Chapter 2 – An Integrative Approach to Psychopathology

I. What Is a Paradigm?

A. Perspectives, views, filters

B. Helps in organizing data

C. Risks narrowing of observations and interpretations

1. “If all you have is a hammer, everything looks like a nail.”

D. Error of assuming cause via successful treatment

E. More interactions than single-paradigm theories would suggest

F. So, focus on factors involved, rather than single paradigms?

II. Genetic Factors

A. Genes vs gene expression, polygenic etiology

B. How do we determine extent of genetic component? (see chpt 4)

1. Family studies: compare rates in gen’l pop vs. families of probands

2. Twin studies: concordance rates in DZ vs. MZ twins

3. Adoption studies: concordance rates between kids and biol. vs. adoptive parents

4. Linkage analyses

C. Heritability: a population statistic

D. Gene/environment interactions

1. diathesis-stress model

2. reciprocal gene-environment model

E. Tx = awareness of vulnerabilities à better prevention/identification?

G. Evaluation: Much evidence for role of genetics. But: Reductionistic? Can’t ignore environment.

III. Neuroscience Factors

A. Role of neurotransmitters

1. too many or too few receptors

2. receptors too easily or not easily enough excited

3. problems in reuptake process

4. neurotransmitter functioning affected by agonists/antagonists

B. Neuroendocrine system

1. Hypothalamus-pituitary-adrenal (HPA) axis

a. stress hormones

C. Tx = adjust brain chemistry via medication

D. Evaluation: Much evidence for neuroscience, but again, reductionistic?

IV. The Psychoanalytic Paradigm, Psychoanalytic/Psychodynamic Factors

A. Traditional psychoanalysis

B. Modern psychodynamic perspectives

1. continued emphasis on unconscious, defenses, intrapsychic dynamics

2. less emphasis on psychosexual stages, earliest childhood

3. tends to be briefer and more focused

C. Tx, as described previously: Make the unconscious conscious

F. Evaluation: Much criticism of Freudian theory (very little scientific support, based on very narrow sample, largely unfalsifiable, and when tested, often is disproven). But is important in emphasizing that childhood plays a role in adulthood, there are unconscious/nonconscious influences on us, not everything is obvious.

V. Cognitive and Behavioral Factors

A. Based in learning theory and cognitive science

1. Conditioning processes (both classical and operant)

a. Role of cognition in conditioning

b. Role of preparedness in conditioning

2. Learned helplessness (see chpt 7)

3. Modeling

4. Sub/Non-conscious processes

a. schemas

i. interpretation of events, not events themselves

ii. faulty interpretations develop via schemas

b. attentional bias

c. implicit memory

B. Tx =

1. Exposure

2. Token economies, reward/punishment, etc

3. Modeling, role-playing, behavioral rehearsal

4. Cognitive challenging

C. Evaluation: CBT treatment methods are amongst best-studied, and most effective. Criticisms: can’t always find relevant learning history to explain problem, ignores individual differences (e.g., in temperament), difficult to measure cognition, or show where it comes from; little focus on historical factors?

VI. Emotional Factors

A. Three components of emotion

1. behavior, physiology, cognition

2. each interacts with the others

VII. Sociocultural Factors

A. Includes impact of gender, culture, subculture, etc

B. Culture-bound syndromes

C. Socioculturally influenced expressions of emotions/behaviors/thoughts

D. Sociocultural differences in prevalence, treatment-seeking, outcome