Clinical Psychology

1(a) Explain what is meant by ‘systematic desensitisation’. 2 Award 1 mark for a basic explanation of the term/concept. Award 2 marks for a detailed explanation of the term/concept. For example – Gradual exposure therapy.(1) The patient is taught relaxation techniques (1) and are gradually exposed to increasing levels of the object/situation they have a phobia of until their phobic reaction subsides. (1) Other appropriate responses should also be credited. 1(b) Describe the cognitive explanation of phobias. 4 Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example – A phobia may develop due to irrational thoughts.(1) The person believes that the phobic object/situation as more dangerous or harmful than the object/ situation really is.(1) Due to these thoughts, when the person sees the object they will have a strong fear reaction.(1) These irrational thoughts could have developed from a bad experience (e.g. being bitten by a dog) and the irrational belief that this is likely to happen again in the future.(1) Other appropriate responses should also be credited. © UCLES 2021 Page 6 of 22 1(c) Explain two strengths of the cognitive explanation of phobias. 6 Likely strengths include – • Backed up by evidence from the DiNardo study. DiNardo found that dog phobia was more common in people who had a fearful experience with a dog and also believed that this was likely to happen again in the future. This evidence supports the explanation as it shows how people with phobias will have irrational thoughts (‘I will be bitten again by a dog’) compared to those people who had the bad experience but did not believe it would happen again in the future. This increases the validity of the cognitive explanation of phobias. • DiNardo is supporting evidence. Credit strengths of this study (e.g. validity, in depth data from interview, etc.). Level 3 can only be awarded when the evaluation is clearly linked back to the explanation e.g. One strength of this explanation is that it is backed up by evidence from the DiNardo study which collected both quantitative and qualitative data. This data allowed comparisons to be made between the fearful and non-fearful participants as well as DiNardo collecting data on the dog experience and likelihood of a bad experience happening again. This adds to the validity of the cognitive explanation as the results which back up this explanation are highly detailed. • Practical applications – CBT is a useful application of this explanation. Can challenge the irrational thoughts the patient has of the phobic object or situation. Also shows that a traumatic experience in the past may have led to the irrational thoughts developing and the CBT therapist can discuss this with their client. • Somewhat holistic as this explanation takes into account both the experience of the phobic object/situation as well as the person’s cognitions about the phobic object. The person thinks that there is a high likelihood that the bad experience they had will happen again in the future. Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain two strengths. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one appropriate strength in detail OR two strengths in less detail. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation of a strengths. They could include two strengths but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2021 Page 7 of 22

2(a) Describe the treatment and management of obsessive-compulsive and 8 related disorders. Treatment and management of obsessive-compulsive and related disorders, including the following: • Biomedical (SSRIs) • Psychological: cognitive (Lovell et al., 2006), and exposure response prevention (Lehmkuhl et al., 2008) Biomedical (SSRIs) The main medications prescribed are selective serotonin reuptake inhibitors (SSRIs). These can help improve OCD symptoms by increasing the levels of a chemical called serotonin in the brain. This seems to then cause a lessening of anxiety experienced by the patient and therefore they do not need to engage in the OCD behaviours in order to relieve their anxiety (such as hand washing). Cognitive (Lovell et al., 2006) Study - Comparing telephone versus face-to-face treatment of CBT for OCD. 72 out-patients took part. 10 weekly sessions of exposure and response prevention therapy were given. 3 depression inventories given during therapy (Yale-Brown, Beck and client satisfaction). No significant differences found at six months. Concluded both face-to-face and telephone treatment are equally as effective in treating OCD. Credit can also be given for describing CBT therapy as it might be used to reduce OCD symptoms e.g. challenging the faulty thinking that hands need to be washed excessively in order to remove dirt and germs and keep the person safe from harm. Exposure response prevention (Lehmkuhl et al., 2008) Case study with a 12-year-old boy called Jason who had both autism and OCD. 10 50-minute sessions of CBT over 16 weeks. Used exposure response prevention – for example - Exposure – getting Jason to touch objects he has difficulties with such as elevator buttons, door handles, etc. Response prevention – reducing the anxious response to the objects by using coping statements. Jason does have high anxiety responses but he learns as therapy progresses that these reduce quickly within a few minutes. After therapy score on Y-BOCS dropped from 18 to 3. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2021 Page 8 of 22 2(b) Evaluate the treatment and management of obsessive-compulsive and 10 related disorders, including a discussion about determinism versus free-will. A range of issues could be used for evaluation here. These include: • Named issue – determinism/free will nature of the treatments e.g. biomedical is more deterministic as it suggests that the release of serotonin is what will reduce the OCD symptoms due to the reduction in anxiety and it is not down to anything the patient might do or think. However, it is the free will of the patient to take the SSRI. On the other hand, the psychological treatments suggest more free will as the patient can choose to go away and practice the tasks set by the therapist. They do, however, need the therapist’s insight into their thoughts and behaviours which is somewhat more deterministic. • Validity • Application of psychology to everyday life (with reference to treatments). • Nature versus nurture debate with reference to the various treatments (via the approaches upon which they are based) • Comparisons of different treatments • Reductionist nature of the treatments • Appropriateness of treatments • Cost of treatments • Ethics of psychological treatments Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2021 Page 9 of 22

1(a) Explain what is meant by ‘bipolar’ disorder. 2 Award 1 mark for a basic explanation of the term/concept. Award 2 marks for a detailed explanation of the term/concept. For example, Two strongly contrasting phases of mood. (1) Periods of severely elevated mood followed by periods of very low mood lasting for several weeks or months. (2) Other appropriate responses should also be credited. 1(b) Describe cognitive restructuring (Beck, 1979) as a treatment for 4 depression. Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example, This is where the patient participates in a number of therapy sessions over weeks and/or months to alleviate their symptoms of depression. (1) As it is believed the depressive symptoms are due to faulty thinking the therapist will help the patient to identify their faulty thinking and then correct these thinking patterns to more helpful ways of viewing themselves, the world and the future.(1) Initially the patient and therapist will identify what the thinking patterns are and the patient will be helped to come up with alternative thoughts. (1) The patient then goes away between sessions and practices these alternative thoughts which should then lead to more helpful behaviours which will lead the patient to feel more hopeful and positive.(1) Other appropriate responses should also be credited. © UCLES 2021 Page 6 of 22 1(c) Explain one strength and one weakness of cognitive restructuring as a 6 treatment for depression. Likely strengths include – • Effectiveness of treatments – shown to be as effective as SSRIs for treating depression and give a toolkit for patients to use in the future if the depressive symptoms return. • Treatment does not have any side effects like medication and the patient has learned techniques to help with depression should they relapse in the future. • Can be inexpensive for the patient as could be offered for free in some countries • Fairly quick compared to other therapies as around 6–8 sessions. Psychotherapy can take over a year. • Empowering the patient – their free will is acknowledged and the patient is actively involved in their treatment. Likely weaknesses include – • Appropriateness of treatments as some patients will not want to discuss their personal problems with a therapist. OR some patients may be so severely depressed they cannot engage with the therapy. • Cost of treatment. Therapist’s time must be paid for either by the patient or by the health service. Therapists can charge £50–100 for a 50 minute session. This could lead to the patient feeling more depressed if they suffer financial hardship paying for the treatment. • Time consuming. Takes 6–8 sessions but can be offered up to 12. Some therapists will have two weeks between treatments so it could take almost six months to finish the therapy. For someone who is very depressed and might engage in self-injurious behaviour waiting for the therapy to get to the point where it is helpful might be dangerous. • Lots of effort/motivation required from the patient. • Patients may feel uncomfortable discussing their problems and may not be completely honest about their thoughts and experiences. Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain one strength and one weakness. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one appropriate weakness in detail or one appropriate strength in detail. OR one weakness and one strength in less detail. © UCLES 2021 Page 7 of 22 1(c) Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation of either a strength or a weakness. They could include both but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2021 Page 8 of 22

2(a) Describe the causes of impulse control disorders and non-substance 8 addictive disorder. Causes of impulse control disorders and non-substance addictive disorder including the following – Biochemical: dopamine Behavioural: positive reinforcement Cognitive: feeling-state theory (Miller, 2010). Biochemical – dopamine The neurotransmitter dopamine has been linked to impulse control and addictive disorders. Dopamine’s release is triggered by rewarding stimuli, such as engaging in pleasurable behaviours. So a pyromaniac will feel the reward of this ‘happy chemical’ when they start a fire. As the behaviour increases, levels of dopamine in striatum are reduced. This can lead to the perpetuation of the compulsions/addictions. Known as ‘reward deficiency syndrome’. Behavioural – positive reinforcement Operant conditioning states that the frequency of a behaviour is increased by the use of a reward. For the gambler this can be money (for the kleptomaniac and pyromaniac the thrill associated with their behaviours). Positive reinforcement explains gambling well by the use of schedules of reinforcement with the use of partial positive reinforcement (a reward is not received every time). Gambler is compelled to continue because they ‘might’ win the next time. Cognitive – feeling-state theory (Miller, 2010) Intense positive feelings link with specific behaviours such as gambling. Impulse control disorders are caused because these links form a ‘state- dependent memory’ (feeling state). The intense feeling-state experienced is all the emotions, thoughts and physiological arousal, and this leads to impulse-control problems and obsessions. The individual with negative thoughts about themselves can experience an intense feeling of euphoria and power when they indulge in their impulsive behaviour, overcoming that negative thought to a great extent. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2021 Page 9 of 22 2(b) Evaluate the causes of impulse control disorders and non-substance 10 addictive disorder, including a discussion about nature versus nurture. A range of issues could be used for evaluation here. These include: • Named issue – nature versus nurture – Behavioural is due to nurture as the person with impulse control disorder learns the disorder through rewards, Biological – dopamine could be due to nature (person is born with a stronger dopamine response) or nurture (patient learns the behaviour due to the dopamine release). Feeling state is mainly nurture as the patient develops the feeling state due to their experiences of the behaviour they have developed impulsive behaviour around (e.g. gambling) Example analysis – If something is due to nature the person cannot alter this so therefore it could be argued the behaviour cannot be changed. However, modern medicine has created medications that alter our biochemistry. If something is due to nurture then the environment can be improved so that the rewarding experiences no longer happen (e.g. gambling websites could be prevented from giving such high maximum payments) and therefore the behaviour could either not be learned in the first place or someone being treated might find it easier to stop doing their impulsive behaviour. • Deterministic nature of the causes • Practical applications • Evaluation of evidence of causes • Generalisability of the explanation to all types of impulse control disorders and non-substances. Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2021 Page 10 of 22

1(a) Explain what is meant by ‘systematic desensitisation’. 2 Award 1 mark for a basic explanation of the term/concept. Award 2 marks for a detailed explanation of the term/concept. For example – Gradual exposure therapy.(1) The patient is taught relaxation techniques (1) and are gradually exposed to increasing levels of the object/situation they have a phobia of until their phobic reaction subsides. (1) Other appropriate responses should also be credited. 1(b) Describe the cognitive explanation of phobias. 4 Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example – A phobia may develop due to irrational thoughts.(1) The person believes that the phobic object/situation as more dangerous or harmful than the object/ situation really is.(1) Due to these thoughts, when the person sees the object they will have a strong fear reaction.(1) These irrational thoughts could have developed from a bad experience (e.g. being bitten by a dog) and the irrational belief that this is likely to happen again in the future.(1) Other appropriate responses should also be credited. © UCLES 2021 Page 6 of 22 1(c) Explain two strengths of the cognitive explanation of phobias. 6 Likely strengths include – • Backed up by evidence from the DiNardo study. DiNardo found that dog phobia was more common in people who had a fearful experience with a dog and also believed that this was likely to happen again in the future. This evidence supports the explanation as it shows how people with phobias will have irrational thoughts (‘I will be bitten again by a dog’) compared to those people who had the bad experience but did not believe it would happen again in the future. This increases the validity of the cognitive explanation of phobias. • DiNardo is supporting evidence. Credit strengths of this study (e.g. validity, in depth data from interview, etc.). Level 3 can only be awarded when the evaluation is clearly linked back to the explanation e.g. One strength of this explanation is that it is backed up by evidence from the DiNardo study which collected both quantitative and qualitative data. This data allowed comparisons to be made between the fearful and non-fearful participants as well as DiNardo collecting data on the dog experience and likelihood of a bad experience happening again. This adds to the validity of the cognitive explanation as the results which back up this explanation are highly detailed. • Practical applications – CBT is a useful application of this explanation. Can challenge the irrational thoughts the patient has of the phobic object or situation. Also shows that a traumatic experience in the past may have led to the irrational thoughts developing and the CBT therapist can discuss this with their client. • Somewhat holistic as this explanation takes into account both the experience of the phobic object/situation as well as the person’s cognitions about the phobic object. The person thinks that there is a high likelihood that the bad experience they had will happen again in the future. Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain two strengths. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one appropriate strength in detail OR two strengths in less detail. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation of a strengths. They could include two strengths but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2021 Page 7 of 22

2(a) Describe the treatment and management of obsessive-compulsive and 8 related disorders. Treatment and management of obsessive-compulsive and related disorders, including the following: • Biomedical (SSRIs) • Psychological: cognitive (Lovell et al., 2006), and exposure response prevention (Lehmkuhl et al., 2008) Biomedical (SSRIs) The main medications prescribed are selective serotonin reuptake inhibitors (SSRIs). These can help improve OCD symptoms by increasing the levels of a chemical called serotonin in the brain. This seems to then cause a lessening of anxiety experienced by the patient and therefore they do not need to engage in the OCD behaviours in order to relieve their anxiety (such as hand washing). Cognitive (Lovell et al., 2006) Study - Comparing telephone versus face-to-face treatment of CBT for OCD. 72 out-patients took part. 10 weekly sessions of exposure and response prevention therapy were given. 3 depression inventories given during therapy (Yale-Brown, Beck and client satisfaction). No significant differences found at six months. Concluded both face-to-face and telephone treatment are equally as effective in treating OCD. Credit can also be given for describing CBT therapy as it might be used to reduce OCD symptoms e.g. challenging the faulty thinking that hands need to be washed excessively in order to remove dirt and germs and keep the person safe from harm. Exposure response prevention (Lehmkuhl et al., 2008) Case study with a 12-year-old boy called Jason who had both autism and OCD. 10 50-minute sessions of CBT over 16 weeks. Used exposure response prevention – for example - Exposure – getting Jason to touch objects he has difficulties with such as elevator buttons, door handles, etc. Response prevention – reducing the anxious response to the objects by using coping statements. Jason does have high anxiety responses but he learns as therapy progresses that these reduce quickly within a few minutes. After therapy score on Y-BOCS dropped from 18 to 3. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2021 Page 8 of 22 2(b) Evaluate the treatment and management of obsessive-compulsive and 10 related disorders, including a discussion about determinism versus free-will. A range of issues could be used for evaluation here. These include: • Named issue – determinism/free will nature of the treatments e.g. biomedical is more deterministic as it suggests that the release of serotonin is what will reduce the OCD symptoms due to the reduction in anxiety and it is not down to anything the patient might do or think. However, it is the free will of the patient to take the SSRI. On the other hand, the psychological treatments suggest more free will as the patient can choose to go away and practice the tasks set by the therapist. They do, however, need the therapist’s insight into their thoughts and behaviours which is somewhat more deterministic. • Validity • Application of psychology to everyday life (with reference to treatments). • Nature versus nurture debate with reference to the various treatments (via the approaches upon which they are based) • Comparisons of different treatments • Reductionist nature of the treatments • Appropriateness of treatments • Cost of treatments • Ethics of psychological treatments Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2021 Page 9 of 22

1 Griffiths (2005) refers to a case of a person addicted to gambling who says: ‘If I wasn’t actually gambling I was spending the rest of my time working out clever little schemes to obtain money to feed my habit. These two activities literally took up all my time’. This quote is typical of gambling and many other types of addictive behaviours, including pyromania and kleptomania. 1(a) Explain what is meant by 'pyromania'. 2 Most likely answer (other appropriate responses to be credited): • Where the person has deliberately and intentionally set fires on more than one occasion. • Experiences tension or affective arousal before the act. • Has a fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, and consequences). • Pleasure, gratification, power or relief when setting fires or when witnessing or participating in their aftermath. • The fire-setting is not done for monetary gain, as an expression of socio-political ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment. • The fire-setting is not explained by conduct disorder, a manic episode, or antisocial personality disorder. Marks: 1 mark for basic answer (likes setting fires), 2 marks for detail/elaboration/example (as indicated above) © UCLES 2021 Page 8 of 25 1(b) Give two components of any addiction outlined by Griffiths (2005). 4 Most likely answers: • Salience when the particular activity becomes the most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour) • Mood modification/euphoria the subjective experience that people report as a consequence of engaging in the particular activity (i.e. an arousing ‘buzz’ or a ‘high’) • Tolerance the process whereby increasing amounts of the particular activity are required to achieve the former effects • Withdrawal symptoms the unpleasant feeling states and/or physical effects which occur when the particular activity is discontinued or suddenly reduced • Conflict conflicts between the addict and those around them (interpersonal conflict) or from within the individual themselves (intrapsychic conflict) • Relapse the tendency for repeated reversions to earlier patterns of the particular activity to recur Note: answer does not have to be related to any example, although examples receive credit. Marks: 1 mark basic answer (identification component), 2 marks detail/elaboration/example X2. 1(c) Suggest two ways to measure a person’s addiction to gambling, other 4 than using a questionnaire. Most likely answer (other appropriate responses to be credited): • Observation (covert or overt; structured; non-participant, natural – or any combination of these • Interview (face-to-face or by telephone) • Case study (one person with range of methods, or for example the case study of ‘Jo’ by Griffiths. • Physiological measure (such as ECG, GSR, hormone levels) Marks: 1 mark basic answer (identification of method plus a comment about how that method would work. Max 1 mark for each suggestion if not related to gambling), 2 marks related to gambling, X2 Some answers may suggest ‘anecdotal’ measures. Max 1 mark for such answers Note: 0 marks for questionnaires such as Gambling prevalence survey, CPGI, etc Note: rating scales must be based on a question, so 0 marks for ‘rating scale’ Note: 0 marks for interviews/open ended questions that make no reference to measurement. © UCLES 2021 Page 9 of 25 1(d) Discuss the strengths and weaknesses of using questionnaires to 5 measure kleptomania. You should include a conclusion in your answer. Marks: 1 mark for each strength/weakness (however basic/detailed) which is related/linked to the question (max 4 marks). 1 mark for conclusion. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Most likely answer (other appropriate responses to be credited): Strengths: • Asking people directly, using a questionnaire, especially open-ended, means that participants are given the opportunity to express their feelings about stealing and explain their stealing behaviour rather than the researcher trying to work out reasons for this behaviour from other methods • Relatively large numbers of participants can be done relatively easily in comparison to say a face-to-face interview or experiment. Questionnaires are easy to replicate. • Data can be qualitative, but may also be quantitative depending on type of question Weaknesses: • Some participants may provide socially desirable responses; not give truthful answers about their stealing behaviour; respond to demand characteristics. • Closed/fixed-choice questions may force people into choosing answers that do not reflect their true opinion and therefore may lower the validity. • Researchers have to be careful about use of leading questions; it could affect the validity of the data collected. © UCLES 2021 Page 10 of 25

5(a) Design a longitudinal study to investigate whether cognitive- 10 behavioural therapy (CBT) manages schizophrenia effectively. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method: longitudinal study. Any method can be used, provided that the data gathered is over a period of time. Typical features: • Experiments: type, IV, DV, controls, experimental design. • Observations: type, setting, response categories, sampling frame, number of observers. • Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique & sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Marks: use generic levels of response ‘Design a study’ question part (b). ‘Psychological’ = 4 marks; ‘methodological’ = 4 marks If only methodological or psychological explanation is provided max 5 marks If ‘psychological’ described and not related to part (a) max 2 marks. Syllabus: cognitive-behavioural therapy (Sensky et al., 2000) Psychological: Sensky et al. (2000) used cognitive-behavioural therapy (CBT) to treat schizophrenia in patients already taking medication. After CBT sessions patients showed improvement. At the 9-month follow-up evaluation they continued to improve. It was concluded that CBT is effective. Note 0 marks for candidates who merely replicate this study. Methodological: explanation of method using general and specific features as above. © UCLES 2021 Page 18 of 25

9 ‘Psychometric measures, such as the Kleptomania Symptom 12 Assessment Scale (K-SAS), provide therapists with no useful information.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: measures: Kleptomania Symptom Assessment Scale (K-SAS) Most likely (any other appropriate responses should be credited): Useful: • Measures such as K-SAS indicate the severity of a disorder • The measure can highlight specific features of the disorder • The measure can be used as a comparison to others with the same disorder • The measure provides quantitative data • Any feature of a psychometric test (e.g. reliable, standardised) Not useful: • Measures can use scales (5 or 7 point) which allow the person to ‘opt out’ or give a neutral answer’ • Scales do not take individual differences into account; there might be some aspect which the scales do not cover • A patient may want to talk to a therapist about the problem, not just fill in a questionnaire. • Interviews by therapists may reveal far more about the individual problem • Interviews can reveal specific problems not covered by a general psychometric test. © UCLES 2021 Page 22 of 25

1 Three comments about electro-convulsive therapy (ECT): ‘It was the best thing that my wife could have had at that time; a good decision by the doctors after drugs had failed.’ ‘It was a positive experience; worked well for my schizophrenia.’ ‘I was able to go home after five months of inpatient stay as a result of ECT, after years of unsuccessful psychological treatment.’ 1(a) Outline the procedure of electro-convulsive therapy (ECT). 2 Most likely answer (other appropriate responses to be credited): • Muscle relaxant given • Electricity applied bilaterally or unilaterally • Patient convulses/has seizures (twitches because of muscle relaxant) • Patient is unconscious, then wakes and recovers. • Applied once or twice a week for several weeks. Marks: 1 mark for each correct point to 2 max. 1(b)(i) Outline one biochemical treatment for schizophrenia. [2] 2 Most likely answer Biochemical: the giving of drugs/prescribed medication. Drugs such as: • antipsychotics/neuroleptics e.g. chlorpromazine • atypical antipsychotics block dopamine receptors • ‘third generation’ e.g. aripiprazole Marks: 1 mark basic answer (‘giving drugs/identified brand name/identified type’ all 1 mark, but two identifications does not = 2 marks) 2 marks detailed answer/elaboration/example (how these drugs work or ‘generations’). NB: also credit side effects, such as TDK as elaboration. 1(b)(ii) Give one advantage of this biochemical treatment for schizophrenia. 2 • Drugs are effective. They work, they reduce symptoms of schizophrenia. • Use of drugs can help to restore the ‘chemical balance’ • Drugs can be given on a fixed schedule (by the patient or by therapist) • Drugs require very little effort by the patient (are ‘quick’ and ‘easy’, they just swallow a pill) unlike non-chemical therapies • Drugs are cost effective (0 mark) but if explained e.g. ‘compared to ECT, or CBT’ (2 marks) Marks: 1 mark basic answer (basic advantage), 2 marks detail/elaboration/ example Note: if identify ‘time and cost’ = 0 marks, but if explained, then 2 marks. © UCLES 2021 Page 8 of 25 1(c) Outline two psychological treatments for schizophrenia. 4 Most likely answer • token economy (Paul and Lentz, 1977) use of operant conditioning (desirable behaviours positively reinforced) using a token. Behaviours such as self-care, attending therapy and engaging socially. Tokens later exchanged for clothing, TV use, sweets and cigarettes. • cognitive-behavioural therapy (Sensky et al., 2000) compared CBT group with control, randomly allocated. 90 patients aged 16–60 received average of 19 sessions. CBT = engaging with patient, discussing disorder, symptoms and challenged beliefs about voices. Marks: 1 mark basic answer (CBT is a ‘talking therapy’), 2 marks detail/ elaboration/example ×2 1(d) Discuss the strengths and weaknesses of ECT as a treatment for 5 schizophrenia. You should include a conclusion in your answer. Marks: 1 mark for each strength/weakness (however basic/detailed) which is related/linked to the question (max 4 marks). 1 mark for conclusion. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Most likely answer (other appropriate responses to be credited): Strengths: • It is a medical treatment, prescribed by and applied by medical doctors • It is necessary for patients where all other medications have not worked • It successfully treats many patients both with schizophrenia and depression Weaknesses: • How ECT works still isn’t known • ECT can be given to a person to treat schizophrenia without their consent in some countries (person is not ‘of sound mind’) • ECT has side-effects, both long and short term: loss of memory (temporary or worse), aspects of short-term or long-term memory. In people with other conditions it may affect the central nervous system and cardiovascular system. Note: do not credit ethics. This is not a study where ethics applies. It is real life, where ECT can be given without consent (‘not of sound mind’ etc.) © UCLES 2021 Page 9 of 25

5(a) Cognitive-behavioural therapy (CBT) can be used to treat obsessive- 10 compulsive disorder (OCD). Design a study to test gender differences in effectiveness of CBT administered by telephone for OCD. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method: any appropriate method. Specific features: • Experiments: type, IV, DV, controls, experimental design. • Observations: type, setting, response categories, sampling frame, number of observers. • Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Marks: use generic levels of response ‘Design a study’ question part (b). ‘Psychological’ = 4 marks; ‘methodological’ = 4 marks If only methodological or psychological explanation is provided max 5 marks If ‘psychological’ described and not related to part (a) max 2 marks. Syllabus: psychological: cognitive (Lovell et al., 2006) and exposure and response prevention (Lehmkuhl et al., 2008) Psychological: Lovell et al. (2006) compared the effectiveness of CBT face-to-face with CBT given over the telephone. The conclusion was that there was no difference in effectiveness. However, there may have been an age difference that was not explored. NB: Lovell used BDI. Methodological: explanation of method using general and specific features as above. © UCLES 2021 Page 18 of 25

9 ‘Even though Charles was just one child, Rapoport’s case study of 12 Charles’ obsessive-compulsive disorder (OCD) can be generalised to everyone.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: examples and case studies (‘Charles’ by Rappaport,1989) Most likely (any other appropriate responses should be credited): Can be generalised: • Washing behaviour is a common type of OCD • The rituals associated with washing behaviour are common in others. • Comorbidity associated with OCD applies in others. • Treatments undergone with Charles can apply to others Cannot be generalised: • People are different and what applies to many people will not apply to all. • Rituals will occur, but they will be different. • Charles was a child and what he can do/not do will be different in an adults (who has to work, for example). © UCLES 2021 Page 22 of 25

1 Griffiths (2005) refers to a case of a person addicted to gambling who says: ‘If I wasn’t actually gambling I was spending the rest of my time working out clever little schemes to obtain money to feed my habit. These two activities literally took up all my time’. This quote is typical of gambling and many other types of addictive behaviours, including pyromania and kleptomania. 1(a) Explain what is meant by 'pyromania'. 2 Most likely answer (other appropriate responses to be credited): • Where the person has deliberately and intentionally set fires on more than one occasion. • Experiences tension or affective arousal before the act. • Has a fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, and consequences). • Pleasure, gratification, power or relief when setting fires or when witnessing or participating in their aftermath. • The fire-setting is not done for monetary gain, as an expression of socio-political ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment. • The fire-setting is not explained by conduct disorder, a manic episode, or antisocial personality disorder. Marks: 1 mark for basic answer (likes setting fires), 2 marks for detail/elaboration/example (as indicated above) © UCLES 2021 Page 8 of 25 1(b) Give two components of any addiction outlined by Griffiths (2005). 4 Most likely answers: • Salience when the particular activity becomes the most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour) • Mood modification/euphoria the subjective experience that people report as a consequence of engaging in the particular activity (i.e. an arousing ‘buzz’ or a ‘high’) • Tolerance the process whereby increasing amounts of the particular activity are required to achieve the former effects • Withdrawal symptoms the unpleasant feeling states and/or physical effects which occur when the particular activity is discontinued or suddenly reduced • Conflict conflicts between the addict and those around them (interpersonal conflict) or from within the individual themselves (intrapsychic conflict) • Relapse the tendency for repeated reversions to earlier patterns of the particular activity to recur Note: answer does not have to be related to any example, although examples receive credit. Marks: 1 mark basic answer (identification component), 2 marks detail/elaboration/example X2. 1(c) Suggest two ways to measure a person’s addiction to gambling, other 4 than using a questionnaire. Most likely answer (other appropriate responses to be credited): • Observation (covert or overt; structured; non-participant, natural – or any combination of these • Interview (face-to-face or by telephone) • Case study (one person with range of methods, or for example the case study of ‘Jo’ by Griffiths. • Physiological measure (such as ECG, GSR, hormone levels) Marks: 1 mark basic answer (identification of method plus a comment about how that method would work. Max 1 mark for each suggestion if not related to gambling), 2 marks related to gambling, X2 Some answers may suggest ‘anecdotal’ measures. Max 1 mark for such answers Note: 0 marks for questionnaires such as Gambling prevalence survey, CPGI, etc Note: rating scales must be based on a question, so 0 marks for ‘rating scale’ Note: 0 marks for interviews/open ended questions that make no reference to measurement. © UCLES 2021 Page 9 of 25 1(d) Discuss the strengths and weaknesses of using questionnaires to 5 measure kleptomania. You should include a conclusion in your answer. Marks: 1 mark for each strength/weakness (however basic/detailed) which is related/linked to the question (max 4 marks). 1 mark for conclusion. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Most likely answer (other appropriate responses to be credited): Strengths: • Asking people directly, using a questionnaire, especially open-ended, means that participants are given the opportunity to express their feelings about stealing and explain their stealing behaviour rather than the researcher trying to work out reasons for this behaviour from other methods • Relatively large numbers of participants can be done relatively easily in comparison to say a face-to-face interview or experiment. Questionnaires are easy to replicate. • Data can be qualitative, but may also be quantitative depending on type of question Weaknesses: • Some participants may provide socially desirable responses; not give truthful answers about their stealing behaviour; respond to demand characteristics. • Closed/fixed-choice questions may force people into choosing answers that do not reflect their true opinion and therefore may lower the validity. • Researchers have to be careful about use of leading questions; it could affect the validity of the data collected. © UCLES 2021 Page 10 of 25

5(a) Design a longitudinal study to investigate whether cognitive- 10 behavioural therapy (CBT) manages schizophrenia effectively. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method: longitudinal study. Any method can be used, provided that the data gathered is over a period of time. Typical features: • Experiments: type, IV, DV, controls, experimental design. • Observations: type, setting, response categories, sampling frame, number of observers. • Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique & sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Marks: use generic levels of response ‘Design a study’ question part (b). ‘Psychological’ = 4 marks; ‘methodological’ = 4 marks If only methodological or psychological explanation is provided max 5 marks If ‘psychological’ described and not related to part (a) max 2 marks. Syllabus: cognitive-behavioural therapy (Sensky et al., 2000) Psychological: Sensky et al. (2000) used cognitive-behavioural therapy (CBT) to treat schizophrenia in patients already taking medication. After CBT sessions patients showed improvement. At the 9-month follow-up evaluation they continued to improve. It was concluded that CBT is effective. Note 0 marks for candidates who merely replicate this study. Methodological: explanation of method using general and specific features as above. © UCLES 2021 Page 18 of 25

9 ‘Psychometric measures, such as the Kleptomania Symptom 12 Assessment Scale (K-SAS), provide therapists with no useful information.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: measures: Kleptomania Symptom Assessment Scale (K-SAS) Most likely (any other appropriate responses should be credited): Useful: • Measures such as K-SAS indicate the severity of a disorder • The measure can highlight specific features of the disorder • The measure can be used as a comparison to others with the same disorder • The measure provides quantitative data • Any feature of a psychometric test (e.g. reliable, standardised) Not useful: • Measures can use scales (5 or 7 point) which allow the person to ‘opt out’ or give a neutral answer’ • Scales do not take individual differences into account; there might be some aspect which the scales do not cover • A patient may want to talk to a therapist about the problem, not just fill in a questionnaire. • Interviews by therapists may reveal far more about the individual problem • Interviews can reveal specific problems not covered by a general psychometric test. © UCLES 2021 Page 22 of 25

1(a) Outline one cognitive explanation of schizophrenia and delusional 2 disorder. Award 1 mark for a basic explanation of the term/concept. Award 2 marks for a detailed explanation of the term/concept. For example: Frith describes schizophrenia as an ‘abnormality of self-monitoring’ as patients fail to recognise that the hallucination of hearing voices is actually the schizophrenic’s own inner voice but they believe it to be someone else’s. (2) The delusions (inner speech) may not be recognised as being self-generated. (1) Other appropriate responses should also be credited. 1(b) Describe the procedure in the study by Sensky et al. (2000) of cognitive- 4 behavioural therapy (CBT) for schizophrenia. Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example: Participants were referred by clinicians and eligibility confirmed by researchers using clinical interview. (1) 90 patients, 16-60 from 5 different venues – 2 West London, 1 Durham, 1 Cleveland, 1 Newcastle. CBT 46, Befriending 44. 67% CBT male, 50% male in befriending (2 marks max.) Patients were randomly assigned to a treatment and further assessments carried out approximately 9 months later, after intervention had completed and again at 9-month follow-up. (2) Antipsychotic medications were maintained. (1) Patients received individual treatment of CBT or befriending (this intervention was designed to give similar amount of therapist contact as CBT with an aim to be empathic and nondirective, focusing on neutral topics) (2) Done by experienced psychiatric nurses with each patient receiving at least 45 minutes of therapy per week. (1) After approximately 2 months, session frequency could be reduced, with the aim of completing therapy within 9 months. (1) Interviews were audiotaped. (1) Assessors were blind to patient’s assigned group. (1) The Comprehensive Psychiatric Rating Scale (CPRS), Montgomery-Asberg Depression Rating Scale and the Scale for Assessment of Negative Symptoms (SANS) were all used to measure outcomes together with patients completing a 10-item questionnaire to elicit their satisfaction. (2 marks max for assessments given) © UCLES 2021 Page 6 of 21 1(c) Explain one similarity and one difference between CBT and biochemical 6 treatments for schizophrenia/delusional disorder. Likely similarities will be • Both have good evidence for success e.g. Lindstrom et al, 1999 drug trials and Sensky • Both require intervention from a therapist so adding to time, expense and commitment Likely differences will be • CBT based on cognitive approach, biochemical on biological approach • CBT is more active. Drug therapy is passive treatment. • CBT not suited for patients who find it difficult to engage in therapy (lack of motivation, intellect etc.) • Drug therapy has side effects Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain an appropriate similarity and an appropriate difference. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain an appropriate similarity/difference in detail or both a similarity and a difference in less detail. • Candidates will provide a good explanation. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt a similarity and/or difference. This could include both but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2021 Page 7 of 21

2(a) Describe characteristics and measures of bipolar and related disorders. 8 Characteristics of bipolar and related disorders, including the following: • Definitions and characteristics of abnormal affect • Types: depression (unipolar) and depression and mania (bipolar) • Measures: Beck depression inventory Definitions and characteristics of abnormal affect Abnormal effect disorders are classified as ‘mood disorders’ in DSM-V. This is in contrast to brief feelings of sadness/joy. Here, emotions are beyond the usual ups and downs experienced by all and are amplified or enhanced, characterised by persistent negative or positive mood. Emotions may include despair, emptiness, anger or euphoria. The extreme and persistent nature of these moods is distinct from everyday experience. Disorders of abnormal affect significantly impair the individual’s ability to function normally. Types: depression (unipolar) and depression and mania (bipolar) Unipolar depression, also known as major depressive disorder, or a depressive episode, includes having a depressed mood for an extended period of time. This includes a lack of pleasure in most activities, weight changes, changes in sleep patterns (sleeping too much (hypersomnia) or difficulty in sleeping (insomnia)), psychomotor agitation, fatigue, feelings of worthlessness and reduction in ability to concentrate. Bipolar disorder used to be known as manic depression. It is characterised by episodes of mania that cannot be accounted for in a physical way. Mania may include feelings of euphoria, rage or irritability. Behaviours associated with mania include racing thoughts or being easily distracted, over-confidence, speaking quickly, and engaging in risky behaviours (gambling or promiscuity, for example). Mania is one ‘pole’ of bipolarity. The other pole would be features of unipolar depression (although this is not essential for diagnosis). There must also be some change in polarity for a diagnosis of bipolar disorder to be made. Measures: Beck depression inventory This is a psychometric test used by professionals to measure level of depression. It contains 21 items and is used in questionnaire form. Each item includes at least 4 statements, the person taking the test must choose the one that best fits how they have been feeling during the past week or two weeks, depending on the version being used. Examples of items include: Satisfaction 0 I get as much satisfaction out of things as I used to 1 I don’t enjoy things the way I used to 2 I don’t get real satisfaction out of anything anymore

1(a) Outline the behavioural explanation of phobias. 2 Award 1 mark for a basic explanation of the term/concept. Award 2 marks for a detailed explanation of the term/concept. For example: Classical conditioning can explain how a phobia can be learned. (1) A previously neutral stimulus can be repeatedly paired with an unconditioned stimulus that produces fear, so that the neutral stimulus becomes the conditioned stimulus. (2) This could occur as a result of trauma where one pairing may be sufficient.(1) Other appropriate responses should also be credited. 1(b) Describe the Generalised Anxiety Disorder assessment (GAD-7). 4 Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example: GAD-7 is a screening tool using a questionnaire for generalised anxiety. (1) It consists of 7 items each scored on a scale of 0 to 3. (1) Patients are asked to report how often in the last 2 weeks they have been bothered by the 7 items. (1) 0 represents not at all, 1 is several days, 2 is over half the days and 3 is nearly every day. (1) The 7 items are 1 Feeling nervous, anxious, or on edge

2 Not being able to stop or control worrying

1(a) Outline one cognitive explanation of schizophrenia and delusional 2 disorder. Award 1 mark for a basic explanation of the term/concept. Award 2 marks for a detailed explanation of the term/concept. For example: Frith describes schizophrenia as an ‘abnormality of self-monitoring’ as patients fail to recognise that the hallucination of hearing voices is actually the schizophrenic’s own inner voice but they believe it to be someone else’s. (2) The delusions (inner speech) may not be recognised as being self-generated. (1) Other appropriate responses should also be credited. 1(b) Describe the procedure in the study by Sensky et al. (2000) of cognitive- 4 behavioural therapy (CBT) for schizophrenia. Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example: Participants were referred by clinicians and eligibility confirmed by researchers using clinical interview. (1) 90 patients, 16-60 from 5 different venues – 2 West London, 1 Durham, 1 Cleveland, 1 Newcastle. CBT 46, Befriending 44. 67% CBT male, 50% male in befriending (2 marks max.) Patients were randomly assigned to a treatment and further assessments carried out approximately 9 months later, after intervention had completed and again at 9-month follow-up. (2) Antipsychotic medications were maintained. (1) Patients received individual treatment of CBT or befriending (this intervention was designed to give similar amount of therapist contact as CBT with an aim to be empathic and nondirective, focusing on neutral topics) (2) Done by experienced psychiatric nurses with each patient receiving at least 45 minutes of therapy per week. (1) After approximately 2 months, session frequency could be reduced, with the aim of completing therapy within 9 months. (1) Interviews were audiotaped. (1) Assessors were blind to patient’s assigned group. (1) The Comprehensive Psychiatric Rating Scale (CPRS), Montgomery-Asberg Depression Rating Scale and the Scale for Assessment of Negative Symptoms (SANS) were all used to measure outcomes together with patients completing a 10-item questionnaire to elicit their satisfaction. (2 marks max for assessments given) © UCLES 2021 Page 6 of 21 1(c) Explain one similarity and one difference between CBT and biochemical 6 treatments for schizophrenia/delusional disorder. Likely similarities will be • Both have good evidence for success e.g. Lindstrom et al, 1999 drug trials and Sensky • Both require intervention from a therapist so adding to time, expense and commitment Likely differences will be • CBT based on cognitive approach, biochemical on biological approach • CBT is more active. Drug therapy is passive treatment. • CBT not suited for patients who find it difficult to engage in therapy (lack of motivation, intellect etc.) • Drug therapy has side effects Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain an appropriate similarity and an appropriate difference. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain an appropriate similarity/difference in detail or both a similarity and a difference in less detail. • Candidates will provide a good explanation. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt a similarity and/or difference. This could include both but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2021 Page 7 of 21

2(a) Describe characteristics and measures of bipolar and related disorders. 8 Characteristics of bipolar and related disorders, including the following: • Definitions and characteristics of abnormal affect • Types: depression (unipolar) and depression and mania (bipolar) • Measures: Beck depression inventory Definitions and characteristics of abnormal affect Abnormal effect disorders are classified as ‘mood disorders’ in DSM-V. This is in contrast to brief feelings of sadness/joy. Here, emotions are beyond the usual ups and downs experienced by all and are amplified or enhanced, characterised by persistent negative or positive mood. Emotions may include despair, emptiness, anger or euphoria. The extreme and persistent nature of these moods is distinct from everyday experience. Disorders of abnormal affect significantly impair the individual’s ability to function normally. Types: depression (unipolar) and depression and mania (bipolar) Unipolar depression, also known as major depressive disorder, or a depressive episode, includes having a depressed mood for an extended period of time. This includes a lack of pleasure in most activities, weight changes, changes in sleep patterns (sleeping too much (hypersomnia) or difficulty in sleeping (insomnia)), psychomotor agitation, fatigue, feelings of worthlessness and reduction in ability to concentrate. Bipolar disorder used to be known as manic depression. It is characterised by episodes of mania that cannot be accounted for in a physical way. Mania may include feelings of euphoria, rage or irritability. Behaviours associated with mania include racing thoughts or being easily distracted, over-confidence, speaking quickly, and engaging in risky behaviours (gambling or promiscuity, for example). Mania is one ‘pole’ of bipolarity. The other pole would be features of unipolar depression (although this is not essential for diagnosis). There must also be some change in polarity for a diagnosis of bipolar disorder to be made. Measures: Beck depression inventory This is a psychometric test used by professionals to measure level of depression. It contains 21 items and is used in questionnaire form. Each item includes at least 4 statements, the person taking the test must choose the one that best fits how they have been feeling during the past week or two weeks, depending on the version being used. Examples of items include: Satisfaction 0 I get as much satisfaction out of things as I used to 1 I don’t enjoy things the way I used to 2 I don’t get real satisfaction out of anything anymore

1 A woman was treated by Glover (2011) for kleptomania. She had a 14- year history of daily compulsive shoplifting and was treated with covert sensitisation. At a 19-month follow-up she was free of stealing behaviour apart from one lapse, and there were corresponding improvements in her self-esteem and socialisation. 1(a) Explain what is meant by ‘covert sensitisation’. 2 Most likely answer (other appropriate responses to be credited): • Covert sensitisation is a form of behaviour therapy in which an undesirable behaviour is paired with an unpleasant image in order to eliminate that behaviour. • Desensitisation is opposite, so 0 marks. Marks: 1 mark for partial answer, 2 marks for elaboration/example. Example can be anything appropriate. Note: if above definition is given award 2 marks. 1(b) Outline how the aversive stimulus was used in the study by Glover 4 (2011) to treat the woman’s kleptomania. Most likely answers: quoting study • It was decided to use imagery of nausea and vomiting paired with the act of stealing. • Episodes of imagery were used involving increasing nausea as she approached an article in a supermarket which she intended to steal, leading to vomiting as she lifted the article, with other shoppers’ attention being attracted to her. • The vomiting and other unpleasant sensations ceased as soon as she replaced the article, turned away and left the shop Marks: 1–2 marks basic answer 3–4 marks detail/elaboration. © UCLES 2021 Page 8 of 23 1(c) Give two differences between covert sensitisation and imaginal 4 desensitisation. Most likely answer (other appropriate responses to be credited): Difference: CS: client imagines engaging in the event (e.g. stealing) and experiencing negative consequences (such as vomiting). ID: uses progressive muscle relaxation with imagery of successfully avoiding event (e.g. stealing) Difference: CS: person creates an imagined unpleasant association between addictive behaviour and unpleasant stimulus. ID: relaxation based. Imaginal desensitisation significantly decreased the heightened state of arousal and anxiety typically associated with gambling urges Marks: 1 mark for description, 2 marks for direct difference (e.g. X is and Y is) x2 1(d) Discuss the advantages and disadvantages of using covert 5 sensitisation to treat impulse control disorders. You should include a conclusion in your answer. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however basic/detailed) which is related to the question (max 4 marks). 1 mark for conclusion. 2 marks max for two strengths and two weaknesses unrelated to the question. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Most likely answer (other appropriate responses to be credited): Advantages: • Techniques can be applied by anyone, in any place at any time. • Behavioural techniques focus on alleviating the symptoms of ICD rather than the cause • Behavioural techniques are more likely to be generalised because all people can learn and ‘unlearn’ following the same principles • No medication is taken; the patient cannot become addicted to medication. • The therapist will guide the patient through the treatment. Disadvantages: • Behavioural techniques take time and effort from the person (unlike swallowing a pill) • The techniques do not cure the ICD, merely make it easier to live with • Behavioural techniques ignore the role of biochemicals • A therapist is needed which is more costly than taking a drug. • Sensitisation involves imagining something unpleasant in association with the event, so is ‘negative’ rather than imaginal desensitisation which is more ‘positive’ © UCLES 2021 Page 9 of 23

5(a) Design a study to investigate the long-term effectiveness of applied 10 tension. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method: any appropriate method. Specific features: • Experiments: type, IV, DV, controls, experimental design. • Observations: type, setting, response categories, sampling frame, number of observers. • Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique & sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: applied tension (Ost et al., 1989) Psychological: At the sight of blood, blood pressure drops sharply often leading the person to faint (pass out). The way to counter the drop in blood pressure is to raise blood pressure. Ost et al. (1989) call the technique of raising blood pressure applied tension. It involves tensing the muscles in the arms, legs and body for about 10–15 seconds, relaxing for 20–30 seconds and then repeating both of these five times. Methodological: explanation of method using general and specific features as above. © UCLES 2021 Page 16 of 23

9 ‘Even though little Hans was just one child, the psychoanalytic 12 explanation of phobias can be generalised to everyone.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: psychoanalytic (Freud, 1909) Most likely (any other appropriate responses should be credited): Can generalise: • The psychoanalytic explanation of phobias applies to everyone; a cultural universal • The psychoanalytic explanation led to the development of ways in which fears and phobias can be explained • The principles, id, ego and superego, can be generalised, not necessarily the specific example. Cannot generalise: • People are different and what applies to many people will not apply to all. • The approach excludes the role of cognitive factors (such as the DiNardo example with fears of dogs) or behavioural explanations. • The case study of little Hans had weaknesses – claims that Hans was not a ‘normal’ child. © UCLES 2021 Page 20 of 23

1 The ABC model of psychological change: • Activating event • Beliefs about the event • Consequences: emotional and behavioural responses. Ellis (1962) used this model in rational emotive behaviour therapy (REBT). The aim of REBT is to treat depression by changing a client’s thinking. 1(a) Explain why a depressed client’s thinking needs to be changed in order 2 to treat their depression. Most likely answer (other appropriate responses to be credited): • Identifying irrational thoughts, feelings and beliefs caused by situations that lead to distress and changing these mistaken beliefs into helping people respond rationally to situations. Marks: 1 mark basic answer, 2 marks detail/elaboration. 1(b)(i) Outline one irrational belief that clients might have before starting 2 REBT. Most likely answers (other appropriate responses to be credited): • awfulising (If I don't succeed it will be awful) • I-can't-stand-it-itis/Low frustration tolerance (I can’t stand it if…) • self-downing (I am a failure) • musterbating (I must be thoroughly competent) Marks: 1 mark statement of belief (such as awfulizing), 1 mark for statement such as ‘I am a failure’ OR +1 mark for ‘person thinking they are worthless, useless’, etc Note: 1 mark max for appropriate anecdotal answers not listed above. 1(b)(ii) Outline how irrational beliefs are changed by REBT. 2 Most likely answer (other appropriate responses to be credited): • D: the dispute or challenge phase. in order to act and feel differently, we must dispute or challenge the irrational beliefs experienced. • E: the new, more effective emotions and behaviours that result from more reasonable thinking about the original event. • Acceptance: If emotionally healthy, a person accepts reality, whether that reality is pleasant or unpleasant. Three forms: unconditional self- acceptance; unconditional other acceptance and unconditional life acceptance. Note: Description of explanation scores no marks [ABC (A: an activating event, B: the belief held about A, C: the consequences – thoughts, feelings or behaviours – resulting from A] but ‘if these are targeted by’ 1 mark max. Marks: 1 mark for ‘D’, ‘E’, ‘A’, 2 marks detail/elaboration. Note: 1 mark max for appropriate answers summarising the process. © UCLES 2021 Page 8 of 22 1(c) Suggest one psychological treatment for depression, other than REBT. 4 Most likely answer • Beck et al. (1979) cognitive restructuring is a stage process: Identify negative automatic thoughts, challenge the NATs and replace with positive thoughts. (i) explanation of therapy, (ii) identification of unpleasant emotions, (iii) the situations in which these occur and (iv) associated negative automatic thoughts. (v) challenge the negative thoughts and (vi) replace them with positive thoughts. (vii) challenge the underlying dysfunctional beliefs and (viii) therapy ends. Note: Description of explanation scores 0 marks [negative cognitive triad, comprising unrealistically negative views about the self, the world and the future] but ‘if these are targeted by’ 1 mark max. Note: 0 marks for any biochemical treatment. Note: CBT scores 0 mark max unless it is fully justified. Marks: 1 mark for basic outline, 2 marks detail/elaboration. 1(d) Discuss the strengths and weaknesses of psychological treatments for 5 depression. You should include a conclusion in your answer. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however basic/detailed) which is related to the question (max 4 marks). 1 mark for conclusion. 2 marks max for two strengths and two weaknesses unrelated to the question. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Note: 0 marks for any biochemical treatment. Most likely answer (other appropriate responses to be credited): Strengths: • Techniques can be applied by anyone, in any place at any time. • cognitive techniques focus on ‘reorganising thoughts’ rather than removing the cause • cognitive techniques are more likely to be generalised because all people can apply the same principles of removing irrational thoughts • No medication is taken; the patient cannot become addicted to medication. • The therapist will guide the patient through the treatment. Weaknesses: • Cognitive techniques take time and effort from the person (unlike swallowing a pill) • The techniques do not cure anything, merely make it easier to live with • Cognitive techniques ignore the role of biochemical (biological determinism) • A therapist is needed which is more costly than taking a drug. © UCLES 2021 Page 9 of 22

5(a) Design a study to investigate the most common type of compulsive 10 behaviour in people with obsessive-compulsive disorder (OCD). Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method: any appropriate method. Specific features: • Experiments: type, IV, DV, controls, experimental design. • Observations: type, setting, response categories, sampling frame, number of observers. • Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). NB If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: examples and case studies (‘Charles’ by Rappaport,1989) Psychological: Most likely inclusion of checking, cleaning/washing, slowness, doubting, ordering, repeating. Most likely example: ‘Charles’ was a compulsive ‘washer’, following a daily ritual. Methodological: explanation of method using general and specific features as above. © UCLES 2021 Page 17 of 22

9 ‘Biomedical treatments for obsessive-compulsive and related disorders 12 are irrelevant.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: types of and common obsessions, common compulsions, hoarding and body dysmorphic disorder (but also explanations of OCD) NB candidates could refer to hoarding and/or BDD in their answer Most likely (any other appropriate responses should be credited): purpose: • if OCD is caused by low serotonin levels, then drugs can be used to increase the activity of serotonin in in the brain • OCD has comorbidity, so drugs can be used to alleviate other symptoms of anxiety or depression • Drugs can create the belief in the person that ‘something is working’, even if it is acting like a placebo. No purpose: • Drugs do not cure the OC/related disorder. It is psychological not physiological • Drugs are not a long-term solution; they cannot be taken forever. • Drugs are often addictive, which can create more problems than they solve. Question Answer Marks

1 A woman was treated by Glover (2011) for kleptomania. She had a 14- year history of daily compulsive shoplifting and was treated with covert sensitisation. At a 19-month follow-up she was free of stealing behaviour apart from one lapse, and there were corresponding improvements in her self-esteem and socialisation. 1(a) Explain what is meant by ‘covert sensitisation’. 2 Most likely answer (other appropriate responses to be credited): • Covert sensitisation is a form of behaviour therapy in which an undesirable behaviour is paired with an unpleasant image in order to eliminate that behaviour. • Desensitisation is opposite, so 0 marks. Marks: 1 mark for partial answer, 2 marks for elaboration/example. Example can be anything appropriate. Note: if above definition is given award 2 marks. 1(b) Outline how the aversive stimulus was used in the study by Glover 4 (2011) to treat the woman’s kleptomania. Most likely answers: quoting study • It was decided to use imagery of nausea and vomiting paired with the act of stealing. • Episodes of imagery were used involving increasing nausea as she approached an article in a supermarket which she intended to steal, leading to vomiting as she lifted the article, with other shoppers’ attention being attracted to her. • The vomiting and other unpleasant sensations ceased as soon as she replaced the article, turned away and left the shop Marks: 1–2 marks basic answer 3–4 marks detail/elaboration. © UCLES 2021 Page 8 of 23 1(c) Give two differences between covert sensitisation and imaginal 4 desensitisation. Most likely answer (other appropriate responses to be credited): Difference: CS: client imagines engaging in the event (e.g. stealing) and experiencing negative consequences (such as vomiting). ID: uses progressive muscle relaxation with imagery of successfully avoiding event (e.g. stealing) Difference: CS: person creates an imagined unpleasant association between addictive behaviour and unpleasant stimulus. ID: relaxation based. Imaginal desensitisation significantly decreased the heightened state of arousal and anxiety typically associated with gambling urges Marks: 1 mark for description, 2 marks for direct difference (e.g. X is and Y is) x2 1(d) Discuss the advantages and disadvantages of using covert 5 sensitisation to treat impulse control disorders. You should include a conclusion in your answer. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however basic/detailed) which is related to the question (max 4 marks). 1 mark for conclusion. 2 marks max for two strengths and two weaknesses unrelated to the question. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Most likely answer (other appropriate responses to be credited): Advantages: • Techniques can be applied by anyone, in any place at any time. • Behavioural techniques focus on alleviating the symptoms of ICD rather than the cause • Behavioural techniques are more likely to be generalised because all people can learn and ‘unlearn’ following the same principles • No medication is taken; the patient cannot become addicted to medication. • The therapist will guide the patient through the treatment. Disadvantages: • Behavioural techniques take time and effort from the person (unlike swallowing a pill) • The techniques do not cure the ICD, merely make it easier to live with • Behavioural techniques ignore the role of biochemicals • A therapist is needed which is more costly than taking a drug. • Sensitisation involves imagining something unpleasant in association with the event, so is ‘negative’ rather than imaginal desensitisation which is more ‘positive’ © UCLES 2021 Page 9 of 23

