Psychological Disorders PDF

 PSYCHOLOGICAL DISORDERS AND PSYCHOTHERAPY I. What is meant by ‘Abnormality’? A psychological disorder or mental disorder is a condition characterised by abnormal thoughts, behaviours and feelings. Abnormal behaviour means, behaviour which...

 PSYCHOLOGICAL DISORDERS AND PSYCHOTHERAPY I. What is meant by ‘Abnormality’? A psychological disorder or mental disorder is a condition characterised by abnormal thoughts, behaviours and feelings. Abnormal behaviour means, behaviour which deviates from what is considered normal, usually refers to maladaptive behaviours. According to Santrock, “Behaviour that is deviant, maladaptive or personally distressful is abnormality.” Abnormality is that which is considered deviant from specific societal, cultural and ethical expectations that are broadly dependent on age, gender, traditional and societal categorisations. A diagnosis of a mental disorder describes a patient who has a medical condition whereby the medical practitioner makes a judgement that the patient is exhibiting abnormal behaviour based on the DSM-5 criteria. Criteria for abnormal behaviour: (not in syllabus) o Developmental inappropriateness – behaviour is not in proportion to development. o Deterioration in personal care and hygiene of the patient. o Behaviour is not culturally sanctioned. o Duration of mental illness o Clinical significance o Cause significant distress to the individual and the others associated with them. What is meant by Abnormal Psychology or Psychopathology? The manifestations of and study of the causes and treatment of mental disorders. II. The Four ‘D’s (common features of abnormal behaviour)  Abnormal behaviour may be explained by the following four types of behaviours: Deviance (Unusual) – Behaviours usually deviates from social norms and rules; different, extreme or even bizarre behaviour. Dysfunctional – Behaviours that interferes with a person’s ability to perform Daily activities in a constructive way. Distressing – Behaviours that are unpleasant and upsetting to the person/s or others. Dangerous – Behaviours that pose harm or injury to the individual’s own self or to others. III. Different views of abnormal behaviour (Modern Perspectives or Models of Abnormal Behaviour) The viewing of mental disorder involves several perspectives that should be viewed as complementary to another. Together these approaches provide a more accurate and complete picture of how such disorders arise and how they can be treated than any single perspective does alone. 1. Statistical Perspective of Abnormal Behaviour – Abnormal Behaviour is a statistical rarity or a substantial deviation from the statistically calculated average called ‘golden mean’ which represents the ‘normal’. The superior and maladaptive fall on the two sides of the curve.  2. Biological and Medical perspectives - This perspective describes abnormality as medical diseases or anomalies in the physiological systems of biological origin. It falls into three categories: a) Brain structural views - It emphasises on the role of the nervous system like nervous system malfunctioning or abnormalities in brain structure. b) Bio-chemical views - Imbalances in various neurotransmitters and hormones (biochemical and glandular) cause disorders. c) Genetic views – Disorganised or faulty inherited genes and chromosomes are also said to cause mental disorders. With the advances in neuroscience and new techniques for observing the brain functions like MRI (Magnetic Resonance Imaging), PET scan, EG, CT scan (CAT), or even the latest one - Augmented Reality, the biological model has become highly influential during the last few decades. 3. Sociocultural perspectives – This approach states that abnormal behaviours develop due to the adverse effects of society or the kind of environment on the person. Family relationships, family dynamics, lack of sympathy during childhood, sibling conflicts, one child favoured over the other, marital conflicts also cause mental disorders. Socio-cultural variables as poverty, profound malnutrition, socio-economic status, unemployment, inferior education, cultural expectations, prejudices etc. are said to cause mental disorders. Diathesis stress is the vulnerability of the individual towards psychopathology. It stresses that genetic or other factors may predispose an organism to develop a mental disorder but the disorder will develop only if the person is exposed to some kinds of stressors or stressful environmental conditions.  4. Psychological perspectives - It emphasises the role of basic psychological process in the occurrence of mental disorders. It attempts to explain psychological factors like repressed desires and motives, faulty learning, incongruence between ideal and real self and irrational thoughts as causes of abnormal behaviour. It includes several approaches: a) Psychodynamic/Psychoanalytic approach - It takes account of all repressed emotions in the unconscious of the individual like hurtful memories, forbidden desires, unresolved conflicts and experiences. Freud states that they originate from primitive, sexual and aggressive instincts. The imbalance in the structural pattern of personality (Id, Ego and Superego) is also highlighted under this perspective. b) Behavioural approach – It focuses on faulty learning or maladaptive behaviours as primary cause of abnormality through classical conditioning, operant conditioning and observational learning. For e.g., in Little Albert's study by John Watson the child is conditioned to fear white rabbit due to which he fears to all white furry objects. Thus, it states stimulus generalisation, repetitive maladaptive behaviour guided by rewards and punishment and observation of aggressive behaviour can result in abnormal behaviours. c) Humanistic approach – This approach states that incongruence between real- self and ideal-self causes anxiety. This congruence resulting in unrealistic conditions of worth and their unfulfilled aspirations gradually lead to mental disorders. d) Cognitive approach – This approach describes the abnormal behaviour as a cause of irrational/illogical thought processes and faulty perceptions. Thus, according to the modern psychologists, these perspectives which delineate the causal factors of abnormal behaviour. IV. Classification of Mental Disorders: Different types of diseases having specific symptoms and mental disorders are classified into several categories on the basis of symptoms including a wide range of maladaptive responses. Despite the presence of various classification systems of mental disorders, currently two are widely used – International Classification of Diseases (ICD-10) produced by the World Health Organization (WHO) and the Diagnostic and Statistical Manual of Mental and Behavioural Disorders (DSM) devised by the American Psychiatric Association (APA). V. Why is classification of disorders necessary? The study and treatment of mental disorders is impossible without scientific classification and categorisation. So, classification of various diseases is very important for the following purposes: 1. The process by which the psychologist gathers information of the problems the person is facing is called assessment, and they are used for diagnosis. Thus, to identify the problem and make appropriate diagnosis, classification of mental disorders is necessary. 2. Classification of various diseases is necessary specific treatment of any physical or mental disorder since different types of diseases have specific symptoms. In certain mental disorders, the symptoms may be similar, but the causes may be quite different. 3. It facilitates communication between researchers and clinicians, patients and clinicians using a common language or precisely defined nomenclature, terms and descriptions. 4. It helps research by ensuring that sample cases are as homogenous or similar as possible 5. It facilitates statistical record for public health institutions.  6. It also describes which types of psychological disorders guarantee insurance reimbursement and how much. Thus, it provides a nosographic reference system (classification and description of diseases to be used in diagnosis and treatment making it indispensable. Dangers of classification (not in syllabus): 1. Although diagnostic labels may facilitate communication and research, they can bias our perception of people’s past and present behaviour. 