Abnormal Psychology in a Changing World Chapter 2

Abnormal Psychology in a Changing World Chapter 2 Contemporary Perspectives on Abnormal Behavior

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.

The Nervous System The nervous system is made up of neurons, nerve cells that transmit signals or “messages” throughout the body. Dendrites – The rootlike structures at the ends of neurons that receive nerve impulses from other neurons. Axon – The long, thin part of a neuron along which nerve impulses travel. Copyright (c) 2011 Pearson Education. All rights reserved.

The Nervous System Terminals – The small branching structures at the tips of axons. Neurotransmitters – Chemical substances that transmit messages from one neuron to another. Synapse – The junction between one neuron and another through which nerve impulses pass. Receptor site – A part of a dendrite on a receiving neuron that is structured to receive a neurotransmitter. Copyright (c) 2011 Pearson Education. All rights reserved.

The Anatomy of a Neuron Copyright (c) 2011 Pearson Education. All rights reserved.

Transmission of Neural Impulses Copyright (c) 2011 Pearson Education. All rights reserved.

Neurotransmitter Functions and Relationships

Central Nervous System Medulla – An area of the hindbrain involved in regulation of heartbeat, respiration, blood pressure. Pons – A structure in the hindbrain involved in body movements, attention, sleep, and respiration. Cerebellum – A structure in the hindbrain involved in coordination and balance. Copyright (c) 2011 Pearson Education. All rights reserved.

Central Nervous System Reticular activating system – Brain structure involved in processes of attention, sleep, and arousal. Thalamus – A structure in the forebrain involved in relaying sensory information to the cortex and in processes related to sleep and attention. Hypothalamus – A structure in the forebrain involved in regulating body temperature, emotion, and motivation. Copyright (c) 2011 Pearson Education. All rights reserved.

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 coordinating motor (movement) processes, regulating postural movements, and coordination. Cerebrum – The large mass of the forebrain, consisting of the two cerebral hemispheres. 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. Copyright (c) 2011 Pearson Education. All rights reserved.

The Geography of the Brain Copyright (c) 2011 Pearson Education. All rights reserved.

Cerebral Cortex Each hemisphere is divided into four lobes. Occipital lobe – Primarily involved in processing visual stimuli. Temporal lobe – Involved in processing sounds or auditory stimuli. Parietal lobe – Involved in processing sensations of touch, temperature, and pain. Frontal lobe – Controls muscle movement and includes the prefrontal cortex that regulates higher mental functions such as thinking, problem-solving, 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. Copyright (c) 2011 Pearson Education. All rights reserved.

Evaluating Biological Perspectives For some disorders, biological processes play the direct causative role. For most disorders, the interaction of biological and environmental factors needs to be examined. Questions about the genetic bases of abnormal behavior touch the long-standing nature versus nurture debate. Scientists today are studying complex interactions between genes and environmental factors to better understand the determinants of abnormal behavior patterns. Epigenetics – The field that focuses on how environmental factors influence genetic expression.

The Psychological Perspective Copyright (c) 2011 Pearson Education. All rights reserved.

Psychodynamic Models Psychoanalytic theory – The theoretical model of personality developed by Sigmund Freud; 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 whose contents lie outside present awareness but can be brought into awareness by focusing attention. Unconscious – To Freud, the part of the mind that lies outside the range of ordinary awareness and that contains instinctual urges. Copyright (c) 2011 Pearson Education. All rights reserved.

The Structure of the Mind Copyright (c) 2011 Pearson Education. All rights reserved.

The Structure of Personality Id – The 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 that corresponds to the concept of the self, governed by the reality principle and characterized by the ability to tolerate frustration. Copyright (c) 2011 Pearson Education. All rights reserved.

The Structure of Personality Reality principle – The governing principle of the ego, which involves considerations of social acceptability and practicality. Superego – The psychic structure that incorporates the values of the parents and important others and functions as a moral conscience. The superego serves as a conscience, or internal moral guardian, that monitors the ego and passes judgment on right and wrong. Copyright (c) 2011 Pearson Education. All rights reserved.

