1. Paper 2: Options
ABNORMAL PSYCHOLOGY

2. Matters rising!
HLs will answer two essays on paper 2, from two different options, i.e. abnormal, health, relationships, developmental
SLs answer one question from one option
For each option there will be a choice of three essay titles; you must choose one.
The IB have guaranteed that there will be one question on each of the three topics in each option, meaning you can seriously slimline the teaching and the revision as preferred
This is a risky strategy, however; if you opt for it is essential that you could write any essay that could come up on that topic.
Hence it is wise to be selective; and think carefully

3. Strategy for today
Teach Paper 2 content that crosses over with paper 1 content 

4. Before we go any further… Guidance column in Paper 2
Different to paper 1, so watch out!
In paper 2 the exam question may incorporate the standard text from column 3 with the topic headings;
bit like paper 1 methods/ethics questions but now also includes approaches (bio, cog and socio-cultural
When choosing topics to revise do not forget the possibility of column 3 style questions, especially if you are only revising single topics.

5. Oh and another thing…
The clarifications document alerts us to the IB’s rule about the use of AND in the guide:
“Any material connected by the word “and” may be worded on exam questions as “and/or".
For example, “thinking and decision-making” may appear in a question as “thinking and/or decision-making”.
You will no get a question on just ‘decision making’ or just ‘thinking’.
Three exceptions where the pairing can be separated all from the paper
gender identity and social roles (developmental psychology)
childhood trauma and resilience (developmental psychology)
dispositional factors and health beliefs (health psychology).

6. Abnormal There will be one question on each of the following topics
Factors influencing diagnosis
Etiology of abnormal psychology
Treatment of disorders

7. Factors influencing diagnosis – 30 miNutes
Normality versus abnormality
Classification systems (ICD and DSM)
The role of clinical biases in diagnosis
Validity and Reliability of diagnosis
Diagnosis and methods
Diagnosis and ethics
Bio, cog and/or sociocultural factors affecting diagnosis

8. Normality versus abnormality
What does being normal look like; what would consider to be the features of ‘good’ mental health?
Jahoda (1958): self-acceptance, potential for growth and development; autonomy; accurate perception of reality; environmental competence; and positive interpersonal relationships.
Rosenhan and Seligman (1989): Irrational, maladaptiveness, observer discomfort, suffering, unpredictability, violation of community standards, vividness and unconventionality!
What are the problems of distinguishing normal from abnormal?
The 4 Ds of diagnosis
Deviation from statistical and social norms
Distress
Dysfunction
Danger

9. Maybe the best TED talk you will ever watch ?
Some important studies you could include:
Rosenhan (1973) (an ancient but excellent video) participant observation
Bolton (2002) (a cracking study about mental health and survivors of the Rwandan genocide) uses interviews and has many of the hallmarks of excellent qualitative research taking an emic approach
Luhrmann (2012) : content/uploads/2012/02/bjp-hearing- voices.pdf uses semi-structured interviews

10. The role of clinical biases in diagnosis
Which topic does this cross over with from Paper 1?
Cognitive Approach: Reliability of cognitive processes (topic) – Biases in thinking and decision-making
One or more of the following should be studied: Confirmation bias
Let’s look at a study of conformation bias in psychiatric diagnosis 

11. Task
You need to collect a list of strength and limitations of the study as we go along
When we have read the study in full, you will be tasked with precising the study down to 190 words.
You will then create two chains of reasoning; one strength and one limitation, neatly linked back to the title of the essay.
Don’t worry I will give you the text of the SAQ to work with in order to create your precis.

12. Confirmation bias
tendency to search for, interpret, favour, and recall information that substantiates our pre- existing beliefs and can lead to poor decision-making
Explains why stereotypes perpetuated
Mathematician: Stereotype/schema?
unemotional
lacking in social skills
strange sense of humour
Selective remembering
rather quiet
didn’t laugh
Talked warmly about daughter
Good eye contact

13. Why do we use confirmation bias?
evolved to cope with intensity/sheer volume of sensory information
‘system one’ thinking is instinctively deploy to cope with cognitive overload (Stanowich and West 2000)
fast and occurs without conscious awareness
no control over this style of thinking
‘forced’ to ignore information that does not fit with prior knowledge
focus on a limited array of details which we use to confirm our pre-existing sense of reality
humans as ‘cognitive misers’ (Fiske and Taylor 1984)
avoid spending unnecessary time and effort; use heuristics or mental short cuts; goal is to survive!

