IB Psych Exam (Paper 2 + 3)

Stunkard et al

Aim: To investigate the role of genetics in obesity. Method: They performed a twin study based on 93 pairs of identical twins reared apart. The researchers compared the twins' BMI and found that genetic factors accounted for 66-70% of the variance in their body weight. Findings: They indicate a strong genetic component in development component in the development of obesity but it's not really clear how genes operate here. A theory is that metabolism rates could be genetically determined but the evidence is still inconclusive. Strengths: Ecologically valid Limit: Hard to tell how genes operate here.

Neuling and Winefield

Aim: To investigate the role of social support in a group of female cancer patients. Method: The researchers performed a longitudinal study with 58 women recovering from surgery for breast cancer. Each woman was interviewed three times within three months. Participants also rated the frequency of social support (emotional, informational, practical) from family, friends, and doctors. Results: It showed that the patients needed a large amount of emotional support from family and that this was also the most frequent kind of support they received. The patients also expressed a wish for more informational support from doctors. Strength: Ecologically valid Limit: Since the data were descriptive, it's not possible to conclude that social support was a more effective strategy than others.

Mair et al

Aim: To see how local communities can use zoning laws to create a retail market offering healthier foods. Method: Currently, fast-food outlets are found in abundance in many predominantly poor areas and this has an impact on wider community health. Findings: Mair et al states that wealthier neighbourhoods have more than three times as man supermarkets as the poorest neighbourhoods. Supermarkets have been linked with healthier diets as a greater range of food is available.However, the residents of poor neighbourhoods have less access to private transport thereby limiting their chances of visiting places with healtheir food available.

Gender Variations in Prevalence of PTSD

Gender. Kessler et al, 2005 found that the lifetime prevalence of PTSD among men was 3.6% and among women was 9.7%. The most commonly-cited reason is that women are more likely than men to experience sexual assault of one kind or another, and this is a likely cause of PTSD. However, PTSD after combat trauma is more common in men, so this is an area that would bear further investigation.

PTSD Prevalence

In spite of what appears to be common neurological processes in the initial response to a traumatic event, cultural variables exercise a major influence on perceived causes, symptoms and responses of society to PTSD. Therefore, determining global prevalence is difficult. Kessler et al, 2005 undertook research in the USA that suggested a lifetime prevalence of PTSD of 6.8%, affecting about 7 million adults.

Inferential generalization

It means that the findings of the study can be applied to settings outside the setting of the study i. This is also called "transferability" or "external validity" Theoretical generalization, which means that theoretical concepts derived from the study can be used to develop further theory

Biomedical Approaches to Treatment

It's based on the assumption that if a mental problem is caused by biological malfunctioning, the cure is to restore the biological system with drugs.

Sociocultual factors related to obesity (Secondhand obesity)

It's the notion that children learn to be obese.

Education

Many people remain ignorant about the food industry in terms of how food is produced and where it comes from. In 2002, the Royal Highland Education Trust (RHET) in Scotland interviewed 126 children aged 8 and 9. They found 30% didn't know where eggs came from and over 50% thought oranges were grown in Scotland. The study was used to justify increased rural education for inner-city children, funding for farm visits, and general food education.

Definition of Obesity

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health.

Dependability

The traditional quantitative view of reliability is based on the assumption of replicability or repeatability. Essentially it is concerned with whether we would obtain the same results if we could observe the same thing twice. But we can't actually measure the same thing twice -- by definition if we are measuring twice, we are measuring two different things. The idea of dependability, on the other hand, emphasizes the need for the researcher to account for the ever-changing context within which research occurs. The research is responsible for describing the changes that occur in the setting and how these changes affected the way the research approached the study.

Cognitive Etiology of PTSD

Themes of threat run through the global negative beliefs found to be associated with the onset and persistence of PTSD. This can be related to the cognitive model of depression and cognitive vulnerability discussed earlier. Dunmore et al (2001) investigated the role of cognitive processing in the development of PTSD after an assault. They found that cognitive factors such as the way the victim processed the assault both during and after the event were significantly correlated with the severity and longevity of PTSD.

Ethical Considerations

There is a large overlap between cultural and ethical considerations in diagnosis. Those not diagnosed, misdiagnosed or mistreated because of their culture are already being treated unethically. Central issues in the ethics of diagnosis are stigmatisation, self-fulfilling prophecy and confirmation bias.

Paykel et al

They conducted a controlled trial of 158 patients who had experienced one episode of major depression. The patients received antidepressant medication but some of them also received cognitive therapy. The CBT group has a relapse rate of 29% compared to those who only had medication.

Neal et al

They conducted a meta-analysis of published studies on the outcome of anti-depressants versus placebo. The study focused on (1) patients who started with anti-depressants and then changed to placebo, (2) patients who only received a placebo and (3) patients who only took anti-depressants. They found that patients who didn't take anti-depressants have a 25% rise of relapse, compared to 42% or higher for those who have been on medication and then stopped it.

Elements of Abnormality: James Butcher, Susan Mineka, and Jill Hooley (2007)

They created a list of concepts called elements of abnormality ○ Each element alone mightn't make a person abnormal ○ The risk of abnormality increases with each addition of an element: 1. Suffering 2. Maladaptiveness 3. Deviancy 4. Violation of the standards of society 5. Social discomfort 6. Irrationality and unpredictability

Cultural Variations in the prevalence of Depression (Weisman et al)

They found cross-cultural variation in data from 10 countries. The study found that the lifetime prevalence of depression ranged from 19.0% (Beirut in Lebanon) to 1.5% (Taiwan). Korea had rates of depression twice has high as those in Taiwan (2.9%) although they are both Asian countries. Paris had a rate of (16.4%) close to that of Beirut although Beirut had experienced war for 15 years. Women had a higher rate than men in all countries. The researchers argue that different risk factors, social stigma, cultural reluctance to endorse mental symptoms as well as methodological limitations of the study may account for some of the differences.

SSRI's

They interfere with serotonin levels and affect mood and emotional responses positively in most people.

Beiner et al

They studied a sample of nearly 800 Australian ex-smokers who had quit within the previous two years to find out what these ex-smokers perceived as the greatest help for them quitting. - 30.5% said anti-tobacco advertisements - 21% said conventional cessation aids and nicotine replacement therapy - 11% said professional help or advice - 8% said self-help materials - 7% said prescribed medications - Young ex-smokers found that the most effective anti-smoking advertisements were those that evoked strong negative emotion such as fear and sadness and conveyed a thought-provoking and believable message about the serious long-term consequences of smoking. The results indicate that media campaigns with anti-tobacco advertisements can be effective.

Emotion-focused coping

This is an attempt to manage the emotional aspects of stress.

Problem-Focused coping

This is an attempt to remove or correct a problematic situation.

Social support

This is related to emotion-focused coping. It can act as a buffer against the physiological and psychological effects of stress but can also protect against potential stress on a daily basis without apparent stressors. Social support can be defined as the experience of being part of a social network with access to mutual assistance and obligations. Strength: Seeking social support may be particularly common among women in times of stress. Limit: In some cultures, it may not be the norm to seek and use advice and emotional support.

Transferability

Transferability refers to the degree to which the results of qualitative research can be generalized or transferred to other contexts or settings. From a qualitative perspective transferability is primarily the responsibility of the one doing the generalizing. The qualitative researcher can enhance transferability by doing a thorough job of describing the research context and the assumptions that were central to the research. The person who wishes to "transfer" the results to a different context is then responsible for making the judgment of how sensible the transfer is.

