Exam 3 Flashcards
Why have clinical psychologists virtually abandoned the terms “normal” and “abnormal”?
They fail to account for the diversity of human experiences, carry potentially harmful stigma, and often rely on subjective or context-dependent criteria. Instead, psychologists now focus on understanding the complexity of human behavior in its proper context, considering individual differences and cultural factors.
What can be used instead of the terms “normal” and “abnormal”?
-Diagnosis
-Investigational approach
-Case formulation
Can you answer questions about the definition of a “mental disorder” based on the DSM-5-TR?
Defined as a significant disturbance in emotional, cognitive, or behavioral functioning, typically associated with distress or dysfunction in key areas of life, and reflecting underlying psychological, biological, or developmental issues. However, certain behaviors related to culture, common stressors, or societal conflicts are excluded from being labeled as mental disorders.
What items are excluded by definition?
○ Culture-bound behaviors
○ A common stressor (death of a loved one)
○Conflicts between individual and society
DSM Signs
= outwardly observable phenomenon
○ Things that can be observed
DSM Symptoms
= subjective experience reported by the client
○ Described by client
DSM Associated features
= aspect of a psychiatric disorder such as its prevalence, course, prognostic factors, or common co-occurring diagnoses.
○ Ex: both parents diagnosed with something
Internal Classification of Diseases (ICD)
= diagnostic codes given for ease of data collection and billing
What key things do you know about the history of the DSM?
Early Classification:
1845: Esquirol classifies mental disorders.
1883: Kraepelin distinguishes different forms of mental illness.
Precursor to DSM:
1917: Statistical Manual for Insane Institutions (22 categories).
DSM-I (1952):
102 categories, influenced by psychoanalysis, divided into psychoses & psychoneuroses.
DSM-II (1968):
182 disorders, vague descriptions, poor reliability.
DSM-III (1980):
Biomedical focus, specific diagnostic criteria, added PTSD & ADHD, removed homosexuality as a disorder.
DSM-III-R (1987):
292 categories, reorganized disorders, added and removed conditions (e.g., hoarding, Asperger’s).
DSM-IV (1997) & DSM-IV-TR (2000):
297 disorders, introduced distress criteria for diagnosis.
DSM-5 (2013) & DSM-5-TR (2022):
265 disorders, based on scientific data, aligned with ICD-10-CM codes.
Advantages of DSM
Standardized Diagnosis: Provides a consistent system for diagnosing mental disorders.
Clear Criteria: Uses specific criteria to help clinicians make accurate diagnoses.
Improved Treatment: Helps guide treatment decisions based on clear diagnoses.
Research Tool: Useful for research and studying mental health conditions.
Insurance Coverage: Helps with insurance billing by providing recognized diagnostic codes.
Limitations of the DSM
-Reliability Issues:
Many disorders have “fair” interrater reliability (e.g., PTSD, ADHD, MDD).
Diagnoses may not be consistent across clinicians, raising concerns about the validity of common disorders.
-Descriptive Criteria Only:
Only signs and symptoms are listed, not causes.
No medical tests for diagnosing disorders, making them based on descriptions rather than objective measures.
-Ambiguous Criteria:
Criteria are often unclear (e.g., “marked fear,” “clinically significant”), leading to varied clinician interpretations.
-Sociocultural Context:
Descriptions may overlook cultural context, meaning behaviors could be seen as disorders without considering cultural differences.
The DSM-5-TR has made efforts to update cultural considerations but still faces challenges.
-Categories vs. Dimensions:
The DSM places disorders into fixed categories rather than seeing them on a continuum (e.g., anxiety being normal in some situations).
-Over Inclusiveness:
Some disorders have an overly broad scope, including behaviors that may not necessarily be mental disorders (e.g., childhood difficulties).
-Additional Concerns:
The DSM may promote essentialism, suggesting that people with mental disorders are intrinsically different, leading to stigmatization.
What is meant by categories vs. dimensions for the limitations of the DSM?
Categories: DSM puts disorders into fixed groups (e.g., anxiety disorder), not considering varying degrees of symptoms.
Dimensions: Symptoms exist on a spectrum (e.g., mild to severe anxiety), but the DSM doesn’t capture this gradual variation.
