Category: Abnormality

How to cut your IB Psychology revision time by 50%!

29/2/2016

We show you exactly what you can get away with when revising for your IB Psychology Paper 2 exams – the Options.

In the IB Psychology Paper 2 exam – the Options – there is much that you can leave out and still get maximum marks. The Paper 2 exam requires you to answer two extended response question (ERQs) if you are studying Higher Level IB Psychology, and one ERQ if you are studying Standard Level. Each ERQ is worth 22 marks and you should be targeting full marks in this exam. Paper 2 is the easiest exam in which to maximise your overall IB Psychology exam score. It’s the easiest exam for which to prepare model answers to exam questions and then practice these until you can regurgitate them perfectly and “wow!” your IB Psychology examiners.

Take a look at picture below left (click to enlarge). You will see that there are three questions associated with each option, of which you only need to answer one. You will know by now that each question asked in the IB Psychology examinations is straight out of the learning outcomes listed in the IB Psychology Guide (if not, please see one of most popular blog posts here).

Paper 2 exam questions

Remember, the IB Psychology LOs listed in the Guide, are your actual exam questions.

Abnormal Learning outcomes

Now if you have a look above right (click to enlarge), at the learning outcomes associated with one of the IB Psychology options – Abnormal Psychology, you might think that there is quite a bit of preparation and revision that you need to do. 12 learning outcomes would equate to preparing and memorising 12 model answers, just for this one option, right? Wrong! Let me explain …

Firstly, within each option you have three essay question (ERQ) choices. Secondly, there has never been, nor is there likely to ever be, an IB Psychology exam where all three questions come from within a single subsection such as “Concepts and Diagnosis” or “Psychological Disorders” in the Abnormal option. This means that you can eliminate one ERQ from each of these sections. Thirdly, IB Psychology examiners can’t set an ERQ exam question based on a lower level command terms such as “explain”, “analyse” or “describe”. Very occasionally you will see exam question twisted and contorted to mix a lower level question term and a higher level command term. It hardly ever happens, you have other questions to choose from, so go ahead, cross these LOs off your list too.

Take a look below (again, click to enlarge) at how many Human Relationship LOs you will need to prepare model answers and revise for if you follow this advice. Instead of revising for 13 LOs, you now only need prepare and revise for six! And because you are now only focussing on six ERQ questions, you can prepare perfect 22/22 answers, commit them to memory and regurgitate them as soon as the IB Psychology Paper 2 exam begins. Genius! (At least your IB Psychology examiner will think you are!)

FRom 13 → 6 Learning Outcomes!

Remember, wwwPsychologyIB.com has model ERQ answers for the two most popular IB Psychology options – Abnormal and Human Relationships, and we guarantee you will be awarded 22/22 marks if you can replicate them in your exams.

Author: Derek Burton - Passionate about IB Psychology

How is this even possible?!

1/1/2016

IB Psychology students, welcome to the very, very strange world of the placebo.

Our last IB Psychology blog post on nocebos generated a tonne of responses, and also a lot of questions. Some of our IB Psychology students concerned themselves with the fact that while we focused on the nocebo effect, we paid scant attention to the placebo effect ... it was almost as if we were assuming that every student of IB Psychology already had a good in-depth understanding of placebos and the placebo effect. And, to be honest, to some extent we were. The placebo effect is integral to the abnormal option and should feature heavily across multiple IB Psychology learning outcomes, including:

To what extent do biological, cognitive and sociocultural factors influence abnormal behaviour?
Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour.
Examine biomedical, individual and group approaches to treatment.
Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder.

It really should be common knowledge. The placebo also takes a starring role in the IB Psychology CLOA learning outcome: To what extent do cognitive and biological factors interact in emotion? Where it features centrally in Schachter and Singer's (1962) two-factor theory of emotion. This piece of research can also be used in any of the IB Psychology exam questions that ask you to evaluate research or ethics at either the cognitive or biological level of analysis. So, as the astute amongst you have already worked out, you get quite good bang for your buck in the IB Psychology examinations by learning about placebos (work smarter, not harder!). So what are they?

Simply put, a placebo, as defined in IB Psychology, is a substance that has no therapeutic effect, and is used as a control in testing new drugs. However, that simple definition misses so much about the inner workings of the human mind. Placebo ares really, really strange beasts and they throw a whole lot of tricky questions at our knowledge and understanding of the human brain. See the must see video below.

WELCOME to the STRANGE world of the placebo

Without a doubt, placebos are one of the most interesting and perplexing concepts IB Psychology throws up. The concept also makes for a great IB Psychology Extended Essay, especially when confined a specific concept - such as the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression. However, our focus here is on using the placebo effect in your IB Psychology abnormal option to help you achieve that elusive IB Psychology 7! To that end, here are some key concepts that can be memorised and included in your ERQs:

Kirsch et al. (2002) found that there was a publication bias in research into the effectiveness of SSRI in depression. In fact, if the results of all studies (including the ones that had not been published) were pooled together it would seem that the placebo effect accounted for 80% of the antidepressant response. A placebo is a substance that has no therapeutic effect, and is used as a control in testing new drugs. Of the studies funded by pharmaceutical companies, 57% failed to show a statistically significant difference between antidepressant and a neutral placebo. This and similar studies cast doubt on the serotonin hypothesis, not to mention the ethics of drug companies. However, it is still widely promoted by pharmaceutical companies and presumably believed by the 10% of Americans taking these SSRIs to treat depression.

Leauhter et al. (2002) examined changes in brain function during treatment with placebo. The study examined brain function in 51 patients with depression who either received placebo or an active antidepressant medication. An EEG was used to compare brain function in the two experimental groups. The design was double-blind and ran over none weeks. The study used two different SSRI, which were randomly allocated to participants.