14. Confirmation bias in medicine
Potential for damaging/devastating consequences
Misdiagnosis - incorrect treatment, complications, death.
Do doctors selectively attend to information that confirm preliminary diagnoses?
Think: type 1 and 2 errors
Example: diagnosed with migraine following headaches, doctor fails to pick up on signs of forgetfulness or co-ordination problems; patient has a brain tumour!
Leading questions in a diagnostic interview; make it more likely that doctor will receive further evidence to support original thoughts about diagnosis
e.g. do you have any visual disturbance before the headache comes on?

15. Mendel et al. (2011) - Aim
to show how confirmation bias affect the validity of psychiatric diagnoses.
Specifically interested in whether confirmation bias limited the search for new information once a preliminary diagnosis had been made
how this affected the final diagnosis
whether this negatively affected treatment recommendations.

16. Mendel - Sample Psychiatrists and medical students
75 psychiatrists (44 men, 31 women, average age 35, average 6 years professional experience) from two state and one university hospitals
75 fourth-year medical students (31 men, 43 women, average age 25) completing one-week internship at a psychiatric hospital.

17. Mendel - Procedure
All shown a vignette about a 65-year-old male patient with depressive symptoms who had been admitted to a psychiatric hospital due to an overdose.
Asked to make a preliminary diagnosis of either Alzheimer’s or severe depressive episode.
96% initially diagnosed depression.
Participants given option of receiving access to further information about the patient.

18. Further information
12 summary statements, six relating to Alzheimer’s and six to depression and asked to tick which ones they would like to read in full
Summaries included sentences such as ‘A hint of the presence of Alzheimer’s disease could be that the patient shows memory problems’, if the participants ticked this option they would then be given more detailed notes of around 150–175 words.

19. What happened next?
Detailed chunks of information were presented one at a time
participants were allowed as many pieces of further information as they wished before making their final diagnosis and suggesting treatment plan
Detailed information was strongly suggestive of Alzheimer’s not depression unlike the summary statements - deliberately more balanced.

20. What did mendel measure?
how many pieces of further information were requested
They also coded the participants’ information search as…
confirmatory (they asked for at least one more piece of information, linked to their initial diagnosis)
balanced (they asked for the same number of pieces of information linked to the two diagnoses)
disconfirmatory (they asked for at least one more piece of information linked to the alternative diagnosis).

21. Findings
Number of pieces of additional information requested did not differ significantly between the psychiatrists and the students (mean was 8/12 for both groups)
However, psychiatrists were significantly more likely to ask for disconfirmatory items than confirmatory items (p< 0.001)
students’ information search was more balanced, although this was not significant, p=0.23
13% of psychiatrists and 25% of students showed confirmation bias
participants conducting a confirmatory information search were significantly less likely to make the correct diagnosis compared to participants searching in a disconfirmatory or balanced way
70% of psychiatrists and 63% of student who used the confirmatory style ended up making a wrongful diagnosis
Number of items requested significantly predicted diagnostic accuracy
Pps selecting six or less items = poorer diagnostic accuracy compared to participants selecting more than six items
Pps who chose the wrong diagnosis prescribed different treatment options compared with Pps who chose the correct diagnosis.

22. Conclusions
confirmation bias clearly affects decision- making in the field of psychiatry
more common on inexperienced thinkers compared with experts.

23. Why does CB occur? Cognitive Dissonance
If people think that a certain outcome is the case e.g. the patient has depression, then being confronted with contradictory evidence (evident signs and symptoms of Alzheimer's) creates an cognitive dissonance
CD reduced without the challenge of changing one’s original position (I was wrong), by searching for additional supportive evidence whilst ignoring information to the contrary.

