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Psychological Theories and Psychiatric Models
for Human Growth and Development through the
Life Span
Introduction
The Psychological Theories and Psychiatric Models are
presented to study its implications to the human growth and
development through the life span. There are situations and
conditions in the study of human behavior that are reflective to the life
experiences. The psychological theories that are comprehensively
given to study its relationship to the human growth and development
are following: (1) Psychoanalytical Theory of Sigmund Freud; (2) Social
Theories; (3) Interpersonal theory; (4) Behavioral Theories; and (5)
Cognitive Theories and Therapy.
The Psychoanalytical Theory is reflected from the study of
Sigmund Freud to address the concern on behavior, social roles,
functioning, unconscious process and even on inner life experiences.
He proposed hypothetical structures in psychology such as the id, the
ego,and the superego- to explain his observation that behaviors are a
result of conflicts among the needs of the individual, the restriction of
the environment, and internalized moral values. Sigmund Freud
provides insights on the psychosexual theories that incorporate the
features and characteristics on growth and development along critical
experiences, developmental task, major characteristics and other
possible personality traits. The stages of psychosexual growth and
development are : 1) Oral Stage (birth-18 months) ; 2) Anal Stage ( 13
months -3 years) ; 3) Phallic (3-5 years) ; 4) Latency ( 6-12 years); 5)
Prepuberty and Adolescence (12-15 years); and 6) Genital ( 15 yearsadult).
On Social Theories reflect significant social interactions that
govern development milestones that influence adaptation across the
life span. These theories also focus on challenges and achievements of
each developmental stage and their impact on resolving the next
stage.It provides an understanding the various life experiences
including the various human responses across the life span and the
whole personality. The social theories included in the study of human
responses are 1) Erikson’s Psychosocial Theory which
presents
developmental stages and its implications on the area of conflict and
resolution, virtues or qualities, positive and negative behaviors,
including the identified institutions; and 2) Analytical Therapy ( Carl
Gustav Jung) on human psyche.
Interpersonal Social Theory emphasizes the importance of
social forces or what one does in relation to other rather than internal
or biological factors. Those who advocated the interpersonal social
theories are ; 1) Alfred Adler ; 2) Harry Stack Sullivan; and 3) Karen
Horny.On attachment theory of Bowlby and Ainsworth provides
discussion primarily the tie between a child and her caregiver as its
evolves the biological adaptive process including observable
attachment on the emotional and physiological development of infants
and children.
The behavioral theories assume a learning model of human
behavior that differs from the intrapsychic or disease model of mental
disorders. These theories are reflected on the works of1) B. F. Skinner
; and 2) A. Bandura and R.H. Walters A. Bandura and R.H. Walters.
The basic concepts of behavioral conditioning are also presented in
relation to stimulus, response, and reinforcement.
The last discussion provides information about the cognitive
theories that involve mental processes, such as thinking,
remembering, attending, planning, wishing, and fantasizing in relation
to self, others, and the future. The prominent proponents of this
theory are Aaron Beck and Albert Ellis . The Cognitive Therapy
addresses the person’s cognitive organization and structure, which are
biologically and socially influenced. Finally, cognitive development
provides the analysis between action and thought which this study
presents the ideas of Jean Piaget. There is also a part to study
cognitive development on the mental disorders on neurotransmitters
such as dopamine (DA), norepinephrine (NE), serotonin (5-HT), and
gama-amino-butyric acid (GABA).
A. Psychoanalytical Theory
Freud’s psychoanalytical theory addresses the relationship
among inner experiences, behavior, social roles, and functioning .This
theory proposes that conflicts among unconscious motivating forces
affect behavior. People usually do not like conflicts and therefore
develop certain structures in their mind, or ways of responding, to
maintain equilibrium and to keep conflicts from causing too much
discomfort.This defensive process id called repression.It is an
unconscious process that requires energy to keep conflicts out of the
realm of awareness, thus avoiding discomfort and pain. (Antai- Otong,
2003)
Antai-Otong (2003) explains the structure of personality on the
psychoanalytical theory that Freud proposed hypothetical structuresthe id, the ego,and the superego- to explain his observation that
behaviors are a result of conflicts among the needs of the individual,
the restriction of the environment, and internalized moral values:
1. The id represents psychological energy, or libido.
According to Freud,this energy is primarily a sexual and
aggressive drive. The id is the first structure to develop in
the personality, and it operates on the pleasure principle
to reduce tension. For example, a hungry infant reflexively
sucks to receive nourishment, thus reducing her hunger.
Id is also characterized by primary process thinking, a
mode of thought that is primarily imagery. It is irrational
and not bsed on reality. Hallucinations or psychotic
clients are examples of primary thinking.
2. The ego is the chief executive officer of the minde.It
mediates between the drives, forces, or conflicts of the id
and the superego, maintaining a reality orientation for the
person. It keeps the strong forces of the superego from
being extremely inhibitive, and the id from causing the
person to become overly exhibitionistic. The ego operates
on the reality principle and is characterized by secondary
process thinking, which is logically oriented in time and
distinguishes between reality and unreality. As much, it
provides a means of delaying gratification of needs.The
ego is partially under conscious control, whereas the id is
unconscious.