Results showed a significant increase in activity in the prefrontal cortex nearly from in the beginning in the trial in the placebo group. The pattern was different from the patients who were treated with the SSRI but patients in both groups got better. This indicates that medication is effective, but placebo is just as effective. The findings from the study are intriguing. The difference in activity in the brain indicates that the brain is perhaps able to heal itself since there was a positive effect for both groups. Believing that they are being treated could be enough for many patients.

These concise and informative key paragraphs above, if reproduced in your IB Psychology exams, will have the examiner ticking all of the knowledge and critical thinking boxes available to her - ensuring you maximum marks!

Remember, we take all of the guess work and all of the hard work out of IB Psychology with our especially prepared model IB Psychology exam answers.

Placebo or real? ... and more importantly, does it even matter?!

The 60 Minutes segment embedded above provides the IB Psychology student with much insight into the role of placebos in medical research and just how much of the effects of antidepressant medications is probably attributable to the placebo effect (not to mention the pharmaceutical industry exploiting this in highly unethical ways).

Author: Derek Burton – Passionate about IB Psychology

Placebos and Nocebos

30/11/2015

Any IB Psychology taking the Abnormal option knows about placebos, do you also know about nocebos?

Placebos are weird (do you know that branded placebos work better than unbranded ones?), nocebos are weirder. Take for example the man who was on a clinical trial for a depression medication. He presented to Accident and Emergency one night after swallowing a whole bottle of the meds he had been prescribed exhibiting all of the signs and symptoms of an overdose of antidepressants. It was serious, he was hyperventilating, his blood pressure plummeted and he collapsed at reception. No trace of the drug could be found in his system and it was only hours later that another doctor arrived and was able to inform everyone that the man was overdosing on sugar pills - he had been assigned to the placebo condition on the clinical trial. His recovery was swift! Welcome to the strange world of the nocebo.

A nocebo (Latin for "I will harm") is something that should be ineffective but which causes symptoms of ill health. A nocebo effect is an ill effect caused by the suggestion or belief that something is harmful. Examples include:

More than two thirds of college students who were told that a nonexistent electrical current passing between two electrodes on their head would cause headaches, subsequently reported a headache.
Japanese researchers tested boys who reported being allergic to a particular plant. One arm of each boy was brushed with the allergenic plant and boys were informed that it was an innocuous plant. Simultaneously, the other arm wa brushed with an innocuous plant and the boys were informed that it was the allergenic plant. Within minutes, the arms brushed with the innocuous plant (which the boys believed they were allergic to) developed rashes and blisters,
In one of the largest and most prestigious longitudinal studies, women who believed that they were at risk of developing heart trouble were up to four times as likely to die of a heart attack then women with matched risk factors, but who didn't believe they were at risk.
Could it also account for those individuals who believe they are wifi sensitive or report that wind turbines, that nobody hear, are causing health problems?; i.e., if you think you are being negatively by something, then your brain makes sure that you are!

Remember, we take the hard work out of IB Psychology - with complete sets of model examination answers!

"Okay Mr Burton, all very interesting I guess, but how do we use it in our IB Psychology exams?", I hear you ask. Well, apart from the fact that that it makes a fascinating topic to explore in the IB Psychology extended essay, it also fits in very well with the IB Psychology Abnormal option in at least three learning outcomes:

Describe symptoms and prevalence of one disorder

Analyse etiologies of one disorder
Examine biomedical, individual and group approaches to treatment.

It could also wow your IB Psychology examiner in your IB Psychology Paper 1 examination - when you are answering the Biological Level of Analysis (BLOA) ERQ: "Using one or more examples, explain effects of neurotransmission on human behaviour." Here, when you discuss the placebo effect in relation to the neurotransmitter serotonin, why not amaze you marker with your knowledge of how the mysterious human brain works and use the nocebo effect as additional support for your argument (just keep it short!).

We could imagine it going something like this: "... Just as the placebo effect is said to account for much of the efficacy of serotonin reuptake inhibitors in many patients, so too could the nocebo effect cause the drug not to work in certain individuals. For example, if a patient prescribed an antidepressant such as Prozac believed that they did not really work and that that they had lots of harmful side effects, then that belief itself, would cause a detriment to the individual - the nocebo effect."

There is no examiner in the history of IB Psychology who wouldn't stop and read those few sentences twice and think to themselves that this student not only knows her stuff, but is a top notch critical thinker too.

Author: Derek Burton – Passionate about IB Psychology

The solution to social anxiety?

31/7/2015

... and a nice way to add some critical thinking to your IB Psychology Abnormal ERQ!

We wouldn't recommend it, but you may find your IB Psychology teacher approaching the Abnormal Psychology option by teaching you about anxiety disorders, rather than affective or eating disorders. Anxiety disorders can be fun to study (e.g., look at these funny phobias) but research and theory can be difficult to discuss in depth and detail. However, IB Psychology students, if you find yourself in a classroom where anxiety disorders are the focus of the Abnormal Option, then we have a great way to incorporate that all important critical thinking into your extended response answers (i.e., that 22 mark essay question you are required to answer in your IB Psychology Paper 2 exam).

Anxiety disorders are the most prevalent of mental disorders in the United States. Social Anxiety Disorder (social phobia) is a subset of anxiety disorders. A whopping 15 million individuals in the US, or 6.8 per cent of the total population suffer from social anxiety. It's equally prevalent between men and women, and individual onset is typically around 13 years of age. Lots of people live with it for a long time before seeking help. 36 per cent of those with social anxiety disorder live with the disorder for over 10 years before seeking help.

