Psychology Clinic PowerPoint Presentation of LVL 2
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ABNORMAL PSYCHOLOGY IN A CHANGING WORLD, NINTH EDITION
Jeffrey S. Nevid/Spenver A. Rathus/Beverly Greene
Chapter 2
Contemporary Perspectives on Abnormal Behavior and Methods of Treatment
The Biological Perspective• The biological perspective, inspired by scientists and
physicians since the time of Hippocrates, focuses on the biological underpinnings of abnormal behavior and the use of biologically based approaches, such as drug therapy, to treat psychological disorders.
• The biological perspective gave rise to the development of the medical model, which remains today a powerful force in contemporary understandings of abnormal behavior.
Central Nervous System• Limbic system – A group of forebrain structures involved in
emotional processing, memory, and basic drives such as hunger, thirst, and aggression.
• Basal ganglia – An assemblage of neurons at the base of the forebrain involved in regulating postural movements and coordination.
• Cerebrum – The large mass of the forebrain, consisting of the two cerebral hemispheres, responsible for higher mental functions.
• Cerebral cortex – The wrinkled surface area of the cerebrum responsible for processing sensory stimuli and controlling higher mental functions, such as thinking and use of language.
Peripheral Nervous System• Somatic nervous system – The division of the peripheral
nervous system that relays information from the sense organs to the brain and transmits messages from the brain to the skeletal muscles.
• Autonomic nervous system – The division of the peripheral nervous system that regulates the activities of the glands and involuntary functions.
• Sympathetic – Pertaining to the division of the autonomic nervous system whose activity leads to heightened states of arousal.
• Parasympathetic – Pertaining to the division of the autonomic nervous system whose activity reduces states of arousal and regulates bodily processes that replenish energy reserves.
Psychodynamic Models• Psychoanalytic theory – The theoretical model developed by Sigmund
Freud that is based on the belief that the roots of psychological problems involve unconscious motives and conflicts that can be traced back to childhood.– also called psychoanalysis.
• Conscious – To Freud, the part of the mind that corresponds to our present awareness.
• Preconscious – To Freud, the part of the mind that contains memories not in awareness but can be brought into awareness by focusing attention on them.
• Unconscious – To Freud, the part of the mind that lies outside the range of ordinary awareness and that contains instinctual urges.
The Structure of Personality• Id – The original and unconscious psychic structure,
present at birth, that contains primitive instincts and is regulated by the pleasure principle.
• Pleasure principle – The governing principle of the id, involving demands for immediate gratification of needs.
• Ego – The psychic structure governed by the reality principle. It organizes reasonable ways of coping with frustration and seeks to curb the demands of the id.
Stages of Psychosexual Development• In Freud’s view, the stages of human development
are psychosexual in nature because they correspond to the transfer of libidinal energy from one erogenous zone to another.
• Freud proposed the existence of five psychosexual stages of development: oral (first year of life), anal (second year of life), phallic (beginning during the third year of life), latency (from around age 6 to age 12), and genital (beginning in puberty).
Stages of Psychosexual Development• Freud believed that phallic-stage children develop unconscious
incestuous desires for the parent of the opposite gender and begin to view the parent of the same sex as a rival.
• Freud dubbed this conflict the Oedipus complex after the legendary Greek king Oedipus, who unwittingly slew his father and married his mother.
• Fixation – In Freudian theory, a constellation of personality traits associated with a particular stage of psychosexual development, resulting from either too much or too little gratification at the stage.
• Swiss psychiatrist Carl Jung developed his own psychodynamic theory called analytical psychology and believed that we not only have a personal unconscious but also inherit a collective unconscious.
• Archetypes – Primitive images or concepts that reside in the collective unconscious.
• Karen Horney (1885–1952) stressed the importance of child–parent relationships in the development of emotional problems.
• Ego psychology – Modern psychodynamic approach originated by Heinz Hartmann (1894–1970) that focuses more on the conscious strivings of the ego than on the hypothesized unconscious functions of the id.
