CHAPTER 2

Foundations of Treatment and Researching Abnormality

OBJECTIVES:
a.) To differentiate the different treatment that target
Neurological, Psychological, and Social Factors
b.) To value the Scientific Method in Understanding Abnormality
c.) To examine the Research Challenges in understanding
Abnormality

❖ Treatments That Target Psychological Factors

▪ Psychodynamic Therapy
Psychodynamic therapy and psychoanalysis are intended to help patients
more adaptively manage unconscious conflicts that arise in large part from id-
driven impulses and urges. They do so by helping a patient develop insight into
events in his or her past (especially interactions with parents) and how these
events and unconscious forces influence current difficulties. Psychoanalysis is
more time-consuming than is psychodynamic therapy.

Psychodynamic therapy and psychoanalytic methods focus on the therapeutic

alliance, and use free association, interpretation, dream analysis, resistance, and
transference.

▪ Client-Centered Therapy
Client-centered therapy is designed to integrate the sense of self by decreasing
the incongruence between a patient’s real and ideal selves. According to the theory
of client-centered therapy, with an integrated sense of self comes reduced
emotional pain. To accomplish these aims, therapists show the patient genuine
empathy and unconditional positive regard.

Behavioral methods often focus attention on the antecedents and consequences

of a maladaptive behavior, as well as on the behavior itself. Specific methods
based on classical conditioning include exposure (sometimes with response
prevention), systematic desensitization, and stimulus control. Methods based on
operant conditioning make use of reinforcement and punishment and may involve
shaping, extinction, and self-monitoring.
 ▪ Cognitive-Behavior Therapy

Cognitive methods based on Ellis’s rational emotive behavior therapy

(REBT) may follow steps (A through F) that are designed to dispute beliefs that
lead to maladaptive consequences. Methods based on Beck’s cognitive
restructuring challenge patients’ maladaptive automatic negative thoughts and
encourage patients to test the accuracy of their beliefs through real-life
experiments. This hypothesis testing leads patients to develop more rational
responses to the automatic thoughts.

The behavioral aspects of cognitive-behavior therapy (CBT) are intended to

transform maladaptive behaviors that stem from previous learning, whereas the
cognitive aspects of CBT are intended to modify irrational thoughts and incorrect
beliefs that influence feelings and behavior maladaptively. Changing behaviors
and thoughts in turn alters feelings as well. CBT often includes psychoeducation.

Dialectical behavior therapy (DBT) relies on CBT methods and also has the
therapist validate the patient’s experience, help the patient accept and integrate
contradictory feelings and thoughts, and teach the patient a Zen Buddhist
approach of being nonjudgmental.
Incorporating Technology Into Treatment
Technology is being incorporated into treatment through the use of electronic
methods for self-monitoring and cognitive restructuring. Virtual reality exposure is
also sometimes used in therapy. Moreover, cybertherapy brings treatment to
patients who are unable or unwilling to go to the offi ce of a mental health clinician,
and it can be a means through which patient and therapist can maintain contact
between visits. However, cybertherapy has drawbacks: The therapist could be an
imposter, confidential information may not remain private, and the lack of
nonverbal cues for the therapist may skew the treatment in a less helpful direction.

Treatments for children and older patients that target psychological factors may
need to be modified for those populations. For instance, children may engage in
play therapy (however, clinicians who have different theoretical orientations will
use this method differently).

❖ Treatments That Target Social Factors

Treatments that target social factors are designed to reduce symptoms and/or improve
quality of life by changing a person’s relationships for the better and by creating,
expanding, or improving a person’s sense of community
 ▪ Interpersonal Therapy
is intended to address a patient’s problematic relationships and improve his
or her interpersonal skills so that relationships become more satisfying; the theory
is that as relationships improve, the symptoms of psychological disorders will
lessen. IPT focuses on four themes in problems with relationships: unresolved
grief, role transition, role dispute, and interpersonal deficits. The methods of IPT
include focusing on the consequences of patients’ actions, role-playing
interactions with significant others, encouraging patients to heighten their
awareness of feelings they have minimized, and helping patients to improve their
communication skills.

▪ Family and Systems Therapy

Family therapy can be conducted using most theoretical approaches;
depending on the specific approach, the focus of family therapy may be an
individual patient in the context of his or her family, or the family itself. In contrast,
systems therapy views the entire family as the unit of change and is designed to
improve communication or behavior patterns among family members—who may
not be the identified patient—and in doing so change the system. Methods of
systems therapy include validating each family member’s experience, reframing
the problem, and using paradoxical intention.

▪ Group Therapy
Group therapy, in which several patients with similar needs meet together with one
or two therapists, can be based on various theoretical approaches, such as
psychodynamic therapy or CBT; the theoretical approach determines the specific
methods employed.

▪ Community-Based Treatment
Treatment most often occurs within a patient’s community—his or her
neighborhood, town, or city. Most people seeking mental health care receive
outpatient treatment—treatment that does not involve an overnight stay in a
hospital. Outpatient treatment may occur in a therapist’s private offi ce, a
community mental health center or mental health clinic, an outpatient unit of a
hospital, or, for those seeking pastoral counseling, within their church, synagogue,
or mosque. For some people with severe symptoms, outpatient treatment
consisting of weekly sessions of up to 1 hour may not be adequate, and more
intensive treatment may be needed or desired. Intensive treatment may take place
in a hospital, clinic, or mental health facility and may last for several hours each
day or evening to 24 hours a day.
Inpatient treatment is the term for treatment that occurs while a patient is
in a psychiatric hospital or in a psychiatric unit of a general hospital.
Partial hospitalization consists of treatment provided at a hospital or other
facility, but the patient does not sleep there; such treatment is more intensive than
 what is available through once-a-week outpatient visits, but is less intensive than
the treatment received through hospitalization.
Residential treatment consists of staying in a staffed facility where patients
sleep, eat breakfast and dinner, and perhaps take part in evening groups.
Some people choose to attend self-help groups, either as a supplement to
their therapy or instead of therapy. Like group therapy, self-help groups
(sometimes referred to as support groups) tend to focus on a particular problem or
disorder. Self-help groups generally do not have a leader who is clinically trained,
although a mental health professional may sometimes advise the group.
Prevention programs are designed to prevent or inhibit the development
or progression of psychological problems or disorders

Targeting Social Factors in Younger and Older Populations

Treatments for children and elderly patients that target social factors may need
to be modified for those specific populations.