5(a) Design a study to investigate the long-term effectiveness of applied 10 tension. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method: any appropriate method. Specific features: • Experiments: type, IV, DV, controls, experimental design. • Observations: type, setting, response categories, sampling frame, number of observers. • Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique & sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: applied tension (Ost et al., 1989) Psychological: At the sight of blood, blood pressure drops sharply often leading the person to faint (pass out). The way to counter the drop in blood pressure is to raise blood pressure. Ost et al. (1989) call the technique of raising blood pressure applied tension. It involves tensing the muscles in the arms, legs and body for about 10–15 seconds, relaxing for 20–30 seconds and then repeating both of these five times. Methodological: explanation of method using general and specific features as above. © UCLES 2021 Page 16 of 23

9 ‘Even though little Hans was just one child, the psychoanalytic 12 explanation of phobias can be generalised to everyone.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: psychoanalytic (Freud, 1909) Most likely (any other appropriate responses should be credited): Can generalise: • The psychoanalytic explanation of phobias applies to everyone; a cultural universal • The psychoanalytic explanation led to the development of ways in which fears and phobias can be explained • The principles, id, ego and superego, can be generalised, not necessarily the specific example. Cannot generalise: • People are different and what applies to many people will not apply to all. • The approach excludes the role of cognitive factors (such as the DiNardo example with fears of dogs) or behavioural explanations. • The case study of little Hans had weaknesses – claims that Hans was not a ‘normal’ child. © UCLES 2021 Page 20 of 23

1(a) Identify two characteristics of bipolar disorder. 2 Award 1 mark for each characteristic of bipolar disorder. Must include both reference to a symptom of low mood and a symptom of high mood for full marks. Two strongly contrasting phases – high mood (manic phase) followed by very low mood. (2) High mood phase symptoms – euphoria, increased activity/energy, racing thoughts, impulsiveness. (1 max) Low mood phase symptoms – depressed mood, low energy/oversleeping, lack of interest in normal activities. (1 max) Other appropriate responses should also be credited. 1(b) Describe rational emotive behaviour therapy (REBT) as a treatment for depression (Ellis, 1962). 4 Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example – This follows the ABC model. (1) Activating agent – what is the behaviour and/or attitude of the patient towards events in their lives. (1) Beliefs – what is the belief of the patient toward the event. (1) Consequence – behavioural response in relation to the belief about the event. (1) Ellis believes if a person has constant negative beliefs about events in their lives, they are likely to suffer from depression. (1) The goal of therapy is to identify the unhelpful thoughts and replace them with more rational and constructive thoughts. The patient will go away between sessions and practice developing more helpful thoughts about life experiences and the depression symptoms should improve. (2) Other appropriate responses should also be credited. © UCLES 2022 Page 7 of 27 1(c) Explain one similarity and one difference between REBT and one biological treatment for depression. 6 Comparison will be for the rational emotive behavioural therapy by Ellis (1962) and biological treatments including chemical/drugs (MAOIs, SSRIs) Similarities  Provides an effective treatment for depression – those receiving the treatment be it biological or REBT showed significant improvements compared to their baseline at the start of treatment and the control group.  Studies that have investigated the effectiveness of these treatments include a control group of patients who do not receive the treatment as a comparison. Allows valid conclusions to be drawn about the effectiveness of the treatment.  Deterministic – it is the biological treatment/REBT that is causing the depression to lift and no other events/ experiences in the person’s life. It could be that the person changed jobs, and this is what caused their depression symptoms to improve rather than the biological treatment/REBT.  Not as effective when there are co-morbidities such as anxiety, schizophrenia. Differences  Biological treatments have side effects such as weight changes, appetite changes, sexual dysfunction, headaches, changes to sleep patterns and REBT does not have any side effects.  The biological treatments might be more appropriate for patients who do not want to see a therapist/not comfortable with talking about their issues compared to REBT.  REBT helps the patient to develop skills to challenge their irrational thoughts and replace them with more helpful thoughts. These skills can be used after therapy is over to continue to treat the depression. In contrast, biological treatments alter neurochemistry and treat the symptom of the disorder (low serotonin) so if the patient stops having the treatment the depression is likely to return.  Biological treatments are from the biological approach which assumes that it is low serotonin levels that are causing the depression, and this is what is treated. In contrast, REBT is from the cognitive approach which assumes that it is due to faulty thinking patterns that the patient has depression, and this is what is addressed by this therapy. © UCLES 2022 Page 8 of 27 1(c) Mark according to the levels of response criteria below: Level 3 (5–6 marks)  Candidates will show a clear understanding of the question and will include one similarity and one difference.  Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks)  Candidates will show an understanding of the question and will include one appropriate similarity in detail or one appropriate difference in detail. OR one similarity and one difference in less detail.  Candidates will provide a good explanation. Level 1 (1–2 marks)  Candidates will show a basic understanding of the question and will attempt a similarity and/or difference. This could include both but just as an attempt.  Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2022 Page 9 of 27

2(a) Describe explanations of phobias. 8 Explanations of phobias, including the following:  behavioural (classical conditioning, Watson, 1920)  psychoanalytic (Freud, 1909)  biomedical/genetic (Ost, 1992)  cognitive (DiNardo et al., 1988) Behavioural (classical conditioning, Watson, 1920) A phobia develops as the neutral stimulus is paired with something the person is afraid of (the unconditioned stimulus). If enough pairings occur or the initial UCS is very frightening the person will end up with a fear of the NS. The NS then becomes the CS. Candidates may describe the case of the little Albert who was conditioned to be afraid of a rat by Watson banging an iron bar behind the baby which made him cry. Eventually just the sight of the rat was enough to cause the crying. Psychoanalytic (Freud, 1909) A fear is repressed into the unconscious to protect the ego. The phobia can be a redirected fear during an intensely frightening experience (e.g. a physical attack) onto an object. Fear and anxiety can result from impulses from the id which may be repressed or denied. This repression creates internal conflict which leads to a phobia. Candidates can also summarise the case of little Hans with reference to explanation of phobia(s). Biomedical/genetic (Ost, 1992) Found that blood-phobic subjects had more first-degree relatives with the same phobia compared to injection-phobic participants (61% vs 29%). In addition, the blood-phobic patients were more likely to fear they would faint in the phobic situation (77% vs 48%). Concluded that there appears to be a strong genetic link and more likely to lead to a strong physiological response (fainting). © UCLES 2022 Page 10 of 27 2(a) Cognitive (DiNardo et al., 1988) We have irrational thoughts about an object due to a previous experience that we believe will be repeated. DiNardo and his colleagues studied 32/37 women (18–21 years old). Some of this group had a dog phobia and some did not suffer from a dog phobia. Started with 17 dog-phobic and 20 non-dog-phobic – some were excluded from some of the results for a variety of reasons e.g. did not do the behavioural test. Participants did a self-report and had a behavioural test where they were approached by and had to touch a dog. Heart rate was monitored and rated anxiety on 0–8 scale. Dog- phobic group rated their fear higher than non-dog-phobic participants and this increased as the dog got closer to the phobic participants. Phobic/no conditioning had higher heart rate than phobic /conditioning event. No significant difference between heart rate of phobic/conditioning and non-phobic/conditioning. Also found that 56% of people with dog phobias could recall being bitten or having a frightening past experience with a dog. However, 66% of the group with no dog phobia also had memories of being bitten by dogs and yet had not developed any anxiety about seeing dogs in the future. This shows that not everyone who is exposed to conditioning would end up developing a phobia, and it may be explained more through our thought processes after an event than the event itself. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2022 Page 11 of 27 2(b) Evaluate explanations of phobias, including a discussion of nature versus nurture. 10 A range of issues could be used for evaluation here. These include:  Names issue – nature versus nurture debate with reference to the various explanations. E.g. biomedical is nature and behavioural is nurture, psychodynamic is both nature and nurture (we all go through the psychosexual stages but whether we pass through them successfully is due to life experiences/nurture), DiNardo/cognitive is mainly nurture as the person needs to have a bad experience but then develops negative thoughts about this experience.  Determinism  comparisons of different explanations  Application of psychology to everyday life (with reference to explanations)  Reductionist/holistic nature of the explanations  Evidence to support the explanations (and an evaluation of this evidence if linked back to explanation) Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2022 Page 12 of 27

1(a) Explain what is meant ‘blood phobia’. 2 Award 1 mark for a basic explanation of the term/concept. Award 2 marks for a detailed explanation of the term/concept. For example: It is an irrational and persistent fear of blood / blood related products / certain medical procedures. (2) People with this phobia tend to avoid these procedures and may faint or feel sick at the sight of blood. (1) Other appropriate responses should also be credited. 1(b) Describe features of the blood injection phobia inventory (BIPI). 4 Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. The Blood-injection Phobia Inventory (BIPI) is a questionnaire has 18 items of stimulus content (1) and 27 phobic responses (1). 50 items total (1) that covered a range of situations related to blood and injection phobias which are rated. (1) Patient asked to evaluate their reaction/response to each on a 4 point scale (0–3). (1) Reactions cover cognitive, physiological and behavioural responses. (1) Rate frequency of symptoms / responses on a scale ranging from 0 = Never to 3 = Always. (1) Credit examples of the situations / responses up to a maximum of 2 marks. (1 per situation/response) E.g. Situations: When I see blood on my arm or finger after pricking myself with a needle. When I think of the colour red. Responses/reactions: I faint. My mind goes blank Other appropriate responses should also be credited. © UCLES 2022 Page 7 of 29 1(c) Explain one similarity and one difference between the BIPI and the Generalised Anxiety Disorder assessment 6 (GAD–7). Similarities  Both self-reports collected quantitative data and ask the participants to rate their response to various statements. Both use a 0–3 rating scale / 4 point scale.  As both collect quantitative data this allows for comparisons to be made (e.g., before and after treatment to see if there is an improvement in symptoms) however it does not give depth of why the patient may feel the way they do about the statement.  Both could be open to social desirability bias as the patient may feel that they should show an improvement post treatment and therefore give a more positive response to the questions than what they really feel. For example, they may say they are not feeling as nervous in the GAD-7 on as many days as they were at the start of treatment. Differences  The GAD–7 is just 7 items while the BIPI is 18/50 items. This means the GAD–7 is fast for the patient to do so they won’t get bored while completing it and not accurately record their symptoms. But the BIPI is a more holistic measure with 18/50 items and can give the practitioner more details about the phobia.  The GAD–7 is for generalised anxiety disorder and refers to how many days in the past two weeks a patient has been thinking and feeling anxious whereas the BIPI is specific to blood phobia and does not specify how often the person reacts in this way or the time period when it has most recently occurred.  GAD–7 is often used as a screening test which could lead to treatment or referral to a specialist. It is often used by general practitioners rather than providing a formal diagnosis which could be done using the BIPI. © UCLES 2022 Page 8 of 29 1(c) Mark according to the levels of response criteria below: Level 3 (5–6 marks)  Candidates will show a clear understanding of the question and will include one similarity and one difference.  Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks)  Candidates will show an understanding of the question and will include one appropriate similarity in detail or one appropriate difference in detail OR one similarity and one difference in less detail.  Candidates will provide a good explanation. Level 1 (1–2 marks)  Candidates will show a basic understanding of the question and will attempt a similarity and/or difference. This could include both but just as an attempt.  Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2022 Page 9 of 29

2(a) Describe the characteristics of impulse control disorders and non-substance addictive disorder (definitions, 8 types, measures). Characteristics of impulse control disorders and non-substance addictive disorder, including the following:  definitions (Griffiths, 2005)  types: kleptomania, pyromania (Burton et al., 2012) and gambling disorder  measures: Kleptomania Symptom Assessment Scale (K–SAS) General definition of impulse control disorder – This is an impulse control disorder where the person feels a compulsion to carry out a certain behaviour, rather than take a substance (e.g., alcohol, food, cigarettes, etc.). Types of behaviours could include gambling, stealing and pyromania. Griffiths, 2005 All addictions have a number of common characteristics including salience, mood modification, tolerance, withdrawal, conflict and relapse. Addictions are part of a biopsychosocial process. Types: kleptomania, pyromania (Burton et al., 2012) and gambling disorder Kleptomania – A recurrent urge to steal but not for reward or profit. Patients feel tension and anxiety before stealing something and the act of stealing gives them a reward, sense of pleasure and gratification. Pyromania – This is an obsessive desire to set fire to things. The person has deliberately and intentionally set fire to something at least twice. The person feels anxiety/heightened arousal prior to setting the fire and once they have done it the arousal reduces. They are also fascinated with fires. Burton et al., 2012 Identifies the differences between fire setting, arson and pyromania. Fire setting is a behaviour – which is setting any type of fire. Many show an interest in setting and watching fire which is a normal behaviour. Often not a criminal or pathological act. Arson is a subtype of fire setting, is a criminal act in which one wilfully and maliciously sets fire to or aids in setting fire to a structure, dwelling, or property of another. Pyromania is a psychiatric diagnosis rather than a legal term. Individuals with pyromania engage in intentional and pathological fire setting, but do not always commit the crime of arson. © UCLES 2022 Page 10 of 29 2 Gambling disorder – This is a non-substance addictive disorder but is very similar to substance disorders in its symptoms and behaviours. The person craves gambling in the same way someone may crave alcohol or drugs. The person finds it difficult to control their impulse to gamble. They engage in persistent and problematic gambling and can go seriously into debt. Measures: Kleptomania Symptom Assessment Scale (K-SAS) A self-report measure to assess the severity of kleptomania in a patient. There are 11/12 items that lead to a score. The higher the score, the more severe the symptoms. Scored on a scale of 0–4 or 0–5. Examples from the scale include – During the past week, how much were you able to control your thoughts of stealing? 0 (very much) to 4 (No Control) Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2022 Page 11 of 29 2(b) Evaluate the characteristics of impulse control disorders and non-substance addictive disorder (definitions, 10 types, measures), including a discussion about self-reports. A range of issues could be used for evaluation here. These include:  Named issue – Self reports K-SAS – This produces quantitative data so can therefore make comparisons from the results to averages for the population to determine if the person suffers from kleptomania or not. As the responses are quantitative the person completing it (or telling their doctor their response) may find it easier to do this rather than explain their behaviour and symptoms in depth which could be embarrassing for someone with kleptomania, etc. Weaknesses could include just having quantitative data so cannot collect detailed responses as to why the person with kleptomania has had these thoughts and urges in the past week. And it may be easier to lie about symptoms as no explanation is required. Responses that discuss the strengths and weaknesses of self-reports used by practitioners to diagnose the types of impulse control disorders are creditworthy.  Validity of characteristics and diagnostic tools  Psychometrics  Application to everyday life  Nature versus nurture debate  Reductionist nature of the characteristics Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2022 Page 12 of 29

1(a) Identify two characteristics of bipolar disorder. 2 Award 1 mark for each characteristic of bipolar disorder. Must include both reference to a symptom of low mood and a symptom of high mood for full marks. Two strongly contrasting phases – high mood (manic phase) followed by very low mood. (2) High mood phase symptoms – euphoria, increased activity/energy, racing thoughts, impulsiveness. (1 max) Low mood phase symptoms – depressed mood, low energy/oversleeping, lack of interest in normal activities. (1 max) Other appropriate responses should also be credited. 1(b) Describe rational emotive behaviour therapy (REBT) as a treatment for depression (Ellis, 1962). 4 Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example – This follows the ABC model. (1) Activating agent – what is the behaviour and/or attitude of the patient towards events in their lives. (1) Beliefs – what is the belief of the patient toward the event. (1) Consequence – behavioural response in relation to the belief about the event. (1) Ellis believes if a person has constant negative beliefs about events in their lives, they are likely to suffer from depression. (1) The goal of therapy is to identify the unhelpful thoughts and replace them with more rational and constructive thoughts. The patient will go away between sessions and practice developing more helpful thoughts about life experiences and the depression symptoms should improve. (2) Other appropriate responses should also be credited. © UCLES 2022 Page 7 of 27 1(c) Explain one similarity and one difference between REBT and one biological treatment for depression. 6 Comparison will be for the rational emotive behavioural therapy by Ellis (1962) and biological treatments including chemical/drugs (MAOIs, SSRIs) Similarities  Provides an effective treatment for depression – those receiving the treatment be it biological or REBT showed significant improvements compared to their baseline at the start of treatment and the control group.  Studies that have investigated the effectiveness of these treatments include a control group of patients who do not receive the treatment as a comparison. Allows valid conclusions to be drawn about the effectiveness of the treatment.  Deterministic – it is the biological treatment/REBT that is causing the depression to lift and no other events/ experiences in the person’s life. It could be that the person changed jobs, and this is what caused their depression symptoms to improve rather than the biological treatment/REBT.  Not as effective when there are co-morbidities such as anxiety, schizophrenia. Differences  Biological treatments have side effects such as weight changes, appetite changes, sexual dysfunction, headaches, changes to sleep patterns and REBT does not have any side effects.  The biological treatments might be more appropriate for patients who do not want to see a therapist/not comfortable with talking about their issues compared to REBT.  REBT helps the patient to develop skills to challenge their irrational thoughts and replace them with more helpful thoughts. These skills can be used after therapy is over to continue to treat the depression. In contrast, biological treatments alter neurochemistry and treat the symptom of the disorder (low serotonin) so if the patient stops having the treatment the depression is likely to return.  Biological treatments are from the biological approach which assumes that it is low serotonin levels that are causing the depression, and this is what is treated. In contrast, REBT is from the cognitive approach which assumes that it is due to faulty thinking patterns that the patient has depression, and this is what is addressed by this therapy. © UCLES 2022 Page 8 of 27 1(c) Mark according to the levels of response criteria below: Level 3 (5–6 marks)  Candidates will show a clear understanding of the question and will include one similarity and one difference.  Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks)  Candidates will show an understanding of the question and will include one appropriate similarity in detail or one appropriate difference in detail. OR one similarity and one difference in less detail.  Candidates will provide a good explanation. Level 1 (1–2 marks)  Candidates will show a basic understanding of the question and will attempt a similarity and/or difference. This could include both but just as an attempt.  Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2022 Page 9 of 27

2(a) Describe explanations of phobias. 8 Explanations of phobias, including the following:  behavioural (classical conditioning, Watson, 1920)  psychoanalytic (Freud, 1909)  biomedical/genetic (Ost, 1992)  cognitive (DiNardo et al., 1988) Behavioural (classical conditioning, Watson, 1920) A phobia develops as the neutral stimulus is paired with something the person is afraid of (the unconditioned stimulus). If enough pairings occur or the initial UCS is very frightening the person will end up with a fear of the NS. The NS then becomes the CS. Candidates may describe the case of the little Albert who was conditioned to be afraid of a rat by Watson banging an iron bar behind the baby which made him cry. Eventually just the sight of the rat was enough to cause the crying. Psychoanalytic (Freud, 1909) A fear is repressed into the unconscious to protect the ego. The phobia can be a redirected fear during an intensely frightening experience (e.g. a physical attack) onto an object. Fear and anxiety can result from impulses from the id which may be repressed or denied. This repression creates internal conflict which leads to a phobia. Candidates can also summarise the case of little Hans with reference to explanation of phobia(s). Biomedical/genetic (Ost, 1992) Found that blood-phobic subjects had more first-degree relatives with the same phobia compared to injection-phobic participants (61% vs 29%). In addition, the blood-phobic patients were more likely to fear they would faint in the phobic situation (77% vs 48%). Concluded that there appears to be a strong genetic link and more likely to lead to a strong physiological response (fainting). © UCLES 2022 Page 10 of 27 2(a) Cognitive (DiNardo et al., 1988) We have irrational thoughts about an object due to a previous experience that we believe will be repeated. DiNardo and his colleagues studied 32/37 women (18–21 years old). Some of this group had a dog phobia and some did not suffer from a dog phobia. Started with 17 dog-phobic and 20 non-dog-phobic – some were excluded from some of the results for a variety of reasons e.g. did not do the behavioural test. Participants did a self-report and had a behavioural test where they were approached by and had to touch a dog. Heart rate was monitored and rated anxiety on 0–8 scale. Dog- phobic group rated their fear higher than non-dog-phobic participants and this increased as the dog got closer to the phobic participants. Phobic/no conditioning had higher heart rate than phobic /conditioning event. No significant difference between heart rate of phobic/conditioning and non-phobic/conditioning. Also found that 56% of people with dog phobias could recall being bitten or having a frightening past experience with a dog. However, 66% of the group with no dog phobia also had memories of being bitten by dogs and yet had not developed any anxiety about seeing dogs in the future. This shows that not everyone who is exposed to conditioning would end up developing a phobia, and it may be explained more through our thought processes after an event than the event itself. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2022 Page 11 of 27 2(b) Evaluate explanations of phobias, including a discussion of nature versus nurture. 10 A range of issues could be used for evaluation here. These include:  Names issue – nature versus nurture debate with reference to the various explanations. E.g. biomedical is nature and behavioural is nurture, psychodynamic is both nature and nurture (we all go through the psychosexual stages but whether we pass through them successfully is due to life experiences/nurture), DiNardo/cognitive is mainly nurture as the person needs to have a bad experience but then develops negative thoughts about this experience.  Determinism  comparisons of different explanations  Application of psychology to everyday life (with reference to explanations)  Reductionist/holistic nature of the explanations  Evidence to support the explanations (and an evaluation of this evidence if linked back to explanation) Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2022 Page 12 of 27

1(a) In a case study by Glover, a 56-year-old married woman who had been 2 shoplifting every day for 14 years attended treatment sessions. Her treatment used covert sensitisation with aversive imagery. Explain what is meant by the term ‘aversive imagery’. Most likely answer (other appropriate responses to be credited):  an image that induces change in behaviour using negative reinforcement or positive punishment.  for example, in the study by Glover the participant imagined nausea and vomitting as she approached an item in a supermarket with all other shoppers watching until she replaced the item and left the store. Marks: 1 mark for partial explanation; 2 marks for detailed explanation. 1(b) Suggest two strengths of the use of a face-to-face interview by a 4 therapist treating a patient with kleptomania. Most likely answer (other appropriate responses to be credited):  the therapist can observe the patient’s responses to questions and other non-verbal movements which may help with diagnosis/therapy e.g. to see of the patient is being honest or not.  the therapist is providing a more personal service – seeing face to face and giving time to the patient, to understand their kleptomania, unlike a telephone interview which is less personal  the patient can observe the therapist, non-verbal communication, and see whether the therapist gives ‘nods of agreement’ to positive patient behaviour which can be rewarding  the patient can ask questions about their kleptomania which they may not do over a telephone. Marks: 1 mark for suggestion; 2 marks for related to kleptomania 2 1(c) Suggest why biochemical treatments might not be effective when 4 treating kleptomania. Most likely answer (other appropriate responses to be credited):  there is no drug that specifically stops a person from stealing (better used with addiction to alcohol / an emetic such as ipecac which causes vomiting)  the person may not take the drug  the drug may be addictive and long-term use may cause additional problems.  drugs reduce symptoms but do not remove the cause (what symptoms does a person with kleptomania have?) Marks: 1 mark for each suggestion outlined and (1 mark) related to kleptomania 2 OR 1 mark for suggestion and 24 marks for detail and related to kleptomania. © UCLES 2022 Page 5 of 18 1(d) Discuss whether generalisations can or cannot be made from this case 5 study. You should consider both sides of the argument and include a conclusion. Most likely answer (other appropriate responses to be credited): Can  the treatment of covert sensitisation can be generalised to others with kleptomania  covert sensitisation can be used to treat other ICDs such as pyromania Cannot  the specifics of this individual case cannot be generalised  the aversive images (nausea and vomiting) will not work with everyone; different images need to be used. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each point for/against (however detailed) and related to the question up to 4 max. 2 marks max for two points for/against unrelated to the question. 1 mark for conclusion. Question Answer Marks

5(a) Design a study to investigate the effectiveness of biochemical 10 treatments for impulse control disorder. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is: any appropriate method. Specific features:  Experiments: type, IV, DV, controls, experimental design.  Observations: type, setting, response categories, sampling frame, number of observers.  Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses.  General features of research methodology: sampling technique & sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: treating and managing ICDs and non-substance addictive disorder: biochemical (Grant et al., 2008) Psychological: The biochemical treatment using nalmefene is believed by Grant et al. (2008) to help reduce the urge to gamble. To test its effectiveness, participants were assessed to ensure they were suitable to participate. They were then randomly allocated to either a group receiving nalmefene or to a group receiving a placebo. Methodological: explanation of method using general and specific features as above. © UCLES 2022 Page 13 of 18

9 ‘Psychometric measures used to assess obsessive-compulsive disorder (OCD) provide therapists with no useful information.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: measures: Maudsley Obsessive-Compulsive Inventory (MOCI), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) Most likely (any other appropriate responses should be credited): Useful:  measures such as Y-BOCS and MOCI indicate the severity of a disorder  these measures can highlight specific features of the disorder  these measures can be used as comparisons with others with the same disorder  these measures provide quantitative data Not useful:  talking to a therapist in a clinical interview can reveal perhaps more than any test  the measure can use scales (5 or 7 point) which may not represent what the person thinks: they could take a neutral option  people answering the questionnaires may not be honest about everything  measures assume people have similarities; they are less individualistic. Question Answer Marks

1 Schizophrenia can be treated with medical techniques and it can be managed with psychological techniques. Medical treatments include the use of electro-convulsive therapy (ECT) and drugs such as antipsychotics and atypical antipsychotics. Schizophrenia can be managed psychologically using token economy and cognitive- behavioural therapy (CBT). 1(a) Suggest one difference between medical and psychological 2 techniques for treating and managing schizophrenia. Most likely answer (other appropriate responses to be credited):  medical requires therapist to prescribe drug/treatment; psychological does not need prescription. Psychologist cannot prescribe drugs/ECT  patient is passive with medical techniques; patient is active with psychological  medical changes physiology; psychological changes thinking/behaviour Marks: 1 mark for each side of term. Note: Medical techniques can include ECT and psychological can include token economy and CBT. 1(b) Explain two differences between antipsychotic drugs and atypical 4 antipsychotic drugs. Most likely answer (other appropriate responses to be credited):  antipsychotics (first generation, 1950s), atypical antipsychotics (second generation, 1990s)  antipsychotics (typical side effects more likely: ExtraPyramidal Symptoms (EPS) and tardive dyskinesia (TD: abnormal facial, tongue and mouth movements). EPS includes: dyskinesia: (chewing movements); dystonia: (muscle rigidity); akathisia (inability to keep still)  atypical antipsychotics (atypical because side effects less likely, such as EPS and TD, but weight gain, heart disease and diabetes more likely)  typical: block neurotransmitters (dopamine and serotonin); atypical block but for shorter time (so fewer side effects) Marks: 1 mark for each side of term  2. Antipsychotics more side effects, Atypical antipsychotics fewer side effects = 2 marks because both types are named correctly. No mark if they are not. Note: 0 marks for ‘more effective’ no evidence to suggest this is the case. 0 marks for descriptions. © UCLES 2022 Page 8 of 24 1(c) Explain how ECT is used to treat schizophrenia. 4 Most likely answer:  muscle relaxant given  electricity applied bilaterally or unilaterally  patient convulses (twitches because of muscle relaxant)  patient is unconscious, then wakes and recovers. Marks: 1 mark for each different (correct) point of how it is used to treat schizophrenia. Note: side effects etc. are irrelevant. 1(d) Discuss the strengths and weaknesses of psychological techniques to 5 manage schizophrenia. You should include a conclusion in your answer. Most likely answer (other appropriate responses to be credited): Strengths:  person has to be active in treatment, rather than passive  treatments aim to ease the symptoms; learn to cope  treatments such as CBT can be applied anywhere  no drugs are involved which cause side effects and are addictive Weaknesses:  some people prefer to be passive drugs, such as swallowing a pill is easy  drugs inhibit production of neurochemicals associated with schizophrenia  CBT still needs a therapist to supervise  more costly and time-consuming than giving drug Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each strength/weakness (however detailed) and related to the question up to 4 max. 2 marks max for two strengths/weaknesses unrelated to the question. 1 mark for conclusion. © UCLES 2022 Page 9 of 24

5(a) Design a study to investigate the effectiveness of chemical/drug 10 treatments (MAOIs, SSRIs) for depression. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is: any appropriate method. Specific features:  Experiments: type, IV, DV, controls, experimental design.  Observations: type, setting, response categories, sampling frame, number of observers.  Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: treatment and management of depression: biological: chemical/ drugs (MAOIs, SSRIs) Psychological: For example: MAOIs inhibit the enzyme monoamine oxidase. This enzyme normally breaks down noradrenaline, serotonin and dopamine, but these neurotransmitters are not broken down, they stay at normal high levels and so ‘reduce depression’. The Beck Depression Inventory (BDI) will also feature in this answer (as DV) Methodological: explanation of method using general and specific features as above. © UCLES 2022 Page 17 of 24

9 ‘The nature versus nurture debate is irrelevant when explaining 12 depression.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: Explanations of depression Most likely (any other appropriate responses should be credited): Relevant:  nature versus nurture is reductionist and can therefore be studied much more precisely than say psychoanalytic explanations  nature or nurture can allow research to focus on the cause of the depression  reasearch done on ‘nurture’ such as ‘learned helplessness’ other done on biological. Irrelevant:  People will suffer from depression whether it is nature or nurture  People’s symptoms will be treated whether the cause is nature of nurture  The nature versus nurture debate is theoretical. It has no practical value  Nature versus nurture determines the type of treatment (drugs versus restructuring or REBT)  It might be that for some people the cause is ‘nature’ for others it is ‘nurture’. © UCLES 2022 Page 21 of 24

1(a) In a case study by Glover, a 56-year-old married woman who had been 2 shoplifting every day for 14 years attended treatment sessions. Her treatment used covert sensitisation with aversive imagery. Explain what is meant by the term ‘aversive imagery’. Most likely answer (other appropriate responses to be credited):  an image that induces change in behaviour using negative reinforcement or positive punishment.  for example, in the study by Glover the participant imagined nausea and vomitting as she approached an item in a supermarket with all other shoppers watching until she replaced the item and left the store. Marks: 1 mark for partial explanation; 2 marks for detailed explanation. 1(b) Suggest two strengths of the use of a face-to-face interview by a 4 therapist treating a patient with kleptomania. Most likely answer (other appropriate responses to be credited):  the therapist can observe the patient’s responses to questions and other non-verbal movements which may help with diagnosis/therapy e.g. to see of the patient is being honest or not.  the therapist is providing a more personal service – seeing face to face and giving time to the patient, to understand their kleptomania, unlike a telephone interview which is less personal  the patient can observe the therapist, non-verbal communication, and see whether the therapist gives ‘nods of agreement’ to positive patient behaviour which can be rewarding  the patient can ask questions about their kleptomania which they may not do over a telephone. Marks: 1 mark for suggestion; 2 marks for related to kleptomania 2 1(c) Suggest why biochemical treatments might not be effective when 4 treating kleptomania. Most likely answer (other appropriate responses to be credited):  there is no drug that specifically stops a person from stealing (better used with addiction to alcohol / an emetic such as ipecac which causes vomiting)  the person may not take the drug  the drug may be addictive and long-term use may cause additional problems.  drugs reduce symptoms but do not remove the cause (what symptoms does a person with kleptomania have?) Marks: 1 mark for each suggestion outlined and (1 mark) related to kleptomania 2 OR 1 mark for suggestion and 24 marks for detail and related to kleptomania. © UCLES 2022 Page 5 of 18 1(d) Discuss whether generalisations can or cannot be made from this case 5 study. You should consider both sides of the argument and include a conclusion. Most likely answer (other appropriate responses to be credited): Can  the treatment of covert sensitisation can be generalised to others with kleptomania  covert sensitisation can be used to treat other ICDs such as pyromania Cannot  the specifics of this individual case cannot be generalised  the aversive images (nausea and vomiting) will not work with everyone; different images need to be used. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each point for/against (however detailed) and related to the question up to 4 max. 2 marks max for two points for/against unrelated to the question. 1 mark for conclusion. Question Answer Marks

5(a) Design a study to investigate the effectiveness of biochemical 10 treatments for impulse control disorder. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is: any appropriate method. Specific features:  Experiments: type, IV, DV, controls, experimental design.  Observations: type, setting, response categories, sampling frame, number of observers.  Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses.  General features of research methodology: sampling technique & sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: treating and managing ICDs and non-substance addictive disorder: biochemical (Grant et al., 2008) Psychological: The biochemical treatment using nalmefene is believed by Grant et al. (2008) to help reduce the urge to gamble. To test its effectiveness, participants were assessed to ensure they were suitable to participate. They were then randomly allocated to either a group receiving nalmefene or to a group receiving a placebo. Methodological: explanation of method using general and specific features as above. © UCLES 2022 Page 13 of 18

9 ‘Psychometric measures used to assess obsessive-compulsive disorder (OCD) provide therapists with no useful information.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: measures: Maudsley Obsessive-Compulsive Inventory (MOCI), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) Most likely (any other appropriate responses should be credited): Useful:  measures such as Y-BOCS and MOCI indicate the severity of a disorder  these measures can highlight specific features of the disorder  these measures can be used as comparisons with others with the same disorder  these measures provide quantitative data Not useful:  talking to a therapist in a clinical interview can reveal perhaps more than any test  the measure can use scales (5 or 7 point) which may not represent what the person thinks: they could take a neutral option  people answering the questionnaires may not be honest about everything  measures assume people have similarities; they are less individualistic. Question Answer Marks

1(a) Outline the cognitive explanation of depression (Beck, 1979). 2 Award 1 mark for a basic outline of the term/concept. Award 2 marks for a detailed outline of the term/concept. Example 2-mark response: Depression is due to faulty information processing (1) in which the individual feels responsible for even the most insignificant events (1). For example, someone with depression may blame themselves for choosing the ‘wrong’ day for a family outing because it rains (1). Other appropriate responses should also be credited (e.g. other cognitive explanations not in the syllabus). 1(b) Describe the study by Oruc et al. (1997) about a biological explanation 4 for bipolar disorder. Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. • 42 participants (aged between 31 and 70; 25 f 17 m) with diagnosis of bipolar disorder from 2 psychiatric institutions in Croatia • Control group of 40 (no history of mental illness), matched for sex and age • Information collected from participants and their family members and diagnosis confirmed through medical records • DNA testing for polymorphisms in serotonin receptor 2c (5-HTR2c) and the serotonin transporter (5-HTT) gene • 16/42 (38%) of experimental group had first degree relative with major affective disorder • But no overall association found between genes and presence of bipolar disorder • But when participants analysed separately by gender (as serotonin as a neurotransmitter is understood to be sexually dimorphic), associations found for both polymorphisms in female participants • Suggests polymorphisms in these genes could be responsible for increased risk of bipolar disorder in females © UCLES 2022 Page 6 of 24 1(c) Explain two strengths of the study by Oruc et al. 6 Likely strengths include: • Valid – as control group of 40 is used for comparison • Reliable – Information about incidence of bipolar disorder in family collected by more than one means, increasing both reliability and validity • Objective – DNA valid as objective data and all results quantitative • Comprehensive – two different gene polymorphisms examined rather than just one to give larger view of role of serotonin mechanisms • Useful – If increased susceptibility in females then some intervention could be employed early on to reduce risk of development (but not necessary in males) • Ethical – confidentiality maintained and participants not put under any harm Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain two strengths. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one appropriate strength in detail. OR • two strengths in less detail. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation of a strength. They could include 2 strengths but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2022 Page 7 of 24

2(a) Describe characteristics of obsessive-compulsive and related 8 disorders (types, examples/case studies, measures). Characteristics of obsessive-compulsive and related disorders, including the following: • Types of and common obsessions, common compulsions, hoarding disorder and body dysmorphic disorder • Examples and case studies (‘Charles’ by Rappaport, 1989) • Measures: Maudsley Obsessive-Compulsive Inventory (MOCI), Yale- Brown Obsessive-Compulsive Scale (Y-BOCS) Types of and common obsessions, common compulsions, hoarding disorder and body dysmorphic disorder could include: OCD can affect up to 5% of the population. An individual with OCD is likely to suffer with obsessions and compulsions (although they may not experience both). Obsessions are thoughts (cognitive) that are persistent, worrying, intrusive and disturbing. Common examples include: • fear of illness or infection • fear of accidentally injuring oneself or others • strong desire for order and symmetry • fear of deliberately harming oneself • imagining fire breaking out in any building they enter • worrying that a family member come to harm Compulsions are behaviours that are repetitive and give temporary relief to the anxiety/obsessions. Engaging in these compulsions is a means of supressing obsessions. Behaviours are excessive and are not a realistic way to relieve the source of anxiety. Common examples include: • frequent and excessive handwashing • ordering objects in some way e.g. cans in a cupboard with labels aligned or ornaments in precise positions • checking repeatedly e.g. checking front door is locked 20 times before leaving home • Ritualistically sequenced behaviour e.g. switching off lights and locking doors in a precise sequence with any irregularity or breach of concentration causing need for sequence to start again • Repetitive counting (can be up to a specific designated number) or repeating word or phrase over and over again • Repetitive tapping © UCLES 2022 Page 8 of 24 2(a) Hoarding disorder is characterised by difficulty in disposing of possessions. This can result in collecting so many items that their homes are unhygienic and unsafe. Hoarders may collect clothes, magazines, household supplies, photographs and newspapers. Hoarders cannot part with items without this leading to great distress and anxiety regardless of the utility or value of the items concerned. Hoarders may hoard because they think someone will come to harm if something is thrown away or because they fear that they will need an item in the future or because they believe items have an emotional significance. Body dysmorphic disorder (BDD) is characterised by obsessive thoughts about perceived flaws in physical appearance. These faults may be slight and not noticed by others and are often on the skin of the face. Anxiety about these perceived flaws (obsessions) leads to compulsive repetitive behaviours such as frequent mirror-checking or grooming (hair-washing, shaving, or constant comparisons with others) that may occupy several hours per day. Examples and case studies (‘Charles’ by Rappaport, 1989): • Charles washes excessively (compulsion) • Elaborate ritual that takes many hours • Obsession with germs • Drug trial with tricyclic antidepressants Measures: Maudsley Obsessive-Compulsive Inventory (MOCI), Yale- Brown Obsessive-Compulsive Scale (Y-BOCS). MOCI is a psychometric test designed to assess OCD. It is a quick assessment tool for clinicians, rather than a formal diagnostic tool. MOCI is a self-report questionnaire using a forced choice ‘yes’ or ‘no’ format. There are 30 items leading to a total score between 0 and 30. The 30 items are divided into 4 sub-scales: • Checking (9 items) e.g. ‘I frequently have to check things (gas or water taps, doors, etc.) several times’ • Cleaning/washing (11 items), e.g. ‘I am not unduly concerned about germs and diseases’ • Slowness (7 items) e.g. ‘I do not take a long time to dress in the morning’ • Doubting (7 items) e.g. ‘Even when I do something very carefully, I often feel that it is not quite right’ Y-BOCS is used to measure the nature and severity of symptoms. It involves a semi-structured interview, taking about 30 minutes and involves a checklist of different obsessions and compulsions, with a 10-item severity scale. Obsessive categories include religious, contamination and aggressive. Compulsion categories include counting, hoarding and washing. Individuals can rate the time they spend on obsessions, how hard they are to resist and how much distress they cause. Scores range from 0 (no symptoms) to 40 (severe symptoms). Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2022 Page 9 of 24 2(b) Evaluate characteristics of obsessive-compulsive and related 10 disorders (types, examples/case studies, measures) including a discussion of qualitative and quantitative data. A range of issues could be used for evaluation here. These include: • Named issue – qualitative and quantitative data. The diagnosis of OCD and related disorders is likely to be collected qualitatively but use some quantitative measures in diagnosis (a certain number of symptoms present for a specific length of time), case study by Rappaport gathers mostly qualitative data, MOCI and Y-BOCS both gather quantitative data with Y-BOCS having the option for qualitative data too. – The strengths of quantitative data are the weaknesses of qualitative data. Quantitative data can be easily used to analyse for comparison e.g. use of Y-BOCs with Charles before and after treatment – Weaknesses of quantitative data include the potential lack of validity e.g. in MOCI patient is unable to describe in own words or pick an option other than yes or no (forced choice) so can limit validity – Qualitative data is often more comprehensive (allows individuals to describe their feelings about compulsions in detail in Y-BOCS) however it will not always be helpful to use as a comparison tool • Case studies • Psychometric tests / reliability and validity of measures • Practical applications • Psychometric tests • Cultural bias • Generalisability • Reductionism Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2022 Page 10 of 24

1(a) Explain what is meant by ‘kleptomania’. 2 Award 1 mark for a basic explanation of the term/concept. Award 2 marks for a detailed explanation of the term/concept. For example: Kleptomania is a non-substance addictive disorder in which the person concerned cannot resist the impulse to steal objects (1). The objects are not needed for personal use and they are not stolen because of their monetary value (1). Kleptomaniacs may feel tension or anxiety before the act of stealing and pleasure/gratification after the theft (1). Other appropriate responses should also be credited 1(b) Outline two of the components that Griffiths (2005) used to define 4 addiction. For each component: Award 1 marks for a basic answer with some understanding of the topic area e.g. naming the component. Award 2 marks for a detailed answer with clear understanding of the topic area. • Salience – the activity (e.g. gambling, pyromania) becomes the most important thing to the individual. They think about it all the time even when not engaged in it. This can be experienced as a ‘craving’ • Mood modification – the activity has the subjective experience of altering the person’s mood. This could be a ‘buzz’ or a ‘high’, ‘euphoria’, or paradoxically it can be tranquilising with an ‘escape’ or ‘numbing’. This can be for the same substance/activity • Tolerance – the process whereby increasing amounts of a particular activity are required to achieve the effects from before e.g. a gambler increasing their bet or spending longer periods of time in gambling • Withdrawal symptoms – The unpleasant feeling and/or physical effects occurring when the activity is reduced suddenly or stopped. This can be seen as irritability or physical (e.g. insomnia, headaches) • Conflict – this can be between the addict and those around them (interpersonal conflict) or within the individual themselves (intrapsychic conflict). This can result in compromising relationships, work or social activities. Intrapsychic conflict can be experienced by the individual as a ‘loss of control’ • Relapse – the tendency for repeatedly returning to the addictive behaviour even after a long period of abstinence or control Other appropriate responses should also be credited. © UCLES 2022 Page 6 of 28 1(c) Explain one strength and one weakness of the definition of addiction 6 proposed by Griffiths. Likely strengths include: • Comprehensive definition with objective criteria. This makes it pretty clear whether or not an individual is an addict as they have to exhibit all 6 components. This can help with diagnosis • Individuals (and their families/colleagues) having knowledge of these components can even self-diagnose putting them in a position to acknowledge their problem and seek help • Clear diagnosis using these 6 components can lead to appropriate treatment or modification techniques and also ability to recognise when relapse has occurred • By classifying all addictions in the same way, whether substance or non-substance, the essential elements of what constitutes addiction can be better researched • There is a growing body of research that points to the similarities present in all addictions, whether pyromania, exercise, overeating, gambling, smoking or taking drugs. This model supports that Likely weaknesses include: • Possible lack of validity / individual differences. Someone engaging in a potentially addictive behaviour may not have experienced all of the components (e.g. relapse, as they have not yet tried to reduce the behaviour) but this would not necessarily mean they are not an addict • Components rely partly on the subjective experience of the individual who may still not wish to recognise their addiction and so deny, for example, that they need to do more and more to get their ‘fix’, potentially limiting treatment • It does not explain why someone becomes addicted and another person does not. Why, for example, might one person play a slot machine for 30 minutes one day (experiencing the ‘high’) and not do so again for years, but another person with the same experience finds themselves thinking about it all the time • Many would argue that to describe non-substance addiction in the same way as substance addiction is incorrect because there has to be a physiological aspect to withdrawal and this does not occur without a substance Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain one strength and one weakness. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one appropriate weakness in detail or one appropriate strength in detail. OR • one weakness and one strength in less detail. © UCLES 2022 Page 7 of 28 1(c) Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation of either a strength or a weakness. They could include both but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2022 Page 8 of 28

2(a) Describe treatments and management of schizophrenia and delusional 8 disorder (biochemical, ECT, token economy, CBT). Treatment and management of schizophrenia and delusional disorder, including the following: • biochemical (antipsychotics and atypical antipsychotics) • electro-convulsive therapy • token economy (Paul and Lentz, 1977) • cognitive-behavioural therapy (Sensky, 2000) Biochemical (antipsychotics and atypical antipsychotics) Chlorpromazine and other antipsychotics block dopamine and serotonin receptors in the (cortical and limbic regions) brain. Reduces agitation and hostility in the patient. After 2+ weeks reduces positive symptoms. Electro-convulsive therapy A general anaesthetic and a drug that relaxes muscles is given. Electrodes are placed on the scalp and a finely controlled electric current through those electrodes for a very short time. This will cause a brief seizure in the brain. The seizure is what treats the symptoms. Can be performed unilaterally or bilaterally. Often 12 weeks of treatment done 2x per week. One theory is affects post-synaptic responses to CNS transmitters. Often used effectively for acute episodes of psychosis and for catatonic symptoms. Token economy (Paul and Lentz, 1977) Aim was to investigate the effectiveness of operant conditioning by reinforcing appropriate behaviour with schizophrenic patient. Set up token economy system in hospital ward. 84 patients given tokens as reward when behaved appropriately. Could be exchanged for luxury items. Study lasted around 4.5 years. Independent measures design where half of patients received milieu therapy (therapeutic community), traditional hospital treatment and token economy. Behaviour monitored through observations, interviews and standardised questionnaires. Results – positive and negative symptoms were significantly reduced 11% of patients needed drug treatment, compared to 100% of the control group. Being able to live independently – 97% token economy group, 71% milieu therapy and 46% traditional hospital treatment group. Conclusion – operant conditioning is an effective means of treating people with chronic schizophrenia. Cognitive-behavioural therapy (Sensky, 2000) To compare cognitive behavioural therapy (CBT) with non-specific befriending interventions for patients with schizophrenia. A randomised controlled design: • Patients were allocated to one of two groups: a cognitive behavioural therapy group and a non-specific befriending control group • 90 patients. 57 from clinics in Newcastle, Cleveland and Durham and 33 from London. They had diagnoses of schizophrenia that had not responded to medication. Aged 16–60 years • Patients were allocated to one of two groups • Both interventions were delivered by two experienced nurses who received regular supervision © UCLES 2022 Page 9 of 28 2(a) • Patients were assessed by blind raters at baseline after treatment (lasting up to 9 months) at a 9-month follow-up evaluation • Assessed on measures including the Comprehensive Psychiatric Rating Scale, the Scale for Assessment of Negative Symptoms, plus a depression rating scale • Patients continued to receive routine care throughout the study. The patients received a mean of 19 individual treatment sessions over 9 months Both interventions resulted in significant reductions in positive and negative symptoms and depression. After treatment there was no significant difference between the two groups. At the nine-month follow-up evaluation, patients who had received cognitive therapy showed greater improvements on all measures. They had improved, while the befriending group had lost some of the benefits. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2022 Page 10 of 28 2(b) Evaluate treatments and management of schizophrenia and delusional 10 disorder (biochemical, ECT, token economy, CBT), including a discussion of ethics. A range of issues could be used for evaluation here. These include: • Named issue – Ethics: Some treatments can be forced on a patient with schizophrenia such as biochemical and ECT if they are committed to a hospital. You cannot force anyone to participate in cognitive and behavioural treatments so they could be considered more ethical. Difficult to be sure that a psychotic individual has given fully informed consent to any treatment. Potential risk of physical harm from treatment with ECT and (to a lesser extent) drug therapies. However, ethical issues of consent and withdrawal could be balanced against benefit to the individual in helping manage their symptoms. • Determinism • Nature versus nurture • Appropriateness • Usefulness/effectiveness • Reductionism • Cost • Psychological approaches • Evaluation of studies on effectiveness Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2022 Page 11 of 28

1(a) Outline the cognitive explanation of depression (Beck, 1979). 2 Award 1 mark for a basic outline of the term/concept. Award 2 marks for a detailed outline of the term/concept. Example 2-mark response: Depression is due to faulty information processing (1) in which the individual feels responsible for even the most insignificant events (1). For example, someone with depression may blame themselves for choosing the ‘wrong’ day for a family outing because it rains (1). Other appropriate responses should also be credited (e.g. other cognitive explanations not in the syllabus). 1(b) Describe the study by Oruc et al. (1997) about a biological explanation 4 for bipolar disorder. Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. • 42 participants (aged between 31 and 70; 25 f 17 m) with diagnosis of bipolar disorder from 2 psychiatric institutions in Croatia • Control group of 40 (no history of mental illness), matched for sex and age • Information collected from participants and their family members and diagnosis confirmed through medical records • DNA testing for polymorphisms in serotonin receptor 2c (5-HTR2c) and the serotonin transporter (5-HTT) gene • 16/42 (38%) of experimental group had first degree relative with major affective disorder • But no overall association found between genes and presence of bipolar disorder • But when participants analysed separately by gender (as serotonin as a neurotransmitter is understood to be sexually dimorphic), associations found for both polymorphisms in female participants • Suggests polymorphisms in these genes could be responsible for increased risk of bipolar disorder in females © UCLES 2022 Page 6 of 24 1(c) Explain two strengths of the study by Oruc et al. 6 Likely strengths include: • Valid – as control group of 40 is used for comparison • Reliable – Information about incidence of bipolar disorder in family collected by more than one means, increasing both reliability and validity • Objective – DNA valid as objective data and all results quantitative • Comprehensive – two different gene polymorphisms examined rather than just one to give larger view of role of serotonin mechanisms • Useful – If increased susceptibility in females then some intervention could be employed early on to reduce risk of development (but not necessary in males) • Ethical – confidentiality maintained and participants not put under any harm Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain two strengths. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one appropriate strength in detail. OR • two strengths in less detail. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation of a strength. They could include 2 strengths but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2022 Page 7 of 24

2(a) Describe characteristics of obsessive-compulsive and related 8 disorders (types, examples/case studies, measures). Characteristics of obsessive-compulsive and related disorders, including the following: • Types of and common obsessions, common compulsions, hoarding disorder and body dysmorphic disorder • Examples and case studies (‘Charles’ by Rappaport, 1989) • Measures: Maudsley Obsessive-Compulsive Inventory (MOCI), Yale- Brown Obsessive-Compulsive Scale (Y-BOCS) Types of and common obsessions, common compulsions, hoarding disorder and body dysmorphic disorder could include: OCD can affect up to 5% of the population. An individual with OCD is likely to suffer with obsessions and compulsions (although they may not experience both). Obsessions are thoughts (cognitive) that are persistent, worrying, intrusive and disturbing. Common examples include: • fear of illness or infection • fear of accidentally injuring oneself or others • strong desire for order and symmetry • fear of deliberately harming oneself • imagining fire breaking out in any building they enter • worrying that a family member come to harm Compulsions are behaviours that are repetitive and give temporary relief to the anxiety/obsessions. Engaging in these compulsions is a means of supressing obsessions. Behaviours are excessive and are not a realistic way to relieve the source of anxiety. Common examples include: • frequent and excessive handwashing • ordering objects in some way e.g. cans in a cupboard with labels aligned or ornaments in precise positions • checking repeatedly e.g. checking front door is locked 20 times before leaving home • Ritualistically sequenced behaviour e.g. switching off lights and locking doors in a precise sequence with any irregularity or breach of concentration causing need for sequence to start again • Repetitive counting (can be up to a specific designated number) or repeating word or phrase over and over again • Repetitive tapping © UCLES 2022 Page 8 of 24 2(a) Hoarding disorder is characterised by difficulty in disposing of possessions. This can result in collecting so many items that their homes are unhygienic and unsafe. Hoarders may collect clothes, magazines, household supplies, photographs and newspapers. Hoarders cannot part with items without this leading to great distress and anxiety regardless of the utility or value of the items concerned. Hoarders may hoard because they think someone will come to harm if something is thrown away or because they fear that they will need an item in the future or because they believe items have an emotional significance. Body dysmorphic disorder (BDD) is characterised by obsessive thoughts about perceived flaws in physical appearance. These faults may be slight and not noticed by others and are often on the skin of the face. Anxiety about these perceived flaws (obsessions) leads to compulsive repetitive behaviours such as frequent mirror-checking or grooming (hair-washing, shaving, or constant comparisons with others) that may occupy several hours per day. Examples and case studies (‘Charles’ by Rappaport, 1989): • Charles washes excessively (compulsion) • Elaborate ritual that takes many hours • Obsession with germs • Drug trial with tricyclic antidepressants Measures: Maudsley Obsessive-Compulsive Inventory (MOCI), Yale- Brown Obsessive-Compulsive Scale (Y-BOCS). MOCI is a psychometric test designed to assess OCD. It is a quick assessment tool for clinicians, rather than a formal diagnostic tool. MOCI is a self-report questionnaire using a forced choice ‘yes’ or ‘no’ format. There are 30 items leading to a total score between 0 and 30. The 30 items are divided into 4 sub-scales: • Checking (9 items) e.g. ‘I frequently have to check things (gas or water taps, doors, etc.) several times’ • Cleaning/washing (11 items), e.g. ‘I am not unduly concerned about germs and diseases’ • Slowness (7 items) e.g. ‘I do not take a long time to dress in the morning’ • Doubting (7 items) e.g. ‘Even when I do something very carefully, I often feel that it is not quite right’ Y-BOCS is used to measure the nature and severity of symptoms. It involves a semi-structured interview, taking about 30 minutes and involves a checklist of different obsessions and compulsions, with a 10-item severity scale. Obsessive categories include religious, contamination and aggressive. Compulsion categories include counting, hoarding and washing. Individuals can rate the time they spend on obsessions, how hard they are to resist and how much distress they cause. Scores range from 0 (no symptoms) to 40 (severe symptoms). Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2022 Page 9 of 24 2(b) Evaluate characteristics of obsessive-compulsive and related 10 disorders (types, examples/case studies, measures) including a discussion of qualitative and quantitative data. A range of issues could be used for evaluation here. These include: • Named issue – qualitative and quantitative data. The diagnosis of OCD and related disorders is likely to be collected qualitatively but use some quantitative measures in diagnosis (a certain number of symptoms present for a specific length of time), case study by Rappaport gathers mostly qualitative data, MOCI and Y-BOCS both gather quantitative data with Y-BOCS having the option for qualitative data too. – The strengths of quantitative data are the weaknesses of qualitative data. Quantitative data can be easily used to analyse for comparison e.g. use of Y-BOCs with Charles before and after treatment – Weaknesses of quantitative data include the potential lack of validity e.g. in MOCI patient is unable to describe in own words or pick an option other than yes or no (forced choice) so can limit validity – Qualitative data is often more comprehensive (allows individuals to describe their feelings about compulsions in detail in Y-BOCS) however it will not always be helpful to use as a comparison tool • Case studies • Psychometric tests / reliability and validity of measures • Practical applications • Psychometric tests • Cultural bias • Generalisability • Reductionism Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2022 Page 10 of 24

1 Richard has a fear of oranges and knows about the behavioural explanation of phobias. Richard wants to be treated using systematic desensitisation (Wolpe, 1958). However, his partner thinks that other treatments may be better. 1(a) Explain what is meant by a ‘behavioural explanation of phobias’. 2 Most likely answer (other appropriate responses to be credited): • all behaviours are learned (and so are phobias) • behaviours are learned through association and so are phobias • example of little Albert (Watson, 1920) may be given Marks: 1 mark for basic answer; +1 mark for elaboration/example. 1(b) Explain how systematic desensitisation would be used to treat 4 Richard’s fear of oranges. Most likely answer (other appropriate responses to be credited): Systematic desensitisation (Wolpe (1958) 1 learning of progressive muscle relaxation / deep breathing.