What social anxiety feels like

The IB Psychology learning outcomes, which we all know by now are the examination questions, right? (see previous post), in the Abnormal option will ask students to learn and answer the following examination questions:

Examine biomedical, individual and group approaches to treatment.
Evaluate the use of biological, individual and group approaches to the treatment of one disorder.
Discuss the use of eclectic approaches to treatment.
Discuss the relationship between etiology and therapeutic approach in relation to one disorder.

Now we're not going to run you through the model answers to each of these four IB Psychology exam questions here. Our model answers focus on the affective disorders (depression). But we are going to show you how to incorporate that all important critical thinking and craft a perfect response, yourself.

The majority of the content you will need to discuss and evaluate in the treatment of anxiety disorders will be psychotherapy and drugs. You will likely look at cognitive behavioural therapy.

The complete set of model answers to ALL of the IB Psychology ERQs

Of course, you will need to be able to fully discuss and evaluate concepts, theories, models and studies relevant to anxiety treatments. But also, a great way to show the IB Psychology examiner that you are able to engage in and demonstrate your ability to think critically around this topic is to incorporate the study below into your answer.

TRew and Alden (2015)

Unsurprisingly, socially anxious people often avoid social interactions. They will go out of their way to limit their opportunities to engage in social interactions ("Sorry, I'm washing my hair that night, thanks.") and reduce the number of social interactions they engage in, such as the number of people they will interact with at a party they haven't been able to get out of.

These two researchers found that people who were socially anxious were able to mingle more easily with other people in social situations if they busied themselves with acts of kindness. They split their participants into three groups. One group was asked to perform three acts of kindness for two days each week. THis could be mowing a neighbours lawns, giving to charity or cooking dinner for friends. Another was asked to engage in a social interaction three times for days each week. The final group was just asked to record what they had done each day.

I know what you're thinking (and please make it clear to the IB Psychology examiner!), getting people to do acts of kindness forces those with social anxiety to go out there and interact with the people they're performing kind acts for.

TRew and Alden (2015)

Social anxiety PDF

However, these socially anxious participants in the study could perform their acts of kindness - mowing lawns, giving to charity without engaging in any social interactions whatsoever and still experience the same positive effects. In fact, the same positive effects have been found by doing something as simple as feeding coins into the expiring parking meters of strangers.

Traditional cognitive behavioural therapy works by the therapist asking her patient to imagine social situations while practicing mental relaxation techniques, to the point where they no longer feel intimidated by the thought of social interactions. This is then followed by a set of baby steps towards small scale social interaction (asking someone for the time, talking about the weather at the water cooler, etc.) while practicing the same relaxation techniques. Continuing on until the patient is comfortable in larger social situations like an office party or joining a club.

The acts of kindness study shows how cognitive behaviour therapy can be effectively and quickly modified. Social anxiety, by and large, is the result of individuals thinking about themselves too much. When they are in social situations they are monitoring their behaviour and constantly judging themselves as to how they might be being perceived by others they're interacting with. Stressful stuff. The Trew and Alden study shows that the best cognitive therapy is to get them doing nice things for others. This stops them thinking about themselves by forcing them to think of others instead. Once they're thinking about themselves less, they become naturally more relaxed in the presence of others. Boom! everyone's a winner ... the anxiety sufferers, the people receiving these acts of kindness, even you, as you receive full marks for critical thinking in your IB Psychology exam!

Do something nice for someone before you go to your next party

Author: Derek Burton – Passionate about IB Psychology

Don't Panic! - SAQs are Easy

30/6/2014

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Describe one interaction between cognition and physiology in terms of behaviour.
The example used comes from the IB Psychology Abnormal option with regard to anxiety disorders. The sample SAQ should be awarded full marks. However, remember that Paper 2 IB Psychology examination questions will never be asked as SAQs, you only answer one 22 mark ERQ.

One way in which cognition and physiology interact in behaviour has been seen in studies of panic attacks. Clark (1996) argues that panic attacks are the result of a catastrophic misinterpretation of stimuli. When there is an environmental stimulus - for example, a loud noise - the heart may begin to beat faster in response. This is a result of the activation of the sympathetic nervous system, preparing the body for possible fight or flight. When the heart begins to beat faster, the person may then begin to think "why is my heart beating faster?"

Clark's theory is that people whose schema interpret bodily changes as dangerous or "scary," will begin to interpret the increase in heart-rate negatively. This then leads to a further increase in heart-rate, which then increases the concern. This is a positive feedback loop. The physiology affects the cognition and the cognition affects the physiology, resulting in a panic attack.

Telch & Harrington (1992) did a study with a group of university students. Each student was given a written test to see their level of anxiety with regard to health and wellness. All participants took part in two trials. In the first trial, they were asked to breathe room air. In the second trial, they were asked to breathe air with high levels of CO2. The participants were told that the air would make them feel relaxed. In the "room air" group, no one felt aroused, in spite of their score on the anxiety test. However, when asked to breathe in CO2, in the low anxiety group 5% experienced high arousal whereas 52% of the high anxiety group did. In other words, it was the interaction of high anxiety schema and physiological responses to stimuli that lead to the panic response.

panic attack! - It's not pretty

Author: Derek Burton – Passionate about IB Psychology

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Shine a light on me

6/5/2014

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Hate being in the spotlight? Relax, no one is watching.

We are talking anxiety disorders. People with a social phobia tend to fret about being noticed by others. It is not actually being noticed that leads to stress and anxiety, it is the fear of being judged by others that can cause the onset of a panic attack.

