Psychological Problems PDF

# Specification for Psychological Problems ## What Students Need to Learn: * **Understand the two mental health problems unipolar depression and addiction, including:** * Symptoms and features according to the International Classification of Diseases (ICD) of: * **Depression:**...

# Specification for Psychological Problems ## What Students Need to Learn: * **Understand the two mental health problems unipolar depression and addiction, including:** * Symptoms and features according to the International Classification of Diseases (ICD) of: * **Depression:** * **Addiction:** * **How the incidence of mental health problems changes over time.** * **How mental health problems affect individuals and society.** * **The influence of genes as an explanation, including strengths and weaknesses of each explanation:** * **Depression:** * **Addiction:** * **The use of cognitive theory as an explanation of depression, including strengths and weaknesses of the explanation.** * **The use of learning theory as an explanation of addiction, including strengths and weaknesses of the explanation.** * **The use of cognitive behavioural therapy (CBT) as a treatment, including strengths and weaknesses of each therapy:** * **Depression:** * **Addiction:** * **The use of drugs as a treatment, including strengths and weaknesses of each treatment:** * **Depression:** * **Addiction:** * **Studies:** Understand the aims, procedures, and findings (results and conclusions), strengths and weaknesses of the following studies: * **Depression:** * Caspi et al. (2003) Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene * **Addiction:** * Young (2007) Cognitive Behaviour Therapy with Internet Addicts: Treatment Outcomes and Implications * **Issues And Debates:** * Understand the nature and nurture debate, including: * The term 'nature' * The term 'nurture' * The use of content, theories, and research drawn from psychological problems to explain the nature and nurture debate ## Key Terms | **Term** | **Definition** | |---|---| | Diathesis-stress model | An explanation for depression that claims people can have a gene that makes them more likely to develop depression, but only if they face a stressful situation that triggers depressive thoughts. | | Dizygotic twins | Twins developed from two different eggs fertilised during the same pregnancy; dizygotic twins are not genetically identical. | | Genetic predisposition | Biological tendency to develop a particular behaviour as a result of the genes someone has. | | Monozygotic twins | Twins developed from one fertilised egg that has split into two; monozygotic twins are genetically identical. | | Noradrenaline | A type of neurotransmitter that is involved in mood and is released during times of stress. | | Serotonin | A neurotransmitter associated with controlling mood. | | Unipolar depression | A type of mood disorder causing periods of feeling sad and lacking motivation to do everyday activities. | | Cognitive behavioural therapy (CBT) | A therapy for mental health disorders that aims to change thought processes in order to reduce symptoms. | | Cognitive theory | An explanation that focuses on how thought processes influence behaviour | | Functional analysis | The first stage of CBT to treat addiction that identifies triggers | | Skills training | The second stage of CBT to treat addiction whereby addicts learn ways to control the patterns of behaviour that lead to their addiction | | Addiction | A mental health problem that means people need a particular thing - a substance or an activity - in order to be able to go about their normal routine. | | Detoxification | When an addict tries to stop taking the substance they are addicted to. | | Genetic predisposition | A biological tendency to develop a particular behaviour as a result of the genes someone has. | | Relapse | A return of symptoms after treatment has been given. | | Withdrawal | A set of unpleasant physical or psychological symptoms someone gets when they are trying to quit or cannot satisfy their addiction. | | Classical conditioning | Learning by associations | | Learning theory | An explanation that believes behaviour is learned through associations and experiences. | | Likert-type scale | A scale where a person can rate their level of agreement to a statement. | | Operant conditioning | Learning from the consequences of actions. | | Positive punishment | Receiving something unpleasant for a behaviour, so we do not do it again. | | Positive reinforcement | Receiving something pleasant for a behaviour, so we repeat it. | | Questionnaires | A self-report technique designed to ask lots of people questions about a topic | | Social learning theory | Behaviour is learned through the observation and imitation of role models. | ## **Unipolar Depression** **Unipolar depression:** A type of mood disorder causing periods of feeling