Summary Introduction to CBT
Psychopathology, Second Edition
By: Graham Davey
Chapter 1: An introduction to Psychopathology: Concepts, Paradigms
Crazy/madness/insanity using reasons:
1. When someone’s behavior deviates from expected norms
2. When we are unclear about the reasons for someone’s actions
3. When a behavior seems to be irrational
4. When a behavior or action appears to be maladaptive or harmful to the individual or others
Psychopathology= the study of deviations form normal or everyday modes of functioning by
Clinical psychology= branch of psychology responsible for understanding and treating
Just because someone’s behavior deviates from accepted norms or patterns does not mean they are
suffering from a mental or psychiatric illness. Just because we use the word ‘crazy’ to describe
someone’s behavior does not mean that it is the product of disordered thinking. We cannot attempt
to define psychopathology on the basis that some ‘normal’ functioning has gone wrong, because:
1. We are still some way from understanding the various processes that contribute to
2. Many forms of behavior that require treatment by clinical psychologists are merely extreme
forms of what we would call ‘normal’ or ‘adaptive’ behavior (e.g. we all worry sometimes,
but for some people this interferes with daily life significantly).
1.1. A brief history of psychopathology
The term ‘madness’ does not imply a cause: it simply redescribes the behavior as something that is
Demonic possession= historical perspective on explaining psychopathology.
Medical model= An explanation of psychopathology in terms of underlying biological or medical
1.1.1. Demonic Possessions
Many forms of psychopathology are accompanied by what appear to be changes in the individual’s
personality. Changes in personality or behavior are some of the first symptoms that are noticed.
Historically they were called possessed: personality appears to have been taken over and replaced by
the persona of someone or something else. Rather persecuted and psychically abused rather than
offered the support and treatment they need.
Demonology= ancient civilizations believing that hose exhibiting symptoms of psychopathology were
possessed by bad spirits and the only way to exorcise these bad spirits was with elaborate ritualized
ceremonies that frequently involved direct physical attacks on the sufferer’s body in an attempt to
force out the demons (e.g. through starvation). Such actions usually had the effect of increasing the
distress and suffering of the victim.
The continued adoption of demonic possession as an explanation of mental health is often linked to
local religious beliefs, and may often be accompanied by exorcism as an attempted treatment – even
in individuals with a known history of diagnosed psychotic symptoms.
1.1.2. The Medical or Disease Model
When starting to understand some of the biological causes of psychical disease and illness, our
conception of ‘madness’ moved slowly towards treating it as a disease. Somatogenic hypothesis= the
causes or explanations of psychological problems can be found in physical or biological impairments.
General paresis= a brain disease occurring as a late consequence of syphilis, characterized by
dementia, progressive muscular weakness and paralysis.
Psychiatry= a scientific method of treatment that is based on medicine, the primary approach of
which is to identify the biological causes of psychopathology and treat them with medication or
Biological explanations are not the only way in which psychopathology can be explained. Biological
dysfunction not necessarily a factor underlying all psychopathology. It is often a person’s
experiences that are dysfunctional.
Implications medical model:
It implies that medical or biological causes underly psychopathology: not always the case,
bizarre behavior can be developed by normal learning processes. It’s often the experiences.
Adopts reductionist approach by attempting to reduce the complex psychological and
emotional features of psychopathology to simple biology. Often influenced by the socio-
economic situation in which the individual lives, their potential for employment and
education, and the support they are given that will provide hope for recovery and support for
Implicit assumption that psychopathology is caused by ‘something not working properly’.
Something is broken and needs to be fixed. Problematic because:
- Rather than reflecting a dysfunction, psychopathology might just represent a more
extreme form of normal behavior. Psychopathology can be viewed as being on a
dimension from normal to distressing.
- By implying that psychopathology is caused by a normal process that is broken,
imperfect of dysfunctional, it may have an important influence on how we view
people suffering from mental health problems and, how they might view themselves.
