Chapters 13, 15, 16

PSYC 1010: CHAPTER 13, 15, 16 TEXTBOOK NOTES
Chapter 15: Psychological Disorders

April 4, 2016
Abnormal Behaviour: Myths, Realities and Controversies

The Medical Model Applied to Abnormal Behaviour
Medical model: proposes that it is useful to think of abnormal behaviour as a disease
- The basis for many of the terms used to refer to abnormal behaviour
o Mental illness, psychological disorder, and psychopathology (pathology refers to
manifestations of disease)
- The rise of this model brought improvements in the treatment of those who exhibited
abnormal behaviour (before the 18th century abnormal behaviour equates to evil)
- Not without its flaws  medical diagnoses of abnormal behaviour labels people
o Carries a social stigma that can affect their lives forever
- Research has demonstrated that many psychological disorders are at least partly
attributable to genetic and biological factors  similar to physical illness (less stigma)
- Critics (Ex. Thomas Szasz)  the medical model converts moral and social questions
about what is acceptable behaviour into medical questions
- Medical concepts have proven valuable in the treatment and study of abnormality
o Diagnosis: involves distinguishing one illness from another
o Etiology: refers to the apparent causation and developmental history of an
illness
o Prognosis: is a forecast about the probable course of an illness
Criteria of Abnormal Behaviour

1. Deviance  violation of the norms (Standards and expectations of their society)
o Ex. Transvestic fetishism  sexual disorder in which a man achieves sexual
arousal by dressing in women’s clothing (deviates from our cultural norms)
2. Maladaptive behaviour  when a person’s everyday adaptive behaviour is impaired
o Key criterion in the diagnosis of substance-use (drug) disorders
o Ex. Cocaine  begins to interfere with a person’s social or occupational
functioning
3. Personal distress  diagnosis of psychological disorder based on individual’s report of
great personal stress
o Criterion most often met by people troubled by depression or anxiety disorders
- People are often viewed as disordered when only one criterion is met
- Diagnosis of psychological disorder involves value judgments about what represents
normal or abnormal behaviour
o Judgment reflect prevailing cultural values, social trends, and political forces, as
well as scientific knowledge
- It is often difficult to draw a line between normal and abnormal or mental health and
mental illness
- Psychological disorder occurs when behaviour becomes extremely deviant, maladaptive,

or distressing  normality and abnormality exist on a continuum; a matter of degree
Stereotypes of Psychological Disorders
1. Psychological disorders are incurable  the people who do get better greater
outnumber those who do not (either spontaneously or through formal treatment)
2. People with psychological disorders are often violent and dangerous  modest
association (media attention on violent incidents involving mental illness)
3. People with psychological disorders behave in bizarre ways and are very different from
normal people  only true for a small minority of cases
o At first glance, most with psychological disorders are hard to distinguish
Psychodiagnosis: The Classification of Disorders

- A sound system for classifying psychological disorders can facilitate empirical research
and enhance communication among scientists and clinicians
- Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American
Psychiatric Association  currently on the fifth edition (947 pages long); most used
o Three major sections: (1) historical material; (2) criteria for the main diagnostic
categories along with other disorders; and (3) assessment measures and criteria
for psychological disorders that are subjects for further study
- DSM-IV-TR Diagnosis System  Axis I (clinical syndromes); Axis II (personality disorders
or mental retardation); Axis III (general medical conditions); Axis IV (psychosocial and
environmental problems; and Axis V (global assessment of functioning, GAF, scale)
- DSM-5 has 22 major categories of disorder
- Alternatives  International Classification of Disease and Health Related Problems (IDC)
by WHO and the Research Domain Criteria Project (RDoC) by NIMH
DSM-5: Changes and Continuing Challenges

- Concerns and limitations of the DSM-IV:
o Overemphasis on a categorical organization
o Diagnostic reliability or the extent to which different clinicians seeing the same
case would agree on a diagnosis
o Lack of explicit acknowledgment of culture in the diagnosis and manifestation of
illness
o Specific organization of autism and related disorders
- DSM-5 was developed to address the concerns and limitations
o Dropped the axial approach
o Categories were deleted, some new ones added, and others were reorganized
and dimensional ratings (on the severity and intensity of symptoms) were added
o Names were changed (address associated stigma)
- Continuing controversies:
o Overlap among various disorders in symptoms  specific diagnoses may not
reflect distinct disorders but merely variations of the same underlying one
 Comorbidity: the coexistence of two or more disorders
o Argues that categorical to be replaced with the dimensional approach

 Dimensional approach  described with continuous dimensions
o Added disruptive mood dysregulation disorder (DMDD)
 Some believe that what is typical is made to seem pathological
o Dropped bereavement exclusion from diagnoses of depression
 Depressed for up to two months after the death of a significant other
would previously not be diagnosed as suffering from major depression
o Combination of four distinct categories of disorder into one new spectrum
disorder  autism spectrum disorder (ASD)
 Those with Asperger’s would not be assessed as having mental illness
The Prevalence of Psychological Disorders

Epidemiology: the study of the distribution of mental or physical disorders in a population
Prevalence: in epidemiology, it is the percentage of a population that exhibits a disorder during

a specified time period
- Prevalence of psychological disorders is quite a bit higher than most assumed
- Most common  (1) substance (alcohol and drugs) use disorders; (2) anxiety disorders,
and (3) mood disorders
- There is gender variation across categories of disorder
- Most people who report symptoms do not seek assistance (68% in Canada)
- Many who need mental health care do not get it or do not fully get it
Lifetime prevalence: the percentage of people who endure a specific disorder at any time in
their lives
- Psychological disorders found in 1/3 of the population (study in 1980s-90s)
- 44% of adults will struggle with some sort of psychological disorder (later research)
- 51% will be at risk of a psychiatric disorder (most recent)
Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders

Anxiety Disorders
Anxiety disorders: are a class of disorders marked by feelings of excessive apprehension and
anxiety
- Four principle types (not mutually exclusive):
Generalized Anxiety Disorder

Generalized anxiety disorder: marked by a chronic, high level of anxiety that is not tied to any
specific threat; sometimes called free-floating anxiety (nonspecific)
- People with this disorder worry constantly about yesterday’s mistakes and tomorrow’s
problems (minor matters related to family, finances, work, and personal illness)
- Viscous loop  worry about worrying; more common in females
Specific Phobias
Phobia: marked by a persistent and irrational fear of an object or situation that presents no
realistic danger
- Mild phobias  common; phobic disorder  fears interfere with everyday behaviour
- People can develop phobias to anything; but most common  acrophobia,
claustrophobia, brontophobia, hydrophobia, and various animal and insect phobias
- Many realize their fears are irrational but cannot control themselves
o Even imagining objects or situations can be triggering
Panic Disorder
Panic disorder: characterized by recurrent attacks of overwhelming anxiety that usually occur
suddenly and unexpectedly
- Becomes apprehensive after a number of panic attacks  may lead to agoraphobia
Agoraphobia
Agoraphobia: a fear of going out to public places
- Traditionally viewed as a phobic disorder  recent evidence suggests it to often be a
complication of a panic disorder
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD): marked by persistent, uncontrollable intrusions of
unwanted thoughts (obsession) and urges to engage in senseless rituals (compulsion)
- Previously classified as a type of anxiety disorder
- Now a classification on its own including conditions such as: body dysmorphic disorder,
excoriation, and hoarding disorder
- Obsessions sometimes centre on inflicting harm on others, personal failures, suicide, or
sexual acts  feel they have lost control of their mind and plagued by uncertainty
- Compulsion usually involve stereotyped rituals that temporarily relieve anxiety
- Often seen as a unitary disorder; recent research suggests it may be a heterogeneous
disorder
o Four factors underlie the symptoms (obsessions and checking, symmetry and
order, cleanliness and washing, and hoarding)
- Hoarding disorder  difficulty discarding possessions no matter how worthless
o Disrupt normal living arrangements and their social and occupational activities
o Usually to avoid the distress that would result from throwing things out
Post-Traumatic Stress Disorder (PTSD)

- Part of a new class  trauma- and stressor-related disorders
o Follow an individual’s exposure to some type of chronic or acute stressor
- Not restricted to military members
- Often elicited by any of a variety of traumatic events (ex. Rape, assault, accidents,
natural disasters, or witnessing death)
- Sometimes does not manifest until months after the event  tied to the memory
- Prevalence higher in women than men

- Intensity of one’s reaction at the time of the traumatic event  key predictor of
vulnerability towards PTSD (greatest in people with intense reactions)
Etiology of Anxiety and Anxiety-Related Disorders
Biological Factors
Concordance rate: indicates the percentage of twin pairs or other pairs of relatives who exhibit
the same disorder
- Both twin studies and family studies suggest that there is a moderate genetic
predisposition to anxiety disorders
o Inherited differences in temperament  increased vulnerability
 Inhibited temperament
o Research suggests that anxiety sensitivity  increased vulnerability
 Some people are highly sensitive to the internal physiological symptoms
of anxiety and probe to overreact with fear
 May fuel the inflationary spiral (anxiety breeds more anxiety)
o Link between anxiety disorders and neurochemical activity (neurotransmitters)
 Drugs reduce excessive anxiety  alter activity at GABA synapses
 Abnormalities in neural circuits using serotonin (panic disorder and OCD)
Conditioning and Learning

- Many anxiety responses may be acquired through classical conditioning (stimulus) and
maintained through operant conditioning (aversive tactics; avoidance response)
- Martin Seligman’s concept of preparedness:
o People are biologically prepared by their evolutionary history to acquire some
fears much more easily than others
- Evolved module for fear learning:
o Automatically activated by stimuli related to survival threats in evolutionary
history and relatively resistant to intentional efforts to supress the resulting fears
- Problems  traumatic events do not always end in phobias; not all people with phobias
can identify a traumatic conditioning experience; phobias can be acquired indirectly
- The development of phobias may depend on synergistic interactions among a variety of
learning processes
Cognitive Factors
- Certain styles of thinking make some people particularly vulnerable to anxiety disorders
- More likely to suffer from problems with anxiety because they tend to:
o Misinterpret harmless situations as threatening
o Focus excessive attention on perceived threats
o Selectively recall information that seems threatening
- Human experience is highly subjective  cognitive view holds that some people are
prone to anxiety disorders because they see threat in every corner of their lives
Stress
- Patients with panic disorder had experienced a dramatic increase in stress in the month
prior to the onset of their disorder
- High stress often helps to precipitate the onset of anxiety disorders
Dissociative Disorder
Dissociative disorders: a class of disorders in which people lose contact with portions of their
consciousness or memory, resulting in disruptions in their sense of identity
- Most controversial set of disorders in the diagnostic system (little is known about it)
Dissociative Amnesia
Dissociative amnesia: a sudden loss of memory for important personal information that is too
extensive to be due to normal forgetting
- Memory losses may occur for a single traumatic event or for an extended period of time
surrounding the event (ex. Disasters, accidents, stress, abuse, witness death, etc.)
Dissociative fugue: people lose their memory for their life and experiences, along with their
sense of personal identity
- A specifier of dissociative amnesia
o Specifiers identify a homogeneous subgrouping of the disorder  further
refining the diagnosis relevant to understanding and treating the disorder
- These people only remember matters unrelated to their identity
Dissociative Identity Disorder

Dissociative identity disorder (DID): involves the coexistence in one person of two or more
largely complete, and usually very different, personalities
- Previous known as multiple personality disorder
- People with DID feel they have more than one identity  each with his or her own
name, memories traits, and physical mannerism (each often unaware of the others)
o Alternative personalities commonly display traits foreign to the original
o Transitions often occur suddenly
- Rarely occurs in isolation (grouped with anxiety or mood or personality disorders)
- Seen more in women than men
Etiology of Dissociative Disorders