2. It also unfairly stigmatizes these individuals through labelling. VI. DSM – IV ❖ The DSM IV or the Diagnostic and Statistical Manual of Mental and Behavioural Disorders is a user-friendly manual designed to help all mental health practitioners and recognise and correctly diagnose specific disorders. ❖ It is devised by the American Psychiatric Association (APA) established 1994. ❖ It categorises the mental disorders along with their clinical features and diagnostic criteria, predisposing factors, prevalence, etc., in DSM. ❖ The DSM IV classification of mental disorders evaluates the individual on five dimensions, foci or ‘axes’ (otherwise known as ‘multi-axial’ approach). ❖ The first three axes assess an individual's present clinical status or conditions. 1. Axis I – The particular clinical syndromes or other conditions that is focus of clinical attention like Schizophrenia and Anxiety Disorders such as Generalised Anxiety disorder, Attention Deficit and Disruptive Behaviour disorders, major depression and substance dependence, and other Psychotic disorders, Mood disorders and eating disorders.  It lists the disorders that typically causes significant distress or impairment to the individual and requires immediate attention except personality disorders and intellectual impairments. 2. Axis II - It lists the disorders that cause life-long or prolonged difficulty that pervades all of a person's life. It includes Personality Disorders such as histrionic personality disorder, paranoid personality disorder, or antisocial personality disorder as well as Intellectual Impairments. Axis II provides a means of coding for long-standing maladaptive personality traits that may or may not be involved in the development and expression of an Axis 1 disorder. These do not require immediate attention, but complicates treatment of any other problem that the person might face. 3. Axis III – This axis includes Generalised medical conditions that are related to or are causal factors of mental disorders (i.e. the psychological condition maybe a byproduct of an illness). These include diabetes, hypertension, and cancer which can lead to other psychological problems such as memory loss and depression (for diabetes). anxiety and anger issues disorders (for hypertension), and mood disorders and depression (for cancer). Also includes conditions like Infectious and Parasitic diseases, Respiratory diseases, Digestive disorders, Congenital anomalies, injury and poisoning etc. This axis can be used in conjunction with Axis-I. On any of the first three axes where the criteria is met, more than one diagnosis is possible and in fact encouraged. ❖ The last two DSM-IV axes are used to assess broader aspects of an individual's situation. 4. Axis IV - It reports the psychological and environmental stressors that may affect the diagnosis, treatment and prognosis of the disorders. The diagnosistician uses a checklist consisting of various categories like family, economic, legal, occupational, psychosocial and environmental problems. 5. Axis V - This is where the clinicians note how well the individual is coping at the present time and their overall functioning.  A l00-point rating-scale, the Global Assessment of Functioning (GAF) Scale, is provided for the examiner to assign a number summarising the patient's overall functionability. 100 = excellent functioning, 50 = indicates serious symptoms and impairments, 10 = person is danger to oneself and others. The higher the score or GAF, the better is its prognosis and lesser the need to rely on medications and treatments has to only involve therapies. Advantages of DSM-IV: a. It encourages a comprehensive evaluation and provides a standardised format for explaining clinical descriptions in a common language. b. It gives a complete picture of the patient's current condition. c. It reflects efforts to take greater account of the potential role of cultural factors. Limitations of DSM-IV: a. It is largely descriptive in nature. It describes psychological disorders but does not explain them. b. It leads to labelling people according to their abnormal behaviour. Stigma and stereotyped attitude could be displayed against them. c. It states gender-based classifications which may show gender bias in the social attitude. d. DSM IV has classified mental disorders into discreet categories. People may have a disorder to various degrees i.e., severe, moderate or mild. This is why many prefer a dimensional rather than a descriptive approach. Thus, the multiaxial system of DSM-IV is a convenient format for organising clinical information. It helps clinicians to get a comprehensive understanding of every patient’s current state and psychological functioning.  MAJOR PSYCHOLOGICAL DISORDERS I. ANXIETY DISORDERS: What is anxiety? o Anxiety can be defined as increased arousal accompanied by generalized feelings of fear or apprehension. o In simple words it is the weak concern that something unpleasant will occur soon. o Anxiety disorders are of three primary kinds- Generalised Anxiety Disorder (GAD), Phobias, Obsessive compulsive disorder (OCD) 1. Generalized Anxiety Disorder (GAD): An anxiety disorder that consists of persistent anxiety for at least one month the individual with this order cannot specify the reasons for the anxiety. General symptoms:  Uncontrollable anxiety persisting for more than 6 months  Restlessness or feelings of being keyed up the edge  Overly vigilant to find possible signs of threat  A sense of being easily upset  Difficulty concentrating or mind going blank  Irritability  Muscle tension  Sleep disturbance  Free floating anxiety - feeling that something dreadful is about a happen but cannot identify a specific object or situation that causes it.  Causes: a. Biological factors: Genetic predisposition - a common gene is believed to be related to anxiety which effects the brain's ability to use serotonin which is a mood regulating neurotransmitter. Chemical imbalance - Gamma Amino Butyric Acid (GABA) is a neurotransmitter that reduces anxiety in stressful situations. A deficiency of the neurotransmitter GABA in the human brain is linked to GAD. b. Psychological factors: Psychodynamic view suggests that anxiety occurs when Id is unable to express its unacceptable anxiety as it is suppressed and there is a breakdown of defense mechanisms. The person experiences free floating anxiety because he or she is unable to deal with, displace or deny anxiety. c. Cognitive factors: It includes the role of intense negative thoughts when facing stress as the cause of anxiety. It also includes automatic thoughts that come up in any situation like "what if I fail" or "I will never be as capable as I should be". d. Psychosocial or socio-cultural factors: It involves having harsh self-standards that are hard to achieve or maintain. Having an overly strict up bringing or trauma such as abusive parenting, spouse, death of a loved one can produce low self-esteem and self-criticism. 2. Phobias: Phobias are intense or irrational fears of objects are situations that may present little or no danger to a person. There are currently three recognised types of phobic disorders - Specific or simple phobia, Social Phobia, Agoraphobia.  General symptoms:  The fear is unreasonable or excessive but the person is unable to help himself or herself from being rational.  The phobic situation is avoided otherwise it is endured with great distress.  It causes personal distress and impaired functioning.  The anxiety associated with phobias is not related to other psychological disorders. Causes: a. Biological factors: Genes -Specific genes may affect anxiety and fearfulness. Chemical Imbalance - An Imbalance in the brain chemical Serotonin could be a factor. helps regulate mood and emotions. Fear responses- The limbic system of the brain is involved in controlling strong emotions, motivation and learning. The amygdala may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response. b. Behavioural perspective: this view explains anxiety in phobic disorders as a learned response to stress. Operant Conditioning – when a behaviour or situation is reinforced through punishments, a fear response is evoked. Classical conditioning - associate neutral stimuli with strong emotional reactions. For example, an individual may develop a phobia of buzzing noises such as those made by bees after being stung by a bee or wasp. c. Social Cognitive view: Observational learning leads to fears typical of phobias, when the individual witnesses a negative consequence to a situation or behaviour. For example, a little girl may have developed a fear of high places because she may have seen or heard of people who were afraid of high places. d. Psychodynamic approach: This view suggests that phobias are a kind of defense mechanism adopted by individuals against anxiety stemming from some repressed id impulses.  