Transcript abnormal PSYCHOLOGY Third Canadian Edition

Chapter 2
Current Paradigms and Integrative
Approaches
What is a Paradigm?
•…a set of basic assumptions, a general
perspective, that defines how to:
• conceptualize and study a subject
• gather and interpret relevant data
• think about a particular subject.
•A model of reality: the way reality is or is
supposed to be
•A paradigm is a set of basic assumptions that
outline the particular universe of scientific
inquiry.
What is a Paradigm?
•It is a set of concepts and methods
used to collect and interpret data
(Kuhn, 1992)
A paradigm guides the definition,
examination, and treatment of mental
disorders
•
Paradigms
•A paradigm injects inevitable biases
into the definition and collection of
data and may also affect the
interpretation of facts.
• The meaning or import given to data may
depend to a considerable extent on a
paradigm.
Paradigms in Abnormal Psychology
•Biological Paradigm
•Cognitive-Behavioural Paradigm
• Behavioural perspective
• Cognitive perspective
•Psychoanalytic Paradigm
•Humanistic-Existential Paradigms
•Integrative Paradigm
• The diathesis–stress
• Biopsychosocial
Biological Paradigm
•Continuation of the somatogenic
hypothesis
• Mental disorders caused by aberrant or
•
•
defective biological processes
Often referred to as the medical model or
disease model
The dominant paradigm in Canada and
elsewhere from the late 1800s until
middle of the twentieth century
Behavioural Genetics
•Study of individual differences in behaviour attributable
to differences in genetic makeup
• Genotype – unobservable genetic constitution
•
•
The total genetic makeup of an individual
Fixed at birth, but it should not be viewed as a static entity
• Phenotype – totality of observable, behavioural
characteristics
•
•
Dynamic (i.e., it changes over time)
Product of an interaction between genotype and environment
Behavioural Genetics
•Various clinical syndromes are
disorders of the phenotype, not of the
genotype.
•For instance, it is not correct to speak
of the direct inheritance of
schizophrenia or anxiety disorders
• at most, only the genotypes for these
disorders can be inherited.
Behavioural Genetics
•Methods
•
Family method
• Can be used to study a genetic predisposition among
•
members of a family because the average number of
genes shared by two blood relatives is known.
Index cases, or probands
•
Individuals who bear the diagnosis in question.
• Twin method
•
Concordance rates
• When the MZ concordance rate is higher than the
DZ rate, the characteristic being studied is said to
be heritable.
• Adoptees method
Important Note About MZ Twins
•Recent studies have identified MZ twins who differ both
genetically and epigenetically in terms of developmental
changes in gene expression (see Bruder et al., 2008;
Haque, Gottesmann, & Wong, 2009).
Interpreting Genetic Data
•This data can be difficult to interpret
•Let us assume that children of parents with panic
disorder are themselves more likely than average to
have panic disorder.
• Does this mean that a predisposition for this anxiety
disorder is genetically transmitted?
•
Not necessarily – there are other potential confounds such as
child rearing practices
•The ability to offer a genetic interpretation of data from
twin studies hinges greatly on what is called the equal
environment assumption.
Molecular Genetics
•
Tries to specify particular gene(s) involved and precise functions
of target genes
•
•
Overview
46 chromosomes (23 pairs); thousands of genes per
chromosome
Allele – any one of several DNA codings that occupy the same
position or location on a chromosome
•
•
•
•
•
•
•
•
Person’s genotype is his or her set of alleles
Genetic polymorphism
refers to variability among members of the species
Involves differences in the DNA sequence that can manifest in different
forms
Entails mutations in a chromosome that can be induced or naturally
occurring
Linkage analysis
Method in molecular genetics that is used to study people
•
Typically study families in which a disorder is heavily concentrated; genetic
markers
Examples of Linkage Analysis
•A study in Toronto that established an association
between obsessive-compulsive disorder (OCD) and the
gamma-aminobutyric acid (GABA) type B receptor 1
(GABBR1) gene (Zai et al., 2005).
