Abnormal – Key Studies

Being Sane In an Insane place, Rosenhan (1973)AimTo test the reliability of psychiatric diagnosesProcedure

- Rosenhan conducted a field experiment- 8 mentally and physically healthy people acted as

confederates- Confederates went to 12 different mental institutes

o Confederates were instructed to tell the clinicians the same ‘symptoms’ that would lead the clinicians to think that they were experiencing schizophrenia

That they were hearing unfamiliar noises and words

Findings- 7 of 8 were diagnosed with schizophrenia and admitted

to the institute- After hospitalization, the confederates told the doctors

and nurses that they were feeling fine and no longer experiencing symptoms

- None of the confederates were released immediatelyo It took an average of 19 days to be released

- When they were released the confederates were diagnosed with ‘schizophrenia in remission’

o Suggesting that the doctors still saw them as mentally abnormal

o Even though doctors were not able to recognize the people whether or not they were abnormal or normal

- Genuine patients in the institute were able to recognise this difference

ConclusionRosenhan’s study clearly demonstrates the reliability and validity of diagnosis in mental hospitals.Evaluation

- Ethical considerationso Informed consent

o Debriefingo Justified by the results of the study

- Old study, conducted 40 years agoo Are the results still applicable in today’s societyo Results lead to further exploration in abnormal

psychology- High ecological validity

o Conducted as a field experiment

Rosenhan 2 (1973)AimTo see if abnormal individuals can be classified normalProcedure

- He told the staff of the psychiatric hospital that pseudo-patients would try to gain admittance

- No real pseudo-patients were actually sentFindings

- 41 genuine patients were suspected as pseudo-patients by at least one member of the staff

- 19 patients were suspected by doctorsConclusionRosenhan demonstrated conclusive proof that diagnosis was unreliable and it lacks scientific evidence on which conclusive diagnosis can be made.Evaluation

- Ethical considerationso Some of the suspected patients may not be able to

receive the treatment they require- High ecological validity

o Conducted as a field experiment

US – UK Diagnostic Project, Cooper (1972)AimThe aim was to investigate reliability of diagnosis of depression and schizophreniaProcedureThe researchers asked American and British psychiatrists to diagnose patients by watching a number of videotaped clinical interviewsFindings

- British psychiatrists diagnosed patients in the interview to be clinically depressed twice as often

- American psychiatrists diagnosed the same patients to be suffering for schizophrenia twice as often

ConclusionThis indicates that the same cases did not result in similar diagnosis in the two countries. This points towards problems of reliability as well as cultural differences in interpretation of symptoms and thus in diagnosis.Evaluation

- Unreliable resultso Should be retested to make results more reliable

- Should be tested with other cultures/countries

5HTT Gene in Depression, Caspi et al. (2003)AimTo investigate the possible role of 5HTT gene in depression after experiences of stressful eventsProcedure

- The researchers compared participants with a normal 5HTT gene and a mutation of the 5HTT gene

o With shorter alleles- The longer allele of the gene is more common (57%)

Findings- Participants who carried a mutation of the 5HTT gene and

had experienced many stressful events were more likely to become depressed

ConclusionThe mutation of the 5HTT gene and stressful life experiences is correlated with a higher chance of the development of depression. However, being genetically predisposed to depression does not mean that a person will develop depression.Evaluation

- Being genetically predisposed does not mean predestination

o May not always follow the assumed genetic predisposition

- Knowing this information could result in personal distresso May have a negative impact on participants

E.g. Deciding not to have children- Cannot assume a cause and effect relationship

o It is not clear how environmental factors influence genes

More research must be conducted before we can come to a conclusion

Genetic Basis of Depression, Nurnberger & Gershon (1982)AimTo show the revelations of carrying genes linked to depressionProcedure

