Amy Wenzel Discusses Abnormal Psychology/Psychopathology

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    • 00:00

      [MUSIC PLAYING][How would you define abnormal psychology and psychopathologyto your students?]

    • 00:10

      AMY WENZEL: Sure.Abnormal psychology is the branch of psychologythat focuses on unusual emotional, behavioral, andcognitive experiences.[Amy Wenzel, Clinical Assistant Professor of Psychiatry,Perelman School of Medicine]I do have to say, though, that in my view,the term abnormal psychology is a bit dated.And one of the reasons that I view it as being so datedis that if you look at the prevalence rates

    • 00:31

      AMY WENZEL [continued]: of various types of these unusual emotional, behavioral,and cognitive experiences, a large segment of the populationexperiences them at one point or another.So in that way, I think that the term abnormalmight be misleading because in fact, these experiences arequite common.The psychopathology is a scientific studyof some of these unusual cognitive, emotional,

    • 00:53

      AMY WENZEL [continued]: and behavioral experiences, and it's typicallylinked with the study of mental health disorders.So in that way, I view psychopathologyas being one large subset of what we wouldview as abnormal psychology.The other thing I'd like to add isthat one doesn't go and get a graduate degreein abnormal psychology.Certainly there are abnormal psychology undergraduate

    • 01:14

      AMY WENZEL [continued]: courses.Typically what a student will do is get a PhDin clinical or counseling psychology,and they will focus then on the studyof one or more mental health disordersor these unusual emotional, behavioral, or cognitiveexperiences.[What are areas of difference or similarity between abnormalpsychology and psychopathology?]Again, abnormal psychology is more just

    • 01:37

      AMY WENZEL [continued]: a branch of psychology, so I would view itas a description of some of the scientific studyand scholarship that happens, whereas psychopathology reallyis the scientific study looking at diagnosis, lookingan etiology, maintenance, and treatment specificallyof mental health disorders.[What first inspired you to start research in the fieldof abnormal psychology and psychopathology?]

    • 02:01

      AMY WENZEL [continued]: I really fit the cliche of somebodywho really wanted to devote my career to helping people.And I was thinking about, what is very uniqueabout the human experience?Certainly I could have been a medical doctor,but I always said, medical doctors, oftentimes they'reworking on bodily processes that don't reallycapture what is unique about the human experience.I was interested in consciousness.

    • 02:22

      AMY WENZEL [continued]: I was interested in our phenomenological experiences.And that really drew me to psychology.Because I wanted to help people, then itwas logical that I went into clinical psychology rather thananother branch of psychology like cognitive psychologyor experimental psychology.[Which key thinkers have inspired you,and who continues to influence you?]

    • 02:43

      AMY WENZEL [continued]: There are many key thinkers.I would be remiss if I didn't mentionDr. Aaron Beck who is considered the fatherof cognitive therapy.I have always been drawn to the cognitive behavioraltheoretical orientation as well as the treatment approach,because it's very much the way that I personallyapproach the world.it also is a type of psychotherapy, cognitive

    • 03:03

      AMY WENZEL [continued]: behavioral therapy, that has the largest evidencebase supporting its efficacy and effectiveness.And so I'm very much an advocate for evidence-based practice.Dr. Beck certainly isn't the only one, though.There are a lot of innovations thatare happening right now in the fieldthat I find truly inspirational.

    • 03:24

      AMY WENZEL [continued]: William Miller at the University of New Mexico and his colleagueStephen Rollnick, they have been, since the late 1980s,developing an approach called motivational interviewing thathas just mushroomed over the past three decades.And now a number of cognitive behavioral therapistsand researchers have become interestedin motivational interviewing and arelooking at the manner in which the two theoretical approaches

    • 03:46

      AMY WENZEL [continued]: are synonymous.The story by which motivational interview developedis also a fascinating one where Dr. Miller really wentagainst the green and really embracedhis client-centered roots from graduate school in orderto really challenge some of the conventional ways of treatingaddictive disorders back then.And so I think the similarity between both him and Dr. AaronBeck is that they're open minded, very creative thinkers

    • 04:10

      AMY WENZEL [continued]: who went against the grain of what was traditionallyat the time when they developed their approaches.And then they backed up their ideasnot only with a really coherent theoretical framework,but importantly, the data to supportthe efficacy of the approach.[How has the field of abnormal psychology and psychopathologychanged in recent years?]The big trajectory that I have seen in the field-- well,

