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Understanding the psychological approaches is not merely an academic exercise: the lasting test of any approach is what it does in the real world. Each of the six approaches has generated distinctive practical applications — above all, methods of treating psychological disorders — that are used every day in clinics, hospitals, schools, prisons and workplaces. This is one of the most powerful sources of evaluation in the whole topic, because the success or failure of an approach's applications is itself evidence for or against the approach: the fact that drug therapies work tells us that biology genuinely influences disorder, just as the success of CBT tells us that cognition matters. This lesson works systematically through the application of each approach to therapy — behaviourist (systematic desensitisation, flooding, token economies), cognitive (CBT, REBT), biological (drug therapy), psychodynamic (psychoanalysis) and humanistic (client-centred counselling) — and then steps back to consider the ethics of applying psychology, evidence-based practice and NICE guidelines, and how the choice of treatment flows from the underlying view of mental health. Throughout, the key evaluative questions are: does the treatment work (effectiveness), is it appropriate for the disorder, and is it ethical?
This lesson draws together the AQA A-Level Psychology (7182) Approaches in Psychology topic with its applications, supporting the evaluation requirement that each approach be assessed partly through its real-world use. It links directly to the Psychopathology topic on Paper 1 (the behavioural, cognitive and biological treatments of phobias, depression and OCD — systematic desensitisation, flooding, CBT and drug therapy — are examined there in detail) and to Schizophrenia and other options on Paper 3 (antipsychotics, CBT for psychosis, token economies). It also connects to the free will/determinism and ethical implications material in Issues and debates (Paper 3).
Because the behaviourist approach holds that all behaviour — including maladaptive behaviour — is learned through conditioning, its therapies aim to help the person unlearn unwanted responses and learn healthier ones.
| Therapy | Based On | How It Works | Used For |
|---|---|---|---|
| Systematic desensitisation (SD) | Classical conditioning (counter-conditioning) | The feared stimulus is gradually re-associated with relaxation instead of fear, working up an anxiety hierarchy | Phobias |
| Flooding | Classical conditioning (extinction) | The person is exposed to the feared stimulus at full intensity, without escape, until the fear response extinguishes | Phobias |
| Aversion therapy | Classical conditioning | An unpleasant stimulus (e.g. a nausea-inducing drug) is paired with an unwanted behaviour to create a negative association | Alcohol dependence, smoking |
| Token economies | Operant conditioning | Desired behaviours are reinforced with tokens (secondary reinforcers) exchangeable for rewards | Behaviour management in institutions (psychiatric wards, prisons) |
| Behaviour modification | Operant conditioning | Reinforcement and (less often) punishment systematically shape behaviour | Classroom management, parenting programmes |
Exam Tip: Systematic desensitisation has three stages: (1) constructing an anxiety hierarchy (least to most feared situations); (2) training in relaxation (e.g. deep breathing, progressive muscle relaxation); and (3) gradually working up the hierarchy while staying relaxed. It rests on reciprocal inhibition — the principle that you cannot be relaxed and anxious simultaneously, so relaxation displaces the fear. Flooding works by the different mechanism of extinction: with no avoidance possible, the feared stimulus eventually produces no fear because the feared consequence never arrives.
The token economy deserves separate attention because it is the clearest application of operant conditioning and because it raises ethical issues the other behavioural therapies do not. In a token economy, run typically on a psychiatric ward or in a secure institution, staff identify target behaviours (e.g. self-care, social participation) and reinforce each instance immediately with a token — a secondary reinforcer that has no value in itself but can later be exchanged for primary reinforcers or privileges (sweets, time watching television, a pass). The immediacy of the token bridges the delay until the reward, which is essential for effective conditioning. Token economies can be remarkably effective at managing behaviour within the institution, but two limitations recur: the behaviour change frequently fails to generalise to life outside, where tokens no longer follow, and the technique can be criticised as a tool of social control, shaping people to be compliant and convenient for the institution rather than for their own benefit. These features make the token economy a favourite example for questions that combine effectiveness with ethics.
