Psychopathology Textbook Notes PDF

Chapter 1: Psychopathology: Past and Present ​ Introduction ○​ Unusual thoughts, emotions, and behaviors are the result of a state sometimes called psychopathology, abnormal functioning, maladjustment, psychological dysfunctioning, emotional disturbance, or ment...

Chapter 1: Psychopathology: Past and Present ​ Introduction ○​ Unusual thoughts, emotions, and behaviors are the result of a state sometimes called psychopathology, abnormal functioning, maladjustment, psychological dysfunctioning, emotional disturbance, or mental illness ○​ The term pathology has become more popular only recently because the other terms can be stigmatizing, degrading, and painful ○​ Some professionals worry the conventional use of the term “psychopathology” may seem to suggest illness and medical explanations even though such views of psychological problems are not necessarily agreed upon by today’s clinical professionals ○​ Psychopathology - the scientific study of mental difficulties or disorders, including their explanations, causes, progression, symptoms, assessment, diagnosis, and treatment ○​ Clinical scientists gather informations systematically so that they can describe, predict, and explain the phenomena they are studying ○​ Clinical practitioners detect, asses, and treat patterns of psychopathology using the knowledge acquired by clinical scientists ​ What are the key features of psychopathology? ○​ The defining features of psychopathology are hard to pinpoint ○​ The commonly cited features of psychopathology are often call the “four Ds” ​ Deviance (different, extreme, unusual, bizarre) ​ Distress (unpleasant, upsetting) ​ Dysfunction (interfering with the person’s ability to function) ​ Danger ○​ Deviance ​ Judgements of deviance and of psychopathology must take specific circumstances into consideration ○​ Distress ​ Distress does not always have to be present before a person’s functioning can be considered to reflect psychopathology ○​ Dysfunction ​ Psychopathology upsets, distracts, or confuses people that they cannot care for themselves properly, participate in ordinary social interactions, or work productively ○​ Danger ​ Danger is often cited as a feature of psychopathology but research suggests that it is actually the exception rather than the rule ​ Most people experiencing anxiety, depression, and even bizarre think pose no immediate danger to themselves or others  ○​ The absence of distress, dysfunctions, and danger behaviors alone do not signify psychopathology ○​ The roles of society and culture ​ Norms - a society;s stated and unstated rules for proper conduct ​ Behavior, thoughts, and emotions that break norms of psychological functioning may be labels pathological ​ Norms vary from culture to culture ​ Thomas Szasz paces emphasis on society’s role in shaping what is considered normal that he found the whole concept of mental illness to be invalid, a myth of sorts ​ The impact of societal norms can sometimes lead clinicians and the public to inadvertently minimize or overlook significant psychological problems ​ Overattentions to a society’s norms may lead clinicians and the public to confuse eccentricities with mental disturbances ​ Cultural Humility - a process in which clinical scientists or practitioners continuously examine their own beliefs and cultural identities, explore individual’s cultures and historical realities that differ from their own, seek to understand the cultural context of each person’s mental health challenges, and respond accordingly ​ What is treatment? ○​ Treatment/therapy - a systematic procedure designed to change dysfunctional behavior into more functional behavior ○​ All forms of therapy have three essential features: ​ A sufferer who seeks relief from the healer ​ A trained, socially accepted healer, whose expertise is accepted by the sufferer and the sufferer’s social group ​ A series of contacts between the sufferer and the healer, through which the healer tries to produce certain changes in the sufferer;s emotional state, attitudes, and behavior ​ Some clinicians see psychopathology as a problem in living that may not involve suffering, others see it as an illness a therapy is the procedure to cure it ​ How was psychopathology viewed and treated in the past? ○​ Ancient views and treatments ​ Disturbed behavior was typically interpreted as a victory by evil spirits, and the sure for such behavior was to force the demons from a victim’s body ​ Trephination - an ancient operation in which a stone instrument was used to cut away a circular section of the skull to treat severe psychopathology  ​ The treatment for problematic thought and behaviors in these early societies was often exorcism ○​ Early European and Asian views and treatment ​ Humors - according to the early Greeks and Romans, bodily chemicals that influence mental and physical functioning ​ Hippocrates taught that illness had natural causes and saw pathological behavior as a disease arising from internal physical problems ​ Chinese ,medical texts characterized disturbed mood and behavior as arising, in part from physical pathology, as well as from disharmony with nature and one’s surroundings ○​ Europe in the middle ages: Demonology returns ​ Deviant behavior was seen as evidence of Satan’s influence ​ During this period psychopathology increased greatly ​ There were outbreaks of mass madness where large numbers of people apparently shared hallucinations and delusions, or absurd false beliefs ​ Exorcisms because popular again to treat psychopathology ​ Medical views also gain favor once gain during this time period and people with psychological disturbances were able to receive treatment in medical hospitals ○​ The Renaissance and the rise of asylums ​ Johann Weyer is considered the founder of the modern study of psychopathology ​ Across Europe, religious shrines were devoted to the humane and loving treatment of people with mental disorders ​ Asylums - a type of institution that first became popular in the sixteenth century to provide care for persons with mental disorders ​ Most asylums became virtual prisons ○​ The nineteenth century: reform and moral treatment ​ Philippe Pinel reformed asylums by treated patients with sympathy and kindness rather than chains and beatings ​ William Tuke brought similar reforms to northern england by treating patients with a combination of rest, talk, prayer, and manual work ○​ The spread of moral treatment ​ Moral Treatment - a nineteenth century approach to treating people with mental dysfunction that emphasized moral guidance and human and respectful treatment ​ Benjamin Rush is most responsible for the spread of moral treatment in the United States ​ Dorthea Dix made humane care a public and political concern in the U.S. ​ State hospitals - state-run public mental institutions in the U.S.  ○​ The decline of moral treatment ​ One factor that lead to the reversal of the moral treatment movement was the speed with which the movement had spread ​ Severe money and staffing shortages developed, recovery rates declined, and overcrowding in the hospitals became a major problem ​ Public mental hospitals were providing only custodial care and ineffective treatments and were becoming more overcrowded every year ○​ The early twentieth century: the somatogenic and psychogenic perspectives ​ Somatogenic perspective - the view the psychopathology has physical causes ​ Psychogenic perspective - the view that the chief causes of psychopathology are psychological ​ Emil Kreapelin was a major factor in the rebirth on the somatogenic perspective because he published a textbook arguing that physical factors are responsible for mental dysfunction ​ Biological discoveries such as the discovery of syphilis which led to general paresis, and irreversible disorder with both mental symptoms and physical ones, also triggered the rise of the ​ Not until the 1950s, when a number of effective medications were finally discovered, did the somatogenic perspective truly benign to pay off for patients ​ The psychogenic perspective did not gain much of a following until studies of hypnotism demonstrated its potential ​ Friedrich Anton Mesmer created a treatment called mesmerism but it was so controversial the eventually Mesmer was banished from Paris ​ Due to hypnotic suggestion, leading scientists concluded that hysterical disorders were largely psychological in origin ​ Psychoanalysis - either the theory or the treatment of psychopathology that emphasizes unconscious psychological forces as the cause of psychological dysfunction ​ Freud and his followers offered psychoanalytic treatment to patients in their offices for sessions of about an hour—a format of treatment now known as outpatient therapy ​ Recent Decades ad Current Trends ○​ How are people with severe disturbances cared for? ​ Psychotropic medications - drugs that mainly affect the brain and reduce many symptoms of mental dysfunction ​ Antipsychotic drugs - help reduce extremely and confused distorted thinking ​ Antidepressant drugs - lifts the mood of depressed people  ​ Antianxiety drugs - reduces tensions and worry ​ Deinstitutionalization - the practice of releasing patients from public mental hospitals; begun in the 1960s with the release of hundreds of thousands of patients ​ Outpatients care has now become the primary mode of treatment for people with severe psychological disturbances ​ The community health approach has left hundreds of thousand of people without lasting recoveries ○​ How are people with less severe disturbances treated? ​ Outpatients care has been the preferred mode of treatment for people who experience moderate disturbances ​ Private psychotherapy - an arrangement in which a person directly pays a therapist for counseling services ​ At least 20% of clients enter therapy because of milder disruptions in living ​ Outpatient care has developed programs devoted exclusively to specific psychological conditions ○​ A growing emphasis on preventing disorder and promoting mental health ​ Prevention - interventions aimed at deterring mental disorders before they can develope ​ Positive psychology - the study and enhancement of positive feeling, traits, and abilities ○​ Multicultural psychology ​ Multicultural psychology - the field that seeks to understand how the varied histories, opportunities, and barriers experience by people of different races, ethnicities, genders, sexual orientations, abilities, languages, and other such factors affect behavior, emotion, and thought ​ Intersectionality - a multicultural framework that examines how each individual’s memberships in multiple cultural groups and social identities combine to shape their particular experiences, opportunities, outlook, and functioning ○​ The increasing influence of insurance coverage ​ Managed care programs - health care coverage in which the insurance company largely controls the nature, scope, and cost of medical or psychological services ​ Therapists and clients fear the programs inevitably shorten therapy, unfairly favor treatments whose results are not always lasting, pose a special hardship for those with severe mental disorders, and result in treatment determined by insurance companies rather than by therapists  ​ A key problem with insurance coverage is that reimbursements for mental disorders tend to be lower than those for physical disorders ​ Congressed passed a law calling for stricter government regulation of each insurance company’s parity coverage ○​ What are today’s leading theories and professions? ​ To this day, no single viewpoint has dominated the clinical field as much as the psychoanalytic perspective once did ​ Before the 1950s, psychotherapy was only offered by psychiatrists ​ After WWII other professional groups had to provide psychotherapy as well for the millions of soldiers returning home ​ Each specialty conducts therapy in a distinctive way, but in reality clinicians from the various specialties often use similar techniques ○​ Technology and mental health ​ Our digital world provides new sources for psychological dysfunction ​ Research suggests the social media platforms may increase peer pressure and social anxiety in some adolescents ​ With a wealth of online informations some an enormous amount of misinformation about psychological conditions and their treatment ​ Technology can be good for mental health through the use of relaxing apps or smart watches to monitor key psychophysiological processes ​ Telemental health - the use of remote technologies, such as long-distance videoconferencing, to deliver mental health services without the therapist being physically present ​ Policies were changed during COVID-19 the empowered therapists to practice telemental health without concern for personal or professional consequences ​ Telemental health is predicted to remain a permanent part of the clinical field because of it many advantages Chapter 2: Research in Psychopathology ​ Introduction ○​ Research is the key to accuracy in all fields of study; it is particularly important with regard to psychopathology because a wrong belief in this field can lead to great suffering ○​ An example of inaccurate research is the belief that lobotomies could cure schizophrenia ​ This belief was wrong and caused irreversible brain damage ○​ Only by fully testing a theory or technique on representative groups of individuals can clinicians evaluate the accuracy, effectiveness, and safety of their ideas and techniques ​ What do clinical researchers do? ○​ Clinical researchers try to discover broad laws, or principles, of mental dysfunction ○​ Scientific method - the process of systematically gathering and evaluating information, through careful observations, to understand a phenomenon ○​ Clinical researchers depend on mainly three methods of investigation: case study (typically focused on one individual) and the correlational method on experimental method (usually used to gather information about many individuals ○​ Hypotheses - a hunch or prediction that certain variables are related in certain ways ○​ Clinical researchers must always ensure that the rights of their research participants, both human and animal, are not violated ○​ They must also figure out how to measure such elusive concepts as unconscious motives, private thoughts, mood changes, and human potential ​ The case study ○​ A case study is a details description of a person’s life and psychological problems ○​ The clues offered by a case study may help a clinician better understand or treat the person under discussion ○​ How are case studies helpful? ​ Case studies can be a source of new ideas about behavior ​ Case studies may offer tentative support for a theory ​ Case studies can show the value of new therapeutic techniques ​ Case studies may offer opportunities to study unusual problems that do not occur often enough to permit a large number of observations ○​ What are the limitations of case studies? ​ Case studies are reported by biased observers (therapists who have personal stake in seeing their treatments succeed ​ Case studies rely on subjective evidence ​ Internal validity - the accuracy with which a study can pinpoint one factor as the cause of a phenomenon ​ Case studies provided little basis for generalization ​ External validity - the degree to which the results of a study may be generalized beyond that study ​ Case studies are low in internal and external validity ​ The correlational method and experimental method address the limitations of case studies by helping investigators draw broad conclusions about psychopathology in the population at large ​ With correlational and experimental methods, the researchers typically observe many individuals, apply procedures uniformly, and use statistical  tests to analyze the results of a study and determine whether broad conclusion are justified ​ The correlational method ○​ Correlation is the degree to which events or characteristics vary along with each other ○​ Correlational method - a research procedure used to determine how much events or characteristics vary along with each other ○​ A sample should be representative of the larger population that researchers wish to understand ○​ Describing a correlation: ​ The line of best fit - a line that the data points are as close to it as possible ​ When variables change the same way, the correlation of those variable is said to have a positive direction and is referred to as a positive correlation ​ In a negative correlation, the value of one variable increases as the value of the other variable decreases ​ The variables under study may be unrelated, meaning that there is no consistent relationship between them ​ Researched also need to know the magnitude or strength of a correlation ​ The steeper the line of best fit, the stronger the correlation is ​ The direction and magnitude of a correlation are often calculated numerically and expressed by a statistical term called the correlation coefficient ​ +1.00 - perfect positive correlation ​ -1.00 - perfect negative correlation ​.00 - no correlation or relationship between variables ​ The closer r is to.00, the weaker the relationship is ​ Most correlations found in psychological research fall short of a perfect or negative correlation ○​ When can correlations be trusted? ​ Scientist use statistical analysis to see how likely it is that the study’s particular findings have occurred by chance ​ If there is less than a 5% probability that a study’s findings are due to chance (p <.05) the findings are said to be statistically significant and are thought to reflect a true correlation in the larger population ○​ What are the merits of the correlational method? ​ The correlational method has higher external validity than case studies ​ Correlational studies are feasibly replicable with new samples of participants to check the results of earlier studies ​ On the other hand, correlation studies lack internal validity  ​ Correlational studies can describes the relationship between two variables but cannot explain it ​ Whatever the cause, just knowing that there is a correlation may enable clinicians to take measures to help save lives ​ The experimental method ○​ An experiment is a research procedure in which a variable is manipulated and the manipulations’s effect on another variable is observed ○​ Independent variable - the variable in an experiments that is manipulated to determine whether it has an effect on another variable ○​ Dependent variable - the variable in an experiment that is expected to change as the independent variable is manipulated ○​ Confounds - in an experiment, as variable other than the independent variable that is also acting on the dependent variable ○​ Experimenters must try to eliminate all confounds from the studies to ensure that it’s is the independent variable causing the observed changes ○​ To guard against confounds, researchers should included three important features in their experiments: ​ A control group ​ Random assignment ​ A masked design ○​ The control group: ​ Control group - in an experiment, a group of participants who are not exposed to the independent variable ​ Experimental group - in an experiment, the participants who are exposed to the independent variable under investigation ​ To guard against confounds, experimenters try to provide all participants, both control and experimental, with experience that are identical in every way – except for the independent variable ​ Similarly to correlational studies, if there is less than a 5% probability that a study’s findings are due to chance (p <.05) the findings are said to be statistically significant and are thought to reflect a true correlation in the larger population ​ Statistical significance - indicated whether a participant’s improvement in functioning occurred because of treatment ​ Clinical significance - indicated whether the amount of improvement is meaningful in the individual’s life ○​ Random assignment: ​ Random assignment - a selection procedure in an experiment that ensures that participants are randomly placed in either the control or experimental group  ○​ Masked design: ​ Participants may bias an experiment’s results by trying to please or help the experimenter ​ Masked design - a feature of an experiment in which participants do not know whether they are in the experimental condition or control condition ​ Placebo therapy - a pretend treatment that the participants in an experiment believes to be genuine ​ Experimenter bias - experimenters may have expectations that they unintentionally transmit to the participants in their studies ​ Experimenters can eliminated their own bias by arranging to be unaware themselves ​ It is best that both the experimenter and participants are kept unaware in an experiment – a research strategy called a double-masked design ​ Alternative research designs ○​ Matched designs ​ Investigators make use of groups that already exist in the world at large ​ This strategy violates the rule of random assignment and so introduces possible confounds into the study ​ The matched design helps minimize such confounds ​ Matched design - a research design that matches the experimental participants with control participants who are similar on key characteristics ○​ Natural experiments ​ Natural experiments - an experiment in which nature, rather than an experimenter, manipulates an independent variable ​ The participants of the experiment includes victims of natural disaster such as floods, earthquakes, and wildfires ○​ Analogue experiments ​ Analogue experiment - a research method in which the experimenter produces pathological-like behavior in laboratory participants and then conducts experiments on the participants ​ Often uses animals as participants ​ Limitation of all analogue research: researchers can never be certain that the phenomena they induce in the laboratory are the same as the psychological disorders they are investigating ○​ Single-case experiments ​ Single-case experimental design - a research method in which a single participant is observed and measured both before and after the manipulation of and independent variable (also called a single-subject experimental design)  ​ Single-case experiments rely on information gathered prior to any manipulations ​ Since the experiment is only on one person, the researcher cannot be sure that the participant’s reaction to the independent variable is typical of people in general ○​ Longitudinal studies - ​ Longitudinal studies - a study the observes the same participants on many occasions over a long period of time ​ Researchers do not directly manipulate the independent variable or randomly assign participants to conditions, and