CHAPTER 2 – UNDERSTANDING AND TREATING MENTAL DISORDERS

One-Dimensional Models of Mental Disorders:

 Biological views
 Psychological issues
 Dysfunctional social relationships
 Sociocultural influences
 A model describes or attempts to explain a phenomenon or process that we can’t directly observe

A Multipath Model of Mental Disorders:

 A multipath model – an integration of biological, psychological, social and sociocultural influences
 This model operates under several assumptions:
o No one theoretical perspective is adequate to explain the complexity of the human condition and
the development of mental disorders
o There are multiple pathways to and influences on the development of any single disorder
o Not all dimensions contribute equally to a disorder
o This model is integrative and interactive
o The biological and psychological strengths and assets of a person and positive aspects of the
person’s social and sociocultural environment can help protect against psychopathology, minimise
symptoms, or facilitate recovery
 Focus on 4 dimensions:
o Biological factors: genetics, brain structure and physiology, CNS functioning, autonomic nervous
system reactivity, and so forth
o Psychological factors: personality, cognition, emotions, learning, coping skills, self-efficacy, values
and so forth
o Social factors: family and other interpersonal relationships, social support, sense of belonging,
community connections and so forth
o Sociocultural factors: race, gender, sexual orientation, spirituality or religion, socioeconomic status,
ethnicity, culture, and so forth
 Important to be aware that:
o Each dimension may include a variety of explanations for a disorder to be based on distinct theories
o Factors within each of the 4 dimensions can interact and influence each other in any direction
o A particular mental health condition may be caused by various combinations of influences within the
4 dimensions
o Many disorders appear to be heterogeneous in nature
o The same triggers or underlying vulnerabilities may cause different disorders
 In addition to understanding the circumstances linked to the development of mental disorders, it is equally
important to remain aware of protective factors that can improve mental health

Dimension 1: Biological Factors

 Assumptions:
o Characteristics that make us who we are are embedded in genetic material of our cells
o Thoughts, emotions, and behaviours involve physiological activity occurring within the brain;
changes in the way we think, feel, or behave affect these electrical and chemical processes and can
change brain function and structure
o Many mental disorders are associated with inherited biological vulnerability and pre-existing brain
abnormality
o Medications and other biological interventions used to treat mental disorders focus on modifying
physiological processes within the brain and body

The Human Brain:

 The forebrain:
o Responsible for higher level mental processes
o Associated with characteristics such as thoughts, perceptions, intelligence, language, personality,
imagination, planning, organisation, and decision making
 o Prefrontal cortex is responsible for executive functioning which helps us manage our attention,
behaviour and emotions, thus allowing us to accomplish short-term and long-term goals
o The prefrontal cortex helps us exercise good judgement and keep our feelings and impulses in check
o Many mental disorders involve dysfunction in the prefrontal cortex
o The limbic system is associated with emotions, decision making, and the formation of memories
o Amygdala is in the limbic system and plays a key role by facilitating the recall of our emotional
memories, thus guiding our response to potential threat
o Hippocampus is in the limbic system and helps us form, organise, and store memory; this includes
evaluating short-term memories and sending emotionally relevant memories to the cerebral cortex
for long-term storage
o The hippocampus also assists with the recall of emotions associated with specific memories
o Emotional responses originating in the limbic system directly affect the autonomic nervous system
(ANS)
o The ANS coordinates basic functions such as digestion and respiration when we are at rest
o The ANS regulates automatic physical responses associated with emotional reactions, the fight or
flight response
o The hypothalamus regulates our bodily drives and body conditions and plays a key role in our
reactions via the hypothalamic-pituitary-adrenal (HPA) axis
o When stress or perceived threat triggers the HPA axis, the hypothalamus stimulates the pituitary
gland to release hormones that produce a sequence of events that prepare the body to respond to
the potentially dangerous situation

Biochemical Processes Within the Brain and Body:

 Biochemical theories attempt to explain how irregularities in biochemical functioning trigger mental
disorders
 Read through page 44 and 45

