Understanding Abnormal Psychology

What is Abnormal Psychology?

• Scientific study of abnormal behavior is used to describe, predict, explain, and change abnormal patterns of functioning.
• Numerous definitions exist, but none have been universally accepted.

Definitions Over Time

• Words like "abnormal" and "mental disorder" are commonly used, however, terms did not always exist.
• Insanity, distressed disturbed, and unbalanced debuted in print as early expressions of psychological dysfunction.
• The Oxford English Dictionary provides dates for terms like abnormal, psychopathology, psychiatric, and maladjustment.
• The 19th and 20th centuries saw the emergence of slang and clinical terms to describe mental illness.

What Is Psychological Abnormality?

• Four common features define psychological abnormality including the 4 D's: deviance, distress, dysfunction, and danger.
• Deviance is when a behaviour is different from society's norm or ideas of normality, and viewed as extreme, unusual, or bizarre.
• Distress is when behaviour causes unpleasant experience to the person and could be experienced as a positive for the person.
• Dysfunction is when behaviour interferes with the person's ability to conduct daily activities
• Danger is when behaviour poses risk of harm to self or others and includes behavior that may be confused, hostile, or uncaring of self.
• Influences of what is abnormal are the societal norms, the culture, and the context

Defining Abnormality

• Abnormality is defined by general criteria but definitions can be vague, inconsistent, and subjective.
• Szasz argued deviations society calls abnormal are simply "problems in living," not signs of an internal issue.
• Separating abnormality that requires intervention from eccentricity that does not need to be addressed can be challenging.
• In 2015, Weeks estimated 1 in 5,000 persons may be "classic, full-time eccentrics."
• Weeks found that eccentrics had fewer emotional problems than the general population.

What Is Treatment?

• Treatment involves the use of procedures designed to change abnormal behavior into more normal behavior.
• All forms of therapy have 3 key features: The sufferer seeks relief from the healer, a trained healer is accepted by the sufferer and his social group, and a series of contacts with the healer attempts to produce changes in the sufferer.
• Most clinicians think that large numbers of people could benefit from therapy and therapy can be effective.

Abnormal Views and Treatments: Ancient Views

• Every society, past and present, has experienced psychological abnormality.
• Ancient societies regarded abnormal behavior as the work of evil spirits.
• This may have begun as far back as the Stone Age.
• Treatment involved trephination and exorcism.

Abnormal Views and Treatments: Greeks & Romans in 500 B.C.E to 500 C.E.

• Philosophers and physicians offered different explanations and treatments for abnormal behaviors
• Hippocrates believed illnesses had natural causes in the four humors.
• Treatment included quiet life, vegetable diet, temperance, exercise, celibacy and bleeding.

Abnormal Views and Treatments: Europe in the Middle Ages, 500-1350 C.E

• The Church rejected scientific forms of investigation and controlled all education.
• Mental disorders had demonic causes leading to mass madness, shared delusions, and tarantism (impulse to dance).
• Demonology and its methods began to lose favor at the close of the Middle Ages.
• Treatment during this time included exorcism, torture, and gradually hospitalization.

Abnormal Views and Treatments: The Renaissance (1400-1700 C.E.)

• With increased scientific knowledge, demonological views of abnormality continued to decline.
• Johann Weyer, a German physician, was the first mental health provider. He believed that the mind was as susceptible to sickness as the body.
• Care happened at religious shrines which was the precursor to modern community health programs.
• Asylums emerged by the mid-sixteenth century.

Abnormal Views and Treatments: The Nineteenth Century Reforms

• Advocacy for more human treatment emerged.
• Pinel (France) and Tuke (England) emphasized moral treatment and use of humane techniques.
• Benjamin Rush (U.S.) was known as the physician and father of psychiatry, who developed humane treatment approaches.
• Dorothea Dix (U.S.), a Boston schoolteacher, brought the issue of mental health treatment to light in the public and in politics.
• This resulted in more funding and the formation of state hospitals.

Abnormal Views and Treatments: The Nineteenth Century Reforms - Reversal

• Several factors led to a reversal of the moral treatment movement in the early 20th century.
• Money and staff shortages, declining recovery rates, and overcrowding in hospitals were some of the main factors in the reversal.
• Long-term stays increased in asylums, as well as, the rise of prejudice towards poor and immigrant patients.

Abnormal Views and Treatments: The Early 20th Century - Somatogenic Perspective

• Two factors responsible for the rebirth of this perspective: Emil Kraepelin (German Researcher), and new biological discoveries.
• Kraepelin believed physical factors are responsible for mental dysfunction and developed the first classification system, later the DSM.
• New biological discoveries included the cure for syphilis and the development of effective medications in the late 20th century.