- Dissociative amnesia and fugue are usually attributed to excessive stress
o Relatively little is known about why this occurs in only a minority of people
o Speculations that certain personality traits (fantasy proneness and a tendency to
become absorbed in personal experiences) make some more susceptible
- Some believe it’s make belief; others say there’s no incentive to pretend
Mood Disorders
Mood disorders: a class of disorders marked by emotional disturbances of varied kinds that may
spill over to disrupt physical, perceptual, social, and thought processes
- Mood disorders tend to be episodic (come and go) interspersed among periods of
normality  can be deliberating but people can still do much
o Episodes can vary in length but often lasts 3 – 12 months
- DSM-5 has two separate classes of mood disorders:
o Bipolar and related disorders  bipolar I, bipolar II, and cyclothymic disorder
 Vulnerable to emotional extremes at both ends (depression and mania)
o Depressive disorders  major depressive, disruptive mood dysregulation,
premenstrual dysphoric, persistent depressive disorder
 Experiences only one end of the mood continuum (depression
Major Depressive Disorder

Major depressive disorder: people show persistent feelings of sadness and despair and a loss of
interest in previous sources of pleasure
- Lack energy or motivation to do anything  often give up enjoyable things
- Alterations in appetite and sleep patterns are common
- Depression plunges people into feelings of hopelessness, dejection, and boundless guilt
- Usually experiences other disorders as well (ex. Anxiety and substance-use disorders)
- Recurrence of depressive episode becomes higher after each episode and with time
- Chronic major depression may persist for years  associated with a particularly severe
impairment of functioning and high rates of comorbidity (additional disorders)
- Very common (especially in women)
o Greater experience of stress and adversity and greater tendency to ruminate
Anhedonia: a diminished ability to experience pleasure

- A central feature of depression
Bipolar Disorder
Bipolar I disorder: characterized by the experience of one or more manic episode as well as
periods of depression; formerly known as manic depressive disorder
- One manic episode is sufficient to qualify for this diagnosis
o Periods of elevated euphoria; extreme optimism, energy, and extravagant plans
o High self-esteem; sleeplessness; impaired judgment; impulsivity; recklessness
o Typically lasts for four months (most typically spend more time in depression)
- Less common than depressive disorders (equally often in males and females)
Bipolar II disorder: individuals suffer from episodes of major depression along with hypomania
in which their change in mood and behaviour is less severe than those seen in full mania
Cyclothymic disorder: exhibit chronic but relatively mild symptoms of bipolar disturbance
Diversity in Mood Disorders

Seasonal affective disorder (SAD): a type of depression that follows a seasonal pattern
- Specifier relates to the seasonal pattern of the disorder; most common being winter
o Suggestions that it is related to melatonin production and circadian rhythms
- Treatment  exposed systematically to therapeutic light
Postpartum depression: a type of depression that sometimes occurs after childbirth

- Specifier relates to an onset of the disorder postpartum (within four weeks of childbirth)
- Urban and/or immigrant women appear to have higher rates
Mood Disorders and Suicide

- Suicide is associated with mood disorders
- Suicide is one of the three leading causes of death of people between 15 and 34
- Women attempt suicide more often than men but men are more likely to actually kill
themselves in an attempt
- Suicide prevention tips:
o Take suicidal talk seriously
o Provide empathy and social support
o Identify and clarify and crucial problem
o Do not promise to keep someone’s suicidal ideation secret
o In an acute crisis, do not leave a suicidal person alone
o Encourage professional consultation
Etiology of Mood Disorders

Genetic Vulnerability
- Twin studies suggest that genetic factors are involved in mood disorders
- Heredity can create a predisposition to mood disorders
- Environmental factors probably determine whether these predisposition is converted
into actual disorder
- Influence of genetic factors appears to be stronger for bipolar disorders than for
unipolar disorders
Biological and Neurochemical Factors

- Correlations have been found between mood disorders and abnormal levels of:
norepinephrine and serotonin
o Drugs that elevate serotonin levels relieve depression (promotes neurogenesis)
- Studies have found correlation between mood disorders and structural abnormalities in
the brain: reduced hippocampal volume (stress  suppression of neurogenesis)
Hormonal Factors
- Depressed patients tend to show elevated levels of cortisol  key stress hormone
produced by hypothalamic pituitary-adrenocortical (HPA) axis (1/2 pathways)
o Some believe these hormonal changes eventually suppress neurogenesis
Dispositional Factors
- Perfectionism has been a characteristic associated with depression
- Three aspects of perfectionism:
1. Self-oriented: tendency to set high standards for oneself
2. Other-oriented: setting high standards for others
3. Socially prescribed: tendency to perceive others setting high standards for oneself
- Link between perfectionism and eating disorders, symptoms of depression, problematic
interpersonal relationships, other health problems, and postpartum depression
- Two other personality-based models of depression
1. Sociotropy and autonomy are related to depression
o Sociotropic individuals are especially invested in interpersonal relationships 
concerned with avoiding interpersonal problems and emphasize pleasing others
o Autonomous individuals are oriented toward their own independence and
achievement
2. Introjective personality orientation (excessive self-criticism) and anaclitic orientation
(overdependence on others)
Cognitive Factors
- Beck  depressed individuals are characterized by a negative cognitive triad; reflects
their tendency to have negative views of themselves, their world, their future
o Dysfunctional schemas underlie many symptoms associated with depression
 The tendency to selectively attend to negative information about self
- Seligman  learned helplessness model of depression and hopelessness theory
o Learned helplessness  passive “giving up” behaviour produced by exposure to
unavoidable aversive events
o Pessimistic explanatory style  especially vulnerable to depression
 Tend to attribute their setbacks to personal flaws instead of situations
o Hopelessness theory  builds on these insights  depression
- People who ruminate about their depression remain depressed longer than those who
try to distract themselves  excessive rumination tends to foster and amplify episodes
- Negative thinking  depression; or depression  negative thinking?
Interpersonal Roots
- Behavioural approaches emphasize how inadequate social skills put people on the road
to depressive disorders
- Depression-prone people lack the social finesse needed to acquire important reinforcers
- Depressed people tend to be depressing  irritable and pessimistic; complain a lot; not
enjoyable companions  tend to court rejection from those around them
o Lower social support  increase vulnerability to depression
- Depressed people tend to gravitate to partners who view them unfavourably
- Viscous cycle
Sports Concussions and Depression

- Depression is a common feature of postconcussion syndrome
- Depression rates in head trauma patients are many times higher than in the general
population and that depression can be long-lasting
- Results of brain scans  reduced activation of the dorsolateral prefrontal cortex and
striatum and attenuated deactivation in medial frontal and temporal regions
o Of athletes who suffered from concussions and depression
o Depression levels correlated with the level of neural response in areas typically
associated with depression (along with grey matter loss in those areas)
Precipitating Stress
- Evidence suggests the existence of a moderately strong link between stress and the
onset of mood disorders
- Also appears to affect the response to treatment and whether relapse happens
- People vary in their degree of vulnerability to mood disorders (some do not get them
even when faced with great stress)
Schizophrenia
Schizophrenia: a disorder marked by delusions, hallucinations, disorganized speech, negative
symptoms (ex. Diminished emotional expression), and deterioration of adaptive behaviour
- Schizophrenia literally means “split mind”  the fragmentation of thought processes
seen in the disorder not like DID (split personalities)
- Currently employing the dimensional perspective to distinguish by severity (DSM-5)
- Used to be in subtypes  paranoid, catatonic, disorganized, and undifferentiated
- Similar symptoms as those with severe mood disorders; however:
o Disturbed thought lies at the core of schizophrenia instead of disturbed emotion
- Extremely costly illness for society because it is a severe, debilitating illness that tends to
have an early onset and often requires lengthy hospital care
- Relatively low frequency compared to many of the other forms of psychopathology
o Relatively high visibility  due to severity and media portrayal
General Symptoms
Delusions and Irrational Thought
Delusions: false beliefs that are maintained even though they clearly are out of touch with
reality
- Delusions of grandeur  people maintain that they are famous or important
- Typical  private thoughts are broadcasted; thoughts are being controlled
- Thinking becomes chaotic rather than logical and linear
o Loosening of associations  disjointed topic shifts
Deterioration of Adaptive Behaviour

- Schizophrenia usually involves a noticeable deterioration in the quality of the person’s
routine functioning in work, social relationships, and personal care
Hallucinations
Hallucinations: sensory perceptions that occur in the absence of a real, external stimulus or are
gross distortions of perceptual input
- Most common perceptual distortions  auditory hallucinations (hearing nonexistent
voices or absent people talking to them)
Disturbed Emotions
- Some victims show little emotional responsiveness (blunted of flat affect)
- Others show inappropriate emotional responses that do not relate to the situation or
what they’re saying
- People with schizophrenia may become emotionally volatile
Positive versus Negative Symptoms

- Four subtypes are useless  catatonic is disappearing; undifferentiated = leftovers; no
meaningful differences in etiology, prognosis, or response to treatment
- Alternative approach (distinguishing between types of symptoms: positive and negative)
o Most exhibit both types and vary only in the degree which dominate
Negative symptoms: involve behavioural deficits, such as flattened emotions, social

withdrawal, apathy, impaired attention, and poverty of speech
Positive symptoms: involves behavioural excesses or peculiarities, such as hallucinations,

delusions, bizarre behaviour, and wild flights of ideas
- Predominance of positive symptoms is associated with better adjustment prior to the
onset of schizophrenia and greater responsiveness to treatment
Course and Outcome

- Schizophrenia usually emerges during adolescence or early adulthood (75% by 30)
- Emergence may be sudden but is usually insidious and gradual
- People with schizophrenia tend to fall into three broad groups:
o Successfully treated and enjoy a full recovery (20%)
o Partial recovery and can return to independent living for a time
 Experiences regular relapses over the remainder of their lives
o Chronic illness market by relentless deterioration and extensive hospitalization
Etiology of Schizophrenia
- Twin studies  high concordance rate for identical compared to fraternal twins
- Those born to two schizophrenic parents has higher chances of developing it
- Similar to that seen for mood disorders
o Some people inherit a poly-genically transmitted vulnerability
Neurochemical Factors
- Excess dopamine activity has been implicated as a possible cause of schizophrenia
o Riddled with inconsistencies, complexities, and interpretive problems
- Dysfunctions in neural circuit using glutamate may play a role in schizophrenia
- Research suggested that marijuana use during adolescence may help precipitate
schizophrenia in young people who have a genetic vulnerability to the disorder
o Study found that marijuana use doubled the risk of psychotic disturbance
o THC may increase neurotransmitter activity in dopamine circuits in certain areas
Structural Abnormalities in the Brain

- Schizophrenics exhibit a variety of deficits in attention, perception, and info processing
o Impairments in working memory are especially prominent
o Suggest that schizophrenia may be caused by neurological defects
- CT scans and MRI scans  association between enlarged brain ventricles (fluid-filled
cavities) and schizophrenic disturbance  reflect the degeneration of nearby tissue
o Could be a consequence or a contributing cause
- Other abnormalities  reduction in grey and white matter in specific regions
o Reflect losses of synaptic density and myelinisation
o Suggest that schizophrenia is caused by disruptions in the brain’s neural
connectivity which impairs the normal communication among neural circuits
The Neurodevelopmental Hypothesis