Mitchel et al. (2009)

○ The study used data from 41 clinical trials (w/ 50,000 patients) that had used semi-structured interviews to assess depression ○ The general practitioners (GPs) had 80% reliability in identifying healthy individuals and 50% reliability in diagnosis of depression. Many GPs had problems making a correct diagnosis for depression. ○ Generally GPs were more likely to identify false positive signs of depression after the first consultation. Mitchel et al. argued that GPs should see patients at least twice before making a diagnosis since accuracy of diagnosis was improved in studies that used several examinations over an extended period. ○ Evaluation of the study: (1) The strengths of meta-analysis are that it can combine data from many studies and it is possible to generalise to a larger population; (2) Limitations of meta-analysis are that it may suffer from the problem of publication bias; since data from many different studies are used there may also be problems of interpretation of the data because it isn't certain that each study uses exactly the same definitions.

Sociocultural factors of substance abuse

For social learning theory (SLT), it says that smoking is learned through modelling.

Periera

- 60 TR-MDD (treatment-resistant major depressive disorder, very low remission rates) were randomised into 1 of 3 groups: Facebook w/ psychiatrist as "friend", Facebook w/out psychiatrist as "friend", and control group w/ no Facebook (being males or females aged 18-70 years) - Both Facebook groups spent at least 1 hr/day on Facebook, 7 days a week during the 3 months ○ All patients maintained their usual pharmacotherapy - All participants evaluated at baseline and at 1, 2, and 3 months for depressive symptoms using HAD17 and BDI-II - Results showed that both Facebook groups had a decrease on their HADM17 and BDI-II scores and higher remission and response rates than control group, w/ better results if psychiatrist was a "friend" on Facebook Strengths: 1. Informed consent with participants to be in the 3 different groups 2. Confidentiality within the people Limits: 1. Small sample group, can't be generalised much Unsure if people actually spent at least an hour on Facebook everyday

Fernando (1991) Diagnosis is a social process and it's not objective

- Clinical assessment, classification and diagnosis can never be totally objective according to Fernando since there are value judgements involved. The diagnostic process in psychiatry isn't the same as making a medical diagnosis. There may also be problems in understanding symptoms from individuals in different cultures.

Diagnostic Manuals

- DSM-IV, now in its 4th revised version, is developed by the American Psychiatric Association. The manual lists what it terms "mental disorders". For each of the 300 disorders there's a list of symptoms that the clinician could look for in order to diagnose correctly. A new 5th version is on its way. The diagnostic manual doesn't identify causes of psychological disorders (etiology) but merely describes symptoms. ICD-10 (The International Classification of Diseases) is published by WHO. The manual uses the term "mental disorder". The diagnostic manual includes reference to causes of the disorders (etiology).

Diagnosis

- Diagnosis within abnormal psychology means identifying and classifying abnormal behaviour on the basis of symptoms, the patients' self-reports, observations, clinical tests or other factors such as information from relatives - Clinicians use psychological assessment and diagnostic manuals to make diagnosis. The diagnostic manuals help to classify and standardise diagnosis. - Diagnosis involves matching the results of the psychological assessment with classification systems such as DSM-IV-TR and ICD-10. the purpose of diagnosis is to find a treatment for the patient and to make a prognosis.

Jahoda's positive mental health

- Marie Jahoda (1958) took a different approach where she tried to define what's normal, not abnormality - Jahoda identified six components of ideal mental based on a review of literature: ○ Positive attitude toward own self ○ Growth, development, and self-actualization ○ Integration ○ Autonomy ○ Accurate perception of reality ○ Environmental mastery - Her approach suggests that the state of ideal mental health is achieved when a person has a realistic and positive acceptance of who they are, and is able to resist stress (so they maintain a lack of symptoms of psychological disorders) while they act voluntarily in the interests of their own growth in physical and social environments they inhabit - It appears that the more intensely one analysis it, the fewer people we might be able to say are in such a state of ideal mental health (though it's an attractive approach)

Reliability of Diagnosis

- Reliability in diagnosis means that clinicians should be able to reach the same correct diagnosis consistently if they use the same diagnostic procedure (e.g. standardised clinical interview, observation of the patient's symptoms, neuropsychological examination with scanners and diagnostic manuals). This is called inter-judge reliability. - Reliability can be improved if clinicians use standardised clinical interview schedules, which define and specify sets of symptoms to look for. The individual psychiatrist must still make a subjective interpretation of the severity of the patient's symptoms. - The introduction of diagnostic manuals has increased reliability of diagnosis over the year even though the manuals aren't without flaws - Reliability of diagnosis is a necessary prerequisite for validity. Rosenhahn (1973) performed a classic study that challenged reliability and validity of psychiatric diagnosis and showed the consequences of being labelled as "insane". In this study 8 pseudo-patients were diagnosed as suffering from severe psychological disorders but they were in reality imposers

Cooper et al (1972)

- The aim of the study was to investigate reliability of diagnosis of depression and schizophrenia - The researchers asked American and British psychiatrists to diagnose patients by watching a number of videotaped clinical interviews - The British psychiatrists diagnosed the patients in the interview to be clinically depressed twice as often. The American psychiatrists diagnosed the same patients to be suffering from schizophrenia twice as often. - The results indicated that the same cases didn't 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.

Validity of Diagnosis

- Validity of diagnosis refers to receiving the correct diagnosis. This should result in the correct treatment and a prognosis (predictive validity). Validity presupposes reliability of diagnosis. - It's much more difficult to provide a correct diagnosis and give a prognosis for a psychological disorder than for a physical disorder because it's not possible to observe objective signs of the disorder in the same way. - The DSM-IV manual doesn't include etiology but only symptoms. Sometimes patients have symptoms that relate to different psychological disorders so it can be difficult to make a valid diagnosis.

Quist-Paulsen and Gallefors

AIm: The researchers wanted to see if a longer intervention including fear arousal could promote smoking cessation. Method: The participants (heart patients) were randomly allocated to a treatment group and a control group. All patients were offered group counselling sessions. Patients in the control group only received group counselling. Patients in the treatment group also got personal advice from trained nurses and information material stressing the risks of continued smoking (fear arousal) and advantages of cessation. They were advised to stop smoking and nicotine replacement was offered to those with cravings. Nurses contacted the patients in the treatment group by telephone 9 times after they came home to encourage cessation and stressed the negative aspects of smoking on their condition. Findings: In the intervention group 57% of participants and in the control group 37% had stopped smoking at the end of the programme. Strengths: Results indicate that cures to action and perceived threat can predict behavioural change. Limits: Using fear arousal is controversial but the researchers argue that it was justified since many more stopped smoking in the treatment group.

Yehuda

Aim To collect empirical data to investigate the impact of the Holocaust on the second generation. To systematically document trauma exposure and psychiatric disorder in these individuals. Method The researchers examined the prevalence of stress and exposure to trauma, current and lifetime post-traumatic stress disorder (PTSD), and other psychiatric diagnoses in 100 adult offspring of Holocaust survivors and a demographically similar comparison group (N=44). Results Although adult offspring of Holocaust survivors did not experience more traumatic events, they had a greater prevalence of current and lifetime PTSD and other psychiatric diagnoses than the demographically similar comparison subjects. This was true in both community and clinical subjects. Conclusion The findings demonstrate an increased vulnerability to PTSD and other psychiatric disorders among offspring of Holocaust survivors, thus identifying adult offspring as a possible high-risk group within which to explore the individual differences that constitute risk factors for PTSD.

