Ch9. Clinical Psychology and Psychotherapy — The Science of Healing the Mind

Abnormal Psychology — Where Is the Line Between “Normal” and “Abnormal”?

The 4 D's of Abnormal Behavior:
Deviance:    departure from sociocultural norms
Distress:    the person experiences subjective suffering
Dysfunction: interference with daily functioning or relationships
Danger:      risk of harm to self or others

→ All four criteria need not be present simultaneously
→ Cultural context is critical

Major Mental Disorders

Major Depressive Disorder (MDD)

Symptoms (5 or more, present most of the day for at least 2 weeks):
- Depressed mood nearly every day
- Loss of interest or pleasure (anhedonia)
- Sleep disturbance (hypersomnia or insomnia)
- Appetite changes
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating
- Recurrent thoughts of death or suicide

Lifetime prevalence: approximately 15–20%
Women are diagnosed roughly twice as often as men

Anxiety Disorders

Generalized Anxiety Disorder (GAD):
→ Excessive, uncontrollable worry about multiple topics for 6+ months

Panic Disorder:
→ Sudden intense episodes of fear (racing heart, shortness of breath,
  feeling of impending doom)
→ Unexpected and recurrent

Social Anxiety Disorder:
→ Intense fear of social situations due to fear of embarrassment or judgment
→ Avoidance of public speaking, conversations, being observed

Specific Phobia:
→ Irrational, persistent fear of a specific object or situation
→ Heights, spiders, flying, etc.

PTSD (Post-Traumatic Stress Disorder)

Develops after a traumatic event:
- Intrusion symptoms: flashbacks, nightmares
- Avoidance: avoiding people, places, or thoughts related to the trauma
- Negative cognitions and mood: guilt, feeling detached from others
- Hyperarousal: exaggerated startle response, sleep disturbance

Effective treatments: EMDR and prolonged exposure therapy

Major Approaches to Psychotherapy

Cognitive Behavioral Therapy (CBT)

The most widely used and evidence-supported therapy currently available:

Core principle:
Changing the links between thoughts (cognitions) → emotions → behavior

Cognitive restructuring:
→ Identify automatic negative thoughts
→ Examine the evidence → replace with more balanced thinking

Behavioral activation:
→ Increase engagement in pleasurable activities during depression
→ Gradually face avoided situations

Exposure therapy:
→ Gradual, systematic exposure to feared stimuli
→ Allows extinction of the anxiety response

Psychoanalytic / Psychodynamic Therapy

Rooted in Freud:
→ Unconscious conflicts are the source of symptoms
→ Free association and dream analysis reveal the unconscious
→ Analysis of transference (projecting feelings about past figures onto the therapist)

Contemporary psychodynamic therapy:
→ Connects early attachment experiences to current relationship patterns
→ Long-term treatment (months to years)

Humanistic Therapy — Rogers’ Person-Centered Approach

Three core conditions:
Unconditional positive regard: acceptance without judgment
Empathic understanding:       seeing the world through the client's eyes
Congruence (genuineness):     the therapist is authentic

Humans have an innate drive toward self-actualization
→ The therapist's role is to facilitate — not direct — that growth

→ Effective even in shorter-term formats; foundational to all therapy

Biological Treatments

Antidepressants:
SSRIs (Selective Serotonin Reuptake Inhibitors): fluoxetine (Prozac)
→ Block reuptake of serotonin, increasing synaptic concentration
→ Effects typically appear after 2–4 weeks

Anti-anxiety medications:
Benzodiazepines: fast-acting, but risk of dependence
→ Recommended for short-term use only

Electroconvulsive Therapy (ECT):
→ Used for severe depression when other treatments have failed
→ Effective but associated with memory side effects

Treatment Selection Guide

Depression:           CBT + antidepressants (combination > either alone)
Anxiety disorders:    CBT + exposure therapy (first-line treatment)
PTSD:                 EMDR, prolonged exposure therapy
Personality disorders: Dialectical Behavior Therapy (DBT), long-term psychodynamic
Schizophrenia:        Antipsychotic medication + psychosocial support

4 D’s of abnormal behavior: Deviance, Distress, Dysfunction, Danger CBT: change the thought–emotion–behavior loop — the strongest evidence base of any therapy SSRIs: inhibit serotonin reuptake → first-line medication for depression and anxiety Rogers’ three conditions: unconditional positive regard, empathy, congruence