- This hypothesis posits that schizophrenia is caused in part by various disruptions in the
normal maturational process of the brain before or at birth
- Insults to the brain during sensitive phases of prenatal development or during birth can
cause subtle neurological damage that elevates individual’s vulnerability years later
o Insults include: viral infections or malnutrition during prenatal development and
obstetrical complications during the birth process, severe maternal stress, etc.
o Minor physical anomalies that is consistent with prenatal neurological damage
are more common among people with schizophrenia than among others
Expressed Emotion
Expressed emotion (EE): the degree to which a relative of a schizophrenic patient displays
highly critical or emotionally overinvolved attitudes toward the patient
- Element of family dynamics  influences and a good predictor of the course the illness
- Those who return to a family high in expressed emotion show higher (3x) relapse rates
o High in expressed emotion  families are more sources of stress than support
Precipitating Stress
- High stress may serve to precipitate a schizophrenic disorder in those vulnerable
- High stress can also trigger relapses in patients who made recovery progress
Personality Disorders
Personality disorders: a class of disorders marked by extreme, inflexible personality traits that
cause subjective distress or impaired social and occupational functioning
- Hard to differentiate between healthy and not; relatively mild comparable disturbances
- People with these disorders display certain personality traits to an excessive degree and
in rigid ways that undermine their adjustment
- DSM-5 lists ten personality disorders (grouped into three clusters)
1. Anxious/fearful  maladaptive efforts to control anxiety and fear of social rejection
o Avoidant  excessively sensitive to potential rejection; social withdrawn
o Dependent  excessively lacking in self-reliance and self-esteem; subordinate
o obsessive-compulsive  preoccupied with organization, rules, etc.; not warm
2. Odd/eccentric  distrustful, socially aloof, and unable to connect emotionally
o Schizoid  defective capacity for forming social relationships; not warm/tender
o Schizotypal  social deficits and oddities of thinking, perception, and
communication; resembles schizophrenia
o Paranoid  pervasive and unwarranted suspiciousness and mistrust of others
3. Dramatic/impulsive  first two (exaggeration); last two (impulsivity)
o Histrionic  overly dramatic; egocentric; attention seeking; overly exaggerated
o Narcissistic  grandiosely self-important; success fantasies; no empathy
o Borderline  unstable self-image, mood, and relationships; impulsivity
o Antisocial  violates others’ rights; failing to accept norms and form attachment
Diagnostic Problems
- Many argue there are too much overlap between personality disorders and others
o makes it extremely difficult to achieve reliable diagnoses
- Questions categorical approach to describing personality disorders
o Wrongly assumes  people fit in discontinuous (nonoverlapping) categories
- Support for dimensional approach is particularly strong for personality disorders
Antisocial Personality Disorder

- Does not mean they shun social interaction  many are sociable, friendly, and
superficially charming (often make a good first impression on others)
Description
Antisocial personality disorder: market by impulsive, callous, manipulative, aggressive, and
irresponsible behaviour that reflects a failure to accept social norms
- Rarely feel guilty about their transgressions (as they do not accept the social norms)
- More frequent among males than females; moderately common disorder
- Many become involved in illegal activities; though many channel it within the law
o Ex. Con artists, drug dealers, cutthroat business execs, scheming politicians, etc.
- Psychopathy is often used interchangeably with the term antisocial personality disorder
o Robert Hare  Psychopathy Checklist Revised (PCL-R) assess psychopathy
- Many with antisocial personalities exhibit quite a variety of maladaptive traits
o Rarely experience genuine affection; skilled at faking it to exploit others

o Sexually predatory and promiscuous; irresponsible and impulsive
o Tolerate little frustration; pursue immediate gratification
- Forms unreliable relationships with anyone
Etiology
- Many believe biological factors contribute to the development of these disorders
- Evidence suggest a genetic predisposition (twin studies); strong genetic vulnerability
- People with antisocial personalities lack the inhibitions that most have about violating
moral standards  people might inherit relatively sluggish autonomic nervous systems
o Slow acquisition of inhibitions through classical conditioning
- Psychological factors  inadequate socialization in dysfunctional family systems
o At risk homes, abuse, neglect, bad models (observational learning), etc.
Disorders of Childhood
Autism Spectrum Disorder
Autism spectrum disorder (ASD): a developmental disorder characterized by social and
emotional deficits, along with repetitive and stereotypic behaviours, interests, and activities
- Part of the neurodevelopmental disorders classification (which also includes intellectual
disability, ADHD, specific learning disorder, motor disorders, and tic disorders)
- Donald Gray Tripplett  first person diagnosed with autism
o Obsessed with and developed a “mania” for spinning blocks and other objects
o Interruption leads to a tantrum and exhibition of strong detached orientation
- Relatively rare  public debate due to government reluctance to fund its treatment
- Seen to exhibit three types of deficits as well as sensory difficulties:
1. Impairment in social interaction  autistic aloneness
o Do not develop relationships with others typical of children their age
2. Impairment in communication  deficits from the very beginning of language
development  echolalia (mimic and repeat back what they heard from others)
3. Repetitive, stereotyped behaviours/interest/activities  obsessive-compulsive
behaviour; higher-order repetitive behaviour (special interest in specific topics)
- Part of the problem may lie with a very limited theory of mind (people’s understanding
of other people, their perspectives, intentions, affect, etc.)
- Treatment  individualized, difficult, and labour-intensive (ex. EIBI)
Etiology of ASD
- Originally blamed on cold, aloof parenting  discredited by research
- Most view ASD to originate from biological dysfunctions
- Twin studies and family studies have demonstrated that genetic factors make a major
contribution to ASD
- Some attribute it to brain abnormalities (relatively little progress in this department)
- Discredited hypothesis that it’s related to the mercury used in vaccines
o May result from a time coincidence or the lack of explanation for causes of ASD
Psychological Disorders and the Law

Insanity
- Not criminally responsible on account of mental disorder (NCRMD) those “out of their
mind” may not be able to appreciate the significance of what they’re doing; no intent
o Insanity laws or insanity defence (not the proper terms)
- Most people with diagnosed psychological disorders would not qualify as insane
o Those that qualify have severe disturbances that display delusional behaviour
- The most widely used rule to determine insanity  M’Naghten rule
o Insanity exists when a mental disorder makes a person unable to distinguish
right from wrong
- Use and success of this defence are rarer than assumed  only used in cases of most
severely disordered defendants
- Defendants may be found unfit to stand trial if judged unable to conduct a defence
- If found NCRMD the defendant may be absolutely discharged, given a conditional
discharge, or ordered to a psychiatric facility
- Automatism  the idea that you should not be held responsible if you had no control
over your behaviour (ex. Sleep walking)
Culture and Pathology

- Laws governing mental disorders and involuntary commitment are culture-specific
- Judgments of normality and abnormality are influenced by cultural norms and values
- Stigmas affect  willingness to admit to and seek treatment (vary with culture)
o Asian Canadians have one of the lowest levels of accessing mental health
services; unwilling to take their concerns to therapists
- Relativistic view of psychological disorders  criteria of mental illness vary greatly
across culture and that there is no universal standards of normality and abnormality
- Universalistic or pancultural view  criteria of mental illness are much the same around
the world and that basic standards of normality and abnormality are universal
Are Equivalent Disorders Found around the World?

- Most agree that principal categories of serious psychological disturbances are universal
o Ex. Schizophrenia, depression, and bipolar illness
o Most are regarded as clearly abnormal in Western are viewed the same in others
- Cultural variations are more apparent in the recognition of less severe disturbances
Culture-bound disorders: abnormal syndromes found only in a few cultural groups

- Koro (withdrawal of penis into abdomen) found in Chinese males in Southern Asia
- Windigo (craving for human flesh; fear of turning into a cannibal) in Algonquin cultures
- Pibloktoq (Arctic hysteria) associated with the Inuit
- Anorexia nervosa (eating disorder) largely seen only in affluent Western cultures
- Recognized in the DSM-5
Are Symptom Patterns Cultural Invariant?

- The more a disorder has a strong biological component, the more it tends to be
expressed in similar ways across varied cultures
o Even in severe, heavily biological disorders  cultural variations are seen
 Ex. Delusions are seen in all cultures for schizophrenia but the type of
delusion reported can be tied to their cultural heritage
- Symptom patterns are probably most variable for depression
o Guilt and self-deprecation lie at the core of depression in Western cultures
o Non-Western cultures  somatic symptoms; dejection and low self-esteem
o Different acceptable ways of expressing symptoms of psychological distress
- Psychopathology is characterized by both cultural variance and invariance
Personal Application—Understanding Eating Disorders

Description
Eating disorders: severe disturbances in eating behaviour characterized by preoccupation with
weight and unhealthy efforts to control weight
- DSM-5  feeding and eating disorders category
- Rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa,
bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorder
Anorexia Nervosa
Anorexia nervosa: intense fear of gaining weight, disturbed body image, refusal to maintain
normal weight, and dangerous measures to lose weight
- Two subtypes: restricting type (reduce intake of food) and binge-eating/purging type
(inducing vomit after meals, misusing laxatives and diuretics, excessive exercising)
- Have a morbid fear of obesity (never satisfied with their weight)
- Gaining weight  panic; only thing that makes them happy is losing weight
- Lead to amenorrhea (loss of menstrual cycles), gastrointestinal problems, low blood
pressure, osteoporosis (loss of bone density), and metabolic disturbances
Bulimia Nervosa
Bulimia nervosa: habitually out-of-control overeating followed by unhealthy compensatory
efforts (self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise)
- Eating binges in secret followed by intense guilt and concern about gaining weight
- Lead to cardiac arrhythmias, dental problems, metabolic deficiencies, and
gastrointestinal problems, and often coexist with other psychological disturbances
- Shares many features with anorexia nervosa
o Many who initially develop one syndrome cross over to display the other
- Differences  bulimia is a much less life-threatening condition; those with bulimia are
more likely to recognize their behaviour as pathological and more likely to cooperate
Binge-Eating Disorder
Binge-eating disorder: distress-inducing eating binges that are not accompanied by purging,
fasting, and excessive exercise seen in bulimia
- Less severe; more common; still creates distress (disgusted with weight and actions)
- Frequently overweight (excessive eating is often triggered by stress)
History and Prevalence

- Not entirely new but anorexia nervosa only became a common affliction after 1950
- Bulimia nervosa appears to be a new syndrome that emerged in 1970s
- Both a product of modern, affluent, Western culture where food is generally plentiful
and the desirability of being thin is widely endorsed
o But western influence is far reaching and others are being affected (esp. in Asia)
- Huge gender gap (90-95% are females)  cultural pressure rather than biological
- Prevalence rates appear to be trending higher
Etiology of Eating Disorders

- Not as strong, but some may inherit a genetic vulnerability to eating disorders
o Supported by family and twin studies
Personality Factors
- Certain personality traits increase vulnerability
o Anorexia  tend to be obsessive, rigid, and emotionally restrained
 Perfectionism is a risk factor
o Bulimia  tend to be impulsive, overly sensitive, and low in self-esteem
Cultural Values
- Western society  young women are socialized to be attractive (aka thin)
o Media portrayal of thin actresses and fashion models
The Role of the Family

- Family dynamics can contribute to the development of anorexia nervosa and bulimia
nervosa in young women
- Parents who are overly involved turn the push for independence into a struggle
o The need for autonomy make teens seek extreme control over their body
- Mothers contribute to eating disorders by endorsing society’s message
Cognitive Factors
- Many emphasize the role of disturbed thinking in the etiology of eating disorders
o Anorexics typically believe that they are fat (even when they are not)
- Patients with eating disorders display rigid, all-or-none thinking and many maladaptive
beliefs
- May be a cause of a symptom of eating disorders
Critical Thinking Application—Working with Probabilities in Thinking

about Mental Illness
Medical student’s disease: erroneous belief that one or one’s friends have whatever disease
one is currently learning about
Representativeness heuristic: the estimated probability of an event is based on how similar the
event is to the typical prototype of that event
- Prototypes: best examples
- People tend to think of the severe and infrequent disorders and so underestimate the
prevalence of mental disorders
Conjunction fallacy: occurs when people estimate that the odds of two uncertain events
happening together are greater than the odds of either event happening alone
- Cumulative probabilities: “or” relationships; often overlooked
- Life-time prevalence rate vs. point prevalence rates
- Conjunctive probabilities: “and” relationships  comorbidity (coexistence of disorders)
- Vulnerable to the conjunction fallacy because of the representative heuristic, or the
power of prototypes
Availability heuristic: the estimated probability of an event is based on the ease with which
relevant instances come to mind
- Many envision mentally ill to be violent and overestimate the frequency of the use of
the insanity defence  media coverage  events are easy to retrieve from memory
- Hindsight bias  journalists tend to question why authorities couldn’t foresee and
prevent the violence of former psychiatric patients (emphasises the mental illness)
Chapter 16: Treatment of Psychological

Disorders
April 5, 2016
The Elements of the Treatment Process

Psychedelic: the experience users have after taking mescaline, psilocybin, or d-lysergic acid
diethylamide (LSD)
The Elements of the Treatment Process

- Sigmund Freud is widely credited with launching modern psychotherapy and with calling
into question the view that we are logical, rational beings
- Anna O (Bertha Pappenheim)  physical symptoms cleared up when encouraged to talk
about emotionally charged experiences from her past  led to Freud’s psychoanalysis
Treatments: How Many Types Are There?

