Transcript PPT_Treatments_PH..

DISORDERS
a.
b.
c.
G543
Clinical Characteristics
Explanations
Treatments
HEALTH & CLINICAL PSYCHOLOGY
3. Treatments for Phobia
a.
b.
c.
Biological: Liebowitz
Behavioural: McGrath
Cognitive: Ost & Westling
EXAM STYLE QUESTIONS (ESQ)
Treatments
BIOLOGICAL
June 2011
a.
b.
How could a psychological disorder be treated biologically? (10 marks)
Compare approaches to treating the disorder you referred to in part (a). (15 marks)
BEHAVIOURAL
January 2013
a. Outline the behavioural treatment of one disorder. (10 marks)
b. Assess strengths and weaknesses of treatments for the disorder you referred to in part (a).
(15 marks)
COGNTIVE
June 2012
a. Outline the cognitive behavioural therapy as a treatment for one disorder. (10
marks)
b. Assess the effectiveness of treatments for one disorder. (15 marks)
Resources:
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Information Booklet
PowerPoint
Essay Help Booklet
Exam Style Questions (ESQ)
Activity 1
Worksheet 1: KEY WORDS
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Complete the key terms related to this topic
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You can use the resources and internet to help
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Each definition should be at least two sentences long
You should use these terms where appropriate in your
essays
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Activity 2
Worksheet 2: Summary Notes
Complete summary notes for each section
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a.
b.
c.
Biological Approach
Behavioural Perspective
Cognitive Approach
You can use the resources and internet to help
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Biological Approach
2a. Summary Questions: BIOLOGICAL
LIEBOWITZ, 1988
Aims
Method & Procedures
What was the aim of this study?
What research method was used in this study?
What are the details of the sample? Total sample,
age range
What is a single-blind placebo controlled trial?
What is the IV?
What is the DV? What measurements were taken?
How were the participants assessed for social
phobia?
Why did Leibowitz use a placebo group?
What design did Leibowitz use?
What happened?
Background
What is social phobia?
What does Phenelezine do?
What is Atenolol?
Sample
Results
What are the details of the sample?
Total sample, age range
What was the main finding?
Which drug worked better?
2a. Summary Information: BIOLOGICAL APPROACH
Liebowitz, 1988
Aim
To find out if people with a social phobia could be
helped by taking either phenelzine or atenolol.
Background
A social phobia is a fear of interacting with other
people. Phenelezine prevents the breakdown of the
monoamine neurotransmitters serotonin, melatonin,
norepinephrine and dopamine. This leads to an increase
in the concentrations of these neurochemicals and
therefore an alteration in neurochemistry in the brain,
making a patient calmer and less depressed. Atenolol is
a beta blocker which slows the heart beat and lowers
blood pressure.
Sample
80 patients meeting the DSM-III criteria for social phobia
aged 18-50 and who were not suffering from any other
medical or psychological condition took part. Only 41
had completed the trial by the time the paper was
published.
2a. Summary Information: BIOLOGICAL APPROACH
Liebowitz, 1988
Method/
Procedure
Results &
Conclusion
Single blind placebo controlled trial. Patients were given a
placebo for seven days to see if they got better. If they did,
they were not included in the treatment phase. They were
randomised to the three treatments in an independent
measures design. Patients were given with phenelzine or
matching placebo or atenolol or matching placebo. Eight
weeks later they were assessed by independent evaluators
and then they continued for a further 8 weeks. After 16
weeks half the patients who were recovering got a placebo
for four weeks, while the others continued to get the active
drugs. Assessment was by blood tests to check they were
taking the medication and a series of rating scales.
Phenelzine but not atenolol was effective in the treatment of
the phobia by appearing to reduce anticipatory anxiety
and the difference appeared by eight weeks.
Behavioural Perspective
2a. Summary Questions: BEHAVIOURAL
McGrath, 1990
Aims
Method & Procedures
What was the aim of this
study?
What research method was used in this
study?
What happened?
How many sessions did Lucy have to
have before she became less fearful?
Background
What is systematic desenitisation?
Sample
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What are the details of the
sample? Who was the
participant in McGrath’s study on
systematic desensitization?
Results
What happened after the first
treatment session?
What happened in subsequent
treatment sessions?