5(a) Design a longitudinal study using observation to investigate whether a 10 token economy effectively manages schizophrenia. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is observation. Specific features: Observations: type, setting, response categories, sampling frame, number of observers. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks. Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: token economy (Paul and Lentz, 1977). Psychological: token economy is the use of positive reinforcement whereby tokens given for correct or appropriate behaviour can be exchanged for something desirable. Paul and Lentz (1977) used this to help people with schizophrenia. Methodological: explanation of method using general and specific features as above. © UCLES 2022 Page 16 of 24

9 ‘In the future a genetic explanation of schizophrenia will be the only 12 explanation needed’. To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: genetic (Gottesman and Shields, 1972). Most likely (any other appropriate responses should be credited): Only one needed: • Genetic explanations are reductionist and can therefore be studied much more precisely than say psychodynamic explanations • Genetic findings can be replicated and generalised to everyone if a specific gene for phobias is identified • Genetic explanations provide an underlying cause for how it is possible for phobias to arise at all (an ultimate i.e. evolutionary explanation) whereas others can only provide an explanation of a specific phobia in a specific individual Not only one needed: • Other explanations are also ‘scientific’; behavioural explanations are based on observable behaviour • Just because an explanation is based on science it does not mean that it is correct. The psychodynamic explanation has no science, yet it may be correct • Explanations should take a more holist view, rather than reducing the explanation to one factor © UCLES 2022 Page 21 of 24

1 The Blood Injection Phobia Inventory (BIPI) is a questionnaire with items about phobic situations. The participants rate their cognitive, behavioural and physiological responses to these phobic situations on four-point scales. Fig. 1.1 shows one of these items. Item 5. When I hear a conversation about blood. four-point scale Type of Response response statement never sometimes almost always always Cognitive I think I’m 0 1 2 3 going to faint. Behavioural I escape from the situation 0 1 2 3 immediately. Physiological Response X 0 1 2 3 Fig 1.1 1(a) Suggest one physiological response statement that could be used for 2 Response X in Fig. 1.1. Most likely answer (other appropriate responses to be credited): Answers from the original are: (a) My heartbeat speeds up. (b) My palms or armpits sweat. (c) My muscles start to tense. (d) I feel that I am getting dizzy. (e) I breathe more quickly. (f) I feel a cold sweat all over my body. (g) I feel more blood pumping in my body. (h) I feel my face is hot. (i) I lose consciousness. (j) I get pale. (k) I faint. (l) I feel a lump in my throat (m) I feel stomach discomfort. Note: Any other appropriate physiological statement/question to receive credit. Marks: 1 mark for appropriate physiological response; +1 mark for ‘response statement’ i.e. worded as a statement. 0 marks for statement if physiological response is incorrect. © UCLES 2022 Page 8 of 24 1(b) Suggest two strengths of using a four-point scale to measure anxiety 4 in people with blood injection phobia. Most likely answer (other appropriate responses to be credited): • a four point scale allows a wide range of responses e.g. from ‘never’ to ‘always’ so allows individual differences in ratings of anxiety • a four point scale is ‘simple’ i.e. easy to choose from • a four point scale provides quantitative data that can be statistically analysed* • the BIPI is a four point scale – it is a psychometric test (valid, reliable, etc.) • a four point scale can be used over time to check improvement (1 mark) in a person trying to reduce anxiety of blood/injection phobia (+1 mark). Marks: 1 mark for correct answer (as above) +1 mark for related to study (examples as above) ×2 Note: quantitative data is NOT objective. Credit quantitative (as above)* but not ‘it is objective’ Note: do not credit ‘general/overall less time consuming / easy/convenient’ 1(c)(i) Suggest one way in which anxiety in people with blood injection 2 phobia could be measured, other than using a rating scale. Most likely answer (other appropriate responses to be credited): • Observation of the behaviour of the person with blood anxiety (1 mark) such what do they do when they see a pool of blood on the floor (+1 mark). • Clinical interview with the person with blood anxiety, (1 mark) asking questions about how they feel in certain situations such as ‘When I see a pool of blood on the floor’ (+1 mark) Marks: 1 mark identification of ‘other way’ +1 mark for relating to blood anxiety. Note: answers involving inventories/questionnaires (with rating scales) = 0 (BIPI is an Inventory) Note: credit answers using ‘rating scales’ on ‘machinery’ e.g. blood pressure, etc 1(c)(ii) Suggest one weakness with the measure you suggested in (c)(i). 2 Most likely answer (other appropriate responses to be credited): • Observation: cognitive responses cannot be observed; some physiological responses cannot be seen (1 mark) such as muscles tensing (1 mark) • Clinical interview: person may not tell the truth (1 mark) e.g. ‘I’m going to faint’ when they are not (1 mark) Marks: 1 mark for weakness +1 mark for relating to study. Note: if part (a) is incorrect then part (b) must also be incorrect. © UCLES 2022 Page 9 of 24 1(d) Discuss the strengths and weaknesses of using quantitative data to 5 assess blood injection phobia. You should include a conclusion in your answer. Most likely answer (other appropriate responses to be credited): Strengths: • responses from participants can be compared with responses from other participants on the same rating scale. • data can be compared with other studies done previously and in the future. • data can be analysed statistically • a number isn’t open to question by researchers and researcher bias doesn’t apply. Weaknesses: • a reason or explanation cannot be provided by participants • participants can feel uninvolved if they are not asked for an explanation • reducing a phobia to numbers is not perhaps what a patient would expect to happen. Note: do not credit demand characteristics – this is not a ‘study’ this is real life (and people with a real phobia) Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each strength/weakness (however detailed) and related to the question up to 4 max. 2 marks max for two strengths/weaknesses unrelated to the question. 1 mark for conclusion. © UCLES 2022 Page 10 of 24

5(a) Design a study to investigate the effectiveness of a biomedical 10 treatment (SSRIs) for obsessive-compulsive disorder (OCD). Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is: any appropriate method. Specific features: • Experiments: type, IV, DV, controls, experimental design. • Observations: type, setting, response categories, sampling frame, number of observers. • Questionnaires/Interviews: type, setting, example questions. Scoring/ rating scale, analysis of responses. General features of research methodology: sampling technique & sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: biochemical (Grant et al., 2008) Psychological: The biochemical treatment using nalmefene is believed by Grant et al. (2008) to help reduce the urge to gamble. To test its effectiveness, participants were assessed to ensure they were suitable to participate. They were then randomly allocated to either a group receiving nalmefene or to a group receiving a placebo. Methodological: explanation of method using general and specific features as above. © UCLES 2022 Page 17 of 24

9 ‘The cognitive explanation of phobias is better than all other 12 explanations.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: definitions, types, examples and case studies of schizophrenia and psychotic disorders Most likely (any other appropriate responses should be credited): Better: • cognitive explanations are reductionist and can therefore be studied much more precisely than e.g. psychodynamic explanations • ‘everyone thinks’ and so a cognitive explanation applies to everyone (e.g. people have negative thoughts which can be changed to positive thoughts) • cognitive explanations such as DiNardo’s explain why people behave in certain ways, a strictly behavioural approach cannot. • cognitive explanations lead to cognitive therapies which have shown to be successful over many years Not better • other explanations may be more ‘scientific’; cognitive explanations are based on what cannot be observed. • cognitive explanations are reductionist and do not take into account other explanations which together may provide a more holistic approach. • cognitive explanations are ‘individual’ rather than ‘situational’ © UCLES 2022 Page 21 of 24

1 Richard has a fear of oranges and knows about the behavioural explanation of phobias. Richard wants to be treated using systematic desensitisation (Wolpe, 1958). However, his partner thinks that other treatments may be better. 1(a) Explain what is meant by a ‘behavioural explanation of phobias’. 2 Most likely answer (other appropriate responses to be credited): • all behaviours are learned (and so are phobias) • behaviours are learned through association and so are phobias • example of little Albert (Watson, 1920) may be given Marks: 1 mark for basic answer; +1 mark for elaboration/example. 1(b) Explain how systematic desensitisation would be used to treat 4 Richard’s fear of oranges. Most likely answer (other appropriate responses to be credited): Systematic desensitisation (Wolpe (1958) 1 learning of progressive muscle relaxation / deep breathing.

5(a) Design a longitudinal study using observation to investigate whether a 10 token economy effectively manages schizophrenia. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is observation. Specific features: Observations: type, setting, response categories, sampling frame, number of observers. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks. Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: token economy (Paul and Lentz, 1977). Psychological: token economy is the use of positive reinforcement whereby tokens given for correct or appropriate behaviour can be exchanged for something desirable. Paul and Lentz (1977) used this to help people with schizophrenia. Methodological: explanation of method using general and specific features as above. © UCLES 2022 Page 16 of 24

9 ‘In the future a genetic explanation of schizophrenia will be the only 12 explanation needed’. To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: genetic (Gottesman and Shields, 1972). Most likely (any other appropriate responses should be credited): Only one needed: • Genetic explanations are reductionist and can therefore be studied much more precisely than say psychodynamic explanations • Genetic findings can be replicated and generalised to everyone if a specific gene for phobias is identified • Genetic explanations provide an underlying cause for how it is possible for phobias to arise at all (an ultimate i.e. evolutionary explanation) whereas others can only provide an explanation of a specific phobia in a specific individual Not only one needed: • Other explanations are also ‘scientific’; behavioural explanations are based on observable behaviour • Just because an explanation is based on science it does not mean that it is correct. The psychodynamic explanation has no science, yet it may be correct • Explanations should take a more holist view, rather than reducing the explanation to one factor © UCLES 2022 Page 21 of 24

1(a) Explain what is meant by ‘pyromania’. 2 Award 1 mark for a basic explanation of the term/concept. Award 2 marks for an explanation of the term/concept. This is an obsessive desire to set fire to things. (1) The person has deliberately and intentionally set fire to something at least twice. (1) The person feels anxiety / heightened arousal prior to setting the fire and once they have done it the arousal reduces. (1) They are also fascinated with fires. (1) Other appropriate responses should also be credited. 1(b) Describe the study by Glover (2011) that used covert sensitisation as a 4 treatment for kleptomania. Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example A case study was carried out by Glover (2011) on a 56 year old woman with kleptomania. (1) After interviewing the patient it was decided to use the imagery of nausea and vomiting paired with the act of stealing. (1) She was given 4 therapy sessions (1) and muscle relaxation was used in the first 2 sessions to enhance visualisation. (1) The patient learned to associate the unpleasant sensation of vomiting with the undesirable stealing behaviour. (1) She was seen at a 19 month follow up and her kleptomania had greatly reduced. (1) Other appropriate responses should also be credited. © UCLES 2023 Page 6 of 23 1(c) Explain one strength and one weakness of the study by Glover. 6 Likely strengths include –  In depth as a case study done over a number of weeks (with a follow up at 19 months). Qualitative data collected  Shows the effectiveness of covert sensitisation.  Has a long term benefit due to 19 month follow-up.  Good ecological validity as the patient was able to practice the imagery outside of the sessions and when she felt tempted to steal. Likely weaknesses include –  Poor generalisability as one patient with kleptomania so may not apply to men, people in other age groups (she was 56) or people with other types of impulse control disorders (e.g. gambling)  Social desirability bias – the patient may have told Glover that she felt better and wasn’t stealing as much in order to please him.  No quantitative data collected so comparisons cannot be made. Mark according to the levels of response criteria below: Level 3 (5–6 marks) Candidates will show a clear understanding of the question and will explain one strength and one weakness. Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) Candidates will show an understanding of the question and will explain one appropriate weakness in detail or one appropriate strength in detail. OR one weakness and one strength in less detail. Level 1 (1–2 marks) Candidates will show a basic understanding of the question and will attempt an explanation of either a strength or a weakness. They could include both but just as an attempt. Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited © UCLES 2023 Page 7 of 23

2(a) Describe explanations of depression. 8 Explanations of depression, including the following:  biological: genetic and neurochemical (Oruc et al., 1997)  cognitive (Beck, 1979)  learned helplessness / attributional style (Seligman, 1988) Genetic and neurochemical (Oruc et al., 1997) Depression has a genetic basis. Oruc et al. found the participants in their study with bipolar disorder – sixteen of the participants had at least one first degree relative who had a major affective disorder. In addition, polymorphisms in the genes of the participants could be responsible for the increased risk of developing bipolar disorder (just with the females in the sample). Also credit neurochemical explanation (low levels of serotonin). Cognitive (Beck, 1979) Depression due to faulty processing of information. Created the cognitive triad (negative views about the world, negative views about oneself and negative views about the future) which all influence each other and can lead the depressed individual to spiral into lowering moods. Learned helplessness / attributional style (Seligman, 1988) Credit this as an application to depression. Attributional Style Questionnaire given to 39 unipolar depressed patients at the beginning and end of cognitive therapy and also after a one year follow-up. Also gave this to 12 bipolar patients during a depressed episode. Found a pessimistic explanatory style for bad events correlated with severity of depression. As therapy progressed depression reduced as the explanatory style became less pessimistic. This continued to remain improved at the one-year follow-up. Learned helplessness is where the depressed person has learned they are helpless in the unpleasant situation they are currently living in and they no longer try to make their life/mood better. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2023 Page 8 of 23 2(b) Evaluate explanations of depression, including a discussion about 10 reductionism versus holism. A range of issues could be used for evaluation here. These include:  Named issue – Reductionism versus holism – the genetic/neurochemical explanation is more reductionist as it suggests depression has a genetic/biochemical cause and does not explain any other causes. Not everyone who has a first degree relative with depression will develop it and therefore other explanations could also explain the development of depression. The cognitive explanation is more holistic as it considers complex thought processes involved in the development of depression, however it could be considered to be somewhat reductionist as it ignores learning depression and/or genetic factors. Learned helplessness is also more holistic than genetic/neurochemical explanations as it looks at the more complex process of learning depression from life experiences. However, it could also be considered to be environmentally reductionist as it does not consider genetic/neurochemical causes.  Nature versus nurture debate with reference to the various explanations.  Comparisons of different explanations  Application of psychology to everyday life (with reference to explanations)  Deterministic nature of the explanations  Evidence to support the explanations (and an evaluation of this evidence) Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2023 Page 9 of 23

1(a) For one specific phobia: 2 Identify two characteristics of this phobia. Award 1 mark for each characteristic/symptom For example Blood – Hemophobia or haemophobia is extreme and irrational fear of blood (1) and can extend to needles. (1) Leads to increase in heart rate and drop in blood pressure can lead to fainting. (1) Buttons – It is an irrational and persistent fear of buttons (stand alone ones or those on clothing). (1) People suffering from koumpounophobia tend to avoid clothes with buttons. (1) Agoraphobia – excessive fear of open spaces. (1) Person will avoid leaving their home. (1) Zoophobia – extreme fear of animals / specific type of animal. (1) Avoid any activity where they might be exposed to the animal(s) such as going to the zoo. (1) Other appropriate responses should also be credited. 1(b) Describe the psychoanalytic explanation of phobias (Freud, 1909). 4 Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example A fear is repressed into the unconscious to protect the ego. (1) This is as a result of unresolved conflict between the id and the superego. (1) OR could be due to the repressed urges of the id that are being denied. (1) Ego uses defence mechanism to repress the conflict such as displacement. (1) The phobia can be a displaced/redirected fear during an intensely frightening experience (e.g. a physical attack) onto an object. Other appropriate responses should also be credited. © UCLES 2023 Page 6 of 26 1(c) Explain one strength and one weakness of the psychoanalytic 6 explanation of phobias. Likely strengths include –  Backed up by evidence to support the theory of phobias from case studies (e.g. Little Hans) Allow strength of case studies (e.g. in depth) if linked to how this improves the validity / explanatory power of this explanation of phobias.  Psychodynamic treatment from this approach to help reduce phobia. Can resolve the conflict and the phobia will reduce / go away.  Somewhat holistic nature of the explanation – considers the underlying cause of the phobia. Likely weaknesses include –  There are problems with the evidence upon which the explanation of phobias is based (e.g. poor generalisability of case studies, lack of validity of the evidence due to it being collected by a family member in the case of Little Hans.)  Deterministic nature of the explanation – the ego defence mechanism will just occur and the person does not have free will to stop it. Therefore no free will over the development of a phobia.  Somewhat reductionist as it does not consider, for example biomedical or cognitive causes. Mark according to the levels of response criteria below: Level 3 (5–6 marks)  Candidates will show a clear understanding of the question and will explain one strength and one weakness.  Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks)  Candidates will show an understanding of the question and will explain one appropriate weakness in detail or one appropriate strength in detail. OR one weakness and one strength in less detail. Level 1 (1–2 marks)  Candidates will show a basic understanding of the question and will attempt an explanation of either a strength or a weakness. They could include both but just as an attempt.  Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2023 Page 7 of 26

2(a) Describe the treatment and management of obsessive-compulsive and 8 related disorders. Treatment and management of obsessive-compulsive and related disorders, including the following:  Biomedical (SSRIs)  Psychological: cognitive (Lovell et al., 2006), and exposure response prevention (Lehmkuhl et al., 2008) Biomedical (SSRIs) The main medications prescribed are selective serotonin reuptake inhibitors (SSRIs). These can help improve OCD symptoms by increasing the levels of a chemical called serotonin in the brain. This occurs because SSRIs block the re-uptake of serotonin into the pre-synaptic neuron giving the serotonin neurotransmitters a greater chance of being absorbed into the post synaptic neuron. Can also increase the number of serotonin receptors which also increases levels of serotonin. This seems to then cause a lessening of anxiety experienced by the patient and therefore they do not need to engage in the OCD behaviours in order to relieve their anxiety (such as hand washing). Serotonin can increase the feelings of calm and regulate mood of the patient. This means the patient may feel less anxiety around their obsessive thoughts and therefore there is less need to engage in compulsions to reduce anxiety. Cognitive (Lovell et al., 2006) Study – Comparing telephone versus face to face treatment of CBT for OCD. 72 out-patients from two psychology treatment units in Manchester, UK took part. Age 16–65. 10 weekly sessions of exposure and response prevention therapy were given. 3 depression inventories given during therapy (Yale- Brown, Beck and client satisfaction). Therapy – Explained exposure and response prevention where patient created hierarchy of fears. Patient set weekly targets to exposure to items on hierarchy (starting from lowest) to practice 1 hour per day – monitored progress on homework sheet. The therapist reviewed homework, helped devise weekly targets, encouraged the use of a co-therapist (relative or friend), pre-empted difficulties, and helped solve problems. Telephone therapy – one face to face session with therapist covered same material as first session of face to face, followed by eight weekly telephone calls of up to 30 minutes. Treatment was same as in the face to face and telephone, but it was delivered in shorter period of time and the therapist sent homework sheets to the patient. The final session was a one hour face to face treatment session. Evaluated at 1, 3 and 6 months. No significant differences found at six months. Concluded both face to face and telephone treatment are equally as effective in treating OCD. Credit can also be given for describing CBT therapy as it might be used to reduce OCD symptoms e.g. challenging the faulty thinking that hands need to be washed excessively in order to remove dirt and germs and keep the person safe from harm. © UCLES 2023 Page 8 of 26 2(a) Exposure response prevention (Lehmkuhl et al., 2008) Case study of Jason , a 12 year old boy had both autism and OCD. Had ten 50 minute sessions of CBT over 16 weeks. Used exposure response prevention. Jason could not identify specific obsessions and therefore not possible typical ERP. For Jason, cognitive component of treatment focused on identifying feelings of distress and learning coping statements to reduce anxiety, e.g. ‘I know that nothing bad will happen’ and ‘Doing the exposures will help me get better’. Between sessions Jason monitored thoughts using thought record to encourage identification of anxious thoughts. Jason learned to distinguish between normal worries and obsessive thoughts. 2nd session – Start with lowest level of hierarchy and move up. Jason was required to touch several common items in hospital such as elevator buttons, door handles) and exposures were repeated until Jason habituated to the anxiety. Sessions 3–8 – Gradually increased exposure to situations on hierarchy that Jason had obsessional thoughts about. Exposure – getting Jason to touch objects he has difficulties with such as elevator buttons, door handles, etc. Response prevention – reducing the anxious response to the objects by using coping statements. Jason does have high anxiety responses but he learns as therapy progresses that these reduce quickly within a few minutes. After therapy score on Y-BOCS dropped from 18 to 3. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2023 Page 9 of 26 2(b) Evaluate treatment and management of obsessive-compulsive and 10 related disorders, including a discussion about reductionism versus holism. A range of issues could be used for evaluation here. These include:  Named issue – Reductionism versus holism – e.g. biomedical is more reductionist as they focus on the biomedical cause of OCD which they then aim to treat through medication such as SSRIs which cause serotonin levels to increase in the patient. This approach to treatment ignores the cognitive causes of OCD and related disorders and might therefore be less effective. However, the psychological therapies such as exposure and response prevention are more holistic as they focus on both cognitive and biological changes in the body (that cause the anxiety response). As the patient is exposed to the stimuli / intrusive thoughts that causes the anxiety they experience a heightened fear response but as time passes this fear response will lessen. This highlights that this therapy does acknowledge both cognitive (thoughts about the stimuli) and biochemical (fight or flight response that will eventually lesson as the stimuli isn’t dangerous). Candidates may also argue that this approach focuses more on cognitive/behavioural than it does on biochemical and these type of responses are also creditworthy.  determinism versus free-will  validity  application of psychology to everyday life (with reference to treatments)  nature versus nurture debate with reference to the various treatments (via the approaches upon which they are based)  comparisons of different treatments  usefulness (effectiveness) of different treatments  reductionist nature of the treatments  appropriateness of treatments  cost of treatments  ethics of psychological treatments Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2023 Page 10 of 26

1(a) Explain what is meant by ‘pyromania’. 2 Award 1 mark for a basic explanation of the term/concept. Award 2 marks for an explanation of the term/concept. This is an obsessive desire to set fire to things. (1) The person has deliberately and intentionally set fire to something at least twice. (1) The person feels anxiety / heightened arousal prior to setting the fire and once they have done it the arousal reduces. (1) They are also fascinated with fires. (1) Other appropriate responses should also be credited. 1(b) Describe the study by Glover (2011) that used covert sensitisation as a 4 treatment for kleptomania. Award 1–2 marks for a basic answer with some understanding of the topic area. Award 3–4 marks for a detailed answer with clear understanding of the topic area. For example A case study was carried out by Glover (2011) on a 56 year old woman with kleptomania. (1) After interviewing the patient it was decided to use the imagery of nausea and vomiting paired with the act of stealing. (1) She was given 4 therapy sessions (1) and muscle relaxation was used in the first 2 sessions to enhance visualisation. (1) The patient learned to associate the unpleasant sensation of vomiting with the undesirable stealing behaviour. (1) She was seen at a 19 month follow up and her kleptomania had greatly reduced. (1) Other appropriate responses should also be credited. © UCLES 2023 Page 6 of 23 1(c) Explain one strength and one weakness of the study by Glover. 6 Likely strengths include –  In depth as a case study done over a number of weeks (with a follow up at 19 months). Qualitative data collected  Shows the effectiveness of covert sensitisation.  Has a long term benefit due to 19 month follow-up.  Good ecological validity as the patient was able to practice the imagery outside of the sessions and when she felt tempted to steal. Likely weaknesses include –  Poor generalisability as one patient with kleptomania so may not apply to men, people in other age groups (she was 56) or people with other types of impulse control disorders (e.g. gambling)  Social desirability bias – the patient may have told Glover that she felt better and wasn’t stealing as much in order to please him.  No quantitative data collected so comparisons cannot be made. Mark according to the levels of response criteria below: Level 3 (5–6 marks) Candidates will show a clear understanding of the question and will explain one strength and one weakness. Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) Candidates will show an understanding of the question and will explain one appropriate weakness in detail or one appropriate strength in detail. OR one weakness and one strength in less detail. Level 1 (1–2 marks) Candidates will show a basic understanding of the question and will attempt an explanation of either a strength or a weakness. They could include both but just as an attempt. Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited © UCLES 2023 Page 7 of 23

2(a) Describe explanations of depression. 8 Explanations of depression, including the following:  biological: genetic and neurochemical (Oruc et al., 1997)  cognitive (Beck, 1979)  learned helplessness / attributional style (Seligman, 1988) Genetic and neurochemical (Oruc et al., 1997) Depression has a genetic basis. Oruc et al. found the participants in their study with bipolar disorder – sixteen of the participants had at least one first degree relative who had a major affective disorder. In addition, polymorphisms in the genes of the participants could be responsible for the increased risk of developing bipolar disorder (just with the females in the sample). Also credit neurochemical explanation (low levels of serotonin). Cognitive (Beck, 1979) Depression due to faulty processing of information. Created the cognitive triad (negative views about the world, negative views about oneself and negative views about the future) which all influence each other and can lead the depressed individual to spiral into lowering moods. Learned helplessness / attributional style (Seligman, 1988) Credit this as an application to depression. Attributional Style Questionnaire given to 39 unipolar depressed patients at the beginning and end of cognitive therapy and also after a one year follow-up. Also gave this to 12 bipolar patients during a depressed episode. Found a pessimistic explanatory style for bad events correlated with severity of depression. As therapy progressed depression reduced as the explanatory style became less pessimistic. This continued to remain improved at the one-year follow-up. Learned helplessness is where the depressed person has learned they are helpless in the unpleasant situation they are currently living in and they no longer try to make their life/mood better. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2023 Page 8 of 23 2(b) Evaluate explanations of depression, including a discussion about 10 reductionism versus holism. A range of issues could be used for evaluation here. These include:  Named issue – Reductionism versus holism – the genetic/neurochemical explanation is more reductionist as it suggests depression has a genetic/biochemical cause and does not explain any other causes. Not everyone who has a first degree relative with depression will develop it and therefore other explanations could also explain the development of depression. The cognitive explanation is more holistic as it considers complex thought processes involved in the development of depression, however it could be considered to be somewhat reductionist as it ignores learning depression and/or genetic factors. Learned helplessness is also more holistic than genetic/neurochemical explanations as it looks at the more complex process of learning depression from life experiences. However, it could also be considered to be environmentally reductionist as it does not consider genetic/neurochemical causes.  Nature versus nurture debate with reference to the various explanations.  Comparisons of different explanations  Application of psychology to everyday life (with reference to explanations)  Deterministic nature of the explanations  Evidence to support the explanations (and an evaluation of this evidence) Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2023 Page 9 of 23

1(a) Obsessive-compulsive disorder (OCD) can be treated with biomedical 2 treatments and it can be managed with psychological treatments. Biomedical treatments include the use of drugs such as SSRIs. OCD can be managed psychologically using exposure and response prevention. Explain how SSRIs work when treating OCD. Most likely answer (other appropriate responses to be credited): It is assumed that OCD is caused by low levels of serotonin.  it is thought that SSRIs work by increasing serotonin levels in the brain.  serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). It's thought to have a good influence on mood, emotion and sleep.  after carrying a message, serotonin is usually reabsorbed by the nerve cells (known as ‘reuptake’). SSRIs work by blocking (‘inhibiting’) reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells. Marks: 1 mark basic answer; 2 marks elaboration/example. 1(b)(i) Explain what is meant by an obsession, using an example. 2 Most likely answer (other appropriate responses to be credited): Explanation: An obsession is a recurring and persistent thought that interferes with normal behaviour. (1 mark) NB: 0 marks for ‘thoughts’ or ‘obsessive thoughts’; 1 mark for repetitive/recurring thoughts Example:  fearing contamination from anything that is unclean  fear of losing control  fear of losing or not having things you might need.  order and symmetry: the idea that everything must line up “just right”. Marks: 1 mark for explanation; 1 mark for example. © UCLES 2023 Page 8 of 26 1(b)(ii) Explain what is meant by a compulsion, using an example. 2 Most likely answer (other appropriate responses to be credited): Explanation: Compulsions or compulsive acts are repetitious, purposeful physical or mental actions that the individual feels compelled to engage in according to their own strict rules or in a stereotyped manner (1 mark) NB: 0 marks for ‘behaviours’ or ‘compulsive behaviours’ or ‘obsessive behaviours’; 1 mark for repetitive/excessive behaviours; 1 mark for ‘when obsessions are acted upon’. Example:  excessive double checking of things such as doors, locks  repeating counting, checking words  excessive washing or cleaning  accumulating things ‘junk’ (hoarding) Marks: 1 mark for explanation; 1 mark for example. NB: 0 marks for examples of impulse control disorders such as pyromania, kleptomania and gambling. 1(c) Outline one case study where exposure and response prevention was 4 used to treat OCD. Most likely answer (other appropriate responses to be credited):  exposure and response prevention (ERP) exposure means facing or confronting the feared stimuli and/or situations repeatedly until the fear associated with them subsides, and response prevention means not carrying out the compulsive, avoidant, or escape behaviour. ERP targets the behavioural component of CBT.  Lehmkuhl et al. (2008), ERP was used to treat a 12-year-old boy. Jason experienced contamination fears, avoiding ‘contaminated’ items (e.g. door knobs, library books, etc.) He would not sit on chairs, turn pages with his hands, or touch papers that other children had touched. Jason attended ten 50-minute sessions over 16 weeks. Jason was exposed to items he avoided and over the sessions his anxiety dropped. After three months his Y-BOCS score remained low. Marks: 1 mark basic answer (must include ERP and case study of OCD); 2–4 marks description of ERP with increasing detail and quality. NB: 0 marks for ‘Charles’, (OCD but no ERP) or the boy with button phobia (Saavedra and Silverman, ERP but not OCD) © UCLES 2023 Page 9 of 26 1(d) Discuss the strengths and weaknesses of using drugs to treat OCD. You 5 should include a conclusion in your answer. Most likely answer (other appropriate responses to be credited): Strengths  drugs easy to take; swallowing a pill  drugs mean the patient is passive in their treatment (and advantage for many people)  drugs have been shown to be effective in many studies Weaknesses  drugs are addictive so should be short-term use only  drugs are effective for associated problems such as anxiety  drugs ignore the role of alternative explanations of OCD (treat symptom, not cause) Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however detailed) and related to the question up to 4 max. 2 marks max for two strengths/weaknesses unrelated to the question. 1 mark for conclusion. © UCLES 2023 Page 10 of 26

5(a) Patients with obsessive-compulsive disorder (OCD) can receive 10 treatment with a therapist face-to-face or by telephone. Design a study using a telephone interview to investigate whether face- to-face therapy is more effective for women with OCD than for men with OCD. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is: telephone interview. Specific features: Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis. © UCLES 2023 Page 18 of 26 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). NB If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: treatment and management of O-C and related disorders: psychological: cognitive (Lovell et al., 2006) Psychological: (study abstract) Objectives To compare the effectiveness of cognitive behaviour therapy delivered by telephone with the same therapy given face to face in the treatment of obsessive compulsive disorder. Design Randomised controlled non-inferiority trial. Setting Two psychology outpatient departments in the United Kingdom. Participants 72 patients with obsessive compulsive disorder. Intervention 10 weekly sessions of exposure therapy and response prevention delivered by telephone or face to face. Main outcome measures Yale Brown obsessive compulsive disorder scale, Beck depression inventory, and client satisfaction questionnaire. Results Difference in the Yale Brown obsessive compulsive disorder checklist score between the two treatments at six months was – 0.55 (95% confidence interval – 4.26 to 3.15). Patient satisfaction was high for both forms of treatment. Conclusion The clinical outcome of cognitive behaviour therapy delivered by telephone was equivalent to treatment delivered face to face and similar levels of satisfaction were reported. Methodological: explanation of method using general and specific features as above. © UCLES 2023 Page 19 of 26

9 ‘Biochemical techniques, such as the use of drugs, can treat all patients 12 with schizophrenia effectively.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: biochemical (antipsychotics and atypical antipsychotics) and also electro-convulsive therapy, token economy (Paul and Lentz, 1977) and cognitive-behavioural therapy (Sensky et al., 2000) Most likely (any other appropriate responses should be credited): Agree  drugs easy to take; swallowing a pill; drugs such as anti-psychotics and atypical anti-psychotics  drugs mean the patient is passive in their treatment (and advantage for many people)  drugs have been shown to be effective in many studies and the ‘third generation drugs’ such as aripiprazole have fewer side effects Disagree  drugs are addictive so should be short-term use only  drugs may not be taken as prescribed (non-adherence) because of the side effects such as tardive dyskinesia  drugs ignore the role of alternative explanations of schizophrenia (treat symptom, not cause) alternatives such as the cognitive approach (e.g. Frith) © UCLES 2023 Page 23 of 26

1 Paul and Lentz (1977) conducted a study with 84 schizophrenic patients allocating each to one of three types of treatment, including token economy. After more than 4 years the effectiveness of each treatment was compared. Alternatively, schizophrenia can be treated using biochemical techniques. 1(a) Outline how operant conditioning explains token economy. 2 Most likely answer (other appropriate responses to be credited):  giving a token is positive reinforcement (1 mark) and so desirable patient behaviour is likely to be repeated (2 marks)  Behavioural approach and behaviourists believe that all behaviour is learned (1 mark). This means that appropriate behaviour for patients is learned through token economy (2 marks) Note: Any relevant comment about operant conditioning (1 mark) relevant to token economy and schizophrenia / Paul and Lentz (+1 mark) Note: answers outlining classical conditioning receive no marks. Marks: 1 mark for identification; 2 marks for elaboration/example 1(b) Outline the findings about the effectiveness of token economy from this 4 study. Most likely answer (other appropriate responses to be credited):  effective: a reduction in positive symptoms  effective: reduction in negative symptoms  effective: reduction in catatonic behaviour  effective: 97% were able to live independently for 1.5–5 years (compared to milieu or hospital therapy)  effective in withdrawal / social behaviour  effective in interacting with others  less effective: in reducing hallucinations and delusional thinking Note: Question states ‘findings’ (plural) so two (or more) findings are required. Marks: 1 mark basic answer +1 (or +2) marks for elaboration or example OR 1 mark for each different (specific) finding (4 max) OR can be 3 marks + 1 mark Note: 0 marks for general ‘was highly effective’ (OWTTE) Note: two ‘general findings’ = 1 mark e.g. ‘displaying normal behaviour’ and ‘highly effective’. © UCLES 2023 Page 8 of 24 1(c) Suggest two reasons why an independent measures design was a better 4 choice for this study than any other experimental design. Most likely answer:  if patients used a different design, i.e. repeated measures (participants do all treatments) the study would not be valid as it would not be known which technique was the most effective.  if two designs were used there could be cross-over effects where one treatment might interfere with the other. Marks: 1 mark basic reason plus 1 mark for elaboration/example 2 1(d) Discuss the strengths and weaknesses of using biochemical techniques 5 to treat schizophrenia. You should include a conclusion in your answer. Strengths  drugs (such as anti-psychotics and atypical anti-psychotics) are easy to take; swallowing a pill  drugs mean the patient is passive in their treatment (an advantage for many people)  drugs have been shown to be effective in many studies Weaknesses  drugs are addictive so should be short-term use only  drugs may not be taken as prescribed (non-adherence)  drugs ignore the role of alternative explanations of schizophrenia (treat symptom, not cause) Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however detailed) and related to the question up to 4 max. 2 marks max for two strengths/weaknesses unrelated to the question. 1 mark for conclusion. © UCLES 2023 Page 9 of 24

5(a) Design a study using observation to investigate the frequency of the 10 characteristics of schizophrenia spectrum and psychotic disorders. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is: observation. Specific features: Observations: type, setting, response categories, sampling, number of observers. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis. 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note: If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: Characteristics of schizophrenia spectrum and psychotic disorders Psychological: Most likely: hallucinations, disorganised thoughts, (observation of associated behaviours) catatonic behaviour, negative symptoms (loss of normal functioning such as loss of speech, lack of typical facial expressions. Crucial is duration and severity of these symptoms Methodological: explanation of method using general and specific features as above. © UCLES 2023 Page 18 of 24

9 ‘All impulse control disorders are caused by high levels of dopamine.’ 12 To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: causes of impulse control disorders and non-substance addictive disorder: biochemical: dopamine Most likely (any other appropriate responses should be credited): Agree  evidence has shown the relationship between high levels of dopamine and addictive behaviours.  dopamine can be measured physiologically and the presence of high levels is an objective measurement.  dopamine is perhaps the underlying cause of all ICDs and addictions. Disagree  correlation of dopamine with ICDs is not causal  dopamine does not explain why there are different ICDs such as kleptomania and pyromania  alternative explanations are equally valid: the behavioural: positive reinforcement explanation and feeling-state theory (Miller, 2010) Question Answer Marks

1(a) Obsessive-compulsive disorder (OCD) can be treated with biomedical 2 treatments and it can be managed with psychological treatments. Biomedical treatments include the use of drugs such as SSRIs. OCD can be managed psychologically using exposure and response prevention. Explain how SSRIs work when treating OCD. Most likely answer (other appropriate responses to be credited): It is assumed that OCD is caused by low levels of serotonin.  it is thought that SSRIs work by increasing serotonin levels in the brain.  serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). It's thought to have a good influence on mood, emotion and sleep.  after carrying a message, serotonin is usually reabsorbed by the nerve cells (known as ‘reuptake’). SSRIs work by blocking (‘inhibiting’) reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells. Marks: 1 mark basic answer; 2 marks elaboration/example. 1(b)(i) Explain what is meant by an obsession, using an example. 2 Most likely answer (other appropriate responses to be credited): Explanation: An obsession is a recurring and persistent thought that interferes with normal behaviour. (1 mark) NB: 0 marks for ‘thoughts’ or ‘obsessive thoughts’; 1 mark for repetitive/recurring thoughts Example:  fearing contamination from anything that is unclean  fear of losing control  fear of losing or not having things you might need.  order and symmetry: the idea that everything must line up “just right”. Marks: 1 mark for explanation; 1 mark for example. © UCLES 2023 Page 8 of 26 1(b)(ii) Explain what is meant by a compulsion, using an example. 2 Most likely answer (other appropriate responses to be credited): Explanation: Compulsions or compulsive acts are repetitious, purposeful physical or mental actions that the individual feels compelled to engage in according to their own strict rules or in a stereotyped manner (1 mark) NB: 0 marks for ‘behaviours’ or ‘compulsive behaviours’ or ‘obsessive behaviours’; 1 mark for repetitive/excessive behaviours; 1 mark for ‘when obsessions are acted upon’. Example:  excessive double checking of things such as doors, locks  repeating counting, checking words  excessive washing or cleaning  accumulating things ‘junk’ (hoarding) Marks: 1 mark for explanation; 1 mark for example. NB: 0 marks for examples of impulse control disorders such as pyromania, kleptomania and gambling. 1(c) Outline one case study where exposure and response prevention was 4 used to treat OCD. Most likely answer (other appropriate responses to be credited):  exposure and response prevention (ERP) exposure means facing or confronting the feared stimuli and/or situations repeatedly until the fear associated with them subsides, and response prevention means not carrying out the compulsive, avoidant, or escape behaviour. ERP targets the behavioural component of CBT.  Lehmkuhl et al. (2008), ERP was used to treat a 12-year-old boy. Jason experienced contamination fears, avoiding ‘contaminated’ items (e.g. door knobs, library books, etc.) He would not sit on chairs, turn pages with his hands, or touch papers that other children had touched. Jason attended ten 50-minute sessions over 16 weeks. Jason was exposed to items he avoided and over the sessions his anxiety dropped. After three months his Y-BOCS score remained low. Marks: 1 mark basic answer (must include ERP and case study of OCD); 2–4 marks description of ERP with increasing detail and quality. NB: 0 marks for ‘Charles’, (OCD but no ERP) or the boy with button phobia (Saavedra and Silverman, ERP but not OCD) © UCLES 2023 Page 9 of 26 1(d) Discuss the strengths and weaknesses of using drugs to treat OCD. You 5 should include a conclusion in your answer. Most likely answer (other appropriate responses to be credited): Strengths  drugs easy to take; swallowing a pill  drugs mean the patient is passive in their treatment (and advantage for many people)  drugs have been shown to be effective in many studies Weaknesses  drugs are addictive so should be short-term use only  drugs are effective for associated problems such as anxiety  drugs ignore the role of alternative explanations of OCD (treat symptom, not cause) Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however detailed) and related to the question up to 4 max. 2 marks max for two strengths/weaknesses unrelated to the question. 1 mark for conclusion. © UCLES 2023 Page 10 of 26

5(a) Patients with obsessive-compulsive disorder (OCD) can receive 10 treatment with a therapist face-to-face or by telephone. Design a study using a telephone interview to investigate whether face- to-face therapy is more effective for women with OCD than for men with OCD. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is: telephone interview. Specific features: Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis. © UCLES 2023 Page 18 of 26 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). NB If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: treatment and management of O-C and related disorders: psychological: cognitive (Lovell et al., 2006) Psychological: (study abstract) Objectives To compare the effectiveness of cognitive behaviour therapy delivered by telephone with the same therapy given face to face in the treatment of obsessive compulsive disorder. Design Randomised controlled non-inferiority trial. Setting Two psychology outpatient departments in the United Kingdom. Participants 72 patients with obsessive compulsive disorder. Intervention 10 weekly sessions of exposure therapy and response prevention delivered by telephone or face to face. Main outcome measures Yale Brown obsessive compulsive disorder scale, Beck depression inventory, and client satisfaction questionnaire. Results Difference in the Yale Brown obsessive compulsive disorder checklist score between the two treatments at six months was – 0.55 (95% confidence interval – 4.26 to 3.15). Patient satisfaction was high for both forms of treatment. Conclusion The clinical outcome of cognitive behaviour therapy delivered by telephone was equivalent to treatment delivered face to face and similar levels of satisfaction were reported. Methodological: explanation of method using general and specific features as above. © UCLES 2023 Page 19 of 26

9 ‘Biochemical techniques, such as the use of drugs, can treat all patients 12 with schizophrenia effectively.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: biochemical (antipsychotics and atypical antipsychotics) and also electro-convulsive therapy, token economy (Paul and Lentz, 1977) and cognitive-behavioural therapy (Sensky et al., 2000) Most likely (any other appropriate responses should be credited): Agree  drugs easy to take; swallowing a pill; drugs such as anti-psychotics and atypical anti-psychotics  drugs mean the patient is passive in their treatment (and advantage for many people)  drugs have been shown to be effective in many studies and the ‘third generation drugs’ such as aripiprazole have fewer side effects Disagree  drugs are addictive so should be short-term use only  drugs may not be taken as prescribed (non-adherence) because of the side effects such as tardive dyskinesia  drugs ignore the role of alternative explanations of schizophrenia (treat symptom, not cause) alternatives such as the cognitive approach (e.g. Frith) © UCLES 2023 Page 23 of 26

1(a) Outline two common compulsions of body dysmorphic 2 Credit 2 types of camouflaging or grooming behaviour disorder (BDD). Skin picking, Award 1 mark for a basic outline of the term/concept – No credit to focus on body weight/weight loss, checking one compulsion body smell and applying deodorant, constant face washing. Award 2 marks for a detailed outline of the term/concept – two compulsions For example, • Camouflaging (with clothing, make-up, posture) • Mirror checking • Excessive grooming (shaving, tooth-brushing, hair- washing) • Comparing appearance to other people’s • Seeking cosmetic surgery Other appropriate responses should also be credited. © UCLES 2023 Page 9 of 41 1(b) Describe the psychodynamic explanation for obsessive- 4 Adler’s explanation for OCD is also creditworthy – due to compulsive disorder (OCD). feelings of inferiority that drives individuals to achieve personal goals. Award 1–2 marks for a basic answer with some Must refer to anal phase (or outline it) and that the person understanding of the topic area. becomes stuck in this phase. Award 3–4 marks for a detailed answer with clear understanding of the topic area. OCD arises from the anal stage of psychosexual development. (1) There may have been difficulties between the child and parent at this stage when the child defecated or urinated (1). Children may become either anally expulsive or anally retentive and the individual may become fixated at this stage (1). Compulsive cleaning or other rituals may help to soothe the early childhood trauma (1). Could also be the id and the superego in conflict with each other.(1) The obsessive cleaning could act as an ego defence mechanism to deal with this conflict (1). Other appropriate responses should also be credited. © UCLES 2023 Page 10 of 41 1(c) Explain one similarity and one difference between the 6 If more than one similarity/difference given, credit the best psychodynamic explanation for OCD and genetic similarity/difference. explanations for OCD. Likely similarities include: • Deterministic – In neither case does the individual have any control of their OCD. Genes not under personal control and neither are psychosexual stages. Both highly deterministic (hard determinism) • Influence of parents – Heritability of genes in genetic explanations and psychosexual stages influenced by upbringing, particularly in fixation due to punishment or shame. • Treatments/therapies – Psychoanalytic therapy (psychoanalysis) could be used from the psychodynamic explanation. Gene therapy is a potential treatment from genetic explanations. • Reductionist – explanation is at basic level (although less so for psychodynamic). Fails to take into account other factors influencing. Likely differences include: • Treatments – gene therapy not possible at this time but psychoanalysis is used for OCD and has some success • Types of determinism – biological (for genetic) and psychic (for psychodynamic) • Objective versus subjective – Gathering of evidence for genetic will be objective but for psychodynamic will be subjective and depend on interpretation • Nature vs nurture – genetic explanation purely nature but psychodynamic more nurture (though has elements of nature in the id). © UCLES 2023 Page 11 of 41 1(c) Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain one similarity and one difference • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one appropriate similarity (or difference) in detail OR one similarity and one difference in less detail. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation of a similarity (or difference). They could include both a similarity and a difference but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2023 Page 12 of 41

2(a) Describe the treatment and management of impulse 8 No credit to ECT. Also allow antidepressants (e.g. SSRIs) control disorders and non-substance addictive disorder. and anticonvulsants (e.g. toporimate) as a treatment. Treatment and management of impulse control disorders Grant, 2008 or Grant, 2005 can be credited. and non-substance addictive disorder, including the following: • biochemical (Grant et al., 2008) • cognitive-behavioural: covert sensitisation (Glover, 2011), imaginal desensitisation (Blaszczynski and Nower, 2002), impulse control therapy (Miller, 2010) Biochemical (Grant et al., 2008) 284 participants with gambling disorder treated in double- blind placebo-controlled trails. Either treated for 16 weeks with opiate antagonist nalmefene, 18 weeks with placebo/naltrexone or placebo/control. Gambling assessed using the Y-BOCs. Found the opiate group showed a greater reduction in symptoms than the placebo group on their Y-BOCs scores. Those with a family history of alcoholism showed the strongest response to the opiate antagonist. Higher doses of the opiate nalmefene was associated with a greater reduction in symptoms. Younger participants were more likely to respond to the placebo. Concluded that opiates can be an effective treatment especially for those who may have a genetic predisposition to respond positively to opiates. Covert sensitisation (Glover, 2011) Covert sensitisation is a form of behaviour therapy in which an undesirable behaviour is paired with an unpleasant image in order to eliminate that behaviour. Therefore, the impulsive behaviour could be paired with an unpleasant image or experience. For example, if the person was addicted to gambling they could think about their gambling © UCLES 2023 Page 13 of 41 2(a) and then look at images of people who have gone bankrupt. They could eventually learn to do this while gambling or bring these images with them and look at them when they imagine gambling. Study involves a case study of a 56 year old woman seeking help with shoplifting. After the therapy her stealing behaviour had greatly reduced. Imaginal desensitisation (Blaszczynski and Nower, 2003) Taught progressive muscle relaxation, visualise situation where they feel the desire to carry out impulsive behaviour, they imagine carrying out the desire and then imagine leaving the situation. This works to reduce arousal and anxiety around the compulsive behaviour and can help to reduce the desires if practiced outside of the therapy sessions. A pathological gambler, Mary, age 52 is described in the study. She is taught the technique and this is used in the study to illustrate the therapy. Mary was taught to use imagery to identify typical gambling behaviours which helped to decrease the urge to gamble. Steps 1 Identify typical behavioural sequences when the client becomes aware of the urge to gamble. 2 Break up the sequence into 4–6 ‘scenes’ that usually lead to gambling.