Neuroplasticity:
 The process of frequent change that enables the brain to adjust to environmental conditions or to
compensate for injury
 Our brains respond to environmental circumstances by creating neural circuits as needed and by pruning the
neural pathways that are no longer used
 Involves brain changes associated with the birth of new neutrons (neurogenesis)
 We can alter brain functioning at any point in life by engaging in experiences that stimulate neurogenesis

Genetics and Heredity:

 Heredity – the genetic transmission of traits
 Genotype – genetic makeup
 Our genotype and environmental circumstances interact and produce our phenotype, our observable
physical and behavioural characteristics
 Some mental disorders are influenced by common genetic variations called polymorphisms

Epigenetics:
 Refers to the study of the complex biochemical processes that allow our fed to adapt to a changing
environment
 Most genetically determined differences between people are due not only to variations in our genes but also
to distance epigenetic processes controlling which genes are expressed
 Epigenetic modifications appear to result from 4 primary categories of environmental influences: nutrition,
behaviour, exposure to stress, and contact with toxins

Biology-Based Treatment Techniques:

 Treatments based on biological principles aim to improve an individual’s social and emotional functioning by
producing changes in physiological functioning
Psychopharmacology:
 The study of how psychotropic medications affect psychiatric symptoms, including thoughts, emotions, and
behaviour
 Classes of medication include anti anxiety drugs, antipsychotics, antidepressants, and mood stabilisers
 Page 50

Electroconvulsive Therapy:
 A procedure that can change brain chemistry and reserve symptoms associated with some mental disorders

Neurosurgical and Brain Stimulation Treatments:

 Pages 50-52

Criticisms of Biological Models and Therapies:

 Failure to consider an individual’s unique life circumstances or psychological, social, or cultural influences on
a person’s symptoms

Dimension 2: Psychological Factors

 Focuses on emotions, learned behaviour, and cognitions

Psychodynamic Models:
 Views mental disorders as the result of childhood experiences and unconscious conflicts
 Freud

Personality Components:
 3 personality components
 Id- operates from the pleasure principle and seeks immediate gratification of instinctual needs
 Ego – represents the realistic and rational part of the mind and is influenced by the reality principle
 Superego – moralistic considerations and the conscience is the part of the superego that instilled guilt in us

Psychosexual Stages:
 Human personality develops through a sequence of 5 psychosexual stages, each brings a unique challenge
 Oral – first year of life
 Anal – around second year of life
 Phallic – beginning around 3rd or 4th year
 Latency – 6-12 years
 Genital – beginning in puberty

Defense Mechanisms:
 To distance ourselves from uncomfortable feelings associated with unpleasant thoughts or other internal
conflicts
 Ways of thinking/behaving that operate unconsciously and protect us from anxiety, often by distorting
reality
 Repression
 Reaction formation
 Projection
 Rationalisation
 Displacement
 Undoing
 Regression

Contemporary Psychodynamic Theories:

 Page 53

Therapies Based on the Psychodynamic Model:

 Traditional psychodynamic therapy
 o Psychoanalytic therapy, or psychoanalysis, aims to overcome a client’s defences so that material
blocked from consciousness can be uncovered, allowing the client to gain insight into inner thoughts
and unresolved childhood conflicts
o Free association
o Dream analysis
o Look for and attempt to analyse evidence of resistance
o Transference
 Therapy based on later psychodynamic theories:
o View experiences with early attachment figures as having powerful effects on current interpersonal
difficulties
o Therapy focuses on existing social and interpersonal relationships rather than on unconscious
conflicts

Criticisms of Psychodynamic Models and Therapies:

 Freud relied heavily on case studies and on his own self-analysis as a basis for his theory
 His patients represented a very narrow spectrum of society
 Has minimal therapeutic value with people who are less talkative, less psychologically minded, or more
severely disturbed

Behavioural Models:
 Concerned with the role of learning in the development of mental disorders and are based on experimental
research

Classical Conditioning Paradigm:

 Pavlov
 Also known as respondent conditioning
 Unconditioned stimulus (UCS)
 Unconditioned response (UCR)
 Conditioned stimulus (CS)
 Conditioned response (CR)
 Extinction could occur
 Watson

Operant Conditioning Paradigm:

 Thorndike and Skinner
 Behaviours are sometimes influenced by events that follow them
 Operant conditioning - Involves voluntary behaviours
 Operant behaviour is a controllable behaviour that “operates” on an individual’s environment
 Behaviours are controlled by reinforcers – anything that influences the frequency or magnitude of a
behaviour
 Positive reinforcement – involves actions that increase the likelihood of a behaviour
 Negative reinforcement – when behaviour is reinforced because something has been removed

The Observational Learning Paradigm:

 Suggests that we acquire new behaviours and emotional reactions simply by watching other people perform
or experience them
 The process of learning by observing is called vicarious conditioning or modelling
 Bandura and Rosenthal

Behavioural Therapies:
 Exposure therapy – also known as extinction therapy, can involve graduated exposure, gradually introducing
a person to feared objects or situations, or flooding, which involves rapid exposure to produce high levels of
anxiety
 Systematic desensitisation – involves having the extinction processes occur while the client is in a competing
physiological state, such as relaxation
 Social skills training
  Assertiveness training

Criticisms of the Behavioural Models and Therapies:

 Neglects factors such as inner determinants of behaviour or the sociocultural context in which the behaviour
occurs

Cognitive-Behavioural Models:
 Beck and Ellis
 Theorised that the manner in which we interpret situations can profoundly affect our emotional reactions
and behaviours
 Emotional responses result from our thoughts about events rather than from the events themselves
 The ABC theory of emotional disturbance

Cognitive-Behavioural Approaches to Therapy:

 Helps clients recognise patterns of illogical thinking and replace them with more realistic and helpful
thoughts
 Therapists encourage clients to become actively involved in their treatment outside of therapy sessions by
assigning homework
 Rational Emotive Behaviour Therapy (REBT) – Ellis
o Mental distress occurs when someone takes a reasonable desire and changes it into an illogical
expectation
 Beck’s approach to cognitive therapy, which has strong research support for treating depression and other
conditions, focuses on mental schema – the framework for which we automatically organise and give
meaning to information
 Mindfulness
 Dialectical behaviour therapy (DBT)
o Linehan
o Uses an empathetic and validating environment to help clients learn to mindfully experience and
regulate their emotions, cope with stress, and improve interpersonal skills and social relationships
o DBT relies on 4 interrelated modules:
1. Mindfulness
2. Distress tolerance
3. Emotional regulation
4. Interpersonal effectiveness

Criticisms of the Cognitive-Behavioural Models and Therapies:

 Cognitions aren’t observable phenomena and cannot form the foundations of empiricism
 Fails to acknowledge that human behaviour involves more than thoughts and beliefs

Humanistic-Existential Models:
 Emphasise the whole person rather than looking at parts of the personality
 Belief in the innate goodness of humanity, in our uniqueness and individuality, and in our capacity to choose
our life direction
 Assumptions:
o What we see as “reality” is a product of our unique experiences and perceptions of the world
o We have the ability to make free choices and are responsible for our own decisions
o Believe in the wholeness or integrity of the person and assume that we will lead lives that are best
suited to who we are

The Humanistic Perspective:

 Car Rogers
 Based on the idea that people are motivated not only to satisfy their biological needs but also to cultivate,
maintain, and enhance the self
 Maslow’s concept of self-actualisation
The Existential Perspective:
 Focus on the irrationality, difficulties, and suffering all humans encounter in life and believe we must be
viewed within the context of the human condition
 Maintain that human unhappiness and psychopathology stem from the avoidance of important life
challenges, resulting in a life that is directionless and without meaning

Humanistic and Existential Therapies:

 The relationship between the client and therapist is viewed as the key to successful psychotherapy
 Person-centred therapy
 Existential therapists work to have their clients consider ways in which their freedom is impaired so they can
remove obstacles to autonomy and increase their opportunities for choice

