Identifying disorders and why it's not as simple as it seems

Characteristics for disorders (DSM-IV)

SCHIZOPHRENIA

• Psychotic disorder
• Generally characterised by loss of contact with “reality”
• Must have 2+ symptoms, as well as socio-occupational dysfunction
• Positive symptoms such as delusions, hallucinations and disordered thought/speech/actions
• Negative symptoms such as loss of contact with reality, catatonia, loss of pleasure in usual activities and loss of emotional responses

DEPRESSION

• Affective disorder, so most linked to mood changes
• Can be unipolar or bipolar as well as dysthymic (chronic)
• Must have 5+ symptoms to be classified as depression
• Behavioural symptoms include loss of pleasure and loss of appetite
• Physical symptoms include catatonia, fatigue and insomnia
• Cognitive symptoms include poor concentration and suicidal thoughts
• Emotional symptoms include feelings of worthlessness and persistent negative moods
• Bipolar disorder includes episodes of these characteristics alongside manic episodes, including delusions of grandeur, excessive happiness and feeling restless (those with bipolar may be confused with schizophrenia due to the occasional presence of delusions and disordered speech, thought or actions)

PHOBIA

• Anxiety disorder
• Persistent, excessive fear or anxiety and recognised as so
• Immediate fear response on contact
• Actively seeks to avoid phobic situation
• Disruption to everyday life
• May seem irrational to others but has very real consequences to the individual

Issues with identifying disorders:

• Highly subjective
• Requires self-report from individuals who may not perceive their behaviour as abnormal or dysfunctional, or who may be prone to lying/disordered thoughts and social desirability
• There is significant overlap between disorders e.g. loss of pleasure is a factor in depression and schizophrenia, whilst bipolar disorders and schizophrenia can feature delusions and disordered actions. Anxiety is also somewhat common amongst people who are depressed, due to feelings of worthlessness and pessimistic depressive thought patterns.

Some great short videos on clinical disorders

If you're anything like me, by this point in your revision looking at past papers and studies have started to get so monotonous you aren't sure it's going in. So, try a different approach.

Here's a link to a website some of you might find really useful. It's full of videos and short summaries of characteristics of disorders, explanations and treatments. Just use the search bar at the top to navigate yourself around. 

Enjoy!

Evaluation points for Stress

As requested, I've done some evaluation points for stress. They aren't the only ones, so if you think of any more, feel free to use those. 

Causes of Stress

• You could evaluate the extent to which each of these were nomothetic - does everybody have lack of control/work/daily hassles/life events? Does it cause each person stress?
• You could look at situational versus dispositional - all of these actually tend to favour situational explanations of stress, but the treatments tend to be dispositional, so this could be a good issue to look into. 
• You could maybe also look at how simple these causes would be to fix, and how the knowledge that they cause stress could be use. This leads you to evaluation issues such as usefulness and application. 

Measures of Stress

• Validity is a major issue here. You've got low construct validity in that it's hard to define stress and thus hard to know when you're measuring it, as well as face validity because the measures of stress can be affected by lying, memory, demand characteristics, illness, emotion, etc. Also, different people experience stress differently so using only one measure on participants may not be a valid approach.
• Reliability is also important. As different people experience stress differently, measures are unlikely to give consistent results if used again in similar situations. Too many things affect measures of stress and stress itself in order to give consistent results on physiological or self-report measures.
• Reductionism is a potential issue. Obviously, measures which are only self-report (e.g. SRRS) or only physiological (e.g. heart rate monitor) are reductionist and don't look at many features of stress response or the dynamic between them, whilst combined measures are holistic and thus may be more appropriate and useful.

Managing Stress

• Situational versus dispositional is also appropriate to evaluate here. Social support takes the situational approach whilst cognition is dispositional, as is behaviourism (biofeedback). Though, behaviourist ways of managing stress emphasise the role of positive reinforcement, so it has a situational element as well. You could obviously link this to reductionism and holism. 
• You could look at whether symptoms or causes of stress are targeted, and evaluate whether this is a good approach to managing stress. SIT attempts to prevent stress as well as help the individual overcome their current stress which Meichenbaum suggests is the actual cause of stress, thus it targets causes rather than symptoms. Biofeedback treats the symptoms of stress response rather than the causes as it teaches relaxation, though this may prevent stress too. Social support targets the symptoms and causes in that having strong social networks can provide support to prevent stress, and provide support once stress has onset. 
• You could also look at effectiveness by looking at whether research supports it, or by cost and time effectiveness. Biofeedback in the form of EMG machines are expensive and require a practitioner, it's somewhat difficult and expensive to get a therapist but once you've learned the skills it lasts a long time, and social support is free and lasts a long time, but is not instantaneous. 

