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Abnormal Psychology Psychology: A Concise Introduction 2nd Edition

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1 Abnormal Psychology Psychology: A Concise Introduction 2nd Edition
Richard Griggs Chapter 10 Prepared by J. W. Taylor V

2 Abnormal Psychology The scientific study of mental disorders and their treatment

3 The Journey… The Diagnosis and Classification of Mental Disorders
Three Major Categories of Mental Disorders The Treatment of Mental Disorders

4 The Diagnosis and Classification of Mental Disorders
The Diagnostic and Statistical Manual The Perceptual Bias of Labeling

5 Criteria for a Behavior/Thought Process to be a “Disorder”
1. Is the behavior/thought process atypical (statistically infrequent)? 2. Is the behavior/thought process maladaptive (i.e., does it prevent the person from successfully functioning and adapting to life’s demands)? 3. Is the behavior/thought process personally distressing? 4. Is the behavior/though process irrational?

6 Diagnostic and Statistical Manual
The DSM-IV, published in 1994 by the American Psychiatric Association, is the most widely used diagnostic system for disorders First appeared in 1952 and at that time, described only about 60 disorders During the last half-century, we have learned a lot about various disorders and how to differentiate them, so we can identify more disorders (there are more than 300 known disorders today) Health insurance companies require a DSM-IV classification before they will pay for therapy

7 Diagnostic and Statistical Manual
Some disorders share certain symptoms, so the DSM-IV clusters these disorders into major categories Anxiety disorders: Involve highly anxious or fearful behavior Mood disorders: Involve eccentric or odd behavior patterns Schizophrenic disorders: Involve excessively dramatic, emotional, or erratic behavior patters The DSM-IV also requires a separate decision as whether or not a person has a personality disorder Characterized by inflexible, long-standing personality traits that lead to behavior that impairs social functioning and deviate from cultural norms

8 Perceptual Bias of Labeling
A problem with classifying mental disorders is that labels are attached to people, and this biases our perception of these people in terms of the labels For instance, the word “crazy” has strong connotations

9 Perceptual Bias of Labeling
Rosenhan (1973) wanted to see if researchers could get admitted to mental hospitals when complaining of auditory hallucinations, hearing the words “thud,” “empty,” and “dull” He also wanted to learn what would happen after such people were admitted – if they acted normal, said that they no longer heard the voices, and said they were feeling normal again.

10 Perceptual Bias of Labeling
First, the fake patients were indeed admitted based only on this single symptom Second, their subsequent normal behavior was misinterpreted in terms of their diagnosis For instance, one person’s notetaking (for research purposes) was interpreted as a function of his illness

11 Three Major Categories of Mental Disorders
Anxiety Disorders Mood Disorders Schizophrenic Disorders

12 Three Major Categories of Clinical Disorders
Category Specific Disorders within Category Anxiety disorders Specific phobia, social phobia, agoraphobia, panic disorder with and without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder Mood disorders Major depressive disorder, bipolar disorder Schizophrenic disorders Schizophrenia (paranoid, disorganized, catatonic, undifferentiated, and residual subtypes)

13 A Caveat… Be wary of the medical school syndrome, the tendency to think that you have a disorder when you read about its symptoms Although we all get anxious or depressed from time to time, such symptoms are problematic when they prevent us from functioning normally (i.e., when they are atypical, irrational, maladaptive, and cause us personal distress)

14 Perspectives The causes of abnormal behavior and thinking can be found in the four major research perspectives Biological Behavioral Cognitive Sociocultural However, no one perspective adequately explains even one disorder The biopsychosocial approach to explaining abnormality examines the interaction between biological, behavioral, cognitive, and social/cultural factors

15 Anxiety Disorders Disorders in which excessive anxiety leads to personal distress and atypical, maladaptive and irrational behavior Specific Phobia Social Phobia & Agoraphobia Panic Disorder Generalized Anxiety Disorder Obsessive-Compulsive Disorder

16 Specific Phobia Indicated by a marked and persistent fear of specific objects or situations (such as snakes or heights) that is excessive or unreasonable The anxiety and fear of the specific stimulus may be rational to an extent, but in the case of a specific phobia, the anxiety and fear are in excess of what is typical

17 Specific Phobia For example, there was woman with a specific phobia of birds. She became housebound because of her fear of encountering a bird. Any noises she heard within the house she thought were birds that had broken in to get her. When she did leave the house, she was careful not drive near any birds, because if she hit a bird, they would take revenge on her. She knew her fears were irrational, but she could not control their effects on her behavior and thinking.