- Reviewed the results of 7 twin studiesFindings

- MZ twins had a concordance rate of 65%- DZ twins had a concordance rate of 14%- Monozygotic twins (MZ) had a consistently higher

concordance rate than dizygotic twins (DZ)ConclusionGenetic predisposition to depression will be a contributing factor to depression. The concordance rate is not 100%, which suggests that there are other factors affecting depression instead of only genes.Evaluation

- Methodology of the studies being reviewed may be flawed

- Researcher biaso Only selected 7 twin studies when there are moreo Selected studies that allow results appropriate to

their hypothesis

Vulnerability Model, Brown & Harris (1978)AimTo investigate to what extent social and cultural factors contribute to the onset of depression in womenProcedure

- 458 women in South London were surveyed on their daily life and depressive episodes

o Through semi-structured interviews- Important biographical details were later rated in severity

by independent researcherso Particular life events or difficulties

Findings- Working class women were 4x more likely to develop

depression than middle class women- Of the 90% of women who developed clinical depression,

8% experienced an adverse life event or serious difficulty- 30% of the women who did not suffer from depression

suffered from these difficulties/life events- Working class women were 4 times more likely to

develop depressiono Compared to middle class women with children

- There are 3 important factorso Protective factors

Protects against development of depression High level of intimacy with husband

o Vulnerability factors Socioeconomic status Lack of confiding relationship Unemployment

o Provoking factors Stressors resulting in grief and hopelessness

in vulnerable women with no supportConclusionShows that social factors in the form of life-stress could be linked to depression. According to Brown and Harris, low social status leads to increased exposure to vulnerability factors and provoking agents, whereas high social status was associated with increased exposure to protective factors and decreased

exposure to provoking agents. It also supports Beck’s theory of cognitive vulnerability factors.Evaluation

- Use of semi-structured interviewo Able to get an in-depth understanding of the

participant’s situationo Higher reliability

- New methodological insightso Applied in other research

- Unable to generalise to a general populationo Only females were used, gender biaso However, this relationship may also be applicable to

men- Based on self-reporting methods

o It is impossible to determine the extent of depression in each participant

o Results may not be accurate Reduces reliability Participants may want to present a positive

self-image- Correlational study

o We cannot assume a cause and effect relationship Other variables are not controlled Further study is required before we can make

a definite statement- Showed that social factors (not only personality factors)

were involved in the development of depression

Meta-analysis of Diagnosis, Mitchell et al. (2009)AimTo investigate the reliability of diagnosis of depressionProcedure

- Meta-analysis of validity of diagnosis of depression- Data came from 41 clinical trials (50,000 patients) that

used semi-structured interviews to assess depressionFindings

- GPs had 80% reliability in identifying healthy individuals- GPs had 50% reliability in the diagnosis of depression

ConclusionMany GPs had problems making correct diagnosis. Mitchel et al. argued that GPs should see the patient at least twice before making a diagnosis since the accuracy of diagnosis improved in studies that used several examinations over an extended period of time.Evaluation

- Able to generalise to a larger populationo Through the use of a meta-analysis

- May not be valido Publication bias, selected studies may not have

been published- Misinterpretation of data

o Different studies may not use the same definitions

Culture and Depression, Zhang et al. (1998)AimTo explore the cross-cultural differences in psychopathologyProcedure

- Conducted a survey in 12 regions of ChinaFindings

- Only 16 out of 19,223 people reported to have suffered from a mood disorder

- More people reported neurastheniaConclusionThis would suggest that the prevalence rate for depression in China is much lower than that in US. This would show that there are cross-cultural differences in prevalence rates of abnormal behaviour. This can be explained through the traditional Chinese explanation of disease as a disharmony of vital organs and imbalance of energy flow.Evaluation

- Self-reported resultso Participants may want to project a better self-image

Especially in a collectivist culture where they do not want to stand out

o Reduces reliability of the survey- Gender differences may have affected the results of the

survey rather than culture

5-HTT Gene, Duenwald (2008)Aim

Neurasthenia in China, Kleinman (1982)AimTo investigate if neurasthenia in China could be similar to depression in the DSM-IIIProcedure

