Introduction, Historical Overview, and

Current Paradigms in Psychopathology

 ABNORMAL & THERAPEUTIC PSYCHOLOGY

How many people die from Anorexia?

What is schizophrenia?
Can I ‘catch’ depression if I hang
out with someone who’s
depressed? Does anxiety
run in
What causes people to hallucinate?
families?

Can psychologists read people’s minds?

Can we prevent mental illnesses?

Do psychological treatments really work?

 Psychopathology

• Study of the nature, development, and

treatment of psychological disorders

• Challenges in the study of psychopathology:

– Maintain objectivity
– Avoid preconceived notions
– Reduce stigma

© 2014 John Wiley & Sons, Inc. All rights reserved.

What is ‘abnormal’
psychology?

• Statistical infrequency
• Violation of social norms
• Personal distress
• Dysfunction
• Disability
 Defining Mental Illness

• Behavioural or psychological syndrome or pattern that is associated

with distress or disability
• Not expected in the person’s cultural context
• It is not primarily a result of social deviance or conflict with society
Core Concepts:
Some key principles of
clinical psychology
• Scientist-practitioner model

• Assessment is continuous

• Therapeutic relationship is key

• Behaviour is functional
 Historical conceptions of
abnormal behaviour
• Major psychological disorders have existed across
time and cultures
• Causes and treatment of abnormal behaviour varied
widely, depending on context
• Three main explanations:
• Supernatural
• Biological
• Psychological
 Supernatural Tradition
• Demons
– Possession by evil beings or
spirits
• Exorcism
• Dark Ages (2nd century AD)
– Monks cared and prayed for
mentally ill

• Witches (13th century AD)

– Torture sometimes led to bizarre
delusional sounding
confessions, e.g., concourse
with demons.
• Initially, historians
concluded many of the
accused were mentally ill.
• Further research found little
support for this conclusion.
 History of Psychopathology:
Lunacy Trials
• Lunacy Trials
– Trials held to determine sanity
• Began in 13th century England
– Municipal authorities assumed responsibility for care of
mentally ill
– Lunacy attributes insanity to misalignment of moon
(“luna”) and stars
 The Evolution of Contemporary
Thought: Biological Approaches
• Physical disturbance
– Hippocrates (5th century BC)
• Mental disturbances have natural (not
supernatural) causes (problems with the
brain)
– Three categories of mental
disorders: mania, melancholia, &
phrenitis (brain fever)
– Normal brain functioning depended
on balance of four humors: blood,
black bile, yellow bile, & phlegm
• Galen: humoral theory, hysteria
• Kraepelin: diagnosis and classification
• Development of biological treatments
The Evolution of Contemporary Thought:
Biological Approaches

• General paresis and Syphilis

– Degenerative disorder with psychological symptoms
(delusions of grandeur) and physical symptoms (progressive
paralysis)
– By mid-1800’s, it was known that general paresis and syphilis
occurred together in some patients
– In 1905, biological cause of syphilis found
– Since general paresis had biological cause, other mental illness
might also
• Biological causes of psychopathology gained credibility
 The Evolution of Contemporary Thought :
Genetics

• Galton’s (1822–1911) work lead to notion that mental

illness can be inherited
– Nature (genetics) and nurture (environment)
– Eugenics
• Promotion of enforced sterilization to eliminate undesirable
characteristics from the population
• Many state laws required mentally ill to be sterilized
 Early Biological Treatments
• Insulin-coma therapy
– Sakel (1930’s)
• Electroconvulsive
Therapy (ECT)
– Cerletti and Bini (1938)
– Induce epileptic seizures
with electric shock
• Prefrontal lobotomy
– Moniz (1935)
– Often used to control violent
behaviors; led to
listlessness, apathy, and
loss of cognitive abilities
Psychological Tradition

• Asylum reform
• Return to
custodial care

• Moral therapy
• Emotional or
psychological
treatment
 History of Psychopathology:
Asylums

• Asylums (15th century)