Another study of genetic linkage in adolescents and
young adults found that a locus on chromosome 9 is
associated with enhanced risk for externalizing
psychopathology (i.e., aggression and conduct disorder)
(see Stallings et al., 2005).
•
Gene-environment interactions
•…the notion that a disorder or related symptoms are
the joint product of a genetic vulnerability and specific
environmental experiences or conditions.
•A concern:
• an exclusive focus on genetic factors promotes the notion
•
that illness and mental illness are predetermined.
Believing that “biology is destiny” could limit the extent to
which people try to modify lifestyle and environmental
factors that contribute to health and mental health
problems.
Genetic Differences Reflected In Temperament
•Robins, John, Caspi, Moffitt, and Stouthamer-Loeber (1996)
analyzed data from 300 adolescent boys in the United States
and found three types or categories:
• (1) the resilient type
• cope well with adversity
• is quite adaptive and high functioning (i.e., high IQ and high self-esteem and school
performance)
• (2) the overcontrolling type
• are overly inhibited and prone to distress
• linked with shyness, loneliness, and moderate self-esteem and school performance,
• (3) the undercontrolling type
• are impulsive and can seem out of control at times.
• is prone to acting out and aggressive behaviours.
• associated with delinquency and externalizing problems, school conduct difficulties,
and lower levels of IQ and school performance.
Neuroscience
•is the study of the brain and the
nervous system.
•Forms of neuroscience:
• cognitive neuroscience
• molecular neuroscience
• cellular neuroscience
The Nervous System
•The nervous system is composed of billions of neurons
•Each neuron has four major parts:
•
•
•
•
(1) the cell body
(2) several dendrites
(3) one or more axons of varying lengths
(4) terminal buttons
•Nerve impulse
•
a change in the electric potential of the cell that travels down the
axon to the terminal endings.
•Synapse
•Neurotransmitters
•
•
chemical substances that allow a nerve impulse to cross
the synapse.
The Nervous System
•Reuptake
–Some of what remains in the synapse is
broken down by enzymes and some is
pumped back into the presynaptic cell
through a process called reuptake.
Synapse
The Nervous System and Psychopathology
•Theories linking neurotransmitters to psychopathology:
• A given disorder is caused by either too much or too little of a
•
particular transmitter (e.g., mania results from too much
norepinephrine and anxiety disorders from too little GABA).
Disturbances in the amounts of specific transmitters could result
from alterations in the usual processes by which transmitters are
deactivated after being released into the synapse.
•Receptors are at fault in some psychopathologies
• If the receptors on the postsynaptic neuron were too numerous
or too easily excited, the result would be akin to having too
much transmitter released.
Biological Approaches To
Treatment
•An important implication of the biological
paradigm is that prevention or treatment of
mental disorders should be possible by
altering bodily functioning.
• Most biological interventions in common use,
however, have not been derived from precise
knowledge of what causes a given disorder.
Deep Brain Stimulation
•This practice involves planting batteryoperated electrodes in the brain that
deliver low-level electrical impulses.
• This approach seems quite effective
though the specific processes and
mechanisms implicated in improvement
have yet to be identified.
Reductionism
•Refers to the view that whatever is being
studied can and should be reduced to its
most basic elements or constituents.
• An influential viewpoint among biological
•
psychiatrists, in philosophical circles, it has
been severely criticized.
However, often the whole is greater than the
sum of the parts.
Cognitive-Behavioural
Paradigm
•The Behavioural
(Learning) Perspective
The Cognitive
Perspective
•
The Behavioural Perspective
•The behavioural (learning) perspective
• Views abnormal behaviour as responses
learned in the same ways other human
behaviour is learned
•Classical Conditioning
•Operant Conditioning
•Modelling
Classical Conditioning
•Ian Pavlov
(1849-1936)
Classical Conditioning
•Unconditioned stimulus (UCS)
•Unconditioned response (UCR)
•Conditioned stimulus (CS)
•Conditioned Response (CR)
•Extinction
•
What happens to the CR when the repeated CS is not
followed by UCS - fewer and fewer CRs are elicited and
the CR gradually disappears.
