Prescribed studies: clinical psychology

Welcome to the Prescribed Studies in Clinical Psychology!

In this chapter, we dive into the evidence that shapes how we understand mental health. You will explore one Classic Study that changed the face of psychiatry forever, and a selection of Contemporary Studies that look at modern issues like nutrition in hospitals, the impact of television, and how therapy works in the real world.

These studies are the "evidence" you will use in your Unit 4 exam to support your arguments about diagnosis, symptoms, and treatments. Don't worry if the names seem long; we will break down each study into the Aim, Procedure, Results, and Conclusion.

1. The Classic Study: Rosenhan (1973)

"On being sane in insane places"

This is perhaps one of the most famous (and controversial) studies in the history of psychology. Rosenhan wanted to test a simple but terrifying question: Can mental health professionals actually tell the difference between people who are "sane" and those who are "insane"?

The Aim

To see if the validity of psychiatric diagnosis was based on the patients themselves or the environment (the hospital) they were in. In other words, if a sane person goes into a hospital, will the doctors realize they are sane?

The Procedure

1. Eight pseudo-patients (fake patients), including Rosenhan himself, went to 12 different psychiatric hospitals across five US states.
2. They claimed they were hearing voices that said "thud", "hollow", and "empty".
3. Aside from this fake symptom and changing their names/occupations, everything else they told the doctors was true.
4. Once admitted to the ward, they stopped reporting the symptom and behaved completely normally.

The Results

1. All pseudo-patients were admitted. Seven were diagnosed with Schizophrenia, and one with Bipolar Disorder.
2. The doctors and nurses never realized they were fake patients. Interestingly, the real patients often suspected them, saying things like, "You're not crazy, you're a journalist!"
3. The average stay was 19 days. When they were finally released, their Schizophrenia wasn't "cured"; it was labeled as being "in remission" (meaning the label stayed with them).
4. In a follow-up study, a hospital was warned that pseudo-patients would be sent. They "identified" 41 people as fakes, but Rosenhan had actually sent zero pseudo-patients!

The Conclusion

Rosenhan concluded that we cannot distinguish the sane from the insane in psychiatric hospitals. He coined the term "the stickiness of psychodiagnostic labels"—once you are labeled "Schizophrenic," every normal behavior you do (like taking notes or waiting early for lunch) is seen as a symptom of your illness.

Quick Takeaway: This study highlights the lack of validity in diagnosis and shows how the hospital environment can bias a doctor’s judgment.

2. Contemporary Study (Schizophrenia): Suzuki et al. (2014)

While Rosenhan looked at the label of Schizophrenia, Suzuki et al. looked at the physical health of those living with the disorder in Japan.

The Aim

To investigate the physical health status, specifically the prevalence of being underweight and having undernutrition, in Japanese patients hospitalized with Schizophrenia.

The Procedure

The researchers conducted a cross-sectional study of patients in psychiatric hospitals in Japan. They measured Body Mass Index (BMI) and blood levels (specifically albumin) to check for nutrition levels in a large sample of inpatients.

The Results

1. They found a high prevalence of patients who were underweight compared to the general population.
2. There was a significant issue with undernutrition among these inpatients.
3. This was particularly noticeable in older patients and those who had been in the hospital for a long time.

The Conclusion

The physical health of people with Schizophrenia is often neglected. The study suggests that clinicians need to pay more attention to nutritional management as part of the treatment for Schizophrenia, not just focusing on the "mind."

3. Contemporary Study (Other Disorder)

For your exam, you will have studied either Unipolar Depression or Anorexia Nervosa. You only need to know the studies for the disorder you have chosen.

Option A: Unipolar Depression

Study 1: Hans and Hiller (2013)

Aim: To look at how effective Cognitive Behavioral Therapy (CBT) is for depression in "real-world" outpatient settings and to see how many people drop out of treatment.
Findings: They found that CBT is generally very effective for reducing depression symptoms. However, they also found that a significant number of people drop out before finishing. This tells us that while CBT works, we need to find ways to keep patients engaged in the process.

Study 2: Ma, Quan and Liu (2014)

Aim: To see how social support helps the relationship between how someone evaluates themselves and their level of depression.
Findings: They found that people with higher self-evaluation (feeling good about themselves) had less depression. Crucially, social support acted as a "bridge" or mediator. If you have good friends and family, it helps you feel better about yourself, which in turn reduces depression.

Option B: Anorexia Nervosa

Study 1: Becker et al. (2002)

Aim: To see if the introduction of television would change eating behaviors and attitudes in Fiji (a place that previously didn't have Western TV and traditionally valued larger body shapes).
Findings: After TV was introduced, adolescent girls showed a massive increase in disordered eating and a desire to lose weight to look like the characters on screen. This study is a powerful example of how culture and media (non-biological explanations) can trigger eating disorders.

Study 2: Reichel et al. (2014)

Aim: To look at the brain's reaction to pictures of very thin ("emaciated") bodies in people with Anorexia compared to a control group.
Findings: They used the terms "glass fairies" and "bone children" to describe the types of images. They found that people with Anorexia had different attentional biases and emotional reactions to these images compared to people without the disorder, showing how their brains process body image differently.

4. Summary and Key Evaluation Points

When you are writing about these studies in the exam, try to think about these "GRAVE" points:

• Generalisability: Can we apply the results to everyone? (e.g., Rosenhan only used US hospitals; Suzuki only looked at Japan).
• Reliability: Was the procedure standardized? (e.g., Rosenhan's pseudo-patients all used the same three words: "thud, hollow, empty").
• Application: How does this help us in the real world? (e.g., Becker shows us we need to be careful with media; Suzuki shows we need to feed patients better).
• Validity: Does it measure what it claims to? (e.g., Did Rosenhan prove diagnosis is fake, or just that doctors trust their patients?).
• Ethics: Was it "right" to do? (e.g., Rosenhan deceived the doctors, and the pseudo-patients couldn't leave when they wanted to).

Common Mistake to Avoid: Don't mix up the dates! Rosenhan is 1973 (Classic), while the others are much more recent (Contemporary). The examiners want to see that you understand how psychology has developed over time.

Note: For more information on the symptoms of these disorders or how they are classified (DSM/ICD), please refer to the "Schizophrenia: symptoms and explanations" or "Definitions of abnormality" chapters.