so they cannot definitively pinpoint causes ○​ Epidemiological studies ​ Epidemiological studies - a study that measures the incidence and prevalence of a problem, such as a disorder, in a giver population ​ Incidence - the number of new cases of a disorder occurring in a population over a specific period of time ​ Prevalence - the total number of cases of a disorder occurring in a population over a specific period of time ​ The Epidemiologic Catchment Are study is one of the largest epidemiological studies of mental disorders ever conducted to determine the prevalence of many psychological disorders in the United States ​ Such epidemiological studies have helped researched identify groups at risk for particular disorders ○​ Qualitative studies ​ Qualitative studies - an exploratory research strategy that examines variables in their unfiltered and natural states, often through open-ended questioning, to gather rich descriptive accounts in great depth ​ The researchers measure relationships between variables and then use statistical analyses to make predictions about broader populations ​ Quantitative methods work well when assessing objective and straightforward information across participants ​ Qualitative methods - natural and unfiltered research methods intended to seek out each participant’s direct perspective – gathering information that is offered in the participant’s own words ​ Qualitative findings are not well suited for testing hypotheses or drawing conclusions beyond the sample under study ○​ Mixed-methods designs ​ A research tradition that combines, or mixes, both quantitative and qualitative approaches within the same research project  ​ Qualitative methods are used to help generate new hypothesis, whereas quantitative methods are used to test hypotheses ​ Findings from mixed-methods research often provide fuller and more revealing information than either quantitative or qualitative studies alone ​ Community-based participatory research ○​ In the community-based participatory research (CBPR) approach, members of an affected community work collaboratively with academically trained scientists on all stages of the research process ○​ The CBPR approach has brought about some important insights and changes in the realm of health disparity ○​ To help reduce the current health disadvantages for black people, Black community leaders and organizations have partnered with university research to develop creative barbershop-based and hair salon-based interventions in Black neighborhoods ○​ These programs have made significant positive differences in the patrons ​ Protecting human participants ○​ Every researcher’s primary obligation is to avoid harming the human participants in their studies – physically or psychologically ○​ The U.S. government and the institutions in which research is conducted now take careful measures to ensure that the safety and rights of human research participants are properly protected ○​ Institutional Review Boards (IRBs) - an ethics committee in a research facility that is empowered to protect the rights and safety of human research participants ○​ IRBS try to ensure that each study grants the following rights to its participants: ​ The participants enlist voluntarily ​ Before the participants enlist, they are adequately informed about what the study entails ​ The participants can end their participation in the study at any time ​ The benefits of the study outweigh its costs/risks to participants ​ The participants are protected from physical and psychological harm ​ The participants have access to information about the study ​ The participants privacy is protected by principles such as confidentiality or anonymity ○​ Participants have to read and sign an “informed consent” document but these documents typically aren’t very clear ○​ The IRB system is flawed ​ Keeping and eye on research methods ○​ It is best to view each research methods as a part of team of approaches that together my shed light on psychopathology Chapter 3: Models of Psychopathology ​ Introduction ○​ models/paradigms - A set of assumptions and concepts that help scientists explain and interpret observations ○​ Until recently, clinical scientists of a given place and time tended to agree on a single model of psychopathology – a model greatly influenced by the beliefs of their culture ○​ Today, several models are used to explain and treat psychopathology ○​ Models are sometimes in conflicts ○​ None of the models are complete in themselves ​ The Biological Model ○​ Biological model - a full understanding of thoughts, emotions, and behavior must include and understanding of the biological basis ○​ How do biological theorists explain psychopathology? ​ Biological theorists view psychopathology as an illness brought about by malfunctioning parts of the organism ○​ Brain chemistry and Psychopathology ​ Studies indicate that irregular activity by certain neurotransmitters is sometimes tied to mental disorders ​ Researchers have learned that mental disorders are sometimes related to irregular chemical activity in the body’s endocrine system ○​ Brain Anatomy, Circuitry, and Psychopathology ​ Clinical researchers have sometimes linked particular psychological disorders to problems in specific structure of the brain ​ Proper communication among structures of a circuit tends to result in healthy psychological functioning, where as flawed communication may lead to psychological dysfunction ​ Studies suggest that the fear circuit functions improperly in people who are experiencing certain anxiety disorders ○​ Sources of Biological Irregularities ​ Two factors that have received attention in the biological model are genetics and evolution ​ Studies suggest that inheritance also can play a part in certain mental disorders ​ Many of the genes that contribute to psychological dysfunction are actually the result of ordinary evolutionary principles ​ Evolutionary theorists argue that human reactions and the genes responsible for them have survived over the course of time because they have help individuals to thrive and adapt  ​ Genes that may have helped one’s ancestors survive and reproduce might now leave them particularly prone to fear reactions, anxiety disorders, or related psychological patterns ○​ Biological Treatments ​ The three leading kinds of biological treatments used today are drug therapy, brain stimulation, and psychosurgery ​ Psychotropic medications - drugs that mainly affect the brain and reduce many symptoms of mental dysfunction ​ Four major psychotropic drug groups are used in therapy: anti anxiety drugs, antidepressant drugs, antibipolar drugs, antipsychotic drugs ​ It takes an average of 12 to 15 years and hundreds of millions of dollars for a pharmaceutical company to bring a newly identified chemical compound to market ​ Brain stimulation - interventions that directly or indirectly stimulate the brain inorder to bring about psychological improvements ​ Electroconvulsive therapy (ECT) - a biological treatment in which a brain seizure is triggered when an electric current passes through electrodes attached to the patient’s forehead ​ Research suggests that each of these newer brain stimulation techniques is able to improve the psychological functioning of many people who depressive or related disorders have been unresponsive to other forms of treatment ​ Psychosurgery - brain surgery for mental disorders ​ Psychosurgeries are typically only used after certain severe disorders have continues for years without responding to any other treatment ○​ Assessing the