18 Causes of Specific Phobias
Classical conditioning In Watson and Rayner’s study on the infant Little Albert, they conditioned the infant to fear white rats by pairing together a loud startling noise (an unconditioned stimulus) with a white rat (a conditioned stimulus) Biological predispositions Certain associations (such as taste and sickness) are easy to learn, while others (such as taste and electric shock) are much more difficult to learn

19 Social Phobia A marked and persistent fear of one or more social performance situations in which there is exposure to unfamiliar people or scrutiny by others For instance, a person may fear eating in public, rejecting all lunch and dinner invitations

20 Agoraphobia A fear of being in places or situations from which escape might be difficult or embarrassing Includes being in a crowd, standing in line, and traveling in a crowded bus or train or in a car in heavy traffic To avoid such situations a person won’t leave the security of their homes

21 Panic Disorder A condition in which a person experiences recurrent panic attacks (i.e., sudden onsets of intense fear) Some panic attacks occur when a person is faced with something he dreads, such as giving a speech, but other attacks occur without any apparent reason Panic disorder can occur with or without agoraphobia. One explanation for panic disorder is a fear-of-fear hypothesis: Agoraphobia is the result of the fear of having a panic attack in public; thus, agoraphobia is a case of classical conditioning in which the fear and avoidance response is a conditioned response to the initial panic attack

22 Generalized Anxiety Disorder
A disorder in which the person has excessive, global anxiety and worry that they cannot control, for a period of at least 6 months The anxiety is not tied to any specific object or situation (as it is in a phobic disorder) May be related to a biochemical dysfunction in the brain, which involves GABA, a major inhibitory neurotransmitter People with generalized anxiety disorder may have problems with activation of GABA, allowing more and more neurons to get excited

23 Obsessive-Compulsive Disorder
A person experiences recurrent obsessions or compulsions that are perceived by the person as excessive or unreasonable, and cause significant distress and disruption in the person’s daily life An obsession is a persistent intrusive thought, idea, impulse, or image that causes anxiety A compulsion is a repetitive and rigid behavior that a person feels compelled to perform to reduce anxiety

24 Obsessive-Compulsive Disorder
Although it is not known for sure what causes obsessive-compulsive disorder, recent research suggests that a neurotransmitter imbalance involving serotonin may be involved Antidepressent drugs that increase serotonin activity (e.g., Prozac and Anafranil) help many obsessive-compulsive patients

25 Obsessive-Compulsive Disorder
Two parts of the brain, the orbital region of the frontal cortex (the area just above our eyes) and the caudate nucleus (an area in the basal ganglia), have significantly higher than normal level of activity in obsessive-compulsive people These two areas help filter out irrelevant information and disengaging attention, two central aspects of obsessive-compulsive disorder

26 Obsessive-Compulsive Disorder
One strange case of obsessive-compulsive disorder highlights the importance of the frontal lobe region A man with obsessive-compulsive disorder got severely depressed and attempted suicide He shot himself in the head, but fortunately survived and was cured of his disorder The bullet removed some his orbital front cortex and the disorder with it

27 Major Depressive Disorder
Mood Disorders Involve dramatic changes in a person’s emotional mood that are excessive and unwarranted Major Depressive Disorder Bipolar Disorder

28 Major Depressive Disorder
To be classified as major depressive disorder, a person must have experienced one or more major depressive episodes A major depressive episode is characterized by symptoms such as Feelings of intense hopelessness, low self-esteem and worthlessness, and extreme fatigue Dramatic changes in eating and sleeping behavior Inability to concentrate Greatly diminished interest in family, friends, and activities for a period of two weeks or more

29 Major Depressive Disorder
It is important to note that feelings of sadness and downward mood following stressful life events (such as a death in the family) are understandable and normal, and given time usually are self-correcting Such feelings under such circumstances do not necessarily indicate a major depressive disorder Women suffer from major depressive disorder twice as often as men