The most interesting IB Psychology option available to us is our Abnormal Option (not doing this one? berate your terrible Psychology teacher!). And within Abnormal, we can study anxiety disorders as one of our three groups of disorders: anxiety, affective and eating disorders. Again, a pretty interesting route to explore. For example, I'm sure you are all high achieving IB Psychology students and as such could have a degree of atychiphobia - the fear of failure!

Social phobias are our most prevalent anxiety disorders. Who out there is not just a little bit anxious about getting up on a stage and addressing an audience - having the spotlight shone upon us to be judged? A teacher might just be immune perhaps? ...

Discussing the 'Spotlight Effect'

We tend to vastly overestimate how much attention other people are paying to us. This snippet of a Freakanomics podcast below is an entertaining discussion about the spotlight effect. Honestly, we''re only the centre of our own universes, not everyone elses'.

Psychology in everyday life. One of the things about devoting a rather large proportion of my life to the study and teaching of Psychology is that I'm very much aware of the many, many cognitive biases that we have. Sometimes I find myself in the midst of a particular situation where I'll suddenly think, "hang on! didn't I read a study about this somewhere?"

As if being a teacher doesn't put me out in front of literally hundreds of people each day, the classroom I teach in tends to accentuate the fact I'm up in front of my students, ahem, performing. My classroom used to be the old music room and I have this little stage to teach from, hopping up and down as the lesson dictates; down to students, up to the whiteboard, computer and projector.

Today in class, in front of my lovely, lovely Year 11s I took a dive off my 'stage' . Hilarious! Much, much better than the time I tripped over my laptop chord and brought everything crashing down around me. This was all fine, after a number of near mishaps I had resigned myself to the fact that this was an inevitability. I've been preparing for this for the last two years and as a teacher I'm used to my students laughing at (surely with?) me, so finding myself the sudden and undignified centre of attention wasn't what interested me. I picked myself up, shrugged off the laughter of twenty giggling school girls and went to help answer a student's question, admittedly, a little redder than usual.

What piqued my psychological interest wasn't the glare of unwanted attention from my stage dive, it was the fact that I now had a rather large rip across one knee of my trousers. Which, I might add, I had only just got back from the drycleaners having spent $15. What suddenly gave me pause for thought was this: Am I suddenly in the middle of the Barry Manilow t-shirt experiment?

In Gilovich et al.'s (2000) classic experiment ''Barry Manilow t-shirt experiment', participants were misinformed that they were in an experiment which aimed to examine memory. Memory for details about other people. First, picture this. Assume you are not a 12 year old girl and someone has asked you to put on a t-shirt with a big Justin Bieber face on it, walk through a door and briefly face a room full of complete strangers before exiting the room. The spotlight was on them, they were probably self-conscious enough already and now they had to wear this ridiculous t-shirt in front of a group of peers without being able to explain themselves. Fantastic! You have to love Psychology experiments.

The Spotlight Effect

The original journal article on the spotlight effect on social judgement - Gilovich et al. (2000).

PDF Download Gilovich et al. (2000)

The Justin Bieber of his generation?

The experimenters were interested in comparing two things. Firstly, an estimate from participant as to how many of the other participants would have noticed they were actually wearing an embarrassing Barry Manilow t-shirt. Gilovich wanted to then compare this estimate to the number of observing participants who had actually noticed the t-shirt.

By now, you will be able to take a pretty good stab at the results. Wearing an embarrassing t-shirt made participants very self-conscious, and being self-conscious vastly inflated overestimations of other people being aware of the ridiculous t-shirt. The assumption was that almost all of the observing participants would have noticed. The reality was that when questioned, hardly any of these observing participants could recall the t-shirt when prompted. No one notices the embarrassing stuff. I'll repeat that, because it is enormously liberating ... No. One. Notices. The. Embarrassing. Stuff.

Humans are highly, highly social beings. Evolution has shaped us to be able to think about what other people are thinking about us. This ability to 'read minds' helps us function is social situations. We know it is not OK to eat with our mouths open because other people will think badly of us. We know it is good to make others laugh, we will be socially accepted and more readily able to belong to our ingroups. And we know, for sure, that it is not OK to wear a Justin Bieber t-shirt, because we will be shunned by others if we do. It turns out that we are terrible mind readers, at least in situations where we think we have made fools of ourselves.

Anyway, back to the classroom. Ripped trousers a bit embarrassing, yes. After all, have you ever had the pleasure of being taught by a teacher wearing nice shiny shoes, a crisp shirt (this was only second period), nice tie ... and a massive big rip across the knee of his nice dress trousers? No? I didn't really think so.

However, armed with my Psychology, I knew that, apart from significant numbers of students in my initial stage-diving class, almost no one else I encountered that day would notice that I was dressed like a fool. Knowledge is power, as the saying goes. With this knowledge I was free to roam the corridors, teach my classes and sit down and chat naturally with my colleagues in the teachers' lounge.

Yeah, you might think. First chance I got, I gapped it home to change ...

Every normal person, in fact, is only normal on the average. His ego approximates to that of the psychotic in some part or other and to a greater or lesser extent. - Sigmund Freud

Author: Derek Burton – Passionate about IB Psychology

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Black thoughts, black boxes and black magic

23/4/2014

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Are America's children over-medicated?

In the IB Psychology Abnormal option we examine the effect of various biomedical approaches to the treatment of various psychological disorders. We examine the biomedical approach to the treatment of major depression under the following two learning outcomes:

Examine biomedical, individual and group approaches to treatment.
Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder.