    • 04:32

      AMY WENZEL [continued]: I guess I haven't seen, because it startedaround the mid 1800s-- is more and more care and respecthas been going into understanding people whostruggle with mental health problems and caring for them.So you hear stories from, again, the mid 1800sof people being locked up in insane asylumsand having all sorts of very invasive and potentially

    • 04:56

      AMY WENZEL [continued]: harmful treatments that were delivered,and that certainly isn't happening now.Much more of a movement to treat the person as an individual whois struggling with a mental health disorder, as opposedto the mental health disorder actually defining the person.In terms of key developments in the field,there are just a number of them that I've been considering.One is just purely in terms of the type of research

    • 05:18

      AMY WENZEL [continued]: that is done in clinical and abnormal psychology.When I was in graduate school in the mid 1990s,if I had an idea, I could very quickly,probably in a night's period of time,develop an IRB proposal in order to get approvalto conduct the study.And I would hand write the IRB proposal,it would get approved in a couple of days,and I could start to use participants, particularly

    • 05:41

      AMY WENZEL [continued]: undergraduate research participants for my study.These days, the whole process of developing research proposalsand getting approval for them is just so much different now.A lot of the most rigorous researchis collaborative in nature, where principal investigators--there are multiple principle investigators

    • 06:02

      AMY WENZEL [continued]: at various institutions.Neuroscientists, statisticians, diagnosticianswho are very, very specialized or veryspecific in what they do are oftentimesbrought onto the research team.So no longer is it really usually an endeavorof sort of one person really having sort of an ideathat they alone go out and test.It really involves a lot of collaboration

    • 06:24

      AMY WENZEL [continued]: with other people.And again, the research needs to be funded.And so again, 30 years ago if somebody had an idea,they could probably execute it and gather some meaningful dataand write it up for publication without havingresearch funding.In these days, that's not necessarily the case.So research is just a much more complex and major and intricate

    • 06:45

      AMY WENZEL [continued]: endeavor.[What is an IRB, and what is its purpose?]IRB stands for Institutional Review Board.And that is an assemblage of scholarsas well as some members from the community, attorneys,who actually review research proposalsand just make sure that human subjects are being protected,

    • 07:06

      AMY WENZEL [continued]: that the procedures are ethical and whatnot.And so again, as these research proposalsthat people are bringing together and developingare expanding and expanding, the processof getting approval from an institutional review boardalso is more and more complex and takes a bit more time.So again, it's not the same as my hand written proposals

    • 07:26

      AMY WENZEL [continued]: that I wrote in the 1990s.It usually takes several months for a proposalto get approved these days.[What developments in the field of abnormal psychologyand psychopathology do you consider most significant?]So as a person who has her foot both in academics as wellas in clinical practice, I pay a great deal of attentionto a movement of the so-called third wave psychotherapies.

    • 07:48

      AMY WENZEL [continued]: So let me define that.The first wave was considered behavior therapyin the 1950s and the 1960s, and that was reallybased in both classical conditioning as wellas operant learning.So all of the research that was conducted by researcherssuch as BF Skinner, that was also then influencingclinical practice.And so an example would be a type of treatment called

    • 08:09

      AMY WENZEL [continued]: systematic desensitization.A very well known behavior therapistnamed Joseph Wolpe had the idea that if one imagines encounterswith feared or anxiety-provoking stimulae--like, say an encounter with a dog for somebodywho was a dog phobia-- if one paired that with relaxation,then the person would start to learn a relaxation response

    • 08:31

      AMY WENZEL [continued]: instead of a fear response.However, the 1970s were a time of whatwe call the cognitive revolution, realizingthat human behavior was determinedby more than a simple stimulus that evoked a response,that there was a middle piece there,and the middle piece was cognitionor one's internal experience of the manner in which theywere perceiving and thinking about the world.

    • 08:53

      AMY WENZEL [continued]: And that really corresponded, again,with Dr. Aaron Beck who I mentioned earlierwho just made a revolutionary step forward in psychotherapywith the basic premise that the way we think about things--in particular when we're depressedor when we're anxious-- the way we make meaningof stressful and difficult situations

    • 09:14

      AMY WENZEL [continued]: plays a large part in that depressive or anxious response.And so Dr. Beck's cognitive therapyis considered the second wave, and that reallycorresponded with so much researchin cognitive psychology and information processing.Cognitive therapy was really developed and researcheda great deal in the 1970s, 1980s, 1990s.