3. The superego has two main functions reward and
punishment. It is the superego that rewards moral
behavior and punishes actions that are no acceptable by
creating guilt. The superego is our conscience, a residue
of internalized values and moral training of early
childhood. An overly strict superego may lead to extremes
of guilt and anxiety. The ego manages the sexual
aggressive drives of the id, keeping it from being
destructive. When the ego cannot mediate against the
unconscious drives, anxiety results. Anxiety is warning to
the ego of an emerging danger. Repression is the first line
of defense against unacceptable, painful, and unwanted
memories.Repression is an unconscious process that
keeps unacceptable impulses, or drives, is not changed or
sublimated into something but into extra energy to keep
the drive out of the awareness and are defended against
in other ways.
Freud’s Stages of Psychosexual Growth and
(Freud, 1946)
Development
Sigmund Freud provides insights on the psychosexual theories
that incorporate the features and characteristics on growth and
development along critical experiences, developmental task, major
characteristics and other possible personality traits. The stages of
psychosexual growth and development are : 1) Oral Stage (birth-18
months) ; 2) Anal Stage ( 13 months -3 years) ; 3) Phallic (3-5 years) ;
4) Latency ( 6-12 years); 5) Prepuberty and Adolescence (12-15 years);
and 6) Genital ( 15 years- adult).
1. Oral Stage ( birth-18 months)
This development begins at birth, extending about
18 months. During this stage, stimulation of the
mouth, such as in sucking, biting and swallowing, is
the primary source of satisfaction. Not getting needs
met at this stage may produce problems with eating
and habits such as smoking and biting nails. A wide
range of adult behaviors, from excessive optimism to
sarcasm, cynicism, and pessimism, has been
attributed to problems during this stage. Fixation at
this stage is characterized by narcissism and
incorporation of loved objects . ( Fenichel, 1945)
Critical Experiences
Developmental Task
Major Characteristics
: Weaning
: Establishing trust
: Autoeroticism, narcissism,
omnipotence, pleasure
principle,
frustration and defense
Other Possible Personality Traits
: Fixation at the oral
stage is associated with ;
passivity, gullibility, and
dependence, the use of
sarcasm,
and
the
development
of
orally
focused habits.
2. Anal Stage ( 13 months -3 years)
During the anal stage sexual gratification
shifts to anus.This occurs during the period of toilet
training. The child is concerned with retaining and
letting go feces. Problems occurring in resolution of
this phase may result in rebelliousness and an
exaggerated need to be in control across the life
span. If the fixation is with retention or holding in,
the adult may be excessively neat,clean, and
compulsive. If ,however, expulsion is the problem,
the adult may be dirty, wasteful, and extravagant.
(Antai-Otong ,2003)
Critical Experiences
: Toilet training
Developmental Task
: Developing sphincter
control, self-control,
feeling of autonomy
Major Characteristics : Reality principle, fear of loss of
object love, approval and
disapproval, beginning
superego development
Other Possible Personality Traits
: Fixation associated
with anal retentiveness ( stinginess,
rigid thought patterns, obsessivecompulsive
disorder)
or
anal
expulsive
character
(messiness,
destructiveness ,cruelty)
3. Phallic (3-5 years)
During this stage, which occurs at the end of
the third or fourth year, erotic gratification shifts to
the genital region.The child becomes sexually
attracted to the parent of the opposite sex and fears
the parent of the same sex, who is now perceived as
the rival.The child overcomes this conflict by
identifying with the parent of the same sex. Object
love at this stage is ambivalent and may affect
object relations in adult life. (Antai-Otong ,2003)
Critical Experiences
: Oedipal conflict, castration
anxiety
Developmental Task
: Establishing sexual identity,
beginning socialization
Major Characteristics : Differentiation between sexes,
superego more
internalized
Other Possible Personality Traits
:Unresolved
outcomes may result in
difficulties
with
sexual
identity and with authority
figure.
4. Latency ( 6-12 years)
The early school-age years ( 6 to12 years )
constitute a period of quiescence Freud called
latency.The child begins to submit to the demands
of the superego and sublimate instincts. The way
the person handles he internal and external
demands, for better or for worse, becomes
consolidated during this time. (Antai-Otong ,2003)
Critical Experiences
: Peer group experience,
intellectual growth
Developmental Task
: Group Identification
Major Characteristics : Superego influence in erotic
interests, immense
intellectual development
Other Possible Personality Traits
: Fixation can result
in difficulty in identifying with others
and in developing social skills,
resulting in a sense of inadequacy
and inferiority.
5. Prepuberty and Adolescence (12-15 years)
This stage the critical experience establishes
heterosexual relationship. There is the development
of social control over instincts. The major
characteristics are identity, turmoil, consideration
of needs of others.
6. Genital ( 15 years- adult)
At the start of adolescence, the final stage, called
the genital stage, begins. Heteresexual behavior is
evident, and the person undertakes various
activities in preparation for marriage and family. .
(Antai-Otong ,2003)
Critical Experiences
Developmental Task
: Sexual maturity
: Resolving dependenceindependence conflict
Major Characteristics : Heterosexual relations
Other Possible Personality Traits
:
Inability
to
negotiate this stage could result in
difficulties in becoming emotionally and
financially independent, lack of strong
personal identity and future goals, and
inability to form satisfying intimate
relationships.
B. Social Theories
Social theories reflect significant social interactions that govern
development milestones that influence adaptation across the life
span.These theories also focus on challenges and achievements of
each developmental stage and their impact on resolving the next
stage. By understanding various human responses across the life
span and the whole personality. The social theories identified by
Antai- Otong ( 2003) are : 1) Erikson’s Psychosocial Theory; and 2)
Analytical Therapy ( Carl Gustav Jung).
