CHAPTER 3

MODELS OF ABNORMALITY

BIOLOGICAL MODEL

Points to physical causes of abnormal behavior (biochemical and bioelectrical processes) and
seeks physical methods of treatment (biological causes in the brain)

Nervous System (neurotransmitters)

Depression: low serotonin, norepinephrine and glutamate neurotransmitters

Endocrine System (hormones)

Endocrine glands work with neurons to control growth, reproduction, sexual activity, heart
rate, body temperature, and responses to stress.

Ex. Adrenal glands, during stress, secrete cortisol (abnormal secretion of it linked to stress and
anxiety)

BRAIN ANATOMY AND CIRCUITRY

A brain circuit is a network of particular brain structures that work together, triggering each
other into action to produce a distinct behavioral, cognitive, or emotional reaction.

Proper interconnectivity (communication) among the structures of a circuit tends to result in

healthy psychological functioning, whereas flawed interconnectivity may lead to abnormal
functioning.

One of the brain’s most important circuits is the “fear circuit” consists of a number of specific
structures (including the prefrontal cortex, anterior cingulate cortex, insula, and amygdala)

Studies suggest that this circuit functions improperly (that is, displays flawed interconnectivity)
in people suffering from certain anxiety disorders (Fullana et al., 2020).

Possible Factors in malfunctioning circuitry: prenatal events, brain injuries, viral infections,
environmental experiences, stress.
Biological model focuses on: genetics and evolution.

GENETICS: Each cell – 23 pairs of chromossomes. Each cromossome made um of numerous

genes.

BIOLOGICAL TREATMENTS

Look into family history (search for same abnormal patterns – ex.: mother once hospitalized
for depression)
Was the behavior triggered by any events (ex. Having a drink when went into fit of jealousy)

LEADING BIOLOGICAL TREATMENTS TODAY

Drug therapy (most comon), brain stimulation, psychosurgery

DRUG THERAPY

1950 – discovery of PSYCHOTROPICS (affects emotions and thought processes)

Problem: overused; do not help all

FOUR MAJOR PSYCHOTROPIC DRUG GROUPS USED IN THERAPY:

ANTIANXIETY DRUGS (anxiolytic, minor tranquilizers): help reduce tension and anxiety;

ANTIDEPRESSANTS: help improve the functioning of people with depression and certain other
disorders.

ANTIBIPOLAR DRUGS (mood stabilizers), help steady the moods of those with a bipolar
disorder, a condition marked by mood swings from mania to depression.

ANTIPSYCHOTIC DRUGS: reduce the confusion, hallucinations, and delusions that often
accompany psychosis, a loss of contact with reality found in schizophrenia and other disorders.

BRAIN STIMULATION
Interventions that directly or indirectly stimulate certain areas of the brain.

Electroconvulsive therapy (ECT): oldest (and most controversial); used primarily on severely
depressed people. Two electrodes are attached to a patient’s forehead, and an electrical
current of 65 to 140 volts is passed briefly through the brain. The current causes a brain
seizure that lasts up to a few minutes. After seven to nine ECT sessions, spaced two or three
days apart, many patients feel considerably less depressed. (still used in patients who do not
respond to drug treatments)
Transcranial magnetic stimulation (TMS)
Vagus nerve stimulation (VNS)

PSYCHOSURGERY (Only after years of depression persist without response to drug treatment)
Lobotomy
deep brain stimulation (combination of psysurgery and brain stimulation)

ASSESSING THE BIOLOGICAL MODEL

Today it is a respected approach. HOWEVER:

Our mental life is an interplay of biological and nonbiological factors, and it is important to
understand that interplay rather than to focus on biological variables alone.
SIDE EFFECTS TO WEIGHT AGAINST BENEFIT OF THE TREATMENT

THE PSYCHODINAMIC MODEL

Psychodynamic theorists believe that a person’s behavior, whether normal or abnormal, is

determined largely by underlying psychological forces of which the individual is not consciously
aware. These internal forces are described as dynamic — that is, they interact with one
another — and their interaction gives rise to behavior, thoughts, and emotions. Abnormal
symptoms are viewed as the result of conflicts between these forces.