- Researcher interviewed 100 patients diagnosed with neurasthenia

o Using structured interviews based on the DSM-III diagnostic criteria

Findings- 87% of the patients can be classified to be suffering from

depressiono 90% complained of headacheso 78% complained of insomniao 73% complained of dizzinesso 48% complained of various painso 9% complained of a depressed mood

ConclusionNeurasthenia could be a specific Chinese way of expressing depression in somatic ways as the majority of the patients only presented physical symptoms of depression. This shows concerns in cross-cultural diagnosis. Somatization (refers to the physical aspect) is a cultural mode of distress in China, compared to psychologization (refers to mood) in the West. Clinicians should be aware of these differences when diagnosing patients.Evaluation

- Difficult to compare this data to Western datao Patients do not make the same complaints

- Unable to generalise to a general populationo Small sample size

- Study should be replicated in different countrieso To make the results more reliable

Ethnic Bias in Diagnosis, Jenkins-Hall & Sacco (1991)AimTo show that there is a level of ethnicity bias in diagnosisProcedure

- Researchers presented videotapes of a person in therapy to European American male and female therapists

- The videotape had 4 conditions:o The patient can be male or female, black or white,

with depressed symptoms or withoutFindings

- (White) therapists were more likely to make false-positive diagnosis if the patient was black

- Therapists rated both non-depressed black and white patients very similarly

ConclusionIt is evident that cultural considerations in diagnosis play a big role since it is difficult to define and diagnose mental disorders. This is because each culture has a different set of norms and expectations. This study can also be linked to the social identity theory, as the therapists distinguished themselves from the other cultures through their diagnosis.Evaluation

- Study should be replicated in other countries/raceso To make the results more reliable

Genetic Influence of Depression, Sullivan et al. (2000)AimTo investigate the genetic influence of major depressionProcedure

- Meta-analysis of twin studieso Including 21,000 twins

Findings- MZ twins were twice as likely to develop major

depression if their co-twin had the disordero Compared to DZ twins

- Genetic influence on developing major depression was 31% to 42%

ConclusionThe researchers concluded that major depression is a familial disorder with a strong genetic component and is a complex disorder resulting from the interaction of genetic and environmental factors. Because the genetic influence is not 100%, there are other factors such as the sociocultural environment.Evaluation

- There are other factors affecting depressiono Continuous stress in the environment can play a

role- Unable to generalise to a general population

o Twins were usedo Are twins representative of the general population?

- Limitations of the studies used will apply- Not all studies will have the same definitions

o Leading to misinterpretation of datao Reducing reliability

- Large sample sizeo Increase reliability

Swedish Twin Study, Kendler et al. (2006)AimTo investigate risk factors and genetic inheritance in bulimia nervosaProcedure

- This was a longitudinal study- Participants were a sample of 2,163 female twins- Researchers conducted interviews with the twins

o To see if the other twin would develop bulimiao To also see if the concordance rates were higher in

MZ twins than DZ twinsFindings

- Overall concordance rate for bulimia in MZ twins was 23%

- Compared to the 9% concordance rate for DZ twins- Bulimia has a heritability of 55%

ConclusionGenetic vulnerability may predispose the bulimia but other factors trigger the disorder. It is important to investigate the environmental factors that can interact with the genetic predisposition.Evaluation

- Has a heritability of 55%o 45% due to other factors

- Natural experimento Researchers did not manipulate any variableso There was no control groupo We cannot produce a cause and effect relationship

- Unable to generalise to the general populationo Sample was all female twinso Are twins representative of the general population?