There are different biomedical treatments for depression that could be considered here, for example lobotomies and electroshock (electroconvulsive) therapy, but by far the most widely used biomedical approach to the treatment of major depression is the use of antidepressants. You are probably familiar with the brand names Prozac and Zoloft even if you have never had a sad day in your life. The biological mechanisms behind our most common (and effective) antidepressants seem grounded in sound science.

Serotonin is our brain's 'feel good' neurotransmitter, and by boosting serotonin levels in the brain we should be able to make our depressive patients feel a whole lot better about themselves and life in general. SSRIs, or selective serotonin re-uptake inhibitors, do exactly this, they inhibit the neurotransmitter serotonin from being reabsorbed back into the synapses where it was initially released, thus allowing for a build up of serotonin in the synaptic gap and an increase in activity in serotonergic neurons. What you will find once you dig deep enough is that this is incredibly controversial.

This question of biomedical treatments is examined in-depth in two model answers to the IB Psychology ERQs

And, when we start prescribing these medications to our children in ever increasing numbers you can be sure that serious questions are going to be raised. Consider the list of side effects of one of our most commonly prescribed SSRIs:

The long, long side effects of Prozac list:

anxiety
decreased appetite
decreased sexual ability
decreased sexual drive
diarrhea
dizziness
drowsiness
dry mouth
headache
increased sweating
nausea
nervousness
symptoms of hypoglycemia (low blood sugar), including:
anxiety or nervousness
chills
cold sweats
cool pale skin
difficulty concentrating
drowsiness
excessive hunger
fast heartbeat
headache

shakiness or unsteady walk
unusual tiredness or weakness
tiredness
trouble sleeping
upset stomach
weakness
breast enlargement or pain
difficulty urinating
fast or irregular heartbeat
hallucinations
inability to sit still, or restlessness
missed menstrual periods
allergic reaction (e.g., skin rash, hives, or itching)
bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts)
symptoms of increased pressure in the eyes (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)
talking, feeling, and acting with excitement and activity you cannot control
unusual or incomplete body or facial movements
unusual secretion of milk (women)
convulsions (seizures)
serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
bleeding in the stomach
hyponatremia (low blood sodium), including:
confusion
convulsions (seizures)
increased thirst
lack of energy
serotonin syndrome, including:
diarrhea
fever
increased sweating
mood or behaviour changes
overactive reflexes
racing heartbeat
restlessness
shivering or shaking

ARe America's Children Over-medicated?

The documentary above provides an informative and entertaining look into the world of psychotropic medications being prescribed to children in America.

Is the effectiveness of SSRIs due to the placebo effect? Reviewing the evidence we can conclude that using the most common antidepressant medications, the SSRIs such as Prozac and Zoloft are no more effective than taking a placebo. Moreover, reviewing the list of side effects, taking a placebo may be a whole lot safer!

The biomedical treatment of depression
The biomedical approach to treatment is based on the assumption that if a mental problem is caused by biological malfunctioning, the cure is to restore the biological system with drugs. For example, the serotonin hypothesis of depression suggests that depression is linked to low levels of the neurotransmitter serotonin (Coppen, 1967). Serotonin is a neurotransmitter produced by specific neurons in the brain that are called serotonergic neurons because they produce serotonin. Antidepressant treatment should therefore aim to regulate serotonin levels. Antidepressants are often used in the treatment of bulimia nervosa because many patients also suffer from other disorders such as depression (the problem of comorbidity).

Antidepressants are also used to treat minor depressive symptoms but the American Food and Drug Administration (FDA, 2004) warned that the use of antidepressants for children and adolescents could perhaps lead to an increased risk of suicide. In fact, the FDA adopted a "black box" label warning indicating that antidepressants may increase the risk of suicidal thinking and behaviour in some children and adolescents with major depression at about twice the rate of placebo. A black-box warning is the most serious type of warning in prescription drug labelling.

Selective serotonin reuptake inhibitors (SSRIs)

Figure 1: SSRIs increase serotonin levels in the synaptic gap

Antidepressants in the form of selective serotonin reuptake inhibitors (SSRI) block the reuptake process for serotonin This results in an increased amount of the serotonin in the synaptic gap (see figure 1). The theory is that this increases serotonergic nerve activity leading to an improvement in mood. Essentially, the only evidence that exists in favour of the serotonin hypothesis is the alleged efficacy of SSRIs – if they make your serotonin more potent and this improves your condition, the problem must have been in your serotonin levels to begin with, or so the logic goes. According to Lacoste & Leo (2005) this is an example of backward reasoning. Assumptions about the causes of depression are based on how people respond to a treatment and this is logically problematic. For example, the symptoms of headaches can be treated by aspirin, but this is definitely not to say that the cause of headaches is a deficiency of aspirin.

SSRI drugs such as Prozac, Zoloft and Paxil are now amongst the most commonly prescribed antidepressants and this has been taken as indirect support for the serotonin hypothesis. They do affect mood and emotional responses positively in most people (although much of this may be due to the placebo effect; Kirsch et al., 2008). SSRIS have been criticised because they treat the symptoms of depression but do not cure the mental disorder, and because depressive episodes usually recur, it is necessary for patients to continue taking the medication. Unless the medication is used with therapy, it is unlikely that the disorder will disappear permanently.

However, SSRIs are popular because they have fewer side effects than previous drugs such as tricyclic antidepressants. Not everyone can use SSRIs and the most common side effects are headache, nausea, sleeplessness, agitation and sexual problems.

Neale et al. (2011) conducted a meta-analysis of published studies on the outcome of antidepressants versus placebo. The study focussed on:
(i) patients who started with antidepressants and then changed to placebo,
(ii) patients who only received placebo, and
(iii) patients who only took antidepressants. The study found that patients who do not take antidepressants have a 25% risk of relapse, compared to 42% or higher for those who have been on medication and then stopped it.

