Cambridge A Level Psychology 9990: Clinical Psychology — Practice Questions

These are original practice questions written in the style of Cambridge AS & A Level Psychology (9990) assessment objectives. They are not taken from any past paper and are not endorsed by Cambridge International.

This practice set covers all five topics of Specialist Option 1, Clinical Psychology, in Cambridge International A Level Psychology 9990 (syllabus for 2024 to 2026). Section A uses Paper 3 style short-answer questions and a structured essay (6 marks describe, 10 marks evaluate). Section B uses Paper 4 style application and research-methods questions. All scenarios and people are fictional.

Related: Clinical Psychology revision notes · Clinical Psychology study guide

Section A: Paper 3 style questions

1. (a) Outline two negative symptoms of schizophrenia. [2]

1. (b) Describe the procedure of the study by Freeman et al. (2003) on persecutory ideation. [4]

2. (a) Explain what is meant by the “negative triad” in Beck’s cognitive theory of depression. [3]

2. (b) Outline one difference between how tricyclic antidepressants and SSRIs work. [2]

3. Explain how positive reinforcement could explain gambling disorder. [3]

4. (a) Describe systematic desensitisation as a treatment for a fear-related disorder. [6]

4. (b) Evaluate systematic desensitisation as a treatment for fear-related disorders, including a discussion of idiographic versus nomothetic approaches. [10]

Section B: Paper 4 style questions

5. Maya is a clinical psychologist. Her client, Tomasz, washes his hands up to 40 times a day because he believes he will spread germs to his family. When he is stopped from washing, he becomes very anxious.

(a) Identify the obsession and the compulsion in this description. [2]

(b) Explain how the behavioural (operant conditioning) explanation accounts for Tomasz’s hand-washing. [3]

(c) Maya decides to measure Tomasz’s symptoms with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Explain one strength and one weakness of using this measure. [4]

6. Lovell et al. (2006) compared telephone and face-to-face CBT for OCD.

(a) Explain why this study is described as a randomised controlled trial. [2]

(b) Suggest one reason why the findings might not generalise to all people with OCD. [2]

7. A psychologist wants to test whether a new atypical antipsychotic reduces positive symptoms more than an existing typical antipsychotic.

(a) Identify a suitable experimental design and justify your choice. [3]

(b) Describe one ethical issue the psychologist must consider and how to deal with it. [3]

8. Grant et al. (2008) found that a family history of alcoholism predicted response to opiate antagonists. Explain what this suggests about the nature versus nurture debate. [3]

Answers

1. (a) One mark each for any two, briefly outlined: avolition (lack of motivation to start or keep up activities); alogia or poverty of speech (very little speech or empty replies); flat or blunted affect (reduced emotional expression); social withdrawal or asociality; anhedonia (loss of pleasure).

1. (b) Up to 4 marks. Twenty-four non-clinical participants (1). They entered a virtual reality library scene containing computer-generated characters that behaved neutrally (1). Before or after the VR experience they completed dimensional assessments of psychiatric symptoms such as anxiety and interpersonal sensitivity (1). They then reported their thoughts about the virtual characters, which were assessed for persecutory content (1). Credit any accurate detail of the standardised environment.

2. (a) Up to 3 marks. Beck proposed that depressed people hold negative views of three things (1): the self (e.g. “I am worthless”) (1), the world or their experiences (e.g. “nobody cares about me”) and the future (e.g. “things will never improve”) (1). These are automatic and maintained by cognitive errors.

2. (b) Up to 2 marks. Tricyclics block the reuptake of both serotonin and noradrenaline (1), whereas SSRIs selectively block the reuptake of serotonin only, so they usually have fewer side effects (1).

3. Up to 3 marks. Winning money or the excitement of a bet is pleasant and acts as a positive reinforcer (1), making gambling behaviour more likely to be repeated (1). Wins arrive unpredictably (a variable-ratio schedule), which makes the behaviour very resistant to extinction, so the person keeps gambling despite losses (1).

4. (a) Up to 6 marks for a clear, detailed description. Based on classical conditioning and reciprocal inhibition: relaxation and fear cannot occur at the same time (1). The client is taught relaxation techniques such as deep breathing or progressive muscle relaxation (1). Client and therapist build an anxiety hierarchy from least to most feared situations (1). The client is exposed to each step while relaxed, starting at the bottom (1). They move up only when calm at the current step (1). Exposure can be imagined (in vitro) or real (in vivo), and the end point is the most feared situation with no fear response (1).