• Erik Erikson (1902–1994) focused on psychosocial development and attributed more importance to social relationships and formation of personal identity than to unconscious processes.
• Object-relations theory – The psychodynamic viewpoint developed by Margaret Mahler that focuses on the influences of internalized representations of the personalities of parents and other strong attachment figures (called “objects”).
• In the Freudian model, mental health is a function of the dynamic balance among the psychic structures of id, ego, and superego.
• Freud believed that the underlying conflicts that give rise to psychological disorders originate in childhood and are buried in the depths of the unconscious.
• Psychosis – A severe form of disturbed behavior characterized by impaired ability to interpret reality and difficulty meeting the demands of daily life.
Learning Models• The behavioral perspective is identified with the Russian
physiologist Ivan Pavlov (1849–1936), the discoverer of the conditioned reflex, and the American psychologist John B. Watson (1878–1958), the father of behaviorism.
• Behaviorism – The school of psychology that defines psychology as the study of observable behavior and that focuses on the role of learning in explaining behavior.
• Watson and other behaviorists, such as Harvard University psychologist B. F. Skinner (1904–1990), believed that human behavior is the product of our genetic inheritance and environmental or situational influences.
Role of Classical Conditioning• Conditioned response – In classical conditioning, a learned
response to a previously neutral stimulus.• Unconditioned stimulus – A stimulus that elicits an unlearned
response. • Unconditioned response – An unlearned response.• Conditioned stimulus – A previously neutral stimulus that
evokes a conditioned response after repeated pairings with an unconditioned stimulus that had previously evoked that response.
• Classical conditioning – A form of learning in which a response to one stimulus can be made to occur to another stimulus by pairing or associating the two stimuli.
Humanistic Models• Self-actualization – In humanistic psychology, the
tendency to strive to become all that one is capable of being. The motive that drives one to reach one’s full potential and express one’s unique capabilities.
• Unconditional positive regard – Valuing other people as having basic worth regardless of their behavior at a particular time.
• Conditional positive regard – Valuing other people on the basis of whether their behavior meets one’s approval.
Cognitive Models• Cognitive theorists study the cognitions—the thoughts,
beliefs, expectations, and attitudes—that accompany and may underlie abnormal behavior.
• They focus on how reality is colored by our expectations, attitudes, and so forth, and how inaccurate or biased processing of information about the world—and our places within it—can give rise to abnormal behavior.
• Cognitive theorists believe that our interpretations of the events in our lives, and not the events themselves, determine our emotional states.
Information-Processing Models• Information-processing theorists discuss human cognition in
terms such as input (sensory and perceptual processes), manipulation (interpreting or processing), storage (placing information in memory), retrieval (accessing information from memory), and output (acting on the information).
• Psychological disorders are seen as disturbances in these processes.
• People with schizophrenia, for example, frequently jump from topic to topic in a disorganized fashion, which may reflect problems in retrieving and manipulating information.
Albert Ellis• Psychologist Albert Ellis (1977b, 1993), a prominent
cognitive theorist, believed that troubling events in themselves do not lead to anxiety, depression, or disturbed behavior.
• Ellis used an “ABC approach” to explain the causes of the misery. Being fired is an activating event (A). The ultimate outcome, or consequence (C), is emotional distress.
• But the activating event (A) and the consequences (C) are mediated by various beliefs (B).
Aaron Beck• Aaron Beck proposes that depression may result from errors in
thinking or “cognitive distortions,” such as judging oneself entirely on the basis of one’s flaws or failures and interpreting events in a negative light (through blue-colored glasses, as it were).
• Beck stresses the four basic types of cognitive distortions that contribute to emotional distress:1. Selective abstraction 2. Overgeneralization3. Magnification4. Absolutist thinking
Ethnicity and Mental Health• A recent analysis of ethnic group differences in rates of
mental disorders revealed an interesting pattern.
• Using data from a nationally representative sample of adult Americans, investigators found that traditionally disadvantaged groups (non-Hispanic Black Americans and Hispanic Americans) had either significantly lower rates of psychological disorders or comparable rates, as compared to European Americans (non-Hispanic Whites), but greater chronicity or persistence.
