Paper 2

Psychological Problems
GCSE Psychology

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Key Terms
International
Classification of
Diseases (ICD-10)

Social Stigma

Unipolar Depression

Bipolar Depression

Mania

Biological
Explanations

Neurotransmitters

Serotonin

Presynaptic neuron

Postsynaptic neuron

Synapse

Reuptake

Reductionist

Holistic

SSRIs

Effective

Appropriate

Placebo

Psychological
Explanations

Negative Schema

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Attribution

Internal Attribution

External Attribution

Stable Attribution

Unstable Attribution

Cognitive
Behavioural Therapy

Disputing

Addiction

Compulsion

Dependence

Tolerance

Withdrawal
Symptoms

Substance misuse

Substance abuse

Herediatry

Social Learning
Theory

Aversion Therapy

Classical
Conditioning
Self-Management
Programmes

Self-Help Groups

12 Step Recovery
Programme

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An Introduction to Mental Health
Characteristics of mental health
A person with good mental health will display some (not necessarily all) of these characteristics:

• Positive engagement with society

• Effectively copes with challenges
• Not being overcome by difficult feelings
• Having good relationships with others
• Being able to deal with disappointments and problems
• Being able to cope with stresses and demands of everyday life
• Being able to make decisions

Individuals with poor mental health have an absence of several or all of these characteristics.

There are many different types of mental health problems, some more common than
other such as depression and anxiety. Others occur less often such as bipolar and
schizophrenia.
Mental health problems are diagnosed using two classification systems: The World
Health Organisations (WHO) International Classification of Diseases (ICD-10) and the
American Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders (DSM-5)

Cultural Variations in Beliefs

People around the world have different interpretations of what is considered poor mental health. Some
behaviours that the Western world would consider abnormal are normal in some cultures.
For example, hearing voices (auditory hallucinations) are a symptom of mental health problems, such as
schizophrenia. In other parts of the world such as India and Africa, more people report hearing voices, and
they regard this as a positive experience because it is a sign that God is speaking to them.
Some mental health problems are also culturally bound syndromes, because
they are only recognised in certain cultures
For example, Koro is when a young man believes his nipples or penis would
retract into his abdomen, resulting in death. This disorder is found almost
entirely in Asia.
Another example is anorexia which is predominantly a mental health
disorder in the Western world.

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How the incidence of significant mental health problems changes over time
The occurrence of mental health issues is on the rise. The charity MIND estimates that by 2030,
approximately 2 million more adults in the UK will have mental health problems that there were in 2013.

There are three potential reasons for this increase:

1. Increased challenges of modern living

Economic deprivation in modern times could explain the increase in Mental
Health Issues. 27% of men in low-income household experience mental issues
compared to only 15% in higher income households.
Another, explanation could be social isolation for people living in cities. Elderly
people who have lost their relatives and have mobility issues means they may
live in isolation because they struggle to get out and socialise.

2. Increased recognition of the nature of mental health problems

Mental health issues have been recognised throughout history but there is a growing identification of
mental health as well as physical health problems. Traditionally, mental health
issues where thought to be caused by spiritual or supernatural causes but in the
19th century, psychiatry became a specific area within medicine and in the 20th
century psychoanalysis (therapy) and medication became a common way of
treating mental health issues.

Today biological and psychological causes are more accepted, but myths and
misconceptions are still wide spread, especially in rural areas and developing
countries. As the biological and psychological nature of mental health problems
become more recognised, this is like to increase in diagnoses rates as people
are more likely to seek treatment.

3. Lessening of the social stigma

In the past, people who has psychological problems were called lunatics or
insane which became a problem because these labels affect how a person is
treated. Labels can be harmful because they can result in discrimination like
difficulties in finding a job. The phrase ‘mental health problems’ attempted to
reduce the stigma associated with it, as it suggests that people can get
better.
Research has also found that opinions towards mental health problems in the
UK are changing as people are becoming more aware and accepting of mental health. This could lead to an
increased level of diagnosis due to the lessening of the social stigma attached to it, so people feel more
confident in seeking treatment to address the issue.

