What is the historical overview of psychopathology? - Chapter 1

Psychopathology is the study of the nature, development, and treatment of psychological disorders.

There is a lot of stigma surrounding with psychological disorders. Stigma is the destructive beliefs and attitudes that are attributed to groups that are seen as different. It has four elements:

1. A group of people is labeled, and this label distinguishes them from others.

2. Society links the label to abnormal and undesirable characteristics.

3. The label makes people with the label seem different from those without the label.

4. The label makes the people with the label being unfairly discriminated against.

In this century psychological disorders are still the most stigmatized conditions.

How is psychological disorder defined?

The best definition of psychological disorder has these aspects:

• The individual has the disorder within himself.

• There are difficulties in thinking, feeling and/or behaving that are of clinical significance.

• It often involves a kind of personal distress.

• There is impairment in processes that support mental functioning, such as: psychological, developmental, and/or neurobiological.

• The problems are not a culturally specific reaction to an event.

• The problems are not only a result of conflict with society.

Each aspect covers a part of psychological disorders. Four aspects will be further discussed.

If a person’s behavior causes him enormous distress, the behavior may be classified as disordered. A lot of psychological disorders causes distress, but not all of them.

Disability is an impairment in some important aspect of life. Psychological disorder can also be characterized by disability. Just like distress, a lot of psychological disorders can involve disability, but not all of them. There is no rule to determine which disability belongs to the study of psychopathology and which do not.

If a behavior violates social norms, it can be classified as disordered. This definition of psychological disorders is both too broad and too narrow. It is important to note here that social norms are different among cultures and ethnicity.

The DSM considers developmental, psychological and biological dysfunctions as interrelated.

What is the history of psychopathology?

Demonology is the doctrine that a person can have an evil being dwell within himself, and this being can control his mind and body. This doctrine was mostly seen in times before the age of scientific inquiry. In these times events beyond human control were seen as supernatural.

The first to separate medicine from religion and superstition was Hippocrates. He believed that mental illnesses had natural causes and should be treated as such. He also believed that mental illnesses were caused by a disbalance between four fluids of the body: blood, black bile, yellow bile and phlegm.

When the church gained in influence after the Greek and Roman civilization ceased to exist, the believe in supernatural causes of psychological disorders returned. A lot of psychological disorders was ascribed to witchcraft. Witchcraft was seen as a denial of God.

In Europe there were a lot of hospitals for patients with leprosy until the fifteenth century. The old leprosy hospitals were turned into asylums, when the attention shifted from leprosy to psychological disorders due to disappearance of leprosy in Europe. Asylums were buildings used to give housing and care to people with psychological disorders.

Around 1817, the hospitals provided humane treatment, known as moral treatment. The people in the hospitals had close contact with their supervisors and talked a lot with them. They lived their life as close to normal as possible and took care of themselves most of the time. You can compare the moral treatment to mental hospitals nowadays. 

What is the evolution of contemporary thought?

At first the biological approaches. Biological approaches gained credibility when a link was made between infection, damage to the brain and a form of psychopathology. This happened for the first time in 1905, when the microorganisms causing syphilis were discovered. Francis Galton was one of the first to ascribe many behavioral characteristics to heredity as a result of his studies with twins in the late 19th century. He talked about differences in nature (genetics) and nurture (environment). Some researchers became interested in the idea of heritability in psychological disorders and started studying it.

Cerletti and Bini introduced electroconvulsive therapy (ECT), which uses electric shocks in the head to induce seizures. Nowadays, it is used as treatment for schizophrenia and severe depression. 

Secondly, the psychological approaches. Breuer was a Viennese physician who thought of the cathartic method. Catharsis is reliving an earlier emotional trauma and by expressing previously forgotten thought about the event, emotional tension was released.

Freud was a younger colleague of Breur. Freud theorized that psychopathology is caused by unconscious conflicts in the individual. This is often referred to as psychoanalytic theory. He divided the psyche into three main parts: id, ego and superego. The id wants immediate gratification of its basic urges. Also known as the pleasure principle. Tension is produced when the urges of the id are not satisfied.