According to the researchers, antidepressants may interfere with the brain’s self-regulation. They argue that drugs affecting serotonin or other neurotransmitters may increase the risk of relapse. The drugs reduce symptoms in the short-term but, when people stop taking the drug, depression may return because the brain’s natural self-regulation is disturbed.

Ingeniously, Henninger et al. (1996) performed experiments where they reduced serotonin levels in healthy individuals to see if they would develop depressive symptoms. The results did not support that levels of serotonin could influence depression; i.e., there was no evidence for a cause-effect relationship, and they argued that it was necessary to revise the serotonin hypothesis. This is strong evidence against the hypothesis because if low levels of serotonin do cause depression and they were successful in reducing serotonin levels in their participants (and the evidence presented suggests that this was the case), then this can be considered strong evidence against the serotonin-depression hypothesis. However, there has been debate around just how depression was monitored in this study.

Leauhter et al. (2002) examined changes in brain function during treatment with placebo. The study examined brain function in 51 patients with depression who either received placebo or an active antidepressant medication. An EEG was used to compare brain function in the two experimental groups. The design was double-blind and ran over none weeks. The study used two different SSRI, which were randomly allocated to participants.

Results showed a significant increase in activity in the prefrontal cortex nearly from in the beginning in the trial in the placebo group. The pattern was different from the patients who were treated with the SSRI but patients in both groups got better. This indicates that medication is effective, but placebo is just as effective. The findings from the study are intriguing. The difference in activity in the brain indicates that the brain is perhaps able to heal itself since there was a positive effect for both groups. Believing that they are being treated could be enough for many patients.

Kirsch et al. (2002) found that there was a publication bias in research into the effectiveness of SSRI in depression. In fact, if the results of all studies (including the ones that had not been published) were pooled together it would seem that the placebo effect accounted for 80% of the antidepressant response. A placebo is a substance that has no therapeutic effect, and is used as a control in testing new drugs. Of the studies funded by pharmaceutical companies, 57% failed to show a statistically significant difference between antidepressant and a neutral placebo. This and similar studies cast doubt on the serotonin hypothesis, not to mention the ethics of drug companies. However, it is still widely promoted by pharmaceutical companies and presumably believed by the 10% of Americans taking these SSRIs to treat depression.

In sum, when evaluating the evidence for the biomedical approach to the treatment of major depression we can conclude that SSRIs may reduce depressive symptoms but they have side effects and do not cure patients. It is likely that the placebo effect could account for the effectiveness of the medication. Further, because the mechanisms are not well understood not how antidepressants affect the brain in the long-term, it is possible that the heavy use of these could well be damaging. There is also increasing criticism of the role of pharmaceutical companies and their marketing of antidepressants, which has led to an increase in the prescription of SSRI.

So parents, your kid is acting a little bit moody, disinterested and disengaged from her surrounds, should you be pushing your GP for some Prozac?

Have a read of the side effects of antidepressants in children and adolescents in the journal article below.

Black Magic - The Placebo Effect

Antidepressants are placebos

Black box warnings

side effects of SSRIs on children

If your answer to the above question was a resounding "No way!", based on the evidence that that they aren't effective, then you may have added reason to pat yourself on the back ... the FDA has also issued a 'black box' warning on all SSRI antidepressants. They found and believed it was in the public interest that those taking SSRIs be warned that there is an increased risk of suicidal thoughts or behavior (suicidality) in children and adolescents treated with SSRI antidepressant medications.

The black box warning, a type of warning issued by the FDA that must appear on the packaging of certain prescription drugs. The U.S. Food and Drug Administration (FDA) has required all pharmaceutical companies to place a boxed warning on the labeling of prescription antidepressants, or in literature describing it. It is the strongest warning that the FDA requires, and signifies that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects.

In this instance, the FDA believes that already depressed children are more likely to commit suicide because taking these medications leads to the idea of suicide becoming more salient.

Consequently, prescriptions issued for antidepresants have fallen by over 20 per cent in the US.

Now, this may seem a good thing in light of all of the evidence presented here. But consider this: during this time, child and adolescent suicides in the US jumped by 11 per cent! So, I'll leave you with this final thought ... should we now be prescribing a nice, safe placebo instead for a mental illness that has very real consequences for the sufferer?

Author: Derek Burton – Passionate about IB Psychology

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Abnormality is in the eye of the beholder

14/4/2014

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Another ERQ model answer from IB Psychology

Abnormal psychology is based upon the assumption that we know what 'abnormal' is, which in turn, is based upon us knowing what 'normal' is. So, how exactly do we make these judgments?

You're hanging out a LOT in your dark, smelly and incredibly messy bedroom, not talking to family and only interacting with your friends online. Teachers are concerned about you, your family is worried sick. Do you have some sort of social anxiety disorder? Surely this is a manifestation of a mental illness? ... but hang on! Isn't this just 'normal' teenage behaviour?

Have you ever wondered just how easily you could be confined to a mental hospital if say, your parents, didn't like the way you were behaving? If their concepts of normality and abnormality differed from yours? The answer is, probably pretty easily, but not as easily as in the past, and more easily in some countries than in others. Thus, we need some some sort of objective definition or classification of what abnormal behaviour actually is, and how we can make a judgement as to whether someone has a mental illness or not.

The IB Psychology learning outcome: Examine concepts of normality and abnormality, takes a very good look at this thought-provoking issue.