Ethnicity and Mental Health• Native Americans are a traditionally disadvantaged
minority group with high rates of mental disorders (Gone & Trimble, 2012).– Most commonly alcohol dependence, posttraumatic
stress disorder, and depression (Beals et al., 2005).
• Compared to other Hawaiians, Native Hawaiians experience higher rates of mental health problems, including higher suicide rates among men, higher rates of alcoholism and drug abuse, and higher rates of antisocial behavior.
Evaluating the Sociocultural Perspective• Social causation model – The belief that social
stressors, such as poverty, account for the greater risk of severe psychological disorders among people of lower socioeconomic status.
• Downward drift hypothesis – The theory that explains the linkage between low socioeconomic status and behavior problems by suggesting that problem behaviors lead people to drift downward in social status.
The Biopsychosocial Perspective• The biopsychosocial perspective examines the contributions of
multiple factors representing biological, psychological, and sociocultural domains, as well as their interactions, in the development of psychological disorders.
• Even disorders that are primarily biological may be influenced by psychological factors, or vice-versa.
• For example, some phobias may be learned behaviors that are acquired through experiences in which particular objects became associated with traumatic or painful experiences. Yet, some people may inherit certain traits that make them susceptible to the development of acquired or conditioned phobias.
The Diathesis-Stress Model• Diathesis-stress model – A model that posits that abnormal
behavior problems involve the interaction of a vulnerability or predisposition and stressful life events or experiences.
• Diathesis – A vulnerability or predisposition to a particular disorder.
• In some cases, people with a diathesis for a particular disorder, say schizophrenia, will remain free of the disorder or will develop a milder form of the disorder if the level of stress in their lives remains low or if they develop effective coping responses for handling the stress they encounter.
Types of Helping Professionals• Clinical psychologists – Have earned a doctoral degree in
psychology (either a Ph.D., or Doctor of Philosophy; a Psy.D., or Doctor of Psychology; or an Ed.D., or Doctor of Education) from an accredited college or university.
• Counseling psychologists – Also hold doctoral degrees in psychology and have completed graduate training preparing them for careers in college counseling centers and mental health facilities.
• Psychiatrists – Have earned a medical degree (M.D.) and completed a residency program in psychiatry.
Types of Helping Professionals• Clinical or psychiatric social workers – Have earned a master’s degree
in social work (M.S.W.) and use their knowledge of community agencies and organizations to help people with severe mental disorders receive the services they need.
• Psychoanalysts – Typically are either psychiatrists or psychologists who have completed extensive additional training in psychoanalysis.
• Counselors – Have typically earned a master’s degree by completing a graduate program in a counseling field. Counselors work in many settings, including public schools, college testing and counseling centers, and hospitals and health clinics.
• Psychiatric nurses – Typically are R.N.s who have completed a master’s program in psychiatric nursing.
Psychotherapy• Psychotherapy – A structured form of treatment
derived from a psychological framework that consists of one or more verbal interactions or treatment sessions between a client and a therapist.
• Psychotherapy is used to treat psychological disorders, to help clients change maladaptive behaviors or solve problems in living, or to help them develop their unique potentials.
Dream Analysis• In psychoanalytic theory, dreams have two levels of content:
1. Manifest content: The material of the dream the dreamer experiences and reports.2. Latent content: The unconscious material the dream symbolizes or represents.
• Freud believed dreams represented the “royal road to the unconscious.”
• Transference relationship – In psychoanalysis, the client’s transfer or generalization to the analyst of feelings and attitudes the client holds toward important figures in his or her life.
• Countertransference – In psychoanalysis, the transfer of feelings or attitudes that the analyst holds toward other persons in her or his life onto the client.
Modern Psychodynamic Approaches• Like Freudian psychoanalysis, the newer psychodynamic
therapists explore their client’s psychological defenses and transference relationships – a process described as “peeling the onion” (Gothold, 2009).
