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Chapter 15 Abnormality, Therapy, and Social Issues


Chapter 15 Abnormality, Therapy, and Social Issues Module 15.1 Abnormal Behavior: An Overview Abnormality, Therapy and Social Issues What is abnormal? – PowerPoint PPT presentation

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Title: Chapter 15 Abnormality, Therapy, and Social Issues

Chapter 15Abnormality, Therapy, and Social
Module 15.1
  • Abnormal Behavior An Overview

Abnormality, Therapy and Social Issues
  • What is abnormal?
  • It seems simple there is normal and abnormal
  • The distinction between normal and weird is
    clear to everyone. Isnt it?
  • Define abnormal
  • Behavior must be interpreted in its context.
  • Normal is a matter of place and time as well as
    mental state and action.

Defining Abnormal Behavior
  • No definition of abnormal that cant be
  • Example subjective feelings of distress
  • Anyone who thinks they have a problem
    automatically qualifies.
  • What about people who behave in bizarre and
    dangerous ways, but insist they are fine?
  • Examplebehavior that could result in suffering
    or death
  • heroic deeds would be a bona fide symptom.
  • Example behavior that is very different from
    the usual
  • very depressed people would be diagnosed,
  • but so would very happy people.

APA definition of abnormal behavior
  • The American Psychiatric Association
    characterizes abnormal behavior as "behavior that
    leads to distress (pain), disability (impaired
    functioning), or an increased risk of death,
    pain, or loss of freedom."
  • Even this definition has problems
  • Heroic behavior sometimes leads to death does
    that make it abnormal?
  • Does everyone who reports psychological distress
    actually have a psychological problem?
  • Some people whose behavior appears to be
    seriously disordered report no distress at all.
  • It is safest to reserve official psychiatric
    diagnoses for people whose mental problems
    seriously interfere with their daily lives.

Cultural influences on abnormality
  • Abnormality is culturally defined, to some
  • Each era and society has had its own
    interpretations of abnormal behavior.
  • Culture-specific disorders are found all over the
  • Demonic possession has been a common diagnosis in
    some societies for thousands of years.
  • Running amok consists of episodes of
    indiscriminant violent behavior in young
    Southeast Asian men.
  • Social Anxiety US vs. Japan

Cultural influences on abnormality
  • Dissociative Identity Disorder (aka Multiple
    Personality Disorder, split personality)
  • There is alternation between two or more
  • Each has its own disposition, behavior, and name,
    as if each were a separate person.
  • Very rare disorder until the 1950s, when a few
    cases received widespread publicity.(Three Faces
    of Eve, Sybil)
  • By the early 1990s there were many cases of DID
  • Some observers began to claim that the disorder
    did not exist at all.
  • It is most likely that it was being promoted by
    over eager therapists.

Defining Abnormal Behavior
  • The biopsychosocial model -- 3 major factors to
    understanding mental illness
  • Biological roots - include genetic factors,
    injury, disease processes, and the like which
    result in abnormal brain development, damage,
    imbalances of neurotransmitters and hormones, all
    of which can result in abnormal behavior.
  • Psychological roots an individuals life
    history and experiences contribute to his or her
    ability to cope and degree of vulnerability to
  • Social and cultural context people are greatly
    influenced by how other people act toward them
    and the expectations people hold for them.

  • Most of us feel sad, anxious, or angry
  • Our moods change, we have or develop bad habits,
    and we have funny beliefs.
  • Mental health diagnoses are reserved for people
    with problems that seriously interfere with their

  • Diagnostic and Statistical Manual of Mental
    Disorders (DSM-IV-TR)
  • describes specific symptoms and diagnostic
    guidelines for psychological disorders
  • Provides a common language to label mental
  • Comprehensive guidelines to help diagnose mental

Background of DSM
  • First published by APA in 1952
  • Used as a resource by the majority of mental
    health professionals.
  • In earlier editions, many clinicians considered
    it merely a tool for researchers.
  • Now, in an era of managed care, clinicians often
    forced to rely on standardized criteria in DSM to
    support insurance claims or legal defenses.
  • While widely used as a resource the DSM is not a
    substitute for a clinical diagnosis
  • The DSM provides diagnostic categories and
    criteria for their diagnoses. The proper use of
    these requires clinical training, knowledge and
    skills to apply them.

