Tuesday, 1 October 2013

Abnormal Psychology



Introduction: What is Abnormal Psychology?

Syllabus Point: Discuss to what extent biological, cognitive and sociocultural factors influence abnormal behaviour.
Answered throughout.

Syllabus Point: Evaluate psychological research relevant to the study of abnormal psychology.
Answered throughout.

Concepts and Diagnosis

Syllabus Point: Examine the concepts of normality and abnormality.
-          It is difficult to define normality. Simply it’s used to refer to conformity to standard or regular patterns of behaviour, but of course, IBO doesn’t want your life to be that easy.
-          Abnormality hence becomes the failure to conform to behaviour considered ‘normal’. But wait, there’s more!

Statistical Abnormality
-          The term normality implies that there is such a thing as average.
-          Behaviours considered normal are ones that occur most frequently in situation.
-          Therefore, behaviour that does not occur very often in a given context is regarded as being abnormal.
-          This does not mean that it is a bad thing.
-          E.g. IQ scores: very low = abnormal, very high = abnormal.
-          Whereas a very low IQ would require treatment, you wouldn’t treat an individual with very high IQ to reduce their high IQ.
-          Statistics are a useful approach when dealing with numbers as you can identify the mean, etc.
-          Statistics can only be used when dealing with numbers however, so it’s restricted.
Deviation from Social Norms
-          Deviation from social norms assumes that there is an expected behaviour in any circumstance.
-          The expected behaviour is what society and culture dictate is appropriate for the context.
-          People associate the breech of these social rules to madness and abnormality. There are however, 3 problems with such an approach:
1-      Social norms vary widely across cultures and social situations.
2-      Historical variation; what was abnormal in the past may be considered very normal in today’s world.
3-      What is considered to be socially acceptable/unacceptable is often dictated by groups with social power. Judging normality according to conformity is inaccurate and has led to cruel treatment of individuals whose behaviour opposes the interests of powerful groups.
-          Therefore, mental health practitioners must understand the diversity of behaviour across cultures, times and gender in order to treat their patients correctly.

Maladaptiveness and Adequate Functioning
-          Assumption: humans perform behaviours that are good for them.
-          Maladaptive: behaviour that threatens a person’s ability to function well in a social context.
-          Examples include alcoholism + anorexia; people engage with behaviour that is damaging to their health – maladaptive.
-          Limitation of this approach: people who don’t suffer from a mental disorder may also engage in maladaptive behaviour, such as extreme sports and extreme protests.

Suffering and Distress
-          If the person is suffering or experiencing distress they may be regarded as abnormal.
-          You take the individual’s own opinion of their behaviour but this assumes that individuals engaging in abnormal behaviour will have sufficient insight to experience distress – not always the case.
-          For example: a person may begin to drink a lot of alcohol but be unaware of the damages it may cause their health, as such they do not suffer nor do they experience any distress.
-          Must also consider that some degree of suffering and distress is a normal response to challenging life events, as such it is not considered a mental illness but a sign of mental health.

Jahoda’s Positive Mental Health
-          Marie Jahoda (1958) tried to define what is normal.
-          Jahoda identified 6 components of ideal health:
1-      Positive attitude toward oneself
2-      Growth, development, and self-actualization
3-      Integration
4-      Autonomy
5-      Accurate perception of reality
6-      Environmental mastery
-          Not everyone will possess all 6 qualities all the time – according to this approach fewer people will be regarded as being in a state of ideal mental health.

Syllabus Point: Discuss validity and reliability of diagnosis.
-          The 3 main diagnostic systems used are: The Diagnostic and Statistical Manual of Mental Disorders (DSM), the International Classification of Diseases (CID) and the Chinese Classification of Mental Disorders (CCMD).

DSM:
-          Published by the American Psychiatric Association and is very popular.
-          Published in 1952, but constantly revised, currently 4th edition is available DSM-IV
-          Revisions are done in order to increase its reliability and validity.
-          Its aimed that 2 clinicians will agree on the same diagnosis when using the DSM.
-          Disorders are added, removed and altered. In 1980, homosexuality was taken out.
-          The DSM groups disorders into categories and has a list of symptoms for each disorder.
-          The DSM’s strength is that, in 1987 there was the implementation of the multiaxial approach which urged clinicians to take a more holistic approach as the individual’s medical conditions, psychosocial and environmental problems and their overall wellbeing would need to also be taken into consideration before a diagnosis is made.