24. Time to get writing
10 mins: PET chain on Mendel as support for clinical biases in psychiatry
10 mins critical thinking about the study; balanced review of the usefulness of the study.
Peer marking with the rubric for Criteria C and D

25. Second bias/study Why not look at Di Li-Repac (1980)
The study looks at the way White Caucasian and Chinese-American practitioners differentially viewed both white and Chinese patients
This is a handy study to choose as it looks at the role of socio-cultural factors in making a diagnosis (whereas Mendel was looking at cognitive factors)
Could be useful in an approaches (column 3) style question
If you were in a methods question both these studies are quasi-experimental as Pps. are not randomly located to groups, therefore you need a study with another method, but it can come from any of the 4 content points for this topics, e.g. Bolton (cultural validity of DSM), Luhrrman (abnormality and normality).

26. Etiology of abnormal psychology
Explanations for disorder(s) (Bio, Cog Soc)
Prevalence rates and disorder(s)
The integration of different approaches to understanding behaviour
Biological
Cognitive
Sociocultural
Ethical considerations
Approaches to research (Methods)

27. Disorders
Choose a disorder which has clear cut bio, cog and socio-cultural explanations
Depression or anorexia are good choices
My depression booklet

28. Genes and behaviour
The guide says its okay to focus on one behaviour, e.g. depression;
Nature/nurture debate: To what extent does genetic inheritance contribute to individual differences in behaviour? How much is genetics and how is environmental experiences?
What is a gene? What is a chromosome? What is meant by genotype?
genetic material (DNA) inherited from parents; when psychologists argue behaviour may be inherited, what exactly do they mean?
What is inherited in the genes that give rise to the development of specific physiological processes that contribute to specific traits and behaviour?
We are not looking here at single genes but the way in which inheriting more or less a certain genes increases or decreases the probability of developing a certain disorder
genetic predispositions - genotype
Interaction of genes with environmental stimuli; genes “turned on/off” and behaviours are expressed - phenotype

30. Caspi et al (2003)
Create a sample of 10; how many roughly would have each possible allele pairing?
17% two short
51% one short and one long
32% two long

31. Fill in the gaps: Answers
Parents
Mother
17%
Eye colour
Father
Short
Insomnia
Alleles
Five
Mood
5HTT
15%
Genotype
Transporters 3%
Interaction
Serotonin
Three
Nucleus
pre-synaptic
Long
Chromosomes
too low
phenotype
DNA
Mutated
Genes
New Zealanders

32. Genetic similarity
A rather strangely worded area of the spec which makes it hard to generate meaningful questions
SAQ Explain how genetic similarities help psychologists in the study of genes and behaviour.
ERQ Discuss how genetic similarities help psychologists in the study of genes and behaviour.
Specialist terms: twin studies and kinship studies were added as words which could be used to create questions from 2020; many have complained to the IB as kinship studies is not a psychological term and I IB have said it will be removed
However, whether the term twin studies is used in a question or not it is important to understand them to answer questions in this area
We will briefly focus here on twin studies but make sure you have example of familial and adoption studies too.

33. Twin studies of Depression
PowerPoint on features of twin studies
Example: Kendler et al (2006) – see John’s website

34. Evolutionary explanations for behaviour
As we now know nothing has come up at all from the genetic and behaviour topic and therefore any of the three content areas are fair game.
I have always taught this section of the guide in the abnormal section in year 2 and taught an evolutionary explanation of depression.
Explanation: Price’s ‘Social Competition Hypothesis’
SAQ one research study: Raleigh and Maguire (1991)

35. Evolutionary Psychology
Common/universal behaviours/skills today had survival value (adaptive) for our evolutionary ancestors
Modern day humans, (homo sapiens) first lived 35,000-3 million years ago in Africa; The Environment of Evolutionary Adaptation, (EEA).  
terrain and climate were harsh
food was short
humans forced to live in hierarchically ordered social group to survive;
Inherited traits which increased survival and/or reproductive success were passed on to the next generation;
these traits became more common in the gene pool;
traits that were less beneficial become less common.

36. Social competition hypothesis: Price (1994)
todays modern environment very different to the EEA; previously adaptive behaviours now maladaptive, e.g. depressive symptoms
depressive symptoms evolved to help people respond to a loss of position/status, following a conflict
these submissive behaviours helped to maintain social harmony and avoid injury
a honest signal to the stronger opponent of defeat (as the behaviours were costly to the individual)
depressive symptoms function to limit further physical or social damage
allowed the defeated opponent to accept the loss and adjust to their subordinate role 
preserved stability within the social group, allowing the group to continue to function successfully, thus increasing each individual’s fitness.