DETERMINISTIC: assumption that no symptom or behavior is “accidental”: all behavior is

determined by past experiences.

FREUD – formulates psychodynamic model – psychoanalysis - to explain both normal and

abnormal behavior, and equivalent treatment (conversational)

3 central forces (interactive and unconscious) that shape personality:

Id: instinctual needs, drives, and impulses. Operates according to pleasure principle. To Freud,
all id instincts tend to be sexual, and libido (sexual energy) is what fuels the Id.

Ego: part that realizes reality principle (not every one of our instinctual needs are going to be
met by environment), and separates from the Id – also seeks gratification, but according to
reality principle
ego defense mechanisms = strategies to to control unacceptable id impulses and avoid or
reduce the anxiety they arouseREPRESSION.

Super-Ego: personality force that operates by the morality principle, a sense of what is right
and what is wrong. Usually shaped by the parent’s values absorbed by the child.

THE THREE ARE ALWAYS IN TENSION, however, A HEALTHY PERSONALITY is one in which an
effective working relationship, an acceptable compromise, has formed among the three forces.
If the id, ego, and superego are in excessive conflict, the person’s behavior may show signs of
dysfunction.

Defense mechanisms

REPRESSION
DENIAL
PROJECTION
RACIONALIZATION
DISPLACEMENT
INTELLECTUALIZATION
REGRESSION

DEVELOPMENTAL STAGES
At each stage of development, from infancy to maturity, new events challenge individuals and
require adjustments in their id, ego, and superego. If the adjustments are successful, they lead
to personal
growth. If not, the person may become fixated, or stuck, at an early stage of development.

Oral stage – 0-18monts

Anal (18 months to 3 years of age),
phallic (3 to 5 years),
latency (5 to 12 years)
genital (12 years to adulthood)

OTHER PSYCHODINAMIC THEORIES

(split from the Vienna school) – but all hold to Freud’s premise that human functioning is
shaped by dynamic (interacting) psychological forces.

Self theorists: emphasize the role of the self — the unified personality. Basic human motive is
to strengthen the wholeness of the self

Object relations theorists: propose that people are motivated mainly by a need to have
relationships with others and that severe problems in the relationships between children and
their caregivers may lead to abnormal development.

PSYCHODINAMIC THERAPIES AND TECHNIQUES

Seek to uncover past traumas and the inner conflicts that have resulted from them and try to
help clients resolve, or settle, those conflicts and to resume personal development.

FREE ASSOCIATION

THERAPIST INTERPRETATION
Sharing interpretations when feel patient is ready to hear it.
Interpretations of three phenomena are particularly important — resistance, transference, and
dreams.
Freud: defense mechanisms are less operant in dreams

CATHARSIS: insight must be emotional as well as intellectual, patients should experience

catharsis, a relieving of past repressive feelings

WORKING THROUGH: single catharsis not enough, issue must be constantly revisited, gaining
ever more clarity;

CURRENT TRENDS

Short term psychodynamic therapies: patients choose a single problem — a dynamic focus —
to work on, such as difficulty getting along with other people. The therapist and patient focus
on this problem throughout the treatment and work only on the psychodynamic issues that
relate to it.

Relational Psychoanalytical therapy: therapists are key figures in the lives of patients —
figures whose reactions and beliefs should be included in the therapy process; therapists
should also disclose things about themselves, particularly their own reactions to patients, and
try to establish more equal relationships with patients. (Ex Goodwill hunting)

Assessing Psychodinamic Model

Helped us understand that normal and abnormal behavior may be rooted in the same causes
Psychological conflict as a common experience (only excess becomes problematic)
First to apply theory systematically to treatment
Shortcommings:
Concepts hard to research (id, ego, superego processes happening at unconscious level… how
to be sure they are happening?
Psychodynamic theorists rely largely on individual case studies;
COGNITIVE BEHAVIORAL MODEL

 Focuses on the behaviors people display and the thoughts they have.
 Is interested in the interplay between behaviors and thoughts — how behavior affects
thinking and how thinking affects behavior.
 Is concerned with the impact the behavior– cognition interplay often has on feelings
and emotions.

