1. Paper 2 revision session 4 Treating psychopathological disorders (OCD, depression, phobias)

2. Take an A3 piece of paper and draw this on it…
Treating
psychopathological disorders.

3. Rate yourself
On a scale of 1-10 how well do you think you can explain…
behavioural approach to treating phobias
The cognitive approach to treating depression
The biological approach to treating OCD

4. Phobias

5. The Behavioural Approach
Phobias are learnt through our environment!
All behaviour is learned whether it is normal or abnormal. Some behaviours that are learned can be adaptive and help people lead a happy life, some can be maladaptive and therefore undesirable. The emphasis of the behavioural approach is that phobias are caused through the environment, through the process of classical conditioning; operant conditioning and social learning theory. This approach ignores the role of biology or any internal thoughts or feelings.
Phobias develop / remain in 3 ways:
Classical conditioning – behaviour is learnt through association
Operant conditioning – behaviour is learnt through reinforcement
Social learning theory – learning through observation

6. How can we treat phobias?
The behavioural approach to treating phobias: systematic desensitisation, including relaxation and use of hierarchy; flooding.
The specification identifies two behavioural methods used in the treatment of phobias:
systematic desensitisation
flooding

7. Behavioural Treatments
In his two-process model of phobia acquisition, Mowrer suggests that phobias are acquired as a result of classical conditioning and maintained by operant conditioning.
Behavioural treatment therefore aims to:
reduce phobic anxiety through the principle of classical conditioning whereby a new response to the phobic stimulus is paired with relaxation instead of anxiety - counterconditioning
reduce phobic anxiety through the principle of operant conditioning whereby there is no option for avoidance behaviour

8. Systematic Desensitisation (SD)
There are three processes involved in SD
The anxiety hierarchy is constructed by the patient and the therapist. This is a stepped approach to getting the person to face the object or situation of their phobia from least to most frightening
The patient is trained in relaxation techniques, so that they an relax quickly and as deeply as possible
The patient is then exposed to the phobic stimulus whilst practising the relaxation techniques as feelings of tension and anxiety arise. When this has been achieved the patient continues this process by moving up their hierarchy.

9. Example of an anxiety hierarchy
Step 1: Learn relaxation techniques
Step 2: Create a hierarchy of what you fear
Step 3: Engage each level of the hierarchy while using relaxation techniques
Behaviour
Think about a spider
Look at a photo of a spider
Look at a real spider in a closed box
Hold the box with the spider
Let a spider crawl on a table in front of you
Let a spider crawl on your shoe
Let a spider crawl up your leg
Let a spider crawl on your sleeve
Let a spider crawl on your bare arm

10. Evaluation It is effective
These techniques have proven most effective with specific phobias when a particular phobic object/situation can be identified- less effective with agoraphobic and social phobias.
It is suitable for a diverse range of patients
As this is a simple process that the patient controls, it is often the most suitable form of treatment
It is acceptable to patients
When given the choice between SD and flooding, more often patients choose SD as it does not cause the same degree of trauma and actually involves a pleasant aspect (the relaxation techniques)

11. Flooding
This involves overwhelming the individual’s senses with the item or situation that causes anxiety so that the person realises that no harm will occur.
No relaxation techniques or step by step build up.
Individual is exposed repeatedly and in an intensive way with their phobia.
Individual has their senses flooded with thoughts, images and actual experiences of the object of their phobia.

12. How does flooding work? Flooding stops phobic responses very quickly
Without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless – this process is called extinction
A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten)
The result is that the conditioned stimulus no longer produces the conditioned response (fear)

13. Evaluation It is cost-effective
The quick effect that flooding can have means that patients are free of their symptoms as soon as possible and this makes the treatment cheaper than alternatives
It is less effective for some types of phobia
Flooding is less effective for treating more complex phobias like social phobias. This may be because social phobias have cognitive aspects – an individual does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation
The treatment is traumatic for patients
Flooding produces high levels of fear and this can be very traumatic and as a result many patients refuse to start or complete treatment

14. Exam Questions
Outline one behavioural method for treating phobias. (4 marks)
Evaluate flooding as a way to treat phobias. (4 marks)
Explain one limitation of using systematic desensitisation to treat phobias (4 marks)
John has had a phobia of dogs since he was bitten by one in the park, leaving him with severe injuries. As a young adult, John has now decided to tackle his fear of dogs. Having researched alternative treatments, he has opted for systematic desensitisation. Explain how you might put together an anxiety hierarchy to treat John's phobia of dogs. (4 marks)

15. Treating depression
The cognitive approach to treating depression: cognitive behavioural therapy including challenging irrational thoughts

16. CBT…
This is a method for treating mental disorders based on both behavioural and cognitive techniques
The therapist aims to make the client aware of the relationship between thought, emotion and actions
CBT can help people to change how they think (‘cognitive') and what they do (‘behaviour'). These changes can help them to feel better.

