• One Dimensional Model

(a) Biological views (including genetics and other physiological explanations);

(b) Psychological issues, rooted in the invisible complexities of the human mind;
(c) Social relationships, dysfunctional social relationships including stressful interactions with family members
and peers;
(d) Socio-cultural influences, including the effects of discrimination and stressors related to race, gender, and
socioeconomic status.

Limitations of the One-Dimensional Models

(a) set up a false “either/or” dichotomy between
accepting one explanation or another (e.g., nature
vs. nurture),
(a) neglect the possibility that a variety of
factors contribute to the development of mental
disorders, and
(c) failure to recognize the reciprocal influences of the various contributing factors

T.-Y. Zhang & Meaney, (2010).

B. Multipath Model of Mental Disorders:

- an integration of biological, psychological, social, and sociocultural influences to explain mental disorders.

The biopsychosocial model, suggests that interactions between biological, psychological, and social factors cause
mental disorders.

• Concerns about the use of biopsychosocial model:

(a) there is limited focus on how factors interact to produce illness;
(b) the model provides little guidance regarding how to treat the disorder; and
(c) the model neglects the powerful influences of culture (sociocultural influences such as the effects of poverty or
discrimination in explaining mental disorders).
Ghaemi, 2010b; Sue & Sue, (2013)

The multipath model operates under several assumptions:

1. No one theoretical perspective is adequate to explain the complexity of the human condition and the
development of mental disorders.
2. There are multiple pathways to and influences on the development of any single disorder.
3. Not all dimensions contribute equally to a disorder. In the case of some disorders, current research suggests
that certain etiological forces have the strongest influence on the development of the specific disorder.
4. The multipath model is integrative and interactive.
It acknowledges that factors may combine in complex and reciprocal ways so that people exposed to the
same influences may not develop the same disorder and that different individuals exposed to different factors
may develop similar mental disorders.

The Multipath Model

• Dimension One: Biological Factors
Modern biological explanations of normal and
abnormal behaviors share certain assumptions:
1. Characteristics that make us who we are—our physical features, susceptibility to illness, and physiological
response to stress, to name a few—are embedded in the genetic material of our cells.

Additionally, many of our personal qualities result from complex interactions between our biological makeup and
the environment.
 2. Thoughts, emotions, and behaviors involve physiological activity occurring within the brain; changes in the
way we think, feel, or behave affect these biological processes and, over time, can change brain structure.
3. Many mental disorders are associated with inherited biological vulnerability and/or some form of brain
abnormality.
4. Medications and other biological interventions used to treat mental disorders influence various
physiological processes within the brain.

• The Human Brain

• forebrain—responsible for higher-level mental processes;
• midbrain—involved with basic functions such as hearing and vision, motor movement, alertness and
sleep/wake cycles, and temperature regulation; and
• hindbrain—the most primitive brain region; designed for self-preservation and survival; responsible for
instinctive behavior, balance and equilibrium, and basic bodily functions such as heartbeat, respiration, and
digestion.

The Forebrain
• The forebrain contains brain structures associated with characteristics that make us human—thoughts,
perceptions, intelligence, language, personality, imagination, planning, organization, and decision making.
• The forebrain holds the largest and most advanced part of the brain, the cerebrum.
• Another significant part of the forebrain is the cerebral cortex, which consists of layers of specialized nerve
cells, called neurons, that transmit information to other nerve cells, muscles, and gland cells throughout
the body.
• The prefrontal cortex, the region of the cerebral cortex responsible for executive functioning, helps us
manage our attention, behavior, and emotions so that we reach short term and long-term goals. Executive
functioning involves a combination of emotional, social, and intellectual capacities.
• The ability to foresee consequences of our actions, guided by memories from the past in combination with
assessment of present circumstances, is an important aspect of executive functioning.
• The limbic system is a group of deep brain structures associated with emotions,
decision making, and the formation of memories The intricate connections in this system link our emotions
and our memories.