- Three major categories of approaches to treatment:
1. Insight therapies  “talk therapy”; psychoanalysis; engage in complex verbal

interactions with the therapists (ex. Family therapy and marital therapy)
2. Behaviour therapies  based on the principles of learning; make direct efforts to alter
problematic responses and maladaptive habits; change overt behaviour
3. Biomedical therapies  involve interventions into a person’s biological functioning
o Most widely used  drug therapy and electroconvulsive (shock) therapy
Clients: Who Seeks Therapy?

- Therapeutic triad  therapist, treatment, clients
- Clients have the greatest diversity (full range of human problems)
o Two most common presenting problem: excessive anxiety and depression
- People often delay for many years before finally seeking treatment
- A client in treatment does not necessarily have an identifiable psychological disorder
o Some seek professional help for everyday problems (ex. Career decisions) or
vague feelings of discontent
- People vary considerably in their willingness to seek psychotherapy (stigma)
o Many people who need therapy don’t seek it (thinks it’s a sign of weakness)
Therapists: Who Provides Professional Treatment?

- Primary care physicians are extremely important in terms of most Canadians’ access to
mental health  main source of mental health care and information
- Psychotherapy refers to professional treatment by someone with special training
o Primary care physicians do not count
Psychologists
- Two types that specialize in the diagnosis and treatment of psychological disorders and
everyday behavioural problems
1. Clinical psychologists  emphasizes the treatment of full-fledged disorders
2. Counselling psychologists  slanted toward the treatment of everyday adjustment
problems
- Traditionally had to earn a doctoral degree  now either Ph.D or M.A; limited Psy. D
- Psychologists use either insight or behavioural approaches; more likely to use
behavioural and less likely to use psychoanalytic (compared to psychiatrists)
Psychiatrists
Psychiatrists: physicians who specialize in the diagnosis and treatment of psychological
disorders
- Devote more time to relatively severe disorders (still treat everyday problems)
- Have an M.D. degree  medical school background can prescribe drugs
- Increasingly emphasize drug therapies; more likely to use psychoanalysis
Other Mental Health Professionals

- Clinical social workers and psychiatric nurses often work as part of a treatment team
with a psychologist or psychiatrist
- Psychiatric nurses play a large role in hospital inpatient treatment
- Clinical social workers generally work with patients and their families to ease the
patient’s integration back into the community
- Counsellors provide therapeutic services  schools, colleges, human service agencies
o Often specialize particular types of problems (ex. Vocational, martial, drug, etc.)
Insight Therapies
Insight therapies: involve verbal interactions intended to enhance clients’ self-knowledge and
thus promote healthful changes in personality and behaviour
Psychoanalysis
Psychoanalysis: an insight therapy that emphasizes the recovery of unconscious conflicts,
motives, and defences through techniques such as free association and transference
- Sigmund Freud’s thinking about the roots of mental disorders:
o Unconscious conflicts left over from early childhood (id, ego, and superego)
o People depend on defence mechanisms to avoid confronting the conflicts
- Mainly treated neuroses (anxiety-dominated disturbances)
- Can be a slow, painful process of self-examination that routinely requires 3 to 5 years
o Patients need time to work through problems and accept unnerving revelations
- Recognize the unconscious sources of conflicts  resolve and discard neurotic defences
Probing the Unconscious

- Psychoanalysis attempts to probe unconscious to discover and resolve conflicts
- Analysts must interpret their clients’ dreams and free association (a critical process)
- Relies on two techniques:
Free association: clients spontaneously express their thoughts and feelings exactly as they
occur, with as little censorship as possible
- Gradually most clients begin to let everything pour out without conscious censorship
- The information is used as clues for what’s going on in the client’s unconscious
Dream analysis: the therapist interprets the symbolic meaning of the client’s dreams
- Dreams were since by Freud as the “royal road to the unconscious”  the most direct
means of access to patients’ innermost conflicts, wishes, and impulses
Interpretation
Interpretation: refers to the therapist’s attempts to explain the inner significance of the client’s
thoughts, feelings, memories, and behaviours
- Analysts do not interpret everything, instead they move forward inch by inch
o Offering interpretations that should be just out of the client’s own reach
Resistance
Resistance: refers to largely unconscious defensive manoeuvres intended to hinder the progress
of therapy
- Clients do not want to face up to the painful, disturbing conflicts that they have buried
- Reactions vary  lateness, dishonesty, anger, etc.
- A key consideration is the handling of transference in combating resistance
Transference
Transference: occurs when clients unconsciously start relating to their therapist in ways that
mimic critical relationships in their lives
- Clients start relating to a therapist as though the therapist were someone else
- Clients can re-enact relationships with crucial people in the context of therapy
o Help bring repressed feelings and conflicts to the surface
Modern Psychodynamic Therapies

- Classical  geared to a particular kind of clientele (white, middle-, upper-class women)
- Psychodynamic approaches  collection of the descendants of psychoanalysis
o Interpretation, resistance, and transference continue to play key roles
- Other central features of modern psychodynamic therapies:
1. Focus on emotional experience
2. Exploration of efforts to avoid distressing thoughts and feelings
3. Identification of recurring patterns in patients’ life experiences
4. Discussion of past experiences (especially in early childhood)
5. Analysis of interpersonal relationships
6. Focus on the therapeutic relationship itself
7. Exploration of dreams and other aspects of fantasy life
Client-Centred Therapy
Client-centred therapy: insight therapy that emphasizes providing a supportive emotional
climate for clients, who play a major role in determining the pace and direction of their therapy
- Rogers using humanistic perspective
- Rogers maintains that most personal distress is due to inconsistency, or “incongruence,”
between a person’s self-concept and reality
- Incongruence makes people feel threatened by realistic feedback about themselves
o Anxiety about feedbacks  defence mechanisms, distortions of reality, and
stifled personal growth
- Excessive incongruence is thought to be rooted in clients’ overdependence on others for
approval and acceptance
- Insights differ from psychoanalysts  client-centred therapists help clients to realize
that they don’t have to worry constantly about pleasing others and winning acceptance
o Encourage self-respect, restructure their self-concept, and foster growth
Therapeutic Alliance: The Importance of Therapy Climate

Therapeutic alliance: consists of the emotional bond between therapist and client, along with
agreement on goals for the therapy and agreement on therapeutic tasks
- The importance is central to most contemporary therapeutic orientations
- Correlates with positive therapy outcomes
- Rogers believe that the process of therapy is not as important as the emotional climate
in which the therapy takes place  critical force promoting healthy changes in therapy
o It is critical for the therapist to provide a warm, supportive, accepting climate
 Safe environment  confrontation without feeling threatened
 Help them open up
- To create this atmosphere, client-centred therapists must provide three conditions:
1. Genuineness  communications must be honest and spontaneously
2. Unconditional positive regard  show complete, nonjudgmental acceptance of client
3. Empathy  understand the client’s world from the client’s point of view
Therapeutic Process
- Client and therapist work together as equals
- Therapist provides little guidance and keeps interpretation and advice to a minimum
o Provides feedback; key task being clarification (function like an enhanced mirror)
o Help clients better understand their interpersonal relationships and become
more comfortable with their genuine selves
- Emotion-focused couples therapy  acknowledge and work with the underlying
emotions are central to this approach
o Roots in earlier client-centred work by Carl Rogers and Fritz Perls
- Both client-centred and psychoanalysis  a major reconstruction of personality
Therapies Inspired by Positive Psychology

- Positive psychology uses theory and research to better understand the positive,
adaptive, creative, and fulfilling aspects of human existence
- Well-being therapy  seeks to enhance clients’ self-acceptance, purpose of life,
autonomy, and personal growth (successful treatment of mood and anxiety disorders)
- Positive psychotherapy  attempts to get clients to recognize strengths, appreciate
blessings, savour positive experiences, forgive others, and find meaning (depression)
- Effectiveness of online intervention to increase either self-compassion or optimism
o Increases in happiness and decreases in depression scores
Group Therapy
Group therapy: the simultaneous treatment of several clients in a group
Participants’ Roles
- Typically, 4 – 15 clients; ideally 8
- Therapist usually screens the participants  exclude those likely to disrupt
o Debate about whether the group should be homogeneous
- Participants essentially function as therapists for one another

o Discuss among each other and share; provide acceptance and support
- Therapist’s responsibility  selecting participants, setting goals, initiating and
maintaining the therapeutic process, and protecting clients from harm
o Stay in the background and promote group cohesiveness
- Therapist and clients are usually on a much or equal footing than individual therapy
Advantages of the Group Experience

- Save time and money  critical for understaffed mental hospitals and other institutions
- Unique strengths  inclusivity, see that others share similar or worse problems
Couples and Family Therapy

- Common goals  seek to understand the entrenched patterns of interaction that
produce distress (assume people’s behaviours are due to their role in the family system)
o Seek to help improve communication and move toward healthier interaction
Couples (marital) therapy: involves the treatment of both partners in a committed, intimate
relationship, in which the main focus is on relationship issues
- Help clarify the needs and desires, appreciate mutual contribution, enhance
communication, increase role flexibility and tolerance, work out power balance, etc.
Family therapy: involves the treatment of a family unit as a whole, in which the main focus is on
family dynamics and communications
- Often emerges out of efforts to treat children or adolescents with individual therapy
How Effective Are Insight Therapies?