1. Erikson’s Psychosocial Theory
It emphasizes the concept of identity or an inner sense of
sameness that perseveres despite external changes, identity
crises, and identity confusion in the dynamics of personality
development. Basically , these developmental stages consist
of a series of normative conflicts that every person must
handle. The two opposing energies .(developmental crisis)
must be synthesized in a constructive manner to produce
positive expectations for new experiences. If the crisis is
unresolved, the person does not develop attitudes that will be
helpful in meeting future developmental tasks. Failure to
resolve a challenge or conflict also results in negative
behavior or developmental problems. An opportunity to
resolve such conflicts recurs later in one’s life span. The
following are the developmental stages for the Erikson’s
Psychosocial Theory and its implications on the area of
conflict and resolution, virtues or qualities, positive and
negative behaviors, including the identified institutions
( Shives and Isaacs,2002)
a.
Sensory-Oral Early Infancy ( Birth to 18 months)
Area of Conflict and Resolution : Trust vs Mistrust – For
infant, trust is the faith that things will be “all right.” It
develops favorable ratio of trust to mistrust results in
hope.
Virtues or Qualities : Drive and Hope
Positive Behavior : Displays, affection, confidence,
gratification, recognition, and the ability to trust others.
Negative Behavior : Suspicious of others, fears affection,
projection
Institution : Religion
b. Muscular-Anal or Later Infancy ( 18 months- 3 years)
Area of Conflict and Resolution : Autonomy vs Shame and
Doubt – For toddler without self – control (autonomy) ,
children feel shame and doubt. A favorable ratio of
autonomy to shame- and- doubt results in self direction
with self-esteem.
Virtues or Qualities : Self Control and Willpower
Positive Behavior : Cooperative, expresses one-self, displays,
self-control, views set apart from parents
Negative Behavior : Self doubt, denial, dependency, low
esteem, loss of self- control.
Institution : Law and Order
c. Locomotor –Genital or Early Childhood ( 3-5 years)
Area of Conflict and Resolution : Initiative vs. Guilt – For
preschooler, initiative adds to autonomy the quality of
doing them. A sense of guilt is often experience over
things contemplated or actually done. A favorable ratio of
initiative to guilt results in a sense of purpose.
Virtues or Qualities : Direction and Purpose
Positive Behavior : Tests reality.Shows imagination, displays
some ability to evaluate own behavior, exerts positive
controls over self.
Negative Behavior : Excessive guilt feels victimized passive ,
apathetic
Institution : Education and Economic
d. Latency or Middle Child
Area of Conflict and Resolution : Industry vs. Inferiority
Virtues or Qualities : Method and Competence
Positive Behavior : Develops a sense of duty, and scholastic
and social competencies. Displays perseverance and
interacts with peers in a less infantile manner.
Negative Behavior : Feels inferior, lacks motivation,
uncooperative, incompetent, unreliable.
Institution : Technology
e. Puberty and Adolescence (12-18 years)
Area of Conflict and Resolution : Identity vs. Role Confusion
Virtues or Qualities : Devotion and Fidelity
Positive Behavior : Displays self-certainty, experiments with
role, expresses ideologic commitments, chooses a career
or vocation, and develops interpersonal relationships
Negative Behavior : Self-doubt, dysfunctional relationships,
rebellion, substance abuse
Institution : Ideology
f. Young Adulthood (19-40 years)
Area of Conflict and Resolution : Intimacy vs. Isolation
Virtues or Qualities : Affiliation and Love
Positive Behavior : Establishes mature relationship with a
member of the opposite sex, chooses a suitable marital
partner, performs work and social roles in socially
acceptable manner.
Negative Behavior : Self-imposed isolation, emotionally
jealous,possessive
Institution : Ethics
g. Middle Adulthood (41- 64 years)
Area of Conflict and Resolution : Generativity vs. Stagnation
Virtues or Qualities : Productivity and ability to care for others
Positive Behavior : Spends time wisely by engaging in helpful
activities such as counseling, community activities, and
volunteer work. Display creativity
Negative Behavior : Egocentric, disinterested in others,
overinvolved in activities
Institution : Generative succession
h. Late Adulthood or maturity ( 65 years to death)
Area of Conflict and Resolution : Ego Integrity vs. Despair
Virtues or Qualities : Renunciation or “ letting go,” and wisdom
Positive Behavior : Reviews life past realistically, accepts past
failures and limitations, helps members of younger
generations view life positively and realistically, accepts
death with dignity
Negative Behavior : Feels hopeless, helpless, fears death,
dwells
on past failures, disappointments, unable to adjust
to aging process
Institution : Unnamed
2. Analytical Therapy ( Carl Gustav Jung)
Jung’s approach, known as analytical therapy.Carl
Gustav Jung( pronounced “Yoong”) was , at one time,
considered by Freud to be his heir apparent.In 1907, Freud
wrote to Jung, “ I could hope for no one better than
yourself… to continue and complete my work”. Yet the
direction that Jung took with his analytical differed from
psychoanalysis in some very significant ways, and Freud’s
affection for Jung faded. These are the main differences on
their works (Morgan,et.al, 1986):
1.
He
thought
of
childhood
psychosexual
development to be nearly so important to adult
adjustment as Freud did.
2.
3.
He placed much less emphasis than Freud on
sexual and aggressive impulses arising from past
conflicts and much more emphasis on people’s
future-oriented goals, hopes ,and plans.
On the nature of the unconscious, Jung believed
to be part of the unconscious mind that went
beyond the personal experiences of the
individual.