STRUCTURES OF THE LIMBIC SYSTEM

• The amygdala’s role in the limbic system is to facilitate recall of our emotional memories and our response
to potential threat. It is sometimes referred to as a barometer of our emotions—the stronger the emotion,
the greater the arousal in the amygdala.
The amygdala activates in response to our thoughts or imagination, as well as real-world stimuli; this
reactivity in response to our thoughts is a key factor in various mental disorders.
• The hippocampus, which helps us form, organize, and store memory; this includes evaluating short-term
memories and sending emotionally relevant memories to the cerebral cortex for long-term storage, as well
as assisting with the recall of emotions associated with specific memories.
• The hypothalamus, a structure that regulates bodily drives, such as hunger, thirst, and sexual response, and
body conditions, such as body temperature and circadian rhythms, plays a key role in our reactions via the
hypothalamic-pituitary-adrenal (HPA) axis, a system activated under conditions of stress or emotional
arousal.
• When stress or perceived threat triggers the HPA axis, the hypothalamus stimulates the pituitary
gland to release hormones that produce a sequence of events (including stimulation of the adrenal
gland) that prepare the body to respond to the potentially dangerous situations.
• The midbrain is involved in vision and hearing and -- along with the hindbrain – in the control of sleep,
alertness and pain.
• Has a role in manufacturing chemicals such as serotonin, NE, and dopamine – that have been
implicated in certain mental disorders.
• The hindbrain appears to control functions such as heart rate, sleep and respiration.
• It also manufactures serotonin.
 • Biochemical Processes within the Brain and Body
Biochemical theories attempt to explain how irregularities in biochemical functioning trigger mental
disorders.
These theories are based on the involvement of the brain’s biochemical actions in most physiological and
mental processes, from sleeping and digestion to thinking and feeling.
Research confirms the connection between biochemical processes within the brain and the etiology of
specific mental disorders.

• Genetics and Heredity

Research strongly indicates that heredity—the genetic transmission of traits—plays
an important role in the development of mental disorders.

• Sex Differences in Brain Development

Men have more volume in the hypothalamus and amygdala (which regulates sexual behavior) whereas women have
a larger hippocampus (associated with recall of emotional memories)
and more volume in regions of the cortex associated with decision making and emotionalr egulation.

Gender differences in brain functioning can help explain, to some degree, why the frequency and progression of
mental disorders differs in men and women.

E.g., the prevalence of disorders involving reactivity to stress (such as depression, anxiety, and eating
disorders) is higher among women and girls whereas disorders involving impulsivity and risktaking (such as substance
abuse and attention-deficit disorder) are more prevalent among men and boys.

• 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: is the study of how psychotropic medications affect psychiatric symptoms, including
thoughts, emotions, and behavior, (also known as drug therapy).
Classes of medication used to treat mental disorders include:
(a) antianxiety drugs (or minor tranquilizers),
(b) antipsychotics (or major tranquilizers or neuroleptics),
(c) antidepressants (used for both depression and anxiety), and
(d) mood stabilizers (sometimes called antimanic drugs).

• Antianxiety medications (minor tranquilizers) such as benzodiazepines (including Valium

and Xanax) are used to calm people and to help themsleep.
Benzodiazepines increase the activity of GABA, an inhibitory neurotransmitter, thereby reducing the
transmission of nerve impulses, with a resultant reduction in symptoms of anxiety. They are usually prescribed in
low doses and on a short-term basis due to their addictive potential.

• Antipsychotic medications (also referred to as neuroleptics or major tranquilizers) play a

major role in treating the agitation, mental confusion, and loss of contact with reality associated with psychotic
symptoms.

In 1951, the first drug with antipsychotic properties (chlorpromazine; generic name
Thorazine) was synthesized in France.

