Psychological Disorders and Psychotherapy | ISC Class 12 Psychology Notes

This note covers the meaning of "abnormal behaviour" and its common features, the biological, psychological and socio-cultural perspectives on abnormality, the need for classification and the DSM system, the characteristics and causes of anxiety, mood and personality disorders, neurodevelopmental and childhood anxiety disorders, the meaning and main types of schizophrenia, and the major forms of psychotherapy: psychoanalysis, client-centred therapy, behavioural therapy, psychosocial rehabilitation and Cognitive Behaviour Therapy including Ellis's A-B-C-D-E model.

What is meant by "abnormal behaviour"?

The word abnormal literally means "away from the normal", implying a deviation from some clearly defined norm or standard.

Psychology has no single "ideal" or "normal" model of human behaviour to use as a base for comparison, so several approaches have been used to mark the boundary between normal and abnormal.

Definition: abnormal behaviour. Most definitions of abnormality share certain common features, often called the "four Ds": deviance (different, extreme, unusual, even bizarre), distress (unpleasant and upsetting to the person and to others), dysfunction (interfering with the person's ability to carry out daily activities in a constructive way), and possibly danger (to the person or to others).

The statistical stand

The statistical approach treats as abnormal any behaviour or trait that is statistically rare, that is, far from the average of the population. If a trait such as anxiety or intelligence is measured across many people, most scores cluster around the average, and scores at either extreme are called abnormal.

Its main limitation is that rarity alone does not mean disorder: an exceptionally high intelligence or a rare musical talent is statistically unusual but not a problem, while a common difficulty such as depression may still need help. So the statistical stand is usually combined with the features of distress and dysfunction.

A related approach views abnormal behaviour as a deviation from social norms: behaviours, thoughts and emotions that break a society's stated or unstated rules for proper conduct are labelled abnormal.

Since norms grow from a society's culture, a society valuing competition may accept aggressive behaviour, whereas one emphasising cooperation and family values, such as in India, may consider the same behaviour unacceptable.

This definition has been criticised because it assumes that conformity itself equals normality.

The biological/medical approach

The biological or organic model holds that abnormal behaviour has a biochemical or physiological basis.

Researchers have linked abnormal activity of neuro-transmitters to specific disorders: low activity of gamma aminobutyric acid (GABA) to anxiety disorders, excess dopamine activity to schizophrenia, and low serotonin activity to depression.

Genetic factors have also been linked to bipolar disorder, schizophrenia and intellectual disability, although no single gene explains any one disorder, and biology alone cannot account for most mental disorders.

How do the psychological and socio-cultural perspectives explain abnormality?

The second broad view treats abnormal behaviour as maladaptive: the test is not whether society accepts the behaviour but whether it fosters the individual's well-being, growth and fulfilment. Conforming behaviour can itself be seen as abnormal if it interferes with optimal functioning.

The psychoanalytic (psychodynamic) perspective

Psychodynamic theorists believe behaviour, normal or abnormal, is determined by unconscious psychological forces. Freud held that three forces shape personality: instinctual needs, drives and impulses (id), rational thinking (ego), and moral standards (superego). Abnormal behaviour is seen as a symbolic expression of unconscious conflicts traceable to early childhood.

The behavioural perspective

This model states that both normal and abnormal behaviours are learned, through classical conditioning, operant conditioning and social learning (imitation), and that what has been learned can be unlearned.

The cognitive perspective

Abnormal functioning can result from holding irrational and inaccurate assumptions about oneself, thinking in illogical ways, and making overgeneralisations, that is, drawing broad negative conclusions from a single insignificant event.

The socio-cultural dimension

According to the socio-cultural model, abnormal behaviour is best understood in the light of family structure and communication, social networks, societal conditions, and the labels and roles society assigns to troubled people.

People who are socially isolated and lack strong interpersonal relationships are more likely to become, and remain, depressed.

The widely accepted diathesis-stress model combines these views: a diathesis (an inherited biological predisposition) is set off by a stressful situation, producing the disorder.

Why is classification necessary, and what does the DSM system cover?

A classification lists categories of disorders grouped by shared characteristics. Classifications let psychologists, psychiatrists and social workers communicate about a disorder and understand its causes and course.

The American Psychiatric Association (APA) publishes the Diagnostic and Statistical Manual of Mental Disorders, which presents discrete clinical criteria indicating the presence or absence of disorders.