The collective unconscious contains the universal
memories and history of all humans. It is that part of
unconscious material that is universal in humans, in
contrast with the personal unconscious that is determined
by individual personal experience. From his study ( AntaiOtong,2003)
Shive and Isaacs (2002) explained the view of Carl
Jung that the human psyche as consisting of a social mask
(persona),
hidden
personal
characteristics
( Shadow),feminine identification in men ( anima), masculine
identification in women ( animus), and innermost center of
the personality (self).
B. Interpersonal Social Theory
Interpersonal theorists emphasize the importance of social
forces or what one does in relation to other rather than internal or
biological factors. Theorists assert that the adult mental disorders
stem from impaired interpersonal relationships of childhood. Because
of the dynamics of interpersonal relationships, understanding these
concepts enables nurses to form healthy relationships with their
clients at various developmental stages and have an impact on the
clients ability to adapt to environmental stressors. According to AntaiOtong ( 2003) those who advocated the interpersonal social theories
are ; 1) Alfred Adler ; 2) Harry Stack Sullivan; and 3)Harry Stack
Sullivan.
1. Alfred Adler
Alfred Adler (Ansbacher & Ansbacher, 1956), another
psychoanalyst, departed from Freudian theory by emphasizing the
conscious as the core of personality. He believed that one’s social
environments shape personality and interactions and that people
actively guide their own growth and development. Adler proposed that
inferiority feelings are the stimulus for growth, but that inferiority
complex prevents people from solving life’s problems. An inferiority
complex is an exaggeration of feelings of inadequacy and insecurity
resulting in defensiveness and neurotic behavior. Feelings of
inferiority arise from being biologically inferior, by being spoiled and
then rejected, or by being neglected. When people strive for
improvement, superiority, or perfection, tension increases, and more
and more energy is expended. Each person creates a unique pattern of
striving for superiority that is learned from early parents-child
interactions.
According to Adler, al people must solve three categories of
problems during their lifetime: problems involving behavior toward
others, problems of occupation, and problems of love. He described
four basic styles that people use in working through these problems:
avoiding, expecting to get everything from others, dominating others,
and cooperating with others. Healthy people are characterized by selfreliance and cooperatively working others within the culture.
2. Harry Stack Sullivan
Harry Stack Sullivan (1940) studied traditional psychoanalysis
but focused on interpersonal relationships instead of on the
unconscious. He believed that cultural environment greatly shapes
personality and that personality development does not end at 5 years
of age but continues until young adulthood. Sullivan extended the
description of personality development through stages. He emphasized
the importance this progresses through adolescence. He called this
development of the self-system personification. Personification
includes all related attitudes, feelings, and concepts about oneself or
another acquired from extensive experience. The persona is what one
is talking about when one refers to “I” or “me”. The development of the
persona begins in infancy with perceiving the mother as good or bad.
As the self begins to differentiate, the infant comes to perceive the
mother as both good and bad.
The persona, or self-concept, begins with idea of “good me,”
“bad me, and “not me.” The good me is perceived when the mother is
rewarding the infant. The bad me arises in response to the negative
experiences with the mother. The “not me” arises out of extreme
anxiety that the child rejects as part of the self. As development
proceeds, the child integrates these personas into a realistic view of
self.
Sullivan emphasized the importance of peers and reciprocal
relationships to the developing child and adolescent. When a child
learns patterns of responding that hinder interpersonal relationships
and cause other to respond negatively, she experiences intense
anxiety that further interferes with social relationships. These ways of
responding are primarily communication patterns. Sullivanb (1971)
believed that if communication patterns between individuals, groups
and nations could be changed, then each of those entities could be
changed.
3. Karen Horney
Karen Horney’s (1937) key concept was that of basic anxiety,
the feelings of isolation and helplessness in a potentially hostile world.
Because people are dependent on each other, she believed, they often
find themselves in a state of anxiety conflict when others do not treat
them well. Insecure, anxious children develop personality patterns to
help them cope with their feelings of isolation and helplessness. They
may become too submissive, or they may become selfish and selfpitying as a way of gaining attention or sympathy.
In
general,
people relate to each other in one of three ways. (1) they can move
toward others, seeking love, support, and cooperation; (2) they can
move away from others trying to be independent and self-sufficient; or
(3) they can move against others, being competitive, critical, and
domineering . Ideally, the healthy personality balances all three
orientations. Problems arise when people become locked into only one
mode; too weak-willed and self-denying, afraid to offend another; too
independent, afraid to admit dependency; or too hostile, afraid to
express affection.
C. Attachment Theory
Attachment has become a classic term for the primary tie
between a child and his or her caregiver and a process seen as
evolving and biologically adaptive and critical to emotional and
physiological development and survival. Attachment is readily
observable when an infant is separated from the primary caregiver
because the child pretests and tries to reestablish contact with this
individual.
John Bowlby and Mary Ainsworth have made significant
contributions to the study and definition of attachment theory.
Findings from contemporary studies continue to support their earlier
findings. These data validate the significance of early caregiving and
its lifelong impact on one’s perception of self and others. (AntaiOtong, 2003)
1. John Bowby
John Bowbly expanded the works of Anna Freud and others
from a study involving a hospitalized 2-years-old and documentation
of the child’s separation reactions form care-givers. Bowlby’s (1969)
later work delineated the predictable patterns of behaviors of infants
and young children during and following their stay for designated
periods in nurseries or hospital units, he postulated that children who
experience healthy and protected relationships with their mother
exhibit predictable. phases of behaviors during normal separations.