Behavior can be external – going to work – or internal – having a feeling

Clinicians developed cognitive-behavioral theories of abnormality that took both behaviors

and cognitive processes into account, and cognitive-behavioral therapies that sought to
change both counterproductive behaviors and dysfunctional ways of thinking

Behavioral Dimension:

Behavior is learned by Conditioning

Classical Conditioning: “association” (two stimuli repeatedly occurring together close in time)
ex: kid who has painful experience of shots given by doctor in white apron develops phobia of
white aprons.
Modeling: learn behavior by observing other people’s reactions to things (ex. Father always
reacting frightfully around dogs… kid develops fear of dogs)
Operant Conditioning: behavior learned due to consequences of it – Reinforcements =
rewards or punishment

Therapists will apply these forms of conditioning to help change the behavior of their clients;

COGNITIVE DIMENSION

Cognitive abilities — special intellectual capacities to think, remember, and anticipate.

Clinicians must ask questions about the assumptions and attitudes that color a client’s
perceptions, the thoughts running through that person’s mind, and the conclusions to which
the assumptions and thoughts are leading.
Abnormal functioning can result from several kinds of cognitive problems. Some people may
make assumptions and adopt attitudes that are disturbing and inaccurate

Illogical thinking processes are another source of abnormal functioning, according to

cognition-focused theorists. Beck has found that depressed people consistently think in
illogical ways and keep arriving at self-defeating conclusions. (Overgeneralizing, for instance:
During divorce problem: I’m a failure… (overlooks all other areas of life in which they are a
success)

In treatment, cognition-focused therapists use several strategies to help people with

psychological disorders adopt new, more functional ways of thinking. They guide depressed
clients to identify and challenge any negative thoughts, biased interpretations, and errors in
logic that dominate their thinking and contribute to their disorder. The therapists also guide
the clients to try out new ways of thinking in their daily lives.

Cognitive Behavioral Interplay

Ex: Social Anxiety Disorder: severe anxiety about social situations in which they may face
scrutiny by other people.

Behavior: perform “avoidance” and “safety” behaviors: avoid speaking in public, reject social
opportunities, limit their lives in many ways, wear excessive make-up tp cover up feelings in
social situations…

Cognitive: have a series of believes and expectations such as:

Holding unrealistically high social standards and so believing that they must perform perfectly
in social situations.
_ Viewing themselves as unattractive social beings.
_ Viewing themselves as socially unskilled and inadequate.
_ Believing they are always in danger of behaving incompetently in social situations.
_ Believing that inept behaviors in social situations will inevitably lead to terrible
consequences.

Treatment approach:

Therapists combine several techniques, including exposure therapy: Therapist encourage

clients to immerse themselves in various dreaded social situations and to remain there until
their fears subside. Usually the exposure is gradual. Then, using a cognitive-focused
intervention, the clinicians and clients reexamine and challenge the individuals’ maladaptive
beliefs and expectations in light of the recent social encounters.

NEW WAVE COGNITIVE BEHAVIORAL THERAPIES

New approaches, including the increasingly used acceptance and commitment therapy (ACT),
help clients to accept many of their problematic thoughts rather than judge them, act on
them, or try fruitlessly to change them;

Use of MINDFULNESS techniques: pay attention to the thoughts and feelings that are flowing
through their minds during meditation and to accept such thoughts in a nonjudgmental way.

