© Cengage Learning 2016 Understanding and Treating Mental Disorders 2

© Cengage Learning 2016 Model –Attempts to describe a phenomenon that cannot be directly observed –Models are intrinsically limited and cannot explain every aspect of a disorder Human behaviors are complex Models of psychopathology –Biological, psychological, social, and socio- cultural One-Dimensional Models of Mental Disorders

© Cengage Learning 2016 Highlights the fact that interactions between biological, psychological, and social factors cause mental disorders Limitations –Does not focus on how these factors interact to produce illness –Provides little guidance on treatment –Neglects the influence of culture Biopsychosocial Model

© Cengage Learning 2016 Considers the multitude of factors researchers have confirmed are associated with each disorder –Views disorders from a holistic framework Some assumptions of the multipath model –Multiple pathways and influences contribute to the development of any single disorder –Not all dimensions contribute equally Multipath Model

© Cengage Learning 2016 The Multipath Model

© Cengage Learning 2016 The Four Dimensions and Possible Pathways of Influence

© Cengage Learning 2016 Many disorders tend to be heterogeneous in nature Different combinations within the four dimensions may influence development of a particular condition –Within each dimension, distinct theories exist Same triggers or vulnerabilities may cause different disorders Aspects of the Multipath Model

© Cengage Learning 2016 The human brain –Forebrain controls all higher mental functions –Cerebrum –Cerebral cortex Prefrontal cortex helps manage attention, behavior, and emotions –Limbic system Role in emotions, decision-making, and memories Dimension One: Biological Factors

© Cengage Learning 2016 Structures in the Limbic System

© Cengage Learning 2016 Biological explanations alone are one- dimensional and linear Science increasingly rejects idea of “one gene for one disease” –Diathesis-stress theory: holds that people do not inherit a particular abnormality but rather a predisposition to develop illness Environmental forces (stressors) may activate the predisposition, resulting in a disorder Multipath Implications

© Cengage Learning 2016 The brain is composed of: –Neurons (nerve cells) Dendrites Axon –Glia cells act in supporting roles Biochemical Processes within the Brain and Body

© Cengage Learning 2016 Synaptic Transmission

© Cengage Learning 2016 Major Neurotransmitters and Their Functions

© Cengage Learning 2016 Major Neurotransmitters and Their Functions (cont’d.)

© Cengage Learning 2016 Ability of the brain to evolve and adapt Neurogenesis –Birth of new neurons Neural stem cells have capability to generate new neurons needed for new skills or experiences Chronic stress results in negative changes in brain activity –Exercise can produce positive changes Neuroplasticity

© Cengage Learning 2016 Heredity: genetic transmission of traits Chemical compounds outside the genome control gene expression –Whether or not genes are “turned on” or “turned off” Genotype and phenotype Genetic mutations Epigenetics –Biochemical activities occurring outside genes Genetics and Heredity

© Cengage Learning 2016 Differences in size of some brain structures between men and women Men and women use different brain regions for certain activities Frequency and progression of mental disorders differs –Disorders involving reactivity to stress higher among women –Disorders involving risk-taking higher among men Sex Differences in Brain Development

© Cengage Learning 2016 Psychopharmacology –Study of effects of psychotropic medications Medication categories –Anti-anxiety drugs –Anti-psychotics –Antidepressants –Mood stabilizers Biology-Based Treatment Techniques

© Cengage Learning 2016 Antidepressant categories –Selective serotonin reuptake inhibitors (SSRIs) –Tricyclic antidepressants –Monoamine oxidase inhibitors (MAOIs) –Others (buproprion) Medications do not cure mental disorders –Help alleviate symptoms Types of Medications

© Cengage Learning 2016 Electroconvulsive therapy –Induce small seizures with electricity or magnetism –Reserved for those not responding to other treatments Neurosurgical and brain stimulation treatments –Psychosurgery (removing parts of brain) Very uncommon today –Deep brain stimulation Other Biological Approaches

© Cengage Learning 2016 Model fails to consider individual’s unique circumstances Rapid growth in sale and marketing of psychotropic medications Drug-drug interactions possible Criticisms of Biological Models and Therapies

© Cengage Learning 2016 Four major perspectives –Psychodynamic –Behavioral –Cognitive –Humanistic-existential Dimension Two: Psychological Factors

© Cengage Learning 2016 The components of personality –Id: pleasure principle –Ego: realistic and rational –Superego: moral considerations (conscience) Psychosexual stages –Freud proposed that human personality largely developed during first five years of life Defense mechanisms –Protect us from anxiety Psychodynamic Models

© Cengage Learning 2016 Adler and Erickson –Suggested that the ego has adaptive abilities With the ability to function separately from the id Bowlby and Mahler –Proposed that the need to be loved, accepted, and emotionally supported is of primary importance in childhood Contemporary Psychodynamic Theories

© Cengage Learning 2016 Psychoanalysis –Objective: uncover material blocked from consciousness –Free association –Dream analysis –Effect of experiences with early attachment figures Interpersonal psychotherapy –Links childhood experiences with current relational patterns Therapies Based on the Psychodynamic Model

© Cengage Learning 2016 Fails to address cultural and social influence –Freud relied on case studies and self-analysis His parents represented a narrow spectrum of society Far fewer outcome studies exist compared to other models May not be useful with certain people (less talkative, etc.) Criticism of Psychodynamic Models and Therapies

© Cengage Learning 2016 Concerned with the role of learning in development of mental disorders Based on experimental research Three paradigms –Classical conditioning (Ivan Pavlov) –Operant conditioning (B. F. Skinner) –Observational learning (Albert Bandura) Behavioral Models