Much of what we examine in the model ERQ answer focuses on Rosenhan's seminal research. Rosenhan (1973) performed some ground-breaking research with his quasi-experimental study. Here, he and his fellow researchers managed to gain admittance to a variety of psychiatric hospitals around the US after presenting themselves and claiming that a voice in their head was saying "empty", "hollow" and "thud". They found that getting committed was very easy, and getting out was very, very hard ...

short videos examining concepts of mental illness and abnormality

Just Give Me the Answers! provides you with the complete collection of model answers for all extended response questions in the Paper 1 and 2 IB Psychology exams. This will save you hundreds of hours of work!

Rosenhan's 1973 original article
This article, published in the very prestigious 'Science' journal caused a great deal of controversy and forced the Psychiatric industry to examine their understand of, and practices and procedures around the 'mentally ill'. It changed the way we diagnose and assess degrees of mental illness.

Examine concepts of normality and abnormality

Another exemplar model ERQ answer for the IB Psychology course. This one is from the Abnormal option and if the student manages to replicate in their IB Psychology exams they are guaranteed to be awarded the full possible 22/22 marks.

Examine concepts of normality and abnormality

The presence of a mental disorder may be considered a deviation from mental health norms and hence the study of mental disorders is often known as abnormal psychology. ‘Normal’ and ‘abnormal’, as applied to human behaviour, are relative terms. Many people use these classifications subjectively and carelessly, often in a judgmental manner, to suggest good or bad behaviour. As defined in the dictionary, their accurate use would seem easy enough: ‘normal’ – conforming to a typical pattern and ‘abnormal’ – deviating from a norm. The trouble lies in the word norm. Whose norm? For what age person? At what period of history? In which culture?

The definition of the word abnormal is simple enough but applying this to psychology poses a complex problem. The concept of abnormality is imprecise and difficult to define. Examples of abnormality can take many different forms and involve different features, so that, what at first sight seem quite reasonable definitions, turns out to be quite problematical. There are several different ways in which it is possible to define ‘abnormal’ as opposed to our ideas of what is ‘normal’

Defining normality

Mental health model of normality (Jahoda, 1958)

The model suggests criteria for what might constitute normal psychological health (in contrast to abnormal psychological health). Deviation from these criteria would mean that the health of an individual is ‘abnormal’:

The absence of mental illness
Realistic self-perception and contact with reality
A strong sense of identity and positive self-esteem
Autonomy and independence
Ability to maintain healthy interpersonal relationships (e.g., capacity to love)
Ability to cope with stressful situations
Capacity for personal growth and self-actualisation

Evaluation of the mental health model of normality

The majority of people would be categorised as ‘abnormal’ if the criteria were applied to them. It is relatively easy to establish criteria for what constitutes ‘physical health’ but it is impossible to establish and agree on what constitutes ‘psychological health’. According to Szasz (1962) psychological normality and abnormality are culturally defined concepts, which are not based on objective criteria.

Taylor & Brown (1988) argue that the view that a psychologically healthy person is one that maintains close contact with reality is not in line with research findings. People generally have positive ‘illusions’ about themselves and they rate themselves more positively than others (Lewinshohn et al., 1980). For example most people rate themselves as being above average in driving ability, and above average in physical appearance, both of which are a statistical nonsense when considering the essential nature of an average.

Further, the criteria in the model are culturally biased value judgements; i.e., they reflect an idealised perception of what it means to be human in a Western culture. For example, self-actualisation (Maslow, 1968) means the achievement of one's full potential through creativity, independence, spontaneity, and a grasp of the real world. The concept of self-actualisation to a South Sudanese in the middle of sectarian strife, war and famine would be nonsensical at that point in time.

Defining abnormality

The mental illness criterion (the medical model)

The mental illness criterion sees psychological disorders (abnormality) as psychopathology. Pathology means ‘illness’ so it literally means ‘illness in the psyche’. The criterion is linked to psychiatry, which is a branch of medicine, specifically, a branch of medicine that deals with the diagnosis, treatment, and prevention of mental and emotional disorders. Patients with psychological problems are seen as ‘ill’ in the same way as those who suffer from physiological illnesses.

Diagnosis of mental illness is based on the clinician’s (clinical psychologist, psychiatrist) observations, the patient’s self-reports and diagnostic manuals (classification systems) that classify symptoms of specific disorders to help doctors find a correct diagnosis. The most widely used classification system is the new DSM-5, which is the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders. In the United States the DSM serves as a universal authority for the diagnosis of psychiatric disorders. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications.

Being diagnosed or labelled as being abnormal – mentally ill can have striking consequences in this model, as a controversial study designed to test the medical model and its conception of normality and abnormality.

Rosenhahn (1973) – on being sane in insane places

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 eight participants consisting of five men and three women (including Rosenhahn himself). Their task was to follow the same instructions and present themselves at 12 psychiatric hospitals in the US. These pseudo-patients telephoned the hospital for an appointment, and arrived at the admissions office complaining that they had been hearing voices. They said the voice, which was unfamiliar and the same sex as themselves, was often unclear but it said “empty”, “hollow”, “thud”.

After they had been admitted to the psychiatric ward, the pseudo patients stopped simulating any symptoms of abnormality. The pseudo patients took part in ward activities, speaking to patients and staff as they might ordinarily. When asked how they were feeling by staff they said they were fine and no longer experienced symptoms. Each pseudo patient had been told they would have to get out by their own devices by convincing staff they were sane.

Results and conclusion: All participants were admitted to various psychiatric wards and all but one were diagnosed with schizophrenia (the other diagnosis was for manic depression). All pseudo-patients behaved normally while they were hospitalised because they were told 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 and 52 days before the participants were released. They came out with a diagnosis (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 as impostors 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.

