Module 2 Models of Abnormal Behavior PDF

Home C-PSYM317 BSY31 ABNORMAL PSYCHOLOGY 1st Sem ( 2024-2025 ) - Period MH1300-1430 Midterm: Module 2 Models of Abnormal Behavior (Sept9-14) Lesson: Models of Abnormal Behavior Immersive Reader Models of Abnormal Behavior Researchers studying psychopathology use a variety of models, each embodyi...

Home C-PSYM317 BSY31 ABNORMAL PSYCHOLOGY 1st Sem ( 2024-2025 ) - Period MH1300-1430 Midterm: Module 2 Models of Abnormal Behavior (Sept9-14) Lesson: Models of Abnormal Behavior Immersive Reader Models of Abnormal Behavior Researchers studying psychopathology use a variety of models, each embodying a particular theoretical approach. Such models help researchers determine relevant information, ask probing questions, make educated guesses about the causes of mental disorders, and organize information in a meaningful way. Theorists do not expect to develop one definitive model of human behavior because they recognize the complexities involved in being human. They realize that the models they construct are limited and cannot explain every aspect of the phenomena they are studying (Brooks-Harris, 2008). Rather, they use the models to visualize psychopathology as if it truly worked in the manner described. The following are used as models of abnormal behavior: A. Diathesis-stress model B. Biopsychosocial model C. One-Dimensional Models D. Multipath Models The diathesis-stress model was originally proposed by Meehl (1962) and developed further by Rosenthal (1970). It suggests that it is not a particular abnormality that is inherited but rather a predisposition to develop illness (the diathesis). Certain environmental forces, called stressors, may activate the predisposition, resulting in a disorder. Alternatively, in a benign and supportive environment, the abnormality may never materialize. The biopsychosocial model suggests that interactions between biological, psychological, and social factors cause mental disorders. This model was first conceptualized by George Engel in 1977. Although the biopsychosocial model highlights the fact that multiple factors can influence the development of mental disorders, concerns remain: (a) there is limited focus on how factors interact to produce illness; (b) the model provides little guidance regarding how to treat the disorder; and (c) the model neglects the powerful influences of culture (Ghaemi, 2010b; Sue & Sue, 2013). Of particular concern in the use of the biopsychosocial model is the relative neglect of sociocultural influences such as the effects of poverty or discrimination in explaining mental disorders. Models of psychopathology, whether biological, psychological, social, or sociocultural, help us to organize and make sense of what we know about mental illness. These models, however, can foster a one-dimensional and linear explanation of mental disorders, thus limiting our ability to consider other perspectives. Scientists now recognize that one-dimensional perspectives are overly simplistic because they (a) set up a false “either/or” dichotomy between accepting one explanation or another (e.g., nature vs. nurture), (b) neglect the possibility that a variety of factors contribute to the development of mental disorders, and (c) fail to recognize the reciprocal influences of the various contributing factors (T.-Y. Zhang & Meaney, 2010). Sue et al. (2016) used the multipath model—an integration of biological, psychological, social, and sociocultural influences—to explain the mental disorders. The multipath model addresses the limitations associated with one-dimensional models and will help conceptualize how various interacting factors can contribute to mental illness. A Multipath Model of Mental Disorders The integrative and interacting multipath model will prompt you to consider the multitude of factors that researchers have confirmed are associated with each disorder we discuss. The multipath model is not a theory but a way of looking at the variety and complexity of contributors to mental disorders. In some respects it is a metamodel, a model of models that provides an organizational framework for understanding the numerous factors that increase risk for the development of mental disorders, the complexity of potential interactions among factors, and the need to view disorders from a holistic framework. The multipath model operates under several assumptions: No one theoretical perspective is adequate to explain the complexity of the human condition and the development of mental disorders. There are multiple pathways to and influences on the development of any single disorder. Explanations of abnormal behavior must consider biological, psychological, social, and sociocultural elements. Not all dimensions contribute equally to a disorder. In the case of some disorders, current research suggests that certain etiological forces have the strongest influence on the development of the specific disorder. Additionally, our understanding of mental disorders often evolves as further investigation provides new insights into contributing factors. The multipath model is integrative and interactive. It acknowledges that factors may combine in complex and reciprocal ways so that people exposed to the same influences may not develop the same disorder and that different individuals exposed to different factors may develop similar mental disorders. The biological and psychological strengths and assets of a person and positive aspects of the person’s social and sociocultural environment can help protect against psychopathology, minimize symptoms, or facilitate recovery from mental illness. Here is the Multipath Model of Mental Disorder, as presented by Sue et al. (2016) in their book Understanding Abnormal Behavior. Dimension One: Biological Factors Modern biological explanations of normal and abnormal behaviors share certain assumptions: 1. Characteristics that make us who we are—our physical features, susceptibility to illness, and physiological response to stress, to name a few—are embedded in the genetic material of our cells. Additionally, many of our personal qualities result from complex interactions between our biological makeup and the environment. 2. Thoughts, emotions, and behaviors involve physiological activity occurring within the brain; changes in the way we think, feel, or behave affect these biological processes and, over time, can change brain structure. 3. Many mental disorders are associated with inherited biological vulnerability and/or some form of brain abnormality. 