PSYCHOLOGI

CALDI
SORDERS
ABNORMALBEHAVI
OUR
Abnor
mal
behav
iourmeans,
thebehav
iourwhi
chdev
iat
esf
rom whati
sconsi
der
ed
nor
mal
,usual
l
yref
erst
omal
adapt
ivebehav
iour
s.
Bi
ologi
cal
,Psy
chol
ogi
cal
andSoci
oCul
tur
alper
spect
ive
Tounder
standanddeal
wit
hthement
aldi
sor
der
s,t
hebi
ologi
cal
,psy
chody
nami
cand
soci
ocul
tur
alper
spect
iveneedt
obev
iewedcompl
i
ment
ari
l
ytooneanot
hersot
hati
t
pr
ovi
desmor
eaccur
ateandcompl
etepi
ctur
eoft
hedi
sor
derandt
hushel
pint
he
t
reat
ingoft
hement
aldi
sor
der
.
Thebi
ologi
calmodel
,emphasi
zest
her
oleoft
hener
voussy
stem i
nment
aldi
sor
der
s.
Thi
sappr
oachseekst
ounder
standsuchdi
sor
der
sint
ermsofmal
funct
ioni
ngof
por
ti
onsoft
hebr
ain,
imbal
ancesi
nvar
iousneur
otr
ansmi
tt
ersandgenet
icf
act
ors.
I
tisseent
hatmanyment
aldi
sor
der
sshowahi
ghdegr
eeofconcor
danceamong
cl
oser
elat
ives.I
fonef
ami
l
ymemberdev
elopsadi
sor
der
,thenot
her
sar
eati
ncr
eased
r
iskf
ordev
elopi
ngi
ttoo.Thebi
ologi
cal
model
hasbecomei
ncr
easi
ngl
yinf
luent
ial
in
r
ecenty
ear
sasadv
ancesi
nneur
osci
encehav
erev
eal
edmor
eandmor
eaboutt
her
ole
ofv
ari
ouspor
ti
onsoft
hebr
aini
nmanyaspect
sofbehav
iour
,andast
echni
quesf
or
obser
vingt
hef
unct
ioni
ngoft
hebr
ain(
e.g.magnet
icr
esonancei
magi
ng,
PETscans)
hav
eimpr
oved.
Psy
chol
ogi
calf
act
ors,
toocanbei
mpor
tant
.Thepsy
chol
ogi
cal
per
spect
ive
emphasi
zest
her
oleofbasi
cpsy
chol
ogi
cal
processesi
ntheoccur
renceofment
al
di
sor
der
s.Fori
nst
ance,
manypsy
chol
ogi
stsbel
i
evet
hatl
ear
ningpl
aysakeyr
olei
n
manydi
sor
der
s.Anexampl
e:phobi
as,
orexcessi
vef
ear
sofobj
ect
sorsi
tuat
ions.
Thepsy
chol
ogi
cal
per
spect
iveal
soemphasi
zest
her
oleofcogni
ti
vef
act
orsi
nment
al
di
sor
der
s.Fori
nst
ance,
manyt
heor
iesofdepr
essi
onsuggestt
hatl
ong-
last
ing
negat
ivef
eel
i
ngsof
tenst
em f
rom f
aul
typat
ter
nsoft
hought
s.Thepsy
chol
ogi
cal
per
spect
iveal
sot
akesaccountofunconsci
ousf
orcesandconf
li
ctswi
thi
nindi
vi
dual
s
–t
hef
act
orsal
sov
ivi
dlyemphasi
zedbyFr
eudandhi
sfol
l
ower
s.
Soci
ocul
tur
alf
act
orsdopl
ayar
olei
nment
aldi
sor
der
s.Psy
chol
ogi
stsandot
her
ment
alheal
thpr
ofessi
onal
sbel
i
evet
hatt
heydo,
andpoi
ntt
othei
mpor
tantr
oleof
suchsoci
alv
ari
abl
esaspov
ert
y,unempl
oyment
,inf
eri
oreducat
ionandpr
ejudi
ceas
pot
ent
ial
causesofatl
eastsomement
aldi
sor
der
s.I
not
herwor
ds,
thesoci
o-cul
tur
al
per
spect
iveemphasi
zest
hef
actt
hatext
ernal
fact
orssuchasnegat
iveenv
ironment
,a
di
sadv
ant
agedposi
ti
oni
nsoci
ety
,andcul
tur
alt
radi
ti
onscanpl
ayar
olei
nment
al
di
sor
der
s.