37. Social competition hypothesis: Price (1994) cont’d…
Some innate behaviours known as fixed action patterns cut in automatically when triggered by specific environmental stimuli or ‘innate releasing mechanisms’
symptoms of depression can also be explained in this way; stimuli indicative of ‘loss’ trigger involuntary submissive behaviours
This reduces the individual’s level of aspiration and the probability of the individual continuing to engage in a futile battle.
Nowadays, loss situations such as redundancy or marital breakup may be the triggers which lead to maladaptive behaviours.

38. Raleigh et al (1984)
Aim: to explore the relationship between social status and serotonin in adult vervet monkeys living in captivity
Procedure:
33 adult males living in captivity for at least 5 months observed in their enclosures
Studied included 10 different social groups of males and females plus offspring
observation schedule; 6 behaviours, e.g. threaten, contact, display
high levels of inter-rater reliability between 0.86 and 0.94
Coded the monkeys in pairs as either dominant or submissive
monkey with the highest percentage of successful encounters (i.e. the other monkey retreated or showed submission) classed as dominant (alpha) male; all others, subordinate.

39. deprived of fruit for 48 hours and fasted overnight
blood sample taken and tested for serotonin (indirect measure of brain serotonin)
ketamine administered 15 minutes before taking blood tests to make them easier to handle
all samples taken between 6.30 and 8.00 am; at least five samples taken over the course of 90 days, at least 11 days apart.
Researches manipulated the social groups by removing dominant monkeys, thus allowing a previously subordinate monkeys to become dominant
Continued to measure blood serotonin levels to monitor any changes in monkeys who changed their social status

40. Findings
In four of the groups, a naturally arising change occurred in the dominance hierarchy
a previously subordinate monkey became dominant and the dominant monkey became subordinate
Serotonin levels increase by about 60% for those monkeys which became dominant and decrease by about 40% in monkeys which became submissive
suggesting depressive symptoms, caused by low levels of serotonin, may result from a loss of social position.
when researchers deliberately elicited changes in the dominance hierarchies, blood serotonin levels changed accordingly, i.e. increasing in the subordinates that became dominant and decreasing in dominants that became subordinate.

41. LINKing study to HUMANS
If you use of animals study in an SAQ you MUST make an explicit link to human behaviour
Raleigh et al suggest loss of social status can result from retirement or an extended personal crisis leading to reduced blood serotonin, and consequently depressive symptoms.

42. Neurochemical theories of depression
Schildkraut
Low
Dopamine
Amygdala
Hypothalamus
Hippocampus
Noradrenaline
Low
Catecholamine
Serotonin
Permissive
Tryptophan
monoamine-oxidase
Reuptake
Pre
Upregulation
Cortisol
hypothalamic-pituitary-adrenal axis.
Decision-making
Emotion

43. Extra studies - criteria D credit
Moreno: Read from booklet or search abstract online; let’s practice criteria D; two chains of reasoning, (2x95 approx.) this time within you reasoning try contrasting the study with Caspi; what does Moreno tell us that Caspi does not?
Strickland: Cortisol and serotonin
Risch et al. and Wilhelm: Confusion over Caspi!

44. Cognitive Explanation of depression
Schema theory – negative self schema; pessimistic view of future, blaming self (dispositional), globalising problems
Reconstructive memory – attention focused on negative aspects; remembering life through a negative lens
Thinking and decision-making – negative thinking biases, depressive attributional style

45. Socio-cultural Explanation of depression
As behaviour is tied to the group we being to, when groups are in conflict so is behaviour.
Acculturation
Veling – weakest cultural identity – most severely disordered (Veling XXXX) first and second generation immigrants in The Netherlands
Native Americans – The Standing Rock Pipeline
Lackey – Focus Group study: Depression and Mexican Males
Inductive Content Analysis
Mumford and Whitehouse study of Asian school girls in Bradford and in Lahore

46. Treatment of disorders
Watch the Andrew Solomon film
Biological treatment
Psychological treatment
The role of culture in treatment
Assessing the effectiveness of treatment(s)