– Establishments for the confinement and care of
mentally ill
– Priory of St. Mary of Bethlehem (founded in 1243)
• One of the first mental institutions
• The wealthy paid to gape at the insane
• Origin of the term bedlam (wild uproar or confusion)
– Treatment non-existent or harmful at asylums
• Benjamin Rush recommended drawing copious amounts
of blood, to relieve brain pressure
 History of Psychopathology:
Pinel’s Reforms and Moral Treatment
• Philippe Pinel (1745–1826)
– Pioneered humanitarian treatment at
LaBicetre
• Moral Treatment
– Small, privately funded, humanitarian mental
hospitals
• Friends Asylum (1817)
• Patients engaged in purposeful, calming activities
(e.g., gardening)
• Talked with attendants
 History of Psychopathology:
Dorothea Dix
• Dorothea Dix (1802–1887)
– Crusader for prisoners and mentally ill
– Urged improvement of institutions
– Worked to establish 32 new, public hospitals
– Unfortunately, small staffs at these new public
hospitals could not provide necessary
individual attention
– Hospitals administered by physicians, who
were more interested in biological rather than
psychological aspects of mental illness
 The Evolution of Contemporary Thought:
Psychological Approaches
• Mesmer (1734–1815)
– Treated patients with hysteria using “animal
magnetism”
– Early practitioner of hypnosis
• Charcot (1825–1893)
– His support legitimizes hypnosis as treatment for
hysteria
• Breuer (1842–1925)
– Used hypnosis to facilitate catharsis in Anna O.
– Cathartic Method
• Release of emotional tension triggered by reliving and talking
about event
Current psychological
paradigms
Science & Psychopathology
• Paradigm = conceptual framework within
which a scientist views the object of study

• Implications of adopting a Paradigm

• Affects way of working
• Permits communication
• Gives a research base to guide treatment
Biological paradigms
 Biological Paradigm

• Mental disorders caused

by biological factors
• Heredity
• Imbalances of brain
chemistry
• Disordered
development of brain
structures
 Biochemistry
• Neurons: nerve cells
• Transmit messages by electrical
and chemical impulses
• Neurotransmitters: chemical
messengers released from
presynaptic neuron into the synapse
• Inhibitory or excitatory
• Received by postsynaptic neuron
• Reuptake
 Biological Treatments

• Psychoactive drugs
• Modify neurotransmitter activity (serotonin,
dopamine)
• Reductionism
• Criticised as too simplistic – doesn’t capture
complexity
 The Genetic Paradigm
•DNA is made up of base pairs
(A, T, G, C)
•A human being has 46
chromosomes (23 pairs) inherited
from their biological parents
•Allelles = different forms of the
same gene
•Genes don’t ‘cause’ behaviour.
 Behaviour Genetics
• Degree to which heredity plays a role in abnormal
behaviour
• genotype = genetic material you inherit
• phenotype = behavioural characteristics
• Methods
• Family method
• Twin studies
• Adoptees method
• Linkage analysis
 Gene-Environment
Interactions
• “nature via nurture”
• Caspi et al., 2003
• Belsky & colleagues’: ‘differential susceptibility’ model
(2009)
 Epigenetics
• Harvard Centre for the Developing Child
• http://developingchild.harvard.edu/

• Three Core Concepts in Early

Development
• http://developingchild.harvard.edu/resources/multimedia/videos/three
_core_concepts/brain_architecture/

• How Early Experiences Alter Gene

Expression and Shape Development
(Interactive Feature)
• http://developingchild.harvard.edu/index.php/resources/multimedia/int
eractive_features/gene-expression/
Psychological paradigms

Psychodynamic
 Freud
• Breuer and Freud (1856–1939) jointly
publish “Studies in Hysteria” in 1895, which
serves as the basis for Freud’s theory.
• Freudian or psychoanalytic theory
– Human behavior determined by unconscious
forces.
– Psychopathology results from conflicts among
these unconscious forces.
The Influence of Freud
 Freud’s Psychoanalytic
Paradigm
• Unconscious conflicts = psychopathology
• Id
– Unconscious
– Pleasure principle
• Immediate gratification
– Libido
• Energy of id
• Ego
– Primarily conscious
– Reality principle
• Attempt to satisfy id’s demands within reality’s
constraints
• Superego
– The conscience
– Develops as we incorporate parental and society values
 Defense Mechanisms

