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Understanding and Treating Mental Disorders

One-Dimensional Models of Mental Disorders

Model

Attempts to describe a phenomenon that cannot be directly observed

Models are intrinsically limited and cannot explain every aspect of a disorder

Human behaviors are complex

Models of psychopathology

Biological, psychological, social, and socio-cultural

Multipath Model

Considers the multitude of factors researchers have confirmed are associated with each disorder

Views disorders from a holistic framework

Some assumptions of the multipath model

Multiple pathways and influences contribute to the development of any single disorder

Not all dimensions contribute equally

The Multipath Model

Figure 2.1 The Multipath Model Each dimension of the multipath model contains factors found to be important in explaining mental disorders. Reciprocal interactions involving factors within and between any of these dimensions can also influence the development of mental disorders.

The Four Dimensions and Possible Pathways of Influence

Figure 2.2 The Four Dimensions and Possible Pathways of Influence Conceptually, mental disorders arise from four possible dimensions (biological, psychological, social, and sociocultural) and from reciprocal interactions between factors within a dimension or among factors in multiple dimensions.

Aspects of the Multipath Model

Many disorders tend to be heterogeneous in nature

Different combinations within the four dimensions may influence development of a particular condition

Within each dimension, distinct theories exist

Same triggers or vulnerabilities may cause different disorders

Dimension One: Biological Factors

The human brain

Forebrain controls all higher mental functions

Cerebrum

Cerebral cortex

Prefrontal cortex helps manage attention, behavior, and emotions

Limbic system

Role in emotions, decision-making, and memories

Structures in the Limbic System

Figure 2.5 The limbic system, comprised of an interconnected group of brain structures, controls emotional reactions and basic human drives. It is also involved in motivation, decision making, and the formation of memories.

Multipath Implications

Biological explanations are best considered in the context of other factors

Science suggests that most individual differences result from some combination of genetic and environment variations

People do not inherit a particular abnormality but rather, a predisposition to develop illness

Environmental forces (stressors) may activate the predisposition, resulting in a disorder

Biochemical Processes within the Brain and Body

The brain is composed of:

Neurons (nerve cells)

Dendrites

Axon

Glia cells that act in supporting roles

Synaptic Transmission

Figure 2.6 Synaptic Transmission Electrical impulses travel along the axon, through the synapse, and to the dendrites of the next neuron. Neurotransmitters facilitate the transmission of the impulse across the synapse.

Major Neurotransmitters and Their Functions

Table 2.2 Major neurotransmitters and their functions

Major Neurotransmitters and Their Functions (cont’d.)

Table 2.2 Major neurotransmitters and their functions

Neuroplasticity

Ability of the brain to evolve and adapt

The brain reacts to environmental circumstances by making new neural circuits and pruning old ones

“Neurons that fire together, wire together”

Chronic stress results in negative changes in brain activity

Exercise can produce positive changes

Neurons that fire together, wire together: Nerve pathways that we used frequently become mylienated which makes them stronger and more efficient. When we practice a behavior it becomes more hard-wired over time.

Genetics and Heredity

Heredity: genetic transmission of traits

Chemical compounds outside the genome control gene expression

Whether genes are “turned on” or “turned off”

Genotype and phenotype

Genetic mutations

Epigenetics

Environmental factors trigger biochemical processes that affect gene expression

Biology-Based Treatment Techniques

Psychopharmacology

Study of effects of psychotropic medications

Medication categories

Antianxiety drugs (e.g., benzodiazepines like Valium)

Antipsychotics (e.g., chlorpromazine)

Antidepressants (e.g., selective serotonin reuptake inhibitors like fluoxetine)

Mood stabilizers (e.g., lithium)

Other Biological Approaches

Electroconvulsive therapy

Induce small seizures with electricity or magnetism

Can change brain chemistry and reverse some symptoms

Reserved for those not responding to other treatments

Other Biological Approaches (cont’d.)

Neurosurgical and brain stimulation treatments

Psychosurgery (removing parts of brain)

Very uncommon today

Repetitive transcranial magnetic stimulation

Deep brain stimulation

Criticisms of Biological Models and Therapies

Drugs are not always effective

Drugs do not cure mental illness

Side effects and interactions are possible

Dimension Two: Psychological Factors

Four major perspectives

Psychodynamic

Behavioral

Cognitive

Humanistic-existential

Psychodynamic Models

The components of personality

Id: pleasure principle

Ego: realistic and rational

Superego: moral considerations (conscience)

Psychosexual stages

Freud proposed that human personality largely developed during first five years of life

Defense mechanisms

Protect us from anxiety

Contemporary Psychodynamic Theories

Adler and Erickson

Suggested that the ego has adaptive abilities

With the ability to function separately from the id

Bowlby and Mahler

Proposed that the need to be loved, accepted, and emotionally supported is of primary importance in childhood

Therapies Based on the Psychodynamic Model (cont’d.)