Abnormal Views and Treatments: Psychogenic Perspective

• Abnormal functioning has psychological causes.
• Its rise in popularity was based on work with hypnotism.
• Mesmer and Breuer treated hysterical disorders, which was controversial.
• Freud developed psychoanalytic theory and treatment.
• Freud focused on unconscious psychological processes causing dysfunction.
• Techniques developed into outpatient treatment which became widely accepted.

Abnormal Views and Treatments: Changes in the 20th Century

• Psychotropic medications were discovered in the 1950s, including antipsychotic, antidepressant, and anti-anxiety drugs.
• Deinstitutionalization included outpatient care and community mental health approach
• Deinstitutionalization resulted in a lack of resources, increased homelessness, and recycling to hospitals.

Abnormal Views and Treatments: Current Trends – 21st Century

• Negative attitudes and disagreements still exist, major changes have occurred in the last 60 years in the way abnormal behavior is understood and treated.
• Outpatient care is the primary mode of treatment.
• Less expensive outpatient settings and insurance coverage are more common.
• There are more theories and treatments available with programs devoted exclusively to specific problems.

Prevention Approach

• Emphasis on preventing disorders and promoting mental health is growing
• Strategies address social conditions.
• Approaches help individuals at risk for developing emotional problems.
• It utilizes positive psychology to teach coping skills.

Cultural Competence

• Multicultural psychology recognizes that members of U.S. racial and ethnic minority groups collectively make up 40% of the population and will continue to increase.
• Multicultural Psychologists focus on how culture, race, ethnicity, gender, and similar factors affect behavior and thought.
• They also focus on how people of different cultures, races, and genders may differ psychologically.

Increasing Influence of Insurance Coverage

• The dominant form of coverage is managed care.
• Insurance companies determine care
• Reimbursements for mental disorders still tend to be lower than those for medical disorders.
• The U.S. Congress federal parity law (2008) mandated equal coverage for mental health.
• The Affordable Care Act (ACA/2014) says that certain benefits must be provided.

Today's Leading Theories and Professions

• There is a growth of numerous theoretical perspectives: psychoanalytic, biological, cognitive-behavioral, humanistic-existential, sociocultural & developmental.
• No single perspective dominates the clinical field.

Social Workers

• Mental Health Professionals include Psychiatrists, Psychologists, Social Workers, and Counsellors
• The vast majority of Social Workers in the US are female (83%)

Technology and Mental Health

• There are new triggers and vehicles for expression of abnormal behavior:
• Social media stalking, bullying, exhibitionism (porn), pedophilic attention and violent video games and antisocial behavior development
• The Multitude of digital distractions lead to shorter attention spans.
• An increased use of telemental health services and mental health apps is being utilized.

What Do Clinical Researchers Do?

• Obtain nomothetic understanding in the form of laws or principles that apply across people.
• They seek a general understanding of the nature, causes, and treatments of abnormal functioning.
• Researchers obtain idiographic or individualistic understanding involving assessing, diagnosing, or treating individual clients via clinical practitioners.
• The scientific method is the process of systematically gathering and evaluating information, through careful observations, to understand a phenomenon using Variables and Hypotheses.

Methods of Investigation – Case Studies

• Offer a detailed and interpretative description of a person's life and psychological problems.
• They are a source of new ideas about behavior.
• They provide tentative support for a theory and challenge for a theory's assumptions.
• Case studies introduce new therapeutic techniques, and provide opportunities to study unusual problems.

Methods of Investigation – Case Studies: Limitations

• Limitations arise from biased observers.
• Reliance on subjective evidence is seen as a low source of validity.
• The is Little basis for generalization due to low external validity.

Methods of Investigation – Correlation

• This studies the degree to which events or characteristics vary with each other through research to see how much events or characteristics vary along with each other
• Subjects or participants are people chosen for study that are collectively called a sample.
• Samples must be representative of the larger population.

Correlation: Relationships

• A positive one means the variables change in the same way.
• A negative one means the value of one variable increases as the value of the other variable decreases.
• Unrelated variables mean there is no consistent relationship between variables.

Correlation: Direction and Magnitude

• Direction and magnitude are calculated numerically and expressed by a correlation coefficient.
  • The coefficient can vary from +1.00-1.00
  • Sign (+ or –) indicates direction
  • Number indicates magnitude with a higher number indicating the higher strength of the magnitude
• Correlations often fall short of a perfect positive or negative correlation.

Correlation: Statistical Significance

• Correlations are based on a statistical analysis of probability
• Statistical significance: The finding is unlikely to have occurred by chance:
• The data is considered statistically significant is there is Less than a 5 percent probability that findings are due to chance (p < .05).
• Confidence generally increases with the size of the sample and the magnitude (strength) of the correlation
• Advantages of high external validity allow generalizing findings.

Correlation: Difficulties

• Despite advantages in external validity there is a lack of internal one.
• The method can be difficult as it can describe but does not explain a relationship or causation.
• Correlation is not causation, but shows a relationship only
• The method can repeat (replicate) studies with other samples

Methods of Investigation – The Experimental Method: Researchers

• Researchers typically observe many individuals.
• Apply procedures uniformly, so these can be replicated. Use statistical tests to analyze results determining whether broad conclusions are justified.

Methods of Investigation – The Experimental Method: Clinical Treatment

• In clinical treatment statistical significance is noted as well as clinical significance.
• Placebo therapy is sometimes used.
• The method uses a research procedure in which a variable is manipulated and the manipulation's effect on another variable is observed
• The independent variable is what is being manipulated, while the dependent one is what is being observed
• Questions about causal relationships can only be answered by this method.

Methods of Investigation – The Experimental Method: Confound

• Confound variables are ones other than the independent variable that may also be affecting the dependent variable.
• Three features to guard against confounds: Control group and Experimental group

Confound: Control and Experimental Design

• A control group consists of research participants who are not exposed to the independent variable, but whose experience is like that of the experimental group.
• Both groups are compared to determine the effect of the independent variable.
• Statistical significance rules are applied.

Methods of Investigation – Experiment Design

• Random assignment is any selection procedure that ensures that every participant in the experiment is as likely to be placed in one group as another.
• Masked (blind) design is an experiment in which participants do not know which assigned group they are in; This design can us placebo therapy.
• Double-masked (blind) design is an experiment in which both participants and experimenters are unaware of the groups to which participants are assigned.

Methods of Investigation – Alternative Research Designs

• Clinical researchers often must settle for designs that are less than ideal and include quasi- experimental designs, such as Matched designs, Natural experiments, Analogue experiments, Single-subject experiments, Longitudinal studies (high-risk or developmental study), and Epidemiological studies

Methods of Investigation – Alternative Research Designs: Matched Mix and Natural

• Matched designs put participants that are not randomly assigned to control and experimental groups but participants are placed in existing groups. Matches are used to address confounds based on demographic and other variables.
• Natural experiments leverage the natural world so that Nature manipulates the independent variable, and the experimenter observes the effects.
• With natural experiments events cannot be replicated at will, and broad generalizations cannot be drawn from a single study.

Methods of Investigation – Alternative Research Designs: Analogue and Single

• Analogue experiments freely manipulate ethical and practical limitations are avoided, and laboratory subjects are induced to behave in ways that resemble real life.
• Single-subject experiments leverage a single participant, and that person is observed before and after manipulation of the independent variable.
• Baseline data is set as a standard for comparison making it a higher internal validity than the case study because the independent variable is manipulated

Methods of Investigation – Alternative Research Designs: Longitudinal Studies

• Longitudinal studies occur when the same individuals observed on many occasions over a long period.
• Independent variable manipulation or random assignment of participants to conditions is not possible
• Causes in studies such as this cannot be pinpointed.

Methods of Investigation – Alternative Research Designs: Epidemiological Studies

• Epidemiological studies reveal the incidence and prevalence of a disorder in a particular population.
  • Incidence: is the number of new cases that emerge in each period
  • Prevalence: is the total number of cases in each period Examples of epidemiological studies:
  • Epidemiologic Catchment Area Study (Cottler et al.)
  • National Comorbidity Survey
  • National Comorbidity Survey Replication
  • National Epidemiologic Survey on Alcohol and Related Conditions

Clinical Investigations

• No single methodological approach addresses all problems involved in studying human behavior.
• Best practice involves a team of approaches
• Clinical practice is carried out by a variety of professionals trained in different ways
• Current research methods each have flaws therefore limiting our knowledge and use of clinical information

Protecting Human Participants

• Human research participants have needs and rights that must be respected
• Researchers must avoid physical or psychological harm for human participants.
• Institutional Review Board (IRB), an ethics committee in a research facility, is empowered to protect the rights and safety of human research participants

Protecting Human Participants: Ethics

• IRBs ensure studies grant participant rights including:
  • The participants enlist voluntarily.
  • Participants are adequately informed about what the study entails (“informed consent").
  • Right to end their participation in the study at any time.
  • The benefits of the study outweigh its costs and risks.
  • Participants are protected from physical and psychological harm.
  • Participants have access to information about the study.
  • Participants' privacy is protected by principles such as confidentiality or anonymity.

Use of social Media in Research: Pros and Cons

• There has been an increased use of social networks for research studies.
  • Research can leverage contributions for access to large databases
• Concerns such as data sometimes examined without subscriber consent, or direct and secret manipulation of social media by researchers without informed consent remain areas of ethical concern.