30 Major Depressive Disorder
A leading biological explanation involves neurotransmitter imbalances, primarily inadequate serotonin and norepinephrine activity There also appears to be a biological predisposition to the disorder For identical twins, the concordance rate is 50%, much higher than for fraternal twins and the base rate of occurrence in the general population

31 Major Depressive Disorder
Non-genetic factors are also important For example, the “pessimistic explanatory style” in which a person explains events in terms of causes that are internal (their own fault), stable (here to stay), and global (applies to all aspects of their life)

32 Bipolar Disorder The person’s mood takes dramatic swings between depression and mania, with recurrent cycles of depressive and manic episodes A manic episode is a period of at least a week of abnormally elevated mod in which the person experiences such symptoms as inflated self-esteem with grandiose delusions, a decreased need for sleep, constant talking, distractibility, restlessness, and poor judgment

33 Bipolar Disorder In bipolar I disorder, the person has both major manic and depressive episodes In bipolar II disorder, the person has full-blown depressive episodes, but the manic episodes are milder The concordance rate for bipolar is 70%, so biological causes are the most common explanation In fact, current research is trying to identify the specific genes that make a person vulnerable to this disorder

34 Schizophrenic Disorders
More people are institutionalized with schizophrenia than any other disorder About 1% of the population suffers from schizophrenia The onset tends to be in late adolescence or early adulthood Tends to strike men earlier and more severely, though both sexes are equally vulnerable Higher incidence in lower socioeconomic groups and for people who are single, separated or divorced rather than married

35 Schizophrenic Disorders
Is a psychotic disorder because it is characterized by a loss of contact with reality Schizophrenia means “split mind,” as mental functions do indeed become split from each other and detached from reality

36 Symptoms of Schizophrenia
Positive symptoms are the more active symptoms that reflect an excess or distortion of normal thinking or behavior, including hallucinations (false sensory perceptions) and delusions (false beliefs) Hallucinations tend to be auditory, such as hearing voices that are not real There are different forms of delusions Delusions of persecutions involve thoughts of conspiracy against you Delusions of grandeur involve believing that you are a person of great importance, such as Jesus Christ Hallucinations and delusions are positive symptoms because they refer to things that have been added

37 Symptoms of Schizophrenia
Negative symptoms refer to things that have been removed There are deficits or losses in emotion, speech, energy level, social activity, and even basic drives such as hunger Disorganized symptoms include disorganized speech, disorganized behavior, and inappropriate emotion When the person’s speech is disorganized, it might be like a “word salad,” with unconnected words incoherently spoken together

38 Technical Definition According to the DSM-IV, schizophrenia is defined as the presence, most of the time during a one-month period, of at least two of the following symptoms Hallucinations Delusions Disorganized speech Disorganized or catatonic behavior Any negative symptoms (such as loss of emotion)

39 Five Subtypes of Schizophrenic Disorder
Symptoms Disorganized Disorganized speech, disorganized behavior, or inappropriate emotion Catatonic Extreme movement symptoms ranging from excessive motor activity to posturing (immobility for long periods) Paranoid Organized cognition and emotion, but with hallucinations and delusions that are usually concerned with persecution Undifferentiated Mixed-bag category—symptoms fit the criteria of more than one of the above three types or none of them Residual There has been a past schizophrenic episode, but presently only some negative symptoms and no positive symptoms (hallucinations and delusions)

40 Type I and Type II Another distinction is between Type I and Type II schizophrenia Type I schizophrenia is characterized by positive symptoms Type II schizophrenia is characterized by negative symptoms Type I is more acute, as the person functioned normally before the disorder strikes and has a better chance of recovery because Type I can usually be alleviated with drugs, whereas Type II tends to stem from more permanent brain abnormalities

41 Causes of Schizophrenia
Concordance rate is about 50%, although no particular genes have been identified, and it is possible different genes might be involved in the different types of schizophrenia One hypothesis involves prenatal viral infections People are at increased risk if there was a flu epidemic during the middle of their fetal development In the northern hemisphere, people born in the winter/spring months, January through April, following the fall/winter flu season, are more at risk than people born other months of the year

42 Causes of Schizophrenia
A second hypothesis involves neurotransmitters Schizophrenics have elevated levels of dopamine activities in certain areas of their brains A third hypothesis involves various brain abnormalities, especially among those with Type II schizophrenia Shrunken cerebral tissue and enlarged fluid filled areas The thalamus seems to be smaller and the frontal lobes less active in many schizophrenic brains