1(a) Explain what is meant by ‘mania’. 2 Euphoria, extreme high, over-confidence in one’s own ability, anger = 1 mark Award 1 mark for a basic explanation of the term/concept – one symptom. No credit for happiness, mood is lifted or improved, Award 2 marks for a detailed explanation of the term/ excitement, bad sleeping habits (as mania is just not concept – two symptoms. needing to sleep) For example: Max 1 if candidate states or implies that mania is bi-polar A condition suffered by those with bipolar disorder, which is disorder but does give symptom(s) of mania in their the opposite ‘pole’ to depression (1) It is characterised by response. any of the following – 1 mark per symptom • Long periods of euphoria (or ‘high’) • Rage/irritability • ‘spur of the moment’ decision-making • Racing thoughts • Suddenly starting new projects/hobbies • Extreme confidence • Having lots of new ideas / heightened creativity • Speaking quickly • Not needing to sleep / sleeping much less • Engaging in risky behaviour (gambling, sexual promiscuity) Other appropriate responses should also be credited. © UCLES 2023 Page 9 of 39 1(b) Describe the study on depression and attributional style 4 No credit for just explaining how attributional style and by Seligman et al. (1988). depression are linked with no mention of the study. Award 1–2 marks for a basic answer with some No credit for linking learned helpless with depression. understanding of the topic area. e.g. stating that depression has a pessimistic attribution Award 3–4 marks for a detailed answer with clear style is not a result. However, stating that the more severe understanding of the topic area. the depression the more pessimistic the attributional style is = 1 result 39 patients with unipolar depression and 12 patients with bipolar disorder (mean age 36 from the same outpatients’ Full marks needs some detail of the sample (e.g. unipolar/ clinic), (together with 10 non-clinical adults acting as a bi-polar), data collection and one result. control group), were assessed. (1) All completed a short form of the BDI and the Attributional Style Questionnaire (ASQ) before their cognitive therapy, after their cognitive therapy and a year after therapy finished. (1) The ASQ asks patients to make causal attributions for 12 hypothetical events (both good and bad). They then rate each cause on a 7-point scale for internality, stability and globality. (2) The results were that a pessimistic explanatory style (scoring highly for internal, stable and global) for negative (bad) events correlated significantly with severity of depression at all three time points,(1) Explanatory style improved by the end of the therapy, as did depressive symptoms for the unipolar group. (2) The pattern was also seen in bipolar depressives but the significant results were not as strong. (1) This suggests that the way we make attributions is an important mechanism underlying the experience of depression. Other appropriate responses should also be credited. © UCLES 2023 Page 10 of 39 1(c) Explain the effectiveness of the controls used in the 6 Annotate with levels study by Seligman et al. Credit can be given to demand characteristics with reference Points could include to BDI/ASQ • Make the study more reliable. The same procedure/ treatment was done for all participants in the study. This meant all experienced exactly the same thing during the study. • Reduces individual differences acts as a control as the study includes both unipolar and bi-polar patients. • The control group is not a very effective control in the study as they were just used as a baseline comparison for BDI and ASQ as the control group did not experience any therapy (as they had no psychiatric disorder). • Increases validity and reliability as scores of depression and attributional style were administered before and after treatment so that changes in these could be clearly measured. • Enables more objective data rather than reliance on subjective interpretations (use of same procedure/tests before and after treatment) • Relationships are not cause and effect but only correlational as participants cannot be randomly assigned to groups (quasi experiment). • Validity of the DNA collected using automated equipment in a lab-removes researcher bias. © UCLES 2023 Page 11 of 39 1(c) Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain at least two points regarding controls. • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one point about control in detail or two (or more) in less detail. • Candidates will provide a good explanation. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation about controls. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2023 Page 12 of 39

2(a) Describe explanations of schizophrenia and delusional 8 disorder. Explanations of schizophrenia and delusional disorder, including the following: • genetic (Gottesman and Shields, 1972) • biochemical (dopamine hypothesis) • cognitive (Frith, 1992) Genetic (Gottesman and Shields, 1972) Schizophrenia appears to have a genetic cause as shown by Gottesman and Shields in their review article of studies of adoption, siblings and twins with schizophrenia. All adoption studies found an increased incidence of schizophrenia in adopted children with a schizophrenic biological parent. Biological siblings of children with schizophrenia showed a much higher percentage of schizophrenia. All twin studies found a higher concordance rate for schizophrenia in monozygotic (MZ) than dizygotic (DZ) twins. In Gottesman and Shield’s own study the rate was 58% for identical twins, and 12% for non-identical twins. Conclusion – There is obviously a heavy genetic input into the onset of schizophrenia. Biochemical (dopamine hypothesis) The dopamine hypothesis of schizophrenia states that symptoms may be caused by an excess of dopamine in the mid-brain and a reduction in dopamine in the prefrontal cortex. The dopamine hypothesis of schizophrenia suggests that a high level of activity of dopamine D2 receptor neurotransmission in subcortical and limbic brain regions contributes to positive symptoms of schizophrenia, whereas negative and cognitive symptoms of the disorder can be attributed to heightened activity of dopamine D1 receptor neurotransmission in the prefrontal cortex. © UCLES 2023 Page 13 of 39 2(a) Cognitive (Frith, 1992) The symptoms of schizophrenia are due to faulty thinking processes. The patient fails to recognise through a central monitoring system that they thoughts they are having are self-created (such as our inner voice) and instead believe these are cause by external factors. The delusions may be a way of explaining the hallucinations. There may be a cognitive impairment of patients with schizophrenia which could explain some of the symptoms such as speech poverty and disorganised thoughts. The patients may also have a less developed theory of mind and find it difficult to understand the actions of others and so may develop delusions as a way of understanding other people’s behaviours. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited. © UCLES 2023 Page 14 of 39 2(b) Evaluate explanations of schizophrenia and delusional 10 disorder, including a discussion of nature versus nurture. A range of issues could be used for evaluation here. These include: • Named issue – nature versus nurture – The biological explanation (and the Gottesman and Shields study) support the nature side of the debate as schizophrenia is inherited. The biochemical explanation is also supporting nature as the excess of dopamine could be caused by genetic factors. It could, however, also be said to support nurture as it may be the overload of experiences that the schizophrenic person is having that lead to the excess of dopamine. The cognitive explanation can be seen to supports the nurture side of the debate as the cognitions the person is experiencing are due to experiences. However, Frith/cognitive does not deny the importance of dopamine and the role of biochemical processes in the cognitive experiences of the schizophrenic patient. • Individual versus situational • Reductionism • Application of psychology to everyday life (with reference to explanations • Deterministic nature of the explanations • Evidence to support the explanations Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited. © UCLES 2023 Page 15 of 39

1(a) Outline two common compulsions of body dysmorphic 2 Credit 2 types of camouflaging or grooming behaviour disorder (BDD). Skin picking, Award 1 mark for a basic outline of the term/concept – No credit to focus on body weight/weight loss, checking one compulsion body smell and applying deodorant, constant face washing. Award 2 marks for a detailed outline of the term/concept – two compulsions For example, • Camouflaging (with clothing, make-up, posture) • Mirror checking • Excessive grooming (shaving, tooth-brushing, hair- washing) • Comparing appearance to other people’s • Seeking cosmetic surgery Other appropriate responses should also be credited. © UCLES 2023 Page 9 of 41 1(b) Describe the psychodynamic explanation for obsessive- 4 Adler’s explanation for OCD is also creditworthy – due to compulsive disorder (OCD). feelings of inferiority that drives individuals to achieve personal goals. Award 1–2 marks for a basic answer with some Must refer to anal phase (or outline it) and that the person understanding of the topic area. becomes stuck in this phase. Award 3–4 marks for a detailed answer with clear understanding of the topic area. OCD arises from the anal stage of psychosexual development. (1) There may have been difficulties between the child and parent at this stage when the child defecated or urinated (1). Children may become either anally expulsive or anally retentive and the individual may become fixated at this stage (1). Compulsive cleaning or other rituals may help to soothe the early childhood trauma (1). Could also be the id and the superego in conflict with each other.(1) The obsessive cleaning could act as an ego defence mechanism to deal with this conflict (1). Other appropriate responses should also be credited. © UCLES 2023 Page 10 of 41 1(c) Explain one similarity and one difference between the 6 If more than one similarity/difference given, credit the best psychodynamic explanation for OCD and genetic similarity/difference. explanations for OCD. Likely similarities include: • Deterministic – In neither case does the individual have any control of their OCD. Genes not under personal control and neither are psychosexual stages. Both highly deterministic (hard determinism) • Influence of parents – Heritability of genes in genetic explanations and psychosexual stages influenced by upbringing, particularly in fixation due to punishment or shame. • Treatments/therapies – Psychoanalytic therapy (psychoanalysis) could be used from the psychodynamic explanation. Gene therapy is a potential treatment from genetic explanations. • Reductionist – explanation is at basic level (although less so for psychodynamic). Fails to take into account other factors influencing. Likely differences include: • Treatments – gene therapy not possible at this time but psychoanalysis is used for OCD and has some success • Types of determinism – biological (for genetic) and psychic (for psychodynamic) • Objective versus subjective – Gathering of evidence for genetic will be objective but for psychodynamic will be subjective and depend on interpretation • Nature vs nurture – genetic explanation purely nature but psychodynamic more nurture (though has elements of nature in the id). © UCLES 2023 Page 11 of 41 1(c) Mark according to the levels of response criteria below: Level 3 (5–6 marks) • Candidates will show a clear understanding of the question and will explain one similarity and one difference • Candidates will provide a good explanation with clear detail. Level 2 (3–4 marks) • Candidates will show an understanding of the question and will explain one appropriate similarity (or difference) in detail OR one similarity and one difference in less detail. Level 1 (1–2 marks) • Candidates will show a basic understanding of the question and will attempt an explanation of a similarity (or difference). They could include both a similarity and a difference but just as an attempt. • Candidates will provide a limited explanation. Level 0 (0 marks) No response worthy of credit. Other appropriate responses should also be credited. © UCLES 2023 Page 12 of 41

2(a) Describe the treatment and management of impulse 8 No credit to ECT. Also allow antidepressants (e.g. SSRIs) control disorders and non-substance addictive disorder. and anticonvulsants (e.g. toporimate) as a treatment. Treatment and management of impulse control disorders Grant, 2008 or Grant, 2005 can be credited. and non-substance addictive disorder, including the following: • biochemical (Grant et al., 2008) • cognitive-behavioural: covert sensitisation (Glover, 2011), imaginal desensitisation (Blaszczynski and Nower, 2002), impulse control therapy (Miller, 2010) Biochemical (Grant et al., 2008) 284 participants with gambling disorder treated in double- blind placebo-controlled trails. Either treated for 16 weeks with opiate antagonist nalmefene, 18 weeks with placebo/naltrexone or placebo/control. Gambling assessed using the Y-BOCs. Found the opiate group showed a greater reduction in symptoms than the placebo group on their Y-BOCs scores. Those with a family history of alcoholism showed the strongest response to the opiate antagonist. Higher doses of the opiate nalmefene was associated with a greater reduction in symptoms. Younger participants were more likely to respond to the placebo. Concluded that opiates can be an effective treatment especially for those who may have a genetic predisposition to respond positively to opiates. Covert sensitisation (Glover, 2011) Covert sensitisation is a form of behaviour therapy in which an undesirable behaviour is paired with an unpleasant image in order to eliminate that behaviour. Therefore, the impulsive behaviour could be paired with an unpleasant image or experience. For example, if the person was addicted to gambling they could think about their gambling © UCLES 2023 Page 13 of 41 2(a) and then look at images of people who have gone bankrupt. They could eventually learn to do this while gambling or bring these images with them and look at them when they imagine gambling. Study involves a case study of a 56 year old woman seeking help with shoplifting. After the therapy her stealing behaviour had greatly reduced. Imaginal desensitisation (Blaszczynski and Nower, 2003) Taught progressive muscle relaxation, visualise situation where they feel the desire to carry out impulsive behaviour, they imagine carrying out the desire and then imagine leaving the situation. This works to reduce arousal and anxiety around the compulsive behaviour and can help to reduce the desires if practiced outside of the therapy sessions. A pathological gambler, Mary, age 52 is described in the study. She is taught the technique and this is used in the study to illustrate the therapy. Mary was taught to use imagery to identify typical gambling behaviours which helped to decrease the urge to gamble. Steps 1 Identify typical behavioural sequences when the client becomes aware of the urge to gamble. 2 Break up the sequence into 4–6 ‘scenes’ that usually lead to gambling.

1 One explanation of bipolar disorder is that it is genetic. The study by Oruc et al. (1997) selected 42 patients with bipolar disorder. Sixteen of these patients had a first-degree relative with a history of bipolar disorder. All patients had a clinical interview and their DNA was analysed. 1(a) Explain what is meant by the term 'bipolar disorder'. 2 Most likely answer (other appropriate responses to be credited): • also known as manic depression (1 mark) characterised by extreme mood swings from one pole to the other (hence bipolar) (2 marks) • bipolar disorder (BP) is characterised by episodes of elevated mood alternating with periods of depression (Oruc et al.) (2 marks) Marks: 1 mark for basic explanation, 2 marks for elaboration/detail. 1(b) Outline two findings from the study by Oruc et al. 4 Most likely answer (other appropriate responses to be credited): • no significant associations were found (1 mark) in the total patient sample (2 marks) OR between bipolar patients and control group (2 marks) • polymorphisms in female patients were observed (1 mark) OR these results suggest an increase in susceptibility for bipolar disorder in women (1 mark) i.e. serotonin receptor 5-HTR2c and serotonin transporter 5-HTT genes (2 marks) Marks: 1 mark basic, 2 marks for detail  2. 1(c) Outline one explanation for depression, other than a biological 4 explanation. Most likely answer: • Cognitive (Beck, 1979) proposes that people react differently to aversive stimuli because of negative automatic thoughts (NATs). Depression results from the negative cognitive triad, comprising unrealistically negative views about the self, the world and the future. • Learned helplessness/attributional style (Seligman, 1988) If a person makes an internal attribution (they are the cause), and if they believe that this is stable and global (the cause is consistent and this applies everywhere), then they may feel helpless and may experience depression. However, if they make other attributions (e.g. that the cause is external or situational; or unstable and specific), then helplessness and depression are unlikely. Marks: 1 mark basic answer, 2–4 marks outline of increasing detail and quality. © UCLES 2023 Page 8 of 24 1(d) Discuss the strengths and weaknesses of using clinical interviews to 5 gather data about the genetic explanation of depression. You should include a conclusion in your answer. Most likely answer (other appropriate responses to be credited): Strengths: • the participant knows their family relationships and health and illness history, the practitioner does not • the participant can explain and answer any question that may be asked • the practitioner can use verbal and non-verbal skills or other tests • Weaknesses: • the participant may not tell the truth, exaggerate or underemphasise details • a clinical interview is subjective and no objective information is available • a participant may not know sufficient terminology to answer what is being asked Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however detailed) and related to the question up to 4 max. 2 marks max. for two strengths/weaknesses unrelated to the question. 1 mark for conclusion. © UCLES 2023 Page 9 of 24

5 Pressure (to conform) pressure placed on dissenters

9 ‘Psychometric measures used to assess anxiety disorders, such as the 12 Generalised Anxiety Disorder assessment (GAD-7), provide therapists with no useful information.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: characteristics of anxiety disorders: measures: the blood injection phobia inventory (BIPI); Generalised Anxiety Disorder assessment (GAD-7) Most likely (any other appropriate responses should be credited): Useful: • measures such as BIPI and GAD-7 indicate the severity of a disorder. • these measures can highlight specific features of the disorder. • these measures can be used as comparisons with others with the same disorder. • these measures provide quantitative data. Not useful: • talking to a therapist in a clinical interview can reveal perhaps more than any test. • the measure can use scales (5 or 7 point) which may not represent what the person thinks: they could take a neutral option. • people answering the questionnaires may not be honest about everything. • measures assume people have similarities; they are less individualistic. © UCLES 2023 Page 21 of 24

1 Generalised anxiety is a disorder that can be caused by a wide range of situations or events, rather than one specific event. Whereas for phobias, it is possible to have a specific phobia, such as an animal phobia. Generalised anxiety can be measured using the GAD-7. 1(a) Outline two characteristics of generalised anxiety, other than it being 2 caused by a wide range of situations or events, rather than one specific event. Most likely answer (other appropriate responses to be credited): • excessive, uncontrollable and often irrational worry, which • interferes with daily functioning • it is a long-term condition • feeling anxious most days and struggling to remember the last time they felt relaxed; as soon as one anxious thought is resolved, another may appear about a different issue • physical symptoms of headaches, nausea, numbness in hands and feet, muscle tension, difficulty swallowing and/or breathing, trembling, twitching and sweating, increased heart rate (any two features needed for 1 mark) • panic attacks Marks: 1 mark for each correct characteristic (i.e. 1 mark for each correct bullet-point) 1(b) Explain how the GAD-7 measures generalised anxiety disorder. 4 Most likely answer (other appropriate responses to be credited): • selecting from a 0–3 scale (none to nearly every day). • 7 problems/situations • example: worrying too much about different things (0, 1, 2, 3) • Max score 21. • 4 point scale (0–3) • Total score 0–5 mild anxiety, 6–10 moderate anxiety, 11–15 moderately severe anxiety and 15–21 severe anxiety. • Max score 21 Marks: 1 mark for each correct point. Note: the other measure in this syllabus section is the BIPI for assessing the specific blood/injury phobia. Descriptions of BIPI score 0 marks. © UCLES 2023 Page 8 of 25 1(c) Outline two case studies that investigated a child with an animal phobia. 4 Most likely answers: • Little Albert (Watson, 1920) Albert was classically conditioned to be afraid of a white rat (and similar things). This was achieved using the ‘classical conditioning formula’. • Little Hans (Freud, 1909) who has a fear of horses (displacement from his father because Hans was in Oedipus complex). Marks: 1 mark basic answer, 2 marks for elaboration and detail 2 Marks: 0 marks for ‘Kimya’ who was 39 years old 1(d) Discuss the strengths and weaknesses of using psychometric tests, 5 such as the GAD-7, to measure generalised anxiety. You should include a conclusion in your answer. Most likely answer (other appropriate responses to be credited): Strengths: • quantitative data produced by a psychometric test allows comparison between one person and another • subjectivity of a clinical interview is removed • person can complete the questionnaire/scale in their own time Weaknesses: • psychometric tests are subjective and a person may not answer truthfully in relation to their anxiety • there may be ‘social desirability’ • person may not understand terminology used on a test Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however detailed) and related to the question up to 4 max. 2 marks max for two strengths/weaknesses unrelated to the question. 1 mark for conclusion. © UCLES 2023 Page 9 of 25

5(a) Design a study using a questionnaire to investigate the frequency of 10 characteristics of addiction in a group of individuals diagnosed with a gambling disorder. Marks: use generic levels of response Design a study question part (a). Additional: Candidates should design the study showing evidence of design features appropriate to the named method. The named method is: questionnaire. Specific features: Questionnaires/Interviews: type, setting, example questions. Scoring/rating scale, analysis of responses. General features of research methodology: sampling technique and sample, type of data, ethics, reliability, validity, data analysis. © UCLES 2023 Page 17 of 25 5(b) Explain the psychological and methodological evidence on which your 8 study is based. Marks: use generic levels of response ‘Design a study’ question part (b). Note If only methodological or psychological explanation is provided max 5 marks Candidates are expected to explain the reasons for the suggested design in part (a). Explanation should be both psychological and methodological. Psychological to include appropriate theory or research. Additional: candidates are expected to justify their decisions or evidence presented regarding the design made in answer to question part (a). Syllabus: characteristics of ICDs and non-substance addictive disorder: definitions (Griffiths, 2005) Psychological: Griffiths outlines six characteristics of addiction. • salience when the particular activity becomes the most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour) • mood modification/euphoria the subjective experience that people report as a consequence of engaging in the particular activity (i.e. an arousing ‘buzz’ or a ‘high’) • tolerance the process whereby increasing amounts of the particular activity are required to achieve the former effects • withdrawal symptoms the unpleasant feeling states and/or physical effects which occur when the particular activity is discontinued or suddenly reduced • conflict conflicts between the addict and those around them (interpersonal conflict) or from within the individual themselves (intrapsychic conflict) • relapse the tendency for repeated reversions to earlier patterns of the particular activity to recur Methodological: explanation of method using general and specific features as above. © UCLES 2023 Page 18 of 25

9 ‘A case study of a person with an impulse control disorder, such as 12 kleptomania, will reveal more about the characteristics of the disorder than any other method.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C Syllabus: characteristics of ICDs and non-substance addictive disorder Most likely (any other appropriate responses should be credited): Agree (support): • a case study gives in-depth detail showing the specifics of the ICDs allowing more about the disorder to be learned • there is no reason why the details of one person should not apply to others • the general principles of any ICD therapy can be applied to other people Disagree: • the K-SAS is a psychometric measure so the extent of kleptomania can be compared in different people. Can be other points about K-SAS • there are always individual differences and what may be true for one person may not be true for another • a nomothetic approach is more useful than an idiographic; every person is a unique individual. • treatments cannot be tailored to each individual. The use of drugs as a treatment is applied to everyone. • a case study may not generalise to other people with gambling problems or other types of impulse-control problems © UCLES 2023 Page 22 of 25

1 One explanation of bipolar disorder is that it is genetic. The study by Oruc et al. (1997) selected 42 patients with bipolar disorder. Sixteen of these patients had a first-degree relative with a history of bipolar disorder. All patients had a clinical interview and their DNA was analysed. 1(a) Explain what is meant by the term 'bipolar disorder'. 2 Most likely answer (other appropriate responses to be credited): • also known as manic depression (1 mark) characterised by extreme mood swings from one pole to the other (hence bipolar) (2 marks) • bipolar disorder (BP) is characterised by episodes of elevated mood alternating with periods of depression (Oruc et al.) (2 marks) Marks: 1 mark for basic explanation, 2 marks for elaboration/detail. 1(b) Outline two findings from the study by Oruc et al. 4 Most likely answer (other appropriate responses to be credited): • no significant associations were found (1 mark) in the total patient sample (2 marks) OR between bipolar patients and control group (2 marks) • polymorphisms in female patients were observed (1 mark) OR these results suggest an increase in susceptibility for bipolar disorder in women (1 mark) i.e. serotonin receptor 5-HTR2c and serotonin transporter 5-HTT genes (2 marks) Marks: 1 mark basic, 2 marks for detail  2. 1(c) Outline one explanation for depression, other than a biological 4 explanation. Most likely answer: • Cognitive (Beck, 1979) proposes that people react differently to aversive stimuli because of negative automatic thoughts (NATs). Depression results from the negative cognitive triad, comprising unrealistically negative views about the self, the world and the future. • Learned helplessness/attributional style (Seligman, 1988) If a person makes an internal attribution (they are the cause), and if they believe that this is stable and global (the cause is consistent and this applies everywhere), then they may feel helpless and may experience depression. However, if they make other attributions (e.g. that the cause is external or situational; or unstable and specific), then helplessness and depression are unlikely. Marks: 1 mark basic answer, 2–4 marks outline of increasing detail and quality. © UCLES 2023 Page 8 of 24 1(d) Discuss the strengths and weaknesses of using clinical interviews to 5 gather data about the genetic explanation of depression. You should include a conclusion in your answer. Most likely answer (other appropriate responses to be credited): Strengths: • the participant knows their family relationships and health and illness history, the practitioner does not • the participant can explain and answer any question that may be asked • the practitioner can use verbal and non-verbal skills or other tests • Weaknesses: • the participant may not tell the truth, exaggerate or underemphasise details • a clinical interview is subjective and no objective information is available • a participant may not know sufficient terminology to answer what is being asked Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a ‘decision reached by reasoning’ and so a summary of points already made scores 0 marks. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however detailed) and related to the question up to 4 max. 2 marks max. for two strengths/weaknesses unrelated to the question. 1 mark for conclusion. © UCLES 2023 Page 9 of 24

5 Pressure (to conform) pressure placed on dissenters

9 ‘Psychometric measures used to assess anxiety disorders, such as the 12 Generalised Anxiety Disorder assessment (GAD-7), provide therapists with no useful information.’ To what extent do you agree with this statement? Use examples of research you have studied to support your answer. Marks: use generic levels of response in table C. Syllabus: characteristics of anxiety disorders: measures: the blood injection phobia inventory (BIPI); Generalised Anxiety Disorder assessment (GAD-7) Most likely (any other appropriate responses should be credited): Useful: • measures such as BIPI and GAD-7 indicate the severity of a disorder. • these measures can highlight specific features of the disorder. • these measures can be used as comparisons with others with the same disorder. • these measures provide quantitative data. Not useful: • talking to a therapist in a clinical interview can reveal perhaps more than any test. • the measure can use scales (5 or 7 point) which may not represent what the person thinks: they could take a neutral option. • people answering the questionnaires may not be honest about everything. • measures assume people have similarities; they are less individualistic. © UCLES 2023 Page 21 of 24

1 Prisha is hearing voices that seem real to her but no one else in her 4 % not required for full marks. family can hear them. If no % then need to mention that She tells her doctor about the voices and that her identical twin sister concordance is higher between identical was diagnosed with schizophrenia three years ago. Prisha’s doctor compared to non-identical. diagnoses her with schizophrenia. Can allow biochemical linked to hearing Outline two explanations for Prisha’s diagnosis, based on what she told voices. her doctor. For each characteristic: Award 2 marks for a detailed explanation of schizophrenia linked to Prisha. Award 1 mark for a basic explanation of schizophrenia linked to Prisha. Likely explanations Genetic (Gottesman and Shields) Cognitive (Firth) Example: Prisha may have been diagnosed with schizophrenia because it is genetic and Prisha’s twin sister was diagnosed three years ago. (1) Gottesman and Shields found that there was a concordance rate of approximately 50% between identical twins. (1) OR Research has found there was a higher concordance rate for identical twins compared to non-identical twins. (1) Prisha may have schizophrenia due to an inability to recognise her own internal voice and instead interprets this as an external voice. (1) Frith describes this as an inability to self-monitor internal thoughts. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 7 of 44

2(a) Outline what is meant by a situational explanation of obsessive- 2 Context = explanation of obsessive- compulsive disorder (OCD), including an example from the behavioural compulsive disorder explanation of OCD. Allow 1 mark for behavioural explanation of Award 1 mark for an outline of the term/concept. OCD if doesn’t mention environment. Award 1 mark for an example. Example: Situational explanation is the view that behaviour is caused by the environment the person is in.(1) AND For example, the person with OCD learns that by washing their hands this provides temporary relief (negative reinforcement) from anxiety and so repeats this behaviour. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 8 of 44 2(b) Explain one weakness of the situational explanation of OCD, including an 2 Context = behavioural explanation of example from the behavioural explanation of OCD. obsessive-compulsive disorder Award 2 marks for a detailed explanation of the weakness in context. Award 1 mark for a basic outline/identification of weakness. Problems might include: • Deterministic explanation – suggests that there is no free-will in the development of the obsessive-compulsive disorder as it has developed from situational factors outside of the control of the individual. • Reductionist explanation – suggests obsessive-compulsive disorder is caused by psychological factors (e.g. negative reinforcement) and ignores other possible causes such as biochemical, genetic or individual causes. • Difficult to determine if it is the situational factor that is the only cause of obsessive-compulsive disorder. • Poor practical applications – as the explanation is based on situational factors and it is not possible for the patient with obsessive-compulsive disorder or a therapist to prevent the situational factor from occurring. • Individual differences – not everyone who has a negative thought/anxiety about their environment (e.g. dirty surfaces) and then engages in cleaning will develop OCD even though they have experienced negative reinforcement. Example: One weakness of the situational explanation is that it is difficult to determine if the situational factor is the only cause of OCD.(1) For example, some people develop OCD due to genetic and/or biochemical causes rather than just the experience of doing the compulsion (interacting with their environment/ situation) and then experiencing negative reinforcement. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 9 of 44

3(a) Mary has obsessive-compulsive disorder (OCD). She worries that 4 Can do more on obsession or compulsion something bad will happen if she does not check her front door is locked e.g. 3 + 1 or 2 + 2 20 times every night. Mary needs help with her symptoms. For information – not creditworthy on it’s Suggest how exposure and response prevention (ERP) can reduce: own. • Mary’s obsession • Mary’s compulsion. Exposure and response prevention involves – Award 3–4 marks for a detailed answer with clear understanding of ERP linked Introductory session(s) where to helping Mary with both her obsession and her compulsion. obsessions/compulsions are identified. Award 1–2 marks for a basic answer with some understanding of ERP with an Treatment sessions where clients are given attempt to link to helping Mary with her obsession/compulsion. task(s) to do each week where they gradually stop doing their compulsion so Example: that they will learn that the outcome that Mary would begin ERP by explaining her obsession with something bad they fear will not happen. Overtime the happening and her compulsion that she needs to lock her front door 20 times. exposure will be increased until eventually (1) During therapy, Mary would gradually lock her door fewer times each the client experiences little to no obsessions evening until eventually she would leave her door unlocked. (1) Mary would and anxiety over not completing their experience anxiety and an increase in her obsession that something bad would compulsion. happen. (1) But this would reduce as nothing bad would happen to her and eventually Mary should no longer need to lock her front door 20 times and her Can allow reference to CBT as used in obsession would reduce as the thing she feared did not happen. (1) Lehmkuhl et al. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 10 of 44 3(b) Explain one weakness of using ERP to help Mary. 2 Award 2 marks for a detailed explanation of a weakness of ERP for Mary. Award 1 mark for a basic explanation of a weakness of ERP for Mary. One weakness from: • The treatment will be very stressful for Mary. • The underlying cause of her OCD is not being treated. • Time (6–12 sessions)/cost Example: The treatment will be very stressful for Mary. (1) It may be difficult for her to do the therapy as her anxiety about something bad happen if she doesn’t lock her front door 20 times will worsen to begin with. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 11 of 44

4(a) Describe the study by Oruč et al. (1997) on association analysis of the 6 For full marks genetics of depressive disorder. Indication of sample (number of Use Table A: AO1 Knowledge and understanding to mark candidate responses participants, different groups) to this question. Results No significant association OR a specific The response must describe the key study. result. Details may include: Aim – To research the theory that serotonin genes are linked to bipolar disorder. Sample – 42 patients with bipolar (type 1) from in and out patients of a clinic in Croatia (25 f and 17 m aged 31–70), 40 healthy controls (age and sex matched). Procedure – Genetic analysis of DNA polymorphisms in the serotonin receptor 2c (5-HTR2c) and serotonin transporter (5-HTT) genes. Results – No significant associations in polymorphism in the receptor gene (5- HTR2c) were found in the total patient sample. 16 BPI patients had a positive family history as defined by at least one first-degree relative suffering from major affective disorders. When the individuals were divided according to gender, trends for association with both polymorphisms in female patients were observed. These results suggest that variations in these genes may be responsible for a minor increase in susceptibility for bipolar disorder in women. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 12 of 44 4(b) Evaluate the study by Oruč et al., including a discussion about reliability. 10 Evaluation in your answer can include strengths, weaknesses and a discussion of issues and debates. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include: • Named issue – Reliability – The study is very reliable as a standardised procedure was followed with objective tests that can be repeated to check for reliability. A matched pairs design can be used in the same way on a future sample. DNA testing is objective and reliable. Family members' mental health status were checked using similar methods (asking the patient and checking medical records). However, it is possible the reliability of the family members diagnosis could be questioned as the diagnostic criteria applied to each family member could be different, done at different times using different guidelines and possibly interpreted differently by the practitioner. • Nature versus nurture – Somewhat on nature side of debate as found a genetic association for 16 of the participants as well as the female participants. Suggests nurture could be involved as a strong genetic link was not found for all participants. • Reductionism versus holism – Reductionist as the focus is just on the DNA analysis and family background of each participant. • Determinism versus free will – For those participants with a genetic association this suggests the bipolar disorder has been caused by genetics which is outside of the control of the patient. However, many of the participants did not show a genetic association which suggests that there could be other determining factors such as environment. Free will can be involved as the patient may choose to engage with both the manic and the depressive episodes (both thoughts and behaviours) © Cambridge University Press & Assessment 2024 Page 13 of 44 4(b) • Experiments – Highly controlled laboratory experiment with objective testing. Other issues could include: • Generalisability of findings • quantitative data • objective data Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 14 of 44

1 From the key study by Grant et al. (2008) on treating gambling disorder with drugs and placebo: 1(a) Explain what is meant by a double-blind, placebo-controlled trial as 4 used in this study. Syllabus: 1.3.3 Key study on treating gambling disorder with drugs and placebo: Grant et al. (2008). Marks: Double-blind: Award 2 marks for a detailed explanation. Award 1 mark for a partial explanation (definition). Placebo controlled: Award 2 marks for a detailed explanation. Award 1 mark for a partial explanation (definition). Answers may include (other appropriate responses to be credited): • double-blind: an experimental procedure where neither the participant nor the researcher is aware of which condition the participant is in (1 mark) so a participant could be in the nalmefene (or naltrexone) group or the control (placebo) group and not know which group they are in (2 marks) • placebo-controlled: a control group where no test medication is received but where the medication given has no actual effect, but the participant may think they are receiving the test medication (1 mark) so a participant could be in the nalmefene (or naltrexone) group or the control (placebo) group and not know which group they are in (2 marks). 1(b) Suggest one effect if a double-blind trial had not been used in this 2 study. Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited). Note: ‘effect’ could be on anything, not just validity. Note: only one of the two possibilities below is required for 2 marks. • participant bias: if a participant knows which group they are in, nalmefene (or naltrexone) group or the control (placebo) group, they might change their behaviour to support the aims of the study (or go against it) (2 marks). • experimenter bias: if an experimenter knows which group a participant is in nalmefene (or naltrexone) group or the control (placebo) group, they may bias their behaviour toward the participant to support the aims of the study (2 marks). © Cambridge University Press & Assessment 2024 Page 6 of 36 1(c) Explain two strengths of conducting placebo-controlled trials in studies 4 of gambling disorder. Marks: up to 2 marks for each strength 2 Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • it is a control with a control group so there is a baseline to which the results of the experimental group can be compared (1 mark) and the effectiveness of the nalmefene (or naltrexone) on gambling disorder can be revealed (2 marks). • it is a placebo and so the participant will behave as if they are in the experimental group (1 mark) because they do not know whether they are in the nalmefene (or naltrexone) group or the control (placebo) group (2 marks) © Cambridge University Press & Assessment 2024 Page 7 of 36

5 From the key study by Yokley and Glenwick (1984) on improving medical adherence using community interventions: 5(a)(i) Describe one cause of confounding identified by Yokley and Glenwick. 2 Syllabus: 3.2.3: Key study on improving medical adherence using community interventions: Yokley and Glenwick (1984). Marks: Award 2 marks for a detailed description. Award 1 mark for a partial description. Definitive answer: • confounding may have resulted if individual children were targeted and children in the same family received different mail prompts emphasising different things. 5(a)(ii) Explain what was done in the study by Yokley and Glenwick to prevent 2 confounding. Marks: Award 2 marks for a detailed explanation. Award 1 mark for a partial explanation. Definitive answer: • rather than individual children, individual families were targeted (1 mark) which meant that only one prompt was sent to each family (2 marks) • randomly assigned to one of six conditions. 5(b) Suggest one strategy for promoting health that could be used to 2 improve medical adherence, other than the strategy used by Yokley and Glenwick. Marks: Award 2 marks for an appropriate suggestion and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited). • providing information on the benefits of medical adherence (1 mark) such as that used by Lewin (heart health manual) to tell people why they need to adhere (2 marks) • using fear arousal on the problems associated with medical non- adherence (1 mark) such as the strategy used by Janis and Feshback to scare people into adhering (2 marks) © Cambridge University Press & Assessment 2024 Page 14 of 36 5(c) Explain two strengths of conducting field experiments to study 4 participation in immunisation interventions in communities. Marks: Up to 2 marks for each strength 2 Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • the setting is natural/high ecological validity (1 mark) the participants receive the mailing about participation in immunisation in their own home – just like any other mail (2 marks) • the participant behaves naturally because they do not know they are participating in a study (1 mark) the participants decide what to do about immunisation reflecting their beliefs about immunisation (2 marks) © Cambridge University Press & Assessment 2024 Page 15 of 36

9(a) Plan a covert observation to investigate the effectiveness of covert 10 sensitisation for treating kleptomania. Your plan must include details about: • structured or unstructured observation • steps for making the study reliable. Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate): • structured or unstructured • sample and sampling technique • covert or overt • ethical guidelines • controlled or naturalistic • a procedure • participant or non-participant • type of data, analysis of data*, • number of observers (inter-rater use of descriptive statistics reliability) • an aim or hypothesis • behavioural categories (directional or non- • could include: event or time directional)/null hypothesis sampling • steps for making the study valid and reliable © Cambridge University Press & Assessment 2024 Page 22 of 36 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.3.3 Treatment and management of impulse control disorders. covert sensitisation, including a study, e.g. Glover (1985) Answers are likely to include (other appropriate responses to be credited): (1) covert sensitisation is a form of behaviour therapy in which an undesirable behaviour is paired with an unpleasant image in order to eliminate that behaviour. (2) details from the Glover study can be used, or any other appropriate study. (3) kleptomania: this is the repetitive, uncontrollable stealing of items not needed for personal use. diagnostic criteria could also be included. Note: credit ‘muscle relaxation’ for covert sensitisation because it was used by Glover. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response © Cambridge University Press & Assessment 2024 Page 23 of 36 9(c)(i) Explain one reason for your choice of a structured or unstructured 2 observation. Candidates must use the choice of structured or unstructured observation stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Example: a structured observation uses behaviour checklists so it might be more reliable than unstructured observation (1 mark) related to plan (2 marks). 9(c)(ii) Explain one strength of using covert observation in your study. 2 Candidates must use the choice of covert observation stated in (a). Marks Description 2 Strength is given and applied to the plan 1 Strength is given without being applied to the plan 0 No creditable response Example • the role of observer would not be apparent / would be hidden/disguised from the participant (1 mark) related to plan (2 marks) • participants won’t change behaviour / respond to demand characteristics / show social desirability (1 mark) related to plan (2 marks) 9(c)(iii) Explain one reason for your choice of steps for making the study 2 reliable. Candidates must use the steps for making the study reliable stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Example: • use of behavioural categories and two observers (1 mark) related to plan (2 marks) • use of two observers so inter-rater agreement can be assessed (1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2024 Page 24 of 36

1 Sarah is always thinking about germs. At work she eats 4 1 max for reference to Sarah’s obsession/belief = lunch alone as she believes this will protect her colleagues. germs, protect colleagues, colleague gets ill. She always washes her hands for 15 minutes in very hot water. She feels better after this, but after 45 minutes she 1 max for reference to Sarah compulsion – washing wants to wash again. When Sarah gets home, she washes hands for 15 mins/very hot water, washing clothing, her clothing, shoes and coat. One day, when Sarah had sat shoes, coat. next to a colleague, she could not sleep that night as she was convinced that he would get ill. 1 max for reference to persistence/time-consuming = always thinking about, takes up to at least an hour a day Explain how Sarah meets the diagnostic criteria for (15 min every 45). obsessive-compulsive disorder (OCD). 1 max for explain why obsession is irrational. Award 3–4 marks for a detailed answer with clear understanding of how Sarah fits the diagnostic criteria for OCD. 1 mark for explain that the compulsion acts to reduce Award 1–2 marks for a basic answer with some understanding of the anxiety created by the obsession. how Sarah fits the diagnostic criteria for OCD.

2 max for reference to impairment in life (couldn’t sleep, Diagnostic criteria ICD-11 sitting alone at lunch).  Presence of persistent obsessions/compulsions  Obsessions are repetitive and persistent that are Allow reference to both ICD and DSM guides. intrusive/unwanted  Compulsions are repetitive behaviour or rituals Do not credit ‘obsessions and compulsions’ on its own  Obsessions and compulsions are time-consuming or result in as in the question. significant distress/impairment in personal, family, social, educational, occupational, or other important areas of The response must identify both obsessions and functioning. compulsions from the stem to be awarded full marks. © Cambridge University Press & Assessment 2024 Page 8 of 63 9990/31 Cambridge International AS & A Level – Mark Scheme May/June 2024 PUBLISHED Question Answer Marks Guidance 1 Example: DSM-5 is creditworthy Sarah fits the diagnostic criteria for OCD as she is experiencing Presence of obsessions and/or compulsions. obsessions and compulsions. One of her obsessions is thinking Obsessions are recurrent/persistent thoughts that are about germs. (1) This is something Sarah thinks about intrusive/unwanted – thoughts are neutralised with some frequently, so it is persistent. (1) In addition, Sarah engages in other thought/action. compulsions which include washing her hands for 15 minutes in Compulsions are repetitive behaviours/mental acts that very hot water. (1) Sarah’s behaviour is repetitive and/or the individual feels driven to perform in response to an ritualistic (e.g. 15 minutes of hand washing and/or washing her obsession or according to rules that must be applied clothing, shoes and coat). rigidly. The compulsion is aimed at preventing/reducing When she washes her hands, she does feel better, however her anxiety; however, these behaviours are excessive. anxiety returns, and she has to wash her hands again which is Obsessions and/or compulsions are time-consuming or time-consuming and excessive. (1) Her obsessions and cause significant distress or impairment in social, compulsions are having a negative effect on her job as she is occupational, or other important areas of functioning. spending time washing her hands as well as feeling distressed with her thoughts about germs. (1) She is also missing out on socialising with her colleagues at lunchtime as she has to sit alone. (1) The other negative effect she is experiencing is not being able to sleep at night if she accidentally touches someone. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 9 of 63 2(a) Outline what is meant by the determinism versus free-will 2 No credit for using just the terminology from the Q. debate. Award 2 marks for an outline of the term/concept. Award 1 mark for a basic outline of the term/concept. Example: The extent to which human behaviour is caused by internal/external factors beyond our control or due to individual choice (behaviour is self-determining). (2) OR Determinism is where behaviour is caused by internal/external factors beyond our control. (1) Free-will is where behaviour is due to individual choice (behaviour is self-determining). (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 10 of 63 2(b) Explain one strength of applying the determinism side of 2 Context = biological explanation of depressive disorder the determinism versus free-will debate to the biochemical (unipolar) explanation for depressive disorder (unipolar). No credit for explanation of why biochemical explanation Award 2 marks for a detailed explanation of strength in context. is deterministic. Award 1 mark for a basic outline of strength. No credit for just identifying the strength. Strengths might include:  Explanatory power– deterministic explanations align with viewing psychology as a science which explains the causes of behaviour.  Increases the status of psychology – deterministic explanations establish psychology as a science that offers unbiased and objective explanations for behaviour.  Application to everyday life – if the cause of behaviour (e.g. low levels of serotonin in the case of depression) then a solution can be found (e.g. SSRIs).  Establishes cause and effect relationships.  Enables causes to be tested in a laboratory experiment with good control.  Takes the blame for behaviour away from the person. The patient with depressive disorder will not feel blamed for their depression as the cause of it is due to internal biochemical factors. Example: One strength is application to everyday life, as a deterministic explanation identifies the cause of behaviour (e.g. low levels of serotonin for depressive disorder) which can then be treated. (1) For example, depressive disorder can be treated using SSRIs which increase serotonin levels through blocking re-uptake of serotonin into neurons. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 11 of 63

3 Olivia has a bipolar disorder and is receiving cognitive restructuring as therapy. In her first session she said: ‘My life used to be 100% perfect! I had an amazing job and friends. I stayed up one night to research an expensive holiday. Recently everything has changed. I am not working and have no energy. No one likes me, not even my family, as I am not fun to be with. I have cancelled the holiday. Why does this keep happening to me? I feel amazing for a while and then it all changes and I am depressed again.’ 3(a) Suggest how cognitive restructuring can help Olivia with 4 Can credit reference to type I or II bipolar. both her depressive and manic episodes. If candidate discusses either depression or manic and Award 3–4 marks for a detailed suggestion with clear not both can get 3 out of 4 marks. understanding of cognitive restructuring linked to helping Olivia with both her depression and manic episodes. No direct link to Olivia’s specific symptoms 2 marks. Maximum 3 marks for detailed suggestion with clear understanding of cognitive restructuring linked to helping Olivia with either her depression or her manic episodes. Award 1–2 marks for a basic suggestion with some understanding of cognitive restructuring linked to helping Olivia with both her depression and manic episodes. © Cambridge University Press & Assessment 2024 Page 12 of 63 3(a) Cognitive restructuring involves – Talking therapy where the therapist asks questions and identifies the patient’s irrational/illogical thinking patterns. Initially the therapist explains how the cognitive triad (self, others and future) works and the effect this has on behaviour and mood. The patient is set homework to identify their mood, thoughts and behaviour and this is discussed in subsequent sessions with the therapist. The therapist will discuss with the patient more rational and logical thoughts and help the patient to recognise the irrational thinking outside of the therapy sessions (‘reality testing’). At the end of therapy, the patient will have the ability to challenge their irrational thoughts, engage in positive behaviour and increase mood. The manic episodes for someone with bipolar disorder are characterised by an overly positive view of self, world and future. Example: Olivia’s therapist can use Olivia’s description of her life to explain the cognitive triad is made up of thoughts about yourself, the world/others and the future. (1) The therapist can challenge both the manic and the depression illogical thinking and help Olivia to replace these thoughts with more rational statements about herself, the world and her future. (1) For example, no one’s life is 100% perfect – a more rational view is that life can be good but doesn’t need to be perfect – this will help Olivia to see herself in a more logical way and help her mania reduce. (1) For the depression, the therapist could challenge that it is unlikely that no one likes her and that she is never any fun to be around with a more realistic view that Olivia is liked by people in her life which will increase her mood. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 13 of 63 3(b) Explain one strength of using cognitive restructuring 2 No credit to ‘will improve her mania and depression’ on therapy with Olivia. its own. Award 2 marks for an explanation of a strength of cognitive 0 marks to long term benefits/improvements on its own. restructure for Olivia. No credit to just identifying a strength. Award 1 mark for a basic explanation of a strength of cognitive restructure for Olivia. Allow full credit for reference to research that shows effectiveness for bi-polar or depression. One strength from:  There are no side effects, unlike medication (e.g. Lithium – mood stabiliser – feeling tired, weight gain, dry mouth, excessive thirst, etc.)  Effective therapy – e.g. Dobson found those who had cognitive restructuring as opposed to drug therapy did significantly better (90% versus 70% improvement in depression symptoms).  Long term effectiveness – teaches the patient how to recognise automatic overly positive or overly negative thinking and how to challenge these thoughts. The patients can do this on their own when therapy is over.  Cognitive therapy is shorter term and therefore cost effective (6–12 sessions) compared to other types of therapy (e.g. psychotherapy). Example: One strength of cognitive restructuring for Olivia is that it has long-term effectiveness as Olivia will learn how to recognise her automatic overly positive and negative thoughts. (1) Once therapy has finished if Olivia goes back into a manic episode, she can replace the overly positive thoughts (e.g. ‘my life is perfect’) with more rational thinking (e.g. 'my life is really good, not perfect. No one’s life is perfect’). (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 14 of 63

4(a) Describe the behavioural explanation and the 6 Award up to 4 marks where the response has described psychodynamic explanation of fear-related disorders. only part of the question even if the response otherwise meets the criteria for level 3. Use Table A: AO1 Knowledge and understanding to mark candidate responses to this question. Candidates must discuss both behavioural and psychodynamic explanations of fear-related disorders, but they do not need to use Watson’s Little Albert and/or Freud’s Little Hans examples from the syllabus. Behavioural (classical conditioning) A phobia develops as the neutral stimulus is paired with something the person is afraid of (the unconditioned stimulus). If enough pairings occur or the initial UCS is very frightening the person will end up with a fear of the NS. The NS then becomes the CS. e.g. Watson and Raynor (1920) Little Albert who was conditioned to be afraid of a rat (NS) by Watson banging an iron bar (UCS) behind the baby which made him cry (UCR). Eventually just the sight of the rat (CS) was enough to cause the crying (CR). Psychodynamic A fear is repressed into the unconscious to protect the ego. The phobia can be a redirected fear during an intensely frightening experience (e.g. a physical attack) onto an object. Denied/repressed impulses of the id which happen during childhood – often during psychosexual stage of development – when there is conflict between the desires of the id and the desires of the ego. Conflict is repressed into the unconscious and the phobic object/situation symbolises this conflict. © Cambridge University Press & Assessment 2024 Page 15 of 63 4(a) e.g. Freud, 1909 may also summarise the case of Little Hans with a focus on phobia (horse or bath). For example, Hans developed a fear of white horses as this was a redirected fear of his father. Hans was in the phallic stage of psychosexual development and was experiencing the Oedipus complex. He had sexual desires for his mother and feared his father would castrate him. Hans displaced these strong feelings of fear/hatred towards his father onto horses which reminded him of his father with long mane/black noseband (similar to his father’s facial hair) and blinkers (similar to father’s glasses). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 16 of 63 4(b) Evaluate the behavioural explanation and the 10 psychodynamic explanation of fear-related disorders, including a discussion about longitudinal studies. Evaluation in your answer can include strengths, weaknesses and a discussion of issues and debates. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include: Named issue – Longitudinal studies Strengths  Shows change in behaviour over time  Watson’s study lasted a few months (8 months 26 days until 12 months 21 days – 4 months) and conditioned Little Albert to become afraid of rats, white fluffy objects, etc. over the course of the study. Freud’s study lasted from age 3-5 years and investigated the development and resolution of the Oedipus complex during the study.  Often in-depth as time to collect a lot of data e.g. Freud collected in-depth data from letters from Little Hans’ father describing events and conversations he had with Hans  Holistic – develop a thorough understanding of the participant(s) in the study © Cambridge University Press & Assessment 2024 Page 17 of 63 4(b)  Freud had a holistic view of the causes of Hans’ behaviour. For example, he was sent letters with conversations between Hans and his father describing little Hans’ thoughts/fantasies. Freud was able to report on how the fantasies changed during and after the phallic stage to explain how someone transitions from one psychosexual stage to the next. Watson was somewhat holistic – tested Little Albert on a number of different objects to explain the development of the phobia of rats and also how phobias can generalise to other objects similar to the phobic object.  No recall bias as the participant doesn’t have to remember past events.  Both Watson and Freud (through the father) were recording events, behaviours, etc. as they occurred during the study. For example, little Hans’ father did not have to recall events from Hans’ childhood but could record them in his letters as they happened. Makes the data more valid. Weaknesses  Time-consuming/attrition.  In some longitudinal research participants drop out of the study due to loss of contact, unwillingness to continue, etc. This did not happen during Watson or Freud’s studies, but the Freud study was very time consuming. A researcher can invest a lot of time in the study and as longitudinal studies often have one or few participants if someone leaves the study this could mean the research cannot progress.  Researcher can develop a close bond with the participant and can be less objective in interpretation of data – particularly if qualitative data  Freud’s research has been accused of being biased as the data was collected by the father who had a close relationship with his son (as well as Freud). © Cambridge University Press & Assessment 2024 Page 18 of 63 4(b)  Nature versus nurture – Behavioural is nurture as phobias are learned through association between a neutral stimulus and an unconditioned stimulus. In contrast, psychodynamic is both nature and nurture- we all go through the psychosexual stages but whether we pass through them successfully is due to life experiences/nurture.  Determinism versus free will – The explanations of phobias are deterministic. The behavioural explanation suggests phobias are learned. This is deterministic because the person who develops the phobia has no choice but to develop it due to their learning experience. For example, Little Albert learned to be afraid of the white rat because of the noise he associated with the rat not because he chose to be afraid. However, some element of free-will as a phobic patient can unlearn their phobia (e.g. through systematic desensitisation). Psychodynamic is also deterministic. Freud theorised that a phobia is caused by the expression of anxiety in the unconscious over which we have no control. In addition, the repression of anxiety occurs due to early childhood experiences over which there is little to no control. However, a phobic patient does have free will to go to psychoanalysis and allow the psychotherapist to help them bring the fear into the conscious mind so that it can be resolved. © Cambridge University Press & Assessment 2024 Page 19 of 63 4(b)  Case studies - Strengths – in depth research (Watson and Freud) and good ecological validity (e.g. Freud). Weaknesses – lacks generalisability as just one young boy (e.g. Watson and Freud) and researcher can become overly involved leading to bias data (e.g. Freud).  Validity – Freud’s study is open to bias as data was collected by the father of Little Hans and reported via letters to Freud. All data was qualitative and open to interpretation. Little Hans had a frightening experience with a horse which could explain his phobia and yet this was dismissed by Freud. Watson’s data was collected via observation – noting down the behaviour of little Albert (e.g. was he calm, fussing, crying). As Albert was a 9-month-old baby there are no demand characteristics or social desirability which increases validity. It is unlikely that Watson misinterpreted the behaviour of Albert as the difference between a baby being calm and crying are clear. Also increasing validity. However, poor ecological validity as no one is purposefully conditioned to develop a phobia. Many phobias develop with just one bad experience with the phobic object. Repeated and systematic exposure to the banging of the iron bar is very unrealistic. Additional issues candidates may include:  generalisations from findings (if not evaluated within case studies)  qualitative data  subjective data  ethics Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 20 of 63

1 Craig has a phobia of blood and injections. He watches someone having an 4 For full marks injection on television, feels faint and now he is too frightened to turn on his Must reference Craig needs to do the television. AT/tensing muscles while he is watching TV. Suggest how applied tension could treat Craig’s phobia so that he can watch television. Must be in context to achieve 3-4 marks (e.g. referencing watching tv, Award 3–4 marks for a detailed answer with clear understanding of applied tension blood/injections). linked to treating Craig’s phobias so he can watch television. Award 1–2 marks for a basic answer with some understanding of applied tension Can achieve 1 mark for tensing linked to treating Craig’s phobia. muscles and a 2nd mark for approximate timings of tensing/relax Example: e.g. He should tense his muscles (1) Craig should go to therapy to learn applied tension as he is likely to feel faint or for about 10 to 15 seconds and then actually faint when he tries to watch television. (1) During the therapy Craig can relax for about 20 to 30 seconds. (1) learn to tense his muscles (1) when he sees a television or tries to switch the television on. (1) Craig should practice this several times a day and he will find that Relaxation on its own = 0 marks. he can watch television without fainting. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 7 of 47

2(a) Outline what is meant by ‘nurture’, including an example from the 2 Context – behavioural explanation of behavioural explanation of fear-related disorders. fear-related disorders. Award 1 mark for outline of nurture. Social learning theory is Award 1 mark for example from behavioural explanation of fear-related disorders. creditworthy as an example e.g. learning a phobia due to copying the Example: phobia of a parent, vicarious Nurture is where behaviour is caused by the environment / is learned. (1) The reinforcement, role model, behaviourist explanation of phobias suggests that a phobia is learned through observational learning. association of the neutral stimulus with the unconditioned stimulus until it produces a conditioned response of fear. (1) Trauma on its own is not creditworthy. Needs to outline that trauma is then Other appropriate responses should also be credited. associated with the object, situation, etc. that the person becomes phobic to. Behavioural – phobias can be learned = 0 marks. Just identifying a study e.g. Little Albert or button phobia or identifying ‘classical conditioning’ on its own = 0 marks. © Cambridge University Press & Assessment 2024 Page 8 of 47 2(b) Explain one weakness of the behavioural explanation of fear-related 2 Context = behavioural explanation of disorders from the nurture side of the nature versus nurture debate. fear-related disorders. Award 2 marks for an explanation of the weakness in context. The weakness must be a weakness of Award 1 mark for a basic outline of weakness. behavioural explanation being due to nurture and not a generic weakness Weaknesses might include: of behavioural (e.g. the Little Albert  Ignores biological/psychodynamic explanations of fear-related disorders. study is unethical).  Impossible to determine if fear-related disorders are due to nurture or nature (or the extent to which the disorder is due to nurture or nature). No credit to just identifying a  Reductionist explanation suggests the factor causing the fear-related disorder weakness on its own. (e.g. it is is the environment (pairing of NS and UCS) when some have a fear-related reductionist). disorder without this experience.  Suggests that anyone exposed to a negative stimulus will develop a phobia (deterministic) when this is not the case. Example: One weakness of the behavioural explanation of phobias from the nurture side of the debate is that it is difficult to determine if the phobia is due to nurture or nature. (1) There is evidence that phobias may develop due to genetics and evidence from the study on Little Albert that phobias can be learned. (1) It is impossible to know whether a phobia someone has is due to their genetics/environment or a mixture of the two. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 9 of 47

3 Dr Begum is a clinician who sees a patient, Joan. Joan describes how she spends her day feeling miserable and not knowing what to do with her time. She thinks it is her own fault because she cannot decide if she wants to go out, so she stays in. Joan wants to sleep but this is also difficult. 3(a) Suggest how Dr Begum could use the Beck depression inventory (BDI) with 4 Cap at 2 marks outlining the features Joan. of the BDI with no link to Joan or how it can be used with her. Award 3–4 marks for a detailed answer with clear understanding of using BDI with Joan. Cap at 3 marks if no reference is Award 1–2 marks for a basic answer with some understanding of using BDI with made to Joan specifically (e.g. one Joan. of her symptoms) but the response refers to how Dr Begum can use the Beck Depression Inventory BDI with Joan (e.g. diagnosis). 21-item multiple choice questionnaire. It is a psychometric self report that Used to diagnose Joan with measures the severity of depression. The patient reads various statements and depression = 1 mark answers with how much the statement applies to them on a 0-3 / 4 point scale over the past two weeks. The statements cover issues such as self-dislike, tiredness, etc. The higher the score, the more depressed the person is deemed to be. e.g.  (0) I do not feel sad.  (1) I feel sad.  (2) I am sad all the time and I can't snap out of it.  (3) I am so sad or unhappy that I can't stand it. 1–10 : These ups and downs are considered normal 11–16: Mild mood disturbance 17–20: Borderline clinical depression 21–30: Moderate depression 31–40: Severe depression over–40: Extreme depression © Cambridge University Press & Assessment 2024 Page 10 of 47 3(a) Version 2– got rid of the statements that had the same scoring. Version 3 – changed questions on body image, hypochondria and difficulty working and added in questions on sleep loss and appetite. For example: Dr Begum could use the Beck Depression Inventory with Joan where she would read 21 statements (1) and answers on a 0-3 scale over the past week. (1) Joan will likely give high scores to the statements about sadness, sleep, losing interest in other people (1). She might also score highly on feeling she is worse than other people and feeling like a failure as she thinks it is her fault. (1) A score over 21 would indicate a diagnosis of depression as this is moderate depression. (1) OR a score over 17 might be considered for a diagnosis of depression as this is borderline clinical depression. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 11 of 47 3(b) Explain one reason why the Beck depression inventory (BDI) is valid. 2 Allow reference to either ICD-11 or DSM V. Award 2 marks for an explanation of why BDI is valid. Award 1 mark for a basic explanation of why BDI is valid. Objective data can be credited where the response explains that the Likely answers from: clinician isn’t interpreting the  There are 21 items, so the measure is valid as measuring a wide variety of response of the patient. symptoms of mood (affective) disorder. Includes both cognitive and physical symptoms (e.g. sadness, sleep). No credit to identifying that the data  There is a choice of 4 items per statement rather than yes/no responses. is objective or quantitative on its Gives respondent opportunity to express how they feel in more depth. own.  Good validity as covers the symptoms for depression that are in the ICD-11 such as depressed mood and loss of interest in activities. No credit to reliability.  Good concurrent validity with Hamilton Psychiatric Scale (another measure of depression). The BDI has a positive correlation with the HAMD. Example: The Beck Depression Inventory is a valid way to measure depression as it includes 21 items so measures a wide variety of symptoms. (1) These symptoms include both cognitive and physical symptoms so patients with different types of symptoms (e.g. mainly cognitive) could receive a diagnosis of depression. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 12 of 47

4(a) Describe electro-convulsive therapy (ECT) and cognitive-behavioural 6 Award up to 4 marks where the therapy (CBT) for the treatment and management of schizophrenia. response has described only part of the question even if the response Use Table A: AO1 Knowledge and understanding to mark candidate responses to otherwise meets the criteria for Level this question. 3. Candidates must discuss both electro-convulsive and cognitive behavioural For full marks for ECT need to refer to therapy for schizophrenia, but they do not need to use the Sensky example in the seizure. syllabus. For full marks for CBT needs to refer Electro-convulsive therapy (ECT) to how it will reduce symptom of SZ. A general anaesthetic and a drug that relaxes muscles is given. Electrodes are places on the scalp and a finely controlled electric current through those ECT No credit for side effects electrodes for a very short time. This will cause a brief seizure in the brain. Can be performed unilaterally or bilaterally. Targets positive symptoms/for severe cases of CBT – Does not treat causes of SZ or SZ. past trauma. Effects of ECT (if covered in response) Sensky – need a brief outline of CBT Effects post synaptic response to central nervous system transmitters. treatment for full credit. Used during acute episodes of psychosis = ECT may/does increase the release of neurotransmitters such as serotonin, dopamine, and norepinephrine. ECT activates the dopamine system at various levels, including hormone release, neurotransmission, and receptor binding. Cognitive-behavioural therapy Talking therapy that involves cognitive restructuring. Therapist and patient discuss the goals of the therapy which are problem-focused (often 5–20 weeks). For schizophrenia this could involve reducing delusions, ignoring hallucinations and/or coping strategies. Will discuss issues (e.g. delusional thoughts) with therapist and set homework to challenge thoughts during the week. For example, if the patient has a delusion that they are being followed by spies the therapist could acknowledge that is possible but question why spies would be interested in the patient and suggest who else it might be (e.g. friends out for a walk). As therapy © Cambridge University Press & Assessment 2024 Page 13 of 47 4(a) progresses the patient learns how to challenge their thoughts and becomes aware of improvements in symptoms. e.g. Sensky, 2000 To compare cognitive behavioural therapy (CBT) with non-specific befriending interventions for patients with schizophrenia. A randomized controlled design. Patients were allocated to one of two groups: a cognitive behavioural therapy group and a non-specific befriending control group. CBT is talk therapy. The therapist and patient work to replace negative thoughts and behaviours with more accurate and functional ones. This could involve the therapist challenging the patient’s delusions and suggesting alternative explanations for their experience. During CBT the patient learns to:  Check the credibility of thoughts and perceptions.  Ignore or tolerate unreal voices they may hear.  Manage their response to other symptoms related to schizophrenia. 90 patients. 57 from clinics in Newcastle, Cleveland and Durham and 33 from London. They had diagnoses of schizophrenia that had not responded to medication. Aged 16–60 years.  Both interventions were delivered by two experienced nurses who received regular supervision.  Patients were assessed by blind raters – at baseline. – after treatment (lasting up to 9 months). – at a 9-month follow-up evaluation.  Assessed on measures including the Comprehensive Psychiatric Rating Scale, the Scale for Assessment of Negative Symptoms, plus a depression rating scale. © Cambridge University Press & Assessment 2024 Page 14 of 47 4(a) Patients continued to receive routine care throughout the study. The patients received a mean of 19 individual treatment sessions over 9 months. Results – both groups showed reduction in symptoms immediately following treatment. 9 month follow up CBT group were still showing reduction in positive/negative symptoms whereas befriending group had levelled off. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 15 of 47 4(b) Evaluate ECT and CBT for the treatment and management of schizophrenia, 10 including a discussion about the idiographic versus nomothetic approach. Evaluation in your answer can include strengths, weaknesses and a discussion of issues and debates. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include:  Named issue – idiographic versus nomothetic approach ECT follows a nomothetic approach as the general law is that all patients will experience a seizure and this will lead to an improvement in symptoms. However, it does have an idiographic element to it as it is recognised that it may not work for all patients, time between treatments varies, side effects vary, etc. Cognitive- behavioural therapy is somewhat nomothetic as it has a general law that the therapy is beneficial due to a therapeutic relationship developing between patient and therapist and the therapist helps the patient restructure their cognitions with a focus on goals and problem-solving. However, it is also idiographic as the goals/problems/cognitions will be unique for every patient.  Experiments For example, Sensky’s study was an experimental design with lots of controls (e.g. length of treatment, blind raters, etc.). Good ecological validity. Random allocation to conditions.  Longitudinal studies Strengths:  Shows change in behaviour over time – Sensky investigated change in symptoms over a 9-month period.  Often in-depth as time to collect a lot of data.  Holistic – develop a thorough understanding of the participant(s) in the study.  No recall bias as the participant doesn’t have to remember past events. © Cambridge University Press & Assessment 2024 Page 16 of 47 4(b) Weaknesses:  Time-consuming/attrition.  In some longitudinal research participants drop out of the study due to loss of contact, unwillingness to continue, etc.  Researcher can develop a close bond with the participant and can be less objective in interpretation of data.  Generalisations from findings Sensky’s study was done on 90 patients. 57 from clinics in Newcastle, Cleveland and Durham and 33 from London. They had diagnoses of schizophrenia that had not responded to medication. Aged 16–60 years. Good generalisability of findings. Can discuss issues with not generalisable to patients who have responded well to medication but might still benefit from CBT.  Ethics with SZ some treatments can be forced on a patient such as ECT if they are committed to a hospital. You cannot force anyone to participate in cognitive treatments so they could be considered more ethical. Difficult to be sure that a psychotic individual has given fully informed consent to any treatment. Potential risk of physical harm from treatment with ECT. However, ethical issues of consent and withdrawal could be balanced against benefit to the individual in helping manage their symptoms. Additional issues/debates candidates may include:  Determinism versus free-will  Quantitative data  Subjective data  Cost and time  Appropriateness  Effectiveness Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 17 of 47

1 Sarah is always thinking about germs. At work she eats 4 1 max for reference to Sarah’s obsession/belief = lunch alone as she believes this will protect her colleagues. germs, protect colleagues, colleague gets ill. She always washes her hands for 15 minutes in very hot water. She feels better after this, but after 45 minutes she 1 max for reference to Sarah compulsion – washing wants to wash again. When Sarah gets home, she washes hands for 15 mins/very hot water, washing clothing, her clothing, shoes and coat. One day, when Sarah had sat shoes, coat. next to a colleague, she could not sleep that night as she was convinced that he would get ill. 1 max for reference to persistence/time-consuming = always thinking about, takes up to at least an hour a day Explain how Sarah meets the diagnostic criteria for (15 min every 45). obsessive-compulsive disorder (OCD). 1 max for explain why obsession is irrational. Award 3–4 marks for a detailed answer with clear understanding of how Sarah fits the diagnostic criteria for OCD. 1 mark for explain that the compulsion acts to reduce Award 1–2 marks for a basic answer with some understanding of the anxiety created by the obsession. how Sarah fits the diagnostic criteria for OCD.