sad and lacking motivation to do everyday activities. * It is called 'unipolar' because it refers to someone's mood being pulled in one (uni) direction. It is different to 'bipolar' depressions where patients have 'mood swings'. **Symptoms of Unipolar Depression:** - according to the International Classification of Diseases (ICD) there are several symptoms that can be present in a patient and are classed as mild, moderate or severe. Some are * Feelings of suicide or attempting to commit suicide * Difficulty sleeping and extreme tiredness * Poor appetite or an increase in normal appetite * Lack of self-esteem and not enjoying activities they used to * Feelings of guilt or blaming themselves **The main symptoms of unipolar depression are:** 1. Lowering of mood - feeling sad/upset 2. Lack of energy 3. Lack of motivation * 1 in 15 people will suffer from depression every year and unipolar depression will effect twice as more females than males. | **Episode** | **Symptoms** | **Features** | |---|---|---| | **Mild** | 4 symptoms from above displayed | Patients will find symptoms upsetting but will continue day to day activities | | **Moderate** | 5/6 symptoms from above displayed | Serious problems doing day to day activities, such as going to work or school | | **Severe** | 7 or more symptoms from above, plus feelings of worthlessness | A patient may have suicidal thoughts or engage in self-harm to cope with feelings. | ## **Incidences of Depression Over Time** * In the 1980's people were 10 times more likely to be diagnosed with depression than they were in 1940. * A report by The King's Fund estimate that by 2026, 1.45 million people will be diagnosed with mental health in England, compared to 1.24 million in 2007. Teenagers and young adults are one age group where there has been a large increase in diagnosis. * Reasons for this increase over time include more awareness of the symptoms, modern living (sleep deprivation and poor diet), increased social isolation and high levels of social media usage. ## **Depression - The Effects on Individuals and Society** | **Group** | **Effects** | |---|---| | **Individuals** | One major effect is the increase risk of suicide. Unipolar depression creates feelings of worthlessness and sadness and make people feel like they need a 'way out'. 10-15% of patients with severe depression will commit suicide. | | **Workplace** | One major impact is the amount of time missed from work by patients. In 2014-15 9.9 million days of work was missed because of stress, anxiety or depression associated with work. This creates cost implications for the employers as they have to cover their workload. | | **Society** | Treatment - Most people that are diagnosed with depression require treatment. Anti-depressant are prescribed but can be expensive. Alternative treatments, such as counselling, is also available but this costs money to train therapists and have them available. In 2007, treatment cost the NHS £1.7 billion for that one year. This takes puts a strain on the other services that NHS provide | ## **BIOLOGICAL - Genetic Explanation of Unipolar Depression** * Evidence suggests that if someone in your family has been diagnosed with unipolar depression then there is a higher risk that you will be diagnosed too. This suggests unipolar depression is inherited through family genes. * However, there are 17 different gene variations linked to developing depression, which means identifying people at risk from developing depression is quite a challenge. ### 1. **Twin Studies** * Monozygotic twins (identical) share 100% the same genes while dizygotic twins (non-identical) share only 50% the same genes. * A study by McGuffin found that if one monozygotic twin became depressed, there was a 46% chance that their co-twin would develop depression too. However, if a dizygotic twin became depressed, there was only a 20% chance the other twin would go on to develop it. * This study supports the genetic explanation for depression. ### 2. **Genetic Predisposition** * A biological tendency to develop a behaviour as a result of the genes someone has * Not all family members related to someone with depression will become depressed themselves. Some people may have a gene that increases their risk but they will need a 'trigger' from the environment, such as a stressful situation, in order for the gene to become 'active' and effect their mood. This is known as the diathesis-stress model. * **Diathesis-stress model:** An explanation for depression that claims people can have a gene that makes them more likely to develop depression, but only if they face a stressful situation that triggers depressive thoughts. ## **Genetic Predisposition - Key supporting study (Caspi 2003)** * **Aim:** To investigate why stressful life events seem to lead to depression in some people but not others and whether stressful events were more likely