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Exam Practise

Q1

Identify one characteristic of mental health (1 mark)

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Q2
The number of people with significant mental health problems has changed over time.
Use your knowledge of psychology to suggest two reasons for this change (2 marks)

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Effect of mental health problems on society and the individual

Individual Effects

Damage to relationships

Mental health issues often affect how people communicate with family
and friends. For example, someone with depression may become
focused on themselves and struggle to understand how other people are
feeling

People with mental health problems also isolate themselves from other
people because they feel bad about themselves and/or may feel judged.
People may misunderstand this and feel like the person is avoiding them
because they don’t like them, which can damage the relationship.
An individual who has children may not effectively be able to take care of
their child, which may result in the child going to live with another family
member or into the care system. This can then cause further stress on
the family and children.

Difficulties coping with day-to-day life

Having poor mental health may have difficulty looking after
themselves they may struggle to get out of bed in the morning, dress
themselves, prepare food and keep their home clean and tidy. They
may also struggle to engage in activities outside of their home such as
socialising with friends and partaking in hobbies. This can be
distressing for themselves and others who may have to look after
them. As a result of not coping with day-to-day life, this may lead to
poor attendance at work or school and lead to unemployment or poor
qualifications.

Negative impact on physical wellbeing

When an individual is anxious or stressed and individuals body
releases a hormone called cortisol. This weakens an individual’s
immune system, which makes physical illness more likely, such as an
increase in colds. Individuals suffering from mental health problems
may also under eat or overeat, leading to weight gain or weight loss
and they may have difficulty sleeping (insomnia). Medication that
individuals are taking can also impact physical wellbeing such as lack
of concentration or sickness.

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 Social Effects

Need for more social care

In the UK, taxes pay for social care services which helps people cope with
and treat their mental health issues. This could be through offering basic
necessities such as food, warmth and human company or in offering to
help an individual care for themselves. For example, helping people who
struggle to live alone learn new social and work skills to help them feel
less isolated and more competent. In some cases, social care services will
provide social housing for the individual and offer benefits to those who
are unemployed. As the number of people being diagnosed with mental
health issues increases, so does the need for these social care services.

Increased crime rates

It is a myth that mental illnesses make people more violent, but other
factors such as substance abuse can result in a person being violent.
However, because individuals with mental health issues tend to have a
lower standard of living and more isolation that could result in violent
behaviours.

Implications on the economy

A recent government report suggests that the direct costs of mental health in
England is about 22 billion a year. This figure only includes direct costs such as
spending in health and social care services but does not include indirect costs
such at the impacts on the criminal justice system e.g. more policing needed
and unemployment benefits.

Another major issue is the increase in dementia, which costs the government
a lot of money because older people are living longer and so more care will
be required.

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Exam Practise
Q1

Briefly explain how significant mental health problems can affect both individuals and society. Refer to the
article in your answer (4 marks)
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DEPRESSION

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Characteristics of Clinical Depression

Sadness is a normal human emotion: a reaction to certain experiences like

death of a loved one. Depression is an abnormal emotional state. When a
person is depressed, they feel sad about everything though there may not be
a clear cause for it. One of the key characteristics of depression is sadness,
but it is sadness that lasts for a considerable time and affects that individual’s
ability to function day-to-day.

Unipolar Depression
Individuals with unipolar depression only experiences the one emotional state of depression.
The ICD-10 classifies depression as the following symptoms being present all or most of the time, for
longer than two weeks.

Key Symptoms:

• Low mood
• Loss of interest of pleasure in activities
• Reduced energy levels (lethargy)
• Other symptoms
• Changes in sleep patterns (insomnia OR hypersomnia)
• Changes in appetite levels (eating too much or too little)
• Decrease in self-confidence (can sometimes result in self-loathing)
• Reduced concentration and attention
• Ideas of self-harm or suicide.
• Ideas of guilt or unworthiness
• Pessimistic view of the future

What is the difference between unipolar and bipolar depression?