biological model ​ A shortcoming of the biological model is that it expects that all human behavior can be explained in biological terms and treated with biological methods ​ Another shortcoming is that several of today’s biological treatments are capable of producing significant undesirable effects ​ The Psychodynamic Model ○​ Psychodynamic theorists believe that all behaviors are determined largely by underlying psychological forces of which individuals are not consciously aware ○​ Psychodynamic theories rest on the deterministic assumption that no symptom or behavior is “accidental”: all behavior is determined by past experiences ○​ How did Freud explain psychological functioning? ​ Freud believed that three central forces shape personality: instinctual needs, rational thinking, and moral standards ​ Freued called the forces the id, the ego, and the superego  ​ If the id, ego, and superego are in excessive conflict, the person’s behavior may show signs of dysfunction ○​ The Id ​ Id - according to Freud, the psychological force that produced instinctual needs, drives, and impulses ○​ The Ego ​ Ego - according to Freud, the psychological force that employs reason and operates in accordance with reality principle ​ Ego defense mechanisms - according to psychoanalytic theory, strategies developed by the ego to control unacceptable id impulses and to avoid or reduce the anxiety the arouse ○​ The Superego ​ Superego - according to Freud, the psychological force that represents a person’s values and ideals ○​ Developmental stages ​ Fixated - a condition in which the id, ego and superego do not mature properly and are frozen at an early stage of development ○​ How do other Psychodynamic explanations differ from Freud’s? ​ Although the new theories departed from Freud’s ideas in important ways, each held on to freud’s belief that human functioning is haped by dynamic psychological forces ​ Self theorists - the psychodynamic theory that emphasizes the role of the self – our unified personality ​ Object relations theorist - the psychodynamic theory that views the desire for relationships as the key motivating force in human behavior ○​ Psychodynamic Therapies ​ Psychodynamic therapists seek to uncover past traumas and the inner conflicts that have resulted from them ​ Therapists must subtly guide therapy discussion so that the patients discover their underlying problems for themselves ○​ Free association ​ Free association - a psychodynamic technique in which the patient describes any thought, feeling, or image that comes to mind, even if it seems unimportant ○​ Therapist Interpretation ​ Interpretations of three phenomena are particularly important to psychodynamic therapists – resistance, transference, and dreams ​ Resistance - an unconscious refusal to participate fully in therapy ​ Transference - the redirection toward the psychotherapist of feelings associated with important figures in a patient’s life, now or in the past  ​ Freud identifies two kinds of dream content – manifest and latent ​ Manifest content - consciously remembered dream ​ Latent content - its symbolic meaning ○​ Catharsis ​ Catharsis - the reliving of past repressed feelings in order to settle internal conflicts and overcome problems ○​ Working Through ​ The client and therapist must examine the same issues over and over in the course of many sessions, each time with greater clarity ○​ Current Trends in Psychodynamic Therapy ​ An increased demand for focuses, time-limited psychotherapies has resulted in efforts to make psychodynamic therapy more efficient and affordable ​ Short term psychodynamic therapies: client chooses a single problem, the therapist and client focus on this problem throughout the treatment and work only on the psychodynamic issues that relate to it ​ Relational psychoanalytic therapy: argues that therapists are key figures in the lives of clients, therapist establish a more equal relationship with client ○​ Assessing the Psychodynamic Model ​ Psychodynamic theorist have also helped us to understand that dysfunctional behavior may be rooted in the same process as functional behavior ​ Freud and his many followers were the first to apply theory systematically to treatment ​ Because processes such as id drives, ego defenses, and fixation are abstract and supposedly operate at an unconscious level, there is no way of knowing for certain if they are occurring ​ Psychoanalytic explanations and treatments have received relatively limited research support over the years ​ The Cognitive-Behavioral Model ○​ The cognitive-behavioral model of psychopathology focuses on the behaviors people display and the thoughts they have ○​ Conditioning - a simple form of learning ○​ Clinicians began to explain and treat psychopathology by applying principles derived from laboratory conditioning studies ○​ The Behavioral Dimension ​ Dysfunction behaviors can be learned ​ Classical conditioning - a process of learning by temporal association in which two event that repeatedly occur close together in time become fused in a person’s mind and produce the same response  ​ Modeling - a process of learning in which an individual acquires responses by observing and imitating others ​ Operant conditioning - a process of learning in which individuals come to behave in certain ways as a result of experiencing consequences of one kind or another whenever they perform the behavior ​ Behavior-focused therapists seek to replace such types of behaviors with more appropriate ones, applying the principles of operant and classical conditioning and modeling ○​ The Cognitive Dimension ​ Some clinicians proposed the we can best explain and treat psychopathology not only by looking at behaviors but also by focusing on cognitions ​ Psychopathological functioning can result from several kinds of cognitive problems ​ Illogical thinking processes are another source of psychopathological functioning ​ Therapists guide clients with depression to identify and challenge any negative thoughts, biases interpretations, and errors in logic that dominate their thinking and contribute to their disorder ○​ The Cognitive-Behavioral Interplay ​ Exposure therapy - A behavior-focused intervention in which fearful people are repeatedly exposed to the objects or situations they dread ​ In an example of social anxiety, clients come to adopt more accurate social beliefs, engage in more social situations, and experience less fear during social encounters ○​ New Wave Cognitive-Behavioral Therapies ​ These approaches help clients accept many of their troubling thoughts ​ These techniques borrow heavily from a form of meditation called mindfulness meditation ○​ Assessing the Cognitive-Behavioral Model ​ Nearly half of today’s clinical psychologists report their approach is cognitive and/or behavioral ​ One reason for the appeal of the cognitive-behavioral model is that it can be tested in the laboratory ​ Cognitive behavioral therapies have impressive research performance ​ Cognitive behavioral therapies do not help everyone ​ Cognitive behavioral therapists may be paying too little attention to the influence of early life experiences and relationships on a client's current difficulties ​ The cognitive behavioral model is narrow in certain ways ​ The Humanistic-Existential Model ○​ Humanistic and existential theorists are often grouped together because of their common focus on these broader dimensions of human existence ○​ Self-actualize - the humanistic process by which people fulfill their potential for goodness and growth ○​ Existentialists agree that