Assessing Cognitive Behavioral Model

Can be tested in the laboratory - stimulus, response, reward, attitude, and interpretation can
be observed and measured;
People with psychological disorders often display the kinds of reactions, assumptions, and
errors in thinking that cognitive-behavioral theorists would predict;
Both in the laboratory and real life, cognitive behavioral therapies have proved very helpful to
many people with anxiety disorders, depression, sexual dysfunction, intellectual disability, and
yet other problems;
Shortcommings:
Does not necessarily identify/treat CAUSES: The problematic behaviors and cognitions seen in
psychologically troubled people could well be a result rather than a cause of their difficulties.
Although cognitive-behavioral therapies are clearly of help to many people, they do not help
everyone.
Focusing primarily on clients’ current experiences and functioning: pay little attention to the
influence of early life experiences and relationships on a client’s current difficulties or other
issues (existential) such as how people approach life, what value they extract from it, and how
they deal with the question of life’s meaning.

HUMANISTIC-EXISTENTIAL MODEL
Both models share view that humans are more than cognitive-behavior processes: have the
ability to pursue philosophical goals such as self-awareness, strong values, a sense of meaning
in life, and freedom of choice.

Humanists: more optimistic, believe that human beings are born with a natural tendency to
be friendly, cooperative, and constructive.
People are driven to self-actualize — fulfill their potential for goodness and growth.
They can do so only if they honestly recognize and accept their weaknesses as well as their
strengths and establish satisfying personal values to live by.
Suggest that self-actualization leads naturally to a concern for the welfare of others and to
behavior that is loving, courageous, spontaneous, and independent (Selva, 2019; Maslow,
1970).

Existentialists: agree that human beings must have an accurate awareness of themselves and
live meaningful — “authentic” lives - in order to be psychologically well-adjusted.

Do not believe that people are naturally inclined to live positively. They believe that from birth
we have total freedom, either to face up to our existence and give meaning to our lives or to
shrink from that responsibility. Those who choose to “hide” from responsibility and choice
will view themselves as helpless and may live empty, inauthentic, and dysfunctional lives as a
result.

1940’s: Carl Rogers (1902–1987) client-centered therapy: warm and supportive approach that
contrasted sharply with the psychodynamic techniques of the day. He also proposed a theory
of personality that paid little attention to irrational instincts and conflicts.

Ideas of nineteenth-century European existential philosophers who held that human beings
are constantly defining and so giving meaning to their existence through their actions;

Humanistic principles apparent in Positive Psychology;

ROGER’S HUMANISTIC THEORY AND THERAPY

Begin in infancy: received positive regard or not as a child – are able or not to develop
unconditional Self-regard (recognize their worth as persons even if they know they are not
perfect);

If child feels it’s not worthy of regard, develops conditions of worth: standards that tell them
they are lovable and acceptable only when they conform to certain guidelines. To maintain
positive self-regard, these people have to look at themselves very selectively, denying or
distorting thoughts and actions that do not measure up to their conditions of worth. They thus
acquire an inauthentic view of themselves and their experiences.

Therapists Approach

Try to create a supportive climate in which clients feel able to look at themselves honestly and
acceptingly;
Display three important qualities throughout the therapy: unconditional positive regard (full
and warm acceptance for the client), accurate empathy (skillful listening and restating), and
genuineness (sincere communication)

Assessing:
Client-centered therapy has not fared very well in research.
Was one of the first major alternatives to psychodynamic therapy, and it helped open up the
clinical field to new approaches. Rogers also helped pave the way for psychologists to practice
psychotherapy, which had previously been considered the exclusive territory of psychiatrists.

GESTALT THEORY AND THERAPY

1950’S - Frederick (Fritz) Perls (1893–1970).