Spontaneous remission: a recovery from a disorder that occurs without formal treatment
- One cannot automatically assume the recovery is due to treatment
- Insight therapy is superior to no treatment or to placebo treatment and that the effects
of therapy are reasonably durable
Behaviour Therapies
Behaviour therapies: involve the application of learning principles to direct efforts to change
clients’ maladaptive behaviours
- Behaviour therapists believe insights are not necessary to produce constructive change
- Designs a program to eliminate the maladaptive behaviour (do not care about the roots)
- Insight therapists treat pathological symptoms as signs of an underlying problem while
behaviour therapists think that the symptoms are the problem
- Based on certain assumptions:
1. Behaviour is a product of learning (past learning and conditioning)
2. What has been learned can be unlearned
Systematic Desensitization
Systematic desensitization: a behaviour therapy used to reduce phobic clients’ anxiety
responses through counterconditioning
- Assumes that most anxiety responses are acquired through classical conditioning
- The goal is to weaken the association between the CS and the CR of anxiety
- Three steps:
1. Therapist helps the client build an anxiety hierarchy  least to most anxiety arousing
2. Train the client in deep muscle relaxation
3. Client tries to work through the hierarchy, learning to remain relaxed while imagining
each stimulus  starting with the least and work up and unlearn anxiety responses
Counterconditioning: attempt to reverse the process of classical conditioning by associating the

crucial stimulus with a new conditioned response
- Recondition people so that the conditioned stimulus elicits relaxation instead of anxiety
Exposure therapies: clients are confronted with situations that they fear so that they learn that
these situations are really harmless
- Gradual exposure progression from less-feared to more-feared stimuli
- Once the situation proves harmless  anxiety responses decline
- One-session treatment (OST) of phobias  intensive three-hour intervention that
depends primarily on gradual increased exposures to specific phobic objects/situations
Aversion Therapy
Aversion therapy: a behaviour therapy in which an aversive stimulus is paired with a stimulus
that elicits an undesirable response
- Most controversial of the behaviour therapies (only sign up if you are desperate)
- Client has to endure decidedly unpleasant stimuli (ex. Shock or drug-induced nausea)
o Ex. Alcoholics  emetic drug (causes nausea and vomiting) paired with alcohol
 Creating a conditioned aversion to alcohol
- Takes advantage of the automatic nature of responses produced through classical
conditioning
- Is not widely used; usually only one element in a larger treatment program
Social Skills Training

- Many psychological problems grow out of interpersonal difficulties
- Behaviourists believe people aren’t born with social finesse but acquire through learning
- Social ineptitude can contribute to anxiety, feelings of inferiority, and various kinds of
disorders  focus on social skills training
Social skills training: a behaviour therapy designed to improve interpersonal skills that
emphasizes modelling, behavioural rehearsal, and shaping
- This can be conducted individually or in groups
- Depends on the principles of operant conditioning and observational learning
- Modelling  encouraged to watch socially skilled friends and colleagues in order to

acquire appropriate responses through observation
- Behavioural rehearsal  practise social techniques; reinforces with approval
- Shaping  gradually handle more complicated and delicate social situations
Cognitive-Behavioural Treatments
Cognitive-behavioural treatments: use varied combinations of verbal interventions and
behaviour modification techniques to help clients change maladaptive patterns of thinking
- Some emerged out of insight therapy (ex. Albert Ellis’s rational-emotive behaviour
therapy and Aaron Beck’s cognitive therapy)
- Some emerged from behavioural tradition (ex. Systems developed by Meichenbaum)
Cognitive therapy: uses specific strategies to correct habitual thinking errors that underlie
various types of disorders
- Originally devised as a treatment for depression (caused by “errors” in thinking)
- Assert that depression-prone people tend to:
1. Blame setbacks on personal inadequacies not considering circumstantial explanations
2. Focus selectively on negative events while ignoring positive events
3. Make unduly pessimistic projections about the future
4. Draw negative conclusions about their worth as a person
- The goal is to change client’s negative thoughts and appraisals, and maladaptive beliefs
- Clients are taught to detect their automatic negative thoughts and the therapist helps
them see how unrealistically negative they are
- Uses behavioural techniques (modelling, systematic monitoring, and rehearsal)
o Homework assignments  focus on changing clients’ overt behaviours
Self-instructional training: clients are taught to develop and use verbal statements that help
them cope with difficult contexts
- Donald Meichenbaum
- Help clients deal with current stressors and serve to inoculate them against future stress
Mindfulness-based therapy: integrates key ideas drawn from cognitive therapy and from
mindfulness meditation to heighten awareness of dysfunctional changes in mind and body
- Teaches individuals to focus on troubling thoughts or emotions and to accept them
without judging or elaborating on them
- The goal is to enable vulnerable individuals to extricate themselves from negative
automatic thoughts
- Mindfulness practices help people acquire important skills:
1. Increased awareness  notice where our attention is; bring it back to focus; expand our
awareness to capture the fullness of our experience
2. Present moment  bring the mind back to present moment whenever thinking of past
difficulties and worries
3. Self-compassion  the ability to have compassion for yourself and your experiences
4. Accepting things as they are  accept and respond as they are; avoid dysfunctional
reactivity that occurs when we contrast them to the way we want things to be
How Effective Are Behaviour Therapies?

- Behaviour therapists place more emphasis on the importance of measuring therapeutic
outcomes than insight therapists have
- The effectiveness of behaviour therapies is there but does not apply to all problems
Biomedical Therapies
Biomedical therapies: physiological interventions intended to reduce symptoms associated with
psychological disorders
- Assume that psychological disorders are caused (in part) by biological malfunctions
- Chlorpromazine became the first effective antipsychotic drug (for schizophrenia)
Treatment with Drugs

Psychopharmacotherapy (drug therapy): the treatment of mental disorders with medication
- Four main categories of therapeutic drugs for psychological problems:
Antianxiety Drugs
Antianxiety drugs: relieve tension, apprehension, and nervousness
- Ex. Valium and Xanax (trade names for diazepam and alprazolam)
- These drugs and others in the benzodiazepine family are  tranquilizers
- Immediate effect but relatively short-lived
- Side effects  drowsiness, depression, nausea, confusion, etc.
- Potential for abuse, drug dependence, and overdose; as well as withdrawal symptoms
Antipsychotic Drugs
Antipsychotic drugs: used to gradually reduce psychotic symptoms, inducing hyperactivity,
mental confusion, hallucinations, and delusions
- Used primarily in the treatment of schizophrenia as well as people with severe mood
disorders who become delusional
- Decreases activity at dopamine synapses
- Respond within one to three weeks; improvements may occur for several months
- Can also reduce the likelihood of a relapse into an active schizophrenic episode
- Side effects  drowsiness, constipation, dry mouth, symptoms of Parkinson’s disease
(muscle tremors, muscular rigidity, and impaired motor coordination)
- Brief periods of partial noncompliance with one’s drug regimen increases risk of relapse
Tardive dyskinesia: neurological disorder market by involuntary writing and tic-like movements
of the mouth, tongue, face, hands, or feet
- Seen in 20-30% of patients who receive long-term treatment with traditional drugs
- No cure; remissions sometimes occur after discontinuation of medication
Atypical antipsychotic drugs: roughly similar in therapeutic effectiveness but produce fewer
unpleasant side effects and carry less risk for tardive dyskinesia
- Affect some treatment-resistant patients who do not respond to the traditional ones
Antidepressant Drugs
Antidepressant drugs: gradually elevate mood and help bring people out of depression
- The most frequently prescribed class of medication in North America
- Two principle classes of antidepressants:
1. Tricyclics  inhibit reuptake at serotonin and norepinephrine synapses
o Fewer problems with side effects and complications than MAO inhibitors
2. MAO inhibitors  disable MAO enzymes that would normally metabolize and inactivate
neurotransmitters at dopamine, norepinephrine, and serotonin synapses
3. Selective serotonin reuptake inhibitors (SSRIs)  slows reuptake process at serotonin
synapses (activity is increased only at serotonin synpases)
o Ex. Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline)
o Similar therapeutic gains to tricyclics with fewer side effects
o Effective treatment of OCD, panic disorders, and other anxiety disorders
4. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
o Venlafaxine (Effexor) and duloxetine (Clexa)
o Produce slightly stronger effects than the SSRIs; but broader range of side effects
- Effects are gradual (over a period of weeks)
- Patients with serious depression benefit the most from antidepressant
- Concern  SSRIs may increase risk for suicide; others say it lowers; others no ties
- When antidepressants are compared to placebo treatment  data shows
antidepressants lead to a slight elevation in the risk of suicidal behaviour
Mood Stabilizers
Mood stabilizers: drugs used to control mood swings in patients with bipolar mood disorders
- For many years, lithium was the only effective drug in this category
o Valuable in preventing future episodes of both mania and depression
o Can be used to bring out of current manic or depressive episodes
o Dangerous side effects if not managed skillfully  kidney and thyroid gland
o Lithium levels must be monitored carefully (high levels  toxic or fatal)
- Alternatives  anticonvulsant agent called valproate (most popular)
o Similar results fewer side effects
How Effective Are Drug Therapies?

- Effective for many problems (especially impressive for those that defy other therapies)
- Controversial:
1. Not as effective as advertised and produce superficial effects; substantial relapse rates
when use is discontinued
2. Drugs are overprescribed and many patients are overmedicated
3. Damaging side effects may be underestimated; some are worse than the illness
4. Pharmaceutical industry has gained a lot of power and influence (conflict of interest)
o Financial ties appear to undermine the objectivity required in further research
o Industry-financed drug trials tend to be too brief to detect long-term risks
o Unfavourable results are often withheld from the public
o Often research exaggerates positive and minimize negative effects
Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT): a biomedical treatment in which electric shock is used to
produce a cortical seizure accompanied by convulsions
- Controversial  overused due to it’s lucrative procedure
- Others argue it’s underused due to public misconceptions about the procedure
- Recently it’s primarily recommended for the treatment of depression
Effectiveness of ECT
- Varied interpretations  remarkably effective treatment for major depression
o Many who do not benefit from antidepressant medication improve with ECT
- Against  available studies are flawed and inconclusive; ECT is the same as a placebo
- Enough evidence to justify conservative use of ECT in treating severe mood disorders
- Relapse rates after ECT are distressingly high; reduced if given antidepressants
Risks Associated with ECT

- Memory losses, impaired attention, and other cognitive deficits  short-term
- No objective evidence that ECT causes structural damage in the brain or that it has any
lasting negative effects on the ability to learn and remember information
New Brain Stimulation Techniques

Transcranial magnetic stimulation (TMS): new technique that permits scientists to temporarily
enhance or depress activity in specific area of the brain
- Mostly experimenting as a treatment for depression; by itself or with medicine
- Treatments delivered to the right and left prefrontal cortex show promise in reducing
depressive symptoms
- Minimum side effects
Deep brain stimulation (DBS): thin electrode is surgically implanted in the brain and connected
to an implanted pulse generator so that various electrical currents can be delivered to the brain
tissue adjacent to the electrode
- Valuable in the treatment of the motor disturbances associated with Parkinson’s
disease, tardive dyskinesia, and some seizure disorders
Current Trends and Issues in Treatment

Blending Approaches to Treatment
- A clinician would often use several techniques in working with a client
- Multiple approaches are particularly likely when a treatment team provides therapy
- Trend  a movement away from strong loyalty to individual schools of thought and a
corresponding move toward integrating various approaches to therapy
Eclecticism: in the practice of therapy involves drawing ideas from two or more systems of
therapy instead of committing to just one system
- Two common approaches:
1. Theoretical integration  two or more systems of therapy are combined or blended to
take advantage of the strengths of each
2. Technical eclecticism  borrowing ideas, insights, and techniques from a variety of
sources while tailoring one’s intervention strategy to the unique needs of each client
Increasing Multicultural Sensitivity in Treatment

- Modern psychotherapy emerged from a cultural milieu that viewed the self as
independent, reflective, rational being, capable of self-improvement
o Disorders were assumed to have natural causes, amendable with treatments
o Reflects Western cultural values that are far from universal
- Nonindustrialized societies  disorders are attributed to supernatural forces
o Victims seek help from priests rather than doctors
o Raised questions about the applicability of modern therapies to ethnic minorities
within Western culture
- Variety of barriers that contribute to underuse of therapeutic services by NA minorities
1. Cultural barriers  some cultures are reluctant to turn to formal professional help
o Prefer to rely on informal assistance from those who share their cultural heritage
o Some have bad interactions with bureaucracies and are distrustful
o Chinese Canadians  less likely to use services; report somatic symptoms
2. Language barriers  effective communication is crucial to the provision of
psychotherapy but many institutions are not adequately staffed with diverse languages
3. Institutional barriers  the inability of therapists to provide culturally responsive forms
of treatment; most are trained in the treatment of white, middle-class clients
- To give appropriate and effective treatment, clinicians need to be sensitive to diverse
cultural conventions and sensitivities (especially with the First Nations)
o Indigenous healing practices (pan-Amerindian healing movements) are
increasingly visible and popular in Aboriginal treatment centres
Institutional Treatment in Transition