ICD:
-          Currently in its 10th edition, ICD-10. More commonly used internationally than the DSM (Mezich, 2002).
-          Was initially developed to record causes of death by the WHO.
-          Intended more for classification rather than diagnosis but contains a chapter dedicated to mental disorders.
-          Very similar to the DSM as both authoring teams consulted with each other. With every new edition the ICD and DSM have decreasing differences.

CCMD
-          Not very popular outside of Chinese territory.
-          Maintains a focus on issues that are of interest to the Chinese culture.
-          Some disorders in the DSM and the ICD are not found in the CCMD as they are not prevalent in China. Vice versa also, some not in the ICD and DSM are found in the CCMD.
-          E.g. homosexuality is a disorder that can be treated in the CCMD.

RELIABILITY ISSUES
-          Inter-rater reliability: assessed by having more than one practitioner observe the same person and use the same diagnostic manual to make a diagnosis. If the practitioners make the same diagnosis, the manual is reliable.
-          Test-retest: to see whether the same individual will receive the same diagnosis if they are assessed more than once (e.g. at diff times)
-          Nicholls et al. (2000): a city that assessed the inter-rater reliability of several diagnostic manuals.
-          2 practitioners were asked to use either the DSM-IV, ICD-10 or the Great Ormond Street Hospital’s own diagnostic manual (GOS) to diagnose 81 children who had eating problems.
-          Correlational study: reliability was assessed according to the agreement of the practitioners.
-          Inter-rater reliability: ICD-10 = 36%, DSM-IV = 64%, GOS = 88%
-          Researchers suggest that the GOS was the most reliable in this study because it was specially designed for young people.
-          Mary Seeman (2007): test-retest reliability: found that initial diagnosis of schizophrenia, especially in women, would change over time as the clinicians became more familiar with their patients.

VALIDITY ISSUES
-          In regards to diagnostic manuals, validity is concerned with whether people are correctly diagnosed when they have a particular disorder and do not give a diagnosis to people who don’t.
R.D. Laing:
-          Suggests that diagnosis is made more with respect to social factors than medical ones as it is often difficult to find the biological factors which cause psychological disorders.
-           Diagnosis is full of financial, political and legal implications.
-          The pharmaceutical industry has been heavily criticized for their influence over the medical profession.
-          Many of the advisory panels for the DSM-IV had financial ties to the pharmaceutical industry, in terms of research funding (Cosgrove et al., 2006)
Thomas Szasz
-          Szasz suggested that it’s incorrect to use mental illnesses as a metaphor to describe behaviour that does not conform to expectations.
-          Biological causes have not been established for many psychological disorders and terms such as ‘depression’ and ‘schizophrenia’ are just labels given to a set of behaviours, emotions or thoughts.
-          The name given is the problem, not the cause of the problem.
-          The DSM-IV specifically states that bad events in a person’s life must be taken into consideration when diagnosing disorders such as depression.

Rosenhan et al. (1973) - really good study
-           Rosenhan and a group of individuals presented themselves to 12 different hospitals across USA, complaining of hearing voices, but otherwise being completely normal.
-          11 of the individuals were admitted to hospital and diagnosed as suffering from schizophrenia.
-          Once admitted, the 11 individuals seized to complain about any symptoms and behaved normally. Their goal was to get out.
-          All of them were released, but with a diagnosis of schizophrenia on remission.
-          Their normality was never detected, despite nurses indicating that there was no further display of psychotic behaviour.
-          It took 7-52 days for the pseudopatients to be released. During their stay they made observations regarding hospital life and patient-staff interactions.
-          Rosenhan also found that ‘abnormal’ people may be mistakenly assumed as being ‘normal’.
-          After conducting his study, Rosenhan returned to the hospitals, questioning how many patients the staff thought were pseudopatients over the course of 3 months.
-          The staff believed 19 were pseudopatients and turned them away, despite all of them being genuine patients which Rosenhan had not sent.
-          Rosenhan’s (1973) study essentially shows that there is a general inability to tell the difference between normal and abnormal behaviour.

Criterion-related validity
-          Gavin Andrews published research on using the DSM and ICD-10 manuals. He found that if an individual can be diagnosed with a disorder using one manual but not the other by a group of practitioners, this indicates poor validity.