1.1.3. From Asylums to Community Care
Asylums= in previous centuries hospices converted for the confinement of individuals with mental
Moral treatment= approach to the treatment of asylum inmates, developed by the Quaker
movement in the UK, which abandoned contemporary medical approaches in favor of
understanding, hope, moral responsibility, and occupational therapy.
Restraint as intervention often led to social breakdown syndrome: confrontational and challenging
behavior, physical aggressiveness, and a lack of interest in personal welfare and hygiene.
Milieu therapies= the first attempts to structure the hospital environment for patients, which
attempted to create a therapeutic community on the ward in order to develop productivity,
independence, responsibility and feelings of self-respect. Mutual respect between staff and patients,
opportunity for patients to become involved in vocational and recreational activities. Patients more
likely to be discharged from hospital sooner and less likely to relapse.
Token economy= a reward system which involves participants receiving tokens for engaging in
certain behaviors, which at a later time can be exchanged for a variety of reinforcing or desired
items. Social and self-help behaviors. Apparent success.
Mental health treatment and aftercare in the community.
1.2. Defining psychopathology
Abnormal psychology= an alternative definition of psychopathology, albeit with stigmatizing
connotations relating to not being ‘normal’. Implies that those people suffering psychopathology are
in some way ‘not normal’ or are inferior members of society. The ‘abnormal’ label may affect our
willingness to fully include such individuals om everyday activities and may lead us to treating them
with suspicion rather than respect.
Service user groups= groups of individuals who are end users of the mental health services provided
by, for example, government agencies such as the NHS.
1.2.1. Deviation from the Statistical Norm
Statistical norm= the mean, average, or modal example of a behavior. Decide whether an activity or
psychological attribute deviates substantially. In some areas used to decide whether a particular
disorder meets diagnostic criteria. Problems:
Better approach to evaluate the specific needs of individuals with disabilities in a way that
allows us to suggest strategies, services and supports that will optimize individual functioning
Substantial deviation from the norm does not necessarily imply psychopathology (e.g.
individuals with exceptionally high IQ are also statistically rare, but not considered
Where we draw our cut-off points between normality and abnormality will be a subjective
Emotions (e.g. anxiety, depression) that underlie the most common mental health problems
are not statistically rare emotions.
1.2.2. Deviation from Social and Political Norms
We assume that socially normal and acceptable behaviors have evolved to represent adaptive ways
of behaving, and that anyone who deviates from these norms is exhibiting psychopathology. Difficult
to use deviation from social norms or violations of social norms as a way of defining
Different cultures often differ significantly in what they consider to be socially normal and
Difficult to use cultural norms to define psychopathology because cultural factors seem to
significantly affect how psychopathology manifests itself. Examples:
- Social and cultural factors will affect the vulnerability of an individual to causal
factors (e.g. poor mental health is more prevalent in low-income countries).
- Culture can produce ‘culture-bound’ symptoms of psychopathology which seem
confined to specific cultures and can influence how stress, anxiety, and depression
manifest themselves. Ataque de Nervois= a form of panic disorder found in Latinos
from the Caribbean. Seizisman= a state of psychological paralysis found in the
- Society or culture can influence the course of psychopathology.
1.2.3. Maladaptive Behavior and Harmful Dysfunction
Harmful dysfunction= assumption that psychopathology is defined by the dysfunction of a normal
process that has the consequence of being in some way harmful. We still know very little about the
brain mechanisms that generate psychopathology symptoms, so it is difficult to know what normal
process might be dysfunctioning.
1.2.4. Distress and Disability
Defining psychopathology in terms od the degree of distress and impairment expressed by the
sufferer is useful because:
It allows people to judge their own normality rather than subjecting them to judgements
about their normality made by others in society. Judges of their own needs.
Can be independent of the type of lifestyle chosen by the individual. We do not judge
whether someone has a psychopathology purely on the basis of whether they are perceived
as productively contributing to society or not, or whether they actively violate social norms,
but on the basis of how they are able to cope with their lifestyle.
