychosurgery, Electroconvulsive Therapy (ECT) Psychodynamic Psychoanalysis, Psychodrama Humanistic Client-Centred therapy





DEVIATION FROM SOCIAL NORMS: When a person’s behaviour or beliefs go against what is regarded as acceptable and expected within a particular society they may be judged as ‘abnormal’ eg. Talking to one self.

STATISTICAL INFREQUENCY: If behaviour is infrequent within a population (if the behaviour falls in the top or bottom 2.5% of a normal distribution graph) it is considered to be abnormal eg. Having an IQ of below 70.


DEVIATION FROM SOCIAL NORMS: Social norms are behaviours that are expected from people at certain times. They are (often) unwritten social rules or standards that determine normal and moral behaviour or beliefs. Social norms identify behaviours that are desirable for both the individual & society as a whole. Hence deviance from social norms is usually abnormal & undesirable. This definition implies abnormality is when someone defies the norms of society and does not act in line with expectations or usual behaviour ie. ‘not behaving or feeling as one should’. Some social norms are supported by laws such as driving on the left when driving in the UK, but others are unwritten.

The use of this definition is seen in DSM-IV-TR (2000) when defining the symptoms of anti-social personality disorder. The diagnostic manual states that one of the symptoms of this disorder is a ‘failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest’. Other diagnoses such as paedophilia and zoophilia are also based largely on the social unacceptability of the individual’s behaviour. There are however factors that have to be considered when applying this definition such as culture, situation, age, gender and historical context. Eg. A child being naked in public would be acceptable within social norms but an adult would be classed as deviant.


DEVIATION FROM SOCIAL NORMS: – If culture, age, situation, historical context and gender have to be considered then it is hard to have a reliable idea of what is abnormal. Therefore diagnosis is difficult, as there are no set symptoms to rely on, which would make this definition unsuitable to help with diagnosis. – Problems can occur if a mental health professional from one culture assesses someone from another. Social norms are culturally specific and thus misunderstanding could lead to judgements of abnormality, this may be why Black and Irish people in the UK are significantly more likely to be diagnosed with a mental disorder.

+ Unlike certain other definitions, such as statistical infrequency, the deviation from social norms definition considers the desirability of behaviour – both for the individual & for society. For example in terms of frequency depression affects a high percentage of the population however it is not a desirable state for the individual and using the social deviancy definition depression would be classed as abnormal and intervention could be recommended.

STATISTICAL INFREQUENCY: – Unlike the social norm definition, this definition does not take into account the desirability of a characteristic. Many qualities that occur infrequently are desirable eg. High intelligence; low susceptibility to anxiety. – The 2.145% cut off point is arbitrary (quite random & meaningless), why not 3% or 2% for eg. + This definition is relatively objective; it is not based on opinion and affected by value judgements.


DEVIATION FROM SOCIAL NORMS: + The definition is in line with our common sense and every day thinking of what constitutes abnormal behaviour for example with the use of some definitions high levels of intelligence would be classed as abnormal but under the social norms definition it would not, which is in line with common perception.

+ This definition explains why different cultures have alternative ideas of what is normal behaviour and takes into account that there is no universal rule about what is abnormal.

– Social deviancy is not always negative. Some people are socially deviant because they have chosen a non-conformist lifestyle. It may difficult to distinguish between someone who is an eccentric & those who are abnormal. Others may be branded as socially deviant when their behaviour is determined by high principles, such as those ‘deviants’ in Nazi Germany who spoke out against the atrocities that were being committed. – Focusing on the ways in which an individual chooses to deviate from social norms can lead to severely restricting their freedom of choice. There are many historical examples of people being categorised as abnormal due to deviation from social norms that today (because social norms have changed) we would regard as discriminatory and a form of social control. Thus using social deviancy as a means of establishing a standard allows serious abuses of human rights to occur.

Hence this definition can be helpful, but it cannot function as an exclusive definition since there are several problems with its use.

STATISTICAL INFREQUENCY: – The tests that are used to assess a particular characteristic eg. IQ may not be valid. – The 2.5% cut off point may not be applicable to other cultures where there isn’t a normal distribution. + Often behaviours generally regarded as abnormal do tend to occur relatively infrequently eg. schizophrenia.
??EXTENSION An alternative definition – Failure to Function Adequately AO1: In a given society there are expectations about how people should live & how they should contribute to the social groups around them. If an individual cannot meet these expectations they may not be functioning adequately eg. not contributing to the larger social group. Such an individual may be experiencing distress or discomfort & may recognise they are not functioning adequately. Rosenhan & Seligman extend this definition with use of 7 criteria: unpredictability & loss of control; irrationality & incomprehensibility; observer discomfort; violation of moral & ideal standards; suffering; maladaptiveness; vividness & unconventionality of behaviour. The fewer of the features that are displayed the more a person can be regarded as normal.

AO2 – Evaluation: + Recognises there may be degrees of normality & abnormality. + It is relatively easy to assess the consequences of dysfunctional behaviour eg. absenteeism from work, as measures of the level of functioning. + The use of several criteria may increase validity & takes a wider view of defining abnormality. – Definition still requires subjective judgements & interpretation – Some of the criteria are based on social norms & so may not apply universally – Some of the criteria would also apply to non-conformists who do not require treatment. – Some individuals may be abnormal but do not meet the criteria eg. a manic depressive may not experience distress during periods of mania. A psychopath may still attend work and are not suffering.

Exam practice question: Abnormality is difficult to define, discuss (20)



? MUST KNOW – A01 • Classification of mental disorder involves taking sets of symptoms and putting them into categories. • Diagnosis involves assessing a patient’s symptoms and deciding whether they meet the criteria for one or more mental disorders. • DSM-IV-TR is multi-axial and has five axes which are used to evaluate an individual’s mental state. • Axis 1 psychiatric disorders, axis 2 personality traits, axis 3 general medical conditions, axis 4 life stressors and axis 5 functioning.

? SHOULD KNOW – A01 Classification of mental disorder involves taking sets of symptoms and putting them into categories. For example symptoms of depressed mood, having low self-esteem and sleeping too much or too little can often occur together. We can then say that someone showing these symptoms has a particular disorder. This can then be classified as part of a wider class of disorders. Once a practitioner has a set of abnormal symptoms classified into a disorder the individual can be diagnosed according to their symptoms. Diagnosis involves assessing a patient’s symptoms and deciding whether they meet the criteria for one or more mental disorders.

There are several known classification systems used to categorise abnormal patterns of thinking, behaviour and emotion in relation to a particular disorder. The systems include DSM-IV-TR (Diagnostic Statistic Manual, edition four with text revisions, which is the American system, APA 2000) and the International Classification of Diseases (ICD, produced by the World Health Organisation). The main purpose of classification systems is to try to initiate an agreement on a universal definition or criteria for a specific disorder.

DSM is multi-axial and has five axes which are used to evaluate an individual’s mental state. Axis 1 and 2: concerned with the diagnosis of mental disorders. Axis 3: looks at general medical conditions, as the symptoms of some medical disorders are similar to mental disorders. Axis 4: psychosocial and environmental problems, which may have an effect on the disorder eg. Family problems or problems with employment. Axis 5: is the Global Assessment of Functioning (GAF) scale, which ranges from 0 to 100. The psychiatrist has to assess how able the patient is to cope with everyday life and so how urgent their need for treatment is.

The use of axes reflects the assumption that most disorders are caused by the interaction of biological, psychological and sociological factors. The axes allow a patient to be assessed much more broadly, giving a more in-depth picture. In the classification system the disorders are listed along with a specified list of symptoms, all or some of which must be present for a specified period of time.


A valuable classification system needs to satisfy certain criteria, such as: – The categories should be mutually exclusive – the boundaries between different categories should not be blurred & it should be clear what disorder a person has. – The application of the system should be valid & reliable

Reliability: – Early studies showed poor diagnostic reliability. The US-UK Diagnostic Project (Cooper et al, 1972) showed American and British psychiatrists the same videotaped clinical interviews and asked them to make a diagnosis. New York psychiatrists diagnosed schizophrenia twice as often as, while the London psychiatrists diagnosed mania and depression twice as often.

+ Cooper (1983), the newest classification systems leave little room for subjective judgement & thus the reliability of the diagnosis is high. This was aided by the introduction of a multi-axial assessment with DSM-III (1980).

+ DSM-IV is thought to have made further improvements on DSM-IIIR in terms of reliability.

– Nicholls et al (2000) compared the reliability of DSM-IV, ICD-10 and Great Ormond Street’s classification system for children with eating disorders. ICD hada reliability rate of 36%, DSM of 64%but only because 50% of the raters agreed they couldn’t make a diagnosis. The Great Orrmond Street system had 88% agreement. The study demonstrated that neither ICD-10 nor DSM-IV demonstrates good inter-rater reliability for the diagnosis of eating disorders in children.

+ Pontizovsky et al (2006) compared diagnosis on admission of a patient with diagnosis on release from psychiatric hospitals in Israel. Using the PPV system of assessing reliability, 94.2% of patients with mood disorders had the same diagnosis when released from hospital as when they were admitted. For psychotic patients 83.8% were given the same diagnosis. Using the Kappa system reliability was found to be 0.68 and 0.62 respectively. The study found reasonably good levels of test-retest reliability. (Extension: read p.137 of Angles A2 ‘Making sense of reliability figures’ to learn the difference between PPV and Kappa measures of reliability)

Validity: Andrews et al (1999) found good criterion validity on particular disorders when comparing DSM-IV with ICD-10. They found good agreement on depression, general anxiety disorders and substance abuse. However, moderate agreement was found on other anxiety disorders and poor agreement on post-traumatic stress disorder.

Cleusa et al (1990) compared DSM-IV and the Portuguese classification system for dependence disorders and found good agreement for measuring the severity of dependence on cocaine cannabis and alcohol. However an implicit assumption in this study is that the alternative classification system is valid – which

it may not be.

The changing categorisation of homosexuality as a disorder raises the issue of construct validity. Homosexuality is no longer categorised as a disorder even though the behaviour itself has not changed which suggests early version of DSM were invalid. The fact that DSM has undergone several revisions confirms the constructive nature of attempts to classify psychological disorders.

Allardyce et al (2007) questions the construct validity of schizophrenia. One reason is that one symptom of schizophrenia is delusions and hallucinations, however these experiences are fairly common amongst the general population and thus there is no clear cut off point beyond which we can say someone is suffering schizophrenia. In addition there are similarities between schizophrenia and drug-induced psychosis meaning someone with schizophrenia could appear similar to someone suffering this effect from drug use.

Cultural issues: Culture can affect the diagnosis and treatment of mental disorders, as different cultures have different attitudes to mental disorders. In addition culture can affect how much information a patient is likely to disclose eg. personal disclosure is not part of some cultures, which can affect diagnosis if not all symptoms are mentioned. Culture can also affect the likelihood that a person will seek medical intervention. Sue and Sue (1992) found that many Asian-Americans do not like to talk about their emotions and so are less likely to admit having a problem or talk to a therapist.

Critics suggest that the use of DSM shows bias (which also ties in to validity & reliability) as: – Psychiatrists in different countries will use the classification system in different ways. – Some mental illnesses included in the classification system are not universal & there are ‘culture-bound syndromes’.

– Psychiatrists may have expectations or prejudices of people from different races.

Some conditions are thought to be culture specific. Certain disorders that are widely found in a given culture are not recognised in others (culture-bound syndromes). The APA formally recognised such disorders by including a separate listing in the appendix of DSM-IV. Western psychiatry maintains that most of these disorders are merely variants of known syndromes & do not warrant new classification. However this raises the issue of the definition and diagnosis of abnormality being culturally relative.

Depression, which is common in Britain, appears to be absent in Asian cultures. However, it has been suggested that this difference reflects the statistical likelihood of seeking professional help for emotional states, rather than a true indication of the prevalence of the disorder.

One of the major difficulties with studies using diagnostic data is that figures are based on hospital admissions, which may not reflect the true morbidity rates for particular ethnic groups or particular disorders. Rack (1982), in China, mental illness carries a great stigma & therefore the Chinese are careful to label only those whose behaviour is indisputably psychotic.

