Abnormal Psychology – Paradigms & Integrative Approaches

Why Paradigms?

Paradigms can be thought of as theoretical approaches with underlying beliefs and assumptions at the root of a specific phenomenon.  Paradigms thus become a foundation by which science can begin to investigate the workings of the phenomenon and validity of the mechanics by which the paradigm is believed to utilize.

Because a paradigm makes key assumptions of the mechanics by which a phenomenon exists, there is inevitable bias.  How we come to assume that the mechanics of a phenomenon operate influences the data collected and its interpretation.  Thus, it would be arguably favourable to explore phenomenon from multiple paradigms as well as have multiple paradigms critique the underlying assumptions of other paradigms.

Biological Paradigm

The biological paradigm builds off of the somatogenic hypothesis (a perspective that mental states and disorders are symptoms of bodily processes).  Thus the key perspective is that biological processes are the cause of abnormal behaviour.  This is also known as the medical model or disease model.

Behaviour Genetics

Behaviour genetics looks to the human genome, and how variances in genes can be attributed to abnormal behaviour.  To examine the genome there are two concepts that are important to consider.  The genotype is an individual’s unobservable genetic makeup (genome).  This is distinguished from the phenotype, which is the individual’s collection of observable experience (such as behavioural characteristics or subjective experiences of symptoms).  It should be noted that throughout the lifespan, various genes can be switched on or off to control physical development and environment.  Thus, the phenotype is a product of an interaction between the individual’s genotype and their environment.

With behavioural genetics, it is important to note that while genotypes of disorders can be inherited,  it does not mean that the phenotypic behaviours will occur.  It depends on the environment whether or not the disorder would emerge.  Thus, a predisposition to a disorder, a diathesis, is all that one could accurately examine as being heritable.

To research a diathesis, the family method can look at predispositions as the likelihood of shared genes amongst blood relatives is known.  In family method research there is a need to have an individual who bears the diagnosis in question.  These individuals are referred to as the index cases or probands in the investigation.  The further the degree of relation (first-degree relatives sharing 50% of the genetic makeup, second-degree sharing 25% of the genetic makeup, etc.) the less the likelihood of the diathesis emerging as a phenotype of the disorder in question would be expected.

The twin method by which identical twins (monozygotic) or fraternal twins (dizygotic) twins are compared, monozygotic twins, the concordance (the extent by which predisposition is inherited) would be expected to be higher in monozygotic twins.  Differences in monozygotic twins can reflect differences in life experiences that influence the epigenetics and their role in gene expression throughout human development.  One of the assumptions used in twin studies is the equal environment assumption, which assumes that the environments experienced in monozygotic and dizygotic twin studies are not consequential to the concordance, as the twins are believed to have the same experiences within their studied pair.

The equal environment assumption can be contrasted to the adoptee method, in which the children are adopted and reared apart from their parents.  Documentaries such as “Three Identical Strangers” can highlight the experimental design as well as ethical dilemmas of such studies.

Molecular Genetics

Molecular genetics goes another degree deeper than behavioural genetics and tries to identify the specific gene(s) involved in the phenotype of the disorder.  It also seeks to identify the functions of the involved gene(s).  Of specific interest to molecular genetics are alleles, which are multiple genetic codings that can occupy the same location/position on a chromosome.  The entire collection of an individual’s alleles makes up their genotype.

Genetic polymorphism at a macro level looks at the gene diversity of a species as a whole.  It includes variances in DNA sequences of individuals within the same habitat, as well as naturally occurring gene mutations within the population.

An analysis method in which researchers study a family with a high concentration of a disorder is referred to as linkage analysis.  Blood samples are typically taken to then study the inheritance pattern or characteristics, where the genes are fully understood (usually referred to as genetic markers).  This area of genetic-behaviour research often hypothesizes gene-environment interactions – linking disorders and symptoms as a joint product of genetic vulnerability to conditions and environmental experiences.  While this area of inquiry plays a role in qualifying the potential influences of genetic factors, it also runs the risk of creating or strengthening a discourse that illness and mental illness are predetermined and absent of influences present in other contexts.  The medical model’s “biology is destiny” runs the risk of downplaying the role of lifestyle and environmental influences on mental health.

Temperament Genetics

Temperment can be conceptualized as variability in the degree of reactivity one has in self-regulation, and how genetics play a role in predetermined predispositions.  This is based of the idea that attributes are detectable shortly after birth.  Self-regulation can be categorized into forms of behaviour expression (how one responds to environmental circumstances that would elicit a response).  For children, there are three general types that are conceptualized.  They are:

1. The difficult child
2. The easy child
3. The hard-to-warm-up child (more reserved)

Work by Robins, John, Caspi, & Moffitt (1996) identified 3 categories in their research.  They are:

1. The resilient type: These children cope well with adversity
2. The overcontrolling type: These children are more overtly inhibited and prone to distress.
3. The undercontrolling type: These children are more prone to acting out and using aggressive behaviours.

What was found in this study was that behaviours/attributes were associated with the categories.  Some of the behaviours/attributes include:

1. The resilient type: Associated with high adaptability and functioning
2. The overcontrolling type: Associated with shyness, loneliness, moderate school performance and self-esteem
3. The undercontrolling type: Associated with delinquency, problem externalization, school conduct difficulties, and lower school performance

*It is noteworthy that this research appears to be done on adolescent boys, so it is unclear how the environment or other extraneous variables come into play.

Neuroscience & Biochemistry

Neuroscience is an area of study focused on the brain and nervous system.  In studying the neuron there are 4 components that can be studied.  They include:

1. The cell body.
2. Dendrites (receiving neuron impulses to the cell).
3. Axons (sending neuron impulses to other cells).
4. Terminal buttons (the ends of neurons that send neurotransmitters to other cells to transmit a nerve impulse – the change in electric potential of the cell).

At the synapse (the space between the preceding terminal buttons of a preceding neuron and dendrites of another neuron), neurotransmitters are emitted to the post-synaptic cell to be received by receptor sites on the post-synaptic cell.  The post-synaptic cell integrates a multitude of signals that influence an action potential.  Excitatory impulses create a nerve impulse post-synaptic cell, while inhibitory decreases the likelihood of a nerve impulse.  Inhibitory neurotransmitters act as mood stabilizers or balancers, while excitatory stimulate the brain.

Remaining neurotransmitters in the synapse can be broken down by enzymes and be returned to the presynaptic cell through the process of reuptake.

Key neurotransmitters that can influence behaviour include:

• Norepinephrine: used in the peripheral nervous system, this neurotransmitter is involved in arousal and involved in anxiety disorders.
• Serotonin: Common neurotransmitter in the brain.  It may be involved in depression.
• Dopamine: Another common neurotransmitter in the brain.  It may be involved with schizophrenia.
• GABA: Another common brain neurotransmitter that can inhibit some nerve impulses and insufficient amounts can be implicated in anxiety disorders.

These neurotransmitters are produced in neurons from amino acids.  The ability to synthesize in a controlled environment as well as carry out reuptake of excess neurotransmitters in the synapse is important in carrying out nerve impulses.

Too many or too few receptors on the post-synaptic neuron influence the ability of the post-synaptic neuron to properly receive a signal to create an action potential.  These impacts can be akin to too many or too few neurotransmitters being released from the presynaptic neuron.  Neurons can self-adjust through upregulation (the creation of more receptor sites for a neurotransmitter) or downregulation (the reduction in the number of receptor sites for a neurotransmitter).

Biological Interventions

Many interventions within the biological sphere are not derived from a precise understanding of how the intervention works.  One of the concerns that arise from this is the increased use of psychoactive drugs in children and adolescents.  When looking at a macro level, differences in world regions may provide considerations for how mental illness is a social construct.  For example, the increased use of psychotropic medications in America over Europe is one example.

Deep brain stimulation is another option in treating abnormal behaviours.  Electrodes sending impulses from batteries are placed in the brain to deliver low-level electrical impulses.  While it may prove to be an effective treatment for treatment-resistant depression, the mechanisms by which it alters behaviour is not yet fully understood.  Deep brain stimulation may be an effective treatment of specific areas of the brain are identified as having a role in the subjective experience of mental illness.  Such an example would be the stimulation of subgenual cingulate.  However, randomized control studies of deep brain stimulation are not conclusive in their results.

As diagnostic imaging technology improves, more clarity of the region(s) of the brain involved in abnormal behaviour and the connections between the regions will emerge.

Summary

One of the primary concerns of the biological paradigm is reductionism, the belief that abnormal behaviour can be reduced to its most basic elements.  When it comes to the brain, the whole is greater than the sum of its parts, and the interplay between multiple levels of the human experience needs to be factored into our understanding of behaviour.

