Models of Abnormality and Related Concepts (Vocabulary) Chapter 2

The Biological Model

  • Philip Berman is treated as a biological being; thoughts and feelings are the result of biochemical and bioelectrical processes in brain and body. Proponents argue that understanding these biological bases is essential to understanding thoughts, emotions, and behaviors, and that biological treatments are often most effective.
  • How do biological theorists explain abnormal behavior?
    • Adopt a medical perspective: abnormal behavior is an illness caused by malfunctioning parts of the organism, typically brain problems.
  • Brain chemistry and abnormal behavior
    • Brain has ~86 billion neurons and trillions of glia; information is transmitted via electrical impulses between neurons through synapses.
    • Neurons communicate via dendrites, axons, and nerve endings; neurotransmitters cross the synapse to bind to receptors on receiving neurons.
    • Neurotransmitters can be excitatory (trigger firing) or inhibitory (prevent firing).
    • Abnormal activity of neurotransmitters linked to mental disorders (e.g., Depression associated with low activity of serotonin, norepinephrine, and glutamate).
  • Endocrine system and hormones
    • Endocrine glands release hormones into the bloodstream; hormones influence growth, reproduction, heart rate, stress responses, etc.
    • Cortisol from adrenal glands increases under stress; abnormal cortisol can be linked to anxiety and depression.
  • Brain anatomy, circuitry, and abnormal behavior
    • Brain structures form circuits that regulate behavior; circuits operate via interconnected neurons and neurotransmitters.
    • Brain circuit: network of structures that work together to produce a behavioral, cognitive, or emotional response.
    • Example: the fear circuit includes structures such as the prefrontal cortex, anterior cingulate cortex, insula, and amygdala.
    • Proper interconnectivity supports healthy functioning; flawed interconnectivity can contribute to anxiety disorders.
    • The “fear circuit” helps produce fear reactions; dysfunction in this circuit can contribute to persistent fear and related disorders.
  • Sources of biological abnormalities
    • Factors range from prenatal events to brain injuries, infections, environmental experiences, and stress.
    • Genetics and evolution receive particular attention.
    • Each cell contains 23 pairs of chromosomes; about 20,000 genes per cell; genes contribute to both physical traits and vulnerability to mental disorders.
  • Genes, inheritance, and evolution
    • Twin studies (e.g., identical twins) show genetic influence on certain traits.
    • Some genes contributing to mental disorders may be mutations or inherited mutations; other theories suggest some abnormality genes arose through normal evolutionary processes.
    • Evolutionary perspective: fear and other responses may have been adaptive, but certain gene variants can predispose to anxiety disorders in modern contexts.
  • Biological treatments
    • Clinicians look for physical sources of dysfunction (family history, physiological triggers) to guide treatment.
    • Three leading biological treatments: drug therapy, brain stimulation, and psychosurgery.
  • Drug therapy
    • Discovered in the 1950s; psychotropic drugs affect emotions and thought processes; widely used alone or with psychotherapy.
    • Criticisms: drugs may be overused; not effective for everyone; side effects and long-term impacts.
    • Direct-to-consumer (DTC) drug advertising has grown in the U.S. and New Zealand; it directly promotes drugs to consumers.
    • DTC ads are controversial due to economic costs, misinformation, and potential influence on prescribing.
    • DTC advertising stats:
    • About 80%80\% of American adults have seen these ads.
    • At least 30%30\% of those surveyed ask their doctors about advertised drugs.
    • U.S. pharmaceutical companies spend about 6.6 billion6.6\text{ billion} annually on TV and online advertising in America.
    • Four major psychotropic drug groups:
    • Antianxiety drugs (anxiolytics)
    • Antidepressants
    • Antibipolar (mood stabilizers)
    • Antipsychotic drugs
    • Drugs may relieve symptoms for many, but not all patients; side effects and varying efficacy.
  • Brain stimulation and electroconvulsive therapy (ECT)
    • Brain stimulation techniques directly or indirectly stimulate brain areas.
    • ECT: oldest and most controversial; uses electrical currents (65–140 volts) to induce a brain seizure lasting a few minutes; administered in 7–9 sessions (every 2–3 days); helpful for severe depression unresponsive to other treatments.
    • Other brain stimulation methods include:
    • Transcranial Magnetic Stimulation (TMS): electromagnetic coil induces currents in specific brain regions.
    • Vagus Nerve Stimulation (VNS): implanted pulse generator stimulates the vagus nerve to influence brain activity.
  • Deep brain stimulation and psychosurgery
    • Deep brain stimulation implants electrodes in specific brain areas connected to a battery-powered device; used for severe, hard-to-treat depression.
    • Psychosurgery: historical roots in lobotomy; modern psychosurgery is more precise and used only after other treatments fail.
  • Assessing the Biological Model
    • Strengths: strong empirical support, real relief when other approaches fail; ongoing advances in understanding brain function.
    • Shortcomings: some proponents overemphasize biology; life is an interplay of biological and nonbiological factors; purely biological explanations may overlook context and learning.
  • NOTE on research and limitations
    • Slow, careful evaluation is needed for drug development and evaluating long-term effects.