Statistics show there are significant differences in the prevalence rates for mental disorders between different ethnic or cultural groups in Britain. For instance, there is an over-representation of black immigrants among those diagnosed with schizophrenia. Cochrane (1983) indicates this has not been found to the same extent anywhere else in the world. However, no differences occur in comparing Asian & British individuals, except for less severe disorders where more white people are admitted.

Fernando (1988) claims stereotyped ideas about race are inherent in British Psychiatry. Research has shown the compulsory detaining of African-Caribbean patients in secure hospitals is higher than for any other group, which may linked to stereotypes.




Aim: To investigate whether psychiatrists can reliably tell the difference between people who have a mental disorder and those that do not.

Method Study 1: The main study was a field experiment involving participant observation. The participants were hospital staff in 12 different hospitals. The first part of the study involved eight sane people (pseudo-patients) attempting to gain admission to 12 different hospitals by telephoning the hospital for an appointment, and arriving at the admissions office complaining that they had been hearing voices. After they had been admitted to the psychiatric ward, the pseudo patients stopped simulating any symptoms of abnormality. Results: None of the pseudo patients was detected and all but one were admitted with a diagnosis of schizophrenia and were eventually discharged with a diagnosis of ‘schizophrenia in remission’. The pseudo-patients remained in hospital for 7 to 52 days (average 19 days), Method Study 2: In the secondary study, staff of a teaching and research hospital, were falsely informed that during the next three months one or more pseudo patients would attempt to be admitted into their hospital. Staff members were asked to rate on a 10-point scale each new patient as to the likelihood of them being a pseudo patient. Results: Many patients of the hospitals regular intake were judged to be pseudo patients. For example, around ten per cent of their regular intake was judged by one psychiatrist and another staff member to be pseudo patients. Conclusion: Rosenhan claims that the study demonstrates that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.


Background: The most commonly accepted approach to understanding and classifying abnormal behaviour is known as the medical model (in line with the Biological Approach). In the 1960’s a number of psychiatrists and psychotherapists, known as the anti-psychiatry movement, started to fiercely criticise the medical approach to abnormality. David Rosenhan was a critic of the medical model and this study can be seen as an attempt to demonstrate that psychiatric classification is unreliable.

Aim: The aim of this study was to study how well psychiatrists could distinguish real patients with schizophrenia from pseudopatients, who faked a single symptom. This provided a measure of the validity of the DSM-II system for diagnosis.

Method Study 1: The independent variable of the field experiment was the fake symptoms of the pseudo patients, and the dependent variable was the psychiatrists’ admission and diagnostic label of the pseudo patient. The study also involved participant observation. The pseudo-patients kept written records of how the ward as a whole operated, as well as how they personally were treated. The eight sane people who volunteered to conduct the procedure attempted to gain admission to 12 different hospitals, in five different states in the USA. These pseudo-patients, on arrival at admissions at the hospital, complained that they had been hearing voices. They said the voice, which was unfamiliar and the same sex as themselves, was often unclear but it said ’empty’, ‘hollow’, ‘thud’. The pseudo patients gave a false name and job (to protect their future health and employment records), but all other details they gave were true including general ups and downs of life, relationships, etc. After they had been admitted to the psychiatric ward, the pseudo patients stopped simulating any symptoms of abnormality. The pseudo patients took part in ward activities, speaking to patients and staff as they might ordinarily. When asked how they were feeling by staff they were fine and no longer experienced symptoms. Each pseudo patient had been told they would have to get out by their own devices by convincing staff they were sane. The pseudo patients spent time writing notes about their observations.
In four of the hospitals the pseudo patients carried out an observation of behaviour of staff towards patients that illustrate the experience of being hospitalised on a psychiatric ward.

Results: None of the pseudo patients was detected and all but one was admitted with a diagnosis of schizophrenia and was eventually discharged with a diagnosis of ‘schizophrenia in remission’. This diagnosis was made without one clear symptom of this disorder. They remained in hospital for 7 to 52 days (average 19 days). Although they were not detected by the staff, many of the other patients suspected their sanity (35 out of the 118 patients voiced their suspicions). Some patients voiced their suspicions very vigorously for example ‘You’re not crazy. You’re a journalist, or a professor. You’re checking up on the hospital’.

The pseudo patients’ normal behaviours were often seen as aspects of their supposed illness. For example, nursing records for three of the pseudo patients showed that their writing was seen as an aspect of their pathological behaviour. ‘ Patient engages in writing behaviour’. The observation of staff treatment of patients revealed that the pseudo patients were treated as if they were invisible.

Rosenhan noted that experience of hospitalisation for the pseudo patients was one of depersonalisation and powerlessness. It was estimated that staff administered 2,100 medication tablets to the pseudo-patients. The number of times medical staff came onto the ward, and the amount of time spent with psychiatrists, psychologists, registrars and so forth was, on average, under seven minutes per day.

Method Study 2: The staff of a teaching and research hospital, which was aware of the first study, was falsely informed that during the next three months one or more pseudo patients would attempt to be admitted into their hospital. Staff members were asked to rate on a 10-point scale each new patient as to the likelihood of them being a pseudo patient. This false information was the manipulated independent variable, and the dependent variable was the number of patients which staff subsequently suspected of being pseudo patients.

Results: Judgement of all admissions patients as to the likelihood that they are pseudo patients

Conclusion: The study demonstrates that psychiatrists cannot reliably tell the difference between people who mentally disordered and those that are mentally healthy. It also indicates that DSM-II was not a valid measurement of mental illness and once labelled with a condition like schizophrenia, patients find it difficult to escape the label and be judged as ‘normal’.

+ Rosenhan used a range of hospitals. They were in different States, on both coasts, both old/shabby and new, research-orientated and not, well staffed and poorly staffed, one private, federal or university funded. This allows the results to be generalised.

+ The study had some control over variables and certain procedures were standardised allowing for replication. As the study was conducted/ repeated in several hospitals where similar results were found this enhances the reliability of the findings.

-/+ The staff at the hospital (the participants) were deceived and they were naive to being participants in a study which is unethical. However confidentiality was maintained, Rosenhan did not reveal the names of hospitals or staff and he attempted to eliminate any clues which might lead to their identification.

+/- Rosenhan’s study highlighted the need for revisions and improvements of DSM as a diagnostic tool and thus had useful application. When Rosenhan did his study the psychiatric classification in use was DSM-II. However, since then a new classification has been introduced which was to address itself largely to the whole problem of unreliability – especially unclear criteria. It is argued that with the newer classifications, psychiatrists would be less likely to make the errors they did. Studies now would be unlikely to replicate the findings.

+ Quantitative data was gathered by measuring the number of diagnoses of schizophrenia and the number of days each patient stayed in the hospital. In addition qualitative data was gathered through the observation. Thus data was rich and varied which enhances the validity.

– However, whilst the pseudo-patients’ observations would try to be objective, some subjectivity and the emotions of the pseudo-patients could have influenced these observations.



Features usually involve statistics about the disorder, or aspects of it such as how the illness develops or how other factors such as gender and age link. Symptoms are what characterise the disorder with regard to how the person thinks, feels or behaves.

The array of symptoms, while wide ranging, frequently includes psychotic manifestations, such as hearing internal voices or experiencing other sensations not connected to an obvious source (hallucinations) and assigning unusual significance or meaning to normal events or holding fixed false personal beliefs (delusions). No single symptom is definitive for diagnosis; it can be thought of as a group of psychotic disorders. The diagnosis encompasses a pattern of signs and symptoms, in conjunction with impaired occupational or social functioning.

Symptoms of Schizophrenia Schizophrenia symptoms are typically divided into positive and negative symptoms:

– Positive symptoms are those that are additional to our everyday experiences (they are unusual). Positive symptoms are behaviours not seen in healthy people. People with positive symptoms often “lose touch” with reality.


These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. eg. Hallucinations and delusions.

– Negative symptoms involve the loss of normal functioning eg. Reduced emotional responsiveness and reduced richness of speech. These often persist in the lives of people with schizophrenia during periods of low (or absent) positive symptoms. Negative symptoms are associated with disruptions to normal emotions and behaviours. These symptoms are harder to recognise as part of the disorder and can be mistaken for depression or other conditions. These symptoms include: – “Flat affect” (a person’s face does not move or he or she talks in a dull or monotonous voice) – Lack of pleasure in everyday life – Lack of ability to begin and sustain planned activities – Speaking little, even when forced to interact. – People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.

Features of Schizophrenia There are several different types of schizophrenia, the main ones are outlined below, other types include residual and undifferentiated. Type of schizophrenia Characteristics Paranoid schizophrenia Suspicion of others, grand schemes of persecution at the root of their behaviour, hallucinations eg. Auditory hallucinations, and frequently experience delusions eg. Delusions of grandeur, where they think they are someone grand or famous, like Elvis Presley or royalty or have special powers. Or will have delusions of persecution – believing that people are plotting against them or spying on them. Disorganised schizophrenia Verbally incoherent, may have moods and emotions that are not appropriate to the situation. Hallucinations are not usually present. Flat or inappropriate affect – no emotional response or out of context laughter eg. at a funeral. Catatonic schizophrenia Withdrawn, negative and isolated, marked psychomotor disturbances, apathy (loss of interest in normal goals); and loss of drive (feeling drained of energy, unable to follow through with a course of action).

Schizophrenia has been found in all countries where research has been carried out. According to Jablensky (2000) schizophrenia is found in any nation at a rate of about 1.4-4.6 per 1000 people. DSM-IV (1994) states that estimates of prevalence rates differ, studies have indicated that between 0.2% – 2.0% of the population are affected by schizophrenia. Lewine (1991) found onset in males was 14 – 25 and in females 24 – 35. About one quarter of those who have schizophrenia have it continually without any breaks. About one quarter of people who have had a schizophrenic episode recover and do not get another one. Fifty percent of people with schizophrenia have periods of recovery (remission) and periods of symptoms. ? MUST KNOW – A01 Explanations of schizophrenia

Biological explanation – Genetic factors

Schizophrenia may run in families and so there may be a genetic link. The rate of schizophrenia in the general population is about 1%, but estimates vary. Studies using twins show that in identical (monozygotic or MZ) twins, if one has schizophrenia, the other has 40-50% chance of developing the illness. Concordance rates for schizophrenia are three times higher in identical twins than non-identical twins (dizygotic or DZ). If one parent has schizophrenia then a child has about ten percent chance of developing it. The common view now is that schizophrenia is caused by a number of genes rather than one specific gene. The search for genes that may contribute to schizophrenia has indicated that chromosomes number 6 and 13 might be involved, but evidence so far is uncertain. Social explanations – the impact of social class

The sociogenic hypothesis: People diagnosed with schizophrenia come from all types of social backgrounds, but most are clustered in the lower socio-economic groups and live in the poorest areas of cities. This has led to suggestions that social factors might be important. Schizophrenia shows clustering in declining inner-city areas so perhaps being brought up in such areas leads to schizophrenia. The hypothesis suggests that poor social conditions create stresses that trigger schizophrenia in some people. Thus being in a low social class may cause schizophrenia.

Schizophrenia Explanations

No single cause has been identified for schizophrenia; biological, behavioural and social research suggests a complex interplay between factors. For example, people might have an inherited tendency towards schizophrenia that is triggered by environmental circumstances. The explanations are numerous but can be divided into two groups: Nature: Biological/genetic/neurological Nurture: Social/environmental Biochemical factors eg. The Dopamine hypothesis Brain structural abnormalities or brain damage Genetics Season-of-birth/viral connection Double-bind theory Social factors eg. Social Drift Hypothesis, Social Causation Hypothesis Life stress Psychodynamic Behavioural. Nature and Nurture: Diathesis-Stress model; Stress-Vulnerability model – comprise both sets of theories.
Biological Explanations: Crow (1980) suggested that positive symptoms may be the result of a disturbance of neurotransmitter mechanisms, whereas negative symptoms may be due to a structural abnormality in the brain.

