Download Biological therapy

Thinking hats:
7 mins
What are the key assumptions of
each approach?
What are the benefits of each
approach?
What are the weaknesses of each
approach?
This is basically what you did for your exit
task, last lesson so we will skip it.
What applications, in terms of
therapy, could each approach
have?
Management role: walk round and
chat to people (about their Q!)
Biological Treatment
Biological treatments generally include the
administering of medication.
This is controversial.
Why do you think that is?
Biological therapy
 Drugs are the most common form of biological therapy and
are often the first thing administered to patients
 The assumption is that there is an underlying biological cause
for abnormal behaviour
 This could be due to brain structure, genetics or hormones
 What might the positive side of this be?
 Rapid treatment, quick and cheap to administer, can put the
patient in a better position to respond to therapy
 What might be the negative?
 Medicalising emotions, ‘quick fix’, doesn’t tackle the cause
(masks the problem), don’t work for everyone, side effects.
Phenelzine
 Read: http://www.mayoclinic.org/diseases-
conditions/depression/in-depth/maois/art20043992
 In pairs discuss how this drug works?
 Using the information from the website complete the
diagram on the next slide to fully understand how
MAOI’s work.
Phenelzine
 A form of antidepressant
 MAOI – monoamine oxidase inhibitor
 Monoamine oxidase inhibitors (MAOIs) are chemicals which





inhibit the activity of the monoamine oxidase (MAO) enzyme
family.
MAO enzyme degrades and removes neurotransmitters such as
dopamine and serotonin from the brain
MAOI inhibit this action which makes more of these brain
chemicals available.
Boosting mood by improving brain cell communication.
Has quite a few side effects, generally used when other
medicines have not been effective
There is now a new generation of MAOIs with fewer side effects
Presynaptic
neuron
Synaptic Cleft
Postsynaptic
neuron
MAO – Monoamine
Oxidase
S – Serotonin
MAOI – Inhibitor
Presynaptic
neuron
Synaptic Cleft
Postsynaptic
neuron
MAO – Monoamine
Oxidase
S – Serotonin
I – Inhibitor
Neurobiology of Social Anxiety Disorder:
 Neurobiology of Social Anxiety Disorder:
Dysregulation of neurotransmitter function in the brain is
thought to play a key role in Social Phobia (SP).
 Specifically, dopamine (DA), serotonin (SE) are hypothosised
in most cases of SP. in varying degrees depending on the
individual.
 So how does phenelzine work to treat social phobia?
 The MAOI antidepressant "phenelzine" boosts the levels of
dopamine and serotonin
 There is strong evidence for dopamine dysfunction in Social
Phobia
Physiology of Anxiety
Fearful Stimuli
Sympathetic nervous system
(brain and spinal cord) releases
hormones (i.e. adrenaline)
Fight or flight response: Increased
heart rate, enlarged pupil's, sweat
Increased anxiety helps a person
to prepare for an appropriate
course of action
Atenolol
 Beta-Blocker
 Work by blocking the transmission of nerve
impulses
 They blocking the effects of the hormone
epinephrine, also known as adrenaline. When
you take beta blockers, the heart beats more
slowly and with less force, thereby reducing
blood pressure
Read: http://patient.info/health/beta-blockers
Beta-blockers – How do they work?
 Using the information from the website complete the
diagram by adding in the labels.
Tissue cell
Beta-blocker
Receptor on
cell surface
Nerve
ending
Adrenaline
Complete the table
How do they work
Side effects
MAOI
•
•
•
•
•
•
•
Beta-blockers
•
•
•
•
•
•
Leibowitz (1988): Treatment of Social Phobia with Phenelzine
Potential
pitfalls?
Biological treatment
Key study: Leibowitz (1988)
Aim
 To see if the drug phenelzine can help treat patients with
social phobia.
 To see if phenelzine is more effective than a placebo and
atenolol in treating social phobia.
 Why use a placebo group?
Method
 A controlled experiment where patients were allocated
to one of three conditions, and treated over 8 weeks.
They were assessed for social phobia on several tests such
as:
 The Hamilton Rating Scale for Anxiety
 Leibowitz Social Phobia Scale. This had common
manifestations of social phobia and patients rated 1-4
for the fear produced and
1-4 for the steps taken to avoid the phobic situation.
Participants
 80 patients meeting DSM criteria for social phobia aged
18–50 years. They were medically healthy and had not
received phenelzine for at least two weeks before the
trial. Each was assessed to see that there were no other
disorders. Each signed a consent form before the
research.
Design
 An independent design with patients being allocated