After six months of life, the ego starts to develop. The contents of the ego are mainly conscious. It needs to deal with reality and thus is driven by the reality principle. The ego mediates between the demands of the id and the demands of reality.

The superego can be seen as a person’s conscience. The superego develops throughout childhood. It incorporates the values of the parents to receive the pleasure of the parents’ approval and avoid the pain of disapproval. Freud and his daughter Anna see defense mechanisms as a strategy of the ego to protect itself from anxiety. There are several forms of defense mechanisms.

Psychoanalysis is the psychotherapy based on Freud’s theory. The therapist’s goal is to understand the early-childhood experiences of the patient, the nature of important relationships, and the patterns in current relationships. The therapist pays attention to emotional and relational themes that surface again and again. A key aspect of psychoanalytic therapy is the analysis of transference. The responses of a patient to his analyst sometimes seem to reflect ways of behaving toward important people in the patient’s past. This is what transference is.

Jung was a Swiss psychiatrist who proposed that a part of the unconscious is common to all people. That part is called collective unconscious. Alfred Adler is known as the founder of individual psychology. An important part of his work was on helping people change their dysfunctional ideas and expectations.

Freud’s influence is most visible in the next three well-known assumptions:

• Adult personality is partly shaped by childhood experiences. The focus lies often on the parent-child relationships.

• Behavior is also influenced by unconscious processes.

• It is not always obvious what causes human behavior or what the purpose is of one’s behavior.

Observable behavior is the center of behaviorism rather than that consciousness of mental functioning. The behaviorist approach was influenced by three types of learning:

• Classical conditioning. A neutral stimulus is linked to another stimulus (unconditioned stimulus, UCS) that automatically elicits a certain response (unconditioned response, UCR). The neutral stimulus becomes a conditioned stimulus (CS) after repeated trials. The conditioned stimulus elicits the same response (conditioned response, CR).

• Operant conditioning. Thorndike’s law of effect states that if behavior is followed by consequences that are satisfying the individual, that behavior will be repeated. In contrast, behavior with unpleasant consequences will be discouraged. Skinner formulated the following reinforcements. Positive reinforcement is increasing the change a certain behavior will re-occur by presenting a pleasant event. Negative reinforcement strengthens a reaction by the removal of an unpleasant event.

• Modeling. Modeling is learning via watching and imitating others.

Behavior theory is based on the principles of classical and operant conditioning. In this kind of therapy, the clinicians try to change behavior, feelings and thoughts by the use of methods and discoveries made by experimental psychologists. A disadvantage of the behavioral approach is that there was no room for emotion and cognition.

Cognitive therapy emphasizes the idea that a major determinant in psychological disorders is how people see themselves and the world. According to the cognitive approach, people feel, think and behave.

What do mental health professions do? 

There are different kinds of mental health professions: clinical psychologists (study of human behaviour), psychiatrists (medical degree), psychiatric nurses and social workers (focus on psychotherapy). 

What are the current paradigms in psychopathology? - Chapter 2

Thomas Kuhn is a philosopher of science who views the notion of a paradigm as central to scientific activity. A paradigm is a conceptual framework or approach within which a scientist works – that is, a set of basic assumptions, a general perspective, that defines how to conceptualize and study a subject, how to gather and interpret relevant data, even how to think about a particular subject.

In this chapter, three paradigms, that guide the study and treatment of psychopathology, will be presented: genetic, neuroscience and cognitive behavioral. The important role of emotion and sociocultural factors in psychopathology will also be considered in this chapter.

Finally, another paradigm will be described: diathesis-stress paradigm, which is the basis for an integrative approach.

What is the genetic paradigm?

Nowadays it is known that almost all behavior is heritable to some degree and despite this, genes do not operate in isolation from the environment. Throughout the life span, the environment shapes how our genes are expressed, and our genes also shape our environments.

In other words, researchers are learning how environmental influences shape which of our genes are turned on or off and how our genes influence our body and brain.