CommonFeat
ures
Dev
iance
Di
str
ess
Dy
sfunct
ion
Danger
TheFi
veAxesofDSM I
V:Ashasbeent
hecasesi
ncet
headv
entofDSM-
II
Iin1980,
DSMI
Vev
aluat
esani
ndi
vi
dual
accor
dingt
ofi
vef
oci
,or‘
axes’
.Thef
ir
stt
hreeaxes
assessani
ndi
vi
dual
’
spr
esentcl
i
nical
stat
usorcondi
ti
on.
•Axi
sI:Thepar
ti
cul
arcl
i
nical
syndr
omesorot
hercondi
ti
onst
hatmaybeaf
ocusof
cl
i
nical
att
ent
ion.Thi
swoul
dincl
udeschi
zophr
eni
a,gener
ali
zedanxi
etydi
sor
der
,
maj
ordepr
essi
onandsubst
ancedependence.Axi
sIcondi
ti
onsar
eroughl
y
anal
ogoust
othev
ari
ousi
l
lnessanddi
seaser
ecogni
zedi
ngener
almedi
cine.
•Axi
sII
:Per
sonal
i
tydi
sor
der
s.Av
erybr
oadgr
oupofdi
sor
der
s,t
hatencompassesa
v
ari
etyofpr
obl
emat
icway
sofr
elat
ingt
othewor
ld,
suchashi
str
ioni
cper
sonal
i
ty
di
sor
der
,par
anoi
dper
sonal
i
tydi
sor
der
,orant
isoci
alper
sonal
i
tydi
sor
der
.Thel
astof
t
hese,
forexampl
e,r
efer
stoanear
ly–dev
elopi
ng,
per
sist
entandper
vasi
vepat
ter
nof
di
sregar
dforaccept
edst
andar
dsofconduct
,incl
udi
ngl
egal
ones.Axi
sIIpr
ovi
desa
meansofcodi
ngf
orl
ong-
standi
ngmal
adapt
iveper
sonal
i
tyt
rai
tst
hatmayormaynot
bei
nvol
vedi
nthedev
elopmentandexpr
essi
onofanAxi
sIdi
sor
der
.Ment
al
r
etar
dat
ioni
sal
sodi
agnosedasanAxi
sIIcondi
ti
on.
•Axi
sII
I:Gener
almedi
cal
condi
ti
ons.Li
stedher
ear
eanygener
almedi
cal
condi
ti
ons
pot
ent
ial
l
yrel
evantt
ounder
standi
ngormanagementoft
hecase.Axi
sII
IofDSI
-I
V
maybeusedi
nconj
unct
ionwi
thanAxi
sIdi
agnosi
squal
i
fiedbyt
hephr
ase,
“Due’
to[
a
speci
fi
cal
l
ydesi
gnat
ed]
”gener
almedi
cal
condi
ti
on–f
orexampl
e,wher
eamaj
or
depr
essi
vedi
sor
deri
sconcei
vedasr
esul
ti
ngf
rom unr
emi
tt
ingpai
nassoci
atedwi
th
somechr
oni
cmedi
cal
disease.Onanyoft
hesef
ir
stt
hreeaxeswher
etheper
ti
nent
cr
it
eri
aar
emetmor
ethanonedi
agnosi
sisper
missi
ble,
andi
nfactencour
aged.That
i
s,aper
sonmaybedi
agnosedashav
ingmul
ti
plepsy
chi
atr
icsy
ndr
omes,
suchas
Pani
cDi
sor
derandMaj
orDepr
essi
veDi
sor
der
;di
sor
der
sofper
sonal
i
ty,
suchas
DependentorAv
oidant
;orpot
ent
ial
l
yrel
evantmedi
cal
probl
ems,
suchasCi
rr
hosi
s
(
li
verdi
seaseof
tencausedbyexcessi
veal
cohol
use)andOv
erdose,
Cocai
ne.Thel
ast
t
woDSM-
IVaxesar
eusedt
oassessbr
oaderaspect
sofani
ndi
vi
dual
’
ssi
tuat
ion.
•Axi
sIV:Psy
chol
ogi
cal
andenv
ironment
alpr
obl
ems.Thi
sgr
oupdeal
swi
tht
he
st
ressor
sthatmayhav
econt
ri
but
edt
othecur
rentdi
sor
der
,par
ti
cul
arl
ythoset
hat
hav
ebeenpr
esentdur
ingt
hepr
iory
ear
.Thedi
agnost
ici
ani
sinv
itedt
ouseacheckl
i
st
appr
oachf
orv
ari
ouscat
egor
iesofi
mpi
ngi
ngl
i
fepr
obl
ems–f
ami
l
y,economi
c,
occupat
ional
,l
egal
,et
c.Forexampl
e,t
hephr
ase“
Probl
emswi
thPr
imar
ySuppor
t
Gr
oup”
,maybei
ncl
udedwher
eaf
ami
l
ydi
srupt
ioni
sjudgedt
ohav
econt
ri
but
edt
othe
di
sor
der
.
•Axi
sV:Gl
obal
assessmentoff
unct
ioni
ng.Thi
siswher
ecl
i
nici
ansnot
ehowwel
l
t
hei
ndi
vi
dual
iscopi
ngatt
hepr
esentt
ime.A100-
poi
ntr
ati
ngscal
e,t
heGl
obal
AssessmentofFunct
ioni
ng(
GAF)Scal
e,i
spr
ovi
dedf
ort
heexami
nert
oassi
gna
numbersummar
izi
ngapat
ient
’sov
eral
lfunct
ional
abi
l
ity
. (

ANXI
ETY
Meani
ng
For
ms
Gener
ali
sedAnxi
etyDi
sor
der
.
● Excessi
veanxi
etyandwor
ry,
occur
ri
ngmor
eday
sthannotf
oratl
east6
mont
hsaboutanumberofev
ent
soract
ivi
ti
es(
suchaswor
korschool
per
for
mance)
● Theper
sonf
indsi
tdi
ff
icul
ttocont
rol
wor
ry.

● Theanxi
etyandwor
ryar
eassoci
atedwi
thatl
eastt
hree(
ormor
e)oft
he
f
oll
owi
ngsi
xsy
mpt
oms:
-Rest
lessnessorf
eel
i
ngkey
eduporonedge
-Bei
ngeasi
l
yfat
igued
-Di
ff
icul
tyconcent
rat
ingormi
ndgoi
ngbl
ank
-Vi
gil
ancei
sev
idencedbyi
rr
it
abi
l
ity
-Muscl
etensi
onmani
fest
edi
nshaki
ness,
rest
lessnessandheadaches.
 -Sl
eepdi
stur
bance(
dif
fi
cul
tyf
all
i
ngorst
ayi
ngasl
eeporr
est
less,
unsat
isf
ying
sl
eep)
- Hy
per
act
ivi
tyi
smani
fest
edbyshor
tnessofbr
eat
h,excessi
vesweat
ing,
pal
pit
ati
onsandev
enst
omachai
l
ment
sli
kechr
oni
cdi
arr
hea.
● Thef
ocusoft
heanxi
etyandwor
ryi
snotconf
inedt
ofeat
uresofanAxi
sI
di
sor
der
,
● Theanxi
ety
,wor
ryorphy
sical
sympt
omscausecl
i
nical
l
ysi
gni
fi
cant
di
str
essori
mpai
rmenti
nsoci
al,
occupat
ional
orot
heri
mpor
tantar
easof
f
unct
ioni
ng.
Thedi st
urbanceisnotduetothedir
ectpsychol
ogicaleff
ectsofasubst ance(exampl
e
drugsofabuse[ or]medi
cati
on)orageneralmedicalcondit
ion(
e.g.hyperthyr
oidi
sm),
anddoesnotoccurexcl usi
vel
yduri
ngamooddi sorder
,psychot
icdisorder,ora
pervasiv
edev el
opmentaldi
sorder
.