Biochemical factors The Dopamine Hypothesis

The main biochemical explanation for schizophrenia is the dopamine hypothesis. This idea is based on the role of chemical messengers (neurotransmitters) between nerve cells. There seems to be a chemical imbalance in the action of the neurotransmitter dopamine in the brains of those with schizophrenia. It is proposed that schizophrenia results from excess activity at dopamine synapses. Over-stimulation of the dopamine synapses can produce the symptoms of schizophrenia. Structural Differences in the brains of schizophrenics

MRI techniques (magnetic resonance imaging) have shown that many schizophrenics have larger than normal ventricles (Zipursky et al, 1992). Suggesting there is less space occupied by neurons. Schizophrenic brains have fewer neurons in the cerebral cortex, dorsomedial thalamus, amygdala & hippocampus. Schizophrenics also show small frontal lobes, cerebrums, and craniums, plus signs of disorganisation among their neurons i.e. The neurons will not be in the correct part of the brain. Individuals may show signs of impaired transfer of information across the corpus callosum, e.g. Experimenter points at one of the patients’ fingers & asks the patient to raise the same finger on the opposite hand.
Individuals with schizophrenia have lower than average levels of brain metabolism esp. in the hippocampus, & temporal & frontal areas of the cortex. Such individuals fail to recruit extra activity in parts of the frontal cortex when necessary & tasks get performed poorly e.g. Sorting cards. Generally, the greater the increase in metabolism, the better they perform the task.

Post mortem tissue analysis has also revealed chronic abnormalities in the orientation of cells in the hippocampi of schizophrenics; these have not been found in degenerative disorders such as Alzheimer’s disease or Huntington’s chorea, so schizophrenia may be a developmental disorder, where the abnormalities occur in the developing embryo.

Social/environmental explanations

People diagnosed with schizophrenia come from all types of social backgrounds, but most are clustered in the lower socio-economic groups and live in the poorest areas of cities. This has led to suggestions that social factors might be important. In the UK an incidence of above 4 people per 1000 has been found both in the lowest social class in the white population and in black immigrant groups.

Two theories consider the link between social class and schizophrenia:

The social drift hypothesis: Proposes that people become lower class because of the difficulties that arise from having schizophrenia. It is suggested that people with schizophrenia are unable to function normally, lose their jobs and drift into lower social classes, and poor

areas of cities. During the course of their developing psychosis, schizophrenics may drift into the poverty-ridden areas of the city. The growing cognitive & motivational problems besetting the individuals may so impair their earning ability that they cannot afford to live elsewhere, or they may choose to move to these areas where they may experience little social pressure & can escape intense social relationships.

The sociogenic hypothesis: Schizophrenia is more associated with cities than rural communities, so it might be something in city life leads to schizophrenia. Schizophrenia shows clustering in declining inner-city areas so perhaps being brought up in such areas leads to schizophrenia. The hypothesis suggests that poor social conditions create stresses that trigger schizophrenia in some people. Some people believe that being in the low social class may cause schizophrenia, the degrading treatment the person receives from others, the low level of education & the unavailability of reward & opportunity taken together make membership in the lowest social class such a stressful experience that the individual develops schizophrenia.

Family communication: Some psychologists suggest that dysfunctional family relationships with ‘abnormal’ communication may play a part, creating highly stressful environments. However, this might be due to difficulties in coping with a member of the family who is mentally disturbed, not the reason for the illness.




Evaluation of the dopamine hypothesis and brain structural differences explanation:

– The evidence for brain structural differences is only correlational eg. Enlarged ventricles may be a symptom and not a cause and non-schizophrenics can also show this difference.

– The twin studies do not show a concordance rate of 100% which suggests that genetics are not a complete explanation.
+ Evidence for the dopamine hypothesis comes from drugs that increase the release of dopamine, for example, amphetamines. An overdose produces symptoms like those of schizophrenia. This is known as amphetamine psychosis.

+ Neuroleptic drugs relieve the symptoms of schizophrenia (such as hallucinations and delusions) by blocking the post-synaptic dopamine receptors, hence decreasing the activity of dopamine.

– The dopamine hypothesis may explain positive symptoms but it would be expected that negative symptoms would be associated with low rather than high levels of dopamine.

+ Chua and McKenna reviewed research using imaging devices to compare schizophrenic and non-schizophrenic brains. The research demonstrated that schizophrenics have a smaller corpus callosum, high densities of white matter in the right frontal and parietal lobes, and unusually large ventricles.

+ Lindstroem et al found that when L-DOPA (a chemical which is used by the brain to produce dopamine) was administered and traced using a radioactive label it was taken up more quickly in schizophrenic patients than a control group. This indicated that the patients with schizophrenia were producing more dopamine than the control group.



? MUST KNOW – A01 Twin studies involve comparing MZ and DZ twins to see what differences there are in the incidence of a certain characteristic which is indicated by the rate of concordance. If a characteristic is genetic and based on nature it is believed that MZ twins would both show the characteristic and have high concordance, whereas there would be the same degree of similarity between MZ twins as between DZ twins if a characteristic is not genetically given but comes from environmental factors (nurture).


Twin studies involve comparing MZ and DZ twins to see what differences there are in the incidence of a certain characteristic. Identical or MZ (monozygotic) twins share 100% of their genetic make-up and come from one egg. Fraternal or DZ (dizygotic) twins share 50% of their genes like any other brother/sister pair, as they come from two eggs. Twins are studied as if a characteristic is completely genetically given (nature), MZ twins would both show the characteristic. However if a characteristic is not genetically given but comes from environmental factors (nurture) then MZ twins will not share that characteristic any more than DZ twins. In twin studies, researchers look at concordance rates, the extent to which a certain trait in both twins is in ‘concord’ or agreement. A higher sharing of a characteristic or concordance for MZ twins than for DZ twins is thought to indicate a genetic component for that characteristic. If genetic factors are important in determining a characteristic then the score for one twin will be close to that of the other. This would give a positive correlation which is indicated as a correlation coefficient between 0 and 1. The closer the value is to 1 the higher the correlation and thus the more similar the twins would be.
? MUST KNOW – A02 + Twin studies involve the collection of quantitative data which is objective and scientific. – Twin studies do not show cause and effect as the similarity between twins may not be due to genetics as they also share the same environment which could lead to a higher concordance rate. – Sample sizes may be limited particularly in studying schizophrenia as it is difficult to find a large sample of identical twins who possess the variable being studied.

– MZ twins share their DNA but even in the womb and after birth they may experience different environments and life experiences, which may lead them to develop differently. – MZ twins may be treated more alike than DZ twins because they are identical and share their gender too and thus environmental factors are not fully controlled when comparing MZ and DZ twins.

+ Findings from twin studies provide controlled evidence for the nature side of the nature-nurture debate furthering psychological knowledge of the understanding of genetic influences on behaviour and cognitive processes. + Twin studies are conducted empirically with controlled procedures and can be replicated to test for reliability. For example Gottesman and Shields found that for MZ twins around 42% of the time when one twin has schizophrenia the other has it too and in 1991 Gottesman found 50% concordance between MZ twins.

? MUST KNOW – A01 Aim: To investigate the relative importance of genetic and environmental influences on schizophrenia by comparing MZ and DZ twins. Method: Researchers questioned whether if one twin had developed schizophrenia the other twin was also diagnosed with schizophrenia. Records of 57 twins from one hospital in the USA provided the sample. At least one of the twins had been diagnosed as having schizophrenia. Data was collected using methods such as use of hospital notes, personality testing and semi-structured interviews to assess the concordance rate for schizophrenia between the twins. Results: Concordance was higher in MZ twins than DZ by on average about 35% Conclusion: the results indicates that there may be some genetic basis for schizophrenia

Method: The twins were of the same sex, born between 1893 and 1945 and had survived to age 15 (from a total of about 45,000 psychiatric patients). The research method was a twin study which incorporated the use of a range of methods to collect data including: using hospital notes, case histories for the twins based on a self-report questionnaire, tape recordings of 30-minute samples of verbal behaviour gathered by semi-structured interviews, personality testing, and a test to look at thought disorders. When one twin is found to have the same characteristic as the other twin this is known as concordance. The researchers in the study looked at the concordance rate within MZ and DZ twins to see in what percentage of cases when one twin was diagnosed with schizophrenia, the other one was too. Concordance was assessed in a variety of different ways: – Where both twins had been hospitalised and diagnosed with schizophrenia. – Where both twins have had psychiatric hospitalisation but the co-twin has a different diagnosis. – Where the co-twin has some psychiatric abnormality (e.g. out-patient care, GP care, neurotic or psychotic personality profile or being abnormal on interview) – Where the co-twin has no disorder

Results: In the MZ twins there was a concordance rate for schizophrenia of between 35% and 58% and in DZ twins the concordance rate of between 9% and 26%. Thus for MZ twins around 42% of the time when one twin has schizophrenia the other has it too. For DZ twins the average was around 17%. For the most severe cases of schizophrenia the concordance rate for MZ twins was between 75% and 91%.

Conclusion: Genes appear to play an important role in schizophrenia because the concordance rate is higher in MZ twins than DZ twins. However environmental factors must also be important. ? MUST KNOW – A02

– A problem with determining cause and effect is that twin studies are unable to separate the effects of nature and nurture. Twins are raised in the same environment but they may have encountered very different experiences which could have caused the condition.

+ Gottesman (1991) went on to investigate the influence of genes on schizophrenia by combining the results of 40 investigations spanning over 60 years. The findings are similar to the average figures found by Gottesman and Shields suggesting the results are reliable.

+ Current research has shown that there may be biological causes for schizophrenia such as brain structural differences and brain chemistry which could be inherited.

+ The study found similar results to previous studies suggesting they are reliable eg. Inouye (1961) in Japan, found a 74% concordance rate for twins with progressive chronic schizophrenia, similar to Gottesman and Shields’ figure.

– Concordance rates indicate a correlation however cause and effect is not established. Thus twin studies can indicate a genetic link but it cannot be concluded for certain that genetics cause the disorder. There is no control over other variables which may have caused the disorder such as life experiences, environmental triggers etc.

+ The study addresses criticisms of previous studies that had been carried out by detailing the sampling carefully, so that it was understood which twins were included and why. There is much detail about the different diagnoses, e.g. whether it was schizophrenia, other psychoses or a different abnormality.

– Although the figures link schizophrenia to genetics, there is no evidence to explain the illness apart from this. The researchers suggest that there might be different forms of schizophrenia with different causes, e.g. life experiences. The qualitative data that was gathered was not explored thoroughly so the reasons for developing schizophrenia are not clear.

– Twin studies only allow for limited conclusions to be drawn regarding a possible genetic link in causing schizophrenia. The concordance rate only gives information on the probability that both twins will be affected by the condition. It would be useful to have information about the degree of abnormality, for example the severity of the schizophrenia. Some recent studies have provided a more detailed insight into a possible genetic link for example Xu et al (2008) examining genetic mutation and schizophrenia and Brown et al who found a link between higher paternal age at conception and the incidence of schizophrenia, which may have more beneficial applications.


? MUST KNOW – A01 An interview is a type of survey which involves direct verbal questioning of the participant by the researcher. Interviews can be structured, semi-structured or unstructured which vary in terms of the number of fixed questions that are asked of every participant. The interview usually begins by gathering background and relevant demographic information eg. Age or gender and will then move on to ask either open or closed questions (usually a combination of both).An example of a study of schizophrenia using the interviewing method was conducted by Schofield and Balian (1959)

? SHOULD KNOW – A01 Surveys are a method of research in psychology that involves asking people questions. They can take the form of: Questionnaires and Interviews.

Interviews: Interviews are in-depth conversations with individuals concerning a particular topic. The interviewer will find out about the personal data required for the study (often demographic information) eg. Gender, marital status or employment status. The interviewer will use some standard instructions at the start of the interview so that the respondent is aware of the ethical issues such as confidentiality and the right to withdraw. The respondent will also be given some information about the purpose of the interview. In all types of survey questions can be open or closed. Closed questions require a fixed response which can be analysed quantitatively. Open questions encourage extended answers and tend to generate qualitative data. Interviews are generally less structured than questionnaires, although an interview can have varying degrees of structure ranging from structured, semi structured to unstructured.