Operant Conditioning
•J. F. Skinner (1904-1990)
•Law of Effect
• Behaviour that is followed by + consequences will be
repeated
• Behaviour that is followed by – consequences will be
discouraged
•Positive reinforcement
• Strengthening of a tendency to respond by virtue of the
presentation of a pleasant event - Positive reinforcer
•Negative reinforcement
• Strengthens a response by the removal of aversive events
•Modelling
Behaviour Therapy
•Sometimes called Behaviour Modification
•Counterconditioning and Exposure
•
Counterconditioning is relearning achieved by eliciting a new
response in the presence of a particular stimulus.
Behaviour Therapy
•Systematic Desensitization
– compile a list of feared situations, starting with those
that arouse minimal anxiety and progressing to the
most frightening.
•Aversive Conditioning
– A stimulus attractive to the client is paired with an
unpleasant event
Behaviour Therapy
•Operant Conditioning
•
Time-out
•Modelling
•
Assertion training
The Cognitive Perspective
•Cognitive psychologists regard the learner as
an active interpreter of a situation, with the
learner’s past knowledge imposing a perceptual
funnel on the experience.
•Focuses on people:
• Structure experiences, interprete experiences, relate current
•
experiences to past ones
Schemas
•
Cognitive sets
•Main focus: Cognitive restructuring
Beck’s Cognitive Therapy
•The psychiatrist Aaron Beck developed a
cognitive therapy (CT) for depression based
on the idea that a depressed mood is caused
by distortions in the way people perceive life
experiences (Beck, 1976; Salkovskis, 1996)
Beck ’s therapy tries to persuade clients to
change their opinions of themselves and the
way in which they interpret life events.
•
Rational-Emotive Behaviour
Therapy
•Albert Ellis
• Sustained emotional reactions are
•
caused by internal sentences that people
repeat to themselves
Self-statements reflect sometimes
unspoken assumptions— irrational
beliefs —about what is necessary to lead
a meaningful life.
Rational-Emotive Behaviour Therapy
•In Ellis ’s rational-emotive therapy
(RET), subsequently renamed
rational-emotive behaviour therapy
(REBT) (Dryden, David, & Ellis, 2010;
Ellis, 1995), the aim is to eliminate
self-defeating beliefs through a
rational examination of them.
Implementing Rational-Emotive Behaviour
Therapy
•Therapists who implement Ellis ’s ideas differ greatly on how they
persuade clients to change their self-talk.
• Some therapists, like Ellis himself, argue with clients, cajoling
and teasing them, sometimes in very blunt language.
• Others believe that social influence should be more subtle and
that individuals should participate more in changing
themselves, encourage clients to discuss their own irrational
thinking and then gently lead them to discover more rational
ways of regarding the world (Goldfried & Davison, 1994).
Cognitive Behaviour Therapy
•Cognitive behaviour therapy (CBT)
incorporates theory and research on
cognitive and behavioural processes
and represents a blend of cognitive and
learning principles.
•Cognitive restructuring
• a general term for changing a pattern of
thought that is presumed to be causing a
disturbed emotion or behaviour.
The Cognitive-Behaviour Integrated Approach
•Carter, Forys, and Oswald (2008) conducted a
recent review of the cognitive-behavioural
paradigm.
• Observed that cognitive-behavioural models differ in
•
terms of how much emphasis is placed on cognitive
versus behavioural factors.
All of these models are based on the basic premise that
the person is influenced as much and perhaps more by
his or her perception of events versus the objective
features of these events.
Evaluation of the
Cognitive-Behavioural Paradigm
•Criticism
– The fact that a treatment based on learning principles is
–
–
–
–
effective in changing behaviour does not mean that the
behaviour was itself learned in a similar way.
Particular learning experiences have yet to be discovered
How does observing someone lead to a new behaviour?
Cognitive processes must be engaged
Schemas are not well defined; regarded as causing
depression, but there is no explanation of what causes the
‘gloomy’ schemas
Unclear differences between behaviour and cognitive
influences: importance of behaving in new ways for change
to occur
A Review of Challenging Thoughts in CBT
•Longmore and Worrell (2007) asked “Do
we need to challenge thoughts in CBT?”