17. What is CBT? It is a way of talking (psychotherapy) about:
how you think about yourself, the world and other people
how what you do affects your thoughts and feelings.
From the cognitive point of view therapy aims to deal with the thinking, such as challenging negative thoughts
The therapy also includes behavioural techniques such as behavioural activation (encouraging patients to engage in those activities they are avoiding)

18. What is CBT?
CBT can help to break the vicious circle of maladaptive thinking, feelings and behaviour.
It focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of distress or symptoms in the past, it looks for ways to improve the state of mind now.
When the parts of the sequence are clearly outlined and understood, they can be changed.
CBT aims to get the person to a point where they can ‘DIY', and work out their own ways of tackling their problems.

19. Each session will last between 30 and 60 minutes.
What does CBT involve?
The Sessions
Meet with a therapist for between 5 and 20, weekly, or fortnightly sessions.
Each session will last between 30 and 60 minutes.
Some CBT therapists work with the techniques influenced by Beck and some work with the techniques influenced by Ellis. Most draw on both
Handout with process
Then worksheet

20. Beck vs Ellis CBT… Ellis Beck
Beck developed a therapy to challenge the negative triad (beliefs) of the client.
First, the client will be assessed to discover the severity of their condition.
The therapist will establish a baseline (or starting point), prior to treatment, to help monitor improvement.
The therapist would use a process of reality testing e.g. if the client says, ‘I’m useless, and I always fail’, they will be asked whether in reality, they have been successful at something.
The therapist might ask the client to do something to demonstrate their ability to succeed.
3. Clients beliefs are directly challenged
Ellis’ Rational Emotive Behaviour Therapy
REBT extends the ABC model to an ABCDE model
D = Dispute (challenge the thoughts)
E = Effect (see a more beneficial effect on thought and behaviour)
Therefore the central technique of REBT is to identify and dispute the patient’s irrational thoughts
REBT is based on the premise that whenever we become upset, it is not the events taking place in our lives that upset us; it is the beliefs that we hold that cause us to become depressed, anxious, enraged, etc.

21. CBT Evaluation…
CBT may not work for the most severe cases
In some cases depression may be so severe that patients cannot motivate themselves to engage in the therapy
CBT is effective…
CBT is effective in reducing symptoms of depression and in preventing relapse and there is a large body of evidence to support this (March et al, 2007)
It is the most effective psychological treatment for moderate depression
Success may be due to the therapist-patient relationship
Research has shown that there is little difference between CBT and other forms of psychotherapy
It may be the quality of the therapist-patient relationship that makes the difference to the success of the treatment rather than the treatment itself

24. Treating OCD
The biological approach to explaining treating OCD: drug therapy

25. Drug therapy
The most commonly used biological therapy for anxiety disorders is drug therapy.
This therapy assumes that there is a chemical imbalance in the brain
This can be corrected by drugs, which either increase or decrease the levels of neurotransmitters in the brain.

26. SSRI (Selective Serotonin Reuptake Inhibitors)
The standard medical treatment used to tackle the symptoms of OCD are SSRIs
SSRIs work on increasing certain neurotransmitter in the brain by preventing the re-absorption of serotonin.
By preventing the re-absorption of serotonin, SSRIs effectively increase its levels in the synapse and thus continue to stimulate the post-synaptic neuron

27. Combining SSRIs with other treatment
Drugs are often used alongside cognitive-behavioural therapy (CBT)
The drugs reduce the sufferer’s emotional symptoms, such as anxiety or depression
This means that the patient can then engage more effectively with CBT
Some sufferers may respond best to CBT alone without the need for medication

28. Alternatives to SSRIs
Where an SSRI is not effective after three to four months the dose can be increased or it can be combined with other drugs
Patients respond differently to different drugs and sometimes alternatives work well for some people and not at all for others
tricyclics
SNRIs

29. Evaluations Drug therapy is effective at tackling OCD symptoms
There is clear research to suggest that SSRIs are effective in reducing the severity of OCD symptoms (Soomro: 2009)
Drugs are cost-effective and non-disruptive
Drug treatments are cheap in comparison to psychological treatments and, unlike psychotherapy, they are non-disruptive to patients’ lives
Drugs can have side-effects
Although the use of drugs is effective for most, a significant minority receive no benefit and/or may suffer side-effects: weight gain, dry mouth, sexual dysfunction and loss of memory. Coming off a drug is a slow process in which the dosage has to be gradually reduced over a period of six months – risk of relapse.