Psychology and counseling - 3

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Psychotherapy

Scenario:
Ahmed, a 28-year-old teacher, has been struggling with intense anxiety for the past year. He reports constant worry about work performance, difficulty sleeping, muscle tension, and frequent panic attacks before entering his classroom. These symptoms have started interfering with his ability to teach effectively, and he fears losing his job. Ahmed finally seeks professional help and is referred to a psychotherapist.

Drawing upon the understanding of psychotherapy as a treatment involving structured methods and the therapeutic relationship, explain:

• a. How Ahmed’s symptoms and circumstances align with problems psychotherapy aims to help.

• b. The possible goals of psychotherapy for Ahmed.

• c. How the therapist–patient relationship contributes to his recovery.

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• Shared beliefs: In Maria’s culture, ancestral voices symbolize wisdom and continuity, not illness. DSM-5 acknowledges cultural context in defining abnormality. Without considering culture, normal experiences risk being pathologized.

• Cross-cultural challenges: Western psychiatry may misinterpret cultural rituals as psychosis. Such misdiagnosis can lead to unnecessary medication and stigma. Clinicians must use cultural formulation interviews and consult cultural experts.

• Implication: Diagnosis must balance universal clinical criteria with cultural sensitivity. Failure to do so risks invalid treatment and loss of patient trust.

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Abnormal Psychology (Culture & Diagnosis)

Scenario:
Maria, a 42-year-old woman from a rural community, reports feeling visited by her late mother in dreams and hearing her voice guiding her decisions. In her culture, this is respected as a spiritual connection. However, when she consults a Western-trained psychiatrist in an urban hospital, she is suspected of having schizophrenia because of “auditory hallucinations.”

Task:
Critically analyze this case in light of DSM-5 and cultural perspectives by addressing:

• The significance of shared cultural beliefs and practices in interpreting her experience.

• The challenges in cross-cultural assessment and risks of misdiagnosis.

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Answer (Key Points):

• Shared beliefs: In Maria’s culture, ancestral voices symbolize wisdom and continuity, not illness. DSM-5 acknowledges cultural context in defining abnormality. Without considering culture, normal experiences risk being pathologized.

• Cross-cultural challenges: Western psychiatry may misinterpret cultural rituals as psychosis. Such misdiagnosis can lead to unnecessary medication and stigma. Clinicians must use cultural formulation interviews and consult cultural experts.

• Implication: Diagnosis must balance universal clinical criteria with cultural sensitivity. Failure to do so risks invalid treatment and loss of patient trust.

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Motivation & Emotion

Scenario:
Sara, a 20-year-old university student, once highly motivated to achieve top grades, has recently lost interest in studying. Despite having important exams approaching, she procrastinates, feels little drive to succeed, and spends more time on social media. However, when asked about her hobbies (painting, music), she lights up and engages with enthusiasm.

Task:
Using theories of motivation and emotion, discuss:

• How Sara’s change in motivation can be explained.

• The role of intrinsic vs. extrinsic motivation in her behavior.

• How understanding her emotional state could help restore her academic motivation.

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Answer (Key Points):

• Theoretical explanation: Atkinson’s Achievement Motivation Theory → Sara’s expectancy of success may have lowered, reducing effort. Maslow’s hierarchy → unmet psychological/emotional needs could shift priorities.

• Intrinsic vs. extrinsic: Sara shows high intrinsic motivation for hobbies but low extrinsic motivation for academic tasks. Grades may no longer serve as a strong incentive.

• Emotion’s role: Emotions (possibly stress or mild depression) impact motivation. Positive affect in hobbies suggests re-engaging intrinsic motivation in academics through linking studies with personal goals, supportive environment, and stress reduction.

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Motivation

Scenario:
Ali, a 17-year-old student, often eats large amounts of fast food late at night even when he is not hungry. His parents are concerned about his weight gain. Ali says he feels drawn to food advertisements on TV and feels comforted when eating, especially after stressful school days.

Task:
Using motivational theories and biological/environmental influences on hunger, explain:

• Why Ali eats excessively despite not being physically hungry.

• How biological and environmental factors interact in his case.

• One psychological strategy to help regulate his eating.

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Answer (Key Points):

• Why excessive eating? Incentive theory → external food cues (ads, taste) motivate eating beyond biological need. Emotional regulation → stress triggers eating as comfort.

• Biological/environmental interaction: Environmental → food availability & advertising. Biological → possible leptin/hormonal imbalance, brain reward pathways. Together → “obesogenic environment.”

• Psychological strategy: CBT to identify stress–eating patterns, use healthier coping strategies (exercise, relaxation). Exposure reduction to food cues (limiting ads, avoiding junk food storage).

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Abnormal Psychology & Classification

Scenario:
Hassan, a 35-year-old man, has been feeling sad for weeks after losing his job. He has reduced appetite, low energy, and occasional crying spells. His family is worried he may be depressed. However, he still socializes with friends and is motivated to find another job.

Task:
With reference to DSM-5 and classification issues, discuss:

• Whether Hassan’s behavior should be classified as a mental disorder.

• The advantages and disadvantages of classifying his condition.