As a result of his early work, Bowlby (1969; 1973) believed that
the interaction between the infant’s helplessness. He postulated that
the helplessness infant maintains intimacy with the primary caregiver
by means of emotional and behavioral responses referred to as the
attachment system, theoretically,the attachment system is instinctual
or motivational and, like hunger and thirst, integrates the infant’s
memory processes, prompting the child to satisfy them by interacting
with the mother. Infant behaviors, such as crying, angers, and pain,
usually signal distress, whereas smiling, vocalizing, reaching and
looking, strengthen attachment. These behaviors elicit various
responses in the caregiver, including a calming voice, rocking and
holding and comforting, and further reinforce the child-parent
attachment. The attachment system plays a vital role in survival by
allowing the infant’s undeveloped brain to use the caregivers
developed or mature functions to regulate her life process. The
caregiver’s emotional responsiveness to the infant’s emotional and
behavioral demands or signals governs the maturity of the attachment
system. The amount of time spent with early caregivers is less
significant that the quality if time and interactions between child and
caregiver. The level of distress, manifested as anxiety, arising from
separations parallels the child development stage and distinct
attachment phase.
Bowbly (1969) described separation anxiety as a predictable
process involving several stages: protest, despair, and detachment.
Situations that interfere with closeness of the attachment (mother or
other caregiver) produce anxiety, anger, and protest. Protest behaviors
are thought to have adaptive properties and reflect the infant’s
attempt to restore closeness with the caregiver. Examples of protest
behaviors include increasing anxiety, crying, clinging throwing self
down, and searching. The child’s ability to modulate anxiety depends
on the mother or caregiver’s ability to modulate anxiety or fear.
Normally, when the mother calms the child through holding, smiling,
rocking, or other comforting behaviors, the child gains a sense of
comfort and security. In contrast, prolonged separation produces
despair, and the infant’s response moves from anxiety and anger to
despondency. If the child’s anxiety or fears persist because of the
caregiver’s inability to provide comfort and reduce anxiety and fear,
attachment disturbances are likely to ensue. Common manifestations
of despair include sadness, helplessness, and a sense of hopelessness,
which the caregiver will return. In addition, the infant’s energy
declines and she becomes socially isolative. Unlike the adaptive
qualities of protest, despair is thought to play a role in passive
survival by conserving energy and resulting in withdrawal form
danger. Detachment behaviors are similar to despair in that the child
appears listless, is apathetic, and socially isolates and withdraws from
the caregiver even when she returns. The latter two contribute to
attachment disturbances, including various anxiety disorders,
difficulty forming trusting relationships, and low self-esteem.
Bowbly (1969) theory indicates that early interactions play key
roles in how an individual perceives herself and others, and how she
modulates or copes with anxiety throughout the life span. The infant
internalizes early child caregivers experiences and forms cognitive
models or schemata that resolve if the person deserves care (selfperception) and whether others are reliable providers of care
(perception of others). Early child-caregiver interactions or
attachments shape one’s perceptions of self and others and the
quality of relationships throughout the life span.
2. Mary Ainstworth
Mary Ainsworth’s research extended and clarified Bowbly’s
theory and revolutionized developmental research. Her systematic
study of infant-caregiver attachment behaviors by means of the
Strange Situation protocol has provided an empirical template for
delineating and measuring Bowbly’s attachment theory. This
templates splurged a plethora of clinical and scholarly contributions
that transformed researchers’ and clinicians’ perception of early childparent interactions. These first relationships make a greater impact on
an individual than was once thought and reflect the continuous need
and capacity of infants for secure attachment.
The strange situation protocol focused on assessing the quality
and security of the infant’s attachment. It involved a series of brief
and security of the infant’s attachment. It involved a series of brief
stress-inducing laboratory sequences that began with the mother and
infant in a strange room with toys, and evolve through a series of
diverse situations, each lasting less than 3 minutes. A series involved
the stranger, and the mother eventually returning. The infant’s
behavior was then rated as a function of her avoidant, enthusiastic, or
varied responses to the mother’s return. Ainsworth’s findings revealed
diverse reactions form the infant and confirmed that attachment
modulates anxiety and serves as a secure base. Overall, ainsworth’s
theory supports the importance of attachment and its anxiety
reducing qualities in helping children separate effectively from
primary caregivers and subsequent self-regulation of internal and
external stressors across the life span.
D. Behavioral Theories
Behavioral theories do not address the unconscious or the selfconcept as do the psychosocial theories of personality. In behavioral
theories the emphasis is on the behaviors of the person. These
theories assume a learning model of human behavior that differs from
the intrapsychic or disease model of mental disorders. Behaviors, both
adaptive and maldaptive, are most likely learned.
Differences in human behavior are accounted for by the
experiences in the person’s life that initiative a response. The human
being is like a machine that operates according to fixed laws. Behavior
can be controlled by the kind and extent of reinforcement that follows
a particular behavior. A behavior that is reinforced will likely be
repeated. A person is best understood by observing what he or she
does in a particular situation. The prominent behavioral theories
identified by Antai- Otong ( 2003) are ; 1) B. F. Skinner ; and 2) A.
Bandura and R.H. Walters A. Bandura and R.H. Walters. The basic
concepts of behavioral conditioning are also presented in relation to
stimulus, response, and reinforcement.
1. B.F. Skinner
B. F. Skinner (1953), a prominent behavioral theories in
America, identified two types of behavior: respondent and operant.
Respondent behavior occur when a known and specific stimulus
elicits a response. They can be simple, as in a reflex action, or learne,
such as those behaviors involved in conditioning. Operant behaviors
are those that obtain a response or reinforcement from the
environment of from another person.