• Concluded that “there is little empirical support
for the role of cognitive change as causal in
the symptomatic improvements achieved in
CBT” (p. 173).
Evaluation of the CB Paradigm (cont.)
•Contributions
• Integration of two perspectives, i.e., CBT, has
•
•
shown benefits in psychotherapy
Strong evidence of its benefits in improving
depression, anxiety disorders, eating disorders,
autism, and schizophrenia
Ex.: CBT can be more effective long-term than
antidepressants in treating depression
Psychoanalytic Paradigm
•
Developed by Frued
•
Psychopathology results from unconscious conflicts in the
individual
•
•
Structure of Mind (according to Freud)
ID
•
•
•
•
•
•
•
•
•
•
Present at birth
Part of the mind that accounts for all the energy needed to run the psyche
Comprises the basic urges for food, water, elimination, warmth, affection, and sex
EGO
Primarily conscious
Begins to develop from the id during the second six months of life
Task is to deal with reality
SUPEREGO
Operates roughly as the conscience
Develops throughout childhood
Pleasure Principle
•Id seeks immediate gratification and operates
according to the pleasure principle.
•When the id is not satisfied, tension is produced,
and the id strives to eliminate this tension.
•Another means of obtaining gratification is
primary process thinking , generating images—in
essence, fantasies—of what is desired.
Reality Principle
•The ego is the next aspect of the
psyche to develop.
Unlike the id, the ego is primarily
conscious and begins to develop from
the id during the second six months of
life.
Its task is to deal with reality.
•
•
Reality Principle
•Through its planning and decision- making
functions, called secondary process thinking , the
ego realizes that operating on the pleasure
principle at all times is not the most effective way
of maintaining life.
The ego operates on the reality principle as it
mediates between the demands of reality and the
immediate gratification desired by the id.
•
The Conscience
•The final part of the psyche to emerge is the superego,
which operates roughly as the conscience and develops
throughout childhood.
•The superego developed from the ego much as the ego
developed from the id.
•As children discover that many of their impulses, such as
biting or bedwetting, are not acceptable to their parents,
they begin to incorporate, or introject, parental values as
their own to enjoy parental approval and avoid
disapproval.
Psychoanalytic Paradigm (cont.)
•Objective anxiety
• When one ’s life is in jeopardy, one feels objective
(realistic) anxiety —the ego ’s reaction, according to
Freud, to danger in the external world.
•Neurotic anxiety
• a feeling of fear that is not connected to reality or to any
real threat.
•Moral anxiety
• arises when the impulses of the superego punish an
individual for not meeting expectations and thereby
satisfying the principle that drives the superego—namely,
the perfection principle
Defence Mechanisms
•Unconscious strategies used to protect the ego from anxiety
• Examples
•
•
•
•
•
•
•
•
Repression (which pushes unacceptable impulses and thoughts into the
unconscious)
Denial (disavowing a traumatic experience and pushing it into the unconscious)
Projection (attributes to external agents characteristics or desires that an individual
possesses but cannot accept in his or her conscious awareness)
Displacement (redirecting emotional responses from a perhaps dangerous object to
a substitute)
Reaction formation (converting one feeling into its opposite)
Regression (retreating to the behavioural patterns of an earlier age)
Rationalization (inventing a reason for an unreasonable action or attitude)
Sublimation (converting sexual or aggressive impulses into socially valued
behaviours)
Psychoanalytic Therapy
•An insight therapy that attempts to remove the earlier
repression and help the client face the childhood conflict, gain
insight into it, and resolve it in the light of adult reality.
•Free association
•
Resistances - blocks to free association where the client may
suddenly become silent or change the topic.
•Dream analysis
• Latent content (symbolic content)
•Some key components of psychoanalytic therapy
• Transference
• Countertransference
• Interpretation
Modifications in the
Psychoanalytic Theory
•Group Psychodynamic Therapy
•Ego Analysis
•
place greater emphasis on a person’s ability to control the
environment and to select the time and the means for
satisfying instinctual drives, contending that the individual
is as much ego as id.
