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The context is important to how we label as normal or abnormal and the culture they belong to
LOOKING AT ABNORMALITY: • we tend to be experts in abnormal because of the way we were socialized
NORMAL :Behaviours, thoughts, and feelings are the following:
• Typical for the social context
• Not distressing to the individual
• Not interfering with social life or work/school
• Not dangerous
Example: College students who are self confident and happy, performed to the capacity in school, and have good friends)
SOCIALLY ESTABLISHED DIVISION BETWEEN NORMAL AND ABNORMAL: Behaviours, thoughts, and feelings are one or more of the following:
• somewhat unusual for the social context
• distressing to the individual
• Interfering with social or occupational functioning
• Dangerous
example college students who are often unsure and self critical, occasionally abuse, prescription, drugs, fail some courses, and avoid friends who disapprove of their drug use)
ABNORMAL: Behaviours, thoughts, and feelings are one or more of the following:
• highly unusual for the social context
• The source of significant individual distress
• Significantly interfering with social or occupational functioning
• Highly dangerous to the individual or others
Example college students who are hopeless about the future, our self loathing, chronically abuse, drugs, fail, courses, and have alienated all their friends
Defining Abnormality Abnormal psychology is also known as psychopathology, abnormal behaviour is not the same as psychological disorder (need certain things met)
• The four dimensions of abnormality:
Dysfunction - dysfunctional when they start to interfere with peoples ability to function, forming relationships, or studying or holding a job
Distress - cause distress to individual themself and to the people around them
Deviance- deviant from the social norm, vary across cultures
Dangerousness - harm to individual (cutting, burning) and to others through aggression
The Disease Model of Mental Illness the focus is identifying what is wrong with the individual to provide treatment
• No biological test is available to diagnose the psychological disorders that we will discuss in this course
Mental disorders consist of issues concerning cognition, emotional responses/regulation, and social behavior (biologically and enviornmentally understood)
• ex. Patient with schizophrenia
CULTURAL RELATIVISM oppsite from the disease model of mental illness
• Cultural relativism: the perspective that no universal standards exist for labelling behaviors as abnormal
Abnormality exists only relative to cultural norms
Opponents of cultural relativism: argue that it can be dangerous when cultural norms are allowed to dictate abnormality
Thomas Zaz:psychiatrist societies often label people as abnormal to justify the control of the group (ex. Hitler saying jews were abnormal, slavery in the US, only in 1973 that
the American Psychiatric removed homosexuality as abnormal)
HISTORICAL PERSPECTIVES ON ABNORMALITY:
• 3 types of theories have been used to explain abnormal behavior:
1) Biological Theories - abnormal behaviour is similar to physical diseases, treatments surround restoring bodily health
2) Supernatural Theories- abnormal behaviour is because of divine intervention, sins, curses, demonic, treatment involves rituals, atomics, confessions and exorcism
3) Psychological Theories- abnormal behaviour is because of physiological processes like beliefs, coping styles, and life events (trauma) treatment = rests, relaxation, changing
environment and thought processes
• the way we see an abnormal individual is impacted by our theoretical position
ANCIENT THEORIES:
• Many historians speculate that prehistoric people had a concept of insanity likely tied to supernatural beliefs (treatment was exorcism sometimes killed)
• Treatment for abnormality during Stone Age and into Middle Ages: drilling holes in skull of the individual displaying abnormal behavior using a trephine (trephination)
Purpose: to allow evil spirits to depart
• holes in the skulls date back to half a mill year ago, and sections were cut away
• Individuals who heard things that weren’t real or who were chronically ill often faced this
• Some believed it was to treat blood clots so still a matter of debate
• Ancient China: human body has a positive force (yang) and a negative force (yin) which both confront and complement each other. If forces are not balanced, insanity can
result
• with the rise of Buddhism and dowism, this led to the evil ghosts being blamed
• Ancient Egypt, Greece, and Rome
Strong reliance on biological theories
“Wandering uterus”: (quite common) when women experienced unexplainable aches, sadness, apathy, it was thought that the uterus would wander around the body and
create ailments when it was hungry for semen (e.g. if stuck in the rib cage may lead to chest pain)
- Greeks named this disorder hysteria (hystera means uterus)
- Treatments: vaginal fumigations, fragrances, vaginal inserts made of wool
- The ultimate treatment for issues with the womb: marriage, sexual intercourse, and pregnancy
• shows how mental disorders can be misinterpretated and can lead to
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ANCIENT THEORIES CONT’D:
• Ancient Egypt, Greece, and Rome
Hippocrates: believed removing pateitn from difficult family could help restore mental health
- Regarded as the father of medicine
- Abnormal behavior is akin to other bodily diseases
- Body is composed of 4 basic humors: blood, phlegm, yellow bile, and black bile
- Diseases are caused by imbalances in these humors
• categorized into 4 main categories: epilepsy, mania, melancholia and brain fever (treatment to restore the balance of the humors, bleeding patient, rest, relaxation, change
in diet) non medical and same as modern except for blood
Plato- belief that insanity occured when irrational mind was overcome by impluse, passion or appetite (treatment was discussion with individual with intention with restoring
rational control over emotions)
• Medieval Views:
Middle Ages (400-1400CE): strong dependence upon supernatural explanations of abnormal behavior (particularly in the late Middle Ages)
- Most laypeople believed in demons/curses as cause of abnormal behavior.
- Physicians and government officials acknowledged physical causes or trauma as underlying cause of abnormal behaviour
• during 11th century, individuals practicing witchcraft were targeted known as renaissance
ASYLUMS: harsh and inhumane conditions
• 12th century: Europe started to take responsibility for housing/care of individuals considered to be mentally ill
• 11th-12th century: general hospitals started to include special facilities for individuals who showed abnormal behavior
• Act for Regulating Madhouses in England:
Passedin1774
Purpose: to assist in improving conditions of hospitals and madhouses and protect individuals from being unjustly jailed for insanity
• the mentally ill were basically inmates, patients were exhibited to public for fee, chained to a wall, locked in small boxes
TREATMENT IN 18TH-19TH CENTURIES: industrial revolution
• Mental hygiene movement:
New treatment approach based on the view that individuals developed psychological issues because of:
- separation from nature
- stress associated with rapid social changes
Treatment: prayers, incantations, rest, relaxation (in a serene and physically appealing location)
• Dorothia dicks, retired school teacher visited a jail and found poor and brutality, she allowed laws to improve institutions
• In the 19th century, increasing of patients in asylums and prejudice to foreigners and quality of care went back down, effective treatments developed in 20th century
and those who couldn’t afford got no treatment
EMERGENCE OF MODERN PERSPECTIVES:
BEGINNINGS OF MODERN BIOLOGICAL PERSPECTIVES:
Late 19th century:
Knowledge of anatomy, physiology, neurology, and chemistry of the body increased significantly
- Increasing focus on the biological underpinnings of abnormality
• Richard craft: sphyillis can be a cause of insanity and helped push forward that biological factors can lead to abnormal behaviours
- Wilhelm Griesinger (1945): published The Pathology and Therapy of Psychic disorders
- Argued that all psychological disorders are due to brain pathology
- Emil Kraepelin (1856-1926): published a similar text and developed a system for classifying symptoms into discrete disorders
Why is it important to have a classification system? This can be very critical for researchers to have a common set of terms and criteria to distinguish between disorders and
to advance studies of tjem
THE PSYCHOANALYTIC PERSPECTIVE:
• Franz Mesmer (1734-1815): believed that distribution of magnetic fluid in one person could be impacted by others and alignment of planets
Austrian physician who applied animal magnetism to treat diseases the focus was among those with hysteric disorders where they would lose feeling in body and used iron
rods to realign magnetic force (changes occured due to hypnosis)