People with unipolar depression only experience one emotional state
(depression) WHEREAS people with bipolar experience changes between
two mood states (depression and mania)
Mania is a state of euphoria of frenzied activity in which people may have
an exaggerated belief that the world is theirs for the taking.
Individuals diagnosed with bipolar alternate between states of mania and
states of depression. For weeks/months a person is manic, running around,
making big plans and feeling very excited. This is then followed by weeks or
months of depression. In between mania and depression, there may be
periods of a ‘normal’ mood (episodic disorder).

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Exam Practise
Q1
‘Changes in sleep patterns’ is listed in the International Classification of Diseases (ICD) as a symptom of
unipolar depression.
Identify two other symptoms of unipolar depression listed in the ICD (2 marks)
1.
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2.
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Q2
What is the difference between unipolar depression and bipolar depression? (2 marks)
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 Biological Explanation of Depression
Biological influences look at physical influences on a person’s mind and behaviour

Neurotransmitters are chemical messengers in the brain which send

messages between neurons. One example of a neurotransmitter is
serotonin, which regulates an individual’s mood.
Individuals with low serotonin are more likely to suffer from depression.
Serotonin travels from the presynaptic neuron, across the synapse to the
post-synaptic neuron to transmit a message.

When serotonin levels are low, then the levels in the synapse are low and
the message is not transmitted, leading to a low mood. Serotonin can also affect an individual’s memory,
sleep and appetite.

Synaptic Transmission

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 Reductionism vs Holism

Biological Explanations (AO3)

Research to support the biological explanation of depression comes from McNeal and Cimbolic
(1986) who conducted research into the serotonin levels of depressed individuals compared to those
who were not depressed (control group). They found lower levels of serotonin in the patients suffering
from depression. This supports the biological explanation of depression because it shows the link
between serotonin and depression.

However, much of the research into the biological approach is based on correlations. This is a
problem because correlations only show a link between depression and serotonin and not causation.
There may be another factor causing depression such as loss of a loved one. This reduces the validity of
the biological explanation of depression.

Furthermore, the biological explanation of depression is criticised for being reductionist. This is
because it reduces the complex behaviour of depression down to levels of serotonin. It ignores the
holistic approach which would consider social and psychological aspects as well. Therefore, the
biological explanation make lack validity as an explanation of depression.

An alternative explanation of depression is the cognitive approach which suggests that depression
is due to faulty thinking and negative schemas, rather than low levels of serotonin in the brain.
Therefore, the biological explanation of depression may not be the only explanation to consider when
explaining depression.

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Exam Practise
Q1
Describe and evaluate the biological explanation of depression (9 marks)

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 Biological Therapies for Depression: Anti-Depressant Medication

According to the biological approach, low levels of

serotonin cause depression. Therefore, in order to
treat depression, we should increase an individual’s
serotonin levels.
One drug therapy used for depression is and anti-
depressant called selective serotonin reuptake
inhibitors (SSRIs).

This works by blocking the reuptake of serotonin from the synapse back into the pre-synaptic neuron
This leaves more serotonin in the synapse in addition to the new serotonin being released from the
presynaptic neuron.

This allows the serotonin to continue activating the post-synaptic neuron and transmitting messages, as a
result this decreases symptoms of depression.

How do SSRIs work?

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 Evaluating Treatments

S ide effects
E vidence (research to support or contradict)
R eductionism vs Holism
M otivation
Key Terms:

Effectiveness

Appropriateness

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Biological Therapies for Depression (AO3)
Side Effects

A weakness of using SSRIs is that they have side effects including nausea, insomnia and dizziness.
Some people have also reported having more suicidal thoughts on antidepressant medication. This is
unlike CBT which does not cause people side effects. Therefore, SSRIs as a treatment for depression
may not be effective as people may stop taking them to stop the side effects.