human beings must have an accurate awareness of themselves and live meaningful lives in order to be psychologically well-adjusted ○​ This model was very popular in the 1960s and 1970s but since have lost their popularity ○​ Roger’s Humanistic Theory and Therapy ​ People who receive unconditional positive regard in early life are likely to develop unconditional self-regard, they come to recognize their worth as person while recognizing that they're not perfect ​ Conditions of worth - standards that tell them they are loveable and acceptable only when they conform to certain guidelines ​ Client-centered therapy - the humanistic therapy developed by Carl Rogers in which clinicians try to help clients by conveying acceptance, accurate empathy, and genuineness ​ Full and warm acceptance for the client ​ Skillful listening and restating ​ Sincere communication ​ Client centered therapy has not fared very well in research ○​ Gestalt Theory and Therapy ​ Gestalt therapy - clinicians actively move clients towards self-recognition and self-acceptance by using techniques such as role-playing and self-discovery exercises ​ Through role-playing, clients may come to accept feelings that previously made them uncomfortable ​ Approximately 1% of psychologists today describe themselves as gestalt therapists ○​ Spiritual Views and Interventions ​ Many articles and books have been published linking spiritual issues to clinical treatment in the past 15 years ​ Spirituality does often correlate with psychological health ​ Many therapists now make a point of including spiritual issues when they treat religious clients ○​ Existential Theories and Therapy ​ Existentialist talk about a kind of self-deception in which people hide from life’s responsibilities and fail to recognize that it is up to them to give meaning to their lives  ​ Existential therapy - a therapy the encourages clients to accept responsibility for their lives and to live with greater meaning and value ​ Little controlled research has been devoted to the effectiveness of this approach ○​ Assessing the Humanistic-Existential Model ○​ Existential focus on abstract issues of human fulfillment gives rise to a major problem from a scientific perspective: these issues are difficult to research ○​ Humanistic and existential theorists tap into an aspect of psychological life that is typically missing from other models ​ The Socio-Cultural Method: Family-Social and Multicultural Perspectives ○​ The sociocultural model is composed of two major perspectives ​ The family-social perspective ​ The multicultural perspective ○​ How Do Family Social Theorists Explain Psychopathology? ​ Clinical theorists should concentrate on those broad forces that operate directly on individuals (family, relationships, social interactions) ​ Pay particular attention to three kinds of factors: ​ Social labels and roles ​ Social connections and supports ​ Family structure and communication ○​ Social Labels and Roles ​ When people are reacted to as “crazy” or “sick” the gradually learn to accept and play the assigned social role ○​ Social Connections and Supports ​ Researcher have often found ties between deficient social connection and psychological dysfunction ​ People’s online relationships tend to parallel their offline relationships ○​ Family Structure and Communication ​ Family systems theory - a theory that views the family as a system of interacting parts whose interactions exhibit consistent patterns and unstated rules ​ Certain family systems and interaction patterns are particularly likely to produce psychological dysfunction in individuals ○​ Interpersonal Psychotherapy (IPT) ​ A therapy the addresses four impersonal problem areas that may be leading to psychopathology: interpersonal losses, interpersonal role disputes, interpersonal role transitions, and interpersonal deficits ​ IPT therapists encourage clients who have experienced recent interpersonal losses to explore their relationship with the lost person  ​ IPT therapist help clients who are going through interpersonal role transitions develop the social supports and skills their new roles require ​ IPT therapists help clients who may display significant interpersonal deficits to recognize their deficits, appreciate the disruptive impact that these deficits can have on intimate relationships, and develop more effective social skills and assertiveness ​ IPT and related interpersonal treatments are often very helpful for clients, especially those with depression ○​ Group Therapy ​ Group therapy - a therapy format in which a group of people with similar problems meet together with a therapist to work on those problems ​ Support group - a group made up of people with similar problems who help and support one another without the direct leadership of a clinician ○​ Family Therapy ​ Family therapy - a therapy format in which the therapist meets with all members of family and helps them to change in therapeutic ways ​ Research has not clarified how helpful family therapy is ○​ Couple Therapy ​ Couple therapy - A therapy format in which the therapist works with two people who share a long-term relationship ​ Couple therapy may follow the principles of any of the major therapy orientations ​ Couples treated by couple therapy seem to show greater improvement in their relationships than couples with similar problems who do not receive treatment ○​ Community Treatment ​ Community Mental Health Treatment - a treatment approach that emphasizes community care ​ A key principle of community treatment is prevention ​ Community workers recognize three types of prevention ​ Primary ​ Secondary ​ Tertiary ​ Primary prevention consists of efforts to improve community attitudes and policies and overall wellness ​ Secondary prevention consists of identifying and treating psychological conditions in the early stages, before they become serious ​ Tertiary prevention provides effective treatment to specific persons who have already developed moderate or severe disorders so that these disorders do not become long-term problems  ○​ How Do Multicultural Theorists Explain Psychopathology? ​ Multicultural perspective - the view that each culture in a society has particular values, beliefs, and pressures that influence the behavior and functioning of its members ​ Psychopathology, especially severe psychopathology, is more common among less affluent people than among wealthier people ​ Multicultural theorists are careful to not imply that marginalized groups are in some way inferior or less adequate than a country’s dominant population ​ Multicultural theorist focus as much on differences within cultural groups as on differences between cultural groups ​ Multicultural theorists take into consideration that an individual is often as member of multiple diverse groups ○​ Multicultural Treatments ​ People of color and other marginalized groups tend to show less improvement in clinical treatment, make less use of mental health services ​ Two features that can increase a therapist's effectiveness will clients from the full spectrum of cultural backgrounds ​ Greater sensitivity to cultural issues ​ Inclusion of cultural moral and model in treatment, for adult, adolescent, and child clients ​ Culturally responsive therapies - treatment approaches that are designed to help address the unique issues faced by members of different cultural groups ○​ Assessing the Sociocultural Model ​ Factors such as family cultural, social, and societal issues were overlooked just 40 years ago ​ The treatment formats offered by the sociocultural model