Classifying Psychological Disorders
  • The DSM-IV
  • Diagnosis is made along five axes (lists).
  • A person can have one or more diagnoses on a
    given axis, or none at all.
  • Clinical disorders are diagnosed on Axis
    I--mental disorders that arise after infancy and
    are viewed as deteriorations in overall mental
  • Most common psychological disorders are listed on
    Axis I.

  • Table 15.1 Some major categories of psychological
    disorders according to Axis I of DSM-IV.

Classifying Psychological Disorders
  • The DSM-IV
  • Axis II is reserved for personality disorders and
    mental retardation.
  • These are disorders that persist throughout life.
  • A personality disorder is a maladaptive,
    inflexible way of dealing with situations and

  • Table 15.2 Some major categories of psychological
    disorders according to Axis II of DSM-IV.

Classifying Psychological Disorders
  • The DSM-IV
  • Axis III is for general medical conditions that
    may influence the persons mood or behavior.
  • Axis IV is for psychosocial and environmental
    problems that may increase the persons level of
  • Axis V is a 1-90 scale called the global
    assessment of functioning. The lower the number
    assigned by the assessing clinician, the less
    likely it is that the person being diagnosed is
    able to function without treatment and support.

Classifying Psychological Disorders
  • Differential diagnosis
  • disorders often have similar or overlapping
  • Psychologists and psychiatrists are trained to
    make differential diagnoses.
  • They look at all the disorders with similar
    symptoms that listed in the DSM-IV as well as
    disorders that are purely medical but affect mood
    and behavior.
  • They either rule these disorders out or revise
    their original diagnosis based on the information
    they have gathered.
  • This may take place over time.

Classifying Psychological Disorders
  • Criticisms of DSM-IV
  • 1) distinguishing normal from abnormal behaviors
    can be pretty arbitrary
  • E.g., having symptom for 5 months vs. 6 months
  • 2) Difficult to judge marginal or very mild cases
  • 3) Some people still do not fit neatly into any
    diagnostic category.
  • 4) Sometimes DSM treats problems of adjustment
    (i.e., to a new situation or change in ones
    life) as mental health problems.
  • Pressure to make diagnoses - leading to the worry
    that normal concerns are being turned into
    psychiatric conditions.

Criticisms of DSM-IV (continued)
  • 5) Criteria for Mental disorders are influenced
    by culture and history
  • While widely accepted among psychologists and
    psychiatrists, the manual has proved
    controversial in choices for what constitutes a
    mental disorder.
  • E.g., DSM-II classified homosexuality as a mental
    disorder, a classification that was removed by
    vote of the APA in 1973
  • Even the definition of what counts as a
    disorder (I.e. that it causes distress) was
    influenced by the debate on homosexuality. By
    defining disorder as something that caused
    distress, homosexuality itself was removed and
    Sexual Orientation Disorder was added for
    homosexuals who were unhappy about being gay.

