Thinking hats: What are the key assumptions of each approach? What are the benefits of each approach? What are the weaknesses of each approach? This is basically what you did for your exit task, last lesson so we will skip it. What applications, in terms of therapy, could each approach have? Management role: walk round and chat to people (about their Q!) 7 mins

Biological Therapies Biological therapies generally include the administering of medication. This is controversial. Why do you think that is?

Drugs are the most common form of biological therapy and are often the first thing administered to patients The assumption is that there is an underlying biological cause for abnormal behaviour This could be due to brain structure, genetics or hormones What might the positive side of this be? Rapid treatment, quick and cheap to administer, can put the patient in a better position to respond to therapy What might be the negative? Medicalising emotions, ‘quick fix’, doesn’t tackle the cause (masks the problem), don’t work for everyone, side effects.

Phenelzine Actually a form of antidepressant MOAI – monoamine oxidase inhibitor Based on the theory that depression is caused by a deficit of neurotransmitters called monoamines Prevents the breakdown of monoamines therefore increasing their availability Has quite a few side effects, generally used when other medicines have not been effective There is now a new generation of MOAIs with fewer side effects

Leibowitz (1988): Treatment of Social Phobia with Phenelzine Potential pitfalls?

Biological treatment Key study: Leibowitz (1988) Aim To see if the drug phenelzine can help treat patients with social phobia. To see if phenelzine is more effective than a placebo and atenolol in treating social phobia. Why use a placebo group?

Method A controlled experiment where patients were allocated to one of three conditions, and treated over 8 weeks. They were assessed for social phobia on several tests such as: The Hamilton Rating Scale for Anxiety Leibowitz Social Phobia Scale. This had common manifestations of social phobia and patients rated 1-4 for the fear produced and 1-4 for the steps taken to avoid the phobic situation.

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

Design An independent design with patients being allocated randomly to one of four groups: one group was treated with phenelzine one group was given a matching placebo a second treatment group was given atenolol another group was given a matching placebo.

Procedure Patients were assessed at the beginning, and then given their drug or placebo, with gradual increases in dosage of phenelzine or atenolol in the treatment groups. Each patient was then reassessed. Independent evaluators were used to carry out clinical assessments in a double blind situation.

Findings After eight weeks significant differences were noted for the phenelzine groups, with better scores on the tests for anxiety compared to the placebo groups. There was no significant difference between the patients taking atenolol and those taking a placebo. Conclusions Phenelzine but not atenolol is effective in treating social phobia after eight weeks of treatment.

Plenary On your pass: Outline 2 advantages to drug therapy 2 disadvantages Extension: Suggest a solution

Activity: Evaluate the Leibowitz study Pair 1 Sample, generalisability, ethics Pair 2- reliability, methodology Pair 3 – usefulness, validity Pair 4 – nature/nurture, reductionism/holism, 12 mins

Evaluation of Liebowitz Method Controls – inc. placebo group and 2 comparison groups Controlled IV – could measure cause and effect Scale used – quantitative data – comparable Issues with this: could be misinterpreted, may still be subjective i.e. what constitutes a ‘5’ on the scale? – validity and reliability

Design Independent design Necessary in order to establish cause and effect in this case Random allocation – no bias in sample, everyone had an equal chance of being allocated to each group

Sample Wide age range – generalisable across age ranges Medically healthy and had not had phenelzine for 2 weeks before – control of possible confounding variables

Data collection Likert scale – 1 to 5 rating system Used a scale that is commonly used in psychiatry Used to different scales – one psychiatrists report and the other self-report (validity) Independent evaluators, double blind – no experimenter bias

Reliability Standardised procedure – easily replicable Good controls – clear IV (i.e. which group they were placed in) so effect on DV could be measured

Validity Independent evaluators – double-blind, did not know what the study was about so could not be responding to demand characteristics Participants were going about their daily lives – it was longitudinal so presumably the results are ecologically valid Two different types of scale LSPS (self-report, patients subejctive experience) plus assessed with Hamilton Rating Scale. If the results are in agreement, it suggests they are both measuring what they are supposed to measure.

Bias Could be some bias in interpreting the rating scales, particularly initially However, the patients were independently evaluated in a double-blind procedure and therefore they could not be subject to demand characteristics The above were not the researchers so no experimenter bias

Ethics Consent given One group given a placebo – is this ethical? They may not receive the benefits of the treatment Wider benefits for society if an effective treatment for social phobia is evidenced

Reductionistit is, it assumes that social phobia can be treated with drugs alone and does not take into account the reasons behind the social phobia However, patients who took phenelzine showed greater improvement, so in some ways this is actually a strength as it led to improved recovery. DeterministDeterminist – it takes control out of the hands of the patient and places it with the psychiatrist and medical staff Ethnocentric N vs NNature Vs Nurture – supports the role of biological factors in social anxiety. Doesn’t take into account the environmental triggers.

Homework McGrath (1990) Successful Treatment of a Noise Phobia Research the aims, procedure, findings and conclusions Evaluate and add notes to your booklet. Extension: find additional research to support the study For next the lesson.