Many psychologists study how the mind works, but a lot of them focus on how the mind doesn't work.
Abnormal behavior is defined as any maladaptive action or cognitive process that defies social norms or is otherwise atypical, as well as the psychological disorders believed to cause such behavior.
We will discuss the causes of abnormal behavior, the classification of psychological disorders, and the various frameworks for treatment in this chapter.
Every community has had its share of people who regularly violate social expectations and other members of the community can't help but think that there is something wrong with them.
Explanations for why some people behave oddly have varied throughout history, but they fall into two categories.
On the one hand, there is a view that external force causes people to act irregularly, on the other hand, there is a view that internal problem is responsible.
The external force view believes that when people behave in unusual ways, something else is acting through them.
The idea that evil spirits or other supernatural forces can take control of an individual's body is what advocates of this view believe.
Techniques such as trephination (drilling small holes into a person's skull) and exorcism (using ritual prayers and ceremonies to draw evil spirits from a person) have been used throughout history to cure possession.
misguided practices like these would not end the abnormal behavior, and communities would use more extreme measures to deal with "possessed" people, such as ostracism, exile, torture, or even execution.
The view that abnormal behavior is the result of internal problems is different from the one that caused more suffering.
Ancient Greek and Roman civilization classified abnormal behavior as a health problem and even classified a number of mental disorders, such as melancholia, mania, dementia, and hysteria.
The ancient thinker tried to explain the disorders medically.
The Hippocratic Oath is named after the Greek physician Hippocrates, who believed that mental disorders were caused by an imbalance in four bodily fluids.
Blood, phlegm, yellow bile, and black bile are some of the humors.
According to the humorist view, an excess or deficiency in any of these fluids could cause mental illness.
While the medical explanations for abnormal behavior would eventually dominate over the moral explanations, there was very little physicians could do for those with mental disorders.
Some of the asylums for the mentally ill were set up as humane places for treatment, but others were designed to isolated the mentally ill, often in horrifying and inhumane conditions.
There were more calls for humanitarian treatment of the mentally ill as a more medical perspective of mental illness became prominent.
In the 19th century, a largescale movement emerged to reform asylums and to treat the mentally ill with respect and compassion.
A number of state-run asylums in the United States and Europe were committed to humane treatment, thanks to Dorothea Dix.
The debate on the causes of abnormal behavior was changed in the 19th century.
The somatogenic and psychogenic perspectives disagreed about the nature of abnormal behavior but agreed that it had internal causes.
The updated version of Hippocrates' view was called the somatogenic perspective.
Sigmund Freud, who adopted a psychogenic perspective, believed disorders to be the result of childhood trauma and unconscious conflicts and employed non-physiological treatments like hypnotism and talk therapy to alleviate symptoms.
The debate between psychogenic and somatogenic views continued during the twentieth century.
The somatogenic view gained the upper hand with the discovery of drugs that could treat a variety of symptoms, including depression, anxiety, and psychosis.
The policy of deinstitutionalization led to patients being released back into their communities in great numbers, as a result of the more effective treatments and social factors.
In the United States, the institutionalized population fell from 600,000 in the middle of the twentieth century to less than 100,000 by century's end.
Many patients who were economically disadvantaged found themselves homeless and neglected after being reintegrated into the community.
The medical model of psychological disorders has a long history.
The view dates back to Hippocrates, but has been refined as modern scientific medicine has changed healthcare.
Abnormal behaviors are symptoms of an underlying disease in the medical model.
Psychopharmaceuticals and other proven medical technologies are typically advocated as treatments by this model.
We frequently use phrases like "mental health" and "mental illness" without realizing that they assume a medical orientation.
Medical treatments are highly effective for a wide range of disorders.
The medical model has proven to be successful in treating a variety of symptoms, so it makes sense that it would also be successful in treating psychological symptoms.
The medical model is supported by a lot of research.
The medical model's limitations include the way in which medicalization can affect everyday phenomena that have been seen as normal for centuries.
There is a danger that the medical perspective willpathologize unpleasant emotions like fear and sadness, so that even sensible expressions of these feelings will be viewed as symptoms, rather than natural responses to the human condition.
The medical model can be similar to the biological model in that it reduces all disorders to a matter of biology and eliminates the role of responsibility and choice.
The medical model has the potential of ignoring underlying causes and focusing on the symptoms, which are relatively easy to treat.
The psychodynamic model is the psychogenic perspective originally formulated by Freud.
The underlying causes of psychological symptoms are the unconscious parts of the mind and the conflicts between them.
Childhood trauma and other experiences are said to have shaped these unconscious processes.
According to this model, psychological disorders are best treated by uncovering unconscious causes and bringing consciousness to the traumas and conflicts that produce symptoms.
Some success in treating patients is a strength of the model.
Freud was able to restore functioning to a number of women with hysteria.
The model respects meaningful aspects of life like childhood experiences, which may be ignored by approaches like the medical and biological.
The way that other psychotherapies have developed has been shaped by the way that the psychoanalytic model was applied in psychotherapy.
Many of the model's concepts are not well-defined or easy to operate in experiments.
Evidence in favor of the model tends to be dependent on case studies, with very little quantitative research in its support.
Critics contend that the model is inherently unverifiable, meaning that it could never be adequately tested in experiments.
Effective treatment for a wide variety of illnesses can't be provided due to the fact that psychoanalysis seeks to reduce most symptoms to a limited set of unconscious causes.
Human beings possess the freedom and the capacity to grow and flourish, which is maintained in the model of psychological disorders.
Humanistic psychology is about self-actualization, the realization of an individual's unique potential.
Human beings must achieve fulfillment on a variety of levels before reaching self-actualization.