43 Causes of Schizophrenia
A popular bio-psycho-social explanation is the vulnerability-stress-model that contends that genetic, prenatal, and postnatal biological factors render a person vulnerable to schizophrenia, but environmental stress determines whether it develops A person’s level of vulnerability interacts with the stressful social-cognitive events in their live to determine the likelihood of schizophrenia The disorder does tend to strike in late adolescence and early adulthood, periods of unusually high stress levels

44 The Treatment of Mental Disorders
Biomedical Therapies Psychotherapies

45 Different Types of Mental Health Professionals
Credential and Job Description Clinical psychologist Doctoral degree in clinical psychology; provides therapy for people with mental disorders Counseling psychologist Doctoral degree in psychological or educational counseling; counsels people with milder problems such as academic, job, and relationship problems Psychiatrist Medical degree with residency in mental health; provides therapy for people with mental disorders; only therapist who can prescribe drugs or other biomedical treatment Psycho- analyst Any of the above credentials, but with training from a psychoanalytic institute; provides psychoanalytic therapy for psychological disorders Clinical social worker Master’s or doctoral degree in social work with specialized training in counseling; helps with social problems (e.g., family problems)

46 Two Major Types of Therapy
Biomedical Therapy Involves the use of biological interventions, such as drugs Psychotherapy Involves the use of psychological interventions

47 Biomedical Therapies The earliest use to biomedical therapy may date to the Stone Age, when trephination was used Here, a trephine (a stone tool) was used to cut away a section of the person’s skull, supposedly to let evils spirits causing the disorder to exist the body In the early 1800s, the “tranquilizing chair” was used, in which the patient was strapped into a chair, with their head enclosed inside a box for a long periods of time Such restriction was designed to calm the person

48 Biomedical Therapies Even modern biomedical therapies are not without controversy Direct biological interventions have a downside in that they involve potential dangers and possible serious side effects High levels of some drugs can be toxic and potentially fatal if not monitored carefully

49 Electro- convulsive Therapy
Biomedical Therapies Drug Therapy Electro- convulsive Therapy Psycho- surgery

50 Drug Therapy Lithium Antianxiety Drugs Antidepressants
Antipsychotic Drugs

51 Lithium Not a drug, but rather a naturally occurring metallic element (a mineral salt) that is used to treat bipolar disorder Around 1950, John Cade, a psychiatrist, injected guinea pigs with a mixture of uric acid, which he thought was the cause of manic behavior, and mixed lithium with it so that the acid more easily liquefied Instead of becoming manic, the guinea pigs became lethargic, and later tests with human showed that lithium stabilized the mood of bipolar patients Lithium levels in the blood must be monitored carefully because of possible toxic effects Because of lithium’s side effects, anticonvulsant drugs are now sometimes prescribed for people with bipolar disorder

52 Antidepressant Drugs Monoamine oxidase (MAO) inhibitors break down neurotransmitters such as serotonin and norepinephrine in the synaptic gap This means that MAO inhibitors increase the availability of these neurotransmitters by preventing their breakdown Can have very dangerous side effects, particularly interactions with several different foods and drinks that lead to high blood pressure and possibly death Tricyclics are agonists for norepinephrine, serotonin, and dopamine and make these neurotransmitters more available by blocking their reuptake during synaptic gap activity

53 Antidepressant Drugs The most common anti-depressant drugs are selective serotonin reuptake inhibitors (SSRIs) They selectively block the reuptake of serotonin in the synaptic gap, keeping the serotonin active and increasing its availability Examples include Prozac, Zoloft, and Paxil Very mild side effects Usually required 3-6 weeks to being to see mood improvement

54 Antidepressant Drugs Neurogenesis is the growth of new neurons
The neurogenesis theory of depression assumes that neurogenesis in the hippocampus stops during depression, and neurogenesis resumes, the depression lifts Research has shown that SSRIs lead to increased neurogenesis in other animals It takes about 3-6 weeks for new cells to mature, the same timeframe it takes SSRI patients to improve This means that, in the case of the SSRIs, the increased serotonin activity may be responsible for getting neurogenesis going again and lifting our moods