Phobi
aisat
ypeofanxi
etydi
sor
dert
hatcausesani
ndi
vi
dual
toexper
ience
ext
reme,
irr
ati
onal
fearaboutasi
tuat
ion,
li
vi
ngcr
eat
ure,
place,
orobj
ect
.
Ther
ear
ethr
eet
ypesofPhobi
arecogni
sedbyt
heAmer
icanPsy
chi
atr
ic
Associ
ati
on(
APA)
.Thesei
ncl
ude:
Speci
fi
cphobi
a:Thi
sisani
ntense,
irr
ati
onal
fearofaspeci
fi
ctr
igger
.
Soci
alphobi
a,orsoci
alanxi
ety
:Thi
sisapr
ofoundf
earofpubl
i
chumi
l
iat
ion
andbei
ngsi
ngl
edoutorj
udgedbyot
her
sinasoci
alsi
tuat
ion.Thei
deaofl
arge
soci
algat
her
ingi
ster
ri
fyi
ngf
orsomeonewi
thsoci
alanxi
ety
.Iti
snott
hesame
asshy
ness.
Agor
aphobi
a:Thi
sisaf
earofsi
tuat
ionsf
rom whi
chi
twoul
dbedi
ff
icul
tto
escapei
faper
sonwer
etoex
per
ienceext
remepani
c.
Sy
mpt
oms:
Aper
sonwi
thaphobi
awi
l
lexper
iencet
hef
oll
owi
ngsy
mpt
oms.
Theyar
ecommonacr
osst
hemaj
ori
tyofphobi
as:
•Asensat
ionofuncont
rol
l
abl
eanxi
etywhenexposedt
othesour
ceoff
ear
.
•Af
eel
i
ngt
hatt
hesour
ceoft
hatf
earmustbeav
oidedatal
lcost
s.
•Notbei
ngabl
etof
unct
ionpr
oper
lywhenexposedt
othet
ri
gger
.
•Acknowl
edgementt
hatt
hef
eari
sir
rat
ional
,unr
easonabl
e,andex
agger
ated,
combi
nedwi
thani
nabi
l
ityt
ocont
rol
thef
eel
i
ngs.
Aper
soni
sli
kel
ytoexper
iencef
eel
i
ngsofpani
candi
ntenseanxi
etywhen
exposedt
othesubj
ectoft
hei
rphobi
a.Thephy
sical
eff
ect
soft
hesesensat
ions
cani
ncl
ude:
•sweat
ing
•abnor
mal
breat
hing
•accel
erat
edhear
tbeat
•t
rembl
i
ng
•hotf
lushesorchi
l
ls
•achoki
ngsensat
ion
•chestpai
nsort
ight
ness
•but
ter
fl
iesi
nthest
omach
•pi
nsandneedl
es
•dr
ymout
h
•conf
usi
onanddi
sor
ient
ati
on
•nausea
•di
zzi
ness
•headache
Ty
pes:
•Cl
aust
rophobi
a
•Aer
ophobi
a
•Dr
ivi
ngphobi
a
•Emet
ophobi
a
•Hy
pochondr
ia
•Zoophobi
a
•Aquaphobi
a
Causes:
I
tisunusual
foraphobi
atost
artaf
tert
heageof30y
ear
s,andmostbegi
n
dur
ingear
lychi
l
dhood,
thet
eenagey
ear
s,orear
lyadul
thood.
Theycanbecausedbyast
ressf
ulexper
ience,
afr
ight
eni
ngev
ent
,orapar
entor
 househol
dmemberwi
thaphobi
athatachi
l
dcanl
ear
n.Theseusual
l
ydev
elop
bef
oret
heageof4t
o8y
ear
s.I
nsomecases,
itmaybet
her
esul
tofat
raumat
ic
ear
lyex
per
ience.Phobi
ast
hatst
artdur
ingchi
l
dhoodcanal
sobecausedby
wi
tnessi
ngt
hephobi
aofaf
ami
l
ymember
.
Somear
easoft
hebr
ainst
oreandr
ecal
ldanger
ousorpot
ent
ial
l
ydeadl
yev
ent
s.
I
faper
sonf
acesasi
mil
arev
entl
ateroni
nli
fe,
thosear
easoft
hebr
ainr
etr
iev
e
t
hest
ressf
ulmemor
y,somet
imesmor
ethanonce.Thi
scausest
hebodyt
o
exper
iencet
hesamer
eact
ion.I
naphobi
a,t
hear
easoft
hebr
aint
hatdeal
wit
h
f
earandst
resskeepr
etr
iev
ingt
hef
ri
ght
eni
ngev
enti
nappr
opr
iat
ely
.
•Genet
icorper
sonal
i
tyf
act
ors
•Behav
iour
alappr
oach
•Psy
chody
nami
csappr
oach
Medi
cat
ions:
•Bet
abl
ocker
s
•Ant
idepr
essant
s
•Behav
iour
alt
her
apy
•Desensi
ti
zat
ion,
orexposur
ether
apy
•Cogni
ti
vebehav
iour
alt
her
apy(
CBT) (
Meani
ng,
cause/t
ype/ef
fect
/
sy
mpt
om)

Obsessi
onCompul
siv
eDi
sor
der
Obsessi
vecompul
siv
edi
sor
der
:Ananxi
etydi
sor
deri
nwhi
chi
ndi
vi
dual
shav
e
r
ecur
rent
,di
stur
bingt
hought
s(obsessi
ons)t
heycannotpr
eventunl
esst
heyengagei
n
speci
fi
cbehav
iour
s(compul
sions)

A Ei
therObsessi
onsorCompul
sions
Obsessi
onsar
edef
inedbyt
hef
oll
owi
ng:
-
1. Recur
rentorper
sist
entt
hought
s,i
mpul
sesori
magest
hatar
eexper
iencedat
somet
imedur
ing t
hedi
stur
bancesasi
ntr
usi
veand i
nappr
opr
iat
eand cause
mar
kedanxi
etyorst
ress.
2. Thet
hought
simpul
sesori
magesar
enotsi
mpl
yexcessi
vewor
ri
esaboutr
eall
i
fe
 pr
obl
ems.
3. Theper
sonat
tempt
stoi
gnor
eorsuppr
esssucht
hought
s,i
mpul
sesori
magesor
t
oneut
ral
i
zet
hem wi
thsomeot
hert
hought
soract
ion
4. Theper
sonr
ecogni
zest
hatt
heobsessi
onalt
hought
s,i
mpul
sesori
magesar
ea
pr
oductofhi
sorherownmi
nd.
Compul
sionsar
edef
inedbyt
hef
oll
owi
ng:
-
1. Repet
it
ivebehav
ior
s(e.
g.handwashi
ng,or
der
ing,checki
ng)orment
alact
s(e.
g.
pr
ayi
ng,
count
ing,
repeat
ingwor
dssi
l
ent
ly)t
hatt
heper
sonf
eel
sdr
ivent
oper
for
m
i
nor
dert
oresponset
oanobsessi
on,oraccor
dingt
orul
est
hatmustbeappl
i
ed
r
igi
dly
.
2. Thebehav
ior
sorment
alact
sar
eai
medatpr
event
ingorr
educi
ngdi
str
essor
pr
event
ingsomedr
eadedev
entorsi
tuat
ion;howev
ert
hesebehav
ior
sorment
al
act
sei
therar
enotconnect
edi
nar
eal
i
sti
cwaywi
thwhatt
heyar
edesi
gnedt
o
neut
ral
i
zeorpr
eventorar
ecl
ear
lyexcessi
ve.
B Atsomepoi
ntdur
ingt
hecour
seoft
hedi
sor
der
,theper
sonhasr
ecogni
zedt
hatt
he
obsessi
onsorcompul
si
onsar
eexcessi
veorunr
easonabl
e.Howev
er,t
hisdoesnot
appl
ytochi
l
dren.
C The obsessi
ons orcompul
sions cause mar
ked di
str
ess,ar
eti
me consumi
ng or
si
gni
fi
cant
lyi
nter
fer
ewi
tht
heper
sonsnor
malr
out
ine,occupat
ionalf
unct
ioni
ng,or
usual
soci
alact
ivi
ti
esorr
elat
ionshi
p.
D I
fanot
herAxi
s-Idi
sor
deri
spr
esent
,thecont
entoft
heobsessi
onsorcompul
sionsi
s
notr
est
ri
ctedt
oit
(e.
g.pr
eoccupat
ionwi
thf
oodi
nthepr
esenceofaneat
ingdi
sor
der
,
hai
rpul
l
ingi
nthepr
esenceoft
ri
chot
il
lomani
a,concer
nwi
tht
heappear
anceofonei
n
t
hepr
esenceofbodydy
smor
phi
cdi
sor
der
,pr
eoccupat
ionwi
thdr
ugsi
nthepr
esenceof
subst
anceusedi
sor
der
,pr
eoccupat
ionwi
thhav
ingaser
iousi
l
lnessi
nthepr
esenceof
hy
pochondr
iasi
s,pr
eoccupat
ion wi
th sexualur
gesorf
ant
asi
esi
nthepr
esenceof
par
aphi
l
ia,
orgui
l
tyr
umi
nat
ionsi
ntt
hepr
esenceofmaj
ordepr
essi
vedi
sor
der
)
E Thi
sdi
stur
bancei
sduet
odi
rectef
fect
sofasubst
ance.
(e.
g.dr
ugsofabuseand
medi
cat
ion)oragener
almedi
cat
ioncondi
ti
on.