The model says that psychological disorders are temporary stumbling blocks on the way to a richer life.
According to this model, the proper treatment for such problems would be something like Rogerian client-centered therapy, in which the therapist constantly reinforces the value of the client and his or her life choices.
The positive outlook is the greatest strength of the model.
The optimism of humanism can help people who suffer from depression.
It is more heartening to view a disorder as a temporary obstacle on the road to self-actualization than it is to view an illness that requires medical intervention.
Humanism takes the ideas of freedom and responsibility more seriously than other models because they have the danger of explaining the causes of abnormal behavior without leaving room for human agency.
Disadvantages include a lack of empirical support, as was the case with the psychoanalytic model.
The use of techniques like positive regard could prove counter-productive for disorders in which an individual's self-worth is pathologically inflated, such as narcissistic personality disorder, as the model may have difficulty explaining the origins of conditions like schizophrenia and other psychotic disorders.
According to the cognitive model of psychological disorders, abnormal behaviors are the result of faulty beliefs and maladaptive emotional responses.
Individuals with depression have distorted views of themselves and the world around them, highlighting bad features and underestimating their ability to bring about positive changes.
A person's world can be better if they adopt a more optimistic outlook, because many things in life are only good or bad if they are perceived to be that way.
The use of cognitive therapy is proposed by advocates of this model.
Later in the chapter, cognitive therapeutic strategies are discussed.
The model helps to explain and treat certain psychological disorders, such as depression and anxiety.
The cognitive model doesn't attempt to reduce psychological disorders to biological illnesses, but instead emphasizes distinctly human elements like thoughts and feelings that give existence meaning.
The cognitive model can't explain the causes of psychological disorders.
The symptoms of some disorders can't be easily traced to distorted beliefs and feelings, an issue that plagues the model.
Cognitive therapy doesn't provide effective treatment for many mental health problems.
According to the biological model of mental health, psychological disorders have biological causes.
The model seeks to understand the brain chemistry that underlies abnormal behavior.
The model's advocates want to understand the extent to which psychological disorders are inherited and why they persist even when they seem maladaptive.
Psychotropic drugs help to restore chemical balances and are the most common treatment approach under the biological model.
The biological model can be used to explain psychological disorders.
When a condition can be linked to a particular chemical, it can be precisely targeted with drugs.
The biological model has a lot of empirical support.
Genetics and evolution help to give a broader perspective on the causes of mental illness, including how psychological disorders happen and why they persist in the human species.
Weaknesses of the biological model include its limited focus on physiological causes and no place for mental and social phenomena that human beings find meaningful and valuable.
The biological model reduces complex phenomena to relatively simple cause-and-effect processes.
Many conclusions are based on studies of nonhuman animals so they may not generalize to human beings.
The treatments advocated by this model can often be effective, but they come with a lot of side effects.
The model of psychological disorders is based on social psychology, sociology, and anthropology.
Behaviors are only considered abnormal in a particular cultural and historical context.
The sociocultural model sees the existence of mental health patients as symptoms of larger social problems like poverty, oppression, and injustice.
A sociocultural approach is more likely to look beyond the treatment of individual patients and instead to advocate wide-scale interventions through mechanisms such as public policy, which can address social problems directly.
The model recognizes cultural differences in ideas of abnormal behavior and psychological disorders.
The sociocultural model supports human diversity.
Increased cultural awareness promoted by this view has helped therapists to work with a broader range of patients and to deal with these patients in more culturally sensitive ways.
It's difficult to investigate the sociocultural model.
Social problems can't be reproduced in the lab.
It's difficult to identify specific variables because of the wide array of social influences.
The sociocultural model doesn't have much to say about what causes disorders.
It may be possible to explain why a minority group has a higher incidence of depression, but it can't explain why others don't.
The behavioral model of abnormal behavior does not concern itself with underlying psychological disorders.
It sees abnormal behavior like any other kind of behavior, as the result of conditioning and learning from the environment.
Classical conditioning, operant conditioning, and observational learning are principles that behavioral psychologists use to explain abnormal behaviors.
To reduce the incidence of abnormal behaviors, this model advocates the application of learning principles.
The strength of the behavioral model is that it relies on observable, quantifiable phenomena, so it is relatively easy to test.
Behavioral therapy is effective at treating obsessive-compulsive disorder.
The model does not consider underlying causes beyond learning.
Critics say that the view is too simplistic and ignores the many factors that influence abnormal behavior.
Some behavioral treatments can be relatively short-lived in their effectiveness; without ongoing reinforcement, newly learned adaptive behaviors may soon be extinguished.
The Diagnostic and Statistical Manual of Mental Disorders is used by clinicians to diagnose psychological disorders.
The manual organizes disorders into 20 categories, which are discussed below.
The DSM-5 does not classify disorders by their origin, but rather by their symptoms.
More consistent diagnosis and treatment of mental health problems has been enabled by the use of the DSM-5.
There are twelve major diagnostic categories.
Some of the categories have a few disorders, while others have more than a dozen.
The material most likely to be featured on the AP psychology exam is the characteristics that define each category and the most common disorders under each heading.
More than a dozen types of anxiety disorders are characterized by fear and anxiety and include hypervigilance, evasive behaviors, and bodily tension.
The different types of anxiety disorders are determined by what causes the anxiety and what kind of behavior results from it.
Women are more likely to suffer from anxiety disorders than men.
These disorders affect the patient's ability to function.
Generalized anxiety disorder is defined as excessive worry about numerous aspects of life over a period of at least six months.
The patient needs to present at least three of the following symptoms in order to be considered for this diagnosis.
The symptoms of specific phobias last six months or more and are caused by an irrational fear of an individual object or situation.
