Chapter 2: Models of Psychopathology

• PSYC 168, Chapters 1 and 2 cover important concepts in the history and models of psychopathology.
• Syllabus updates may be needed.

Nineteenth Century: Moral Treatment

• The care for those with mental disorders started to improve during this era.
• Pinel of France and Tuke of England advocated for humane, respectful techniques like moral treatment.
• Benjamin Rush and Dorothea Dix promoted moral treatment in the United States.
• A shortage of money and staff, low recovery rates, overcrowding, and prejudice led to the end of the moral treatment movement in the United States and Europe by the early twentieth century.

Early Twentieth Century

• Various perspectives emerged regarding the causes and treatment of psychopathology.
• The somatogenic perspective believed that psychopathology has physical causes.
• Tooth extraction, tonsillectomy, hydrotherapy, lobotomy, and eugenic sterilization were tried as methods, whose results were disappointing and cruel.
• Biological issues were regarded as the sole cause.
• The psychogenic perspective believed that psychopathology has psychological causes.
• Based on work with hypnotism by Mesmer, and psychoanalysis by Freud, the popularity increased in it.
• Freud asserted that talk therapy could replace lobotomies
• Medication was eventually invented, and Freud's work became mainstream in psychiatry.

Recent Decades and Current Trends

• Psychotropic meds are one of the most important inventions.
• New psychotropic medications were discovered in the 1950s, including antipsychotic, antidepressant, and anti-anxiety drugs.
• Deinstitutionalization involved outpatient care and a community mental health approach.
• Healthcare institutions admittance became less common.
• Before the 1950s, private psychotherapy and counseling predominated psychotherapy delivery.
• Insurance primarily pays for today's psychotherapy.
• Positive psychology and disorder prevention are increasingly emphasized, focuses on good traits/ methods rather than pathology.
• There is more focus on multicultural psychology.
• Rising telehealth and insurance coverage are increasingly influential.
• Below are US Statistics from 2022 concerning the variety of professionals offering help to people with psychological conditions:
• Psychiatrists were at 26,000, while psychologist was at 179,000, Social worker was at 716,000 and counselors were at 328,000.

Clinical Research

• Research is the way to accuracy in psychopathology.
• Clinical science role in research is key.
• Evidence-based practices ensures the legitimacy of practices performed.
• It is essential to understand unique research methods and issues specific to psychopathology.

Case Studies

• Detailed, interpretative description of a person's life and psychopathology is performed.
• This is a source of new ideas about behavior and discoveries.
• New therapeutic techniques are introduced
• It offers opportunities to study unusual pathologies
• Bias and low generalization are some limitations.

Correlational and Experimental Research

• Correlational and experimental research methods help to provide more generalized findings; read independently.
• Concepts important for studies in psychopathology should be understood.

Clinical Treatment

• Indicates whether improvement occurred because of the treatment which helps to see the statistical significance.
• Clinical significance indicates whether the quantity of improvement is meaningful in the individual's life.
• Masked (blind) designs are a form of research.
• Individuals are kept unaware of their assigned research group.
• Placebo therapy is often implied.
• Experimenter bias (Rosenthal effect) is a key factor.
• Participants and researcher are both kept unaware of their assigned group in double-masked (blind) design

Analogue Research

• The researcher must induce anxiety in order to test anxiety.
• Experimenter created situations and participants behaved in ways to resemble real-life psychopathology.

Epidemiological Research

• Incidence: Number of new cases that emerge in a given period
• Prevalence: Total number of cases in a given period
• Previous studies should always be higher except in first year because new cases are all cases.

Qualitative and Mixed Method Studies

• Qualitative studies gathers through unfiltered methods seeks the direct perspective of each participant along with their Gather information in participants' own words.
• Mixed-Methods designs combines both quantitative and qualitative approaches which provide fuller and more revealing information.

Community-Based Participatory Research

• The Collaboration with certain folks in the community and trains them to provide therapeutic help to those not in professional therapy.
• Historically, most research has been performed by trained clinical researchers alone
• Members of an affected community work collaboratively with academically trained scientists on all stages of a Community-Based Participatory Research.
• Responsibility is equally shared between community and researchers
• Important for analyzing health disparities among other issues

Models or Paradigms of Psychopathology

• Models are used by scientists and clinicians to treat psychopathology.
• The text covers biological, psychodynamic, cognitive-behavioral, humanistic-existential, and sociocultural models.