    • 09:34

      AMY WENZEL [continued]: And now towards the end of the 1990s there has been, what?This third wave psychotherapy.And it's much more diffused than justsimply focusing on behavior or focusing on cognition.A big part of it, though, is focusing on acceptance,focusing on being present in one's experienceas opposed to trying to change behavior or change cognitions,

    • 09:55

      AMY WENZEL [continued]: and also living according to one's values.And so examples of these third wave psychotherapiesinclude mindfulness-based cognitive therapy.Again, an extension of cognitive therapyas developed by Dr. Beck, but adding this mindfulnessand making actually very central this mindfulness component.It's a terrific relapse preventiontype of approach for people with chronic depression.

    • 10:18

      AMY WENZEL [continued]: Acceptance and commitment therapy is another one.And a big controversy in the field rightnow is whether these third wave psychotherapies are indeeddifferent than cognitive therapy or cognitive behavioral therapyor not.And there are some very fierce proponentson both sides of the argument.[Are there any major academic debates in this field?What are the principal areas of contention, and why?]

    • 10:41

      AMY WENZEL [continued]: A number of cognitive therapists are-- nowwe call them cognitive behavioral therapists.Those terms are used interchangeably-- theyhave a great deal of respect for the developers of the third waypsychotherapies, but oftentimes their reaction can be,well, this isn't anything new.This is something that we've been doing now for a while.Whereas my sense of some of the developers of the third wave

    • 11:03

      AMY WENZEL [continued]: psychotherapy say, no.This is different.Cognitive behavioral therapies are about change,about changing people's cognitions,about changing behavior.This is really more focused on acceptanceand being in the present moment without judgment,without changing everything or anything,and then living according to one's valuesand engaging in value-driven activity.

    • 11:25

      AMY WENZEL [continued]: Personally, I'm a person-- I fall probably rightin the middle of that camp.I have to say that just personally, I'ma person who's very much interested in Zen Buddhismand mindfulness practices of acceptance,so I have always integrated that into the way that I thinkabout psychopathology, as well as into the manner in which Itreat my patients.But I do agree with the developers of the third wave

    • 11:47

      AMY WENZEL [continued]: psychotherapies that they actually haddifferent end goals in mind.And some of these developers havebeen very precise in terms of empirically demonstratingvarious phenomena that are a bit different than what we seein cognitive behavioral therapy, and translating that directlyinto practice.[How important are research methodology and methodsfor a rigorous analysis of abnormal psychologyand psychopathology?What key methods do you employ?]

    • 12:10

      AMY WENZEL [continued]: Research methodology is absolutely crucial,and one of the reasons is that these phenomenathat researchers who focus on abnormal psychologyor psychopathology, that they focused on,these are largely internal phenomena.I'm sure they translate into behavior,but they're very difficult to define,they're very difficult to operationalize given that these

    • 12:32

      AMY WENZEL [continued]: are mental health phenomena.And so it's important then for researchersto come up with very precise operational definitions,understand how to measure these phenomena,and then to demonstrate validity or ensuringthat these phenomenon actually are what they claim to be.I use a lot of self-report inventoriesin order to capture symptoms-- some of my research

    • 12:54

      AMY WENZEL [continued]: is on postpartum anxiety.Another line of my research is actually in suicidal behavior,so I use a lot of very well validated questionnairesthat quantify some constructs associatedwith those two domains of mental health problems.But this is a good illustration about research methodology.If I only relied on self-report inventories, then

    • 13:15

      AMY WENZEL [continued]: a lot of my research would be called into question.Because again, self-report inventoriesnecessitate that the person who'sexperiencing the mental health problemsis giving his or her report.And we want to know his or her reportand subjective experience, but it could alsobe biased in terms of the mental health problemsthat he or she is actually experiencing.There could be a response bias, there

    • 13:36

      AMY WENZEL [continued]: could be a bias in the way they directtheir attention to certain types of these internal phenomena.So it's also very important to use multiple methods.And so I usually then will supplementmy gathering of self-report data with diagnostic interviews.And again, one could argue that a diagnostic interview alsorelies on the patient's self-report