Types of Interview: Structured interview: Structured interviews involve all respondents being asked the same questions in a set order. This can be completed using a questionnaire

Semi-structured interview: Semi-structured interviews combine elements of both in that some questions may be the same but researchers can ask additional questions when an area arises that they would like further information on. Questions can be changed or adapted to meet the objectives.

Clinical interviews are an example of a semi-structured interview which is used in Clinical Psychology. Freud used clinical interviews in consultations with patients to assess the nature of their problem. Some standard questions may be asked of all patients but the client is also able to lead the discussion in important directions.

Unstructured interview: Unstructured interviews typically start with the same opening question and may have some common prompts. This format gives the researcher lots of flexibility. These are conducted with a fairly open framework which allow for focused, conversational, two-way communication. The format will be unstructured but will still have a schedule and areas for the interviewer to cover.

An interview is an effective method of getting a large amount of information as it is likely that open-ended questions will generate a lot of conversation. Unlike the questionnaire framework, where detailed questions are formulating ahead of time, unstructured interviewing starts with more general questions or topics. Not all questions are designed and phrased ahead of time. The majority of questions are created during the interview, allowing both the interviewer and the person being interviewed the flexibility to probe for details or discuss issues. This is different to structured interviews where questions are prepared in advance and interviewers will read the questions exactly as they appear on the survey questionnaire. A structured interview also standardises the order in which questions are asked of survey respondents, so the questions are always answered in the same order.

Schofield and Balian (1959) used the interview method to study the link between early family relationships and the onset of schizophrenia. Interviews were used to gather in-depth information about early childhood experiences and parent-child relationships.

Goldstein (1988) used the interview method to study to examine the differences in schizophrenia between males and females. Goldstein gathered case histories of patients and also used trained interviewers to gather data about the symptoms of the patients. Questionnaires administered by an interviewer were used

? MUST KNOW – A02 – Interviews are much more time consuming than questionnaires and this is likely to therefore reduce the number of participants used. + Interviews can be used to gather both quantitative and qualitative data which can enhance validity. – Interviews can be subjective if the interviewer is required to interpret the interviewee’s answers.


+ Interviews can gather in-depth information and can use follow-up questions when conducted in a semi-structured or unstructured way, which enhances validity.

+ Also interviews allow the researcher to explore the interviewee’s reasoning/feelings/beliefs by allowing the interviewer to probe the interviewee when the situation arises.

– Information from interviews is harder to analyse as information is usually qualitative and interpretation of interview material may be interpreted subjectively.

+ Validity can be improved as the interviewer can encourage the interviewee to elaborate on their answer and ensure they are really addressing the issue which is being assessed

– Interviews are only reliable if standardised and if the interviewer sticks rigidly to the questions being asked, thus structured interviews are more reliable than unstructured interviews.

-/+ Structured interviews have some reliability whereas unstructured interviews are low in reliability due to the nature of the questions asked i.e. Whether they are standardised


Aim: To compare the childhood experiences of people with and without schizophrenia to see whether the patients had more difficult childhood relationships.

Method: 178 patients with schizophrenia who were being treated at an American teaching hospital were given in-depth interviews regarding childhood traumas, maternal characteristics and the quality of relationships between parents. A control group of 150 non-psychiatric participants matched for education, socioeconomic status and marital status received the same interviews. The two groups were then compared.

Results: No differences were found between the groups in terms of relationships with parents, frequency of parental death, divorce or alcohol abuse. In terms of childhood trauma, patients with schizophrenia were significantly less likely to report poverty. There were significant differences in the reported quality of mothering, with mothers of patients with schizophrenia being less affectionate and more dominant and over-protective.

Conclusion: It was concluded that the quality of the maternal relationship may increase the risk of schizophrenia in adulthood. This finding is consistent with the theory of the ‘schizophrenogenic mother’.

? MUST KNOW – A02 + The study was conducted with some empiricism as a matched pairs design was used providing a more valid control group to generate comparisons and draw conclusions. + The interview gathered qualitative, in-depth information which enhances the validity of the findings. – Russell et al argue that there is little sound evidence to suggest that family dynamics alone can lead to the development of schizophrenia, there is far more empirical support for alternative explanations such as the biological theory.


– The study has negative implications for the mothers of people with schizophrenia who could be blamed for their child’s condition. – The use of interviewing in this study is flawed as the information is retrospective and thus may not be an accurate recall of family life. In addition patients with schizophrenia who may be experiencing cognitive distortions, hallucinations and delusions may perceive their childhood differently as a result.

+ Klein and Bion were in agreement with the findings of this study when they proposed that a poor relationship with the primary care-giver in the first few months of life can lead to a ‘schizophrenic core of personality’. + The study provides support for Psychodynamic theories of schizophrenia such as Fromm-Reichmann’s notion of the ‘schizophrenogenic mother’. She believed that a cold and controlling mother can create tension and secrecy in the family which could be linked to schizophrenia. The study also contributes to the nurture argument in explaining schizophrenia that early experiences can cause psychological disorders.

+ Doane et al (1985) found that the recurrence of schizophrenic symptoms was reduced when parents reduced their hostility, criticism and intrusiveness towards the offspring. + Patients were able to give their consent to the study, although it was unlikely to be fully informed as this may have affected the results. There is an issue of protection of participants as recalling traumatic childhood memories could have been distressing.

? MUST KNOW – A01 Biological Treatments – General Information Within the Biological Approach disorders are considered to stem from physical causes such as genetics and brain chemistry or structure. If it is assumed that psychological problems originate from a biological problem then the treatment for the condition will be biologically based. Biological treatments aim to treat the underlying physical causes of mental illness or to alleviate the symptoms of these causes. Treatments from this approach include psychosurgery, chemotherapy (drug use) and electroconvulsive therapy.

Anti-Psychotic drugs: These are used in the treatment of schizophrenia. They are major tranquillisers, which sedate the person and reduce symptoms such as thought disorder, withdrawal, delusions and hallucinations. They tranquillise without impairing consciousness. The result of these drugs is that they allow schizophrenics to live outside of mental institutions.

? SHOULD KNOW – A01 Biological Treatments – chemotherapy (drug use) Eg. Anti-anxiety drugs: includes the minor tranquillisers such as Librium and Valium. They were introduced in the 1950s and 1960s and soon became the most prescribed drugs in the world. They are used to reduce the symptoms of generalised anxiety disorders and to combat withdrawal symptoms from alcohol addiction, etc. Side effects include drowsiness and addiction. Buspirone has fewer side effects.

Eg. Anti-depressant drugs: These are stimulants e.g. monoamine oxidase inhibitors (MAOls) and tricyclics. Generally, antidepressants work by raising the levels of monoamine neurotransmitters in the brain. MAOIs prevent the breakdown of serotonin, noradrenaline and dopamine, so that all three build up. The drugs increase arousal but can be affected by rebound (depression after initial euphoria). It regulates mood, causes relaxation and controls aggression. They can be effective in treating depression, but they do not work for all patients. They can also be used to treat phobias. However they can have side effects including dizziness and drowsiness. Newer antidepressants such as selective serotonin reuptake inhibitors (SSRls, e.g. Prozac) tend to work on one monoamine only. Approx 500,000 people in Britain take Prozac which stops serotonin being reabsorbed and broken down.

Drug Therapy for Schizophrenia Anti-psychotics include chlorpromazine, which is used to treat schizophrenia. They help patients by alleviating the symptoms, although they do not cure the disorder. Anti-psychotics block dopamine receptor sites. Possible side effects include blurred vision and a decrease in white blood cells (which can be fatal). The first anti-psychotics worked by blocking the receptors in synapses that absorb dopamine, reducing the action of dopamine (see page 146 of A2 Angles). Second generation antipsychotics have fewer side effects and each drug has a distinct chemistry. In some cases it is not known how they act on the brain to reduce psychotic symptoms. Antipsychotics can be administered in tablet form, syrup or as an injection. Some patients require them long-term while others find their symptoms stop after a short course.

General Evaluation of Drug Treatment and its use with Schizophrenia

+ Schooler et al randomly allocated 555 patients in their first episode of schizophrenia to either treatment with a first generation antipsychotic or a second generation drug.  In both groups, 75% of patients had a reduction in symptoms.  However there were fewer side-effects in the second generation drug group and 42% had relapses compared to 55% in the first generation group, indicating that the second generation drugs seem to be a preferable treatment.

+ Drugs can be effective when used in conjunction with psychotherapy; they relieve disabling symptoms, allowing the contributing psychological factors to be dealt with.

– Many patients suffer relapses, either through failing to take their medication or in spite of doing so. – Drugs treat the symptoms but do not treat the problem, unlike other treatments. But people may prefer to take them because taking tablets are a familiar activity, unlike other therapies. – The use of the anti-psychotics can cause unpleasant side effects which range from constipation and weight gain which are common to serious damage of the nervous system in a minority of cases. Some patients also experience disabling side effects such as tardive dyskinesia (causing involuntary movements of the face and limbs), although this is less frequent with second generation antipsychotics.

– Critics of drug therapies have argued that they are chemical-straitjackets as they control people and infringe the individual’s rights. This is especially true when treatment is forced via sectioning. – It has also been argued that the use of medication has been purposely misused as a form of social control. This was especially seen in psychiatric institutions where some biological forms of treatment including drugs and ECT were seemingly used to control patients and occasionally to punish. – In some cases the person may have got better without the drug. Their improvement may have coincided with taking the tablet. Drugs may be effective because the patient believes that the doctor expects them to improve and this can affect their health. – The biological approach to treatment is reductionist focusing only on the physical causes of the disorder. This approach may lead to the neglect of many important psychological or social factors that contribute to the development of the disorder. Therapies such as Client-centred therapy which is based on the humanistic approach provides is much more holistic.

? MUST KNOW – A01 Social Approach Treatments – General Information According to the Social Approach, mental disorder can be triggered by factors in the environment (social factors). The aim of community-based care is to rehabilitate the patient, help patients avoid becoming institutionalised and ensure they can function as normally as possible in society. Care in the community can therefore take a number of forms: short term in-patient care in local hospitals or residential treatment programmes, half-way houses in ‘family group’ homes, night care or sheltered housing, home-care (ideally with respite care arrangements), day-care, out-patient therapy at local hospitals or drop-in centres. Care staff are available to provide help and support when it is needed, and oversee the day-to-day living if needed, though residents are encouraged to make their own decisions and be as independent as possible.

? SHOULD KNOW – A01 Care in the Community Care In the 1970’s and 80’s some psychiatric institutions were shut down and a variety of community-based care programmes were established. In Britain this care involved: sheltered accommodation with 24 hour care, work and employment opportunities in sheltered social firms and co-operative businesses, specialist mental health outreach teams to provide long-term social support and care, in-patient hospital care when required (Department of Health, 1997).

According to the Social Approach, mental disorder can be triggered by factors in the environment (social factors). Community care involves providing treatment and support for those suffering from a mental disorder under more socially integrated, naturalistic and less controlling conditions, rather than in long-term
institutions, wherever possible. The aim of community-based care is to rehabilitate the patient, help patients avoid becoming institutionalised and ensure they can function as normally as possible in society. The therapeutic rationale for community care is that more normal living conditions and social integration will encourage greater independence, self-care skills, social skills, self-esteem, and ‘normal’ and productive interactions, activities, relationships and behaviour, compared to care in institutions. While those with very serious disorders or those who represent a danger to themselves or others may require round the clock support, care and control, others may benefit from varying degrees of these factors.

Care in the community can therefore take a number of forms: short term in-patient care in local hospitals or residential treatment programmes – these involve high degrees of support, control and/or therapy, but for shorter periods than in long-stay institutions. Half-way houses in ‘family group’ homes, night care or sheltered housing, these involve higher degrees of support and less therapeutic measures, but are still tied to less socially integrated residential arrangements. Individuals can indulge in productive and everyday activities, eg. Employment, but still live with others with mental health difficulties and access to support is usually on hand from healthcare staff. Home-care (ideally with respite care arrangements), day-care, out-patient therapy at local hospitals or drop-in centres – these involve socially integrated independent residents or home residents with relatives, with some access to therapy. Care staff are available to provide help and support when it is needed, and oversee the day-to-day living if needed, though residents are encouraged to make their own decisions and be as independent as possible.