Treating a Multicultural Population

Culturally competent mental health clinicians provide treatment that is sensitive
to people from different backgrounds. Mental health services that are tailored to
the needs of a specific cultural or ethnic group are more likely to be used by
members of that group.

Finances and Managed Care

The bulk of the costs for mental health treatments are borne by health insurance
programs; managed care organizations in particular may restrict treatment in an
effort to minimize costs

Creating a Treatment Plan

▪ Choosing a Specific
The treatment or treatments given to a particular patient depend on the patient’s
willingness to receive particular treatments, on research results regarding specific
treatments for the patient’s problem, and on the expertise of the mental health clinician.
▪ Treatment Choosing One or More Treatments
Some patients may receive more than one type of treatment, depending on their specific
problem(s), the effectiveness of a given treatment, the patient’s interest in pursuing
additional treatments, and the patient’s insurance benefi ts and fi nances
Although any given treatment targets only one factor, changes brought about by an
effective treatment in turn affect other factors.
 Researching Abnormality

❖ Using the Scientific Method to Understand Abnormality

The Scientific Method
Researchers use the scientific method to understand and study
psychopathology. In doing so, they observe relevant phenomena, identify a question to
be answered, develop a hypothesis that might answer the question, collect new
observations to test the hypothesis, draw on the evidence to formulate a reasonable
theory, and test the theory.

Types of Scientific Research

When conducting experiments, researchers systematically manipulate one
or more independent variables (changing one at a time) and observe possible
changes in one or more dependent variables. Researchers examine the possible
contribution of confounds by using control groups or control conditions. To
minimize unintentional bias, they randomly assign participants to groups. In
addition, stimulus items are chosen to assess the relevant variables, and
confounding characteristics are eliminated. Experiments should have both internal
and external validity.
 Ethical Guidelines for Research
Psychologists have developed an ethical code of conduct that lays out
guidelines for research, including the requirements that informed consent must be
obtained from participants and that participants must be debriefed after a study is
over.

❖ Research Challenges in Understanding Abnormality

Challenges in Researching Neurological Factors
Many studies that focus on neurological factors are correlational and so do not
reveal how neurological factors may give rise to psychological disorders. They reveal only
that certain neurological factors are associated with some disorders.
Neuroimaging studies are becoming more common, and these studies may
indicate differences in brain structure or function between those with a psychological
disorder and those without a disorder. However, it is not always clear how such
differences contribute to a disorder
 Challenges in Researching Psychological Factors

Self-reports of patients or reports by others may be biased in what is paid

attention to, remembered, or reported. In addition, participants may respond
differently to questions that are asked during an interview and those that are
presented on a questionnaire. Moreover, participants may misunderstand the
intent of a question and hence answer in way that distorts the results. Researchers
must take care in phrasing questions in order to minimize misinterpretation and
various types of biases.

Challenges in Researching Social Factors

Challenges in studying social factors can also create challenges in studying
other types of factors. Such challenges include experimenter-infl uenced biases, such as
experimenter expectancy effects (which can be reduced with a double-blind design) and
reactivity. A major challenge for cross-cultural research on psychopathology is the diffi
culty of translating words or concepts across cultures

❖ Researching Treatment

Researching Treatments That Target Neurological Factors

When studying biomedical treatments, researchers should try to determine the
extent to which a placebo effect—rather than a true drug effect—influences the results.
Researchers should also take attrition rates into account when examining the effects of a
treatment.
Many of the challenges that arise in studying biomedical treatments, such as
placebo effects and attrition, also arise when studying psychological treatments. When
we say, Placebo this is the effect a positive effect of a medically inert substance or
procedure. When we say attrition, this is the reduction in the number of participants during
a research study. A treatment may be effective because of common factors, as well as
because of specific factors unique to that treatment. Control groups and analogue studies
can allow researchers to examine specific factors and to rule out possible effects of some
confounding factors. In general, research has demonstrated that therapy is more helpful
than no treatment. Although the Dodo bird verdict found no one form of therapy superior
overall, some specific therapies are better for some particular disorders.
Researching Treatments That Target Psychological Factors

Randomized clinical trials (RCTs) are designed to investigate the efficacy of

specific factors or treatments. RCTs typically involve manual-based treatment; some
RCTs may have limited generalizability because of their exclusion criteria, homogenous
samples, and other factors. Results of well-designed and wellconducted studies may
indicate whether a particular treatment is empirically supported for a specific disorder.
The results of research generally suggest a dose-response relationship. The code of
ethics for psychologists includes specific guidelines for research on experimental
treatments.

Researching Treatments That Target Social Factors Feedback Loops in Action: The
Placebo Effect
Research on treatments that target social factors reveals that matching patients
and therapists by ethnicity, gender, or age does not systematically alter the effectiveness
of therapy. For patients with a strong preference, however, matching may lead to a better
outcome. Cultural forces influence whether a treatment (including placebo) is effective.
Any successful treatment, whatever type of neuropsychological factor it targets,
also affects the other factors through feedback loops, inducing positive change. This is
also true of changes that arise because of the placebo effect.