Modifications in the Psychoanalytic Theory
•Brief Psychodynamic Therapy
•
Freud originally wanted psychoanalysis to be brief
•
Brief therapies share several common elements (Koss & Shiang, 1994):
•
•
•
•
•
•
Assessment tends to be rapid and early.
It is made clear right away that therapy will be limited and that improvement
is expected within a small number of sessions (from 6 to 25).
Goals are concrete and focused on improving the client ’s worst symptoms,
helping the client understand what is going on in his or her life, and enabling
the client to cope better in the future.
Interpretations are directed more toward present life circumstances and
client behaviour than on the historical significance of feelings.
Development of transference is not encouraged.
There is a general understanding that psychotherapy does not cure, but that
it can help individuals learn to deal better with life ’s inevitable stressors.
Modifications in the
Psychoanalytic Theory
•Contemporary Analytic Thought
• Lerner identified five conceptual approaches that are predominant in
contemporary psychoanalytic thought: (1) modern structural theory;
(2) self-psychology; (3) object relations theory; (4) interpersonalrelational; and (5) attachment theory.
•Interpersonal Therapy
• The American psychiatrist Harry Stack Sullivan pioneered the
•
•
interpersonal approach.
This approach emphasizes the interactions between a client and his
or her social environment.
Our needs are interpersonal in that whether they are met depends
on the complementary needs of other people.
Evaluation of the
Psychoanalytic Paradigm
•Freud was vilified when he proposed his theory of
infantile sexuality (i.e., the notion that infants and
children are motivated by sexual drives).
•Criticism
• Theories based on anecdotes during therapy sessions are
•
not grounded in objectivity, thus, not scientific
Freud’s observations, recollections could be unreliable
Evaluation of the
Psychoanalytic Paradigm
•Contributions
• Childhood experiences held shape adult personality
• There are unconscious influences on behaviour
• People use defense mechanisms to control anxiety
•
and stress
Valid research shows the effectiveness of
psychodynamic therapies
Reviews of Psychoanalysis
•Saskia de Maat and colleagues (de Maat, de Jonghe,
Schoevers, & Dekker, 2009) conducted a systematic
review of 27 studies dealing with the effectiveness of longterm psychoanalytic therapy published since 1970.
•
They concluded that psychotherapy resulted in high
mean overall success rates (64% at termination; 55%
at follow-up).
Reviews of Psychoanalysis
•A meta-analysis of 17 studies on the
effectiveness of short-term psychodynamic
therapy showed that it yielded significant
improvements that were maintained at followup and were comparable in magnitude with
the gains achieved through other forms of
treatment (Leichsenring, Rabung, & Leibing,
2004).
Humanistic-Existential Paradigms
•Similar to psychoanalytic therapies, in that they are
insight-focused
• the assumption that disordered behaviour results from a lack
of insight, and can best be treated by increasing the
individual ’s awareness of motivations and needs
•But psychoanalytic paradigm assumes that human nature
is something in need of restraint
•Humanistic and existential paradigms
• Place greater emphasis on the person’s freedom of choice
• Free will as the person’s most important characteristic
• Exercising one’s freedom of choice take courage and can
•
generate pain and suffering
This approach seldom focuses on the cause of problems
Carl Roger’s Client-Centred Therapy
•Also known as person-centred therapy
•Our lives are guided by an innate tendency toward self-actualization, thus
focusing on positive factors
•Based on following assumptions:
• People can be understood only from the vantage point of their own
•
•
perceptions and feelings (phenomenological world)
Healthy people are aware of their behaviour, are innately good and
effective, and are purposive and goal-directed
Therapists should not attempt to manipulate events for the individual
• Create conditions that will facilitate independent decision-making by
the client
•Features – unconditional positive regard & empathy
Positive Psychology
•The emphasis on self-actualization and maximizing potential and
the belief that people are innately good are in keeping with the
current movement toward positive psychology.
Positive psychology promotes a focus on attributes and personal
characteristics (e.g., resilience, optimism, hope) that emphasizes
“wellness” and being able to function, as opposed to psychology’s
seeming preoccupation with negative outcomes and dysfunction.
Focus on protective factors as opposed to vulnerability factors
•
•
Humanistic-Existential Paradigm (cont.)