Held the belief that individuals have a magnetic fluid in their body that must be distributed in a specific pattern to maintain health
• Sigmund Freud (1856-1939): said hypnosis could lead to catharsis
Viennese neurologist
Argued that a significant portion of mental life is unconscious
- Worked with Josef Breuer (1842-1925)
- Physician interested in hypnosis/unconscious processes
THE ROOTS OF BEHAVIOURISM:
• Ivan Pavlov (1849-1936): unconditioned stimulus = food, unconditioned response = salvation, conditioned stimulus = footsteps with person with food
Russian physiologist
Discovered classical conditioning:dogs could be conditioned to salivate if presented with stimuli previously paired with food.
• John Watson (1878-1958):
Used classical conditioning principles in order to understand human behaviors (e.g. phobias) passing by same intersection you had accident, says that fear could be reduced by
exposure while maintaining relaxation
• Thorndike (1874-1949) and Skinner (1904-1990):
Studied how the consequences of behaviors can impact their likelihood of recurring
- Operant/instrumental conditioning
• behaviours followed by pos consequence are more likely to be repeated and vice versa
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THE COGNITIVE REVOLUTION:
• 1970’s saw a significant shift towards the study of cognitions
Focus on thought processes which mediate the association between stimulus and response
Cognitions: thought processes which impact behavior and emotion
- Encompass attention, beliefs, and interpretations of events
- Pioneers in the cognitive revolution:
- Alberta Bandura- argued self advocacy (a persons beliefs regarding their ability to execute behaviours required to control an event) beliefs are
imporant in determining sense of well-being
- Albert Ellis - individuals who are prone to psychologiclal diorders are prone to having negative assumptions about themselves and world (developed
rational emotive therapy - considered to be controversial as patients had to challenge their irrational belief systems
- Aaron Beck - irrational thought who had psychological disorders and beck cognitive therapies is the most used for depressive and anxiety based
disorder
MODERN MENTAL HEALTH CARE
• 1950s saw significant breakthroughs in drug treatments
This was associated with deinstitutionalization: meaning the patients prescribed the drugs no longer need to be institutionalized b/c their symptoms were controlled
• Between 1955 and 2016 the number of patients in psychiatric hospitals went from 500,000 to 38000, seen in US, europe and Canada
• 1960’s patients’ rights movement:
Advocates argued that patient recovery was supported if individuals were integrated into the community rather than being institutionalized in asylums and hospitals
- More satisfying lives could be achieved with the support of community-based treatment facilities: represented positive change
MODERN MENTAL HEALTH CARE CONT’D:
• Community mental health centers:
Typically include multidisciplinary teams of therapists,social workers, and physicians
- Halfway houses: offer individuals with long-term mental health issues to live in a supportive and structured environment
- Day treatment centers: partial hospitalization programs (PHP) provide more intensive therapy for those with greater needs: less intense than patient or resident
placements
- When is hospitalization necessary? Necessary for individuals who have acute psychiatric symptoms, average stay is 3-10 days, once the acute symptoms have
subsided, they are usually released to a community based center for continued care, to treat serious mental health problems, more time is necessary
• Many people who are chronically ill are re-hosptialized every week
• Pros and cons of deinstitutionalization:
In some cases, (primary benefit if enough primary resources are available) can enhance the quality of life for individuals
Cons:
- Because of the underfunding of community mental health programs: Many individuals left institutions only to become victims of poverty and neglect
• limited access to impatient treatment is associated with higher risk suicide, homelessness, premature mortality, violent crime and incarceration
DEINSTITUTIONALIZATION AND CRIME:
• Because of the lack of accessible treatment:
Many individuals with severe mental illness (SMI) end up in hospitals for short durations with inadequate treatment and others become part of the criminal justice
system
Individuals with SMI are increasingly becoming transinstitutionalized ( process where people who previously have been deinstitionalized become institutionalized in a diff
setting - from hospital to jail) to the criminal justice system
• Research conducted among prison inmates: suggests that 2/3 of inmates had some form of diagnosable mental health disorder in their lifetime.
Approximately 60% of inmates reported having symptoms of a mental health disorder within the year preceding their incarceration.
• Despite the high rates, about 83% did not receive mental health care after being in jail
• Trend seen around the world,prisons replacing hospitals
TREATMENT UTILIZATION:
• Many individuals with psychological disorders do not receive treatment
Approximately 33% of adults with a mental illness and 41% of adults with a serious mental illness have received treatment in the past year (majority of the people
who need help, they don’t get the help they need)
Treatment barriers:
- Structural barriers: cost, not knowing where to get help, not being able to get an appointment
- Attitudinal barriers: perceived stigma, perception of treatments to be ineffective
PROFESSIONS WITHIN ABNORMAL PSYCHOLOGY:
• Psychiatrists: can perscribe meds
Have an MD degree
Have specialized training in treatment individuals with
psychological disorders
• Clinical Psychologists: can conduct psychotherapy but not give meds
Usually have a PhD in psychology
Specialize in treating/researching psychopathology
PsyD degree: doctoral degree from a graduate program emphasizing clinical training more heavily than research training
• Master’s-level career options:
Marriage and family therapists (MFT)
Clinical social workers (masters degree)
Mental health counsellors
Psychiatric nurses (degree and specialization
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THEORETICAL PERSPECTIVES:
• Theory: set of ideas which provide a framework to ask questions regarding a phenomenon and for collecting/interpreting information about that phenomenon
The vast majority of theories of psychological challenges have searched for one factor: one gene, etc which is the cause of psychological symptoms
Therapy: a treatment which is typically based upon a theory of a phenomenon
• Targets the factors that (the theory asserts) cause the phenomenon of interest
- Many contemporary theorists adopt a biopsychosocial approach (recognizes the development of psychological symptoms is due to the combination of
biological, cultural and sociocultural factors - all collectively referred to as risk factors
RISK FACTORS:
• Typically risk factors create an increased risk for numerous different issues
Transdiagnostic risk factors: factors which increase the risk of many types of psychological issues ex. Severe stress from childhood trauma
Some risk factors may lead to very specific symptoms
• psychological risk: difficulty staying calm
• Sociocultural: growing up with stress of discrimination
DIATHESIS-STRESS MODEL
Diathesis: means risk factor
diathesis-stress model: agrues that onlu when
you have risk factor and stress (trigger) thats
when you have a disorder
TREATMENTS:
• Proponents of biological, psychological, and sociocultural theoretical perspectives tend to adopt different treatment approaches
• Biological: prescribe meds, socio: psycho therapy using therapist and discuss symptoms and factors
• Both have proven to be effective and often used together, meds alone has increased
• sociocultural might try to change social conditions to improve mental health
BIOLOGICAL APPROACHES:
BRAIN DYSFUNCTION:
• The brain is divided into 3 main areas:
Hindbrain: includes all posterior parts of brain, closest to spinal cord (important for basic life function,
Midbrain: located in middle brain
Forebrain: front part of brain
FOREBRAIN:
• Subcortical structures: are located just under the cerebrum
Thalamus: directing info from sensory to cerebrum: vision, hearing Relaying sensory info and
Hypothalamus: regulating eating, drinking, sexual behaviour, basic emotions movement
Pituitary gland: endocrine system Regulates responses to
Limbic system: set of structures critical for instinctive behaviour: eating, drinking, response to stress rewards
- Amygdala: processing emotions *fear Control breathing and reflex
- Hippocampus: consolidating memories Timing of sleep and attention, network
of neurones that controls arousal
BRAIN DYSFUNCTION:
• Causes of brain dysfunction:
Controls coordination of movement
Injury (e.g. head injury from contact sports)
Diseases (e.g. Alzheimer’s disease)