Also, some of the studies are pretty unethical, such as Geer and Maisel, and those which put participants on waiting lists rather than giving them therapy. Though control groups help with internal validity checks, they aren't the most ethical. E.g. Meichenbaum's study had a control group of students who did worse on their exams than the experimental groups - if they were in the other group, they'd have benefited and thus they lost out. 

Evaluation points for Turning to Crime

I may be posting more of these, so keep checking back. If you have any other suggestions for the blog, leave a comment! 

S = strength, W =weakness

? = potentially

UPBRINGING

-          Situational perspective (S=useful for government, W=reductionist)

-          Nurture perspective (S=easier to change than biology, W=ignores biology)

-          Determinist explanation (S=follows scientific laws as in physics, may encourage rehabilitation rather than punishment, W=ignores freewill, how can we punish people for something they didn’t choose)

-          Reductionist (S=easier to understand, helps us to determine causality and importance of individual factors, W=ignores dynamic of relationship between factors, may not be valid)

-          Runs in families; not necessarily upbringing (S=easier to change environment than biology, W=may not have face validity)

-          For maximum validity, studies testing this explanation need to be longitudinal (S=more in-depth, track development, W=attrition, observer bias, ethics)

COGNITION

-          Dispositional perspective (S=suggests therapy may be useful, W=reductionist)

-          Doesn’t specify nature or nurture; could be both (S=holistic, W=unknown cause?)

-          Soft deterministic as it suggests that cognitions determine behaviour but we have some freewill over our cognitions (S=more holistic, W=to what extent can we blame the individual?)

-          Cognitions aren’t observable (S=more complex than behaviourist approach, accepts that people have individual differences, W=subjective, non-scientific, may be invalid)

-          Somewhat more holistic as cognition can be influenced by situation as well as nature and nurture (S=likely to be valid as it looks at a variety of factors, W=still reductionist in that biology and upbringing tend to be overlooked, may not enable causality so may be less useful)

-          Relies on self-report (S=allows for attitudes and cognitions to be accessed, qualitative and quantitative data, W=validity may be poor due to demand characteristics, lying, and misinterpretation etc.)

BIOLOGY

-          Deterministic (S= follows scientific laws as in physics, may encourage treatment rather than punishment, W=ignores freewill, how can we punish people for something they didn’t choose)

-          Reliance on correlation (S=more ethical than manipulating biology, W=causality; how do we know whether brain dysfunction/genes/serotonin is a cause or result of criminal behaviour?)

-          Reductionist (S=easier to understand, helps us to determine causality and importance of individual factors, W=ignores dynamic of relationship between factors, may not be valid)

-          Nature approach (S=more scientific, observable, objective, W=harder to rehabilitate, reductionist)

What the examiners are looking for

Obviously, you need to answer 4 questions from 2 sections. You need to answer them well, describe and evaluate research and studies, and show the examiners what you know.

Sometimes though, the mark schemes are less than clear about how to reach that top band (the As and A*s). Here are some generic tips I've found in the mark schemes that are important in getting as close to full marks as you can:

January 2013

• Relevant research should be applied to part a)
• Must address “how” if the question asks for this
• “Discussion” may involve a comparison and following/challenging a viewpoint
• Detail is beneficial in part a)
• Usefulness, application, ecological validity, reductionism, reliability and ethics are all good evaluation points for interviewing witnesses
• A good way to “assess strengths and weaknesses” is to discuss whether or not an apparent “weakness” may actually be desirable or necessary in order to fulfil a function