55 Antidepressant Drugs There is controversy about the effectiveness of antidepressant drugs Some research suggests a placebo effect, improvements due to expectations of getting better Why would placebo effects make people feel better? It may also be the case that positive thinking, in the form of a strong placebo effect, might also get neurogenesis going again

56 Antianxiety Drugs Drugs that treat anxiety problems and disorders
Benzodiazepines reduce anxiety by stimulating receptor sites for GABA and also increasing the receptivity of these sites, which increases GABA activity Examples of benzodiazepines include Valium and Xanax

57 Antipsychotic Drugs Drugs that reduce psychotic symptoms
Early antipsychotic drugs (e.g., Thorazine and Stelazine) greatly reduced the positive symptoms of schizophrenia, but had little impact on the negative symptoms Greatly reduced the need to institutionalize people with schizophrenia Produced side effects in motor movement caused by their antagonistic effect on dopamine

58 Antipsychotic Drugs New-generation antipsychotic drugs (e.g., Clozaril amd Risperdal) are more selective in where in the brain they reduce dopamine activity Consequently, they do not produce the severe movement side effects, such as tardive dyskinesia, in which the person has uncontrollable facial tics, grimaces and other involuntary movements of the lips, jaw, and tongue

59 Electroconvulsive Therapy (ECT)
A biomedical therapy for severe depression that involves electrically inducing a brief brain seizure Electrodes are placed on one or both sides of the head, and a very brief electrical shock is administered causing a brain seizure that leads the patient to convulse for a few minutes Patients are given anesthetics, so they are not conscious during the procedure, and muscle relaxants to minimize the convulsions

60 Electroconvulsive Therapy (ECT)
We really do not understand why ECT works in treating depression One explanation is that the electric shock increases the activity of serotonin and norepinephrine, which improves mood ECT may also increase neurogenesis, which it has been demonstrated to do in rats ECT does not lead to any type of detectable brain damage or long-term cognitive impairment, but there is memory loss for events prior to and following the therapy ?

61 Psychosurgery The destruction of specific areas in the brain to treat the symptoms of disorders A lobotomy, the most famous type of psychosurgery, involves cutting the neurological connections between the frontal lobes to lower areas of the brain Was the common means to “treat” schizophrenia in the 1940s and 1950s, until drugs became available

62 Psychosurgery Psychosurgery still exists but not in terms of frontal lobe lobotomies For instance, cingulatomies, in which dime-sized holes are surgically burnt in specific areas of the frontal lobes (the cingulate gyrus) are sometimes performed on severely depressed or obsessive-compulsive patients who have not responded to other types of treatment

63 Psychotherapies Psychoanalysis Behavioral Humanistic Cognitive
Four major types Psychoanalysis Behavioral Humanistic Cognitive

64 Psychotherapies Psychoanalysis and humanistic therapies are called insight therapies because they stress that a person achieve understanding of the causes of their behavior and thinking Behavioral and cognitive therapies are usually referred to as actions therapies because they stress that the actions of the person must change for therapy to be effective

65 Psychoanalysis A style of psychotherapy originally developed by Sigmund Freud in which the therapist helps the person gain insight into the unconscious sources of their problems Psychoanalysts must collect data from a multitude of sources

66 Psychoanalysis Free association is a technique in which the patient spontaneously describes, without editing, all thoughts, feelings, or images that come to mind The assumption is that free association will provide clues to the unconscious conflicts leading to a person’s problems A resistance is a patient’s unwillingness to discuss particular topics When a resistance is hit, it may provide clues into unconscious conflicts

67 Psychoanalysis Dream interpretation also provides clues into unconscious conflicts Dreams have two levels of meaning: The manifest content is the surface, literally meaning of the dream; it is what the dream reports when awakening The latent content is the underlying, true meaning of the dream and is of primary interest to the psychoanalyst When we dream, we are not inhibited, and this dreams allow us the chance to symbolically experience our unconscious conflicts

68 Psychoanalysis Transference occurs when the patient acts toward the therapist as she did or does toward important figures in her life, such as her parents Transference is like a reenactment of earlier or current conflicts with important figures in the patient’s life

69 Psychoanalysis Psychoanalysis requires a lot of time because the therapist must piece together clues with only vague circumstantial evidence Critics question the validity of psychoanalysis’ main construct, unconscious conflicts and their impact on behavior and thinking ?

