Treating Abnormality

Biological therapies
1. Psychosurgery-systematically damaging brain Frontal lobotomy-schizophrenia;cut pathways between higher+lower centres of brain/waggling scalpel up+down
  1. Eval
    1. So rare-hard to judge effectiveness With schizophrenia it only targeted symptoms+ at best made patients manageable
    2. Major ethical issues, brain damage is irreversible+consequences unpredictable +patient may not be able to give consent
2. Electroconvulsive therapy-passing current through brain causing seizures We don't know how it works (likely to effect neurotransmitters)
  1. Evaluation
    1. Muscle relaxant drugs prevent convulsions but it's still a violent assault on the brain+ some cases cause memory impairment
    2. Only recommended for severely depressed people, though they may not fully grasp the nature+consequences=no consent
    3. Can be effective
3. Drugs
  1. Schizophrenia(hallucinations delusions+loss of insight+contact with reality) Laborit suggested chlorpromazine (normally used as sedative)
    1. It reduced some symptoms (hallucinations delusions+thought disorder) It overtook frontal lobotomy
      1. It was found; this+other antipsychotics reduce dopamine activity, linking schizophrenia to high levels of dopamine
      2. Other drugs shown to be as effective but fewer side effects such as clozapine (it also acts on other neurotransmitters)
    2. Evaluation of drug treatment for schizophrenia
      1. Effective for only 50-60%
      2. Doesn't cure disorder =drug treatment is for life
      3. Bad side effects Eg movement disorders/lowers WBC's
      4. Patients can't give consent
      5. As we know more about drug action =contributes to understanding of disorder
  2. Depression Treatment; monoamine-oxidase inhibitors+tricyclic antidepressants Both raise levels of serotonin+noradrenaline
    1. This has lead to monoamine theory of depression-relates depression to low levels of serotonin+noradrenalin
    2. Both can have bad side effects; MAOI interacts bad with some food +tricyclics-heart problems
      1. New antidepressant;selective serotonin reuptake inhibitors (SSRI) Eg Prozac=raises serotonin (more effective+safer)
    3. Evaluation
      1. Can be effective (only for 60-70% 30% respond to placebo)
      2. Don't cure depression; doesn't change daily stressors/cognitive biases
      3. Psych+physical dependance with long use (people think they need to keep taking or brain becomes adjusted to them
      4. Side effects
      5. May be unable to give consent
      6. As we know more of antidepressants=contributes to development of biological models of depression
  3. Other drug groups; anti-anxiety (from group called benzodiazepines+can cause dependance +side effects)+Lithium (for bipolar depression)
  4. Evaluation of drug therapy
    1. Effective for some disorders
    2. Only treats symptoms+are reductionist; ignores cognitive emotional etc
    3. Side effects+dependance
    4. Can lead to stigmatism as patient is labelled as shizophrenic etc
Psychodynamic approach; adult neuroses Eg depression is rooted in early experiences They are protected by these conflicts by ego defence
1. Free association Express anything Each incident may lead to other thoughts/memories=ego defence mechanisms may lower-repressed material accessed
2. Dream analysis Symbolic images reflect unconscious material Wish fulfillment too threatening to be acknowledged=distorted
  1. To understand meanings=assumptions; 1content that can be recalled-manifest content 2latent content- meaning behind manifest content 3 dream work
  2. Dream work is the process that latent content gets distorted into manifest content through symbolism and displacement
  3. Projective tests allow client to impose their thoughts on some particular stimulus material=ink blot test(asked what shapes means to them)
3. Evaluation
  1. These theories accept humans are complicated
  2. Therapy can be long lasting=expensive
  3. Depend on client having insight
  4. Need insight=unsuitable for some disorders Eg schizophrenia
  5. Ethical issues as a result of bringing up distressing material
Behavioural approach; alter behaviour using conditioning
1. Behaviour therapy is based on classical conditioning and involves systematic desensitisation, flooding+aversion therapy
  1. Flooding; inescapable exposure to feared object/situation until fear disappears Assumes high levels of fear+anxiety can't be sustained+will fall If it ends too soon-may have opposite affect
    1. Highly threatening+stressful but quick
  2. Systematic desensitisation, a form of counter conditioning Therapist attempts to replace fear response with harmless response Hierarchy of fears
    1. Therapist trains client in deep relaxation techniques (the harmless response), Visualise least feared situation+relax When relaxed=next situation Eventually- can cope with most feared (can go back+start again at a certain level)
  3. Aversion therapy aims to associate undesirable behaviour with an unpleasent stimulus Eg in the past gay men have been shown pictures of naked men while given an electric shock-no evidence to suggest it worked Now it is used for addicts, smoking is associated with feeling sick
  4. Eval; Assumes behaviour is learned through simple conditioning principles, there is no attempt to address deeper psych issues, they focus on symptoms not underlying causes Can be effective when treating phobias Ethical issues
2. Behaviour modification based on operant conditioning This attempts to alter voluntary behaviour rather than reflexive behaviour
  1. Token economy used in institutions Eg psychiatric hospitals Tokens given as rewards for good behaviour They can then be exchanged for sweets cigarettes etc It modify's behaviour+doesn't targeting symptoms Eg with a schizophrenic but once released effects may reverse
  2. Social learnign theory has a cognitive element When a model is rewarded for a behaviour the obserever=more likely to imitate Eg a phobic person can observing a model coping effectively with a phobic situation
  3. Token economy has been affective way of improving anti-social behaviour+works in a structured institution but not for the outside world Unethical to treat patients as stimulus-response machines Social learning involves cognitive processes Both ignore biological/genetic aspects
Cognitive approach/cognitive behavioural therapy; to challenge irrational thought processes
1. Beck's cognitive therapy 1976; to challenge irrational cognitions+replace them with a more realistic appraisals by identifying -ive thoughts (with a diary)+challenging dysfunctional cognitions (drawing attention to +ive incidents) This is reality testing
  1. Also using behavioural techniques to encourage +ive behaviour Eg set list of small goals to develop sense of personal effectiveness Another aspect may be training in problem solving skill or elaxation techniques
2. Ellis's rational-emotive behavioural therapy (REBT) People maintain -ive+self-defeating beliefs by telling themselves how inadequate they are +looking for confirming evidence=tharapist helps identify situations+ -ive reactions to them; rationalise it for a realistic view This may occur in intense debates Both Beck+Ellis's approach involves helping client to deal with depressive realisms as well
3. Eval; CBT is structured but acknowledges complex cognitive processes Important that therapist acknowledges that depression can be based on accurate perceptions of reality Effective for depression Less effective for other disorders though it may be beneficial for them Ignores biological factors Schemata lacks detail Less time consuming+cost effective Avoids stressful indepth probing
Effectiveness of therapies
1. The most important feature is whether they work or not
2. To compare therapies in 1 study=reliable However, large numbers required (all diagnosed with same disorder at same level of severity) careful assessment needed of patients before+after, length of study decided, should be a placebo /control group(effective therapy should show improvement above this group)
3. Elkin et al 1989
4. Davidson et al 2004
5. Meth issues P's should have the same age gender severity of disorder etc Length of study should be sufficient for treatment There should be a non-treated group Measures of improvement should be consistent+thorough
6. Eth issues; consent, avoid psych harm debriefing etc Non-treated groups are denied help No therapy seems to be the best but there can be a treatment that is most appropriate if we consider accessibility+speed of action (drugs) duration of action+ethical issues (side effects)

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Treating Abnormality

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