4. Medications and other biological interventions used to treat mental disorders influence various physiological processes within the brain. Understanding biological explanations of human behavior requires some basic knowledge about the structure and function of the brain, particularly the structures and physiological processes associated with the development of mental disorders. The Human Brain The brain’s role as the center of consciousness, including all thoughts, memories, and emotions, is significant to psychopathology. The brain coordinates a variety of highly complex functions, including the following: (a) regulating activities necessary for our survival (such as breathing and heartbeat); (b) receiving and interpret- ing sensory information (from both inside and outside our bodies); (c) transmitting information to our muscles and other organs; and (d) coordinating our responses to incoming stimuli. Viewed cross sectionally, the brain has three parts: the forebrain—responsible for higher-level mental processes; the midbrain—involved with basic functions such as hearing and vision, motor movement, alertness and sleep/wake cycles, and temperature regulation; and the hindbrain—the most primitive brain region; designed for self-preservation and survival; responsible for instinctive behavior, balance and equilibrium, and basic bodily functions such as heartbeat, respiration, and digestion. Biochemical Processes within the Brain Biochemical theories attempt to explain how irregularities in biochemical functioning trigger mental disorders. These theories are based on the involvement of the brain’s biochemical actions in most physiological and mental processes, from sleeping and digestion to thinking and feeling. Research confirms the connection between biochemical processes within the brain and the etiology of specific mental disorders. To see how biochemical dysfunction is associated with psychopathology, it is important to understand the physiological processes underlying mental and emotional functioning. Neurotransmitters, hormones, neuropeptides, and related biochemical processes play an important role in our overall functioning, affecting our mood, behavior, coordination, communication, and higher-level thinking, as well as basic physiological activities occurring throughout our brains and bodies. When hormonal and neurotransmission processes do not function appropriately, the result can be the symptoms seen in some mental disorders. Biochemical processes also play an important role in adaptive structural changes that occur in the brain and central nervous system. Neuroplasticity The human brain evolves and adapts to ensure our survival. This process of frequent change, neuroplasticity, enables the brain to adjust to environmental circumstances or to compensate for injury. Many factors influence changes in our brains, including the following: our interactions with people, places, and events; our thoughts and emotional reactions; and biological factors such as health, nutritional intake, and exercise patterns. Throughout your lifetime, physical, sensory, and emotional stimulation have produced electrical and chemical changes within your central nervous system, as well as changes in the structures within your brain. Your brain responds to environmental circumstances by creating neural circuits as needed (for example, to facilitate new learning or to cope with environmental stressors) and by pruning the neural pathways that are no longer used. Although many of the neurons in our brain remain healthy over much of our lifetime, the synapses that connect neurons are constantly changing. You may have heard the saying “neurons that fire together, wire together.” This refers to another important concept related to neuroplasticity—nerve pathways that we use frequently become myelinated and thus become stronger and more efficient. Neural circuits are bolstered when you practice a new skill or new way of reacting to a situation—the neural circuits become “hardwired” into the brain. This is true for healthy, productive thoughts and behaviors, as well as for the distressing or dysfunctional thoughts and behaviors associated with mental disorders. Neuroplasticity also involves brain changes associated with the birth of new neurons (neurogenesis). We all have neural stem cells (uncommitted cells) in certain regions of our brain, cells that can be stimulated to form new neurons and glia. This means we can alter brain functioning at any point in life by engaging in experiences that stimulate neurogenesis. Neural stem cells have the ongoing potential to generate neurons needed for new skills or experiences, as well as to compensate for brain damage or changes in the brain associated with illness or aging (Gage & Temple, 2013). Just as we know that conditions such as chronic stress can have negative effects on brain functioning, we also know that exercise, challenging mental activities, some forms of psychotherapy, and some medications can produce positive changes in brain activity and brain structure via neurogenesis, particularly in the hippocampus (Thakker-Varia & Alder, 2009). Genetics and Heredity Research strongly indicates that heredity—the genetic transmission of traits—plays an important role in the development of mental disorders. Epigenetics Although genes program the sequence of human development, the environment shapes the path the development takes. Epigenetics refers to biochemical activities occurring outside of our genes. Epigenetic changes occur when environmental factors trigger processes that affect gene expression. When epigenetic processes leave biological markers on the DNA responsible for regulating gene expression, these markers can produce traits different from those coded in our DNA. We are learning more about how environmental influences can change our epigenome and alter development. To date, documented epigenetic alterations appear to result from four primary environmental influences: nutrition, behavior, exposure to stress, and contact with toxins (Faulk & Dolinoy, 2011). Even minor events that occur during certain critical periods of development can have significant epigenetic consequences (Relton & Davey-Smith, 2012). Sex Differences in Brain Development Brain differences between men and women are well documented (Zaidi, 2012). First, there are differences in the size of some brain structures. For example, men have more volume in the hypothalamus and amygdala (which regulates sexual behavior) whereas women have a larger hippocampus (associated with recall of emotional memories) and more volume in regions of the cortex associated with decision making and emotional regulation. The female brain has a thicker left hemisphere (associated with communication), whereas the male brain has a thicker right hemisphere (associated with spatial skills). Second, men and women tend to use different brain regions when recognizing and processing emotions, storing and retrieving memories, and making decisions. In general, the female brain is more integrated; women tend to use both hemispheres and display greater neural efficiency. Additionally, male and female brains have differences in key neurotransmitter systems, including those involving serotonin, dopamine, and GABA. Overall, the differences are extensive enough to suggest that nature has separate blueprints for the brain development in females as compared to males (Hines, 2011). Some sex differences in brain development are probably evolutionary based: brain regions associated with spatial and navigational skills are larger in men and regions associated with fine motor and communication skills are larger in women. What causes these differences? Sex-linked genes and testosterone are believed to influence prenatal gender differences in brain development, as well as brain changes during critical periods such as puberty. Of course, it is likely that socialization and other environmental experiences strengthen the neural circuitry arising from genetic and hormonal influences (Hines, 2011). Gender differences in brain functioning can help explain, to some degree, why the frequency and progression of mental disorders differs in men and women. For instance, the prevalence of disorders involving reactivity to stress (such as depression, anxiety, and eating disorders) is higher among women and girls whereas disorders involving impulsivity and risk- taking (such as substance abuse and attention-deficit disorder) are more prevalent among men and boys. This information may eventually assist in constructing gender-specific treatments or prevention efforts. Biology-Based Treatment Techniques Treatments based on biological principles aim to improve an individual’s social and emotional functioning by producing changes in physiological