Kessler et al

Aim To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Method Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older answered questions on lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Results Lifetime prevalence estimate for anxiety disorders was 28.8%, with an estimate of 6.8% for PTSD. Prevalence was elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Post traumatic stress disorder is strongly co-morbid with other lifetime disorders. Survival analysis shows that more than one third of people with PTSD fail to recover even after many years. Conclusion About half of adults in the USA will meet the criteria for a DSM-IV (now DSM -5) disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

Dunmore et al, 2001

Aim To investigate cognitive factors involved in maintaining PTSD. Method Fifty-seven victims (31 women and 26 men) of physical or sexual assault participated in the study. 51 were physically assaulted within the last four months and six were sexually assaulted. Cognitive factors were assessed through interview and questionnaires within 4 months of assault and victims were followed-up 6 and 9 months after the assault. Results Cognitive variables which significantly predicted PTSD severity at both follow-ups were: cognitive processing style during assault (mental defeat, mental confusion, detachment); appraisal of assault effects (appraisal of symptoms, perceived negative responses of others, permanent change); negative beliefs about self and world; and maladaptive control strategies (avoidance/safety seeking). Relationships between early appraisals, control strategies, and processing styles and subsequent PTSD severity remained significant after statistically controlling for gender and perceived assault severity Conclusion Cognitive factors during after the assault were significantly correlated with the severity and longevity of PTSD.

Kendler et al

Aim To investigate the heritability of lifetime major depression; whether genetic influences in major depression are more important in women than in men, and whether genetic risk factors are the same in the two sexes. Method Lifetime major depression was assessed at personal interview by modified DSM-IV criteria in 42,161 twins from the national Swedish Twin Registry. Results The heritability of liability to major depression was significantly higher in women (42%) than men (29%) and the genetic risk factors for major depression were moderately correlated in men and women. Conclusion Lifetime major depression was moderately heritable, with estimates similar to those in prior studies. In accord with some but not other previous investigations, this study suggests both that the heritability of major depression is higher in women than in men and that some genetic risk factors for major depression are sex-specific in their effect.

Beck

Aim To investigate why people suffer from MDD. Method Interviews and research into self reports of people suffering from MDD. Results Beck identified a number of faulty thinking processes: the cognitive triad of negative views about oneself, the world and the future. selective attention: seeing only the negative features of an event magnification: exaggerating the importance of undesirable events overgeneralization: drawing broad negative conclusions on the basis of a single insignificant event Conclusion A person's reaction to specific upsetting thoughts may contribute to MDD. As we confront the many situations that arise in life, both comforting and upsetting thoughts come into our heads. Beck calls these unbidden cognition's automatic thoughts. When a person's stream of automatic thoughts is very negative you would expect a person to become depressed.

Ferrari et al, 2013

Aim To present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity of populations. Method A systematic review of prevalence and incidence of MDD was undertaken, by searching Electronic databases Medline, PsycINFO and EMBASE. Results The literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4-5.0%). Conclusion This research provides a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.

Gender Variations in prevalence of Depression (Ferrari et al)

Aim To present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity of populations. Method A systematic review of prevalence and incidence of MDD was undertaken, by searching Electronic databases Medline, PsycINFO and EMBASE. Results The literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4-5.0%). Conclusion This research provides a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.

Singh et al (2007)

Aim To systematically review detention and ethnicity, with meta-analyses of detention rates for black and minority ethnic (BME) groups, and to explore the explanations offered for ethnic differences in detention rates. Method Literature search and meta-analysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated. Results 49 studies met inclusion criteria, and of these,19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence. Conclusion Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported by evidence and more investigation is needed.

Speisman et al

Aim To test the Two Factor Theory of emotion to see if the manipulation of cognitive appraisal would lead to different emotional outcomes. Procedure The sample was made up of 56 undergraduate psychology students. The researchers had participants watch a film of an aboriginal circumcision ceremony which involved the cutting of the young boys' genitals. While showing this film, one of three sound-tracks was played. The trauma condition: participants could hear the noises of the surgery and they were also told just how painful this surgery is; The intellectualization condition: the participants heard a voice-over by an anthropologist explaining the history of the tradition The denial condition: the overall tone of the presentation was about the celebration of these young boys becoming men. There was also a control group in which the film was shown but without sound. While participants watched the film, the researchers measured their heart rate and galvanic skin responses. Immediately after the film was complete, the participants were asked to fill in questionnaires that evaluated the participants' feelings of stress. Results The results showed that the trauma condition showed much higher physiological measures of stress than the participants in the other two conditions. Although there was an increase in physiological response, it is difficult to label the results as "emotions." Emotional responses, which were self-reported in the questionnaire, were stronger for those that were in either the control group or the trauma group. The study shows that we gather information from our environment to determine how we react to a situation.

Pampallona et al

Aim: To analyse whether combining anti-depressants and psychotherapy was more effective in the treatment of depression. Method: 16 randomized controlled studies were conducted including 932 patients taking antidepressants only and 910 receiving combined treatment. The patients had all been randomly allocated to the treatments. Findings: The results showed that patients in combined treatment improved significantly more compared to those receiving drug treatment alone. This was particularly true in studies that ran over more than 12 weeks and there was also a significant reduction in dropouts.

Stahre et al

Aim: To examine effectiveness of CBT in treating obesity. Method: Participants were obese women in Sweden (mean age 48.5 years and mean BMI 36.5). The experimental group joined a weight loss programme that included CBT. The control group did moderately intense physical activity. The treatment lasted for 10 weeks (2 hours per week). Participants' weight was controlled periodically over an 18-month period. There was a small drop-out in both groups. Findings: The results showed a significantly greater weight loss (5.9 kg) in the treatment group after 18 months compared to the control group who gained 0.3 kg on average.

Brown and Harris

Aim: To investigate how depression could be linked to social factors and stressful life events in a sample of women from London. Procedure: In London, 458 women were surveyed on their life and depressive episodes. The researchers used interviews where they addressed particular life events and how women had coped. Findings: In the previous year, 37 women (8% of all the women) had been depressed. Of these, 33 (90%) had experienced an adverse life event or a serious difficulty. Working-class women with children were four times more likely to develop depression than middle-class women with children. The researchers found that vulnerability factors such as lack of social support, more than three children under 14 years at home, unemployment, and early maternal loss, in combination with acute or ongoing serious social stressors, were likely to provoke depressive episodes.

Sapolsky

Aim: To investigate how the social hierarchy of baboons and how it affects their stress hormone release. Method: Quantitative study used dart guns in order to get a blood sample from the higher-ranking baboons and lower ranking baboons Because hormones such as glucocorticoid and adrenaline are the backbone of stress, Sapolsky looked for the level of these hormones in the blood system Findings: When the baboon was higher in rank (dominant male) then it had lower stress levels, and when the baboon was lower in rank then it had higher stress levels. An increased stress level indicated increased heart rate and higher blood pressure.