All aspects of behavior are controlled through reinforcement;
therefore, a person is a product of past reinforcements. Past
experience are important only to the degree that they are still active in
directly contributing to the client’s present distress. For example, a
toddler who falls down the steps may have a lifelong fear of going up a
flight of stairs or may develop a fear of heights.
Some psychologists trained in the behavioral school began to
believe that behavior was not merely the product of environmental
stimuli. In the social learning approach, cognitive processes mediate
the influence of environmental events on behavior by determining
what stimuli are attended to, perceived, and interpreted. Rotter (1954)
added the belief that the likehood of a particular behavior occurring is
influenced by the person’s expectancy that the behavior will lead to
goal attainment and the values attached to these goals. In other
words, people generally choose actions that they expect will lead to
valued goals. For instance, the toddler who fell down the steps, may
choose not to go when confronted with a flight of stairs because she
does not want to feel anxious.
2. A. Bandura and R.H. Walters
Bandura and Walters (1963) placed emphasis on the role of
modeling in learning behaviors. Many social response and personality
characteristics are acquired simply by imitating or coping with the
behavior of the models one observes. Modeling typically involves a
social situation and a social relationship (the model and the imitator).
The model can be an actual person, a film, or a cartoon
representation. Modeling, or imitation, can produce repid acquisition
of social behaviors. Learning does not require direct, or external,
reinforcement of imitated behavior. The person merely “tries on” the
behavior.
Bandura (1977) also emphasized the importance of internal
reinforcement. A person is a able to reinforce his or her own behaviors
that have a sense of self-efficacy. Self-efficacy refers to the expectation
that one can effectively cope with and master situations such as
addictions, and achieve the desired outcomes through one’s own
personal efforts. This model offers high-risk groups a range of coping
responses that often lead to relapse. The major appeal of this model is
its emphasis on the client’s self-efficacy, hope, and optimism.
The primary goal of self-efficiency is to encourage or persuade
the client that he or she has the capacity to make adaptive behavioral
changes in an identified problem are for example, the client with
schizophrenia who has just found out that he is going to lose his job
may experience overwhelming anxiety and subsequently give up and
stop taking prescribed medications and have relapse. The nurse can
use the self-efficacy model to encourage the client to explore options
to manage his or her anxiety, through either supportive therapy or
anxiety-reducing relapse. The success of this model stems from the
client’s motivation to change maldaptive coping behaviors and develop
adaptive coping skills. This behavior can be positively reinforced with
each successful resolution of a crisis or overwhelming situation and
be used to facilitate adaptive behavioral changes.
3. Conditioning
Basic concepts of behavioral theories derive from stimulus,
response, and reinforcement. In classic conditioning. The
reinforcement is the presenting stimulus that causes the response. If
a neutral stimulus repeatedly, the neutral stimulus is paired with the
reinforcing stimulus repeatedly, the neutral stimulus will become a
reinforcing stimulus producing the same response. The original
stimulus is called the unconditioned stimulus, and the original
stimulus is called the unconditioned stimulus, and the original
response becomes the unconditioned response. The neutral stimulus
becomes the conditioned response. And the response then becomes
the conditioned response. An example of classic conditioning is
Pavlov’s experiment with dogs. The dogs learned to salivate at the
sound of a tone that had been previously presented at the same time
as meat powder on the tongue.
Operant conditioning occurs when behavior is produced without
an observable external stimulus. The person’s response is seemingly
spontaneous in that it is not related to any unknown observable
stimulus. Operant behavior operates on the persons environment,
resulting in a reward. An example is the bell that rings when a person
fails to buckle the seat belt. The person puts on the seat belt, and the
bell stops ringing. The operant behavior is the act of putting on the
seat belt in expectation of a reward. The reinforcement occurs when
the bell stops ringing. This is also an example of negative
reinforcement. The response in classic conditioning does not operate
on the environment, and the reinforcement comes before instead of
after the response.
When a person’s behavior is rewarded, the behavior will likely
be repeated. Behaviors is strengthened by positive and negative
reinforcement; it is weakened by punishment. Positive reinforcement
refers to an increase in the frequency of a response followed by a
favorable event. Negative reinforcement refers to an increase in
behavior as a result of avoiding or escaping from an aversive event
that one would have expected to occur had the escape behavior not
been emitted. Punishment is an aversive event contingent on a
response. The result is a decrease in the frequency of that response.
Exiction refers to the cessation or removal of a response.
To learn new behaviors, reinforcement of animal studies may be
presented in several ways. The behavior can be rewarded each time
the behavior occurs, at fixed intervals, or at a fixed ratio. None of
these is what actually happens. realistically, rewards are random and
are the most potent form of reinforcement. The shorter the interval
between reinforcement, the more rapidly animals will respond.
Conversely, as the interval between reinforcement gets longer, the rate
of animal response decreases.
The frequency of reinforcement affects the extinguishing of a
response. Behaviors are extinguished more frequently when they are
reinforced continuously and the reinforcement is then stopped when
reinforced intermittently. Animals of a fixed-ratio schedule respond
much faster than those on a fixed-interval schedule. Responding
faster on fixed –interval reinforcement does not make any difference;
for example, the animal presses the bar for food 5 times or 50 times
and it will still be reinforced only when the predetermined interval has
passed.
A fixed-ratio schedule of payment is used in industry in
situations when a worker’s pay depends on the number of units
produced, or the salesperson’s commission depends on the number of
items sold. This reinforcement schedule is effective as long as the ratio
is not set too high and the reinforcement is worth the effort. Other
reinforcement schedule include variable rations, variable intervals,
and mixed schedules.