The Psychodynamic Model

  • The psychodynamic model is one of the oldest and most influential psychological models.
  • Core idea: behavior (normal or abnormal) is determined largely by unconscious forces such as unresolved conflicts and past experiences.
  • Freud’s influence
    • Three central forces shape personality and operate largely in the unconscious: the id, the ego, and the superego.
    • Id: instinctual needs, drives, impulses; operates on the pleasure principle; libido fuels the id.
    • Ego: develops to satisfy id impulses in a realistic way; operates on the reality principle; uses ego defenses to manage anxiety.
    • Superego: morality principle; internalized parental and cultural values; conscience.
  • Ego defense mechanisms
    • The ego develops defenses to control unacceptable impulses and reduce anxiety. Examples include:
    • Repression: banishing threatening thoughts from consciousness.
      • Example: An executive’s desire to attack their boss is denied access to awareness.
    • Denial: refusing to acknowledge external sources of anxiety.
    • Projection: attributing one’s own unacceptable impulses to others.
    • Rationalization: offering socially acceptable explanations for unacceptable motives.
    • Displacement: redirecting emotions to a safer target.
    • Intellectualization: avoiding emotions by focusing on logical explanations.
    • Regression: returning to an earlier developmental stage.
    • These mechanisms help explain dysfunctional behavior as outcomes of unconscious conflict.
  • The Superego
    • Represents a person’s values, morals, and conscience; strives for perfection; can generate guilt when standards are unmet.
  • Developmental stages and fixation
    • Freud proposed stages of psychosexual development (oral, anal, phallic, latency, genital).
    • At each stage, new events require adjustments; unresolved conflicts can lead to fixation and later dysfunction.
    • Example: oral stage (0–18 months) involves oral needs; fixation can lead to dependence or mistrust and later depression.
  • Freud’s model and beyond
    • Self theory and object relations theory are influential contemporary psychodynamic approaches:
    • Self theory focuses on the self and its integration; strives for wholeness.
    • Object relations theory emphasizes relationships with others and how early relationships shape personality.
  • Psychodynamic therapies
    • Aim to uncover past traumas and inner conflicts and help clients resolve them; long-term therapy often involved.
    • Core techniques:
    • Free association: clients speak freely, revealing unconscious content.
    • Therapist interpretations: resistance, transference, and dreams are key targets for interpretation.
    • Catharsis: emotional release of repressed feelings.
    • Working through: repeatedly examining issues across therapy to achieve deeper change.
  • Key concepts in practice
    • Resistance: unconscious refusal to participate fully.
    • Transference: redirecting feelings toward the therapist reflecting past relationships.
    • Dreams: Freud saw them as royal road to the unconscious; manifest vs latent content.
    • Catharsis and working through describe the emotional and cognitive processing needed to resolve conflicts.
  • Example excerpts
    • Free association example of a patient recounting fear and sexual feelings related to a park setting and her father.
  • Current trends in psychodynamic therapy
    • Short-term psychodynamic therapies: focus on a single problem; time-limited; outcomes show some effectiveness for certain complex problems.
    • Relational psychoanalytic therapy: emphasizes the therapist’s role and transparency; tries to establish a more equal, collaborative relationship with patients.
  • Assessing the Psychodynamic Model
    • Strengths: historic influence; emphasizes unconscious processes; first to demonstrate psychological treatments’ potential.
    • Limitations: difficult to study empirically; much evidence from case studies; long-term treatments; still influential but less dominant in some clinical settings.
  • Summary
    • Psychodynamic theorists view behavior as determined by internal dynamic conflicts rooted in early experiences; therapies aim to resolve these conflicts and promote growth.