• Id, Ego, & Superego continually in conflict

– Conflict generates anxiety
– Ego generates strategies to protect itself from
anxiety
• Defense mechanisms
• Psychological maneuvers used to manage stress and
anxiety
Defense Mechanisms
 Stages of Psychosexual
Development
• Oral
• Anal
• Phallic
• Oedipus complex (male)
• Electra complex (female)
• Latency period
• Genital
 Neo-Freudian
Psychodynamic
Perspectives
• Jung (1875–1961)
– Analytical psychology
• Freudian and humanistic
• self-realisation
– Collective unconscious
– Archetypes
– Catalogued personality characteristics
• Extraversion vs. Introversion

• Adler (1870–1937)
– Individual psychology
• Fulfillment derived from working for the
social good
 Psychoanalytic
Treatment
• Goals of Psychoanalytic Therapy or
Psychoanalysis
– Understand early-childhood
experiences, particularly key (parental)
relationships
– Understand patterns in current
relationships
• Free association
• Dream analysis
• Transference
 Table 1.3:
Major Techniques of Psychoanalysis
 Continuing Influences of Freud
and His Followers
• Childhood experiences help shape adult
personality
• There are unconscious influences on
behavior
 Humanistic Paradigms
• Carl Rogers’ Client-Centered Therapy
• Unique perspective
• Capacity for self-awareness
• Humans are basically good and self-
directed
• Goal = self-actualisation

• Techniques
• Unconditional positive regard
• Empathy (primary, advanced)
Existential Therapy

• Personal growth, freedom to make

choices (but this causes anxiety)

• Confront anxiety

• Make important decisions

 Gestalt Therapy
• Frustration and denial of our basic nature

• Therapy techniques
• I-language
• Empty chair
• Projection of feelings
• Non-verbal cues
• Metaphor
 Other Paradigms

• Learning or behavioural

• Cognitive

• Diathesis-stress

• Integrative/biopsychosocial
Psychological paradigms

Behaviourism
 The Rise of Behaviorism

• John Watson (1878–1958)

• Behaviorism
– Focus on observable behavior
– Emphasis on learning rather than thinking or
innate tendencies
• Three types of learning:
– Classical Conditioning
– Operant Conditioning
– Modeling
 Classical Conditioning
• Discovered by Pavlov (1849–1936)
– Unconditioned Stimulus (UCS)
• Meat powder (automatically elicits salivation)
– Unconditioned Response (UR)
• Salivation (automatic response to meat powder)
– Neutral Stimulus (NS)
• Initial ringing of bell (does not automatically elicit salivation)
– Conditioned Stimulus (CS)
• After pairing the NS and the UCS, the NS becomes a CS (bell now
automatically elicits salivation)
– Conditioned Response (CR)
• Salivation (automatic response to bell)
– Extinction
• CS (bell) not followed by UCS (meat powder) causes gradual
disappearance of CR (salivation)
 Figure 1.3:
The process of classical conditioning
 Operant Conditioning

• E. Thorndike (1874–1949)
– Learning through consequences
– Law of Effect
• Behavior that is followed by satisfying consequences will be repeated;
behavior that is followed by unpleasant consequences will be
discouraged

• B.F. Skinner (1904–1990)

– Principle of Reinforcement
• Positive reinforcement
– Behaviors followed by pleasant stimuli are strengthened
• Negative reinforcement
– Behaviors that terminate a negative stimulus are
strengthened
 Reinforcement & Punishment

• • Positive reinforcement - behaviour becomes more

• likely as a result of pleasant result (positive reinforcer)
• • Negative reinforcement - behaviour becomes more
• likely because it results in removal of aversive stimuli
• • Positive punishment - behaviour becomes less likely
• as a result of aversive result (punisher)
• • Negative punishment - behaviour becomes less
• likely because it leads to the loss of something nice
 Modeling

• Learning by watching and imitating

others’ behaviors
– Can occur without reinforcement
• Bandura & Menlove (1968)
– Modeling reduced children’s fear of dogs
 Behaviour Therapy
• Contingency management
• –Time-out
• –Token economy
• –Aversive conditioning
• Modelling
• –Role-playing
• • Counterconditioning
• • Exposure
Psychological paradigms

Cognitive therapy
 Importance of Cognitions

• Behaviorism criticized for ignoring thoughts

and emotions
• Cognitive Therapy
– Emphasizes that how people think about
themselves and their experiences can be a major
determinant of psychopathology
– Focuses on understanding maladaptive thoughts
– Changes cognitions to change feelings and
behaviors
 Cognitive Science