Alternation to size and activity of frontal cortex are associated with schizophrenia, depression, ADHD
Particular areas of the brain are associated with a range of psychological functions
BIOCHEMICAL IMBALANCES:
• Neurotransmitters: biochemicals which act as messengers by carrying impulses from one neuron to another in the brain and in other areas of the nervous system
BIOCHEMICAL THEORIES OF PSYCHOPATHOLOGY:
• Psychological symptoms may be associated with:
The amount of neurotransmitters available within synapses. This is impacted by: both processes happen naturally, but when malfunction can have low or high
neurotransmitter
- Reuptake: happens when neuron releasing neurotransmitter absorbs the neurotransmitter and decreases what it available in synapse
- Degradation: happens when receiving/ releasing neuron releases an enzyme in the synapse and break down neurotranmitter
The number of receptors for neurotransmitters (on dendrites)
The functioning of receptors for neurotransmitters (on dendrites)
SEROTONIN:
• Travels through many areas of the brain:
Dysfunction in the system which regulates serotonin is a transdiagnostic risk factor associated with psychopathology
• emotional wellbeing, depression and anxiety, abnormal behaviours like aggressive impulses
DOPAMINE:
• Critical neurotransmitter in regions of the brain associated with:
Experience of reinforcements/rewards: impacted by substances (alcohol)
Functioning of muscle systems(ex. Strong role in disorders that involve disorders that control muscles, ex parkisons)
Dopamine dysfunction is a transdiagnostic risk factor
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NOREPINEPHRINE (NORADRENALINE)
• Neurotransmitter which is primarily produced by neurons within the brain stem(drugs like cocaine can prolong norepinephrine by slowing down the reuptake process)
• too little found in brain, individuals can get depressed
GABA: Interaction within
Genotype S/s S/l L/l
• Inhibits the action of other neurotransmitters interaction and
Many drugs have a tranquilizing effect on the body because they increase the activity of GABA genes
• disfunction associated with anxiety symptoms Individuals with at
THE ENDOCRINE SYSTEM: important for psychological disorders least 1 short had
• The endocrine consists of a system of glands which are responsible for producing hormones. higher chance of
depression but only
These hormones (chemicals that carry messages throughout the body and can have impact on mood, reactivity level and
if they had a
reaction to stress) are released directly into the blood
history of
GENETIC ABNORMALITIES:
maltreatment as
• Behavioral genetics: the study of the genetic basis of personality and abnormality kids
• Serotonin transporter gene: impacts the functioning of serotonin systems in the brain
Research suggests that the presence of at least 1 short allele on the serotonin transporter gene can increase risk for developing depression
- Polygenic: Importantly, a combination of genetic abnormalities likely contribute to depression (ex. Diabetes, epilepsy, coronary heart disease)
• combination of abnormalities likely contribute to depression
INTERACTIONS BETWEEN GENES AND ENVIRONMENT: there is a bi directional association within genes and enviornment
• Genes: impact the environments we choose
These environments can reinforce our genetically influenced interests/personalities
• children with aggression and impulses choose friends who support the impulses behaviours and give anti-social interactions
INTERACTIONS BETWEEN GENES AND ENVIRONMENT:
• Epigenetics: environmental factors can impact the expression of genes, focuses on heritable changes and the expression of genes with no change in the actual genetic
sequence
• diet, exercise, seasonal changes, financial status can have neg or pos impact on development by impacting the expression of genes
• cells, tissues, can be altered in development as a cause of enviornment
DRUG THERAPIES:
• Drug therapies: improve the functioning of neurotransmitter systems and as a result, can relieve psychological symptoms
• the standard first line treatment for the majority of psychiatric disorders include both medications and psychotherapy
• Antipsychotic drugs:
Reduce symptoms of psychosis (hallucinations and delusions)
Phenothiazines: the first group of antipsychotic drugs
- Helpful in reducing psychotic symptoms
- Side effects: severe sedation, visual disturbances, and tardive dyskinesia
• tardive dyskinesia: neurological disorders resulting in involuntary movements of the face
tongue, mouth and jaw
Atypical antipsychotics:
- Effective in treating psychosis with fewer side effects
• Antidepressant drugs:
Reduce symptoms of depression: sadness, low motivation, disturbances in appetite and sleep
- Selective serotonin reuptake inhibitors (SSRIs): most frequently used antidepressants
- Selective serotonin-norepinephrine reuptake inhibitors (SNRIs): target both serotonin and norepinephrine (side effects of both: nausea, diarrhea, headache, tremor,
sexual disfunction and agitation
• Lithium: side effects: nausea, vomitting, diarrhea, blurred vision, toxicity (organ damage) and tremor
Used as a mood stabilizer
Has been prescribed for bipolar disorder for more than 60 years (prescription rate is declining due to the side effects)
Prevents/treats mania
• Antianxiety drugs: SSRI are often prescribed due to the withdrawal symptoms
Barbiturates:
- Induce relaxation and sleep
- Highly addictive and can lead to dangerous withdrawal symptoms (life threatening - a significant rate in heart rate, delirium and convulsions)
Benzodiazepines (tranquilizers) about 80% of those who take this for 6 weeks or longer tend to show withdrawal symptoms
- Used in the treatment of anxiety, insomnia, seizures, and neuropathic pain
- E.g. Xanax, Klonopin, Valium, Ativan
- Highly addictive and show significant withdrawal symptoms (heart rate increase, irritability and sweating)
ELECTROCONVULSIVE THERAPY (ECT) 1 million people get it yearly
Introduced in early 20th century
Used to treat severe mood disorders
Treatment involves passing an electrical current (70-150 V) through a patient’s brain:
- This induces a seizure for about 1 min
- Anesthesia and muscle relaxants are administered before the procedure
- Has been shown to be effective in the treatment of:
- Depressive disorders
- Bipolar disorder
- *Potentially OCD
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ALTERNATIVE APPROACHES TO STIMULATE THE BRAIN:
• Repetitive Transcranial Magnetic Stimulation (rTMS): treatment resistant depression
Noninvasive technique to stimulate the brain
- Exposes patients to high-intensity magnetic pulses that are focused on specific brain regions
• Deep Brain Stimulation (DBS):
Electrodes are surgically implanted into particular areas of the brain (deliver stimulation to certain neural areas)
• Vagus Nerve Stimulation (VNS):
Electrodes are surgically implanted in the vagus nerve (vagas nerve: transports info to the brain)
This approach provides superior outcomes in terms of effectiveness and mortality among patients with chronic, and treatment resistant depression, can also reveal auditory
hallucinations
PSYCHOSURGERY: main issue:we don’t know what part of the brain is causing symptoms, and numerous parts of the brain are likely
Controversial approach to treatment
• Trephination:
prehistoric form of crude brain surgery to release evil spirits
• Prefrontal lobotomy: later seen as cruel and not effective, side effects were severe and permanent (side effects: inability to control impulses, iniate actitivy, seizures and
sometimes death)
Procedure was introduced in 1935
For treatment of individuals experiencing psychosis
• By the 1950s:
use of psychosurgery had declined significantly
• Today:
Psychosurgery is used, but rarely
ASSESSING BIOLOGICAL APPROACHES:
• PRO:
Many find the biological approach appealing
- It promotes the view that mental disorders ought to be viewed as medical diseases (eliminates blame)
• CON:
Not everyone responds well to drugs or other biological treatments available
Most of these therapies have significant side effects
• critiques worry these individuals will become dependent on the meds instead of confronting the issues
• Those who rely more on biological approaches are more pessimistic
PSYCHOLOGICAL APPROACHES: Behavioural approaches
BEHAVIOURAL APPROACHES
• Classical Conditioning:
Ivan Pavlov discovered this phenomenon
Behavioral Approaches
• Operant Conditioning:
E.L. Thorndike:
- The Law of Effect: behaviors that are followed by a reward are strengthened. Those that are followed by a punishment are weakened
Operant conditioning: shaping behaviors by
- providing rewards for desired behaviors
- providing punishments for undesired behaviors
- B.F. Skinner promoted research in this domain (stated that birds could press bars if bars were associated with delivery of food, pigeon would avoid if it was associated
with electrical shock)
• Operant conditioning reinforcement schedules:
Continuous reinforcement schedule (reward or punishment every time the behaviour occurs)
