Psychopathology From Science to Clinical Practice, 2nd
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PSYCHOPATHOLOGY
From Science to Clinical Practice
SECOND EDITION
edited by
LOUIS G. CASTONGUAY
THOMAS F. OLTMANNS
ABIGAIL POWERS LOTT
THE GUILFORD PRESS
New York London
Copyright © 2021 The Guilford Press
A Division of Guilford Publications, Inc.
370 Seventh Avenue, Suite 1200, New York, NY 10001
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Last digit is print number: 9 8 7 6 5 4 3 2 1
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are accepted at the time of publication. However, in view of the possibility of human error
or changes in behavioral, mental health, or medical sciences, neither the authors, nor
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Library of Congress Cataloging-in-Publication Data
Names: Castonguay, Louis Georges, editor. | Oltmanns, Thomas F., editor. |
Lott, Abigail Powers, editor.
Title: Psychopathology : from science to clinical practice / Louis G. Castonguay,
Thomas F. Oltmanns, Abigail Powers Lott.
Description: Second edition. | New York : The Guilford Press, [2021] |
Includes bibliographical references and index.
Identifiers: LCCN 2021000526 | ISBN 9781462547616 (cloth)
Subjects: LCSH: Psychology, Pathological.
Classification: LCC RC454 .P7863 2021 | DDC 616.89—dc23
LC record available at [Link]
To Larry Beutler and Clara Hill, for years of friendship and collaboration,
as well as for inspiring and guiding the field of psychotherapy
toward the integration of science and practice
—L. G. C.
To Richard McFall and Richard Bootzin, inspirational friends
who worked tirelessly for many years to foster the integration of science
and practice in clinical psychology
—T. F. O.
To Vasiliki Michopolous and Jennifer Stevens, for their friendship
and leadership, and for helping me to approach my research in novel ways
and encouraging my integration of science and practice
across both my treatment research and clinical care
—A. P. L.
About the Editors
Louis G. Castonguay, PhD, is Liberal Arts Professor of Psychology at The Pennsylvania State
University. With more than 200 publications, he focuses his research on different aspects of
therapeutic change and training (including variables related to interventions, relationship,
client, and therapist), especially in the context of psychotherapy integration. Dr. Castonguay
is also involved in practice-oriented research and the development of practice research net-
works aimed at facilitating collaboration between clinicians and researchers. In addition, he
has been investigating the process and efficacy of integrative treatments for generalized anxi-
ety disorder and depression. Dr. Castonguay is a recipient of the Distinguished Psychology
Award from Division 29 (Society for the Advancement of Psychotherapy) of the American
Psychological Association and the Distinguished Career Award from the Society for Psycho-
therapy Research (SPR). He has served as president of SPR and of the North American chapter
of SPR.
Thomas F. Oltmanns, PhD, is the Edgar James Swift Professor of Psychology in Arts and
Sciences and Professor of Psychiatry at Washington University in St. Louis, where he was for-
merly Director of Clinical Training in Psychology. Dr. Oltmanns’s current research focuses on
links between maladaptive personality traits, adverse life events, and health in middle-aged
and older adults. He has served on the board of directors of the Association for Psychological
Science and as president of the Society for Research in Psychopathology, the Society for a Sci-
ence of Clinical Psychology, and the Academy of Psychological Clinical Science. Dr. Oltmanns
is a recipient of awards for outstanding teaching from Washington University in St. Louis and
the University of Virginia, as well as the Toy Caldwell-Colbert Award for Distinguished Edu-
cator in Clinical Psychology from Division 12 (Society of Clinical Psychology) of the Ameri-
can Psychological Association.
Abigail Powers Lott, PhD, ABPP, is Assistant Professor in the Department of Psychiatry and
Behavioral Sciences at Emory University School of Medicine. A board-certified clinical psy-
chologist, she conducts research spanning a range of topics across personality, trauma, and
negative health outcomes. Dr. Lott has a particular focus on understanding mechanisms of
risk associated with chronic trauma exposure across the lifespan and advancing culturally
relevant treatment interventions in underserved and at-risk populations. She has received
numerous teaching awards for her efforts in educating both clinical psychology interns and
psychiatry residents at Emory University.