Therapists guide their clients toward self-recognition and self-acceptance, but unlike client-
centered therapists, they try to achieve this goal by challenging and even frustrating the
clients, demanding that they stay in the here and now during therapy discussions, and pushing
them to embrace their real emotions.
Use of role-playing

Not a lot of research, since subjective experiences and self-awareness cannot be measured
objectively;

SPIRITUAL VIEWS AND INTERVENTIONS

For most of the nineteenth and twentieth centuries, clinicians viewed religion as a negative —
or at best neutral — factor in mental health.
Freud: argued that religious beliefs were defense mechanisms “born from man’s need to make
his helplessness tolerable”
Researchers have learned that spirituality does, in fact, often correlate with psychological
health.
Studies have examined the mental health of people who are devout and who view God as
warm, caring, helpful, and dependable: are found to be less lonely, pessimistic, depressed, or
anxious than people without any religious beliefs or those who view God as cold and
unresponsive. Also less drug abuse;

HOWEVER: correlation does not indicate CAUSATION

EXISTENTIAL THEORIES AND THERAPY

Psychological dysfunction is caused by self-deception: a kind of self-deception in which

people hide from life’s responsibilities and fail to recognize that it is up to them to give
meaning to their lives. According to existentialists, many people become overwhelmed by the
pressures of present-day society and so look to others for explanations, guidance, and
authority.
They overlook their personal freedom of choice and avoid responsibility for their lives and
decisions. Such people are left with empty, inauthentic lives. Their dominant emotions are
anxiety, frustration, boredom, alienation, and depression.

In existential therapy, people are encouraged to accept responsibility for their lives and for
their problems. Therapists try to help clients recognize their freedom so that they may choose
a different course and live with greater meaning.
Techniques vary a lot;
Therapists place great emphasis on the relationship between therapist and client and try to
create an atmosphere of honesty, hard work, and shared learning and growth.

Assessing Humanistic-Existential Model

Recognize special challenges of human existence: tap into an aspect of psychological life that
typically is missing from the other models;
The factors that they say are essential to effective functioning — self-acceptance, personal
values, personal meaning, and personal choice — are certainly lacking in many people with
psychological disturbances.
Optimistic Tone
Emphasis on Health: not “sick patients” but people who have yet to fulfill their potential;
Shortcommings:
Abstract issues difficult to research;
Except for Rogers, humanists and existentialists have traditionally rejected the use of empirical
research – this is beginning to change among some humanistic and existential researchers
(may lead to important insights about the merits of this model in the coming years)

SOCIO-CULTURAL MODEL: FAMILY-SOCIAL AND MULTICULTURAL

PERSPECTIVES

Social Labels and Roles

Social connections and support

Family Structure and Communication

FAMILY-SOCIAL TREATMENTS

Group therapy: people with similar problems meet together with a therapist to work on those
problems.
(OBS: Support groups are not “treatments”): people with similar problems who help and
support one another without the direct leadership of a clinician. Also called a self-help group,
peer group, or mutual-help group.

Family Therapy: therapist meets with all members of a family and helps them change in
therapeutic ways.
Can work with different approaches, but usually adopts family systems theory.

Couples therapy: therapist works with two people who share a long-term relationship. Also
called marital therapy. Recognize and change problem behaviors largely by teaching specific
problem- solving and communication skills. A broader, more sociocultural version, called
integrative behavioral couple therapy, further helps partners accept behaviors that they
cannot change and embrace the whole relationship nevertheless.

Community Treatment: Community mental health treatment programs allow clients,

particularly those with severe psychological difficulties, to receive treatment in familiar social
surroundings as they try to recover. Such community-based treatments, including community
day programs and residential services, seem to be of special value to people with severe
mental disorders

Key Principle = PREVENTION

3 KINDS:
Primary prevention: efforts to improve community attitudes and policies.
Goal: prevent psychological disorders altogether; often called “universal prevention.”
Ex.: Community workers may consult with a local school board, offer public workshops on
stress reduction, or construct websites on how to cope effectively.
Secondary prevention: Identifying and treating psychological problems in the early stages,
before they become serious. Ex. Community workers may work with teachers, ministers, or
police to help them recognize the early signs of psychological dysfunction and teach them how
to help people find treatment. (Websites to)
Terciary prevention: provide effective treatment to specific persons who have already
developed moderate or severe disorders so that these disorders do not become long-term
problems.