How Common are Psychological Disorders?
  • Figure 15.1 According to one survey, about half
    the people in the United States will suffer at
    least one psychological disorder at some time.
    (Based on data of Kessler et al., 1994

How Common are Psychological Disorders?
  • Approximately 48 of adults experienced symptoms
    at least once in their lives
  • Approximately 80 who experienced symptoms in the
    last year did NOT seek treatment
  • 2 ways of interpreting this
  • There is a stigma associated with receiving a
    mental health diagnosis.
  • Many people who could benefit from treatment do
    not seek it
  • Most people seem to deal with symptoms without
    complete debilitation

Module 15.2
  • Psychotherapy An Overview

  • Psychotherapy is a treatment of psychological
    disorders by methods that include an ongoing
    relationship between a trained therapist and a
  • Psychotherapy is utilized for a wide variety of

Types of Therapy
  • Psychotherapyuse of psychological techniques to
    treat emotional, behavioral, and interpersonal
  • Based on assumption that psychological factors
    play a significant role in troubling feelings,
    behaviors, or relationships
  • Biomedicaluse of medications and other medical
    therapies to treat the symptoms associated with
    psychological disorders
  • Based on assumption that symptoms of many
    psychological disorders involve biological
    factors, such as abnormal brain chemistry
  • Treating psychological disorders with a
    combination of psychotherapy and biomedical
    treatments is increasingly common

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  • Psychotherapy
  • Psychoanalytic/Psychodynamic
  • Humanistic
  • Behavioral
  • Cognitive
  • Other (group, family, couples, etc.)

  • Developed by Sigmund Freud based on his theory of

Freuds view of the mind
  • conscious-- what youre aware of, can verbalize
    and think about in a logical fashion.
  • preconscious -- ordinary memory. Not conscious,
    but can be easily brought into conscious.
  • unconscious -- not directly accessible. A dump
    box for urges, feelings and ideas that are tied
    to anxiety, conflict and pain. These feelings and
    thoughts still exert influence on our actions and
    our conscious awareness.

Defense Mechanisms
  • Defense mechanisms come into play to prevent
    undesirable urges or conflicts
  • E.g., repression--pulling into the unconscious
  • For example forgetting sexual abuse from your
    childhood due to the trauma and anxiety

Causes of Psychological Problems
  • Undesirable urges and conflicts are repressed
    or pushed to the unconscious
  • Unconscious conflicts exert influence on
    behaviors, emotions, and interpersonal dynamics
  • Understanding and insight into repressed
    conflicts leads to recognition and resolution
  • Goal of Pyschoanalysis--unearth past problems so
    patient gains insight into real source of problems

How to reveal the unconscious
  • Unconscious sometimes reveals itself in disguise
  • Dreams
  • Memory lapses
  • Slips of the tounge
  • Accidents (spilling hot coffee on someone you

Techniques of Psychoanalysis
  • Free associationspontaneous report of all mental
    images, thoughts, feelings as a way of revealing
    unconscious conflicts
  • Resistancepatients unconscious attempt to block
    revelation of unconscious material usually sign
    that patient is close to revealing painful

More Psychoanalytic Techniques
  • Dream interpretationdreams are the royal road
    to the unconscious interpretation often reveals
    unconscious conflicts
  • Some symbols in dreams and their potential
  • queen and king or empress and emperor
  • father and mother
  • knives, daggers, lances, sabers, swords, guns,
    rifles, revolvers, cannons
  • a phallus
  • mountains, rocks, sticks, umbrellas, poles,
  • a phallus
  • shafts, pits, caves, bottles, boxes, suitcases,
    tins, pockets, closets, stoves, ships
  • female genitalia
  • Apples, peaches and fruits in general
  • breasts
  • playing instruments, sliding, slipping and
    breaking branches
  • masturbation
  • teeth falling out or getting pulled
  • castration (as punishment for masturbation)

More Psychoanalytic Techniques
  • Transferenceprocess where emotions originally
    associated with a significant person are
    unconsciously transferred to the therapist

How psychoanalytic techniques work
  • Goal is to help patient see how past conflicts
    influence present behavior
  • Once insight is achieved therapist helps patient
    work through and resolve conflicts
  • As conflicts are resolved maladaptive behaviors
    driven by conflicts can be replaced with more
    adaptive emotional and behavioral patterns