Davis et al (2007)

Aim: To investigate if MBSR could reduce smoking. Method: 18 participants that had an average smoking history of 19.9 cigarettes per day for 25.4 years. MBSR instructors trained the group in mindfulness in 8 weekly sessions. Participants attempted smoking cessation in week 7 without use of drugs or nicotine replacement. 6 weeks after quitting the participants' breath was tested to see if they stopped. Findings: 56% of the participants had stopped smoking (breath test). There was a positive correlation between compliance with meditation, smoking cessation, and low levels of stress. Strength: Ecologically valid Limits: Needs to be tested in a larger controlled study

Kleinman (1982)

Aim: To investigate if neurasthenia in China could be similar to depression in DSM-III. Method: Kleinmen interviewed 100 patients diagnosed with neurasthenia using structured interviews based on DSM-III diagnostic criteria. Findings: He found that 87% of the patients could be classified as suffering from depression; 90% complained of headaches, 78% of insomnia, 73% of dizziness, and 48% of various pains. Depressed moods was only given as the main complain in 9% of cases.

Kiecolt-Glaser et al

Aim: To investigate if the stress of an important exam had an effect on the body's immune functioning. Method: A sample of 75 volunteer medical students participated. Blood tests were taken twice: one month before and on the first day of the final exam. Immune functioning was assessed by measuring the amount of the natural killer cells in the immune system (T cells) in the blood samples. The students also completed scales of life events, bodily symptoms, and satisfaction with interpersonal contacts. Results: It showed a significant decrease in the amount of T-cells in the second blood test. The high stress in relation to the exam had diminished the effectiveness of the immune system. Students who reported feeling the most lonely or had experienced other stressful life experiences had the lowest T-cell counts. Strength: The study was longitudinal and conducted in a natural environment so it has high ecological validity. Limit: It's not possible to establish a cause-effect relationship in a natural experiment.

Bullen et al. (2010)

Aim: To investigate short-term effectiveness of electronic cigarettes on desire to smoke and withdrawal symptoms compared to inhalators Method: Single blind controlled randomized experiment, 40 smokers who smoke 10+ cigarettes a day, but had not smoked overnight, they were given either cigarettes, an inhaler or electronic cigarettes (either with 0 or 16mg of nicotine) Findings: Electronic cigarette produced the same significant decline in the desire as nicotine inhaler and had fewer side effects. Even 0mg cigarette supressed the desire to smoke. Strengths: Ecologically Valid

Unger et al (2001)

Aim: To investigate smoking habits in relation to peers and cultural background. Method: the sample consisted of adolescents from California (5,143 people with a mean age of 13) through a cross-cultural survey Findings: White students with close friends who smoked were much more likely to smoke than non-white students (e.g. Asian American and Hispanic students). Strengths: Ecologically valid. Limits:

Prochaska and Di Climente

Aim: To investigate stages of self-change in relation to smoking cessation. Method: Newspaper advertisements were used to recruit 872 smokers who wanted to change their smoking habits on their own. Participants were allocated to 5 different groups (long-term quitters, recent quitters, relapsers, immotives-no intention to stop smoking, and contemplators-thinking about quitting). Participants answered a questionnaire to determine current stage of change. Saliva tests were taken to increase validity of self-reports on smoking stage. The study ran for two years. Findings: It showed 10 different processes of change. The researchers developed this into a model with five stages of change that are not necessarily linear but involved a shift across the 5 stages. The study showed that some of the smokers stayed in the contemplation stage throughout and that smokers often make a number of action attempts before they reach the maintenance stage.

Hanewinkel and Wiborg

Aim: To investigate the effectiveness of a school-based campaign in Germany with regard to primary and secondary prevention. Method: The sample consisted of 131 classes with 2,142 pupils (mean age 12.9 years). Smoking status was assessed twice, once before a competition started and again six months after the end of the competition. The classes decided whether they wanted to be a "smoke-free class" for six months or not. The control group consisted of classes who didn't enter the competition. The classes in which pupils didn't smoke during the six months eventually participated in a prize draw with many attractive prizes. There were no difference in prevalence of smoking at baseline between the control (18.5% smokers) and the experimental group (15.2% smokers). Results: It showed that pupils in the control condition showed significantly higher prevalence of smoking (32.9% smokers) compared to pupils in the experimental condition (25.5% smokers). More pupils stayed smoke-free in the experimental group than in the control group. Limits: The competition wasn't effective in smoking cessation (secondary prevention).

Evans and Kim

Aim: To investigate the long-term relationship between poverty or low socioeconomic status, cumulative risk factors and physiological stress. Method: Participants were 200 seven-year-olds. The researchers measured blood pressure and cortisol levels. Stress regulation was assessed by measurement of the hear's reactivity to a standard acute stressor, and recovery after exposure to the stressor. Exposure to risk factors such as substandard housing, and family violence were included to have a measure of cumulative stress factors. Results: It showed that there was a positive correlation between long-term exposure to a social risk factors on physiological measures of stress. A greater number of years spent living in poverty correlated with more elevated cortisol levels and more problems for the heart to recover after exposure to the stressor.

Difranza et al (2006)

Aim: To investigate the relationship between attitudes to smoking and smoking habits. Method: It was longitudinal and used questionnaires and interviews for data collection.Method: longitudinal study of 217 adolescents (mean age of 12) in US, all having at least smoked at least 1 cigarette. They answered questionnaires on their smoking history, social environment, and beliefs and attitudes towards smoking. 11 were interviewed. Assessing tobacco dependence based on reported cravings, time devoted to smoking and inability to quit. Results: Of the adolescents who recalled a relaxation effect after their first inhale adolescents who had an immediate experience of relaxation after first puff, 67% became dependent compared to 29% of those who didn't experience the effect. Strength: Ecological Validity Limit: Hard to determine if it was genetics playing into the addiction.

Ludwig et al

Aim: To investigate the relationship between soft drinks and obesity in children. Method: The 19-month study involved 548 children whose average age was just under 12 years at the Children's Hospital in Boston. Findings: It found that the chances of becoming obese increased significantly with each additional daily serving of sugar-sweetened drink.

Lucy et al

Aim: To investigate the relative effectiveness of the two treatments for major depression. Method: A 16-week therapy with 8 to 19 individual sessions was attended by 177 patients diagnosed with major depression. Patients were randomly allocated to either CBT or IPT. They didn't receive medication and those who eventually decided to use it were not included in the study. Findings: Generally the results showed no difference in effect of the two forms of psychotherapy but CBT was more effective in severe depression. Only 20% of patients with severe depression responded to IPT, whereas 57% of patients responded to CBT.

Rosenhahn (1973)

Aim: To test reliability and validity of diagnosis in a natural setting. Rosenhahn wanted to see if psychiatrists could distinguish between "abnormal" and "normal" behaviour Procedure: This was a covert participant observation with 8 participants consisting of 5 men and 3 women (including Rosenhahn himself). Their task was to follow the same instructions and present themselves in 12 psychiatric hospitals in the US. Results: - All participants were admitted to various psychiatric wards and all but one were diagnosed with schizophrenia. The last one was diagnosed with manic depression. - All pseudo-patients behaved normally while they were hospitalised because they were told that they would only get out if the staff perceived them to be well enough. - The pseudo-patients took notes when they were hospitalised but this was interpreted as a symptom of their illness by the staff. It took between 7 to 52 days before the participants were released. They came out with a diagnoses (schizophrenia in remission) so they were "labelled". - A follow-up study was done later where the staff at a specific psychiatric hospital were told that imposters would present themselves at the hospital and that they should try to rate each patient whether he or she was an imposter. Of the 193 patients, 41 were clearly identified by at least one member of the staff, 23 were suspected to be impostors by one psychiatrist, and 19 were suspected by one psychiatrist and one staff member. There were no impostors. Evaluation: - This controversial study was conducted nearly 40 years ago but it had an enormous impact in psychiatry. It sparked off a discussion of the consequences of diagnosis for patients. The development of diagnostic manuals has increased reliability and validity of diagnoses although the diagnostic tools aren't without flaws. - The method used raises ethical issues (the staff weren't told about the research) but it was justified since the results provided evidence of problems in diagnosis which could benefit others. There were serious ethical issues in the follow-up study since the staff thought that impostors would be present, but they were real patients and may not have had the treatment that they needed.