Defense Mechanisms Defense mechanisms – The reality-distorting strategies used by the ego to shield the self from awareness of anxiety-provoking impulses. These mechanisms enable us to constrain impulses from the id as we go about our daily business. Freud believed that slips of the tongue and ordinary forgetfulness could represent hidden motives that are kept out of consciousness by repression. Copyright (c) 2011 Pearson Education. All rights reserved.

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). Copyright (c) 2011 Pearson Education. All rights reserved.

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. Copyright (c) 2011 Pearson Education. All rights reserved.

Other Psychodynamic Theorists Archetypes – Primitive images or concepts that reside in the collective unconscious. Ego psychology – Modern psychodynamic approach that focuses more on the conscious strivings of the ego than on the hypothesized unconscious functions of the id. Object-relations theory – The psychodynamic viewpoint that focuses on the influences of internalized representations of the personalities of parents and other strong attachment figures (called “objects”). Copyright (c) 2011 Pearson Education. All rights reserved.

Psychodynamic Views on Normality and Abnormality 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. Copyright (c) 2011 Pearson Education. All rights reserved.

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. Copyright (c) 2011 Pearson Education. All rights reserved.

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. Copyright (c) 2011 Pearson Education. All rights reserved.

The Classical Conditioning Model Figure 2. 7 Schematic diagram of the process of classical

Role of Operant Conditioning In operant conditioning, responses are acquired and strengthened by their consequences. Operant conditioning – A form of learning in which behavior is acquired and strengthened when it is reinforced. Reinforcement – A stimulus or event that increases the frequency of the response that it follows. Copyright (c) 2011 Pearson Education. All rights reserved.

Role of Operant Conditioning Positive reinforcers – Reinforcers that, when introduced, increase the frequency of the preceding behavior. Negative reinforcers – Reinforcers that, when removed, increase the frequency of the preceding behavior. Punishment – Application of aversive or painful stimuli that reduces the frequency of the behavior it follows. Copyright (c) 2011 Pearson Education. All rights reserved.

Social-Cognitive Theory Social-cognitive theory – A learning-based theory that emphasizes observational learning and incorporates roles for cognitive variables in determining behavior. Modeling – Learning by observing and imitating the behavior of others. Expectancies – Beliefs about expected outcomes. Copyright (c) 2011 Pearson Education. All rights reserved.

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. Copyright (c) 2011 Pearson Education. All rights reserved.

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. Copyright (c) 2011 Pearson Education. All rights reserved.

Information-Processing Models Information-processing theorists discuss human cognition in terms such as input (based on perception), manipulation (interpreting or transforming information), 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. Copyright (c) 2011 Pearson Education. All rights reserved.

Albert Ellis Psychologist Albert Ellis (1977 b, 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). Copyright (c) 2011 Pearson Education. All rights reserved.

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. Overgeneralization 3. Magnification 4. Absolutist thinking Copyright (c) 2011 Pearson Education. All rights reserved.

The Sociocultural Perspective Copyright (c) 2011 Pearson Education. All rights reserved.

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). Copyright (c) 2011 Pearson Education. All rights reserved.

Ethnicity and psychological disorders in the United States Copyright (c) 2011 Pearson Education. All

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. Copyright (c) 2011 Pearson Education. All rights reserved.

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. Copyright (c) 2011 Pearson Education. All rights reserved.

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. Copyright (c) 2011 Pearson Education. All rights reserved.

The Diathesis-Stress Model Copyright (c) 2011 Pearson Education. All rights reserved.

Methods of Treatment

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 – 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.

Overview of Major Types of Psychotherapy

Psychodynamic Therapy Psychoanalysis – The first method of psychotherapy developed by Sigmund Freud. Psychodynamic therapy – Therapy that helps individuals gain insight into, and resolve, unconscious conflicts. Free association – The method of verbalizing thoughts as they occur without a conscious attempt to edit or censure them.