2 max for reference to impairment in life (couldn’t sleep, Diagnostic criteria ICD-11 sitting alone at lunch).  Presence of persistent obsessions/compulsions  Obsessions are repetitive and persistent that are Allow reference to both ICD and DSM guides. intrusive/unwanted  Compulsions are repetitive behaviour or rituals Do not credit ‘obsessions and compulsions’ on its own  Obsessions and compulsions are time-consuming or result in as in the question. significant distress/impairment in personal, family, social, educational, occupational, or other important areas of The response must identify both obsessions and functioning. compulsions from the stem to be awarded full marks. © Cambridge University Press & Assessment 2024 Page 8 of 63 9990/33 Cambridge International AS & A Level – Mark Scheme May/June 2024 PUBLISHED Question Answer Marks Guidance 1 Example: DSM-5 is creditworthy Sarah fits the diagnostic criteria for OCD as she is experiencing Presence of obsessions and/or compulsions. obsessions and compulsions. One of her obsessions is thinking Obsessions are recurrent/persistent thoughts that are about germs. (1) This is something Sarah thinks about intrusive/unwanted – thoughts are neutralised with some frequently, so it is persistent. (1) In addition, Sarah engages in other thought/action. compulsions which include washing her hands for 15 minutes in Compulsions are repetitive behaviours/mental acts that very hot water. (1) Sarah’s behaviour is repetitive and/or the individual feels driven to perform in response to an ritualistic (e.g. 15 minutes of hand washing and/or washing her obsession or according to rules that must be applied clothing, shoes and coat). rigidly. The compulsion is aimed at preventing/reducing When she washes her hands, she does feel better, however her anxiety; however, these behaviours are excessive. anxiety returns, and she has to wash her hands again which is Obsessions and/or compulsions are time-consuming or time-consuming and excessive. (1) Her obsessions and cause significant distress or impairment in social, compulsions are having a negative effect on her job as she is occupational, or other important areas of functioning. spending time washing her hands as well as feeling distressed with her thoughts about germs. (1) She is also missing out on socialising with her colleagues at lunchtime as she has to sit alone. (1) The other negative effect she is experiencing is not being able to sleep at night if she accidentally touches someone. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 9 of 63 2(a) Outline what is meant by the determinism versus free-will 2 No credit for using just the terminology from the Q. debate. Award 2 marks for an outline of the term/concept. Award 1 mark for a basic outline of the term/concept. Example: The extent to which human behaviour is caused by internal/external factors beyond our control or due to individual choice (behaviour is self-determining). (2) OR Determinism is where behaviour is caused by internal/external factors beyond our control. (1) Free-will is where behaviour is due to individual choice (behaviour is self-determining). (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 10 of 63 2(b) Explain one strength of applying the determinism side of 2 Context = biological explanation of depressive disorder the determinism versus free-will debate to the biochemical (unipolar) explanation for depressive disorder (unipolar). No credit for explanation of why biochemical explanation Award 2 marks for a detailed explanation of strength in context. is deterministic. Award 1 mark for a basic outline of strength. No credit for just identifying the strength. Strengths might include:  Explanatory power– deterministic explanations align with viewing psychology as a science which explains the causes of behaviour.  Increases the status of psychology – deterministic explanations establish psychology as a science that offers unbiased and objective explanations for behaviour.  Application to everyday life – if the cause of behaviour (e.g. low levels of serotonin in the case of depression) then a solution can be found (e.g. SSRIs).  Establishes cause and effect relationships.  Enables causes to be tested in a laboratory experiment with good control.  Takes the blame for behaviour away from the person. The patient with depressive disorder will not feel blamed for their depression as the cause of it is due to internal biochemical factors. Example: One strength is application to everyday life, as a deterministic explanation identifies the cause of behaviour (e.g. low levels of serotonin for depressive disorder) which can then be treated. (1) For example, depressive disorder can be treated using SSRIs which increase serotonin levels through blocking re-uptake of serotonin into neurons. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 11 of 63

3 Olivia has a bipolar disorder and is receiving cognitive restructuring as therapy. In her first session she said: ‘My life used to be 100% perfect! I had an amazing job and friends. I stayed up one night to research an expensive holiday. Recently everything has changed. I am not working and have no energy. No one likes me, not even my family, as I am not fun to be with. I have cancelled the holiday. Why does this keep happening to me? I feel amazing for a while and then it all changes and I am depressed again.’ 3(a) Suggest how cognitive restructuring can help Olivia with 4 Can credit reference to type I or II bipolar. both her depressive and manic episodes. If candidate discusses either depression or manic and Award 3–4 marks for a detailed suggestion with clear not both can get 3 out of 4 marks. understanding of cognitive restructuring linked to helping Olivia with both her depression and manic episodes. No direct link to Olivia’s specific symptoms 2 marks. Maximum 3 marks for detailed suggestion with clear understanding of cognitive restructuring linked to helping Olivia with either her depression or her manic episodes. Award 1–2 marks for a basic suggestion with some understanding of cognitive restructuring linked to helping Olivia with both her depression and manic episodes. © Cambridge University Press & Assessment 2024 Page 12 of 63 3(a) Cognitive restructuring involves – Talking therapy where the therapist asks questions and identifies the patient’s irrational/illogical thinking patterns. Initially the therapist explains how the cognitive triad (self, others and future) works and the effect this has on behaviour and mood. The patient is set homework to identify their mood, thoughts and behaviour and this is discussed in subsequent sessions with the therapist. The therapist will discuss with the patient more rational and logical thoughts and help the patient to recognise the irrational thinking outside of the therapy sessions (‘reality testing’). At the end of therapy, the patient will have the ability to challenge their irrational thoughts, engage in positive behaviour and increase mood. The manic episodes for someone with bipolar disorder are characterised by an overly positive view of self, world and future. Example: Olivia’s therapist can use Olivia’s description of her life to explain the cognitive triad is made up of thoughts about yourself, the world/others and the future. (1) The therapist can challenge both the manic and the depression illogical thinking and help Olivia to replace these thoughts with more rational statements about herself, the world and her future. (1) For example, no one’s life is 100% perfect – a more rational view is that life can be good but doesn’t need to be perfect – this will help Olivia to see herself in a more logical way and help her mania reduce. (1) For the depression, the therapist could challenge that it is unlikely that no one likes her and that she is never any fun to be around with a more realistic view that Olivia is liked by people in her life which will increase her mood. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 13 of 63 3(b) Explain one strength of using cognitive restructuring 2 No credit to ‘will improve her mania and depression’ on therapy with Olivia. its own. Award 2 marks for an explanation of a strength of cognitive 0 marks to long term benefits/improvements on its own. restructure for Olivia. No credit to just identifying a strength. Award 1 mark for a basic explanation of a strength of cognitive restructure for Olivia. Allow full credit for reference to research that shows effectiveness for bi-polar or depression. One strength from:  There are no side effects, unlike medication (e.g. Lithium – mood stabiliser – feeling tired, weight gain, dry mouth, excessive thirst, etc.)  Effective therapy – e.g. Dobson found those who had cognitive restructuring as opposed to drug therapy did significantly better (90% versus 70% improvement in depression symptoms).  Long term effectiveness – teaches the patient how to recognise automatic overly positive or overly negative thinking and how to challenge these thoughts. The patients can do this on their own when therapy is over.  Cognitive therapy is shorter term and therefore cost effective (6–12 sessions) compared to other types of therapy (e.g. psychotherapy). Example: One strength of cognitive restructuring for Olivia is that it has long-term effectiveness as Olivia will learn how to recognise her automatic overly positive and negative thoughts. (1) Once therapy has finished if Olivia goes back into a manic episode, she can replace the overly positive thoughts (e.g. ‘my life is perfect’) with more rational thinking (e.g. 'my life is really good, not perfect. No one’s life is perfect’). (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 14 of 63

4(a) Describe the behavioural explanation and the 6 Award up to 4 marks where the response has described psychodynamic explanation of fear-related disorders. only part of the question even if the response otherwise meets the criteria for level 3. Use Table A: AO1 Knowledge and understanding to mark candidate responses to this question. Candidates must discuss both behavioural and psychodynamic explanations of fear-related disorders, but they do not need to use Watson’s Little Albert and/or Freud’s Little Hans examples from the syllabus. Behavioural (classical conditioning) A phobia develops as the neutral stimulus is paired with something the person is afraid of (the unconditioned stimulus). If enough pairings occur or the initial UCS is very frightening the person will end up with a fear of the NS. The NS then becomes the CS. e.g. Watson and Raynor (1920) Little Albert who was conditioned to be afraid of a rat (NS) by Watson banging an iron bar (UCS) behind the baby which made him cry (UCR). Eventually just the sight of the rat (CS) was enough to cause the crying (CR). Psychodynamic A fear is repressed into the unconscious to protect the ego. The phobia can be a redirected fear during an intensely frightening experience (e.g. a physical attack) onto an object. Denied/repressed impulses of the id which happen during childhood – often during psychosexual stage of development – when there is conflict between the desires of the id and the desires of the ego. Conflict is repressed into the unconscious and the phobic object/situation symbolises this conflict. © Cambridge University Press & Assessment 2024 Page 15 of 63 4(a) e.g. Freud, 1909 may also summarise the case of Little Hans with a focus on phobia (horse or bath). For example, Hans developed a fear of white horses as this was a redirected fear of his father. Hans was in the phallic stage of psychosexual development and was experiencing the Oedipus complex. He had sexual desires for his mother and feared his father would castrate him. Hans displaced these strong feelings of fear/hatred towards his father onto horses which reminded him of his father with long mane/black noseband (similar to his father’s facial hair) and blinkers (similar to father’s glasses). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 16 of 63 4(b) Evaluate the behavioural explanation and the 10 psychodynamic explanation of fear-related disorders, including a discussion about longitudinal studies. Evaluation in your answer can include strengths, weaknesses and a discussion of issues and debates. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include: Named issue – Longitudinal studies Strengths  Shows change in behaviour over time  Watson’s study lasted a few months (8 months 26 days until 12 months 21 days – 4 months) and conditioned Little Albert to become afraid of rats, white fluffy objects, etc. over the course of the study. Freud’s study lasted from age 3-5 years and investigated the development and resolution of the Oedipus complex during the study.  Often in-depth as time to collect a lot of data e.g. Freud collected in-depth data from letters from Little Hans’ father describing events and conversations he had with Hans  Holistic – develop a thorough understanding of the participant(s) in the study © Cambridge University Press & Assessment 2024 Page 17 of 63 4(b)  Freud had a holistic view of the causes of Hans’ behaviour. For example, he was sent letters with conversations between Hans and his father describing little Hans’ thoughts/fantasies. Freud was able to report on how the fantasies changed during and after the phallic stage to explain how someone transitions from one psychosexual stage to the next. Watson was somewhat holistic – tested Little Albert on a number of different objects to explain the development of the phobia of rats and also how phobias can generalise to other objects similar to the phobic object.  No recall bias as the participant doesn’t have to remember past events.  Both Watson and Freud (through the father) were recording events, behaviours, etc. as they occurred during the study. For example, little Hans’ father did not have to recall events from Hans’ childhood but could record them in his letters as they happened. Makes the data more valid. Weaknesses  Time-consuming/attrition.  In some longitudinal research participants drop out of the study due to loss of contact, unwillingness to continue, etc. This did not happen during Watson or Freud’s studies, but the Freud study was very time consuming. A researcher can invest a lot of time in the study and as longitudinal studies often have one or few participants if someone leaves the study this could mean the research cannot progress.  Researcher can develop a close bond with the participant and can be less objective in interpretation of data – particularly if qualitative data  Freud’s research has been accused of being biased as the data was collected by the father who had a close relationship with his son (as well as Freud). © Cambridge University Press & Assessment 2024 Page 18 of 63 4(b)  Nature versus nurture – Behavioural is nurture as phobias are learned through association between a neutral stimulus and an unconditioned stimulus. In contrast, psychodynamic is both nature and nurture- we all go through the psychosexual stages but whether we pass through them successfully is due to life experiences/nurture.  Determinism versus free will – The explanations of phobias are deterministic. The behavioural explanation suggests phobias are learned. This is deterministic because the person who develops the phobia has no choice but to develop it due to their learning experience. For example, Little Albert learned to be afraid of the white rat because of the noise he associated with the rat not because he chose to be afraid. However, some element of free-will as a phobic patient can unlearn their phobia (e.g. through systematic desensitisation). Psychodynamic is also deterministic. Freud theorised that a phobia is caused by the expression of anxiety in the unconscious over which we have no control. In addition, the repression of anxiety occurs due to early childhood experiences over which there is little to no control. However, a phobic patient does have free will to go to psychoanalysis and allow the psychotherapist to help them bring the fear into the conscious mind so that it can be resolved. © Cambridge University Press & Assessment 2024 Page 19 of 63 4(b)  Case studies - Strengths – in depth research (Watson and Freud) and good ecological validity (e.g. Freud). Weaknesses – lacks generalisability as just one young boy (e.g. Watson and Freud) and researcher can become overly involved leading to bias data (e.g. Freud).  Validity – Freud’s study is open to bias as data was collected by the father of Little Hans and reported via letters to Freud. All data was qualitative and open to interpretation. Little Hans had a frightening experience with a horse which could explain his phobia and yet this was dismissed by Freud. Watson’s data was collected via observation – noting down the behaviour of little Albert (e.g. was he calm, fussing, crying). As Albert was a 9-month-old baby there are no demand characteristics or social desirability which increases validity. It is unlikely that Watson misinterpreted the behaviour of Albert as the difference between a baby being calm and crying are clear. Also increasing validity. However, poor ecological validity as no one is purposefully conditioned to develop a phobia. Many phobias develop with just one bad experience with the phobic object. Repeated and systematic exposure to the banging of the iron bar is very unrealistic. Additional issues candidates may include:  generalisations from findings (if not evaluated within case studies)  qualitative data  subjective data  ethics Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 20 of 63

1 The key study by Freeman et al. (2003), using virtual reality to investigate persecutory ideation, included a number of self-reports such as the VR-Paranoia questionnaire. 1(a)(i) Give two examples of items (questions) included 2 in the VR-Paranoia questionnaire. Syllabus 1.1.1 Key study using virtual reality to investigate persecutory ideation: Freeman et al. (2003). 1 mark for each correct answer NOTE: Any item from the items listed in the study list, e.g. ‘they were hostile towards me’, ‘they were watching me’ (does not need to be word for word for credit). 1(a)(ii) State two features of the scale used by participants to answer the VR- 2 Paranoia questions.

5 In the key study by Bridge et al. (1988), the ‘profile of mood states’ questionnaire was used to assess the effectiveness of their relaxation and imagery treatment programme on stress. 5(a)(i) Explain why the study by Bridge et al. is longitudinal. 2 Syllabus: 3.4.3 Key study on relaxation and imagery in reducing stress during medical treatment: Bridge et al. (1988). Award 2 marks for a detailed explanation. Award 1 mark for a partial explanation. Answers may include:  the study lasted for six weeks (1)  patients saw two researchers once a week for six weeks (+1)  scores were taken by Leeds General Scale and profile of mood states at initial assessment and again after six weeks (2 marks). 5(a)(ii) Compare the results for total mood disturbance for any two groups. 2 Award 2 marks for an appropriate statement plus numbers. Award 1 mark for an appropriate statement. Answers may include:  At six weeks total mood disturbance score was significantly less in the intervention groups than the control group (1) intervention e.g. 53.9 compared to 61.4 (+1).  Women in the combined intervention group being more relaxed than those receiving relaxation training only (1) e.g. 53.9 compared to 61.9 (+1). NOTE: numbers do not have to be exact. Groups include control group. NOTE: ‘initial’ versus ‘six weeks’ are not groups. 5(b) Suggest how the results of total mood disturbance could be presented 2 in a graph. Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include:  bar chart (1) with bars for initial/six-week tests and for each of the three groups (2). NOTE: credit up to 2 marks for full explanation without naming graph. NOTE: drawings are not required for full marks, although a drawing is creditworthy. NOTE: 0 marks for histogram (data not continuous scale). Other appropriate responses to be credited. © Cambridge University Press & Assessment 2024 Page 12 of 30 5(c) Explain two strengths of using a longitudinal study to assess the 4 effectiveness of relaxation and imagery on stress. Up to 2 marks for each strength x 2. Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied. Answers may include:  It determines change or effectiveness in same person over time (1) the participants who were assessed on the Leeds scale and profile of mood were assessed at the beginning of the study and again at the end (2).  It tracks the development of the same individual, so many participant variables remain constant (1) the Leeds scale and profile of mood were used both at the beginning of the study and again at the end on the same participant (2).  The consistency of the measures can be tested i.e. reliability (1) the Leeds scale and profile of mood were used both at the beginning of the study and again at the end on the same participant (2). Other appropriate responses to be credited. Question Answer Marks

9 There can be problems with using electro-convulsive therapy (ECT) as a treatment for schizophrenia, for example side effects. 9(a) Plan an experiment with a longitudinal design to investigate whether 10 there are problems with ECT as a treatment for schizophrenia. Your plan must include details about: • controls • a directional or non-directional hypothesis. Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate):  type of experiment  sample and sampling technique independent variable  ethical guidelines dependent variable  a procedure  controls  type of data, analysis of data, choice of experimental design. use of descriptive statistics  If appropriate:  an aim or hypothesis  counterbalancing, random (directional or non- allocation (RCT) directional)/null hypothesis  single blind/double blind  steps for making the study valid  other appropriate features and reliable Credit other elements of the plan as appropriate using the marking grid. © Cambridge University Press & Assessment 2024 Page 19 of 30 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.1.3 Treatment and management of schizophrenia – electro- convulsive therapy. Description: 1. Muscle relaxant given; electricity applied bilaterally or unilaterally; patient convulses (twitches because of muscle relaxant); patient is unconscious, then wakes and recovers. 2. Possible side effects: 20% to 50% of the people who respond well to a course of ECT relapse within 6 months; Short-term memory loss is often reported. Many patients perceive the treatment as terrifying and shameful. Immediately after treatment the patient is often confused (and the confusion may not be temporary). Marks Description 3-4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1-2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response. 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your experiment. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that identifies a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature. 0 No creditable response. Example: IV group with ECT and group without. Control: both groups with no other medication or treatment. Design: independent. Hypothesis directional: ECT more problems than not. ‘Problems’ could be side effects i.e. the DV. © Cambridge University Press & Assessment 2024 Page 20 of 30 9(c)(i) Explain one reason for your choice of controls. 2 Candidates should use the controls stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Example:  makes it more likely the study is valid; it is more likely that the DV has been caused by the IV (1) related to plan (2)  participant variables are controlled such as being matched (1) related to plan (2) 9(c)(ii) Explain one weakness of the use of a longitudinal design in your study. 2 Candidates should use the longitudinal study stated in (a). Marks Description 2 Weakness is given and applied to the plan. 1 Weakness is given without being applied to the plan. 0 No creditable response. Example  participant attrition: participants may drop out (1) related to plan (2)  once started the design cannot be changed (1) related to plan (2) 9(c)(iii) Explain one reason for your choice of directional or non-directional 2 hypothesis. Candidates should use the directional/non-directional hypothesis stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Award 0 marks if it is not a directional or non-directional hypothesis or it does apply to the plan. Example:  A directional hypothesis was chosen because it was predicted that X would score more/be better/etc. than Y (1) reason related to plan (2).  a non-directional hypothesis was chosen because it was predicted that there would be a difference between X and Y (1) X reason related to study (2). © Cambridge University Press & Assessment 2024 Page 21 of 30

1 From the key study by Lovell et al. (2006) on the treatment of obsessive- compulsive disorder: 1(a)(i) Identify two criteria that were necessary for participants to meet to be 2 included in the study. Syllabus: 1.5.3 Key study on treatment of obsessive-compulsive disorder using telephone administered cognitive- behavioural therapy (CBT): Lovell et al. (2006). Award 1 mark for each appropriate reason. Definitive answer:  diagnosis of obsessive-compulsive disorder  score of 16 or more on YBOCS (Yale-Brown scale)  age 16–65. 1(a)(ii) Outline two reasons why some participants were excluded from the 2 study. Award 1 mark for each appropriate reason. Definitive answer: patients with:  obsessional slowness  organic brain disease  a diagnosis of substance misuse  severe depression or with suicidal intent  patients who had been on anti-depressants or anxiolytics for less than 3 months. NOTE: 0 marks for ‘withdrawing from study’; 0 marks for ‘mixing/doubling up’ with Q1(a)(i) 1(b) Suggest why Lovell et al. did not include a control group in their study. 2 Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include:  a control group was not needed (1) the aim was to see if CBT by telephone was as good as face-to-face; both groups receiving CBT (2)  a control group would receive no treatment (1) and if they were to be an appropriate control group they would have to meet the same inclusion criteria as the experimental groups (2). Other appropriate responses to be credited. © Cambridge University Press & Assessment 2024 Page 7 of 34 1(c) Explain two strengths of excluding some participants from studies on 4 obsessive-compulsive disorder (OCD). Up to 2 marks for each strength  2. Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/ stated but not applied. Answers may include:  maintains ethical guidelines (protection from psychological harm) the participant may not be suitable for the treatment (1) and it may do their OCD more harm that good, particularly if they are undergoing an alternative treatment (2)  maintains ethical guidelines (protection from psychological harm) the treatment may not be suitable for the participant (1) a participant may have a problem regarding telephones; they may have hearing problems; may not have a telephone (2)  ‘telephone treatment’ was 50% shorter than a face-to-face consultation (1) so this should only be done with suitable OCD participants not those who need longer sessions or face-to-face to help them (2). Other appropriate responses to be credited. © Cambridge University Press & Assessment 2024 Page 8 of 34

5 how often did thoughts about stealing come up?

9 on average, how much excitement and pleasure did you feel when you successfully committed a theft? If you did not actually steal, please estimate how much excitement and pleasure you believe you would have experienced if you had committed a theft.

1 The key study by Freeman et al. (2003), using virtual reality to investigate persecutory ideation, included a number of self-reports such as the VR-Paranoia questionnaire. 1(a)(i) Give two examples of items (questions) included 2 in the VR-Paranoia questionnaire. Syllabus 1.1.1 Key study using virtual reality to investigate persecutory ideation: Freeman et al. (2003). 1 mark for each correct answer NOTE: Any item from the items listed in the study list, e.g. ‘they were hostile towards me’, ‘they were watching me’ (does not need to be word for word for credit). 1(a)(ii) State two features of the scale used by participants to answer the VR- 2 Paranoia questions.

5 In the key study by Bridge et al. (1988), the ‘profile of mood states’ questionnaire was used to assess the effectiveness of their relaxation and imagery treatment programme on stress. 5(a)(i) Explain why the study by Bridge et al. is longitudinal. 2 Syllabus: 3.4.3 Key study on relaxation and imagery in reducing stress during medical treatment: Bridge et al. (1988). Award 2 marks for a detailed explanation. Award 1 mark for a partial explanation. Answers may include:  the study lasted for six weeks (1)  patients saw two researchers once a week for six weeks (+1)  scores were taken by Leeds General Scale and profile of mood states at initial assessment and again after six weeks (2 marks). 5(a)(ii) Compare the results for total mood disturbance for any two groups. 2 Award 2 marks for an appropriate statement plus numbers. Award 1 mark for an appropriate statement. Answers may include:  At six weeks total mood disturbance score was significantly less in the intervention groups than the control group (1) intervention e.g. 53.9 compared to 61.4 (+1).  Women in the combined intervention group being more relaxed than those receiving relaxation training only (1) e.g. 53.9 compared to 61.9 (+1). NOTE: numbers do not have to be exact. Groups include control group. NOTE: ‘initial’ versus ‘six weeks’ are not groups. 5(b) Suggest how the results of total mood disturbance could be presented 2 in a graph. Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include:  bar chart (1) with bars for initial/six-week tests and for each of the three groups (2). NOTE: credit up to 2 marks for full explanation without naming graph. NOTE: drawings are not required for full marks, although a drawing is creditworthy. NOTE: 0 marks for histogram (data not continuous scale). Other appropriate responses to be credited. © Cambridge University Press & Assessment 2024 Page 12 of 30 5(c) Explain two strengths of using a longitudinal study to assess the 4 effectiveness of relaxation and imagery on stress. Up to 2 marks for each strength x 2. Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied. Answers may include:  It determines change or effectiveness in same person over time (1) the participants who were assessed on the Leeds scale and profile of mood were assessed at the beginning of the study and again at the end (2).  It tracks the development of the same individual, so many participant variables remain constant (1) the Leeds scale and profile of mood were used both at the beginning of the study and again at the end on the same participant (2).  The consistency of the measures can be tested i.e. reliability (1) the Leeds scale and profile of mood were used both at the beginning of the study and again at the end on the same participant (2). Other appropriate responses to be credited. Question Answer Marks

9 There can be problems with using electro-convulsive therapy (ECT) as a treatment for schizophrenia, for example side effects. 9(a) Plan an experiment with a longitudinal design to investigate whether 10 there are problems with ECT as a treatment for schizophrenia. Your plan must include details about: • controls • a directional or non-directional hypothesis. Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate):  type of experiment  sample and sampling technique independent variable  ethical guidelines dependent variable  a procedure  controls  type of data, analysis of data, choice of experimental design. use of descriptive statistics  If appropriate:  an aim or hypothesis  counterbalancing, random (directional or non- allocation (RCT) directional)/null hypothesis  single blind/double blind  steps for making the study valid  other appropriate features and reliable Credit other elements of the plan as appropriate using the marking grid. © Cambridge University Press & Assessment 2024 Page 19 of 30 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.1.3 Treatment and management of schizophrenia – electro- convulsive therapy. Description: 1. Muscle relaxant given; electricity applied bilaterally or unilaterally; patient convulses (twitches because of muscle relaxant); patient is unconscious, then wakes and recovers. 2. Possible side effects: 20% to 50% of the people who respond well to a course of ECT relapse within 6 months; Short-term memory loss is often reported. Many patients perceive the treatment as terrifying and shameful. Immediately after treatment the patient is often confused (and the confusion may not be temporary). Marks Description 3-4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1-2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response. 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your experiment. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that identifies a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature. 0 No creditable response. Example: IV group with ECT and group without. Control: both groups with no other medication or treatment. Design: independent. Hypothesis directional: ECT more problems than not. ‘Problems’ could be side effects i.e. the DV. © Cambridge University Press & Assessment 2024 Page 20 of 30 9(c)(i) Explain one reason for your choice of controls. 2 Candidates should use the controls stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Example:  makes it more likely the study is valid; it is more likely that the DV has been caused by the IV (1) related to plan (2)  participant variables are controlled such as being matched (1) related to plan (2) 9(c)(ii) Explain one weakness of the use of a longitudinal design in your study. 2 Candidates should use the longitudinal study stated in (a). Marks Description 2 Weakness is given and applied to the plan. 1 Weakness is given without being applied to the plan. 0 No creditable response. Example  participant attrition: participants may drop out (1) related to plan (2)  once started the design cannot be changed (1) related to plan (2) 9(c)(iii) Explain one reason for your choice of directional or non-directional 2 hypothesis. Candidates should use the directional/non-directional hypothesis stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Award 0 marks if it is not a directional or non-directional hypothesis or it does apply to the plan. Example:  A directional hypothesis was chosen because it was predicted that X would score more/be better/etc. than Y (1) reason related to plan (2).  a non-directional hypothesis was chosen because it was predicted that there would be a difference between X and Y (1) X reason related to study (2). © Cambridge University Press & Assessment 2024 Page 21 of 30

1 Jude has a phobia of some foods. This affects his everyday life because he is 4 Context = food types, eating in anxious when other people are eating these foods near him. public – If just identifying food phobia – Suggest how systematic desensitisation could treat Jude’s phobia. max 3; needs something specific (as above) for full Award 3–4 marks for a detailed answer with clear understanding of how systematic marks. desensitisation could help Jude with his phobia of certain foods. Award 1–2 marks for a basic answer with some understanding of how systematic Must include for full marks: desensitisation could help Jude with his phobia of certain foods. Fear hierarchy, relaxation, how gradual exposure works and • Hierarchy of fear created by Jude and therapist with most fearful situation given contextualised highest rating, lowers fear level food-related situation at the bottom. • Therapist teaches Jude how to relax. Reciprocal inhibition can be • Jude is exposed to lowest level fear level and learns to relax (based on reciprocal credited (needs to outline this inhibition). rather than just identify for • Jude exposed to next level of fear and learns how to relax while encountering credit). phobic stimulus • Many take a number of sessions to work right up to the most fearful situation. Example: Jude will be asked to create a fear hierarchy with least feared food encounter at the bottom and most at the top, usually giving a rating of fear for each level.(1) If his phobia is of, for example, eating fatty foods, then on his hierarchy his lowest fear level could be being in a restaurant with other diners but not eating himself (1), mid-fear could be seeing a very fatty food on the plate of someone on his table/nearby, highest level could be having a lot of fatty food on his plate and being in a restaurant and eating with others.(1) Therapist will teach relaxation techniques to Jude so that he can relax when in his phobic situation, since we cannot be fearful and relaxed simultaneously.(1) Jude will be exposed to lower level fearful food-related situation first (go to a restaurant) and learn how to relax in that situation. © Cambridge University Press & Assessment 2024 Page 9 of 44 1 Once relaxed, move on to the next level of fear (someone nearby has fatty food on their plate) and learn to relax in that situation. (1) This is continued gradually, over a number of sessions, each time exposing Jude to situations he rated as higher and higher on his fear hierarchy. Eventually Jude will be able to encounter his most feared food-related situation and not feel fear. (1) Other appropriate responses should also be credited. Question Answer Marks Guidance

2(a) Outline the reductionism side of the reductionism versus holism debate. 2 Award 2 marks for an outline of the term/concept. Award 1 mark for a basic outline of the term/concept. Example: The extent to which complex processes/phenomena/ideas can be put in simple terms/basic units (2) or explaining psychological phenomena by breaking it down into smaller component parts (2) Examples of 1 mark answers could include: • Lowest/most basic level of explanation • Simple/basic way to describe something • Ignoring other, more complex explanations Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 10 of 44 2(b) Explain how the biochemical explanation of schizophrenia is reductionist. 2 1 mark = biochemical explanation Award 2 marks for an explanation in context. 1 mark = how is it reductionist Award 1 mark for a basic outline/identification. Ignores environmental/cognitive/ Example: psychological factors = 0 A biochemical explanation of schizophrenia suggests it is caused by imbalance of dopamine in various parts of the brain (1) A chemical, like dopamine, is a single element and its actions are basic as they do not involve other processes such as cognition or family influences. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 11 of 44

3(a) Aisha finds she has trouble relaxing. She visits her doctor, who suggests using 4 the Generalised Anxiety Disorder assessment (GAD-7). Suggest two reasons why the doctor wants to use the GAD-7 with Aisha. For each reason: Award 2 marks for an answer with clear understanding of GAD-7 in context. Award 1 mark for a basic answer with some understanding of GAD-7 GAD – 7 = • GAD-7 is a screening test for anxiety. • Trouble relaxing is one of the items on the GAD-7 • Quick to do and won’t make Aisha more anxious e.g. 7 items, each scoring from 0 to 3 • Patient assigns scores to items according to how often they have experienced them in the last 2 weeks with 0 = not at all, 1 = ‘several days’, 2 = ‘more than half the days’, 3 = ‘nearly every day’ • The maximum score that can be obtained is 21. • The 7 items are feeling nervous, anxious or on edge, not being able to stop or control worrying, worrying too much about different things, trouble relaxing, being so restless that it is hard to sit still, becoming easily annoyed or irritable, feeling afraid as if something awful might happen. Example: The clinician can use GAD-7 with Aisha to screen for Generalised Anxiety disorder (1). If her score is high enough, she can be referred on to a specialist for further therapy for anxiety (1) GAD-7 is an easy assessment to use with Aisha as she only needs to answer simple questions related to how she feels over the last 2 weeks. It only takes a few minutes to complete. (2) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 12 of 44 3(b) Explain one weakness of the GAD-7. 2 Award 2 marks for an explanation of a weakness of GAD-7. Award 1 mark for a basic explanation of a weakness of GAD-7. One weakness from: • Only a screening test. Cannot be used for full diagnosis. • Needs practitioner for levels moderate and above • List of items cannot explain the complexity of experiencing anxiety • Items only say how often symptoms occur and not how severe they are or the effect on the person’s life • It can be difficult to be fully aware of what was experienced over the past 2 weeks unless a detailed diary had been kept • Possibility as self-report or under- or over-estimating experiences due to potential social desirability • Lacks qualitative in-depth understanding of anxiety experienced by patient. Example: One weakness of GAD-7 is that a psychometric screening test like this cannot successfully capture the experience of anxiety. (1) Aisha may have found some items far more debilitating on her daily living than others and this is not shown simply by how often they are experienced. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 13 of 44

4(a) Describe the study by Lovell et al. (2006) on treatment of obsessive-compulsive 6 For full marks – Some disorder (OCD) using telephone administered cognitive-behavioural therapy information on participants (e.g. (CBT). number of Ps, where from), IV, DV (one of the measures), Use Table A: AO1 Knowledge and understanding to mark candidate responses to this Result. question. Max 2 for participants Max 2 for measures (DV) Aim: to compare outcomes of those with OCD treated with CBT (expose and response Max 2 for procedure. prevention) face-to-face with those receiving the same therapy via telephone. Accept an outline of CBT not Design: 72 out-patients with OCD from two hospitals in UK. 16 – 65 years. Scored at ERP least 16 on Y-BOCs. Randomised controlled trial (independent groups). Both groups Abstract – Objectives To received 10 weekly sessions either via telephone (30-minute appointments) or face-to- compare the effectiveness of face (60 minutes). The telephone group received 2 face-to-face sessions of one hour at cognitive behaviour therapy the beginning and end. delivered by telephone with the Measures: Assessed on Yale Brown obsessive compulsive disorder scale, Beck same therapy given face to face depression inventory, and client satisfaction questionnaire. Prior to treatment, all in the treatment of obsessive assessed twice four weeks apart. Post treatment – one, three and six month follow up. compulsive disorder. Results: Both groups’ scores very similarly in Yale Brown obsessive compulsive Design Randomised controlled disorder scale, showing a reduction in their symptoms of OCD during the treatment and non-inferiority trial. up to 6 months later. Both groups reported high satisfaction. Setting Two psychology Average Y-BOCS pre-treatment = 25. No significant difference between mean scores of outpatient departments in the Y-BOCS and BDI between two groups prior to treatment. United Kingdom. 77% drop in YBOCs (clinically significant) for telephone and 67% face-to-face. 72% Participants 72 patients with reduction across the two groups. obsessive compulsive disorder. Intervention 10 weekly For example: sessions of exposure therapy Comparing telephone versus face-to-face treatment of CBT for OCD. 72 out-patients and response prevention took part. 10 one-hour weekly sessions of exposure and response prevention therapy delivered by telephone or face were given to face to face treatment group and 2 face to face meetings (session 1 and to face. session 10) and 8 30-minute telephone sessions given to telephone treatment group. 3 Main outcome measures Yale inventories given during therapy (Yale-Brown, Beck and client satisfaction). No Brown obsessive compulsive significant differences found at six months. Concluded both face to face and telephone disorder scale, Beck depression treatment are equally as effective in treating OCD. inventory, and client satisfaction questionnaire. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 14 of 44 4(a) Results Difference in the Yale Brown obsessive compulsive disorder checklist score between the two treatments at six months was −0.55 (95% confidence interval −4.26 to 3.15). Patient satisfaction was high for both forms of treatment. Conclusion The clinical outcome of cognitive behaviour therapy delivered by telephone was equivalent to treatment delivered face to face and similar levels of satisfaction were reported. © Cambridge University Press & Assessment 2024 Page 15 of 44 4(b) Evaluate the study by Lovell et al., including a discussion of reliability. 10 Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include: • Named issue – Reliability • Used both Y-BOCs and Beck depression inventory consistently as well as satisfaction survey to repeatedly assess patients at various times – consistent measures • Same therapy used whether by phone or face-to-face • Same therapist used for both phone or face-to-face within each hospital • Quantitative data (can make comparisons between treatment groups, statistical analysis of results) • Follow-up done at 6 months to check longer term effectiveness of treatment. • Useful as shows the shorter telephone interviews just as effective as the longer face to face sessions. Individual and Situational The situation of being in either treatment group is shown to not affect the outcome for the patient. However, there will be significant individual differences. Although the treatment was successful on the whole, the efficacy of CBT depends upon the relationship between the patient and the practitioner as well as the motivation of the patient. It may be that less motivated patients will find it easier to engage in therapy either via telephone (will not need to leave their home) or face-to-face (perceived greater attention from the clinician) Cultural differences Study took part in the UK where CBT is quite a widely used treatment for disorders. Western-based and thus individualistic society. In a more collectivist culture, CBT – with it’s focus on individual thoughts – will be less commonly used and perhaps not so accepted as a treatment. © Cambridge University Press & Assessment 2024 Page 16 of 44 4(b) There may be greater (or lesser) stigma attached to a mental illness like OCD in other cultures, leading to potential different willingness to engage in therapy via telephone or face-to-face. In more remote communities, access to this type of therapy face-to-face may make use of telephone therapy far more helpful to individual. Telephone therapy also cheaper and this may affect uptake in countries where healthcare is not universal. Other possible issues/debates: Determinism vs Free will Reductionism vs holism Quantitative data Psychometrics Nomothetic vs idiographic Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 17 of 44

1 Manjit has been diagnosed with schizophrenia. Her psychiatrist thinks 4 Candidates can focus on genetic and/or that all mental disorders have a biological cause. biochemical explanations. Suggest how the psychiatrist could help Manjit to understand a Can credit more than one biological cause. biological cause of her schizophrenia. Genetic (1) Award 3–4 marks for a detailed answer with clear understanding of a biological Imbalance of dopamine or too high explanation of Manjit’s schizophrenia. dopamine (1) Award 1–2 marks for a basic answer with some understanding of a biological explanation of Manjit’s schizophrenia. Too little dopamine can be creditworthy if linked to prefrontal cortex. Biochemical (dopamine hypothesis) The dopamine hypothesis of schizophrenia states that symptoms may be caused by an excess of dopamine in the mid-brain and a reduction of dopamine in the prefrontal cortex. The dopamine hypothesis of schizophrenia suggests that a high level of activity of dopamine D2 receptor neurotransmission in subcortical and limbic brain regions contributes to positive symptoms of schizophrenia, whereas negative and cognitive symptoms of the disorder can be attributed to heightened activity of dopamine D1 receptor neurotransmission in the prefrontal cortex. Genetic Schizophrenia appears to have a genetic cause as shown by Gottesman and Shields in their review article of studies of adoption, siblings and twins with schizophrenia. All adoption studies found an increased incidence of schizophrenia in adopted children with a schizophrenic biological parent. Biological siblings of children with schizophrenia showed a much higher percentage of schizophrenia. All twin studies found a higher concordance rate for schizophrenia in monozygotic (MZ) than dizygotic (DZ) twins. In Gottesman and Shield’s own study the rate was 58% for identical twins, and 12% for non-identical twins. Conclusion - There is a heavy genetic input into the onset of schizophrenia. © Cambridge University Press & Assessment 2024 Page 10 of 47 1 Example: Research shows a number of biological causes/explanations for schizophrenia. These include both biochemical and genetic explanations (1) Schizophrenia has a genetic component so you may have inherited genes that predispose you to the condition. (1) It is also probable that you have excess of a neurotransmitter called dopamine in the mid-brain and a reduction in the prefrontal cortex. (1) These levels of dopamine may be causing both your positive and negative symptoms. (1) One reason for believing that dopamine is involved is that treating with anti-psychotics that regulate dopamine makes most patients feel better and reduces their symptoms, helping them to live a more normal life (1) Other appropriate responses should also be credited. Question Answer Marks Guidance

2(a) Outline the idiographic versus nomothetic debate. 2 Idiographic collects qualitative data(1) and nomothetic collects quantitative data.(1) Award 2 marks for an outline of the term/concept in context. Award 1 mark for a basic outline of the term/concept. Idiographic tends to do case studies. (1) Nomothetic does lab studies/controlled Example: studies. (1) The extent to which psychology seeks to capture the uniqueness of an individual and their subjective experience (idiographic) or establishes Can award 1 mark for two poorly outlined generalisations/laws that apply to all people (nomothetic). (2) definitions. OR An idiographic approach focuses on individual unique experiences often using qualitative data. (1) A nomothetic approach aims to establish laws that apply universally using psychometrics and quantitative data. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 11 of 47 2(b) Explain one strength of using an idiographic approach to diagnosing 2 For full marks it needs to refer to schizophrenia. something about schizophrenia specifically (e.g. symptoms) Award 2 marks for an explanation of a strength in context. Award 1 mark for a basic outline/identification of strength. If candidate refers to strength of treatment, only creditworthy if links to diagnosis first. Strengths might include: • People are unique and quantitative measures cannot capture the full experience of a complex condition like schizophrenia. • Diagnosis of schizophrenia is not a simple matter of quantities of a series of symptoms and needs to look at the subjective experience of the individual. • Idiographic techniques such as unstructured interviews can give insight into the experiences of the individual patient, giving greater insight. • Descriptions given of specific delusions or the way positive or negative characteristics have impacted their lives allows the practitioner to diagnose better. Example: One strength of an idiographic approach is that the practitioner can use an unstructured interview (1) with the patient in order to ascertain the quality of their experience with delusions/hallucinations or other symptoms, potentially arriving at a clearer diagnosis of schizophrenia. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 12 of 47

3(a) Leo’s parents are worried about his recent behaviour. His mother thinks 4 For full marks they must include reference that he may have obsessive-compulsive disorder (OCD). Leo’s father to says ‘I do not agree. Leo has not been washing his hands all the time.’ • Obsessions • Other compulsions Suggest two reasons why Leo’s mother may think he has OCD. • Refer to Leo For each suggestion: No credit for washing hands in secret. Award 2 marks for an outline of the suggestion linked to the context. Award 1 mark for a basic outline/identification of each of the suggestions. Can credit any explanation of OCD that Leo’s mum might think could have led to Diagnostic criteria from ICD-11: him developing OCD such as • Persistent obsessions or compulsions, or most commonly both psychodynamic, behaviourist, genetic. • Obsessions and repetitive and persistent thoughts, images or impulses To obtain full credit would need to then link that are intrusive, unwanted and associated with anxiety to obsession and compulsion that Leo • Individual attempts to ignore or suppress obsessions or to neutralise would show. them by performing compulsions • Compulsions are repetitive behaviours, including repetitive mental acts that the individual feels driven to perform in response to an obsession, according to rigid rules, or to achieve a sense of ‘completeness’ • In order to be diagnosed, obsessions and compulsions must be time consuming (e.g., taking more than an hour per day) or result in significant distress or significant impairment in functioning (including personal, family, social, occupational or educational). Obsessions can include images (e.g., violent scenes), impulses/urges (e.g., to stab someone) as well as persistent thoughts (e.g., of contamination). Compulsions can include checking, ordering objects, mentally repeating specific phrases, reviewing a memory, mentally counting objects as well as repetitive washing. © Cambridge University Press & Assessment 2024 Page 13 of 47 3(a) Example: OCD includes obsessions and compulsions (usually both). Leo may have told his mother that he is having obsessions. For example, he could be experiencing fear that his parents will come to harm (1). In order to deal with the anxiety Leo is experiencing he is performing a compulsion. For example, he could be repeatedly count to 20 in his head. He may need to do this multiple times (1). Leo is spending all of his time at home in his room isolated from the rest of his family and rarely seeing friends so is showing distress (1). Leo’s obsessions and compulsions are time-consuming (up to two hours per day, for example) (1). Although repeatedly washing hands is one example of a compulsion it is not the only one (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 14 of 47 3(b) Explain one reason why an interview with Leo may not help to diagnose 2 Must refer to interview technique and at him with OCD. least one characteristic of OCD Award 2 marks for an explanation of why an interview with Leo may not necessarily be helpful in diagnosing him with OCD. Award 1 mark for a basic explanation of why an interview with Leo may not necessarily be helpful in diagnosing him with OCD. One reason from: • Leo may feel ashamed of/embarrassed about his OCD and disclose little about what he is experiencing so that the clinician will not be aware of whether or not he fits the criteria for OCD. • Leo may find it difficult to articulate how he feels, particularly if he is young, leading to difficulties with diagnosis. • Clinician needs to be sensitive with his or her questioning giving plenty of opportunities for Leo to explain the effect his obsessions and compulsions are having on his life. • The setting may not be conducive to disclosure. If Leo’s parent(s) want to be there then this may lead to Leo down-playing his symptoms. • Although Leo may be distressed by what he is experiencing, he may believe that his repeated intrusive thoughts are ‘normal’ so will not share them. Example: The interview technique employed by Leo’s clinician may include a number of open-ended questions. Leo may find it difficult to articulate how he feels (1) When Leo tries to talk about his dark thoughts and repetitive behaviours, he may find it can be hard to put into words. This failure to disclose could lead to a lack of diagnosis as the various criteria for OCD have not been captured. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 15 of 47

4(a) Describe the psychological explanations of impulse control disorders: 6 Award up to 4 marks where the response • behavioural: positive reinforcement and has described only part of the question • cognitive: Miller’s feeling-state theory. even if the response otherwise meets the criteria for Level 3. Use Table A: AO1 Knowledge and understanding to mark candidate responses to this question. Behavioural – positive reinforcement Operant conditioning states that the frequency of a behaviour is increased through the use of a reward. For the gambler this can be money (for the kleptomaniac and pyromaniac the thrill associated with their behaviours). Positive reinforcement explains gambling well by the use of schedules of reinforcement with the use of partial positive reinforcement (a reward is not received every time). Gambler is compelled to continue because they ‘might’ win the next time. Cognitive – Miller’s feeling-state theory Intense positive feelings link with specific behaviours such as gambling. Impulse control disorders are caused because these links form a ‘state- dependent memory’ (feeling state). The intense feeling-state experienced is all the emotions, thoughts and physiological arousal, and this leads to impulse-control problems and causes obsessions. The individual with negative thoughts about themselves can experience an intense feeling of euphoria and power when they indulge in their impulsive behaviour, overcoming that negative thought to a great extent. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 16 of 47 4(b) Evaluate the psychological explanations of impulse control disorders: 10 • behavioural: positive reinforcement and • cognitive: Miller’s feeling-state theory, including a discussion about nature versus nurture. Evaluation in your answer can include strengths, weaknesses and a discussion of issues and debates. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. • Named issue – nature versus nurture Behavioural is due to nurture as the person with impulse control disorder learns the disorder through rewards. Feeling state is mainly nurture as the patient develops the feeling state due to their experiences of the behaviour they have developed (e.g., gambling). Example analysis – If something is due to nature the person cannot alter this so therefore it could be argued the behaviour cannot be changed. However, modern medicine has created medications that alter our biochemistry. If something is due to nurture then the environment can be improved so that the rewarding experiences no longer happen (e.g., gambling websites could be prevented from giving such high maximum payments) and therefore the behaviour could either not be learned in the first place or someone being treated might find it easier to stop doing their impulsive behaviour. • Free will and determinism Hard determinism would say that behavioural causes are beyond our control however, it could be argued that individuals could choose to stay away from situations that expose them to their impulsive behaviours e.g., pyromaniacs choosing not to seek fires to watch, lowing their risk of starting their own. Cognitive less deterministic as many types of therapies and theories have shown how we can change our thought processes leading to potential ‘cures’. © Cambridge University Press & Assessment 2024 Page 17 of 47 4(b) • Individual and situational explanations Behavioural are situational as the environment creates the impulse control disorder. However, individuals may be attracted to these specific environments. Gamblers choose to go to casinos or pubs where there are fruit machines, for example. Cognitive more individual as thought processes seen as unique to that individual • Reductionism versus holism Reductionist nature of the causes. They do not take into account the background of the sufferer or the potential contribution of other factors e.g., genetics or indeed how these factors may be interacting within the individual. • Application to everyday life Behavioural explanation useful because it allows treatment for the disorder by rewarding alternative behaviours, so extinguishing the original addiction. Cognitive allows individuals to have insight into what causes their behaviours in order to treat them. Other issues could include • Evaluation of evidence of causes • Generalisability of the explanation to all types of impulse control disorders and non-substances. • Idiographic versus nomothetic Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 18 of 47

