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Part Ⅰ Background and methods1

1 Introduction3

Modern concepts of abnormality3

Historical overview5

Somatogenic and psychogenic perspectives7

Care in the community8

Issues of diagnosis9

The medical model9

Alternatives to the medical model15

The aetiology of mental health problems17

Genetic models18

Biological models21

Psychological models21

Socio-cultural models24

Systemic models25

Biopsychosocial models26

Diathesis-stress model27

Chapter summary27

For discussion28

Further reading29

2 The psychological perspective30

The psychoanalytic approach30

Freud30

Freud's contemporaries and descendants35

The practice of psychoanalysis36

Behavioural approaches38

Classical conditioning38

Operant conditioning39

Combining classical and operant conditioning40

Behaviour therapy40

Cognitive approaches44

Alternative models of the emotions46

Cognitive behavioural therapy47

Humanistic approaches52

Models of the individual and neurosis53

Humanistic therapy55

How effective are the therapies?58

Meta-analyses58

Therapist-client relationship59

Chapter summary59

For discussion60

Further reading60

3 Biological explanations and treatments61

The behavioural anatomy of the brain61

Hindbrain,midbrain and forebrain61

Cerebrum62

The synapse65

The neurotransmitters66

The autonomic nervous system67

Drug therapies69

Treating depression69

Treating anxiety72

Treating schizophrenia73

Adherence to drug treatments75

Electroconvulsive therapy76

Use of ECT77

The ECT controversy77

Psychosurgery79

Availability of psychosurgery80

Post-operative effects80

Chapter summary82

For discussion83

Further reading83

4 Moving beyond the individual84

Family models of mental health disorders84

Systemic therapy85

Structural family therapy86

Strategic family therapy88

How effective is systemic therapy?90

Psychosocial explanations of mental health problems92

Socio-economic status92

Gender differences94

Minority status96

Preventing mental health problems98

Health promotion98

Therapeutic interventions99

Using the media100

Public education100

Organizational interventions101

Chapter summary102

For discussion103

Further reading103

5 The process of therapy104

Assessment issues105

Standardized interview schedules106

Symptom-specific measures107

General measure107

Other measures107

Working through the problem108

Ending therapy110

Who benefits most from therapy?111

Client characteristics111

Client responses113

What makes a good therapist?113

Therapist experience114

Therapist training115

Gender and ethnicity115

Within-therapy factors116

Treatment acceptability116

Therapist competence116

The therapeutic alliance117

Self-disclosure118

Specific techniques118

Factors beyond the therapy situation119

Chapter summary120

For discussion121

Further reading121

PartⅡ Specific issues123

6 Schizophrenia125

The nature of schizophrenia126

Personal experiences126

DSM diagnostic criteria for schizophrenia128

Alternative view of the symptoms128

Deconstructing schizophrenia129

Aetiology of schizophrenia130

Genetic factors130

Biological mechanisms133

Substance abuse136

Psychosocial factors136

A psychobiological model138

Psychological models139

Treatment of schizophrenia142

Antipsychotic medication142

ECT144

Psychological approaches144

Chapter summary147

For discussion148

Further reading149

7 Anxiety disorders150

Generalized anxiety disorder150

Aetiology of generalized anxiety disorder151

Treatment of generalized anxiety disorder155

Panic disorder158

Aetiology of panic disorder158

Treatment of panic disorder163

Obsessive-compulsive disorder165

Obsessions165

Compulsions166

Aetiology of obsessive-compulsive disorder167

Treatment of obsessive-compulsive disorder170

Chapter summary173

For discussion175

Further reading175

8 Mood disorders176

Major depression176

Aetiology of major depression177

Treatment of major depression183

Suicide186

Aetiology of suicide187

Treatment of attempted suicide189

Seasonal affective disorder190

Aetiology of seasonal affective disorder191

Treatment of seasonal affective disorder193

Bipolar disorder193

Aetiology of bipolar disorder194

Treatment of bipolar disorder197

Chapter summary198

For discussion199

Further reading200

9 Trauma-related conditions201

Post-traumatic stress disorder201

Aetiology of post-traumatic stress disorder204

Treatment of post-traumatic stress disorder207

Recovered memory210

Explanations of recovered memory211

Evidence of recovered memory212

Dissociative identity disorder216

Aetiology of dissociative identity disorder217

Treatment of dissociative identity disorder223

Chapter summary225

For discussion226

Further reading226

10 Sexual disorders228

Sexual dysfunctions228

Erectile dysfunction229

Aetiology of erectile dysfunction229

Treatment of erectile dysfunction230

Vaginismus232

Aetiology of vaginismus232

Treatment of vaginismus233

The paraphilias233

Paedophilia234

Aetiology of paedophilia235

Treatment of paedophilia237

Transvestic fetishism242

Aetiology of transvestic fetishism244

Treatment of transvestic fetishism245

Gender identity disorder246

Aetiology of gender identity disorder247

Treatment of gender identity disorder248

Chapter summary252

For discussion253

Further reading253

11 Personality disorders255

Personality disorders255

A dimensional view challenging DSM257

A cognitive model258

Borderline personality disorder260

Aetiology of borderline personality disorder261

Treatment of borderline personality disorder262

Antisocial personality and psychopathy269

Aetiology of antisocial personality and psychopathy270

Treatment of antisocial personality274

Treatment of psychopathy275

Chapter summary279

For discussion280

Further reading280

12 Eating disorders281

Anorexia nervosa281

Bulimia nervosa283

Aetiology of anorexia and bulimia284

Interventions in anorexia292

Interventions in bulimia298

Chapter summary300

For discussion301

Further reading302

13 Developmental disorders303

Learning difficulties303

Aetiology of learning difficulties305

Social interventions in learning difficulties307

Psychological interventions in learning difficulties310

Autism312

Core limitations of autism313

Aetiology of autism315

Treatment of autism318

Attention-deficit/hyperactivity disorder321

Diagnostic versus categorical understandings of ADHD322

Aetiology of attention-deficit/hyperactivity disorder323

Treatment of attention-deficit/hyperactivity disorder325

Working with adults who have ADHD328

Chapter summary329

For discussion331

Further reading331

14 Neurological disorders332

Alzheimer's disease332

Aetiology of Alzheimer's disease334

Treatment of Alzheimer's disease337

Head injury341

Cognitive rehabilitation following head injury343

Multiple sclerosis345

Aetiology of multiple sclerosis348

Psychological sequelae of multiple sclerosis349

Treatment of multiple sclerosis351

Chapter summary353

For discussion353

Further reading354

15 Addictions355

Drugs and drug dependence355

Excess alcohol consumption357

Aetiology of excess alcohol consumption359

Interventions in excess alcohol consumption362

Heroin use366

Aetiology of heroin use367

Treatment of heroin use370

Pathological gambling374

Aetiology of pathological gambling375

Treatment of pathological gambling378

Chapter summary379

For discussion381

Further reading381

Glossary382

References386

Index425