- Dorothea Dix helped reform the way mental patients were treated
o Jails, poorhouses, streets, islands  government-funded institutions
Disenchantment with Mental Hospitals

- Around 1950s, hospitalization often contributed to the development of pathology
o Underfunded, overcrowded, understaffed, undertrained, overworked, etc.
- Disenchantment with the public mental hospital system inspired the community mental
health movement in the 1960s emphasizing:
1. Local, community-based care

2. Reduced dependence on hospitalization
3. Prevention of psychological disorders
Deinstitutionalization
Deinstitutionalization: refers to transferring the treatment of mental illness from inpatient
institutions to community-based facilities that emphasize outpatient care
- Two developments:
1. The emergence of effective drug therapies for severe disorders
2. The deployment of community mental health centres to coordinate local care
- Dropped the average inpatient population in state and county mental hospitals
- There’s a shift toward placing them in local general hospitals for brief periods instead of
distant psychiatric hospitals for long periods
- Length of stays in psychiatric hospitals and units in general hospitals have decreased;
local facilities try to get patients stabilized and back into the community swiftly
- Positive  more effective, less costly
- Negative  chronic patients had nowhere to go after release; not prepared
o Left two major problems: a “revolving door” and sizable homeless population
Mental Illness, the Revolving Door, and Homelessness

- Although proportion of hospital days dwindled, admission rates climbed
- Deinstitutionalization and drug therapy has created a revolving door through which
many mentally ill people pass again and again; caught in the mental health system
o Usually those who suffer from chronic, severe disorders
o Vicious cycle: stabilized  released  not prepared  destabilize  readmitted
o Many end up in prison
- Deinstitutionalization  blamed for the growing population of homeless people
Personal Application—Looking for a Therapist

- Treatment can sometimes have harmful rather than helpful effects; paramount that you
find an appropriate therapist
Where Do You Find Therapeutic Services?

- Private practitioners  self-employed; tend to be expensive but highly experienced
- Community mental health centres  salaried workers; provide a variety of services
- Hospitals  inpatient treatment; some outpatient therapy as well
- Human service agencies  provide short-term counselling
- Schools and workplaces  counselling centres for students/employees
Is the Therapist’s Profession or Sex Important?

- Researchers have not found any reliable association between therapists’ professional
background and therapeutic efficacy
- The importance of sex depends on whether it is important to the client
Is Treatment Always Expensive?

- Depends, private practitioners tend to be the most expensive
- Community mental health centres and social services are usually supported by taxes
- Provincial health-care programs often cover the services of psychiatrist
o But usually not services pf psychologists in private practice
Is the Therapist’s Theoretical Approach Important?

- Improvement rates for various theoretical orientations are fairly similar
o May be misleading as these scores are averages of many types of patients and
many types of problems
- Most think that for certain types of problems some approaches are better
o Panic disorders  cognitive therapy
o Specific phobias  systematic desensitization
o OCD  behaviour therapy or medication
- The variation among individual therapists, in skills, may be one of the main reasons why
it is hard to find efficacy differences between theoretical approaches to therapy
o Effective therapy requires skill and creativity (to individualize the treatment)
What Should You Look for in a Prospective Therapist?

- Personal warmth and sincere concern  can be candid and nondefensive with them
- Empathy and understanding  able to appreciate your view
- Self-confidence  communicates a sense of competence
- You should like your therapist  to establish rapport
What Should You Expect from Therapy?

- Have realistic expectations to avoid unnecessary disappointments
- Therapy is usually a slow process and requires hard work
Critical Thinking Application—From Crisis to Wellness – But Was It

the Therapy?
- Generally, therapy will help people feel better even if professional treatment itself were
utterly worthless and totally ineffectual
Placebo effects: occur when people’s expectations lead them to experience some change even
though they receive a fake treatment
- People have a remarkable tendency to see what they expect to see
Regression toward the mean: occurs when people who score extremely high or low on some
trait are measured a second time and their new scores fall closer to the mean (average)
- If you are near the bottom, there’s almost nowhere to go but up
- If you are near the top, there’s almost nowhere to go but down
- Most who seek therapy are already at their rock bottom  with regression towards the
mean, a period of time later they are more than likely to be more normal (“better”)
- Not an inevitability  but a statistical tendency that happens more often than not
Chapter 13: Social Behaviour

April 11, 2016
Social psychology: the branch of psychology concerned with the way individual’s thoughts,
feelings, and behaviours are influenced by others
Person Perception: Forming Impressions of Others

Personal perception: the process of forming impressions of others
- Influenced by physical appearance
- Impressions are continuously being updated as we get to know people better
- Solomon Asch demonstrated the importance that central traits can have on the
impressions we form of others
- Impressions are often inaccurate because of the many biases and fallacies that occur in
person perception
Effects of Physical Appearance

- Judgments of others’ personality are often swayed by their appearance
o Especially their physical attractiveness
- People tend to ascribe desirable personality characteristics to good-looking people
o More sociable, friendly, poised, warm, well adjusted, and more competent
o Small correlation between attractiveness and income (less than brains though)
- In reality, there’s little correlation exists between attractiveness and personality traits
o Although they tend to have more friends and better social skills overall
- Why?  vastly overrepresented in the entertainment media and our perceptions are
swayed by our desire to bond with attractive people
- People are quick to draw inferences about people based on their style of nonverbal
expressiveness (how they move, talk, and gesture)
o People were able to make inferences about the Big Five from simple pictures
Cognitive Schemas
Social schemas: organized clusters of ideas about categories of social events and people
- Help people efficiently process and store the wealth of information that they take in
Self-schema: integrated set of memories, beliefs, and generalizations about one’s behaviour in
a given domain
- Affects how one processes information about themselves in that domain and how one
processes information about others in terms of that domain
- Aschematic in that domain  do not have a self-schema relevant to a particular domain
Stereotypes
Stereotypes: widely held beliefs that people have certain characteristics because of their
membership in a particular group
- Special type of schemas that are part of their shared cultural background
- A cognitive process that is frequently automatic and saves time and effort
o Saves energy by simplifying our social world
- Broad overgeneralizations that ignore the diversity within social groups and foster
inaccurate perceptions of people  slanted probabilities (not certain but likely)
- Most common  gender, age, ethnic, and occupational stereotypes
- Self-fulfilling prophecy  if you feel a strong way about something you may behave in
such a way to make it true (strengthen stereotyping by “confirming” it)
o Immediate style  sitting closer and more eye contact
o Nonimmediate style  sitting farther away, more speech errors, looking away
- The influence of our stereotypes can also directly affect our own behaviour
o Ex. Elderly and neutral priming conditions  elderly primed were slower
o Being exposed to elderly-related words served to activate or prime
schemas/stereotypes associated with the elderly and affected behaviour
o When schemas are made active by priming, they automatically and
unconsciously affect behaviour and higher mental processes
Subjectivity and Bias in Person Perception

- Stereotypes and other schemas create biases in person perception that frequently lead
to confirmation of people’s expectations about others
Illusory correlation: occurs when people estimate that they have encountered more
confirmations of an association between social traits than they have actually seen
- People see what they want to see and overestimate how often they see it
o Also tend to underestimate the number of disconfirmations encountered
- Memory processes can contribute to confirmatory biases in person perception
o Individuals selectively recall facts that fit with their schemas and stereotypes
An Evolutionary Perspective on Bias in Person Perception

- Attractiveness  reproductive potential in women; health, vigour, and wealth in men
- Automatic tendency to categorize others  evolution need to separate friend from foe
o Programmed by evolution to immediately classify people as members of an:
 Ingroup: a group that one belongs to and identifies with
 Tend to be viewed in a favourable light
 Outgroup: a group that one does not belong to or identify with
 Tend to be viewed in terms of various negative stereotypes which
allows people to justify decriminalizing or dehumanizing them
- Bias in person perception  cognitive mechanisms shaped by natural selection
Attribution Process: Explaining Behaviour

Attributions: inferences that people draw about the causes of events, others’ behaviour, and
their own behaviour
- Plays a key role the in explanatory efforts of behaviour (significant effects on relations)
Internal versus External Attributions
- Fritz Heider  within a person or outside a person
Internal attributions: ascribe the causes of behaviour to personal dispositions, traits, abilities,
and feelings (personal factors)
External attributions: ascribe the causes of behaviour to situational demands and

environmental constraints (situational factors)
Attributions for Success and Failure

- Weiner’s model of attributions for success and failure
o Assumes that explanations for success and failure emphasize internal versus
external causes and stable (permanent) verses unstable (temporary) causes
- Four categories: internal-stable (ability), internal-unstable (amount of effort), external-
stable (luck), and external-unstable (difficulty level)
Bias in Attribution
- Attributions are only inferences and may not be correct explanations for events
The Fundamental Attribution Error and Actor-Observer Bias

Fundamental attribution error: observers’ bias in favour of internal attributions in explaining
others’ behaviour
- Observer tend to overestimate the likelihood that an actor’s behaviour reflects personal
qualities rather than situational factors
o Situational pressures may not be readily apparent to an observer
o Alternative two-step model of attribution: automatically attribute to personal
disposition (easy and effortless)  situational attribution (effortful second step)
o Many people feel that situational factors negate freedom of choice
o Observers are often unaware of historical and situational considerations
Actor-observer bias: actors favour external attributions for their behaviour, whereas observers
are more likely to explain the same behaviour with internal attribution
Defensive Attribution
Defensive attribution: a tendency to blame victims for their misfortune, so that one feels less
likely to be victimized in a similar way
- In attempting to explain the calamities and setbacks that befall others, the tendency to
make internal attributions may become even stronger than normal
- Hindsight bias contributes to this tendency
- Helps people maintain their belief that they live in a just world
- Those that view the world as just are especially likely to engage in victim derogation
Cultural and Attributional Tendencies

- Cultural disparities have emerged in research on attribution processes
Individualism: involves putting personal goals ahead of group goals and defining one’s identity
in terms of personal attributes rather than group memberships (generally in Western societies)
- Emphasizes  independence, self-esteem, and self-reliance
- Self-serving bias is particularly prevalent in individualistic, Western societies
Collectivism: involves putting group goals ahead of personal goals and defining one’s identity in
terms of the group one belongs to (generally in Eastern societies)
- Emphasizes  obedience, shared values and resources, cooperation, and reliability
- Less prone to the fundamental attribution error and are more likely to assume that
one’s behaviour reflects adherence to group norms
- More likely to display the self-effacing bias
Self-serving bias: the tendency to attribute one’s successes to personal factors and one’s
failures to situational factors
Self-effacing bias: tendency to attribute success to help received from others or to the ease of
the task and downplay the importance of ability; tendency to be self-critical of failures
Close Relationships: Liking and Loving (refer to OneNote Notes)

Interpersonal attraction: positive feelings toward another
Key Factors in Attraction

Physical Attractiveness
- Attractive people enjoy greater mating success
- People prefer physically attractive partners in romantic relationships, they may consider
their own level of attractiveness in pursuing dates
Matching hypothesis: proposes that males and females of approximately equal physical
attractiveness are likely to select each other as partners
- Attractive people expect to date more attractive individuals
- Unattractive people expect to date less attractive partners
Similarity Effects
- More support for a similarity-pull than a difference-pull in attraction
- Married and dating couples tend to be similar in age, race, religion, social class,
personality, education, intelligence, physical attractiveness, and attitudes
- Holds for both friendships and romantic relationships (regardless of sexual orientation)
Perspectives on the Mystery of Love