to lead to depression in people with a certain variation of 5-HTT gene. * **Sample:** 847 people, who were part of a Multidisciplinary Health and Development study, were studied from birth to young adulthood. * **Procedure:** * Longitudinal study * Participants were divided into 3 groups based on the version of the 5-HTT gene they have * Group 1 2x short version, * Group 2 1x short 1x long version * Group 3 2x long version) * Participants then completed 2 questionnaires, 1) based on life events such as problems with money, health or relationships and 2) to assess whether they have had symptoms of depression before * The researcher then collated a 'depression score' based on their answers * **Results:** * Participants with the short version of the 5-HTT gene and had experienced a stressful event were more likely to be diagnosed with depression than those with the long version of the gene. * Participants with 2x short versions of 5-HTT gene and has gone through a number of stressful events, were most likely to report severe depressive symptoms and develop suicidal thoughts. * **Conclusion:** The evidence suggests that there is an interaction between life events and genetic influences causing depression. A person needs both a specific gene and stressful life event in order to become depressed. ## **Strengths of the study:** * **High external validity:** 847 participants were used which is a large, representative sample so the results can be generalised to the target population. * **The results will be beneficial to doctors:** as it tells them that someone with depression could have different causes for their symptoms. ## **Weaknesses of the study:** * **Results collected from questionnaires are not always reliable:** as people give socially desirable answers. They may exaggerate their symptoms or 'play them down' to not make a big deal. * **Participant differences:** some people are naturally more likely to put themselves in situations where stressful events happen. Therefore the gene and life events may not cause depression but the more stressful situations you are in causes the depression. ## **Evaluations of the BIOLOGICAL Genetic Explanation of Unipolar Depression** ### **Strengths of the explanation:** * **If depression can be explained by the genes we inherit, it might take away the feelings of 'fault and guilt' and remove the stigma associated with depression.** It means society might be more accepting of mental health disorders. * **Lots of research, such as Caspi, support the idea that some people are more prone to depression than others and that genes play a significant role in developing depression.** ### **Weaknesses of the explanation:** * **The genetic explanation is very deterministic:** because it assumes that if you have certain genes you will become depressed, whereas other people believe you have free-will and choose whether you 'let yourself' become depressed. * **The genetic explanation is reductionist:** because it fails to take into account other factors that can explain why someone is depressed, i.e. a death of a family member or losing a job. It is too simplistic to assume it is just an 'abnormal gene' that causes depression. ## **BIOLOGICAL Treatment for Depression** ### **Drug Therapy:** * Antidepressant drugs will be used to treat patients suffering with moderate or severe depression. The antidepressant drugs work by raising the levels of neurotransmitters, such as serotonin and noradrenaline, which play a role in controlling our mood. The drugs increase the amount of neurotransmitters or help to make them last longer. ### **Types of Antidepressants:** * Drugs that treat depression don't work in the same way and will be different for different people. | **Antidepressant** | **How They Work** | |---|---| | Selective serotonin reuptake inhibitors (SSRIs) | These are the most commonly prescribed antidepressants in the UK. They block the reuptake of serotonin which means the serotonin is available for longer and increases the levels of it in the brain. This will improve the person's mood. | | Serotonin and noradrenaline reuptake inhibitors (SNRIS) | Similar effect to SSRIs but these block the reuptake of both serotonin and noradrenaline. This increases the levels of them in the brain and makes them available for longer, which improves mood. | | Monoamine oxidase inhibitors (MAOIS) | These prevent monoamine oxidase from doing its job! Monoamine oxidase breaks down the neurotransmitter serotonin and noradrenaline after they have been released but these drugs prevent monoamine oxidase from doing this. This means there is more of the neurotransmitters available, which improves their mood. | | Tricyclics (TCAS) | These are the oldest drugs still available. They work by boosting the effect of serotonin and noradrenaline in the brain by preventing the reabsorption of theses neurotransmitters into the neuron. This means they have longer to act on the brain, so improves mood for longer. | * **Serotonin and Noradrenaline are types of neurotransmitters that are involved in mood and are released during times of stress.