Berkowitz et al

Aim: To test the effectiveness of the drug sibutramine in reducing weight compared with a placebo. Method: The sample consisted of 498 obese adolescent boys and girls (age range 12-16, average weight of 97.7 kg). The study was longitudinal. The drug sibutramine was given to 386 participants and 130 had the placebo. All participants had counselling about healthy eating, physical activity, stress reduction, and keeping track on how much they ate. Findings: It showed that participants in the sibutramine group usually lost weight (6.4 kg) rapidly during the first 8 months and then maintained their weight for the rest of the trial. The main side effect of the drug was an increase in heart rate. Those in the placebo group usually gained weight (1.8 kg). Limits: About 1/4 of the participants left the study, which only ran for a year. There was no follow up on the long-term benefits or harm of the drugs. The researchers didn't control weight changes after the study, which makes it difficult to determine whether the weight loss was permanent. Strength: Ecologically valid

Whitehall

Aim: to investigate the relationships between workplace stress, health, and various individual and social risk factors. Participants were taken from London-based Government civil servants. The focus of the Whitehall study was on an individual's sense of control in his or her work environment. The degree of control a person has over their workload has been shown to affect directly the level of stress experienced. High levels of control lead to lower levels of stress, while low levels of control - typically experienced by workers lower down the organization hierarchy - can increase stress levels. Procedure They analyzed data from over 7000 participants in the Whitehall II study. The sample was made up of both male and female civil servants, aged 35 - 55, working in the London offices of 20 different Whitehall departments. Participants were given an initial screening to make sure that all were free of heart problems prior to the study. The aim was to then find out whether they those in the lower position jobs - that is, with less control over their work environment - would develop heart problems over the five year period. This is an example of a prospective longitudinal study. Though it still is correlational, it establishes that in fact heart disease developed over the course of the study - eliminating pre-conditions as a confounding variable. In order to gather their data, the researchers used a series of questionnaires, as well as carried out health screenings. The participants were invited to the research clinic and a questionnaire was sent to their homes at five year intervals. Self-reported non-fatal heart problems, as well as cases of cancer and diabetes, identified in the questionnaires were verified by hospital records. Results The final data showed a similar correlation between heart disease and status as found in the first Whitehall study. The rate of heart problems in the lowest levels of the system were 1.5 times the rate in the highest levels. When the researchers analyzed the data in detail they found that risk factors such as smoking, obesity and hypertension could account for some of the increase in lower grades, but the most significant factor was the degree of control that participants felt they had. Lack of control had a significant effect, independent of socio-economic and other risk factors. Discussion It appears that there is a relationship between one's sense of control in their working environment and the health of the cardiovascular system. The study has been supported by animal research carried out by Robert Salpolsky. Sapolsky studied the effect of social hierarchy on stress levels. Dominant male baboons were shown to have much lower levels of stress than subordinate baboons. Sapolsky observed the bigger, dominant males often easing the weaker ones, pushing them around and not letting them have a fair share of food or mating privileges. In fact, the baboons that were most submissive to the dominant males revealed brain activity similar to the kind found in clinically depressed humans. The findings are also supported by other studies that have demonstrated a clear relationship between stress at work and lack of control. The fact that this is a longitudinal prospective study is a key strength of the research. Also, since everyone in Britain receives the same quality healthcare, the level of health care cannot be considered a confounding variable to the extent that it would be in the United States. However, there are some limitations of the study. The study was based primarily on selfreport questionnaires. Social desirability effect could play a role in individual responses regarding risk factors. In addition, not all participants may have been conscious of - or honest about - their health over the five year period. Though hospital records were also used, access to these records was not always available to the researchers. In addition, the sample was taken from the British government's civil servants. The hierarchy is perhaps more rigid in the Civil Service than in other large employers. This is simultaneously a strength and a weakness of the Whitehall II study. The study may not be representative of conditions experienced in the average workplace. Finally, the researchers may have overly attributed the effects on health to the hierarchy, rather than to dispositional factors. Though control within the system may be the root of stress related illness, one has to question whether there is a disposition toward sense of control. The research does not account for differences within each level of the system, only between them.

Thornicroft et al, 2013

Background Better newspaper coverage of mental health-related issues is a target for the Time to Change (TTC) anti-stigma programme in England, whose population impact may be influenced by how far media coverage perpetuates stigma and discrimination. Aims To compare English newspaper coverage of mental health-related topics each year of the TTC social marketing campaign (2009-2011) with baseline coverage in 2008. Method Content analysis was performed on articles in 27 local and national newspapers on two randomly chosen days each month. Results There was a significant increase in the proportion of anti-stigmatising articles between 2008 and 2011. However, there was no concomitant proportional decrease in stigmatising articles, although the contribution of mixed or neutral elements decreased. Conclusions These findings provide promising results on improvements in press reporting of mental illness during the TTC programme in 2009-2011, and a basis for guidance to newspaper journalists and editors on reporting mental illness.

Biological Etiology of PTSD

Because only a proportion of people exposed to traumatic events develop PTSD, it is important to investigate the factors that increase the risk for the development of PTSD following trauma exposure. Genetic influences Yehuda et al (1998) argued that there are biological and familial risk factors for PTSD. Their study demonstrated an increased prevalence of PTSD in the adult children of Holocaust survivors, even though these children, as a group, had not been exposed to any unusual trauma. It is difficult, as Yehuda noted, to disentangle the biological and sociocultural factors here; it may be that living with a parent who has PTSD following their treatment during the Holocaust is enough to predispose children to developing this, rather than any genetic connection. Researchers have also found a version of the 5-HTTLPR gene, which controls levels of serotonin, also appears to be a factor in anxiety disorders like PTSD (Hariri et al, 2002). Like other mental disorders, it is likely that many genes with small effects are at work in PTSD. Neurotransmitter imbalance Spival et al (1999) investigated the role of neurotransmitters in PTSD. They found higher levels of noradrenaline/norepinephrine and reduced levels of serotonin and dopamine in seventeen males with combat-related PTSD, compared to a control group.

CBT

CBT for obesity aims to change cognitions related to eating as well unhealthy eating behaviour. The focus is on cognitions that lead directly to eating such as the client's permission-giving thoughts. The CBT programme involves: 1. Focus on behaviours: identify and adjust destructive eating patterns; monitor calorie intake; identify alternatives to social and emotional eating; start manageable exercise programme. 2. Focus on cognitions: identify and confront dysfunctional thinking that prevents healthy eating habits; improve body image and self-confidence; increase social support and adjust thinking to prevent feelings of shame and hopelessness. 3. Focus on strategies to maintain weight loss: maintain motivation and strengthen coping skills to deal with challenging situations and setbacks.