© Cengage Learning 2016 Exposure therapy –Graduated exposure –Flooding –Systematic desensitization Social skills training Criticisms of behavioral models and therapies –Often neglect inner determinants of behavior Behavioral Therapies

© Cengage Learning 2016 Focus on observable behaviors –Also on how thoughts influence emotions and behaviors Beck and Ellis –A-B-C theory of emotional disturbance A is an event C is a person’s reaction B are the person’s beliefs about A, which causes reaction C Cognitive-Behavioral Models

© Cengage Learning 2016 Ellis’s A-B-C Theory of Personality

© Cengage Learning 2016 Nonreactive attention to emotions can reduce their power to create distress Mindfulness –Conscious attention to the present Dialectical behavior therapy (DBT) –Supportive and collaborative therapy –Therapists reinforce positive actions and avoid reinforcing maladaptive behaviors Acceptance and commitment therapy (ACT) Third-Wave Cognitive-Behavioral Therapies

© Cengage Learning 2016 Behaviorists –Psychology is about observable behaviors (Watson) –Cognitions are not observable phenomena (Skinner) The authority role of therapist –The power to identify irrational beliefs may intimidate clients Criticisms of the Cognitive-Behavioral Models and Therapies

© Cengage Learning 2016 Emphasize the whole person Acknowledge the role of free will Humanistic perspective (Carl Rogers) –Humans are basically good, forward-moving, and trustworthy Maslow’s concept of self-actualization –The inherent tendency to strive for full potential Humanistic Models

© Cengage Learning 2016 A set of attitudes in the context of the human condition –Focuses on challenges encountered by all humans –Responsibility to ourselves and others The Existential Perspective

© Cengage Learning 2016 Person-centered therapy –Human need for unconditional positive regard –Provides an accepting therapeutic environment Existential therapy –Rooted in philosophy and universal challenges of humanity –Clients become aware of choices they have made More able to choose a new direction Humanistic and Existential Therapies

© Cengage Learning 2016 Fuzzy, ambiguous nature Lack of scientific grounding –Not suited to scientific investigation Rely on people’s unique, subjective experiences Do not explain many mental disorders Do not address cultural or social factors Criticisms of Humanistic-Existential Therapies

© Cengage Learning 2016 Social-relational models –Healthy relationships are important for human development and functioning Provide many intangible benefits –When relationships are dysfunctional or absent, individuals are more vulnerable to mental distress Dimension Three: Social Factors

© Cengage Learning 2016 Family systems model –Behavior of one family member affects entire family system –Characteristics Personality development strongly influenced by family characteristics Mental illness reflects unhealthy family dynamics and poor communication Therapist must focus on family system, not just an individual Family, Couples, and Group Perspectives

© Cengage Learning 2016 Conjoint family therapeutic approach –Stresses importance of teaching message- sending and message-receiving skills to family members Strategic family approaches –Consider family power struggles and move towards more healthy distribution Structural family approaches –Reorganizes family in relation to level of involvement with each other Social-Relational Treatment Approaches

© Cengage Learning 2016 Couples therapy –Aimed at helping couples understand and clarify their communication, needs, roles, and expectations Group therapy –Initially strangers Share certain life stressors –Provides supportive environment –Allows therapist to observe patient’s actual social interactions Couples and Group Therapy

© Cengage Learning 2016 Studies have generally not been rigorous in design Cultural diversity is not adequately addressed Family systems models may have negative consequences –Parental influence may not be a factor in an individual’s disorder but are burdened with guilt Criticisms of Social-Relational Models

© Cengage Learning 2016 Emphasizes importance of several factors in explaining mental disorders –Race –Ethnicity –Gender –Sexual orientation –Religious preference –Socioeconomic status –Other factors Dimension Four: Sociocultural Factors

© Cengage Learning 2016 Higher prevalence of depression and eating disorders among women –Women are subjected to more stress than men Largely due to societal roles Exposure to sexual harassment –Begins during middle school –Affects well-being and learning Gender Factors

© Cengage Learning 2016 Lower socioeconomic class associated with: –Limited sense of personal control –Poorer physical health –Higher incidence of depression Life in poverty subjects people to multiple stressors –Fulfilling life’s basic needs Socioeconomic Class

© Cengage Learning 2016 Acculturative stress –Associated with challenges of moving to a new country –Loss of social support –Hostile reception –Educational and employment challenges –Most common among first generation immigrants and their children Immigration and Acculturative Stress

© Cengage Learning 2016 Two early models –Inferiority model –Deficit model Multicultural model –Emerged in the 1980s and 1990s Sociocultural conditions in treatment –Therapists need to be careful not to assume that the patient shares traits common to the group Race and Ethnicity

© Cengage Learning 2016 Critics see a disorder as a disorder –Regardless of culture –Example: some believe hallucination is always undesirable Can be considered desirable by some American Indian or Hispanic/Latino groups Relies heavily on case studies Questions are asked based on a Western worldview Criticisms of the Multicultural Model and Related Therapeutic Techniques

© Cengage Learning 2016 All perspectives have strengths and weaknesses Evidence-based understanding of mental disorders has evolved Diathesis-stress theory –Predisposition to develop illness is inherited Cultural neuroscience –Study of how culture shapes biology and how biology shapes culture Contemporary Trends and Future Directions

© Cengage Learning 2016 What models of psychopathology have been used to explain abnormal behavior? What is the multipath model of mental disorders? How is biology involved in mental disorders? How do psychological models explain mental disorders? Review

© Cengage Learning 2016 What role do social factors play in psychopathology? What sociocultural factors influence mental health? Why is it important to consider mental disorders from a multipath perspective? Review (cont’d.)