General Evaluation of Care in the Community and its use with Schizophrenia


? SHOULD KNOW – A02 + Trauer et al (2001) reported that patients who moved from a psychiatric hospital to community sheltered units, after one year, although there was no change in their symptoms, the quality of life was significantly better. Patients much preferred this sort of supported community living. + Leff (1997) showed that patients with schizophrenia who were housed in long-term sheltered accommodation showed much lower levels of symptom severity (especially negative symptoms) than hospitalised patients. + The various methods of community care can more flexibly meet individual’s needs and abilities since mental health problems differ in severity between individuals and over time. Work, friend and family relationships can be more readily maintained.

– Community care tends to be under-funded creating limitations in the number of people who can benefit from community based support. Staff can also become over-stretched which can impact on patients’ recovery. Some authorities have been unwilling to reinvest funds from closed psychiatric hospitals. – There can be a lack of consistency in the standard of community care provided. Kuno et al (2005) found that in America white affluent areas had a higher quality of care than low-income African American areas. – The social approach on which community care is based assumes that schizophrenia and other disorders are triggered by social factors however some disorders may have other causes such as biological and faulty cognitions thus it is important that community care is combined with other treatments.

??EXTENSION Exam practice question: a) Describe one treatment for schizophrenia (4) b) Evaluate the effectiveness of two treatments for schizophrenia (8)

FOR PHOBIAS, DESCRIBE THE FEATURES AND SYMPTOMS, DESCRIBE AND EVALUATE TWO EXPLANATIONS FROM TWO DIFFERENT APPROACHES FROM UNITS 1 AND 2 AND DESCRIBE AND EVALUATE TWO TREATMENTS FROM TWO DIFFERENT APPROACHES Unit 4 How Psychology Works ? MUST KNOW – A01 A phobia is defined as an irrational and intense fear of a specific object or situation. In DSM-IV-TR phobias fall under the broader category of anxiety disorders. DSM-IV indicates that the fear experienced is intense & persistent & that individuals are compelled to avoid the object or situation. DSM-IV identifies 3 categories of phobia: specific, agoraphobia and social phobias. Symptoms of phobias often involve feelings of panic, dread, or terror, despite recognition that those feelings are excessive in relationship to any real danger – as well as physical symptoms like shaking, rapid heartbeat, trouble breathing, and an overwhelming desire to escape the situation that is causing the phobic reaction.

? SHOULD KNOW – A01 Anxiety is an adaptive emotion. It places people in a state of arousal ready to deal with any threat & it means we approach certain situations cautiously. However, anxiety can become disabling if it becomes disproportionate to any problem experienced. Anxiety disorders are a group of mental disorders characterised by levels of fear & apprehension that are disproportionate to any threat posed.

Fears/phobias become a clinical problem when they affect the person’s life in a significant way & thus can be described as: ‘… a disrupting, fear-mediated avoidance, out of proportion to the danger posed by a particular object or situation & recognised by the sufferer as groundless.’ The term phobia usually implies subjective distress or social/occupational impairment.

Specific phobias: fears of particular items/objects or situations eg. Snakes, heights, darkness, blood or death. Agoraphobia: refers to a cluster of fears involving public places, crowds and open spaces and being unable to escape or find help should the individual suddenly become incapacitated. The severity of the restrictions & anxiety may vary for the individual & leaving the house with someone can sometimes help. Social phobias: any activity which involves social situations & the presence of others can elicit extreme anxiety eg. eating in public or using a public toilet.
Although the symptoms of each type will vary, there are some symptoms common to all phobias. These include: irrational fear, physical symptoms: eg.shaking, obsessive thoughts, anticipatory anxiety, desire to flee, know it is irrational.

Although phobics tend to perceive their disorder as beyond their control and wish to get rid of it, with the exception of agoraphobics, the phobics everyday functioning is often unimpaired.
Additional features:

Relating to all phobias, Myers et al (1984) found a rate of 5.9 phobias/100 people, with women having more than men (8.0:3.4). According to the National Institute of Mental Health, between 8.7% and 18.1% of Americans suffer from a phobia.

With social phobias onset is often during adolescence. It is often associated with generalised anxiety disorder, specific phobia, panic disorder & avoidant-compulsive personality disorders (Turner et al, 1990). Myers et al (1984) state that up to 2% of the population are affected & it occurs almost equally in both sexes.

According to Davidson & Neale (1996) only 3% of phobics have specific phobias. Ost found that age of onset differed across 4 major groupings of specific phobias: Animal phobias – around age 7; blood – age 9; dental phobias – age 12; claustrophobia – age 20.

Agoraphobia is the most common phobia seen in clinic – constituting roughly 60% of all phobias examined & it is more common in women. This phobia often develops in early adulthood & often begins with recurrent panic attacks. The severity of the restrictions & anxiety may vary for the individual & leaving the house with someone can sometimes help. Sometimes people can experience more than one phobia. Buglass et al (1977) found 93% of a sample of agoraphobics also reported fearing heights & enclosed spaces.
Explanations for Anxiety Disorders: Phobias

? MUST KNOW – A01 Learning theory: there are several explanations from the learning approach. In terms of classical conditioning a phobia may be learned through an association forming between fear and a particular object or situation. An example can be found in Watson and Rayner’s study of Little Albert. In terms of Social Learning theory phobias may be learned through observation and imitation of role models.

Psychodynamic theory: phobias occur as a result of the use of defence mechanisms. Unacceptable wishes and fears are repressed and displaced onto a more acceptable source which can be more easily avoided. An example can be found in Freud’s case study of Little Hans who was believed to have displaced the fear of his father onto horses.


Learning theory: Behaviourists explain phobias as a product of maladaptive learning. Classical conditioning – from this perspective it is proposed that phobias occur due to an association between anxiety & a situation or object eg. if a person has a panic attack due to being trapped in a lift. This anxiety becomes generalised to all lifts. Hence the person will then avoid lifts.

Thus an originally neutral stimulus becomes associated with an unpleasant or traumatic experience and so becomes a fear-eliciting conditioned stimulus. This was demonstrated in Watson and Rayners study of Little Albert


The Little Albert case is an example of ‘avoidance-conditioning’ where a stimulus becomes anxiety inducing because it is paired with another stimulus that already leads to anxiety.

The avoidance-conditioning model can be applied to social phobias eg. related to public toilets. Someone may experience paruresis once (inability to urinate because of the presence of others) and suffer the resulting anxiety, they then become conditioned to avoid the situation of being in a public toilet.

The persistence of phobias is explained by Mowrer’s ‘Two-factor’ theory. It suggests that phobias are acquired through classical conditioning but are maintained through operant conditioning (because the avoidance of unpleasant phobic situation and the reduction in anxiety is negatively reinforced).

Operant conditioning – This theory can explain the maintenance of phobias for example if someone has a phobia of lifts, avoidance of lifts is reinforced by the reduction in anxiety experienced when the person adopts alternative strategies, eg using the stairs.
Social learning theory: From an early age we may observe role models avoiding particular objects or situations. Through modelling our behaviour on others such as our parents (& also may be part of our culture) we learn the avoidance behaviour and the fear of an object or situation. If the observer sees the model being rewarded for their behaviour, Eg. through attention from a loved one, (vicarious reinforcement) imitation is even more likely. Social learning theory holds that behaviour can also be learned at the cognitive level through observing the actions of other people. Once learned the behaviour may be reinforced or punished by its consequences like any operant behaviour.

Bandura (1977) suggested that there are three main influences on people’s behaviour: 1. External reinforcement (as in operant theory) – positive reinforcement, negative reinforcement and punishment 2. Vicarious reinforcement – the observation of other people being rewarded or punished for their behaviour. An example of vicarious learning: If a child sees someone steal from a shop and leave with the item without being punished then he or she may be motivated to copy this behaviour. If a child sees the same behaviour being punished they would be unlikely to copy. 3. Self-reinforcement – gaining internal satisfaction from an activity, which therefore motivates the individual to behave in a similar way in the future.

According to Bandura observational learning can occur spontaneously without any deliberate effort on the learner’s part or any intention to teach on the model’s part. For behaviour to be learned and modelled: – The learner must pay attention to the important parts of the action. – The learner has to store & retain the memory eg. via rehearsal. – The learner must have the physical ability to be able to copy the behaviour. – The learner must be motivated to reproduce the behaviour. – They must reproduce it for themselves following seeing the model. – They should be motivated to perform the action eg via reinforcement. Thus phobias may be modelled and learned through attention, retention, motivation and reproduction. A person may observe phobic behaviour either directly or indirectly in real life or in the media.

Psychoanalytic theory:

The psychodynamic model sees phobias as the surface expression of a much deeper conflict between the id, ego and superego, which has its origins in childhood. Freud suggested phobias are a defence against anxiety produced by repressed id impulses often stemming from unresolved oedipal or electra conflict. Phobias are caused by displacement of unconscious anxiety onto harmless external objects. The anxiety 0stems from unconscious conflict, which has to be resolved before the phobia can be dealt with. Phobias are associated with unconscious sexual fears & they operate through defence mechanisms eg repression & displacement. The original source of fear is repressed into the unconscious & the fear is then displaced onto some other person, object or situation. Thus the fear appears to be irrational because there is no conscious explanation for it. An example can be found in Freud’s study of Little Hans. Freud believed that phobias were expressions of unacceptable wishes, fears and fantasies displaced from their original, internal source onto some external object or situation that can be easily avoided.

Freud’s case of Hans, a boy with a horse phobia, was explained using psychodynamic theory. Freud attributed Hans’ fear of horses to an oedipal conflict that was not resolved, and he explained that Hans repressed his sexual feelings for his mother and his wish that his father would die. Freud proposed that Hans feared that his father would discover his wish, repressed his wish to attack his father, and displaced his fear of his father’s aggression onto horses. The young boy resolved the conflict of loving and hating his father by hating horses rather than admitting that he had aggressive feelings towards his father. Hans was better able to avoid the feared horses than his father.
An alternative psychodynamic theory stems from Bowlby who suggested that all anxiety disorders can be explained with reference to attachment. Bowlby (1973) explained that phobias may link to ‘separation anxiety’ in early childhood, especially where parents are overprotective. Bowlby argued that Hans phobia could be partially attributed to separation anxiety brought about by her threats to leave him if he did not behave himself combined with Hans separation from her when she giving birth to his sister a year earlier.

? MUST KNOW – A02 Learning theory: + Watson and Rayner’s study of Little Albert provides support for the classical conditioning explanation as they demonstrated that a fear could be conditioned in by pairing a previously neutral stimulus with an unconditioned stimulus to create anxiety at what became the conditioned stimulus (rat). +/- Classical conditioning and operant conditioning cannot explain why people have phobias of objects or situations that they have never experienced however social learning theory can explain this. – DiNardo found that many people had traumatic experiences with dogs but did not become phobia of dogs, though 50% of dog phobics had been involved in a dog related incident that they found traumatic.

Psychodynamic theory: + Freud found support for the Psychodynamic explanation of displaced emotion with his study of Little Hans who was believed to have displaced his fear of his father onto horses. – It is much more likely that Han’s phobia was due to witnessing a serious accident involving a horse and cart moving at great speed. The psychodynamic explanation ignores this much more obvious classical conditioning explanation. – There is no empirical evidence to support Freud’s theory directly. It is very difficult if not impossible to study possible unconscious causes and the existence of id impulses, especially as ‘the unconscious’ and ‘the id’ are abstract concepts. The theory is unfalsifiable.


Learning theories: + Barlow and Durand found that 50% of people with a specific phobia of driving recalled a traumatic experience of driving that was linked to the onset of the phobia. – However Clark and Menzies found that only 2% of water phobias were due to a trauma in water.