Since, it would be very upsetting for the person to become aware of the repressed id impulse, the anxiety is displaced on to some external object or situation. i. Specific Phobias: A specific phobia, formerly called simple phobia is characterised by an intense and persistent fear of a specific object or situation such as snakes, heights, blood, insects, etc. Symptoms: Intense, excessive and unreasonable fear of a specific object or situation. The level of fear is usually inappropriate to the situation as the object or situation presents very little or no actual danger. This unusual fear compels the person to avoid the particular object or situation or endure the situation with great level of distress. The fear is uncontrollable in spite of best efforts. Person recognises that the fear is unreasonable. Exposure to phobic stimulus or mere anticipation of the same results in extreme fear and anxiety response in the person. Duration of the symptoms must be for diagnose the person with specific phobia. ii. Social Phobia: In Social Phobia an individual experiences extreme and irrational fear of social situations. They may have trouble in meeting and interacting with new people, in attending social gatherings, or public speaking. They have an excessive fear of being negatively judged and scrutinized by others. Symptoms: Extreme fear and worry about social situation. Avoiding social situations and trying to blend in the background. Excessive worry about being scrutinised and embarrassed in social situation.  Exposure to social situation induces extreme fear or panic attack Person realises the fear to be unreasonable. iii. Agoraphobia: The word 'agoraphobia' was thought to be fear of 'agora', i.e., a Greek word meaning public places. It is characterised by extreme fear of certain public places like shopping malls, market place, crowded streets, movie halls, etc. Person with agoraphobia feels trapped or helpless or embarrassed in all these aforesaid places. People with agoraphobia are also frightened by their bodily reactions showing very little level of arousal as they feel it to be the triggering point of an panic attack. So, these people avoid any activities associated with arousal like exercising, watching horror movies, etc. Symptoms: Extreme fear and anxiety of places from where the person feels escape or getting help will be difficult and embarrassing. Afraid of leaving their homes for extended periods. Afraid of losing control in a public place, fear of a panic attack Situations are avoided or are tolerated with severe level of distress. 3. Obsessive-Compulsive Disorder (OCD): Obsessive Compulsive Disorder is characterized by two components: Obsessions - "A persistent, unwanted thought or idea that keeps recurring" and Compulsion - "An irresistible urge to thought or idea that that seems strange and unreasonable." actions that people perform to neutralize the obsessions. Characteristics/Symptoms:  Repetitive, stereotypical behaviour  persistent thoughts  distressing, impulsive acts   intense anxiety,  judge risks unrealistically  "what if illness" - fear that something terrible will happen Types of Obsessions: Fear of contamination Pathological doubt: Undue concern about not having done a job well enough even Obsessional Need for Precision Repetitive thoughts Types of Compulsions: Repetitive Cleaning Compulsion like washing hands repeatedly Checking Compulsion like checking doors, windows, taps or gas repeatedly Counting Compulsion like counting objects a particular number of times Ordering/Arranging Compulsion like constantly arranging things to be symmetrical Compulsive worrying like uncontrollable and upsetting repetitive negative thoughts. Hoarding compulsion like hoarding old mail, newspapers and other useless objects They are often successful in hiding their symptoms from coworkers and friends. Causes: a. Biological factors: Role of Genes: Studies Involving identical twins and first-degree relatives in families have shown a high rate of concordance rate. Role of Brain Structure: Abnormalities in brain structure such as an overactive frontal cortex may generate so many impulses to the thalamus of the brain that the result is obsessive thoughts and compulsive actions. Role of Chemical Imbalances: The levels of the neurotransmitter Serotonin may be less in the brain and this has been linked to the development of OCD. b. Psychodynamic factors: OCD symptoms may develop as a result of fixation at the anal stage of psychosexual development explained by Freud. Toilet training by their parents involves teaching them to learn control. If parents are too harsh and make the child feel dirty or bad about soiling themselves, they may cause a lot of guilt and shame in the child. Thus the intense conflict between the id to 'let go' and the ego 'to control' can lead to OCD symptoms as adults. c. Cognitive factors: Major life changes may trigger stress, like childbirth, a change in occupational or marital status. These in turn may lead a person to develop anxiety associated with OCD. They may fear losing control and so may develop rituals which they believe helps them to exert control over their anxiety. Also, to avoid past experiences like severe embarrassments. d. Behavioural factors: According to this view OCD is a learned behaviour, which is learned by classical conditioning and continued due to operant conditioning. Suppose, person may associate an unfriendly neighbour (neutral stimuli) with the obsessive though (threatening stimuli) that the neighbour will loot the house via classical conditioning. Once this association is formed, the person discovers that the anxiety caused by the obsessive thought can be reduced by checking the locks. So, since checking the locks reduces his anxiety, so this checking response gets reinforced. II. MOOD DISORDERS: Moods can be defined as emotional states. Most of us experience different mood states - being happy or sad and upset at other times. Mood disorders are "Psychological disorders in which individuals experience swings in their emotional states that are much more extreme and prolonged than is true of most people." There are two major types of Mood Disorders: 1. Unipolar / Major Depression 2. Bipolar / Manic Depressive Disorder 1. Unipolar Depressions/Major Depression: Unipolar depressions disorder is" a mood disorder in which individuals experience extreme unhappiness, lack of energy and several related problems." This is characterized only by depressive episodes. Symptoms: o Dysphoric or unpleasant mood. This entails feelings of gloom, dejection, and o despondence o Profound unhappiness Rapid weight loss or weight gain o Feelings of anxiety o Change in appetite. o Fatigue or a loss of energy o Sleep disturbances; Insomnia o Recurrent headaches or stomach aches o Feelings of worthlessness or guilt in an excessive or inappropriate manner o A recurrent inability to think or concentrate or make decisions o Recurrent thoughts of suicide or death. o Loss of interest in all the usual pleasures of life  o Psychomotor agitation or retardation o Neglect of physical appearance Causes: a. Neurochemical factor: low level of thyroid hormone leads to depression. low level of serotonin may affect the level of other neurotransmitters such as dopamine and norepinephrine. This in turn may cause extreme changes in mood, leading to depression. b. Cognitive factor: Learned helplessness, a concept given by Seligman is also responsible for causing depression as it constitutes a belief where individuals feel that they have no control over their destinies. People with negative thinking patterns and low self-esteem are more likely to develop severe depression Depressed persons have automatic repetitive, negative thoughts about the self, surrounding world and future. This Beck had termed as negative cognitive triad. c. Behavioural factor: Behavioural theories of depression propose that people become depressed when their behaviour meets with punishment. Depression can also result when the person's behaviour is no longer reinforced positively. d. Genetic factor: Family history of depression increases the risk of depression. Family studies have shown that prevalence of severe depression is approximately three times higher among children of depressed persons. e. Psychodynamic factor: This viewpoint explains severe depression based on grief, loss and feelings of inadequacy. Since, at the tender age, ego of the child is mainly self-centred, so the child misinterprets the loss and the feelings of rejection as resulting from something wrong which he/she has done. As a result, these feelings of anger and hostility gets turned inward resulting in self-blame, criticism and punishment. As an adult, when this same child faces any loss, he/she regresses back to his childhood and adopt the same behaviour pattern. 