AS Abnormality – Extension Tasks

The Biological Approach To Psychopathology

The core in your skeleton notes refers to two areas where the biological approach has been influential: autism and depression. The core is all you need to know for the exam but following these links will help you to understand more deeply what has been found and what issues remain. Deeper understanding brings better recall.

Autism

Firstly, you need to understand what mirror neurons are. This video explains this: it comes from a PBS documentary from the US. For the connection to autism, watch this extract from the same programme. If you want to know more about autism, use the autism tag on this blog or use the search box at the top. The idea that autism is the result of a problem in the mirror neurone system has been challenged more recently. In this article, Mo Costandi explains what the problem might be.

Depression

Firstly, you need to be sure that you understand how neurotransmitters work. This video explains it really clearly. It comes from the University Of Bristol website: please follow this link for further details. The idea that depression is related to problems with the neurotransmitter serotonin is explained in this extract from a documentary made for New Zealand television. You can read about the research into the serotonin transporter gene research here and you can watch some video about it here. This research is now a few years old. Researchers are gradually realising that depression is not simply all about serotonin but is a complex condition which has many different causes. This programme is a good place to start to explore current research. You can also use the depression category at the bottom of this blog to explore more.

 

How can the nature vs nurture debate be applied to explanations for abnormality? Can we really separate nature and nurture?

In our lesson, we will look at what each of the explanations of abnormality has got to say about nature-nurture. We will then focus on explanations of eating disorders. The best research in this area is being done at the Institute Of Psychiatry. You can visit their Eating Disorders Unit website here. You can click on the information button on the right of the screen to get to the What We Already Know page. Start with the section on Why Do Eating Disorders Develop?. Work out which of the ideas there are about nature and which are about nature. Most researchers now think that it is impossible to separate out nature and nurture. Do you agree with them? If so, why?

For a different take on the nature-nurture debate, you can listen to this podcast here from Naked Neuroscience. It features Professor Mike Owen from Cardiff University and Prof Barbara Sahakian from Cambridge University, two big names in the field.

 

Biological And Psychological Therapies: Further Questions

Both groups watched and commented on the Rick Stein video. Here is a summary of the questions to be asked.

We noted that back when Rick Stein’s father was being treated, psychoanalysis was not very effective. The only viable treatment for someone with such serious bipolar disorder was ECT. Since then, cognitive behavioural therapy has grown into a major force in therapy. Question: what is the evidence from recent studies about how to combine drug treatment with CBT?

If Rick Stein’s father was alive now, it would be possible to give him drugs to stabilise his mood. It would be possible in theory to personalise the treatment to reflect his needs, adjusting his medication to match his mood. However, some people have suggested that drug treatments for mental disorders are not always appropriate to the needs of patients. Question: what are the problems about personalising treatments for mental disorders?

When Rick Stein’s father was ill, there was little understanding about what caused bipolar disorder. In the fifty years since, much work has been done to understand that it is a disorder with a biological basis. Question: what is the evidence that disorders such as depression, eating disorders and autism have a biological cause?

In the time since Rick Stein’s father died, progress has been made in discovering new therapies and understanding how and why they work. Research has been done to demonstrate the effectiveness of these therapies. Question: how well do we understand how therapies used for conditions such as depression, eating disorders and bipolar disorder work?

The treatment given to Rick Stein’s father was in some ways inhumane. People at that time would be given ECT without anaesthetic, which could be painful and distressing. People then were given treatments without the understanding of how they worked or whether they would be effective. This would have caused anxiety to the patient and to his/her family and friends. We would like to think that therapies today are less stressful for the people who undergo them. Question: what are the risks and costs in terms of time, money and distress for therapies used today? Is the therapy always worth the cost?

The psychiatrist in the video talks about using drugs to prevent a condition like the one suffered by Rick Stein’s father from getting worse. This suggests that prevention is better than cure. Question: what steps have been taken to use therapies to prevent illness rather than just cure it?

You can answer these questions by focusing on biological therapies. The best place to start to understand the controversy about the use of drugs to treat abnormality is this radio documentary. You can listen to the programme by clicking here. After that, use the Prozac tag or use the search box to read about more of the controversies which surround the use of drugs to treat depression and other disorders. ECT is in many ways a less controversial therapy. As a contrast to the video about Rick Stein’s father which we will have watched in class, watch this TED talk by Sherwin Nuland. You can use the ECT tag on this blog to find out a bit more.