Cognitive-Behavioural Paradigm

The behavioural paradigm, consisting of learning, was combined with the cognitive paradigm to create what is now the cognitive-behavioural paradigm.  Cognitive-behavioural, along with the remaining paradigms increase the emphasis on the role of social factors, including socio-cultural considerations on the internal psychological process.  Behaviouralism rose as a response to introspection (a client’s “looking within” and having clients describing their own subjective experiences as stimuli change), by focusing on the observable behaviour of a client over consciousness.

Classical Conditioning

The classical conditioning of Pavlov provided several key concepts that can be used to understand behaviour.  First is the unconditioned stimulus (UCS), which can be thought of as a stimulus that has not yet been associated with an anticipated outcome.  The response to the stimulus can be described as an unconditioned response (UCR).  When an unconditioned stimulus is consistently paired with a conditioned stimulus (CS), an association begins to form that allows the conditioned stimulus to not be required to form the initially unconditioned response.  Once the unconditioned response can take place without the unconditioned stimulus, using only the conditioned stimulus, a conditioned response (CR) has taken place.  If maintenance of the association between the UCS, UCR, CS, & CR is not reinforced, the phenomenon of extinction takes places.  In this instance, the CR gradually disappears as its association with the CS decreases.

Operant Conditioning

Operant conditioning focuses on looking at how behaviour relates to the environment.  The law of effect, the relation between a response and its (dis)favourable consequences/contingencies, was used to shift the discourse of conditioned responses to one of adaptability.  That is, discriminative stimuli refer to external events that signal to an organism that the performance of behaviour(s) will have certain subsequent consequences.

Positive reinforcement is thought of within the cognitive-behavioural paradigm as a strengthening of a response tendency by using a positive reinforcer (pleasant event).  Another type of reinforcer, a negative reinforcer, strengthens a response but does so by presenting an adverse effect (unpleasant event).

Abnormal behaviour such as aggressive behaviour can be explored by exploring behaviour through an operant conditioning lens.  Abnormal behaviour can be reinforced by having needs or wants to be met through what may be considered anti-social behaviour, reinforcing the use of these need-meeting strategies.

Another consideration to keep in mind is a form of observational learning, modelling, in which one learns by watching and imitating others.  It can lead to the acquisition of abnormal behaviours.  This can be the case in instances of substance-abuse problems and some phobias.  There are 4 key components to observational learning:

1. Attention (noticing someone’s behaviour)
2. Retention (remembering someone’s behaviour)
3. Reproduction (personally exhibiting the behaviour)
4. Motivation (repeating imitated behaviours if they result in positive consequences)

Cognitive-Behavioural Interventions

Behaviour therapy seeks to utilize classical and operant conditioning to alter clinical problems. Sometimes called behaviour modification, this intervention uses three theoretical approaches (modelling, counterconditioning & exposure, and operant conditioning).

Counterconditioning seeks to elicit relearning by having a client generate a new response to the presence of a particular stimulus.  One of the methods utilized is systematic desensitization.  In this process, a client compiles a list of feared situations, going from minimal anxiety to most frightening. While practicing relaxation strategies the client progresses through the increasing intensity of conditions that elicit an adverse response.  The individual with time begins to tolerate increasingly more difficult scenarios.  The basis of this intervention is desensitization.

Aversive conditioning is another intervention that uses a stimulus attractive to the client along with an unpleasant event (such as a drug that would make one sick).  The objective is to create a new association between the attractive stimulus and unpleasant event – hoping to endow the negative properties onto the pleasant stimulus, making it unpleasant.  This has been successfully utilized in reducing smoking, substance use, and socially inappropriate desires such as pedophilia.

Cognitive Paradigm

Cognitive Theory

Cognitive psychologists see learning as being more complex than stimulus-response associations.  The learner is an active interpreter of the situation, and past knowledge/experiences influence the perception of the client.  Schemas are an important part of the theory, as they are a cognitive set of information that the individual fits new information into.  If the information does not match a schema, the learner reorganizes the schema to fit the new information or reworks the understanding of knowledge to fit the schema.