functioning. Psychopharmacology Psychopharmacology is the study of how psychotropic medications affect psychiatric symptoms, including thoughts, emotions, and behavior. Psychotropic medications, prescribed after careful diagnosis and analysis of symptoms, are widely used to treat a variety of mental health conditions. Classes of medication used to treat mental disorders include (a) antianxiety drugs (or minor tranquilizers), (b) antipsychotics (or major tranquilizers), (c) antidepressants (used for both depression and anxiety), and (d) mood stabilizers (sometimes called antimanic drugs). Antianxiety medications (minor tranquilizers) such as benzodiazepines (including Valium and Xanax) are used to calm people and to help them sleep. Antipsychotic medications (also referred to as neuroleptics or major tranquilizers) play a major role in treating the agitation, mental confusion, and loss of contact with reality associated with psychotic symptoms. Medical professionals prescribe atypical antipsychotics not only to control psychotic symptoms, but also to stabilize mood fluctuations in conditions such as bipolar disorder. These powerful medications require careful monitoring because they may produce a variety of possible side effects. Antidepressant medications are prescribed to help relieve symptoms of depression and anxiety. Many of these medications increase the availability of neurotransmitters by blocking their reabsorption, allowing them to remain in the synapse and produce neural-communication effects for a longer period. Mood-stabilizing medications are prescribed to treat the excitement associated with episodes of mania, as well as to help prevent future mood swings. Lithium, a naturally occurring chemical compound, is a well-known and frequently prescribed mood stabilizer. A variety of anticonvulsant (used to treat seizure disorders) and antipsychotic medications are also used for mood stabilization. The exact means by which these medications work to calm brain activity remain unclear. Electroconvulsive Therapy Electroconvulsive therapy (ECT) is a procedure that can change brain chemistry and reverse symptoms associated with some mental disorders. ECT, usually reserved for those who have not responded to other treatments, applies moderate electric voltage to the brain to induce a short convulsion (seizure). The person undergoing treatment receives a general anesthetic and muscle relaxant before the procedure. Neurosurgical and Brain Stimulation Treatments During the 1940s and 1950s, psychosurgery—performing brain surgery in an attempt to correct a severe mental disorder— became increasingly popular. The treatment, which involves destruction or removal of a small area of the brain, raised many scientific and ethical objections. As a result, psychosurgery is now very uncommon and has been replaced by neurosurgical techniques that focus on stimulation rather than destruction of brain tissue. A contemporary neurosurgical treatment, deep brain stimulation (DBS), involves implanting electrodes that produce ongoing stimulation of specific regions of the brain. Another approach, vagus nerve stimulation, involves surgically implanting a pacemaker-like device under the skin on the chest; when activated, the device sends signals along a wire connected to the vagus nerve (the longest cranial nerve), which then sends signals to various regions of the brain. A noninvasive brain stimulation procedure, repetitive transcranial magnetic stimulation (rTMS), involves weeks of daily stimulation of the prefrontal cortex and regions of the brain involved with mood regulation; this is done by means of magnetic pulses emitted from an electromagnetic coil held against the forehead (George, Taylor, & Short, 2013). Each rTMS treatment takes less than an hour and requires no sedation or anesthesia. All of these procedures aim to reduce symptoms by changing physiological processes within the brain; however, they are used only with certain conditions, such as severe depression, and when other treatments have not been effective. Criticisms of Biological Models and Therapies Most biological models of mental illness only minimally acknowledge psychological, social, or cultural influences. Biological models are criticized for their failure to consider the unique circumstances of the individual and environmental influences on the etiology of symptoms. The majority of biological research comes from physicians and researchers whose worldview strongly supports the medical model and the use of medication to treat mental disorders. This is a particular concern given the rapid growth in the sale and marketing of psychotropic medications and the frequent use of these medications without first conducting a careful mental health evaluation (Smith, 2012). There is also little discussion of where psychotherapy fits into treatment planning and when to consider medication in the course of comprehensive treatment. Prescribing multiple medications has also become common, increasing the importance of watching for side effects and possible drug-drug interactions. Another concern is the limited focus on ethnic or gender group differences in physiological response to medication. There is clearly a need for more discussion about how mental health professionals, health care providers, and clients can effectively collaborate in monitoring the effectiveness of medications and other biological interventions; however, it is equally important that all involved consider psychological factors that may be influencing symptoms and treatment outcome. Dimension Two: Psychological Factors A number of psychological factors contribute to the etiology of mental disorders. The psychological dimension focuses on emotions, conflicts in the mind, learned behavior, and cognitions. Interestingly, psychological explanations of abnormal behavior vary considerably depending on the underlying theory. The four major psychological perspectives that explain abnormal behavior include the following: psychodynamic, behavioral, cognitive, and humanistic-existential. Psychodynamic Models Psychodynamic models view mental disorders as the result of childhood trauma, anxieties, and unconscious conflicts. The early development of psychodynamic theory is credited to Sigmund Freud (1938, 1949). Freud originally characterized much of human behavior as attempts to express, gratify, or defend against sexual or aggressive impulses—instinctual drives that operate at an unconscious level, continually seeking expression. Psychological symptoms are associated with these sexual or aggressive impulses. Further, certain experiences or mental conflicts are too threatening to face, so we block them from consciousness. As a result, we sometimes experience emotional symptoms, but do not understand their meaning. Freud believed that the therapist’s role was to help individuals experiencing mental distress achieve insight into these unconscious processes. Personality Components Freud developed a model suggesting that all behavior is a product of interactions between three personality components: the id, the ego, and the superego. The id, a key part of our unconscious psyche, is present at birth. The id operates from the pleasure principle—the impulsive, pleasure-seeking aspect of our being—and seeks immediate gratification of instinctual needs, regardless of moral or realistic concerns. In contrast, the ego represents the realistic and rational part of the mind. It is influenced by the reality principle—an awareness of the demands of the environment and of the need to adjust behavior to meet these demands. The ego’s decisions are dictated by realistic considerations rather than by