The case study method

Case studies are based upon the principle of methodological triangulation., often using a combination of interviews, psychometric testing, questionnaires and observations. The case study method involves observing what happens to, as well as often reconstructing the case history of a single participant or group of individuals - such as a school class or a specific social group. The case study is not itself a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies such as qualitative techniques (semi-structured interviews, participant observation), personal notes (e.g. letters, photographs, diaries) or official documents (e.g. case notes, clinical notes, appraisal reports). All the approaches mentioned here focus on the individual case without reference to a comparison group.

Culture Variations in Prevalence of PTSD

Culture. Responses to trauma vary culturally, as do symptoms of PTSD. Watters (2010) uses events following the 2004 Asian tsunami as example of cultural differences in reaction to trauma. He describes how western therapists arrived in Sri Lanka to provide counselling and treatment for PTSD without really considering the effect culture has on outward symptoms and coping mechanisms resulting from exposure to a traumatic event. Immediately following the tsunami, Sri Lankan peoples' top priority seemed to be aiding those around them, rather than seeking treatment themselves, behaviours that were viewed by many of the therapists as signs of "denial" and "shock," and considered to be warning signs of PTSD. However, in many cultures, the practice is to help others before you help yourself. No culture is immune to the pain and suffering caused by catastrophic or life-threatening events, but there are important cultural differences in how these events are interpreted and dealt with. Therefore best diagnostic practices (on which prevalence rates are built) in one culture cannot necessarily be applied to another.

Let's Move Initiative

One of the most important results has been increasing public awareness of the importance of obesity. In 2008, over two-thirds of adults and a third of adolescents and children in the United States were obese or overweight. Although most Americans already saw obesity as a major problem, a majority opposed increasing federal spending to combat it. This attitude has begun to change. By 2011, a Pew survey found that most Americans believe the government should play a significant role in reducing obesity among children. Today, 80 percent of Americans acknowledge that childhood obesity is a serious problem. Mrs. Obama's campaign has also led to improvements in the access to and content of school meals. In late 2010, the lame-duck Congress passed the Healthy, Hunger-Free Kids Act which, for the first time in 30 years, increased funding for school breakfasts and lunches above the inflation rate. The act also gives the Agriculture Department authority to set health standards for all foods sold on school property — including those in vending machines. It has been only two years since Let's Move began, and we can't know yet if there has been any reduction in childhood obesity rates. After all, it took nearly 50 years to convert the country to be obese but will take time to return to be slim fit (it's possible).

Depression Prevalence

Prevalence It is very difficult to place a figure on the percentage of the world's population that are suffering at any one time from MDD. Ferrari et al, 2013 used data from the 2010 Global Burden of Disease study and found that the global prevalence of MDD was 4.7%

Primary and Secondary prevention

Primary prevention: Strategies to prevent people from starting smoking Secondary prevention: Interventions to help people stop smoking

Confirmability

Qualitative research tends to assume that each researcher brings a unique perspective to the study. Confirmability refers to the degree to which the results could be confirmed or corroborated by others. There are a number of strategies for enhancing confirmability. The researcher can document the procedures for checking and rechecking the data throughout the study. Another researcher can take a "devil's advocate" role with respect to the results, and this process can be documented. The researcher can actively search for and describe any negative instances that contradict prior observations. And, after the study, one can conduct a data audit that examines the data collection and analysis procedures and makes judgments about the potential for bias or distortion. Traditional Criteria for Judging: internal validity external validity reliability objectivity Alternative Criteria for Judging: credibility transferability dependability confirmability

Kuyken et al

The study investigated the effectiveness of MBCT in a randomized controlled study with 123 participants with a history of 3 or more episodes of depression. All participants received anti-depressant medication. Participants were randomly allocated to two groups. Over the 15 month study, the control group continued their medication and the experimental group participated in an MBCT course and gradually diminished their medication. People in the control group who received anti-depressive medication had a relapse rate of 60% compared to the experimental group of 47%. Participants in the MBCT group overall reported a higher quality of life, in terms of enjoyment of daily living and a physical well-being. Anti-depressive medication was significantly reduced in the MBCT group and 75% of the patients stopped taking the medication.

Selye GAS (General Adaptation Syndrome)

Seyle's GAS theory of stress states that humans would respond with the same physiological pattern of physiological changes no matter the stressor. With prolonged exposure to stress, the physiological system will be damaged and the organism may eventually die. The three stages of stress: Alarm: Physiological mobilization to respond to the danger. It's the same as the fight or flight response. Resistance: Attempts to cope with the stress response. Exhaustion: Occurs when the organism fails to overcome the danger and is incapable of further coping. Strengths: - It's generated a lot of research and it remains an important theory in the field - It provides an explanation of the interaction of environmental stressors and physiological responses. Limitations: - There's no reference to individual differences, social or cognitive factors in the model. - The model cannot explain that humans can experience stress by merely thinking of stressful events.

Shapiro et al

Shapiro et al. (1998) MBSR and coping with exam stress • The aim of the study was to investigate effectiveness of MBSR as a coping strategy to control exam stress • The study used a controlled experimental design. Some premedical students at the University of Arizona were offered an introductory course of MBSR for course credits • The participants were randomly assigned to the MBSR course (37) or to a waiting list (36). An equal number of men and women were in the sample. Participants in the MBSR group and the waiting list group filled out a questionnaire assessing stress at the start of the term (before the course) and during the exams at the end of the term (after the course). They also completed a questionnaire on empathy • The results showed no difference in stress between the two groups at the beginning of the term. There was a difference at the time of the exams. Students on the waiting list expressed more perceived stress compared to those who had participated in the MBSR class. The MBSR students were in fact less anxious than at the start • The results suggest that the course had taught them to cope effectively with the stress of exams • MBSR seems to be an effective means of coping with stress but people must be willing to learn MBSR and it may not suit everybody The participants were students and participated for course credits. This means that the findings cannot be generalized. The results have been replicated in another controlled study with 130 medical students. This indicates that MBSR is effective in stress reduction

Nicotine Replacement Therapy

Strength is that it helps relieve withdrawal symptoms but a limitation is that some smokers are unable to tolerate the taste and chewing demands.

MBSR

Strength is that it works but a limit is that it takes a while for the strategies to work. It's a stress reduction programme based on meditation principles form Buddhism.

Evaluation of Biomedical Treatment

Strengths of biomedical therapies for MDD, PTSD and bulimia nervosa. If drug therapy or ECT succeeds in reducing the symptoms of psychologically-crippling mental disorders then this in itself has to be seen as a huge advantage. Research suggests that in many cases there is an alleviating of symptoms, especially when used in tandem with individual therapy (Spijker et al, 2013). For some people, just having a label to attach to their feelings, and being told that medication might help, may be enough to make them feel somewhat better. Limitations of biomedical treatment for any of the mental disorders. The anti-depressants prescribed for any of these disorders can be physically and/or psychologically addictive. There are many documented side-effects, and most anti-depressant medication takes at least four weeks to start working. They treat the symptoms, but unless the cause of the disorder is addressed, it is likely that it will recur.