For a general overview of CBT and the issues which surround it, this programme is excellent. There are many links on this blog to articles about CBT. Use the tag to access some of them. This story on the BBC website shows how CBT is being used to treat serious mental illness. It’s controversial though. You can find out about how drug treatments and CBT have been combined effectively by reading this article here.

On psychoanalysis, the main controversy concerns repressed memories. You can read about this issue here and here. Psychoanalysis went out of fashion for a while but is still a powerful therapy for many people. Here’s a discussion about psychoanalysis and religion.

To find out more about systematic desensitisation, listen to this programme about the originator of systematic desensitisation, Joseph Wolpe. A couple of clips from this programme focusing on evaluation and limitations of SD can also be accessed.

The final word on both models and treatment of abnormality ought to go to Thomas Insel. He is director of the National Institute of Mental Health in the US. You can read more about him and his ideas by clicking on the Insel tag on this blog. Here he speaks about what the future of prevention and treatment might look like.

http://www.ted.com/talks/thomas_insel_toward_a_new_understanding_of_mental_illness

 

 

 

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6 comments

  1. The lessons yesterday with both 12A and 12C were really interesting because of the ways in which students saw these approaches and the issues they raised. It was roughly the same points in both groups. They were:-

    a) The idea of having different approaches is a strange one. In a science lesson, you explain, for example, the life cycle of a fruit fly from one approach. You don’t come up with four completely different ways of talking about it.

    b) This is really an exercise in the history of Psychology. The psychodynamic, behavioural and cognitive approaches have each, at different times, enjoyed prominence and success. In the twenty-first century, we now try to take the best of each approach and combine ideas from different approaches in order to understand better.

    c) You cannot separate explanation from therapy: we can only evaluate the psychodynamic explanation properly once we have understood how psychoanalysis works. That’s just one example.

    d) The exam questions require you to write about an explanation (or a therapy) one at a time. Researchers and clinicians don’t think like that now but use combinations of approaches to explain pathologies. So writing about any of these approaches is about separating out each approach and then explaining that it cannot offer a complete answer by itself.

    e) I’ve given you a core of evaluation points but this is really a safety net. People are starting to see different issues to include: nature-nurture (including the idea of combining them), free will and determinism, links to treatment. That will get us into some really good writing.

  2. Katie S · · Reply

    The nature vs. nurture debate can be applied to psychological abnormality because it arises the question of whether psychological abnormality is genetic, suggesting it’s inevitable, or non-genetic, suggesting it’s our environment and upbringing that is the cause.

    From listening to the podcast from Naked Neuroscience, it seems like psychological abnormality is caused by both nature and nurture. In the podcast it was mentioned that with more severe psychological disorders, people can inherit genes that will make them more or less susceptible to them. However, it was also said that even when having inherited the genes to make you more susceptible to serious psychological disorders, it still depends on a string of circumstances throughout your development.

    I personally think nature and nurture cannot be separated as they are so closely link and stem from one another. I like to think of nature giving us the basics and nurture filling in the rest, (I may be biased due to studying Sociology).

  3. From 12C’s lesson on Friday …… Katie makes a fundamental point. I try hard to keep the approaches separate but it is only a matter of time before they collapse into each other. Katie mentions the sociology perspective. What I think happens now is that in trying to understand nature and nurture, people do not stick to their perspective as sociologists, psychologists, psychiatrists and so on but rather use the best of each tradition to come to a view which combines different approaches and types of evidence. In our lesson today, Emily got hold of how an understanding of eating disorders depended on a bit of all four approaches.

    I learnt some other things as well from the lesson. Rachael asked a really good question about the nature of evidence for the psychodynamic approach. She described the lack of evidence as “hippyish”. When I did my Psychology degree about 20 years ago, I was taught to dismiss the psychodynamic approach as being unscientific. The point I’ve been trying to get across is that the case studies of Anna O and Little Hans in your skeletons and the other evidence for the approach relies on the interpretation of an analyst to look beneath the surface for deeper meaning. In the psychodynamic approach, nothing is as it seems. What’s then interesting is how the source on eating disorders we were looking at makes reference to unconscious processes. The psychodynamic way of looking at abnormalities is still seen as valid.