Evidence (Research)

A further limitation of SSRIs as a treatment for depression is that there is some uncertainty as to
how effective they are. Around 50-65% of people will experience some improvement by taking them
but 25-30% will also improve when they take a placebo. Just the belief that they are taking medication
leads to an improvement. This limits the use of SSRIs as a treatment for depression because it suggests
there may not be a physical basis for depression at all.
Reductionism vs Holism (YOU MUST KNOW THIS AO3 POINT)

Another weakness of SSRIs as a treatment for depression is that the treatment is reductionist. This
is because it reduces the treatment of depression to increasing levels of serotonin in an individual. This
neglects a holistic approach which would consider other psychological and social factors that could be
causing depression. This limits the use of SSRIs as a treatment for depression.
Motivation

One strength of SSRIs as a treatment for depression is that it requires little motivation. This is
because the patient only needs to remember to take a tablet once or twice a day unlike CBT where an
individual needs to go to sessions, challenge their thoughts and practice this outside the session.
Therefore, SSRIs may be a more appropriate treatment for depression, especially as a symptom is
lethargy (lack of motivation).

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Exam Practise
Q1
Describe and evaluate biological therapies for depression (9 marks)

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Q2

Briefly evaluate the use of antidepressant medications as an intervention for depression (4 marks)

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 Psychological Explanation of Depression
The psychological explanation looks at the influence of others or an individual’s thought processes.
Psychologists believe that when an individual is depressed, it is due to faulty thinking. They tend to pay
attention to the negative aspects of a situation and ignore the positives which leads to feelings of
hopelessness and depression.

Negative schemas
Schemas are a mental representation that an individual has of
the world, themselves, situations. These are developed
through experiences. Individuals with depression have a
negative self-schema which means you are likely to interpret
all information about yourself in a negative way making an
individual vulnerable to depression.

Attributions

Attributions are the way in which people explain the causes of behaviour and situations.
Internal and External Attributions
People who make internal attributions explain situations or behaviours as being caused by dispositional
factors such as personality or ability.

People who make external attributions explain situations or behaviours as being caused by situational
factors such as the weather or the economy.
Stable and Unstable Attributions
People who make a stable attribution would explain situations of behaviours as being caused by factors
that do not change

People who make an unstable attribution would explain situations of behaviours as being caused by
factors that are temporary

Someone who fails an exam and believes they are not clever enough to pass or do anything about this
would make internal and stable attributions.
Someone who fails an exam and believes that it is because they did not do enough revision and were
tired would make external and unstable attributions
Research has found that individuals who have attributions which are external and stable are more
likely to develop depression because they see situations and problems as their own fault and
permanent.

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Psychological Explanations of Depression (AO3)

Research to support the cognitive approach to explaining depression

was conducted by Grazioli and Terry on 65 pregnant women. It was found
that those judged as high in cognitive vulnerability (those who display
negative thinking) were more likely to suffer post-natal depression. This
supports the psychological explanation of depression because it
demonstrates the role of negative thoughts in the development of
depression

However, much of the research into the psychological explanation of

depressed is based on correlations. This is a problem because correlations
only show a link between depression and negative schemas/attributions
and not causation. It may be that depression is causing faulty thoughts
rather than fault thoughts causing depression. This reduces the validity of
the psychological explanation of depression.

An alternative explanation of depression is the biological approach

which suggests that depression is due low levels of serotonin the brain
rather than faulty thinking and negative schemas. Therefore, the
biological explanation of depression may not be the only explanation to
consider when explaining depression.

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 Psychological Therapies for Depression: CBT (AO1)

Aim: The aim of cognitive behavioural therapy is to challenge faulty, irrational thought
processes and change them into rational, logical ones.

Cognitive: The cognitive aspect focuses on challenging the clients irrational and faulty thoughts
via disputing. The therapist will ask the client questions such as ‘where is the proof that
everybody hates you’ or ‘do you always do badly in schoolwork?’. This will make the client see
their thoughts are irrational and change them to rational, logical ones.

Behavioural: The therapist will also encourage clients to take part in pleasant activities each day
such as hobbies they once enjoyed and exercise. This will create positive emotions and improve
the client’s mood.