Phobias differ from fear in that the degree of anxiety resulting from the condition exceeds the actual danger.
Animals, natural phenomena, and social situations are some of the stimuli that the DSM-5 recognizes as phobic stimuli.
Any stimuli can be the focus of a specific fear.
Panic disorder is an anxiety disorder characterized by panic attacks.
Fear, hyperventilation, heart palpitations, sweating, shaking, and a sense of unreality are some of the symptoms of a panic attack.
For a panic disorder to be diagnosed, the attacks must be unexpected, meaning there is no stress that could cause the attack.
Social anxiety disorder is caused by social or performance situations that the patient believes to be overwhelming and could cause them embarrassment.
Individuals with dissociative disorders can avoid stress by adopting a different identity.
The patient believes that he or she is a different person when he or she retains a realistic sense of the world beyond his or her self.
A feeling of being detached from one's mind and body is caused by depersonalization/derealization disorder.
Derealization is characterized by a feeling of being in a dream, whereas depersonalization may result in failure to recognize one's reflection or photograph.
The disorder often impairs normal daily functioning when it is experienced at the same time or individually.
The memory is not affected.
Dissociative amnesia is when a patient can't remember past experiences.
This type of forgetfulness is considered "dissociative" because it doesn't correlate with brain trauma, such as a concussion, or with a neurological disorder.
Dissociative fugue is a type of disorder in which a patient expresses confusion over identity.
In cases of fugue, individuals may flee to new locations, create entire histories for new identities, and forget their actual identities for years.
Dissociative identity disorder is a form of mental escape from trauma or stress.
There is evidence that supports the contention that DID is therapist-generated.
Two or more distinct personalities may direct a patient's behavior.
The various personality have opposing elements that the individual struggles to express cohesively.
Individuals with this disorder exhibit gaps in memory when they switch from one personality to another.
Anointing and eating disorders are characterized by obsessive eating habits.
There is a lot of concern about one's physical appearance.
They have been seen as more prevalent in women than in men.
Anorexia nervosa is characterized by the fear of gaining weight, a very strong inclination to lose weight, a low body mass index, and habitually restrictive eating.
Patients with an eating disorder often deny the problem, hide their behavior, and feel shame over their weight.
Binge eating, also known as intentional vomiting or the use of laxatives, is a symptom of bulimia nervosa.
Patients with bulimic tendencies usually have a normal body mass index.
There is an obsession with weight loss.
Binge eating disorder is characterized by a lack of control during a binging episode, or by restrictive eating habits such as consuming excessive amounts of food in a limited time period.
Patients with binge eating disorder often eat alone, eat when they are not hungry, or eat until they are uncomfortable.
Binge eating is more severe than normal eating.
Somatic symptom and related disorders are characterized by a pattern of physical symptoms that result in stress and impair normal daily functioning.
The symptoms of patients with somatoform disorders are better explained by psychological factors.
Somatic symptom disorder can be diagnosed if a patient experiences at least one symptom, regardless of whether or not it is linked to an underlying medical condition.
The patient must devote an unreasonable amount of time or attention to the issue or experience anxiety to qualify for a diagnosis.
Unexplained voluntary inhibition of functions is a hallmark of conversion disorder.
Paralysis and blindness are examples of inhibited sensory or motor functions.
In the absence of a traumatic brain injury, these symptoms usually follow a traumatic event.
Hypochondriasis is a disorder characterized by constant, intrusive thoughts about having or developing a severe medical condition.
Patients with illness anxiety disorder may avoid doctor's appointments because of their fear of being diagnosed with a condition.
They may visit a physician frequently if they are afraid.
Obsessive-compulsive and related disorders are characterized by unwanted obsessions that cause fear, anxiety, or negative thoughts, followed by compelling urges to perform a behavior that reduces the distress.
To meet criteria for a diagnosis in this category, the obsessions and compulsions must be time- consuming and cause significant stress as a result of the disorder.
obsessive-compulsive disorder and body dysmorphic disorder are included in this category.
Obsessive-compulsive disorder is characterized by intrusive impulses and repetitive actions.
The patient experiences stress because of the obsessions and the compulsions.
The patient's normal functioning is disrupted by this cycle.
Body dysmorphic disorder involves a skewed perception of one's physical appearance, often with a negative focus on one specific body part.
The patient's preoccupation with an inaccurate view of a normal body part affects their day-to-day life.
Extreme solutions may be sought by patients with this disorder.
When sadness is experienced as a result of distressing events, it is a normal emotion.
When sadness reaches a certain level of severity and duration, an individual may be suffering from depression, especially when these intense emotions interfere with normal daily functioning.
Depressive disorders are unipolar in that low feelings are not paralleled by manic episodes, as is the case with bipolar disorders.
Major depression is a disorder that lasts at least two weeks.
The patient may experience a persistent depressed mood, anhedonia, weight loss or gain, disturbed sleep or appetite, feelings of guilt, difficulty concentrating, and possibly thoughts of suicide.
Depression is more likely in women than in men.
It is also known as persistent depression disorder.
Similar symptoms to those seen in a major depression are present in patients with dysthymia.
The chronic condition usually lasts for two years.
There is a form of depression called Seasonal Affective disorder.
In the DSM-5, seasonal changes in the winter bring on major depression as a result of SAD.
Sometimes bright light therapy, in which the patient is exposed to a bright, artificial light for a period each day during the triggering season, is an effective treatment.
There are two types of disorders: depression and manic episodes.
Depressive episodes are characterized by a lack of activity.
Manic episodes are characterized by constant activity, an elevated mood, inflated self-esteem, decreased need for sleep, and distractibility.
Manic episodes tend to last longer than depression episodes.
There are manic episodes with or without the presence of depression.