What was Lucy able to do by the end
of her treatment?
2b. Summary Information: BEHAVIOURAL
McGrath, 1990
Aim
To treat a girl with noise phobia using systematic
desensitsation.
Background
Fear of loud noises is common in children but for
some it impacts on normal life. Lucy, the girl in
this study, could not go to parties and school trips
or anywhere where fireworks might go off.
Sample
Lucy was a nine-year old of low average
intelligence (IQ97). She showed as averagely
depressed, fearful and anxious when she was
tested and therefore was felt has fear of noise
was not part of a wider condition and could b
treated.
2b. Summary Information: BEHAVIOURAL
McGrath, 1990
Method
Systematic desensitisation was used and written up as a
case study.
Procedure
Lucy was taught to relax and then she created a hierarchy
of feared noises including doors banging, cap-guns
popping, balloons bursting and unexpected explosions of
party poppers. Imaging herself at home with her toys and
her bed and deep breathing was used to control fear. She
also used a gear thermometer, rating her fear from 1 to 10.
As she was given the feared object, she paired it with the
relaxation and imagery she had learnt until she was calm.
Results &
Conclusion
Balloon bursting was the first fear to be tackled and by the
fourth session, Lucy could bear it being popped 10 metres
away quite calmly. In the fifth session she was able to pop
the balloon herself. The other feared objects were then
introduced and by the tenth session her fear thermometer
scores had dropped from 7/10 to 3/10 for balloons
popping and fear of the cap gun from 8/10 to 5/10.
Cognitive Approach
2c.Summary Questions: COGNITIVE
Ost & Westling, 1995
Aims
Method & Procedures
What was the aim of this study?
What research method was used in this
study?
How were the patients assessed before
treatment?
What happened?
How was data collected?
Background
Which two therapies did Ost and Westling
compare?
What does the cognitive approach suggest
as a way to treat anxiety disorders?
Sample
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What are the details of the sample? Total
sample, average age
How was the sample recruited?
How many were diagnosed with mild
agoraphobia?
Results
•What did Ost and Westling find?
•How did Ost and Westling explain
the similarity in findings between the
two therapy groups?
2b. Summary Information: COGNITIVE
Ost & Westling, 1995
Aim
To compare cognitive behavioural therapy (CBT) with
applied relaxation to treat panic disorder.
Background
The cognitive therapy of panic disorders proposes that
people who experience panic attacks have a welldeveloped tendency to interpret body sensations in a
catastrophic way. This then leads to a vicious cycle of
symptoms and interpretations leading to panic attack.
Sample
38 patients who fulfilled the DSM-III criteria for panic
disorder, 8 of whom also had mild agoraphobia. They were
recruited through referrals from psychiatrists and adverts in
the paper and had to have a least three panic attacks and
suffered with the condition for at least a year. 26 females
and 12 males with an average age of 32.6yrs.
2b. Summary Information: COGNITIVE
Ost & Westling, 1995
Method
Patients were randomly assigned to the two treatment and
assessment pre- and post-treatment and follow-up one year
later. Patients completed questionnaires and were
interviewed at the start and instructed in what to do if they
got a panic attack and how to keep a panic diary. After the
last session the patient again filled out a questionnaire and
had a brief interview. One year later they were mailed the
questionnaire and had a telephone interview. Both
treatments were given, lasting one hour, once a week for 12
weeks. Progressive relaxation techniques and normal CBT
approach were used.
Results &
Conclusion
CBT patients were 78% panic free after the treatment and
89% panic free after one year. The relaxation patients
were 65% panic free immediately after treatment and 82%
panic free after one year. So both treatments worked, but
CBT was more effective. Both groups reduced their
medication to the same extent.
Activity 3
Worksheet 3: Evaluation
Part 1: Evaluation & Debates
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* Write/type up your responses. Elaborate your responses fully.
Part 2: EVALUATION GRID
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3a. Evaluation Questions: BIOLOGICAL
What is a problem with using rating scales repeatedly?
Is the sample representative?
Identify 2 strengths and 2 weakness of the biological
treatment for phobia.
Is drug therapy oversimplifying the complexity of social
phobia? Does it deal with the root cause of the problem?
Could drug therapy offer a short-term or long-term
solution?