    • 13:57

      AMY WENZEL [continued]: because we're actually interviewing the patient.However, the person that is deliveringthe diagnostic interview has a great dealof training under his or her beltso that it also involves behavioral observation,it involves following up on certain thingsthat the patient says in order to get, I guess,a richer or more intricate picture of the person's

    • 14:19

      AMY WENZEL [continued]: mental health disorder.I'm also a big proponent on behavioral observationin terms of actually, say, gettinga videotape of somebody's behaviorand actually then coding that behavior in certain segmentsin order to really, from an observer perspective,be able to gather information that other people can

    • 14:40

      AMY WENZEL [continued]: see that would be indicative of the mental health problem.So I would say really the messagethat I'm trying to communicate hereis that when working with phenomena like mental healthdisorders, you want to use multiple methods in orderto converge on the key constructs of interestassociated with that disorder.[What new research directions do you find most exciting,and where would you like to take your own research?]

    • 15:01

      AMY WENZEL [continued]: Going along with this idea of the third wave psychotherapies,there's so much research that's being conducted right now.And a number of trials are just in the processof being completed at the moment where they are comparingmore traditional cognitive behavioral approaches with someof these third wave approaches like acceptance and commitmenttherapy.

    • 15:22

      AMY WENZEL [continued]: Truly exciting for me.My guess is that for the most part,they're going to be seen as equivalent because that usuallyhappens in rigorous psychotherapy trialswhen two established treatments are pitted against each other.But secondly, where I think some of the more exciting researchis going to happen is looking at the mechanismsof change associated with these disorders.And what we mean by mechanisms of change

    • 15:44

      AMY WENZEL [continued]: are the specific pathways by which these treatments work.And so again, the two treatments mightbe equivalent in terms of their outcome,but if one treatment works through a different pathwaythan another treatment, that's really important informationfor clinicians to have in order to focusand in order to hone the specific techniques that theyuse with their individual patients

    • 16:05

      AMY WENZEL [continued]: in order to achieve that change.Another realm of research that I'mfinding really exciting, and quite honestlyreally necessary, is in the dissemination of empiricallysupported treatments.And what we mean by the disseminationis that it's the transporting of these treatmentsfrom the academic setting into quote,unquote, "real life settings."And so we're starting to see community

    • 16:26

      AMY WENZEL [continued]: mental health therapists and therapists whowork in Veteran Affairs center being trained rigorouslyin these treatment packages.And then these institutions themselves are actuallynot only evaluating outcome, but also evaluatingthe degree to which training is successful,evaluating the degree to which clinicians thenadopt these principles with their entire caseload-- not

    • 16:48

      AMY WENZEL [continued]: only their caseload that they're supposed to be deliveringthe therapy to-- and then in some casesthey're even looking at the attitudes of clinicians whoare trained in these treatments as wellas in the agencies themselves that are embracing them.So in order to bridge that gap between science and practice,we do need to have that dissemination.And so I'm really thrilled that clinical psychologists are

    • 17:08

      AMY WENZEL [continued]: starting to team up with organizational researchersin order to see the facilitators as well as the opticals thatexist at an organizational level to achieve that dissemination.In terms of my own research, I ama person who I had been in full time academia for several yearsat the beginning of my career, and I'mnow in a unique position where I have one foot in academia.

    • 17:31

      AMY WENZEL [continued]: I also have my own consulting agencyand I do some private practice as well,as well as training and consultingsupervision of therapists.So I'm a person that right now I wear many hats.And so with that then in terms of my own sortof scholarly work, what I'm really priding myself onis critically evaluating the scientific literature,

    • 17:53

      AMY WENZEL [continued]: being able to translate that to my individual patientsto the therapists who I train and who I supervise,and the others who I consult with.And so my primary scholarly activity rightnow is writing books in order to achieve that translation.I do, though, have some lines of research that are still open.As I was saying earlier, one of my lines of research

    • 18:14

      AMY WENZEL [continued]: is in postpartum anxiety.I find that really exciting because it'sjust intuitive that new mothers are very anxious, and so muchresearch was focused on postpartum depressionin the 1980s, '90s, and 2000s.Absolutely much needed, but it wasn't accountingfor the anxiety part.And so some of my research was the early research