Syllabus Point: Discuss cultural and ethical considerations in diagnosis.
-           Labeling theory: once a diagnosis is made, it tends to stick.
-          This is problematic if the diagnosis is not valid and will affect the way others treat the individual.
-          Caetano (1973) conducted an experiment whereby he video recorded a male psychiatrist interviewing a paid university student and a hospitalized mental patient.
-          The video was shown to 77 students and 36 psychiatrists who were either told that the interviewees were both students or both patients.
-          What they had been told affected the final outcome as psychiatrists were more likely to diagnose the interviewees who they were told were mentally ill.
-          Scheff (1966) argued that the adverse effect of labels if the self-fulfilling prophecy – people will begin to act as they have been labeled.
-          Doherty (1975) reported that those who reject the label, recover faster.
-          Morgan et al. (2006) found that in the UK incidences of schizophrenia were 9 times higher amongst Afro-Caribbean’s and 6 times higher for those of black African descent than for white British people.
-          It is most likely that diagnostic biases of clinicians account for these findings.
-          Ethnic minorities are over represented in mental hospitals in Europe and America, women are also more likely to be diagnosed with depression than men.
-          Another consideration is confirmation bias. Therapists tend to presume that the client must have a disorder if they are turning up for treatment.
-          Since the therapists job is to diagnose abnormalities, they may overreact and see abnormality all the time which was shown by Rosenhan’s (1973) study.
-          Conceptions of abnormality differ between cultures which can have a significant impact on the validity of diagnosis of mental disorders.
-          Many disorders are universal, however some abnormalities are thought to be culturally specific. (called culture-bound syndromes).
-          For example, Shenjing Shuairuo which is found in the CCMD and is widespread in China. The symptoms are similar to mood disorders in the DSM.
-          Depression is common in western cultures but seems to be absent in Asian cultures which may be a result of different lifestyles or because Asians do not see the need to consult doctors to handle their own problems.
-          Culture blindness: problem of identifying symptoms of a psychological disorder, if they are not the norm in the clinicians own culture.
-          Cochrane and Sashidharan (1995) found that based on the assumption that behaviours of the white population is considered normal, any deviation by another ethnic group reveals some racial or cultural pathology.
-          Rack (1982) points out rthat a member of a minority group who exhibits a set of symptoms similar to that of a white British-born individual will be diagnosed as suffering from the same disorder.
-          This may not always be the case.
-          Example: the ethnic culture the individual is from may not consider hearing voices as abnormal during a time of mourning, however the DSM would diagnose this as psychotic.
 
Psychological Disorders & Treatment Review

Syllabus Point: Describe symptoms and prevalence of one disorder from two of the following groups
-          Anxiety disorders
-          Affective disorders
-          Eating disorders
Syllabus Point: Discuss cultural and gender variations in prevalence of disorders.
Syllabus Point: Analyse etiologies (in terms of biological, cognitive and/or sociocultural factors) of one disorder from two of the above groups.
^The 3 syllabus points above are answered together below

ANXIETY DISORDER – POST-TRAUMATIC STRESS DISORDER
-          PTSD lasts for more than 30 days. It develops in response to a stressor.
-          Characterized by intrusive memories of a traumatic event, emotional withdrawal, heightened autonomic arousal which may cause insomnia, hypervigilance, loss of control over anger and aggressive behaviour.
-          PTSD patients often experience decreased interest in others and a sense of separation.
-          May exhibit an inability to feel positive emotions – known as anhedonia.  
Symptoms

-          Anhedonia
-          emotional numbing
-          Hypervigilance
-          Passivity
-          Nightmares
-          Flashbacks
-          exaggerated startle response
-           intrusive memories
-          inability to concentrate
-          Hyperarousal
-          lower back pain, headaches
-          stomach ache
-          digestion problems
-          Insomnia
-          regression in children
-          losing acquired developmental skills

-          Is associated with impairment of the person’s ability to function in social or family life.

Prevalence
-          In US, prevalence rate of 1-3%, a lifetime prevalence of 5% in men and 10% in women.
-          Davidson et al. (2007) estimates that PTSD affects 15-24% of individuals who are exposed to traumatic events.
-          Not all individuals who are exposed to traumatic events develop PTSD.
-          In communities with frequent traumatic events, prevalence rate increases to 9%.
-          The type of trauma is a key factor: 3% = people who experience a personal attack, 20% = wounded veterans, 50% = rape victims, develop PTSD.
-          Most frequent trigger is the loss of a loved one, accounting for 1/3 of all cases.
-          PTSD symptoms are frequent and common amongst war veterans, regardless of their background.