** ## **Evaluations of Drug Therapy Treatment for Unipolar Depression** ### **Strengths of the treatment:** * **The antidepressants improve a patient's symptoms enough to make it easier for them to access other psychological therapies.** Their mood will improve which should improve their motivation. * **65% of patients with moderate to severe symptoms of depression show improvements, compared to only 25% of patients with similar symptoms who were given a placebo (fake pill).** ### **Weaknesses of the treatment:** * **Drugs can have very negative side effects.** They can make patients feel drowsy, nauseous, dizzy, disturb sleep pattern and more seriously, can cause diabetes and increase suicidal feelings. * **Drugs only treat the symptoms not the cause of depression.** Patients are more likely to relapse after the treatment. ## **COGNITIVE Explanation of Unipolar Depression** **Beck's Cognitive Triad** * **Beck thought that depression could be explained by 3 negative thought patterns that people may develop about world, oneself and the future (WOF).** These are examples of cognitive biases where things are viewed negatively, for example they see themselves in a negative way, think the world is generally a bad place and think the future is bleak. **Negative Views About:** * **The World:** *"Everybody hates me because I am worthless"* * **Oneself:** *"I am worthless"* * **The Future:** *"I'll never be good at anything because everyone hates me"* * **Beck felt that this negative triad develops from bad experiences in someone's past. **Once they have a negative way of thinking, they are more likely to perceive things in that way. This leads to a negative self-schema where a person's whole belief system is covered in negativity and they are prone to magnification. * **Magnification:** A form of cognitive bias that makes people see their problems as far worse and bigger than they actually are. * **Beck believed that if a person has all 3 types of negative views, then they will show symptoms of depression** ## **Ellis ABC Model** * **Ellis suggests there are 3 stages that cause a person to develop negative thought processes, which can lead to them becoming depressed.** * **A- Activating Event:** Something happens to a person that makes them feel unsettled, such as a bad exam result or losing their job * **B- Belief:** The thoughts the person associates with the event, such as why it happened. These can either be rational (healthy) or irrational (unhealthy). * **C- Consequences:** If the person has an irrational thought about the event, this will result in a negative emotional consequence. ## **Evaluations of the COGNITIVE Explanation of Unipolar Depression** ### **Strengths of the explanation:** * **It takes into account the events in a person's life and accepts that these events can trigger depression, unlike the genetic explanation which says people will 'naturally' become depressed.** * **CBT is one of leading treatments for depression and challenges the irrational thoughts people have to reduce the depression.** ### **Weaknesses of the explanation:** * **It is difficult to tell whether irrational thoughts are the cause of depression or a symptom of being depressed.** * **Some types of depression may not be so easily explained by thought processes, for example post-natal depression is linked to a change in your hormones which supports more biological factors/causes.** ## **COGNITIVE treatment for Unipolar Depression** **Cognitive Behavioural Therapy (CBT)** * **CBT is a type of treatment that is used to treat many different mental health disorders.** * **The main aim of CBT is to:** * **Help the patient change the way they think (cognitive part of therapy)** * **Help the patient to change the way they act to improve the symptoms they are having (behavioural part of the therapy)** * **CBT is based on the understanding that the way we think affects how we feel, and how we feel influences how we behave.** **1. The First Stage of CBT:** * For treating depression is for the patient to discuss their symptoms with the therapist and explain how they feel and what makes them feel this way. * **Example:** Someone who has lost their job might feel like a failure because they can't provide for their family in the same way they used to. **2. The Next Stage of CBT:** * Involves challenging these irrational ways of thinking. When a patient can recognise thoughts that are irrational or negative they should try and replace them with more rational and positive ways of thinking. * **Example:** The person who has lost their job and feels like a failure might be encouraged to look at the reasons they lost their job, i.e. the company had to save money and close one department. **3. Between Sessions:** * Patients will be given 'homework' to do in the form of a diary. This stage of therapy helps them practice the rational thought processes and discuss it at the next sessions. ## **Evaluations of CBT Treatment for Unipolar Depression** ### **Strengths of the treatment:** * **Evidence supports CBT is effective in reducing a patients symptoms and it has been found that when combined with drug therapy, there was a significant improvement in their symptoms.