2. Bipolar Mood Disorder: Bipolar Mood Disorder suffer from wide swings in their mood. They move over varying periods of time between deep depression and an emotional state known as mania. It is also known as manic-depressive disorder, because a person's mood can alternate between the "poles" mania (highs) and depression (lows). This change in mood or "mood swing" can last for hours, days, weeks or months. The first episode may be either manic or depressive. The periods of highs and lows are called episodes of mania and depression. i. Mania - It is a state characterized by extreme excitement, elation, power and energy. Symptoms include: o Irritability o Euphoria o Hostility o Decreased sleep o Rapid speech o Difficulty focusing attention o Abundance of energy o Inflated self-esteem o Grandiose or lofty plans o Poor judgment ii. Depression - Depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer. Depressive symptoms include: o Increased or decreased sleep o Weight gain or weight loss o Severe sadness o Crying spelis o Loss of joy o Loss of interest in activities o Difficulty thinking or concentrating o Severe depression may lead to thoughts and plans of suicide. If not treated adequately, death through suicide is a very real possibility in the severely depressed person with bipolar disorder. Causes: a. Biological factors: Genetic Factors - In reviews of twin studies, adoption studies, and family studies, heredity does seem to play a role in predisposing the individual to depression. Depression among adoptive family members had little effect on a child's risk of depression; however, the disorder was three times more common among adopted children whose biological relatives suffered depression.  Chemical imbalances - Over secretion of cortisol, a stress hormone can increase or trigger manic reactions. Excessive of calcium into brain cells has been indirectly shown to be higher in people with bipolar disorders than others. Excess calcium can trigger restlessness and irritability. Imbalances of neurotransmitters -serotonin and nor epinephrine. Scientists think a deficiency in serotonin may cause the sleep problems, irritability, and anxiety associated with depression. A decreased amount of norepinephrine, which regulates alertness and arousal, may contribute to the fatigue and depressed mood of the illness. Cortisol - In normal people the level of cortisol in the bloodstream peaks in the morning, then decreases as the day progresses. In depressed people, however, cortisol peaks earlier in the morning and does not level off or decrease in the afternoon or evening. Role of Brain Structures -Abnormal hyperactivity has been identified in parts of the brain associated with emotion and movement coordination and low activity in parts of the brain associated with concentration, attention, inhibition, and judgment. b. Psychological factors: Freud - depressed patient suffered the loss, real or imagined, of someone with whom they were very close. They are unable to cope with the loss, the person then creates an internal representation of the lost individual so that they can maintain the close relationship. Anger begins to develop towards the lost individual which is internalized. Depression, then, is essentially an instance of anger turned inwards. c. Cognitive factors: It involves a heightened self-awareness. Tend to focus inward on themselves. When they do, they realize gaps between what they are in life and what they would like to be - Real self and ideal self. They develop negative self-schemas with automatic, repetitive negative thoughts about the self and the world. d. Behavioural factors: A Behavioural explanation of depression is given by Martin Seligman in his theory of Learned Helplessness. Depressed individuals begin to believe that they are helpless-that they do not have the power to control the events in their lives. Thus, this response to prolonged stress over which the individual has no control may lead to apathy and helplessness, which may lead to depression. e. Sociocultural causes: Prevalence of stressful life events in an individual's life than with genetics. Depression followed the occurrence of negative events such as divorce, loss of a job, and loss of a loved one. Socio-economic issues like poverty and lower socio-economic status are also associated with depression. There are cultural variations in the development of depression. IV. PERSONALITY DISORDERS: Personality is the set of unique behavioural and mental traits that characterise an individual. Hence, personality disorders are marked by inflexible and extreme personality traits and behaviours that are deviations from social norms and expectations. Persons with personality disorders have faulty cognition, inappropriate emotional expressions, difficulties in interpersonal functioning and in controlling one's emotions. Some of the personality disorders are Anti-Social Personality Disorder, Dependent Personality Disorder 1. Anti-Social Personality Disorder: An individual of at least 18 year of age, whose behaviour show continuous disregard for or violation of the rights of others, is diagnosed to have anti-social personality disorder. This disorder is also called psychopathy or sociopathy. Symptoms: Repeated failure to conform to social norms and behave lawfully. Engaging in various deceitful criminal or delinquent activities without any remorse or feelings of guilt. Excessive impulsivity, irritability and aggressiveness. Consistent irresponsible behaviour. A possible history of conduct disorder or presence of symptoms of conduct disorder (childhood disorder marked by aggressive and anti- social behaviour) in childhood. Disregard for safety of self and of others Causes: a. Biological factors: Neurochemical factor-Certain brain areas like temporal lobes and prefrontal cortex regulate mood and behaviour. Serotonin is the neurotransmitter that has been linked with impulsive and aggressive behaviour. So, an abnormal functioning of serotonin or these brain areas may lead to the impulsive and aggressive behaviour associated with anti-social personality disorder. Genetic factor-Research has indicated partial level of hereditary influence in case of anti-social personality disorder. Parents having psychopathic traits like aggression, impulsivity, callousness may have children who might develop anti- social personality disorder in adulthood. b. Environmental factor: Dysfunctional family environment in terms of poverty, illiteracy, broken homes, large families, unemployment, substance abuse leads to inappropriate nurture, discipline and supervision of the child. Due to absence of proper parental guidance and care, he/she lacks an appropriate role model. So, he/she uses aggression to solve disputes. This aggression often leads to rejection by peers. This in turn compels them to choose similar aggressive peers. These relationships may lead to form gang to carry out various anti-social activities. 2. Avoidant Personality Disorder: Individuals with avoidant personality disorder is marked by behaviour pattern of social inhibition, feelings of inadequacy and hyper-sensitivity to negative evaluation by others. As a result they are reluctant to enter into any social interactions and has limited social relationships. It is also known as Anxious personality disorder. Symptoms: Self-imposed social isolation. Preoccupation of being criticised or rejected and hyper sensitivity to rejection or criticism. Extreme shyness or anxiety in social situations due to fear of being shamed or ridiculed. Low self-esteem and feelings of inadequacy. Self-critical Causes: a. Genetic and personality factor: According to Big Five factor model of Costa and McCrae, high levels of introversion is indicated by their inhibited and shy behaviour, feelings of inferiority. While high levels of neuroticism is indicated by their fear and anxiety of being shamed, ridiculed.  