– In conflict with social learning theory, phobics who seek treatment do not often report that they became frightened after witnessing someone else’s distress. In addition some phobics are unable to recall a distressing incident involving the feared object or situation which poses problems for classical and operant conditioning.

+ The study Mineka et al, 1984, demonstrated that monkeys could develop a snake phobia simply by watching another monkey experiencing fear in the presence of a snake, which supports SLT, however SLT cannot explain why the monkeys only learned fear to dangerous stimuli (which suggests there may be an evolutionary link to the development of phobias in animals). -/+ Merckelbach et al, 1996, argued that there is little evidence that phobias such as claustrophobia are due to modelling or information transmission but there is quite a lot of evidence for these explanations in relation to small animal phobias and blood and injection type phobias.

+ Unlike Psychodynamic explanations the learning explanations are supported by objective, empirical research eg. Watson and Rayner, Mineka et al. + The success of treatments such as systematic desensitisation and flooding in removing phobias suggests that phobias may be learned.
– The learning theories only consider the influence of nurture and neglect the possible effects of nature. Phobias can occur within families which may suggest learning however often family members fear different stimuli. Fyer et al (1990) conducted a family study of 49 first-degree relatives of people with specific phobias. They found that 31% of relatives were also diagnosed with phobias, but only two people had the same type.
Psychodynamic theories:

– A problem with many psychoanalytic theories is that evidence in support of such views is restricted to conclusions drawn from clinical case reports. Thus the findings may not generalise to the wider population as the studies are unique and they only involve people who have a psychological disorder thus the sample is not representative of the wider population.

+ Cross-cultural studies do indicate that anxieties and phobias are more common in cultures characterised by strict upbringing & punishment.

– Arieti argues the repression is of a particular interpersonal problem of childhood rather than of an id impulse.

+/- Parker found that being overprotected correlated to development of social phobias which supports Bowlby’s explanation. However the development of agoraphobia correlated with a lack of affection from parents. In addition, many studies have found no relationship between anxiety disorders and parenting styles. Hence research is inconsistent.

+ Chartier et al (2001) looked for risk factors in the history of 8116 Canadians taken from the National Risk Survey. A number of psychodynamic risk factors for social phobias emerged, including the lack of close relationship in childhood, parental discord and sexual abuse.

+ Fonagy (1996) found that in anxiety disorders, as in other mental disorders, the majority of patients were classified as having type D attachments. This suggests that anxiety conditions in general have some association with early family experiences.

? MUST KNOW – A01 Aim: To investigate whether rhesus monkeys can learn fear through observing it in other rhesus monkeys. Method: Two experiments were conducted where videotapes of model monkeys behaving fearfully were shown. The videos were spliced so that it appeared that the models were reacting fearfully either to fear-relevant stimuli (such as toy snakes or a toy crocodile), or to fear-irrelevant stimuli (such as flowers or a toy rabbit). Observer groups watched one of four kinds of videotapes for 12 sessions. Results: Observers acquired a fear of fear-relevant stimuli (toy snakes and toy crocodile), but not of fear-irrelevant stimuli (flowers and toy rabbit). Conclusion: Rhesus monkeys can learn fear to dangerous stimuli through observing other monkeys.

? SHOULD KNOW – A01 Aim: To test whether monkeys can acquire fear responses by imitation of other monkeys and to see whether they are more likely to learn fear of dangerous objects than non-dangerous ones. Method: Experiment 1 -An animal laboratory experiment was conducted which involved 22 laboratory-reared rhesus monkeys aged 4-11 years (the observer monkeys). The observer monkeys were shown edited videotapes of a model responding to particular stimuli. The videotaped models were a 32-year-old wild-reared monkey and a 7-year old laboratory reared monkey who had a fear of snakes. Observers in one group watched videotapes of models reacting fearfully with toy snakes and non-fearfully with wooden blocks. Observers in a second group watched models reacting fearfully to flowers and non-fearfully to wooden blocks.
Experiment 2 – 20 laboratory-reared rhesus monkeys aged 4-17 were used. The observer monkeys watched videotapes of a model reacting fearfully to a toy crocodile and non-fearfully to a toy rabbit. Two further tapes were used showing the model reacting fearfully to the toy rabbit and non-fearfully to the toy crocodile. In both experiments fear in the observers was then assessed by the time taken to reach for food in the presence of the fear stimulus (toy snake, toy crocodile, flowers, blocks or toy rabbit).

Results: In both experiments the times taken to reach for food increased after watching the videotape when the fear stimulus was dangerous (the snake or the crocodile). The time taken increased from 9 to 27 seconds in the presence of a toy snake. In the presence of the crocodile the time taken increased from to approx 5 to 26 seconds. The time taken did not increase when the fear stimulus was not dangerous (the flowers or the toy rabbit).

Conclusion: Fear responses can be acquired by social learning, but only to potentially dangerous objects.

? MUST KNOW – A02 + The study was conducted under laboratory conditions with carefully controlled variables and standardised procedures making the procedure replicable. -/+ As the study was conducted using monkeys this limits the generalisability of the findings to humans as monkeys do not share the same level of cognitive ability as humans. There may be more cognitions involved in the causation of phobias in humans. However as a highly evolved species was used this makes generalisations more valid than if a lower species such as rats were used. + The control over potentially confounding variables and the artificial environment which enhances control allows for conclusions to be drawn regarding cause and effect. Thus the researchers are able to conclude that the IV had an impact on the DV. – Some issues exist with regard to ecological validity as most of the monkeys used in the study were laboratory-reared and thus they may not behave in the same way as wild monkeys. In addition the fear stimuli used were toys which posed no danger and thus the behaviour observed may have been different in the study as a result.


+ The findings of the study has contributed to psychological understanding of the cause of phobias as the results partially support the social learning theory of phobias and also provide evidence for the preparedness theory as the monkeys were able to distinguish between dangerous and non-dangerous stimuli. + By using laboratory reared monkeys as the observers the researchers were able to control for prior experiences with fear-relevant and rear-irrelevant stimuli which is an advantage over human experiments on the learning of fears. + The finding that monkeys can learn fear to specific stimuli through observation is supported by a number of studies eg. Cook et al 1985, Mineka et al 1984) indicating that the research is reliable.

– In conflict with social learning theory and the findings of Cook and Mineka, phobics who seek treatment do not often report that they became frightened after witnessing someone else’s distress. Merckelbach et al, 1996, argued that there is little evidence that phobias such as claustrophobia are due to modelling or information transmission but there is quite a lot of evidence for these explanations in relation to small animal phobias and blood and injection-type phobias. – The findings of the study do not help to explain why humans fear situations or objects that are not dangerous such as clowns or cotton wool. The findings also do not explain fears that are acquired without observation of the fear response in others to a particular stimuli.

+ The findings support the work of Bandura et al who demonstrated that aggression could be learned via observation of models on television. Both studies indicate that real life models are not necessary for learning to occur which has implications for the impact of the media on learning.

– The study has some ethical implications as some would argue that research on animals should not be conducted especially if it is simply for human benefit as this constitutes ‘speciesism’. One of the monkeys involved in the study was wild-reared and thus intervention by the researchers will have impacted on natural behaviour. Quite a large number of monkeys were used in the study and the number of animals studied should be kept to a minimum. In addition monkeys are a highly evolved species and thus more distress could have been caused by caging and the study procedure than with the use of a lower species such as a rat.

??EXTENSION Additional reading related to the study: http://pjackson.asp.radford.edu/CookMineka1989.pdf – original journal article http://www.psych.utoronto.ca/users/peterson/psy334/Ohman%20A%20Malicious%20Serpent%20Current%20Directions%202003.pdf


Systematic desensitisation – Learning Approach

? MUST KNOW – A01 Based on classical conditioning, systematic desensitisation makes use of counter-conditioning to help the client ‘unlearn’ their phobia. The treatment, developed by Wolpe, is based on the notion of reciprocal inhibition. Systematic desensitisation involves three stages: development of an anxiety hierarchy, relaxation training and graduated exposure – gradually pairing relaxation with the situations described in the anxiety hierarchy.

General information on one treatment from the Learning Approach

Background: Within the Learning Approach it is assumed that psychological abnormality is the result of learning from the environment. It is believed that learning occurs via classical and operant conditioning and social learning. Consequently, the model suggests that psychological abnormality can be treated by getting the person to unlearn the abnormal behaviour, and learn more adaptive ways of responding.

Systematic Desensitisation: This treatment uses the concept of classical conditioning. It is used mainly in the treatment of phobias. It is based on the idea of reciprocal inhibition, that a person cannot be anxious and relaxed at the same time. This idea is that the person is put in a situation whereby they learn to produce a relaxation response to a situation where previously they produced an anxiety response. Through his experience in the late 1950s in extinguishing laboratory-induced neuroses in cats, Wolpe developed the treatment programme for anxiety that was based on the principles of counter-conditioning. Wolpe found that anxiety symptoms could be reduced (or inhibited) when the stimuli to the anxiety were presented in a graded order and systematically paired with a relaxation response. Hence this process of reciprocal inhibition came to be called systematic desensitisation. Although his theoretical assumptions about the role of the sympathetic and parasympathetic nervous systems in extinguishing anxiety were actually erroneous, his Systematic Desensitisation program, as a practical application of his theories, proved to be highly successful and it revolutionised the treatment of neurotic anxiety.

The Procedure: Functional analysis: Working together the client and the psychologist draw up an anxiety hierarchy. This is a list of situations in which the person would feel anxiety, arranged from the least anxiety to the most anxiety produced. For example, in the case of arachnophobia, at the bottom of the scale the client might put ‘hearing the word spider’ and at the top of the list, ‘having a spider crawl across my face’. At this stage, the client decides which treatment goals they want to work towards.

Relaxation training: The client is taught different techniques of relaxation. These would probably include controlling breathing and muscular tension and might include other techniques, like positive self statements and visualization techniques.
Systematic desensitisation and deconditioning phobias Behaviourists believe that phobias are an example of a conditioned reflex. Through some experiences the person has had, they have learned an association between an anxiety provoking stimulus and a previously neutral one (e.g. learning to fear dogs after being bitten by one). Because behaviourists believe that such behaviour is learned, it follows that it can be un-learned. The treatment aims to establish a new association between the phobic stimulus (e.g. a dog) and a non-anxiety response. Through counterconditioning the intensity of a conditioned response (anxiety, for example) is reduced by establishing an incompatible response (relaxation) to the conditioned stimulus (a snake, for example).
Dog Fear Dog + relaxation Reduced fear
Systematic desensitisation can be conducted in vitro which involves imagining the anxiety inducing situations or objects; alternatively it can be in vivo which involves live encounters. Systematic desensitisation can also be paired with modelling, whereby the patient observes others (the “model(s)”) in the presence of the phobic stimulus who are responding with relaxation rather that fear. In this way, the patient is encouraged to imitate the model(s) and thereby relieve their phobia.

? MUST KNOW – A02 – Systematic desensitisation has limited application as it only suited to particular disorders such as phobias but is not suitable for conditions such as schizophrenia. + Systematic desensitisation is more ethical than some other behavioural treatments such as flooding as patients can control the exposure and they only move onto the next level of the hierarchy when they ready and relaxed. +/- The treatment has a very high success rate with specific phobias rather than more general phobias such as agoraphobia. McGrath et al found that 75% of patients with specific phobias showed clinically significant improvement following the treatment.

? SHOULD KNOW – A02 + The treatment is relatively quick and cheap as the patient often requires only 6-12 sessions, whereas psychoanalysis can be very time-consuming, sometimes taking years which can become highly expensive. + Empirical research such as Watson and Rayner indicates that phobias can be learned and thus it is logical that they can be unlearnt. + Jones applied systematic desensitisation to infants with phobias, such as the case of Little Peter who had a phobia of rats and rabbits. After 40 sessions Peter was able to stroke a rabbit that was sat on his lap.
+ Capafons et al showed that the treatment worked with fear of flying which gives evidence of the success of the treatment. +/- The treatment only focuses on observable symptoms which is positive in terms of providing empirical results of its success however deeper, underlying issues are not addressed which may have caused the disorder, unlike with psychoanalysis.