I will be prone to severe mania that impairs his or her normal functioning as well as psychotic episodes when I am a patient with bipolar.
Hypomanic episodes, periods of mania not sufficient in duration or severity to be considered manic episodes, as well as at least one major depression episode, are included in the disorder.
There are hypomanic episodes and dysthymic episodes that are not severe enough to qualify as major depression in cyclothymic disorder.
A personality disorder is characterized by maladjusted behavior that impairs cognitive, emotional, or interpersonal functioning.
Patients suffering from personality disorders think their behavior is normal, whereas patients with other types of psychological conditions think their behavior is problematic.
There are three clusters of personality disorders.
Paranoid personality disorder is characterized by distrust of others.
Schizotypal personality disorder is characterized by strange patterns of thinking and beliefs.
Schizoid personality disorder can be found in cases of detaching from emotions and social interactions.
The patients have poor social skills.
Dramatic, emotional, or erratic behavior is included in Cluster B.
Antisocial personality disorder is marked by total disregard for others.
Patients with this condition are more likely to be male.
Patients are often characterized as dishonest and aggressive.
An overwhelming fear of abandonment and an unstable mood are some of the symptoms of a personality disorder.
Women are twice as likely to have this disorder as men.
Histrionic personality disorder is characterized by excessive attention-seeking behavior.
Feelings of entitlement, a delusional perspective of the patient's importance and successes, a need for admiration, and vulnerable self-esteem are some of the symptoms of a personality disorder.
These people are usually seen as not caring at all for the well being of others.
The behavior of unaffected people is considered to be anxious or fearful.
Avoidant personality disorder is characterized by shyness and a fear of rejection.
Even though they have a strong wish to be accepted and to experience affection, these patients are usually isolated socially.
A dependent personality disorder is marked by dependence on one other individual to make decisions for the patient, as well as the patient's intense need to be reassured about his or her choices.
Obsessive-compulsive personality disorder is characterized by stubbornness and perfectionist tendencies.
These people embrace rules and order, dislike change, and stick to their routines.
Individuals with OCD view their obsessive-compulsive behaviors as a problem, while individuals with OCPD don't.
Positive symptoms include delusions, disorganized thoughts, and catatonic behavior.
Negative symptoms include avolition, which is a decrease in motivation, and the affect, which is a decrease in emotional expression.
Schizophrenia is the most common psychotic disorder.
Schizophrenia is a disorder that breaks between reality and perception.
To be diagnosed with schizophrenia, the patient must have at least two of the following symptoms, one of which must be one of the first three symptoms: delusions, hallucinations, disorganized speech, and catatonic behavior.
The patient must have these symptoms for at least six months to be considered for a diagnosis.
In previous versions of the DSM, schizophrenia was divided into different types, such as Type I and Type II, but the DSM-5 no longer recognizes these distinctions, instead considering this psychotic disorder to be a spectrum.
Subtypes for the disorder were eliminated because people with the disorder have different symptoms.
Most cases of neurological disorders emerge before grade school.
There may be challenges with social, academic, or occupational functioning.
Some of the conditions include very specific impairments, while others include a wide array of challenges.
A patient will exhibit more than one of these conditions, with certain combinations occurring more frequently than others.
Inattention, disorganization, and impulsivity are some of the symptoms of attention deficit hyperactivity disorder.
Patients with attention deficit disorder have a hard time waiting, may be defiant, and struggle to stay on task.
When this condition is not treated, it can lead to impaired social, academic, or occupational functioning.
There is a tendency towards sameness, restricted behaviors, interests, and activities, communication deficits, and difficulty with social interactions and nonverbal elements of communication.
In certain tasks, autistic patients can exhibit heightened abilities beyond the norm.
When a patient's deficit is specific to one field of perception or processing, it's called specific learning disorder.
When an individual struggles to learn the foundations of an academic subject, it becomes evident that they have a disorder.
There are challenges with word recognition and spelling that are related to learning disorders.
Intellectual disability is characterized by general deficiencies in reasoning, judgment, abstract thinking, and other mental tasks.
Due to delayed conceptual, practical, and social development, patients with this disorder are unable to adapt to change and learn from their environment.
Intellectual disabilities are diagnosed when individuals fail to meet developmental benchmarks that are anticipated for their peers, usually before the age of which standardized testing could similarly indicate the disorder.
When a patient experiences a particularly traumatic event and are characterized by variable stress reactions, including but not limited to dissociation, anhedonia, fear, anxiety, anger, and dysphoria, trauma- and stressor-related disorders are included.
Posttraumatic stress disorder is the most common of these disorders, but there are many other trauma and stress related disorders.
Posttraumatic stress disorder is characterized by disturbing memories, flashbacks, or nightmares that cause the patient to relive the event that caused the disorder.
When exposed to stimuli associated with the traumatic event itself, individuals with post-traumatic stress disorder often experience negative changes in mood or thought, which may partially or severely affect day-to-day functioning.
The patient's gradual loss of independence is the result of a decline in various mental abilities.
Depending on the degree to which the disorder limits the patient, the DSM-5 categorizes it as either minor or major.
The two most common major disorders are discussed below, but there are other diseases that result in general cognitive decline, such as Huntington's disease and Creutzfeldt-Jakob disease.
Alzheimer's disease is a brain disorder characterized by progressive memory loss, disorientation, changes in behavior, and a tendency to misplace things.
The patient must have several symptoms to be diagnosed with this disease.
Parkinson's disease is characterized by tremors, slurred and softened speech, instability, and trouble with standing upright and moving freely.
Parkinson's is caused by the loss of dopaminergic neurons.
A patient with Parkinson's may experience mild decline of some mental functions, or they may experience what is referred to as "global dementia," meaning all critical mental abilities are affected by the disease.