E. Cognitive Theories
The foundation of cognitive theories involve mental
processes, such as thinking, remembering, attending, planning,
wishing, and fantasizing in relation to self, others, and the future. The
person’s perceptions and interpretations influence subsequent
biological and behavioral responses. Predictably, if the person
consistently misinterprets or over generalizes an event, emotional and
physiological distress and maladaptation are likely to occur and
require interventions that restore homeostasis. Antai- Otong (2003)
identified the proponents of cognitive theories, these are Aaron Beck
and Albert Ellis .
1. Aaron Beck
Aaron Beck (1991) is on of the foremost proponents of cognitive
psychology. Cognitive theories emphasize the mental processes
involved in knowing. The field looks at how people direct their
attention, perceive, think, remember, solve problems, forms mental
images, and arrive at beliefs. Cognitive researchers study how people
explain their own behavior, understand a sentence, do arithmetic,
solve intellectual problems, reason, form opinions, and remember
events. These mental; processes determine, to great extent, emotional,
behavioral, and physiological responses.
A basic assumption of cognitive theories is that schemata shape
personality. Schemata are cognitive structures, or patterns, that
consist of a person’s beliefs, values, and assumptions. Schemata are
cognitive structures, or pattern’s, that consist of a person’s beliefs,
values, and assumptions. Schemata develop early in life from personal
experiences, and become active in response to stressful situations.
Schemata influence people to interpret certain life situations in a
biased or distorted way. The content of cognitive processing is
determined starting with preferential selection of data to which the
person attends, through the evaluation, interpretation, and recall from
short-term memory, activated by schemata, or biases. These schemata
even influence retrieval from long-term memory. According t this
theory, these cognitive distortions produce the symptoms of various
psychological disturbances and mediate physiological responses that
contribute to anxiety disorders and mood disorders. Clients with
cognition themes of loss or defeat are likely to be depressed. A client
with an anxiety disorder interprets situations as dangerous. In
paranoid conditions, the person selectively interprets themes of abuse
or interference. Exaggerated interpretations of personal gain
characterize the client with mania. Beck identifies six comon cognitive
distortions that result in maladaptive behaviors.
2. Albert Ellis
Albert Ellis (1984, 1985) called his cognitive theory rational
emotive therapy (RET). He believed that irrational thoughts cause
maladaptive behavior and emotional distress. He explained his theory
using the acronym ABC. An activating event or situation arises that is
threatening to the person. Because the person has a certain belief, an
emotional response or consequence occurs. RET modifies the
underlying irrational beliefs to change the emotional consequence.
Back and Ellis disagree on certain issues. Beck views the
cognition as maladaptive rather than irrational. Ellis believes that
irrational belief causes the maladaptive behaviors, whereas Beck
believes that cognitions are symptoms of, rather than cause of, the
disorders. The activation of the schemata is the mechanism, and not
the cause, by which the depression or anxiety or aggression develops.
Biological, genetic, stress, and personality factors combine to
predispose people to various mental disorders.
Therapy helps the person recognize the connections among
cognition, affect, and behaviors. Reality-oriented interpretations for
the distorted cognition are substituted for the distorted thoughts. This
requires identifying and altering the maladaptive beliefs that
predispose one to distorted experiences and distress. Excessive
maladaptive behavior and distressing emotions found in diverse
mental disorders are exaggerations of normal adaptive processes.
3. Cognitive Therapy
Cognitive therapy addresses the person’s cognitive organization
and structure, which are biologically and socially influenced. Therapy
helps modify assumptions that maintain maladaptive behaviors,
distortion in logic, and systematic distortions in thinking. The
therapist and the client together construct “counters,” to the cognitive
distortions. A counter is a statement that counteracts or negates the
thought. Clients are often asked to challenge these distortions by
questioning their bases and practicality. This theory does not yet
identify the factors that produce a shift in information processing to
the negative and what factors maintain the shift.
Research over three past 40 years supports aspects of the
theory. Studies’ outcomes support the effectiveness of the therapy in
the outpatient treatment of unipolar depression, anxiety disorders,
and panic disorder (Bryant & Harvey, 200). In the past twp decades,
the efficacy of cognitive therapy for the treatment of major depression
has been extensively studied in more than 80 controlled trials. Some
meta-analyticals studies have quantified the effectiveness of cognitive
thearapy (Dobson, 1989; Gaffan, Tsaousis & Kemp-Wheeler, 19956;
DeRubeis, Gelfand, Tang, & Simos, 1999). The national Institute of
Mental Health’s collaborative study of the treatment of depression has
shown the superiority of cognitive therapy in depression has shown
the superiority of cognitive therapy in comparison to antidepressant
drugs and interpersonal therapy (Elkinet a1., 1989) Shea et a1.,
1990). Other studies showed the efficacy of the therapy in treating
anxiety disorders. (Antai- Otong, 2003)
4. Jean Piaget
Cognitive theories also address human development. Whereas
the psychoanalytical theorists addressed psychosexual development
and Erickson Described social development, Jean Piaget proposed a
sequence of cognitive development that emphasized the relationship
between action and thought. Piaget began his research on children in
the early 1920’s. He studied the responses of children and young
people to various tasks concerning physical phenomena. Piaget and
his coworkers developed a theory of reasoning based on these
responses. They identified stages that are characterized by distinctive
features in the patterns of a person’s reasoning. Piaget and his
coworkers developed a theory of reasoning based on these reponses.