** * **It is a longer lasting treatment for depression than drug therapy and it allows patients to deal with their own symptoms and reduces the feelings of helplessness associated with depression.** ### **Weaknesses of the treatment:** * **CBT relies on patients wanting to change their behaviour and recognise their own irrational thoughts, however depression can lead to lack of motivation so the patient may struggle to do this and the treatment becomes ineffective.** * **Ethical issues can arise with CBT.** The therapist is encouraging the patient to believe their thoughts and behaviours are 'wrong' and this can cause them to become further distressed. # **ADDICTION** **Addiction:** A mental health problem that means people need a particular thing, a substance or an activity, in order to be able to go about their normal routine. * **Addiction is a psychological problem where people feel that they need to 'have' or 'do' something regularly to avoid negative feelings** **Examples of addictions are:** * **Dependency Disorder - Substances (alcohol, tobacco, legal or illegal drugs)** * **Behavioural Addiction - Activities (gambling, shopping, internet use and exercise)** **People with addictions often have symptoms of withdrawal if they cannot have/do what they are addicted to.** They make the person feel that bad that they have to take/do the addictive thing to feel 'normal' again. **Withdrawal:** a set of unpleasant physical or psychological symptoms someone gets when they are trying to quit or cannot satisfy their addiction. ## **Dependency Disorder** * The International Classification of Diseases version 10 (ICD-10), refers to addiction as a 'dependency disorder' if the body 'depends' on a substance in order to feel normal. * To be diagnosed an addict, at least 3 symptoms need to be present at the same time for 1 month in total or repeated occasions over a year. ### **Symptoms of Dependence Disorder:** * A feeling a person needs to take the substance * Stopping or reducing the substance is difficult * Physical withdrawals i.e. shaking, sweating, vomiting when the substance has not been used for a period of time * Tolerance increases - the amount taken needs to increase to get the same effect * It interferes with normal or fun activities (either using it or recovering after it) * Ignoring evidence that taking the substance is harmful to them ## **Behavioural Addiction** * **Symptoms of behavioural addiction to activities are very similar** ### **Symptoms of Behavioural Addiction:** * They need to do the activity regularly * Reducing the activity is very difficult * They have to increase the activity to get the same 'buzz' * They spend more time doing the activity than any other activity * They ignore arguments that the activity is unhealthy or damaging ## **Features of Addiction:** * The NHS have estimated that about 2 million people in the UK are suffering from some kind of addiction. * In 2014/15, there were 142,000 adults being treated for problems with substance misuse (mainly opiates such as painkillers or heroin) and the next highest groups being treated for alcohol addiction. However, the number of people with addictions is difficult to estimate as many people may not realise they have an addiction or may not seek help. ## **Incidences of Addiction Over Time:** * **The definition of 'addiction' has changed over time.** For example, addiction now includes internet addiction and addiction to video games (both behavioural addictions), whereas in the past addiction was mainly concerned with substance misuse. * **Society's relationship with drugs have changed over time.** In the past, someone who was regularly taking opiates, such as heroin, for medical reasons was seen as acceptable, now they may be considered to be an addict. * **Access to certain substances (alcohol, heroin and cannabis) have become easier and cheaper than they were in the past, which has resulted in an increase in addictions between these groups.