    Paige had some good insights into the ideas about perfectionism which are at the heart of eating disorders. We wondered whether these were a product of nature or nurture. We ended up thinking that this was not a question we could answer. They are both a response to trauma and something that reflects something fundamental about a person which may have a genetic basis. We’re back here to the idea of a genetic basis.

    Teddy’s point at the end of the session was really good. She quoted some evidence about the rates of diagnosis of ADHD in different countries. This means that we need to add classification and diagnosis into the mix. We cannot separate diagnosis from explanation and from treatment. If you decide that ADHD is a biologically based condition, then you will treat it with drugs. If you think you can treat it successfully with drugs, you will find more people who you think could benefit and diagnose them.

    Finally, I’ve been spending a lot of this week thinking about how both to separate and then connect approaches in Psychology. I have also been thinking about sensitive issues and student mental health: please see Post Of The Week for more commentary on this. My big fear is that people walk away from these lessons with a view of abnormality which is too simple and with the idea that any condition they might think they have is either inevitable or their fault. There’s no doubt this time around that we are all seeing that it is much more complicated than that.

  4. Here’s what we can learn from the Rick Stein video, based on what both groups said today.

    We noted that back when Rick Stein’s father was being treated, psychoanalysis was not very effective. The only viable treatment for someone with such serious bipolar disorder was ECT. Since then, cognitive behavioural therapy has grown into a major force in therapy. Question: what is the evidence from recent studies about how to combine drug treatment with CBT?

    If Rick Stein’s father was alive now, it would be possible to give him drugs to stabilise his mood. It would be possible in theory to personalise the treatment to reflect his needs, adjusting his medication to match his mood. However, some people have suggested that drug treatments for mental disorders are not always appropriate to the needs of patients. Question: what are the problems about personalising treatments for mental disorders?

    When Rick Stein’s father was ill, there was little understanding about what caused bipolar disorder. In the fifty years since, much work has been done to understand that it is a disorder with a biological basis. Question: what is the evidence that disorders such as depression, eating disorders and autism have a biological cause?

    In the time since Rick Stein’s father died, progress has been made in discovering new therapies and understanding how and why they work. Research has been done to demonstrate the effectiveness of these therapies. Question: how well do we understand how therapies used for conditions such as depression, eating disorders and bipolar disorder work?

    The treatment given to Rick Stein’s father was in some ways inhumane. People at that time would be given ECT without anaesthetic, which could be painful and distressing. People then were given treatments without the understanding of how they worked or whether they would be effective. This would have caused anxiety to the patient and to his/her family and friends. We would like to think that therapies today are less stressful for the people who undergo them. Question: what are the risks and costs in terms of time, money and distress for therapies used today? Is the therapy always worth the cost?

    The psychiatrist in the video talks about using drugs to prevent a condition like the one suffered by Rick Stein’s father from getting worse. This suggests that prevention is better than cure. Question: what steps have been taken to use therapies to prevent illness rather than just cure it?

  5. Mikaela · · Reply

    Biological and Psychological Therapies

    1. What evidence is there from recent studies about how to combine drug treatment with CBT?

    Bipolar is usually treated with mood stabilisers such as lithium. However even with this prescribed medicine, there are still high rates of relapse within patients.

    Randomised controlled trials have been recently used combining medication and CBT, and results have suggested that combining medication and CBT have significantly reduced the bipolar relapse rate compare to just medication.

    CBT has been found to be effective in both treatment and prevention of a relapse in unipolar depression, so research is trying to find out whether it’s possible for CBT and medication together would reduce the relapse rate in bipolar patients.

    Therapies based on teaching patients new coping skills, as is done in cognitive therapy (see, e.g. Williams & Garland, 2002), may be particularly appropriate for bipolar disorder, given recent evidence that particular coping skills and behavioural responses are important in the course of bipolar illness.

    http://apt.rcpsych.org/content/9/2/110.full

    1. Thanks Mikaela. That’s a useful and authoritative resource which you have found and a really useful insight. For me, it represents a theme which has come up often in recent weeks in both AS and A2. The exam asks us to think about explanations and therapies in separate approaches but the reality for people working in the field and for people trying to get better is that they have to combine approaches and therapies.

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