Homework: Clients are asked to complete a thought diary and write down any negative,
irrational thoughts they have. They will then need to write a rational response to negative
thoughts in order to practice the disputing techniques in real life and reduce their negative
thoughts that are causing their depression.

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Psychological Therapies for Depression (AO3)
Side Effects

One strength of CBT as a treatment for depression is that there is no side effects because it is a non-
invasive treatment unlike SSRIs which cause people to have insomnia and dizziness. This means that
people are more likely to attend CBT sessions than have antidepressants making it a more effective
treatment for depression.

Evidence

Research to support the effectiveness of CBT was conducted by Wiles et al (2013). She randomly
allocated depressed participants to either the antidepressants condition or the antidepressants with CBT
condition. She found that those patients who had combined antidepressants and CBT showed more
reduction in symptoms compared to those with antidepressants alone. This shows that CBT is effective
in reducing depression and there is greater chance of recovery compared to antidepressants alone.

Reductionism vs Holism (YOU MUST KNOW THIS AO3 POINT)

A further strength of CBT as a treatment for depression is that the treatment is holistic. This is
because it looks at the bigger picture by focusing on a person’s thoughts and feelings and how these are
impacted by their depression. This is better than a reductionist treatment which reduces treatment
down to levels of neurotransmitters. This suggests that CBT may be a more appropriate treatment for
depression compared to SSRIs as it focuses on a wide range of factors that may impact an individual’s
depression.

Motivation

However, a weakness of CBT is that it requires motivation. This is because an individual needs to
attend sessions and challenge their thoughts as well as keep a thought diary outside of the session. This
is unlike SSRIs as the patient only needs to remember to take a tablet once or twice a day. Therefore,
CBT may not be an appropriate treatment for depression, especially as a symptom is lethargy (lack of
motivation).

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Key Study: Wile’s Study

Aim: To see whether CBT combined with antidepressants was a more effective treatment
for depression than antidepressants alone.

Sample: 469 patients from UK GP surgeries who had been on antidepressants

Method:

• Patients were randomly allocated one of two conditions

• Condition one: continued on antidepressants only
• Condition two: had antidepressants and 12-18 CBT sessions.
• They measured their reduction of symptoms using the Beck Depression Inventory (a
questionnaire on their symptoms of depression).

Findings:

• 22% of patients who had antidepressants only had a 50% reduction in symptoms
• 46% of patients who had antidepressants combined with CBT had a 50% reduction in
symptoms
• Those who had antidepressants + CBT had greater levels of recovery and a greater
chance of remission.

Conclusion: CBT with antidepressants is a more effective treatment for depression

compared to antidepressants alone.

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 Wile’s Study (AO3)

One strength of Wile’s study into the effectiveness of CBT is that it had high control over
extraneous variables such as the level of depression experienced by participants. To control for this,
Wiles used random allocation to allocate participants in each group. This reduces individual differences
in depression and reduces potential researcher bias, increasing the validity of her study into the
effectiveness of CBT.

However, a weakness of Wiles’ study into the effectiveness of CBT is that it measured depression
on a questionnaire which is open to social desirability. This means participants may lie about their
symptoms of depression to help or hinder the researcher or because the questions are subjective. This
reduces the validity of Wile’s research into the effectiveness of CBT.
Stretch: A further strength of Wiles’ study into depression is that it has practical applications in the real
world This is because the research has shown the most effective strategy for helping patients to
overcome depression by combining both antidepressants and medication. As people are also less likely
to be in remission with a combination of the two treatments, this means it can help to save the NHS
money on wasted treatments (antidepressants alone). Therefore, Wile’s research into CBT is an
important part of applied psychology.