They identified stages that are characterized by distinctive features in
the patterns of a person’s reasoning. Piaget proposed that each stage
serves as a precursor to all succeeding stages so that reasoning
develops sequentially, always from the less effective to the more
effective stage. This progression Is not necessarily at the same rate for
every person, and people do not progress through the stages
exhibiting all the reasoning characteristics of a particular stage.
Reasoning develops gradually, at a particular time showing the
features of age 1 on some problems, while exhibiting certain features
of stage 2 on others. The stage concept is more useful in classifying
reasoning patterns than for describing the overall intellectual behavior
of a particular person at a given time. (Antai- Otong, 2003)
F. Neuroscience
Studies of brain function in persons with mental disorders
indicate that there are abnormalities in the amount of
neurotransmitters produced or that are available to the receptor sites.
Normally,
neurons
communicate
through
neurotransmitters
synthesized at the end of the axon. As the electrical mitter substance
is released into the synaptic cleft. Receptor sites on the receiving
neuron pick up the neurotransmitter substance that, in turn, causes
the receiving neuron to activate. One enzymes deactivate the
neurotransmitter chemicals involved are key elements in
understanding the medications used to treat mental illness and their
effect on the transmitters at receptor sites to alleviate symptoms.
Four important neurotransmitters are dopamine (DA),
norepinephrine (NE), serotonin (5-HT), and gama-amino-butyric acid
(GABA). The neurochemicals are synthesized in the zxon terminal,
where they are released. (Antai- Otong, 2003)
1. DOPAMINE
Dopamine (DA) is primarily responsible for the motor movement,
sensory integration, and emotional behavior. Dopamine is metabolized
by monoamine oxidase (MAO). A plethora of dopamine receptors
exists, including at least five with pharmacologic significance
including (D1, D2, D3, D4 and D5). Each D receptor carries out
different degree of stimulation or inhibition of the postsynaptic
response. D4 receptors have a greater affinity for “atypical
antipsychotic agents.” Hyperactivity of the dopaminergic system is
implicated in schizophrenia and mania, whereas hypoactive dopamine
systems are believed to contribute to depression and Parkinson’s
disease. Likewise, dopamine plays a major role in addiction because
drugs, such as cocaine, opiates, and alcohol, increase the amount of
dopamine to act on D2 receptors and stimulate the reward system in
brain.
2.NOREPINEPHRINE
Norepinephrine (Ne) I also known as noradrenaline. It is closely
related to its precursor DA and is secreted primarily by noradrenergic
neurons in the locus ceruleus in the pons, limbic system, amygdala,
thalamus, and hypothalamus. NE is the precursor to adrenaline, the
main ingredient in the sympathetic “fight or flight” response to a real
or perceived threat. Two classes of noradrenergic receptors exist to
mediate different postsynaptic responses to NE release. NE
transmission and reuptake are impaired in a variety of mental illness,
bnut primarily in the anxiety and substance-related disorders.
3.SEROTONIN
Serotonergic neuron cell bodies are located in the upper pons
raphe nuclei. These neurons project to the basal ganglia, the limbic
system, and the cerebral cortex. They modulate wakefulness and
alertness and are known to influence the transmission of sensory of
pain, mood disorders, anxiety, aggression, and schizoaffective
disorders.
4.GAMMA-AMINOBUTYRIC ACID
Gamma-aminobutryic
acid
(GABA)
is
an
inhibitory
nuerotransmitter that sreves as the brain’s modulator. GABA receptor
throughout the brain counteact the effects if the excitatory
nuerotransmitter NE and DA preventing disorganized and frenzied
responses to stimuli and dampening emotional arousal. A person with
low levels of GABA or fewer GABA receptors is more vulnerable to
anxiety disorders or panic symptoms.
5. PSYCHOPHARMACOLOGIC AGENTS AND
NEUROTRANSMITTERS
Psychopharmalogic agents are prescribed to manipulate the
processes of neutransmitter production and absorption reestablish
“normal” neurochemical balance. Foristance, antidepressants increase
the amount of NE and serotonin I the synaptic cleft. The selective
serotonin reuptake inhibitors (SSRIs) prevent the reuptake of
serotonin, thus leaving substance in the synaptic cleft to activate
other neurons. Major side effects of SSRIs include restlessness, sexual
disturbance, and insomnia. The selective serotonon norepinephrine
reuptake inhibitor (SNRI), venlafaxine, is used in major depressive
disorders and generalized anxiety disorder. Interestingly, this drug
acts as a serotonin inhibitor in low doses; NE reuptake inhibitor in
moderate doses, and inhibitor of DA reuptake at high doses. These
newer agents have complex properties and are likely to selectively
target symptoms of major depression and anxiety than older
antidepressant medication.
REFERENCES
Antai-Otong, Debrah ( 2003) Psychiatric Nursing: Biological and
Behavioral Concepts. Veterans Administration North Texas
Health Care System. Dallas, Texas. Delmar, A division of
Thomas Learning.
Bandura, A. (1986). Social Foundations of Thought and Action: A
Social-Cognitive Theory. Upper Saddle River, NJ: PrenticeHall.
Bandura, A. (1997). Self-efficacy: The Exercise of Control. New York:
W. H. Freeman.
Fenichel, O. (1945) . The Psychoanalytic Theory of Neurosis. New
York:W.W. Norton.
Morgan, Clifford et.al. ( 1986) Introduction to Psychology, 7th
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Shives, Louise Rebraca and Isaacs Ann (2002 Psychology5th
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Sullivan, H. S. (1968). The Interpersonal Theory of Psychiatry. New
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