Sy
mpt
omsofOCD
•Cont
ami
nat
ion
•Pat
hol
ogi
cal
Doubt
•I
ntr
usi
vet
hought
s
•Sy
mmet
ry
•Psy
chody
nami
cper
spect
ive
Causes
•Neur
ochemi
cal
fact
ors
•Her
edi
ty
•Behav
iour
alper
spect
ive
•Cogni
ti
veper
spect
ive
(
Gener
almeani
ngofobsessi
onandcompul
sionandt
hreepoi
nts)

MoodDi
sor
der
s

Per
sonal
i
tyDi
sor
der
s
(
i)Ant
i-
soci
alper
sonal
i
tydi
sor
der
:
Sy
mptoms:
•Lackofconf
ormi
tyt
olawandr
epeat
edl
ycommi
tt
ingcr
imes.
•Repeat
edl
ydecei
tf
uli
nrel
ati
onshi
ps
•Fai
l
uret
othi
nkorpl
anahead
•Tendencyofi
rr
it
abi
l
ity
,angerandaggr
essi
on
•Di
sregar
dforper
sonal
saf
etyorsaf
etyofot
her
s
•Per
sist
entl
ackoft
aki
ngr
esponsi
bil
i
ty
•Lackofgui
l
tforanywr
ongact
ivi
ty.
Causes:
•Env
ironment
alf
act
or
•Genet
icf
act
or
•Neur
ochemi
cal
fact
or
•Br
ainar
easl
i
ket
empor
all
obesandpr
efr
ont
alcor
tex.Ser
otoni
nresponsi
blef
or
aggr
essi
vebehav
iour
.

(
ii
)Dependentper
sonal
i
tydi
sor
der
:
Sy
mpt
oms:
•Chr
oni
candper
vasi
vepat
ter
nofdependent
,submi
ssi
ve,
andneedybehav
iour
.
•Seeki
ngoutexcessi
veadv
ice,
appr
oval
andencour
agement
.
•Sensi
ti
vi
tyt
ocr
it
ici
sm orr
eject
ion.
•Lowsel
f-
conf
idenceandsel
f-
est
eem.
•Ani
nabi
l
ityt
omakedeci
sionswi
thoutdi
rect
ionf
rom ot
her
s.
•Feel
i
ngsofhel
plessnesswhenal
one.
•Ani
nabi
l
ityt
odi
sagr
eewi
thot
her
s.
•Ext
remedev
ast
ati
onwhencl
oser
elat
ionshi
psendandaneedt
oimmedi
atel
y
begi
nanewr
elat
ionshi
p.
•Di
ff
icul
tyi
nmaki
ngev
ery
daydeci
sions.
Causes:
•Genet
icandper
sonal
i
tyf
act
ors
•Behav
iour
alandcogni
ti
vef
act
ors.
(
i) Sy
mpt
omsofBi
pol
arDi
sor
der
:
•Shi
fti
nmoodbet
weent
wost
ates(
pol
es)-Depr
essi
ont
omani
a
•Mani
aischar
act
eri
zedbyhi
ghener
gy,
impul
siv
eness,
euphor
ia
•I
tisadi
sti
nctper
iodofabnor
mal
l
yel
evat
ed,
expansi
ve,
ori
rr
it
abl
emood,
last
ing
atl
eastoneweek.
•I
nfl
atedsel
f-
est
eem orgr
andi
osi
ty
•Decr
easedneedf
orsl
eep(
rest
edaf
tert
hreehour
sani
ght
)
•Mor
etal
kat
ive/Pr
essur
edspeech
•Raci
ngt
hought
sfor“
Fli
ghtofi
deas”
•Di
str
act
ibi
l
ity
•I
ncr
easedgoal
-di
rect
edact
ivi
tyorpsy
chomot
oragi
tat
ion
•Excessi
vei
nvol
vementi
npl
easur
abl
eact
ivi
ti
eswi
thhi
ghchanceofpai
nful
consequences•Maj
ordepr
essi
onshownext
remesadness(
dysphor
ia)
•Ext
remeapat
hy(
lossofi
nter
esti
nact
ivi
ti
es)
•Lossofsenseofhumour
•Lackofdr
ive
•Sui
cidal
thought
s
•Anxi
ety
•St
ayi
ngi
nbed,
•Easi
l
ydi
str
act
ed. (
anyt
wo)
 (
ii
) Sy
mpt
omsofAv
oidantper
sonal
i
tydi
sor
der
:
•Ext
remeshy
ness
•Sensi
ti
vi
tyt
ocr
it
ici
sm andr
eject
ion
•Lowsel
f-
est
eem andf
eel
i
ngsofi
nadequacy
•Adesi
ref
orcl
osenesswi
thot
her
sbutdi
ff
icul
tyi
nfor
mingr
elat
ionshi
pswi
th
peopl
eout
sideofi
mmedi
atef
ami
l
y
•Av
oidanceofsoci
alsi
tuat
ions,
incl
udi
ngt
hoser
elat
edt
oschool
orwor
k.
•Per
sonav
oidsoccupat
ional
act
ivi
ti
es
•Per
soni
srel
uct
antt
opar
ti
cipat
einanysoci
ali
nvol
vement
.
•Per
soni
spr
eoccupi
edwi
thcr
it
ici
zedorr
eject
ed.