Many of the diagnostic labels featured in the DSM-5 are included in the manual as well.
Any patient who seeks help from a clinician will usually be diagnosed with a disorder listed in the DSM-5 prior to receiving any treatment.
Nearly half of US citizens will receive at least one DSM diagnosis at some point in their lives.
Diagnostic labels and their criteria allow for consistency.
This consistency can be found in both clinical practice and research, with diagnoses of and treatments for specific disorders being more regular even between different practitioners.
Diagnostic labels are useful for patients.
Being able to put a name to the problems they are experiencing is seen as the first step in alleviating their distress by many patients.
Diagnostic labels may reduce some of the stigma associated with psychological disorders by giving them a more clinical veneer, and people are more likely to judge others for their moral failings than for their medical problems.
Diagnostic labels are imperfect tools that may reflect the biases of certain cultures.
They can be misapplied by practitioners with their own biases.
One disadvantage is that some people may be suffering from symptoms that don't fit the criteria for any single category; indeed, it is not uncommon for patients to partially fulfill the criteria for many disorders without perfectly fitting any one diagnosis.
The tendency of these labels to be applied to an increasing array of conditions, many of which may be of questionable clinical significance, is a further downside.
Some patients are given power by these labels.
A patient may treat a label as a kind of self-fulfilling prophecy, allowing his or her diagnosis to excuse maladaptive behavior associated with the disorder.
Other people may use these labels to discriminate against people who have been diagnosed with them.
Some may view a patient's behavior through the lens of their diagnosis.
A famous study was conducted in 1973.
The aim of the experiment was to find out how psychiatric labels affected the perception of clinical practitioners.
Most of the pseudo patients received a diagnosis of scurvy.
Despite feigning no other symptoms after being admitted, the pseudopatients stayed an average of 19 days before being released, and none of the staff at any of the hospitals recognized the sanity of any pseudopatient.
The pseudo patients had to agree to stay on the drugs even after they were released.
Proponents of the experiment who object to it for its use of deception or other reasons support the idea that diagnostic labels change the way people are treated.
People who are considered mental health patients may find it harder to find gainful employment or be taken seriously by others.
The pseudopatients in the study felt powerless, bored, tired, and invisible to the nurses and other staff.
Like any other medical diagnosis, psychiatric labels are considered confidential because of the potential stigmas.
The judicial system interacts with clinical psychology in a number of ways, two of which are important to know for the AP Psychology exam.
The confidentiality of personal health information is mandated by the Health Insurance Portability and Accountability Act of 1996.
The information can't legally be disseminated unless a patient agrees to do so.
This includes any information that is discussed during therapy.
When a therapist has reason to believe that a client poses a danger to herself or other people, there are exceptions to these restrictions.
In such cases, therapists have a responsibility to report these dangers to appropriate authorities or to take other measures to avoid harm.
There is a legal category for insane people.
An individual deemed to be insane can't be held responsible for his or her actions because he or she can't tell the difference between right and wrong.
When defendants attempt to plead insanity, psychologists and psychiatrists often serve as expert witnesses.
Personal health information that would otherwise be considered confidential can be disclosed by expert witnesses during their testimony.
When a person is found not guilty by reason of insanity, they are usually committed for long stays in a mental hospital and are often released only on condition of adhering to certain rules.
People with and without psychological disorders benefit from psychological treatment.
Mental health professionals who provide psychological treatment include psychologists, medical doctors and nurses, social workers, and licensed counselors.
The two most common forms of treatment are talk therapy and drug therapy.
Psychotherapy is an ongoing interaction between a patient and a mental health professional, often referred to as a therapist, in which the two discuss the patient's experiences and symptoms.
The goal of therapy is to increase psychological well being.
The idea of a "talking cure" was introduced by Sigmund Freud.
Mental health professionals collect a patient's psychosocial history, which includes information about the patient's symptoms, functioning, family, and goals for treatment.
Depending on the treatment orientation of the mental health professional, the content of psychotherapy varies.
Psycho education is one of the activities that may be included in therapy.
The goal of therapy is to change the patient's thoughts, feelings, self-concept, or behavior.
A mental health professional prescribes a drug to treat psychological distress.
According to recent estimates, drug therapy is very common, with nearly one in five adults taking medication for a psychological or behavioral disorder.
A discussion of possible side effects and monitoring of the symptoms' response to the treatment is included in a prescription.
Not all mental health professionals have the ability to use drugs.
In the United States, most psychotropic medications are prescribed by primary care physicians.
Some states allow psychologists with a special license to prescribe psychotropic drugs.
Depending on the severity of the patient's distress, treatment may take place in different settings.
If you have incapacitating psychological symptoms, you may need to be in a medical facility and receive psychological treatment daily.
The creation of state institutions to care for people with psychological disorders was started by Dorothea Dix.
The quality of life for people in institutions was a concern for activists.
Community outpatient treatment is more common than state institutional care.
It is very common for patients in outpatient treatment to receive both therapies from mental health professionals.
The activism of Dorothea Dix changed the way psychological treatment is done.
After viewing abusive "treatments" in a local prison, Dix began advocating for reform.
She founded state institutions that focused on moral treatment as an alternative to barbaric treatments.
The moral treatment was characterized by regular walks, a healthy diet and environments with natural light.
Until deinstitutionalization, institutions were the main treatment setting for mental illness.
Specific approaches to psychological treatment are described in the next section.
A number of common features are shared by these approaches.
The person providing the treatment and the individual receiving it communicate about the best plan for treatment.
Mental health professionals will keep the patient's privacy confidential with all psychological treatment.
If they violate confidentiality, many mental health professionals will lose their licenses.
There are exceptions to the law surrounding confidentiality.