Exam Practise
Q1

Outline Wiles’ study into the effectiveness of CBT

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Q2

a) Identify one intervention or therapy for depression (1 mark)

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b) Evaluate the intervention of therapy for depression that you have identified in your answer to part a) (4
marks)

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ADDICTION

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 What is Addiction?
An addiction is when an individual takes a substance OR engages in a behaviour that is pleasurable by
eventually becomes compulsive with harmful consequences. Addiction is characterised by physical or
psychological dependence, tolerance, and withdrawal.

Dependence is a strong need to Withdrawal symptoms: when

continue a behaviour or substance use substance use or an activity is stopped,
because the brain/body only works a person may experience physical
normally when the substance or problems such as headaches, difficulty
behaviour is present. When it is not, sleeping or psychological problems
withdrawal symptoms with occur. such as moodiness.

Dependence vs Addiction
Dependency does not always mean an individual has an addiction. For example, an individual may be
dependent on pain medication because without it they cannot lead a normal life. Dependence crosses
the line into addiction when they take the substance or engage in a behaviour to give themselves a
buzz or a sense of escape. It is also signalled by withdrawal symptoms.

Substance Misuse vs Substance Abuse

Substance misuse is when an individual uses a drug in the wrong way for the wrong purpose for
example, an individual takes antidepressant to help them lose weight or taking more than the
prescribed number of sleeping pills.
WHEREAS
Substance abuse is when an individual uses a drug for the wrong purpose as a mood modification, for
example to experience euphoria (a ‘high’)

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Characteristics of Addiction
The ICD-10 classifies addiction as three or more of the following symptoms being present in an individual
for some time during the previous year

• As strong desire to use the substance (compulsion)

• Persisting with the substance or behaviour despite harm
• Difficulty in controlling use
• A higher priority being given to the substance or behaviour than other activities or obligations
• Withdrawal symptoms
• Evidence of tolerance (requiring increased dosages to feel the same effects)

Exam Practise
Q1
One characteristic of addiction is dependence.

What is meant by dependence? (2 marks)

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 The Biological Explanation of Addiction

Psychologists believe that addiction is influenced by hereditary factors, meaning that

addictions are inherited and will run in families. If there is a family history of addiction,
then this increases the likelihood of an individual developing an addiction as they have
a genetic vulnerability (more at risk). It is likely that environmental stresses will trigger
for the addiction.

Kaij’s Twin Study (AO1)

Aim: To see whether alcoholism could be explained in terms of hereditary factors

Sample: 384 male twins from Skane in Sweden where at least one twin had alcoholism

Method: Kaij conducted interviews with the twins and sometime with close relatives to collect data
about their drinking habits.

Findings:
61% of the identical twins were both alcoholics (these twins shared 100% of their DNA)
39% of the non-identical twins were both alcoholics (these twins share 50% of their DNA)

Conclusion:
As the percentages for identical twins was higher than non-identical twins, this suggests a genetic link
in the development of alcohol addiction.

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Biological Explanation of Addiction (AO3)

One strength is that there is further research to support the genetic explanation of addiction, which
was conducted by Kendler et al (1997). He repeated Kaij’s research with a larger sample and still found
that if one twin was an alcoholic, the other twin is also likely to be alcoholic and the percentages were
higher for identical twins compared to non-identical twins. This suggests that Kaij’s research into
genetic vulnerability and addiction has high reliability.

One weakness of Kaij’s twin study is that she used self-report methods which are open to social
desirability bias. This is because the twins may have lied about their drinking habits to present
themselves in the best possible light. Stretch: Not to be viewed as an alcoholic. This reduces the validity
of Kaij’s research into genetic vulnerability and the development of addiction.

However, an alternative explanation for addiction is the psychological explanation (social learning
theory). This suggests that addictions are influenced by nurture, through observing others and imitating
their behaviours e.g. seeing their peers smoking so individuals copy that behaviour rather than having a
hereditary risk. Therefore, genetic vulnerability may not be the only explanation of addiction.

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Exam Practise
Q1
Describe and evaluate biological explanations of addiction (9 marks)

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 The Psychological Explanation of Addiction: Peer Influence

Peers can influence an individual’s development during adolescence as they spend more time with them
and less time with their family.