vii
Contributors
Jonathan S. Abramowitz, PhD, Department of Psychology and Neuroscience,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Evelyn Attia, MD, New York State Psychiatric Institute and Department of Psychiatry,
Columbia University Irving Medical Center, New York, New York
Jacques P. Barber, PhD, ABPP, Gordon F. Derner School of Psychology, Adelphi University,
Garden City, New York
Ashley Battaglini, MA, Department of Psychology, University of British Columbia,
Vancouver, British Columbia, Canada
Sophie Bergeron, PhD, Department of Psychology, University of Montreal,
Montreal, Quebec, Canada
Craig J. Bryan, PhD, ABPP, Department of Psychiatry and Behavioral Health,
The Ohio State University, Columbus, Ohio
Richard A. Bryant, PhD, School of Psychology, University of New South Wales,
Sydney, Australia
Louis G. Castonguay, PhD, Department of Psychology, The Pennsylvania State University,
University Park, Pennsylvania
Elise M. Clerkin, PhD, Department of Psychology, Miami University, Oxford, Ohio
Paul F. Crits-Christoph, PhD, Department of Psychiatry, University of Pennsylvania,
Philadelphia, Pennsylvania
Judith R. Davidson, PhD, Department of Psychology, Queen’s University,
Kingston, Ontario, Canada
Matthew V. Elliott, BS, Department of Psychology, University of California, Berkeley,
Berkeley, California
ix
x Contributors
Deborah R. Glasofer, PhD, New York State Psychiatric Institute and Department
of Psychiatry, Columbia University Irving Medical Center, New York, New York
Alexandra K. Gold, MA, Department of Psychological and Brain Sciences,
Boston University, Boston, Massachusetts
Marvin R. Goldfried, PhD, Department of Psychology, Stony Brook University,
Stony Brook, New York
Sheri L. Johnson, PhD, Department of Psychology, University of California, Berkeley,
Berkeley, California
Terence M. Keane, PhD, National Center for PTSD, VA Boston Healthcare System,
Boston, Massachusetts
E. David Klonsky, PhD, Department of Psychology, University of British Columbia,
Vancouver, British Columbia, Canada
Ann M. Kring, PhD, Department of Psychology, University of California, Berkeley,
Berkeley, California
Joelle LeMoult, PhD, Department of Psychology, University of British Columbia,
Vancouver, British Columbia, Canada
Abigail Powers Lott, PhD, ABPP, Department of Psychiatry and Behavioral Sciences,
Emory University School of Medicine, Atlanta, Georgia
Jeffrey J. Magnavita, PhD, Strategic Psychotherapeutics, Glastonbury, Connecticut;
Department of Psychiatry, Yale University, New Haven, Connecticut
Ioan Tiberiu Mahu, BA, Department of Psychology and Neuroscience,
Dalhousie University, Halifax, Nova Scotia, Canada
Atina Manvelian, MA, Department of Psychology, University of Arizona, Tucson, Arizona
Alexandra F. Muratore, PhD, New York State Psychiatric Institute and Department
of Psychiatry, Columbia University Irving Medical Center, New York, New York
Michelle G. Newman, PhD, Department of Psychology, The Pennsylvania State University,
University Park, Pennsylvania
Thomas F. Oltmanns, PhD, Department of Psychological and Brain Sciences,
Washington University in St. Louis, St. Louis, Missouri
Michael W. Otto, PhD, Department of Psychological and Brain Sciences, Boston University,
Boston, Massachusetts
Robert O. Pihl, PhD, Department of Psychology, McGill University,
Montreal, Quebec, Canada
Kathleen M. Pike, PhD, Departments of Psychiatry and Epidemiology, Columbia University
Irving Medical Center, New York, New York
Caroline F. Pukall, PhD, Department of Psychology, Queen’s University,
Kingston, Ontario, Canada
Gavin N. Rackoff, MS, Department of Psychology, The Pennsylvania State University,
University Park, Pennsylvania
Katerina Rnic, PhD, Department of Psychology, University of British Columbia,
Vancouver, British Columbia, Canada
Contributors xi
Julia M. Salinger, MA, Department of Psychology and Neuroscience,
University of Colorado Boulder, Boulder, Colorado
David A. Sbarra, PhD, Department of Psychology, University of Arizona, Tucson, Arizona
Jeremy T. Schwob, MA, Department of Psychology, The Pennsylvania State University,
University Park, Pennsylvania
Alexandra L. Silverman, MA, Department of Psychology, University of Virginia,
Charlottesville, Virginia
Lynne Siqueland, PhD, Children’s and Adult Center for OCD and Anxiety,
Plymouth Meeting, Pennsylvania
David A. Smith, PhD, Department of Psychology, University of Notre Dame,
Notre Dame, Indiana
Sherry H. Stewart, PhD, Department of Psychology, Dalhousie University,
Halifax, Nova Scotia, Canada
Lauren E. Szkodny, PhD, Department of Psychiatry Dartmouth–Hitchcock Medical Center,
Lebanon, New Hampshire
Bethany A. Teachman, PhD, Department of Psychology, University of Virginia,
Charlottesville, Virginia
Norah Vincent, PhD, Department of Clinical Health Psychology, Max Rady College
of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Mark A. Whisman, PhD, Department of Psychology and Neuroscience,
University of Colorado Boulder, Boulder, Colorado
Preface
Chris Muran, a prominent and prolific clinical psychologist, once said that publish-
ing a book is like getting a medal or a trophy in sport. You work very hard for a long
time, you get a sign of recognition for your accomplishments, you put that sign on
a wall or a bookshelf, you look at it a few times, and then you move on to another
challenge.