Partial reinforcement schedule (reward or punishment happens sometimes the behaviour occurs)
• Extinction: elimination of a learned behavior (Extinction is more difficult if behaviour was learned through partial reinforcement
• Hobart Mowrer’s (1939) two-factor model (shows how combinations of classical and operant conditioning can explain how fears persist)
• Initially individuals develop fears through classical conditioning (ex. Woman may fear malls as she was assaulted in one a year ago), second stage is they develop
behaviours to help them avoid triggers for that fear (Ex, woman would avoid mall) extinction cannot happen if she doesn’t expose herself
• Modeling and Observational Learning:
Albert Bandura:
- Social Learning Theory: people learn to engage in behaviors by watching others
- Modeling (people learn by imitating influential people (caregivers)) - more common if the person who they are imitating is see an an authority figure or the
individual modelling behaviour is be like oneself (kids are more likely to look at the same-sex caregiver as them)
- Observational learning (people observes the rewards or punishments another person gets for their behaviour and acts accordingly (observing consequences
of others behaviour ex sibling getting in trouble
- Some researchers argue that observational learning can be used to explain violence and criminal activity
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BEHAVIOURAL THERAPIES:
psychology
• Focus:
Identify reinforcements and punishments that impact a person’s maladaptive behaviors
- Try to alter specific behaviors
- Requires a behavioral assessment of the client problem
• ex( what are the triggers, when are the likely to use drugs, what are the circumstances)
• Systematic desensitization therapy:
Gradual approach for the extinction of anxiety responses to stimuli AND the maladaptive behavior associated with that anxiety
• clients will learn relaxation and fear stimuli, therapist helps by using least feared to most feared stimulus while doing relaxation exercises
• good treatment the most for anxiety, and often combined with modelling (watching the therapist)
ASSESSING BEHAVIOURAL APPROACHES: limitations are unclear, doesn’t recognize the impact of free will
• The effectiveness of behavioral therapies has been strongly supported in controlled studies
COGNITIVE APPROACHES:
• Causal attributions:
The attributions that we make for events that occur in our lives can have an impact upon our behavior
The attributions we make for our behavior can have an impact upon our emotional responses and self- concept
Global assumptions: broad beliefs that we have about ourselves, our relationships, and the world.
- Can be positive/helpful or negative/destructive
• albert elis and aaron beck made the arguement that the vast majority of maladaptive behaviours result from disfunction global assumptions
• disfunctional assumptions: rigid rules for living that tend to be unrealistic (“i should be loved by everyone” or “its better to avoid problems than to face them”
individuals who hold onto these will react to situations with irrational thoughts and behaviours
• example: if we act rude to another person we attribute that to situational factors (not having a good sleep), and not feel as guilty, however if you attribute that to
personal factors (not being a nice person) you are more likely to feel guilty
• Cognitive therapies: this approach is designed to be short-term (12-20 sessions, 1-2 a week)
Assist clients in identifying and challenging negative/dysfunctional beliefs
Goal: collaborate with clients to define issues and teach them effective problem-solving techniques to more adaptively cope with their challenges
Main goals to therapy: 1. To help clients identify maladaptive thoughts (ex, diary of thoughts) 2. Teach the clients to challenge their maladaptive thoughts so they will be
encouraged and 3. Encourage clients to face their fears and understand how to cope effectively
• Cognitive-Behavioral Therapy (CBT): very common,
Cognitive techniques combined with behavioral techniques
Focus: problem-oriented, emphasis on the present
ASSESSING COGNITIVE APPROACHES:
• Maladaptive cognitions are common among individuals with:
Mood disorders
Anxiety disorders
Sexual disorders
Eating disorders
Substance use disorders
• limitation: hard to prove that maladaptive cognitive being the cause rather the consequence
*Cognitive therapy tends to be useful in the treatment of these disorders
PSYCHODYNAMIC APPROACHES
• Freud developed psychoanalysis (collaborated with Jospeh Brewer in order to understand a client named Anna Oh, used hypnosis on her)
Catharsis: release of emotions connected to unconscious memories, hysteria that anna oh had were from repressed memories
Repression: motivated forgetting of a distressing experience (symptoms can still become manifested, so it doesn’t eliminate the emotion with the memory
PSYCHODYNAMIC THEORIES: 3-4 session per week for years, symptom relief over focus on past
• Ego psychology: emphasizes the importance of a person’s ability to regulate their defense mechanisms in a way that facilities healthy functioning within a society
• Object relations (Klein, Mahler, Kernberg): our early relationships create unconscious representations of ourselves and others
• these are carried with us for our entire life and cause expectations for future relationships (ex. Early relationship with care givers can effect future relationships)
PSYCHODYNAMIC THERAPIES: goal: help clients understand the maladaptive coping strategies they use and the sources of unconscious conflucts
• Focus: uncovering and resolving unconscious factors responsible for psychological symptoms
• Free association: a client talks about whatever comes to mind without censoring themselves
• Client’s resistance: material that the client is resistant to talking about
• Transference (happens when clients responds to therapist like father or mother) and countertransference (therapist builds emotions and feelings for clients): can be
important sources of insight and can be used as a tool in psychotherapy
Most threatening conflicts are the ones that our ego tries to repress
• Comparing classical psychoanalysis vs modern psychodynamic theory
• Interpersonal therapy (IPT):
Emerged from modern psychodynamic theory
Focus on the client’s pattern of relationships with individuals in their life
• therapist is structuring and directive, often therapist will provide interpretations early on with strong focus on how the client can change their current relationship
ASSESSING PSYCHODYNAMIC APPROACHES:
• Psychodynamic approaches have played a strong role in shaping psychology and psychiatry (primarily in highlighting the importance of the unconscious mind)
• Limitations:
Difficulty in testing fundamental assumptions in this approach using valid/reliable methods b/c key factors are unconscious
Generalizability is questionable
Financially inaccessible to many (since it tends to be long-term)
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HUMANISTIC APPROACHES
• Carl Rogers (1951):
psychology
Developed humanistic theory
Believed that people naturally move in the direction of personal growth, self- acceptance, and self- actualization (self-actualization is defined as fulfillment of our potential
for our creativity, meaning and love in our lives)
- Pressure from others can interfere with this (can have distorted perspective of ourself)
HUMANISTIC THERAPY: hold the belief that if they can provide the client with a supportive environment and relationship, that the client will grow and gain insight
• Purpose: assist clients in discovering their greatest potential through the process of self-exploration
• Client-centered therapy (CCT):
Developed by Carl Rogers
Therapist communicates:
- Genuineness
- Unconditional positive regard
- Empathetic understanding
- * Primary strategy to communicate these elements is reflection
• the therapist will express an attempt to understand what the client is trying to say
ASSESSING HUMANISTIC APPROACHES:
• has helped with individuals diagnosed with depression, alcoholism, schizophrenia, anxiety, and personality disorders (good for those partially distressed, not for severely
distressed)
• This approach gained significant traction in the 1960s. Currently is utilized in:
Self-help groups
Peer-counseling programs
Humanistic theories focus on helping individuals to achieve their greatest potential rather than focusing on pathology.
Criticisms:
- Vague
- Difficult to test empircally
FAMILY SYSTEMS APPROACHES:
• The family is viewed as a complex interpersonal system
• Hierarchy and rules: shape and sculpt family member behavior
Can be functional (dynamic support growth of family members and accept change) or dysfunctional (nurture psychopathology and maintain it)
FAMILY SYSTEMS APPROACHES:
• How psychopathology manifests in an individual is contingent upon:
Family cohesiveness
Communication style
Adaptability to change
Common issues in family systems: inflexible family(resistant to forces outside family and do not adapt well to changes in family), enmeshed family (family members overly
involved, individual family members may feel controlled), disengaged family (family doesn’t pay attention to each and act as isolated units)
FAMILY SYSTEMS THERAPY: family system theorists believe that a person’s problems stem from interpersonal problems, you cannot help the individual without treating the
entire family
• Behavioral Family Systems Therapy (BFST): focuses on family communication and problems solving
Behavioral and cognitive methods are harnessed to teach effective communication and problem solving skills
ASSESSING FAMILY SYSTEMS APPROACHES: research in this domain can be hard since relational dynamic are hard to capture, they will often behave differently in a lab
• Particularly useful in the treatment of children
• Families play a strong role in impacting psychological symptoms of its members
THIRD-WAVE APPROACHES:
DIALECTICAL BEHAVIOUR THERAPY (DBT): most established third way approach and developed by marsha lineham to treat those with borderline personality disorder, more with
borderline personality disorder who are suicidal
• Dialectical: there is continual tension between conflicting thoughts, images, or emotions among individuals who are at risk of psychopathology (ex. Individuals with borderline
personality disorder will feel like they want to connect with and push away an individual, conflicting emotions)
Three main goals: 1. To improve problem solving skills, 2. To improve interpersonal skills 3. To improve the management of negative emotions
DBT focuses on the effective management of negative emotion and effortful control over impulsive behaviors
• DBT has significant transdiagnostic relevance, it has been adapted to treat mood and eating disorders, issues with emotional regulation and impulse control issues
ACCEPTANCE AND COMMITMENT THERAPY (ACT)
• Developed by Steven Hayes
Fundamental assumption that experiential avoidance (avoidance of painful thoughts, emotions or memories)underlies many mental health problems
Intervention models combine:
-Mindfulness (state of consciousness where attention is focused on the present) and acceptance (willingness of a person to experience their thoughts, emotions and
sensations without trying to change or avoid them) in order for positive thoughts
- Behavioral principles
- Understanding of personal values
ASSESSING THIRD-WAVE APPROACHES: further research is needed on how these approaches work and why they work so affectively
• Effectiveness of therapies with a focus on emotion regulation suggest that these approaches can be useful in treating many mental health challenges
USING NEW TECHNOLOGY TO DELIVER TREATMENT: there are many disparities for mental health access associated with ethnicity, race, low SES, rural locations, immigration
status
• The rate of mental health challenges is higher among disadvantaged ethnic minority groups
These are the groups that also have less access to mental health services
• Telepsychology: can reduce disparities in mental heath service access (used during covid 19)
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SOCIOCULTURAL APPROACHES
SOCIOCULTURAL FACTORS:
psychology
• Socioeconomic disadvantage:
Transdiagnostic risk factor for many mental health concerns
• Upheaval and disintegration of societies are risk factors for mental health concerns
• Social norms and policies stigmatize and marginalize certain groups of individuals:
These individuals are at an increased risk for mental health challenges
- E.g. LGBTQ individuals experience higher rates of substance use, anxiety, depression, and suicidality in comparison to heterosexuals, there is a 7% reduction of suicide
attempts for sexual minority youths in states who passed marriage
• Culture: knowledge and meaning within a group of individuals which is passed on through generations. Strong focus on shared:
Beliefs
Values
Behaviors
Ways of life
Shared cultural belief systems play a strong role in determining how psychological disorders are understood and how they are identified, rates vary across sexes and cultures
• Impact of social media:
We are more likely to accept information which supports our beliefs and we are more likely to seek out friends with similar beliefs
• opinion based confirmation bias can end up strengthening rumours and tends to segregate groups and end up with echo chambers
Echo chambers:
- Like-minded clusters of opinion
- Selective exposure to others and opinion-based confirmation bias ends up reducing the likelihood of exchanging different perspectives
• The new age of misinformation has significant consequences for culture and our understanding of mental illness
CROSS-CULTURAL ISSUES IN TREATMENT: people with diverse backgrounds are typically treated with the same psychotherapy
• Multiculturalism in therapy: a clinician’s investment into embracing cultural differences which exist in their clients.
They must simultaneously acknowledge the impact of their own culture in shaping their perceptions of and responses towards clients.
• Psychotherapy: emphasizes the expression of emotions and vulnerability in sharing personal concerns
Some cultures tend to value restraint in emotional expression, others place a high premium upon emotional expression
• Italian and Jewish families tend to show tendency to use emotional expression to show vulnerabilities, conversely Scandinavian asian and native Americans tend to
withdrawal and don’t discuss feelings and openly
• Family based therapy tends to be more appropriate than individual therapy with cultures that are highly family oriented (ex. Native american, hispanic, african american,
asian)
• Is ethnic matching between therapist and client important? Research tends to show that it doesn’t tend to be important to predict, matching can have an impact on client
preferences and treatment attendance
• Is gender matching between therapist and client important? In terms of gender matching, there isn’t much evidence, both male and females report a therapist of the same
gender, gender matching may be beneficial for comfort (important for searching and continuation
ASSESSING SOCIOCULTURAL APPROACHES:
• The sociocultural approach highlights the importance of focusing on larger social and cultural forces that impact behavior
• Strength: this approach does not place the responsibility of psychopathology on the individual
• Drawback: vague about how social and cultural factors cause psychological disturbances among individuals
Professions that focus on empowering the individual to alter social circumstances to improve quality of life are community psychologists and social workers
PREVENTION PROGRAMS: all three work to reduce psychopathology on individuals and community
• Primary prevention: ex. Drug abuse (changing neighbourhood characteristics)
Stopping a disorder from developing (before they even start)
• Secondary Prevention: could do questionnaire
Detecting a disorder at its earliest stages
Early identification through screening
Interventions designed to prevent the illness from becoming worse
• Tertiary prevention: ex medical treatments
Assisting individuals who already have a disorder
Goals: prevent relapse, reduce the impact of the disorder on the individual’s quality of life
COMMON ELEMENTS IN EFFECTIVE TREATMENTS
• Positive therapeutic relationship between client and therapist: can be a good indicator of outcomes (positive may account for more successful treatment)
• since therapy in interpersonal, it is an emotion experience and they need to trust them and believe they understand them
• clients with a positive relationship with therapist are more likely to be vulnerable, try new skills and new coping technique
• authenticity, empathy, unconditional positive regard
• Having an explanation for symptoms
• having a label for their symptoms and explanations helps them to feel better
• Client buy-in to the treatment approach
• when the rationale behind the approach, they are more likely to engage actively and apply the principles they learned in their daily lives and complete homework
• Confrontation of painful emotions
• assist individuals to become less sensitive to those emotions
• behavioural, systematic desensitization, psychodynamic might be used
• goal is to help client accept emotions and express them instead of avoiding
Purpose of all; to promote positive change and increase psychological functioning and well-being in the everyday life
 psychology
In this figure you can see the connection between institutionalization and incarceration
• data from US
• individuals released from psychiatric institutions, they start to live in group homes where there
wasn’t enough mental health support
• Some individuals didn’t have the support to watch and take care of mental health individuals so
there was a significant increase in homelessness (around 20-50% homeless suffer from
mental illness most commonly drug or alcohol dependence
• Bidirectional relationship between homelessnes and mental health patients

Same trend of incarceration from US occurs in Canada

• looks at psychiatric deinstitutionalization in BC and the neg consequences

Integrationist approach:
Biological what are your biological vulnerabilities?
Psychological: what coping mechanisms do you use? Do you feel in control of your life and problem solving
strategies
Social: do you have a support network?
All the factors collectively predict an individual’s mental health

Natural response IVAN PAVLOV:

They would salivate with food in mouth or if they heard footsteps
Ex. After a car accident a person may have stress response after seeing their vehicle

Behaviour change techniques:

 psychology
These three are biocycle social approach to understanding mental health
Risk factors all intertwine
Sociocultural: result of culture norms and environmental, deviance
behaviours are understandable from social stress
Biological: disorders as abnormal genes or neurobiological disfunction
Psychological: disorders result of thinking processes, personality styles

Cerebral cortex: outer layer of cerebrum, involves in complex thinking, two

hemispheres connected by corpus callosum
Each lobe separated into 4: frontal, parietal, occipital and temporal

Neurotranmitter

LIMBIC SYSTEM

ENDOCRINE SYSTEM:
Pituitary gland: Master gland- produces large
number of hormones and controls secretion
processes of other endocrine glands
• relationship with hypothalamus: illustrates GENETIC
complex interactions between central ABNORMALITIES
nervous system and endocrine
• When experiencing stress, neurons in
hypothalamus secrete CRF, carried from
hypothalamus to pituitary and stimulates the
pituitary to release ACTH, ACTH is carried by
the blood stream to adrenal glands and
triggers the release of approx 30 hormones
to help the body to adapt to emergency
situations At conception, zygote contains 46 chromosomes
• Individuals who have dis regulated HPA axis • one pair determines sex XX = female XY= male
have abnormal physiological responses to • Mother will always give x, male can give xy
stress that can make it more challenging to
• Alterations to chromosomes can cause:
cope with stress and can cause anxiety and
• down syndrome: one extra chromosome on
depression
21 pair, intellectual disabilities, heart malformations,
• HPA axis often implicated in stress but also in
facial features (flat face, small nose, slanted eyes)
anxiety and depressive disorders
• chromosomes contain genes and DNA
• Genes provides coded instructions, come in pairs
• Abnormalities in genes are more common than
abnormalities in the structure or number of
chromosomes
 ▫

ASSESSING AND DIAGNOSING ABNORMALITY

psychology
HOW ARE PSYCHOLOGiCAL DISORDERS EVALUATED?
• Purposes of psychological assessment: involves interviews, observations, psychological and neurological tests to get a better understanding and refine
Collect information
Draw conclusions
Develop treatment plan *most important
• Assessment: process of using clinical methods in order to evaluate psychological, social and emotional functioning
• information gathered includes symptoms, methods of coping with stress, physical conditions, drug and alcohol use, family history, cognitive functioning
• Utility of a standardized diagnostic system: Ex. DSM 5 and ICD 10
Supports effective communication among mental health professionals:
Facilitates research:
Informs community regarding best practices for treating psychological disorders
ASSESSMENT TOOLS:
Validity:
• Validity: the accuracy of a test in assessing what it is meant to measure
Concurrent (or convergent) validity: the degree to which a test shows the same results as other established measures of the same thoughts, behaviors, or feelings
*there are no definitive tests for the psychological disorders that we will discuss throughout this course
Reliability:
• Reliability: consistency of a test in measuring what it is supposed to measure
• Issue: when individual complete a test the second time they might try to complete the same responses, avoid this using alternative form
Standardization:
• Standard method of administering a test:
Can improve validity and reliability and reduce impact of extraneous factors
• Standard method of interpreting a test:
Increases the validity and reliability of test interpretation (ex. Have scores above a certain number considered to be clinically extreme)
Clinical Interview: subjective
• Typically a face-to-face conversation between a client and mental health professional
Information is gathered regarding:
Behavior
Emotions
Attitudes
Life history
Personality
Mental status exam is often used: evaluate 5 main categories
1. Client appearance and behaviour: look at overt physical behaviours, appearance, cooperation, facial expressions
2. thought process: how fast does client think? Are thoughts disorganized or in an organized manner?
3. Mood and affect: does client seem to be depressed? What mood do they say and does that match appearance?
4. Intellectual functioning: attentive to how well client speaks, any attention or memory deficits
5. Sensorium: clients general awareness of surroundings, and orientation to things like time place and people. If a client understands when and where and who they are,
they tend to be appropriately oriented
• Multiple formats can be used:
Structured: ask a series of standardized questions about their symptoms and concrete criteria is used (benefit: enhanced reliability and validity, drawback: you don’t
have a whole lot of flexibility)
Unstructured: open-ended questions are asked
Semi-structured: combined both, able to follow up on specific questions in an attempt to gather more personal information
Computerized methods are currently under development
Symptom Questionnaires
• Symptom questionnaire: used as assessment tool
May be generalized or focused on a particular disorder (ex. BDI 2 useful for predicting and detecting major depressive disorder, but can
T be used as single assessment
Not used for the purpose of diagnosing a psychological disorder
Personality Inventories
• Questionnaires that are used as one component of the assessment procedure in order to assess:
Well-being
Self-concept
Attitudes and beliefs
Methods of coping
Social resources
Vulnerabilities
Perceptions of environment
• Minnesota Multiphasic Personality Inventory (MMPI): most widely used personality inventory
• translated into more than 150 languages
• includes 10 clinical skills, assess 10 major categories like: substance abuse, anxiety, etc.
•
 ▫

ASSESSMENT TOOLS CONT’D:

- psychology
Personality Inventories
• MMPI was developed empirically and contains 4 validity scales (assess clients test taking skills, attitude, whether they answered honesty)
• Criticisms of the use of MMPI:
Questionable generalizability to culturally diverse samples
Linguistic accuracy of translated versions is in question
Behavioral Observation and Self- Monitoring : helps clinicians understand certain behaviours
• Behavioral observation: drawback: individuals may alter behaviour as they know they are being observed, and sometimes direction observation is impossible and would then
use role-play
Clinicians identify particular behaviors and will make note of what precedes and what follows those behaviors
This information can guide therapy
Behavioral Observation and Self- Monitoring
• Self-monitoring:
Traditionally, clients would provide a retrospective report to an interviewer about their feelings, emotions or behaviours
Smartphones currently offer innovative ways for client’s to self-monitor
• advantages: social interaction and physical emotions can be reported in real time, disadvantages: self-monitoring is vulnerable to self biases
Intelligence Tests
• Intelligence tests: usually reliable and valid, common for kids
Assess client’s level of cognitive functioning
Assess verbal and nonverbal skills
• Assessments of client intelligence can provide useful information to mental health professions in the diagnostic process
• Intelligence tests are controversial, don’t capture interpersonal or intrapersonal skills, artistic, musical skills etc
Neuropsychological Tests
• Neuropsychological tests:
Can provide useful information to assist with the detection of specific cognitive deficits
Often used if a clinician suspects neurological impairment
• Bender-Gestalt Test: paper and pencil test that tests sensory motor skills, individuals with brain damage may alter drawings or not produce them
• Doesn’t identify different types of brain damage
Brain-Imaging Techniques can reveal whether they have a brain injury or tumour and can reveal important differences such as neural activity
• Neuropsychological tests are often used alongside brain-imaging techniques in order to:
Identify specific neurological deficits
Identify possible brain abnormalities
BRAIN-IMAGING TECHNIQUES
• Computerized tomography (CT): show brain injury, tumours, structural abnormality, doesn’t show neural activity
X-ray beams are passed through an individual’s head
Radiation absorbed by each X-ray beam is measured
Uses a single plane but many different angles
Allows for an image to be constructed of a slice of the brain
Positron-emission tomography (PET):
Reveals activity in the brain
• Single photon emission computed tomography (SPECT):
Procedures very similar to those used in PET with the exception that a different tracer substance is injected, less accurate and less expensive
• Magnetic resonance imaging (MRI):magnetic field is created and causes realignment of hydrogen atoms in the brain, so when magnetic field is on hydrogen atoms emit
magnetic signals
Provides more finely detailed pictures of the brain
than other imaging techniques
Doesn’t require the use of radiation or radioisotopes
Two types:
Structural MRI : provides high resolution static imaging
Functional MRI: provides images of neural activity, images are taken just seconds apart so they will reveal brain changes in response to different stimulus
 ▫

Psychophysiological Tests
• Used to detect changes in the brain and nervous system:
- psychology
Correlate with emotional and psychological changes
E.g. Electroencephalogram (EEG): measures electrical activity on the scalp induced by fire of certain neurons, used to detect seizures, tumours and strokes,
heart rate, respiration: responsive to stress, electrodermal response: galvanic skin response, electrical conductivity on the skin and emotional arousal (ex. Veteran with ptsd
might have strong electrodermal response to the images of war
Projective Tests
• Projective tests: controversial
Fundamental assumption: When individuals are presented with ambiguous stimuli, they tend to interpret this stimuli according to their current feelings, relationships,
conflicts, etc.
Two most frequently used tests:
- Rorschach Inkblot Test: developed in 1921, test is a good measure of disordered thinking, ex. In identifying schizophrenia
• has 10 cards and each card has a symmetrical in black grey and white, ask client what they see and what they think of
- Thematic Apperception Test (TAT)
• individuals are asked to make up a story in response to pictures and their stories might reflect their personality and motives
CHALLENGES IN ASSESSMENT:
Resistance to Providing Information
• Reasons for resistance:
Individual does not want to be assessed
Individual does not want to be treated
• ex. Child may be resistant if a parent told them to go to therapist as it wasn’t their idea in the first place, might purposely give biased info
• Sometimes individuals purposefully present biased and inaccurate information to the assessor
EVALUATING CHILDREN:
• Children have a difficult time self-reporting emotional and behavioral concerns: ex they will say they feel bad, mad, jealous
Parent reports can be important in understanding children’s functioning.(clinicians will interview parent) (parental perception of their children isnt important and have
different expectations for their kids behaviours)
• Children may focus on physical symptoms they are experiencing
• It is important for a clinician to be especially mindful of the nonverbal behavior that children display
• Parent psychological well-being: has a tremendous impact upon the mental health of children
• Reduced help-seeking behaviors among caregivers are associated with:
Beliefs that mental health issues are caused by a child’s personality
Negative perceptions of mental health services
Perception of stigma associated with mental health problems
• parents with a psychological disorder can have a significant impact on the behaviours of their kids, and may not seek help
• kids with anxious parents may show more psychological disfunction in heighten fears, low control, behavioural issues and insecure attachments
• Culture is an important factor in determining whether caregivers will seek help for their children:
• eastern cultures: tend to value interdependence and reliability on family (enmeshment between mother and child is supported in Japan)
• socially anxious: shy anxious or reserved are valued in Asian country, whereas in western these are frowned upon
• individuals tend to be much more likely to access treatment if they are caucasian, have insurance, live in urban area, and kid with severe mental health challenges
Cultures impact how abnormal emotions and behaviors are defined
Cultural background can impact whether caregivers seek out mental health services
• Teachers are often asked to provide information concerning a child’s functioning (sometimes first one to recognize children need mental health support)
Evaluating Individuals Across Cultures
• Mental health treatments tend to be more effective when:
Therapists display multicultural competence
• low cultural competence among mental health professionals is associated with disparities and treatment outcomes
• Ex. Minority clients are much less likely to state concerns. To seek out info or to feel trust
Treatment aligns with the client’s culture
DIAGNOSIS;
• Diagnosis: a label that we attach to a group of symptoms that occur together
• Syndrome: a set of symptoms (not a list of symptoms that every individual will display all the time, can be substantial overlap with symptoms of two syndromes
• often overlap with depression and anxiety
People differ in terms of which symptoms are most prominent
• Classification system: the set of syndromes and the rules used to determine whether an individual’s symptoms are part of one or more of those syndromes
• History of classification systems:
Hippocrates: first classification system for psychological symptoms, divided mental disorders into mania, melancholia, paranoia and epilepsy
Emil Kraepelin: published first modern classification system, forms foundation for systems we use today
• Classification systems commonly used today:
DiagnosticandStatisticalManualofMentalDisorders
(DSM)
International Classification of Disease(ICD)
 ▫

psychology
Diagnostic and Statistical Manual of Mental Disorders (DSM)
• First edition as published in 1952 in an effort to improve communication about the types of patients cared for in hospitals (early edition of this system relied on influence
of psycho analytical theor
Contained 60 psychological disorders
Has gone through 4 major revisions
• Most updated version is the DSM-5-TR
• Latter editions of the DSM (DSM-III and later): DMS - 5 uses a continuum in the diagnosis including autism and personality disorders
Include specific criteria that must be present to receive a diagnosis
Include a specified time duration that individuals must show symptoms in order to be given a diagnosis
The symptoms must be interfering with an individual’s:
• Ability to function
• Sense of well-being
Controversial Elements of the DSM
• The following are some of the most controversial topics regarding the current classification and diagnosis of mental health disorders:
1) Reifying diagnoses: term meaning trying to put in concrete form that is an abstract form, judgements are biased
2) Category or continuum: debate whether it should be one of these, dimensional have been added and reflect increasing support that all behaviours fall on continuum
3) Differentiating mental disorders from one another: comer morbidity, one who has one disorder may have another as their symptoms overlap ex. Irritability and
aggitation (schizophrenia, anxiety, depression) tried to fix this by reducing the overlap, specifically for personality disorders
• questions: “which diagnoses should be the primary? Which one should be treated?”
4) Addressing cultural issues: culture bound syndrome: cultural differences in delusions in schizophrenia
THE SOCIAL-PSYCHOLOGICAL DANGERS OF DIAGNOSIS;
The impact of a diagnostic label
• Once a diagnosis is given: people have a tendency to view it as real instead of as a judgment.
Thomas Szasz criticized the use of diagnostic symptoms (too many biases in determining, mental disorders don’t exist but instead are repressed by society and refuse to
accept their uniqueness)
Research by David Rosenhan (1973) highlights the unintended consequences of diagnostic labels (had him and 7 others admitted to hospitals and state that they heard
voices about empty hollow and thud, all but one got schizophrenia, the other patients noticed the normality
• Once a diagnosis is given: people have a tendency to view it as real instead of as a judgment.
Thomas Szasz criticized the use of diagnostic symptoms
Research by David Rosenhan (1973) highlights the unintended consequences of diagnostic labels
• “Such labels, conferred by mental health professionals, are as influential on the patient as they are on his relatives and friends, and it should not surprise anyone that the
diagnosis acts on all of them as a self-fulfilling prophecy. Eventually, the patient himself accepts the diagnosis, with all of its surplus meanings and expectations, and behaves
accordingly”
- David Rosenhan (1973)
FUNCTIONS OF DIAGNOSTIC SYSTEMS
• Despite the issues associated with diagnostic systems, they serve the following functions:
Organize psychological symptoms which facilitates communication across clinicians (mainly)
Standard diagnostic system facilitates research on psychological disorders
WHAT HAPPENS AFTER A DIAGNOSIS IS MADE?
• A client works with their therapist to develop a treatment plan
• The plan should be comprehensive, should meet the clients needs, should be designed to improve psychological functioning, establish clear goals and should allow for
patient tracking
• therapist is responsible for tracking and keeping records, and focused to put treatment on suicidal idealization, and self care
• Diagnostic labels can:
Deter individuals from seeking treatment
Support self-fulfilling prophecies by those who have received a diagnostic label

In order to get a full part of person, you need to look at these collectively
 psychology
Types of validity: Example of structured interview

If the test is measuring a general characteristic,

Test scores should be similar at two points of time

Types of reliability

Often interviews or observational members and require that they make

judgements in similar ways
• high interrater they have come to the same conclusions

MMPI

Example of Rorschach Inkblot

Test

Even if they are willing to

discuss, their
understanding of their
behaviours and emotions
may be unclear
• ex. Kindergartens
• Behaviours can
provide how they
are feeling and show
DSM - 5 PANIC DISORDER critical information
criteria
 psychology
PRACTICE QUESTIONS:
Thomas Szasz was a ______ who argued that individuals have historically labeled individuals and groups abnormal in order
to justify control of that group. Szasz is a proponent of the _______ perspective.
• Psychiatrist; cultural relativism
In their theories, _______ focused on self-efficacy whereas, _____ focused on irrational negative assumptions (about
themselves and the world) in determining psychological well-being.
• Bandura; Ellis
Albert has lived by railroad tracks throughout his entire life. He is able to disregard the noise of trains at night while he’s
sleeping because of this part of his brain:
• reticular formation