Social Learning Theory

This is when an individual observes a role model who they identify with (due to
similarity) and imitate their behaviour, especially if they are rewarded for doing
so.
In addiction an individual may observe their peers (role models) engaging in an
addictive behaviour and imitate them because they want the reward (a fun time)

Conformity
What is meant by conformity?

An individual may also believe that the social norm of their peer group
is to drink and take drugs and therefore conform to that behaviour to
avoid being left out or rejected from the group

Peers also acts as gateways to addictive behaviours because they can provide opportunities to take
substances e.g. might be able to buy alcohol or provide a place to take drugs.

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The Psychological Explanation of Addiction (AO3)

Research to support peer influence as an explanation of addiction was conducted by Simons-

Morton and Farhat (2010) who reviewed 40 studies into the relationship between peers and smoking.
They found there was a strong correlation between peer influence and the development of smoking in
most of the studies. This support peer influence as an explanation of addiction because it shows that
addiction is initially influenced by peers.

One problem with the research into peer influence as an explanation of addiction is that it is based
on correlations which only show a link between two co-variables, not causation. There may be another
factor such as genetics or culture that could lead individuals to develop an addiction. This lowers the
validity of the researcher into peers as a factor affecting addiction.

However, an alternative explanation for addiction is the biological explanations. This states that
individuals inherit a genetic predisposition that makes them more vulnerable to developing an
addiction and life experiences and stresses trigger this addictive behaviour rather than friends
providing opportunities to take addictive substances. Therefore, the psychological explanation may not
be the only explanation of addiction.

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Exam Practise
Q1

Use your knowledge of theories of addiction to suggest why both David and Georgie started smoking. Use
the conversation to explain your answer (5 marks)
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Use your knowledge of psychology to discuss peer influence and conformity to majority influence as
possible explanations for addictive behaviours (9 marks)
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 Therapies for Addiction: Aversion Therapy
Classical conditioning: Learning a behaviour through associations.

Aim: To unlearn an addictive behaviour by replacing the pleasant association with

something unpleasant.

Alcohol Addiction (Anatabuse)

• A patient takes a drug (Anatabuse) which causes them to

feel nauseous until they eventually vomit.
• Just before the individual vomits, they take an alcoholic
drink (usually whisky)
• This is repeated to strengthen the association between
drinking alcohol and vomiting
• Eventually, the patient will associate drinking alcohol
with vomiting, replacing the pleasant association with an
unpleasant one.

Nicotine Addiction (Rapid Smoking)

• Individuals will have a puff of a cigarette every six seconds.

• This will cause the individual to become nauseous and sick
• This is repeated to strengthen the association between smoking
and nausea
• Eventually the patient will associate smoking with nausea,
replacing the pleasant association with an unpleasant one.

Gambling Addiction (Electric Shocks)

• Gamblers think of phrases related to their gambling behaviour and

write them down on cards e.g. ‘lottery’ and ‘casino’. Some non-
gambling behaviours are also included e.g. ‘went straight home’.
• The participants read out each card and when there is a gambling
related phrase they are given a two second electric shock
• This is repeated to strengthen the association between gambling and
pain
• Eventually the patient will associate gambling with pain, replacing
the pleasant association with an unpleasant one.

Exam Top Tip: Choose one of these therapies to write about in your AO1,
depending on the question/scenario. It is too much to write two/three of them.

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Therapies for Addiction: Aversion Therapy (AO3)
Evidence

Research to contradict aversion therapy as a therapy for addiction was conducted by McConaghy et
al (1983). They looked at the effectiveness of electric shock therapy when treating gambling addictions.
In a one year follow up, only 30% of patients had reduced their gambling behaviours. This does not
support aversion therapy as a therapy for gambling addiction because it shows that overtime,
individuals go back to their gambling addiction afterwards (relapse)

Reductionist vs Holism (YOU NEED TO KNOW THIS AO3)

One weakness of aversion therapy as a treatment for addiction is that the treatment is reductionist.
This is because it focuses on it reduces the treatment of addiction down to changing the pleasant
associations with their addiction to unpleasant ones. This neglects a holistic approach which would
consider other psychological and social factors that could be contributing to addiction such as peer
groups. This limits the use of aversion therapy as a therapy for addiction.