• Cognition
– A mental process that includes:
• Perceiving, recognizing, conceiving, judging, and reasoning

• Schema
– Organized network of previously accumulated knowledge
– We actively interpret new information
• Role of attention in psychopathology
– Anxious individuals more likely to attend to threat or danger
 Ellis (1913–2007) REBT (Rational-
Emotive Behavior Therapy)
• 3 main irrational beliefs:
–I must be outstandingly
competent, or I am worthless.
–Others must treat me
considerately, or they are
absolutely rotten.
–The world should always give
me happiness, or I will die.
 Beck’s Cognitive Therapy

• Initially developed for depression

• Depression caused by distorted thoughts
– Nothing ever goes right for me!
• Information-Processing Bias
– Attention, interpretation, and recall of
negative and positive information
biased in depression
 Cognitive Therapy
• Help patients recognize and change
maladaptive thought patterns
• Negative automatic thoughts
• Maintained by biases such as:
• Black and white thinking
• Filtering
• Mind reading
•Overgeneralising
Beck: Cognitive Therapy
Psychological paradigms

CBT
 Current Paradigms:
Cognitive Behavioral
• Roots in learning principles and cognitive science
• Behavior is reinforced by consequences
– Attention
– Escape or avoidance
– Sensory stimulation
– Access to desirable objects or events
• To alter behavior, modify consequences
– Time out
• Systematic desensitization
• Used to treat phobias and anxiety
• Combines deep muscle relaxation and gradual exposure to the feared
condition or object
• Imaginal or in vivo
• Starts with minimal anxiety producing condition and gradually
progresses to most feared
• http://www.youtube.com/watch?v=lMZ5o2uruXY
 Cognitive Behavior Therapy (CBT)

• Attends to thoughts, perceptions,

judgments, self-statements, and
unconscious assumptions
• Cognitive Restructuring
– Change a pattern of thinking
– Changes in thinking can change feelings,
behaviors, and symptoms
 CBT Techniques
• Activity recording and scheduling
• Pleasant event scheduling
• Breaking tasks into small steps
• Thought records
• Mood records

http://www.getselfhelp.co.uk/freedownloads2.
htm
 Principles of CBT
• Empathic
• Empirical
• Educational
• Here and now
• Structured
• Homework
• Assessment
• Individualised
 Evaluating the CBT Paradigm

• Focus is on current determinants of

disorder
– Childhood and other historical antecedents
given less attention
• Are distorted thoughts the cause or the
result of psychopathology?
– Causal status unclear
Further Developments in CBT
• Last 15 years
• Hayes – third wave of CBT
• Extensions of CBT treatments
–mindfulness
–acceptance
–values
–emotions
–relationships
 Current Paradigms:
Factors That Cut Across the Paradigms
• Affect vs. mood
• Emotion
– Components
• Expressive
• Experiential
• Physiological
– Most psychopathology includes disturbances of one
or more component
• e.g., flat affect in schizophrenia
• What is your ideal affect?
– Happiness vs. calmness
Factors That Cut Across the Paradigms

• Sociocultural Factors
– Gender, race, culture, ethnicity, and
socioeconomic status
– May increase vulnerability to psychopathology
• e.g., women more likely to experience depression
than men
– Some disorders specific to certain cultures
• Hikikomori in Japanese culture
Table 2.1: Lifetime Prevalence Rates of DSM-IV-TR
Disorders Among Different Ethnic Groups
 Interpersonal Factors and Psychopathology
• Object relations theory
– Longstanding patterns of relating to others
• Attachment theory
– Type and style of infant’s attachment to caregivers can
influence later psychological functioning
• Relational self
– Individuals will describe themselves differently depending upon
which close relationships they are told to think about
• Interpersonal therapy (IPT)
– Impact of current relationships on psychopathology
– Unresolved grief; Role transitions; Role disputes; Social deficits
 Current Paradigms:
Diathesis-Stress
• Integrative model that incorporates multiple causal
factors
– Genetic, neurobiological, psychological, and environmental
• Diathesis
– Underlying predisposition
• May be biological or psychological
– Increases one’s risk of developing disorder
• Stress
– Environmental events
• May occur at any point after conception
• Triggering event
• Psychopathology unlikely to result from one single
factor