Other Dynamic Therapies
  • Traditional psychoanalysis is seldom practiced
  • Most therapies today are shorter-term (e.g., a
    few months)
  • Based on goals that are specific and attainable
  • Therapists are more directive than traditional
  • Therapist still uses interpretations to help
    patient recognize hidden feelings and

Interpersonal therapy (IPT)
  • a particularly influential short-term
    psychodynamic therapy
  • focuses on current relationships and social
    interactions and is highly structured.
  • IPT therapy model,
  • four categories of personal problems
  • unresolved grief--dealing with death of
    significant other
  • role disputes--repeating conflicts with
    significant others
  • role transitions--problems with major life change
  • interpersonal deficits--absent or faulty social
  • phases of treatment,
  • 1 the therapist identifies the interpersonal
    problem that is causing difficulties
  • 2 therapist helps the person understand his or
    her particular interpersonal problem and develop
    strategies to resolve it.

Humanistic Therapies
  • Humanistic perspective emphasizes human
    potential, self-awareness, and free-will
  • Humanistic therapies focus on self-perception and
    individuals conscious thoughts and perceptions
  • Client-centered (or person-centered) therapy is
    the most common form of humanistic therapy
  • Carl Rogers (19021987)developed this technique

Client-Centered Therapy
  • Therapy is non-directivetherapist does not
    interpret thoughts, make suggestions, or pass
  • Therapy focuses on clients subjective perception
    of self and environment
  • Does not speak of illness or cure

Therapeutic Conditions
  • Genuinenesstherapist openly shares thoughts
    without defensiveness
  • Unconditional positive regard for clientno
    conditions on acceptance of person
  • Empathic understandingcreates a psychological
    mirror reflecting clients thoughts and feelings

Behavior Therapy
  • Behavioristic perspective emphasizes that
    behavior (normal and abnormal) is learned
  • Uses principles of classical and operant
    conditioning to change maladaptive behaviors
  • Behavior change does not require insight into
  • Often called behavior modification

  • Figure 15.4 A child can be trained not to wet the
    bed by using classical conditioning techniques.
    At first, the sensation of a full bladder (the
    CS) produces no response, and the child wets the
    bed. This causes a vibration or other alarm (the
    UCS), and the child wakes up (the UCR). By
    associating the sensation of a full bladder with
    a vibration, the child soon begins waking up to
    the sensation of a full bladder alone and will
    not wet the bed.

Systematic Desensitization
  • Based on classical conditioning
  • Uses three steps
  • Progressive relaxation
  • Development of anxiety hierarchy and control
  • Combination of progressive relaxation with
    anxiety hierarchy

Sample Anxiety Hierarchy
Token Economy
  • Based on operant conditioning
  • Use for behavior modification in group settings
    (prisons, classrooms, hospitals)
  • Has been successful with severely disturbed
  • Difficult to implement and administeresp. in
    outpatient situations

Therapies That Focus on Thoughts and
BeliefsCognitive Therapy
  • Based on the assumption that psychological
    problems are due to maladaptive patterns of
  • Therapy focuses on recognition and alteration of
    unhealthy thinking patterns

Rational Emotive Therapy (RET)
  • Developed by Albert Ellis
  • ABC model
  • Activating Event
  • Beliefs
  • Consequences
  • Identification and elimination of core irrational

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Cognitive Behavioral Therapy
  • Integrates cognitive and behavioral techniques.
    Based on the assumption that thoughts, moods, and
    behaviors are interrelated

Prevalence of Cognitive Therapy
Half of all faculty in accredited clinical
psychology doctoral programs now align themselves
with a cognitive or cognitive-behavior therapy
orientation. (Data from Mayne others, 1994.
Note Some faculty identify with more than one
Concept Check
  • In which type of therapy would the therapist be
    most likely to interpret a thought, feeling or

Concept Check
  • In which therapies are treatment goals stated in
    clear and specific terms?

Behavioral and cognitive-behavioral
Concept Check
  • In which therapy is the client viewed as
    essentially good and wishing to achieve full
    potential in life?