    • 18:35

      AMY WENZEL [continued]: to really establish postpartum anxietyas an entity unto itself.And there are lots of researchers nowwho are focusing specifically on postpartum obsessivecompulsive disorder and intrusivethoughts who are really running with thatand doing a terrific job.A second line of research that I still have openis examining cognitive processes associated with suicidality,

    • 18:59

      AMY WENZEL [continued]: patients who have a history of suicidal behavior,as well as patients who were recentlyreleased from the hospital for making a suicide attempt.And the reason why I view this research as very importantis up to this point, we have tons and tonsof research on the risk factors for suicidal behavior.And this research typically looks at demographic variables,maybe changes in environment like if a person

    • 19:21

      AMY WENZEL [continued]: was divorced are unemployed.But it doesn't get at the psychological processes at workin the time immediately proceeding a suicidal crisis.And so my research team and I are reallytrying to conceptualize a number of phenomena associatedwith that with then in psychotherapy,and with myself particularly cognitive behavioral therapy

    • 19:41

      AMY WENZEL [continued]: which I do, we can then develop very specificstrategic interventions that patients can practiceand patients can acquire in order to preventsuicidal crises in the future.[What is the difference between postpartum anxietyand postpartum depression?]So the question is, what's the differencebetween postpartum depression and postpartum anxiety,

    • 20:01

      AMY WENZEL [continued]: and does one lead to the other?Honestly, we conceptualize this phenomenonaccording to our diagnostic criteria.So for a diagnosis of depression,a person needs to have either low mood or a lack of interestin activities.There's associations with sleep disturbance, appetitedisturbance, sense of worthlessness,fatigue, difficulty concentrating,

    • 20:22

      AMY WENZEL [continued]: and at times suicidal ideation.Postpartum anxiety actually can have a numberof different manifestations.It's not as clear cut into a single categoryas we see with postpartum depression.So a person can have postpartum generalized anxiety,which is excessive, uncontrollableworry that the person has difficulty getting

    • 20:42

      AMY WENZEL [continued]: out of her head, which actually is associated with someof the same types of experiences depressionlike difficulty concentrating, difficulty sleeping,and so on, as well as some unique symptomslike irritability or muscle tension.There's postpartum obsessive compulsive disorder.Now in the previous version of the DSM,the DSM-IV, obsessive compulsive disorderwas an anxiety disorder.

    • 21:03

      AMY WENZEL [continued]: Now it's in its own category of the obsessive,compulsive, and related disorders.But truly, most experts in the areaview anxiety as being a central component of OCD.And so again, we still view that as a manifestationof postpartum anxiety.Again, the example that we oftentimesgive of postpartum OCD are intrusive thoughts

    • 21:23

      AMY WENZEL [continued]: of taking a knife and harming the child or intrusive thoughtsor worries about touching the baby's genitals whengiving the baby a bath.Things that are experienced as inappropriate and verydisturbing by women, and a personactually gets a diagnosis of OCD if it'sassociated with substantial distress or life interference.And so an example of life interference

    • 21:45

      AMY WENZEL [continued]: might be the woman no longer providing care for her baby,trying to avoid her baby because she's concerned about harmingher baby in some way.Now in response to your question about whether oneleads to another, certainly it's longbeen recognized that there is a substantial anxietycomponent to postpartum depression,even if anxiety was not a separate diagnosis that

    • 22:09

      AMY WENZEL [continued]: was carried by these women.However, it is seen that they are distinct enoughthat if one only assesses for postpartum depressionand does not assess for postpartum anxiety,that they are going to miss some cases of women who could reallybenefit from effective mental health treatment.In terms of whether one leads to the other, at this point

    • 22:30

      AMY WENZEL [continued]: we haven't done a sequential analysis.That hasn't, to my knowledge, been done in the literature.There was some literature-- gosh, backa few decades ago-- at least that proposedthat oftentimes anxiety would manifest itself first,and then as the person became more and more worndown by anxiety and became tired of fighting against it,that depression would often set in in terms

    • 22:51

      AMY WENZEL [continued]: of a sense of helplessness.That certainly could be a theory that could betested with postpartum women.But believe me, there are plenty of postpartum womenwho experience depression right after they give birth.And it persists for several weeksbefore they come to get treatment.And so while they also might be experiencing anxiety,phenomenologically they don't experience the depression

    • 23:13

      AMY WENZEL [continued]: as happening secondary to the anxiety.[What are the strengths and weaknesses of the current DSM?]So the DSM is the Diagnostic and StatisticalManual of Mental Disorders, and it is published by the AmericanPsychiatric Association.So the American Psychiatric Associationreally spearheads the effort.