Because the cognitive approach locates disorder in faulty thinking, its therapies aim to identify, challenge and change maladaptive thoughts. Its great product is Cognitive Behavioural Therapy (CBT), among the most widely used and best-evidenced of all psychological treatments.
| Therapy | Key Theorist | How It Works | Used For |
|---|---|---|---|
| CBT (from Beck's cognitive model) | Aaron Beck | Identifies and challenges negative automatic thoughts and the dysfunctional schemas (the negative triad: self, world, future) that maintain depression; combines cognitive restructuring with behavioural tasks | Depression, anxiety, PTSD, OCD, eating disorders |
| REBT (Rational Emotive Behaviour Therapy) | Albert Ellis | Uses the ABC model: an Activating event (A) is interpreted through a Belief (B), producing an emotional Consequence (C). Where the belief is irrational, the therapist Disputes (D) it to achieve a healthier Effect (E) | Depression, anxiety, anger management |
graph TD
A["Identify negative automatic thoughts"] --> B["Examine the evidence for and against them"]
B --> C["Challenge and replace with more realistic thoughts"]
C --> D["Behavioural experiments / homework to test new beliefs"]
D --> E["Improved mood and functioning"]
CBT is typically delivered over roughly 12--20 sessions, is directive and collaborative, and sets "homework" between sessions so the client tests new beliefs in real life. It is recommended by NICE as a first-line psychological treatment for mild-to-moderate depression and most anxiety disorders. A key strength is that, unlike drug therapy, it addresses the maintaining causes (the dysfunctional cognitions) and equips the client with skills that reduce relapse.
Because the biological approach holds that disorder arises from physical abnormalities — neurochemical imbalance, genetics, brain structure — its applications aim to correct the biology directly, principally through drug therapy (psychopharmacology).
| Drug Type | Mechanism | Used For | Example |
|---|---|---|---|
| SSRIs (Selective Serotonin Reuptake Inhibitors) | Block the reuptake of serotonin at the synapse, leaving more available to act on the post-synaptic neuron | Depression | Fluoxetine, sertraline |
| Antipsychotics | Typical drugs block dopamine receptors; atypical drugs act on dopamine and serotonin receptors | Schizophrenia | Chlorpromazine (typical), clozapine (atypical) |
| Anxiolytics (benzodiazepines) | Enhance the action of GABA, the main inhibitory neurotransmitter, dampening neural activity | Anxiety disorders | Diazepam |
| Beta-blockers | Block the action of adrenaline/noradrenaline on the body, reducing physical arousal | Anxiety symptoms (trembling, racing heart) | Propranolol |
Key Definition: SSRIs (Selective Serotonin Reuptake Inhibitors) — antidepressant drugs that block the reabsorption (reuptake) of serotonin at the synapse, leaving more serotonin available to stimulate the post-synaptic neuron and so improving mood. Their effectiveness is itself evidence for the biological (serotonin) account of depression.
Drug therapies are cheap, require little effort from the patient, and can rapidly relieve severe symptoms, making other treatments (like CBT) more accessible. Their limitations, however, are that they treat symptoms rather than underlying psychological or social causes, can produce significant side effects, and may foster dependence — which is why NICE often recommends combining medication with a psychological therapy.
Because the psychodynamic approach locates disorder in unresolved unconscious conflict rooted in childhood, its therapy aims to make the unconscious conscious so the conflict can be worked through. This was the original "talking cure".
| Therapy | How It Works | Duration |
|---|---|---|
| Psychoanalysis | The client talks freely while the analyst interprets unconscious patterns, resistances and transference | Long-term (months to years; multiple sessions per week) |
| Free association | The client says whatever comes to mind without censorship; the analyst identifies recurring themes and conflicts | A core technique within psychoanalysis |
| Dream analysis | The analyst interprets the latent (hidden) content beneath the manifest content of dreams | A core technique within psychoanalysis |
| Psychodynamic psychotherapy | A shorter, more focused modern descendant, exploring how past relationships shape present functioning | Typically tens of sessions |
Psychoanalysis is generally considered helpful for long-standing relational and emotional difficulties and unhelpful — even contraindicated — for serious conditions such as schizophrenia, where exploring "unconscious meaning" is inappropriate and biological treatment is required.
Because the humanistic approach holds that distress arises from incongruence and conditions of worth, its therapy aims to provide the relational conditions in which the client's own actualising tendency can resume. The client, not the therapist, directs the work.
| Therapy | Key Therapist | How It Works | Used For |
|---|---|---|---|
| Client-centred (person-centred) therapy | Carl Rogers | The therapist supplies unconditional positive regard, empathy and genuineness/congruence; the client sets the agenda and finds their own solutions (non-directive) | General distress, low self-esteem, identity and relationship difficulties |
| Counselling | Various (humanistic roots) | Non-directive, empathic support to help a person explore feelings and reach their own decisions | Bereavement, stress, adjustment difficulties |
This is the purest expression of the approach's commitment to free will: the therapist deliberately refuses to diagnose, interpret or direct, trusting the client's capacity for growth — the polar opposite of the directive stance of psychoanalysis and CBT.