Person-centered (humanistic)
Other Trends Group and Family Therapy
  • One limitation of individual therapies is that
    client is seen in isolation rather than in
    context of interactions with others
  • Therapist must rely on clients interpretation of
  • Group and Family Therapies (Family Systems
    Therapies) address this limitation
  • Types
  • Group therapyOne or more therapists working with
    several people at the same time.
  • Family therapybased on the assumption that the
    family is a system and treats the family as a
  • Couple therapyrelationship therapy that helps
    with difficulty in marriage or other committed

Group Therapy
  • Group can be as small as 3 or 4 or as large as 10
    or more
  • Any approach can be used
  • Advantages
  • Cost effective
  • Therapist observes interactions with others
  • Support and encouragement from others (success
    often hinges on groups sense of cohesion)
  • Advice from group members
  • Safe environment to try out new behaviors
  • Group vs. self-help/support groups
  • Typically conducted by nonprofessionals

Family Therapy
  • Assumption family is a system-- treat the family
    as a unit
  • Psychologically healthier family leads to
    healthier individuals
  • Every family has certain unspoken rules of
    interaction and communication (e.g., who asserts
    power and how, who makes decisions, who is the
  • Unhealthy patterns of family interaction can be
    identified and replaced with new rules that
    promote the psychological health of the family.
  • Often used to enhance individual therapies
  • E.g., schizophrenics are less likely to relapse
    when family is involved in therapy

Couple Therapy
  • Many different types
  • Most share common goals
  • improving communication and problem-solving
    skills and
  • increasing intimacy between the pair

Effectiveness of Psychotherapy
  • Most people do not seek help with problems
  • Some cope with help of family and friends
  • Many people report spontaneous remission--improvin
    g with the passage of time
  • Meta-analyses show that psychotherapy is more
    effective than no treatment
  • On average person who completes therapy is better
    off than 80 of those who do not
  • Gains tend to last long after therapy has ended

  • Improvement for people in weekly psychotherapy
    and people who did not receive psychotherapy.
  • After 8 weekly sessions more than 50 receiving
    therapy were significantly improved compared to
    4 of those not receiving therapy
  • Clearly, psychotherapy accelerates both the rate
    and the degree of improvement for those
    experiencing psychological problems. SOURCE
    McNeilly Howard, 1991.

Is one form of psychotherapy better?
  • Answer 1 No -- in general there is little or no
    difference in the effectiveness of different
    empirically supported psychotherapies
  • Answer 2 Yes -- in some cases one type of
    therapy is more effective than another for
    treating a particular problem
  • E.g.,
  • Depression --
  • cognitive therapy
  • Panic disorder, OCD, phobias
  • cognitive, behaviorist, CBT gt insight oriented
  • Disorders with severe psychotic symptoms (e.g.,
  • insight oriented therapies lt other therapies

What might explain similarities in overall
positive results across approaches?
  • Common Factors in Successful Therapy
  • Therapeutic relationshipcaring and mutually
  • Therapist characteristicscaring attitude,
    ability to listen empathetically, sensitive,
    committed to patients welfare
  • Client characteristicsmotivated, actively
    involved, emotionally and socially mature
  • External circumstances -- stable living
    situation, supportive family

  • A good match between person and type of therapy
    is important
  • Current trend in psychotherapy is
    Eclecticism--pragmatic and integrated use of
    techniques from different psychotherapies.
  • Today therapists identify themselves as eclectic
    more than any other orientation
  • Eclectic psychotherapists carefully tailor the
    therapy approach to the problems and
    characteristics of the person seeking help.

Finding the Best Therapy
  • Research suggests that the various methods of
    therapy and professionals who provide services
    are about equally effective. There is no best
    type of therapist or best method.
  • But no one way of doing psychotherapy is right
    for every client. You need to use your knowledge
    to shop for the therapist who will work best
    with you.