1 Jude has a phobia of some foods. This affects his everyday life because he is 4 Context = food types, eating in anxious when other people are eating these foods near him. public – If just identifying food phobia – Suggest how systematic desensitisation could treat Jude’s phobia. max 3; needs something specific (as above) for full Award 3–4 marks for a detailed answer with clear understanding of how systematic marks. desensitisation could help Jude with his phobia of certain foods. Award 1–2 marks for a basic answer with some understanding of how systematic Must include for full marks: desensitisation could help Jude with his phobia of certain foods. Fear hierarchy, relaxation, how gradual exposure works and • Hierarchy of fear created by Jude and therapist with most fearful situation given contextualised highest rating, lowers fear level food-related situation at the bottom. • Therapist teaches Jude how to relax. Reciprocal inhibition can be • Jude is exposed to lowest level fear level and learns to relax (based on reciprocal credited (needs to outline this inhibition). rather than just identify for • Jude exposed to next level of fear and learns how to relax while encountering credit). phobic stimulus • Many take a number of sessions to work right up to the most fearful situation. Example: Jude will be asked to create a fear hierarchy with least feared food encounter at the bottom and most at the top, usually giving a rating of fear for each level.(1) If his phobia is of, for example, eating fatty foods, then on his hierarchy his lowest fear level could be being in a restaurant with other diners but not eating himself (1), mid-fear could be seeing a very fatty food on the plate of someone on his table/nearby, highest level could be having a lot of fatty food on his plate and being in a restaurant and eating with others.(1) Therapist will teach relaxation techniques to Jude so that he can relax when in his phobic situation, since we cannot be fearful and relaxed simultaneously.(1) Jude will be exposed to lower level fearful food-related situation first (go to a restaurant) and learn how to relax in that situation. © Cambridge University Press & Assessment 2024 Page 9 of 44 1 Once relaxed, move on to the next level of fear (someone nearby has fatty food on their plate) and learn to relax in that situation. (1) This is continued gradually, over a number of sessions, each time exposing Jude to situations he rated as higher and higher on his fear hierarchy. Eventually Jude will be able to encounter his most feared food-related situation and not feel fear. (1) Other appropriate responses should also be credited. Question Answer Marks Guidance

2(a) Outline the reductionism side of the reductionism versus holism debate. 2 Award 2 marks for an outline of the term/concept. Award 1 mark for a basic outline of the term/concept. Example: The extent to which complex processes/phenomena/ideas can be put in simple terms/basic units (2) or explaining psychological phenomena by breaking it down into smaller component parts (2) Examples of 1 mark answers could include: • Lowest/most basic level of explanation • Simple/basic way to describe something • Ignoring other, more complex explanations Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 10 of 44 2(b) Explain how the biochemical explanation of schizophrenia is reductionist. 2 1 mark = biochemical explanation Award 2 marks for an explanation in context. 1 mark = how is it reductionist Award 1 mark for a basic outline/identification. Ignores environmental/cognitive/ Example: psychological factors = 0 A biochemical explanation of schizophrenia suggests it is caused by imbalance of dopamine in various parts of the brain (1) A chemical, like dopamine, is a single element and its actions are basic as they do not involve other processes such as cognition or family influences. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 11 of 44

3(a) Aisha finds she has trouble relaxing. She visits her doctor, who suggests using 4 the Generalised Anxiety Disorder assessment (GAD-7). Suggest two reasons why the doctor wants to use the GAD-7 with Aisha. For each reason: Award 2 marks for an answer with clear understanding of GAD-7 in context. Award 1 mark for a basic answer with some understanding of GAD-7 GAD – 7 = • GAD-7 is a screening test for anxiety. • Trouble relaxing is one of the items on the GAD-7 • Quick to do and won’t make Aisha more anxious e.g. 7 items, each scoring from 0 to 3 • Patient assigns scores to items according to how often they have experienced them in the last 2 weeks with 0 = not at all, 1 = ‘several days’, 2 = ‘more than half the days’, 3 = ‘nearly every day’ • The maximum score that can be obtained is 21. • The 7 items are feeling nervous, anxious or on edge, not being able to stop or control worrying, worrying too much about different things, trouble relaxing, being so restless that it is hard to sit still, becoming easily annoyed or irritable, feeling afraid as if something awful might happen. Example: The clinician can use GAD-7 with Aisha to screen for Generalised Anxiety disorder (1). If her score is high enough, she can be referred on to a specialist for further therapy for anxiety (1) GAD-7 is an easy assessment to use with Aisha as she only needs to answer simple questions related to how she feels over the last 2 weeks. It only takes a few minutes to complete. (2) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 12 of 44 3(b) Explain one weakness of the GAD-7. 2 Award 2 marks for an explanation of a weakness of GAD-7. Award 1 mark for a basic explanation of a weakness of GAD-7. One weakness from: • Only a screening test. Cannot be used for full diagnosis. • Needs practitioner for levels moderate and above • List of items cannot explain the complexity of experiencing anxiety • Items only say how often symptoms occur and not how severe they are or the effect on the person’s life • It can be difficult to be fully aware of what was experienced over the past 2 weeks unless a detailed diary had been kept • Possibility as self-report or under- or over-estimating experiences due to potential social desirability • Lacks qualitative in-depth understanding of anxiety experienced by patient. Example: One weakness of GAD-7 is that a psychometric screening test like this cannot successfully capture the experience of anxiety. (1) Aisha may have found some items far more debilitating on her daily living than others and this is not shown simply by how often they are experienced. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 13 of 44

4(a) Describe the study by Lovell et al. (2006) on treatment of obsessive-compulsive 6 For full marks – Some disorder (OCD) using telephone administered cognitive-behavioural therapy information on participants (e.g. (CBT). number of Ps, where from), IV, DV (one of the measures), Use Table A: AO1 Knowledge and understanding to mark candidate responses to this Result. question. Max 2 for participants Max 2 for measures (DV) Aim: to compare outcomes of those with OCD treated with CBT (expose and response Max 2 for procedure. prevention) face-to-face with those receiving the same therapy via telephone. Accept an outline of CBT not Design: 72 out-patients with OCD from two hospitals in UK. 16 – 65 years. Scored at ERP least 16 on Y-BOCs. Randomised controlled trial (independent groups). Both groups Abstract – Objectives To received 10 weekly sessions either via telephone (30-minute appointments) or face-to- compare the effectiveness of face (60 minutes). The telephone group received 2 face-to-face sessions of one hour at cognitive behaviour therapy the beginning and end. delivered by telephone with the Measures: Assessed on Yale Brown obsessive compulsive disorder scale, Beck same therapy given face to face depression inventory, and client satisfaction questionnaire. Prior to treatment, all in the treatment of obsessive assessed twice four weeks apart. Post treatment – one, three and six month follow up. compulsive disorder. Results: Both groups’ scores very similarly in Yale Brown obsessive compulsive Design Randomised controlled disorder scale, showing a reduction in their symptoms of OCD during the treatment and non-inferiority trial. up to 6 months later. Both groups reported high satisfaction. Setting Two psychology Average Y-BOCS pre-treatment = 25. No significant difference between mean scores of outpatient departments in the Y-BOCS and BDI between two groups prior to treatment. United Kingdom. 77% drop in YBOCs (clinically significant) for telephone and 67% face-to-face. 72% Participants 72 patients with reduction across the two groups. obsessive compulsive disorder. Intervention 10 weekly For example: sessions of exposure therapy Comparing telephone versus face-to-face treatment of CBT for OCD. 72 out-patients and response prevention took part. 10 one-hour weekly sessions of exposure and response prevention therapy delivered by telephone or face were given to face to face treatment group and 2 face to face meetings (session 1 and to face. session 10) and 8 30-minute telephone sessions given to telephone treatment group. 3 Main outcome measures Yale inventories given during therapy (Yale-Brown, Beck and client satisfaction). No Brown obsessive compulsive significant differences found at six months. Concluded both face to face and telephone disorder scale, Beck depression treatment are equally as effective in treating OCD. inventory, and client satisfaction questionnaire. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 14 of 44 4(a) Results Difference in the Yale Brown obsessive compulsive disorder checklist score between the two treatments at six months was −0.55 (95% confidence interval −4.26 to 3.15). Patient satisfaction was high for both forms of treatment. Conclusion The clinical outcome of cognitive behaviour therapy delivered by telephone was equivalent to treatment delivered face to face and similar levels of satisfaction were reported. © Cambridge University Press & Assessment 2024 Page 15 of 44 4(b) Evaluate the study by Lovell et al., including a discussion of reliability. 10 Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include: • Named issue – Reliability • Used both Y-BOCs and Beck depression inventory consistently as well as satisfaction survey to repeatedly assess patients at various times – consistent measures • Same therapy used whether by phone or face-to-face • Same therapist used for both phone or face-to-face within each hospital • Quantitative data (can make comparisons between treatment groups, statistical analysis of results) • Follow-up done at 6 months to check longer term effectiveness of treatment. • Useful as shows the shorter telephone interviews just as effective as the longer face to face sessions. Individual and Situational The situation of being in either treatment group is shown to not affect the outcome for the patient. However, there will be significant individual differences. Although the treatment was successful on the whole, the efficacy of CBT depends upon the relationship between the patient and the practitioner as well as the motivation of the patient. It may be that less motivated patients will find it easier to engage in therapy either via telephone (will not need to leave their home) or face-to-face (perceived greater attention from the clinician) Cultural differences Study took part in the UK where CBT is quite a widely used treatment for disorders. Western-based and thus individualistic society. In a more collectivist culture, CBT – with it’s focus on individual thoughts – will be less commonly used and perhaps not so accepted as a treatment. © Cambridge University Press & Assessment 2024 Page 16 of 44 4(b) There may be greater (or lesser) stigma attached to a mental illness like OCD in other cultures, leading to potential different willingness to engage in therapy via telephone or face-to-face. In more remote communities, access to this type of therapy face-to-face may make use of telephone therapy far more helpful to individual. Telephone therapy also cheaper and this may affect uptake in countries where healthcare is not universal. Other possible issues/debates: Determinism vs Free will Reductionism vs holism Quantitative data Psychometrics Nomothetic vs idiographic Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2024 Page 17 of 44

1 From the key study by Oruč et al. (1997) on mood (affective) disorders: 1(a)(i) Outline what is meant by a clinical interview. 2 Syllabus 1.2.2 Key study on association analysis of genetics of depressive disorder: Oruč et al. (1997). Marks: award 1 mark for each feature (up to 2 marks max). Answers may include (other appropriate responses to be credited). • a face-to-face interview (1 mark) • between a medical practitioner and a person/patient (1 mark) Essential for 2 marks • involving verbal and non-verbal exchange (1 mark) • in a medical setting (1 mark) • designed to diagnose symptoms, prescribe or assess treatment (1 mark) 1(a)(ii) Outline one reason why the participants were interviewed. 2 Marks: Award 2 marks for a detailed outline. Award 1 mark for a partial outline. Definitive answers: • patients had been previously assessed (1 mark) for lifetime psychopathology; the interview was done to confirm this (2 marks) • to ask about first degree relatives (1 mark) who had a history of a major affective disorder (2 marks) • to administer a psychometric test (1 mark) the SADS-L (Schedule for Affective Disorders and Schizophrenia – Lifetime Version) (2 marks) 1(b) The interviews were reviewed by a second psychiatrist. 2 Suggest one effect there could have been on the results if the interviews had not been reviewed by a second psychiatrist. Marks: Award 2 marks for an appropriate effect stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate effect identified but not applied. Answers may include (other appropriate responses to be credited): • the participant may not be suitable for the study (1 mark) which (i) may be bad for the person if they then participated (2 marks) (ii) it might break ethical guidelines (2 marks) • the data may be invalid (1 mark) because the first psychiatrist made an error in (i) diagnosis of BP type 1 (2 marks) (ii) checking the results of the SADS-L (2 marks) © Cambridge University Press & Assessment 2024 Page 7 of 33 1(c) Explain one strength and one weakness of a clinical interview as used in 4 this study. Marks: Up to 2 marks for each strength and up to 2 marks for each weakness: Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • it is used to confirm the individual circumstances (1 mark) the patient knows their family relationships, has to complete the psychometric assessment test; the practitioner only has notes of previous history (2 marks). • the individual patient can explain and answer any question (1 mark) for example about their BP disorder type 1 that may be asked; to clarify their suitability for the study (2 marks) Weaknesses: • the patient may use vague terms to describe their condition and be unable to clearly explain what the practitioner needs to know, or fully understand what the study is about (1 mark) such as BP disorder type 1, transporter genes (2 marks) • the patient may not understand medical jargon (1 mark) that is used such as BP disorder type 1, transporter genes (2 marks) © Cambridge University Press & Assessment 2024 Page 8 of 33

5 From the key study by Savage and Armstrong (1990) on the effect of practitioner style on patient satisfaction: 5(a)(i) Outline how participants were recruited for the study. 2 Syllabus: 3.1.2 key study for the effect of practitioner style on patient satisfaction: Savage and Armstrong (1990). Marks: Award 1 mark each feature (max 2 marks). Definitive answer: NB: Question is how, not identification of sampling technique. • use of a random number generator (essential for 2 marks) • select four patients from each surgery of one doctor • from an inner London general practice • over a four-month period. 5(a)(ii) Outline how participants were randomly allocated to the conditions of 2 the study. Marks: Award 2 marks for a detailed outline. Award 1 mark for a partial outline. Definitive answer: • cards used to randomly allocate directing or sharing style (done by doctor). • done after doctor had confirmed patient was suitable for participation in study. © Cambridge University Press & Assessment 2024 Page 14 of 33 5(b) Suggest one problem if participants had not been randomly allocated to 2 the conditions of the study. Marks: Award 2 marks for an appropriate effect stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate effect identified but not applied. Answers may include (other appropriate responses to be credited). • the results might not be valid (1 mark) because: certain personality types may be in the sharing group or vice versa. (+1 mark). the doctors or experimenters might manipulate allocation to show that a sharing style is better (+1 mark) 5(c) Explain two strengths of the use of random allocation in this study. 4 Marks: Up to 2 marks for each strength  2 Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • no participant bias: The participant does not choose which condition they are in and so they cannot bias the study (1 mark) the participant is randomly put into a directing or sharing condition. (2 marks) • no doctor bias: The doctor presenting the style cannot bias the study (1 mark) because the doctor does not know whether a directing or sharing style is the next card to appear (2 marks).

9(a) Plan an experiment to investigate which anti-depressant drug is more 10 effective for treating depression. Your plan must include details about: • experimental design • type of experiment Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate): • type of experiment • sample and sampling technique • independent variable • ethical guidelines • dependent variable • a procedure • controls • type of data, analysis of data, • choice of experimental design. use of descriptive statistics If appropriate: • an aim or hypothesis • counterbalancing, random (directional or non- allocation, randomised control directional)/null hypothesis trial • steps for making the study valid • single blind/double blind and reliable • other appropriate features Credit other elements of the plan as appropriate using the marking grid. © Cambridge University Press & Assessment 2024 Page 20 of 33 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.2.3 biological treatments including the use of anti-depressants (tricyclics, MAOIs and SSRIs). Description: Biochemicals: there many types of drug that relieve the symptoms of depression: • MAOIs inhibit the enzyme monoamine oxidase. This enzyme normally breaks down noradrenaline, serotonin and dopamine, but these neurotransmitters are not broken down, they stay at normal high levels and so ‘reduce depression’. • SSRIs selective serotonin reuptake inhibitors act on serotonin to stop it being reabsorbed and broken down after crossing a synapse NB: candidates could also legitimately include SNRIs (Serotonin- noradrenaline reuptake inhibitors (SNRIs), TCAs (tricyclic anti-depressants) SARIs (Serotonin antagonists and reuptake inhibitors) Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2024 Page 21 of 33 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your experiment. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response NB 1 mark for explanation of follow on from (b)i; 1 mark for explanation appearing in (a) x2 Example: measure of depression for baseline (BDI). Two independent groups for IV: group 1 given MAOIs, group 2 SSRIs. Controls: no other drugs to be taken; both groups for 12 months. DV is change in level of depression (BDI again). 9(c)(i) Explain one reason for your choice of experimental design. 2 Candidates should use the choice of experimental design stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Example: • an independent design was chosen because it allows an experimental group to be compared directly to a control group or one treatment group with another (1 mark) related to plan (2 marks) • a repeated design would control participant variables (1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2024 Page 22 of 33 9(c)(ii) Explain one weakness of your choice of experimental design. 2 Candidates should use the design stated in (ci) Award 2 marks if a weakness is given and justified. Award 1 mark if a weakness is given but not justified. • with an independent design there is no control over participant variables (1 mark) related to study (2 marks) • a related design would not work because the same participant would do two (or more) conditions and the effect of the first might influence the second (and third) (1 mark) related to study (2 marks) • with a repeated measures design there is the possibility of order effects (1 mark) related to study (2 marks) • with a repeated measures design there is the possibility that the participant is more likely to work out the aim of the experiment (1 mark) related to study (2 marks) 9(c)(iii) Explain one reason for your choice of type of experiment. 2 Candidates should use the choice of experiment stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: • laboratory experiments have high levels of control, so the DV is more likely to be caused by the IV (1 mark) example from part (a) of plan (2 marks) • field experiment perhaps more difficult to control but possible to have high levels of ecological validity (1 mark) example from part (a) of plan (2 marks) © Cambridge University Press & Assessment 2024 Page 23 of 33

1 The key study by Chapman and DeLapp (2013) treated an individual with a blood/injection/injury phobia using an exposure hierarchy with applied tension: 1(a)(i) Explain what is meant by the term ‘exposure hierarchy’. 2 Syllabus: Key study on treating blood/injection/injury phobia using cognitive- behavioural therapy (CBT) with applied tension: Chapman and DeLapp (2013). Marks: Award 2 marks for a detailed explanation. Award 1 mark for a partial explanation. Definitive answer: • an exposure hierarchy is a list of situations that an individual fears or avoids that are ordered according to how much anxiety they elicit. The least anxiety-provoking situations are at the bottom while the most anxiety-provoking situations are at the top. Exposure hierarchies typically consist of 10 or so situations. NB: does not need an example from ‘this study’ 1(a)(ii) Give two examples of situations included in the exposure hierarchy in 2 this study. Marks: Award 1 mark (2 max) for each appropriate example. Definitive answer: • any two situations from the list above. NB answers do not have to be word perfect for credit. NB ‘pricking finger’ is part of the study but not on the hierarchy. © Cambridge University Press & Assessment 2024 Page 5 of 32 1(b) Suggest how blood/injection/injury phobia could be diagnosed without 2 using rating scales. Your suggestion must be ethical. Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited). • use a clinical interview where the clinician can ask any question to aid diagnosis (1 mark) they can ask about blood/injection/injury situations and responses to exposure (2 marks). • use an observation such as a controlled, overt observation where the clinician can control a situation and observe the patient’s responses (2 marks). NB any unethical suggestion receives 0 marks. 1(c) Explain one strength and one weakness of the case study research 4 method as used in this study. Marks: up to 2 marks for each strength and up to 2 marks for each weakness: Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • a case study can be used as a pilot study (1 mark) and it may help others who need treating for vasovagal syncope in relation to medical and other situations (2 marks) • ‘T’ was studied as part of his everyday life (1 mark), he was not a participant volunteering to be part of a study, but a person with real-life problems (2 marks) Weaknesses: • ‘T’ is only one person (not representative of the population) and so generalisations are difficult (1 mark) ‘T’s’ specific experiences regarding fainting and medical procedures may be unique (2 marks) • Case studies are difficult (if not impossible) to replicate (1 mark) because of the uniqueness of each case such as ‘T’ (2 marks) © Cambridge University Press & Assessment 2024 Page 6 of 32

5 The key study by Shoshani and Steinmetz (2014) on using positive psychology in schools used questionnaires to gather data. These included the Rosenberg Self-Esteem Scale (RSE) and the General Self- Efficacy Scale, both of which used four-point scales. 5(a)(i) Outline the Rosenberg Self-Esteem Scale (RSE). 2 Syllabus 3.5.3 Key study on using positive psychology in schools to improve mental health: Shoshani and Steinmetz (2014). Marks: Award 1 mark for each correct point (2 marks max) Definitive answer: • measures worthiness as a human being. • includes ten items • has positively and negatively worded items (e.g. people feeling satisfied with life) • Items rated on a 4-point Likert scale (1 strongly disagree to 4 strongly agree; no neutral) NB 0 marks for ‘self-esteem’ 5(a)(ii) Outline the General Self-Efficacy Scale. 2 Marks: Award 1 mark for each correct point (2 marks max) Definitive answer: • measures perceived self-efficacy • e.g. ‘I can always manage to solve difficult problems if I try hard enough’ • to predict coping with daily hassles and stressful events • it includes ten items, • items rated on a 4-point Likert-scale 1 = not at all to 4 exactly true © Cambridge University Press & Assessment 2024 Page 13 of 32 5(b) Suggest one health promotion strategy that could be used to promote 2 mental health in schools, other than the strategy referred to in this study. Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate effect suggestion but not applied. Answers may include (other appropriate responses to be credited). • providing information is the strategy used in this study, but credit if the answer is different (1 mark) [this study: participants were involved in a positive psychology school-based intervention aimed at enhancing mental health and empowering staff and students (2 marks). • fear arousal could be used (1 mark) aimed at enhancing mental health and empowering the entire educational staff and students (2 marks) • credit ‘positive reinforcement’ (1 mark) example of Tapper et al. (2003, food dudes) 5(c) Explain one strength and one weakness of using four-point scales in 4 this study. Marks: up to 2 marks for each strength and up to 2 marks for each weakness. Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • a four-point scale response must be either agree or disagree (even if 51/49) (1 mark) this means that self-esteem ratings can be determined (Rosenberg Questionnaire gives self-esteem scores of either agree or disagree) (2 marks). • it does not allow any participant to ‘tick’ neutral for every option item (1 mark) if they do not want their true self-esteem score to be known (2 marks) Weakness • a four-point scale allows no opt-out/neutral (1 mark) so no-one can say their self-esteem is neutral even if it is (2 marks). • a person might genuinely not be able to make a decision either way, but can’t opt out (1 mark) or the question is ambiguous (1 mark) or isn’t understood (1 mark) so a person has to commit themselves to a false response about their mental health (2 marks). © Cambridge University Press & Assessment 2024 Page 14 of 32

9(a) Plan a study using a questionnaire with open questions to investigate 10 generalised anxiety disorder in university students. Your plan must include details about: • question interpretation/scoring • the questionnaire technique. Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate): • technique (paper/pencil, online, • sample and sampling technique postal) • ethical guidelines • format (open and/or closed) • a procedure • examples of questions • a location • question • type of data, analysis of data, scoring/interpretation use of descriptive statistics • number of questions • an aim or hypothesis (directional or non- directional)/null hypothesis • steps for making the study valid and reliable Credit other elements of the plan as appropriate using the marking grid. © Cambridge University Press & Assessment 2024 Page 19 of 32 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.4.1 diagnostic criteria (ICD-11) of anxiety disorders and fear- related disorders: – generalised anxiety disorder measures of anxiety and fear-related disorders: – Generalised Anxiety Disorder assessment (GAD-7). Description: 1 Generalised anxiety disorder: a person has a ‘panic attack’ but do not know its cause. Characteristics: excessive, uncontrollable and often irrational worry, which interferes with daily functioning; physical symptoms of headaches, nausea, numbness in hands and feet, muscle tension, difficulty swallowing and/or breathing, trembling, twitching and sweating; feeling anxious most days. Struggling to remember the last time they felt relaxed; as one anxious thought is resolved, another may appear about a different issue. Chronic condition. 2 In support (as GAD questions are closed). The ‘GAD score’ is calculated by assigning scores of 0 (not at all), 1 (several days), 2 more than half the days), and 3 nearly every day. A GAD-7 total score ranges from 0 to 21. 0–5 mild anxiety, 6–10 moderate anxiety, 11–15 moderately severe anxiety and 15–21 severe anxiety. Sample questions may be used. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2024 Page 20 of 32 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response NB 1 mark for explanation of follow on from (b)i; 1 mark for explanation appearing in (a) x2 Example: design paper/pencil questionnaire with open questions asking (for example) ‘Describe the symptoms you experience when having an attack’. From GAD ‘Do you have trouble relaxing? Explain why’ (0–3: not at all > nearly every day). 9(c)(i) Explain one reason for the way you chose to interpret/score responses 2 to your questions. Candidates should use the choice of interpretation/scoring stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Example: • an (n-point) scale was used to keep the answer choice simple for participants because each participant’s score could be compared (1 mark) related to plan (2 marks). • yes/no (don’t know) answers were used to keep the answer choice simple for participants yet provide quantitative data for statistical analysis • the answers gave qualitative data so was coded by raters/judges to ‘convert’ into quantitative data for statistical analysis (1 mark) related to study (2 marks) © Cambridge University Press & Assessment 2024 Page 21 of 32 9(c)(ii) Explain one weakness of the way you chose to interpret/score 2 responses to your questions. Candidates should use the choice of interpretation/scoring responses in (c)(i). Award 2 marks if a weakness is given and applied to the plan Award 1 mark if a weakness is given without being applied to the plan Example: • the raters/judges interpreting the answers may not agree leading to false findings (1 mark) related to study (2 marks) • only one person gathered the answers and they might have some bias toward the outcome of the study (1 mark) related to study (2 marks) 9(c)(iii) Explain one reason for your choice of questionnaire technique. 2 Candidates should use the questionnaire technique stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Example: Paper/pencil • because they are face-to-face perhaps participants are more likely to complete the questionnaire and perhaps be more honest in their answers (1 mark) related to plan (2 marks). • paper/pencil because the researcher is there at the time watching and waiting and so the environment is perhaps more likely to be controlled if done in a laboratory with students for example (1 mark) related to plan (2 marks). Online • online because the sample size can be much larger and potentially much more diverse than paper/pencil or face-to-face which is probably done in a relatively restricted place (in street, laboratory) related to plan (2 marks). • online because there is no researcher waiting, watching or influencing the person in any way. The participant is more likely to be honest in their responses related to plan (2 marks). Postal • postal because the sample size can be much larger and potentially much more diverse than paper/pencil or face-to-face which is probably done in in a relatively restricted place (in street, laboratory) (1 mark) related to plan (2 marks). • postal because there is no researcher waiting, watching or influencing the person in any way. The participant is more likely to be honest in their responses (1 mark) related to plan (2 marks). © Cambridge University Press & Assessment 2024 Page 22 of 32

1 From the key study by Oruč et al. (1997) on mood (affective) disorders: 1(a)(i) Outline what is meant by a clinical interview. 2 Syllabus 1.2.2 Key study on association analysis of genetics of depressive disorder: Oruč et al. (1997). Marks: award 1 mark for each feature (up to 2 marks max). Answers may include (other appropriate responses to be credited). • a face-to-face interview (1 mark) • between a medical practitioner and a person/patient (1 mark) Essential for 2 marks • involving verbal and non-verbal exchange (1 mark) • in a medical setting (1 mark) • designed to diagnose symptoms, prescribe or assess treatment (1 mark) 1(a)(ii) Outline one reason why the participants were interviewed. 2 Marks: Award 2 marks for a detailed outline. Award 1 mark for a partial outline. Definitive answers: • patients had been previously assessed (1 mark) for lifetime psychopathology; the interview was done to confirm this (2 marks) • to ask about first degree relatives (1 mark) who had a history of a major affective disorder (2 marks) • to administer a psychometric test (1 mark) the SADS-L (Schedule for Affective Disorders and Schizophrenia – Lifetime Version) (2 marks) 1(b) The interviews were reviewed by a second psychiatrist. 2 Suggest one effect there could have been on the results if the interviews had not been reviewed by a second psychiatrist. Marks: Award 2 marks for an appropriate effect stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate effect identified but not applied. Answers may include (other appropriate responses to be credited): • the participant may not be suitable for the study (1 mark) which (i) may be bad for the person if they then participated (2 marks) (ii) it might break ethical guidelines (2 marks) • the data may be invalid (1 mark) because the first psychiatrist made an error in (i) diagnosis of BP type 1 (2 marks) (ii) checking the results of the SADS-L (2 marks) © Cambridge University Press & Assessment 2024 Page 7 of 33 1(c) Explain one strength and one weakness of a clinical interview as used in 4 this study. Marks: Up to 2 marks for each strength and up to 2 marks for each weakness: Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • it is used to confirm the individual circumstances (1 mark) the patient knows their family relationships, has to complete the psychometric assessment test; the practitioner only has notes of previous history (2 marks). • the individual patient can explain and answer any question (1 mark) for example about their BP disorder type 1 that may be asked; to clarify their suitability for the study (2 marks) Weaknesses: • the patient may use vague terms to describe their condition and be unable to clearly explain what the practitioner needs to know, or fully understand what the study is about (1 mark) such as BP disorder type 1, transporter genes (2 marks) • the patient may not understand medical jargon (1 mark) that is used such as BP disorder type 1, transporter genes (2 marks) © Cambridge University Press & Assessment 2024 Page 8 of 33

5 From the key study by Savage and Armstrong (1990) on the effect of practitioner style on patient satisfaction: 5(a)(i) Outline how participants were recruited for the study. 2 Syllabus: 3.1.2 key study for the effect of practitioner style on patient satisfaction: Savage and Armstrong (1990). Marks: Award 1 mark each feature (max 2 marks). Definitive answer: NB: Question is how, not identification of sampling technique. • use of a random number generator (essential for 2 marks) • select four patients from each surgery of one doctor • from an inner London general practice • over a four-month period. 5(a)(ii) Outline how participants were randomly allocated to the conditions of 2 the study. Marks: Award 2 marks for a detailed outline. Award 1 mark for a partial outline. Definitive answer: • cards used to randomly allocate directing or sharing style (done by doctor). • done after doctor had confirmed patient was suitable for participation in study. © Cambridge University Press & Assessment 2024 Page 14 of 33 5(b) Suggest one problem if participants had not been randomly allocated to 2 the conditions of the study. Marks: Award 2 marks for an appropriate effect stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate effect identified but not applied. Answers may include (other appropriate responses to be credited). • the results might not be valid (1 mark) because: certain personality types may be in the sharing group or vice versa. (+1 mark). the doctors or experimenters might manipulate allocation to show that a sharing style is better (+1 mark) 5(c) Explain two strengths of the use of random allocation in this study. 4 Marks: Up to 2 marks for each strength  2 Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • no participant bias: The participant does not choose which condition they are in and so they cannot bias the study (1 mark) the participant is randomly put into a directing or sharing condition. (2 marks) • no doctor bias: The doctor presenting the style cannot bias the study (1 mark) because the doctor does not know whether a directing or sharing style is the next card to appear (2 marks).

9(a) Plan an experiment to investigate which anti-depressant drug is more 10 effective for treating depression. Your plan must include details about: • experimental design • type of experiment Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate): • type of experiment • sample and sampling technique • independent variable • ethical guidelines • dependent variable • a procedure • controls • type of data, analysis of data, • choice of experimental design. use of descriptive statistics If appropriate: • an aim or hypothesis • counterbalancing, random (directional or non- allocation, randomised control directional)/null hypothesis trial • steps for making the study valid • single blind/double blind and reliable • other appropriate features Credit other elements of the plan as appropriate using the marking grid. © Cambridge University Press & Assessment 2024 Page 20 of 33 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.2.3 biological treatments including the use of anti-depressants (tricyclics, MAOIs and SSRIs). Description: Biochemicals: there many types of drug that relieve the symptoms of depression: • MAOIs inhibit the enzyme monoamine oxidase. This enzyme normally breaks down noradrenaline, serotonin and dopamine, but these neurotransmitters are not broken down, they stay at normal high levels and so ‘reduce depression’. • SSRIs selective serotonin reuptake inhibitors act on serotonin to stop it being reabsorbed and broken down after crossing a synapse NB: candidates could also legitimately include SNRIs (Serotonin- noradrenaline reuptake inhibitors (SNRIs), TCAs (tricyclic anti-depressants) SARIs (Serotonin antagonists and reuptake inhibitors) Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2024 Page 21 of 33 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your experiment. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response NB 1 mark for explanation of follow on from (b)i; 1 mark for explanation appearing in (a) x2 Example: measure of depression for baseline (BDI). Two independent groups for IV: group 1 given MAOIs, group 2 SSRIs. Controls: no other drugs to be taken; both groups for 12 months. DV is change in level of depression (BDI again). 9(c)(i) Explain one reason for your choice of experimental design. 2 Candidates should use the choice of experimental design stated in (a). Award 2 marks if an appropriate reason is given and justified. Award 1 mark if an appropriate reason is given but not justified. Example: • an independent design was chosen because it allows an experimental group to be compared directly to a control group or one treatment group with another (1 mark) related to plan (2 marks) • a repeated design would control participant variables (1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2024 Page 22 of 33 9(c)(ii) Explain one weakness of your choice of experimental design. 2 Candidates should use the design stated in (ci) Award 2 marks if a weakness is given and justified. Award 1 mark if a weakness is given but not justified. • with an independent design there is no control over participant variables (1 mark) related to study (2 marks) • a related design would not work because the same participant would do two (or more) conditions and the effect of the first might influence the second (and third) (1 mark) related to study (2 marks) • with a repeated measures design there is the possibility of order effects (1 mark) related to study (2 marks) • with a repeated measures design there is the possibility that the participant is more likely to work out the aim of the experiment (1 mark) related to study (2 marks) 9(c)(iii) Explain one reason for your choice of type of experiment. 2 Candidates should use the choice of experiment stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: • laboratory experiments have high levels of control, so the DV is more likely to be caused by the IV (1 mark) example from part (a) of plan (2 marks) • field experiment perhaps more difficult to control but possible to have high levels of ecological validity (1 mark) example from part (a) of plan (2 marks) © Cambridge University Press & Assessment 2024 Page 23 of 33

1 Rahul has obsessive-compulsive disorder (OCD) and constantly worries about his 4 For full marks, candidate needs family’s safety. To reduce these worries, he arranges his books by colour, to suggest how CBT will treat newspapers in date order and food in his kitchen cupboards alphabetically. If any Rahul’s OCD – such as of the items are placed out of sequence, Rahul becomes very anxious and 1 Realising his family’s safety immediately puts them back in order. is not affected by organising his house. Rahul will be Suggest how cognitive-behavioural therapy (CBT) could treat Rahul’s OCD. able to stop organising.

2 Can learn relaxation Possible content – techniques to cope with Up to 2 marks for: anxiety/worry – as this • Using YBOCs to assess before, during and after treatment reduces his worry about • Explaining OCD e.g. how common it is. Links between irrational/intrusive thoughts, family’s safety and will be compulsions and anxiety. able to organise items less • Homework of thoughts/compulsions/ feelings frequently and/or spend less time doing it. For example 3 Help Rahul make a plan for the future if he starts to A counsellor would start the CBT with Rahul by explaining OCD so that Rahul become worried about his understands the connection between his thoughts about his family (‘My family is in family’s safety and/or then danger’) and arranging his possessions in order. (1) Rahul will be given homework wants to organise his between sessions where he will write down his thoughts/worries about his family’s possessions. Rahul can safety, behaviours (arranging books by colour, newspapers in date order and food then do the relaxation alphabetically) and his feelings (worry/anxiety). (1) Rahul and the counsellor will review techniques and/or stop the homework and the counsellor will help him to restructure his thinking about his organising and practice family’s safety. (1) For example, Rahul could replace the thought of ‘Something bad will saying/thinking the happen to my family, unless I keep my food in alphabetical order’ with ‘My family are alternative thoughts. safe. (1) Putting food into alphabetic order does not affect my family’s safety’ which will help Rahul to stop/reduce his compulsive behaviour. (1) Allow exposure and response prevention (ERP). as used in Other appropriate responses should also be credited. Lovell and Lehmkuhl (12 year old boy, Jason, with ASD) © Cambridge University Press & Assessment 2025 Page 10 of 50 9990/32 Cambridge International AS & A Level – Mark Scheme February/March 2025 PUBLISHED Question Answer Marks Guidance 1 Exposed to stimuli that trigger obsessions/helped to refrain from obsessive behaviour. Can allow resisting obsessive behaviour/exposure to objects associated with obsessive behaviour No credit for finding the cause of the OCD or talking about the past/childhood. If no direct reference to Rahul’s symptoms cap at 2 © Cambridge University Press & Assessment 2025 Page 11 of 50 2(a) Outline what is meant by determinism, including an example from the 2 Example = psychodynamic psychodynamic explanation of fear-related disorders. explanation of fear- related disorders. Award 1 mark for an outline of the term/concept. Award 1 mark for an example. Example: Determinism means the individual has little or no control over the decisions that they make. (1) OR behaviour is caused/determined by external or unconscious forces. (1) AND For example, the psychodynamic explanation of phobias is deterministic as the phobia is caused by the unconscious repressing childhood conflict and displacing the fear created by the conflict onto the phobic object.(1) OR the phobia is caused by the unconscious impulses of the ID which is being denied/repressed. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 12 of 50 2(b) Explain one problem psychologists may have when investigating the 2 Not generalisable due to over- psychodynamic explanation of fear-related disorders. reliance on case studies.- must link to psychodynamic/fear- Award 2 marks for an explanation of the problem. related disorders. Award 1 mark for a basic outline of problem. Ethics regarding lack of consent Problems might include: from children = 0 • Fear-related disorder/phobia may have developed in early childhood so the person doesn’t remember what happened. Allow 1 mark for problems with • Psychologist may use techniques such as hypnosis to access childhood memories psychodynamic explanation of which can be inaccurate. fear-related disorders (missing • The ‘true’ cause of the fear is unconscious and difficult to access (or use hypnosis investigating part of Q). as outlined above) • Data collected is usually qualitative (through conversations with the Can credit definition within the example. therapist/psychologist) and is subjective. • The unconscious, ID, Ego, super-ego cannot be measured in a scientific way. Reference to id, ego, superego as from fear-related disorders Example: As the cause of fear-related disorders is early childhood conflict, the patient may not remember it. (1) The psychologist might use techniques such as hypnosis/dream analysis to access these memories but they are subjective ways of collecting data. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 13 of 50

3 Eesha has generalised anxiety disorder and her clinician wants to monitor her during therapy. 3(a) Suggest how the Generalised Anxiety Disorder assessment (GAD-7) could be 4 2 marks max if no reference to used to monitor Eesha during and after her therapy. scoring/items in GAD-7 Award 3–4 marks for a detailed answer with clear understanding of how GAD-7 can be used to monitor Eesha during and after her treatment. Award 1–2 marks for a basic answer with some understanding of how GAD-7 can be used to monitor Eesha during and after her treatment. Example: During – The counsellor can use the GAD 7 to monitor Eesha’s anxiety during treatment such as after a few months to monitor her progress. (1) This will tell them if her difficulties in relaxing or becoming easily irritated are happening less frequently. (1) If Eesha’s score is over 15 out of maximum of 21 this indicates severe anxiety and might suggest therapy needs to be continued. (1) After – The counsellor would want Eesha to have a score of 9 or less which is mild anxiety before completing therapy. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 14 of 50 3(b) Explain one weakness of the GAD-7. 2 Needs to refer to the GAD-7 or Award 2 marks for an explanation of a weakness of GAD-7. symptom(s) of generalised Award 1 mark for a basic explanation of a weakness of GAD-7. anxiety disorder for full marks. One weakness from: Allow outline of social • Collects quantitative data so does not provide any in-depth information on anxiety. desirability • Limited choice of options 0 to 3 – several days and over half the days seem very similar to each other. • A patient may not want to admit her anxiety levels honestly as embarrassed. • Not clear how much of the day you spend feeling anxious in order for it to count as a day. Example: One weakness is that the GAD 7 does not provide in-depth information about the patient’s generalised anxiety disorder as the data collected is quantitative. (1) For example, one of the questions is to rate if you become irritable or annoyed and this does not explain why the person is annoyed so the therapist won’t know if what is annoying the patient is changing from one week to the next. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 15 of 50

4(a) Describe the biochemical (dopamine hypothesis) explanation and the 6 Award up to 4 marks where the psychological (cognitive) explanation of schizophrenia. response has described only part of the question even if the Use Table A: AO1 Knowledge and understanding to mark candidate responses to this response otherwise meets the question. criteria for level 3 Candidates must discuss both the dopamine hypothesis and the cognitive explanation of schizophrenia. They can include examples of studies. L3 – needs to explain SZ – such as linking explanation to one or Biochemical (dopamine hypothesis) The dopamine hypothesis of schizophrenia more symptoms states that symptoms may be caused by an excess of dopamine in the mid-brain and a reduction in dopamine in the prefrontal cortex. The dopamine hypothesis of schizophrenia suggests that a high level of activity of dopamine D2 receptor neurotransmission in subcortical and limbic brain regions contributes to positive symptoms of schizophrenia (also striatum and cortex). Excessive dopamine in Broca’s is associated with hallucinations. Negative and cognitive symptoms (flattened affect) of the disorder can be attributed to decreased dopamine activity in prefrontal cortex. Cognitive (Frith, 1992) The symptoms of schizophrenia are due to faulty thinking processes. The patient fails to recognise through a central monitoring system that they thoughts they are having are self-created (such as our inner voice) and instead believe these are cause by external factors. The delusions may be a way of explaining the hallucinations. There may be a cognitive impairment of patients with schizophrenia which could explain some of the symptoms such as speech poverty and disorganised thoughts. The patients may also have a less developed theory of mind and find it difficult to understand the actions of others and so may develop delusions as a way of understanding other people’s behaviours. Frith does acknowledge biological factors such as genes, biological processes and brain structure. However, as no single gene, biological process or brain structure accepted as cause feels better to focus on cognitive/faulty mental processes. Tested with patients by asking them whether the items read out loud were done by themselves, an experimenter or computer. Patients with incoherent speech performed the worst. © Cambridge University Press & Assessment 2025 Page 16 of 50 4(a) Delusions – as a way of explaining hallucination (e.g. alien control, thought insertion). Avolition/lack of speech/social withdrawal– difficult to make decisions about how to act/what to do without a prompt from someone else as can’t monitor own mental status or those of others. Can’t start a conversation but can contribute to one. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 17 of 50 4(b) Evaluate the biochemical (dopamine hypothesis) explanation and the 10 Can credit practical application psychological (cognitive) explanation of schizophrenia, including a discussion of usefulness/treatment/ about reductionism versus holism. application everyday with an outline of antipsychotics and Evaluation in your answer can include strengths, weaknesses and a discussion of CBT. issues and debates. However don’t credit the ethics Use Table B: AO3 Analysis and evaluation to mark candidate responses to this of the treatments unless clearly question. presented as a counter point to usefulness. A range of issues could be used for evaluation here. These include: • Named issue – Reductionism versus holism - The biochemical/dopamine explanation is more reductionist as it explains schizophrenia in terms of one cause (dopamine) without taking into account other explanations. The cognitive explanation is less reductionist (more holistic) as it considers the cognitive experiences of the patient but also considers that these cognitive distortions could be due to biological/genetic causes. • Nature versus nurture –The biochemical explanation supports nature as the excess of dopamine could be caused by genetic factors. It could, however, also be said to support nurture as it may be the overload of experiences that the schizophrenic person is having that lead to the excess of dopamine. The cognitive explanation can be seen to support the nurture side of the debate as the cognitions the person is experiencing are due to experiences. However, Frith/cognitive does not deny the importance of dopamine and the role of biochemical processes in the cognitive experiences of the schizophrenic patient • Individual and situational explanations – Both explanations can be seen to give an individual explanation as dopamine levels are unique to each person and could be caused by genetics. Cognitive could be considered individual as self-talk and an underdeveloped theory of mind are unique to each individual. However, dopamine can be affected by the situation – such as having a schizophrenogenic mum, child abuse, etc. which can lead to someone becoming vulnerable to developing schizophrenia which leads to imbalance of dopamine. Similarly, the cognitive explanation could involve situational explanations in that type of self-talk could be influenced by upbringing and culture. © Cambridge University Press & Assessment 2025 Page 18 of 50 4(b) • Determinism versus free will – Biochemical explanation is deterministic as it suggests the biochemical cause (dopamine imbalance) of schizophrenia is out of the control of the person. Cognitive can be seen as deterministic as Frith’s theory is that the abnormal self-talk occurs due to biochemical imbalances over which the person has no control. In his study the patients have to decide if items are read out by themselves or the experimenter or a computer. Patients with incoherent speech performed the worst at the task. The patient doesn’t use their free will to create the voices instead these have a biochemical cause. However, there is an element of free will as schizophrenic patients can be helped to bring their self-talk under control and also to recognize disordered/delusional thinking patterns. • Idiographic versus nomothetic – Both explanations are nomothetic. Both give explanations that can be generalized to anyone with schizophrenia. The generalised theories are that the dopamine imbalance leads to the schizophrenia symptoms (e.g. over production of dopamine in Broca’s area could explain hallucinations). Cognitive is also a generalised theory that biological factors contribute to the development of schizophrenia. Due to this, patients fail to recognise their own internal voice and attribute it to an external cause. Other issues could include: • Application to everyday life • Cultural differences Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 19 of 50

1 From the key study by Oruč et al. (1997) on mood (affective) disorders: 1(a)(i) Outline the sample of participants used in this study. 4 AO1 Syllabus: 1.2.2 Key study on association analysis of genetics of depressive disorder: Oruč et al. (1997). Marks: Award 1 mark for each correct feature. Note: cannot have 2 marks from one bullet point. Definitive answer: • 42 test group and 40 healthy controls • test group 25 female and 17 males • control group 25 females and 15 males • age range from 31–70 • unrelated patients • diagnosed with BP disorder type I (BPI) or no disorder • 16 BPI patients had a positive family history as defined by at least one first-degree • relative suffering from major affective disorders • were all in- or out-patients • all associated with the REBRO and Vrapče psychiatric hospitals in Zagreb, Croatia • controls were age- and sex-matched • controls from the hospital staff and their friends. 1(b) Suggest one reason why a control group of participants was used in this 2 study. AO2 Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for reason identified but not applied. Answers may include (other appropriate responses to be credited). • to set a baseline to which the experimental group can be compared (1 mark) • including people who have no bipolar disorder (+1 mark) • including people who have no first-degree relative with a mental illness (+1 mark) © Cambridge University Press & Assessment 2025 Page 8 of 34 1(c) Explain two strengths of the sample used in this study, other than the 4 use of a control group. AO3 Marks: Up to 2 marks for each strength 2 Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied Answers may include (other appropriate responses to be credited): Strengths: • recruiting as in- and out-patients means that the participants are known to the researchers (1 mark) and that the patients are more likely to meet the inclusion criteria for the study (2 marks) • recruiting as in- and out-patients means that the participants are more likely to be familiar with the location for the study (1 mark) perhaps helping them to feel more relaxed and more willing to participate (2 marks) • as the test group participants had BP type 1 diagnosis they were more willing to participate to find out more about their disorder (1 mark) and more likely to want to contribute to research on bipolar disorder (2 marks). Note: accept ‘males and females’; ‘wide age range’ but not large sample size. © Cambridge University Press & Assessment 2025 Page 9 of 34

5 From the key study by Brudvik et al. (2016) on pain assessments by doctors, parents and children: 5(a) Outline two conclusions from the study that add to the understanding of 4 children’s pain. AO1 Syllabus: 3.3.2: Key Study on comparing pain assessments by doctors, parents and children: Brudvik et al. (2016). Marks: Award 2 marks for a detailed outline. Award 1 mark for a partial outline. Definitive answers (from the study): • emergency department physicians significantly underestimate pain (1 mark) from all medical conditions in paediatric patients ≥3 years old, especially from wounds, infections and soft tissue injuries, but less from fractures (2 marks). • physicians’ pain assessments improve with increasing levels of pain (1 mark), but still, hardly half of the children with severe pain receive pain relief (2 marks). • physicians should be cognizant that they are likely to underestimate children’s pain (1 mark) children’s self-reports through age-appropriate pain scales and parents’ assessments are important in order to improve pain management in the emergency department (2 marks). Note: Answers must be those from the study, not candidate suggestions. Note: findings (results) can only support a conclusion 5(b) Suggest one way pain in children could be measured without using self- 2 report pain rating scales. AO2 Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion but not applied. Answers may include (other appropriate responses to be credited). • observation of non-verbal cues (1 mark) such as grimaces, rubbing, limping (+1 mark). • observation of audible expressions (1 mark) groans, ‘ahhh’s’, crying (+1 mark) • observation of negative affect (1 mark) irritable, bad mood, misbehaving, not sitting still, etc (+1 mark) • self-report by the child (1 mark) expressing how much it hurts (+1 mark) (which is not a rating scale) • clinical interview by physician giving subjective estimate of child’s pain (1 mark) e.g. child is asked to describe their pain (2 marks). Note: UAB although a rating scale, is not a self-report and so is creditworthy. Note: MPQ and PPQ use rating scales. All visual analogue scales use rating scales (as do ‘smiley faces’) © Cambridge University Press & Assessment 2025 Page 15 of 34 5(c) Explain two weaknesses of conducting research on pain using children 4 as participants. AO3 Marks: Up to 2 marks for each weakness X2 Award 2 marks for an appropriate weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate weakness stated but not applied. Answers may include (other appropriate responses to be credited): Weaknesses • children may not understand complex instructions (1 mark) • children may not be able to explain what they are thinking or how they feel (1 mark) • …and not describe their pain accurately (+1 mark) • children may not exercise the right to withdraw; they may not understand a debriefing (1 mark) • it may be difficult to judge the reaction of children; lack language skills (1 mark) • …if they are asked questions about pain (+1 mark) Note: question is ‘research on children (in general) so wide range of points can apply. Question Answer Marks

9(a) Plan a study using an online questionnaire to investigate whether 10 rational emotive behaviour therapy (REBT) is effective as a treatment for depression. Your plan must include details about: • question scoring/interpretation • ethical guidelines. Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate): • technique (paper/pencil, • sample and sampling online, postal) technique • format (open and/or closed) • ethical guidelines • examples of questions • a procedure • question • the location scoring/interpretation • type of data, analysis of data, • number of questions use of descriptive statistics • an aim or hypothesis (directional or non- directional)/null hypothesis • • steps for making the study valid and reliable 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.2.3 Treatment and management of mood (affective) disorders. psychological therapies: – Ellis’s rational emotive behaviour therapy (REBT). Answers are likely to include (other appropriate responses to be credited): Ellis focused on how illogical beliefs are maintained through: A: an activating event, B: the belief held about A, C: the consequences – thoughts, feelings or behaviours – resulting from A. RET therefore involves: D: disputing the irrational beliefs, E: the effects of successful disruption of the irrational beliefs. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2025 Page 21 of 34 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response Note: 1 mark for explanation of follow on from (b)i; 1 mark for explanation appearing in (a) 2 Example: the online questionnaire could ask a question such as ‘In relation to irrational beliefs do you dispute them: always/sometimes/never? showing knowledge of how the theory links to the plan. 9(c)(i) Explain one reason for your choice of question scoring/interpretation. 2 Candidates must use the question scoring/interpretation stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example • a (n-point) scale was used because each participant’s could express the amount of agreement/disagreement (1 mark) related to study (2 marks). • a yes/no was used because each participant’s response could be compared (1 mark) related to study (2 marks). • quantitative data was gathered because it allowed statistical analysis/production of descriptive statistics (1 mark) related to study (2 marks). • as the data is qualitative, a number of judges/raters were used to reach agreement on the words produced (1 mark) related to study (2 marks) • the answers gave qualitative data so was coded by raters/judges to ‘convert’ into quantitative data for statistical analysis (1 mark) related to study (2 marks) © Cambridge University Press & Assessment 2025 Page 22 of 34 9(c)(ii) Explain one weakness of your choice of question scoring/interpretation. 2 Candidates must use the choice of response interpretation stated in (ci). Award 2 marks: weakness is given and applied to the plan Award 1 mark: weakness is given without being applied to the plan Example • a different [3 or 7] point scale should have been used rather than the [e.g. 5] point used because the range of answers was too narrow/too wide (1 mark) related to study (2 marks) • a forced/fixed choice point scale should have been used (e.g. 4 point) because many participants opted for the middle/neutral answer on my [5 point] scale (1 mark) related to study (2 marks) • the raters/judges interpreting the answers may not agree leading to false findings (1 mark) related to study (2 marks) • only one person gathered the answers and they might have some bias toward the outcome of the study (1 mark) related to study (2 marks) Note: 0 marks for ‘ambiguous questions’ because that is not interpretation/scoring. 9(c)(iii) Explain one reason for your choice of an ethical guideline that you 2 followed. Candidates must use the ethical guideline stated in (a) Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: Any appropriate guideline receives credit • participants were given the right to withdraw from the study because… (1 mark) related to plan (2 marks) • participants gave informed consent because… (1 mark) related to plan (2 marks) • confidentiality was maintained because… (1 mark) related to plan (2 marks) • there was no deception, because…(1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2025 Page 23 of 34

1 Mahmoud has schizophrenia. His doctor suggests 4 For full marks, candidate needs to suggest how CBT will cognitive-behavioural therapy (CBT) to help manage manage at least one of Mahmoud’s positive symptoms Mahmoud’s positive symptoms. (specifically identified e.g. Hallucination, delusions). Suggest how CBT could be used to help Mahmoud manage his positive symptoms of schizophrenia. 1 mark – challenging irrational Award 3–4 marks for a detailed answer with clear thoughts/hallucinations/delusions/etc. understanding of CBT linked to help Mahmoud’s manage his 1 mark for example of this. positive symptoms. Award 1–2 marks for a basic answer with some Needs to state ‘psychoeducation’ plus brief definition for 1 understanding of CBT linked to help Mahmoud’s manage his (Do not credit if just identified or outlined – must do both) (positive) symptoms. Sensky found that CBT group compared to befriending Positive symptoms include group showed equivalent reduction in positive and negative Hallucinations symptoms at the end of treatment but 9 months later the Delusions improvement remained with CBT group but not befriending. Disorganised thinking Abnormal motor behaviour 1 mark – research has found that CBT is more effective (in reducing positive symptoms) than befriending in long term (9 Likely content month follow-up) • Initial session – therapeutic alliance/trusting relationship built with therapist. No credit to Socratic questioning • Psychoeducation – educating the person/family about the nature of their symptoms and how they are not real. Do not credit finding the cause of the schizophrenia or • Cognitive restructuring – discuss what thoughts the talking about the past/childhood as part of the treatment. person is having (such as delusion or hallucination), recognising the effects of thoughts on behaviour/mood, suggestion of alternative thoughts (e.g. replacing delusion with more rational thought, recognising the hallucination is not real). • Relaxation techniques to cope with anxiety brought on by positive symptoms • Homework – keeping a diary of positive symptoms/thoughts. Practising the alternative thoughts in between sessions. © Cambridge University Press & Assessment 2025 Page 11 of 59 1 For full marks, response must suggest how CBT will manage/reduce positive symptoms of schizophrenia. For example: CBT could help Mahmoud to manage the positive symptom of a delusion. He could discuss with the counsellor what his delusion currently is and why he thinks this way. (1) In between sessions Mahmoud could keep a diary of when he thinks about the delusion and how this makes him feel and/or behave and discuss this with the counsellor in his next session. (1) The counsellor will help him to think of alternative explanations for his delusion. The counsellor could suggest alternative thoughts that are more realistic than Mahmoud’s delusion. (1) This will help Mahmoud as he could think about these alternative thoughts when he is feeling anxious about his delusion or wanting to act on his delusion (1) and this would help him to feel better and/or engage less with his delusion and engage more in social activities. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 12 of 59