Biological Level of Analysis
-          Twin studies show a possible genetic predisposition for PTSD (Hauff and Vaglum, 1994)
-          More research in the neurotransmitter, noradrenaline which is important in emotional arousal.
-          Increased levels of noradrenaline cause people to more openly express their emotions than normal.
-          Geracioti (2001) found that PTSD patients had higher levels of noradrenaline than average.
-          Stimulating the adrenal system in PTSD patients induced a panic attack in 70% of patients and flashbacks in 40% of patients.
-          Bremner (1998): increased sensitivity of noradrenaline receptors in patients with PTSD.

Cognitive Level of Analysis
-          May be differences in the way individuals cognitively process experiences and their attributional styles.
-          Cognitive therapists have found that PTSD patients feel that they lack control in their lives and that their world is unpredictable.
-          Patients often experience guilt regarding the trauma.
-          Experience intrusive memories: memories that come to a person’s consciousness at random.
-          Intrusive memories are usually triggered by sounds, sights or smells related to the traumatic event.
-          Brewin et al. (1996) argues that the flashbacks are a results of cue-dependent memory, where stimuli similar to the original traumatic event may trigger sensory and emotional aspects of the memory, causing panic.
-          Development of PTSD is related to the tendency to take personal responsibility for failures and to cope with stress by focusing on the emotion rather than the problem.
-          Sutker et al. (1995) found that Gulf war veterans who had a sense of purpose and commitment to the military had less chance of suffering from PTSD than other veterans.
-          Cognitive theorists have also found that children who are able to identify that the traumatic event was not their fault are able to overcome the symptoms of PTSD.
-          There is a cognitive explanation because it deals with attributional style and thoughts, linked to schemas.

Sociocultural Level of Analysis
-          Research suggests that experiences with racism and oppression are predisposing factors for PTSD.
-          Roysircar (2000) cites that among Vietnam war veterans, 20.6% of black and 27.6% of Hispanic veterans met the criteria for PTSD, while only 13% were white veterans.
-          Dyregrov argued that threat of death had the strongest influence on intrusive thoughts and avoidance of behaviour (avoiding situations that can trigger anxiety and panic).
-          Social learning may play a role in PTSD.
-          Studies by Silva (2000) indicate that children may develop PTSD by observing domestic violence.

Cultural
-          In many cultures it’s common for survivors to initiate treatment with someone due to somatic complains which, according to the DSM, are uncommon.
-          Kleinman (1987) argues that it’s irrational and ethnocentric to assume that non-western survivors form of PTSD is uncommon.
-          Many assume that the form of PTSD often seen in the West is the norm.
-          Often, non-western survivors exhibit was is called body memory symptoms which are akin to PTSD.
-          One example is dizziness experienced by a woman which was a body memory of her repeated experience with being forced to consume alcohol then being raped (Hanscom 2001).

Gender
-          Research has found significant gender difference in the prevalence of PTSD.
-          Breslau et al. (1991) did a longitudinal study of 1007 young adults who had been exposed to community violence.
-          Found a prevalence rate of 11.3% in women and 6% in men.
-          Horowitz (1995) reviewed a number of studies and found that women have a risk up to 5 times greater than males to develop PTSD after a violent or traumatic event.
-          Symptoms also differ between genders.
-          Men = irritability and impulsiveness, also likely to suffer from substance abuse disorder.
-          Women = numbing and avoidance, also likely to suffer from anxiety and effective disorders.
-          To explain the prevalence of PTSD amongst women: women are raped more often than men and rape has one of the highest risks of triggering PTSD.
-          According to Achenbach (1991), women are more likely to internalize their problems (causing depro mood and such) whereas men are more likely to externalize their problems (more agro, etc).


EATING DISORDER – BULIMIA
Symptoms

-          Feelings of inadequacy
-          Guilt/Shame
-          Recurrent episodes of binge eating
-          Use of vomiting, laxatives, exercise or dieting to control weight
-          Negative self-image
-          Poor body-image
-          Tendency to perceive events as more stressful than most people would
-          Perfectionism
-          Swollen salivary glands
-          Erosion of tooth enamel
-          Stomach or intestinal problems
-          Extreme cases = heart problems

Prevalence
-          According to the National Institute of Mental Health (NIMH), 2-3% of women and 0.02-0.03% of men in the US have been diagnosed with bulimia.
-          According to Frude (1998), the women to men ratio of bulimia sufferers is 10:1.
-          Most often eating disorder, affects around 2% of adults.
-          Onset of bulimia usually occurs in the late teens or early twenties.
-          There is an increase in bulimia incidents.
-          More common in industrialized countries and countries where being thin is desired in a culture.