What do these stand for:
-PTSD
-ADHD
-PD
DMDD
-ODD
-MDD
-OCD
-GAD
® PTSD = posttraumatic stress disorder
® ADHD = attention deficit–hyperactivity disorder
® PD = personality disorder
® DMDD = disruptive mood dysregulation disorder
® ODD = oppositional defiant disorder
® MDD = major depressive disorder
® OCD = obsessive-compulsive disorder
® GAD = generalized anxiety disorder
What are approximate kappa values for MDD and GAD and why is this a problem?
Kappa values for MDD and GAD are around 0.20 (low agreement).
Problem: Low reliability means clinicians don’t consistently agree on the diagnosis, raising concerns about the validity of these disorders.
Does the DSM provide causes for disorders?
No, the DSM only describes symptoms and classifies disorders based on patterns of distress and dysfunction.
It does not explain the causes (biological, psychological, or environmental) of disorders.
Can you answer questions about what the Research Domain Criteria (RDoC) are?
- An initiative of the National Institute of Mental Health (NIMH)
○ Alternative to the DSM that is in progress
○ Promotes research integrating genetics, neuroscience, and behavioral science
○ Leads to objective diagnostic system of “biotypes” aligning with biologically based treatments
○ Includes 6 domains with sets of constructs (identify names)
§ Problems understood in terms of neurobiological processes to determine treatment
What are the 6 domains of the NIMH RDoC?
-Negative valence systems
-Positive valence systems
-Cognitive systems
-Social processes
-Arousal and regulatory systems
-Sensorimotor systems
How does the DSM-5-TR differ from the RDoC?
- DSM-5-TR
○ Categorical
○ Works from the top down, starting with categories and determining what fits into those categories
○ Descriptive diagnostic system
○ Either depressed or nondepressed category - RDoC
○ Dimensional
○ Works from the ground up starting with brain-behavior relationships and linking these to clinical signs and symptoms
○ Grounded in biological theory
What is case formulation?
= a hypothesis about particular psychological mechanisms leading to and maintaing psychological distress/dysfunction
* Grounded in research-based psychological theories
* 4 primary elements
What are the 4 primary elements of case formulation?
-Problem list
-Mechanisms
-Predisposing factors
-Precipitants
How does the DSM-5-TR differ from case formulation?
Unlike the DSM-5-TR’s descriptive and atheoretical diagnostic criteria, case formulation is principle-driven
Why does case formulation employ an interactive approach?
Allows for revising hypotheses based on new information as it comes in.
This approach is tailored to fit individual clients because their needs, experiences, and responses can change over time.
By revisiting and refining the formulation, clinicians can adjust treatment plans and better address the client’s specific situation, leading to more personalized and effective care.
How do clinical psychologists formulate treatment plans?
- Assessment: Gather client information (symptoms, history).
- Case Formulation: Understand issues and causes.
- Set Goals: Define clear treatment objectives.
- Choose Interventions: Select appropriate therapies.
- Tailor to Client: Customize to individual needs.
- Monitor Progress: Continuously assess and adjust the plan.
Important aspects of communicating the treatment plan to the client:
-Clarity: simple wording
-Collaboration: client involved
-Transparency: open about treatment, risks, challenges
-Setting expectations: discuss goals, progress, time it takes
-Cultural sensitivity: consider their background and values
-Confidentiality: privacy & data protection
-Regular check-ins: ongoing review & adjust
Once treatment starts, does assessment stop? Why or why not?
No, assessment is a dynamic and continuous process that supports and improves the effectiveness of treatment
Differentiate between “psychotherapy” and ”psychological treatment”.
Psychotherapy is an unscientific, emotionally charged “talk therapy” that uses a broad range of tools with no required theoretical basis. Psychological treatment, on the other hand, involves science-based interventions tailored to specific issues and has been proven effective in controlled studies.