ADHD
At
tent
iondef
ici
t/
hyper
act
ivi
tydi
sor
der
(ADHD)sy
ndr
omei
schar
act
eri
zedby
per
sist
enti
nat
tent
ionanddi
str
act
ibi
l
ity
,impul
siv
ity
,lowt
oler
ancef
orf
rust
rat
ion
andi
nappr
opr
iat
eov
eract
ivi
ty.Thedi
sor
derhast
woset
sofsy
mpt
oms:
I
nat
tent
ivenessandhy
per
act
ivi
ty.85per
centoft
hecaseswi
thADHDsuf
fer
f
rom bot
hsy
mpt
oms.
I
tbecomesacauseofconcer
nwhent
hesesy
mpt
omsbecomesosev
eret
hat
t
heyi
nter
fer
ewi
tht
hei
ndi
vi
dual
sfunct
ioni
ngi
nschool
/wor
kanddai
l
yli
fe.
ADHDi
soneoft
hemostcommonneur
odev
elopment
aldi
sor
der
sofchi
l
dhood.
I
tisusual
l
yfi
rstdi
agnosedi
nchi
l
dhoodandof
tenl
ast
sint
oadul
thood.Chi
l
dren
wi
thADHDmayhav
etr
oubl
epay
ingat
tent
ion,
cont
rol
l
ingi
mpul
siv
ebehav
ior
s
(
mayactwi
thoutt
hinki
ngaboutwhatt
her
esul
twi
l
lbe)
,orbeov
erl
yact
ive.
ADHDi
schar
act
eri
zedbyaper
sist
entpat
ter
nofi
nat
tent
ion
and/
or.hy
per
act
ivi
ty/
impul
siv
ityt
hati
nter
fer
eswi
thf
unct
ioni
ngordev
elopment
.
(
DSM 5)
.
Sy
mpt
oms
I
nat
tent
iveness(
inabi
l
ityt
osust
ainment
alef
for
ttowar
dapar
ti
cul
aract
ivi
ty)
Di
sor
gani
zed
Easi
l
ydi
str
act
ed
I
mpul
siv
eness
Easi
l
yfor
get
ful
Di
ff
icul
tyr
esi
sti
ngt
empt
ati
onsanddel
ayi
nggr
ati
fi
cat
ion
r
est
lessness
Fi
dget
ing
Hy
per
act
ivi
ty
Squi
rmi
ng

AUTI
SM
Aper
vasi
vedev
elopment
aldi
sor
der
Accor
dingt
otheDSM 5,
aut
ism i
saper
vasi
vedev
elopment
aldi
sor
derchar
act
eri
zedby
mar
keddef
ici
tsi
nver
bal
andnonv
erbal
soci
alcommuni
cat
ionski
l
ls;
soci
ali
mpai
rment
s
appar
entev
enwi
thsuppor
tsi
npl
ace;
li
mit
edi
nit
iat
ionofsoci
ali
nter
act
ions;
andr
educedor
abnor
mal
responsest
osoci
alov
ert
uresf
rom ot
her
s.Per
sist
entdef
ici
tsi
nsoci
al
communi
cat
ionandsoci
ali
nter
act
ionacr
ossmul
ti
plecont
ext
s,asmani
fest
edbyt
he
f
oll
owi
ng,
cur
rent
lyorbyhi
stor
y:
Def
ici
tsi
nsoci
al-
emot
ional
reci
proci
ty,
rangi
ng,
forex
ampl
e,f
rom abnor
mal
soci
alappr
oach
andf
ail
ureofnor
mal
back-
and-
for
thconv
ersat
ion;
tor
educedshar
ingofi
nter
est
s,emot
ions,
oraf
fect
;tof
ail
uret
oini
ti
ateorr
espondt
osoci
ali
nter
act
ions.
Def
ici
tsi
nnonv
erbal
communi
cat
ivebehav
ior
susedf
orsoci
ali
nter
act
ion,
rangi
ng,
for
exampl
e,f
rom poor
lyi
ntegr
atedv
erbal
andnonv
erbal
communi
cat
ion;
toabnor
mal
i
tiesi
ney
e
cont
actandbodyl
anguageordef
ici
tsi
nunder
standi
nganduseofgest
ures;
toat
otal
lackof
f
aci
alexpr
essi
onsandnonv
erbal
communi
cat
ion.
3.
Def
ici
tsi
ndev
elopi
ng,
mai
ntai
ning,
andunder
standi
ngr
elat
ionshi
ps,
rangi
ng,
forexampl
e,
f
rom di
ff
icul
ti
esadj
ust
ingbehav
iort
osui
tvar
ioussoci
alcont
ext
s;t
odi
ff
icul
ti
esi
n shar
ing
i
magi
nat
ivepl
ayori
nmaki
ngf
ri
ends;
toabsenceofi
nter
esti
npeer
s.
Rest
ri
cted,
repet
it
ivepat
ter
nsofbehav
ior
,int
erest
s,oract
ivi
ti
es,
asmani
fest
edbyatl
eastt
wo
oft
hef
oll
owi
ng,
cur
rent
lyorbyhi
stor
y:
St
ereot
ypedorr
epet
it
ivemot
ormov
ement
s,useofobj
ect
s,orspeech(
e.g.
,si
mpl
emot
or
st
ereot
ypi
es,
li
ningupt
oysorf
li
ppi
ngobj
ect
s,echol
ali
a,i
diosy
ncr
ati
cphr
ases)
.
I
nsi
stenceonsameness,
inf
lexi
bleadher
encet
orout
ines,
orr
it
ual
i
zedpat
ter
nsorv
erbal
nonv
erbal
behav
ior(
e.g.
,ext
remedi
str
essatsmal
lchanges,
dif
fi
cul
ti
eswi
tht
ransi
ti
ons,
rigi
d
t
hinki
ngpat
ter
ns,
greet
ingr
it
ual
s,needt
otakesamer
out
eoreatf
oodev
eryday
).
3.Hi
ghl
yrest
ri
cted,
fixat
edi
nter
est
sthatar
eabnor
mal
ini
ntensi
tyorf
ocus(
e.g,
str
ong
at
tachmentt
oorpr
eoccupat
ionwi
thunusual
obj
ect
s,excessi
vel
yci
rcumscr
ibedor
per
sev
erat
ivei
nter
est
).
4.Hy
per
-orhy
por
eact
ivi
tyt
osensor
yinputorunusual
int
erest
sinsensor
yaspect
soft
he
env
ironment(
e.g.
,appar
enti
ndi
ff
erencet
opai
n/t
emper
atur
e,adv
erser
esponset
ospeci
fi
c
soundsort
ext
ures,
excessi
vesmel
l
ingort
ouchi
ngofobj
ect
s,v
isual
fasci
nat
ionwi
thl
i
ght
sor
mov
ement
).