A useful way to organise the five therapies is along a directive--non-directive spectrum, which also maps neatly onto the free will and determinism debate. At the directive end, drug therapy and CBT position the practitioner as an expert who diagnoses the problem and prescribes the remedy — a chemical correction or a structured programme of cognitive change — consistent with the deterministic assumption that the disorder has identifiable causes to be targeted. Behavioural therapies (SD, flooding, token economies) are likewise directive and determinist: the therapist engineers the conditioning. Psychoanalysis is interpretive and therefore directive in a different sense — the analyst, not the client, holds the key to the unconscious meaning — which is precisely the source of the power-imbalance criticism. At the opposite, non-directive end stands client-centred therapy, where the client is the expert on their own experience and the therapist merely supplies the conditions for the client's self-directed growth, reflecting the humanistic belief in free will and agency. Recognising where a therapy sits on this spectrum lets you connect the practical question "how is this delivered?" to the theoretical question "what does this approach assume about human freedom?" — a strong synoptic move in an essay.
The therapy each approach offers follows logically from its model of what mental illness is.
| Approach | View of mental-health problems | Implied treatment |
|---|---|---|
| Behaviourist | Maladaptive learned behaviours | Unlearn them; condition adaptive ones (SD, flooding, token economies) |
| Cognitive | Faulty thinking and irrational beliefs | Identify and challenge the cognitions (CBT, REBT) |
| Biological | Neurochemical imbalance, genetics, brain abnormality | Correct the biology (drug therapy) |
| Psychodynamic | Unresolved unconscious conflict from childhood | Make the unconscious conscious (psychoanalysis) |
| Humanistic | Incongruence and conditions of worth | Provide conditions for growth (unconditional positive regard) |
This mapping is a powerful exam tool: given any treatment you can name the approach behind it and the view of disorder it assumes, and given any disorder you can compare what the rival approaches would do about it.
Putting psychology into practice raises ethical issues that the BPS Code of Ethics and Conduct (built on respect, competence, responsibility and integrity) is designed to manage.
| Ethical Issue | Where it bites | Concern |
|---|---|---|
| Informed consent | All therapies | Clients must understand the nature, aims and risks of treatment before agreeing |
| Confidentiality | All therapies | Client information must be protected, save where there is a serious risk of harm |
| Right to withdraw | All therapies | Clients must be free to end treatment at any time without pressure |
| Potential for harm | Flooding, aversion therapy | Deliberately distressing techniques must be justified and carefully managed |
| Power imbalance / suggestion | Psychoanalysis | The analyst's interpretations may be imposed on a client who feels unable to disagree |
| Cultural sensitivity | All therapies | A treatment developed in one culture may be inappropriate or ineffective in another |
| Social control | Token economies | Reinforcing institutional compliance can shade into controlling people for the institution's convenience |
Exam Tip: Ethics are especially pointed for aversion therapy and flooding (which deliberately cause distress) and for psychoanalysis (where unchallenged interpretation creates a power imbalance). Token economies raise the distinct issue of social control — managing behaviour for the institution rather than the individual — and the gains may not generalise outside the institution once tokens stop.
Key Definition: Evidence-based practice — the principle that treatment decisions should be guided by the best available research evidence, integrated with clinical expertise and the patient's own preferences and values.
Modern clinical psychology is evidence-based and, in the UK, steered by NICE.
Key Definition: NICE (National Institute for Health and Care Excellence) — an independent body that produces evidence-based guidelines for health and social care in England and Wales, including recommended treatments for mental-health conditions.
| Condition | NICE-recommended treatment(s) |
|---|---|
| Mild-to-moderate depression | CBT, guided self-help, exercise |
| Severe depression | CBT plus antidepressant medication (SSRIs) |
| Generalised anxiety disorder | CBT, applied relaxation, SSRIs/SNRIs |
| Phobias | CBT including exposure (systematic desensitisation) |
| Schizophrenia | Antipsychotic medication plus CBT for psychosis plus family intervention |
| OCD | CBT with exposure and response prevention; SSRIs if severe |
| PTSD | Trauma-focused CBT or EMDR |
The striking feature of these guidelines is how often the recommended treatment is combined — typically a psychological therapy (cognitive/behavioural) with a biological one (drugs) — which is the clinical face of the eclecticism and biopsychosocial thinking discussed in the comparison lesson.
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