Is there any other support for this approach (other
research)?
Is there an alternative way to treat phobia?
3a. Debate Questions: BIOLOGICAL
 Why is this a reductionist explanation of
phobia?
Could drug therapy be useful as a short-term
intervention?
3a. Evaluation & Debates: BIOLOGICAL
Small sample size at the time the paper was published.
The use of rating scales repeatedly by the patients may
increase demand characteristics, although it helps with
test-retest reliability and use of several different
instruments helps construct validity.
This is a reductionism explanation of phobia, reducing it to
brain chemistry balance as opposed to a personality disorder.
Usefulness – many people have social phobias, so if a drug
treatment is available it would perhaps support them until they
could master their fear through CBT.
3b. Evaluation Questions: BEHAVIOURAL
Is systematic desensitisation an effective treatment technique? Is it
useful?
Is the sample used in McGrath’s study representative?
Identify 2 strengths and 2 weakness of systematic desensitisation for
phobia
Is re-conditioning oversimplifying the complexity of phobia? Does it
deal with the root cause of the problem?
Could systematic desensitisation offer a short-term or long-term
solution?
Is behavioural therapy useful?
Is there any other support for this approach (other research)?
Is there an alternative way to treat phobia?
Does this approach use scientific methods?
3b. Debate Questions: BEHAVIOURAL
 Nature-Nurture: Can someone have a panicky
personality or is it nurtured?
Usefulness – Why would systematic
desensitisation be better than drug therapy?
3b. Evaluation & Debates: BEHAVIOURAL
Systematic desensitisation seems to be highly
replicable with many different patients and conditions.
Giving the patient control over timing increased the
effectiveness, which is interesting because it introduces a
cognitive component to a behavioural theory.
 Free will vs Determinism could be used because this study suggests our
conscious control can be used to treat fears and phobias.
Reductionism could be explored because it reduces a phobia to a learned
response.
Psychology as a science - this could be a demonstration of a scientific approach
to a treatment.
Usefulness – a very useful treatment with many applications
3c. Evaluation Questions: COGNITIVE
Identify 2 strengths and 2 weakness of CBT for phobia
Is CBT an effective treatment technique? Is it useful?
Is the sample in Ost & Westling’s study representative?
Is self-reporting a reliable measure?
Why is it a problem that Ost & Westling did not have a
control group?
Does CBT deal with the root cause of the problem?
Could CBT offer a short-term or long-term solution?
Is there any other support for this approach (other
research)?
Is there an alternative way to treat phobia?
3c. Debate Questions: COGNITIVE
Free Will vs Determinism – Are our thoughts
under conscious control?
Reductionism – How is behaviour
oversimplified by this approach?
Is CBT a successful treatment?
3c. Evaluation & Debates: COGNITIVE
It is impossible to control for any cognitive changes that might have occurred
in the relaxation group.
Self-reports were used to collect data so patients could have shown demand
characteristics in changing their responses from the first to the second and third
questionnaires as it was expected.
No control group and the patients were not drug free during the trial.
Nature/Nurture: Is there a panicky personality or is it
a nurtured condition?
Usefulness- panic disorder is clearly susceptible to
treatment and either method would help a patient
reduce medication.
Activity 4
Worksheet 4: Essay Plans
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10 Mark Questions
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15 Mark Questions
EXAM STYLE QUESTIONS (ESQ)
Treatments
BIOLOGICAL
June 2011
a.
b.
How could a psychological disorder be treated biologically? (10 marks)
Compare approaches to treating the disorder you referred to in part (a). (15 marks)
BEHAVIOURAL
January 2013
a. Outline the behavioural treatment of one disorder. (10 marks)
b. Assess strengths and weaknesses of treatments for the disorder you referred to in part (a).
(15 marks)
COGNTIVE
June 2012
a. Outline the cognitive behavioural therapy as a treatment for one disorder. (10
marks)
b. Assess the effectiveness of treatments for one disorder. (15 marks)
Biological Treatment [10]
Introduction:
Treatment:
Conclusion:
Liebowitz:
Behavioural Perspective [10]
Introduction:
Treatment:
Conclusion:
McGrath:
Cognitive Approach [10]
Introduction:
Treatment:
Conclusion:
Ost & Westling: