to understand one’s thinking, it is possible to change the way one thinks as well as one’s emotional state and behaviors. One basic feature of our thinking is that it is automatic. Ideas just pop into our mind such as “I can’t solve this” or “It is all my fault.” A number of therapies based on cognitive principles along with behavioral interventions have been shown to be effective (Hollon & Beck, 2013).
Aaron Beck (1967; see also J. Beck, 2011, for an overview and update) developed a cognitive therapy for depression in the early 1960s. The model is described in terms of a cognitive triad related to depression (see Figure 1.13).
Aaron Beck
Courtesy of the Beck Institute for Cognitive Behavior Therapy: www.beckinstitute.org
The first component of the triad is the individual’s negative view of self. This is when the individual attributes unpleasant experiences to his own mental, physical, and moral defects. When something negative happens, the person says it is his fault. In therapy, the client can become aware of the content of his thinking. The second component is the individual’s tendency to interpret experiences in a negative manner. That is, the person tailors the facts to fit negative conclusions. The basic idea is that thinking influences emotion and behavior. The third component is that the person regards the future in a negative way. He envisions a life of only hardships and anticipates failure in all tasks. In therapy, the basic idea is that the individual can modify his cognitive and behavioral responses. Overall, the therapy is directed at the automatic thoughts in relation to catastrophizing—believing that nothing will work out; personalization—believing that everything relates to you; overgeneralization—believing that one event is how it always is; and dichotomous thinking—believing that things are either good or bad.
Figure 1.13 How Do Individuals With Depression See the World?
The cognitive behavioral therapy (CBT) movement sought to understand how cognitions were disordered or disrupted in mental disorders. Whereas humanistic therapies emphasized emotional processing, cognitive behavioral approaches emphasized thoughts and the manner in which a person thought about her life and experiences. The basic idea is that psychological disturbances often involve errors in thinking. One real value of many cognitive behavioral approaches is that they have been tested empirically and are presented in books and manuals that describe the steps involved in therapy.
How does a person with mental illness see the world, the future, and herself?
©iStockphoto.com/valentinrussanov
As with other perspectives, cognitive behavioral approaches have been expanded to include a number of other techniques. Some of these approaches are mindfulness approaches and dialectical behavior therapy, as discussed previously, as well as acceptance and commitment therapy (ACT) and acceptance-based behavioral therapy (ABBT). ACT and ABBT combine mindfulness with an emphasis on accepting inner experiences without judgement, along with awareness and resilience.
These approaches have been referred to as the new way or third wave of CBT (Hofmann, Sawyer, & Fang, 2010). One common theme in these approaches is the role of acceptance. In each approach, clients are encouraged to not react to negative thoughts and feelings. Throughout this book, I will introduce you to the way in which these and other therapies have been used to treat specific disorders.
cognitive behavioral therapy (CBT): a therapy based on the cognitive behavioral perspective, directed at changing the individual’s faulty logic and maladaptive behaviors
Concept Check
What does empirically based treatments mean? Why is it important, and what impacts has the concept had on treatment for psychopathology?
Describe the basic principles underlying each of these perspectives on psychological treatment, identify the scientists associated with them, and give an example of an empirically based treatment from each: psychodynamic perspective, existential-humanistic perspective, behavioral perspective, and cognitive behavioral perspective.
Summary
Three major themes—behavior and experience, neuroscience, and the evolutionary perspective—give us important perspectives for thinking about psychopathology. In addition, an integrative perspective ranging across a number of different levels of analysis provides a greater understanding of psychopathological processes. These levels range from the highest levels of environment, culture, and society to social relationships to individual behavior and experience to our sensory, motor, emotional, and cognitive systems to the physiological processes that make up our central and peripheral nervous systems to the cortical network level to the most basic level of genetics and epigenetics. The genetic level in turn takes us back up to the highest level to understand how environmental conditions influence genetic processes.
Five ideas are critical to the concept of psychopathology. First, the processes involved are maladaptive and not in the individual’s best interest. Second, these processes cause personal distress. Third, the processes are considered to be deviant from cultural and statistical norms. Fourth, the individual has difficulty connecting with his or her environment and also with himself or herself. Finally, the individual is not able to consider alternative ways of thinking, feeling, or doing.
Considering psychopathology from evolutionary and cultural perspectives goes beyond the traditional psychological and physiological considerations. Culture can be seen as a system of inheritance—humans learn a variety of things from others in their culture including skills, values, beliefs, and attitudes. For a more complete understanding of psychopathology, it is important to understand the particular rules a culture has for expressing both internal experiences and external behaviors. Overall, research suggests a close connection between cultural and evolutionary perspectives. Not only can the environment influence genetics; genetics can also in turn influence culture. The evolutionary and cultural perspectives help us ask questions such as these: (1) Can genetic variation influence the manner in which cultural structures formalize social interactions and how this might be related to what is considered mental illness? (2) How long, in terms of our human history, has a particular psychopathology existed? (3) What function might a disorder serve, and how did it come about? (4) How can a basic human process (e.g., the pain of social rejection) develop in relation to an earlier one (e.g., the brain circuits involved in physical pain)?
One of the main themes of the study of evolution is the manner in which organisms are in close connection with their environment. It is this close connection that allows for change—including the turning on and off of genetic processes—to take place. Humans are born less fully developed at birth than many other species and thus are sensitive to changes in their environment as they continue to develop. Unlike animals that live within nature, humans largely live within the backdrop of our culture. Another part of the complexity with humans is our ability to reflect on ourselves and our world. In this way, a layer of thought, including expectation and imagination, is injected between the person and the environment.
Mental disorders have been with us throughout our human history. Since the time that written language became a part of our experience, humans have included descriptions of mental disorders. Examples of historical conceptions of psychopathology include those of Pythagoras and Hippocrates in ancient Greece; Galen from the period of the Roman Empire; advances in anatomy by da Vinci in art and Harvey and Descartes in science from the Renaissance; advances in understanding the brain and nervous system in the 1700 to 1900 period; and Darwin’s description of the theory of evolution and Charcot’s classification of psychological and brain disorders in the 1800s. Historically, the care and treatment of individuals with mental illness also advanced, as did our understanding of the experience