moral judgments. Moralistic considerations are the domain of the superego. The conscience is the part of the superego that instills guilt in us and helps prevent us from engaging in immoral or unethical behavior. Psychosexual Stages Human personality develops through a sequence of five psychosexual stages, each of which brings a unique challenge. If unfavorable circumstances prevail, the personality may be drastically affected. Because Freud stressed the importance of early childhood experiences, he saw the human personality as largely determined in the first 5 years of life—during the oral (first year of life), anal (around the second year of life), and phallic (beginning around the third or fourth years of life) stages. The last two psychosexual stages are the latency (approximately 6 to 12 years of age) and genital (beginning in puberty) periods. The importance of each psychosexual phase for later development lies in whether fixation occurs during that phase. Fixation halts emotional development at a particular psychosexual stage. Someone who is fixated at a particular stage may experience emotional disturbance resulting from the distinct conflicts associated with that period of development. Defense Mechanisms According to psychodynamic theory, we often use defense mechanisms to distance ourselves from feelings of anxiety associated with unpleasant thoughts or other internal conflicts. Defense mechanisms are ways of thinking or behaving that share three characteristics: they protect us from anxiety, they operate unconsciously, and they distort reality. We all experience the self-deception associated with defense mechanisms from time to time. Defense mechanisms are considered maladaptive, however, when they are overused—that is, if they become our predominant means of coping with stress and interfere with our ability to handle life’s demands. Criticisms of Psychodynamic Models and Therapies Three major criticisms are leveled against psychodynamic theory and treatment. First, Freud relied heavily on case studies and on his own self-analysis as a basis for his theory. Second, his patients represented a very narrow spectrum of society— relatively affluent Victorian-era Austrian women. Thus, traditional psychoanalysis fails to address external issues such as social inequality, race, class, gender, and culture. A third criticism is that traditional psychoanalysis has a limited range of usefulness. It has limited therapeutic value with people who are less talkative, less psychologically minded, or more severely disturbed. There are far fewer outcome studies evaluating psychodynamic therapies compared to the large number of studies conducted on other contemporary treatment techniques. This is, in part, because psychodynamic theories are difficult to investigate in a scientific manner; the processes and outcomes are dynamic rather than specific. Compounding this problem are the many different approaches to psychodynamic therapy. Behavioral Models The behavioral models of psychopathology are concerned with the role of learning in the development of mental disorders and are based on experimental research. The differences among the models lie in their explanations of how learning occurs. The three learning paradigms are classical conditioning, operant conditioning, and observational learning. Classical conditioning - a process in which responses to new stimuli are learned through association. Operant conditioning - theory of learning that holds that behaviors are controlled by the consequences that follow them. Observational learning - suggests that an individual can acquire new behaviors by watching other people perform them. Behavioral Therapies Exposure therapy, also known as extinction therapy, can involve graduated exposure, gradually introducing a person to feared objects or situations, or flooding, which involves rapid exposure to produce high levels of anxiety. Another effective behavioral technique, systematic desensitization, developed by Joseph Wolpe (1958), involves having the extinction process occur while the client is in a competing emotional state such as relaxation. Social skills training, which involves the teaching of specific skills needed for appropriate social interactions, is an effective behavioral intervention for individuals who experience social difficulties. Social skills training includes modeling and the use of role-play activities to develop positive behaviors associated with appropriate social interactions. Assertiveness training is a form of social skills training that teaches individuals (especially those who tend to be overly timid or overly aggressive) the difference between nonassertive, aggressive, and assertive responses (Jakubowski & Lange, 1978). Clients describe difficult, real-life situations and then practice appropriate responses with a focus on clear verbal communication and nonverbal skills such as body posture, voice intonation, eye contact, and facial expression. Criticisms of the Behavioral Models and Therapies Opponents of the behavioral orientation, point out that they often neglect or place minimal emphasis on inner determinants of behavior. They also criticize behaviorists’ use of results obtained from animal studies to solve human problems. Some also charge that the behaviorist perspective is mechanistic, viewing people as “empty organisms.” These theories, like many others, also tend to view normal and abnormal human development in a linear and one-dimensional fashion. Cognitive-Behavioral Models Cognitive-behavioral theories focus not only on our observable behaviors but also on how our thoughts influence our emotions and behaviors. According to cognitive- behavioral models, we create our own problems (and symptoms) based on how we interpret events and situations. For example, you might believe that it is important to be loved and accepted by everyone. Is this a realistic belief? Is it logical to expect everyone we know to like us? If we harbor irrational beliefs such as this, we become susceptible to develop distressing emotions and maladaptive behaviors. Cognitive Dynamics in Psychopathology Cognitive theorists, such as Aaron Beck (1921– ) and Albert Ellis (1913–2007), were among the first to break away from traditional behavioral approaches. They both theorized that the manner in which we interpret situations can profoundly affect our emotional reactions and behaviors (Rosner, 2012). Further, their theories link psychopathology with irrational and maladaptive assumptions and thoughts (A. T. Beck & Weishaar, 2010; A. Ellis, 2008). In other words, distressing emotional responses such as anger, depression, fear, and anxiety result from our thoughts about events rather than from the events themselves. A common type of irrational thinking involves catastrophizing, or envisioning the worst possible outcome for situations; for example, you would be catastrophizing if you concluded that you should drop out of school because you failed a class. Exaggerated or inaccurate thoughts such as this distort objective reality and may result in anxiety, depression, or other psychological symptoms of mental distress. Cognitive-Behavioral Approaches to Therapy Cognitive-behavioral therapy (CBT) is rapidly becoming the treatment of choice for many disorders. Cognitive approaches to psychotherapy help clients recognize patterns of illogical thinking and replace them with more realistic and helpful thoughts (A. T. Beck & Weishaar, 2010). Although these therapies emphasize cognitions (patterns of thinking), they are called cognitive- behavioral therapies because they also incorporate changes in social skills and other behaviors. Cognitive-behavioral