What makes us unique is the sequencing of the genes as well as what the genes actually do. What genes do is make proteins that in turn make the body and brain work. Some of these proteins switch on or off other genes, a process called gene expression. Learning about the flexibility of genes and how they switch on or off has closed the door on beliefs about the inevitability of the effects of genes, good or bad. And with respect to most psychological disorders, there is not one gene that contributes vulnerability. Instead, psychopathology is polygenic, meaning several genes interacting with a person’s environment is the essence of genetic vulnerability.

An important term that will be used throughout this summary is heritability. This refers to the extent to which variability in a particular behavior in a population can be accounted for by genetic factors. There are two important points about heritability to keep in mind:

• Heritability estimates range from 0.0 to 1.0: the higher the number, the greater the heritability.

• Heritability is relevant only for a large population of people, not a particular individual.

Other factors that are just as important as genes in genetic research are environmental factors. Shared environment factors include those things that members of a family have in common. Nonshared environment factors are those things believed to be distinct among members of a family.

What are behavior genetics?

Behavior genetics is the study of the degree to which genes and environmental factors influence behavior. The total genetic makeup of an individual, consisting of inherited genes, is referred to as the genotype; the genotype cannot be observed from the outside. In contrast, the totality of observable behavioral characteristics is referred to as the phenotype. The phenotype changes over time and is the product of an interaction between the genotype and the environment.

What are molecular genetics?

Molecular genetics studies seek to identify particular genes and their functions.

Gene expression involves particular types of DNA called promoters. These promoters are recognized by particular proteins called transcription factors. Promoters and transcription factors are the focus of much research in molecular genetics and psychopathology.

Molecular genetics research has focused on identifying differences between people in the sequence of their genes and in the structure of their genes. One area of interest in the study of gene sequence involves identifying what are called single nucleotide polymorphisms or SNPs. A SNP refers to differences between people in a single nucleotide in the DNA sequence of a particular gene.

Another area of interest is the study of differences between people in gene structure, including the identification of so-called copy number variations (CNVs). A CNV can be present a single gene or multiple genes. These abnormal copies van be additions, where extra copies are abnormally present, or deletions, where copies are missing.

What are gene-environment interactions?

The influence of genes to a given person’s sensitivity to an environmental event is called a gene-environment interaction. Furthermore, it is important to know that epigenetics is the study of how environment can change the expression of a gene or its function.

Scientists working within the genetic paradigm in psychology face two major challenges:

• It is difficult to exactly specify how genes and environment influence each other.

• The task is very complex. Multiple genes contribute to a certain disorder.

What is the neuroscience paradigm?

According to the neuroscience paradigm psychological disorders are linked to abnormal processes in the brain.

What are neurons and neurotransmitters?

Neurons are the cells in the nervous system. The nervous system consists of billions or neurons. A neuron has four parts: a cell body, multiple dendrites, one or more axons of different lengths and terminal buttons on the many end branches of the axon. The synapse is a small gap between the cell membrane of the receiving neuron and the terminal endings of the sending axon. What is sent and received is a nerve impulse or signal. Neurotransmitters are chemicals that make the sending possible.

Reuptake is the process of taking back neurotransmitters that have not found their way to postsynaptic receptors into the presynaptic cell. Other neurotransmitters that have not found their way will be broken down by enzymes.

Examples of important neurotransmitters in psychopathology are dopamine, serotonin, norepinephrine and gamma-aminobutyric acid (GABA).

Some of the first theories that linked neurotransmitters to psychopathology proposed that either too much or too little of a certain transmitter caused a given disorder.

What is the structure and function of the human brain?

The brain roughly consists of two hemispheres with a major connection in between, which is called the corpus callosum. The corpus callosum makes communication between the two hemispheres possible. These cerebral hemispheres have four distinct areas: the frontal lobe, the parietal lobe, the temporal lobe and the occipital lobe.

In the very front of the cortex is the prefrontal cortex. This is an important area of the cortex, because it helps regulate the amygdala and plays an important role in many disorders.

A few brain structures will be discussed briefly:

• Thalamus: a relay station for all sensory pathways except the olfactory.

• The brain stem consists of the pons and the medulla oblongata and functions mainly as a neural relay station.

• Cerebellum: receives sensory nerves from the vestibular apparatus of the ear and from muscles, tendons and joints.

• Limbic system: contains different subcortical structures, such as: anterior cingulate, septal area, hippocampus, hypothalamus and the amygdala.

• HPA axis: related to stress and cortisol (stress hormone). This is a slow process for regulating stress in our bodies. Stress has effect on the immune system. The immune system releases cytokines, which helps the HPA axis. 

At some point, the synaptic connections become more specialized and therefore begin to eliminate. This is called pruning and causes stronger brain networks. 

Most of the neuroscience related treatments contain medication. It does reduce the symptoms but does not treat the cause of the disorder. 

What is the evaluation of the neuroscience paradigm?

The writers want to caution against reductionism, which refers to the view that whatever is being studies can and should be reduced to its most basic parts. Most things, disorders, humans are more than the sum of their parts. The danger is that certain phenomena will be missed by researchers who focus only on the molecular level, because the phenomena only emerges at certain other levels of analysis.

What is the cognitive behavioral paradigm?

The idea that problem behavior is likely to continue if it is reinforced is one of the important influences from behaviorism. Generally, four possible consequences are seen as reinforcements of problem behavior: getting attention, escaping from tasks, generating sensory feedback and gaining access to desirable things or situations. Treatment can be tailored to change the consequence of the problem behavior, when the source of reinforcement is known.

The biggest criticism behaviorism received is that it minimized the importance of two factors, namely: thinking and feeling.

The term used to describe the different kinds of mental processes is cognition. The focus with cognitive science lies on how people structure their experiences, how they make sense of their experiences and how people relate their past experiences to current ones.

A schema is an organized network of already accumulated knowledge. Cognitive scientists see people as active interpreters of a situation and trying to fit new information into their existing schemas. Attention is a much studied mental process within cognitive science. These studies are important to psychopathology, because people with certain disorders often have problems with attention.

What is cognitive behavior therapy?

Within cognitive behavior therapy the focus is on private events, such as thoughts, perceptions, judgments, etc. Changing a pattern of thought is called cognitive restructuring.

A well-known cognitive therapy is developed by psychiatrist Aaron Beck. Beck based his therapy on the idea that depression is caused by distortions in the perception of experiences. The goal of his therapy is to give people hope by trying to give people experiences that will change their negative schemas. These experiences can be both inside and outside the therapy room.

Which factors cut across the paradigms?

Firstly, the link between emotions and psychopathology. Emotions help us organize our thoughts and actions and emotions direct our behavior. In contrast to moods, emotions are thought of as states lasting for only a few seconds, minutes or at most hours. Moods lasts longer but are also emotional experiences.

According to contemporary emotion theorists and researchers, emotions have a number of elements, including expressive, experiential and physiological elements. It is important to consider which of these elements is affected when thinking of emotional disturbances in disorders. All can be affected, but it can also just be one element.

Emotions can be studies from multiple perspectives and thus cuts across the paradigms.

Secondly, the link between sociocultural factors and psychopathology. Various researchers have considered the role of gender in different disorders and concluded that some disorders affect the genders differently.

Other researchers conducted studies that show that poverty is a major influence on psychological disorders. Sociocultural factors are getting more and more attention in genetics and neuroscience.

What is interpersonal therapy?

The importance of different relationships in a person’s life and how problems in these relationships can cause psychological symptoms is emphasized in interpersonal therapy. In this therapy, four interpersonal problems are assessed to determine whether one or more might be causing symptoms: unresolved grief, role transitions, role disputes and interpersonal deficits.

Another important theory is the attachment theory by Bowlby. The attachment of the infant is important for the psychological health in their future. These relationships in a person's life are important in interpersonal therapy. This works for depression for example. 

What is the diathesis-stress paradigm?

Not one of the stated paradigms is adequate enough on its own to explain or treat the psychological disorders, because the disorders are much too diverse. Because of this, the diathesis-stress paradigm was introduced. This paradigm links genetic, neurobiological, psychological and environmental factors together and therefore is an integrative paradigm.

There is no guarantee that a person will develop a disorder, even if he has the diathesis. Possessing the diathesis is possessing a predisposition towards a disorder. Stress together with diathesis is needed to trigger a disorder. This is a key idea of the diathesis-stress model. Another key idea of this model is that a disorder is most likely caused by multiple factors.

What is diagnosis and assessment? - Chapter 3

The extremely important first steps in psychopathology are diagnosis and assessment, because:

• a good diagnosis is necessary for good clinical care.

• having a diagnosis can evoke feelings of relief in the patient, mostly because it helps with understanding their own symptoms.

• diagnosis helps therapists and researchers to talk accurately with each other.

• for research on causes and treatments, it is necessary to have diagnosis.

• assessment is necessary to make a good diagnosis.

• assessment can give additional information about a patient beyond the diagnosis.

What are the cornerstones of diagnosis and assessment?

The cornerstones of diagnosis and assessment are reliability and validity. The consistency of measurement is called reliability. Good reliability means the measurement measures the same thing every time. The degree to which two independent observers agree on what has been observed is called interrater reliability. The extent to which people being observed several times receive similar scores is measured by test-retest reliability. Both interrater reliability and test-retest reliability are important to assessment and diagnosis.

If clinicians use two different forms of a test, it is important that both forms are consistent. This is alternate-form reliability. The items on a test should be related to each other. The extent to which this is the case is called internal consistency reliability.

Validity is complex. If a test has good validity it means that the tests measures what it is supposed to measure. An important form of validity in diagnosis are:

• Content validity: the degree to which a test adequately samples a particular domain.

• Criterion validity: the degree to which a test is linked in an expected way to another test.

• Construct validity: the degree to which scores on an assessment test are linked to other variables or behaviors suggested by some theory or hypothesis.

What is the DSM-5 and what are the changes in DSM-5?

DSM stands for Diagnostic and Statistical Manual of Mental Disorders. It is the diagnostic system used by many mental health professionals. The DSM-5 is the latest issue of the manual. In the DSM specific diagnostic criteria are spelled out precisely. For each diagnosis the characteristics are described extensively.

The DSM-5 is based on symptoms instead of causes. There is not enough knowledge about the etiology to base the diagnoses on the causes of the disorders. 

Culture affects the risk factors of psychological disorders. Some disorders are specific for a specific culture. The DSM-5 cautions to keep the culture of your client in mind. It also includes nine cultural specific disorders. Culture has become increasingly important over the past few years. 

Some people criticized the number of possible diagnoses in the DSM. The latest edition contains more than 300 diagnoses. Some critics argue that:

• some relatively common reactions to trauma should not be called a psychological disorder.

• there are too many small differences between diagnoses, which increases the likelihood of comorbidity.

• A lot of risk factors seem to trigger multiple disorders. The diagnoses therefore do not seem to differ in their etiology or treatment.

The risk factors that seem to trigger multiple disorders are combined in the Research Domain Criteria (RDoC). 

Categorical classification is used in the DSM-5 for clinical diagnoses. This system forces mental health professionals to define one threshold as “diagnosable”, but these thresholds often have little support from research.

In a dimensional diagnostic system, one can describe the extent to which an entity is present. This can be more helpful. Such a system is included in the appendix of the DSM-5 for personality disorders.

It is important for diagnostic systems to have high interrater reliability. The DSM-5 has improved on this point in comparison to the DSM-III, but there is still room for disagreement between clinicians. It can be difficult to agree on the definition of words like ‘abnormal’ for example.

A general discussion point is that a diagnosis can have a negative effect. You will always have to carry that diagnosis with you. 

What is psychological assessment?

Different psychological assessment techniques can help clinicians to make a diagnosis. It is very common to use multiple techniques to reach a diagnosis. The measures complement each other.