Cognitive Therapy

Congnitive therapy (CT) is based arround an assumption that cognition is influenced by perception of experiences.  The focus of CT is then to pursuade clients to change their opinions of themselves and the way they interpret their life events.  This can be achieved through techniques such as the use of counter examples.  Thus, the goal of CT is to provide experiences in and out of session that will alter negative schemas and dysfunctional thoughts/feelings/beliefs.  Cognitive therapy had 4 main components used to pursuade clients to change their options:

1. Education about the abnormal behaviour & cognitive model to normalize the individual’s experience.
2. Keeping a diary of thoughts, feelings, and beliefs.
3. Reducing avoidance of feared situations
4. Testing and challenging hypothesized conditional and core beliefs.

Rational-Emotive Therapy

Albert Ellis’ principles in rational-emotive therapy (REBT) were that sustained emotional reactions elicit self-statements that reinforce irrational beliefs about what leads to a good life.  The goal of this intervention thus becomes eliminating self-defeating beliefs by rationally exploring those beliefs.  To do this, historical contexts of a client should not be focused on – the focus should rather be on exploring the interpretations of what is currently happening around the person that can cause emotional turmoil.  More recently, the tyranny of the “shoulds” has come into focus – highlighting the concept of “demandingness” people impose on themselves in self-talk (can include “musts”).

Once a practitioner becomes familiar with the problems of a client, the practitioner presents the basic theory of REBT so that the client can understand and make an informed decision on accepting its approach.  Once situations eliciting afflictive emotions are seen as worthwhile to explore (by the client), the therapist works with the client to teach them how to substitute irrational self-statements self-talk that reduces emotional turmoil.  Participants are the key change agent in this intervention, and clients should be encouraged to identify/discuss their own irrational thinking and be gently led to discover increasingly rational ways of processing their world.

Ellis placed high importance on homework for clients – requiring clients to behave in ways they nad not previously been able to because of negative thoughts.  REBT thus put a greater focus on overt behaviour.

Cognitive Behavioural Therapy

One of the focuses of cognitive behavioural therapy is a blend of cognitive and learning principles.  External events are seen as being reflected internally by cognitions, and a practitioners focus is on private events (thoughts, perceptions, judgements, self-statements, and unconscious assumptions) of the individual.  To aid in changing abnormal behaviour, cognitive restructuring is used to change a pattern of thought that is believed to be at the root of the behaviour.

Cognitive-Behaviour Integrated Approach

This approach is unique in how it distributes an emphasis between cognitive and behavioural factors.  The premise of this approach is that the event(s) is/are not as important as the perception of the event(s).  Feedback loops of thoughts/feelings/beliefs that lead to behaviours contribute to the experienced cognitions that maintain the usefulness of the behaviours.  What is key to this approach is that cognition is the root of features displayed in a disorder.  The approach itself does not account for what led to the schema of disordered thinking in the first place.  The focus is on determinants of the disorder, rather than the historical progression.

Cognitive Interventions

Overall, cognitive interventions are less expensive and more enduring alternatives to medication in the treatment of depression.

Psychoanalytic Paradigm

Known as the psychoanalytic or psychodynamic paradigm, this Freudian approach takes a position that psychopathology results from unconscious conflicts within an individual.

Mind Structure

The id is seen as a component of the mind which is present from birth, and has the energy needed to run the psyche.  It contains all the basic survival urges, such as a need for food, water, elimination (excretion), warmth, affection, and sex.

As the infant develops, the energy of libido develops, and is converted into psychic energy that is unconscious and outside of the individual’s awareness.

The id seeks immediate gratification.  Pursuant to the pleasure principle, when the id is not satisfied a tension is produced that the id seeks to eliminate.  One way of achieving gratification is by utilizing primary process thinking, where images/fantasies having the gratification fulfilled – temporarily helping aleviate the tension.

The ego develops next, and develops in the next six months of life.  Its purpose is to deal with reality.  The ego uses secondary process thinking, recognizing that the pleasure principle is not the most effective mode to continually operate in.  The ego utilizes the reality principle to mediate between the demands of reality and immediate gratification desired by the id.

The final component of the psyche that emerges is the super-ego, which can be thought of as similar to the conscience and develops throughout childhood.  The Freudian perspective assumes that the super-ego develops from the ego as the ego does from the id.  It was believed that as children discovered that their impulses were unacceptable to parents,  the parental values are incorporated/introjected as their own to gain parental approval and avoid disapproval.

*The interplay of the id, ego, and super-ego are referred to as the psychodynamics of one’s personality.