therapists encourage clients to become actively involved in their treatment outside of therapy sessions by assigning homework that includes skills learned during therapy. Albert Ellis and Aaron Beck developed distinct varieties of therapy based on their views regarding the connection between thought processes and emotional reactions and behaviors. Rational Emotive Behavior Therapy (REBT) has a strong focus on challenging illogical thinking (Ellis, 1997). Ellis believed that mental distress occurs when someone takes a reasonable desire such as “I’d like to perform well and be approved by others” and changes it into an illogical expectation such as “I must perform well and be approved” (Ellis referred to this pattern of thinking as “musturbation”). Ellis often confronted clients about their irrational thinking patterns and encouraged them to change “musts,” or irrational demands, into more rational “preferences.” Beck’s approach to cognitive therapy, which has strong research support for treating depression and other conditions, involves making clients aware of cognitive distortions and negative schemas and then learning how to change them. A schema is the framework from which we automatically organize and give meaning to information. We develop cognitive schemas so we can process information more efficiently. In effect, a schema is the lens through which we view the world and ourselves. Because dysfunctional schemas such as “I’m stupid,” “I’m helpless,” or “People are dangerous” result in emotional distress, Beck’s therapy helps clients recognize dysfunctional attitudes and beliefs systems. Clients eventually learn to replace automatic negative thinking with more adaptive thoughts. The newest cognitive-behavioral therapies, sometime referred to as the third wave therapies, also focus on cognitions and behaviors. However, instead of identifying irrational or negative thoughts and refuting them, the newer therapies are based on the premise that nonreactive attention to emotions can reduce their power to create emotional distress. Further, if we continuously avoid distressing thoughts and feelings, they are more likely to persist (Luoma, Hayes, & Walser, 2007). Therefore, clients are taught to nonreactively observe and experience unpleasant emotions. An important component of third wave therapies is mindfulness, maintaining conscious attention to the present, including negative emotions or thoughts, with an open, accepting, and nonjudgmental attitude. Mindfulness allows us to experience stressful emotional states without undue distress or physiological arousal. Mindfulness-based stress reduction, dialectical behavior therapy, and acceptance and commitment therapy are examples of third wave therapies. Mindfulness-based stress reduction focuses on using mindfulness meditation to cope with stress and reduce emotional reactivity (Rosenkranz et al., 2013). Dialectical behavior therapy (DBT) is a supportive and collaborative therapy involving cognitive-behavioral techniques and close therapist-client teamwork (Koerner & Linehan, 2011). This therapy, developed by psychologist Marsha Linehan, uses an empathetic and validating environment to help clients learn to regulate their emotions, cope with stress, and improve social skills. Therapists actively reinforce positive actions while avoiding the reinforcement of maladaptive behaviors, including behaviors that interfere with therapy. Components of Eastern philosophy (Zen) are also part of the therapy—specifically, mindfulness and the acceptance of things that cannot be changed. DBT differs from traditional cognitive therapies due to the emphasis on the therapist-client relationship and the priority given to accepting and validating the client. DBT is very structured and relies on four interrelated modules: Mindfulness—Learning to tolerate and accept your emotions by observing them objectively and nonjudgmentally. Distress Tolerance—Viewing yourself and your circumstances in an objective and dispassionate manner so that you can take productive actions rather than being pulled into an emotional reaction. Emotional Regulation—Identifying and labeling your emotions rather than being emotionally reactive; learning to change your negative thoughts and increase your positive emotions. Interpersonal Effectiveness—Improving your skills in dealing with difficult inter- personal situations such as learning to make requests assertively and to say “no” when appropriate. Using a similar approach, acceptance and commitment therapy (ACT) focuses on learning to notice, accept, and even embrace the uncomfortable thoughts and emotions that are associated with mental distress. Therapists who use ACT also help their clients develop psychological flexibility, the ability to adapt to situational demands, including decisions to change or persist with current behaviors based on the client’s core values. ACT and the other third wave therapies have growing research support (Churchill et al., 2013). Criticisms of the Cognitive-Behavioral Models and Therapies Some behaviorists remain quite skeptical of the cognitive models and therapies. Just before his death, B. F. Skinner (1990) warned that cognitions are not observable phenomena and cannot form the foundations of empiricism. In this context, he echoed the beliefs of John B. Watson, who stated that the science of psychology was about observable behaviors, not “mentalistic concepts.” Cognitive-behavioral theories are also criticized for failing to acknowledge that human behavior involves more than thoughts and beliefs (Corey, 2013). Others question the role of the therapist as teacher, expert, and authority figure, especially because some therapists are quite direct when identifying and attacking irrational beliefs. In such interactions, clients might be intimidated into acquiescing to the therapist’s power and authority. Humanistic-Existential Models The humanistic-existential models include a group of theories that emphasize the whole person rather than looking at parts of the personality such as the id, ego, and superego (psychoanalysis) or specific behavior patterns (behavioral theories). In fact, the humanistic-existential approaches evolved in reaction to the failure of these early models of psychopathology to acknowledge the role of free will. Although each of the humanistic theories has a different emphasis, there is a common belief in the innate goodness of humanity, in our uniqueness and individuality, and in our capacity to choose our life direction. Humanistic approaches are philosophical in nature. They deal with values, decry the use of diagnostic labels, and prefer a holistic view of the person. The humanistic-existential perspectives represent many schools of thought, but they share a set of assumptions that distinguishes them from other approaches. The first is that what we see as “reality” is a product of our unique experiences and perceptions of the world. Our subjective universe—how we construe events— is more important than the events themselves. Therefore, to understand a person’s behavior, it is important to understand the person’s perspective on the world. Second, humanistic theorists assume that we have the ability to make free choices and are responsible for our own decisions. Third, they believe in the wholeness or integrity of the person and assume that we will lead lives that are best suited to who we are. The Humanistic Perspective The best known of the humanistic psychologists is Carl Rogers (1902–1987). His theory of personality (C. R. Rogers, 1959, 1961) and humanistic perspective reflect his concern with human welfare and his deep conviction that humans are