    • 23:34

      AMY WENZEL [continued]: This is a bit of a loaded questionbecause right now it is actually--there's a great deal of controversy about the DSMbecause a new version of the DSM came out about a year ago.We had been using the fourth version,which came out in 1994.And some aspects of it were revised in 2000, but notthe actual diagnostic criteria.

    • 23:54

      AMY WENZEL [continued]: So literally for 20 years, mental health professionalshave been diagnosing their patientsaccording to DSM-IV criteria.DSM-5 came out last May.Some of the mental health disorders in thereare exactly like what we saw in the DSM-IV.Case in point would be most criteria associatedwith major depressive disorder.

    • 24:15

      AMY WENZEL [continued]: But I'm actually even hesitating with that,because one aspect of major depressive disorder that didchange was a grief criterion.So in the previous version of the DSM, DSM-IV,a person could be experiencing substantial depression,substantial interference associatedwith the death of a close other, and they would not

    • 24:36

      AMY WENZEL [continued]: get a diagnosis of depression because thatwas attributed to grief.That now is no longer the case in DSM-5,and that is one example of the controversies associatedwith the DSM-5.Many critics say that now the definition of mental healthdisorders is getting expanded so much that it's pathologizing

    • 24:59

      AMY WENZEL [continued]: normal human experiences like grievingafter the loss of a close other.And so there are a lot of concerns about people beingdiagnosed with something that they'llcarry that diagnosis with them throughout their lives,maybe receive treatment for it when treatment isn't necessary.There are a number of different diagnostic categories

    • 25:19

      AMY WENZEL [continued]: like that.Another criticism, unfortunately,is that I believe I saw the figure, about 70%of the people on the DSM task forcehave affiliations with the drug development industry.And so again, there have been questionsabout the degree to which expandingthe definition of a mental health disorder

    • 25:40

      AMY WENZEL [continued]: is going to benefit the big pharmaceutical companies.And so lots of criticism, lots of controversysurrounding this.I have to say, one of the hats I wearis that I'm the editor of the Encyclopedia for Abnormaland Clinical Psychology.So I'm in the process now of really delving into the DSM-5.

    • 26:00

      AMY WENZEL [continued]: We're writing a number of encyclopedia entrieson these diagnostic categories, includingsome of the new ones that have come out.And so I'm really eager to see what experts in the fieldactually say about the research that now is being conductedon the basis of the DSM-5 in order to really flesh outthe validity and the, I guess, empirical support

    • 26:21

      AMY WENZEL [continued]: for some of these new diagnoses.[Are there any classic or seemingly 'untouchable' studiesin this field that have been reevaluated in light of recentacademic developments?]The one study that came to mind isthe Treatment of Depression Collaborative Research Programstudy.This was funded by the National Instituteof Mental Health in the 1980s, and itwas the largest collaborative clinical trial to date,

    • 26:42

      AMY WENZEL [continued]: where they were looking at patients with major depressivedisorder, and they were comparing actuallyfour conditions.One condition was the drug imipramine, which in the 1980swas a-- well, still is a tricyclic antidepressant.In the 1980s, it was one of the most common medications thatwere used to treat depression.And the imipramine was also paired

    • 27:03

      AMY WENZEL [continued]: with what they call clinical management,where the patients in that conditionactually met with a provider and wherethe provider was providing support and care and concernand whatnot.There was also a placebo conditionwhere the patients were receiving a sugar pill,but also getting that same clinical management.And then two psychotherapies were being evaluated.

    • 27:23

      AMY WENZEL [continued]: One psychotherapy was cognitive behavioral therapy.The other psychotherapy was interpersonal psychotherapy.And the results were published in 1989, I believe.And they were pretty jarring for the field.They actually-- the overall resultssuggested that there really weren't any differencesamong especially the three active treatments, imipramine,

    • 27:45

      AMY WENZEL [continued]: interpersonal psychotherapy, and cognitive behavioral therapy.And in some analyses, there actuallywasn't any difference between those three active treatmentsand even the placebo condition.So imagine the alarm of the field whereso much time and energy, resourceswere devoted to this project, and it was basicallysaying that these treatments, includingplacebo and clinical management, were pretty equivalent.

    • 28:08

      AMY WENZEL [continued]: Well, there is a lot of then unpacking of what happenedin that clinical trial.First of all, that clinical management conditionwhere I said the patients met with a provider who gave themsupporting and care and concern, it was basicallydeemed that they were essentiallyreceiving some sort of psychotherapy,so it wasn't a true placebo condition.It was really a very much enhanced placebo condition,

    • 28:30

      AMY WENZEL [continued]: and it made sense that then the patients who received that alsogot a great deal of benefit.The other thing that happened is in some secondary analyses,interpersonal psychotherapy was outperformingcognitive behavioral therapy.That was very unexpected because at that point much,much more research had been supportingthe efficacy of cognitive behavioral therapy

    • 28:50

      AMY WENZEL [continued]: than interpersonal psychotherapy.So as time went on, researchers were againreally doing some fine grain analyses,really unpacking what happened.And they actually found that in certain sites,cognitive behavioral therapy was notbeing delivered with, I think, the integritythat it was in some of the other siteswhere they were being trained by people affiliated

    • 29:12

      AMY WENZEL [continued]: with Dr. Aaron Beck himself.Another finding that came out of that studywas that for patients with more moderate to severe depression,in some cases the imipramine plus clinical managementactually outperformed psychotherapy.So again, that really reinforced this sort of biasthat was already existent in the field that psychotherapyis fine for moderate mental health problems,

    • 29:34

      AMY WENZEL [continued]: mild to moderate mental health problems.But for mental health problems that are severe,boy, you really had to go the medication route.I will tell you that there is a study that's published nowalmost 10 years ago that was conductedby Stephen Holland and Rob DeRubeislooking at cognitive therapy for moderate to severe depression.And it was compared with Paxil.And at times, Paxil was even augmented

    • 29:55

      AMY WENZEL [continued]: with lithium or another medicationto really have a pretty super powered medication condition.And again, what those results foundwas that there is no difference between medicationand cognitive therapy in the acute phase of treatment.And then in the follow-up period,cognitive therapy much, much outperformed the medicationcondition.Meaning that so many more people who discontinued medication

    • 30:16

      AMY WENZEL [continued]: relapsed relative to people who had completedcognitive therapy.And even when they looked at a subset of people who actuallycontinue on with their medication, cognitive therapystill at least to some degree-- I'm not sureif this was statistically significant--but was associated with lower relapse rates,outperformed medication even when the people could still

    • 30:36

      AMY WENZEL [continued]: be on medication.So that was a really revolutionary studythat supplemented the NIMH collaborativestudy to show that, yes.Psychotherapy is as effective as medication, even for moderateto severe depression.[What are the practical benefits of studying abnormal psychologyand psychopathology for a student's academicor professional future?]So the benefits of studying abnormal psychology,

    • 30:57

      AMY WENZEL [continued]: I think because, again, abnormal psychology isn't so abnormal--so many people experience some sort of manifestationof emotional distress or behavioral problems--that it's a terrific course to take to become awareof these issues and make sure that these issues are notsuch a mystery or associated with such stigmas.So I can't tell you the number of times

    • 31:19

      AMY WENZEL [continued]: that I taught abnormal psychology-- of course,I had a fair number of students come up to me and say,oh my gosh.I think I'm experiencing this disorder or this disorder.And at times, it was a little bit overstated.But I also had a number of students come to meand say that they had family members who arediagnosed with these phenomena.And it really helped them understand the family member,have just some hope there are well validated

    • 31:39

      AMY WENZEL [continued]: treatments that are out there to help those individuals.And certainly then when students graduate and theyare in the workplace, whatever profession that they enterinto, they're going to experience coworkers, clients,colleagues, what have you, who are manifesting someof these types of problematic emotional experiences

    • 32:01

      AMY WENZEL [continued]: and behaviors.So again, being able to conceptualize what'shappening on the basis of that knowledge,not judge, be able to then respond appropriatelyon the basis of that understanding,is really important.I think a second benefit of studying abnormal psychologyis that research method component.I do think by taking abnormal psychology,students learn how to quantify and how