India and many other countries officially use the World Health Organisation's International Classification of Diseases (ICD-10, since revised as ICD-11), which describes the main clinical features and diagnostic guidelines for each disorder.

Definition: DSM multiaxial system. Earlier editions of the manual organised each diagnosis along five axes: Axis I, clinical syndromes such as anxiety or mood disorders; Axis II, personality disorders and intellectual disability; Axis III, general medical conditions affecting the person;

Axis IV, psychosocial and environmental stressors; and Axis V, an overall rating of the person's level of functioning. The five-axis format gives a fuller picture of a person's problems than a single label would.

What are the characteristics of anxiety disorders?

Anxiety is a diffuse, vague, very unpleasant feeling of fear and apprehension, usually accompanied by rapid heart rate, shortness of breath, sweating, dizziness, sleeplessness and tremors.

A certain amount of anxiety before an examination or performance is normal and even motivating; high, distressing levels that interfere with functioning indicate a disorder.

Generalised Anxiety Disorder (GAD)

GAD consists of prolonged, vague, unexplained and intense fears not attached to any particular object, with worry about the future, hypervigilance (constantly scanning the environment for dangers), and motor tension, so the person is restless, shaky and unable to relax.

Phobias

People with phobias have irrational fears related to specific objects, people or situations, often developing gradually, sometimes out of a generalised anxiety disorder.

Phobias fall into three main types: specific phobias (the most common, such as intense fear of an animal or enclosed space), social phobia (intense, incapacitating fear and embarrassment when dealing with others), and agoraphobia (fear of entering unfamiliar situations, often so severe that the person is afraid to leave home).

Obsessive-Compulsive Disorder

A person with OCD cannot control a preoccupation with specific ideas (an obsession, usually experienced as unpleasant and shameful) or cannot stop repeatedly carrying out a particular act or series of acts (a compulsion), commonly involving counting, ordering, checking, touching or washing, to the point that normal activities are affected.

What are the characteristics of mood disorders?

Major depressive disorder is a period of depressed mood and/or loss of interest or pleasure in most activities, together with symptoms that may include a change in body weight, sleep problems, tiredness, inability to think clearly, agitation, greatly slowed behaviour, excessive guilt or feelings of worthlessness, and thoughts of death or suicide.

Genetic make-up, age, and gender are risk factors: women are particularly at risk during young adulthood, while for men the risk is highest in early middle age; experiencing negative life events and lacking social support also raise the risk.

Bipolar I disorder involves both mania and depression, alternating, sometimes with periods of normal mood in between. Manic episodes rarely occur by themselves; they usually alternate with depression. Bipolar mood disorders were earlier called manic-depressive disorders; related conditions include Bipolar II disorder and cyclothymic disorder.

What are the characteristics of personality disorders?

A personality disorder is a long-standing, rigid and inflexible pattern of thinking, feeling and relating to others that causes significant distress or impairment, and usually begins in adolescence or early adulthood.

Definition: antisocial, avoidant and dependent personality disorders. In antisocial personality disorder, the person persistently disregards and violates the rights of others, is deceitful, impulsive and shows little remorse for wrongdoing; it is associated with a troubled or inconsistent upbringing and a long history of conduct problems in childhood.

In avoidant personality disorder, the person is extremely sensitive to rejection and criticism, avoids occupations or social contact involving interpersonal interaction, and feels socially inadequate; it is linked to a history of parental and peer rejection.

In dependent personality disorder, the person has an excessive need to be taken care of, leading to clinging behaviour, difficulty making everyday decisions without reassurance, and fear of being left to care for themselves; it is associated with overprotective or authoritarian parenting in childhood.

What are neurodevelopmental and childhood anxiety disorders?

A common feature of neurodevelopmental disorders is that they appear early in development, often before the child enters school, hampering personal, social, academic or occupational functioning.

Attention-Deficit/Hyperactivity Disorder (ADHD)

The two main features of ADHD are inattention and hyperactivity-impulsivity. An inattentive child finds it hard to sustain mental effort, does not listen, cannot concentrate, is disorganised, easily distracted, forgetful and does not finish assignments.

An impulsive child cannot control immediate reactions, finds it difficult to wait or take turns, and has difficulty resisting temptation. A hyperactive child is in constant motion, fidgets, squirms, climbs, runs around aimlessly, and talks incessantly.

Autism Spectrum Disorder

Autism is characterised by widespread impairment in social interaction and communication, and by stereotyped patterns of behaviour, interests and activities.

Affected children have marked difficulty initiating social behaviour and seem unresponsive to others' feelings; many never develop speech, and those who do show repetitive and deviant speech patterns.

They often show narrow interests and repetitive movements such as hand flapping or rocking. Many children with autism spectrum disorder also have intellectual disabilities.

Separation Anxiety Disorder

Children with Separation Anxiety Disorder (SAD) are fearful and anxious about separation from attachment figures to a degree that is not developmentally appropriate: they may have difficulty being alone in a room, going to school alone, and fear entering new situations, clinging to and shadowing a parent's every move.

To avoid separation they may fuss, scream, throw tantrums or make suicidal gestures.

What is schizophrenia, and what are its main types?

Schizophrenia is the descriptive term for a group of psychotic disorders in which personal, social and occupational functioning deteriorate because of disturbed thought processes, strange perceptions, unusual emotional states and motor abnormalities. The social and psychological costs are tremendous for patients, families and society.

Positive and negative symptoms

Positive symptoms are pathological excesses or "bizarre additions" to behaviour: delusions (false beliefs firmly held on inadequate grounds, not affected by rational argument), disorganised thinking and speech, hallucinations (perceptions occurring without external stimuli, most commonly auditory), and inappropriate affect.

Negative symptoms are pathological deficits: poverty of speech (alogia), blunted or flat affect, loss of volition (avolition), and social withdrawal.

Psychomotor symptoms include reduced spontaneous movement and odd grimaces, which in extreme form become catatonia, such as motionless, silent catatonic stupor, rigid catatonic posture held for hours, or bizarre catatonic posturing.

Definition: main types of schizophrenia. Paranoid schizophrenia is dominated by prominent delusions, commonly of persecution or grandeur, often with auditory hallucinations, while speech and emotional expression are relatively less disturbed.

Disorganised schizophrenia is marked chiefly by disorganised speech and behaviour together with flat or inappropriate affect. Catatonic schizophrenia is marked chiefly by the motor disturbances described above: stupor, rigidity or bizarre posturing.

What is psychotherapy, and how does psychoanalysis work?

Psychotherapy is a voluntary relationship between the client seeking treatment and the therapist, aimed at helping the client solve psychological problems, building trust so problems can be freely discussed.

It aims to change maladaptive behaviours, decrease personal distress and help the client adapt better to the environment.

The special bond formed is called the therapeutic relationship: it is contractual (two willing people entering a partnership) and of limited duration (lasting until the client can take control of her/his own life).

It rests on the therapist's unconditional positive regard (continuing to show positive feeling towards the client regardless of what is confided) and empathy, which is understanding and feeling the client's situation from the client's own perspective, unlike mere sympathy or cold intellectual understanding. The therapist must also keep strict confidentiality.

Psychoanalysis

Psychodynamic therapy holds that intrapsychic conflicts, arising from unfulfilled childhood desires and unresolved childhood fears, are the source of psychological problems.

Its chief methods are free association, in which the client reports whatever thoughts come to mind without censoring them, and the reporting and interpretation of dream analysis, through which the therapist helps the client confront and resolve the underlying conflicts.

The therapist is assumed to understand the client's intrapsychic conflicts better than the client does and so interprets them for her/him.

During treatment, a client may show resistance, an unwillingness to bring painful or threatening material into awareness, and transference, in which the client unconsciously redirects feelings about important figures from childhood onto the therapist; the therapist's own reaction to the client is called countertransference.

The chief benefit sought is emotional insight, that is, understanding the conflict intellectually, accepting it emotionally, and changing one's feelings towards it. Classical psychoanalysis may continue for several years, though several recent versions are completed in 10 to 15 sessions.

How does client-centred therapy work?

Client-centred (person-centred) therapy, developed within the existential or humanistic tradition, is non-directive counselling: the client arrives at her/his own solutions through a process of personal growth, while the therapist merely provides a warm, empathic and accepting relationship in which the client feels secure enough to explore the nature and causes of her/his own problems.

• Unconditional positive regard: the therapist continues to show acceptance and warmth regardless of what the client says or has done.
• Genuineness: the therapist is accepting, empathic, and sincerely warm rather than playing a professional role.
• Empathetic understanding: the therapist feels and understands the client's situation from the client's own point of view, rather than merely sympathising or analysing it intellectually.
• Working towards a fully functioning individual: therapy aims to help the client move towards greater self-awareness, self-acceptance and the ability to grow, rather than remaining bound by rigid, externally imposed conditions of worth, that is, the conditions a person believes must be met before she/he deserves approval.
• Active listening and paraphrasing: the therapist listens closely and reflects the client's feelings back in her/his own words, helping the client to feel heard and to clarify her/his own thoughts.

The humanistic therapies value personal growth, the process of gaining increasing understanding of oneself and one's aspirations, emotions and motives, as the chief benefit, and are typically completed over a shorter period than classical psychoanalysis.

How do behavioural therapies treat disorders?

Behaviour therapy applies learning-theory principles to correct faulty behaviour and thought patterns in the present; the past is relevant only to understand how the faulty pattern arose.

The therapist first conducts a behavioural analysis, identifying the malfunctioning behaviour, the antecedent factors that predispose the person to it, and the maintaining factors that keep it going, before selecting a treatment package.

Techniques based on operant conditioning

In shaping, successive small steps that approximate the desired behaviour are rewarded in sequence until the full behaviour is established.

In a token economy, a token is given as a reward each time a wanted behaviour occurs; tokens are collected and later exchanged for a reward such as an outing or a treat.

Techniques based on classical conditioning

In systematic desensitisation, introduced by Wolpe for treating phobias, the client and therapist build a hierarchy of anxiety-provoking stimuli from least to most frightening; the client is relaxed and asked to imagine the least frightening scene first, stopping if the slightest tension appears, and over sessions progresses to more severe scenes while staying relaxed, on the principle of reciprocal inhibition (one of two opposing forces present at the same time inhibits the weaker one).

In flooding, by contrast, the client is exposed directly and continuously to the feared stimulus at full intensity, without the gradual hierarchy used in desensitisation, until the anxiety response subsides.

Modelling

In modelling, the client learns to behave in a certain way by observing the behaviour of a role model, such as the therapist, who initially acts as the model; this is a form of vicarious learning, and small changes in the client's behaviour are rewarded as the client gradually acquires the model's behaviour.

1. Interview the client and family to conduct a behavioural analysis, identifying the malfunctioning behaviour, its antecedents and the factors maintaining it.
2. Choose a treatment package suited to the specific symptoms, since behaviour therapy is not a single unified technique applied to every disorder.
3. Apply antecedent operations, changing something that precedes the behaviour to alter its likelihood, and consequent operations, such as reinforcement, that follow and shape the behaviour.
4. Use relaxation procedures, such as progressive muscular relaxation, where anxiety is driving the faulty behaviour, so that arousal is first lowered before new behaviour is built.
5. Review progress across sessions and adjust the hierarchy of stimuli or the reinforcement schedule as the client's response changes.

What is psychosocial rehabilitation of the mentally ill?

Psychosocial rehabilitation aims to help a person recovering from a severe mental disorder return to as full and independent a life as possible in the community, rather than remaining in long-term institutional care.

Definition: elements of psychosocial rehabilitation. Deinstitutionalisation is the move away from long-term confinement in mental hospitals towards providing care for recovered mentally ill individuals within the community, an approach that gained ground from the second half of the twentieth century.

Alongside it, programmes of social inclusion help the person re-enter ordinary social life rather than remain isolated; occupational therapy builds practical daily-living and work skills through structured activity;

social skills training teaches the interpersonal skills needed to form and keep relationships; vocational rehabilitation/training prepares the person for paid employment suited to her/his abilities; and cognitive retraining works on attention, memory and problem-solving skills that may have been affected by the disorder.

What is Cognitive Behaviour Therapy, and how does Ellis's A-B-C-D-E model work?

Cognitive therapies locate the cause of psychological distress in irrational thoughts and beliefs rather than in the events themselves. Albert Ellis formulated Rational Emotive Therapy (RET), whose central thesis is that irrational beliefs mediate between an antecedent event and its emotional consequence.

1. A, Activating Event: the event that triggers distress is identified through interview.
2. B, Irrational Belief: the client's irrational belief distorting the event is uncovered, often containing "musts" and "shoulds", such as "one should be loved by everybody all the time".
3. C, Emotional Consequence: the distorted belief, not the event itself, is shown to produce the negative emotions and behaviours the client experiences.
4. D, Disputing the Irrational Belief: the therapist refutes the irrational belief through gentle, non-directive questioning that makes the client think more deeply about her/his own assumptions about life.
5. E, Expected New Behaviour: as the rational belief system gradually replaces the irrational one, the client's philosophy about life changes and psychological distress reduces.

The ABC analysis is the first step of RET: antecedent events are noted, and the client is interviewed to find the irrational beliefs distorting present reality; these beliefs, often assessed through questionnaires and interviews, are then addressed through disputing and replacement as above.

How do psychoanalysis, client-centred, behavioural and cognitive behaviour therapies differ?

Although every psychotherapy aims to remove human distress and foster effective behaviour, the major schools differ sharply in how they see the cause of the problem, their chief method, the nature of the therapeutic relationship, and the chief benefit offered to the client.

Psychodynamic therapy and behaviour therapy both assume that the therapist is the one who works out the solution to the client's problem: in psychoanalysis the therapist interprets the client's unconscious conflicts, and in behaviour therapy the therapist identifies the faulty behaviour and thought patterns and decides what adaptive pattern should replace them. Client-centred (existential/humanistic) therapy takes the opposite view: the therapist merely provides a warm, empathic and non-judgmental environment, and the client is left to work out her/his own solutions through personal growth, rather than being told what to think or do.

The schools also differ in duration. Classical psychoanalysis may continue for several years, though recent versions are completed in 10 to 15 sessions, while behaviour, cognitive behaviour and client-centred therapies are typically completed over a few months. Despite these differences, all psychotherapies share the same underlying method: they work through the therapist, the therapeutic relationship and the process of therapy to reduce the client's psychological distress by psychological means rather than physical or medical ones.

Going beyond the syllabus

Clinical formulation, that is, stating a client's problem in the terms of the therapeutic model being used, guides which techniques a therapist chooses and is usually possible after the first one or two sessions; formulations are revised as fresh insights emerge during therapy.

Suicide prevention measures recommended by the World Health Organisation include limiting access to the means of suicide, responsible media reporting, alcohol-related policies, early identification and treatment of people at risk, and training health workers in suicide assessment and management, since previous suicide attempts remain the strongest single risk factor.

Any unexpected or striking change in a young person's performance, attendance or behaviour, such as a lack of interest in common activities, declining grades, decreasing effort, misbehaviour in the classroom, mysterious or repeated absence, or smoking, drinking or drug misuse, should be taken seriously as a possible sign of distress.

Fostering positive self-esteem in such situations can help: accentuating positive life experiences to build a positive identity, providing opportunities to develop physical, social and vocational skills, establishing trustful communication, and setting goals that are specific, measurable, achievable, relevant and time-bound.

Glossary

• Abnormal behaviour — behaviour marked by deviance, distress, dysfunction and possibly danger to the person or others.
• Diathesis-stress model — the view that a disorder develops when an inherited biological predisposition is triggered by a stressful situation.
• Generalised Anxiety Disorder — prolonged, vague, unexplained intense fear not attached to any object, with hypervigilance and motor tension.
• Phobia — an irrational fear of a specific object, person or situation.
• Obsessive-compulsive disorder — an uncontrollable preoccupation with an idea (obsession) or a repeated act (compulsion) that disrupts normal activity.
• Bipolar disorder — a mood disorder involving mania and depression occurring alternately, sometimes with periods of normal mood.
• Schizophrenia — a group of psychotic disorders where functioning deteriorates owing to disturbed thought, perception, emotion and motor behaviour.
• Delusion — a false belief firmly held on inadequate grounds, unaffected by rational argument.
• Hallucination — a perception that occurs without any external stimulus.
• Catatonia — extreme psychomotor symptoms such as stupor, rigid posture, or bizarre posturing held for long periods.
• Free association — reporting whatever thoughts come to mind without censoring them, used in psychoanalysis.
• Transference — the client's unconscious redirection of feelings about important childhood figures onto the therapist.
• Unconditional positive regard — the therapist's continued acceptance and warmth towards the client regardless of what is disclosed.
• Systematic desensitisation — gradual exposure, paired with relaxation, to a hierarchy of feared stimuli to overcome a phobia.
• Token economy — a system of rewarding wanted behaviour with tokens that are later exchanged for a reward.
• Deinstitutionalisation — shifting care of the mentally ill from long-term hospital confinement to the community.

Common errors and misconceptions

• Misconception: all unusual behaviour is a psychological disorder. Correct: a behaviour must also be distressing, dysfunctional or dangerous, not merely deviant, to count as a disorder.
• Misconception: obsessions and compulsions are the same thing. Correct: an obsession is an uncontrollable thought, while a compulsion is the uncontrollable repeated act performed in response to it.
• Misconception: bipolar disorder means only depressive episodes. Correct: it involves both manic and depressive episodes, alternating, sometimes with normal mood periods in between.
• Misconception: a delusion and a hallucination are the same. Correct: a delusion is a false belief; a hallucination is a false perception occurring without an external stimulus.
• Misconception: sympathy and empathy mean the same thing in therapy. Correct: sympathy is pity for another's suffering, while empathy is understanding and feeling the situation from the other person's own perspective.
• Misconception: systematic desensitisation and flooding use the same method. Correct: desensitisation uses a gradual hierarchy with relaxation, while flooding exposes the client directly to the full-intensity feared stimulus.
• Misconception: behaviour therapy ignores the client's past entirely. Correct: the past is examined only to understand how the faulty pattern arose; treatment corrects the pattern in the present.

Exam-style questions with model answers

Q1. State the "four Ds" used to describe abnormal behaviour. [2 marks]

1. Deviance, that is, behaviour that is different, extreme or unusual.
2. Distress, dysfunction (interfering with daily activities) and danger to self or others.

Q2. Distinguish between an obsession and a compulsion. [2 marks]

1. An obsession is the inability to stop thinking about an unpleasant, shameful idea or topic.
2. A compulsion is the need to repeatedly perform a particular act, such as checking or washing.

Q3. Rohan has had a persistent, unexplained fear for the last six months that something bad will happen, feels constantly restless and tense, and cannot pinpoint any single cause for his worry. Identify his disorder and explain two of its characteristic features. [4 marks]

1. Rohan's symptoms match Generalised Anxiety Disorder (GAD).
2. GAD consists of prolonged, vague, unexplained and intense fear that is not attached to any particular object.
3. It shows hypervigilance, that is, constantly scanning the environment for danger.
4. It is marked by motor tension, so the person is unable to relax, is restless and visibly tense.

Q4. Explain the difference between positive and negative symptoms of schizophrenia, giving one example of each. [4 marks]

1. Positive symptoms are pathological excesses, that is, "bizarre additions" to behaviour.
2. An example of a positive symptom is a delusion, a false belief firmly held despite contrary evidence.
3. Negative symptoms are pathological deficits, meaning something normally present is missing.
4. An example of a negative symptom is flat affect, where the person shows almost no emotional expression.

Q5. A therapist helping a client overcome a fear of lifts builds a list of situations from "looking at a lift" to "riding ten floors", teaches the client to relax, and works through the list gradually while the client stays relaxed. Name this technique and explain how it works, step by step. [5 marks]

1. This is systematic desensitisation, a technique introduced by Wolpe for treating phobias such as the fear of lifts.
2. The therapist interviews the client to elicit fear-provoking situations, and together with the client builds a hierarchy of anxiety-provoking stimuli, arranged from the least to the most frightening.
3. The client is first taught to relax, commonly through progressive muscular relaxation, in which individual muscle groups are tensed and then released until the whole body is relaxed.
4. The client then imagines the least frightening scene on the hierarchy while remaining relaxed, and is asked to stop imagining it the moment the slightest tension appears.
5. Over successive sessions the client progresses to imagining more frightening scenes while staying relaxed throughout, so that relaxation gradually inhibits the anxiety response, a principle called reciprocal inhibition, in which the presence of two opposing forces at the same time inhibits the weaker one.

Q6. Explain Albert Ellis's A-B-C-D-E model of Rational Emotive Therapy, describing each stage. [6 marks]

1. A, the Activating Event, is the trigger that causes the client's distress.
2. B is the Irrational Belief, an unrealistic "must" or "should" belief that distorts how the client sees the event.
3. C is the Emotional Consequence, the negative emotions and behaviours that result from the irrational belief, not from the event itself.
4. D is Disputing the Irrational Belief, where the therapist questions the client gently and non-directively to challenge the irrational belief.
5. E is the Expected New Behaviour, where a rational belief system replaces the irrational one and distress is reduced.
6. The therapist's questioning is deliberately non-directive, encouraging the client to examine her/his own assumptions rather than being told what to think.