Brakmann Historical Phase 1(1920-1954): The Birth of Psychotherapy Research
○ 1920s: Freud’s psychotherapy outcomes using limited data from psychiatric institutions (Specifically psychoanalytical/ today as psychodynamic therapy)
§ Focus on therapist-perceived improvements
§ Vague diagnoses on small heterogenous samples
○ Carl Rogers emphasized client insight
§ Through “Talk therapy”
§ Used empathy, genuineness, and positive regard
○ Hans Eysenck (1952)
§ Proposed benefit due to spontaneous remission
§ Psychotherapies & research methodologies challenged
□ Provocative 1952 article “The effects of psychotherapy”
Brakmann Historical Phase 2 (1955-1969): Advancing Process Research
○ Psychotherapy research more sophisticated
○ Case studies replaced by controlled trials, self-reports, observations (slightly better)
○ Primary outcomes + Secondary outcomes identified
○ Process research emphasized
§ Focuses on the mechanisms responsible for improvement
§ What is actually helping the person to get better
§ Ex: communication patterns between therapists and clients
○ Large datasets allowed treatment researchers to examine predictors of good and poor outcome
§ During this time, many world events (WWII, Vietnam war, segregation, civil riots, etc.) occurred that caused more people obtain major stressors => needing therapy
Brakmann Historical Phase 3 (1970-1984): Expansion and Refinement
-Client-therapist relationship impacts outcomes.
-Outcome measures assess progress (e.g., improvement in functioning).
-Meta-analysis developed and (475 studies) shows treatment is more effective than no treatment.
-Dodo bird verdict; All therapy types win; Eysenck wasn’t right in it just being spontaneous/ nonfunctional =>Treatment better than no treatment
-DSM-3 came out in 1970
Brakmann Historical Phase 4 (1984- Present)
○ Randomized Controlled Trials (RCT)
○ Empirically supported treatment (EST)
○ Online and internet-assisted versions on the rise
○ Help rural communities and those unable to attend office-based sessions
○ Lack of diversity participants limits generalizing study findings; push for culture sensitivity
Methods to assess whether treatment works: Whom
- Client’s Opinion: May be biased, underestimating or overestimating progress due to investment
-Practitioner’s Perspective: Limited by lack of insight into client behavior outside the clinic and potential self-serving bias
-Third Parties: Mixed responses; family may underestimate, while insurers may overestimate treatment benefits
Methods to assess whether treatment works: How
○ Use standardized, reliable, and valid methods (dependent variables in treatment outcome studies)
○ Interview or self-report questionnaire for client
○ Direct observations of behavior, especially in settings where problem behavior occurs
Methods to assess whether treatment works: When
depends on aims of study, and clinician
§ Pre-treatment assessment serves as a baseline for post-treatment comparison
§ Some assess progress (during treatment) at each session to assess client’s progress
§ Post-treatment assessment
§ Follow-up assessments weeks, months, or even years after treatment ends
Differentiate between efficacy and effectiveness of psychological treatment
Efficacy: How well a treatment works in research studies (e.g., RCTs). Measured by comparing treated clients to those on a waiting list. Focuses on internal validity.
Effectiveness: How well a treatment works in real-world settings. Focuses on external validity, showing how well treatments work outside of controlled research environments.
Key features of RCT
-Control group
-Random assignment to treatment or control groups
-Annualized treatment and well-trained therapists
-Carefully selected and homogeneous client groups
-Blinded assessment
Why is external validity a factor in treatment effectiveness?
External Validity: How well study results apply to real-world settings.
Importance: Ensures treatments work outside of research
Common factors vs. specific factors
Common Factors: Features that many therapies share and contribute to positive change (e.g., client-practitioner alliance, hope, optimism).
Specific Factors: Unique therapeutic techniques that target specific psychological processes (e.g., CBT, behavioral interventions).
Into to which category do “hope” and “working alliance” fit?
Common factors
-They represent the emotional connection and positive expectations that enhance therapy outcomes
What are dismantling studies?
Research aimed at identifying the most effective components of multi-part treatments.
What is the interactional perspective?
Common and specific factors work together; a strong client-therapist relationship enhances the effectiveness of specific techniques.
Multicultural humility
= Awareness and skills in recognizing what psychologists don’t know about clients due to unique life experiences, challenging personal assumptions and biases.
Psychoeducation
= Educational component in treatment helping clients understand themselves, their problems, and treatment, while correcting misinformation.
Bibliotherapy
= Client reads informative material independently as part of treatment to address psychological issues
ACT (acceptance and commitment therapy)
metaphors
= progressive muscle relaxation
-A long-standing tradition in therapeutic interventions, particularly within acceptance and commitment therapy (ACT).
-They provide a powerful tool to harness the strength of language in order to comprehend and address stuckness, as well as facilitate behavioral change.
What are the 5 common ACT metaphors?
-The passengers on the bus
-Quicksand
-The chessboard
-Leaves on a stream
-The polygraph machine
Why is practice between sessions important?