What are clinical interviews?

In psychopathological assessment, clinicians use both structured and less structured interviews. A difference to a causal conversation is the way the clinician pays attention to the individual’s response.

It is necessary for mental health professionals to establish rapport with the person seeking their help. Trust is important for the person to open up.

Structured interviews are used when mental health professionals need to collect standardized information, like making diagnostic judgments based on the DSM-5. In such an interview, the questions are set out in a prescribed order for the interviewer. In practice though, the clinicians keep using unstructured interviews for their diagnosis. This makes the reliability much lower. This can be much higher with adequate training.

What are assessments of stress?

Stress is defined as the subjective experience of distress in response to perceived problems in the environment. Stress is a major aspect of many different disorders, that makes it a very important thing to measure. The assessment widely used to study life stressors is the Bedford college life events and difficulties schedule (LEDS). This interview is semi structured. Both the interviewer and the interviewee work to produce an overview of the major events within a time period. The stressors will be rated on the severity and various other dimensions. This way, the importance of every single life event can be personalized. Some other life events that might be a consequence of symptoms can be excluded.

LEDS takes a lot of time to administer. Self-report checklists are used to assess stress quicker. This kind of checklists often list a series of different life events. People need to answer whether these life events happened to them. A problem with this kind of assessment is that people can view the same life events in different ways.

What are personality tests?

Personality tests are a commonly used psychological test. Self-report personality inventory is an example of such a test. In such an inventory, the individual is asked to fill out a self-report questionnaire indicating whether statements apply to him. The statements are about habitual tendencies. A well-known personality test is the Big Five Inventory-2. This measures 5 domains and is more specific than the former Big Five. 

Projective tests are based on the projective hypothesis. The projective hypothesis states that the individual’s response to inkblots will be primarily determined by unconscious processes, because the inkblots are unstructured and ambiguous. The responses will then show the person’s true attitudes, motivations and modes of behavior. The Thematic Apperception Test (TAT) and the Rorschach Inkblot Test are examples of projective tests.

What are intelligence tests?

A way to assess an individual’s current mental ability is by the use of an intelligence test. This kind of testing is often used to predict school performance, but is also used in the following ways:

• Together with achievement tests, it can be used to diagnose learning disabilities and to identify areas of strengths and weaknesses.

• To help assess whether an individual has intellectual disability.

• To find out if a child is intellectual gifted.

• As part of neuropsychological testing.

Reliability of intelligence tests are high, and they have good criterion validity. Other factors besides IQ play an important role in how well a person will do in school. Examples of those factors are family and circumstances, motivation, expectations, performance anxiety and difficulty of the curriculum.

What is behavioral and cognitive assessment?

Assessments can also focus on behavioral and cognitive characteristics, like:

• Characteristics of the individual.

• The frequency and type of problematic behaviors.

• The consequences of the problem behaviors.

• Elements of the environment that might contribute to symptoms.

This assessment is mostly done through observation. A direct observation of behavior can be done, for example, or self-observation (often referred to as self-monitoring). Reactivity is the term used for the phenomenon wherein behavior changes because it is being observed.

What is neurobiological assessment?

Neurobiological assessment is interesting to identify brain dysfunction, because this can cause many different behavioral problems.

The CT or CAT scan (computerized axial tomography) helps to see if there are structural brain abnormalities. The MRI (magnetic resonance imaging) can also be used to see the living brain. It produces images of much better quality than the CT scan. The fMRI (functional MRI) is a technique that can measure both brain structures and brain function, by taking MRI pictures extremely fast. Metabolic changes can be seen because of this fastness.

The PET scan (Positron emission tomography) is less precise as MRI or fMRI but useful for research to neurotransmitters. SPECT is less expensive than PET but works the same. You inject a radioisotope into the bloodstream. Nowadays, researchers want to investigate the connections between brain areas. 