Biological Level of Analysis
-          Krendler et al. (1991) studied 2000 female twins and found a concordance rate of 23% in MZ twins and 9% in DZ twins.
-          The rates vary from 23-83% which can be  attributed to differences in the method of collecting data and the definitions of the disorder.
-          Bulimia tends to be highly secretive and not many people report it.
-          Strober (2000) found that first-degree relatives of women with bulimia are 10 times more likely to develop the disorder than average.
-          Serotonin also has an impact.
-          Increased serotonin levels stimulate the medical hypothalamus and decrease food intake.
-          Carraso (2000) found lower levels of serotonin in patients with bulimia.

Cognitive Level of Analysis
-          According to the body-image distortion theory proposed by Bruch (1962), eating disorder patients suffer from the delusion that they are fat.
-          Research has confirmed that they overestimate their body size.
-          The distortion varies considerably with contextual factors, such as the nature of the questions directed at the patients.
-          Some of the reports given reflect the patient’s emotional appraisal rather than their perceptual experience.
-          Slade and Brodie (1994) suggest that those who suffer from eating disorder are uncertain of their body size and shape, and when asked to make a judgement, they report an overestimation of their body size.
-          Polivy and Herman have looked at the role of cognitive disinhibition – occurs because of dichotomous thinking whereby individuals take an all-or-nothing approach to judging themselves.
-          Bulimics have strict dieting rules and feel the urge to binge eat when they break these rules.
-          Thoughts about eating (cognitions) act to release all dietary restrictions (disinhibition).
-           Polivy and Herman (1985) conducted a study with dieters and non-dieters.
-          They were all asked to take part in a taste test and told that they could eat as much ice-cream as they desired.
-          Study found that the non-dieters consumed a greater amount of ice-cream than the dieters.
-          So, if 3/4 women diet at some point in their lives, but only 1 in 33 women suffer from bulimia, why isn’t there more bulimia?
-          The cognitive explanation that people with eating disorders suffer from perceptual distortions and maladaptive cognitive patterns does not explain how these distortions arise.
-          Hard to establish cause and effect – distorted eating patterns may result in distorted thinking, rather than vice versa.

Sociocultural Level of Analysis
-          The perfect body figure changes over time and varies amongst cultures.
-          Movie stars tend to establish standards for how a person should look, intentional or unintentionally.
-          Some cultures prefer a thinner body shape whereas others prefer a more rounded figure.
-          People constantly compare themselves to others which affects their self esteem.
-          The media advocates extremely uniform and rigid standards of beauty.
-          Standards of beauty have become increasingly difficult to attain, especially for women, with less than 5% of the female population able to attain it.
-          Many eating disorders begin with an individual who is not overweight believing that they need to go on a diet.
-          The desire to be thin is often heavily influenced by media images and messages.

Gender
-          Women are much more likely than men or children to be the target of media propaganda that promotes thinness.
-          Thinness, however, is also widespread in children’s magazines and toys.
-          Sanders and Bazalgette (1993) analysed the body shape of the 3 most popular dolls available to young girls, measuring theur height, hips, waist and bust.
-          They then transformed these measurements to apply to a woman of average height and found that, relative to real women, the dolls had tiny hips and exaggerated inside leg measurements.
-          Distorted ideas of what is normal and acceptable make young children dissatisfied with their own shape, even if it’s in a healthy range.
-          Studies show that by the age of 12, body shape can be a major criterion on self-evaluation and evaluation of others.
-          Men too are now under pressure.
-          In 1993, a MORI survey of adult males in the UK showed that 1/3 of males had been on a diet and almost 2/3 believed that a change in shape would make them more sexually attractive.
-          We’ll see if the growing emphasis on an ideal male shape will increase the number of men suffering from eating disorders.

Culture
-          Jaeger et al. (2002) conducted a study on cross-cultural differences in body dissatisfaction.
-          They aimed to investigate body dissatisfaction as it was a risk factor of bulimia.
-          It was suggested that eating disorders were mainly prevalent in Western societies.
-          Recent research, however, have been able to compare various cultures.
-          1751 medical and nursing students were sampled across 12 nations, including western and non-western cultures.
-          Was a natural experiment as culture (the IV) could not be controlled.
-          10 body silhouettes were shown to the participants in order to assess body dissatisfaction.
-          BMI was also measured.
-          There were significant differences between cultures.
-           Most extreme body dissatisfaction was found in Mediterranean countries, followed by Northern European countries. 
-          Developing countries showed intermediate dissatisfaction whilst non-western countries showed the lowest levels.
-          Body dissatisfaction was the most important influence on dieting in most countries and was found to be independent of self-esteem and BMI.
-          The significant differences across cultures support the explanation that bulimia is due to the “idealized” body images portrayed by the media, which encourages distorted views, leading to body dissatisfaction and dieting.
-          Western countries are more exposed to these and show higher body dissatisfaction than non-western countries.
-          The study, however, doesn’t consider biological factors, and cannot differentiate between nature vs. nurture.
-          The experiment was also natural rather than true so causation cannot be inferred as the independent variable wasn’t directly manipulated by the experimenter.
-          Lastly, all the participants were well-educated people and cannot be generalized to the wider population of their respective countries.