In recent years, psychological treatment has prioritized treatments that are supported by scientific evidence.
Recent research has focused on identifying effective treatments by investigating how well particular approaches alleviate distress or reduce specific symptoms.
Depending on how the therapist approaches psychological disorders and therapy, the type of treatment that a therapist chooses to use.
The therapist's choice of intervention techniques and the goal of treatment are influenced by theoretical orientation.
The most common theories of psychological treatment are psychodynamic, humanistic, behavioral, cognitive, biomedical, and integrated approaches.
This chapter describes the dominant models of abnormal behavior.
Modern psychodynamic therapy evolved from the work of Sigmund Freud.
The results of unconscious conflicts between the id, ego, and superego are what therapists with a psychodynamic orientation view as psychological disorders.
Psychodynamic therapy aims to bring emotions into consciousness and reduce conflict.
Psychodynamic therapists use a number of techniques to get to the unconscious.
Dream interpretation analyzes the meaning of symbols from dreams.
A fear of losing control is associated with dreaming about falling.
The patient is told to think out loud and say everything that comes to mind in free association.
The phenomenon of transference is discussed in psychodynamic therapies.
Feelings directed at one person can become feelings directed at another person.
A patient who is angry at her mother may become angry at her therapist because both people try to care for her.
Abraham Maslow believed that psychological distress is caused by environments that limit people's ability to develop and flourish.
Humanistic therapy is about the individual's ability to live up to his or her full potential.
There are three main manifestations of therapy.
Carl Rogers pioneered client-centered therapy in the 1950s.
Patients are seen as equal partners with the therapist in client-centered therapy, which encourages them to be authentic and build a healthy self concept.
Unconditional positive regard is an essential component of client-centered therapy, in which the therapist communicate positive feelings and acceptance regardless of what the client says or does.
Active listening is a client-centered technique in which the therapist talks to the patient non-verbally in order to encourage openness.
In client-centered therapy, a genuine and authentic therapist is needed.
The other approaches believe in the importance of self-actualization.
When patients focus on what might be, could be, or should be, rather than focusing on the present moment, they experience psychological distress.
Patients are encouraged to become fully immersed in their therapy sessions.
Existential therapy is based on the idea that people are distressed when their lives lack meaning.
Existential therapists help patients find meaning in their lives.
The behaviorist movement shifted focus from the "black box" of the mind towards observable phenomena, specifically behaviors.
Basic principles of classical conditioning, operant conditioning, and other types of learning were believed to help patients improve their functioning.
Common psychological symptoms are explained by behavioral therapists as natural, learned responses to environmental conditions.
Dogs who were repeatedly shocked with no way to escape were similar to the symptoms of depression.
Behavioral therapy aims to increase or decrease the number of certain behaviors.
It could be a bad habit like smoking or a routine activity like teeth brushing.
ABA helps identify factors in the environment that may be reinforcing or punishing behaviors.
Modification of environmental conditions to be in line with the desired behavior change is made after the initial analysis.
One method of reinforcement used to change environmental conditions is the use of token economies, in which patients earn token (symbolic rewards, such as plastic coins or points) for good behavior.
The real world rewards can be exchanged for the token.
Mary Cover-Jones was one of the first people to apply classical conditioning techniques to treatment.
She documented her efforts to cure a child's rabbit fear.
One of the most popular modern techniques in behavioral therapy is systematic desensitization, which is used to treat phobias by creating new associations between fearful and relaxing stimuli.
Aversive conditioning is a behavioral technique that uses aversive stimuli to change a habit.
See for more on classical conditioning.
During the cognitive revolution in psychology in the 1960s, cognitive therapy became a challenge to traditional psychodynamic approaches.
Albert Ellis called his approach rational-emotive behavior therapy.
He believed that therapy should focus on the analysis of thought.
According to cognitive therapists, psychological distress is caused by cognitive distortions, which are automatic and irrational perceptions of the world that contribute to feelings of anxiety or depression.
A core belief is a belief that guides an individual's thoughts.
When broad conclusions are drawn from very little evidence, it is a common cognitive distortion that leads to negative feelings.
A patient who was called lazy might think she was a lazy person despite being very successful in her work.
Patients in cognitive therapy are often asked to keep a thought log, where they write down their thoughts throughout the day.
Cognitive therapists use Socratic questioning to help patients identify cognitive distortions.
Cognitive therapists encourage their patients to be more flexible and adaptive in their thinking by using a process called cognitive restructuring, in which patients challenge irrational beliefs and replace them with more realistic ones.
Cognitive therapy has evolved into a number of different treatment approaches.
The most popular modern approach is cognitive behavioral therapy.
Cognitive and behavioral techniques are combined to find solutions to patients' concerns.
Third wave cognitive therapies, including dialectical behavior therapy and acceptance and commitment therapy, have become popular.
Compared to other cognitive therapies, third wave therapies focus more on values and techniques to manage psychological distress.
Treatments that are consistent with the medical model of psychological disorders are called bio therapies.
Structural problems in the patient's brain are the cause of psychological distress according to the medical model.
There are three main types of therapy.
The most common treatment for mental disorders is psychopharmacology.
Psychotropic medications, which are drugs that influence an individual's thoughts, emotions, and behavior, emerged as treatments in the 1950s.
The levels of certain neurotransmitters in the brain are changed by most psychotropic medications.
When psychotropic medications were originally used to treat a specific disorder, they are often expanded to treat a variety of disorders.
There is a list of drugs worth knowing for the exam.
ECT is a medical procedure that uses small electric currents to the brain to cause a seizure.
Changing levels of neurotransmitters in the brain can help treat depression and catatonia.