The Cognitive-Behavioral Model

  • The cognitive-behavioral (CB) model integrates behavior and cognition to explain abnormal functioning: how we act and how we think influence each other and emotions.
  • Behavioral dimension
    • Conditioning forms account for learned behavior:
    • Classical conditioning: learning by temporal association between stimuli; often used to explain phobias.
      • Example: a child learns to fear a needle when paired with a painful shot.
    • Modeling (observational learning): learning by observing others.
      • Example: a child imitates a parent’s fear of dogs.
    • Operant conditioning: learning via consequences (reinforcements and punishments).
      • Example: aggression reinforced by attention.
    • Implications for treatment: replace problematic behaviors with more adaptive ones using conditioning principles.
  • Cognitive dimension
    • Cognition focuses on thoughts, attitudes, expectations, and interpretations.
    • Illogical thinking and maladaptive assumptions contribute to abnormal functioning (Beck’s cognitive theory).
    • Depressed people often display negative cognitive patterns such as overgeneralization and catastrophizing.
  • The cognitive-behavioral interplay
    • Treatments combine behavioral and cognitive techniques to modify both behavior and thought processes.
    • Social anxiety disorder example: catastrophic beliefs about performance, safety behaviors (e.g., makeup to cover blushing); exposure to feared situations with concurrent cognitive restructuring.
    • Exposure therapy: gradual, repeated exposure to feared situations to reduce fear; followed by cognitive interventions to challenge maladaptive beliefs.
  • New wave cognitive-behavioral therapies (ACT and beyond)
    • ACT (Acceptance and Commitment Therapy): focus on accepting thoughts rather than judging or trying to change them; commit to actions aligned with values.
    • Mindfulness-based approaches: mindfulness meditation helps clients observe thoughts nonjudgmentally and remain present in the moment.
    • Rationale: people often have troubling thoughts; acceptance can reduce struggle and improve functioning.
  • Mindfulness and meditation
    • Mindfulness: being present in the moment, deliberately and nonjudgmentally.
    • Mindfulness-based interventions are used for pain, anxiety, depression, and other disorders.
  • Assessing the Cognitive-Behavioral Model
    • Popularity and practicality:
    • Nearly half of today’s clinical psychologists report cognitive/behavioral orientation.
    • In surveys: 22% eclectic, 46% cognitive/behavioral, 18% psychodynamic.
    • Why CB models are appealing:
    • They are testable in laboratory settings; many concepts (stimulus, response, reward, attitude, interpretation) are observable.
    • They have strong empirical support for many disorders (anxiety, depression, sexual dysfunction, etc.).
    • Limitations:
    • Causality can be difficult: maladaptive behaviors/cognitions may be a result, not a cause, of problems.
    • Not all individuals respond to CB therapies; some life histories and contexts are broader than CB explanations.
    • CB is sometimes criticized for being narrow and not addressing broader existential concerns.
  • New wave CB therapies and telemental health
    • ACT and mindfulness-based CB therapies emphasize acceptance of thoughts and experiences.
    • Telemental health and online therapies have grown, including online CBT and teletherapy; remote approaches have expanded access but raise questions about the loss of in-person interaction.