• They focus more on the client’s present relationships and encourage the client to make adaptive behavior changes and treatment entails a more open dialogue.
• Many contemporary psychodynamic therapists draw more heavily on the ideas of Erik Erikson, Karen Horney, and other theorists than on Freud’s ideas.
Behavioral Therapy• Behavior therapy – The systematic application of the
principles of learning to treat psychological disorders.
• Systematic desensitization – A behavior therapy technique for overcoming phobias by means of exposure to progressively more fearful stimuli while one remains deeply relaxed.
• Gradual exposure – A behavior therapy technique for overcoming fears through direct exposure to increasingly fearful stimuli.
Behavioral Therapy• Modeling – A behavior therapy technique for helping
an individual acquire a target behavior by observing a therapist or another individual demonstrate the behavior and then imitating it.
• Token economy – Behavioral treatment program in which a controlled environment is constructed such that people are reinforced for desired behaviors by receiving tokens that may be exchanged for desired rewards.
Humanistic Therapy• Humanistic therapists focus on clients’ subjective,
conscious experiences.
• Like behavior therapists, humanistic therapists also focus more on what clients are experiencing in the present—the here and now—than on the past.
• The major form of humanistic therapy is person-centered therapy (also called client-centered therapy), which was developed by the psychologist Carl Rogers.
• Cognitive therapy – A form of therapy that helps clients identify and correct faulty cognitions (thoughts, beliefs, and attitudes) believed to underlie their emotional problems and maladaptive behavior.
Rational Emotive Behavior Therapy• Albert Ellis believed that negative emotions such as anxiety
and depression are caused by the irrational ways in which we interpret or judge negative events, not by negative events themselves.
• Rational emotive behavior therapy (REBT) – A therapeutic approach that focuses on helping clients replace irrational, maladaptive beliefs with alternative, more adaptive beliefs.
• Rational emotive behavior therapists help clients substitute more effective interpersonal behavior for self-defeating or maladaptive behavior.
Beck’s Cognitive Therapy• Psychiatrist Aaron Beck and his colleagues developed
cognitive therapy, which, like REBT, focuses on people’s faulty thoughts and beliefs.
• Cognitive therapists encourage clients to recognize and change errors in their thinking, called cognitive distortions, such as tendencies to magnify negative events and minimize personal accomplishments, that affect their moods and impair their behavior.
• Cognitive therapists have clients record the thoughts that are prompted by upsetting events and note the connections between their thoughts and their emotional responses.
Cognitive-Behavioral Therapy• Cognitive-behavioral therapy (CBT) – A learning-based
approach to therapy incorporating cognitive and behavioral techniques.
• CBT attempts to integrate therapeutic techniques that help individuals make changes not only in their overt behavior but also in their underlying thoughts, beliefs, and attitudes.
• CBT draws on the assumption that thinking patterns and beliefs affect behavior and that changes in these cognitions can produce desirable behavioral and emotional changes.
Eclectic Therapy• Eclectic therapy – An approach to psychotherapy that
incorporates principles or techniques from various systems or theories.
• An eclectic therapist might use behavior therapy techniques to help a client change specific maladaptive behaviors, for example, along with psychodynamic techniques to help the client gain insight into the childhood roots of the problem.
• Some therapists are technical eclectics.
• Other eclectic therapists are integrative eclectics.
• In family therapy, the family, not the individual, is the unit of treatment. Family therapists help family members communicate more effectively with one another—for example, to air their disagreements in ways that are not hurtful to individual members. Family therapists also try to prevent one member of the family from becoming the scapegoat for the family’s problems.
Evaluating Methods of Psychotherapy• Reviews of the scientific literature often utilize a statistical technique
called meta-analysis, which averages the results of a large number of studies to determine an overall level of effectiveness.
• In the most frequently cited meta-analysis of psychotherapy research, M. L. Smith and Glass (1977) analyzed the results of some 375 controlled studies comparing various types of therapies (psychodynamic, behavioral, humanistic, etc.) against control groups.