• Antidepressant medications are prescribed to help relieve symptoms of depression and anxiety.
Among the most popular medications for both depression and anxiety are the selective serotonin reuptake
inhibitors (SSRIs), which increase the availability of serotonin. The drugs Prozac (fluoxetine hydrochloride), Paxil
(paroxetine), and Zoloft (sertraline) are SSRIs.
 Another class of antidepressants, the tricyclic antidepressants, increase the availability of both serotonin
and norepinephrine.

• Mood-stabilizing medications are prescribed to treat the excitement associated with

episodes of mania, as well as to help prevent future mood swings.
Lithium, a naturally occurring chemical compound, is a well-known and frequently prescribed mood
stabilizer.
A variety of anticonvulsant (used to treat seizure disorders) and antipsychotic medications are also used for
mood stabilization.
The exact means by which these medications work to calm brain activity remain unclear.

• Electroconvulsive Therapy
(ECT) is a procedure that can change brain chemistry and reverse symptoms associated with some
mental disorders. ECT, usually reserved for those who have not responded to other treatments, applies moderate
electric voltage to the brain to induce a short convulsion (seizure).

• Neurosurgical and Brain Stimulation Treatments

Psychosurgery—performing brain surgery in destruction or removal of a small area of the brain, raised many
scientific and ethical objections.
As a result, psychosurgery is now very uncommon and has been replaced by neurosurgical techniques that
focus on stimulation rather than destruction of brain tissue.

• Criticisms of Biological Models and Therapies

Most biological models of mental illness only minimally acknowledge psychological, social, or cultural
influences.
Biological models are criticized for their failure to consider the unique circumstances of the individual and
environmental influences on the etiology of symptoms.

• Dimension Two: Psychological Factors

The psychological dimension focuses on emotions, conflicts in the mind, learned behavior, and cognitions.
Four major psychological perspectives that explain abnormal behavior: psychodynamic,
behavioral, cognitive, and humanistic-existential.

• Psychodynamic Models: view mental disorders as the result of childhood trauma, anxieties, and
unconscious conflicts.

Personality Components
Freud developed a model suggesting that all behavior is a product of interactions between three
personality components: the id, the ego, and the superego.

Psychosexual Stages
Human personality develops through a sequence of five psychosexual stages, each of which brings a
unique challenge.

Freud stressed the importance of early childhood experiences; he saw the human personality as largely determined
in the first 5 years of life—during the oral (first year of life), anal (around the second year of life), and phallic
(beginning around the third or fourth years of life) stages.

Defense Mechanisms
According to psychodynamic theory, we often use defense mechanisms to distance ourselves from feelings of
anxiety associated with unpleasant thoughts or other internal conflicts.
Defense mechanisms are ways of thinking or behaving that share three characteristics: they protect us from anxiety,
they operate unconsciously, and they distort reality.

• Criticisms of Psychodynamic Models and Therapies

1.Freud relied heavily on case studies and on his own self-analysis as a basis for his theory.
2. Freud’s patients represented a very narrow spectrum of society—relatively affluent Victorian- era Austrian
women. Thus, traditional psychoanalysis fails to address external issues such as social inequality, race, class, gender,
and culture.
3. Traditional psychoanalysis has a limited range of usefulness. It has limited therapeutic value with people who are
less talkative, less psychologically minded, or more severely disturbed.

Behavioral Models: concerned with the role of learning in the development of mental disorders and are based on
experimental research.
• The three learning paradigms are classical conditioning, operant conditioning, and observational learning.

1. classical conditioning, sometimes referred to as respondent conditioning. (learning through association)

Watson and Rosalie Rayner (1920) demonstrated how classical conditioning experiences can create phobias (an
extreme fear of particular objects or situations).

• This has helped in understanding the etiology of anxiety and fear responses.

2. Operant conditioning was first formulated by Edward Thorndike (1874–1949) and further elaborated by B. F.
Skinner (1904–1990).