Biological Model

• Medical perspective and considers illness due to malfunctioning body.
• Points to problems in brain anatomy or brain chemistry.
• 86 billion nerve cells, or neurons, are inside of the brain.
• Irregular activities of neurotransmitters are tied to mental disorders (e.g., serotonin, norepinephrine, glutamate).
• Neurotransmitters are responsible for the transmission of information among neurons and irregularities tied to mental disorders.
• Hormones irregular chemical activity in the endocrine system is related to mental disorders.
• increasingly research focuses on brain circuits rather than a single chemical as the key to disorders.
• Complications in the fear of missing out circuit may cause excess or absence of fear.

Treatment and Biological Model

• Three biological treatments are drug therapy (anxiolytics, antidepressant, mood stabilizers, antipsychotics), brain stimulation (ECT, TMS, VNS), and psychosurgery.

Sigmund Freud and Psychodynamic Model

• Developed theory of Psychoanalysis
• Proposed person's behavior is due largely by underlying unconscious, dynamic, psychological forces
• Suggested psychopathological symptoms are the result of conflict among these forces
• According to Freud, most behavior is determined by the unconscious, with three levels of personality: Id (pleasure), Ego (reality & defense mechanisms), Superego (morality).

Defense Mechanisms

• Repression
• Person avoids anxiety by not allowing painful thoughts to become conscious
• Denial
• Person refuses to acknowledge the existence of an external source of anxiety
• Projection
• Person attributes unacceptable desires to other individuals
• Rationalization
• Person creates a socially acceptable reason for an action that reflects unacceptable motives
• Displacement
• Person displaces hostility away from a dangerous object and onto a safer substitute. Intellectualization
• Person represses emotional reactions in favor of overly logical responses to a problem.
• Regression
• Person retreats from an upsetting conflict to an early developmental stage
• He proposed five developmental stages in early life: oral, anal, phallic, latency, genital.
• New events and pressures require adjustment in the id, ego, and superego at each stage.
• Fixation at an early developmental stage can lead to psychopathology if one is unsuccessful.
• Many other scholars modified or developed new theories based on Freud's theories, we now collectively call them psychodynamic theories or therapies.
• Seeks to uncover past trauma and inner conflicts with the therapist acting as a guide for therapies.
• Psychoanalysis is considered very complex because of Free association, Therapist interpretation, Resistance, Transference, Dream interpretation, Catharsis.
• Traditional Psychoanalysis is expensive and time-consuming. Now, most clinicians provide more focused, short-term psychodynamic therapies.

Cognitive-Behavioral Model

• Focuses on behaviors and cognitive process and their interplay
• One the of the most widely use model in psychopathology
• Evidence-based treatment through Cognitive Behavioral Therapy (CBT) which many clinicians use
• Behavioral Dimension occurs via conditioning (association) , which consist of learning from what one can repeatedly occure close together by social learning theory ( Modeling / observational learning with Bandura's Bobo doll experiment.
• The social learning theory entails that human behaviors are learned through modeling
• The Cognitive dimension consist of focusing on psychopathological thinking processes (assumptions, attitudes & illogical thinking) and change problematic thinking by recognizing challenge.

Humanist-Existential Model

• Humanistic Theory and therapy
• To receive unconditional self- regard due to ones basic human need
• Rogers' client-centered therapy creates a supportive climate
• Provides a safe and warm place to grow within unconditional positive regard
• Encourages to improve accurateness of empathy
• Promotes the need to self-actualization by bringing more genuineness/congruence
• Involves Free will and freedom of choice
• Promotes personal responsibility
• Brings about the meaning of life
• Psychological dysfunction arises when clients overlook their freedom of choice, hide from responsibilities, or unable to find meanings
• Strong philosophical foundations are present in Existential Therapy

Socio-Cultural-Model

• Factors and influences that one uses is best understood context of psychopathology
• Perspectives:
• Family- social
• Multicultural
• Social labels/roles and connections/supports are all parts as to how family social therapist can assist the individual, along with the patterns involved.
• Interpersonal psychotherapy
• Group therapy
• Family therapy
• couple therapy
• Community treatment
• Focuses on race, ethnicity, gender, sexual orientation, ability socioeconomic status, religion and so on to identify the role of oppression and discrimination.
• Also promotes intersectionality for poverty issues and more, to provide Culturally Responsive Therapies

Integrating and Comparing the Models

• Inability for theorist to focus on one type as treatment, should combine to benefit through Biopsychosocial as an "integrated" for "eclectic" model.
• The Developmental psychopathology is framework to understand that variables and principles from various model account for how humans function.
• Equifinality: How Different developmental route lead to the same psychological Multifiinality: How Persons of the same developmental historical outcome can be different.