basically good, forward moving, and trustworthy. Humanistic theory is based on the idea that people are motivated not only to satisfy their biological needs (e.g., for food, warmth, and sex) but also to cultivate, maintain, and enhance the self. Related to this view is Abraham Maslow’s concept of self-actualization—our inherent tendency to strive toward the realization of our full potential. Humanistic Views on the Development of Psychopathology Applying humanistic approaches to the development of mental disorders is a major challenge. Instead of concentrating exclusively on problems, the humanistic approach focuses on bettering the state of humanity and helping people actualize their potential. Rogers believed that when allowed to grow and develop freely, unencumbered by societal restrictions, people will thrive. Anxiety, depression, and other problems occur when society blocks this innate tendency for growth by imposing conditions on whether we have personal value. These standards are transmitted via conditional positive regard—when significant others in our lives, such as parents, friends, or partners, value us only when our actions, feelings, and attitudes meet their expectations. Thus, we begin to believe we have worth only when we have the approval of others. This belief can prevent us from developing optimally and can result in mental distress. Rogers believed that when circumstances allow us to reach our full potential we avoid mental illness. The environmental condition most suitable for this growth is unconditional positive regard—feeling loved, valued, and respected for who we are, regardless of our behavior. The Existential Perspective The existential approach is not a systematized school of thought but a set of attitudes. It shares with humanistic psychology an emphasis on our individual uniqueness, our quest for freedom and for meaning in life, and a belief that we all have positive attributes that we express unless environmental factors interfere. However, existentialism differs from humanism in several ways: (a) existentialists focus on the irrationality, difficulties, and suffering all humans encounter in life; (b) humanists attempt to understand the subjective world of their clients through empathy, while existentialists believe we must be viewed within the context of the human condition; and (c) humanists emphasize that we have the responsibility to determine our life path, while existentialists stress that we have responsibility not only to ourselves, but also to others. Human unhappiness and psychopathology stem from these issues and our avoidance of important life challenges. Thus, for many of us, life is directionless and without meaning. Paradoxically, many of us are responsible for our own unhappiness because we have ignored choices available to us or “unconsciously” chosen an unfulfilling path. Humanistic and Existential Therapies The assumption that humans need unconditional positive regard has many implications for psychotherapy. For therapists, it means fostering conditions that allow clients to grow and fulfill their potential, an approach known as person- centered therapy. Rogers emphasized that therapists’ attitudes and ability to communicate respect, understanding, and acceptance are more important than specific counseling techniques. Rogers believed that therapists help clients reactivate the tendency for self-actualization by providing an accepting therapeutic environment. With unconditional positive regard, clients can make constructive changes and learn to accept themselves, including any imperfections. This self-growth allows clients to cope with present and future problems. The relationship between the client and therapist (the therapeutic alliance) is, in fact, an important contributor to the outcome of psychotherapy (Del Re, Flückiger, Horvath, Symonds, & Wampold, 2012). Existential therapy is rooted in philosophy and the universal challenges of existence faced by all humans. As with other humanistic therapies, the therapeutic-client relationship is important. It is through this relationship that a client can acknowledge or deal with universal challenges. Existential therapists work to have their clients consider ways in which their freedom is impaired so they can remove obstacles to autonomy and increase their opportunities for choice. They also look for underlying meaning in what clients say and challenge clients to examine their lives. When clients become aware of choices they have made, they are more able to choose a new direction rather than continue to react to external forces. The goal is to help people become intentional in directing their lives. Criticisms of the Humanistic and Existential Models and Therapies Critics of the humanistic-existential approaches point to their “fuzzy,” ambiguous, and nebulous nature; lack of scientific grounding; and reliance on people’s unique, subjective experiences. Others question the power of the self-actualizing tendency and whether the therapist-client relationship in and of itself is sufficient to promote change. Although these approaches have been extremely creative in describing the human condition, they have been less successful in constructing theory and treatment strategies. Moreover, they are not suited to scientific or experimental investigation. It is difficult, for example, to verify the humanistic concept of people as rational, inherently good, and moving toward self-fulfillment. Although Carl Rogers studied the processes involved in his client-centered approach to therapy, such research has decreased since the 1960s and the existential therapies have never been subject to much research (Elliott, 2002). Nevertheless, the existential concepts of freedom, choice, and responsibility have had a profound influence on contemporary thought beyond the field of psychology. Another major criticism leveled at the humanistic-existential approaches is that they do not explain many mental disorders, nor do they address cultural diversity or acknowledge social factors such as poverty, discrimination, and prejudice. They seem to be most effective with well-educated individuals experiencing mild distress or adjustment difficulties. These limitations have hindered the application of these perspectives to the treatment of mental illness. Dimension Three: Social Factors These pertain to aspects of our lives such as how current relationships, family, social support, community, and belonging affect the expression of mental distress. It is clear that we are social beings and that our relationships can influence the development, manifestation, and amelioration of mental disorders. Social-Relational Models Social-relational models consider a variety of interpersonal relationships, including those involving intimate partners, nuclear or extended family, or connections within the community. Social-relational explanations of mental distress make several important assumptions (D. W. Johnson & Johnson, 2003): 1. Healthy relationships are important for optimal human development and functioning. 2. Social relationships provide many intangible health benefits (social support, love, compassion, trust, sense of belonging, etc.). 