Neurotic Anxiety

In response to the dangers of the external world, objective (realistic) anxiety becomes the ego’s reaction.  In contrast, neurotic anxiety is a feeling of fear not connected to reality or to a real threat.  It was believed that this was linked to a personality that was not fully developed or being fixated at a psychosexual stage.  Moral anxiety is then viewed as the impulses of the superego, punishing an individual who had not met the expectations of the pleasure principle.

Defense Mechanisms

Defense mechanisms can be conceptualized as a series of unconscious tools used to protect the ego from anxiety by not facing the true nature of the cause of anxiety.  They are as follows:

Denial: The disavowing of a traumatic experience, and pushing it into the unconscious.

Projection: The attribution of one’s own unacceptable feelings onto others.

Displacement: Transferring feelings to a less threatening substitute.

Reaction formation: The conversion of one feeling into it’s opposite.

Regression: Retreating to the behavioural patterns of an earlier age.

Rationalization: Using self-serving (but inaccurate) explanations to justify an unreasonable action or attitude and avoid emotional turmoil.

Sublimation: Converting unacceptable feelings (eg. sexual or aggressive impulses) into behaviours valued by society – such as creative activities.

Psychoanalytic Therapy

Psychoanalytic therapy is based on the impacts of neurotic anxiety, and the situations that arise that remind the psyche of a repressed conflict from childhood (often associated with sexual or aggressive impulses).  The goal is to develop insight in the client and resolve repression helping the client face the conflict of their childhood in the light of adult reality.

One technique used is free association.  In this technique, a client reclines on a couch, not facing the practitioner, and is encouraged to give free rein to their thoughts.  The goal is to verbalize whatever comes to mind, and not censor anything.  There can be many blocks to free association, and they are noted by the analyst as a signal of a sensitive or ego-threatening area.  The analyst would then probe these areas further.

Brief Psychodynamic Therapy

In this intervention, the analyst focuses on specific problems, and the clinician would make it clear to the client that it would not exceed a time-limited number of sessions.  Sessions would ideally be structured in a directive fashion.  In practice, however, mosy psychoanalytic times of treatment take an average of 4.8 years!   Time-limited psychotherapy, knows as brief therapy, was developed to meet the client expectations of a short-term and targeted therapy.  As a result of WWII, brief therapies increased in demand and began to share several elements such as:

• Early and rapid assessments.
• Initiating an early discussion of the time-limited nature of therapy, and expectation that improvement would take place within that timespan.
• Development of concrete goals focused on the improvement of a client’s worse symptoms while building a client’s insight as to what is happening in their life and how to cope better moving forward.
• Interpretations were focused on present life circumstances and behaviour over the historical significance of feelings.
• Development of transference is not encouraged.
• Bringing to light an understanding that psychotherapy is not a cure, but a means by which individuals can learn to better handle life’s stressors.

Contemporary Psychoanalytic Thought

5 conceptual approaches include:

• Modern structural theory
• Self-psychology
• Object relations theory
• Interpersonal-relational theory
• Attachment theory

Psychoanalytic Interventions

Interpersonal therapy (IPT) can be thought of as a modern variation of brief psychodynamic therapy.  It is a relational approach that emphasizes the interactions between a client and their social environment.  Part of the approach involves recognizing that needs are interpersonal, and that meeting needs are dependent on the complimentary needs of others we are connected with.  Thus, the root of abnormal behaviour would be viewed as a misperception of reality that stems from disorganization in the relationships between children and parents.  The therapist thus actively influences the client by examining the past influences and how they have had an impact on current relationships.  To carry out IPT, one would use the following techniques:

• Empathetic listening
• Suggestions for behavioural changes
• Strategies to implement behavioural changes
• Exploration of complexities in present-day problems, with an emphasis on relationships with others
• Role-playing behavioural changes

One of the key criticisms of this paradigm is that the theories are based on anecdotal evidence, and not scientifically founded.  However, three key influences remain from this paradigm to this day:

1. Childhood experiences shape adult personality
2. There are unconscious influences on behaviour
3. People use defence mechanisms to handle anxiety or stress.