•Humanistic Paradigm
• All people are striving to reach self-actualization;
• Anxiety occurs when there is a discrepancy between one’s
•
•
self-perceptions and one’s ideal self;
Carl Rogers – Client-Centred Therapy
Gestalt Therapy – Fritz Pearl
Client-centred Therapy
•Although client-centred therapy is not technique oriented,
one strategy is central to this approach: empathy.
• Primary empathy
•
•
refers to the therapist ’s understanding, accepting, and
communicating to the client what the client is thinking or feeling.
Involves restating the client ’s thoughts and feelings
• Advanced empathy
•
•
entails an inference by the therapist of the thoughts and feelings
that lie behind what the client is saying and of which the client may
only be dimly, if at all, aware.
Advanced empathy essentially involves an interpretation by the
therapist of the meaning of what the client is thinking and feeling.
Evaluation of the
Humanistic-Existential Paradigms
•Criticism
•
•
Therapists inferences of the client’s phenomenology (world)
may not be valid
Assumption not demonstrated: People are innately good
and would behave in satisfactory and fulfilling ways if faulty
experiences did not interfere
Self-awareness does not necessarily lead to change
•
•Contributions
• Rogers insisted that therapy outcomes be empirically
evaluated
Consequences of
Adopting a Paradigm
•Eclecticism / integration in psychotherapy
•Guides the data that will be collected and how they will be
interpreted
•Leads to ignoring possibilities and overlook other
information
•Most therapist use a Prescriptive Eclectic Theory, a
combination of ideas and therapeutic techniques
• CBT therapists show empathy; Learning therapists
inquire about clients’ thoughts; Freud was directive and
encourage behaviour change
Psychosocial Influences On
Mental Health
•The main focus of the paradigms previously noted is on
factors inside the person that contribute to whether a person
remains relatively well-adjusted or is at risk of some form of
mental illness.
•In addition to the growing body of research on gene–
environment interactions, there is now overwhelming
evidence of the role that external factors, especially
psychosocial influences, have in contributing to mental
health versus mental illness.
•People are not simply shaped by their
environments, because each person can
also be an agent of change.
•People can make decisions and engage
in behaviours that alter their
environments.
• One basic way this can occur is in terms of
the company we keep.
Familial Factors: Parenting Style
•Diana Baumrind (1971) identified
three parenting styles:
• authoritarian parenting
• permissive parenting
• authoritative parenting
Authoritarian parents
•Tend to be restrictive, punitive, and
overcontrolling.
Children respond to the perceived harshness of
their parents with externalizing problems or
internalizing problems (Hetherington & Martin,
1986; Patterson & Stouthamer- Loeber, 1984).
leads to poorer intellectual and social
development (see Clarke- Stewart & Apfel,
1979).
•
•
Permissive parents
•show little involvement and may seem
disinterested in their children.
This type of parenting style is also
associated with internalizing and
externalizing symptoms in children.
•
An Authoritative Approach
•is most adaptive
•Authoritative parents use discipline in
conjunction with reason and warmth.
guidelines are set out for the child but
the rationale is communicated in a
matter that signifies a warm, caring
attitude.
•
Familial Factor: Parental Mental Illness
•One of the most pernicious risk factors is exposure to
mental illness in one or both parents.
•In Canada, 1 in 8 children live in households where there
is one or more of parental mood, anxiety, or substance
use disorders.
•17% of the time, there is only one parent in the home
(Bassani, Padoin, Philipp, & Veldhuizen, 2009; Bassani,
Padoin, & Veldhuizen, 2008).
Familial Factor: Parental Mental Illness
•Goodman et al. (2010) conducted a meta-analysis of 193
studies examining maternal depression and child
psychopathology.
•
•
•
They found small but significant associations between maternal
depression and higher levels of internalizing symptoms,
externalizing symptoms, and general psychopathology among
Text
their children.
Associations were stronger among younger as opposed to
older children and among girls versus boys.
The obtained associations were also stronger among families
living in poverty.
Peers And The Broader Social
Environment
•Research on peer influences tends to
emphasize two elements: peer status
and peer victimization.