○ Clients review progress between sessions with clinical psychologist
○ Clients practice skills taught in therapy sessions
§ Self-monitor behaviors and cognitions
What does non-compliance lead to?
§ Lack of follow-up
§ SES or value disparity
§ Unclear explanations of assignments
Evidence-based treatment (EBT)
An intervention or technique that has produced significant change in clients in controlled trials.
○ Interventions or techniques that demonstrate beneficial effects in RCTs
Evidenced-based practice (EBP)
= treatments informed by a number of sources, including scientific evidence about the intervention, clinical expertise, and client needs and preferences.
-Broader category with treatments informed by many sources
How are Evidence-based treatments (EBT) categorized as?
(hierarchy of treatments)
“Well-established”
> “Probably efficacious”
> “Experimental”
>”Possibly efficacious”
developed by Chambless
Why don’t some clinicians buy-in to EBT?
Some clinicians prefer psychotherapy as an “art” and reject Evidence-Based Treatment (EBT) due to personal biases and belief in their own methods.
This creates a research-practice gap, where research and clinical practice don’t align.
Clinicians believe multiple factors, not just treatment, contribute to a client’s improvement.
Observed changes after treatment don’t necessarily mean they were caused by the treatment itself.
What are the rival explanations for apparent client improvement in psychological treatment?
-Placebo effects
-Spontaneous remission
-Regression to the mean and natural fluctuations in psychological problems
-Effort justification
-Multiple treatment interference
-Reporting bias
Why do we need disseminating evidence-based treatments?
Goal: Integrate EBTs into routine practice.
Success Features:
Accessible, cost-effective, and culturally adaptable.
Reach underserved groups, train non-experts.
Ensure acceptability for clients and clinicians.
Challenges:
Intensive clinician training, high costs, disinterest.
Success Factors:
Educate on benefits, implement quality assurance, consider cultural diversity.
What factors might complicate the process of disseminating evidence-based treatments?
○ Intensive training for clinicians
○ Training workshops might be expensive
○ Therapists disinterested in changing treatments
- What is the theoretical basis of behavioral interventions?
Behavioral Treatment: Techniques derived from learning theory (operant conditioning, classical conditioning, modeling, skills training).
Focus: Observable, measurable behavior.
Understand the terms US, CS, UR, CR
○ US= unconditioned stimulus
○ UR= unconditioned response
○ CS= conditioned stimulus
○ CR= conditioned response
What is the conditioning paradigm for classical conditioning?
○ Helps an organism prepare for the future
§ The bell triggers behaviors to prepare for the food
○ Represents an association between the CS and the US
§ Bell associated with food
○ Innate reflex
§ US -> UR
○ Training
§ CS -> dog
§ US -> UR
○ Conditioned
§ CS -> CR
What is the paradigm for operant conditioning?
○ Initially, lots of behaviors are tried out
○ Track outcomes of behavior
§ S^D -> R -> O
§ S^D= discriminative stimulus
§ R= response
§ O= Outcome
○ This knowledge guides future behaviors
§ Behaviors with positive (+) outcomes increase
§ Behaviors with negative (-) outcomes decrease
What are the five guiding principles of behavioral treatment?
- Maladaptive behavior is understood as classically, operantly conditioned
- Behaviors are the problem, motives are unimportant
- Treatments should focus on behavior maintaining processes
- Adaptive behavior can replace maladaptive behavior by applying learning principles
- Behavioral treatments are client-specific
What was the historical contribution of Watson and Rayner?
Conditioned a child to develop a phobia
What was the historical contribution of Jones?
Demonstrated how learned fears can be removed, “reconditioned”
* These paved the way for systematic desensitization and contemporary exposure therapy techniques
What was the historical contribution of Skinner?
Modified behavior of hospitalized psychotic individuals
○ Taught some skills and modified their environment
What are the stage of behavioral treatment in order?
1-Target definition and baseline assessment
2-Functional analysis and treatment planning
3-Implementation
4-Outcome assessment
5-Reformulation
What are the applications of Behavioral Interventions?
-Addressing skill deficits
-Modifying behavior with rewards/consequences
-Reducing clinical anxiety and fear
-Improving depressed mood
-Modifying habit behaviors
-Improving sexual functioning
What techniques are specifically used for addressing skills deficits?
-Social skills training
-Assertiveness training
What techniques are specifically used for modifying behavior with rewards/consequences?
-Contingency management
-Token economies
What techniques are specifically used for reducing clinical anxiety and fear?