** ## **Addiction - The effects on Individuals and Society** | **Group** | **Effects** | |---|---| | **Individuals** | The major effect is on a person's quality of life and health. By 'doing' the thing they are addicted to, the person may start to ignore family members, break up relationships, struggle to function at work and spend money they would normally have for food or accommodation. Crime some people will turn to crime (stealing, fraud) to fund their addiction. This creates emotional and physical costs for the individual. | **Workplace** | Impact on the workplace - people with addictions may develop health problems which could mean that they need to take time off work, which will result in costs for the company in covering the staff and workload. | **Society** | Impact on healthcare services - Every year substance misuse costs the NHS £488 million, including the cost of rehabilitation programmes, and treatments. Crime related costs - Drug-related crimes costs the UK £13.9 billion a year. This includes policing costs, court cases, treatment programmes for the offenders and support for the victims. | ## **BIOLOGICAL - Genetic Explanation of Addiction** * There is evidence that addiction can run in families and therefore has a genetic explanation * Lots of people do activities that could become addictive, such as drinking alcohol or gambling, but do not get addicted to them. This suggests that there could be an addictive gene and not all people will have this gene. * The gene DDR2 has been related to developing addiction. Many different addictions, such as gambling and alcoholism, have been linked to a variation of this gene known as A1. * The gene A1 is thought to affect the way the brain reacts to pleasurable activities so that a person needs to do something more often to get a normal 'buzz' from it. ## **Research to support Genetic Explanation:** * A group of heavy users of cocaine were tested and it was found they were more likely to have a particular version of a dopamine receptor gene. This meant there were fewer D2 receptors in the brains, making them more prone to developing a cocaine addiction. * Research conducted on monozygotic twins found that if one of them was a smoker, there was a high chance the other would smoke too, compared to dizygotic twins. This suggests that addiction to smoking could be genetic. * Research found that adopted children who had at least one biological parent with alcohol addiction were highly likely to show signs of alcohol addiction themselves. This suggests that they might have inherited a gene from their biological parents that make them an addict. ## **Evaluations of the BIOLOGICAL - Genetic Explanation of Addiction:** ### **Strengths of the explanation:** * **Twin studies and adoption studies take part in controlled conditions and this control makes it easier to be sure that the most likely explanation comes from genes rather than other variables, making it more reliable.** * **It can help to explain why only some people are prone to becoming addicts and not others.** It also helps to understand treatments better because it is in their genes and not a choice. ### **Weaknesses of the explanation:** * **It is too reductionist because it fails to take social factors into account.** Family members may share the same genes but they also share the same environment which means that the addiction could be learnt. * **Research cannot find a gene that explains where the addiction has come from.** This makes it difficult to say what is causing the addiction. ## **BIOLOGICAL Treatment for Addiction** ### **Treatments for addiction will depend on the type of addiction they have and the severity of the symptoms:** ### **1. Dependency Disorder:** **Drug Therapy:** * **Patients with drug addictions can often benefit from taking a form of medication to help them cope with the effects of detoxification.** **Detoxification:** When an addict tries to stop taking the substance they are addicted to. * **Many substances like opiates, alcohol and nicotine can cause unpleasant side effects when patients stop using them.** Medication can help reduce these effects and help patients to control their addiction. * **When a person stops using a substance they are addicted to, they can face physical symptoms of withdrawal (sweating, insomnia, vomiting and shaking) as the substance leaves their system.** This can make detoxification difficult so the patient can be given drugs to reduce these symptoms and reduce the chance of them relapsing. * **Many patients who have addictions to substances will find that they crave the substance when they stop using it.** Medication can be given to control these symptoms. For example, *methadone* can be offered to people addicted to opiates, *nicotine-replacements* can be given to smokers and a drug called *naltrexone* can stop the cravings of alcohol addiction. * **Some patients with substance addiction may also have other mental health problems such as depression or anxiety.