2(a) Outline Miller’s feeling-state theory of impulse control 2 Can credit an example of a specific impulse control disorder. disorders. For full marks needs to explain what the feeling-state is Award 2 marks for an outline of the term/concept. (desire to experience the positive emotions/physiological Award 1 mark for a basic outline of the term/concept. arousal again by doing the specific behaviour) Example: Intense positive feelings are linked with specific behaviours (e.g. gambling). (1) These feelings are the positive emotions, thoughts and physiological arousal that is remembered by the person and they want to experience the feeling state again so engage in the impulse control disorder behaviour. (2) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 13 of 59 2(b) Explain one reason why Miller’s feeling-state theory 2 1 mark for definition of holism – behaviour is understood by could be considered holistic. looking at the whole person, big picture, how the components work together to cause behaviour NOT just it is Award 2 marks for an explanation of one reason why Miller’s complex or considers lots of explanations/factors. feeling-state theory could be considered holistic. 1 mark for why holistic (includes experiences, emotions, Award 1 mark for a basic outline/identification of one reason physiology) to explain behaviour why Miller’s feeling-state theory could be considered holistic. 1 mark for example/strength of holism. Example: Miller’s feeling-state theory can be considered holistic as it includes both the emotions and physiological arousal a person experiencing when engaging in an impulsive behaviour (1). Therefore, this theory is holistic as it is explaining that impulse control disorder is due to an integrated experience of both emotions and physiological arousal (rather than just it’s separate parts emotions OR physiological arousal). (2) In addition, it considers the memory of these feelings (their cognitions) that means the person will want to engage in the behaviour over and over again to re-experience the positive feelings. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 14 of 59

3 Emi was unfairly dismissed from her job at a factory which she was very upset about. Afterwards, she started a fire at the factory, which made her feel better. Later she felt very anxious and purchased matches to relieve this anxiety. As she watched each match burn, she felt better. Although Emi has a new job in a shop, she is distracted by thoughts of starting a fire there. These thoughts make her feel very excited. 3(a) Using the diagnostic criteria (ICD–11) for pyromania: 3(a)(i) Suggest one reason why Emi may be diagnosed with 2 Link to ICD–11 pyromania. ICD–11 for Mortality and Morbidity Statistics Must link Emi’s symptom to the appropriate diagnostic Award 2 marks for a suggestion that gives one reason that criteria for full marks. Emi does meet the diagnostic criteria for pyromania. No credit for not intending to harm anyone or how long Emi Award 1 mark for a basic outline of a suggestion that gives has had symptoms. one reason that Emi does meet the diagnostic criteria for pyromania. ICD 11 • A recurrent failure to control strong impulses to set fires, resulting in multiple acts of, or attempts at, setting fire to property or other objects. • Lack of an apparent motive for the acts of, or attempts at, fire setting (e.g., monetary gain, revenge, sabotage, political statement, attracting recognition). • Persistent fascination or preoccupation with fire and related stimuli (e.g., watching fires, building fires, fascination with firefighting equipment). • The individual experiences increased tension or affective arousal prior to instances of, or attempts at, fire setting. • The individual experiences pleasure, excitement, relief or gratification during, and immediately following the act of setting the fire, witnessing its effects, or participating in its aftermath. © Cambridge University Press & Assessment 2025 Page 15 of 59 3(a)(i) Likely answers Fascination with fires (watching matches burn, thinking about factory fire); intense arousal prior to fire setting (feeling very excited while thinking about starting a fire at the shop) Example: One reason Emi meets the diagnostic criteria is that she is thinking a lot about the factory fire/staring a fire at the shop. (1) One of the criteria is showing persistent fascination with fires which is what Emi shows as she can’t stop thinking about fires. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 16 of 59 3(a)(ii) Suggest one reason why Emi may not be diagnosed 2 See 3(a)(i) for diagnostic criteria. with pyromania. Time not creditworthy Award 2 marks for a suggestion that gives one reason that Emi does not meet the diagnostic criteria for pyromania. Award 1 mark for an outline of a suggestion that gives one reason that Emi does not meet the diagnostic criteria for pyromania. Likely answers • There have not been multiple acts of fire setting (just started one fire at the factory) • There is a motive for the fire setting (she was fired from her job) • Co-morbidity with anxiety. Example: One reason Emi does not meet the diagnostic criteria is that it could be for revenge that she started the factory fire. (1) One of the diagnostic criteria is that there should be no motive for starting the fire and yet Emi has a reason. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 17 of 59 3(b) In relation to pyromania, Emi meets some of the 2 Needs to link to pyromania for full marks. diagnostic criteria and not others. Not enough to just repeat the Q in the answer as the link e.g. Emi does not meet all of the diagnostic criteria. Explain one other problem a doctor could have when making their diagnosis of Emi. Award 2 marks for an explanation of a problem a doctor could have when making their diagnosis of Emi. Award 1 mark for a basic explanation of a problem a doctor could have when making their diagnosis of Emi. One problem from: • Emi may not be honest with the doctor about the fire setting/watching the match burn. • There could be multiple reasons why Emi set the fire (fascination with fire and revenge) Example: One problem is that given the nature of this condition, Emi is engaging in illegal behaviour and so may not want to admit she has set a fire. (1) OR She may not want to tell her doctor she is thinking about setting another fire as this could get her into trouble. (1) AND Therefore it is difficult to make a diagnosis as the doctor may not be aware of the full extent of the fire setting behaviour and therefore judge whether she meets the criteria (persistent thoughts/multiple acts) (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 18 of 59

4(a) For the treatment and management of obsessive- 6 Award up to 4 marks where the response has described compulsive disorder (OCD): only part of the question even if the response otherwise meets the criteria for level 3. Describe SSRIs and exposure and response prevention (ERP). L3 – need to describe how SSRIs/ERP leads to reduction in symptoms of OCD. Use Table A: AO1 Knowledge and understanding to mark For SSRIs this could be through reference to the results of a candidate responses to this question. study or lessening of anxiety due to increase in serotonin. Candidates must discuss both the use of SSRI’s and For ERP could refer to results of the study or how it can lead exposure and response prevention (ERP) They can include to reduction in symptoms. examples of studies. For SSRIs SSRIs Can refer to the study by Rapoport on Charles (14-year-old The main medications prescribed are selective serotonin boy) – extensive washing rituals – given clomipramine which reuptake inhibitors (SSRIs). These can help improve OCD led to relief of symptoms (could pour honey onto hands) but symptoms by increasing the levels of a chemical called tolerance developed after 1 year and he relapsed. serotonin in the brain. The medication blocks the re-uptake of serotonin and increases serotonin receptors. A higher Lovell et al. – looked at CBT either face-to-face or on the dosage is given of SSRIs than would be given to someone telephone and used ERP with patients. Both were effective. with depression. This seems to then cause a lessening of Treatment considered to be clinically relevant if YBOCs pre- anxiety experienced by the patient and therefore they do not treatment score drops 2 standard deviations or more post- need to engage in the OCD behaviours in order to relieve treatment. This happened for 72% of all patients – 77% their anxiety (such as hand washing). telephone + 67% face-to-face. Both groups had high patient Soomro et al. did a meta-analysis of 17 studies (3097 satisfaction scores. participants) and found SSRIs more effective than placebo and led to reduction in Y-BOCs score. © Cambridge University Press & Assessment 2025 Page 19 of 59 4(a) Exposure response prevention (ERP) Discuss with therapist the nature of the symptoms – what are the obsession(s) and what compulsive behaviour does this then lead to. Identify situations that the patient will have obsessions about that can increase in severity. The patient will then do the behaviour either in the session or between sessions as homework. They can use coping statements to help them while they feel the heightened anxiety. The patient will learn as they experience each situation that the anxiety does eventually reduce and over time they will stop having the anxiety in these situations. Full credit can be given to an example. Example study – Lehmkuhl et al., 2008 Case study with a 12-year-old boy called Jason who had both autism and OCD. 10 50-minute sessions of CBT over 16 weeks. Used exposure response prevention, for example: Exposure – getting Jason to touch objects he has difficulties with such as elevator buttons, door handles, etc. Response prevention – reducing the anxious response to the objects by using coping statements. Jason does have high anxiety responses, but he learns as therapy progresses that these reduce quickly within a few minutes. After therapy score on Y-BOCS dropped from 18 to 3. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 20 of 59 4(b) For the treatment and management of obsessive- 10 Allow examples from Rapoport’s study. compulsive disorder (OCD): Ethics – children: Evaluate SSRIs and exposure and response prevention Do not credit that have to get consent from child (as parent (ERP), including a discussion about the use of children has given consent) or that ERP is harmful – unless in research. comparing it to the effectiveness of this treatment to reduce child’s OCD symptoms. Evaluation in your answer can include strengths, Allow issues with doing research on SSRIs with children as weaknesses and a discussion of issues and debates. they are more likely to cause physical harm to children than adults. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include: • Named issue – Use of children – Lehmkuhl used a 12-year-old boy (reference to any appropriate study using a child/group of children is creditworthy). Strengths can include – can help a patient early in their experience of OCD so can quickly tackle symptoms before becoming imbedded patterns, consent obtained from parents and also the treatment can be explained to the child if they are old enough to understand. Weaknesses can include – unlikely to be able to do ERP with young children as it may be too upsetting for them and would lack understanding that their anxiety would reduce, side effects from medication would have to be closely monitored/may not be appropriate with children, children may find it difficult to explain what they are thinking or use coping statements effectively. © Cambridge University Press & Assessment 2025 Page 21 of 59 4(b) • Also credit if the response evaluates a study that does not use children as the participants and the response will suggest why it would be difficult to use children in the study (weaknesses of using children in psychological research) and why it would be possible/beneficial to use children in this research (strengths of using children in psychological research). • Cultural differences – SSRI’s are used cross culturally and these have the same effects on the individual regardless of culture. Therapy such as ERP may be seen as being more of a Western treatment of OCD. Patients in some cultures may have difficulty with access to this therapy or there may be stigma around sharing their obsessions/compulsions with a stranger. • Individual and situational explanations – ERP can be seen as a situational explanation of the treatment and management of OCD as the patient is experiencing the situations around their obsessions in order to unlearn their anxious response. Can also be seen as individual explanation of the treatment and management of OCD as each patient’s obsessions/compulsions will be individual to them and therefore the treatment needs to be tailored to this. SSRIs can be seen as individual as the type of SSRI given and the dosage will be tailored to the response of each patient. This will depend on how well the symptoms of OCD are managed as well as side effects experienced. © Cambridge University Press & Assessment 2025 Page 22 of 59 4(b) • Case studies – Any example of a case study can be used. Strengths include – in-depth data received, often longitudinal so can track improvement in symptoms. Weaknesses include – lack of generalisability from findings as either 1 participant or a small group of participants, researcher/therapist may become very involved with the patient during the course of therapy so results may become biased. • Reliability – Can discuss the reliability of treatment (each patient receiving a similar treatment) or the reliability of the research. SSRIs have a specific treatment schedule where the patient often starts on a low dosage and increases over a set period of time which makes it reliable. There is a suggested outline of how to carry out ERP so every patient should experience this which also makes this therapy reliable. However, patients will have a different response to both treatments and therefore the recommended schedule may have to be adjusted. Reliability of research may include a discussion of controls used, selection criteria, data collection methods, etc. Other issues could include: • Determinism versus free-will • Validity • Ethics (do not credit that ERP is harmful but can credit side-effects/withdrawal symptoms when stopping either as part of ethics or on its own for SSRIs which have them and ERP doesn’t; SSRIs are non-addictive). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 23 of 59

1 Fazli has pyromania, he is unable to resist starting fires. Fazli sets fires and then 4 For full marks, candidate watches them burn, in order to relieve his anxiety. needs to suggest how imaginal desensitisation Suggest how imaginal desensitisation could help Fazli manage his symptoms of will help Fazli with his pyromania. symptoms. Award 3–4 marks for a detailed answer with clear understanding of how imaginal Negative reinforcement – desensitisation could help Fazli manage his symptoms of pyromania. reducing the unpleasant feeling of wanting to set Award 1–2 marks for a basic answer with some understanding of how imaginal desensitisation the fire as it is paired with could help Fazli manage his symptoms of pyromania. a feeling of relaxation – they cannot feel both Likely content anxious and relaxed and overtime experience Taught progressive muscle relaxation relaxation Visualise starting the fire/watching it burn Imagine leaving the situation without acting on urge to start the fire while continuing to feel No credit for finding the relaxed cause of pyromania or Can record the session/practice this as homework between therapy sessions talking about the Reduces arousal that is felt prior to starting the fire/while watching the fire burn. past/childhood as part of Reduces the connection between the impulsive behaviour (starting fire) and the positive the treatment. feelings. No credit for covert For example: sensitisation – where the Imaginal desensitisation could help Fazli with his symptoms of pyromania by first teaching him person imagines feeling muscle relaxation. (1) He imagines himself getting matches to take with him and planning something where to go to start the fire. (1) He then visualises starting the fire. Fazli imagines leaving the unpleasant/feeling sick. area where he might start a fire (1) while continuing to practice relaxation. (1) This will help him to learn how to reduce his arousal levels when he thinks about starting fires so he is less likely to do it. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 11 of 52

2(a) Outline systematic desensitisation as a treatment for a specific phobia. 2 Award 2 marks for an outline of the term/concept. Award 1 mark for a basic outline of the term/concept. Likely content • Fear hierarchy • Muscle relaxation • Progressively exposed to object/situation that they have the phobia about. • Experiences ‘reciprocal inhibition’ – cannot feel both anxiety and relaxation around the object/situation at the same time so unlearns phobic reaction. Example: Systematic desensitisation is where the patient devises a fear hierarchy with the least feared object to the most feared object. (1) They are then exposed to the object and practice relaxation in order to reduce their anxiety around this object. (1) Can credit an example of a specific phobia. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 12 of 52 2(b) Explain one reason why systematic desensitisation as a treatment for a specific phobia 2 The response must focus supports the situational side of the debate about individual and situational explanations. on the treatment. Award 2 marks for an explanation of why systematic desensitisation as a treatment for specific 1 mark for definition of phobia supports the situational side. situational. Award 1 mark for a basic explanation of why systematic desensitisation as a treatment for No credit – cause of specific phobia supports the situational side. phobia. Example: Do not credit if only Systematic desensitisation supports the situational side of the debate as the patient has to explaining why it is not unlearn the specific phobia within the situation of treatment. (1) The patient needs to individual with no mention experience the object/situation on their fear hierarchy in treatment sessions in order to of why it is situational. experience fear reduction and unlearn their phobia. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 13 of 52

3 When Lina was a child, outside with her mother, she saw a snake. She then developed a phobia of snakes. 3(a) Suggest a psychodynamic explanation for why Lina has this phobia of snakes. 4 Award 3–4 marks for a detailed answer with clear understanding of a psychodynamic explanation for why Lina has this phobia of a snake. Award 1–2 marks for a basic answer with some understanding of a psychodynamic explanation for why Lina has this phobia of a snake. Likely content • Phobias are a result of unresolved conflict between the id and ego • The snake could be a phallic symbol to represent Lina’s penis envy during the Electra complex which she can’t express (repression) so it is expressed as a phobia of a snake. • Phobia can be displacement – Lina is frightened of something else which she doesn’t want to express (e.g. fear of mum). Example: A psychodynamic explanation for Lina’s snake phobia is that is the expression of her Electra complex that was not resolved. (1) The snake represents her ID’s repressed desire for a penis (1) which Lina’s would not want to express due to feeling ashamed of it. (1) Her fear that someone might find out how she feels, such as her mum, means her feelings of fear get put onto the snake rather than feeling afraid her mum will find out about her penis envy. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 14 of 52 3(b) Explain one weakness of the psychodynamic explanation for Lina’s phobia of snakes. 2 Only credit that it doesn’t consider biological/genetic Award 2 marks for an explanation of one weakness of the psychodynamic explanation for if it is clear that the Lina’s phobia of snakes. response is saying the Award 1 mark for a basic explanation of one weakness of the psychodynamic explanation for psychodynamic does not Lina’s phobia of snakes. consider that Lina could have inherited her phobia One weakness from: from her parents. • Difficult to prove that the snake phobia is due to her unresolved Electra complex as this was something that happened during early childhood and Lina will not remember it. Just stating ‘ignores • Incomplete explanation – something may have frightened Lina when she saw the snake biology/genetic’ on its own and this is why she has the phobia. = 0 • Lina’s phobia has occurred due to psychic determinism – so it is out of her control and she will need the help of a psychotherapist in order to treat it. Context needed for 2nd • Psychodynamic explanation is based on case study evidence (such as Little Hans) which mark (snakes/phobia). means the explanation can lack validity. Accept individual Example: differences. One weakness of the psychodynamic explanation for Lina’s phobia of snakes is that it offers an incomplete explanation of why she might have this phobia. (1) She may have been frightened when she saw the snake (e.g. her mum started shouting) and this is why she has the phobia rather than being due to the unresolved Electra complex. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 15 of 52

4(a) Describe the following psychological explanations of depression: 6 Award up to 4 marks • Beck’s cognitive theory of depression, and where the response • learned helplessness. has described only part of the question Use Table A: AO1 Knowledge and understanding to mark candidate responses to this even if the response question. otherwise meets the Candidates must discuss both Beck’s cognitive theory of depression and learned criteria for level 3. helplessness/attributional style as explanations of depression. They can include examples of studies. Can credit Seligman (1988) study but not study Beck’s cognitive theory of depression on dogs. Depression due to faulty processing of information. Created the cognitive triad (negative views about the world, negative views about oneself and negative views about the future) which all influence each other and can lead the depressed individual to spiral into lowering moods. The triad of a depressed person leads to negative automatic thoughts and are often irrational and inaccurate. These negative thoughts/schema cause patients to distort their view of life experiences through a pessimistic filter, leading to a cycle of negative attitudes, behaviours and emotions. Learned helplessness Learned helplessness – Individuals learn through negative experience(s) to behave in a passive and helpless way. This is because they view the negative experience (s) to be inescapable and so give up trying to feel better. It can occur when the person experiences repeated failures or negative outcomes despite their efforts to change the situation. These repeated failures can lead to a sense of helplessness and depression. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 16 of 52 4(b) Evaluate the following psychological explanations of depression: 10 No credit for evaluation of • Beck’s cognitive theory of depression, and BDI • learned helplessness, including a discussion about determinism versus free-will. Evaluation in your answer can include strengths, weaknesses and a discussion of issues and debates. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include: • Named issue – Determinism versus free-will – Beck’s cognitive theory is somewhat deterministic as it is the negative experiences that lead to the automatic negative thinking. However, individuals can choose to think more positively and this can be seen when CBT is given to patients with depression and they can learn to change these automatic thoughts which shows free-will. Learned helplessness could be seen as somewhat deterministic as the person may feel they have no choice and are trapped in the negative situation. • Nature versus nurture – Beck’s cognitive theory supports nurture as the person is learning to have negative thoughts about themselves, the world and the future. Negative schemas are learned from experiences. Similarly learned helplessness supports nurture as it is the negative experience which is viewed as inescapable that leads to the development of helplessness. • Reductionism versus holism – The cognitive explanation is more holistic as it considers complex thought processes involved in the development of depression, however it could be considered to be somewhat reductionist as it ignores learning depression and/or genetic factors. Learned helplessness could also be considered somewhat holistic as it looks at the more complex process of learning depression from life experiences. However, it could also be considered to be environmentally reductionist as it does not consider genetic/neurochemical causes. © Cambridge University Press & Assessment 2025 Page 17 of 52 4(b) • Experiments – Seligman’s study is a quasi-experimental study. Strengths – good ecological validity, good control of measures of dependent variable used (BDI and attributional style questionnaire). Weaknesses – could have shown social desirability as patients were aware of their clinical/non-clinical status so may have reported more negative thoughts due to their depression diagnosis • Reliability – Seligman’s study was standardised with the use of the BDI and attributional style questionnaire which can be replicated. These are also reliable measures of depression/attributional style. The unipolar participants went through cognitive therapy and showed improvements. Therapy will be carried out differently with each participant which lacks reliability. Other issues could include: • Application to everyday life • Idiographic and nomothetic approach • Validity • Ethics Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 18 of 52

1 Mahmoud has schizophrenia. His doctor suggests 4 For full marks, candidate needs to suggest how CBT will cognitive-behavioural therapy (CBT) to help manage manage at least one of Mahmoud’s positive symptoms Mahmoud’s positive symptoms. (specifically identified e.g. Hallucination, delusions). Suggest how CBT could be used to help Mahmoud manage his positive symptoms of schizophrenia. 1 mark – challenging irrational Award 3–4 marks for a detailed answer with clear thoughts/hallucinations/delusions/etc. understanding of CBT linked to help Mahmoud’s manage his 1 mark for example of this. positive symptoms. Award 1–2 marks for a basic answer with some Needs to state ‘psychoeducation’ plus brief definition for 1 understanding of CBT linked to help Mahmoud’s manage his (Do not credit if just identified or outlined – must do both) (positive) symptoms. Sensky found that CBT group compared to befriending Positive symptoms include group showed equivalent reduction in positive and negative Hallucinations symptoms at the end of treatment but 9 months later the Delusions improvement remained with CBT group but not befriending. Disorganised thinking Abnormal motor behaviour 1 mark – research has found that CBT is more effective (in reducing positive symptoms) than befriending in long term (9 Likely content month follow-up) • Initial session – therapeutic alliance/trusting relationship built with therapist. No credit to Socratic questioning • Psychoeducation – educating the person/family about the nature of their symptoms and how they are not real. Do not credit finding the cause of the schizophrenia or • Cognitive restructuring – discuss what thoughts the talking about the past/childhood as part of the treatment. person is having (such as delusion or hallucination), recognising the effects of thoughts on behaviour/mood, suggestion of alternative thoughts (e.g. replacing delusion with more rational thought, recognising the hallucination is not real). • Relaxation techniques to cope with anxiety brought on by positive symptoms • Homework – keeping a diary of positive symptoms/thoughts. Practising the alternative thoughts in between sessions. © Cambridge University Press & Assessment 2025 Page 11 of 59 1 For full marks, response must suggest how CBT will manage/reduce positive symptoms of schizophrenia. For example: CBT could help Mahmoud to manage the positive symptom of a delusion. He could discuss with the counsellor what his delusion currently is and why he thinks this way. (1) In between sessions Mahmoud could keep a diary of when he thinks about the delusion and how this makes him feel and/or behave and discuss this with the counsellor in his next session. (1) The counsellor will help him to think of alternative explanations for his delusion. The counsellor could suggest alternative thoughts that are more realistic than Mahmoud’s delusion. (1) This will help Mahmoud as he could think about these alternative thoughts when he is feeling anxious about his delusion or wanting to act on his delusion (1) and this would help him to feel better and/or engage less with his delusion and engage more in social activities. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 12 of 59

2(a) Outline Miller’s feeling-state theory of impulse control 2 Can credit an example of a specific impulse control disorder. disorders. For full marks needs to explain what the feeling-state is Award 2 marks for an outline of the term/concept. (desire to experience the positive emotions/physiological Award 1 mark for a basic outline of the term/concept. arousal again by doing the specific behaviour) Example: Intense positive feelings are linked with specific behaviours (e.g. gambling). (1) These feelings are the positive emotions, thoughts and physiological arousal that is remembered by the person and they want to experience the feeling state again so engage in the impulse control disorder behaviour. (2) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 13 of 59 2(b) Explain one reason why Miller’s feeling-state theory 2 1 mark for definition of holism – behaviour is understood by could be considered holistic. looking at the whole person, big picture, how the components work together to cause behaviour NOT just it is Award 2 marks for an explanation of one reason why Miller’s complex or considers lots of explanations/factors. feeling-state theory could be considered holistic. 1 mark for why holistic (includes experiences, emotions, Award 1 mark for a basic outline/identification of one reason physiology) to explain behaviour why Miller’s feeling-state theory could be considered holistic. 1 mark for example/strength of holism. Example: Miller’s feeling-state theory can be considered holistic as it includes both the emotions and physiological arousal a person experiencing when engaging in an impulsive behaviour (1). Therefore, this theory is holistic as it is explaining that impulse control disorder is due to an integrated experience of both emotions and physiological arousal (rather than just it’s separate parts emotions OR physiological arousal). (2) In addition, it considers the memory of these feelings (their cognitions) that means the person will want to engage in the behaviour over and over again to re-experience the positive feelings. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 14 of 59

3 Emi was unfairly dismissed from her job at a factory which she was very upset about. Afterwards, she started a fire at the factory, which made her feel better. Later she felt very anxious and purchased matches to relieve this anxiety. As she watched each match burn, she felt better. Although Emi has a new job in a shop, she is distracted by thoughts of starting a fire there. These thoughts make her feel very excited. 3(a) Using the diagnostic criteria (ICD–11) for pyromania: 3(a)(i) Suggest one reason why Emi may be diagnosed with 2 Link to ICD–11 pyromania. ICD–11 for Mortality and Morbidity Statistics Must link Emi’s symptom to the appropriate diagnostic Award 2 marks for a suggestion that gives one reason that criteria for full marks. Emi does meet the diagnostic criteria for pyromania. No credit for not intending to harm anyone or how long Emi Award 1 mark for a basic outline of a suggestion that gives has had symptoms. one reason that Emi does meet the diagnostic criteria for pyromania. ICD 11 • A recurrent failure to control strong impulses to set fires, resulting in multiple acts of, or attempts at, setting fire to property or other objects. • Lack of an apparent motive for the acts of, or attempts at, fire setting (e.g., monetary gain, revenge, sabotage, political statement, attracting recognition). • Persistent fascination or preoccupation with fire and related stimuli (e.g., watching fires, building fires, fascination with firefighting equipment). • The individual experiences increased tension or affective arousal prior to instances of, or attempts at, fire setting. • The individual experiences pleasure, excitement, relief or gratification during, and immediately following the act of setting the fire, witnessing its effects, or participating in its aftermath. © Cambridge University Press & Assessment 2025 Page 15 of 59 3(a)(i) Likely answers Fascination with fires (watching matches burn, thinking about factory fire); intense arousal prior to fire setting (feeling very excited while thinking about starting a fire at the shop) Example: One reason Emi meets the diagnostic criteria is that she is thinking a lot about the factory fire/staring a fire at the shop. (1) One of the criteria is showing persistent fascination with fires which is what Emi shows as she can’t stop thinking about fires. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 16 of 59 3(a)(ii) Suggest one reason why Emi may not be diagnosed 2 See 3(a)(i) for diagnostic criteria. with pyromania. Time not creditworthy Award 2 marks for a suggestion that gives one reason that Emi does not meet the diagnostic criteria for pyromania. Award 1 mark for an outline of a suggestion that gives one reason that Emi does not meet the diagnostic criteria for pyromania. Likely answers • There have not been multiple acts of fire setting (just started one fire at the factory) • There is a motive for the fire setting (she was fired from her job) • Co-morbidity with anxiety. Example: One reason Emi does not meet the diagnostic criteria is that it could be for revenge that she started the factory fire. (1) One of the diagnostic criteria is that there should be no motive for starting the fire and yet Emi has a reason. (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 17 of 59 3(b) In relation to pyromania, Emi meets some of the 2 Needs to link to pyromania for full marks. diagnostic criteria and not others. Not enough to just repeat the Q in the answer as the link e.g. Emi does not meet all of the diagnostic criteria. Explain one other problem a doctor could have when making their diagnosis of Emi. Award 2 marks for an explanation of a problem a doctor could have when making their diagnosis of Emi. Award 1 mark for a basic explanation of a problem a doctor could have when making their diagnosis of Emi. One problem from: • Emi may not be honest with the doctor about the fire setting/watching the match burn. • There could be multiple reasons why Emi set the fire (fascination with fire and revenge) Example: One problem is that given the nature of this condition, Emi is engaging in illegal behaviour and so may not want to admit she has set a fire. (1) OR She may not want to tell her doctor she is thinking about setting another fire as this could get her into trouble. (1) AND Therefore it is difficult to make a diagnosis as the doctor may not be aware of the full extent of the fire setting behaviour and therefore judge whether she meets the criteria (persistent thoughts/multiple acts) (1) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 18 of 59

4(a) For the treatment and management of obsessive- 6 Award up to 4 marks where the response has described compulsive disorder (OCD): only part of the question even if the response otherwise meets the criteria for level 3. Describe SSRIs and exposure and response prevention (ERP). L3 – need to describe how SSRIs/ERP leads to reduction in symptoms of OCD. Use Table A: AO1 Knowledge and understanding to mark For SSRIs this could be through reference to the results of a candidate responses to this question. study or lessening of anxiety due to increase in serotonin. Candidates must discuss both the use of SSRI’s and For ERP could refer to results of the study or how it can lead exposure and response prevention (ERP) They can include to reduction in symptoms. examples of studies. For SSRIs SSRIs Can refer to the study by Rapoport on Charles (14-year-old The main medications prescribed are selective serotonin boy) – extensive washing rituals – given clomipramine which reuptake inhibitors (SSRIs). These can help improve OCD led to relief of symptoms (could pour honey onto hands) but symptoms by increasing the levels of a chemical called tolerance developed after 1 year and he relapsed. serotonin in the brain. The medication blocks the re-uptake of serotonin and increases serotonin receptors. A higher Lovell et al. – looked at CBT either face-to-face or on the dosage is given of SSRIs than would be given to someone telephone and used ERP with patients. Both were effective. with depression. This seems to then cause a lessening of Treatment considered to be clinically relevant if YBOCs pre- anxiety experienced by the patient and therefore they do not treatment score drops 2 standard deviations or more post- need to engage in the OCD behaviours in order to relieve treatment. This happened for 72% of all patients – 77% their anxiety (such as hand washing). telephone + 67% face-to-face. Both groups had high patient Soomro et al. did a meta-analysis of 17 studies (3097 satisfaction scores. participants) and found SSRIs more effective than placebo and led to reduction in Y-BOCs score. © Cambridge University Press & Assessment 2025 Page 19 of 59 4(a) Exposure response prevention (ERP) Discuss with therapist the nature of the symptoms – what are the obsession(s) and what compulsive behaviour does this then lead to. Identify situations that the patient will have obsessions about that can increase in severity. The patient will then do the behaviour either in the session or between sessions as homework. They can use coping statements to help them while they feel the heightened anxiety. The patient will learn as they experience each situation that the anxiety does eventually reduce and over time they will stop having the anxiety in these situations. Full credit can be given to an example. Example study – Lehmkuhl et al., 2008 Case study with a 12-year-old boy called Jason who had both autism and OCD. 10 50-minute sessions of CBT over 16 weeks. Used exposure response prevention, for example: Exposure – getting Jason to touch objects he has difficulties with such as elevator buttons, door handles, etc. Response prevention – reducing the anxious response to the objects by using coping statements. Jason does have high anxiety responses, but he learns as therapy progresses that these reduce quickly within a few minutes. After therapy score on Y-BOCS dropped from 18 to 3. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 20 of 59 4(b) For the treatment and management of obsessive- 10 Allow examples from Rapoport’s study. compulsive disorder (OCD): Ethics – children: Evaluate SSRIs and exposure and response prevention Do not credit that have to get consent from child (as parent (ERP), including a discussion about the use of children has given consent) or that ERP is harmful – unless in research. comparing it to the effectiveness of this treatment to reduce child’s OCD symptoms. Evaluation in your answer can include strengths, Allow issues with doing research on SSRIs with children as weaknesses and a discussion of issues and debates. they are more likely to cause physical harm to children than adults. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. A range of issues could be used for evaluation here. These include: • Named issue – Use of children – Lehmkuhl used a 12-year-old boy (reference to any appropriate study using a child/group of children is creditworthy). Strengths can include – can help a patient early in their experience of OCD so can quickly tackle symptoms before becoming imbedded patterns, consent obtained from parents and also the treatment can be explained to the child if they are old enough to understand. Weaknesses can include – unlikely to be able to do ERP with young children as it may be too upsetting for them and would lack understanding that their anxiety would reduce, side effects from medication would have to be closely monitored/may not be appropriate with children, children may find it difficult to explain what they are thinking or use coping statements effectively. © Cambridge University Press & Assessment 2025 Page 21 of 59 4(b) • Also credit if the response evaluates a study that does not use children as the participants and the response will suggest why it would be difficult to use children in the study (weaknesses of using children in psychological research) and why it would be possible/beneficial to use children in this research (strengths of using children in psychological research). • Cultural differences – SSRI’s are used cross culturally and these have the same effects on the individual regardless of culture. Therapy such as ERP may be seen as being more of a Western treatment of OCD. Patients in some cultures may have difficulty with access to this therapy or there may be stigma around sharing their obsessions/compulsions with a stranger. • Individual and situational explanations – ERP can be seen as a situational explanation of the treatment and management of OCD as the patient is experiencing the situations around their obsessions in order to unlearn their anxious response. Can also be seen as individual explanation of the treatment and management of OCD as each patient’s obsessions/compulsions will be individual to them and therefore the treatment needs to be tailored to this. SSRIs can be seen as individual as the type of SSRI given and the dosage will be tailored to the response of each patient. This will depend on how well the symptoms of OCD are managed as well as side effects experienced. © Cambridge University Press & Assessment 2025 Page 22 of 59 4(b) • Case studies – Any example of a case study can be used. Strengths include – in-depth data received, often longitudinal so can track improvement in symptoms. Weaknesses include – lack of generalisability from findings as either 1 participant or a small group of participants, researcher/therapist may become very involved with the patient during the course of therapy so results may become biased. • Reliability – Can discuss the reliability of treatment (each patient receiving a similar treatment) or the reliability of the research. SSRIs have a specific treatment schedule where the patient often starts on a low dosage and increases over a set period of time which makes it reliable. There is a suggested outline of how to carry out ERP so every patient should experience this which also makes this therapy reliable. However, patients will have a different response to both treatments and therefore the recommended schedule may have to be adjusted. Reliability of research may include a discussion of controls used, selection criteria, data collection methods, etc. Other issues could include: • Determinism versus free-will • Validity • Ethics (do not credit that ERP is harmful but can credit side-effects/withdrawal symptoms when stopping either as part of ethics or on its own for SSRIs which have them and ERP doesn’t; SSRIs are non-addictive). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 23 of 59

1 The key study by Chapman and DeLapp (2013) on blood/injection/injury phobia used the subjective unit of discomfort scale (SUDS) to assess the change in the anxiety levels of the patient ‘T’. 1(a)(i) Identify two situations included in the SUDS hierarchy used with ‘T’, 2 other than ‘getting a phlebotomy’. Syllabus 1.4.3 Key study on treating blood/injection/injury phobia using cognitive-behavioural therapy (CBT) with applied tension: Chapman and DeLapp (2013). Marks: 1 mark for each correct answer Note: wording does not need to be exact. Definitive answers: Getting a physical or stress test Seeing someone get a phlebotomy in person Getting blood pressure taken at Taking my own blood sugar CVS (a local pharmacy) or Wal-Mart Getting blood pressure by a nurse Wife taking my blood sugar Taking blood pressure myself Seeing someone get a phlebotomy in a video Wrapping a tourniquet around my arm and touching my veins © Cambridge University Press & Assessment 2025 Page 8 of 36 1(a)(ii) Give the results for one situation of the SUDS hierarchy identified in part 2 (a) that show a change in the anxiety levels of ‘T’. Marks: 1 mark for comment related to a situation and comment about numbers but no numbers.

5 From the key study on positive psychology in schools by Shoshani and Steinmetz (2014): 5(a)(i) Identify two features of the sample used in this study. 2 Syllabus: 3.5.3 Key study on using positive psychology in schools to improve mental health: Shoshani and Steinmetz (2014) Marks: Award 1 mark for each correct feature Definitive answers: participants were: • 1167 (at the outset) OR 1038 (completed sets of data by the end) • the seventh, eighth and ninth grades • aged 11.8–14.7 years at the beginning of the study • from two large middle schools in the center of Israel. • were mostly Jewish (98 %). • 57 % of the study population reported middle socioeconomic status • family status (64 % lived in a two-parent family, 36 % lived in a single- parent family) Note: 0 marks for ‘mix of males & females’. M/F numbers not known. © Cambridge University Press & Assessment 2025 Page 16 of 36 5(a)(ii) Give the two reasons why some participants withdrew from the study. 2 Marks: Award 1 mark each correct reason (numbers are not needed but may be provided). Definitive answers (from study): • due to absence (34 intervention, 22 control) • refusal to complete questionnaires (2 intervention, 4 control) Note: intervention group a total of 65 students did not complete the study (65 intervention, 59 in control; this is not a reason); ‘later dropped out’ (29 intervention, 33 control) is not a reason 5(b) The study included a ‘wait-list control condition’. 2 Suggest one reason for including this ‘wait-list control condition’. Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited). • schools and appropriate pupils are ‘ready and waiting’ (1 mark) six school principals agreed to be on the wait-control list (+1 mark) OR Another school was selected to the wait list control group, based on similar features to the intervention school (1 mark) such as socio-demographic characteristics and number of total students (+1 mark). • schools and appropriate pupils are prepared to be the intervention group (1 mark) with pupils continuing with the regular curricula of the social science lessons which were to impart information and to discuss issues related to the period of adolescence (+1 mark) • these schools act as a baseline (1 mark) to which the intervention group can be compared (2 marks) © Cambridge University Press & Assessment 2025 Page 17 of 36 5(c) Explain one strength and one weakness of using longitudinal studies to 4 investigate positive psychology in schools. Marks: Up to 2 marks for each strength and 2 marks for each weakness. Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • it can test to see if what was taught remained with a student over time (1 mark) related to study (2 marks) • it can be used as a pilot study on which to base future studies (1 mark) related to study (2 marks) Note: only credit ‘rich, in-depth information if fully justified. No credit for bias due to ‘relationships’ Weaknesses: • participants are young and can be influenced by things later in life ‘windows of opportunity’ at different ages (e.g. Lau et al) (1 mark) related to study (2 marks) • participants move to different types of education which may or may not promote the same values (1 mark) related to study (2 marks) Question Answer Marks

9(a) Plan a study using a postal questionnaire to investigate attributional 10 styles in adults with depression. Your plan must include details about: • type(s) of data • sampling technique. Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of The general features of the plan should the plan should include: include (if appropriate): • technique • sample and sampling technique (paper/pencil, online, • ethical guidelines postal) • a procedure • format (open and/or • a location closed) • type of data, analysis of data, use of • examples of questions descriptive statistics • question • an aim or hypothesis (directional or scoring/interpretation non-directional)/null hypothesis • number of questions • steps for making the study valid and reliable Credit other elements of the plan as appropriate using the marking grid. Note: Answers which merely post an ASQ without detail are restricted to Level 2 ‘identifies (lists) some appropriate method-specific features’. © Cambridge University Press & Assessment 2025 Page 23 of 36 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.2.2 Explanations of mood (affective) disorders: depressive disorder (unipolar). Psychological explanations: learned helplessness/attributional style, including a study, e.g. Seligman et al. (1988). Description: Seligman et al. (1988) extended learned helplessness; a person’s attributional style determined why people responded differently to adverse situational events. If a person makes an internal attribution (they are the cause), and if they believe that this is stable and global (the cause is consistent and this applies everywhere), then they may feel helpless and may experience depression. However, if they make other attributions (e.g. that the cause is external or situational; or unstable and specific), then helplessness and depression are unlikely. depression is associated with an internal/global/stable pattern. Note: the Seligman study is ‘an example’ so any appropriate alternative study could be used. Attributional style questionnaire (ASQ) could feature. Has 12 hypothetical events (6 good, 6 bad), then four questions: (1) a free-response question about the cause of the hypothetical event. 7-point scale: (2) whether the event has an internal or external cause; (3) a question about stable or unstable cause (4) a question about whether the event has a global or specific cause. Note: no credit for BDI. It does not measure attributional style. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2025 Page 24 of 36 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response Note 1 mark for explanation of follow on from (b)(i); 1 mark for explanation appearing in (a) 2 Example: Male and female participants can be sent an attributional style questionnaire and comparisons can be made about differences in response to the 6 good and 6 bad events. 9(c)(i) Explain one reason for your choice of type(s) of data. 2 Candidates must use the type(s)of data stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: • quantitative data can be statistically analysed by researchers (1 mark) related to plan (2 marks) • qualitative data can allow participants to provide reasons for their answer (1 mark) related to plan (2 marks) • both quantitative and qualitative data can be gathered to provide ‘best of both worlds’ (1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2025 Page 25 of 36 9(c)(ii) Explain one weakness of the use of a postal questionnaire in your study. 2 Candidates must use the postal questionnaire stated in (a) Award 2 marks: weakness is given and applied to the plan Award 1 mark: weakness is given without being applied to the plan Example • postal means that the questionnaire can be treated like ‘junk-mail’ and thrown away (1 mark) related to plan (2 marks) • the questionnaire could be started and then forgotten (1 mark) related to plan (2 marks) • the questionnaire may not be returned because that may incur costs for the participant (1 mark) related to plan (2 marks). 9(c)(iii) Explain one reason for your choice of sampling technique. 2 Candidates must use the sampling technique stated in (a) Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: • a random sample was chosen so everyone in the target population has an equal chance of participating (1 mark) related to plan (2 marks) • an opportunity sample was chosen because large numbers can be obtained relatively more easily than other methods (1 mark) related to plan (2 marks) • a volunteer sample was chosen because people are willing and more likely to participate; (1 mark) related to plan (2 marks). © Cambridge University Press & Assessment 2025 Page 26 of 36

1 In the key study by Freeman (2003) using virtual reality (VR) to investigate persecutory ideation, comments were made by the participants about the avatars. 1(a) Give one positive and one negative comment made by the participants 4 about the avatars. Syllabus: 1.1.1 Key study using virtual reality to investigate persecutory ideation: Freeman et al. (2003). Marks: Award 2 marks for each appropriate answer (exact words or very close to). 1 mark partial answer (‘half’ an answer such as ‘They were ignorant’ missing ‘an unfriendly’) Definitive answers: Note: 1 mark for ‘they (looked/seemed/were/appeared) friendly’ Note: do not credit ‘opposites’. e.g. they looked friendly (is 1 mark) but they looked unfriendly (=0 not 2) © Cambridge University Press & Assessment 2025 Page 8 of 35 1(b) Suggest how the comments about avatars could be analysed. 2 Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited). • content analysis (transforming qualitative data into quantitative data (1 mark) so the number of each type of positive and negative comment can be categorized (2 marks) • categories could be decided by a panel of judges (1 mark) and then each comment made about the avatar by a participant allocated to a category (2 marks) • the number of times the same comment about an avatar was made could be tallied (1 mark) and descriptive statistics applied to this data (2 marks) • could count the number of specific words (1 mark) such as ‘friendly’ (2 marks) Note: 0 marks for ‘positive and negative’ with no elaboration or example. 1(c) Explain one strength and one weakness of collecting qualitative data to 4 investigate schizophrenia using avatars in VR. Marks: Up to 2 marks for each strength and up to 2 marks for each weakness: Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • allows participants to express their view not just give a number (1 mark) such as when making comments about avatars such as ‘I smiled and chuckled’ (2 marks) • provides a wide range of views from participants that researchers may not have thought about (1 mark) such as the range shown in Table 2. (2 marks) Weaknesses: • qualitative data does not allow for comparisons to be made easily with other participants (1 mark) so when positive or negative comments are made about avatars these cannot be easily compared (2 marks) • qualitative data might need judges to assess words for meaning (1 mark) because without this, conclusions about the use of avatars might be ambiguous (2 marks) © Cambridge University Press & Assessment 2025 Page 9 of 35

5 From the key study by Yokley and Glenwick (1984) on improving medical adherence using community interventions: 5(a) Outline two dependent variables (dependent measures) recorded by 4 Yokley and Glenwick. Syllabus: 3.2.3 Key study on improving medical adherence using community interventions: Yokley and Glenwick (1984). Marks: Award 2 marks for a detailed outline. Award 1 mark for a partial outline. Definitive answers: three measures considered most relevant to inoculation promotion were selected: • the number of target children (1 mark) receiving one or more inoculations at the clinic (2 marks) • the number of target children attending the clinic (1 mark) (for any reason) (2 marks) • the total number of inoculations/vaccinations/immunisations (1 mark) received by target children (2 marks). • number of children immunised =1; parents taking children to be immunised =0 5(b) Suggest one way that parents could receive information about the 2 importance of inoculations for their children, other than by post or telephone. Marks: Award 2 marks for an appropriate suggestion and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited): • advertisements on television (1 mark) a ‘famous person/celebrity’ could present an item (+ 1 mark) • school teachers could inform parents/parents’ evening (1 mark) • school teachers could ‘provide information’ teaching their children in class (1 mark) • send parents an email (1 mark) with detail (2 marks) • a fear arousal OR providing information campaign (1 mark) with detail such as ‘from a reliable source such as doctor’ (2 marks) • what specific vaccination/where to get it/when (added to any of above +1 mark) Note: ‘about the importance of inoculations for children’ (0 marks) Note: identification of way = 1 mark e.g. ‘by email’ =1 Note: 0 marks for ‘telephone or phone call’ Credit for text by phone or email by phone. © Cambridge University Press & Assessment 2025 Page 15 of 35 5(c) Explain two strengths of gathering objective data on inoculation 4 adherence. Marks: Up to 2 marks for each strength x2 Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied. Answers may include (other appropriate responses to be credited): Strengths • objective data is fact (1 mark) and the number of children receiving inoculations/ attending the clinic is unambiguous (2 marks) • objective data is derived from a source that has no subjectivity (1 mark) and the number of children receiving inoculations/attending the clinic is unambiguous (2 marks) • gathering objective data in this way is valid (1 mark) children receive their vaccination or they do not (2 marks) • the data collected will allow a comparison to see trends/changes (1 mark) in inoculations over time (2 marks). • objective data lends itself to quantitative analysis (1 mark) so data can be analysed to see patterns in inoculation uptake (2 marks). Question Answer Marks

9(a) Plan a study using an observation to investigate which type of 10 compulsion is most common in people diagnosed with obsessive- compulsive disorder (OCD). Your plan must include details about: • structured observation or unstructured observation • type(s) of data. Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the The general features of the plan plan should include: should include (if appropriate): • structured or • sample and sampling technique unstructured • ethical guidelines • covert or over • a procedure • controlled or naturalistic • a location • participant or non- • type of data, analysis of data, participant use of descriptive statistics • number of observers (inter- • an aim or hypothesis (directional rater reliability) or non-directional)/null hypothesis • behavioural categories • steps for making the study valid • could include: event or time and reliable sampling Credit other elements of the plan as appropriate using the marking grid. © Cambridge University Press & Assessment 2025 Page 21 of 35 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.5.1 diagnostic criteria for obsessive-compulsive disorder (ICD-11) focusing on types of obsessions and compulsions, including a study, e.g. Rapoport (1989) ‘Charles’. Description: should focus on compulsions. Common ones include: ritualistic acts: such as excessive cleaning: cleaning items hand washing checking: items such as locking hoarding items doors, that a switch is ‘off’ counting, ordering or arranging personal possessions Details of ‘Charles’ might be included because of his excessive washing behaviour. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2025 Page 22 of 35 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response Note 1 mark for explanation of follow on from (b)(i); 1 mark for explanation appearing in (a) 2 Example: I would use a structured observation with behavioural categories for checking, counting, cleaning and ritualistic behaviours and tally the behaviours for each person with OCD to see which of these behaviours is most common. I would use the case study of ‘Charles’ to identify the behaviours of washing and how data was gathered in that study. 9(c)(i) Explain one reason for your choice of a structured observation or 2 unstructured observation. Candidates must use the choice of structured or unstructured observation stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example • a structured observation uses behaviour checklists so observers know exactly what they are looking for; it is more reliable than unstructured observation (1 mark) related to study (2 marks) • a structured observation uses behaviour checklists so two observers can independently record behaviour and their reliability checked (1 mark) related to study (2 marks) • a structured observation can be used as a technique to measure the DV in an experiment (1 mark) related to study (2 marks) • an unstructured observation can be used as a pilot study (1 mark) related to study (2 marks) • an unstructured observation can be used when it is not known what specific behaviours should be observed (1 mark) related to study (2 marks) • an unstructured observation can be used to refine the range of behaviours for further study (1 mark) related to study (2 marks) © Cambridge University Press & Assessment 2025 Page 23 of 35 9(c)(ii) Explain one weakness of your choice of a structured observation or 2 unstructured observation. Candidates must use the observation feature stated in (c)(i) Award 2 marks: weakness is given and applied to the plan Award 1 mark: weakness is given without being applied to the plan Example • a structured observation may not include all the categories that need to be observed and so important behaviours are not recorded (1 mark) related to study (2 marks) • a structured observation might not have clearly defined categories and be too general (e.g. record counting, but counting what?) (1 mark) related to study (2 marks) • an unstructured observation means that it could be difficult to record all behaviours and so some might be missed (1 mark) related to study (2 marks) • an unstructured observation means that checking the reliability of observers would be problematic (1 mark) related to study (2 marks) 9(c)(iii) Explain one reason for your choice of type(s) of data. 2 Candidates must use the type(s)of data stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example • quantitative data can be statistically analysed by researchers (1 mark) related to plan (2 marks) • qualitative data can allow participants to provide reasons for their answer (1 mark) related to plan (2 marks) • both quantitative and qualitative data can be gathered to provide ‘best of both worlds’ (1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2025 Page 24 of 35

1 The key study by Chapman and DeLapp (2013) on blood/injection/injury phobia used the subjective unit of discomfort scale (SUDS) to assess the change in the anxiety levels of the patient ‘T’. 1(a)(i) Identify two situations included in the SUDS hierarchy used with ‘T’, 2 other than ‘getting a phlebotomy’. Syllabus 1.4.3 Key study on treating blood/injection/injury phobia using cognitive-behavioural therapy (CBT) with applied tension: Chapman and DeLapp (2013). Marks: 1 mark for each correct answer Note: wording does not need to be exact. Definitive answers: Getting a physical or stress test Seeing someone get a phlebotomy in person Getting blood pressure taken at Taking my own blood sugar CVS (a local pharmacy) or Wal-Mart Getting blood pressure by a nurse Wife taking my blood sugar Taking blood pressure myself Seeing someone get a phlebotomy in a video Wrapping a tourniquet around my arm and touching my veins © Cambridge University Press & Assessment 2025 Page 8 of 36 1(a)(ii) Give the results for one situation of the SUDS hierarchy identified in part 2 (a) that show a change in the anxiety levels of ‘T’. Marks: 1 mark for comment related to a situation and comment about numbers but no numbers.