-Exposure therapy
(In vivo exposure, Imaginal exposure, Interoceptive exposure, Exposure hierarchy, Danger-based expectation)
-Progressive Muscle Relaxation (PMR)
What techniques are specifically used for improving depressed mood?
-Behavioral Activation (BA)
What techniques are specifically used for modifying habit behaviors?
-Habit Reversal Training (HRT)
-Cue exposure
What techniques are specifically used for improving sexual functioning?
-Sensate focus
What is aversion therapy, and what are some of the ethical issues with this technique?
- It is an unpleasant stimulus paired with undesirable target behavior; works on punishment principle
- Covert sensitization is same idea, but relies on imagery, not actual consequences
○ Causes distress - Aversive conditioning is incompatible with APA ethics code
- Positive reinforcement produces longer-lasting behavior changes, instead of punishment
What are the strengths of Behavioral treatments?
Efficacy: Proven effective for many clinical problems, superior to psychodynamic and humanistic therapies in meta-analysis.
Efficiency: Shorter, focused consultations with specific procedures; cost-effective and can be delivered by technicians.
Breadth of Application: Accessible to clients with limited resources, cognitive disabilities, or chronic conditions, reaching a wider population in need.
What are the limitations of behavioral treatments?
○ Behavioral interventions ineffective in treating psychosis, severe depression, bipolar disorder, and some personality disorders
○ Better when included in multicomponent treatment programs
○ Skill-based treatment; need client’s effort
○ Behavioral terminology discomforting
○ Therapists sometimes seen as “cold” or manipulating and not fostering “inner growth”
○ Aversion techniques regarded by some as immoral
Who contributed to CBT?
- Aaron T. Beck
- Albert Ellis
- Albert Bandur
- Julien Rotter
What were the contributions to CBT by Aaron T. Beck?
Background: Initially trained in psychoanalysis but found it inefficient and unscientific.
Contributions: Developed Cognitive Therapy (CT), emphasizing the role of negative thinking patterns in mental health issues. Introduced the idea that cognitive distortions (e.g., catastrophizing) contribute to depression, anxiety, etc. Beck’s approach led to Cognitive Behavioral Therapy (CBT), combining cognitive restructuring and behavioral techniques
What were the contributions to CBT by Albert Ellis?
Background: Also trained as a psychoanalyst but dissatisfied with its methods
Contributions: Developed Rational Emotive Behavior Therapy (REBT), which focused on challenging irrational beliefs that lead to emotional distress.
-Emphasized that people’s emotional responses are shaped by their interpretations, not external events
What were the contributions to CBT by Albert Bandura?
Background: Influenced by behaviorism but added cognitive factors
Contributions: Developed Social Learning Theory (later Social Cognitive Theory), emphasizing vicarious learning (learning through observation) and the role of self-efficacy (belief in one’s ability to influence outcomes)
-His work integrated cognitive processes into learning theory, showing that people actively process information and shape their behaviors based on their beliefs
What were the contributions to CBT by Julien Rotter?
Background: Focused on the interaction between behavior and cognitive expectations
Contributions: Introduced locus of control (internal vs. external), suggesting that beliefs about control over life events influence behavior.
-This concept linked cognition with behavior and influenced later developments in CBT, which focused on modifying beliefs to change behavior.
What is cognition?
= thoughts about events, situations in environment
○ Appropriate behavior from healthy constructive thoughts
○ Irrational, inaccurate congitions bias our thoughts
○ Thoughts become automaticl cause emotional distress, unhealthy behavior, and poorer quality of life
○ Thoughts are appraisals, interpretations, and attributions
What does the cognitive perspective postulate?
= emphasizes how our thinking — that is, our beliefs, interpretations, judgments, attributions, expectations, and other forms of “self-talk” — influence our emotions and behaviors.
What is Cognitive-Behavioral Treatment?
○ Improves psychological functioning; corrects maladaptive thinking and behaving
§ Thoughts influence emotions
○ Changes thoughts and feelings about self, others, and unpleasant situations beyond client’s control
○ Enhances problem solving, communication
What are the treatment implications of the cognitive model?
- ABC model sets stage for CBT:
○ Distress can be conquered by changing B (thoughts)
○ Clients taught to use adaptive and rational thinking
○ Experiencing constructive negative emotions can motivate, help problem-solve
○Unconditional self-acceptance
What does the ABC model stand for?