– One problem with systematic desensitisation conducted using only imagination of the anxiety situations is that some people may have difficulty creating vivid images of encounters. However the use of in vivo desensitisation can overcome this problem. – Less success is found with agoraphobics and relapse rates are high. Craske and Barlow found between 60% and 80% of agoraphobics show some improvement after treatment, but it was only slight and osme clients relapsed completely after 6 months. – Classical conditioning principles, on which systematic desensitisation is based, stem mostly from studies using animals and children and thus the principles may not generalise to older humans. Phobias may be more ingrained in adults and thus harder to remove. In addition adults are more cognitively developed which could create an additional element to phobias which is not targeted by systematic desensitisation.
Dream Analysis – Psychodynamic Approach

? MUST KNOW – A01 Dream analysis is a technique used within psychoanalysis to identify unconscious sources of disorder which are then brought into the conscious mind so they can be dealt with. The client records their dream which is then reported to the therapist who will analyse the content to find the underlying meaning. This may be combined with free association to give further insight into the underlying issues. The analyst will unravel the disguised symbolism of the manifest content (what was remembered) so that that the latent content (what the dream actually means) could be revealed. It is believed that the latent content will reveal the underlying wishes, fear or desires that are at the source of the problem being displayed by the client.

The source of phobias is believed to be material that has been repressed into the unconscious and emotions that have been displaced onto a particular object or situation. Dream analysis is used to interpret symbols which reveal the latent content to give insight into the unconscious causes, so that the issues can be dealt with. An example of the use of dream analysis used in treatment of phobias is Freud’s case study of Little Hans.

? SHOULD KNOW – A01 Psychoanalysis: The Psychodynamic Approach sees mental disorders as coming from the unconscious mind, usually due to repressed thoughts or emotions from childhood. Dream analysis is a technique that is employed within Psychoanalysis. Freud believed that treatment should involve identifying the deeper, underlying unconscious mental causes of disorder and dealing with them as best as possible. The emphasis of the therapy is on exploring the patient’s past and linking it to their current symptoms. Freud discovered the unconscious causes of disorder by interpreting the symbolism of his clients’ behaviour, dream reports and free associations. The process (cathartic and transference) of revealing the hidden causes of their behaviour and the insights Freud provided regarding them gave the relief of anxiety and ego control required to improve their condition. Dream analysis: During traditional psychoanalysis the therapist would sit slightly behind the client, who lies on a couch. This is to allow the client (the analysand) to focus without the analyst being a distraction. One way to analyse the dream is via free association, where the patient talks about the thoughts and emotions that the dream created. Freud believed that dream analysis could uncover

unconscious thoughts and wishes which can influence a person’s behaviour. It was Freud’s view that dreams allow repressed material to leak out in a disguised, symbolic form. Dream analysis involves examining the content of dreams by identifying symbols which require analysis to uncover the unconscious thoughts that the symbols represent. The idea is that if unconscious thoughts can be identified they can be acknowledged and dealt with by the individual.

Freud believed that some symbols are universal – that they could be translated in the same way for all dreamers. Some of these were sexual in nature, including poles, guns & swords representing penises & horse-riding & dancing representing intercourse. However Freud was cautious about universal symbols & believed that, in general, symbols were unique to the individual & that a dream could not be analysed without knowing about the person’s circumstances. Thus the therapist needs to have details about the person’s life so that interpretation can be tailored to the individual. The analysis can take some time as it is not based on one dream; it requires a number of recorded dreams.

The manifest content is the story line of the dream that the dreamer is aware of – it is what they recall from the dream. The manifest content (which is thought to be a combination of day residue and the repressed wish/fear) appears in a distorted & symbolic form (to protect us) & is what is analysed to find the underlying meaning. As our repressed desires & fears are unacceptable to our conscious mind if they were to be made known to us while we are asleep we may get upset or wake up & so instead these issues appear as symbols. The hidden content of the dream is the latent content – the real meaning of the dream, the underlying wish, which is the analyst aims to uncover.

The process whereby the underlying wish is translated into the manifest content is called dream work. The purpose of dream work is to transform the forbidden wish into a non-threatening form, so reducing anxiety & allowing us to sleep in peace. Four of the processes involved in dream work are: displacement, condensation, concrete representation & secondary elaboration.

Displacement: when someone or something is used as a replacement for an object or a person we are really bothered about. An example comes from one of Freud’s patients who was resentful of his sister-in-law. He used to refer to her as a dog & once dreamed of strangling a small white dog. Freud interpreted this as his wish to kill his sister-in-law which was displaced onto a dog. Dreaming of this directly could be distressing & so Freud believed that the mind transforms this wish to protect the conscious mind from distress & guilt. Condensation: this is when different factors are combined into one aspect of the manifest content, for example a woman who has angry feelings towards her husband & father might dream of punishing a single man who represents them both. Concrete representation: this is the expression of an abstract idea in a very concrete way eg. A king in a dream could represent concepts such as authority, power or wealth. Secondary elaboration: this occurs when the unconscious mind strings together images into a logical succession of events which can further obscure the latent content.

Psychoanalysis and phobias: Psychoanalysis using dream analysis has been applied to the treatment of phobias. Freud believed that phobias and other psychological disorders are caused by unconscious desires. According to Freud, individuals repress (force into the unconscious mind) unacceptable desires. A phobia is a symbolic expression of these repressed feelings, such as aggressive impulses or sexual drives, and of the punishment linked with the feelings in the unconscious. It is suggested that repression prevents the expression of unconscious impulses and this leads to anxiety. In psychoanalytic treatment of phobias, dream analysis can be used by the therapist to uncover the repressed feelings believed to be the unconscious source of the problem. Psychoanalysts believe that when a patient fully understands the repressed feelings, the fear will disappear or become manageable.

Freud used dream analysis as part of his treatment of little Hans. Hans experienced a number of dream and fantasies which were interpreted by Freud to reveal his unconscious feelings related to the Oedipus complex. Freud analysed the symbols in Hans’ fantasies and dreams and openly expressed his interpretation to Hans (often via his Hans’ father) to help him to overcome his phobias.


? MUST KNOW – A02 – Dream analysis is highly subjective as the interpretation of symbols is based on the therapists’ own opinion. – In addition a different therapist could draw different interpretations and conclusions, showing that the technique is unreliable.

+ There are a number of case studies which provide support for the effectiveness of dream analysis. Freud reported on the case of little Hans who following dream interpretation as part of psychoanalysis was said to have recovered from his phobia of horses which was believed to have resulted from the Oedipal conflict. Cardwell et al reports on the case of Mary whose phobia of vomiting did not improve following systematic desensitisation. However during psychodynamic therapy Mary recalled that she had been sexually abused as a child which had been repressed into the unconscious and had resulted in a phobia.


– Freud supported his theory using case studies which are subjective and hard to generalise from as they are the unique study of only one person. There is little empirical evidence to support his ideas as it is difficult (if not impossible) to objectively study the unconscious (which we don’t actually know exists!).

– There are a number of criticisms of the dream theory on which dream analysis is based. Hobson & McCarley argue that dreams are a purely physiological process; an accidental by-product of neural activity – they are random & meaningless. This therefore invalidates the treatment as dreams may hold no meaning.
– Dream analysis lacks credibility due to the methodological errors and lack of scientific support. Hobson and McCarley’s explanation of dreaming is supported by empirical research giving it more credibility.

– Dream analysis is based on the belief that phobias stem from unconscious causes and no consideration is given to other explanations such as learning. It has been argued that there are far more rational and logical explanations for phobias such as classical conditioning and thus treatments such as systematic desensitisation may be more appropriate to ‘unlearn’ the phobia.

+ New evidence from neuroscience suggests that Freud may have been correct to link dreaming & wishing. Solms (2000) points to an area of the brain where the limbic system (associated with emotion & memory processes) links to the cortex, the area associated with higher mental functions such as thinking. Damage to this area of the brain leads to the loss of dreaming & wishing. However symbol interpretation still lacks scientific support.

– Eysenck (1952) studied ?24 therapeutic outcome studies (including the use of eclectic therapy and psychoanalysis) and found an overall spontaneous remission rate of 68%. Eysenck concluded that most people with psychological symptoms get better without therapy and he argued that psychoanalysis delays recovery.

+ However, clients who dropped out of psychoanalysis were counted as ‘failures’ and the criteria that Eysenck used to measure success was weighted against psychoanalysis. If success were defined differently the success rate was 83% Bergin and Garfield, 1978)

+ Smith et al (1980) compared psychoanalysis, behaviour therapy and no therapy. They concluded that any therapy is better than no therapy. They also argued that Behaviour therapy was better and psychoanalysis was better for depression.

– It is difficult to assess the success of psychodynamic treatments as unlike behavioural therapy, therapeutic goals (e.g. work through repressed issues) are not easily measured. This makes assessing the effectiveness of psychoanalysis very difficult.

– In dream analysis and other methods in psychoanalysis, the therapist takes an expert role. Because the client has no insight into their own unconscious, they rely on the therapist wholly for feedback about their progress. This can create an imbalance of power between therapist and client. A further ethical problem is the possibility that false memories could be created.

+ Waldron commenting on Menninger’s case studies of the treatment of phobias, anxiety and panic disorders concluded that all 18 patients showed improvement (using the Health-Sickness Rating) following psychoanalytic therapies.

+ Freud’s ideas about dream analysis and his work with psychoanalysis has led to the development of many other branches of psychotherapy and many new treatments such as brief dynamic therapy (BDT) and person-centered the


DESCRIBE AND EVALUATE ONE TREATMENT/THERAPY FROM EACH OF THE AS APPROACHES. CARE IN THE COMMUNITY PROGRAMMES (SOCIAL APPROACH), EITHER COGNITIVE BEHAVIOUR THERAPY OR RATIONAL EMOTIVE THERAPY (COGNITIVE APPROACH), DREAM ANALYSIS (PSYCHODYNAMIC APPROACH), THE USE OF DRUGS/CHEMOTHERAPY (BIOLOGICAL APPROACH) AND SYSTEMATIC DESENSITISATION (LEARNING APPROACH). How Psychology Works Unit 4 NB: To reduce what you have to learn for the exam the majority of these treatments was described previously in general before applying them to specific disorders. Ensure that for the exam you can describe and evaluate the treatments both in general and in application to a specific disorder. For the Cognitive treatment you will only need to know general details.

Rational Emotive Therapy – The Cognitive Approach

? MUST KNOW – A01 This therapy is based on the idea that disorders stem from maladaptive thinking. The aim of the therapy is to replace irrational thoughts with more adaptive, rational thinking. Ellis proposed the ABC model involving a process of cognitive restructuring. A is the activating event, B is the client’s belief system & C is the consequence. Initially the clients thinks that A causes B (eg. that failing a test leads to depression), the therapist has to identify B & make the client realise this cause the problem (eg. belief that the person is stupid or that they have to get excellent grades in all tests). Once the belief has been identified the therapist shows it is irrational through the process of disputation & aims to change this belief for a more rational one, which the client then has to put to use – leading to E (effect) or outcome of the therapy.

Background and basis for the treatment Cognitive therapists (CT’s) focus on an individual’s thoughts or cognitions as being the cause of abnormal behaviour. Cognitivists see the symptoms of a psychological condition as disordered cognitions, and think that by changing these cognitions the disorder can be alleviated. CT’s believe that some people have maladaptive ways of thinking & so they aim to replace these with more adaptive ways & in turn change the person’s feelings & behaviour. There are number of different ways that a person’s thinking may be maladaptive. Ellis believed that the existence of certain irrational beliefs reduces people’s ability to withstand the effects of adverse events (they become less stoic).

Cognitive Therapy – Ellis’s Rational-Emotive Therapy (RET)

Ellis suggested that certain beliefs such as irrational ones can create problems for the individual. Most people have an internal voice that perhaps talks us through difficult tasks, or may pass comment on things. When we get stressed the internal voice may become irrational, making it more harmful than helpful.

RET begins with the therapist making patients aware of the self-defeating nature of their beliefs, the patients then have to analyse these beliefs to see if they are logical & rational.