70 Humanistic Therapy The most influential humanistic therapy is Carl Rogers’s client-centered therapy, also called person-centered therapy A style of psychotherapy in which the therapist uses unconditional positive regard, genuineness, and empathy to help the person to gain insight into their true self-concept

71 Humanistic Therapy To achieve this goal, the therapist is non-directive The therapist doesn’t attempt to steer the dialogue in a certain direction; rather, the client decides the direction of each session The therapist’s job is to create the conditions that allow the client to gain insight into their true feelings and self-concept The therapist establishes an environment of acceptance by giving the client unconditional positive regard

72 Humanistic Therapy To achieve this goal, the therapist is non-directive The therapist demonstrates genuineness by honestly sharing his own thoughts and feelings with the client To achieve empathetic understanding of the client’s feelings, the therapist uses active listening to gain a sense of the client’s feelings, and then uses mirroring to echo these feelings back to the client, so the client can gain a clearer image of their true feelings

73 Behavioral Therapy A style of psychotherapy in which the therapist uses the principles of classical and operant conditioning to change a person’s behavior from maladaptive to adaptive The assumption is that maladaptive behaviors are learned and must be unlearned for therapy to be effective

74 Behavioral Therapy In counterconditioning, a maladaptive response is replaced by an incompatible adaptive response Systematic desensitization is a counterconditioning procedure in which a fear response to an object or situation is replaced with a relaxation response in a series of progressively increasing fear-arousing steps

75 Behavioral Therapy For example, a person with a specific phobia of spiders might find that planning a picnic to be a situation that evoked slight fear because of the possibility that a spider might be encountered on the picnic Seeing a picture of a spider might evoke more fear, and being in the same room with a spider would evoke even greater levels of fear Once this “hierarchy” of fear-provoking situations is established, the patient starts working through the hierarchy and attempts to relax at each step

76 Behavioral Therapy In flooding, another counterconditioning technique, the patient is immediately exposed to the feared object or situation Behavioral therapists also use operant conditioning to reinforce desired behaviors and extinguish undesirable behaviors A token economy is an environment in which desired behaviors are reinforced with tokens (secondary reinforcers, such as stickers) which can be exchanged for rewards such as candy or television privileges This technique is often used with institutionalized patients, and has been fairly effective in managing people with autism, mental retardation, and some schizophrenic populations

77 Cognitive Therapy A style of psychotherapy in which the therapist changes the person’s thinking from maladaptive to adaptive The assumption is that the person’s through processes and beliefs are maladaptive and need to change The therapist identifies the irrational thoughts and unrealistic beliefs that need to change, and then helps the person to execute that change

78 Cognitive Therapy In Ellis’s rational-emotive therapy, the therapist directly confronts and challenges the patient’s unrealistic thought and beliefs to show that they are irrational Such irrational thoughts are marked by words such as “must,” “always,” and “every” A rational-emotive therapist will show a person the irrationality of his thinking and how to make it more realistic

79 Cognitive Therapy This is achieved by Ellis’s ABC model A refers to the Activating event (e.g., failure to be perfect at everything) B refers to the person’s Belief about the event (e.g., feeling like a failure for normal levels of imperfection) C is the resulting emotional Consequence (e.g., depression) According to Ellis, A does not cause C; rather, B causes C Rational-emotive therapy is very direct and confrontational is getting people to see the errors of their thinking

80 Cognitive Therapy A therapist using Beck’s cognitive therapy works to develop a warm relationship with the person and has a person carefully consider the objective evidence for their beliefs to see the errors in their thinking For instance, a student who failed a test may think she blew her chance to get into medical school, so the therapist would have the student examine statistics on how few students actually have a perfect GPA and the GPAs of students admitted to medical school

81 Is psychotherapy effective?
Spontaneous remission is getting better with the passage of time without receiving any therapy Thus, the effect of psychotherapy must be statistically significantly greater than that due to spontaneous remission A meta-analysis (i.e., the pooling of results from a large number of studies into one analysis) of 475 studies involving different types of psychotherapy revealed that psychotherapy is indeed effective The average psychotherapy client is better off than about 80% of people not receiving any therapy No one particular type of psychotherapy, however, is superior to the others

82 Psychotherapy vs. No Treatment

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