HOW DO MULTICULTURAL THEORISTS EXPLAIN ABNORMAL FUNCTIONING

model holds that an individual’s behavior, whether normal or abnormal, is best understood when
examined in the light of that individual’s unique cultural context, from the values of that culture to the special
external pressures faced by members of the culture.

interested in understanding persons through the lens of intersectionality, a framework that examines how each
individual’s memberships across multiple cultural groups and social identities — including race, ethnicity,
socioeconomic class, gender, and sexual orientation — combine to shape their particular experiences, opportunities,
outlook, and functioning.

MULTICULTURAL TREATMENTS

A number of studies suggest that two features of treatment can increase a therapist’s effectiveness with minority
clients:
1. greater sensitivity to cultural issues;
2. inclusion of cultural morals and models in treatment, especially in therapies for children and adolescents

culture-sensitive therapies Approaches that are designed to help address the unique issues faced by members of
cultural minority groups.

gender-sensitive therapies Approaches geared to the pressures of being a female or gender minority in society.

INTEGRATING THE MODELS: DEVELOPMENTAL PSYCHOPATHOLOGY PERSPECTIVE

Integrative explanations - biopsychosocial theories - state that abnormality results from the interaction of genetic,
biological, emotional, behavioral, cognitive, social, cultural, and societal influences;
Therapists now combine treatment techniques from several models;

Studies confirm that clinical problems often respond better to combined approaches than to any one therapy
alone.

developmental psychopathology A perspective that uses a developmental framework to understand how variables
and principles from the various models may collectively account for human functioning.
Pays particular attention to the timing of influential variables. The emergence of particular events, experiences, or
biological factors — from neurons to neighborhoods — can continue to have enormous impact on later functioning if
they occur at vulnerable points in a person’s life.
Critical question is not which single factor is the cause of an individual’s current psychological problems, but rather
when, how, in what context, and to what degree the multiple factors in their life interact with one another.

Contends that various developmental routes can lead to dysfunction.

Two key principles:

equifinality The principle that a number of different developmental routes can lead to the same psychological
disorder.
Ex. Two boys who experience different negative variables throughout their development each wind up manifesting the same
problem — conduct disorder — as teenagers.

multifinality The principle that persons with similar developmental histories may nevertheless have different clinical
outcomes or react to comparable current situations in different ways.
Ex. Two boys who are challenged by several similar negative variables in their childhoods, such as unfavorable genes and a
difficult temperament, wind up with very different teenage outcomes (conduct disorder for one, good adjustment for the
other). This is largely because one boy had the additional disadvantage of ineffective parents while the other boy had the
good fortune of effective parents.

OBS: Protective Factor: a positive developmental variable (such as effective parenting) that helps to offset the impact
of negative variables such as unfavorable genes or a difficult temperament

Focuse on Timing of treatment: tend to prioritize prevention, the introduction of protective factors, and early
intervention for vulnerable persons over treatment for individuals who have already developed severe disorders

echo the call of community mental health advocates for community-wide interventions, commonly targeting entire
schools or neighborhoods, as opposed to individual treatment formats.

DATA / STATISTICS

It takes an average of 12 years and hundreds of millions of dollars for a pharmaceutical

company in the United States to bring a newly identified chemical compound to market.

ECT is used on tens of thousands of persons annually, particularly those whose depression fails
to respond to other treatments (Kellner, Obbels, & Sienaert, 2019).

DTC adds – Direct to Consumer Drug advertisement (ask your doctor about…)

APPROACHES OF THERAPISTS TODAY

18 percent of today’s clinical psychologists identify themselves as psychodynamic therapists

nearly 50% of today’s clinical psychologists report that their approach is cognitive and/
or behavioral

Approximately 2 %of today’s clinical psychologists, 1% of social workers, and 3%of counseling
psychologists report that they employ the client-centered approach;
1% of clinical psychologists and other kinds of clinicians describe themselves as gestalt
therapists

22 percent of today’s clinical, psychologists, 31 percent of counseling psychologists, and 26 percent of social workers
describe their approach as “eclectic” or “integrative”