Thinking hats:What are the key

assumptions of each approach?

What are the benefits of each approach?

What are the weaknesses of each approach?

This is basically what you did for your exit task, last lesson so we

will skip it.

What applications, in terms of therapy, could each approach

have?

Management role: walk round and chat to people (about

their Q!)

7 mins

Biological Therapies

Biological therapies generally include the administering of medication.

This is controversial.Why do you think that is?

Drugs are the most common form of biological therapy and are often the first thing administered to patients

The assumption is that there is an underlying biological cause for abnormal behaviour

This could be due to brain structure, genetics or hormones

What might the positive side of this be?Rapid treatment, quick and cheap to administer, can

put the patient in a better position to respond to therapy

What might be the negative?Medicalising emotions, ‘quick fix’, doesn’t tackle the

cause (masks the problem), don’t work for everyone, side effects.

Phenelzine

Actually a form of antidepressantMOAI – monoamine oxidase inhibitorBased on the theory that depression is caused by

a deficit of neurotransmitters called monoaminesPrevents the breakdown of monoamines

therefore increasing their availabilityHas quite a few side effects, generally used

when other medicines have not been effectiveThere is now a new generation of MOAIs with

fewer side effects

Leibowitz (1988): Treatment of Social Phobia with Phenelzine

Potential pitfalls?

Biological treatment Key study: Leibowitz (1988)

AimTo see if the drug phenelzine can help treat

patients with social phobia.To see if phenelzine is more effective than a

placebo and atenolol in treating social phobia.

Why use a placebo group?

Method

A controlled experiment where patients were allocated to one of three conditions, and treated over 8 weeks. They were assessed for social phobia on several tests such as:

The Hamilton Rating Scale for Anxiety

Leibowitz Social Phobia Scale. This had common manifestations of social phobia and patients rated 1-4 for the fear produced and 1-4 for the steps taken to avoid the phobic situation.

Participants

80 patients meeting DSM criteria for social phobia aged 18–50 years. They were medically healthy and had not received phenelzine for at least two weeks before the trial. Each was assessed to see that there were no other disorders. Each signed a consent form before the research.

Design

An independent design with patients being allocated randomly to one of four groups:

one group was treated with phenelzine one group was given a matching placeboa second treatment group was given atenololanother group was given a matching placebo.

Procedure

Patients were assessed at the beginning, and then given their drug or placebo, with gradual increases in dosage of phenelzine or atenolol in the treatment groups.

Each patient was then reassessed.Independent evaluators were used to carry

out clinical assessments in a double blind situation.

Findings

After eight weeks significant differences were noted for the phenelzine groups, with better scores on the tests for anxiety compared to the placebo groups.

There was no significant difference between the patients taking atenolol and those taking a placebo.

ConclusionsPhenelzine but not atenolol is effective in

treating social phobia after eight weeks of treatment.

Plenary

On your pass: Outline 2 advantages to drug therapy2 disadvantages

Extension: Suggest a solution

Activity:

Evaluate the Leibowitz study

Pair 1 Sample, generalisability, ethicsPair 2- reliability, methodology Pair 3 – usefulness, validityPair 4 – nature/nurture, reductionism/holism,

12 mins

Evaluation of Liebowitz

MethodControls – inc. placebo group and 2

comparison groupsControlled IV – could measure cause and

effectScale used – quantitative data – comparable Issues with this: could be misinterpreted, may

still be subjective i.e. what constitutes a ‘5’ on the scale? – validity and reliability

Design

Independent designNecessary in order to establish cause and

effect in this caseRandom allocation – no bias in sample,

everyone had an equal chance of being allocated to each group

SampleWide age range – generalisable across age

rangesMedically healthy and had not had phenelzine

for 2 weeks before – control of possible confounding variables

Data collection

Likert scale – 1 to 5 rating systemUsed a scale that is commonly used in

psychiatryUsed to different scales – one psychiatrists

report and the other self-report (validity)Independent evaluators, double blind – no

experimenter bias

ReliabilityStandardised procedure – easily replicableGood controls – clear IV (i.e. which group they

were placed in) so effect on DV could be measured

Validity

Independent evaluators – double-blind, did not know what the study was about so could not be responding to demand characteristics

Participants were going about their daily lives – it was longitudinal so presumably the results are ecologically valid

Two different types of scale LSPS (self-report, patients subejctive experience) plus assessed with Hamilton Rating Scale. If the results are in agreement, it suggests they are both measuring what they are supposed to measure.

Bias

Could be some bias in interpreting the rating scales, particularly initially

However, the patients were independently evaluated in a double-blind procedure and therefore they could not be subject to demand characteristics

The above were not the researchers so no experimenter bias

Ethics

Consent givenOne group given a placebo – is this ethical?

They may not receive the benefits of the treatment

Wider benefits for society if an effective treatment for social phobia is evidenced

Reductionist

it is, it assumes that social phobia can be treated with drugs alone and does not take into account the reasons behind the social phobiaHowever, patients who took phenelzine showed greater improvement, so in some ways this is actually a strength as it led to improved recovery.

Determinist

Determinist – it takes control out of the hands of the patient and places it with the psychiatrist and medical staff

Ethnocentric

Ethnocentric

N vs N Nature Vs Nurture – supports the role of biological factors in social anxiety. Doesn’t take into account the environmental triggers.

Homework

McGrath (1990)Successful Treatment of a Noise Phobia

Research the aims, procedure, findings and conclusions Evaluate and add notes to your booklet.

Extension: find additional research to support the study

For next the lesson.