QUESTIONS AND ESSAY PLANS
1. Discuss the issues raised in the classification and diagnosis of one anxiety disorder.
(25 marks)
When answering this question you must not spend much time describing the features of the classification
systems, since the question concerns reliability and validity and does not require you to describe the
systems.
Paragraph 1 Introduction
Give a very brief introduction to what a classification system is and its main purposes (to enable clinicians
to organise data, to provide a summary of the main syndromes, to keep statistics, as the first step in
treatment). Keep it as brief as possible. Then mention the two main systems in use at present, DSM-IV and
ICD-10. Explain how they are very similar in their classification of phobia.
Paragraph 2
Describe what is meant by reliability in the context of a classification system—essentially, the extent of
agreement between clinicians and therefore consistency in diagnosis. Outline what is necessary to achieve
reliability—“tight” and precise descriptions of each category of mental disorder. Similarly, describe what is
meant by validity (i.e. accurate diagnosis) and mention why it is more difficult to establish than reliability.
Reliability is not necessarily hard to achieve—the problem is that it is often done at the expense of validity,
i.e. diagnosis could be consistently wrong! So, essentially, it is difficult to achieve both reliability and
validity, but not necessarily difficult to achieve reliability (although, needless to say, this is pointless
without validity).
Paragraph 3
Explain how the categorical approach and comorbidity limit reliability and validity.
Paragraph 4
Discuss the reliability and validity of clinical interviews. Outline the semi-structured interviews for phobia,
the Structured Clinical Interview for DSM-IV-Patient Version (SCID-I/P) and the Anxiety Disorder
Interview Schedule for DSM-IV (ADIS-IV). Note the fact that diagnosis of phobias is more reliable and
valid than it is for other mental disorders and explain why.
Paragraph 5
Discuss why both diagnostic interviews and DSM-IV and ICD-10 have content validity. Next introduce
criterion validity as being assessed by if those diagnosed with phobia differ in predictable ways from those
who do not have phobia. Consider how, on the one hand, this is true but, on the other, it is true of mental
disorders in general not just phobia.
Paragraph 6
Explain construct validity and use examples as support, such as the fact we can hypothesise that social
phobics underestimate their social skills and the fact there is research that shows this supports construct
validity. The successful use of treatments that relate to possible causes such as cognitive distortions also
support good construct validity. Discuss how issues arise when the hypotheses are not supported.
Paragraph 7
Explain predictive validity and discuss how there is evidence for predictive validity as we are able to
predict which phobic disorder is easiest to recover from, etc. and so can make reasonably valid predictions
about the outcomes.
Paragraph 8 Conclusion
Conclude by mentioning the importance of classification systems but the inevitable problems establishing
reliability and validity at the same time. Both DSM and ICD have been criticised for sacrificing validity on
the altar of reliability. Nevertheless, validity is impossible without reliability, so it is understandable that
there has been a concentration on reliability, which has improved with each subsequent edition. However,
the establishment of a classification system must always be seen as a work in progress. The challenge now
is to attempt to establish not only high reliability but high validity.
2. Compare and contrast two explanations of one anxiety disorder. (30 marks)
To gain marks on this question you need to identify similarities (comparison) and differences (contrast). In
doing so you will describe and evaluate the explanations but this will NOT gain marks unless the content is
related to the comparison and contrasting of the explanations.
Paragraph 1 Introduction
Begin by focusing on the fundamental differences between the biological and behavioural explanations.
The biological approach focuses on the role of inheritance and so nature; the behavioural approach claims
that phobias are a result of maladaptive learning from the environment and so focuses on nurture. Thus,
they are on opposite sides of the nature/nurture debate and focus on opposing factors, as the biological
focuses on internal factors, whereas the behavioural approach focuses on external factors to explain
phobias. Define phobia: phobias are irrational fears that are out of proportion to the reality of the threat
provided by the fear-provoking stimulus. They are a form of anxiety disorder in which the adaptive
emotional response has become chronic and disabling.
Paragraph 2
Discuss the differences in the biological and behavioural explanations of phobias. For example, the
biological claims that they are inherited and so genetically transmitted, whereas the behavioural claims that
they are culturally transmitted. Outline the classical conditioning explanation of acquisition and how this is
supported by research evidence of traumatic experiences triggering the phobias. Then explain that social
learning theory provides a more complex account.
Paragraph 3
Consider the similarity in their approach to research. Both the biological and behavioural explanations
employ the experimental method, as they are concerned with observable and measurable phenomena, and
consequently ignore the subjective experience of the individual. Given that they take a scientific approach
they are both supported by research evidence. For example, the biological approach is supported
by…describe the twin, family, and adoption studies and neurophysiology. Then describe the laboratory
research on phobias conducted by behavioural psychologists such as Watson and Rayner’s (1920)
conditioning of Albert.
