OCR Psychology A Level Book 2 sample

Application Alternatives to the medical model Topic 3 Part (c) of the exam question may require you to apply one or more non-biological treatments to a disorder you specify, using your knowledge of psychology. On this spread we consider two non-biological treatments. For the exam you should also consider the extent to which these treatments would work and how their effectiveness could be researched. A meta-analysis of 33 studies that investigated different psychological treatments for phobias found that in vivo techniques are more successful than in vitro techniques that used pictures or involved the patient imagining the feared stimulus (Wolitzky-Taylor et al . 2008). Does SD work for phobias? Usefulness Kate Wolitzky-Taylor (2008) found that placebo treatments such as visual imagery, watching a relaxing film or receiving information about phobias actually have some effect on reduction of phobic symptoms. This suggests that it is not necessarily the actual treatment itself that is useful for reducing the phobia, rather it is the processes that help the patient to relax or to focus on the phobia itself that have some symptomatic benefits. Effectiveness Peter Lang and David Lazovik (1963) studied 24 people with snake phobias and compared them with a control group of people with similar phobias who did not undertake SD. They found that those who had undergone SD displayed less avoidance of snakes when presented with them and reported fewer phobic behaviours via self- reports. This improvement remained six months later, suggesting that SD is effective at reducing phobias several months after treatment. Practicalities Cost and ease of use are practical issues. SD is significantly cheaper and quicker than treatments such as psychoanalysis , which can go on for years. However, although the patient may appear to have reduced symptoms of the phobia, such treatments may not address the root cause of the phobia (as in the case of Little Hans described on page 41). Other forms of therapy, such as psychoanalysis (on the facing page) focus on the underlying cause. Another practical issue is that some phobic objects are too dangerous or impractical to have in a therapy room, such as wild animals or flying in an aeroplane. The solution is to practise SD in vitro (i.e. in a controlled environment), which means that the phobic object may be represented in photographs and/or imagined rather than being physically present. In vivo treatment (literally ‘in life’), on the other hand, involves the phobic object actually being presented in the room with the patient, for example a spider being in the room. Systematic desensitisation for phobias Systematic desensitisation (SD) was developed by Joseph Wolpe in 1958. SD is based on the principles of classical conditioning so it is a behaviourist therapy to help overcome phobias and other anxiety disorders. On page 35 we saw how phobias might be learned through classical conditioning. If phobias can be learned in this way, then they can be unlearned by forming a new association. In fact the new association is called counterconditioning because the patient is taught a new association that runs counter (i.e. opposite) to the original association. The patient is taught, through classical conditioning, to associate the phobic stimulus with a new response—relaxation instead of fear, meaning the patient is desensitised. You cannot be both anxious and relaxed at the same time so the anxiety response is replaced with a relaxed response. Wolpe referred to this as reciprocal inhibition . There are four main stages to SD: Functional analysis This involves a discussion between the therapist and patient to discover reasons for the phobia, how the patient reacts when faced with the phobia and which scenarios they are actually fearful of. Construction of an anxiety hierarchy The therapist and patient work together to develop a hierarchy of phobic situations, in order from the least to the most fearful situation. For example, they may rate ‘saying spider’ as ONE on a scale of fear reactions, but ‘holding a live spider’ as TEN on the scale. Relaxation training The therapist will teach the patient relaxation techniques. These techniques may include self- hypnosis , breathing exercises or progressive muscle relaxation. The therapist may teach several techniques and let the patient decide which they prefer using. Gradual exposure SD works by gradually introducing the person to the feared situation so it is not as overwhelming. The therapist and patient start with the least threatening thought. At each stage initially the patient would feel a fear reaction, then the therapist would teach them how to relax at the same time as facing that level of fear. When the patient is coping at one stage and reports no anxiety they can move on to the next stage. This process will be repeated over several sessions until the patient is able to experience the most frightening item on their hierarchy without anxiety. Treatment usually takes place over a number of sessions, depending on the severity of the phobia and the client’s ability to relax. Non-biological treatments We looked at biological treatments for mental illness on pages 32–33 and we will now look at non-biological treatments for two mental illnesses— phobias and depression . Non-biological treatments are based on the assumption that mental illness is caused by psychological rather than physiological factors. Non-biological treatment of one specific disorder Chapter 1: Issues in mental health 48