© cengage learning 2016 understanding and treating mental disorders 2

© Cengage Learning 2016 © 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


• 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


• 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


The Multipath Model


The Four Dimensions and Possible Pathways of Influence


• 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


• 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


Structures in the Limbic System


• 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


• The brain is composed of:– Neurons (nerve cells)

• Dendrites

• Axon

– Glia cells act in supporting roles

Biochemical Processes within the Brain and Body


Synaptic Transmission


Major Neurotransmitters and Their Functions


Major Neurotransmitters and Their Functions (cont’d.)


• 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


• 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


• 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


• Psychopharmacology– Study of effects of psychotropic medications

• Medication categories– Anti-anxiety drugs

– Anti-psychotics

– Antidepressants

– Mood stabilizers

Biology-Based Treatment Techniques


• 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


• 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


• 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


• Four major perspectives– Psychodynamic

– Behavioral

– Cognitive

– Humanistic-existential

Dimension Two: Psychological Factors


• 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


• 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


• 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


• 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


• 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


• Exposure therapy– Graduated exposure

– Flooding

– Systematic desensitization

• Social skills training

• Criticisms of behavioral models and therapies– Often neglect inner determinants of behavior

Behavioral Therapies


• 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


Ellis’s A-B-C Theory of Personality


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• Emphasizes importance of several factors in explaining mental disorders – Race

– Ethnicity

– Gender

– Sexual orientation

– Religious preference

– Socioeconomic status

– Other factors

Dimension Four: Sociocultural Factors


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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.)

© cengage learning 2016 understanding and treating mental disorders 2

Documents