b. Psychodynamic factor: This view suggests that this disorder arises out of early painful experiences of chronic parental or peer criticism or rejection. As a result, the persons adopt these avoidant tendencies as a defense to protect self against further criticism from anyone. 3. Dependent Personality Disorder: Dependent Personality Disorder is also known as Asthenic Personality disorder. A person with this personality disorder has a profound psychological dependence on other people. It is a long- term condition in which people depend on others to meet their emotional and physical needs. Symptoms: Inability to take decisions without advice and reassurance from others. They generally show clinging and submissive behaviour. Needs others to assume responsibility for most of major aspects of his/her life. Has difficulty in expressing disagreement with others because of fear of loss of support or approval. Has difficulty in initiating any project or doing things on his or her own. Can do anything to gain support and care from others. Feels uncomfortable or helpless when alone due to exaggerated fears of being lonely. Craves for a relationship for care and support immediately after a close relationship ends. Unreasonable preoccupation with fear of being left alone or abandoned by others; fear of separation.  Causes: a. Genetic and personality factor: Inheritable personality traits of neuroticism and agreeableness leads to anxiety, fear of being left alone and excessive trusting and clinging behaviour, which are characteristics of dependent personality disorder. b. Behavioural and cognitive factor: This view states that dependent personality disorder is the result of authoritarian parents reinforcing dependent behaviour without encouraging the development of autonomy and individuation in their child. The child groomed under such parenting style starts believing that he/she is incompetent to carry out any task. So, he/she must depend on others. The beliefs of incompetency, and so requiring others to survive becomes dominant and gets expressed pervasively in the behaviour. III. BEHAVIOURAL, NEURODEVELOPMENTAL AND ANXIETY DISORDERS IN CHILDHOOD: Behavioural Disorder - Most children show some disruptive behaviour at some time or the other, like not paying attention in class or being defiant to elders. However, when such behaviours starts from about 6 months and result in trouble at school and other social places, it can be called a Behavioural Disorder. Developmental Disorder - Developmental disorders originate in childhood that involve serious impairments in physical, learning, language, or behaviour areas. These conditions usually begin during childhood, have an impact on day-to-day functioning, and usually last for the rest of a person's life.  Such disorders can be caused by,  Physical illness or disability  Malnutrition  Brain damage  Hereditary factors  Divorce of parents  Unstable home  Coercive parents  Inconsistent discipline style  Poor attitude towards schooling 1. Attention Deficit Hyperactive Disorder (ADHD): The symptoms of ADHD They are usually noticeable before the age of 6 that occur in more than one situation, at home and at school. It is of three types, triad, - Inattentiveness, Hyperactivity and Impulsivity. Inattentiveness: i. Short attention span and easily distracted. ii. Careless mistakes in work, like schoolwork. iii. Seem to be forgetful and lose things. iv. Cannot stick to tedious and time-consuming tasks. v. Seem to be unable to listen to and follow instructions. Hyperactivity: i. Constant fidgeting. ii. Inability to keep still and sit quietly in a calm surrounding. iii. Inability to concentrate on tasks. iv. Excessive physical movements. v. Talking a lot. Impulsivity: i. Inability to await his turn when waiting for something. ii. Acting without thinking it through. iii. Interfering and interrupting ongoing conversations. iv. Inability to understand danger.  These symptoms cause a lot of problems in a child's life, in the child's academic performance, and with his social interactions with others and disciplinary issues at various levels. 2. Autism Spectrum Disorder: Autism is a serious pervasive developmental disorder that impairs the ability to communicate and interact. Carson at al-"...deficits in language, perception, motor development; defective reality testing and social withdrawal". Autism too has a triad of symptoms – Language and Communication, Social Interactions and Relations, Stereotyped Behaviour and Narrow Interest. Language and Communication: i. show serious abnormalities in communication and language that persist over time. ii. Some do not develop speech and those who do, have repetitive and deviant speech patterns. Social Interactions and Relations: i. experience profound difficulties in relating to other people. ii. unable to initiate social behaviour and seem unresponsive to other people's feelings. iii. Difficulty in starting conversations and in small talk iv. unable to share experiences or emotions with others. v. Does not understand humour, satire, sarcasm Stereotyped Behaviour and Narrow Interest: i. show narrow patterns of interests; they are not interested in various things ii. repetitive behaviours such as lining up objects or stereotyped body movements such as rocking. iii. motor movements may be self-stimulatory such as hand flapping or self- injurious such as banging their head against wall iv. Dislike of loud noises or sensory seeking behaviours.  3. Separation Anxiety Disorder: Some children are extremely and inappropriately fearful about being separated from their primary care giver or someone they are attached to. They are afraid of staying in a room alone, going to school or entering a new situation and try to find solace in the protection of the primary care giver. Symptoms: i. Experiencing extreme distress at the thought of or when going through separation from home or primary care giver. ii. May throw up a tantrum, scream, fuss or even attempt suicide to avoid the separation. iii. Worrying constantly that something bad, like getting lost, kidnapped etc. or separating the Individual from the parents will happen. iv. Refusal to stay away from home fearing separation. v. Aversion to being alone at home without a parent or a loved one. vi. Continuous nightmare about being separated from the loved ones. vii. Complaint of somatic symptoms like headaches, stomach-aches on anticipating separation from a parent or a loved one. IV. SCHIZOPHRENIA: The term schizophrenia was coined by Eugen Bleuler, a Swiss psychiatrist in 1911. The name schizophrenia originated from German word 'schizen' meaning 'to split' and Greek word 'phrenia,' meaning 'mind'. Thus, schizophrenia is referred to as split in the thought, split between thought and emotion, split between thought and external reality. It is "A complex disorder characterized by hallucinations (Eg, hearing voices), delusions (beliefs with no basis in reality), disturbances in speech, disturbed logical flow of thoughts and several other symptoms." Schizophrenia is usually diagnosed after a long period of onset due to its gradual outward expression. Not all symptoms appear in one individual, but symptoms are found in various combinations. DSM-IV has presented the criteria for the diagnosis of schizophrenia through positive and negative symptoms. Positive symptoms of Schizophrenia: Positive symptoms mean adding something that is not normally there; excessive and bizarre behaviour, seeing and hearing things that do not normally exist. 1. Delusions: They are firmly-held ideas that a person has despite clear and obvious evidence that it isn't true. Common schizophrenic delusions include: a. Delusions of persecution - Belief that others, often a vague "they," are out to get him or her. E.g. "Martians are trying to polson me with radioactive particles delivered through my tap water"). b. Delusions of reference - A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them. c. Delusions of grandeur - Belief that one is a famous or important figure like Napoleon. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). d. Delusions of control - Belief that one's thoughts or actions are being controlled by outside, alien forces. Common delusions of control Include thought broadcasting ("My private thoughts are being transmitted to others"), thought insertion ("Someone is planting thoughts in my head"), and thought withdrawal ("The CIA is robbing me of my thoughts"). 2. Hallucinations: These mean detailed sensory experiences of something that does not exist in reality. For example, seeing, feeling, tasting, hearing or smelling something that does not really exist. Hallucinations can involve any of the five senses, auditory, gustatory, tactile, visual, olfactory hallucinations 3. Disorganized thinking and speech: Fragmented thinking is characteristic of schizophrenia. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They speak incoherently, or say illogical things.  Common signs of disorganized speech in schizophrenia include: a. Loose associations -- Rapidly shifting from topic to topic, with no connection between one thought and the next. b. Derailment - Often one idea in the thought process do not follow a logical sequence to another idea in the same thought. c. Incoherence - In extreme cases, ideas seem to be totally unconnected d. Word Salad – utter few jumbled or unconnected words e. Neologisms - Made-up words or phrases that only have meaning to the patient. f. Perseveration or echolalia- Repetition of words and statements; saying the same thing over and over. g. Clang-Meaningless use of rhyming words ("I said the bread and read the shed and fed Ned at the head". 4. Disorganized behaviour: a. Unpredictable or inappropriate emotional responses b. excessive & peculiar motor activity - agitation, not influenced by external stimuli, grimacing c. behaviours that appear bizarre and have no purpose d. lack of inhibition and Impulse control e. repetitive, unnecessary movements (stereotypy) like flapping the fingers f. normal goal directed activity that socially approved but is repeated out of context mannerisms like bowing head repeatedly g. waxy flexibility - increased flexibility where a person's limbs can be moved into any posture and the patient will retain these postures h. echopraxia - imitating movements of another person i. catatonic excitement - uncontrolled and aimless motor activity Negative Symptoms of Schizophrenia: Negative symptoms include those abilities of individual which are 'lost from the individual. In other words, it includes absence of all those behaviours that are normally present in all individual. 1. Flat/Blunt Affect/Affective flattening - They show total apathetic behaviour to others. Otherwise, they show very little or inappropriate emotional reactions to certain situations. For example, a patient may start laughing loudly when somebody inquires his/her name. They show relatively immobile and unresponsive facial expressions, often accompanied by poor eye contact and little body language or movement. 2. Alogia - refers to difficulty with speaking. In some schizophrenic patients, alogia manifests as reduced total speech output, and reduced verbal fluency (the ease with which words are chosen). 3. Avolition - describes a loss of motivation, will or desire to participate in activities or to do things. Seemingly indifferent to their surroundings, and without displaying any interest in work or social activities. Impairments in a person's ability to take care of him or herself, work, and interact with others. A decline in overall daily functioning. 4. Anhedonia - finding no pleasure in what others find as pleasurable activities. For example, a football fan does not enjoy when the team he/she supports wins. 5. Social withdrawal – They usually have a complete lack of concern for their social environment. They are unable to maintain appropriate social behaviours like communicating with others, or maintaining proper hygiene as per the social standards. 6. Catatonic Stupor – a state of total immobility and mutism, but the person remains conscious (catatonic stupor) There are different types of schizophrenia – Catatonic Schizophrenia, Paranoid Schizophrenia and Disorganized Schizophrenia. 1. Catatonic Schizophrenia: This type of schizophrenia is marked by disturbance in movement and presence of unusual motor characteristics. a) Catatonic Stupor - Affected people may exhibit a dramatic reduction in activity, to the point that voluntary movement stops. b) Catatonic Excitement - Alternatively, activity can dramatically increase. c) Waxy Flexibility - They may maintain a pose in which someone places them, sometimes for extended periods of time. d) Catalepsy - Patients may assume a particular posture and remains in that posture for hours, even days. e) Stereotypic behaviour - Repetitive and bizarre behaviour f) Echolalia - parrot-like repeating of what another person is saying or mimicking the movements of another person. g) Echopraxia - involuntarily imitates the movements of another person. h) Negativism - They may resist any effort by others to change their position. They may even refuse attempts of feeding and refuse other requests. 2. Paranoid Schizophrenia: It is the most common form of schizophrenia. It is marked by presence of high level of suspicion and mistrust towards others. The defining feature of paranoid schizophrenia is absurd or suspicious ideas and beliefs. a) Delusions of persecution – Patients have delusions or false, absurd, illogical beliefs that any person or some individuals (that may be his/her close relatives, friends too) are plotting against them or against the members of their family. They may complain of being followed, poisoned, or talked about by others. b) Delusions of grandeur – They also have a false belief about themselves. As a result, they may claim to be some influential or powerful or wealthy or famous person like a god, saviour-complex, great politician, industrialist etc.  c) Auditory hallucinations or delusions – Their delusions are illogical and are often combined with hallucinations. Typically, the hallucinations and delusions revolve around some theme, and this theme often remains fairly stable over time. d) Cognitive skills – Comparatively, patients with paranoid schizophrenia exhibit fewer problems with their cognitive skills, emotions and attention. This allows them to think about the wide range of peculiar ideas and plots. e) Difficulty in maintaining relations – People with paranoid schizophrenia show a history of increasing paranoia and difficulties in their interpersonal relationships. 3. Hebephrenia or Disorganized Schizophrenia: Its main feature is disorganization of the thought processes. It is characterized by disorganized behaviour, disorganized speech, and emotional flatness or inappropriateness. a. Emotional shallowness/bluntness or Flat Affect - Often, there is impairment in the emotional processes of the individual. For example, these people may appear emotionally unstable, or their emotions may not seem appropriate to the context of the situation. They may fail to show ordinary emotional responses in situations that evoke such responses in healthy people-blunted or flat affect. b. Disorganised thought and speech - The patient is unable to form coherent or logical thoughts, which is evident in their speech. Speech is difficult to understand as it may be marked by loosening of associations or derailment, echolalia or baby talk. Chuckles inappropriately, for example, through a funeral service or other solemn occasion. Ineffective Impairment in their ability to communicate effectively. At times, their speech can become virtually incomprehensible, due to disorganized thinking.  c. Bizarre delusions and hallucinations - Giggling spells with alternate outburst of anger Talking or smiling to themselves or with imaginary persons d. Grossly disorganised behaviour - Patients with this type of schizophrenia may have severe problem in their abilities to take care of themselves and perform regular activities such as bathing, eating, dressing, etc. They may display odd behaviours like facial grimacing (making odd facial expressions), talking to themselves, mannerisms, stereotypy or echopraxia. e. Social withdrawal - All the above symptoms actually leads to severe disruption in communication, maintaining proper hygiene. This makes the patients gradually decline into reclusion. Thus, the patients get shelled in his own world of some hallucinations, delusions away from reality. PSYCHOTHERAPY “Treatment in which a trained professional -a therapist- uses psychological techniques to help someone overcome psychological difficulties and disorders and resolve problems or bring about personal growth.” 