randomly to one of four groups:
one group was treated with phenelzine
one group was given a matching placebo
a second treatment group was given atenolol
another group was given a matching placebo.
Procedure
 Patients were assessed at the beginning, and then given
their drug or placebo, with gradual increases in dosage
of phenelzine or atenolol in the treatment groups.
 Each patient was then reassessed.
 Independent evaluators were used to carry out clinical
assessments in a double blind situation.
Findings
 After eight weeks significant differences were noted for
the phenelzine groups, with better scores on the tests for
anxiety compared to the placebo groups.
 There was no significant difference between the patients
taking atenolol and those taking a placebo.
Conclusions
 Phenelzine but not atenolol is effective in treating social
phobia after eight weeks of treatment.
Plenary
 Outline 2 advantages to drug therapy
 2 disadvantages
 Extension:
 Suggest a solution
Activity:
12 mins
Evaluate the Leibowitz study
Pair 1 Sample, generalisability, ethics
Pair 2- reliability, methodology
Pair 3 – usefulness, validity
Pair 4 – nature/nurture, reductionism/holism,
Evaluation of Liebowitz
 Method
 Controls – inc. placebo group and 2 comparison groups
 Controlled IV – could measure cause and effect
 Scale used – quantitative data – comparable
 Issues with this: could be misinterpreted, may still be
subjective i.e. what constitutes a ‘5’ on the scale? –
validity and reliability
 Design
 Independent design
 Necessary in order to establish cause and effect in this
case
 Random allocation – no bias in sample, everyone had
an equal chance of being allocated to each group
 Sample
 Wide age range – generalisable across age ranges
 Medically healthy and had not had phenelzine for 2
weeks before – control of possible confounding variables
 Data collection
 Likert scale – 1 to 5 rating system
 Used a scale that is commonly used in psychiatry
 Used two different scales – one psychiatrists report and
the other self-report (validity)
 Independent evaluators, double blind – no experimenter
bias
 Reliability
 Standardised procedure – easily replicable
 Good controls – clear IV (i.e. which group they were
placed in) so effect on DV could be measured
 Validity
 Independent evaluators – double-blind, did not know what
the study was about so could not be responding to demand
characteristics
 Participants were going about their daily lives – it was
longitudinal so presumably the results are ecologically valid
 Two different types of scale LSPS (self-report, patients
subejctive experience) plus assessed with Hamilton Rating
Scale. If the results are in agreement, it suggests they are
both measuring what they are supposed to measure.
 Bias
 Could be some bias in interpreting the rating scales,
particularly initially
 However, the patients were independently evaluated in
a double-blind procedure and therefore they could not
be subject to demand characteristics
 The above were not the researchers so no experimenter
bias
 Ethics
 Consent given
 Two groups given a placebo – is this ethical? They may
not receive the benefits of the treatment
 Wider benefits for society if an effective treatment for
social phobia is evidenced
Reductionist it is, it assumes that social phobia can be treated with
drugs alone and does not take into account the reasons
behind the social phobia
However, patients who took phenelzine showed greater
improvement, so in some ways this is actually a strength
as it led to improved recovery.
Determinist Determinist – it takes control out of the hands of the
patient and places it with the psychiatrist and medical
staff
Ethnocentric Ethnocentric
N vs N
Nature Vs Nurture – supports the role of biological
factors in social anxiety. Doesn’t take into account the
environmental triggers.
Strengths and weaknesses of Biological Treatment
Strengths
Weaknesses
Strengths and weaknesses of Biological Treatment
Strengths
Weaknesses
• Psychology as a science – treatments
use knowledge about physiological
mechanisms
• Easy to use - Little effort and quick
response
•
•
•
•
Reductionist
Determinist
Side effects
Treats the symptoms not the cause