It is important to know the difference between a neurologist and a neuropsychologist. A specialist (physician) in diseases that affect the nervous system is called a neurologist. A neuropsychologist is someone who studies how impairments or disfunctions of the brain affect the way people feel, think and behave.

The idea that different psychological functions rely on different areas of the brain forms the basis for neuropsychological tests. These tests are often used besides the brain-imaging techniques.

In psychopathology assessment various neuropsychological tests are used. Two batteries of such tests will be named: Halstead-Reitan neuropsychological test battery and the Luria-Nebraska battery. Examples of the Halstead-Reitan tests are:

• Tactile Performance Test – Time.

• Tactile Performance Test – Memory.

• Speech Sounds Perception Test.

The Halstead-Reitan battery is valid for detecting behavior changes related to brain impairments.

People working in psychophysiology are interested in bodily changes that are linked to psychological events. Sensitivity of psychophysiological assessments is not strong enough to be used for diagnosis. It does give important information about an individual and it is useful when a someone wants to compare individuals. Several measures can be used to measure the activities of the autonomic nervous system:

• Electrocardiogram (EKG).

• Electrodermal responding.

• Electroencephalogram (EEG).

What is known about cultural and ethnic diversity in relation to assessment?

It is important to remember, while reading the next paragraphs, that there are typically more differences within cultural, and ethnic groups than between them.

A measure that is created for one culture or ethnic group may not be as reliable and valid with a different cultural or ethnic group. This notion is referred to as cultural bias. Multiple factors can affect assessment, e.g.:

• Differences in language.

• Differences in religious and spiritual beliefs.

• Presumed timidity of members of ethnic groups.

To avoid cultural bias when conducting assessments, three important issues should be taught to graduate psychology students:

• They should learn about basic issues in assessment.

• Students should learn about the ways in which culture and ethnicity can impact assessment.

• Students must become aware that culture or ethnicity may not impact assessment in every case.

What are the research methods in psychopathology? - Chapter 4

There are many different research methods in psychology. This chapter will focus on research methods in psychopathology. Beginning with the question: what is science?

What is science?

Science is trying to gain knowledge via observation. A theory is formed and then tested by systematically gathering data. A collection of propositions thought of to explain a class of observations is called a theory. A theory gives room for generation of more and specific hypotheses. Hypotheses are expectations about what should occur if a theory is true.

A good theory and good hypotheses are clearly and precisely formulated. The goal of testing theories or hypotheses is to disprove. A good formulated theory or hypothesis makes this possible. Subsequently, replication must be possible with each scientific observation.

What are the approaches to research on psychopathology?

When detailed information is recorded of one person at a time, we talk about a case study. A case study has disadvantages over other research methods: it lacks the control and objectivity. Despite these disadvantages, case studies still have an important role in psychopathology:

• It can be used to give a detailed description of a clinical phenomenon. 

• A case study can disprove a hypothesis.

• It can be used to generate hypotheses that can be tested through controlled research.

With the correlational method researchers try to find out if two variables co-relate. The variables are measured in a different way than in experimental research. Variables are measures as they exist in nature, whereas in experimental research they are manipulated. Researches mostly rely on this method when it is not ethical to manipulate variables.

The correlation coefficient is computed to determine the strength of the relationship between two variables. It can take any value between -1.00 and +1.00. If there is a strong and negative relationship the coefficient is close to -1.00. In contrast, if there is a strong and positive relationship the coefficient is close to +1.00. If the coefficient is close to 0.00, there does not seem to be a relationship between the two variables.

Both statistical and clinical significance should be considered. Statistical significance means that the observed correlation is unlikely to have occurred by chance. Clinical significance means that the relationship between the variables is large enough to matter.

There is a major disadvantage to the use of the correlation method, namely: no conclusions can be drawn about the causation of the relationship. It is not known if one variable causes the other. This is called the directionality problem. You can use a longitudinal design to solve this problem. It is also possible that a third variable has caused the relationship between the two variables. This is known as the third-variable problem.

The study of the distribution of disorders in a population is called epidemiology. This kind of research focuses on three aspects of a disorder: prevalence, incidence and risk factors. Because the study of risk factors is often done without manipulating variables, the study is usually a correlational study.