- Does not consider the environmental factorso The twins could have grown up in the same

dysfunctional environment

Anti-depressants versus Placebo, Neale et al. (2001)AimTo study the outcome of anti-depressants versus placebosProcedure

- Meta-analysis of studies on the outcome of anti-depressants versus placebos

- Analysis was based on 3 conditions:o Condition 1: Patients who started with anti-

depressants and then changed to placeboo Condition 2: Patients who only received placeboo Condition 3: Patients who only took anti-

depressantsFindings

- Patients who do not take anti-depressants have a 25% risk of relapse

- Condition 1 had a 42% or higher risk of relapseConclusionThe researchers concluded that anti-depressants might interfere with the brain’s natural self-regulation of hormones. Drugs affecting neurotransmitters may increase the chance of relapse. Taking drugs is a good short-term solution, however, when the patient stops taking the drug, the depression may return. This is because the brain’s natural self-regulation is disturbed.Evaluation

- Able to generalise to a larger populationo Through the use of a meta-analysis

- May not be valido Publication bias, selected studies may not have

been published- Misinterpretation of data

o Different studies may not use the same definitions

MBCT and Anti-depressive Medication, Kunyen et al. (2008)AimTo investigate the effectiveness of mindfulness based cognitive therapy (MBCT)Procedure

- This is a randomised controlled study- 123 participants with a history of 3 or more depressive

episodes were used- Participants were given anti-depressive medication- Participants were randomly allocated to 2 groups:

o Control: continued their medicationo Experimental: participated in MBCT course

Slowly reduced their medication- This experiment took place over a 15 month period

Findings- The control group had a relapse rate of 60%- Compared to the experimental group with a relapse rate

of 47%o These participants also reported a higher quality of

life In terms of enjoyment of daily living and

physical well-beingo Anti-depressive medication was significantly

reduced in the MBCT group 75% of the patients stopped taking the

medicationConclusionThe researchers concluded that mindfulness based cognitive therapy is a better long-term solution to treating depression as there is a lower relapse rate compared to using drugs.Evaluation

- MBCT may only work for long term treatmento Some patients may not have the timeo Drugs are more effective in the short term

- Unable to generaliseo Only focused on depression as an affective disorder

Meta-analysis of Clinical Trails, Kirsch et al. (2008)AimTo show the overall effect of selective serotonin reuptake inhibitorsProcedure

- Meta-analysis of all clinical trails of anti-depressants submitted to the FDA

o Analysed the trails of the 6 most used anti-depressants

Findings- The overall effects of new-generation anti-depressant

medication (SSRIs) was below the recommended criteria for clinical significant

o Placebo can be just as effective- The highest effect of SSRIs are seen in the most severe

cases of depressionConclusionThe researchers are still unsure whether this effect is due to a decrease in responsiveness to placebo or an increase in responsiveness to SSRI medications. The placebo effect is also seen with SSRI medication, which questions the actual effectiveness of these drugs.Evaluation

- Able to generalise to a larger populationo Through the use of a meta-analysis

- May not be valido Publication bias, selected studies may not have

been published- Misinterpretation of data- Inconsistent methodology used in the different studies

o Must be considered as a factor to treatment

Interpersonal Psychotherapy, Elkin et al. (1989)AimTo investigate the effectiveness of interpersonal psychotherapy in relieving major depressionProcedure

- Participants were 280 patients diagnosed with major depression

- They were randomly divided into 4 conditions:o Condition 1: anti-depressant drug and normal

clinical managemento Condition 2: placebo and normal clinical

managemento Condition 3: cognitive behavioural therapyo Condition 4: interpersonal psychotherapy

- Patients were assessed at different time intervalso Immediately, after 6 weeks and after 18 months

Findings- 50% of the therapy groups showed a reduction in

depressive symptoms- 50% of the participants in condition 1 showed less

depressive symptoms- Only 29% recovered in the placebo group

ConclusionBecause there is no difference in the effectiveness of CBT, IPT or anti-depressant treatment, psychotherapy can be used as an alternative to medication in some cases.Evaluation