- A: activating event, activity, and adversity
○ Whatever happens to kick off the situation - B: beliefs
- C: emotional and behavioral
What part of the ABC model does CBT focus/work on?
Beliefs
○ Can’t control the things or events, but can control the interpretation
○ Cognitive events will lead to different consequences
- We build cognitive schemas around situations, people, activities, and objects
○ Incorrect schemas are problematic
○ Schemas depend on emotional situatiytrtiuon of person
○ Negative schemas lead to depression
○ Optimistic thinking leads to positive emotions
Formulation and implementation of CBT plan?
Cognitive Assessment (Cs): Open-ended questions
Assess Consequences: Frequency, intensity, duration; self-monitoring forms
Activating Events (A): Identify triggering facts via self-monitoring
Client’s Beliefs (Bs): Find dysfunctional beliefs; sentence tasks, handouts
Downward Arrow Technique: Identify adverse event, explore meanings, uncover dysfunctional thoughts.
Constructive negative emotions
○ universal experience that may be an appropriate response in certain circumstances
useful, motivating one to take action and problem-solve
ex: sadness, grief, sorrow, regret, concern, annoyed
Destructive negative emotions
○ more intense and long-lasting destructive negative emotions
○ Ex: hopelessness, worry, and rage, that stifle healthy coping and lead to impulsive or self-defeating behavior
What are dysfunctional beliefs?
Inaccurate, logically flawed, exaggerated, inflexible, way of thinking that is incongruent with goal attainment
All-or-nothing thinking
= seeing things in either “black or white” categories
Overgeneralization
= seeing a single negative event as a never-ending pattern
Mental filter
= exclusively focusing on a negative aspects of a situation
Disqualifying the positive
rejecting positive experiences by instisting that they don’t “count”, for one reason or another
Jumping to conclusions
Making negative interpretations without adequate evidence
Mind reading
Assuming you know what others are thinking without adequate evidence
Catastrophizing
= attributing or anticipating extremely awful consequences to events
Emotional reasoning
assuming that negative emotions necessarily reflect the situational reality
“Should” and “must” statements
endorsing rigid yet arbitrary rules
Labeling and mislabeling
taking one behavior or characteristic of oneself (or others) and applying it to the whole person
Personalization
entirely blaming oneself, or someone else, for a situation that involved many factors or was out of your control
Maladaptive thoughts
endorsing thoughts that are not necessarily irrational or distorted, but are nevertheless unproductive or unhelpful
Why is CBT a “skill-based treatment”?
- Client focuses on:
○ Structured sessions; goal-oriented
○ Little emphasis on causes of faulty thoughts
○ Some work may be out of clinical setting (homework) - Behavioral experiments may happen: method for clients to “put their beliefs to the test.”
What kinds of homework and practice might occur with CBT?
-Downward arrow technique
-Collaborative empiricism
-Culturally responsive modification
Difference between REBT vs. Beck’s Cognitive Therapy
REBT
Founder: Albert Ellis
Approach: More directive and confrontational
Focus: Irrational beliefs (e.g., demandingness, awfulizing)
Techniques: Disputation of beliefs using Socratic questioning
Goal: Challenge and change irrational beliefs
Beck’s Cognitive Therapy
Founder: Aaron Beck
Approach: Non-directive and collaborative
Focus: Cognitive distortions (e.g., overgeneralization, catastrophizing)
Techniques: Guided discovery, structured exercises
Goal: Identify and challenge automatic thoughts
Strengths of CBT approach
Effectiveness
High response rates in adults and children
Effective in outpatient, residential, medical settings
Works individually, in groups, and remotely
Efficiency
Practical, brief, and easy to master
Can be integrated with managed care
Trainable for providers with little experience
Scope of Use
Effective for depression, anxiety, and several other conditions
Moderate effect on schizophrenia symptoms
Less effective for anorexia nervosa, but helps with bulimia and binge-eating
Efficacious for insomnia
Mixed results for personality disorders
Criticisms of CBT approach
○ CBT developed on European Americans; not a diverse sample
○ Individuals of nondominant cultural identities form a minority in study samples
§ Efforts to recognize multiculturism
○ Effort required from client for treatment to work
§ Practice skills regularly and complete homework
○ Limited use for those with less motivation, severe and complex psychological problems, learning difficulties, or developmental disabilities