Some features of cognitive therapy:

– They aim to increase efficacy expectations so that the individual has more self-belief. – They train the individual to slow down their thought processes and become aware of their thoughts. – They change an individual’s attributions eg. someone with low self-esteem usually make internal attributions when they fail.

Beck & Weishaar (1989) identified some common features of cognitive therapies; cognitive therapy consists of highly specific learning experiences designed to teach patients: 1. To monitor their negative, automatic thoughts 2. To recognise the connections between cognition, affect & behaviour 3. To examine the evidence for & against distorted automatic thoughts 4. To substitute more reality-oriented interpretations for these biased cognitions 5. To learn to identify & alter the beliefs that predispose them to distort their experiences.
Ellis devised the ABC model:
Ellis felt that treatment should remove maladaptive thoughts & replace them with more positive ones, known as cognitive restructuring.

The therapy starts with C (Eg. Anxiety), which the client believes is caused by A (eg. A broken relationship). The therapist wants to show the client that the intervening factor B is actually responsible for the move from A to C. In order to change B, the therapist disputes the belief (D) and E occurs when the client can actually employ the changed beliefs (E – is the effects of successfully disputing the irrational beliefs). E can be cognitive (rational beliefs), emotional (appropriate feelings) or behavioural (desirable behaviour).

The disputation can be hard work, as the individual may have believed this for a long time. Ellis sometimes assigned homework tasks (eg. Practising exercises, such as catching & correcting themselves each time they use the habitual thought pattern). In this therapy, the relationship between client & therapist is like learner & teacher.

? MUST KNOW – A02 + Anxious clients in particular who are treated with this therapy improve more than those who receive no treatment or placebo treatments. Cognitive therapy has been very effective for treating depression (Hollon & Beck, 1994).

– Haaga & Davidson (1993) suggests there are problems in evaluating the effectiveness of RET because of the difficulty in defining & measuring ‘irrational beliefs’. – This approach to treatment gives no consideration to genetic factors which may cause the disorder and little attention is paid to the role of social & interpersonal factors or of individuals’ life experiences in producing mental disorders (Eysenck & Flanagan, 2000).

– Therapists using RET tend be rather argumentative & direct, showing less concern for client’s sensitivities. This has been particularly criticised by those who feel empathy is an important part of therapy. The appropriateness of a therapy may depend upon the individual client.


+ Brandsma et al (1978) there is evidence that RET is especially effective with clients who feel guilty because of their own perceived inadequacies & who generally impose high demands on themselves.

+/- Barlow & Durand (1995) RET seems more suitable for individuals suffering from anxiety or depression than for those with severe thought disorders. Ellis maintains that RET is appropriate for any kind of psychological problem eg. Depression or sexual problems, but not for severe mental disturbances, where the patient cannot be treated with talking therapies.

+ The approach has lead to new developments in therapy such as Cognitive-behavioural therapy and surveys suggest that the number of professionals embracing cognitive approaches is continuing to rise.

-/+ Most early studies were conducted on people with experimentally induced anxieties or non-clinical problems such as mild fears. However a growing number of recent studies have been done on actual clinical subjects & have also found that RET is often helpful (Lyons & Woods, 1991).

– Patients may find it stressful to accept responsibility for their mental disorder. The negative thoughts of those with mental disorders are often entirely rational, & reflect accurately the unfortunate circumstances in which they are living.

? MUST KNOW – A01 Issues of validity and reliability There are a number of areas within clinical psychology where the issues of validity and reliability arise. One area is the diagnostic procedures that are used to assess patients. Classification systems that are used for diagnosis of disorders should be reliable ie. Different psychiatrists studying the same patient or symptoms should reach the same diagnosis (inter-rater reliability). Psychologists have studied the reliability of classification systems as the implications of poor reliability for the patient could be an incorrect diagnosis. Brown et al (1996) found that there was a 67% agreement rate for major depression, showing reasonable reliability of the diagnostic procedures.

Classification systems should also be valid ie. That the diagnosis given is accurate in identifying the disorder that a patient is experiencing. If a patients set of symptoms can be interpreted to be different disorders then the manual being used is not a valid measure. Predictive validity means that classification categories should predict the prognosis or outcome, of a disorder. Lahey et al (2006) found there was good predictive validity in relation to their social and academic functioning over a six-year period for children diagnosed with ADHD.

Primary and secondary data Data can be classified as either primary or secondary. Primary data is original data that has been collected by those who witnessed an event first-hand or who collected data themselves for a specific purpose eg. Results from a questionnaire or conducting a tally of observed behaviours such as Charlton et al.

Secondary data is second-hand analysis of pre-existing (primary) data. It is the analysis of data that was collected by someone else usually involving interpretation, evaluation and commentary eg. Gottesman and Bachrach et al.


Issues of validity and reliability

Clinical Psychology Research: Another area where the issues of validity and reliability arise is within Clinical Psychology research. Reliability is found when a study is replicated and similar results are obtained. Reliability is an important aspect of research as if a study is found to be reliable it gives more weight and importance to the findings which can be then be applied and relied upon. Gottesman and Shields found similar results to previous studies suggesting their findings are reliable eg. Inouye (1961) in Japan, found a 74% concordance rate for twins with progressive chronic schizophrenia. Thus it can be more reliably concluded that there may be a genetic link in the causation of schizophrenia.

Validity is found in studies when the researchers measure what they claimed to have measured. It is important the findings are high in validity as this enhances the application of the findings to real life situations (ecological validity) and makes the results more credible. In Rosenhan’s study quantitative data was gathered by measuring the number of diagnoses of schizophrenia and the number of days each patient stayed in the hospital. In addition qualitative data was gathered through the observation. Thus the data was rich and varied which enhances the validity. In addition Rosenhan’s study was conducted in a real life setting which provided more ecological validity. Greater validity allows for more insight into the focus of the study, thus from Rosenhan’s study more insight can be gained regarding the diagnosis of disorders and the experiences of patients in psychiatric hospitals. (For more discussion of validity and reliability see the discussion of DSM)

Primary and secondary data

Primary data means original data that has been collected by those who witnessed an event first-hand or who collected data themselves for a specific purpose. Research in which the individual or group responsible for the design of a study actively participates in its implementation is known as primary research and information gleaned in this way is termed primary data. Examples of primary data include raw data such as results from a questionnaire or a tally of behaviour during an observation Eg. Charlton et al. A further example would be a diary entry that someone writes.

However there are many instances in which the data required to answer a research question will have already been collected by others. This type of research is secondary research and the data is secondary data. Secondary data is second-hand analysis of pre-existing (primary) data. Secondary data analysis uses data that was collected by someone else which tends to involve interpretation, evaluation or commentary. Article analysis whereby a source is summarised for the main issues is an example of secondary data being produced. A further example is Gottesman (1991) who pooled data from 41 different studies to see if there was a genetic link with schizophrenia. The use of meta-analyses is an example of secondary research, this approach attempts to combine the findings of several studies on the same issue to provide a broader overview of a topic.

? MUST KNOW – A02 + Primary data, especially gathered from scientific studies should involve less subjectivity as there is less need to interpret the findings than with secondary data. + Primary data can be more reliable as the researcher knows the procedure and how the data was collected and thus they can replicate the study to check the results. – The scope of the study is limited by the resources of the researcher in terms of time, money and other practical limitations such as sampling.

+ Secondary data saves time and expense that would otherwise be spent collecting data. + In some cases secondary data may be the only way to conduct some research such as comparing attitudes of previous eras with current attitudes or examining large scale trends of the past. – The researcher cannot check the data so its reliability may be questioned.

Comparison of A02 points Primary Data Secondary Data Strengths: + Primary data as it is originates with the researcher is usually current and thus the findings may be more valid and relevant. + In general primary data should be more valid as for example the operationalisation of the variables and procedures taken to avoid confounding variables will be conducted with the research aim in mind. + Due to the likelihood that the validity and reliability of the findings are higher, primary data should also be more credible and trustworthy. In addition, credibility is also enhanced by the careful planning of the procedure and the design fitting the purpose of the study. Strengths: + Quicker to obtain as there is no need to develop the research materials such as questionnaires. + The data can often be obtained cheaply and sometimes without cost such as using resources available on the Internet as the data already exists. + The scope of secondary data will often exceed what the individual might achieve on their own eg. Gottesman was able to obtain broader results from a larger sample by pooling data from 41 studies. + The data can be drawn from different sources which can enhance the validity due to the additional findings that can be included adding a richness to the data used.

Weaknesses: – Primary data can be expensive to obtain as the researcher has to design the experiment from scratch and the research procedure may involve expensive equipment or other costly resources. – It is more time consuming to gather primary data as the researcher has to plan the procedure, conduct the study and spend time analysing the findings. – Primary data collection is limited to the time, place and availability of participants etc, whereas secondary data can come from different sources for example from different time periods.

Weaknesses: – The data used may have been originally collected to meet a particular research purpose. Consequently the way in which the measures have been taken might not meet the needs of the current research eg. Bachrach et al in assessing the effectiveness of psychoanalysis using a meta-analysis found that success had been measured in a number of different ways. This can also lower the validity of the conclusions drawn. – Secondary data are not always current, for example if information is taken from the national census it could be nine years out of date, which can affect the conclusions drawn. – There can be a higher level of subjectivity with secondary data as the researcher may have to use their interpretation to draw conclusions from the primary data.

a) DESCRIBE ONE KEY ISSUE IN CLINICAL PSYCHOLOGY FROM THE CONTENT STUDIED WITHIN THE APPLICATION – EXAMPLES INCLUDE: o Understanding a mental health disorder o Supporting someone with a mental health disorder in the home o Supporting someone with a mental health disorder in work o The way that mental illness is portrayed in the media. o Is schizophrenia a biological condition?
b) PREPARE A LEAFLET USING SECONDARY DATA FOR A PARTICULAR AUDIENCE ABOUT THE KEY ISSUE. – When devising your leaflet be clear on your target audience and why you chose them – Have a clear aim for your leaflet – Think about the format of your leaflet – You will have to include a commentary on the leaflet explaining why decisions were made, who the audience was and what outcomes were intended. – Be able to evaluate your leaflet in light of the decisions you made.
See pages 130-133 of your A2 Brain text, also page 165 of your A2 Angles text for extra information.


    • Once you have drafted and re-drafted and incorporated feedback – write a model answer to keep with your study book for revision, include:

a) Describe one key issue in Clinical Psychology (5) b) Discuss the key issue you identified in a) (8) c) Comment on your design decision eg. Who were your chosen audience and why? What was the aim/intended outcome of your leaflet? What format did you choose and why? (6) d) Evaluate your leaflet (6)



Go through this checklist of what you need to know for Criminal Psychology to self-assess your current understanding. * Use the traffic light coding system to self-assess what you:

  • Use the system again once you have conducted some detailed revision to assess your progress.

I NEED TO KNOW ABOUT 1ST CHECK 2ND CHECK Define clinical psychology Defining the statistical and social norm definitions of abnormality and schizophrenia Defining reliability, validity, primary data and secondary data Explain issues of reliability and validity in clinical psychology Describe and evaluate reliability, validity and cultural issues with regard to the diagnosis of disorders Rosenhan’s (1973) study ‘being sane in insane places’(A01/A02) Describing and evaluating the two definitions of abnormality (statistical and social norms definitions) For schizophrenia, know:

Symptoms and features A biological explanation (A01/A02) A social explanation (A01/A02) A biological treatment – drug therapy (A01/A02) A social treatment – care in the community (A01/A02) Two research methods used to study schizophrenia and an example for each (two studies) (A01/A02) Schofield and Balian – interview Gottesman and Shields – twin study For phobias, know:

Symptoms and features Learning theories (A01/A02) Psychodynamic theory (A01/A02) A psychodynamic treatment – dream analysis (A01/A02) A learning treatment – systematic desensitisation (A01/A02) Mineka and Cook – animal study of phobias

One treatment each from the five AS approaches (A01/A02) Describe and evaluate the use of primary and secondary data One key issue and a practical relating to it


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