C.Sy
mpt
omsmustbepr
esenti
ntheear
lydev
elopment
alper
iod(
butmaynotbecomef
ull
y
mani
festunt
ilsoci
aldemandsexceedl
i
mit
edcapaci
ti
esormaybemaskedbyl
ear
ned
st
rat
egi
esi
nlat
erl
i
fe)
.
D.Sy
mpt
omscausecl
i
nical
l
ysi
gni
fi
canti
mpai
rmenti
nsoci
al,
occupat
ional
,orot
heri
mpor
tant
ar
easofcur
rentf
unct
ioni
ng.
E.Thesedi
stur
bancesar
enotbet
terexpl
ainedbyi
ntel
l
ect
ual
disabi
l
ity(
int
ell
ect
ual
dev
elopment
aldi
sor
der
)orgl
obal
dev
elopment
aldel
ay.I
ntel
l
ect
ual
disabi
l
ityandaut
ism
spect
rum di
sor
derf
requent
lyco-
occur
;tomakecomor
biddi
agnosesofaut
ism spect
rum
di
sor
derandi
ntel
l
ect
ual
disabi
l
ity
,soci
alcommuni
cat
ionshoul
dbebel
owt
hatexpect
edf
or
gener
aldev
elopment
all
evel
.

SCHI
ZOPHRENI
A
Meani
ng
Schi
zophr
eni
aisacompl
exdi
sor
derchar
act
eri
zedbyhal
l
uci
nat
ions(
e.g.hear
ing
v
oices)
,del
usi
ons(
bel
i
efwi
thnobasi
sinr
eal
i
ty)
,di
stur
bancesi
nspeech,
and
sev
eral
sympt
oms.

Mai
nTy
pes
POSI
TIVESYMPTOMS:
1. Del
usi
ons–
a. Theyar
efi
rml
yhel
dbel
i
efst
hathav
enobasi
sinr
eal
i
ty.Del
usi
onsar
emi
sint
erpr
etat
ionsofnor
mal
ev
ent
sandexper
ienceswhi
chhasl
i
ttl
ebasi
sinr
eal
i
ty.Del
usi
onsar
eofdi
ff
erentf
orms:
b. Del
usi
onofper
secut
ion–Thi
sisoneoft
hecommondel
usi
ons–Thebel
i
eft
hatonei
sbei
ng
pl
ott
edagai
nst
,spi
edon,
thr
eat
ened,
orot
her
wisemi
str
eat
ed.
c. Del
usi
onofgr
andeur–Bel
i
eft
hatonei
sext
remel
yfamous,
impor
tant
,orpower
ful
.Peopl
e
suf
fer
ingf
rom t
hisdel
usi
oncl
aimt
obeamov
iest
ar,
presi
dentorev
engod.
d. Del
usi
onofcont
rol
–Thebel
i
eft
hatot
herpeopl
e,ev
ilf
orces,
orev
enbei
ngsf
rom ot
herpl
anetar
e
cont
rol
l
ingone’
sthought
s,act
ions,
orf
eel
i
ngs.Del
usi
onsar
ephasi
c-t
heycomeandgo.Thusatany
gi
vent
imet
heymaybepr
esentt
ovar
yingdegr
ees.
2. Hal
l
uci
nat
ions–
i
. Theyar
evi
vi
dsensor
yexper
iencest
hathav
enobasi
sinphy
sical
real
i
ty.About70%of
schi
zophr
eni
aseeandheart
hingst
hatar
en’
treal
l
yther
e.Thet
ypesofhal
l
uci
nat
ionsar
e:
b. Audi
tor
y–hear
ing
c. Vi
sual
–Seei
ng
d. Tact
il
e–Feel
i
ngasi
fsomet
hingi
scr
awl
i
ngout
sidet
hebody
e. Somat
ic–Feel
i
ngasi
fsomet
hingi
shappeni
ngi
nsi
de.
3. Di
sor
gani
zedt
hought
sandspeech–
a. Per
sonswi
thschi
zophr
eni
adonott
hinkorspeakl
i
keot
herper
sons.Thei
rwor
dsj
umpabouti
na
f
ragment
edanddi
sor
gani
zedmanner
.Ther
eisal
ooseni
ngofassoci
ati
onssot
hatonei
deadoesnot
f
oll
owl
ogi
cal
l
yfr
om anot
her
.Indeed,
ideasar
etot
all
ydi
sconnect
ed.
b. Schi
zophr
eni
aof
tencr
eat
ewor
dsoft
hei
rown–wor
dst
hatr
esembl
ereal
wor
dsbutdonotexi
st
(
e.g.
-“l
i
ttl
ehood”f
orchi
l
dhood)
,
c. Thei
rsent
encesof
tenbegi
nwi
thonet
houghtandt
henshi
ftabr
upt
lyt
oanot
her
.Inext
remecases,
t
hei
rwor
dsseem t
obet
otal
l
yjumbl
edi
ntowhati
ssomet
imest
ermeda‘
ver
bal
sal
ad’
.
d. Thesepr
obl
emsandsev
eral
other
sseemst
ost
em outof‘
sel
ect
iveat
tent
ion’
–Nor
mal
l
y,wef
ocus
ourat
tent
iononcer
tai
nst
imul
iwhi
l
elar
gel
yignor
ingot
her
s.Howev
er,
schi
zophr
eni
csar
egener
all
y
di
str
act
ed.Ev
ent
hesoundoft
hei
rownwor
dsmaydi
sruptt
hei
rtr
ainoft
houghtandsendt
hem
wander
ingof
fint
oamy
ster
iouswor
ldoft
hei
rowncr
eat
ion.
4.Behav
iourDi
sor
der
s–
e. Thebehav
iour
aldi
sor
der
sshownbyaschi
zophr
eni
csar
eev
enmor
ebi
zar
re.
Fori
nst
ance,
theymakeoddmov
ement
sorst
rangegest
ure,
orr
emai
nimmobi
l
einanawkwar
dposi
ti
on
f
orl
ongper
iodsoft
ime–acondi
ti
oncal
l
ed‘
cat
atoni
a’
.
f
. Theymayal
soshowdi
sor
gani
zedbehav
iourt
hatmakesi
timpossi
blef
ort
hem t
odr
ess
t
hemsel
ves,
prepar
efood,
orper
for
m ot
herdai
l
ychor
es.
NEGATI
VESYMPTOMS:
1) Fl
atAf
fect–
a. Manyper
sonswi
thschi
zophr
eni
ashownoemot
ion.
b. Thei
rfacesar
eli
keemot
ionl
essmasks,
andt
heyst
areof
finspacewi
thagl
azedl
ook.
c. Someschi
zophr
eni
csdoshowemot
ion,
butt
hei
rreact
ionsar
einappr
opr
iat
e–t
heymaygi
ggl
e
whendescr
ibi
ngapai
nful
chi
l
dhoodex
per
ience,
orcr
yaf
terhear
ingaj
oke.
d. Thi
sisbecauset
heydoexper
ienceemot
ional
react
ions,
butdon’
tshowanysi
gnoft
hem ont
he
out
side.
2) Av
oli
ti
on–
a. I
tisaseemi
ngl
ytot
all
ackofmot
ivat
ionorwi
l
l.
b. Per
sonsshowi
ngt
hissy
mpt
om maysi
tdoi
ngnot
hinghouraf
terhour
.Ift
heydost
artt
odo
somet
hing,
theywi
l
lof
tenst
opi
nthemi
ddl
eoft
heact
ivi
tyandwanderof
f.
3) Al
ogi
a–
a. I
tisl
ackofspeech.
b. Schi
zophr
eni
csof
tenhav
eli
tt
leornot
hingt
osay
;theymayanswerdi
rectquest
ionsbutot
her
wise
t
endt
oremai
nsi
l
ent
,wi
thdr
awni
ntot
hei
rownpr
ivat
ewor
ld.
TYPES SYMPTOMS
Cat
atoni
c Unususalpat
ter
nsofmot
oract
ivi
ty,
suchasr
igi
dpost
ures;
speechdi
stur
bances
suchasr
epet
it
ivechat
ter
.
Di
sor
gani
zed Absenceofaf
fect
,poor
lydev
elopeddel
usi
ons,
ver
bal
incoher
ence
Par
anoi
d Pr
eoccupat
ionwi
thoneormor
eset
sofdel
usi
ons,of
tencent
eri
ngont
hebel
i
ef
t
hatot
her
sar
e‘outt
oget
’theschi
zophr
eni
cinsomeway
Undi
ff
erent
iat
ed Manysy
mpt
oms,
incl
udi
ngdel
usi
ons,
hal
l
uci
nat
ions,
incoher
ence
Resi
dual Wi
thdr
awal
,mi
nimalaf
fect
,andabsenceofmot
ivat
ion;occur
saf
terpr
omi
nent
 del
usi
onsandhal
l
uci
nat
ionsar
enol
ongerpr
esent