Behaviors are sometimes influenced by events that follow them. Rather than the involuntary reactions (e.g.,
sweating, salivating, and fear responses) involved in classical conditioning, operant conditioning involves voluntary
behaviors.

Behaviors are controlled by reinforcers—anything that influences the frequency or magnitude of a behavior.
1. Positive reinforcement
2. Negative reinforcement - behavior is reinforced because something aversive has been removed—can
increase the likelihood of a behavior.

• Extinction occurs if reinforcement does not follow a behavior: if the reinforcer is no longer present the
behavior will eventually diminish.

Studies have demonstrated a relationship between environmental reinforcers andcertain abnormal behaviors.

3. observational learning theory: suggests that we can acquire new behaviors and emotional reactions simply by
watching other people perform them (Bandura, 1997).

The process of learning by observing models (and later imitating them) is called vicarious conditioning or
modeling.

• In explaining psychopathology, social learning theory posits that exposure to disturbed models is likely
to produce disturbed behaviors.
E.g., When children watch their parents respond with fear, they learn to respond in a similar
manner.
Similarly, if we are exposed to models who display impulsivity, helplessness, or aggression, we are
more likely to acquire these characteristics.

• Behavioral Therapies involve having clients directly face their fears.

 1. Exposure therapy, also known as extinction therapy, can involve graduated exposure, gradually
introducing a person to feared objects or situations.
2. Flooding, which involves rapid exposure to produce high levels of anxiety.
3. Systematic desensitization, developed by Joseph Wolpe (1958), involves having the extinction process
occur while the client is in a competing emotional state such as relaxation.
4. Social skills training, which involves the teaching of specific skills needed for appropriate social
interactions, is an effective behavioral intervention for individuals who experience social difficulties.
5. Assertiveness training is a form of social skills training that teaches individuals (especially those who tend
to be overly timid or overly aggressive) the difference between nonassertive, aggressive, and assertive responses.

• Criticisms of the Behavioral Models and Therapies

1. They often neglect—or place minimal emphasis on inner determinants of behavior.
2. They also criticize behaviorists’ use of results obtained from animal studies to solve human problems.
3. Some also charge that the behaviorist perspective is mechanistic, viewing people as “empty organisms.”
4. These theories, like many others, also tend to view normal and abnormal human development in a linear and
one-dimensional fashion.

• Cognitive-Behavioral Models: focus not only on observable behaviors but also on how thoughts influence
our emotions and behaviors.
According to cognitive behavioral models, we create our own problems (and symptoms) based on
how we interpret events and situations.

• Cognitive Dynamics in Psychopathology

Cognitive theorists are Aaron Beck (1921– ) and Albert Ellis (1913–2007)
-They both theorized that the manner in which we interpret situations can profoundly affect our
emotional reactions and behaviors (Rosner, 2012).
-Their theories link psychopathology with irrational and maladaptive assumptions and thoughts.
-Distressing emotional responses such as anger, depression, fear, and anxiety result from our
thoughts about events rather than from the events themselves.

 The A-B-C theory of emotional disturbance, developed by Albert Ellis (1997, 2008), aims to describe how
people develop irrational thoughts.
A – activating event
B – beliefs about the event
C – consequence
The development of emotional and behavioral problems is often linked to dysfunctional thinking.

• Cognitive-Behavioral Approaches to Therapy

• Cognitive approaches to psychotherapy help clients recognize patterns of illogical thinking and replace
them with more realistic and helpful thoughts (A. T. Beck & Weishaar, 2010).
REBT by Ellis
CBT by Beck

• Criticisms of the Cognitive-Behavioral Models and Therapies

1. B. F. Skinner (1990) warned that cognitions are not observable phenomena and cannot form the foundations of
empiricism.
2. Its failure to acknowledge that human behavior involves more than thoughts and beliefs (Corey, 2013).
3. Others question the role of the therapist as teacher, expert, and authority figure, especially because some
therapists are quite direct when identifying and attacking irrational beliefs.

