Lecture Outline

• Definitions of Psychological Abnormality.

• Diagnostic Systems.
• Psychotherapy.
• Other considerations.

What is Psychological Abnormality?

• The American Psychiatric Association defines abnormal behaviors as those
which lead to:
– Disrupted functioning.
– Distress in the person or in others.
– Danger to the person or to others.
• Abnormality may also involve problems with thoughts or emotions, even
without abnormal behavior.
– For example, severe depression or anxiety.

Beware Medical Student’s Disease

• Upon hearing the symptoms of a disorder, the tendency for people to believe that
they or someone they know shares those symptoms.
• Only a trained professional can diagnose a psychological disorder.

College Students with Symptoms

• A 2007 University of Michigan survey found that more than half of U-M college
students with significant symptoms of anxiety or depression do not seek help.
– The incidence of mental illness on college campuses is increasing.
– Rutgers students can visit one of the RU Counseling and Psychological Services locations.
 The Biopsychosocial Model
• Biological factors.
– Damaged, over-reactive or under-reactive brain structures.
– Imbalance of neurotransmitters.
• Psychological factors.
– Conditioning history.
• For example: classically conditioned fear responses.
– Beliefs and thoughts.
• For example: low self-efficacy, pessimistic interpretation of events.
– Poor social skills.
• Social structures and cultural norms.
– Treatment by others and expectations held by others.

Diathesis-Stress Model
Genetic and
environmental Threshold for
contributions to psychopathology
psychopathology

Genetically Genetically Genetically Not genetically

above near at risk predisposed
threshold threshold

Environmental component
Genetic vulnerability

DSM-IV
• The Diagnostic and Statistical Manual of Mental Disorders.
• Published by the American Psychiatric Association in an attempt to establish
uniform criteria for diagnosis.
– The current edition is termed the DSM-IV.
• Uses a multi-axial system of diagnosis.
 The Axes of DSM-IV
Axis Description
I Clinical disorders – distress, dysfunction
II Personality disorders and mental retardation.
III Medical conditions that may influence mood or behavior.
IV Psychosocial and environmental problems.
V Global assessment of functioning (1-90)

Some Criticisms of DSM-IV

• The DSM-IV includes too many minor disorders.
• Disorders do not cleanly fall into one of the DSM-IV categories as opposed to
the others.
• To what extent is the situation the problem, rather than the person?

Prevalence of Psychological Disorders

• There is a stigma associated with receiving a mental health diagnosis.
• Yet about 50% of people in the U. S. will have a psychological (DSM-IV)
disorder at some point in their lives.

Psychotherapy
• Psychotherapy is a treatment of psychological disorders involving an ongoing
relationship between a trained therapist and a client.
– Medical and biological interventions for specific disorders will be discussed in the next
lecture.
• There are many techniques of psychotherapy, but all of them seem to depend on
the client’s motivation to improve.
 Psychoanalysis (Freudian)
• Mental symptoms reflect unconscious conflicts that induce anxiety.
• Insight.
– Therapeutic change requires the understandings of the internal workings of one’s own
mind.
• The relationship between the patient and therapist is critical.

Psychoanalytic Techniques
• Free Association.
– The patient is encouraged to say whatever comes to mind to reveal unconscious processes.
– Responses to projective tests (e.g., TAT) are analyzed.
• Interpretation.
– The therapist interprets the dreams, associations, and feelings of the patient in order to
reveal the hidden conflicts and motivations.
• Analysis of transference.
– Patients bring into therapy their past troubled relationships; these are transferred to the
therapist.

Cognitive-Behavioral Therapies
• Behavioral, cognitive, and cognitive-behavioral therapies focus on a person’s
specific observable problem behaviors or on a person’s currently experienced
mental distress, such as depression and anxiety.
– The emphasis is on the present rather than on the past.
– The therapist can be very directive.
– Duration is relatively short-term.

Behavior Therapies
• Techniques based on classical conditioning.
– For example: Systematic desensitization.
• Therapist teaches relaxation techniques to the patient.
• While in a relaxed state, the patient is encouraged to imagine situations involving the feared
object, starting with the least fearful image and progressing through the more fearful.
 Cognitive Therapies
• Attempt to change dysfunctional beliefs and thought patterns.
• Albert Ellis’ Rational Emotive Therapy:
– Pathology results when persons have illogical beliefs guiding their responses to life
situations.

Activating Conditions  Beliefs  Emotional Consequences

– Therapist teaches alternative thinking that promotes rational thought.

Beck’s Cognitive Therapy

• Cognitive restructuring.
• Client keeps a daily record of dysfunctional beliefs.
• Client reviews daily record and:
– Identifies automatic thoughts.
– Generates rational responses.

Humanistic Therapies
• Carl Rogers’ Client Centered Therapy.
– Psychological problems result when self-concept differs from actual feelings or
experience.
• Incongruence between the ideal self and the real self.
– Assumes that growth and maturity are natural if allowed to happen.
• Unconditional positive regard from the therapist creates the necessary conditions.
• Therapy is based on empathy: Understanding the client’s feelings without judgment.

Modalities of Therapy
• Individual therapy.
• Group therapy.
– Different groups have different:
• Therapeutic objectives.
• Composition.
• Therapeutic perspectives.
• Family therapy.
• Systems therapy.
• Self-help groups.
 Which Therapy Works Best?
• Difficult to know, because different questions can be asked:
– What percentage of patients are helped?
– Of those who are helped, how much of the problem goes away?
– Of those who are helped, how long do they go before the problems come back?
– How many people drop out of therapy?
• A therapy may be better or worse than others on each of these questions.

Therapeutic Effectiveness Research

• A meta-analysis of 475 experiments found that receiving therapy was better than
being on a waiting list.
• A large Consumer Reports study found outcomes were similar with treatment by
psychiatrists, psychologists, or social workers; less satisfactory with marriage
counselors or medical doctors.
• Different approaches produce similar results.
• Most improvement is seen in the first 25 sessions and subsequently continues at
a slower rate.

Common Factors among All Psychotherapies

• All forms of therapy share the following characteristics:
– A positive, cooperative relationship between the therapist and client (therapeutic alliance).
• The therapist provides empathy and acceptance.
• Therapy involves an opportunity for and the encouragement of emotional disclosure.
• The client makes a commitment to change.
– The client acquires new ways of thinking about problems and new social skills.
– The therapeutic situation provides hope.
• Therefore, there is a strong potential for expectancy (placebo) effects.

Eclecticism in Psychotherapy
• A single therapist may use different psychotherapeutic techniques:
– Depending on the problem.
– If the client doesn’t improve with the first technique.
• 68-98% of therapists use an eclectic approach.