1. PSYCHODYNAMIC THERAPIES: Proposed by Sigmund Freud, it is based on the idea that mental disorders stem mainly from hidden inner conflicts and the possibility that unacceptable unconscious impulses will enter consciousness. Psychoanalysis is "Freud's therapeutic technique for analysing individual's unconscious thoughts and enable them to gain insight into their hidden inner conflicts and repressed wishes."  Classic Freudian Psychoanalysis tends to be hour-long sessions with the psychoanalyst, for 4-6 days a week and tend to go on for years. It involves confronting the conflicts and impulses by bringing them out of the unconscious part of the mind and into the conscious part traced back to childhood experiences. There are several psychoanalytic techniques uses to gain this insight: a. Free Association - is a verbal reporting by persons undergoing psychoanalysis, of everything that passes through their minds, no matter how unimportant or embarrassing it may appear to be. The repressed impulses would then be revealed by these mental wanderings at least to the trained ear of the psychoanalyst. b. Dream analysis – It is another technique used to find clues to the unconscious conflicts and problems. Moving beyond the surface description of a dream (manifest content), therapists seek to find the underlying meaning (latent content), thereby revealing the true unconscious meaning of the dream. Even everyday events like slips of the tongue could aid the analyst in making interpretations concerning the patient's hidden inner conflicts. c. Resistance - The processes of free association and dream analysis do not always move forward easily. The same unconscious forces that produced repression can work to keep past difficulties out of the conscious, producing resistance. Resistance is a patient's stubborn refusal to report certain thoughts or motives and experiences or outward rejection of the therapist's interpretations. For eg: They may forget what they were saying when talking about a childhood memory or completely change the topic. Possibly, resistance occurs because as patients become more and more aware of these conflicts in their consciousness, they try and avoid them. The psychoanalyst has to pick out such instances of resistance and enable the patient to return to the topic and discuss it. d. Transference - are intense emotional feelings of love or hate toward the analyst on the part of the patient undergoing psychoanalysis feelings of love or hate toward the analyst as they did to someone important in their early lives, like their parents. Freud believed that transference could be important for helping individuals work through conflicts with parents. The harm done by unhealthy family relationships can be resolves through psychoanalysis and the transference gradually fades away. e. Counter-transference - is defined as redirection of a therapist's feelings toward a client, or more generally as a therapist's emotional entanglement with a client. A therapist's atunement to their own countertransference is nearly as critical as understanding the transference. Not only does this help the therapist regulate their emotions in the therapeutic relationship, but it also gives the therapist valuable Insight into what the client is attempting to elicit in them. f. Insight, interpretation and working through – Working through is seen as the process of repeating, elaborating, and amplifying interpretations. It is believed that such working through is critical towards the success of therapy. The patient, after insight, comes to terms as an abreaction which is an emotional, unconscious reaction that you have in response to a stimulus that brings back a painful situation you have experienced before. Leading to a catharsis which is an emotional release. This emotional release is linked to a need to relieve unconscious conflicts. The patient is ready to face his/her conflict and deal with it. 2. CLIENT CENTRED THERAPY: Developed by Carl Rogers. Rogers strongly rejected Freud's view that mental disorders result from Unconscious hidden conflicts. It believed that the gap between the Real Self and Ideal Self leads to distortions and denial. This results in mal-adjusted behaviour patterns. "Carl Roger's approach to Psychotherapy seeks to eliminate Irrational or illogical conditions of worth in the client's mind by providing unconditional positive regard in a caring and accepting environment." a. Non-directive counselling – In this view the therapists comments are not interpretations or answers to questions by the clients (like in Psychoanalysis) rather they reflect whatever the client says (For eg: You feel like'; or "In other words, what you are saying is...") b. Client-centred therapy – The main focus is on the client, their thoughts and feelings. Here you act as an equal partner in the therapy process. focuses on offering unconditional positive regard and acceptance of the client and his feelings. High level of empathy and understanding and correct reflection of the client's feelings. c. Unconditional positive regard – Therapist need to communicate to the client that they are caring and non-judgmental people. The therapist relates to the client not as someone diagnosing his problems but as one human being relating to another. In this atmosphere, the client is in a way freed from the fear of not being liked or accepted and they come to accept their ‘real self’ as they really are. As a result they come to see themselves as unique human beings with many good qualities. d. Fully-functional individual - who is one in touch with his or her deepest and innermost feelings and desires. These individuals understand their own emotions and live fully in the here and now with personal inner freedom. e. Actively listening - to the client and showing genuine concern for them are followed today. Rogers was also among the first to tape-record the sessions, so that the therapist can understand whether the client is being helped and what techniques are most helpful. f. Parroting – it means repeating what the client has said back to them. has twin goals of ensuring that the therapist has heard the client correctly, and encouraging the client to further clarify his/her thoughts.  3. BEHAVIOURAL THERAPY Behaviour therapies "are a set of therapies based on the belief that many mental disorders arise from faulty learning and based on the learning principles of reinforcement and extinction." The therapists' role is to change or modify faulty current behaviour and not to correct faulty self-concepts or to resolve inner conflicts like in Humanistic and Psychodynamic therapies. The focus of Behaviour therapies are:  Firstly on the individual's current behaviour.  Secondly, both abnormal behaviour and normal behaviour are learned. Therapies based on Classical Conditioning Classical Conditioning is a process in which organisms learn that the occurrence of one stimulus will be followed by the occurrence of another. The pattern of learning is: A neutral stimulus is paired with an unconditioned stimulus to produce a conditioned response. Eg: After a bee sting and associated pain, the sound of the bee buzzing is enough a evoke a response of fear. UCS UCR CS CR a. Flooding - Behaviour therapists expose the person to the feared stimuli or to mental representations of them in situations from which they cannot escape. A high strength conditioned stimulus is presented over and over again. Eg: Acrophobia - made to stand near a high cliff. b. Systematic Desensitization - This is a form of behaviour therapy for phobias in which gradual exposure to anxiety producing stimuli is paired with relaxation in order to extinguish the response of anxiety.  