Dream Analysis In psychoanalytic theory, dreams have two levels of content: 1. Manifest content: The material of 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 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 personcentered therapy (also called client-centered therapy), which was developed by the psychologist Carl Rogers.

Person-Centered Therapy Person-centered therapy – The establishment of a warm, accepting therapeutic relationship that frees clients to engage in self-exploration and achieve selfacceptance. Person-centered therapy is nondirective. The therapist uses reflection—the restating or paraphrasing of the client’s expressed feelings without interpreting them or passing judgment on them.

Person-Centered Therapy Unconditional positive regard – The expression of unconditional acceptance of another person’s intrinsic worth. Empathy – The ability to understand someone’s experiences and feelings from that person’s point of view. Genuineness – The ability to recognize and express one’s true feelings. Congruence – The fit between one’s thoughts, behaviors, and feelings.

Cognitive Therapy 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.

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.

FIGURE 2. 10 Therapeutic orientations of clinical psychologists.

Group, Family, and Couple Therapy Group therapy – A form of therapy in which a group of clients meets together with a therapist. Family therapy – A form of therapy in which the family, not the individual, is the unit of treatment. Couple therapy – A form of therapy that focuses on resolving conflicts in distressed couples.

Multicultural Issues in Psychotherapy Normal and abnormal behaviors occur in a context of culture and community. Therapists need to be sensitive to cultural differences and how they affect 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 selfdisclosing (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 therapeutic relationships they form with African American clients.

Asian Americans Culturally sensitive therapists not only understand the beliefs and values of other cultures but also integrate this knowledge within therapy process. Generally speaking, Asian cultures, including Japanese culture, value restraint in talking about oneself and one’s feelings. Public expression of emotions is also discouraged in Asian cultures, which may inhibit Asian clients from revealing their feelings in therapy.

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 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 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 therapist and the client (Renfrey, 1992).

Barriers to Use of Mental Health Services by Ethnic Minorities Barriers that exist for ethnic minorities include the following: 1. Cultural mistrust 2. Mental health literacy 3. Institutional barriers 4. Cultural barriers 5. Language barriers 6. Economic and accessibility barriers

Biomedical Therapies There is a growing emphasis in American psychiatry on biomedical therapies, especially the use of psychotropic drugs (also called psychiatric drugs). Psychopharmacology – The field of study that examines the effects of therapeutic or psychiatric drugs. Today, roughly one in five adult Americans takes psychotropic drugs (Smith, 2012). Psychosurgery has been all but eliminated as a form of treatment because of serious harmful effects of earlier procedures.

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.

Antianxiety Drugs Antianxiety drugs – Drugs that combat anxiety and reduce states of muscle tension by reducing central nervous system activity. They include mild tranquilizers, such as diazepam (Valium) and alprazolam (Xanax), as well as hypnotic sedatives, such as triazolam (Halcion). Rebound anxiety – The experiencing of strong anxiety following withdrawal from a tranquilizer.

Antipsychotic Drugs 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 – Drugs used to treat depression that affect the availability of neurotransmitters in the brain. The third class of antidepressants, selective serotoninreuptake inhibitors, or SSRIs, have more specific effects on serotonin function in the brain. Drugs in this class include fluoxetine (Prozac) and sertraline (Zoloft).

Electroconvulsive Therapy Electroconvulsive therapy (ECT) – A treatment in which an electric shock is sent through the patient’s brain, sufficient to induce convulsions. People with major depression show significant improvement following ECT is associated with memory loss for events occurring around the time of treatment and high relapse rates. ECT is generally considered a treatment of last resort after less intrusive methods have been tried and failed. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

Psychosurgery is yet more controversial than ECT and is rarely practiced today. Although no longer performed today, the most common form of psychosurgery was the prefrontal lobotomy. This procedure involved surgically severing nerve pathways linking the thalamus to the prefrontal lobes of the brain.

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.