Humanistic-Existential Models: include a group of theories that emphasize the whole person, innate goodness of
humanity, in our uniqueness and individuality, and in our capacity to choose our life direction.
• The Humanistic Perspective
 1. Carl Rogers (1902–1987), his theory of personality and humanistic perspective reflect his concern with
human welfare and his deep conviction that humans are basically good, forward moving, and trustworthy.
2. Abraham Maslow’s concept of self actualization— our inherent tendency to strive toward the realization
of our full potential.
• Humanistic Views on the Development of Psychopathology
Anxiety, depression, and other problems occur
when society blocks this innate tendency for growth by
imposing conditions on whether we have personal
value.
These standards are transmitted via conditional positive regard—when significant others in our
lives, such as parents, friends, or partners, value us only when our actions, feelings, and attitudes meet their
expectations

• The environmental condition most suitable for this growth is unconditional positive regard—feeling loved,
valued, and respected for who we are, regardless of our behavior.
▫ (People may disapprove of someone’s actions but they still respect, love and care for that person).

• The Existential Perspective: emphasis on individual uniqueness, quest for freedom and for meaning in life,
and a belief that we all have positive attributes that we express unless environmental factors interfere.

Humanistic and Existential Therapies

1. Person- centered therapy: fostering conditions that allow clients to grow and fulfill their potential.
2. Existential therapy : work to have 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 an Existential Models and Therapies

1. Critics of the humanistic-existential approaches point to their “fuzzy,” ambiguous, and nebulous nature;
lack of scientific grounding; and reliance on people’s unique, subjective experiences.
2. Others question the power of the self-actualizing tendency and whether the therapist-client relationship in
and of itself is sufficient to promote change.

• Dimension Three: Social Factors

address important aspects of our lives such as how current relationships, family, social support,
community, and belonging affect the expression of mental distress.
• Social-Relational Models: consider a variety of interpersonal relationships, including those involving
intimate partners, nuclear or extended family, or connections within the community.

• Important assumptions (D. W. Johnson & Johnson, 2003):

1. Healthy relationships are important for optimal human development and functioning.
2. Social relationships provide many intangible health benefits (social support, love, compassion, trust, sense of
belonging, etc.).
3. When relationships prove dysfunctional or are absent, the individual may be vulnerable to mental distress.

• Family, Couples, and Group Perspectives

The social-relational models emphasize how other people, especially significant others, influence our behavior.
The family systems model assumes that the behavior of one family member directly affects the entire
family system.
According to this model, we behave in ways that reflect both healthy and unhealthy family influences.

Three distinct beliefs underlying the family systems approach (Corey, 2013).
1. Personality development is strongly influenced by family’s characteristics, especially the way parents
interact with their children and other family members.
 2. Mental illness in an individual often reflects unhealthy family dynamics, especially poor communication
among family members. Thus, the cause of mental disorders resides within the family system, not within
the individual.
3. Therapy must focus on the family system, rather than the individual; treatment may be ineffective unless
the entire family is involved.

• Social-Relational Treatment Approaches

1. Conjoint family therapeutic approach, developed by Virginia Satir
2. Strategic family approaches by Haley
3. Structural family approaches by Minuchin
4. Couples therapy which targets marital relationships and intimate relationships between unmarried
partners.
5. Group therapy where members may share certain characteristics such as experiencing a similar life stressor
(e.g., chronic illness, divorce, or death of a family member) or having similar mental disorders or similar
therapeutic goals.

• Criticisms of Social-Relational Models

1. Social-relational research studies are generally not rigorous in design; they have often lacked appropriate
control groups or solid outcome measures (Cottrell & Boston, 2002).
2. Considerable evidence exists that couples, marital, and family therapies do not adequately address cultural
diversity (Sue & Sue, 2013).
3. Family systems models may have unpleasant consequences. Family therapists have pointed an accusing
finger at the parents of children with certain disorders, despite an abundance of evidence that factors other
than parental behaviors are likely involved.