We, the first two editors, worked intensively and extensively on the first edi-
tion of Psychopathology: From Science to Clinical Practice. The collaboration that took
place between us and the influential authors we had recruited also felt like playing
an exciting sport—and playing on a successful team! We were obviously proud to
get the book in our hands and happy to look at it (more than a few times, truth to be
told), but it did not stay on a bookshelf for very long. This is because we have been
using it to guide our writing and research (let alone clinical practice) and, most fre-
quently and consistently, we have used it to enhance our graduate teaching.
Our own use of this first edition fit with the purposes we had in mind when
designing it. As conveyed by its title, this book was aimed at weaving together infor-
mation about basic research on psychopathology and the treatment of clinical prob-
lems. As psychotherapy (L. G. C.) and psychopathology (T. F. O.) researchers, we
wanted the book to expand the boundaries of our respective knowledge. We also
intended for the book to serve as a practical reference for clinicians. It was, however,
designed primarily as a textbook for graduate students in the field of mental health.
More specifically, it was created to address a major source of disconnection in the
training of these professional disiplines.
A note about language: In this book, we use they/them/their when referring to a single individual.
We have made this choice to be inclusive of readers who do not identify with masculine or
feminine pronouns.
xiii
xiv Preface
A course on psychopathology is one of the few course requirements in all
accredited programs related to mental health care. Typically, this course has two foci:
description of each disorder (DSM criteria, clinical features, comorbidity, onset, etc.)
and etiology (variables that are involved in the cause and/or the maintenance of the
disorder). This information is relatively standard, and it is covered clearly in exist-
ing textbooks. Unfortunately, very few sources (either textbooks or primary journal
articles) address the need to establish connections between basic psychopathology
research and treatment, and few provide anything more than superficial coverage
of treatment issues. Coverage of basic psychopathology research far outweighs the
space devoted to treatment procedures aimed at the various kinds of mental disor-
ders with which practicing clinicians work on a regular basis. As such, most text-
books miss a tremendous opportunity to solidify the bridge between science and
clinical practice.
Our textbook was designed to correct this failed opportunity. Specifically, it cov-
ers the basic, conventional topics of psychopathology, while also providing a more
extensive and thoughtful discussion of the connections between basic research and
clinical practice. We believe this is a two-way street. Many hypotheses that have
guided scientific studies of psychopathology have been derived from clinical expe-
rience. Conversely, many findings from basic research have been extended to the
realm of clinical practice. The chapters of our book focus on these connections.
Each chapter provides students with relevant clinical guidelines derived from basic
research in psychopathology, as they relate to assessment and case formulation, as
well as treatment plan and interventions.
We, again the first two editors, were delighted when The Guilford Press invited
us to begin working on a second edition of this book. To be completely honest, while
we were happy with the feedback we had received from students and practitioners,
we were surprised and rather humbled that it did well enough to provide us with
an opportunity to play together again—it is one thing to get a medal or a trophy, but
quite another one to go for a repeat experience.