5 From the key study on positive psychology in schools by Shoshani and Steinmetz (2014): 5(a)(i) Identify two features of the sample used in this study. 2 Syllabus: 3.5.3 Key study on using positive psychology in schools to improve mental health: Shoshani and Steinmetz (2014) Marks: Award 1 mark for each correct feature Definitive answers: participants were: • 1167 (at the outset) OR 1038 (completed sets of data by the end) • the seventh, eighth and ninth grades • aged 11.8–14.7 years at the beginning of the study • from two large middle schools in the center of Israel. • were mostly Jewish (98 %). • 57 % of the study population reported middle socioeconomic status • family status (64 % lived in a two-parent family, 36 % lived in a single- parent family) Note: 0 marks for ‘mix of males & females’. M/F numbers not known. © Cambridge University Press & Assessment 2025 Page 16 of 36 5(a)(ii) Give the two reasons why some participants withdrew from the study. 2 Marks: Award 1 mark each correct reason (numbers are not needed but may be provided). Definitive answers (from study): • due to absence (34 intervention, 22 control) • refusal to complete questionnaires (2 intervention, 4 control) Note: intervention group a total of 65 students did not complete the study (65 intervention, 59 in control; this is not a reason); ‘later dropped out’ (29 intervention, 33 control) is not a reason 5(b) The study included a ‘wait-list control condition’. 2 Suggest one reason for including this ‘wait-list control condition’. Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited). • schools and appropriate pupils are ‘ready and waiting’ (1 mark) six school principals agreed to be on the wait-control list (+1 mark) OR Another school was selected to the wait list control group, based on similar features to the intervention school (1 mark) such as socio-demographic characteristics and number of total students (+1 mark). • schools and appropriate pupils are prepared to be the intervention group (1 mark) with pupils continuing with the regular curricula of the social science lessons which were to impart information and to discuss issues related to the period of adolescence (+1 mark) • these schools act as a baseline (1 mark) to which the intervention group can be compared (2 marks) © Cambridge University Press & Assessment 2025 Page 17 of 36 5(c) Explain one strength and one weakness of using longitudinal studies to 4 investigate positive psychology in schools. Marks: Up to 2 marks for each strength and 2 marks for each weakness. Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • it can test to see if what was taught remained with a student over time (1 mark) related to study (2 marks) • it can be used as a pilot study on which to base future studies (1 mark) related to study (2 marks) Note: only credit ‘rich, in-depth information if fully justified. No credit for bias due to ‘relationships’ Weaknesses: • participants are young and can be influenced by things later in life ‘windows of opportunity’ at different ages (e.g. Lau et al) (1 mark) related to study (2 marks) • participants move to different types of education which may or may not promote the same values (1 mark) related to study (2 marks) Question Answer Marks

9(a) Plan a study using a postal questionnaire to investigate attributional 10 styles in adults with depression. Your plan must include details about: • type(s) of data • sampling technique. Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of The general features of the plan should the plan should include: include (if appropriate): • technique • sample and sampling technique (paper/pencil, online, • ethical guidelines postal) • a procedure • format (open and/or • a location closed) • type of data, analysis of data, use of • examples of questions descriptive statistics • question • an aim or hypothesis (directional or scoring/interpretation non-directional)/null hypothesis • number of questions • steps for making the study valid and reliable Credit other elements of the plan as appropriate using the marking grid. Note: Answers which merely post an ASQ without detail are restricted to Level 2 ‘identifies (lists) some appropriate method-specific features’. © Cambridge University Press & Assessment 2025 Page 23 of 36 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.2.2 Explanations of mood (affective) disorders: depressive disorder (unipolar). Psychological explanations: learned helplessness/attributional style, including a study, e.g. Seligman et al. (1988). Description: Seligman et al. (1988) extended learned helplessness; a person’s attributional style determined why people responded differently to adverse situational events. If a person makes an internal attribution (they are the cause), and if they believe that this is stable and global (the cause is consistent and this applies everywhere), then they may feel helpless and may experience depression. However, if they make other attributions (e.g. that the cause is external or situational; or unstable and specific), then helplessness and depression are unlikely. depression is associated with an internal/global/stable pattern. Note: the Seligman study is ‘an example’ so any appropriate alternative study could be used. Attributional style questionnaire (ASQ) could feature. Has 12 hypothetical events (6 good, 6 bad), then four questions: (1) a free-response question about the cause of the hypothetical event. 7-point scale: (2) whether the event has an internal or external cause; (3) a question about stable or unstable cause (4) a question about whether the event has a global or specific cause. Note: no credit for BDI. It does not measure attributional style. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2025 Page 24 of 36 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response Note 1 mark for explanation of follow on from (b)(i); 1 mark for explanation appearing in (a) 2 Example: Male and female participants can be sent an attributional style questionnaire and comparisons can be made about differences in response to the 6 good and 6 bad events. 9(c)(i) Explain one reason for your choice of type(s) of data. 2 Candidates must use the type(s)of data stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: • quantitative data can be statistically analysed by researchers (1 mark) related to plan (2 marks) • qualitative data can allow participants to provide reasons for their answer (1 mark) related to plan (2 marks) • both quantitative and qualitative data can be gathered to provide ‘best of both worlds’ (1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2025 Page 25 of 36 9(c)(ii) Explain one weakness of the use of a postal questionnaire in your study. 2 Candidates must use the postal questionnaire stated in (a) Award 2 marks: weakness is given and applied to the plan Award 1 mark: weakness is given without being applied to the plan Example • postal means that the questionnaire can be treated like ‘junk-mail’ and thrown away (1 mark) related to plan (2 marks) • the questionnaire could be started and then forgotten (1 mark) related to plan (2 marks) • the questionnaire may not be returned because that may incur costs for the participant (1 mark) related to plan (2 marks). 9(c)(iii) Explain one reason for your choice of sampling technique. 2 Candidates must use the sampling technique stated in (a) Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: • a random sample was chosen so everyone in the target population has an equal chance of participating (1 mark) related to plan (2 marks) • an opportunity sample was chosen because large numbers can be obtained relatively more easily than other methods (1 mark) related to plan (2 marks) • a volunteer sample was chosen because people are willing and more likely to participate; (1 mark) related to plan (2 marks). © Cambridge University Press & Assessment 2025 Page 26 of 36

1 Hugh has obsessive-compulsive disorder (OCD). Hugh’s childhood was difficult. His 4 Biochemical explanation is mother had an obsession about germs, insisting on excessive cleanliness. creditworthy= high levels of dopamine and low levels of Suggest two different explanations of why Hugh has OCD. serotonin. Mixed evidence on oxytocin. Can credit oxytocin Syllabus reference: dysfunction can lead to Explanations of OCD feelings of distrust and fear of • biological explanations: biochemical, genetic. stimuli that might pose a • psychological explanations: cognitive (thinking error), behavioural (operant conditioning), threat. psychodynamic Cognitive = faulty thinking For each suggestion about level of threat in 1 mark – named/outlined explanation environment / regarding 1 mark – detail/context of explanation certain objects/situations. Annotate with ticks to show where marks awarded. Dopamine deficiency not creditworthy Examples: Behavioural (operant conditioning) When he was a child, Hugh was rewarded for his clean behaviour by his mother, perhaps through praise (1). This reinforced a compulsion to clean (1), both positively by feeling he is clean and negatively because the obsession with germs is being relieved, albeit briefly (1). Psychodynamic During the anal stage, tension arose between Hugh and his mother (parents) wishing to control his urination and defecation (1). To regain control Hugh may have either become anally retentive because of fear of the responses his parents would have (1). Hugh would have been fixated at the anal stage leading to compulsive cleaning to deal with this earlier childhood trauma (1). © Cambridge University Press & Assessment 2025 Page 10 of 49 1 Genetic Hugh could have inherited OCD from his mother (1). High concordance rates between family members for OCD including Monzani et al. (2014) concordance rate for MZ 52% and DZ 21% (1), Lewis (1936) found 37% of OCD patients had parents with OCD and 21% siblings with OCD (1), pointing to evidence for the heritability of OCD. In addition, a number of genes such as PTPRD and SLITRK3 have been linked to OCD symptoms (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 11 of 49

2(a) Outline what is meant by ‘cultural differences’. 2 Differences between cultures 1 mark – definition of culture = no credit 1 mark – detail of how differences may occur / example of a difference. Candidates should define culture and describe how/why cultures differ. They may use an example. Annotate with ticks to show where marks awarded Examples: • Culture is a shared set of beliefs within a group (society) (1). • The set of beliefs may not be the same between different cultures (1). • Recognising that research conducted in one culture may not apply to another (1) because of the difference in societal norms (1). • Different common practices in one society can affect findings and may not be applicable universally, e.g. One culture may view hearing voices as something desirable (hearing voices of ancestors), whereas within another society this could be seen as a symptom of schizophrenia. (2) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 12 of 49 2(b) Explain one reason why cultural differences could affect the diagnosis of an anxiety 2 disorder. 1 mark – Basic reason given (could have little reference to anxiety disorder). 1 mark – Reason with both cultural differences and anxiety disorder referenced. Candidates may focus on how cultural differences affect diagnosis of an anxiety disorder OR on the implications of that diagnosis within their culture. Annotate with ticks to show where marks awarded Examples: Being aware of the background of the individual gives information as to how debilitating their anxiety disorder is likely to be in terms of failure to function adequately and deviation from social norms (1). Diagnosing someone with a fear of snakes would be more significant (and presumably common) in a culture where snakes are more common and/or venomous (1). It will give the clinician a better understanding of appropriate treatment (1). One difference might be seen with the diagnosis of agoraphobia (1). In some cultures the fear of being outside the home could be linked to social norms of not leaving home frequently / being out alone (1). This could lead to agoraphobia as being seen as more acceptable in society (1). Fear of flying is much more likely to be diagnosed in those from wealthier nations (1). If an individual is unlikely to take a plane, then they are unlikely to be burdened by this phobia (1). More affluent people would be affected more as plane flights needed for travel (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 13 of 49

3(a) Habiba has a phobia of flying insects. She is afraid of the noise they make, and is very 4 For full marks context of flying scared if one lands on her. Habiba’s therapist recommends that she is treated using insects must be included systematic desensitisation. Suggest how Habiba’s therapist can use systematic desensitisation to treat Habiba’s phobia. Annotate with ticks to show where marks awarded 1 mark for outline/reference to each of the following • Teaching relaxation techniques • Creation of fear hierarchy (therapist and Habiba together) • Gradual exposure to least feared item whilst practicing relaxation (reciprocal inhibition) • Move on to next level of exposure, and again use relaxation • Over a number of sessions • Reference to flying insects/example Example: Habiba’s therapist teaches her relaxation techniques. These could include breathing exercises and visualization (1). Habiba and her therapist draw up a fear hierarchy. This could include, at the lowest level, Habiba looking at a picture of a fly (1) the next level up could be hearing a buzzing noise that is quite quiet and at the highest level a number of wasps flying around with one actually landing close to Habiba (1). Habiba is exposed to a photo of a fly and she uses the practiced relaxation techniques so that she feels relaxed when looking at the picture (1) based on the idea of reciprocal inhibition (you cannot feel both fear and relaxation at the same time) (1). Once relaxed at this lowest level, the therapist then exposes Habiba to the next level of stimulus and plays a quiet recording of a buzzing sound (1). Again, Habiba uses the techniques to relax whilst the sound is playing (1). This is repeated over a number of sessions (say 6) until Habiba is able to feel relaxed in the most fear-inducing step on her hierarchy (1). © Cambridge University Press & Assessment 2025 Page 14 of 49 3(b) Explain one weakness of systematic desensitisation. 2 Unethical – not creditworthy. 1 mark – basic weakness (could be true for other therapies) 2 marks – detailed weakness that references systematic desensitisation. Annotate with ticks to show where marks awarded Likely weakness from: • Requires the intervention of a therapist, which could make it difficult to obtain and/or costly • Takes place over several sessions and this requires commitment on behalf of patient • Patient may need to travel for treatment • Not suitable for some phobias • Treatment can be traumatic as involves exposure to feared stimulus – therefore the patient may stop treatment. Example: One weakness of using systematic desensitisation is that it requires commitment on the part of the patient because it usually takes place over a number of sessions (1). Sometimes patients do not have the financial resources or motivation to attend all of their sessions (1). Therapy is challenging as it means the patient has to confront their phobia and be exposed to it (1) as a result the therapy is not likely to be so successful as it hasn’t been completed (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 15 of 49

4(a) Describe what psychologists investigating the treatment and management of mood 6 Annotations: (affective) disorders have discovered about: Add the levels to get the mark • MAOI anti‑depressants, and awarded e.g. NAQ and L2 = 2 • Ellis’s rational emotive behaviour therapy (REBT). marks, L1 and L2 = 3 marks, L1 and L3 = 4 marks, L3 and Syllabus content L3 = 6 marks • Biological treatments including the use of anti-depressants (tricyclics, MAOIs and SSRIs) Plus, overall level at the • Ellis’s rational emotive behaviour therapy (REBT) bottom of the response as follows: For each bullet point award L1 to L3 depending on detail and accuracy. If bullet point not 1 or 2 marks = L1 creditworthy annotate with NAQ. 3 or 4 marks = L2

1 Halema has been having depressed moods. Her psychiatrist thinks Halema has 4 Annotation – one tick per either depressive disorder (unipolar) or bipolar disorder. mark. Suggest two differences that may be seen in Halema’s behaviour that would help 1 mark for the difference distinguish between depressive disorder (unipolar) and bipolar disorder. 1 mark for detail such as an example. For each difference List of symptoms = 1 mark if Award 2 marks for a suggestion with clear understanding of the difference between unclear that there are different depressive disorder and bipolar disorder. episodes of these symptoms Award 1 mark for a basic answer for bipolar. Likely answers: Time - • Presence of manic episodes where mood is high only in bipolar disorder For example – 1 difference is • Periods of mixed episodes (mania and depression) in bipolar disorder only. that bipolar switches between • Descriptions of features of mania that would not be seen in depression (e.g. feeling mania and depression (1) and very high and elated, feeling extremely irritable or touchy, reduced need for sleep) depression is just low mood OR no switching OR it is Examples: constant. (1) If Halema has bipolar disorder, she is likely to experience manic episodes, where she is excessively euphoric and energised (1). She may be extremely talkative and this will last at Symptoms – least one week (1). However, with depressive disorder she will not have manic episodes (1). Difference is that bipolar includes Halema could experience mixed episodes where her mood will cycle rapidly between mania/euphoria/extremely depression and mania if she has bipolar disorder (1). If she has depressive disorder her irritable followed by mood will remain low for a significant length of time (1). She would experience difficulty in depression but unipolar is just concentrating, recurrent thoughts about death, guilt, and/or sleep disturbances (1). loss of appetite, low mood, sleep disruption. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 10 of 42

2(a) Outline learned helplessness as an explanation of depressive disorder. 2 Can credit reference to Seligman’s dog study if the 1 mark = learned helplessness definition response outlines what is 1 mark = how does this explain depressive disorder meant by learned helplessness and/or states Example: how this explains depressive Learned helplessness explains depression as being the result of a perceived lack of disorder. control over situations (1). Depression occurs when the person stops trying to help themselves (1) because they believe nothing that they do will make things better (1). Other appropriate responses should also be credited. 2(b) Explain how the learned helplessness explanation of depressive disorder is an 2 individual explanation. 1 mark = what is an individual explanation 1 mark = link to learned helplessness. Examples: The learned helplessness explanation is individual (as opposed to situational) because the sufferer believes that they have a lack of control which makes them feel depressed because of their own personal experiences and thoughts (2). Two individuals could find themselves in the exact same situation but one will feel they can exert control and escape the situation (1) whereas the other does not. The one who is helpless has an individual view of the world that is different to that of other people (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 11 of 42

3(a) Blake has schizophrenia. His psychiatrist suggests treating him with atypical 4 Both block dopamine antipsychotics rather than typical antipsychotics. receptors but atypical blocks them for a shorter period of Suggest two reasons why atypical antipsychotics could be a suitable treatment for time which leads to less side Blake. effects. For each reason: Must state why suggestion 1 mark for identifying the reason. makes atypical a better 1 mark for detail. choice compared to typical. Likely answers: • Atypical antipsychotics treat both positive and negative symptoms • Fewer/less severe side-effects • More effective than typicals Answers could also be in terms of antipsychotics in general • Evidence of effectiveness. • Controlling positive and/or negative symptoms will make Blake more ready to accept other types of therapy such as CBT Examples: If Blake’s psychiatrist prescribed typical antipsychotics, Blake is more likely to experience severe side-effects such as tardive dyskinesia/movement disorder (1), where he would have sudden jerky movements in his face and body (1). Such side effects may cause him to stop taking his medication (1). This is less likely to occur with atypical antipsychotics as side effects are less severe (1) meaning Blake would continue to receive the treatment he needs. Atypical antipsychotics will tend to treat both positive and negative symptoms of schizophrenia (1). If Blake has found the negative symptoms of flattened affect and lack of motivation (1) particularly problematic, the atypical antipsychotics are more likely to treat these and so help Blake to feel better (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 12 of 42 3(b) Explain one weakness of using antipsychotics to treat schizophrenia. 2 Simply stating that it will lead to relapse with no explanation 1 mark for identifying the weakness. = 0. 1 mark for explanation/example of the weakness. Likely weaknesses: • Patient may forget to take them, especially if feeling ‘well’ causing relapse • Passive treatment • Range of side effects, some of which can be at least debilitating, others very serious. • Chemical cosh • Can develop tolerance leading to breakthrough symptoms / positive symptoms most likely to breakthrough. Negative symptoms can but return more slowly. Example: One weakness of using antipsychotics to treat schizophrenia is that it is a passive treatment (1). The patient is not really engaged in making themselves better but simply taking a pill (1). This means that they could be seen as less invested in their own recovery (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 13 of 42

4(a) Describe the following treatments for anxiety disorders and fear-related disorders: 6 Annotations: • cognitive-behavioural therapy (CBT), and Add the levels to get the mark • applied tension focusing on treating blood/injection/injury phobia. awarded e.g. NAQ and L2 = 2 marks, L1 and L2 = 3 marks, Use Table A: AO1 Knowledge and understanding to mark candidate responses to this L1 and L3 = 4 marks, L3 and question. L3 = 6 marks Syllabus content: Plus, overall level at the Treatment and management of anxiety disorders and fear-related disorders – bottom of the response as psychological therapy (exemplified by the following key study): follows: • Cognitive-behavioural therapy (CBT) 1 or 2 marks = L1 3 or 4 marks = L2 • Applied tension focusing on treating blood/injection/injury phobia Key study on treating blood/injection/injury phobia using cognitive-behavioural therapy 5 or 6 marks = L3 (CBT) with applied tension: Chapman and DeLapp (2013). If the response describes Candidates would be expected to describe the therapies themselves. They can be credited Chapman and DeLapp study for referencing the study on its own must clearly Cognitive-behavioural therapy (CBT) identify which is CBT and which is Applied Tension in This therapy is where the patient and therapist identify faulty thinking about the the study for L3. object/experience that the patient has a phobia about. The patient is taught relaxation techniques and practices these between sessions when faced with the phobic object. The patient is also taught to think alternative thoughts about the phobic object when presented with it (e.g., most dogs do not bite). In the case study, T was educated about how common phobias are and he created a fear hierarchy, which he worked through. Subjective Unit of Discomfort Scale (SUDS), which was used to give ratings of his anxiety (from 0–100) at different stages of the hierarchy exposure. CBT also encourages patients to practice coming up with alternative thoughts between sessions. © Cambridge University Press & Assessment 2025 Page 14 of 42 4(a) Applied tension Developed to help people who have a phobia of blood and/or needles and faint at the sight of them. This involves tensing the muscles in the body to raise blood pressure and makes it less likely the person will faint. In the case study, applied tension with T was used together with cognitive-behavioural therapy. Before treatment, T’s self-assessments showed he had severe anxiety surrounding blood and injections. During the therapy sessions T was able to experience each stage of this fear hierarchy, without his SUDS becoming too high. This ended with him having blood taken (SUDS of 40/100 initially, then soon dropping to ‘nothing’) with only minimal applied muscle tension used. At 4-, 10-, and 12-months post-treatment, T reported back on that he no longer showed fear or terror to medical-related stimuli. Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 15 of 42 4(b) Evaluate following treatments for anxiety disorders and fear-related disorders: 10 For each evaluation • cognitive-behavioural therapy (CBT), and point/issue/strength/weakness • applied tension focusing on treating blood/injection/injury phobia, /paragraph assess each and including a discussion of generalisations. record level on left hand side. Use Table B: AO3 Analysis and evaluation to mark candidate responses to this question. Use AN for analysis and A range of issues could be used for evaluation here. CONT for specific detail. These include: Overall level awarded • Named issue – generalisations – There is a great deal of evidence for the success underneath the candidate’s of CBT in a range of mental illnesses. There is also evidence of the success for response as follows – ‘best fit’ applied tension as a treatment for haemophobia (blood/injection phobia). It is possible from individual points e.g. if all that applied tension does not work well (cannot be generalised to) other anxiety L2 award L2 regardless of disorders or even other phobias. In terms of the study by Chapman and DeLapp this is how many, e.g. 6 L2 = 4 a single case study. It could be that another patient would not be treated as effectively marks. as T and not necessarily receive the same type of combined CBT / applied tension treatment as T. However, unlike other phobias, blood and injection phobias can be If 1 L4 and 2 L3 award L4 (but quite debilitating in a number of individuals, particularly for those who need to undergo give 7 rather than 8 marks). a lot of medical treatment so findings may be quite generalisable despite only being undertaken on one participant. If only 2 points but different levels not usually sufficient for the higher level overall, • Idiographic versus nomothetic – Use of this CBT / applied tension can be seen to e.g. 1 L1 and 1 L2 = L1 (2 be idiographic as it was a case study. However, there is no reason why it may not apply to others with phobias and fear related disorders too, making this more marks). nomothetic. The use of the various questionnaires and assessments will be making e.g. 1 L2 and 1 L3 = L2 (4 marks). use of standardised assessments which will have been based upon results from large numbers of people, making these assessments nomothetic such as Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Blood-Injection Symptom Scale (BISS) • Case studies – Chapman and DeLapp is a case study of one individual. The advantages of case studies are the acquisition of a great deal of data, enabling detail to be established. In this case this includes a variety of objective and quantitative measures, together with subjective data. However, case studies are not necessarily easy to generalise (see generalisations from findings). © Cambridge University Press & Assessment 2025 Page 16 of 42 4(b) • Self-reports – A large number of questionnaires and assessments were used in the Chapman and DeLapp study including Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Blood-Injection Symptom Scale (BISS), Quality-of-Life Satisfaction Questionnaire (Q-LES-Q), all of which allowed comparisons to be made before and after treatment in an objective manner. In addition, the subjective Unit of Discomfort Scale (SUDS), which was personalised to T, also enabled comparisons to be made. Qualitative reports after the study gave information about the success of the treatment. However, questionnaires can carry a risk of participants exaggerating or downplaying their symptoms in a way that more biomedical assessments will not. • Longitudinal studies – As the case study was carried out over some 9 sessions and then findings were further looked at for at least 12 months, this enabled change to be seen in T over an extended period of time. This is a strength because it is the same individual being looked at and it could enable researchers to discover an optimum number of sessions for successful treatment. Other possible issues/debates • Nature versus nurture • Determinism vs Free will • Reductionism vs holism • Quantitative data • Psychometrics Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 17 of 42

1 Hugh has obsessive-compulsive disorder (OCD). Hugh’s childhood was difficult. His 4 Biochemical explanation is mother had an obsession about germs, insisting on excessive cleanliness. creditworthy= high levels of dopamine and low levels of Suggest two different explanations of why Hugh has OCD. serotonin. Mixed evidence on oxytocin. Can credit oxytocin Syllabus reference: dysfunction can lead to Explanations of OCD feelings of distrust and fear of • biological explanations: biochemical, genetic. stimuli that might pose a • psychological explanations: cognitive (thinking error), behavioural (operant conditioning), threat. psychodynamic Cognitive = faulty thinking For each suggestion about level of threat in 1 mark – named/outlined explanation environment / regarding 1 mark – detail/context of explanation certain objects/situations. Annotate with ticks to show where marks awarded. Dopamine deficiency not creditworthy Examples: Behavioural (operant conditioning) When he was a child, Hugh was rewarded for his clean behaviour by his mother, perhaps through praise (1). This reinforced a compulsion to clean (1), both positively by feeling he is clean and negatively because the obsession with germs is being relieved, albeit briefly (1). Psychodynamic During the anal stage, tension arose between Hugh and his mother (parents) wishing to control his urination and defecation (1). To regain control Hugh may have either become anally retentive because of fear of the responses his parents would have (1). Hugh would have been fixated at the anal stage leading to compulsive cleaning to deal with this earlier childhood trauma (1). © Cambridge University Press & Assessment 2025 Page 10 of 49 1 Genetic Hugh could have inherited OCD from his mother (1). High concordance rates between family members for OCD including Monzani et al. (2014) concordance rate for MZ 52% and DZ 21% (1), Lewis (1936) found 37% of OCD patients had parents with OCD and 21% siblings with OCD (1), pointing to evidence for the heritability of OCD. In addition, a number of genes such as PTPRD and SLITRK3 have been linked to OCD symptoms (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 11 of 49

2(a) Outline what is meant by ‘cultural differences’. 2 Differences between cultures 1 mark – definition of culture = no credit 1 mark – detail of how differences may occur / example of a difference. Candidates should define culture and describe how/why cultures differ. They may use an example. Annotate with ticks to show where marks awarded Examples: • Culture is a shared set of beliefs within a group (society) (1). • The set of beliefs may not be the same between different cultures (1). • Recognising that research conducted in one culture may not apply to another (1) because of the difference in societal norms (1). • Different common practices in one society can affect findings and may not be applicable universally, e.g. One culture may view hearing voices as something desirable (hearing voices of ancestors), whereas within another society this could be seen as a symptom of schizophrenia. (2) Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 12 of 49 2(b) Explain one reason why cultural differences could affect the diagnosis of an anxiety 2 disorder. 1 mark – Basic reason given (could have little reference to anxiety disorder). 1 mark – Reason with both cultural differences and anxiety disorder referenced. Candidates may focus on how cultural differences affect diagnosis of an anxiety disorder OR on the implications of that diagnosis within their culture. Annotate with ticks to show where marks awarded Examples: Being aware of the background of the individual gives information as to how debilitating their anxiety disorder is likely to be in terms of failure to function adequately and deviation from social norms (1). Diagnosing someone with a fear of snakes would be more significant (and presumably common) in a culture where snakes are more common and/or venomous (1). It will give the clinician a better understanding of appropriate treatment (1). One difference might be seen with the diagnosis of agoraphobia (1). In some cultures the fear of being outside the home could be linked to social norms of not leaving home frequently / being out alone (1). This could lead to agoraphobia as being seen as more acceptable in society (1). Fear of flying is much more likely to be diagnosed in those from wealthier nations (1). If an individual is unlikely to take a plane, then they are unlikely to be burdened by this phobia (1). More affluent people would be affected more as plane flights needed for travel (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 13 of 49

3(a) Habiba has a phobia of flying insects. She is afraid of the noise they make, and is very 4 For full marks context of flying scared if one lands on her. Habiba’s therapist recommends that she is treated using insects must be included systematic desensitisation. Suggest how Habiba’s therapist can use systematic desensitisation to treat Habiba’s phobia. Annotate with ticks to show where marks awarded 1 mark for outline/reference to each of the following • Teaching relaxation techniques • Creation of fear hierarchy (therapist and Habiba together) • Gradual exposure to least feared item whilst practicing relaxation (reciprocal inhibition) • Move on to next level of exposure, and again use relaxation • Over a number of sessions • Reference to flying insects/example Example: Habiba’s therapist teaches her relaxation techniques. These could include breathing exercises and visualization (1). Habiba and her therapist draw up a fear hierarchy. This could include, at the lowest level, Habiba looking at a picture of a fly (1) the next level up could be hearing a buzzing noise that is quite quiet and at the highest level a number of wasps flying around with one actually landing close to Habiba (1). Habiba is exposed to a photo of a fly and she uses the practiced relaxation techniques so that she feels relaxed when looking at the picture (1) based on the idea of reciprocal inhibition (you cannot feel both fear and relaxation at the same time) (1). Once relaxed at this lowest level, the therapist then exposes Habiba to the next level of stimulus and plays a quiet recording of a buzzing sound (1). Again, Habiba uses the techniques to relax whilst the sound is playing (1). This is repeated over a number of sessions (say 6) until Habiba is able to feel relaxed in the most fear-inducing step on her hierarchy (1). © Cambridge University Press & Assessment 2025 Page 14 of 49 3(b) Explain one weakness of systematic desensitisation. 2 Unethical – not creditworthy. 1 mark – basic weakness (could be true for other therapies) 2 marks – detailed weakness that references systematic desensitisation. Annotate with ticks to show where marks awarded Likely weakness from: • Requires the intervention of a therapist, which could make it difficult to obtain and/or costly • Takes place over several sessions and this requires commitment on behalf of patient • Patient may need to travel for treatment • Not suitable for some phobias • Treatment can be traumatic as involves exposure to feared stimulus – therefore the patient may stop treatment. Example: One weakness of using systematic desensitisation is that it requires commitment on the part of the patient because it usually takes place over a number of sessions (1). Sometimes patients do not have the financial resources or motivation to attend all of their sessions (1). Therapy is challenging as it means the patient has to confront their phobia and be exposed to it (1) as a result the therapy is not likely to be so successful as it hasn’t been completed (1). Other appropriate responses should also be credited. © Cambridge University Press & Assessment 2025 Page 15 of 49

4(a) Describe what psychologists investigating the treatment and management of mood 6 Annotations: (affective) disorders have discovered about: Add the levels to get the mark • MAOI anti‑depressants, and awarded e.g. NAQ and L2 = 2 • Ellis’s rational emotive behaviour therapy (REBT). marks, L1 and L2 = 3 marks, L1 and L3 = 4 marks, L3 and Syllabus content L3 = 6 marks • Biological treatments including the use of anti-depressants (tricyclics, MAOIs and SSRIs) Plus, overall level at the • Ellis’s rational emotive behaviour therapy (REBT) bottom of the response as follows: For each bullet point award L1 to L3 depending on detail and accuracy. If bullet point not 1 or 2 marks = L1 creditworthy annotate with NAQ. 3 or 4 marks = L2

1 The key study by Grant et al. (2008) treated gambling disorder in one of two double-blind placebo-controlled trials, in a university and treatment centres. 1(a)(i) Identify the drug used in each trial. 2 Syllabus: 1.3.3 Key study on treating gambling disorder with drugs and placebo: Grant et al. (2008). Marks: Award 1 mark for each correct answer. Definitive answers: • Nalmefene (1 mark) • Naltrexone (1 mark) NB: trial does not need to be specified (e.g. trial 1 = nalmefene) NB: 0 marks for opioid antagonists. 1(a)(ii) State the duration of each trial. 2 Marks: Award 1 mark for each correct answer. Definitive answers: • 16 weeks (1 mark) • 18 weeks (1 mark) NB: trial does not need to be specified (e.g. trial 1 = 16 weeks) 1(b) Suggest why placebo-controlled trials were used in this study. 2 Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited): • to find out whether a drug treatment works better than a substance that does not have an active drug in it (1 mark) • to act as a control group or baseline to compare ‘with drug’ and ‘without drug’ conditions (1 mark) • to provide a baseline for a comparison between drug and non-drug conditions (1 mark) • without it, it might lead to false conclusions about the effect of the drug (1 mark) • without a placebo group, participants would know that they are receiving an active drug and this alone might result in a change in behaviour (1 mark) • related to study: inclusion of nalmefene/naltrexone; treatment of gambling disorder (+1 mark). NB: answer must refer to placebo for 2 marks. © Cambridge University Press & Assessment 2025 Page 8 of 35 1(c) Explain one strength and one weakness of using multiple locations 4 within this study. Marks: up to 2 marks for each strength and up to 2 marks for each weakness: Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail/elaboration/example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • participants might be different, perhaps making the study more representative/generalisable (1 mark) such as those living close to a university compared to those living near a treatment centre (2 marks) • a different location may provide a different outcome (1 mark) a study conducted in a laboratory (University of Minnesota) compared to a real- life setting (out-patient psychiatric treatment centres) (2 marks) Weaknesses: • participants in one location might have different characteristics from participants in a different location (1 mark) in this study participants were either at a University (attended there/students) rather than those at treatment centres (non-students) (2 marks) • different locations might attract different types of personalities which might affect behaviour/results (1 mark) people perhaps might participate at a university rather than a treatment centre/might participate because it is a treatment centre (2 marks) © Cambridge University Press & Assessment 2025 Page 9 of 35

5 The key study by Bridge et al. (1988) on reducing stress during medical treatment divided the female participants into two experimental groups and one control group. 5(a)(i) Outline the procedure followed by the ‘relaxation plus imagery’ 2 experimental group. Syllabus 3.4.3 Managing stress: Key study on relaxation and imagery in reducing stress during medical treatment: Bridge et al. (1988). Marks: Award 1 mark for correct point about relaxation (common to all groups); award 1 mark for imagery (specific to this group) Definitive answer: • both treatment groups (relaxation and relaxation plus imagery) were taught a relaxation technique which by a process of direct concentration focuses sensory awareness on a series of individual muscle groups. • patients were also given instructions for diaphragmatic breathing, which slows respiration, induces a calmer state, and reduces tension. • in addition to the breathing and relaxation, each patient in the relaxation plus imagery group was taught to imagine a peaceful scene of her own choice as a means of enhancing the relaxation. 5(a)(ii) Outline the experimental design that was used in this study. 2 Marks: Award 1 mark for each correct point (2 marks max) Definitive answer: Independent measures design (1 mark) relaxation only, and relaxation and imagery participated in only one condition (2 marks). 5(b) Suggest one problem if a different experimental design was used in this 2 study, other than the one you outlined in part (a)(ii). Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail/elaboration/example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited): If a repeated measures design was used: • knowledge of one technique would influence the next (1 mark) making either the relaxation or relaxation plus imagery redundant (2 marks). • treatment would go on for too long, potentially leading to attrition (1 mark) and so the sample would be too small to determine the effectiveness of either the relaxation/ relaxation plus imagery technique (2 marks) © Cambridge University Press & Assessment 2025 Page 14 of 35 5(c) Explain one strength and one weakness of using a sample of female 4 participants in studies on reducing stress. Marks: up to 2 marks for each strength and up to 2 marks for each weakness. Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail/elaboration/example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • stress reduction techniques can be tailored specifically for females rather than a generic ‘one size fits all’ (1 mark) particularly useful if the technique is designed to help reduce their anxiety about their illness (2 marks) • stress reduction techniques can be tailored specifically for females with ‘female illnesses’ (1 mark) in this study the participants had breast cancer (2 marks). Weakness • rather than one technique fits all, it would mean that a range of different techniques would be needed (1 mark) that are appropriate for men (or even different age ranges/ different types of illness (2 marks). • The female/female illness techniques would not generalise depending on the illness (1 mark) men can get breast cancer; but not ovarian (females do not get prostate cancer) (2 marks). Question Answer Marks

9(a) Plan a study using a structured observation to investigate the 10 effectiveness of imaginal desensitisation for treating gambling disorder. • naturalistic or controlled observation • type(s) of data Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate): • structured or unstructured • sample and sampling technique • covert or overt • ethical guidelines • controlled or naturalistic • a procedure • participant or non-participant • type(s) of data, analysis of • number of observers (inter-rater data, use of descriptive reliability) statistics • behavioural categories • an aim or hypothesis • could include: event or time (directional or non-directional)/ sampling null hypothesis • steps for making the study valid and reliable © Cambridge University Press & Assessment 2025 Page 21 of 35 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.3.3 Treatment and management of impulse control disorders. imaginal desensitisation, including a study, e.g. Blaszczynski and Nower (2003) Description: Imaginal desensitisation involves teaching progressive muscle relaxation and then the person visualises themselves being exposed to the situation. This triggers the drive to carry out the impulsive behaviour and the aim is to reduce the strength of the drive. Blaszcznski and Nower (2003) found this technique was particularly effective with gamblers. There are six steps in a typical treatment sequence: Initiating the urge, planning to follow through on the urge, arriving at the venue, getting arousal and excitement with the behaviour, having ‘second thoughts’ about the behaviour and decreasing the attractiveness of the behaviour. Blaszcznski and Nower (2003) conducted initial sessions with the therapist then conducted at home. 0 marks for covert sensitisation. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2025 Page 22 of 35 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response Example: In (b)(i) I explained how gamblers are taught progressive muscle relaxation with sessions specific to their type of gambling. Therefore in (a) I planned that after many sessions a structured observation can be conducted in a naturalistic setting to see whether they still engage in their specific type of gambling. 9(c)(i) Explain one reason for your choice of naturalistic observation or 2 controlled observation. Candidates should use the choice of interpretation/scoring stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: naturalistic observation because • it is conducted in a real-world setting (1 mark) such as a gambling casino where gambling behaviour could be covertly observed (2 marks) • behaviours are likely to be normal (high in ecological validity) (1 mark) because the participant will not know they are being observed in the casino and so effectiveness of treatment assessed (2 marks) • a full range of casino atmospherics are present (1 mark) so the effectiveness of the treatment in a real-world setting of a gambling casino is tested (2 marks) controlled observation because • it is conducted in a laboratory setting (1 mark) and so all variables such as the type of gambling, such as cards or machines, can be controlled (2 marks) • it is a ‘safe’ environment where the patient knows they are being observed (1 mark) and that they cannot lose (or win) real money (2 marks) © Cambridge University Press & Assessment 2025 Page 23 of 35 9(c)(ii) Explain one strength of using a structured observation in your study. 2 Candidates should use the choice of covert observation stated in (a). Award 2 marks if an appropriate strength is given and justified. Award 1 mark if an appropriate strength is given but not justified. Example • a structured observation uses behaviour checklists so observers know exactly what they are looking for, it is more reliable than unstructured observation (1 mark) related to study (2 marks) • a structured observation uses behaviour checklists two observers can independently record behaviour and their reliability checked (1 mark) related to study (2 marks) • a structured observation can be used as a technique to measure the DV in an experiment (1 mark) related to study (2 marks) 9(c)(iii) Explain one reason for your choice of type(s) of data. 2 Candidates should use the type(s) of data stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan. Example: • quantitative data can be statistically analysed by researchers (1 mark) related to plan (2 marks) • qualitative data can allow participants to provide reasons for their answer (1 mark) related to plan (2 marks) • both quantitative and qualitative data can be gathered to provide ‘best of both worlds’ (1 mark) related to plan (2 marks) Question Answer Marks © Cambridge University Press & Assessment 2025 Page 24 of 35

1 From the key study by Lovell et al. (2006) on the treatment of obsessive-compulsive disorder (OCD): 1(a) Outline two measures used in this study, other than the client 4 satisfaction questionnaire. Syllabus: 1.5.3 Key study on treatment of obsessive-compulsive disorder using telephone administered cognitive-behavioural therapy (CBT): Lovell et al. (2006). Marks: Award 2 marks for a detailed outline (e.g. two or more features of the measure). Award 1 mark for a partial outline (e.g. one feature) Award 1 marks for identification of both; 0 marks for identification of only one. Definitive answer (quote): • Yale Brown obsessive compulsive (Y-BOCS) checklist (self-report version). This is a 10 item questionnaire; each question scores between 0 and 4 (0 no symptoms, 4 severe symptoms). The total score range is 0–7 very mild, 8–15 mild, 16–23 moderate, 24–31 marked, and 32–40 severe. NB: the YBOCS can be administered by a clinician in a semi-structured, face- to-face interview. Lovell et al. used the self-report version, so no credit for ‘interview’. • a secondary outcome measure was the Beck Depression Inventory. (21 items, 0–3 scale, 63 points max) NB: 0 marks for any question or what Y-BOCS/BDI is measuring (ie OCD/Depression) 1(b) Suggest how the validity of one of these measures could be tested. 2 Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. NB does not need to use the terms criterion validity or construct validity. • concurrent validity by comparing the Y-BOCS/BDI to other measures of OCD (1 mark) and if the two scores have a strong correlation the Y-BOCS/BDI could be said to be valid (2 marks) • construct validity by seeing if seeing if the Y-BOCS/BDI matches up with theoretical ideas about what it is supposed to be measuring (1 mark) and if it does the Y-BOCS/BDI could be said to be valid (2 marks). • ecological validity: does the scale apply to real life (1 mark) do the questions (on paper) reflect real life experiences of people with OCD (2 marks) • temporal validity: test the Y-BOCS/BDI over time (1 mark) to see if the person shows any improvement (2 marks) e.g. reduction on obsessions or compulsions could be said to be valid (2 marks) © Cambridge University Press & Assessment 2025 Page 8 of 33 1(c) Explain two strengths of using rating scales to assess the effectiveness 4 of telephone-administered treatment of OCD. Marks: Up to 2 marks for each strength  2. Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength stated but not applied. Answers may include (other appropriate responses to be credited). • a rating scale can be used to assess the same person over time (1 mark) to see if there is any improvement (or not) in their OCD after treatment (2 marks). • a rating scale can be used to compare one person with another (1 mark) • a rating scale can be used as a diagnostic/assessment tool (1 mark) to determine the features of the person’s OCD and the severity of it on a standardised scale (2 marks). Question Answer Marks

5 From the key study by Savage and Armstrong (1990) on the effect of practitioner style on patient satisfaction: 5(a) Describe two ways that ethical guidelines were followed in this study. 4 Syllabus 3.1.2 Key study for the effect of practitioner style on patient satisfaction: Savage and Armstrong (1990). Marks: Award 2 marks for correct description. Award 1 mark for a partial description  2 Award 1 mark for identification of any two appropriate guidelines. Definitive answers: • informed consent: patients should not be studied without their agreement (1 mark). ‘We obtained patients' consent for the study by giving all patients attending each surgery a written request to allow audio tape recording of the consultation as part of a research project. If the patient refused to take part or was ineligible for the above reasons the next eligible patient to consult was selected.’ (2 marks) • psychological harm: patients should leave a study in the same state as they were before starting (1 mark) (i) ‘Patients were also excluded if it was thought that they would be upset by taking part in the study or would be incapable of completing a part of it.’ (ii) ‘they were excluded if they presented with a life threatening condition or for administrative or preventive measures only’. (2 marks) • right to withdraw (1 mark) ‘30 failed to complete the initial assessment; 110 failed to complete the assessment one week later’. (2 marks) NB: alternative answers can be credited if the ethical guideline followed is supported with a legitimate example from the study. 5(b) Suggest one way that data about satisfaction with the doctor could have 2 been collected, other than by postal questionnaire. Marks: Award 2 marks for an appropriate suggestion and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited): • participants could have participated in a telephone interview (1 mark) which could ask exactly the same questions as the postal questionnaire (2 marks). • participants could have returned to the surgery to complete the questionnaire (1 mark) so more likely data about consulting style would be gathered rather than not returning a postal questionnaire (2 marks). © Cambridge University Press & Assessment 2025 Page 14 of 33 5(c) Explain one strength and one weakness of collecting data on patient 4 satisfaction one week after the consultation, as done in this study. Marks: up to 2 marks for each strength and up to 2 marks for each weakness. Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail / elaboration / example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • one week is sufficiently close enough to the event for people to remember details of what happened (1 mark). This means that data gathered will be appropriate to consulting style (2 marks). • one week is appropriate for people to reflect on their experiences; respond with thought not knee-jerk emotional response (1 mark). This means that data gathered will be appropriate to consulting style (2 marks). Weaknesses: • one week is perhaps too long and people might have forgotten important details (1 mark) this means that data gathered regarding consulting style will be flawed (2 marks). • a week is a long time and things may happen to the person to prevent them from responding; perhaps they drop out or are not available (1 mark) this means that data gathered regarding consulting style will be flawed (2 marks). Question Answer Marks

9(a) Plan a study using a questionnaire to investigate thoughts about fires in 10 people diagnosed with pyromania. Your plan must include details about: • question format • questionnaire technique Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate): • technique (paper/pencil, • sample and sampling technique online, postal) • ethical guidelines • format (open and/or closed) • a procedure • examples of questions • type of data, analysis of data, • question scoring/interpretation use of descriptive statistics • number of questions • an aim or hypothesis (directional or non-directional)/ null hypothesis • steps for making the study valid and reliable 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.3.1 diagnostic criteria (ICD-11) of impulse control disorders: Kleptomania, pyromania & gambling disorder. Description: Pyromania is where a person has the urge to deliberately start a fire (and often to watch the fire or emergency services). Specifically, before setting the fire, the person must have felt some feelings of tension or arousal, must show that attraction to fire, must feel a sense of relief or satisfaction from setting the fire and witnessing it, and must not have other motives for setting the fire. Characteristics of addictions (Griffiths) may also be included. Note: ‘PSAS’ (like K-SAS) does not exist so 0 marks. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2025 Page 20 of 33 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response Example: Question format could be open, asking for example ‘Describe how you feel after watching a fire’. This links the question format I used in (a) with psychological knowledge about feelings after watching a fire I outlined in (b)(i). 9(c)(i) Explain one reason for your choice of question format. 2 Candidates must use the question format stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example (other appropriate responses to be credited): open questions: • the data gathered may be ‘rich’ and detailed (1 mark) related to plan (2 marks) • it allows participants the opportunity to express a range of feelings and explain their behaviour (1 mark) related to plan (2 marks) closed questions: • answers are in the same format for all participants (1 mark) related to plan (2 marks) • answers may be easy to score/analyse (1 mark) related to plan (2 marks) • relatively large numbers of participants can be questioned relatively quickly (1 mark) related to plan (2 marks) both closed and open: • open and closed are used to gather both qualitative and quantitative data (1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2025 Page 21 of 33 9(c)(ii) Explain one weakness of your choice of question format. 2 Candidates must use the question format stated in (c)(i). Award 2 marks: weakness is given and applied to the plan Award 1 mark: weakness is given without being applied to the plan Example (other appropriate responses to be credited): Open questions: • participants may not wish to express a range of feelings or explain their behaviour (1 mark) related to plan (2 marks). • Answers may be more difficult to analyse because it is qualitative data with no scale/fixed answers (1 mark) related to plan (2 marks) Closed questions: • participants have no opportunity to express a range of feelings or explain their behaviour stating ‘yes’ for example, does not allow participants to explain how they feel (1 mark) related to plan (2 marks) • participants can only respond with the answer options they have which might be forced (4-point scale) or limited (5-point scale) (1 mark) related to plan (2 marks) Both open and closed: • longer data analysis (e.g. recording and categorising open answers; use of judges/raters?) (1 mark) related to plan (2 marks) © Cambridge University Press & Assessment 2025 Page 22 of 33 9(c)(iii) Explain one reason for your choice of questionnaire technique. 2 Candidates should use the questionnaire technique stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example (other appropriate responses to be credited): Paper/pencil • because they are face-to-face perhaps participants are more likely to complete the questionnaire and perhaps be more honest in their answers (1 mark) related to plan (2 marks). • paper/pencil because the researcher is there at the time watching and waiting and so the environment is perhaps more likely to be controlled if done in a laboratory with students for example (1 mark) related to plan (2 marks). Online • online because the sample size can be much larger and potentially much more diverse than paper/pencil or face-to-face which is probably done in a relatively restricted place (in street, laboratory) related to plan (2 marks). • online because there is no researcher waiting, watching or influencing the person in any way. The participant is more likely to be honest in their responses (1 mark) related to plan (2 marks). Postal • postal because the sample size can be much larger and potentially much more diverse than paper/pencil or face-to-face which is probably done in in a relatively restricted place (in street, laboratory) (1 mark) related to plan (2 marks). • postal because there is no researcher waiting, watching or influencing the person in any way. The participant is more likely to be honest in their responses (1 mark) related to plan (2 marks). © Cambridge University Press & Assessment 2025 Page 23 of 33

1 The key study by Grant et al. (2008) treated gambling disorder in one of two double-blind placebo-controlled trials, in a university and treatment centres. 1(a)(i) Identify the drug used in each trial. 2 Syllabus: 1.3.3 Key study on treating gambling disorder with drugs and placebo: Grant et al. (2008). Marks: Award 1 mark for each correct answer. Definitive answers: • Nalmefene (1 mark) • Naltrexone (1 mark) NB: trial does not need to be specified (e.g. trial 1 = nalmefene) NB: 0 marks for opioid antagonists. 1(a)(ii) State the duration of each trial. 2 Marks: Award 1 mark for each correct answer. Definitive answers: • 16 weeks (1 mark) • 18 weeks (1 mark) NB: trial does not need to be specified (e.g. trial 1 = 16 weeks) 1(b) Suggest why placebo-controlled trials were used in this study. 2 Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited): • to find out whether a drug treatment works better than a substance that does not have an active drug in it (1 mark) • to act as a control group or baseline to compare ‘with drug’ and ‘without drug’ conditions (1 mark) • to provide a baseline for a comparison between drug and non-drug conditions (1 mark) • without it, it might lead to false conclusions about the effect of the drug (1 mark) • without a placebo group, participants would know that they are receiving an active drug and this alone might result in a change in behaviour (1 mark) • related to study: inclusion of nalmefene/naltrexone; treatment of gambling disorder (+1 mark). NB: answer must refer to placebo for 2 marks. © Cambridge University Press & Assessment 2025 Page 8 of 35 1(c) Explain one strength and one weakness of using multiple locations 4 within this study. Marks: up to 2 marks for each strength and up to 2 marks for each weakness: Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail/elaboration/example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • participants might be different, perhaps making the study more representative/generalisable (1 mark) such as those living close to a university compared to those living near a treatment centre (2 marks) • a different location may provide a different outcome (1 mark) a study conducted in a laboratory (University of Minnesota) compared to a real- life setting (out-patient psychiatric treatment centres) (2 marks) Weaknesses: • participants in one location might have different characteristics from participants in a different location (1 mark) in this study participants were either at a University (attended there/students) rather than those at treatment centres (non-students) (2 marks) • different locations might attract different types of personalities which might affect behaviour/results (1 mark) people perhaps might participate at a university rather than a treatment centre/might participate because it is a treatment centre (2 marks) © Cambridge University Press & Assessment 2025 Page 9 of 35

5 The key study by Bridge et al. (1988) on reducing stress during medical treatment divided the female participants into two experimental groups and one control group. 5(a)(i) Outline the procedure followed by the ‘relaxation plus imagery’ 2 experimental group. Syllabus 3.4.3 Managing stress: Key study on relaxation and imagery in reducing stress during medical treatment: Bridge et al. (1988). Marks: Award 1 mark for correct point about relaxation (common to all groups); award 1 mark for imagery (specific to this group) Definitive answer: • both treatment groups (relaxation and relaxation plus imagery) were taught a relaxation technique which by a process of direct concentration focuses sensory awareness on a series of individual muscle groups. • patients were also given instructions for diaphragmatic breathing, which slows respiration, induces a calmer state, and reduces tension. • in addition to the breathing and relaxation, each patient in the relaxation plus imagery group was taught to imagine a peaceful scene of her own choice as a means of enhancing the relaxation. 5(a)(ii) Outline the experimental design that was used in this study. 2 Marks: Award 1 mark for each correct point (2 marks max) Definitive answer: Independent measures design (1 mark) relaxation only, and relaxation and imagery participated in only one condition (2 marks). 5(b) Suggest one problem if a different experimental design was used in this 2 study, other than the one you outlined in part (a)(ii). Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail/elaboration/example. Award 1 mark for an appropriate suggestion identified but not applied. Answers may include (other appropriate responses to be credited): If a repeated measures design was used: • knowledge of one technique would influence the next (1 mark) making either the relaxation or relaxation plus imagery redundant (2 marks). • treatment would go on for too long, potentially leading to attrition (1 mark) and so the sample would be too small to determine the effectiveness of either the relaxation/ relaxation plus imagery technique (2 marks) © Cambridge University Press & Assessment 2025 Page 14 of 35 5(c) Explain one strength and one weakness of using a sample of female 4 participants in studies on reducing stress. Marks: up to 2 marks for each strength and up to 2 marks for each weakness. Award 2 marks for an appropriate strength/weakness stated and applied as required by the question with detail/elaboration/example. Award 1 mark for an appropriate strength/weakness stated but not applied. Answers may include (other appropriate responses to be credited): Strengths: • stress reduction techniques can be tailored specifically for females rather than a generic ‘one size fits all’ (1 mark) particularly useful if the technique is designed to help reduce their anxiety about their illness (2 marks) • stress reduction techniques can be tailored specifically for females with ‘female illnesses’ (1 mark) in this study the participants had breast cancer (2 marks). Weakness • rather than one technique fits all, it would mean that a range of different techniques would be needed (1 mark) that are appropriate for men (or even different age ranges/ different types of illness (2 marks). • The female/female illness techniques would not generalise depending on the illness (1 mark) men can get breast cancer; but not ovarian (females do not get prostate cancer) (2 marks). Question Answer Marks

9(a) Plan a study using a structured observation to investigate the 10 effectiveness of imaginal desensitisation for treating gambling disorder. • naturalistic or controlled observation • type(s) of data Use Table A: AO2 Application to mark candidate responses to this question. Credit both general features and specific features of the plan. The specific features of the plan The general features of the plan should include: should include (if appropriate): • structured or unstructured • sample and sampling technique • covert or overt • ethical guidelines • controlled or naturalistic • a procedure • participant or non-participant • type(s) of data, analysis of • number of observers (inter-rater data, use of descriptive reliability) statistics • behavioural categories • an aim or hypothesis • could include: event or time (directional or non-directional)/ sampling null hypothesis • steps for making the study valid and reliable © Cambridge University Press & Assessment 2025 Page 21 of 35 9(b) For one piece of psychological knowledge on which your plan is based: 9(b)(i) Describe this psychological knowledge. 4 Syllabus: 1.3.3 Treatment and management of impulse control disorders. imaginal desensitisation, including a study, e.g. Blaszczynski and Nower (2003) Description: Imaginal desensitisation involves teaching progressive muscle relaxation and then the person visualises themselves being exposed to the situation. This triggers the drive to carry out the impulsive behaviour and the aim is to reduce the strength of the drive. Blaszcznski and Nower (2003) found this technique was particularly effective with gamblers. There are six steps in a typical treatment sequence: Initiating the urge, planning to follow through on the urge, arriving at the venue, getting arousal and excitement with the behaviour, having ‘second thoughts’ about the behaviour and decreasing the attractiveness of the behaviour. Blaszcznski and Nower (2003) conducted initial sessions with the therapist then conducted at home. 0 marks for covert sensitisation. Marks Description 3–4 The knowledge is appropriate. Relevant points are correctly described in good detail. 1–2 Basic points are identified with some elaboration and understanding. The answer lacks detail (a sentence or two). 0 No creditable response © Cambridge University Press & Assessment 2025 Page 22 of 35 9(b)(ii) Explain how you used two features of this psychological knowledge to 4 plan your study. Candidates should explain how the psychological knowledge described in (b)(i) has informed their plan in part (a). For each feature: Marks Description 2 Suitable answer that relates a feature and explains how the feature was used, expanded or modified to make it appropriate to the plan. The knowledge has clearly been applied to the plan. 1 Basic answer that identifies a feature 0 No creditable response Example: In (b)(i) I explained how gamblers are taught progressive muscle relaxation with sessions specific to their type of gambling. Therefore in (a) I planned that after many sessions a structured observation can be conducted in a naturalistic setting to see whether they still engage in their specific type of gambling. 9(c)(i) Explain one reason for your choice of naturalistic observation or 2 controlled observation. Candidates should use the choice of interpretation/scoring stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan Example: naturalistic observation because • it is conducted in a real-world setting (1 mark) such as a gambling casino where gambling behaviour could be covertly observed (2 marks) • behaviours are likely to be normal (high in ecological validity) (1 mark) because the participant will not know they are being observed in the casino and so effectiveness of treatment assessed (2 marks) • a full range of casino atmospherics are present (1 mark) so the effectiveness of the treatment in a real-world setting of a gambling casino is tested (2 marks) controlled observation because • it is conducted in a laboratory setting (1 mark) and so all variables such as the type of gambling, such as cards or machines, can be controlled (2 marks) • it is a ‘safe’ environment where the patient knows they are being observed (1 mark) and that they cannot lose (or win) real money (2 marks) © Cambridge University Press & Assessment 2025 Page 23 of 35 9(c)(ii) Explain one strength of using a structured observation in your study. 2 Candidates should use the choice of covert observation stated in (a). Award 2 marks if an appropriate strength is given and justified. Award 1 mark if an appropriate strength is given but not justified. Example • a structured observation uses behaviour checklists so observers know exactly what they are looking for, it is more reliable than unstructured observation (1 mark) related to study (2 marks) • a structured observation uses behaviour checklists two observers can independently record behaviour and their reliability checked (1 mark) related to study (2 marks) • a structured observation can be used as a technique to measure the DV in an experiment (1 mark) related to study (2 marks) 9(c)(iii) Explain one reason for your choice of type(s) of data. 2 Candidates should use the type(s) of data stated in (a). Award 2 marks: reason is given and applied to the plan Award 1 mark: reason is given without being applied to the plan. Example: • quantitative data can be statistically analysed by researchers (1 mark) related to plan (2 marks) • qualitative data can allow participants to provide reasons for their answer (1 mark) related to plan (2 marks) • both quantitative and qualitative data can be gathered to provide ‘best of both worlds’ (1 mark) related to plan (2 marks) Question Answer Marks © Cambridge University Press & Assessment 2025 Page 24 of 35