Passionate and Companionate Love
- Elaine Hatfield and Ellen Bersheid proposed that romantic relationships are
characterized by two kinds of love:
o Passionate love: a complete absorption in another that includes tender sexual
feelings and the agony and ecstasy of intense emotion
 Powerful motivational force that produces profound changes in people’s
thinking, emotion, and behaviour
 Activates dopamine circuits in the brain (similar to cocaine use)
o Companionate love: warm, trusting, tolerant affection for another whose life is
deeply intertwined with one’s own
o May coexist (but doesn’t go hand in hand)  companionate love is more
strongly related to relationship satisfaction
- Robert Sternberg subdivides companionate love into:
o Intimacy: warmth, closeness, and sharing in a relationship
o Commitment: intent to maintain a relationship in spite of the difficulties and
costs that may arise
Love as Attachment
- Infants tend to fall into one of three categories of attachment
o Secure, anxious-ambivalent, and avoidant attachment
- According to Hazan and Shaver  romantic love is an attachment process
o People’s intimate relationships in adulthood follow the same form as their
attachment in infancy  secure, avoidant, and anxious-ambivalent
- Individuals’ infant attachment experiences shape their intimate relationships as adults
- Attachment is best conceptualized in terms of where people fall on two continuous
dimensions  attachment anxiety and attachment avoidance
o Attachment anxiety  how much people worry that their partners will not be
available when needed (fear of abandonment from doubts about their lovability)
 Promotes excessive reassurance seeking (assurances of their worthiness)
o Attachment avoidance  degree of uncomfortable with closeness and intimacy
and therefore the tendency to maintain emotional distance from partners
o Four attachment styles:
 Secure  comfortable with intimacy and autonomy
 Preoccupied  preoccupied with relationship
 Avoidant-dismissing  dismiss of intimacy; unconcerned about rejection
 Avoidant-fearful  fearful of rejection; socially avoidant
Culture and Close Relationships

- Both similarities and differences between cultures in romantic relationships
- Vary in terms of how they understand and conceptualize love and relationships
o Attributable to differences in societal and psychological differences in

individualism and collectivism
- People all over the world value mutual attraction, kindness, intelligence emotional
stability, dependability, and good health in a mate
- Gender differences in mating priorities  nearly universal
o Male  physical attractiveness
o Female  social status and financial resources
- Vary in their emphasis on love (especially passionate love) as a prerequisite for marriage
o Marriage-for-love represents an ultimate expression of individualism
o Arranged marriages are common in cultures high in collectivism
An Evolutionary Perspective on Attraction

- Regards to heterosexual attraction more specifically
- Physical appearance is an influential determinant of attraction as it is a strong indicator
of reproductive fitness
- Facial symmetry seems to be a key element of attractiveness in highly diverse cultures
o Many environmental insults and developmental abnormalities are associated
with physical asymmetries  markers of relatively poor genes or health
- Women’s waist-to-hip ratio transcend culture as well (0.7 to 0.8 – “hourglass figure”)
o Signals health and youth
- Gender differences in humans’ mating preferences
- Women’s menstrual cycles also influence their mating preference and behaviour
Attitudes: Making Social Judgments

Attitudes: positive or negative evaluations of objects of thought
Components and Dimensions of Attitudes

- Attitudes have been traditionally viewed to be made of three parts: a cognitive
component, an affective component, and a behaviour component
- Currently, attitudes may include up to three types of components
- Cognitive  made up of the beliefs that people hold about the object of an attitude
- Affective  consists of the emotional feelings stimulated by an object of thought
- Behaviour  consists of predispositions to act in certain ways toward an attitude object
- Attitudes vary along several crucial dimensions:
o Strength  strong attitudes are ones that are firmly held (resistant to change)
and durable over time, and that have a powerful impact on behaviour
o Accessibility  how often one thinks about the attitude and how quickly it
comes to mind; highly accessible attitudes are quickly and readily available
 Correlated with attitude strength  highly accessible tend to be strong
o Ambivalent  conflicted evaluations that include both positive and negative
feelings about an object of thought
 Increases as ratio of positive to negative evaluations gets closer (equal)
 When ambivalence is high  attitude tends to be less predictive of

behaviour and more pliable in the face of persuasion
Attitudes and Behaviour

- Attitudes are mediocre predictors of people’s behaviour (ex. Seating Chinese patrons)
- But at the same time there are research that supports the conclusion that there are
many conditions under which attitudes are substantial predictors of behaviour
- Why the inconsistency?
o Researchers failed to take variations in attitude strength, accessibility, and
ambivalence into account
 Strong and accessible attitudes that have been stable over time tend to
be more predictive of behaviour
o Attitudes are often measured in a general, global way that isn’t likely to predict
specific behaviour (ex. Like to protect the environment but won’t donate money)
o Behaviour depends on situational constraints (especially your subjective
perceptions of how people expect you to behave)
 Attitude interact with situational constraints to shape people’s behaviour
Implicit Attitudes: Looking beneath the Surface

Explicit attitudes: attitudes that we hold consciously and can readily describe
Implicit attitudes: covert attitudes that are expressed in subtle automatic responses over which
we have little conscious control
- People can have implicit attitudes about virtually anything
- It’s a central issue in the study of prejudice  many express explicit attitudes that
condemn prejudice but unknowingly harbour implicit attitudes that reflect prejudice
- Implicit Association Test (IAT)  a series of words and pictures are presented onscreen
and subjects are urged to respond to these stimuli as quickly and accurately as possible
o IAT scores are predictive of subtle, but potentially important differences in
behaviour
Trying to Change Attitudes: Factors in Persuasion

- We live in the age of propaganda  does persuasion work to change behaviour?
- The process of persuasion  four basic elements
Source: the person who sends a communication
Receiver: the person to whom the message is sent
Message: the information transmitted by the source
Channel: the medium through which the message is sent

Source Factors
- Persuasion tends to be more successful when the source has high credibility
o Expertise  more influential when arguments are ambiguous
o Trustworthiness  can be even more important; accepted with little scrutiny
 Undermined when there’s a conflict of interest
 Enhanced when people appear to argue against their own interest
- Likability increases the effectiveness of a persuasive source
o Physical attractiveness and similarity
Message Factors
- One-sided arguments  ignores the possible problems of the action
- Two-sided arguments  acknowledges multiple concerns about the action
o Tend to be more effective  also increases credibility
- Use of fear  messages that are effective in arousing fear tend to increase persuasion
o Likely to work when your listeners view the dire consequences as exceedingly
unpleasant, fairly probably if they do not listen, and avoidable if they do
- Frequent repetition of a message is also effective
o Truth effect or validity effect  simply repeating a statement causes it to be
perceived as more valid or true
o Most effective when receivers are not motivated to pay close attention
o The truth effect may depend in part on the mere exposure effect
Mere exposure effect: the finding that repeated exposures to a stimulus promotes greater liking
the to stimulus
- Many types of stimuli  sounds, nonsense syllables, meaningful words, line drawings,
photographs, and various types of objects (explains the focus on advertising)
Receiver Factors
- No personality traits that are reliably associated with susceptibility to persuasion have
been found
- Forewarning a receiver gets about a persuasive effort and the receiver’s initial position
on an issue
- Considerations that stimulate counterarguing in the receiver tend to increase resistance
to persuasion
- Stronger attitudes are more resistant to change
- Resistance can promote resistance  when people successfully resist persuasive efforts
to change specific attitudes, they become more certain about those attitudes
Theories of Attitude Formation and Change

Learning Theory
- Attitudes may be learned from parents, peers, the media, cultural traditions, and other
social influences
- The effective, or emotional, component in an attitude can be created through classical

conditioning  evaluative conditioning (transfer of emotions attached)
o Ex. Advertisers routinely pair their products with stimuli that elicit pleasant
emotional responses  occur without awareness and resistant to extinction
- Operant conditioning may come into play when you openly express an attitude
o Agreement from others reinforce and strengthen the tendency to express a
specific attitude; disagreement functions as a punishment which weakens it
- Observational learning  exposure of other people’s attitudes and reinforcements
o Parents and children tend to have similar political attitudes
Dissonance Theory
- Leon Festinger’s dissonance theory  assumes that inconsistency among attitudes
propels people in the direction of attitude change
o Counterattitudinal behaviour  doing something that was inconsistent with
their true feelings
o Those paid $1 exhibited more favourable attitude change compared to those
paid $20
- Dissonance involves genuine psychological discomfort and even physiological arousal
Cognitive dissonance: exists when related cognitions are inconsistent—that is, when they
contradict each other
- Creates an unpleasant state of tension that motivates people to reduce their dissonance
o usually by altering their cognitions
- Those paid $20 for lying had an obvious reason for behaving inconsistently with their
true attitudes and so experienced little dissonance
- Those paid $1 had no readily apparent justification for their lie and experienced high
dissonance  to reduce it they tended to persuade themselves (believe their own lies)
- Also at work when people turn attitudinal somersaults to justify efforts that haven’t
panned out  effort justification syndrome
Self-Perception Theory
- People often infer their attitudes from their behaviour
- Argues that the effects typically attributed to dissonance were instead the results of the
self-perception process
- “A dollar isn’t enough for me to lie so I must have thought the task was enjoyable”
- Some say that self-perception is at work primarily when subjects do not have well-
defined attitudes regarding the issue at hand
Elaboration Likelihood Model

- There are two basic “routes” to persuasion
1. Central route  taken when people carefully ponder the content and logic of
persuasive messages
2. Peripheral route  taken when persuasion depends on nonmessage factors
o Such as physical attractiveness and credibility of the source, or on conditioned

emotional responses
- The model  the durability of attitude change depends on the extent to which people
elaborate on (think about) the contents of persuasive communication
- The central route leads to more enduring attitude changes and predict behaviour better
than attitude changed through the peripheral route
Conformity and Obedience: Yielding to Others

Social roles: widely shared expectations about how people in certain positions are supposed to
behave
- Sometimes we change our behaviour as a result of adopting a new social role
- Philip Zimbardo  prison simulation experiment
o Male undergraduates were randomly assigned the roles of a prisoner or guard
o Collectively the guards became mean, malicious, and abusive
o Within a short time, subjects with no obvious character flaws became tyrannical,
sadistic, brutal guards
- Once people begin behaving a certain way others may be caught up in the pressure to
conform
Conformity
Conformity: occurs when people yield to real or imagined social pressure
- Solomon Asch  “visual perception” study with three lines to test conformity
- There is a propensity to conform
- Group size and group unanimity are key determinants of conformity
o As groups grow larger  conformity increases up to a point
o Group size makes little difference if there’s even one other person that disagrees
- Why do people conform?
o Normative influence: operates when people conform to social norms for fear of
negative social consequences
 They’re afraid of being criticized or rejected  being liked
o Informational influence: operates when people look to others for guidance
about how to behave in ambiguous situations
 They’re uncertain how to behave (using others as a guide)  being right
Obedience
Obedience: a form of compliance that occurs when people follow direct commands, usually
from someone in a position of authority
Milgram’s Studies
- Shock experiment  65% delivered up to ‘xxx’ level of shock (finished the experiment)
- Obedience remained as various aspects of his experiment were changed, except:
o When the authority figure disappeared and was replaced by a normal person
o Obedience increased a bit when others were also performing the act
 When one defied, obedience declined dramatically

- Support Milgram’s thesis that situational factors exert great influence over behaviour
o If situational pressures favouring obedience are decreased, obedience declines
The Ensuing Controversy

- The results were counter to human intuition
- Cannot be generalized to apply to the real world
o Countered  overall the evidence supports the generalizability as the results
were replicated for many years in diverse settings with a variety of subjects
- “Everything must be okay” mentality as participants knew it was an experiment
o Countered  they wouldn’t have experienced the distress if they thought that
- Participates expect to obey orders from an experimenter as they agreed
o Countered  so do real-world soldiers and bureaucrats
- Questioned the ethics  extensive deception, undermine trust, severe stress and
emotional scars, come to accept their actions could have harmed someone
o Argued  this was a small price to pay for the insights gained
- Burger  repeated the experiment with extra precautions and resulted in only slightly
lower obedience levels (people today are just as prone to obedience as before)
Cultural Variations in Conformity and Obedience