Working with Guilford’s staff on how to make this new challenge as enjoyable
and successful as the first one, we agreed that we needed to broaden our editorial
perspectives. We also agreed that the best strategy would be to invite Abigail Powers
Lott to join us as a third member of the editorial team. Representing a “new genera-
tion” of clinical researchers, Abby’s paths of scholarship have been perfectly in sync,
in terms of both content and process, with the major aim of the book. For example,
following over a decade of research into the transdiagnostic impact of trauma expo-
sure across the lifespan, she has translated that research into disseminating cultur-
ally responsive treatments for traumatized individuals in underserved communities.
Abby’s experience as an author on one of the chapters in the first edition, coupled
with her broad background in both research and practice, made her a perfect col-
league (or teammate) to expand our respective knowledge and improve our editorial
(one might say, coaching) partnership.
We further agreed, this time with Abby, to maintain some key elements of the
first edition—the most crucial being that each chapter be coauthored by a pair or a
small team of authors. For most of the chapters, at least one author was an expert
in psychopathology research and at least one other author was an expert in treat-
ment research (for some of our chapters, the authors were experts in both fields). Our
Preface xv
experience with the first edition confirmed that such teamwork can lead to new ways
of thinking about psychopathology and clinical practice. It also fostered new and
exciting experience in writing these book chapters (a process that, too frequently,
tends to involve mainly cutting and pasting old materials!).
For the second edition, we also decided that we would continue to focus on
presenting problems that, for the sake of clinical relevance, meet three criteria. They
have to show a moderate to high level of prevalence in the general population, as
well as a moderate to high prevalence in treatment settings; and they need to be the
focus of a substantial research literature. Several disorders (e.g., dissociative identity
disorder, somatic symptom disorder, and gender dysphoria) are not covered because
they are not encountered frequently in clinical practice and/or there is not enough
basic research on which to build an effective case formulation and treatment plan.
The clinical problems covered in the first edition of this book were depression, gener-
alized anxiety disorder, panic disorder and phobias, obsessive–compulsive disorder,
posttraumatic stress disorder, eating disorders, substance abuse disorders, personal-
ity disorders, bipolar disorders, positive and negative symptoms of schizophrenia,
as well as marital and relationship discord. We agreed to keep all of the chapters
that were included in the first edition, with the exception of the chapters on positive
and negative symptoms. In the current edition, these symptoms are addressed in a
single, integrated chapter on schizophrenia.
We also wanted to preserve the structure of these chapters across the two edi-
tions of the book. As such, each chapter provides a solid descriptive and etiological
grounding to understand psychopathology within the perspective of our current
knowledge. Each presents an up-to-date survey of typical symptoms, clinical fea-
tures (e.g., interpersonal, social, occupational, health, sleep, and sexual problems),
course (e.g., onset, duration, outcome, relapse), epidemiology (e.g., prevalence, gen-
der and cross-cultural differences), comorbidity, and etiology (i.e., vulnerability fac-
tors involved in cause, maintenance, recurrence, and/or relapse). The authors have
also derived clinical implications from the research findings they reviewed, antici-
pating readers’ question: How is this relevant for understanding and treating my cli-
ents? Interestingly, because these clinical implications are drawn from basic research
in psychopathology, they are not restricted to any one theoretical model underlying
current forms of psychotherapy.
All of the chapters on specific clinical problems identify psychosocial (and
medical) treatments that have been empirically validated. While these psychosocial
interventions have been linked to particular models of therapy, the authors have
also derived targets, general strategies, or principles of intervention from these treat-
ments—formulating them in a way that is not necessarily tied to the specific tech-
niques or terminology associated with a particular approach to therapy. As such,
these chapters provide guidelines that could be assimilated (sometimes after special-
ized training) in the practice of clinicians, irrespective of their preferred theoretical
orientation.
As in the first edition, we also wanted to open the book with an introductory
chapter that discusses general issues in psychopathology, as well as their relevance
for the conceptualization, assessment, and treatment of patients. The book closes
with a final chapter that attempts to identify similarities among different clinical
problems by examining clinical and etiological issues that cut across them, and by
xvi Preface
providing general recommendations that may improve their assessment and treat-
ment.
To improve on the first edition, we decided to pursue a number of expansions.
First and foremost, we added three chapters adressing the following clinical prob-
lems: suicide, sleep difficulties, and sexual dysfunction. We chose these transdiag-
nostic issues because they are frequent targets of interventions in clinical practice,
and because they have been the focus of substantial basic and/or applied research.