PSYCHOTHERAPHY
CLI
ENTCENTEREDTHERAPY
Themosti
nfl
uent
ial
humani
sti
cappr
oachi
scl
i
entcent
redt
her
apydev
elopedbyCar
lRoger
s.
Roger
sst
rongl
yrej
ect
edFr
eud’
svi
ewt
hatment
aldi
sor
der
sst
em f
rom conf
li
ctsov
ert
he
expr
essi
onofpr
imi
ti
vei
nst
inct
iveur
ges.Ont
hecont
rar
y,hear
guedsuchpr
obl
emsar
ise
mai
nlybecausecl
i
ent
sef
for
tst
oat
tai
nsel
f-
act
ual
i
zat
ion,
growt
handdev
elopmentar
e
t
hwar
tedear
lyi
nli
febyj
udgment
sandi
deasi
mposedbyot
herpeopl
e.
Accor
dingt
oRoger
s,t
hesej
udgment
sleadi
ndi
vi
dual
stoacqui
rewhathet
ermsunr
eal
i
sti
c
condi
ti
onsofwor
th.Thati
stheyl
ear
nthatt
heymustbesomet
hingot
hert
hanwhatt
heyr
eal
l
y
ar
e,i
nor
dert
obel
ovedandaccept
ed—t
obewor
thwhi
l
easaper
son.
I
tfocusesonel
i
minat
ingsuchunr
eal
i
sti
ccondi
ti
onsofwor
tht
hroughev
aluat
ionofa
psy
chol
ogi
cal
cli
mat
einwhi
chcl
i
ent
sfeel
val
uedasper
sons.Cl
i
entcent
redt
her
api
stsof
fer
uncondi
ti
onal
posi
ti
ver
egar
doruncondi
ti
onal
accept
ance,
oft
hecl
i
entandherorhi
sfeel
i
ngs,
ahi
ghl
evel
ofempat
het
icunder
standi
ngandaccur
ater
efl
ect
ionoft
hecl
i
ent
sfeel
i
ngsand
per
cept
ion.
I
nthi
swar
m,car
ingenv
ironment
,fr
eedf
rom t
hreatofr
eject
ion,
indi
vi
dual
scancomet
o
under
standt
hei
rownf
eel
i
ngsandacceptev
enpr
evi
ousl
yunwant
edaspect
soft
hei
rown
per
sonal
i
ties.Asar
esul
t,t
heycomet
oseet
hemsel
vesasuni
quehumanbei
ngswi
thmany
desi
rabl
echar
act
eri
sti
cs.Tot
heext
ent
,suchchangesoccur
,Roger
ssuggest
s,manyment
al
di
sor
der
sdi
sappearandi
ndi
vi
dual
scanr
esumet
hei
rnor
mal
progr
esst
owar
dssel
f-
ful
fi
lment
.