3. When relationships prove dysfunctional or are absent, the individual may be vulnerable to mental distress. Studies show that social isolation and lack of emotional support and intimacy are associated with a variety of symptoms of mental illness and difficulty coping with stress (Nagano et al., 2010). Family, Couples, and Group Perspectives In contrast to traditional psychological models, social-relational models emphasize how other people, especially significant others, influence our behavior. For example, the family systems model assumes that the behavior of one family member directly affects the entire family system. According to this model, we behave in ways that reflect both healthy and unhealthy family influences. There are three distinct beliefs underlying the family systems approach (Corey, 2013). First, our personality development is strongly influenced by our family’s characteristics, especially the way our parents interacted with us and other family members. Second, mental illness in an individual often reflects unhealthy family dynamics, especially poor communication among family members. Thus, the cause of mental disorders resides within the family system, not within the individual. Third, therapy must focus on the family system, rather than the individual; treatment may be ineffective unless the entire family is involved. Social-Relational Treatment Approaches The Conjoint family therapeutic approach, developed by Virginia Satir (1967), stresses the importance of clear and direct communication and teaches message-sending and message-receiving skills to family members. Like other family therapists, Satir believed that a family member experiencing mental distress or behavioral difficulties (referred to as the “identified patient”) is a reflection of dysfunction in the family system. Strategic family approaches (Haley, 1963, 1987) consider power struggles within the family and focus on developing a more healthy power distribution. Structural family approaches (Minuchin, 1974) attempt to reorganize family relationships based on the assumption that family dysfunction occurs when family members have too much or too little involvement with one another. All of these approaches focus on communication, equalizing power within the family, and restructuring the troubled family system. Another social-relational approach, couples therapy, targets marital relationships and intimate relationships between unmarried partners. Treatment helps couples to understand and clarify their communications, role relationships, unfulfilled needs, and unrealistic or unmet expectations. Couples therapy has become an increasingly popular treatment for those who find that the quality of their relationship needs improvement (Nichols & Schwartz, 2005). Another form of social-relational treatment is group therapy. Unlike couples and family therapy, members of the therapy group are often initially strangers. However, group members may share certain characteristics such as experiencing a similar life stressor (e.g., chronic illness, divorce, or death of a family member) or having similar mental disorders or similar therapeutic goals. Most group therapies focus on a specific topic or interactions among members. Despite their wide diversity, successful group therapies share several features that promote change in clients (Corey, 2013; Yalom, 2005). For example, the group experience: allows participants to become involved in a social situation and to see how their behavior affects others; permits the therapist to see how clients actually respond in a real-life social and interpersonal context; provides group members an opportunity to develop new communication skills, social skills, and insights; allows group members to feel less isolated and less fearful about their problems; and provides participants with strong social and emotional support. The feelings of intimacy, belonging, protection, and trust (which participants may not be able to experience outside the group) can provide powerful motivation for group members to confront and to overcome personal difficulties. Criticisms of Social-Relational Models Social-relational research studies are generally not rigorous in design; they have often lacked appropriate control groups or solid outcome measures (Cottrell & Boston, 2002). Further, considerable evidence exists that couples, marital, and family therapies do not adequately address cultural diversity (Sue & Sue, 2013). Other critics have voiced concern that family systems models may have unpleasant consequences. Too often, family therapists have pointed an accusing finger at the parents of children with certain disorders, despite an abundance of evidence that factors other than parental behaviors are likely involved. This burdens parents with unnecessary guilt over a situation that resulted from factors beyond their control. Dimension Four: Sociocultural Factors Sociocultural perspectives emphasize the importance of considering race, ethnicity, gender, sexual orientation, religious preference, socioeconomic status, and other such factors in explaining mental disorders. The importance of the sociocultural dimension is evident in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which lists disorders that are limited to a specific society or cultural group. It is clear that people’s cultural experiences play an important role in their mental health (Sue & Sue, 2013). The cultural groups to which we belong may expose us to unique stressors or may influence how we express mental distress (Keller & Calgay, 2010). Four major sociocultural influences to illustrate their importance in understanding psychopathology: gender, socioeconomic class, acculturative stress, and race and ethnicity. Gender Factors There is little doubt that sociocultural factors related to gender influence mental health. The importance of gender in understanding psychopathology is evident when examining the much higher prevalence of depression, anxiety, eating disorders, and other mental health conditions among women (Ferrari et al., 2013). Stereotyped standards of beauty in advertisements and the mass media can affect the mental health of girls and women. Body dissatisfaction, eating disorders, and depression are all influenced by these sociocultural standards. Women are also subjected to more stress than their male counterparts (L. Smith, 2010). For example, they are often placed in the unenviable position of fulfilling a variety of feminine social roles defined by society. Even when employed full-time outside of the home, women have more responsibility for domestic chores and childcare (Bureau of Labor Statistics, 2013). Additionally, significant wage disparities exist between men and women working in full-time jobs, with women earning only 77 percent of the wages earned by men (American Association of University Women, 2013). Women with limited income have an increased risk of depression, domestic violence, or having the extra responsibility of being the primary caregiver for children or older family mem- bers (Levy & O’Hara, 2010). Women are also more likely to experience the stress that comes from working in jobs that provide few decision-making opportunities (Verboom et al., 2011). Exposure to sexual harassment often begins during the middle school years, with effects on both psychological well-being and learning (American Association of University Women, 2011). Further, women are much more likely to experience trauma related to sexual assault or intimate partner violence (U.S. Department of Commerce, 2011). For example, many college women report experiencing some form of sexual aggression (Yeater, Treat, Viken, & McFall, 2010). These are just a few of the many findings documenting stressors that have a major effect on the mental health of girls and women. Socioeconomic Class Social class and classism are two frequently overlooked sociocultural factors that influence mental health (L. Smith, 2010). Lower socioeconomic class is associated with a limited sense of personal control, poorer physical health, and higher incidence of depression (Sue, 2010). Increasingly, psychologists are recognizing