• It is difficult to disentangle whether
mental health difficulties and behavioural
tendencies were precursors or
consequences.
Peers And The Broader Social
Environment
•Popular children tend to be better
adjusted than children who are less
popular
• Boivin, Hymel, and Bukowski (1995),
found that negative peer status led to
loneliness, which in turn predicted
depression.
Peers And The Broader Social
Environment
•Analyses of data from the Stockholm Birth Cohort
Study followed over 10,000 participants for 30
years (see Modin, Ostberg, & Almquist, 2011). It
was found that sixth grade peer status predicted
anxiety and depression 30 years later but for
women, not for men.
• These associations held after taking into account socioeconomic status, family status, school performance, and
cognitive decline.
The Cultural Context
•Cultural diversity is important to highly
heterogeneous countries since most of our
discussion of psychopathology is presented
within the context and constraints of Western
European society.
• People from minority groups are, however, individuals who
can differ as much from each other as their cultural or
racial group differs from another cultural or racial group (cf.
Weizmann, Weiner, Wiesenthal, & Ziegler, 1991).
The Cultural Context
•A consideration of group
characteristics is important and is part
of a specialty called minority mental
health (see Sue & Sue, 2003).
• The major paradigms have on occasion
been revised to assist clinicians in their
work with people from different cultural
backgrounds.
Cultural Research in Canada
•Relatively little controlled research has
been conducted in Canada on cultural,
ethnic, and racial factors that are related to
people suffering from psychological
disorders
A majority of investigations with American
minorities fail to provide information relevant
to the assessment and treatment of people
in Canada (see Bowman, 2000).
•
The Cultural Context
•Clinicians must respect the dignity and
worth of each individual, regardless of
cultural background.
•Discussion Point: Should members of
minority groups be specifically recruited
into the mental health professions?
Psychiatric Problems In Minority Groups
•Do French Canadians differ from
Anglo Canadians in the extent of their
mental health problems?
• Probably not, at least not in any major
way.
Psychiatric Problems In Minority Groups
•Although Aboriginal people constitute
only four percent of the Canadian
population, studies report
proportionally higher levels of mental
health problems in many Canadian
Aboriginal communities.
Psychiatric Health In Minority Groups
•The Hutterites in Manitoba, who live in isolated,
religious communities that are relatively free from
outside influences, have remarkably low levels of
mental illness.
• Research conducted in 1953 (Eaton & Weil, 1953) found
•
that they had the lowest lifetime prevalence of
schizophrenia (1.1 per 1,000) of any group studied thus far
in North America.
A reanalysis of the original data (Torrey, 1995) and
another study (Nimgaonkar et al., 2000) confirmed this
finding.
Healthy Immigrant Effect
•A Statistics Canada report indicated
that immigrants had comparatively lower
rates of depression and alcohol
dependence than Canadian-born
members of the population (Ali, 2002),
unrelated to language proficiency in
English or French, employment status, or
sense of belonging.
Healthy Immigrant Effect
•Secondary analyses found that Asian
immigrants had the lowest rates of
depression, while African immigrants had the
lowest rates of alcohol dependence.
The healthy immigrant effect was stronger
among recent arrivals than among those who
had been living in Canada for some time.
•
Healthy Immigrant Effect
•Recent follow-up analyses of the CCHS data
confirmed that the healthy immigrant effect is
reflected in a lower prevalence of anxiety
disorders among recent immigrants when
compared with Canadian-born participants.
This effect was found among recent immigrants
and was detectable but to a lesser effect among
immigrants who had arrived 10 or more years
earlier (Aglipay, Colman, & Chen, in press).
•
Healthy Immigrant Effect
•Limited language proficiency was a robust
predictor of poor health status (also see
Fuller-Thomson, Noack, & George, 2011).
•Other predictors were
• limited friendliness of neighbours
• problems accessing health care (Ng, Pottie, & Spitzer,
2011).
•About 1 in 4 immigrants who experienced a
health decline reported serious problems in
accessing care (Fuller-Thomson et al., 2011).
Where Do Asian Canadians Go For Help?