Humanistic Paradigm

Client-centred Therapy (aka person-centred therapy) is an intervention that changes several of the key assumptions made about human nature.  These are:

• We can only understand people from their own vantage point and perceptions of their feelings (moving towards a phenomenological lens).  The importance is placed on on the experience of events, as they largely influence the responses of the individual.
• People who are healthy are aware of their behaviour.  There is a desirability to self-awareness, and being thoughtful is seen as a primary goal.
• Healthy individuals are innately good and effective.  Faulty learning is what puts a hindrance that leads to ineffective behaviours or disturbance(s).
• Healthy people are goal-directed and purposive.  They do not respond passively to environmental influences or inner drives.  Healthy people are self-directed.
• Therapists should not attempt to manipulate the events of the individual.  The goal is to create conditions that facilitate independent decision-making by the client.  The innate tendency towards self-actualization is achieved by not being concerned by the demands, preferences, and evaluations of others.

Rodgers marked a shift towards positive psychology, or the focus on attributes that emphasize wellness, being able to function, and attributes such as resilience, optimism, and hope.  To implement this shift in the therapeutic environment, Rodgers aimed to do the following in session:

• Avoid the imposition of goals.
• Create an environment that provides the conditions for the client to return to their basic nature and decide on the life-course that is intrinsically gratifying.
• Have the clients take responsibility for themselves, and refrain from giving advice.
• Draw out the individual’s innate capacity for self-growth and self-direction by being warm, attentive, receptive
• Provide unconditional positive regard by valuing the client as they are, regardless of behaviour.
• Utilize both types of empathy:
  • Primary empathy: The understanding, communicating, and accepting of what a client thinks or feels through summaries/paraphrasing.
  • Advanced empathy: Using an inference by the therapist of what the client is thinking or feeling, but may not be in the full awareness of the client.  Involves interpretation of the meaning of thoughts/feelings/beliefs in the client.

One of the aims within this paradigm is to shift the client from his/her current phenomenological world to another one – brought to light with the use of advanced empathy.  Over the course of a number of sessions, the clinician can begin to generate a hypothesis about the distress source that is hidden from the client.

There are three forms of empathy between clinician and client:

1. Empathic rapport
2. Communication attunement to signals and messages of the client
3. Person empathy (displaying an understanding of the client’s experiences)

Eclecticism

Eclecticism can be thought of as the utilization of multiple theories and techniques from a variety of schools or paradigms.

Psychosocial Paradigm

Clients are seen as not only being shaped by their environment(s) but also active participants in creating change.  Essentially, people act in ways that alter their environments.

Parenting Styles

Parenting styles have an influence on mental health and behaviour.  The major styles and their impacts can be thought of as follows:

• Authoritarian – Being restrictive, punitive, and overcontrolling, children respond to the perceived harshness with the development of internalizing or externalizing behaviours.
• Permissive – Showing little involvement or displaying disinterest in children, internalizing/externalizing problems can occur.
• Authoritative – Use of discipline with reason and warmth.  This leads to the best outcomes.
• Neglectful – (Note: look in child development textbook)

Diathesis-Stress Paradigm

The diathesis-stress paradigm links the biological, psychological, and environmental factors, and focuses on the interaction between a predisposition (the diathesis) and environmental, or life, disturbances (the stress).  This can be applied to any characteristic(s) that increase one’s chance of developing a disorder.

Genetic predisposition is not the only factor taken into account, and other biological diathesis such as oxygen deprivation at birth, poor nutrition, maternal viral infections, and maternal smoking can be considered as conditions that influence predisposition of psychopathology.  Diathesis  that can combine with stress include:

1. Psychological
2. Environmental
3. Biological
4. Social (adverse life experiences)

Possessing a diathesis does not provide a causal relation to the development of a disorder.  It is the stress that is paired with the diathesis that can account for how the diathesis manifests itself into a disorder.

Biopsychosocial Paradigm

The biopsychosocial paradigm combines biological, psychological, and social levels of analysis as subsystems with interactions that influence wellbeing.  Within this paradigm there are both protective and risk factors to optimal wellbeing.  Resilience, the ability to bounce back from from adversity, is an important protective factor (see table 2.1 for risk factors, p. 67).  Concepts such as gene-environment interaction play a role in looking at how the biopsychosocial paradigm can be applied to individual mental wellbeing.  Another consideration is socio-economic status (SES) and the stress it puts on children while their brains are developing (along with histories of familial depression).  Access to education, potentially made more accessable by higher SES, also has implications on mental health outcomes.  Environmental components within the social realm, such as poverty and poor housing quality, can impact the biological and psychological realms impacting the daily exposure to stress, greater volnerability to negative events, and disruption of social ties, which can also have mental health implications.