Rosenhahn claims that the study demonstrates that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane. The main experiment illustrated a failure to detect sanity, and the secondary study demonstrated a failure to detect insanity. Rosenhahn explains that psychiatric labels tend to stick in a way that medical labels do not and that everything a patient does is interpreted in accordance with the diagnostic label once it has been applied.

Evaluation: This controversial study was conducted nearly 40 years ago but it had an enormous impact on psychiatry. It sparked off a discussion and revision of diagnostic procedures as well as discussion of the consequences of diagnosis for patients. The development of diagnostic manuals (e.g., DSM-V) has increased the validity and reliability of diagnosis of what is abnormal or normal in terms of mental health, although diagnostic tools are not without flaws.

The method used raises ethical issues (the staff were not told about the research) but it was justified since the results provided evidence of problems in the diagnosis of mental illness (i.e., being non-beneficially abnormal) which could benefit others. There were serious ethical issues with the follow-up study since the staff thought that imposters would present, but they were real patients and may not have had the treatment they needed.

Evaluation of the mental illness criterion

Proponents of the mental illness criterion argue that it is an advantage to be diagnosed as ‘sick’ because it shows that people are not responsible for their acts. For example, an individual who does not get out of bed because they have been diagnosed for depression; i.e., labelled as being ‘depressed’ and not because they are fatigued (a symptom).

Although the origin of some mental disorders (e.g., Alzheimer’s disease) can be linked to physiological changes in the brain, most psychological disorders cannot. Also, critics of the mental illness criterion argue that there is a stigma (i.e., a mark of infamy or disgrace) associated with mental illness.

Abnormality as statistical deviation from the norm

Deviance in this criterion is related to the statistical average. The definition implies that statistically common behaviour can be classified as ‘normal’. Behaviour that is deviant from the norm is consequently ‘abnormal’. In the normal distribution curve most behaviour falls in the middle. A normal distribution curve is a theoretical frequency distribution for a set of variable data (e.g., scores on an IQ test), usually represented by a bell-shaped curve symmetrical about the mean.

An individual with an intelligence quotient (IQ) of 150 is a deviation from the norm of 100. It is statistically rare but it is considered desirable to have high intelligence. Mental retardation seen as an abnormality in the other direction (sometimes defined as having an IQ below 70) but this is considered undesirable. Obesity is becoming statistically ‘normal’ but obesity is considered undesirable.

Evaluation of the statistical criterion

The use of statistical frequency and deviation from the statistical norm is not a reliable criterion to define abnormal behaviour since what is ‘abnormal’ in a statistical sense may both be desirable and undesirable. What may be considered abnormal behaviour can differ from one culture to another so it is therefore impossible to establish universal standards for statistical abnormality. The model of statistical deviation from the norm always relates to a specific culture.

Abnormality as deviation from social norms

Social norms constitute informal or formal rules of how individuals are expected to behave. Deviant behaviour is behaviour that is considered undesirable or anti-social by the majority of people in a given society. Individuals who break rules of conduct or do not behave like the majority are defined as ‘abnormal’ according to this criterion.

Social, cultural and historical factors may play a role in what is seen as ‘normal’ or ‘abnormal’ within a certain society. For example, around the 1900s in the UK, homosexuality was seen as abnormal and people could be imprisoned or forcibly treated for this ‘mental illness’. Homosexuality was classified as an abnormal sexual deviation in the DSM-II (1968). In later revisions of the manual, homosexuality in itself was not seen as abnormal – only feeling distressed about it was.

Evaluation of the deviation from statistical norms criterion

This criterion is not objective or stable since it is related to socially based definitions that change across time and culture. Further, because the norm is based on morals and attitudes it is vulnerable to abuse. For example, political dissidents could be considered ‘abnormal’ and sent to hospitals for treatment, which was something that occurred in the former Soviet Union. Using this criterion could lead to discrimination against minorities, including people who suffer from psychological disorders.

Psychological disorders may be defined and diagnosed in different ways across cultures and what seems to be a psychological disorder in one culture may not be seen the same way in another culture. The DSM includes disorders called ‘culture-bound syndromes’; for example, penis panic (!) or Koro. This indicates that it is impossible to set universal standards for classifying a behaviour as abnormal.

General conclusion

None of the above definitions provide a complete definition of abnormality. Mental health (e.g., Jahoda) and mental illness (i.e., the medical model) are probably two-sides of the same coin, but do provide insights of their own. Examining these concepts through statistical deviations from norms does not tell us about the desirability of the deviation. Attempting to define abnormality is in itself a culturally specific task. What seems abnormal in one culture may be seen as perfectly normal in another, and hence it is difficult to define abnormality.

Word count: 2 000

Author: Derek Burton – Passionate about IB Psychology

Model IB Psychology ERQ Answer

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Black box warnings

side effects of SSRIs on children

Abnormality is in the eye of the beholder

short videos examining concepts of mental illness and abnormality

Examine concepts of normality and abnormality

IB DipLOMA PsychologY:

Archives

Categories

Paper 2 exam questions

Abnormal Learning outcomes

FRom 13 → 6 Learning Outcomes!

WELCOME to the STRANGE world of the placebo

TRew and Alden (2015)

TRew and Alden (2015)

panic attack! - It's not pretty

The Spotlight Effect

ARe America's Children Over-medicated?

Black Magic - The Placebo Effect

Antidepressants are placebos

Black box warnings

side effects of SSRIs on children

short videos examining concepts of mental illness and abnormality

Examine concepts of normality and abnormality

IB DipLOMA Psycho﻿logY:

Archives

Categories

IB DipLOMA PsychologY: