Abnormal Psychology

Module 3: Etiology and Treatment of Mental Disorders

Multidimensional and Biological Methods
and Perspectives
Insufficient Unidimensional Explanations of Mental
Disorders
• System: a set of elements that interact or are
interdependent on one another, but form a coherent
whole that interacts with its environment and/or other
systems

• Multidimensional models: consider how multiple

systems interact in contributing to mental disorders

• Unidimensional: explanations of mental disorders such

as that they are caused by a "chemical imbalance" or
alternatively, that they are caused by a negative
relationship with one's mother are inadequate to fully
understand the disorder and its causes

• Epigenetics: a newer field of study shedding light on

how social, psychological, and environmental influences
can actually change which genes in a person's DNA may
activate or may be turned off, having significant
implications for the development of disorders
Biopsychosocial Model Simplified
Biopsychosocial Model in Psychopathology
Biopsychosocial model (BPS): instead of the medical model
that emphasizes mental illness as disease, this model strives for
a more holistic approach by recognizing that each patient has
their own thoughts, feelings, and history
• Biological: genetic inheritance related to risk of developing
a disorder, malfunctions or disruptions of the system of
neural transmission between neurons in the brain
• potential damage to parts of the brain, infections or
diseases that might affect brain or nervous system
functioning, and hormonal influences or brain-hormone
interactions, etc.
• Psychological: thoughts, feelings, and behaviors including
learned behaviors (conditioning or observed behaviors),
thought patterns that increase or intensify emotions like
sadness or anxiety
• can include events occurring during key developmental
stages in life, strengths and weaknesses, inability to cope
with different life stressors, sense of confidence or self-
efficacy, personality development, etc.
• Social/cultural: external situations that can shape how
people respond to events and other people, often by
influencing the degree of stress a person experiences in their
life
Diathesis-Stress and Gene-Environment Models
• Diathesis-stress model: helps us understand
why one person might develop a disorder, or why
two people from similar backgrounds might
develop different disorders
• diathesis (usually genetic or biological) and
environmental stress, are necessary in the
development of a disorder
• Threshold: a point at which the person's coping
abilities and social, psychological, and biological
defenses cannot manage their level of life stress
• when the combination of a
diathesis/vulnerability and life stress exceeds
the person's threshold, they will develop a
disorder that aligns with their vulnerability
• Gene-environment correlation model (rGE):
is defined as the tendency of individuals to select
and generate their environment based on genetic
features that influence behavior, thoughts, and
feelings
Class Activity: Discussion on Cause

Working in pairs or in a small group, pick a mental disorder and research its
causes.

Find two biological, two psychological, and two psychosocial explanations

that contribute to the development of the disorder.

Based on this information, how would you segment a pie chart for the
leading factors related to that mental disorder, like the one shown below?
Polygenic Inheritance and Genetic Heritability
• All mental disorders have polygenic inheritance;
there is no single gene that causes depression,
schizophrenia, or anorexia nervosa

• There are multiple (poly) genes that interact to

contribute to the development of mental disorders.

• Heritability is a statistic that estimates the degree

of variation of a phenotypic trait in a population,
such as the presence of a mental disorder, that is
due to genetic variation between individuals from
that population.
• calculated by comparing individual variation
among related individuals in a population using
various methods and is helpful in seeking to
understand the impact of genetics versus
environmental influences for a given disorder.
Neural Communication and Neurotransmitters
The soma has branching extensions known as
dendrites.
These signals are transmitted electrically
across the soma and down a major extension
from the soma known as the axon, which ends
at multiple terminal buttons.
Receptors, proteins on the cell surface where
neurotransmitters attach, vary in shape, with
different shapes “matching” different
neurotransmitters
The neuron exists in a fluid environment—it is
surrounded by extracellular fluid and
contains intracellular fluid
Neural Communication and Neurotransmitters
(cont.)
Between signals, the neuron membrane’s potential is held in a
state of readiness, called the resting potential
This positive spike constitutes the action potential: the
electrical signal that typically moves from the cell body down
the axon to the axon terminals

● Dopamine: related to movement, memory, and as part

of the brain's pleasure or reward center
● Serotonin: a neuromodulator, meaning that serotonin
appears to influence the functioning of other
neurotransmitter systems; serotonin is also relevant to
pain, sleep, digestion, and mood
● Norepinephrine: also related to mood, pain, heart rate
and blood pressure
● GABA: a major inhibitory neurotransmitter, often
believed to be related to calming down or relaxation; it
has links and connections to alcohol and other substances
● Glutamate: an excitatory neurotransmitter, related to
learning and memory and other functions
Functions of Areas of the Brain and Endocrine
System
Central nervous system (CNS): consists of the brain and spinal
cord
Peripheral nervous system: further subdivided into the somatic
and autonomic nervous systems
• Somatic nervous system: transmits sensory and motor
signals to and from the central nervous system; it is how we
control our "voluntary" muscle movements.
• Autonomic nervous system: controls the functioning of our
organs and glands including "involuntary' muscle movement
• usually things that we are unaware of most of the time
like breathing, our heart beating, the movement of the
muscles that pushes our food through the intestines and
is part of digestion and elimination
• Sympathetic activation: related to energy use and
maintaining homeostasis such as our body temperature
• its major purpose, though, is to enable us to respond to
emergencies or threats through fight or flight by
mobilizing energy quickly.
• Parasympathetic activation: associated with normal
functioning under relaxed conditions, sometimes referred to as
governing "feed and breed" and then "rest and digest”
Endocrine system: consists of a series of glands that produce
chemical substances known as hormones
Areas and Lobes of the Brain
The two hemispheres of the cerebral
cortex are part of the forebrain, which is
the largest part of the brain, accounting
for about 80% of the neurons in the
central nervous system
• Hindbrain: the lower part of the
brainstem and regulates ongoing,
mostly automatic systems in the body
including heart rate, breathing,
digestion, and other processes we
don't often consciously think about
• Midbrain: handles input from our
senses and uses this to help
coordinate movement and parts of the
reticular activating system which is
involved in managing our sleep/wake
cycle and other processes related to
tension and arousal
 Areas and Lobes of the Brain (cont.)
• Frontal lobe: located in the forward part of the brain
and is involved in reasoning, abstract thinking and
planning, creativity, motor control, emotion, and
language.
• also has the prefrontal cortex, which is responsible
for higher-level cognitive functioning including major
inhibitory pathways of neurons that help us regulate
our behaviors and reactions; and Broca’s area,
which is essential for language production.
• Parietal lobe: located immediately behind the frontal
lobe and is involved in processing information from the
body’s senses
• Temporal lobe: associated with hearing, memory,
emotion, and some aspects of language.
• The auditory cortex, the main area responsible for
processing auditory information, is located within the
temporal lobe.
• Wernicke’s area, important for speech
comprehension, is also located here
• Occipital lobe: located at the very back of the brain,
and contains the primary visual cortex, which is
responsible for interpreting incoming visual information
Biomedical Therapies and Brain Stimulation
Treatment
• Lobotomy: a form of psychosurgery in which parts
of the frontal lobe of the brain are destroyed or their
connections to other parts of the brain severed
• Biomedical therapy: medications used to treat
mental disorders are called psychotropic or
psychoactive medications
• Psychotropic or psychoactive drugs are any type
of drug or chemical that alters the way a person
thinks, feels, or behaves
• Agonists: chemicals that mimic a
neurotransmitter at the receptor site and, thus,
strengthen its effects.
• Antagonists: impede the normal activity of a
neurotransmitter at the postsynaptic receptor
• Electroconvulsive therapy: the best-studied brain
stimulation therapy and has the longest history of
use.
• Repetitive transcranial magnetic stimulation
(rTMS): uses a magnet to activate neurons in the
brain
• Deep brain stimulation (DBS): first developed as
a treatment for Parkinson's disease to reduce tremor,
stiffness, walking problems and uncontrollable
Practice Question 1

Within assessment through diagnostic criterion, which of the following only

focuses on two elements: one being biological disposition and second
external factors?

A. Biopsychosocial Model
B. Diathesis-Stress Model
C. Gene-Environment Model
D. Biological Model
Key Concepts and Treatment Methods
Freud’s Unconscious Theory
Freud said that only about one-tenth of our
mind is conscious or self-aware, and the rest
of our mind is unconscious.
Our unconscious refers to mental activity
(emotional reactions, motivations) of which
we are unaware and are unable to access

• Id: contains our most primitive drives or

urges, and is present from birth. It
directs impulses for hunger, thirst,
aggression, and sex
• Superego: develops as a child interacts
with others, learning the social rules for
right and wrong
• Ego: the rational part of our personality
Psychosexual Development and Defense
Mechanisms
Psychosexual Development States:
• Oral stage (birth to 1 year): pleasure is focused on the mouth
• Anal stage (1–3 years): In this stage, children experience pleasure in their
bowel and bladder movements, so it makes sense that the conflict in this stage is
over toilet training
• Phallic stage (3–6 years): corresponding to the age when children become
aware of their bodies and recognize the differences between boys and girls
• Latency period (6 years to puberty): This period is not considered a stage,
because sexual feelings are dormant as children focus on other pursuits, such as
school, friendships, hobbies, and sports
• Genital stage (from puberty on): In this stage, there is a sexual reawakening
as the incestuous urges resurface

Defense Mechanisms: Freud believed that feelings of anxiety result from the ego’s
inability to mediate the conflict between the id and superego.
Freud believed that the ego seeks to restore balance by reducing anxiety through
various protective measures
Defense Mechanisms
Psychoanalysis and Psychodynamic Treatment
Psychotherapy: a type of treatment for
mental disorders that is mostly focused on
psychogenic models of the etiology of
psychopathology

• Free association: the patient relaxes

and then says whatever comes to mind at
the moment without attempting to edit or
worry how the therapist might react
• Dream analysis: dreams contain not
only manifest (or literal) content, but also
latent (or symbolic) content
• Transference: the patient transfers all
the positive or negative emotions
associated with the patient’s other
relationships to the psychoanalyst
• Psychodynamic perspective: approach
to therapy remains centered on the role of
people’s internal drives and forces, but
treatment is less intensive than Freud’s
original model
Humanistic Approach- Psychopathology

Existentialism: a philosophical approach emphasizing a

holistic view of human beings, validating the nature of human
emotions, thought, behavior, and choices
The goal of person-centered therapy (PCT), created by Carl
Rogers, is to create conditions under which clients can discover
their self-worth, feel comfortable exploring their own identity,
and alter their behavior to better reflect this identity

Unconditional positive regard: refers to the fact that the

therapist accepts their client for who they are, without
condition
Nondirective therapy: the therapist does not give advice or
provide interpretations but helps the person to identify
conflicts and understand feelings so they can take
responsibility for their own direction in life and for their choices
Practice Question 2

Which of Freud’s Theories of Personality associates with the “pleasure

principle”?

A. Id
B. Ego
C. Superego
D. Defense Mechanism
Cognitive and Behavioral Methods
Cognitive and Behavioral Methods
3.3:
Explain the key principles of behaviorism, cognitive psychology, and how cog
nitive and behavioral methods are used together
3.3.1:
Describe the key concepts and applications of the behavioral approach to
psychopathology
3.3.2:
Explain how behavioral principles such as exposure and systematic desen
sitization and others are used in treating psychological disorders
3.3.3:
Describe the key concepts and applications of the cognitive approach to p
sychopathology
3.3.4:
Explain how cognitive-behavioral therapy is used to treat mental disorder
s
3.3.5: Describe major conclusions about the common factors that produce
effective results with psychotherapy and describe several forms of integr
ative or eclectic therapies
3.3.6: Give examples of several relatively new or emerging forms of psyc
hotherapy
Behavioral Approach
• Behavioral Approach: emphasize actual
behaviors by animals and human beings
rather than trying to study or evaluate
things that could not be seen or tested
• Classical conditioning:
• Unconditioned stimulus (UCS): a
stimulus that elicits a reflexive response in
an organism.
• Unconditioned response (UCR): a
natural (unlearned) reaction to a given
stimulus
• example: the dogs’ salivation
• Neutral stimulus: presented immediately
before an unconditioned stimulus
• Conditioned (learned) stimulus (CS): a
stimulus that elicits a response after
repeatedly being paired with an
unconditioned stimulus
• Conditioned response (CR): the
behavior caused by the conditioned
stimulus
Behavioral Approach (cont.)
• Operant conditioning: organisms learn to
associate a behavior with its consequence
• Reinforcement/Reinforcer: consequences
that increase the frequency of a behavior
• Punishment/Punishers: consequences that
decrease how often a behavior occurs
• Observational learning: is essentially a
cognitive process involving perception and
interpretation of behaviors and is important
because not all forms of learning are
accounted for entirely by classical and
operant conditioning
Class Activity: Conditioning

• What is something you’ve learned through classical conditioning?

• What is something you’ve learned through operant conditioning?

Exposure Treatment and Systematic
Desensitization
Counterconditioning: a client learns a new
response to a stimulus that has previously elicited
an undesirable behavior

• Aversive conditioning: uses an unpleasant

stimulus to stop an undesirable behavior
• Exposure therapy: a therapist seeks to treat
clients’ fears or anxiety by presenting them
with the object or situation that causes their
anxiety with the idea that due to extinction
they will eventually get used to it
• Extinction: the gradual disconnection of the
relationship between the unconditioned stimuli
and the conditioned stimuli
• or in operant conditioning, the
disconnection between the operant
behavior and a reinforcer
• Systematic desensitization: wherein a calm
and pleasant state is gradually associated with
increasing levels of anxiety-inducing stimuli
Cognitive Approach to Psychotherapy
Rational-emotive-behavioral therapy (REBT): "irrational thinking" or
irrational thoughts to refer to dysfunctional thoughts that tended to produce
significant negative emotions and consequently, maladaptive behaviors

An REBT therapist would help the client analyze the situation this way, A -> B -
> C:

● A = the Activating Event, the situation or stressor that triggered the

emotion
● B = the Beliefs or negative thought patterns (irrational thinking)
● C = the emotional Consequence of the Belief
Aaron Beck used the term "automatic thoughts" to refer to the thoughts
these patients reported experiencing spontaneously
Cognitive therapy: a form of psychotherapy that focuses on how a person’s
thoughts lead to feelings of distress

● The self – "I'm worthless and ugly", "I wish I was different", or "I can't do
anything right"
● The world – "No one values me", "people ignore me all the time", or "life
is so unfair"
● The future – "Things will never change", "things can only get worse!" or
"I'll never feel good again”
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a very
large group of psychotherapeutic approaches that
help clients examine how their thoughts affect their
behavior
• aims to change cognitive distortions and self-
defeating behaviors
• help people make adaptive, instead of
maladaptive, appraisals
• sessions are very interactive between the
client and the therapist, and treatment
involves between-session homework
assignments

Persons with medical conditions may also benefit

from CBT
• use with chronic back pain, fibromyalgia, post
spinal cord injuries, insomnia, and pain
management in a variety of conditions
including breast cancer
Results of Psychotherapy and
Integrative/Ecclectic
Interpersonal psychotherapy (IPT): focuses on
coping with or improving relationships, dealing with
grief, life transitions such as retirement or divorce, and
resolving conflict with others
• Technical eclecticism: the specific and intentional
use of different psychotherapy techniques and
methods, seeking to match the client's unique
struggles and background with treatments that
have been shown to be effective in that context
• Theoretical integration: this approach blends
two or more models of therapy, both theory and
techniques, in an attempt to find a more effective
approach to helping clients
• Combination therapy: used to describe situations
where physicians or psychiatrists prescribe several
different medications in a patient's treatment

Mindfulness: a process that tries to cultivate a

nonjudgmental, yet attentive, mental state
• There are two important components of
mindfulness: (1) self-regulation of attention, and (2)
orientation toward the present moment
Emerging Forms in Psychotherapy
Internet- and mobile-delivered therapies make
psychological treatments more available, through
smartphones and online access using specific
technologies that encrypt communication and ensure
privacy.

Clinician-supervised online CBT modules allow

patients to access treatment from home on their own
schedule—an opportunity particularly important for
patients with less geographic or socioeconomic
access to traditional treatments

• Cognitive bias modification: patients are

given exercises, often through the use of video
games, aimed at changing their problematic
thought processes
• CBT-enhancing pharmaceutical agents:
drugs used to improve the effects of therapeutic
interventions
Practice Question 3

Counseling theories differ in their approach based on the client’s need.

Which of the following would be consistent with helping to “change cognitive
distortions and self-defeating behaviors”?

A. REBT
B. CBT
C. CT
D. IPT
Treatment Modalities in Psychopathology
Benefits of Different Treatment Modalities
Treatment modalities are not based on any specific theory or
model of psychotherapy; instead, they are different
environments in which treatment takes place
• Intake assessment: therapist gathers specific information to
address the client’s immediate needs and to arrive at a
diagnosis, such as the presenting problem, symptoms, the
client’s support system, and insurance status
• Confidentiality: means the therapist cannot disclose
confidential communications to any third party without the
client's consent unless mandated or permitted by law to do so
• Individual therapy: also known as individual psychotherapy or
individual counseling, the client and clinician meet one-on-one
• Group therapy: a clinician meets together with several clients
with similar problems
• Psychoeducation group: a group for children who have a
parent with cancer
• might discuss in depth what cancer is, types of treatment
for cancer, the side effects of treatments such as hair loss,
as well as ways to support the family member, and ways to
cope with the emotional impact on themselves
• Couples therapy: involves two people in an intimate
relationship who are having difficulties and are trying to resolve
them
• Family therapy: a special form of group therapy, consisting of
one or more families
Impact of Culture on Treatment Availability
Cultural competence: the ability to understand and honestly and openly address issues of race,
culture, and ethnicity

Sociocultural perspective: accepts and integrates the impact of cultural and social norms, starting at
the beginning of treatment
• Therapists who use this perspective work with clients to obtain and integrate information about their
cultural patterns into a unique treatment approach based on their particular situation
Practice Question 4

Michelle and Jen have been having problems in their relationship for the past
several months. Michelle feels that Jen is not supportive enough and Jen feels
Michelle works too much. They both agree that they need to see a therapist
to help deal with their problems. Which type of therapy would be the best
option for them?

A. Group Therapy
B. Couples Therapy
C. Family Therapy
D. Individual Therapy