4. (b) Level-based: 9–10 marks for detailed, balanced evaluation with an issue developed and a conclusion. Indicative content:

• Effectiveness: well supported for specific phobias, and the client controls the pace, so dropout is low compared with flooding.
• Limits: less useful where a disorder has no clear trigger, such as generalised anxiety disorder; for blood-injection-injury phobia, relaxation can lower blood pressure further, which is why applied tension is preferred (Chapman and DeLapp, 2013).
• Idiographic vs nomothetic: each hierarchy is unique to the client, which is idiographic and makes the treatment flexible; but evidence for effectiveness comes from nomothetic group studies, and a personalised hierarchy is hard to standardise and compare across clients.
• Reductionism: treats the fear as a learned association and ignores possible underlying causes; a psychodynamic view (Little Hans) would predict symptom substitution, though evidence for this is weak.
• Practical: needs several sessions and a trained therapist; in vivo steps can be hard to arrange.
• Conclusion: effective and ethical for specific phobias, less suitable for diffuse anxiety.

5. (a) Obsession: the intrusive belief or fear that he will spread germs to his family (1). Compulsion: repeated hand-washing, up to 40 times a day (1).

5. (b) Up to 3 marks. Washing reduces Tomasz’s anxiety (1). The removal of an unpleasant state is negative reinforcement (1), so the washing behaviour is strengthened and repeated whenever the obsession returns; because he never stops washing, he never learns that the feared outcome would not happen (1).

5. (c) Strength (up to 2): it is clinician-rated with standard items, scored 0–4 on ten items (total 0–40), so it gives quantitative data that can be compared before and after treatment and is less open to self-report bias (1+1). Weakness (up to 2): it relies on the clinician’s judgement and Tomasz’s honesty during the interview, so inter-rater reliability could be a problem, or he may play down symptoms out of embarrassment (1+1).

6. (a) Up to 2 marks. Patients were randomly allocated to telephone or face-to-face therapy (1), and the two groups were compared on the same outcome measures, so differences can be attributed to the mode of delivery (1).

6. (b) Up to 2 marks. For example: participants were patients referred to two UK outpatient departments (1), so they may differ from people with OCD in other cultures or who never seek help (1). Or: people willing to accept telephone therapy may be more motivated than others.

7. (a) Up to 3 marks. Independent measures design (1), because a patient cannot take both drugs in sequence without carry-over effects or risk to health (1); patients should be randomly allocated to the two drug conditions to reduce participant variables (1). A matched-pairs design, matched on symptom severity, can also earn full credit if justified.

7. (b) Up to 3 marks. For example: protection from harm (1), because one group might receive a less effective drug or suffer side effects (1); the psychologist should monitor side effects closely and allow patients to switch or withdraw at any time without affecting their care (1). Informed consent and capacity to consent are also creditworthy if explained.

8. Up to 3 marks. A family history of alcoholism suggests a shared genetic or inherited biological factor (for example in reward or opioid systems) affects how gamblers respond to the drug (1), which supports a nature influence (1). But family history also reflects a shared environment, so the finding cannot separate nature from nurture, and the outcome is likely an interaction of both (1).

Frequently asked questions

How are Paper 3 and Paper 4 structured? Each is 1 hour 30 minutes and 60 marks. On Paper 3, each of your two options has three short-answer questions (14 marks) and a structured essay (6-mark describe, 10-mark evaluate). On Paper 4, Section A has two structured questions on each option, and Section B is one planning question from a choice of four: plan a study (10 marks), then evaluate the plan (14 marks).

Will Paper 3 and Paper 4 test the same topic? No. The 9990 syllabus says the topic areas assessed for an option on Paper 3 will be different from those assessed on Paper 4, so revise the whole clinical psychology option.

Do I need the key studies for Paper 3? Key studies are the main focus of Paper 4 Section A, but using one accurately as evidence (for example Chapman and DeLapp for applied tension) strengthens a Paper 3 evaluation.

Where marks are usually lost

• Describing a study’s results when the question asks for the procedure, as in question 1(b).
• Giving only one part of a “difference” answer; say what each drug does.
• Defining reinforcement without applying it to the person in the scenario.
• In question 4(b), naming “idiographic” without explaining what it means for this treatment.
• In design questions, naming a design without a justification tied to the scenario.

Next steps

Check weak areas against the Clinical Psychology study guide, then revisit planning and method terms in the Paper 2 Research Methods practice questions.

Official syllabus

Cambridge International AS & A Level Psychology 9990 syllabus for 2024, 2025 and 2026, Specialist Option 1: Clinical Psychology, and section 4 Details of the assessment (Papers 3 and 4) — cambridgeinternational.org.