** Antidepressants and anti-anxiety medication can be offered to reduce the symptoms. ### **2. Behavioural Addiction:** * Although behavioural addictions, such as gambling, sex and the internet use, are not commonly treated with drugs, there is evidence drugs can be effective for some patients. * **Naltrexone**, a drug used to treat alcohol addiction, is being prescribed to patients with a severe gambling addiction because some of the 'cravings' are the same. Naltrexone reduces the cravings and can prevent the patient from relapsing. * **Drugs, such as SSRIs, increase the amount of serotonin available in the brain and this helps the patient control their urge to do the addictive behaviour.** ## **Evaluations of Drug Therapy Treatment for Addiction** ### **Strengths of the treatment**: * **Evidence supports the effectiveness of drug therapy in treating addiction.** 75% of gambling addicts that were treated with naltrexone showed a significant improvement in their symptoms, compared to 24% who had been treated with a placebo drug. * **Drugs will help treat the symptoms in the short-term which can then help the patient access other methods of treatment in the long-term, for example CBT.** ### **Weaknesses of the treatment:** * **Addiction is a complex mental health problem and the treatments available won't be effective for everyone.** Research found that there was no significant difference in relapse rates over a 12month period between alcoholics taking naltrexone and those taking a placebo. * **Some argue that giving medication to patients already addicted to something, especially another substance, could make their problems worse in the long-term as they may become dependent on the medication.** ## **Learning Theory Explanation of Addiction** * **Learning theories for addiction believe that the behaviour of addicts have been learned through some kind of experience they have had.** ### **Classical Conditioning:** Learning by associations * **Classical conditioning states that behaviour is learned through association, so when two or more things happen at the same time, our mind 'links' them together.** These two things become automatically connected to one another and in the future when we experience one of these things, the other will be triggered. * For example - **if you are sick after eating a certain food, next time you have that food you might associate it to feeling sick again.** * **This can explain why people first become addicted to something.** If a substance or activity is associated with positive feelings, the person learns to associate it with the positive feelings and will do it to get that desired outcome. ### **Operant conditioning:** Learning from the consequences of actions. * **Behaviour that is rewarded makes us feel that this is the 'right thing' to do and increases the chance we will do it again.** This *positive consequence* is a form of *reinforcement* that strengthens a behaviour and makes it more likely to be repeated. * **When there is a negative consequence to our behaviour, that behaviour is usually avoided.** * **Addicts will do/take the thing they are addicted to and it makes them feel good.** This then *positively reinforces* the behaviour and makes them want to do it again. If the person tries to stop, this will lead to negative physical symptoms (*negative consequence*) so they may continue with the addiction to avoid feeling bad. ## **Social learning theory:** behaviour is learned through the observation and imitation of role models. * **Behaviour is learned as a result of observing other people, especially those we consider to be role models and modelling our behaviour on theirs.** * If someone looks up to a family member, friend or even a celebrity who has an addiction, they may go on to copy this themselves. For example, if a child grows up with a parent that smokes, they may copy this when they are young by pretending to 'smoke' with things like pens etc. Then if they are exposed to cigarettes later in life, they may be more likely to try this behaviour. ## **Evaluations of the Learning Theory Explanation of Addiction:** ### **Strengths of the explanation:** * **This explanation believes that addiction is a learnt behaviour therefore this means the behaviour should be able to be 'unlearnt'.** This will make a treatment more effective to help learn to avoid the problem. * **It can explain why previous addicts sometimes relapse, even years after they have stopped.** For example, if a smoker used cigarettes more when they were stressed, years later if they have a stressful event, they may have the urge to smoke as they still have the association between smoking and relaxing. ### **Weaknesses of the explanation:** * **It ignores the role of biological factors that could influence addiction.** The genes DDR2 and A1 affect the way the brain reacts to pleasurable activities so that a person needs to do something more often to get a normal 'buzz' from it. * **This explanation does not explain why lots of people try gambling, alcohol or drugs but don't get addicted to it.