Evaluation of Group Therapy

Strengths of cognitive behavioural group therapy for MDD, PTSD and bulimia nervosa. Consistently good outcomes have been recorded for CBGT in comparison with, and sometimes in combination with, other forms of intervention. The skills learnt are useful, practical and helpful strategies that can be incorporated into everyday life to help sufferers cope better with future stresses and difficulties. Being in a group with people in the same position can help the person with the mental disorder feel less isolated and more hopeful of recovery or improvement. Group support can actually make the prospect of recovery a reality. CBGT is relatively quick and less expensive than other therapy. It usually takes up to about 12 weeks in duration. Limitations of cognitive behavioural group therapy for MDD, PTSD and bulimia nervosa. Limitations of this method include the risk of one patient monopolizing therapy, confrontation between group members, and the development of subgroups. Group settings may also make members more reluctant to discuss disturbing cognitions, and as a result of this fail to undertake and challenge these maladaptive thoughts. Patients who are severely depressed or traumatised may not be able to participate.

Evaluation of Individual Approach Treatment

Strengths of individual cognitive behavioural therapy for MDD, PTSD and bulimia nervosa. The CBT model has great appeal, because, unlike biomedical treatments, it puts control in the hands of the client, rather than the psychologist or psychiatrist. Cognitive theories lend themselves to testing, as many people with psychological disorders, particularly depressive, anxiety, and eating disorders have been found to display maladaptive assumptions and thoughts and cognitive therapy has been found to be very effective for treating many types of mental disorders. See Butler and Beck, 1995 on the use of cognitive therapy for depression. CBT addresses faulty cognitions. Figure 1. CBT addresses faulty cognitions. CBT addresses the underlying negative or repetitive thoughts that can lead to depression, PTSD or bulimia nervosa and helps the person see that these thoughts are faulty and are responsible for their emotional state. In order to treat these mental disorders, clients need to treat their faulty interpretations and conclusions as testable hypotheses. The role of the therapist in a cognitive-behavioural intervention is to help the clients examine alternative interpretations and to produce contradictory evidence in order to move to cognitive restructuring, whereby the client revises and replaces his/her faulty thoughts and beliefs. It is the thought that counts. Therefore its strength is that it addresses what cognitive therapists view as the underlying causes for the disorder, rather than just the symptoms. Limitations of individual cognitive behavioural therapy for MDD, PTSD and bulimia nervosa. The faulty cognitions seen in these mental disorders could be a consequence of their mental disorder, rather than a cause. The cognitive model is narrow in scope - thinking is just one part of human functioning, and maybe broader (biological and/or sociocultural) issues need to be addressed. The client needs to be committed and persistent in tackling and improving their problem with the help of the therapist. It can be hard work. For people who have difficulty expressing themselves verbally, CBT may prove impossible.

Describe stressors

Stress can be defined as a negative emotional experience accompanied by various physiological, cognitive, and behavioural reactions. Acute stress is when it's sudden, while chronic stress is persisting over a long period of time.

Definition of Substance abuse

Substance abuse refers to the continued use of the substance despite knowing problems associated with the substance such as persistent desire to use it and/or unsuccessful efforts to control substance use.

Drug treatments

The National Institute of Health in the US considers obesity to be a chronic disease. Two sorts of drugs are used: - Appetite-suppressant drugs: decrease appetite or increase the feeling of being full because they act on neurotransmitters that affect mood and appetite (e.g. serotonin and adrenaline levels). There is some evidence for the effectiveness of these drugs although they have some side effects such as nausea, constipation, and dry mouth. - Lipase inhibitors: reduce fat absorption. The drug has some unpleasant side effects, especially after eating fat. This may have a preventive effect since eating fat becomes associated with unpleasant consequences such as diarrhea.

DARE

The Social Influence Approach (Evans) emphasizes the importance of social and psychological factors in promoting the onset of drug use. Adolescent drug use is seen as the result of social influences from peers and the media to smoke, drink alcoholic beverages, or use illicit drugs. An assumption of this approach is that teens begin to use drugs largely because they lack the confidence or skills to resist social influences to use drugs Special emphasis is often placed on teaching students to identify the techniques used by advertisers to influence consumer behavior. There are three components to social influence programs like D.A.R.E (Drug Abuse Resistance Education): Teaching people to recognize high-risk situations and to learn to exclude themselves from these situations. Increasing the awareness of media influences, Refusal skills training - that is, learning how to say no. One of the most famous campaigns based on this approach was sponsored by US first lady Nancy Reagan - the Just Say No campaign. Here is a PSA from the 1980s. Research on the effectiveness of the program shows that groups showed a reduction of 30 - 45% in smoking compared to control groups. The effect, however, is short-lived, with most studies showing that the effect lasts less than two years - with only a few studies indicating that it may last up to five years (Flay, 1989). The D.A.R.E. program in the US is usually taught by local police officers to younger children - age 10 - 12.Some studies have shown a short-term positive impact on drug-related attitudes, or behavior. However, most studies that have used large samples, random assignment, and longitudinal follow-up have shown that DARE has little or no impact on drug use (Clayton, Cattarello, & Johnstone, 1996).

McDermut et al

The study was a meta-analysis based on 48 studies published between 1970 and 1998. The patients' mean age was 44 years and 78% of patients were women. All but one study included a cognitive and/or behavioural treatment group. Results showed that 45 of the 48 studies reported that group psychotherapy was effective for reducing depressive symptoms. The overall results showed that group psychotherapy was more effective than no treatment around 19 weeks after the end of treatment. Nine studies showed that individual and gropu psychotherapy were equally effective.

TRUTH (community based anti-smoking promotion)

The TRUTH anti-smoking campaign (Florida) in 1998-99 was a grassroots movement targeting teenagers. The aim of the campaign was to prevent teen smoking by changing teens' attitudes and to encourage them to form groups and spread the message in the community. A core component of the campaign was adolescents confronting the tobacco industry and accusing them of manipulating them to smoke. The strategy of a youth movement against the tobacco industry was decided at the Teen Tobacco Summit in 1998 by teen delegates. The campaign included the formation of a new youth anti-tobacco advocacy group called SWAT (Students Working Against Tobacco) who worked at grassroots level. The campaign used massive advertising including 33 television commercials, billboards, posters, the internet (e.g. YouTube), programme sponsorships, merchandise, and local youth advocacy groups. Effectiveness: Effectiveness of the campaign was measured by telephone surveys with teens. Six months after launching the campaign 92% of teens were aware of the campaign. Teens' negative attitude to smoking had risen. Follow-up surveys showed that non-smoking teens were likely to say that they had been influenced by the campaign.

Credibility

The credibility criteria involves establishing that the results of qualitative research are credible or believable from the perspective of the participant in the research. Since the purpose of qualitative research is to describe or understand the phenomena of interest from the participant's eyes, the participants are the only ones who can legitimately judge the credibility of the results.

Group Approaches to Treatment

The group approaches are based off of the principles of the SCLoA. The theory behind group therapy for MDD is that people may feel more compelled to engage in discussion than they are when alone with a therapist.

Cultural Considerations in Diagnosis

The main challenges for mental health professionals trying to make a cross-cultural diagnosis are: culture-bound syndromes that do not exist outside of their own society; the professionals' own culture blindness and cultural stereotypes; reporting bias and symptoms that vary cross-culturally.