• Dimension Four: Sociocultural Factors:

emphasize the importance of considering race, ethnicity, gender, sexual orientation, religious preference,
socioeconomic status, and other such factors in explaining mental disorders.

• Four major socio-cultural influences that illustrate their importance in understanding psychopathology:
1. gender,
2. socioeconomic class,
3. acculturative stress, and
4. race and ethnicity

• Gender Factors
The importance of gender in understanding psychopathology is evident when examining the much
higher prevalence of depression, anxiety, eating disorders, and other mental health conditions among women
(Ferrari et al., 2013).
▫ Body dissatisfaction, eating disorders, and depression are all influenced by sociocultural standards.

Women are also subjected to more stress than their male counterparts (L. Smith, 2010).
Significant wage disparities exist between men and women working in full-time jobs, with women earning
only 77 % of the wages earned by men (AAUW, 2013).
Women with limited income have an increased risk of depression, domestic violence, or having the extra
responsibility of being the primary caregiver for children or older family members (Levy & O’Hara, 2010).
Women are also more likely to experience the stress that comes from working in jobs that provide few
decision-making opportunities (Verboom, et al., 2011).
Exposure to sexual harassment often begins during the middle school years, with effects on both
psychological well-being and learning (AAUW, 2011).
Women are much more likely to experience trauma related to sexual assault or intimate partner violence
(U.S. Department of Commerce, 2011).
 • Socioeconomic Class
Lower socioeconomic class is associated with a limited sense of personal control, poorer physical health,
and higher incidence of depression (Sue, 2010).
Life in poverty is associated with low wages, unemployment or underemployment, lack of savings, and lack
of food reserves.

• Immigration and Acculturative Stress

Many immigrants face acculturative stress, the psychological, physical, and social pressures associated with
a move to a new country.
Placed in unfamiliar settings and missing their accustomed social support from the communities they left
behind, many experience severe culture shock (Breslau et al., 2011). Feelings of isolation, loneliness, helplessness,
anxiety, and depression are common.

• Race and Ethnicity

Inferiority model: contended that racial and ethnic minorities are somehow inferior to the majority
population.
This model suggests that low academic achievement and higher unemployment rate among African
Americans and Hispanics/Latinos are due to biological differences such as low intelligence.
Deficit model :contended that differences are the result of “cultural deprivation”.
It implied that minority groups lacked the “right” culture.

Multicultural model: emphasizes that being culturally different does not mean that someone is deviant, pathological,
or inferior; instead, it is important to recognize that each culture has strengths and limitations.
It also points out that all theories of human development and psychopathology arise from a
particular cultural context (Ivey, D’Andrea, Ivey, & Simek-Morgan, 2007).

Sociocultural Considerations in Treatment

Therapists who use a multicultural approach take care to show respect for clients’ ethnicity and
cultural background and to incorporate cultural themes into traditional psychotherapeutic techniques.
Multicultural counseling has assumed greater importance as our population has become more
diverse.

Criticisms of the Multicultural Model and Related Therapeutic Techniques

1. Critics of the multicultural model argue that a disorder is a disorder, regardless of the cultural context in which it
occurs.
2. It relies heavily on case studies and ethnographic analyses and that formal research has not yet validated many
of the concepts associated with the model.

IMPT:
A truly comprehensive model of human behavior must address the likelihood that biological, psychological,
social, and sociocultural factors are all involved.
It is important to consider mental disorders from a multipath perspective, and to embrace an integration
of the various theories and treatment approaches.

An early formulation of this perspective was the diathesis-stress theory originally proposed by Meehl
(1962) and developed further by Rosenthal (1970).
This theory suggests that it is not a particular abnormality that is inherited but rather a predisposition to
develop illness (the diathesis).
Certain environmental forces, called stressors, may activate the predisposition, resulting in a disorder.