Criticisms of the Humanistic and Existential Models and Therapies:

 Imprecise nature, lack of scientific grounding, and reliance on people’s unique, subjective experiences
 Doesn’t explain many mental disorders, nor do they address cultural diversity or acknowledge social factors
such as poverty, discrimination, and prejudice

Dimension 3: Societal Factors

Social-Relational Models:
 Important assumptions
o Healthy relationships are important for optimal human development and functioning
o Social relationships provide many intangible health benefits
o When relationships prove dysfunctional or are absent, the individual may be vulnerable to mental
distress

Family, Couples, and Group Perspectives:

 Family systems model assumes that the behaviour of one family member directly affects the entire family
system
 3 distinct beliefs underlying the family systems approach
o Our personality development is strongly influenced by our family’s characteristics, especially the way
our parents interacted with us and other family members
o Mental illness in an individual often reflects unhealthy family dynamics
o Therapy must focus on the family system rather than the individual

Social-Relational Treatment Approaches:

 Conjoint family therapeutic approach stresses the importance of clear and direct communication and
teaches message-sending and message-receiving skills to family members
 Strategic family approaches – consider power struggles within the family and attend to developing a
healthier power distribution
 Structural family approaches – attempt to reorganise family relationships based on the assumption that
family dysfunction occurs when family members have too much or too little involvement with one another
 Couples therapy – targets marital relationships and intimate relationships between unmarried partners
 Group therapy – often initially strangers
o Successful group therapies share several features that prompt change in clients
1. Allows participants to become involved in a social situation and to see how their behaviour affects
others
2. Permits the therapist to see how clients actually respond in real-life social and interpersonal context
3. Provides group members an opportunity to develop new communication skills, social skills, and
insights
4. Allows group members to feel less isolated and less fearful about their problems
5. Provides participants with strong social and emotional support
Criticisms of Social-Relational Models:
 Often lacked control groups, solid outcome measures, or adequate sample sizes
 Often don’t consider cultural diversity and may fail to recognise the hierarchical structure that guides
interactions in familial and intimate relationships within many cultural groups

Dimension 4: Sociocultural Factors

 Sociocultural perspectives emphasise the importance of considering ethnicity, gender, sexual orientation,
religious preference, socioeconomic status, and other such factors in explaining mental disorders

Gender Factors:
 Women have a higher prevalence of many mental health conditions
 Page 66

Socioeconomic Class:
 Lower socioeconomic class is associated with a limited sense of personal control, poorer physical health, and
higher incidence of depression
 Circumstances associated with the social, economic, and physical environment experienced by those living in
poverty have a strong effect on both mental and physical health

Immigration and Acculturative Stress:

 Acculturative stress – the psychological, physical and social pressures associated with a move to a new
country
 Severe culture shock may occur
 Feelings of isolation, loneliness, helplessness, anxiety, and depression are common
 Immigrants without legal status are especially vulnerable to chronic stress

Race and Ethnicity:

 Early attempts to explain differences between various minority groups and their counterparts in the majority
culture tended to adopt one of 2 models
o Inferiority model
 Based on the overtly racist premise that racial and ethnic minorities are inferior to the
majority population
o Deficit or deprivation model
 Explained differences as the result of “cultural deprivation”
 Multicultural model
o Emphasises that being culturally different doesn’t mean that someone is deviant, pathological, or
inferior
o Instead, it is important to recognise that each culture has its strengths and limitations
o All behaviour should be considered from a cultural perspective
o Emphasises that mental health difficulties are sometimes due to sociocultural stressors residing in
the social system rather than conflicts within the person
 Systemic racism occurs on multiple levels (page 69)
o Structural racism
o Cultural racism
o Individual racism

Sociocultural Considerations in Treatment:

 Therapists who use a multicultural approach take care to show respect for clients’ cultural background and
to incorporate cultural and societal themes for disadvantaged groups into traditional psychotherapeutic
techniques