- Does not consider the cause of depression in the patiento Cause may differ

- Low cross-cultural validityo Only used participants from one country

- Unable to generaliseo These results may only apply to depression as a

affective disordero May not apply to other disorders

Effectiveness of CBT and SSRI, Riggs et al. (2007)AimTo study the effectiveness of cognitive behavioural therapy in combination with either a placebo or an SSRIProcedure

- This study is a randomised double blind study- Participants were 126 adolescents from USA

o They were aged 13 to 19o Participants suffered from depression, substance

use disorder and conduct disordero Recruited from social services or juvenile justice

systems- The participants were divided into 2 groups:

o Group 1: CBT and placeboo Group 2: CBT and SSRI drug

- The treatment lasted for 4 months before analysis of the results took place

- Participants were asked to self-complete a reportFindings

- Data could not be gathered for several of the participantso Could not follow up on 6 participantso 2 withdrew from the experimento 12 could not complete the experiment due to

relocation- 67% of the patients in group 1 were rated as ‘very much

improved’- 76% of the patients in group 2 were rated as ‘very much

improved’ConclusionThe researchers concluded that treatment utilising placebo and CBT is effective, however, treatment using SSRI drugs and CBT is more effective.Evaluation

- Researcher biaso 1 researcher rated all the participantso Results are subjective to the researcher

- Flawed methodology

o Researcher did not use any form of scale/measurement to judge the patients

o Solely observational- Self-serving bias

o Reports were self-reportedo Participants may want to change their answer to

comply with the aims of the study

Meta-analysis of CBT Studies, Butler et al. (2006)AimTo investigate the effectiveness of CBTProcedure

- Used data from 16 meta-analysiso Conducted a meta-analysis on themo Data covered over 10,000 patients

Findings- Effective in treating:

o Major depression More than anti-depressives

o Generalised anxiety disordero Panic disorder

With or without agoraphobiao Social phobiao PTSDo Schizophrenia

When used in conjunction with antipsychotic drugs

ConclusionThey concluded that CBT was very effective in treating certain disorders, and can be even more effective when used with certain drugs.Evaluation

- To what extent is CBT effective?- Able to generalise to a larger population

o Through the use of a meta-analysis- May not be valid

o Publication bias, selected studies may not have been published

- Misinterpretation of data- Inconsistent methodology used in the different studies

o Must be considered as a factor to treatment

Dynamic Group Therapy, Toseland & Siporin (1986)AimTo investigate the effectiveness of (dynamic) group therapyProcedure

- Meta-analysis of 74 studies that compared group therapy to individual therapy

- 32 studies were ultimately reviewedo Fit their criteria for inclusion

Findings- 75% of studies show group therapy is equally as effective

as individual therapy- 25% of studies show group therapy is more effective than

individual therapy- No case was individual therapy more effective than group

therapyConclusionThis shows us that group therapy, as a method of treatment can be more effective than individual therapy. Group therapy was also more cost-effective (cheaper) in 31% of the studies.Evaluation

- Able to generalise to a larger populationo Through the use of a meta-analysis

- May not be valido Publication bias, selected studies may not have

been published- Misinterpretation of data- Inconsistent methodology used in the different studies

o Must be considered as a factor to treatment

Childhood Trauma and Schizophrenia, Read et al. (2005)AimTo review the research addressing the relationship of childhood trauma and schizophreniaProcedure

- Studies were identified by computer searches- These studies were later reviewed

Findings- Symptoms related to schizophrenia are strongly related

to child abuse and neglectConclusionThere are several psychological and biological mechanisms that occur during childhood trauma. These mechanisms contribute to the increased the risk of schizophrenia.Evaluation

- Small number of studies- May not be valid

o Publication bias, selected studies may not have been published

- Misinterpretation of data- Inconsistent methodology used in the different studies

o Must be considered as a factor to treatment- Cannot assume cause and effect relationship

o Studies in child abuse and abnormal behaviour is still very weak