The Humanistic-Existential Model

  • A broader, more optimistic view of human nature and functioning
  • Core idea: people can reach self-actualization and meaningful living through authentic choices; human potential can be realized with self-acceptance and values.
  • Humanistic vs existential emphases
    • Humanistic: focus on self-actualization, personal growth, unconditional positive regard, and authentic living.
    • Existential: focus on authenticity, freedom of choice, responsibility, meaning in life, and dealing with existential anxiety.
    • Both emphasize the person as a whole and stress subjective experience, growth, values, and meaning.
  • Rogers’ humanistic theory and client-centered therapy
    • Key concepts: unconditional positive regard, accurate empathy, and genuineness.
    • Therapy aims to create a supportive climate in which clients can look at themselves openly and accept themselves, facilitating self-actualization.
    • Client-centered therapy outcomes: not strongly supported by controlled research but influential in clinical practice; emphasizes the therapist’s attitude and the therapeutic relationship.
    • Role of the therapist: collaborative, nonjudgmental, and supportive; therapists must convey acceptance and empathy.
    • Prevalence: a minority of clinicians practice client-centered therapy (approx. 2% clinical psychologists; 1% social workers; 3% counseling psychologists).
  • Gestalt theory and therapy
    • Developed by Fritz Perls; emphasizes self-recognition and self-acceptance through active techniques.
    • Techniques include role-playing and here-and-now focus; therapists may push clients to confront feelings in the moment.
    • Beating the blues and drum therapy are examples of expressive methods used by Gestalt therapists.
    • About 1% of clinicians identify as Gestalt therapists; research often lacks controlled studies due to proponents’ belief that subjective experience cannot be measured objectively.
  • Spiritual views and interventions
    • Historically, religion was viewed negatively in mental health; modern views recognize spirituality as a potential resource in treatment.
    • Evidence shows correlations between spirituality and mental health (e.g., lower loneliness, depression, and anxiety in devout individuals with warm views of God); however, correlation does not imply causation.
    • Therapists may incorporate spiritual resources and refer clients to religious organizations as appropriate.
  • Existential theories and therapy
    • Existentialism emphasizes responsible living and meaning-making; individuals must confront anxiety and freedom to create meaning in life.
    • Therapists encourage clients to accept responsibility and to live with greater meaning and authenticity.
    • Existential therapy is often less amenable to traditional empirical testing; about 1% of clinicians use existential approaches.
  • Assessing the Humanistic-Existential model
    • Strengths: optimistic, holistic view; emphasizes self-acceptance, values, meaning, and personal growth; compatible with positive psychology.
    • Limitations: difficult to research using conventional controlled studies; some groups have been slow to adopt empirical methods.
  • Summary
    • The humanistic-existential model highlights freedom, value, meaning, self-acceptance, and authentic living; emphasizes growth and the good in human potential.