• How cultural and situational context should influence diagnosis.

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Answer (Key Points):

• Classification: DSM-5 requires significant distress/impairment. Hassan shows sadness but maintains functioning and goal-directed behavior. Likely an adjustment reaction, not Major Depressive Disorder.

• Advantages: Provides common language for professionals, guides treatment planning.

• Disadvantages: Risk of labeling and stigma; may pathologize normal grief/stress.

• Context: Losing a job is a situational stressor; cultural norms may accept temporary sadness as normal. Diagnosis should avoid premature labeling.

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Psychotherapy & Behavior Therapy

Scenario:
Leena, a 24-year-old woman, developed a phobia of dogs after being bitten as a child. She avoids parks, friends’ houses with pets, and feels anxious when she hears barking. She seeks therapy because this fear restricts her social life.

Task:
Explain how systematic desensitization could be applied to Leena’s case by addressing:

• The principles behind the treatment.

• The steps her therapist would use.

• Why this method may be effective for her phobia.

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Answer (Key Points):

• Principles: Based on classical conditioning → fear is learned, so it can be unlearned. Goal = replace fear with relaxation.

• Steps: (1) Relaxation training (deep breathing, progressive muscle relaxation). (2) Anxiety hierarchy (ranking dog-related fears). (3) Gradual exposure while practicing relaxation → from imagining dogs to real-life exposure.

• Effectiveness: Gradual desensitization reduces conditioned fear response, helps her regain confidence, restores normal functioning.

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Abnormal Psychology & Culture

Scenario:
A psychologist in Japan meets Kenji, a 19-year-old student who avoids eye contact with others and fears that his facial expressions may offend people. He avoids social gatherings and often isolates himself, worried that he might cause discomfort to others.

Task:
Analyze this case in relation to cultural syndromes by discussing:

• What disorder this may represent.

• How cultural norms shape the interpretation of his symptoms.

• Why culturally sensitive diagnosis is important.

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Answer (Key Points):

• Disorder: Taijin kyofusho → culture-bound anxiety disorder in Japan, fear of offending others socially.

• Cultural influence: In collectivist cultures, harmony and not disturbing others is highly valued. What seems like social phobia in Western contexts may have a distinct cultural meaning in Japan.

• Importance: Without cultural sensitivity, misdiagnosis as Social Anxiety Disorder could occur. Cultural formulation ensures correct understanding, prevents inappropriate treatment.

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Psychotherapy & Biomedical Approaches

Scenario:
Zain, a 40-year-old man, has been diagnosed with severe depression. He has tried psychotherapy and antidepressant medications but shows little improvement. His psychiatrist suggests electroconvulsive therapy (ECT) as a last resort.

Task:
Discuss ECT in the context of Zain’s treatment by addressing:

• How ECT works and when it is used.

• The potential benefits for Zain.

• Risks and ethical concerns associated with ECT.

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Answer (Key Points):

• How it works: Electric shock induces controlled seizure → alters brain chemistry, improves severe depression symptoms. Used when other treatments fail.

• Benefits: Rapid improvement, especially in treatment-resistant depression. May restore functioning and prevent suicide risk.

• Risks/Ethics: Short-term memory loss, possible cognitive side effects. Ethical issues: informed consent, balancing benefits vs. side effects. Requires strict medical supervision.

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Psychotherapy & Social Skills Training

Scenario:
Mariam, a 22-year-old university student, struggles with making friends. She avoids eye contact, interrupts people when speaking, and feels anxious in group discussions. She seeks therapy because she believes her poor social skills are affecting her ability to build relationships and succeed in her career.

Task:
Discuss how social skills training could be applied to Mariam’s case by addressing:

• The main techniques used in social skills training.

• How these techniques would improve Mariam’s interpersonal functioning.

• Why this approach may be effective in her long-term adjustment.

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Answer (Key Points):

• Techniques: Modeling (watching skilled peers), behavioral rehearsal (role-playing conversations), shaping (gradually practicing harder situations).

• Improvements: Builds confidence, teaches appropriate eye contact, listening, and turn-taking. Corrects maladaptive interaction habits.

• Effectiveness: Practical, structured learning helps Mariam succeed socially. Long-term → reduces anxiety, increases employability, enhances self-esteem.

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Abnormal Psychology & Comorbidity

Scenario:
Ravi, a 29-year-old man, is diagnosed with Major Depressive Disorder. During assessment, he also reports frequent panic attacks and avoidance of social situations. His psychiatrist explains that treating his depression alone may not be enough because he has more than one disorder at the same time.

Task:
Using the concept of comorbidity, explain:

• What comorbidity means in abnormal psychology.

• Why comorbidity is important in Ravi’s case.

• Challenges that comorbidity creates for diagnosis and treatment.

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Answer (Key Points):

• Definition: Presence of two or more disorders in the same individual (e.g., depression + anxiety).

• Importance for Ravi: Explains overlapping symptoms (low mood, avoidance). Treatment plan must address both conditions.

• Challenges: Harder to diagnose (symptoms overlap), treatment may require multiple approaches (medication + CBT), increases risk of chronic impairment.