June 2012

• Responses should be clear, precise and explicit
• To what extent implies a degree of judgement is necessary
• Responses should directly answer the question rather than simply describing research when this is not asked for. Research can be used to illustrate responses but this should be linked to the question.
• Usefulness can be examined in terms of validity, reliability, ethnocentrism, etc.
• Stronger answers with regards to treatments will be contextualised
• Comparison invites similarities as well as differences
• Reliability can be affected by mood, interviewee, social desirability bias, lying and misjudgement 

Behavioural explanation and treatment of depression

Approach	Explanation [Study]	Treatment [Study]
BEHAVIOURAL All behaviour is learned Depression is learned Depression can be unlearned	The behaviourist perspective explains that depression is learned and is the result of the environment; particularly, depression is the result of maladaptive learning experiences. Lewinsohn argued that positive reinforcements were important; lacking positive reinforcement for non-depressed activities and then gaining positive reinforcement for depressed activities could cause depression. Lewinsohn: sample of 30 participants, some with depression and some without. They were asked to self-report their positive reinforcements in a “pleasant events schedule”, and their depression levels were monitored on a “depression adjective checklist”. The results showed a negative correlation between positive reinforcements and depression scores.	The behaviourist perspective assumes that as behaviour can be learned, it can also be unlearned. In terms of positive reinforcements, this means that positive reinforcements can be introduced to the individual’s daily life as a reward for non-depressed activities such as socialising and getting things done. It’s generally part of CBT programmes, rather than administered by itself. e.g. Lewinsohn conducted a study on the CBT course of “coping with depression”, which involved a sample of 69 adolescents with depression. There were 3 groups: a control group, the standard CBT group, and the CBT group with the addition of parents being encouraged to give reinforcements for improvements in behaviour. The control group improved 5%, the standard CBT group improved 43%, and the parent+CBT group improved 47%.

Effectiveness and Appropriateness

These two seem to catch a lot of people out, because they're pretty hard to define and apply to different areas. Here's some generic tips, with an example to help. 

Effectiveness - the extent to which something brings about an effect, usually a positive one.

(Example question: Assess the effectiveness of offender treatment programmes)

Introduction - define effectiveness

1. Who is it effective for?
(e.g. anger management is only effective for non-psychopathic males, who have an anger problem so it isn't effective for a wide audience, whilst cognitive skills programmes are effective for most offenders as they target the cognitions believed to result in criminality, such as taking a social perspective, self-control and morality)

2. To what extent does it make a difference?
(e.g. to what extent do the treatments reduce recidivism or improve behaviour? Anger management is believed to be somewhat effective, but not in all cases. Ireland et al found it did reduce some angry behaviours. Ear acupuncture appears to make a significant difference to aspects of an addicts life such as improving mood and sleep as well as cravings and withdrawal symptoms. Cognitive skills programmes found to reduce recidivism rates by 14% which is positive, but it's obviously not effective enough to reduce it by more)

3. Is it time and cost effective?
(e.g. therapy treatments tend not to be because they require several sessions, whilst biological treatments such as acupuncture are quick and easy to administer)

Conclusion: summary
Somewhat effective, but a holistic approach where two or more methods are combined would be most effective. 

Appropriateness

Appropriateness refers to the extent to which something is suitable, usually in terms of population or situation.

To what extent are treatments for your chosen disorder (e.g. depression) appropriate?

You could answer this by looking at the population: people with depression. Personally, I'd break it down into biological treatments and therapies. 

Biological treatment: drug therapy.
Yes it's appropriate because... it requires little participation from the client, who is likely to feel apathetic, lack motivation, etc. 
No it's not appropriate because... treating a disorder that does not necessarily have a biological cause with drugs may not be treating the real issue, but actually just reducing the symptoms of low serotonin levels.

Cognitive/behavioural therapies: CBT
Yes it's appropriate because... the relationship between the client and therapist may boost confidence in the client and in others and give them a sense of purpose. The behaviourist element to CBT also encourages and rewards self-motivation and non-depressed activities, which helps to teach the client to overcome possible future relapses.
No it's not appropriate because... it requires a LOT of motivation on behalf of the client, it's often quite a lengthy process which people suffering with depression are unlikely to have the energy to go through, etc.

And my conclusion would probably be that drug therapy is appropriate for those with short-term, reactive depression because they need a "quick fix", but if depression is long-term or recurring, therapy enables skills to deal with depression more effectively and thus this may be more appropriate in the long run.