Syllabus Point: Examine biomedical, individual and group approaches to treatment.
Syllabus Point: Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder.
(Both answered below)

Treatments for Phobias

Biomedical
-          Biomedical therapy focuses on using medication to alleviate anxiety symptoms and biofeedback training to help the individual manage their own physiological arousal.
-          Biomedical approaches are generally not used on their own, but in conjunction with other treatment methods.
-          Benzodiazepines are most frequently used. In a study of the use of alprazolam to treat fear of flying, the alprazolam did reduce anxiety, but a week later the effect wore off and the people who had been administered the placebo were better off.
-          Criticism of benzodiazepines: patients develop tolerance rendering them ineffective and they can cause drowsiness, sexual dysfunction, and sometimes an increase in aggression and irritability.
-          They do not tackle the cause of the problem.
-          They maximize the effectiveness of GABA, a neurotransmitter involved in the parasympathetic nervous system that calms the person down, but fails to solve the problem of the initial reaction.
-          Therefore psychotherapy is usually favoured.

Individual Therapy
-          Behavioural Treatment is based on classical conditioning theory, which suggests that fear is a learn response to a stimuli and the association can be broken with various approaches in therapy.
-          Desensitization is very popular. An individual is slowly exposed to their fear gradually, over a period of time until the phobia is completely extinguished.
-          Choy et al (2007) suggests that desensitization is good at reducing anxiety but not at reducing avoidance behaviours.
-          When desensitization is beneficial, it usually lasts for a long time. It has no side-effects and corrects the problem, unlike drugs.
-          In vivo treatment is where the individual is directly exposed to their fear. Most effective for phobias such as fear of flying than fear of dogs.
-          Cognitive therapy is also used. They attempt to correct some of the faulty thinking that is assumed to be causing the problem.
-          Booth and Rachman (1993) found this type of therapy to be effective by itself and in conjunction with in vivo for claustrophobia.

Group Therapy
-          Ost (1998) tested the effectiveness of carrying out group therapy (8 people) to treat spider phobia.
-          1 group = direct contact, 1 group = watched a video of people touching spiders, 1 group = observed the people touching spiders
-          Found that anxiety levels were reduced more in the first group than the other 2 groups.
-          Ost concluded that its probably due to the first group undertaking the procedure and increasing their self-efficacy.
-          Group therapy is much cheaper and more efficient in terms of time than individual therapies.
-          It can be hard to predict, however, how long it will take for each individual to improve.
-          Lumpkin et al (2002) found that with the use of group therapy, all children showed signs of improvement who suffered from a mix of anxiety disorders, except for one child.
-          The problem = good for children who make progress, may make things worse for the child who does not improve.
  
Syllabus Point: Discuss the use of eclectic approaches in treatment.
-          An eclectic approach incorporates principles or techniques from various systems or theories.
-          An eclectic approach can be used in individual therapy by combining medication therapy or by choosing an appropriate psychotherapy from the range available.
-          Beutler (1991) advises that with an eclectic approach, therapists should start from non-confrontational questions then move onto behavioural therapy and then get another close family/support member involved.
-          Eclectic therapy recognizes the strengths and weaknesses of various therapies and crafts sessions to the needs of an individual or group.
-          Rush et al. (1977) suggests that there is a higher relapse rate when patients are treated with drugs alone, because patients who partake in the cognitive-behaviour therapy learn skills to cope with their problems, whereas patients on medication do not.
-          A combination os psychotherapy and drugs appears to be more successful than either psychotherapy or drugs alone (Klerman et al, 1994)

Syllabus Point: Discuss the relationship between etiology and therapeutic approach in relation to one disorder.
This is kinda everything above put together, just link it to a psychological disorder and explain why certain therapeutic treatments are used to treat the disorder.
I swear I’m not just too lazy to write stuff up.

(Clearly I had had quite enough of writing notes for IB psychology by this point ahaha)

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