** If the cause was learning from associations or consequences then everyone who experiences them should learn the addiction but they don't. ## **Cognitive Behavioural Therapy (CBT) as a Treatment for Addiction** * **The use of CBT for treating addictions began as a way of stopping alcoholics from drinking.** Gradually, this developed into a therapy can now be applied to many types of addictions. * **CBT aims to help people understand their triggers for the addictive behaviour and then learn how to control and manage these behaviours.** When treating addicts CBT occurs in 2 key stages - functional analysis followed by skills training. ### **Functional Analysis:** The first stage of CBT to treat addiction that identifies triggers. * **Functional analysis involves looking closely at the addict's behaviour and working out what makes them turn to their addiction.** * The therapist and the addict look at what emotions make them turn to alcohol * They look at who they are with when they feel the urge * This means that the addict, with the help of the therapist, can understand what places/people/feelings to avoid to stop doing the thing they are addicted to. ### **Skills training:** The second stage of CBT to treat addiction whereby addicts learn ways to control the patterns of behaviour that lead to their addiction * **Once they have completed a functional analysis, the therapist will help the patient to learn skills they can use to avoid engaging in the addictive behaviour.** The skills are developed based on each individual person and specific addiction. * **Examples of skills are** * How to cope with cravings * Assertiveness training (how to say no to people) * Improving motivation (help them commit to the therapy and stopping the addiction) * **Homework:** In between CBT sessions, the addict will keep a diary of important events to record their progress and share this with the therapist. ## **CBT Treatment for Internet Addicts - Key Supporting Study - Young (2007)** * **Background:** Internet addiction has only been seen as a mental health problem in recent years, which means there is little information on treatments. Young wants to see whether CBT would be an effective treatment for internet addiction. * **Aim:** To investigate the effect of using CBT to treat a group of patients diagnosed with internet addiction. * **Sample:** 114 USA participants were recruited from the Centre for Online Addiction (a website dedicated to treating people with internet addiction) * **Procedure:** * All participants were given a course of online CBT sessions * The first session (functional analysis) focused on finding out information on their problem * The next few sessions (skills training) helped the client to develop skills to treat the symptoms * Participants then filled in a questionnaire during the 3rd, 8th and 12th online session and again 6 months after the sessions had finished. * Participants rated their behaviour or feelings on a Likert scale on: * How effective counselling was at helping the clients achieve the targeted treatment goals, and the quality of the counselling relationship * Motivation to quit abusing the internet * Ability to control offline activities * Improved relationship functioning * Improved offline sexual functioning (if applicable). * **Results:** * 30% of males were addicted to online pornography whereas 30% females were addicted to online chat rooms * 96% of males and females said that the biggest problems was the time taken up with the addiction * Over the 12 sessions of CBT, the average rating of the quality of the CBT sessions improved and many said they felt an improvement after the 12 weeks of therapy. * **Conclusion:** CBT can be an effective treatment for internet addiction and it gives long-term benefits. ## **Strengths of the study:** * **This study supports that online CBT sessions are effective which might encourage more people to seek treatment as it takes away from the embarrassment of face to face therapy.** * **The method of recording the results was consistent and standardised as they assessed their own behaviour the same way as set periods of time.** This makes the results more reliable. ### **Weaknesses of the study:** * **The data may not be valid as patients filled in the questionnaire themselves and therefore may have lied on the questions.** * **There were too many types of internet addictions identified therefore it was not clear whether the treatment was effective for all types.** ## **Evaluations of CBT Treatment for Addiction** ### **Strengths of the treatment:** * **CBT aims to give the patient control to stop their own addictive behaviour.** This means they build up skills to help stop their addiction and stay away from the behaviour in the future. * **CBT has been found to be effective for treating people with internet addictions both in the short term and up to 6 months after the treatment.** ### **Weaknesses of the treatment:** * **One symptom of the addiction is finding it difficult to stop