- The phenomena of conformity and obedience seem to transcend culture
- Studies found higher levels of conformity in collectivistic than individualistic cultures
Behaviour in Groups: Joining with others

Group: consists of two or more individuals who interact and are interdependent
- Groups can vary in size, purpose, formality, longevity, similarity of members, and
diversity of activities
- Groups share certain features that affect their functioning
o Roles that allocate special responsibilities to some members
o Norms about suitable behaviour
o Communication structure that reflects who talks to whom
o Power structure that determines which members wield the most influence
Behaviour Alone and in Groups: The Case of the Bystander Effect

Bystander effect: people are less likely to provide needed help when they are in groups than
when they are alone
- Evidence that your probability of getting help declines as group size increases
- The only significant limiting condition on the bystander effect is that it is less likely to
occur when the need for help is unambiguous
o Ex. Less likely to occur when someone is in obvious physical danger or if the
bystanders are friends rather than strangers
- Bystander intervention is morel likely to occur when there is surveillance
- Bystander effects are most likely in ambiguous situations because people look around to
see whether others think there’s an emergency
o Other’s inaction suggests that there’s no need to help
o Diffusion of responsibility occurs when responsibility is divided among others
Group Productivity and Social Loafing

- Individual’s productivity often declines in larger groups
- Two factors that contribute to reduced individual productivity in larger groups
1. Reduced efficiency resulting from the loss of coordination
o Duplication of effort and holes
2. Loss of effort
o Social loafing: a reduction in effort by individuals when they work in groups as
compared to when they work by themselves
 Also caused by the diffusion or responsibilities
o Less likely when individuals’ personal contributions to productivity are readily
identified and group norms encourage productivity and personal involvement
o Reduced when people work in smaller and more cohesive groups
o Social loafing may be less prevalent in collectivistic cultures
Decision Making in Groups

Group Polarization
- “Risky shift”  groups arrived at riskier decisions than individuals did (Stoner)
- Groups can shift either way depending on which way the group is leaning to begin with
- Polarization  a shift toward a more extreme position
Group polarization: occurs when group discussion strengthens a group’s dominant point of
view and produces a shift toward a more extreme decision in that direction
- Does not involve widening the gap between factions in a group
- Can contribute to consensus in a group
- Why does it occur?
o Group discussion often exposes group members to persuasive arguments that
they had not thought about previously
o When people discover that their views are shared by others they tend to express
even stronger views because they want to be liked by their ingroups
Groupthink
Groupthink: occurs when members of a cohesive group emphasize concurrence at the expense
of critical thinking in arriving at a decision
- More like a disease that can infect decision making in groups (compared to polarization)
- Janis’s model of groupthink: antecedent conditions (high cohesiveness, group isolation,
directive leadership, high stress)  concurrence-seeking tendency  symptoms of
groupthink  symptoms of defective decision making
- Members suspend their critical judgement and censor dissent (pressure to conform)
o Everyone begins to think alike  mind guards against dissenting information

- Challenges to the group view  “us versus them” and view the outgroup as enemies
- Groupthink promotes incomplete gathering of information (conformity bias)
- Individual members often fail to share information that is unique to them
Group cohesiveness: the strength of the liking relationships linking group members to each
other and to the group itself
- According to Janis  a key precondition to groupthink
A Neuroscience Perspective on Social Psychology

A Neuroscience Perspective on Social Psychology
Social neuroscience: an approach to research and theory in social psychology that “integrates
models of neuroscience and social psychology to study the mechanisms of social behaviour”
- Social neuroscience differs from other areas of psychology in that it examines humans in
their social context, not as isolated “units of analysis”
- Uses PET, fMRI, ERPs, TMS, etc. to examine the mental mechanisms that create, frame,
regulate, and respond to our experience of the social world
Topics in Social Neuroscience

- Theory of mind
- Cross-cultural differences in empathy
- Lying
- Aggression
- Attributions
- Social cognition
- Self and self-judgment
- Social psychology of health and mental health
- Cognitive dissonance
- Attitude change
- Ostracism is related to the inhibition of central stress pathways controlling the release
of cortisol
- The role of the amygdala in people’s responses to white and black faces (study the
characteristics of implicit and explicit evaluations)
o White participants would show greater activation in the amygdala when
presented with black faces most notably under brief presentation times
o Implicit associations to social group may result in automatic emotional response
when encountering members of that group
Personal Application—Understanding Prejudice

Prejudice: a negative attitude held toward members of a group
- Harms victims’ self-concepts, supresses human potential, creates tension and strife
between groups, and even instigates wards
- Three components  beliefs, emotions, and behavioural dispositions
- Racial prejudice is most publicly known but is not the only type of prejudice
Discrimination: involves behaving differently, usually unfairly, toward the members of a group
- Closely related with prejudice and tend to go hand in hand
Stereotyping
- Plays a large role in prejudice  not always negative (although many are)
- Modern racism has merely become more subtle
- Stereotypes are so pervasive and insidious they are often activated automatically
- Stereotypes persist because the subjectivity of person perception makes it likely that
people will see what they expect to see (stereotypes may lie in the eye of the beholder)
Biases in Attribution
- People often make biased attributions for success and failure
- Men and women don’t get equal credit for their success (women  external; men 
internal) which helps sustain the stereotype that men are more competent than women
- Fundamental attribution error are likely when evaluating targets of prejudice  ignore
the situational factors that make it difficult for minorities to achieve upward mobility
Forming and Preserving Prejudicial Attitudes

- Prejudicial attitudes can be found in children as young as ages four or five
- Transmission of prejudice across generations depends on observational learning
o Parents transferring to children
- These prejudice may be strengthened through operant conditioning
- Stereotypic portrayals of various groups in the media can also foster prejudice
Implicit Prejudice
- Below the level of awareness of people  negative associations to an outgroup that are
activated automatically, without control or intention
Competition between Groups

- Oldest and simplest explanations for prejudice  competition between groups can fuel
animosity (resources like jobs and housing; one group’s gain is another’s loss)
- Realistic group conflict theory  intergroup hostility and prejudice are a natural
outgrowth of fierce competition between groups
- Even the mere perception of competition can breed prejudice
- Perhaps contact highlighting cooperation can help reduce prejudice
o Elliot Aronson’s jigsaw classroom technique (reduces prejudice)  just as in a
jigsaw puzzle, each piece (each student’s part) is essential for the completion
and full understanding of the final product
Dividing the World into Ingroups and Outgroups

Ethnocentrism: a tendency to view one’s own group as superior to others and as the standard
for judging the worth of foreign ways
- Us vs. them; derogate an outgroup to feel superior
- The more one identifies with an ingroup the more prejudice toward outgroups
- People tend to see diversity among the ingroup but overestimate the homogeneity of
the outgroup  “they all look alike”
Remedial and Affirmative Action by the Disadvantaged
- If the discrimination is believed to be global and pervasive, action is more likely
- Social identity is based on social experiences are more likely to endorse collective action
against discrimination than those whose social identity is based on stereotypes
- Perceiving discrimination to be isolated promotes an acceptance of the status quo
- Recognizing the pervasiveness of discrimination can have motivation qualities over time
Critical Thinking Application—Whom Can You Trust? Analyzing

Credibility and Social Influence Tactics
- There’s no way to successfully evade the constant, pervasive, omnipresent efforts of
others to shape your attitudes and behaviour
Evaluating Credibility
- Everyone’s entitled to their own opinions but not all opinions are equally valid
o Every person is not equally believable
o Important to carefully examine the evidence presented and the logic of the
argument that supports the conclusion
- To decide what to believe, you need to decide whom to believe and assess credibility
- Consider the following:
o How invested they are at the issue at hand (conflict of interest)?
o What are the source’s credentials?
o Is the information inconsistent with the conventional view on the issue?
 Be wary of wishful thinking
o What was the method of analysis used to reach the conclusion?
 Be careful of anecdotal evidence
 A popular method used by charlatans is to undermine the credibility of
conventional information by focusing on trivial inconsistencies
Recognizing Social Influence Strategies

Foot-in-the-door technique: getting people to agree to a small request to increase the chances
that they will agree to a larger request later
- People have the tendency to try to behave consistently and are reluctant to renege on
their sense of commitment to the person who made the initial request
Reciprocity norm: the rule that we should pay back in kind what we receive from others
- Meant to promote fair exchanges in social interactions; but is usually manipulated so

that it results in a large return for minimal value
Low-ball technique: getting someone to commit to an attractive proposition before its hidden
costs are revealed
Feigned scarcity: drive up the demand for products by giving the impression that they are
scarce
- People want what they cannot have; scarcity threatens your freedom to choose

Chapters 13, 15, 16

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Chapters 13, 15, 16

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PSYC 1010: CHAPTER 13, 15, 16 TEXTBOOK NOTES

Chapter 15: Psychological Disorders

Abnormal Behaviour: Myths, Realities and Controversies

Criteria of Abnormal Behaviour

- Psychological disorder occurs when behaviour becomes extremely deviant, maladaptive,

Psychodiagnosis: The Classification of Disorders

DSM-5: Changes and Continuing Challenges

o Argues that categorical to be replaced with the dimensional approach

The Prevalence of Psychological Disorders

Prevalence: in epidemiology, it is the percentage of a population that exhibits a disorder during

Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders

Generalized Anxiety Disorder

Post-Traumatic Stress Disorder (PTSD)

- Prevalence higher in women than men

Conditioning and Learning

Dissociative Identity Disorder

Etiology of Dissociative Disorders

Major Depressive Disorder

Anhedonia: a diminished ability to experience pleasure

Diversity in Mood Disorders

Postpartum depression: a type of depression that sometimes occurs after childbirth

Mood Disorders and Suicide

Etiology of Mood Disorders

Biological and Neurochemical Factors

Sports Concussions and Depression

Deterioration of Adaptive Behaviour

Positive versus Negative Symptoms

Negative symptoms: involve behavioural deficits, such as flattened emotions, social

Positive symptoms: involves behavioural excesses or peculiarities, such as hallucinations,

Course and Outcome

o Some people inherit a poly-genically transmitted vulnerability

Structural Abnormalities in the Brain

The Neurodevelopmental Hypothesis

Antisocial Personality Disorder

o Rarely experience genuine affection; skilled at faking it to exploit others

Psychological Disorders and the Law

Culture and Pathology

Are Equivalent Disorders Found around the World?

Culture-bound disorders: abnormal syndromes found only in a few cultural groups

Are Symptom Patterns Cultural Invariant?

Personal Application—Understanding Eating Disorders

History and Prevalence

Etiology of Eating Disorders

The Role of the Family

Critical Thinking Application—Working with Probabilities in Thinking

Chapter 16: Treatment of Psychological

The Elements of the Treatment Process

The Elements of the Treatment Process

Treatments: How Many Types Are There?

1. Insight therapies  “talk therapy”; psychoanalysis; engage in complex verbal

Clients: Who Seeks Therapy?

Therapists: Who Provides Professional Treatment?

Other Mental Health Professionals

Probing the Unconscious

Modern Psychodynamic Therapies

Therapeutic Alliance: The Importance of Therapy Climate

Therapies Inspired by Positive Psychology

- Participants essentially function as therapists for one another

Advantages of the Group Experience

Couples and Family Therapy

How Effective Are Insight Therapies?

Counterconditioning: attempt to reverse the process of classical conditioning by associating the

Social Skills Training

- Modelling  encouraged to watch socially skilled friends and colleagues in order to