Modern ECT is very safe, but earlier versions of the procedure sometimes caused serious brain damage.
Deep brain stimulation has been used to treat Parkinson's in the past.
Deep brain stimulation requires an implant in the brain to deliver the electric currents.
Psychosurgery is a medical technique in which part of the brain is damaged.
The 1940s and '50s saw the popularity of a type of psychosurgery called the frontal lobe lobotomy.
Modern psychosurgery is more precise but still controversial because it left patients with serious mental deficits.
Modern psychosurgery targets the limbic system, which is implicated in emotion regulation, in severe cases of depression and obsessive-compulsive disorder.
The majority of therapists don't stick to one approach when treating a patient.
One of the most common types of therapy is eclectic therapy, in which a therapist draws from a variety of treatment approaches.
The transtheoretical model is an approach to behavior change that can be adapted to any therapy.
People vary in their readiness to make changes in their lives according to the transtheoretical model.
Depending on whether patients are in the precontemplation, contemplation, getting ready, or action stage, therapists can tailor their interventions.
Individual, group, couple, and family psychotherapy can be classified into four different formats.
Individual psychotherapy is a format in which a patient and mental health professional meet one-on-one.
Group psychotherapy is a format in which multiple patients meet with one or two mental health professionals at the same time.
All of the patients are expected to participate in the discussion.
Most treatment approaches can be implemented in either format.
There are some key differences between the formats of individual and group therapy.
First, individual therapy focuses on the specific problems and goals of the person seeking treatment, while group therapy focuses on a common problem or goal shared by all members, such as addiction to a substance.
Group therapy allows participants to learn from the experience of other members, to receive support from peers, and to practiceInterpersonal skills.
Group therapy draws upon the relationships between group members as a part of the therapeutic process, while individual therapy depends on the relationship between the therapist and patient.
Two other therapy formats in which more than one person seeks treatment for a shared distress are worth noting.
Therapist provides psychological treatment to romantic partners.
A therapist can provide psychological treatment to a family unit.
They use different treatment approaches than individual and group therapy due to their unique circumstances.
Systemic therapy focuses on how people are influenced by family systems.
Many studies show that psychotherapy helps people make positive changes in their lives.
The average person who engages in therapy is better off by the end of treatment than those who don't, according to reviews of these studies.
Meta-analysis studies show that psychotherapy reduces disability, morbidity, and mortality, improves work functioning, and decreases psychiatric hospitalization.
The importance of evidence-based practice has been emphasized by psychology.
The effective integration of three components in psychotherapy are: the best research evidence available, the patient's specific context, and the therapist's clinical expertise.
Evidence-based treatments are the first component of evidence-based practice.
A treatment that reduces psychological distress is considered an EBT.
A randomized controlled trial is the gold standard for determining whether a treatment is evidencebased.
Patients are assigned to one of two conditions in a randomized controlled trial.
The patient is receiving the treatment being evaluated.
The placebo treatment is given to the patient in the control condition.
The researchers compare the symptoms of patients in two conditions at the end of the study.
The treatment is considered an EBT if it improves symptoms more than the placebo.
There are randomized controlled trials that compare the effectiveness of therapies.
The best results for depression and anxiety can be found in a combination of both treatments.
There is some evidence that the results of therapy are more lasting, and that it does not have the same risk of side effects.
The use of psychotherapy has decreased over the last decade despite the evidence.
The list of EBTs for specific disorders has been updated by the American Psychological Association.
Treatments are considered "well established" if they show results that are superior to placebo or similar to another established treatment.
The majority of established EBTs are derived from cognitive therapy.
CBT is an evidence-based treatment for depression and related disorders.
The most well-established approaches for anxiety disorders include exposure-based behavior therapies.
The dominance of cognitive and behavioral approaches is unsurprising, considering that they value an empirical and rational approach to treatment.
Humanistic and psychodynamic approaches have historically been less successful in providing research evidence for their effectiveness.
The assumption that a specific approach is superior to another is challenged by common factors theory.
There are many randomized controlled trials that compare the effectiveness of different therapeutic approaches in treating certain disorders.
Common factors advocates argue that research should work on identifying the components that are effective in all therapeutic approaches instead of trying to find the best treatment.
Most of the effectiveness in therapy can be attributed to the bond between the client and therapist, the structure of therapy, and the placebo effect.
Culture is a collection of experiences, language, values, attitudes, and beliefs shared by a group in a specific place and time.
The world around us is shaped by how we interpret and understand culture.
Culture can include belonging to a racial or ethnic group, a religious identity, a geographic location, or a specific gender and sexual orientation.
Culture can be applied to a specific workplace, church, or family.
Not all people within a culture are the same.
There are trade-offs between using a universal approach and using a culturally sensitive one.
Human behavior, including abnormal behavior, shares common characteristics that will respond to specific treatment techniques, according to a universal approach.
Culture is unimportant under this "one size fits all" perspective.
Culture impacts the way an individual thinks, behaves, and feels, as well as the experience and expression of psychological distress, according to a culturally sensitive approach.
Some disorders described in the DSM-5 are culture-bound syndromes.
latah, a common phenomenon in Indonesia, describes uncontrollable singing, dancing, and laughing after experiencing an emotional shock.
There are values surrounding family, work, health, etc.
Mental health professionals agree that a culturally sensitive approach to therapy is important, especially considering that members of some racial and ethnic groups are often short changed by traditional therapy approaches.
Different racial and ethnic groups experience different therapeutic outcomes in the United States.
Whites are more likely to seek psychological treatment for psychological distress.
Lack of healthcare insurance, low socio-economic status, and geographic location are believed to be the reasons for decreased access to psychological treatment for some racial and ethnic groups.
Individuals are more likely to end psychological treatment early.