To address these new territories of knowledge and action, we recruited three pairs of
visible researchers who were ready to engage in a new, fresh, and collaborative writ-
ing project with someone at the same career level as their own, but with a different
expertise in the field.
We also wanted the revision of the chapters included from the first edition to
expand on what we know empirically and how we work clinically. We shaped these
expansions by asking authors to update the chapters with regard to psychopathol-
ogy research and to modify, if and when needed, the scope of therapeutic guidelines
that might be derived from such research—in terms of case formulation, treatment
plan, or principles of interventions. For the revision of these chapters, we were for-
tunate to “re-sign” most of our highly recognized scholars, as well as to “sign up”
a number of outstanding early career contributors to the fields of psychopathology
and psychotherapy. We dare to say that in our pursuit of a new medal or trophy,
we have again been able to gather an all-star team of accomplished “veterans” and
promising “rookies.”
We believe the first edition of this book has been successful because it has
allowed students to more fully integrate empirical and clinical knowledge within
their training. In line with the current emphasis on evidence-based practice, we have
also been pleased to hear that it has served as a relevant resource for experienced
practitioners, allowing them to conduct therapy while being informed by research
on psychopathology. We hope the second edition will also be successful in these
aims. We also hope it will offer valuable guidance to psychotherapy researchers by
identifying predictor, moderator, and mediator variables that could be the focus of
treatment interventions. Furthermore, we hope it will be helpful to psychopathology
researchers by highlighting phenomena from clinical practice that have an impor-
tant bearing on issues and problems that they ought to address.
Pursuing these ambious goals has required the help and support of many indi-
viduals. First, we want to thank our authors for contributing chapters that are, in our
opinion, highly informative, insightful, and innovative—let alone elegantly written.
We are also grateful for the vote of confidence and collaborative spirit of The Guil-
ford Press, and in particular for the assistance provided by Jane Keislar. Most impor-
tantly, we want to express our gratitude to the members of our respective families,
who all deserve much more than medals and trophies!
Louis G. Castonguay
Thomas F. Oltmanns
Abigail Powers Lott
Contents
1. General Issues in Understanding and Treating Psychopathology 1
Thomas F. Oltmanns, Abigail Powers Lott, and Louis G. Castonguay
2. Depression 17
Joelle LeMoult, Ashley Battaglini, Katerina Rnic, and Louis G. Castonguay
3. Generalized Anxiety Disorder 56
Michelle G. Newman, Paul F. Crits‑Christoph, Lauren E. Szkodny, Gavin N. Rackoff,
and Jeremy T. Schwob
4. Panic Disorder, Social Anxiety Disorder, and Phobias 77
Bethany A. Teachman, Marvin R. Goldfried, Elise M. Clerkin, and Alexandra L. Silverman
5. Obsessive–Compulsive Disorder 125
Jonathan S. Abramowitz and Lynne Siqueland
6. Posttraumatic Stress Disorder 151
Richard A. Bryant, Abigail Powers Lott, and Terence M. Keane
7. Eating Disorders 185
Deborah R. Glasofer, Alexandra F. Muratore, Evelyn Attia, and Kathleen M. Pike
8. Substance‑Related and Addictive Disorders 221
Robert O. Pihl, Sherry H. Stewart, and Ioan Tiberiu Mahu
xvii
xviii Contents
9. Personality Disorders 255
Abigail Powers Lott, Jeffrey J. Magnavita, Jacques P. Barber, and Thomas F. Oltmanns
10. Bipolar Disorder 294
Sheri L. Johnson, Michael W. Otto, Alexandra K. Gold, and Matthew V. Elliott
11. Schizophrenia 316
Ann M. Kring and David A. Smith
12. Marital and Relational Discord 345
David A. Sbarra, Atina Manvelian, Julia M. Salinger, and Mark A. Whisman
13. Sexual Dysfunctions 369
Caroline F. Pukall and Sophie Bergeron
14. Sleep–Wake Disorders 398
Norah Vincent and Judith R. Davidson
15. Suicide 429
Craig J. Bryan and E. David Klonsky
16. Psychopathology Research and Clinical Interventions: 453
Broad Conclusions and General Recommendations
Louis G. Castonguay, Thomas F. Oltmanns, and Abigail Powers Lott
Index 461