•Asian groups show a greater tendency than whites to be
ashamed of emotional suffering, to be relatively
unassertive, and to experience greater reluctance to seek
out professional help.
Asians in Canada tend to rely on members of their
families and various informal sources of support when they
experience psychological difficulties (e.g.,Naidoo, 1992),
despite the fact that in some centres there are wellestablished mental health services for the large Asian
communities.
•
Integrative Paradigm
•Diathesis-Stress Paradigm
•Biopsychosocial Paradigm
•Both paradigms emphasize the
interplay among the biological,
psychological, and social /
environmental perspectives
Diathesis-Stress Paradigm
•Not limited to one particular school of thought,
but focuses on interaction between
predisposition toward disease (diathesis) and
environmental, or life, disturbances (stress)
•Diathesis
• Constitutional predisposition toward illness
• Any characteristic or set of characteristics that increases
•
a person’s chance of developing a disorder
genetic, psychological, environmental factors can be
predisposing to the development of a mental disorder
Diathesis-Stress Paradigm
•Possessing the diathesis for a disorder
increases a person’s risk of developing it but
does not guarantee that the disorder will
develop.
It is the stress part of diathesis–stress that
accounts for how a diathesis may be
translated into an actual disorder.
Psychopathology is unlikely to result from
any single factor.
•
•
Differential Susceptibility (Belsky & Pluess, 2009)
•Some factors that are considered diatheses
should actually be considered differential
susceptibility factors because they involved the
expected adverse reaction to negative
experiences but also positive reactions to
positive experiences.
• For example, it would actually be a situation of differential
susceptibility if a vulnerable child reacted poorly to parental
criticism but also tended to react quite positively to parental
praise and support.
Biopsychosocial Paradigm
•Biological, psychological, and social factors are
conceptualized as different levels of analysis or
subsystems within the paradigm (Engel, 1980).
•
not limited to a particular school of thought.
•Explanations for the causes of disorders typically
involve complex interactions among many biological,
psychological, and socio-environmental and
sociocultural factors.
Biopsychosocial Paradigm
Risk and Protective Factors
•Risk Factors
•
factors that interact to put people at greater risk of—or
make them more vulnerable to—developing disorders
•Protective Factors
•
Factors that if present, can help protect individuals from
developing disorders
•Resilience
•
the ability to bounce back in the face of adversity, is
referred to as (Smith & Prior, 1995).
Risk Factors
Money: Protective Factor?
•While money is needed to cover basic life necessities and
this serves as a protective factor, being rich is not a surefire
route to happiness.
• A classic, comparative study of very wealthy people on the
•
Forbes 500 list found that relative to other people, the very
wealthy had slightly higher levels of well-being, and none of
these billionaires and millionaires identified money as a major
source of happiness (Diener, Horowitz, & Emmons, 1985).
At the global level, Diener and Seligman (2004) reported that
economic output had risen sharply in recent years, with no
corresponding increase in average levels of well-being; instead,
there have been large increases in depression and distrust.
Different Pathways To Mental Health Issues Based
on SES
•Essex et al. (2006)
– Hegh SES have less severe internalising and externalising
symptoms
•Essex et al. (2006)
– In low SES chronic maternal stress during the child ’s
infancy.
– In high SES, a parental history of depression along with a
family history of psychopathology.
How do poor neighbourhoods
escalate levels of depression?
•Cutrona et al. (2006) identified three
specific processes
–(1) increased daily stress
–(2) greater vulnerability to negative events
–(3) disrupted social ties (i.e., less chance to
develop positive affiliations).
Copyright
•
Copyright © 2014 John Wiley & Sons Canada, Ltd. All rights
reserved. Reproduction or translation of this work beyond
that permitted by Access Copyright (The Canadian
Copyright Licensing Agency) is unlawful. Requests for
further information should be addressed to the Permissions
Department, John Wiley & Sons Canada, Ltd.
The
purchaser may make back-up copies for his or her own use
only and not for distribution or resale. The author and the
publisher assume no responsibility for errors, omissions, or
damages caused by the use of these programs or from the
use of the information contained herein.