Racist and traditional psychotherapy approaches are contributing factors.
Some prospective patients have concerns aboutstitutionalized racism.
A lack of cultural sensitivity can lead to misdiagnosis for members of some racial and ethnic groups.
There were two case studies that were the same except for the race of the patient.
The therapists who read about a black patient were more likely to see the patient as more dangerous than the therapists who read about a white patient.
Black men were allowed to suffer without treatment for decades in racist experiments.
White patients have been the focus of psychotherapy.
Most of the treatment approaches are derived from a white European value system.
Traditional psychotherapy approaches and conceptualizations of illness can be hard for members of racial and ethnic groups who don't share a Eurocentric worldview.
It is common for psychological complaints to be experienced as symptoms of a stomachache in some Asian cultures.
Traditional psychotherapy's focus on an individual's thoughts and feelings may seem inappropriate in a collectivist culture where the family and community are valued over the individual.
Traditional psychotherapy approaches are discouraged in many cultures.
dropout rates are higher when an individual is treated with a Eurocentric therapy approach.
There are factors that reduce the early termination rate for non-white patients.
Patients who are matched with a non-white therapist are less likely to end treatment than patients who are matched with a white therapist.
There are discrepancies in racial representation among mental health professionals.
Multiculturally sensitive treatments have been found to be effective at reducing early termination rates for non-white patients.
Mental health professionals have tried to incorporate multiculturalism into traditional psychotherapy approaches.
Multiculturalism embraces cultural differences.
Mental health professionals' ability to work with patients who are different than themselves in terms of race, gender, ethnicity, sexual orientation, and/or socio-economic status is referred to as multicultural competence.
A multiculturally competent therapist has three characteristics: self-awareness of his or her own cultural context, knowledge of the cultural contexts of other groups, and adoption of appropriate multicultural treatments.
It is possible to modify traditional psychotherapy approaches to be more culturally sensitive.
A multiculturally competent therapist might accept a gift from a patient whose culture values gift-giving in relationships, even though a psychodynamic therapist wouldn't typically accept gifts from a patient.
Intervention is a treatment approach that tries to address a particular cultural context.
Gay black men with depression may be addressed with a treatment.
Multiculturally sensitive interventions are better at reducing psychological distress than traditional therapeutic approaches were found in a meta-analysis.
Multiculturally sensitive treatment approaches include social justice therapy and Afrocentric therapy.
Structural and institutional issues affect the psychological well being of many patients.
Discrimination, prejudice, and even violence can affect the mental health of patients from marginalized groups.
Equal access to housing and employment is not always available to marginalized groups.
A social justice therapist will often advocate for patients outside of their normal role as a therapist.
A social justice therapist can help a patient bring a discrimination lawsuit against their employer or prevent their landlord from evicting them.
Afrocentric therapy is based on African values, rather than Eurocentric values.
African American culture and community are not opposed to Afrocentric therapy.
The five principles of Afrocentric therapy are harmony, balance, interconnectedness, cultural awareness, and authenticity.
Afrocentric therapy helps the patient find harmony in the natural order of the world.
Prevention is the most effective psychological treatment.
Positive economic and social changes are some of the benefits of prevention of mental illness.
Prevention efforts are usually less expensive than psychological treatment.
Prevention should be evidence-based.
Evidence-based prevention programs are rigorously evaluated compared to a control group.
Genetic and environmental influences can affect the risk of mental illness.
Prevention programs can address environmental risk factors such as child abuse.
Specific populations with a higher risk of developing mental illness, including individuals with a family history of mental illness or with certain temperaments, may be targeted by prevention efforts.
Strength promotion is essential to effective prevention.
Prevention programs will often focus on social and emotional skills.
Prevention can be done in schools, neighborhoods, the workplace, and even on highway billboards.
Prevention efforts can be directed at everyone.
Anti-tobacco prevention campaigns try to reach people of all ages through commercials, advertisements, and billboards.
Prevention can be targeted, meaning that it attempts to prevent a specific problem for a specific community, like the prevention of postpartum depression in mothers of newborns.
Health promotion efforts aim to equip people with life skills related to their health.
The ability to navigate the appropriate social, emotional, cognitive, and behavioral tasks at different stages is often the target of health prevention programs.
In an effort to increase their emotional and social competence, a school might teach elementary students how to regulate their emotions.
The development of emotion regulation skills is associated with a lessened risk of mood and conduct related disorders.
Mental health problems are prevented by resilience-building prevention programs.
The ability to thrive, develop, and succeed despite adverse circumstances is called resilience.
The ability to turn a high-risk situation into a positive outcome is called resilience.
The characteristics of resilience are self-esteem, self-reliance, self-reflection, problem-solving abilities, and social skills.
Increasing resilience lowers rates of depression, teen pregnancy, and suicide.
Prevention falls into three levels: primary, secondary, and tertiary.
Primary prevention is meant to prevent a disorder altogether.
Individuals and groups with a high risk of developing a mental illness are the focus of most primary interventions.
IncorporatingMindfulness in schools, increasing social support for at-risk youth, and providing resources for victims of violence are some of the primary prevention programs.
Methods to diagnose and treat a disorder in its early stages are included in secondary prevention.
This decreases the prevalence of a disorder.
Mental health screeners are used in primary care doctor offices.
If an individual is experiencing depression symptoms, they can be referred for therapy, which may prevent them from developing a more severe or persistent mood disorder.
The negative impact of existing disorders is prevented by tertiary prevention efforts.
AA is an example of tertiary prevention.
Providing services to a community following a suicide is addressed in tertiary prevention.
The Rapid Review section has a list of important contributors to clinical psychology.
If you want to practice for an exam on this topic, go to Rapid Review and Practice.
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