BEHAVI
ORALTHERAPY
Ther
api
esbasedoncl
assi
cal
condi
ti
oni
ng:
Iti
sapr
ocessi
nwhi
chor
gani
smsl
ear
nthatt
he
occur
renceofonest
imul
uswi
l
lsoonbef
oll
owedbyt
heoccur
renceofanot
her
.Behav
iour
t
her
api
stssuggest
sthatmanypr
obl
emsar
eacqui
redi
nthi
smanner
.St
imul
ithathappent
o
bepr
esentwhenr
eal
dangeroccurmayacqui
ret
hecapaci
tyt
oev
okei
ntensef
earbecauseof
t
hisassoci
ati
on.Asar
esul
t,i
ndi
vi
dual
sex
per
iencei
ntensef
ear
sinr
esponset
othese
condi
ti
onal
sti
mul
i
,ev
ent
hought
heyposenot
hreatt
othei
rwel
l
-bei
ng.Toel
i
minat
esuch
r
eact
ions,
behav
iourt
her
api
stssomet
imesuset
het
echni
queoff
loodi
ng.Thi
sinv
olv
es
exposur
etot
hef
ear
edst
imul
i
,ort
oment
alr
epr
esent
ati
onsoft
hem,
undercondi
ti
onsi
nwhi
ch
t
heper
sonwi
tht
hephobi
ascan’
tescapef
rom t
hem.Thi
spr
ocedur
esencour
ageext
inct
ionof
suchf
ear
s,t
hephobi
asmaysoonf
adeaway
.Anot
hert
echni
quebasedi
npar
tonpr
inci
plesof
cl
assi
cal
condi
ti
oni
ngi
sknownassy
stemat
icdesensi
ti
zat
ion.I
nthi
s,t
hei
ndi
vi
dual
sfi
rstl
ear
n
howt
oinducear
elaxedst
atei
nthei
rownbodi
es-of
tenbyl
ear
ninghowt
orel
axt
hei
rmuscl
es.
Thenwhi
l
einar
elaxedst
ate,
theyar
eex
posedt
ost
imul
ithatel
i
citf
ear
.Anot
hercl
assi
cal
condi
ti
oni
ngt
echni
quei
nvol
vi
ngunpl
easantst
imul
ati
oni
sav
ersi
ont
her
apy
.It
sobj
ect
ivei
s
nott
oundof
earorr
evul
si
onbutt
oinducesuchf
eel
i
ngs,
especi
all
yinr
elat
iont
ost
imul
ithat
t
ri
ggerunwant
edbehav
iour
.(Anyt
wo)Ther
api
esBasedonoper
antcondi
ti
oni
ng:
Behav
iouri
s
of
tenshapedbyt
heconsequencesi
tpr
oduces;
act
ionsar
erepeat
edi
ftheyy
iel
dposi
ti
ve
out
comesori
ftheyper
miti
ndi
vi
dual
stoav
oidorescapef
rom negat
iveone.I
ncont
rast
,
act
ionst
hatl
eadt
onegat
iver
esul
tsar
esuppr
essed.Thesebasi
cpr
inci
plesofl
ear
ningar
e
i
ncor
por
atedi
nsev
eral
for
msoft
her
apybasedonoper
antcondi
ti
oni
ng.Ther
api
esi
ncl
ude
Cl
eari
dent
if
icat
ionofundesi
rabl
eormal
adapt
ivebehav
iour
set
c,out
war
dlyshownby
∙the
f
oll
owi
ngst
eps:Ef
for
tschanget
heenv
ironmentsot
hatt
hesemal
adapt
ivebehav
iour
sar
eno
l
ongerf
oll
owed∙I
dent
if
icat
ionofev
ent
sthatr
einf
orceandmai
ntai
nsuchr
esponses.
∙
indi
vi
dual
s.byr
einf
orcement
.Oper
antpr
inci
pleshav
esomet
imesbeenusedi
nhospi
tal
set
ti
ngs–Tokeneconomi
es.Thi
sisaf
orm ofbehav
iourt
her
apyi
nwhi
chpat
ient
sinhospi
tal
set
ti
ngsl
ear
ntokenst
heycanexchangef
orv
ari
ousr
ewar
dsbyengagi
ngi
ndesi
rabl
efor
msof
behav
iour
.

CLASSI
CCONDI
TIONI
NGTHERAPY
sy
stemat
icdesensi
ti
zat
ionapr
ocedur
einwhi
chr
elaxat
ionandpl
easantf
eel
i
ngsar
elear
ned
ascondi
ti
onedr
esponsest
ost
imul
ithatonceact
edasf
earpr
oducer
s.Or
dinar
il
ysy
stemat
ic
desensi
ti
zat
ionbegi
nswi
thsomef
orm ofr
elax
ati
ont
rai
ning.I
nthef
orm knownas
pr
ogr
essi
ver
elaxat
ion,
fori
nst
ance,
peopl
ear
etr
ainedt
oal
ter
nat
elyf
lexandr
elaxt
hei
r
muscl
essoast
ogai
ncont
rol
overt
her
elaxat
ionr
esponse.
Thecondi
ti
oni
ngi
nvol
ves
sy
stemat
icpai
ri
ngoft
hef
ear
edst
imul
iwi
thar
elaxedbodi
l
yst
ate.Rel
axat
ioni
snot
compat
ibl
ewi
tht
heki
ndsofbodi
l
yact
ivi
tyi
nvol
vedi
nfearandanxi
ety
-wecannotbebot
h
r
elaxedandt
enseatt
hesamet
ime.Thust
hef
earandanxi
etyweakeni
fthecl
i
entr
emai
ns
r
elaxed.Thepr
inci
plei
nvol
vedi
scal
l
edr
eci
procal
inhi
bit
ion,
iti
sthenot
iont
hatt
wo
i
ncompat
ibl
eresponsescannotoccuratt
hesamet
imeandt
hatt
hest
rongeroft
het
wowi
l
l
r
epl
acet
heweaker
.Tomaxi
mizet
hechancet
hatt
her
elax
ati
onr
esponsewi
l
lbest
rongert
han
t
hecompet
ingf
earr
esponse,
thet
her
api
stbegi
nsbypai
ri
ngr
elax
ati
onwi
thv
eryweakf
ear
s,
t
heni
ncr
easest
hest
rengt
hoft
hef
ear
sgr
adual
l
y.Tobegi
nthi
spr
ocess,
thecl
i
entconst
ruct
s
af
eargr
adi
ent
,oranxi
etyhi
erar
chy
;theobj
ect
sorscenest
hatt
heper
sonf
ear
sar
eranked
f
rom l
east
-f
ear
edt
omost
-f
ear
ed.
Sy
stemat
icdesensi
ti
zat
ionwor
ksbycondi
ti
oni
nganewr
esponse(
rel
axat
ion)t
oapr
evi
ousl
y
f
ear
edst
imul
us.Anot
herappr
oacht
olesseni
ngf
ear
sisst
rai
ght
for
war
dex
tinct
ion:
Afear
-
pr
oduci
ngst
imul
usi
spr
esent
edbyi
tsel
fov
erandov
eragai
n.Suchdi
rectpr
esent
ati
onofa
hi
ghst
rengt
hcondi
ti
onedst
imul
us,
eit
heri
nimagi
nat
ionori
nreal
i
ty,
iscal
l
edf
loodi
ng
Anot
hercl
assi
cal
condi
ti
oni
ngt
echni
quei
nvol
vi
ngunpl
easantst
imul
ati
oni
sav
ersi
ont
her
apy
.
I
tsobj
ect
ivei
snott
oundof
earorr
evul
sionbutt
oinducesuchf
eel
i
ngs,
speci
fi
cal
l
yinr
elat
ion
t
ost
imul
ithatt
ri
ggerunwant
edbehav
ior