Does not provide any standards by which we should judge behavior itself.
Psychopathology classification schemes do not include disorders in which diagnosis does not
require that the sufferer necessarily reports any personal distress or impairment (e.g.
unwilling to admit that behavior is problematic).
1.3. Explanatory approaches to psychopathology
Why we can explain mental health problems in many different ways within a number of different
Human beings are multifaceted organisms: they consist of a genetically propagated biological
substrate which serves as a basis for behavior and a whole range of psychological processes.
These are interdependent and together make up our conception of the complete thinking
and behaving human being. Can also be studies independently.
In many cases, a specific psychopathology can be explained at all the different levels. These
explanations within different paradigms are not mutually exclusive- they supplement each
other and provide a fuller, richer understanding of that psychopathology.
1.3.1. Biological Models
Genetics= the study of heredity and the variation of inherited characteristics.
Identify those genes that may be responsible for human characteristics, disorders and
diseases. Behavior will have at least some genetic component. The way in which genetics
might influence psychopathology can be studied in a variety of ways:
1. By studying psychopathology symptoms across different family members who may
differ in the extent to which they are genetically related to each other. Concordance
studies= studies designed to investigate the probability with which family members
or relatives will develop a psychological disorder depending on how closely they are
related – or, more specifically, how much genetic material they have in common.
2. Twin studies= studies in which researchers have compared the probability with
which monozygotic (MZ) and dizygotic (DZ) twins both develop symptoms indicative
of a psychopathology in order to assess genetic contributions to that
psychopathology. MZ twins share 100% of their genetic material, DZ twins share
3. Because both families and twins are likely to share similar environments as well as
genes, interpretation of family and twin studies can be difficult. Many of these
difficulties can be overcome by studying the offspring of twins.
Diathesis-stress model= a mental health problem develops because of an interaction between a
genetic predisposition and our interactions with the environment.
Heritability= a measure of the degree to which symptoms can be accounted for by genetic factors. It
ranges from 0 to 1, and the nearer the figure is to 1, the more important are genetic factors in
explaining the symptoms.
Molecular genetics= genetic approach that seeks to identify individual genes that may be involved in
transmitting psychopathology symptoms.
Genetic linkage analysis= a method of identifying individual genes by comparing the inheritance of
characteristics for which gene location is known (e.g. eye color) with the inheritance of
psychopathology symptoms. Very rare that psychopathology symptoms can be traced to an
individual gene and often symptoms are associated with multiple genes. Non-human animals can be
used: manipulate or delete genes.
Epigenetics= the study of changes in organisms caused by modification of gene expression rather
than alteration of the genetic code. The way parents behaved can affect the subsequent behavior of
their offspring by influencing their offspring’s genetic heritage: changing nature of their DNA of
triggering or inhibiting the expression of genes that may represent risk factors for psychopathology.
Early experiences of an individual may trigger or inhibit the expression of genes they may possess
that make them vulnerable to mental health problems.
Seeks an understanding of psychopathology by identifying aspects of the individual’s biology that
may contribute to symptoms. Main focus on brain structure and function.
- Brain structure and function
Brain controls and organizes most of a person’s behavior. Brain is divided into two mirror-
image hemispheres that are connected by a set of nerve fibres called =corpus callosum. The
Chapter 1: An introduction to Psychopathology: Concepts, Paradigms and Stigma
Chapter 2: Classification and Assessment in Clinical Psychology
Chapter 3: Research Methods in Clinical Psychology
Chapter 4: Treating Psychopathology
Chapter 6: Anxiety and Stressor-Related Problems
Chapter 7: Depression and Mood Disorders
Chapter 8: Experiencing Psychosis: Schizophrenia Spectrum Problems
Chapter 9: Substance Use Disorders
Article 1: Reflections on Positive Emotions and Upward Spirals
Article 2: An Introduction to Criticality for Students of Positive Psychology