Q7. Compare client-centred therapy with psychoanalysis on the nature of the therapeutic relationship. [4 marks]

1. In psychoanalysis, the therapist is assumed to understand the client's intrapsychic conflicts better than the client does.
2. The psychoanalytic therapist actively interprets the client's thoughts and feelings for her/him.
3. In client-centred therapy, the therapist merely provides a warm, empathic, non-judgmental relationship.
4. The client-centred therapist acts as a facilitator while the client arrives at her/his own solutions through personal growth.

Q8. Describe the main features of Attention-Deficit/Hyperactivity Disorder (ADHD) in children. [5 marks]

1. The two main features of ADHD are inattention and hyperactivity-impulsivity, which together disrupt a child's ability to function at school and at home.
2. Inattentive children find it difficult to sustain mental effort during work or play, do not listen, cannot concentrate, do not follow instructions, and are disorganised, easily distracted and forgetful.
3. Such children are quick to lose interest in boring activities and commonly fail to finish assignments, even when they understand what is expected of them.
4. Impulsive children cannot control their immediate reactions or think before they act, find it difficult to wait or take turns, and have difficulty resisting immediate temptations or delaying gratification.
5. Hyperactive children are in constant motion: sitting still through a lesson is impossible for them, and they may fidget, squirm, climb and run around the room aimlessly, talking incessantly, as if "driven by a motor".

Q9. What is meant by deinstitutionalisation in psychosocial rehabilitation? [2 marks]

1. It is the shift away from long-term confinement of the mentally ill in hospitals.
2. It emphasises providing care for recovered mentally ill individuals within the community instead.

Key takeaways

• Abnormal behaviour is usually marked by deviance, distress, dysfunction and sometimes danger, not just unusualness alone.
• The biological, psychodynamic, behavioural, cognitive and socio-cultural models each locate the cause of abnormality differently.
• Classification systems such as the DSM and the ICD help clinicians communicate about and understand disorders.
• Anxiety disorders include generalised anxiety disorder, phobias and obsessive-compulsive disorder, each with distinct symptoms.
• Bipolar disorder involves alternating manic and depressive episodes, while major depression involves persistent low mood and loss of interest.
• Schizophrenia shows positive symptoms (delusions, hallucinations) and negative symptoms (flat affect, avolition), with paranoid, disorganised and catatonic subtypes.
• Psychoanalysis uses free association and dream analysis to resolve unconscious conflicts and gain emotional insight.
• Client-centred therapy is non-directive and relies on unconditional positive regard, empathy and genuineness.
• Behaviour therapy uses systematic desensitisation, flooding, shaping, token economy and modelling to replace faulty learned behaviour.
• Ellis's ABCDE model shows how disputing irrational beliefs changes the emotional consequences of an activating event.

Test yourself

What are the "four Ds" of abnormal behaviour?

Deviance, distress, dysfunction and danger, meaning behaviour that is unusual, upsetting, interferes with daily functioning, and possibly risky to self or others.

Which neurotransmitter has been linked to low activity in anxiety disorders?

Gamma aminobutyric acid (GABA); low GABA activity has been linked to anxiety disorders, while excess dopamine is linked to schizophrenia and low serotonin to depression.

Name the three main types of phobia.

Specific phobias, social phobia (social anxiety disorder), and agoraphobia, the fear of entering unfamiliar situations.

What is the difference between a delusion and a hallucination?

A delusion is a false belief firmly held despite contrary evidence; a hallucination is a false perception occurring without any external stimulus.

What is "reciprocal inhibition" in systematic desensitisation?

The principle that when two mutually opposing forces are present together, the weaker is inhibited, so a relaxed state inhibits anxiety as feared scenes are imagined.

What does the therapist do in a token economy?

Gives a token as a reward each time a wanted behaviour occurs; the client collects tokens and exchanges them later for a reward.

What is "conditions of worth" in client-centred therapy?

The conditions a person believes must be met before she/he deserves approval; therapy helps the client move beyond these towards a fully functioning self.

What is the "E" stage in Ellis's ABCDE model?

The Expected New Behaviour: once the irrational belief is disputed and replaced with a rational one, the client's distress reduces and behaviour changes.