Paragraph 4
Evaluate that the research evidence for both explanations has similar methodological weaknesses. For
example, the focus on the observable and measurable phenomena means both approaches may have
identified symptoms rather than underlying causes. Another example is bias—the concordance studies may
be biased if it is known another family member has been diagnosed with mental illness. Watson and
Rayner’s (1920) study may also have been subject to bias, which is supported by the fact that later attempts
to condition phobias in the laboratory have been unsuccessful. Explain that reliability is an issue for both
biological and behavioural explanations as there are inconsistencies in the genetic evidence on phobias and
the behavioural approach has problems of replication and a lack of consistency in the research on whether
phobias result from a traumatic experience.
Paragraph 5
Thus, the research evidence is limited for both, but perhaps genetic factors more so…explain. The above
criticisms mean that both biological and behavioural explanations are inconclusive because validity is
questionable as a result of the methodological flaws. Furthermore, both are challenged by contradictory
research. Consider that they are both challenged by the role of cognitive factors.
Paragraph 6
Other perspectives offer support for both explanations. Explain that the evolutionary perspective supports a
genetic basis and the research on social factors supports the social learning theory strand of behaviourism.
Paragraph 7
The validity of the biological and behavioural explanations is supported to some extent by the success of
their treatments. Discuss the different approaches taken to treatment by the biological and behavioural
approaches, i.e. anti-anxiety drugs vs. systematic desensitisation. Then criticise using the treatment
aetiology fallacy and explain what this means. Evaluate both approaches as reductionist and deterministic
and explain why. Distinguish between them in terms of the type of determinism, biological vs.
environmental.
Paragraph 8
The explanations are supported by contrary evidence. Evidence of genetic factors is the universality of
phobias whereas evidence of learning is the variability in the prevalence of phobias, neither of which is
clearly established, which leads to the conclusion that neither explanation is comprehensive on its own.
They contrast because the biological explanation suggests predisposing factors, whereas the behavioural
explanation suggests that classical conditioning and social learning are precipitating factors. Both lack
explanatory power and so other processes must be involved. Hence, both explanations need to be
incorporated into a multi-dimensional approach to phobias. Both approaches are nomothetic as they try to
identify universal explanations for disorder. Whilst a nomothetic approach is useful in identifying
generalisable causes, such universal explanations may have limited relevance to individual cases. Thus, to
conclude, both the biological and behavioural explanations need to be integrated with the alternative
explanations in an idiographic approach, as this may be better able to explain how the different factors
interact and so give rise to different forms of the disorder.
3(a). Outline one or more biological therapy(ies) for one anxiety disorder. (9 marks)
Note the question is divided into AO1 in part (a) and AO2 in part (b).
Paragraph 1 Introduction
Introduce drug therapy as the main biological approach in the treatment of phobias. Describe the use of
anti-anxiety drugs, the benzodiazepines and the anti-depressants, monoamine oxidase inhibitors (MAOIs),
and selective serotonin reuptake inhibitors in the treatment of social phobia.
Paragraph 2
Describe the use of benzodiazepines, SSRIs, and tricyclic antidepressants in the treatment of panic disorder
with agoraphobia. You can also explain that drug therapy has seldom been used in the treatment of specific
phobia.
3(b). Evaluate the therapy(ies) described in (a). (16 marks)
Paragraph 1 Introduction
Compare the effectiveness of drugs for social phobia and panic disorder with agoraphobia. Use empirical
evidence as support, such as Heimberg et al. (1998), Bandelow et al. (2007), and Mitte’s (2005) research
findings.
Paragraph 2
Discuss how drug treatment does not compare as favourably as the cognitive approach in the treatment of
social phobia and panic disorder with agoraphobia, and that the behavioural approach has been found to be
highly effective for specific phobias.
Paragraph 3
Discuss whether a multi-dimensional approach is best to include drugs or not as some research suggests
this reduces relapse rates yet other research suggests that the use of drugs has a negative long-term effect.
Paragraph 4
Consider other issues that undermine the effectiveness and appropriateness of drugs as a therapy for
phobias such as drop-out and relapse rates. Mention the fact that they treat symptoms, not causes, and may
simply show a placebo effect. Also mention the fact that the effects are short-lived, the side effects, and that
our lack of understanding of how they work questions appropriateness.
Paragraph 5
Consider arguments for effectiveness: they do reduce anxiety and the effect is fast-acting. Patients may find
the psychological treatments too demanding in terms of effort and motivation and so drugs compare well in
terms of ease of use. Furthermore, some patients may need drug therapy to calm them down to a state in
which they can benefit from psychological therapy. Discuss how comparisons of the effectiveness of
different treatments should be treated with caution due to issues such as individual differences of the
patient or therapist; the “general therapy effect”; the “hello-goodbye effect”; and publication bias. Consider
the ethical issues of therapy such as informed consent and confidentiality. Conclude, and say why, a multidimensional approach is optimal.