the degree to which poverty subjects people to multiple stressors (L. Smith & Reddington, 2010). Life in poverty is associated with low wages, unemployment or underemployment, lack of savings, and lack of food reserves. Meeting even the most basic needs of food and shelter becomes a major challenge. In such circumstances, people are likely to experience feelings of hopelessness, helplessness, dependence, and inferiority. Immigration and Acculturative Stress Many immigrants face acculturative stress, the psychological, physical, and social pressures associated with a move to a new country. Not only do immigrants face the challenge of adjusting and adapting to new cultural customs, they sometimes receive a hostile reception from both the government and the public. Placed in unfamiliar settings and missing their accustomed social support from the communities they left behind, many experience severe culture shock (Breslau et al., 2011). Feelings of isolation, loneliness, helplessness, anxiety, and depression are common. Many immigrants face additional challenges as they negotiate the educational system, learn a new language, and seek employment. Male immigrants often experience a loss of status and develop a sense of powerlessness. Problems of gender inequities and spousal abuse can increase under these conditions (Ting &Panchanadeswaran, 2009). Acculturation conflicts are common, especially among first- generation immigrants and their children. The children may experience difficulty fitting in with their peers, yet may be considered “too Americanized” by their parents. Racism and discrimination can compound these already stressful circumstances (Sue & Sue, 2013). Race and Ethnicity Early attempts to explain differences between various minority groups and their counterparts in the majority culture tended to adopt one of two models. The first, the inferiority model, contended that racial and ethnic minorities are inferior in some respect to the majority population. For example, this model suggests that low academic achievement and higher unemployment rates among African Americans and Hispanics/Latinos are due to biological differences such as low intelligence. The second model—the deprivation or deficit model—explained differences as the result of “cultural deprivation.” It implied that minority groups lacked the “right” culture. Both models are criticized as being inaccurate, biased, and unsupported by scientific research (Ridley, 2005; Sue & Sue, 2013). During the late 1980s and early 1990s, a new and conceptually different perspective, the multicultural model (or the culturally diverse model; Sue & Sue, 2013), emerged in the literature. This approach emphasizes that being culturally different does not mean that someone is deviant, pathological, or inferior; instead, it is important to recognize that each culture has strengths and limitations. The multicultural model also points out that all theories of human development and psychopathology arise from a particular cultural context (Ivey, D’Andrea, Ivey, & Simek-Morgan, 2007). Thus, many traditional models of psychopathology operate from a European American worldview not experienced or shared by other cultural groups. For example, individualism and autonomy are valued in the United States; we raise children to become increasingly independent, to make their own decisions, and to “stand on their own two feet.” In contrast, many traditional Asian Americans value collectivity; thus, the psychosocial unit of importance is the family rather than the individual. Whereas European Americans fear the loss of individuality, members of traditional Asian groups fear the loss of belonging and group membership. Given these variations in experiences and values, unenlightened mental health professionals may make biased assumptions about human behavior—assumptions that influence their judgments of normality and abnormality among clients who differ from them in terms of race or ethnicity. For example, a mental health professional who does not understand that Asian Americans typically value a collectivistic identity might see clients with close family connections as overly dependent, immature, or unable to make decisions on their own. The same professional might perceive restraint of strong feelings—a valued characteristic among some Asian groups—as evidence of an inability to express emotions. Sociocultural Considerations in Treatment The multicultural model emphasizes that mental health difficulties are sometimes due to sociocultural stressors residing in the social system rather than conflicts within the person. Racism, bias, discrimination, economic hardships, and cultural conflicts are just a few of the realities faced by members of racial and ethnic minorities and other marginalized groups. As a result, it may be more productive for therapists to focus on ameliorating oppressive or detrimental social conditions rather than attempting therapy aimed at changing the individual. Individual therapy may be effective, however, for clients who could benefit from learning strategies for coping with emotional stressors. Sociocultural Considerations in Treatment Multicultural counseling has been called the “fourth force” in the field of psychotherapy following the other major schools of psychoanalytic, cognitive-behavioral, and humanistic-existential therapies. Therapists who use a multicultural approach take care to show respect for clients’ ethnicity and cultural background and to incorporate cultural themes into traditional psychotherapeutic techniques. Multicultural counseling has assumed greater importance as our population has become more diverse. Cultural differences, such as family experiences and degree of assimilation, are essential to consider in assessment and treatment. At the same time, therapists need to be careful not to assume that just because their clients are part of a particular group, they strongly identify with or share the values of that group. Criticisms of the Multicultural Model and Related Therapeutic Techniques According to the multicultural model, normal and abnormal behavior should be evaluated from a cultural perspective. The reasoning is that behavior considered disordered in one context—seeing a vision of a dead relative, for example—might be considered acceptable within another cultural context. As indicated in the DSM, some cultural groups consider it normal to hear or see a deceased relative during bereavement or during religious ceremonies. For example, certain groups, including some American Indian and Hispanic/Latino groups, look upon hallucinations as a positive spiritual event. Critics of the multicultural model argue that a disorder is a disorder, regardless of the cultural context in which it occurs. For example, they would contend that someone who is actively hallucinating (seeing, hearing, or feeling things that are not there) lacks contact with reality. This behavior would represent a dysfunction, according to this viewpoint, even if the person considers the hallucination desirable. Another criticism leveled at the multicultural model is that it relies heavily on case studies and ethnographic analyses and that formal research has not yet validated many of the concepts associated with the model. Multicultural psychologists note that criticisms such as these are based on a Western worldview that emphasizes precision and empirical definitions. They point out that there is more than one way to ask and answer questions about the human condition. Reference: Sue, D., Sue, D. W., Sue, D., & Sue, S. (2016). Understanding abnormal behavior. (11th ed.). 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