An example: You are extremely afraid of flying. The very thought of flying makes you sweat and shake and you'd never been able to get yourself near an airport to know how you'd react if you actually had to fly somewhere. The next step would be to construct a hierarchy of fears -a list in order of increasing severity of the things that are associated with your fears. (For eg: Watching a plane fly overhead, going to an airport, Getting a ticket, Seeing the plane door close, Taking off etc.) Therapies based on Operant Conditioning Behaviour is often shaped by the consequences it produces- actions are repeated if they yield positive outcomes or if they permit people to escape from a negative situation. In contrast actions, which yield negative outcomes, are not repeated. These basic principles of operant conditioning learning are used in various forms of therapy based on rewards as reinforcements and punishments. a. Shaping and Chaining – A gradual, behavior modification technique in which successive approximations to the desired behavior is rewarded. Instead of waiting for a subject to exhibit a desired behavior, any behavior leading to the target behavior is rewarded. With shaping, the learner learns by first approximately performing the goal behavior. As the teacher, you reinforce the approximation of the goal, and you help the learner take "baby steps" to the final goal. As the learner gets better and better, you slowly raise the bar, repeating this cycle until the final goal is met. Some uses for the shaping technique include teaching a child how to sleep in one's bed all night, how to clean his room, how to write his name, language development, and much more. With chaining, you take a multi-step task and break it down into a sequence of smaller tasks. The learner is taught only one step at a time and is not taught any future steps until the current step has been mastered. The chaining technique could be used to teach a child how to tie a shoe, how to zip a jacket, how to brush teeth, how to get dressed, and much more.  b. Token Economy – It seeks to identify and help change potentially negative behaviors. One useful technique commonly used in behavior therapy is the "token economy". This system strengthens positive behavior and frequently therapists use it with children. For a token economy to work, criteria have to be specific and clear. Sometimes client manuals have specifications such as "how many tokens can each target behaviour earn". Sometimes the possibility of 'punishment' or 'time out' by token loss included, technically called 'response cost': disruptive behaviour can be fined with the loss of tokens. Prisoners get a token for good behaviour and the more tokens they collect, the more privileges that they can avail of. c. Modelling Therapy – According to Albert Bandura and Richard Walters (1977), the main proponents of this theory, personality is determined by repeated observation of others' behaviours. In social modelling, one person watches another person give a particular response in a situation and learns about the consequences of that response - Observational Learning. When the observer identifies with the modeler, he will decide to give the same response if he finds himself in a similar situation in the future (if the consequence was positive) or will avoid that response (if the consequence was negative). Bandura also notes that human beings are capable of SELF-REGULATION of their own behaviour. They are capable of setting their own goals and rewarding themselves when the goals are reached-SELF REINFORCEMENT. (Can recall from std XI - Attention; Retention; Reproduction process & Motivation) Therapies based on Cognitive Behaviour These are forms of therapies focused on changing distorted and maladaptive patterns of thought. What we think strongly influences what we feel and what we do. This is the basic principle of cognitive therapies. a. Rational Emotive Therapy - RET Rational Emotive Therapy was (RET) is the first form of cognitive-behavioural therapy (CBT), founded by the American psychologist Albert Ellis. Rational Emotive Therapy (RET) was misperceived by many as ignoring feelings; therefore, in order to correct this misperception, in 1961 Albert Ellis changed the name of RT into Rational Emotive Therapy (RET). According to RET, if we want to change various dysfunctional psychological outcomes (e.g., depression, mood disorders), we have to change our main cognitive determinant, namely irrational beliefs. However, although RET used a wide spectrum of behavioural techniques, it was itself misrepresented by many professionals as being "too cognitive" and ignoring the behavioral tradition. In order to correct this misrepresentation, in 1993 Albert Ellis changed the name of RET Into Rational Emotive Behaviour Therapy (REBT). b. Rational Emotive Behaviour Therapy Rational emotive behaviour therapy (REBT) is a type of cognitive behavioural therapy-CBT developed by psychologist Dr Albert Ellis and Aaron Beck.  REBT is an action-oriented approach that's focused on helping people deal with irrational beliefs and learn how to manage their emotions, thoughts, and behaviours in a healthier more realistic way. The first step in RET is the antecedent-belief-consequence (ABC) analysis Antecedents - events, which caused the psychological distress, are noted. Beliefs - The client is also interviewed to find the irational beliefs, which are distorting the present reality irrational beliefs may not be supported by empirical evidence in the environment. These beliefs are characterised by thoughts with "musts' and 'shoulds', i.e., things 'must' and 'should be in a particular manner. irrational beliefs are assessed through questionnaires and interviews. Examples of irrational beliefs are, "One should be loved by everybody all the time", "Human misery is caused by external events over which one does not have any control", etc. Consequence - This distorted perception of the antecedent event due to the irrational belief leads to the consequence, i.e. negative emotions and behaviours. gradually the client is able to change the irrational beliefs by making a change in her/his philosophy about life. The rational belief system replaces the rational belief system and there is a reduction in psychological distress. In the process of RET, the irrational beliefs are refuted by the therapist through a process of non-directive questioning. The nature of questioning is gentle, without probing or being directive. The questions make the client to think deeper into her/his assumptions about life and problems. The process looks like this: A- Activating Event - the client makes a mistake. B- Belief the client has a thought that says she is a failure and that she is not good at anything. C- Consequence - the client feels awful about her mistake and about herself in general, but she remembers that she can question the cognitive distortion. D- Disputation - she questions the thought. She tells herself that everyone makes mistakes and that one mistake does not mean she is worthless or that she is not good at anything. (example-so what if I did not get selected into the choir this time) E- New Effect - the client accepts that we all make mistakes and replace the negative thoughts with this positive thought. She commits to learning from her mistake and trying again in the future. (example- I shall try harder next time and practice better to get selected into the choir) 4. REHABILITATION: Rehabilitation in context of clinical psychology refers to the reintegration of a psychologically ill individual into mainstream society. It also includes the restoration of his/her rights, facilities and privileges which he/she would have normally enjoyed if he was not ill, convicted, or mentally challenged either physically or mentally. It works successfully in case of juvenile delinquency, the mentally challenged, socially and emotionally challenged persons and mentally disordered persons. In case of mentally challenged persons or persons with severe psychological disorder, rehabilitation programs generally have an institutional setup. These programs do not attempt to cure their disorders but rather help these persons to live a life as close as normal. Rehabilitation includes training, where the individual is taught some practical skills like how to maintain personal hygiene, interact with others, etc. Attempts are made for special education and vocational training so that he/she can sustain on his/her own in future. Rehabilitation can simultaneously treat the individual both by medical intervention and various forms of psychotherapies and counselling. It aims to change the individual's thought process and behaviour pattern through individual and or group counselling. Family and friends counselling is also organised so that the individual gets the environmental support outside the rehabilitation centre. ******