Motivation

Another weakness of aversion therapy is that it requires motivation and commitment from the
patient. This is because the patient has to commit to attending sessions and work with the therapist to
unlearn their addictive behaviour whilst placing themselves in unpleasant situations such as feeling sick
or receiving electric shocks in order to reduce their addiction. This means that aversion therapy may
not be an effective therapy for addiction because individuals may drop out.

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Exam Practise
Q1
Describe and evaluate aversion therapy as a treatment for nicotine addiction (9 marks)

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 Therapies for Addiction: Self-Management Programmes
Self-management programmes are a type of therapy that requires no
professional therapist to guide the attendees (although there may be one
facilitating the group). Members of these programmes set their own rules
and make decisions about their therapy as a group. There are two self-
management programmes you need to know:

• Self Help Groups

• 12-Step Recovery Programme

Self-Help Groups
These are composed of people who all share the same problem e.g. narcotic addictions, and regard
themselves as equals. Self help groups involve individual sharing their experiences so they can gain support
from others and see they are not alone in their problem. Members of the groups who are experienced can
also provide a positive example to new members.

12-Step Recovery Programme The 12 Steps

This is a well-known self-help group which was 1. Admit powerlessness over the addiction
developed by a group of alcoholics (Alcoholics 2. Find hope, believe that a higher power
Anonymous), which is based on 12 spiritual (in whatever form) can help
principles. This programme does have a religious 3. Surrender control over to the higher
concept as the addict surrenders their control to a power
high power, but many non-religious people have 4. Take a personal inventory, focusing on
found it helpful. Some steps involve the person the wrongs done
coming to terms with what they have done wrong 5. Share inventory with the higher power,
by sharing confessions. They recognise recovery as a oneself and another person, admitting
lifelong process where members support each other wrongs done
both in the group and both outside, by having 6. Become ready to have the higher power
names and numbers to call when they feel they correct any short comings in one’s
need support. This is done to avoid relapse. character
7. Ask the higher power to remove these
shortcomings
8. Make a list of people who have been
harmed
9. Make amends if possible, for any past
wrongs
10. Continue personal inventory and
recognise wrongs immediately
11. Use prayer and meditation to continue
connection with the higher power.
12. Carry the message of the 12 steps to
others in need

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Self-Management Techniques for Addiction (AO3)
Evidence

Research to contradict the effectiveness of the 12-step programme was conducted by Ferri et al
(2006). They found there was no significant differences in terms of effectiveness between the 12-step
programme and other forms of treatment. It is difficult to find data into how many people are still in
the programme, how many dropped out and how many still have addictions. This means there is no
clear data into how effective self-help groups such as the 12-step programme are in helping people to
overcome their addictions.

Reductionism vs Holism (YOU MUST KNOW THIS AO3)

One strength of self-help groups such as the 12-step programme in helping people to overcome
their addiction is that it takes an holistic approach to treatment. This is because this therapy focuses on
the whole person, particularly their emotions, feelings of guilt and relationships with others. This is
better than a reductionist treatment such as aversion therapy which reduces addiction down to
associations. This suggests that self-management programmes may be more appropriate as they focus
on a wide range of factors that impact a person’s addiction.

Motivation

However, a weakness of self-help groups is that they require a lot of motivation and commitment.
This is because participants have to attend the sessions at least once a week and complete the 12-step
programme. This may take a long time and be difficult for people as they may feel like they cannot
control their addiction. Therefore, this may not be an effective therapy for addiction as people may
drop out.

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Exam Practise

Q1

Identify one intervention or therapy for addiction that could be viewed as holistic.

Explain your answer (3 marks)

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Q2

Describe and evaluate the 12-step programme as a self-management technique for addiction (9 marks)

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