Health Belief Model

The model assumes that people make rational decisions on health-related behaviours and that people are ready to change if they: - believe they're vulnerable to the health problem in question (perceived vulnerability) - believe the health problem has serious consequences (perceived severity) - believe taking action could reduce their vulnerability to the health problem (perceived benefits) - believe the costs of taking action (perceived barriers) are outweighed by the benefits (perceived benefits) - are confronted with factors (e.g. pain in the chest or a television programme) that prompt actions (cues to action). - are confident that they are able to be successful in the action (self-efficacy)- if people believe they can stop smoking or eat healthier, they are more likely to listen to health promotion messages. Strengths: - HBM has been applied successfully in health promotion. The model can help identify some of the important factors and conditions involved in health behaviours. These factors can be applied to design health promotion strategies at an individual level. - HBM has suggested useful factors to address in health promotion. Health practitioners could address this in one-to-one interventions and discuss how to deal with such barriers. Limitations: - A limitation of the HBM is the focus on individual cognitions. It doesn't include social and economic factors, which are known to influence health behaviours as well. - The main criticism of the model is the assumption that people are rational decision makers. People are sometimes "unrealistically optimistic" about their health and a threat is not always perceived as such by the individual.

Depression Symptoms

The symptoms of MDD include at least five of a list of symptoms, including change in appetite and sleeping patterns, which must have been present during the same 2-week period and represent a change from previous functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure. The DSM -5 did not change the criteria for categorizing the symptoms of MDD from those in the DSM-IV, except to controversially remove the requirement that these symptoms are not occurring within two months after bereavement, such as the loss of a loved one. See a recent BBC news article that argues for reinstating the "bereavement exclusion" and this easy to read response to critics of this change in the DSM 5.

Stages of Change Model

The model identifies 5 stages of change, which highlighted the processes involved in the transition from a smoker to a non-smoker. 1. Precontemplation: The person isn't seriously considering quitting. 2. Contemplation: The person is aware that there is a problem and that something should be done but there is no commitment to quitting. 3. Preparation: The person is seriously considering quitting, perhaps by reducing the number of cigarettes or postponing the first one. 4. Action: The person has stopped smoking. 5. Maintenance: The person works to maintain non-smoking and prevent relapse. Strengths: - The model is simple to use and it has generated a lot of research. It's a useful model because it can raise awareness of an individual's motivation to change and help to design appropriate interventions at the relevant stage of change. -Many health practitioners find the model useful and robust in understanding smoking cessation. It has also been successfully applied in health promotion to stop alcohol abuse. Limits: - Critics of the model argue than an individual may not necessarily contemplate stopping before he or she actually quits. People are more likely to react to cues in the environment such as a friend quitting or a scary media campaign. - The model describes processes of change but does not explain them. The model doesn't take social and cultural factors that could influence motivation to change into account.

Lazarus and Folkman: The transactional model of stress and coping cognitive appraisal model

The model is based on the assumption that stress involves a transaction between an individual and the external world. In the face of potential stressors, the individual engages in a process of of primary and secondary appraisal. Primary appraisal: the event is perceived to be either neutral, positive, or negative in its consequences. Secondary appraisal: this is assessment of one's coping abilities and resources. Various coping strategies are considered before choosing a way to deal effectively with the stressor.

Biological factors of substance abuse

The psychoactive drug in tobacco is nicotine. Nicotine alters levels of neurotransmitters. Secretion of adrenaline results in temporarily increased heart rate and blood pressure. Secretion of dopamine is involved in the alteration of mood. Secretion of acetylcholine appears to enhance memory. Nicotine is also associated with relaxation and changes in mood.

Leuchter et al

The study examined brain function in 51 patients with depression who received either a placebo or an active medication. An EEG was used to compare brain function in the two groups. The design was a double-blind and ran over nine weeks. The study used two different SSRI, which were randomly allocated to the patients. Results showed a significant increase in activity in the prefrontal cortex nearly from the beginning in the trail in the placebo group. This pattern was different from the patients who were treated with the SSRI but patients in both groups did better, This indicates that medication is effective, but placebo seems just as effective.

Triangulation

What is triangulation? Triangulation is the application and combination of several research methodologies in the study of the same phenomenon. Triangulation was originally used in social sciences and has now spread to psychology. By combining multiple observers, theories, methods, and empirical materials, sociologists can hope to overcome the weakness or intrinsic biases and the problems that come from single method, single-observer, single-theory studies. Often the purpose of triangulation in specific contexts is to obtain confirmation of findings through convergence of different perspectives. The point at which the perspectives converge is seen to represent reality. There are four basic type of triangulation Data triangulation, involving time, space, and persons Investigator triangulation, which consist of the use of multiple, rather than single observers; Theory triangulation, which consists of using more than one theoretical scheme in the interpretation of the phenomenon; Methodological triangulation, which involves using more than one method and may consist of within-method or between-method strategies. Multiple triangulation is when the researcher combines in one investigation multiple observers, theoretical perspectives, sources of data, and methodologies.

Sociocultural Etiology of PTSD

While some cultures discourage the reporting of PTSD and talking about trauma, others encourage this as it is seen as part of the healing process. Therefore sociocultural factors can serve to increase hidden PTSD and inflate the figures amongst those encouraged to discuss trauma. Family and friendship factors may also affect a person's risk of developing PTSD. A history of family instability is associated with increased prevalence of PTSD (King et al, 1996), although we need to be careful - it may be that the stress of the PTSD has actually affected the stability of the family. Good social support is associated with lower levels of symptoms (Andrews et al, 2003).

PTSD Symptoms

With PTSD the body's response to a stressful event is changed. Normally, after the event the body recovers as the stress hormones and chemicals the body releases due to the stress go back to normal levels. For some reason in a person with PTSD the body keeps releasing the stress hormones and chemicals. Most psychologists are agreed on three main criteria: re-experiencing the trauma in one's mind; avoiding anything that reminds one of the trauma; symptoms of increased arousal when one is unable to avoid reminders. In order to be defined as symptoms of PTSD, these have to last for 30 days or more.

Individual Approaches to Treatment

With regard to depression, CBT refers to the use of both cognitive restructuring and the behavioural strategy of activity scheduling or behavioural activation. In other words, it addresses the underlying negative thoughts that lead to the depression and helps the person see that these thoughts are faulty and are responsible for their emotional state.

Cultural Stereotyping (considerations for Diagnosis; Li-Repac)

i. AIM: Her hypothesis was that the white and Chinese-American therapists would generally agree on a concept of normality as they had similar training, though the differences would be with the actual diagnosis when diagnosing someone from a different cultural group ii. METHOD: There were 10 subjects- 5 white and 5 Chinese- who were all diagnosed with a mental illness. They were all controlled for age, socioeconomic status, and level of pathology. 3 of the Chinese were diagnosed with schizophrenia, 1 neurotic, and 1 reactive depressive. 2 of the white subjects were diagnosed with schizophrenia, 1 neurotic, 1 with character disorder, and 1 reactive depressive. All of the Chinese subjects were born in China or Hong Kong. The researcher did semi-structured interviews with each subject. The clinicians were 5 white and 5 Chinese-American males, who were recruited through personal contacts of the researcher; the 5 white raters (the clinicians) reported to have no previous contact with Asian clients. Each of the clinicians were asked to describe an ideal, functioning individual using a 112 item test; there was no significant difference showing that their training lead to similar understandings on what constituted normality. They then would rate 4 randomly assigned videos- 2 white and 2 Chinese clients and fill an inventory to describe personal traits and signs of pathology. iii. Findings: The Whites tended to see signs of lower self-esteem in the Chinese client while the Chinese tended to see the Whites as being more aggressive. White raters say the Chinese clients as more depressed and inhibited than the Chinese American raters, the White raters saw Chinese clients as less socially competent and less capacity for interpersonal relationships than the Chinese-American raters and the Chinese-American raters reported more severe pathology than the white raters for judging quiet clients.