The Sociocultural Model: Family-Social and Multicultural Perspectives

  • Philip Berman as a social and cultural being
    • Berman’s problems are understood within family, social, and cultural contexts (family structure, gender roles, social pressures, cultural expectations).
    • Emphasizes the influence of family relationships, social networks, and cultural norms on behavior and emotion.
  • Family-Social perspective: three focal factors
    • Social labels and roles: how labeling (e.g., mentally ill) can shape self and behavior; Rosenhan’s classic study on labeling (On Being Sane in Insane Places, 1973) demonstrated how diagnoses affect perception and treatment.
    • Social connections and supports: isolation and lack of social support are associated with greater risk of dysfunction under stress; online social networks can reflect offline social behavior.
    • Family structure and communication: family systems theory argues the family acts as a system with patterns and rules that influence individual behavior; enmeshed vs disengaged boundaries can contribute to abnormal functioning.
  • Family-social treatments
    • Group therapy, family therapy, couple therapy, and community treatment are used across orientations; practice may integrate principles from various models.
    • Socially oriented therapies emphasize changing family dynamics and improving social supports.
  • Social and online dynamics in modern life
    • Social media and online interactions influence real-world social behavior; online and offline relationships can reflect each other.
    • “Therapy, Now Ready-to-Wear?” discusses mobile and wearable technologies: JITAI (Just-in-Time Adaptive Interventions) deliver micro-interventions via wearables when needed; pros and cons discussed (human element concerns vs timely support).
  • Multicultural perspectives
    • Culture, race, ethnicity, gender, and other identities influence behavior and mental health.
    • Intersectionality: multiple cultural identities intersect to shape experiences and outcomes.
    • Minority stress and prejudice contribute to psychological distress; culture-sensitive therapies emphasize cultural values and contexts.
    • Culture-sensitive therapies include training for therapists to be culturally aware; eight core elements include: therapist cultural instruction, awareness of client’s cultural values, recognizing prejudice and stereotypes, understanding immigrant family dynamics, bicultural balance, self-esteem, etc.
  • Culture and gender-sensitive therapies
    • Therapies designed to address pressures related to gender and culture (e.g., gender-sensitive therapies).
  • Assessing the Sociocultural model
    • Benefits: broad integration of context; can explain why some treatments succeed or fail with minority groups; supports community-level interventions.
    • Limitations: research findings are sometimes hard to interpret; difficult to establish causation; not always predictive for specific individuals; often integrated with biological or psychological explanations.
  • Discrimination and health disparities
    • Discrimination statistics demonstrate that marginalized groups report unfair treatment: e.g., 76% of Black Americans and 58% of Hispanic Americans report discrimination due to race/ethnicity.
  • Multicultural treatments and culture-sensitive practices
    • Treatments that incorporate cultural morals and models can improve outcomes for minority clients, especially youth and families.
    • Culture-sensitive and gender-sensitive approaches are designed to address unique stressors faced by minority groups and respond to cultural values.
  • Summary
    • The sociocultural model emphasizes family, social, and cultural contexts; treatment integrates community and cultural considerations to improve functioning and reduce pathology.

Integrating the Models: The Developmental Psychopathology Perspective

  • None of the models is universally superior; integration helps explain and treat complex cases more effectively.
  • Developmental psychopathology perspective
    • Uses a developmental framework to understand how genetic, biological, emotional, behavioral, cognitive, social, cultural, and societal influences interact across the lifespan.
    • Emphasizes timing: when and in what context influential variables occur can have lasting effects.
    • Equifinality: multiple developmental routes can lead to the same disorder.
    • Multifinality: similar developmental histories can lead to different outcomes.
    • Protective factors: positive influences (e.g., effective parenting) can offset negative variables and reduce risk.
  • Philip Berman revisited through a developmental lens
    • Examines when his brother’s birth occurred, parents’ mental health, early experiences, stress, and social support; how these factors might interact to shape his current functioning.
  • Integrating the models
    • Biopsychosocial approach: abnormality results from interactions between genetic, biological, emotional, behavioral, cognitive, social, cultural, and societal factors.
    • Eclectic/integrative approaches are common in practice:
    • 22% of clinical psychologists, 31% of counseling psychologists, and 26% of social workers describe themselves as eclectic/integrative.
  • Practical emphasis
    • Developmental psychopathology stresses prevention, protective factors, and early intervention; attention to timing and context.
    • Community-wide interventions (schools, neighborhoods) are emphasized as part of prevention.
  • Conclusion
    • The Developmental Psychopathology Perspective highlights the timing and interaction of multiple factors; it underpins contemporary integrative reasoning in psychology and informs prevention and public policy efforts.
  • Key terms recap
    • Equifinality: multiple routes to the same outcome.
    • Multifinality: similar histories can yield different outcomes.
    • Biopsychosocial model: integrates biological, psychological, and social factors.
    • Developmental sequencing: timing of events matters for outcomes.
  • Notes on Philip Berman (case study) throughout the chapters
    • Used to illustrate how different models would interpret and treat a complex presentation combining depression, anger, relationship difficulties, and family dynamics.