sometimes succeed where traditional approaches have failed ​ Sociocultural research findings are often difficult to interpret ​ Unable to predict psychological dysfunction in specific individuals ​ Family-social and multicultural explanations are operating in conjunction with biological or psychological explanations ​ Integrating the Models: The Developmental Psychopathology Perspective ○​ The conclusions and techniques of the various models are often compatible ○​ 22% of clinical psychologist, 31% percent of counseling psychologist, 26% of social workers describe their approach as “eclectic” or “integrative” ○​ Developmental psychopathology - a perspective that uses a developmental framework to understand how variables and principles from the various models may collectively account for human functioning  ○​ Equifinality - the principle that a number of different developmental pathways can lead to the same psychological disorder ○​ Multifinality - the principle that persons with similar developmental histories may nevertheless have different clinical outcomes or react to comparable current situations in very different ways ○​ Protective factor - a positive developmental variable such as effective parenting that helps to offset the impact of negative variable such as unfavorable genes or a difficult temperament ○​ Developmental psychopathologist often play prominent role in social policy Chapter 4: Clinical Assessment, Diagnosis, and Treatment ​ Introduction ○​ Questions clinicians often start out asking themselves: ​ Who is he/she? ​ What is his/her life like? ​ What are his/her symptoms ○​ Idiographic - an individualistic understanding of a single person’s psychopathology ​ Clinical Assessment: How and Why is the Client Showing Psychopathology? ○​ Assessment - the collecting of relevant information in an effort to reach a conclusion ○​ Clinical assessment is used to determine whether, how, and why a person is behaving in a dysfunctional manner and how that person may be helped ○​ Clinical assessment techniques fall into three categories ​ Clinical interviews, test, and observations ○​ Characteristics of Assessment Tools ​ Standardize - the process in which a test is administered to a large group of people whose performance then serves as a standard or norm against which any individual’s score can be measured ​ Test-retest reliability - yields similar results every time it is given to the same people ​ Reliability - a measure of the consistency of test or research results ​ Interrater reliability - different judges independently agree on how to score and interpret the assessment ​ Validity - a measure of the accuracy of a test’s or study’s results ​ Face validity - appears to be valid simply because it make sense and seems reasonable ​ Predictive validity - a tool’s ability to predict future characteristics or behavior  ​ Concurrent validity - the degree to which the measures gathered from one tool agree with the measures gathered from other assessment techniques ​ Before any assessment technique can be fully useful, it must meet the requirements of standardization, reliability, and validity ○​ Clinical Interviews ​ With face-to-face interactions, we can take note of their reactions to what we do and say, we can observe as well as listen as they answer, and we generally get a sense of who they are ​ Clinicians use interviews to collect detailed information about the person’s difficulties and feelings, lifestyle and relationships, and other personal history ​ Clinical interviewers give special attention to those topics they consider most important ​ Interviews can be either structured or unstructured ​ Unstructured interview - the clinicians asks mostly open ended questions ​ Structured interview - the clinician asks prepared—mostly specific—questions ​ Mental status exam - a set of questions and observations that systematically evaluate the client’s awareness, orientation with regard to time and place, attention span, memory, judgment and insight, thought content processes, mood, and appearance ○​ What are the Limitations of Clinical Interviews? ​ Lack validity or accuracy ​ Make mistakes in judgement that slant the information they gather ​ May lack reliability (particularly unstructured interviews) ○​ Clinical Test ​ Clinical Tests - A device for gathering information about a few aspects of a person’s psychological functioning from which broader information about the person can be inferred ​ Most tests lack reliability, validity, and standardization ○​ Projective Tests ​ Requires the clients interpret vague stimuli ​ When clues and instructions are so general, people will “project aspects of their personality onto the task ​ Rorschach test is one of the most widely used projective tests ​ The Rorschach is is when the clinicians asks a clients to tell them what they see in an ink blot or what it reminds them of ​ The Thematic Apperception Test (TAT) is a pictorial projective test  ​ People who the TAT are commonly shown 30 cards with black-and-white pictures of individuals in vague situations and are asked to make up a dramatic story about each card ​ Clinicians who use the TAT believe that people always identify with on of the characters on each card ​ The sentence-completion test is also one of the most widely used projective tests ​ In the sentence-completion test, the test-take completes a series of unfinished sentences ​ In the Draw-a-Person (DAP) test, individuals are first told to draw “a person” and then to draw a person whose gender is different from the first drawing ​ Projective tests used to be most commonly used for assessing personality but recently clinicians and researchers have relied on them largely to gain “supplementary” insights ​ Projective tests are sometimes biased against people of color and other marginalized persons ○​ Personality Inventories ​ Personality inventory - a test, designed to measure broad personality characteristics, consisting of statements about behaviors, beliefs, and feeling that people evaluate as either characteristic or uncharacteristic of them ​ The most widely used personality inventory is the Minnesota Multiphasic Personality Inventory (MMPI) ​ The MMPI-3 consists of 335 self-statements, to be labeled “true,” “false,” or “cannot say” by the test taker ​ The many scales on the MMPI-3 include the following: ​ Self-doubt ​ Worry ​ Anger proneness ​ Aggression ​ Activation ​ Psychoticism ​ Most personality inventories are standardized ​ Objectively scored ​ Take less time to administer than projective tests ​ They often display great test-retest reliability than projective test ​ They have more validity as well ○​ Response Inventories  ​ Response Inventory - tests designed to measure a person’s responses in one specific area of functioning, such as affect, social skills, or cognitive processes ​ Affective inventories measure the severity of of such emotions as anxiety, depression, and anger ​ Social skills inventories indicate how a respondent may react in a variety of social situations ​ Cognitive inventories reveals a person’s typical thoughts and assumptions and can help uncover counterproductive patterns of thinking ​ Few response inventories have been subjected to careful standardization, reliability, and validity procedures ○​ Psychophysiological Tests ​ Psychophysiological test - a test that measures physical responses (such as heart rate and muscle tension) as possible indicators of psychological problems ​ The polygraph (or lie detector) is an example of a psychophysiological test ​ Many of these tests require expensive equipment ​ Can be inaccurate and unreliable ○​ Neuroimaging and Neuropsychological Tests ​ Neuroimaging - neurological test that provide images of brain structure or activity, such as CT scans, PET scans, and MRIs (also called brain scanning) ​ Electroencephalogram (EEG) records brain waves but cannot precisely pinpoint where this brain activity is occurring ​ Computerized axial tomography (CT or CAT scan) x-rays the brain’s structures and different angles and combined ​ Positron emission tomography (PET scan) is a computer-produced motion picture of chemical activity throughout the brain ​ Magnetic resonance imaging (MRI) is a procedure that uses the magnetic property of certain hydrogen atoms in the brain to create a detailed picture of the brain’s structure ​ Functional magnetic resonance imaging (fMRI) converts MRI pictures of brain structures into detailed pictures of neuron activity, thus offering a picture of the functioning brain ​ These techniques are sometimes unable to detect subtle brain pathology ​ Neuropsychological test - a test that detects brain impairment by measuring a person’s cognitive, perceptual, and motor performances ​ Bender Visual-Motor Gestalt Test consists of nine cards, each displaying a simple geometrical design, the patient the copy each design onto a piece of paper one at a time then tries to redraw from memory  ○​ Intelligence Tests ​ Intelligence test - a test designed to measure a person’s intellectual ability ​ Intelligence quotient - an overall score derived from intelligence tests that theoretically represents a person’s overall intellectual capacity ​ The tests play a key role in the diagnosis of intellectual developmental disorder ​ Tests have been standardized ​ High reliability ​ Fairly high validity ​ Factors that have nothing to do with intelligence can greatly influence test performance ​ May contain cultural biases or tasks that place people of one background at an advantage over those of another background ​ Marginalized populations may have little experience with this kind of test ○​ Clinical Observations ​ Naturalistic observation - observing clients in their everyday environments ​ Analog observation - observing clients in an artificial setting, such as a clinical office or laboratory ​ Self-monitoring observation - clients are instructed to observe themselves ​ Naturalistic and analog observation are not always reliable ​ Observers may make errors that affect the validity, or accuracy, of their observations ​ A client’s reactivity may also limit the validity of clinical observations ​ Clinical observations may lack cross-situational validity ​ Self-monitoring is especially useful in assessing behavior that occurs so infrequently that it is unlikely to appear in session or during other kinds of observations ​ Validity is problem with self-monitoring ​ Diagnosis: Does the Client’s Syndrome Match a Known Disorder? ○​ Clinical picture - information gathered by a clinician to construct an integrated picture of the factors that are causing and maintaining a client's disturbance ○​ Diagnosis - a determination that a person’s difficulties reflect a particular disorder ○​ Classification Systems ​ Classification system - a list of disorders, along with descriptions of symptoms and guidelines for making appropriate diagnoses ​ Syndrome - a cluster of symptoms that usually occur together ​ The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the classification system currently written by the APA ​ North America primarily uses DSM and most other countries rely on a system called International Classification of Diseases (ICD) ○​ DSM-5 and DSM-5-TR ​ DSM-5 was published in 2013 and lists more than 500 mental disorders ​ In 2022 the APA revised DSM-5 and provided deeper discussion regarding the impact of racism and other kinds of discrimination on mental disorders ​ DSM-5-TR is the version of DSM now cited in most diagnostic discussions ○​ Providing Categorical and Dimensional Information ​ Categorical information - the name of the distinct category (disorder) indicated by the client’s symptoms ​ Dimensional information - a rating of how sever a client’s symptoms are and how dysfunctional the client is across various dimensions of personality and behavior ​ Comorbid disorders - when a person receives two or more separate diagnoses ​ Diagnosticians using DSM-5-TR must provide dimensional information ○​ Additional Information ​ Clinicians also may include other useful information when making a diagnosis ​ Each diagnosis also has a numerical code that clinicians must state ○​ Is DSM-5-TR an effective Classification System? ​ DSM-5 has greater reliability than previous DSMs ​ DSM-5’s reliability is limited ​ Categories are of most use to clinicians when they demonstrate predictive validity ​ Some of DSM-5’s criteria and categories reflect gender or racial bias ​ The National Institute of Mental Health (NIMH) developed its own neuroscience focused classification tool called the Research Domain Criteria (RDoC) ​ A group of assessment researchers developed the Hierarchical Taxonomy of Psychopathology (HiTOP) that describe psychopathology in dimensional term only ​ HiTOP may detect “lower levels” of pathology that are often neglected by the DSM ○​ Can Diagnosis and Labeling Cause Harm? ​ Sociocultural theorists believe that diagnostic labels can become self-fulfilling prophecies ​ Certain editions of the DSM incorrectly listed a particular pattern of functioning or behaving as a form of psychopathology  ​ Diagnoses can be so flawed and stigmatizing and can contributed to mistreatment ​ Treatment: How Might the Client Be Helped? ○​ Treatment Decisions ​ By combining the client’s idiographic data and their individual information with broad information about the nature and treatment of the diagnosed disorder, the clinician can create a treatment plan ​ Current research may play a role in deciding treatment ​ Evidence-based treatment - treatment that has received clear research support for a particular disorder and has corresponding treatment guidelines ○​ The Effectiveness of Treatment ​ Problems with defining the effectiveness of treatment ​ Define “success” ​ Measuring improvement ​ Variety and complexity of treatments ​ Studies testing the effectiveness of treatment typically ask one of three questions: ​ Is therapy generally effective? ​ Are particular therapies generally effective? ​ Are particular therapies effective for particular conditions? ○​ Is Therapy Generally Effective? ​ Studies suggest that therapy is often more helpful than no treatment or more helpful than placebos ​ 3%-15% of patients actually seem to get worse because of therapy ○​ Are Particular Therapies Generally Effective? ​ Uniformity myth - a false belief that all therapies are equivalent despite differences in the therapists’ training, experience, theoretical orientations, and personalities ​ Most research shows that the major forms of therapy are superior to no treatment or placebo treatment ​ No one form of therapy generally stands out over all other across the full spectrum of mental health conditions ​ Rapprochement movement - a movement to identify a set of common factors, or common strategies, that run through all successful therapies ○​ Are Particular Therapies Effective for Particular Conditions ​ People with different disorders may respond differently to the various forms of therapy ​ Studies show that some clinical disorders may respond better to combined approaches ​ Psychopharmacologist - a psychiatrist who primarily prescribes medications