• The results of their analyses showed that the average psychotherapy client in these studies was better off than 75% of the clients who remained untreated.
Evaluating Methods of Psychotherapy• Although evidence supports the effectiveness of
psychotherapy, researchers lack clarity about why it works—that is, what factors or processes account for therapeutic change (Carey, 2011).
• Suggests the effectiveness of different forms of psychotherapy may have more to do with the common features.
• Nonspecific treatment factors – Factors not specific to any one form of psychotherapy, such as therapist attention and support, and creating positive expectancies of change.
• Another approach to determining whether particular therapies are effective in treating particular problems is known as empirically supported treatments or ESTs.
• Efficacy studies speak to the issue of whether a treatment works better than control conditions.
• Effectiveness studies examine whether particular treatments are effective when used by practitioners.
• Normal and abnormal behaviors occur in a context of culture and community.
• Therapists need to be sensitive to cultural differences and how they affect the therapeutic process.
• We must also recognize that just because a given therapy works with one population does not mean that it will necessarily work with another population.
African Americans• The cultural history of African Americans must be understood
in the context of persistent racial discrimination.• Therapists need to be aware of the tendency of African
American clients to minimize their vulnerability by being less self-disclosing (Sanchez-Hucles, 2000).
• Therapists must be aware of the cultural characteristics such as strong kinship bonds, strong religious and spiritual orientation, multigenerational households, adaptability and flexibility of gender roles, and distribution of child-care responsibilities among different family members.
• Therapists must recognize how stereotypes can become destructive to the therapeutic relationships they form with African American clients.
Hispanic Americans• Although Hispanic American subcultures differ in various
respects, many share certain cultural values and beliefs, such as the importance placed on the family and kinship ties, as well as on respect and dignity (Calzada, Fernandez, & Cortes, 2010).
• Therapists need to recognize that the traditional Hispanic American value of interdependency within the family may conflict with the values of independence and self-reliance that are stressed in the mainstream U.S. culture.
• Therapists should also be trained to reach beyond the confines of their offices to work within the Hispanic American community itself, in settings that have an impact on the daily lives of Hispanic Americans.
Native Americans• Native Americans remain underserved, partly as a result of
underfunding and the cultural gap between providers and recipients.
• Mental health professionals can help Native Americans if they work within a context that is relevant and sensitive to Native Americans’ customs, culture, and values (Gone & Trimble, 2012).
• Many Native Americans expect that the therapist will do most of the talking and they will play a passive role in treatment.
• There may also be differences in nonverbal expression that can impede effective communication between the therapist and the client (Renfrey, 1992).
Drug Therapy• Different classes of psychotropic drugs are used in treating
many types of psychological disorders.
• But all the drugs in these classes act on neurotransmitter systems in the brain, affecting the delicate balance of chemicals that ferry nerve impulses from neuron to neuron.
• The major classes of psychiatric drugs are antianxiety drugs, antipsychotic drugs, and antidepressants, as well as lithium, which is used to treat mood swings in people with bipolar disorder.
• Antipsychotic drugs – Drugs used to treat schizophrenia or other psychotic disorders.
• The use of neuroleptics has greatly reduced the need for more restrictive forms of treatment for severely disturbed patients, such as physical restraints and confinement in padded cells, and has lessened the need for long-term hospitalization.
• Neuroleptics are not without their problems, including potential side effects such as muscular rigidity and tremors.
Antidepressants• Antidepressants – Drugs used to treat depression
that affect the availability of neurotransmitters in the brain.
• The third class of antidepressants, selective serotonin-reuptake inhibitors, or SSRIs, have more specific effects on serotonin function in the brain.
• Drugs in this class include fluoxetine (Prozac) and sertraline (Zoloft).
Evaluation of Biological Approaches• There is little doubt that biological treatments have helped
many people with severe psychological problems.
• On the other hand, some forms of psychotherapy may be as effective as drug therapy in treating anxiety disorders and depression.
• Although we continue to learn more about the biological foundations of abnormal behavior patterns, the interface between biology and behavior can be construed as a two-way street.