Psychoanalysis

Objective: uncover material blocked from consciousness

Free association

Dream analysis

Effect of experiences with early attachment figures

Theories Based on the Psychodynamic Model

Interpersonal psychotherapy

Links childhood experiences with current relational patterns

Focus on current relational patterns

Helps clients learn more effective interaction strategies

Behavioral Models

Concerned with the role of learning in development of mental disorders

Based on experimental research

Three paradigms

Classical conditioning (Ivan Pavlov)

Operant conditioning (B. F. Skinner)

Observational learning (Albert Bandura)

Classical Conditioning Example

Figure 2.8 A basic classical conditioning process: Dogs normally salivate when food is provided (left). With his laboratory dogs, Ivan Pavlov paired the ringing of a bell with the

presentation of food (middle). Eventually, the dogs would salivate to the ringing of the bell alone, when no food was near (right).

Behavioral Therapies

Exposure therapy

Graduated exposure

Flooding

Systematic desensitization

Social skills training

Criticisms of behavioral models and therapies

Often neglect inner determinants of behavior

Cognitive-Behavioral Models

Thoughts profoundly affect emotions and behaviors

Beck and Ellis

A-B-C theory of emotional disturbance

A is an event

C is a person’s reaction

B are the person’s beliefs about A, which causes reaction C

Ellis’s A-B-C Theory of Personality

Figure 2.9 Ellis’s A-B-C Theory of Personality The development of emotional and behavioral problems is often linked to dysfunctional thinking. Cognitive psychologists assist their clients to identify and modify irrational thoughts and beliefs.

Third-Wave Cognitive-Behavioral Therapies

Nonreactive attention to emotions can reduce their power to create distress

Mindfulness

Conscious attention to the present

Dialectical behavior therapy (DBT)

Supportive and collaborative therapy

Reinforce positive actions

Acceptance and commitment therapy (ACT)

Humanistic Models

Humans need unconditional positive regard

Person-centered therapy focuses on facilitating conditions that allow clients to grow and fulfill their potential

Maslow’s concept of self-actualization

The inherent tendency to strive for full potential

Humanistic Therapies

Communicating respect, understanding, and acceptance are more important than techniques

Unconditional positive regard fosters self-acceptance

Self-growth aids in present and future problem solving

The relationship between client and therapist is critically important to outcome

Dimension Three: Social Factors

Social-relational models

Healthy relationships are important for human development and functioning

Provide many intangible benefits

When relationships are dysfunctional or absent, individuals are more vulnerable to mental distress

Family, Couples, and Group Perspectives

Family systems model

Behavior of one family member affects entire family system

Characteristics

Personality development strongly influenced by family characteristics

Mental illness reflects unhealthy family dynamics and poor communication

Therapist must focus on family system, not just an individual

Social-Relational Treatment Approaches

Conjoint family therapeutic approach

Stresses importance of teaching message-sending and message-receiving skills to family members

Strategic family approaches

Consider family power struggles and move towards more healthy distribution

Structural family approaches

Reorganizes family in relation to level of involvement with each other

Couples and Group Therapy

Couples therapy

Aimed at helping couples understand and clarify their communication, needs, roles, and expectations

Group therapy

Initially strangers

Share certain life stressors

Provides supportive environment

Allows therapist to observe patient’s actual social interactions

Dimension Four: Sociocultural Factors

Emphasizes importance of several factors in explaining mental disorders

Race

Ethnicity

Gender

Sexual orientation

Religious preference

Socioeconomic status

Other factors

Gender Factors

Higher prevalence of depression, anxiety, and eating disorders among women

Women experience greater stress in certain areas:

Lower wages;, less decision-making power

Expectations of combining chores, childcare, and paid work

Exposure to sexual harassment, interpersonal violence

Affects well-being and learning

Socioeconomic Class

Lower socioeconomic class associated with:

Limited sense of personal control

Poorer physical health

Higher incidence of depression

Life in poverty subjects people to multiple stressors

Fulfilling life’s basic needs

Immigration and Acculturative Stress

Acculturative stress

Associated with challenges of moving to a new country

Loss of social support

Hostile reception

Educational and employment challenges

Most common among first generation immigrants and their children

Race and Ethnicity

Two early inaccurate, biased models:

Inferiority model

Deficit model

Multicultural model

Emerged in the 1980s and 1990s

A contemporary view that emphasizes the importance of considering a person’s cultural background and related experiences when determining normality and abnormality

Sociocultural Conditions in Treatment

Multicultural counseling is the “fourth force” in psychotherapy

Multicultural counseling is assuming greater importance as our population becomes more diverse

Cultural factors, such as family experience and degree of assimilation, are important in assessment and intervention

Review

What models of psychopathology have been used to explain abnormal behavior?

What is the multipath model of mental disorders?

How is biology involved in mental disorders?

How do psychological models explain mental disorders?

Review (cont’d.)

What role do social factors play in psychopathology?

What sociocultural factors influence mental health?

Why is it important to consider mental disorders from a multipath perspective?