Methods of correlation research in behavior and molecular genetics will be briefly discussed:

In the family method the average number of genes shared within a family is known and therefor a study of genetic predisposition can be done with a family. The starting point in the family method is the person with the diagnosis, those people are called index cases or probands.

In the twin method, twins are compared. Both kind of twins, monozygotic twins and dizygotic twins, are used. Monozygotic twins are interesting because they are genetically the same. Dizygotic twins are about 50% the same genetically. If a disorder can be inherited, the disorder should be seen more in monozygotic twins.

In the adoptee's method, adopted children are raised by parents other than their biological parents. If a disorder is seen in adoptees, while their foster parent do not have the disorder, but their biological parents do, then there is convincing support for the heritability of the disorder. Environmental influences can be determined as well, when the foster parent has a disorder and the biological parent does not. This is called cross-fostering. 

What is an experiment?

To determine a causal relationship between two variables the experiment is the best tool to use. Participants of an experiment will be randomly assigned to different conditions. An independent variable will be manipulated, and a dependent variable will be measured. The conditions within the dependent variable differ from each other. This is called the experimental effect. 

It is important that an experiment has good internal validity. Internal validity refers to the extent to which the experimental effect can be ascribed to the independent variable. To reach internal validity, it is important that the experiment at least has one control group. A control group does not get the experimental treatment. Random assignment is also important to reach internal validity, because it helps ensure that groups are similar.

Researchers want the results of their study also to be true for people outside of the study. The extent to which this is the case is called external validity. It is difficult to determine the external validity.

In a single-case experimental design, the experiment is conducted at one person instead of a group. This can have a high internal validity. The reversal design (ABAB design) is commonly used. In reversal design the participant’s behavior must be measured in a specific order:

1. The baseline: an initial time period (A).

2. The period when a treatment is introduced (B).

3. A reinstatement of the conditions of the period of the baseline (A).

4. A reintroduction of the treatment (B).

In this case, the period without treatment will function as the control condition.

What is Treatment Outcome Research?

When researchers want to know if a particular treatment works, they design a treatment outcome research. Such a study should at least include the following criteria:

• The sample being studied must be clearly defined.

• The treatment being offered must be clearly described.

• The study must include a control group.

• Random assignment.

• Reliable and valid outcome measures.

• The sample should be big enough for the statistical tests being used.

In randomized controlled trials (RCT) clients are randomly assigned to treatment group or control group. The independent variable is the received treatment and the clients’ outcome is the dependent variable. Psychologists want empirical based treatments (empirically supported treatments, ESTs). 

The treatment condition is based on treatment manuals. This provides information about a specific treatment. The control group is important to compare the outcomes of the research to a baseline. Most of the times, a double-blind procedure is used. Sometimes physical or psychological improvement might be observed, because of the patients’ expectations instead of the active ingredient in a treatment. This is called the placebo effect. At last, it is important to look at the sample and their underlying problems. 

RCTs are often designed to determine whether a treatment works under the purest of conditions, in other words they are designed to find out the efficacy of a treatment. Beside the efficacy, also the effectiveness of a treatment should be determined. The effectiveness is how well the treatment works in imperfect conditions, like the real world.

What are analogues in psychopathological research?

It is not always possible to use the experimental method due to ethical reasons. To still take advantage of the benefits of the experimental method, researchers can use an analogue experiment. In an analogue experiment, researchers try to create or observe a phenomenon related to the one they actually want to test. This phenomenon is then the analogue. Results with good internal validity can then be obtained, because a true experiment is conducted. The external validity is the only problem that remains.

How can you combine different findings of multiple studies?

When you replicate a study, you want the results to be the same as in the original study. Because of the publication bias, where negative findings are not published, researchers are not motivated to replicate a study. It needs to become more transparent. A meta-analysis was developed to solve this problem. This can be used to calculate an effect size. A criticism is that some meta-analysis include studies that are of poor quality.