    • 32:23

      AMY WENZEL [continued]: to measure phenomena that are oftentimesvery internal or difficult to observe.And I think they also then start to become critical consumersof the research.So there's so many instances where a magazine or a newspaperwill report about mental health phenomena,and they don't really give an accurate picture.I mean they might, for example, talk about a study that

    • 32:46

      AMY WENZEL [continued]: found a strong correlation between two phenomena,but correlation is not causation.That correlation could certainly be accountedfor by a third variable.That doesn't usually show up in the media,so it leads the more naive consumer of that informationto believe that there's causality there.Students who take abnormal psychologywill go through an entire chapter of research methods,

    • 33:06

      AMY WENZEL [continued]: and they will know that correlation is not causation.And they'll be able to be a bit more savvy in termsof taking in these topics that are given attention toin the media.[What are some misconceptions about abnormal psychologyand psychopathology that you would like to dispel?]Misconceptions about the field that I wouldlike to address or dispel.Certainly one misconception is that some

    • 33:27

      AMY WENZEL [continued]: of these mental health disorders justare indicative of a weak character or bad choices.There's a lot of judgment associatedwith the people who struggle with these mental healthdisorders.Honestly, most if not all mental health disordershave a genetic component.They also have what we call a psychological or cognitive

    • 33:48

      AMY WENZEL [continued]: diethesis where a person just has a personality styleor a style of thinking that then predisposesthem to experience these mental health difficulties in timesof stress.So it's not something that a person would choose.It's not something that a person would intentionallyput themselves in the place of.They have usually a predispositionthat can be triggered in difficult circumstances.

    • 34:09

      AMY WENZEL [continued]: In fact, it's interesting that you ask this question.I was just reading on a website called Medscapethat I would highly recommend viewers to subscribe to.it kind of brings up cutting edge research studies.I subscribe to a psychiatry one, and I alsosubscribe to an addictions one.And I was reading an article called, what is addiction?

    • 34:30

      AMY WENZEL [continued]: And again, I think in the field of addictions, that'swhere there is that myth that it's just a person whogot themselves into trouble and made bad choices,and it's their own fault that theywould be experiencing this.Well, what this article was sayingwas that, that couldn't be further from the truth.It's very likely that people who areprone to having, say, an alcohol or drug problem actually

    • 34:51

      AMY WENZEL [continued]: have a gene that's associated with someabnormalities in the brain that are associated with the rewardsystem.So they are going to be-- so with that reward system,they're going to need so much more in orderto get that reward, and they're goingto be much more sensitive to that reward that would thenpredispose them to engage in that addictive behavior.So they're more and more starting

    • 35:11

      AMY WENZEL [continued]: to understand some possible biological substrates that,again, serves as a predisposition for a personto develop a mental health problemor an addictive disorder much moreeasily than some other people.[What would you identify as the key challenges of a coursein this field for a student, and what strategies would youadvise to counter these challenges?]When I was preparing for this, I was considering the challenges

    • 35:31

      AMY WENZEL [continued]: of students in this field.And I was really making the assumptionthat we're talking about a student whowas going to want to go on and getsome sort of graduate education in clinical psychologyand who will either want to go on and practice and treatpeople with mental health problems,or do some research in the area.And I'm going to say something that Ihave a feeling a number of students are not going to like.But that is that to think ahead about what you really

    • 35:54

      AMY WENZEL [continued]: want to do, what you want to specialize in.The field now is becoming very intricate, very complex,specific.And so there aren't as many generalists around.And I mean a generalist in terms of treatingevery single mental health disorder that'sout there if you're a clinician, or researchinga number of different topics.

    • 36:14

      AMY WENZEL [continued]: If a person specializes either as a clinicianor as a researcher, they're goingto have something to offer that another person is notnecessarily going to offer.So these days, it's not pigeonholing you at allinto a specific topic or a specific area.I actually see it as a necessity.So again, when a student wants to go out and practice,

    • 36:36

      AMY WENZEL [continued]: they're going to have to market themselves.And they're going to have to showhow what they have to offer is different and probably betterthan what the other clinicians have to offer.Similarly as a researcher now, they'regoing to need to demonstrate that they are advancingthe field in a very specific way,and developing a very specific area of expertise

    • 36:57

      AMY WENZEL [continued]: where they're going to be recognizedat an international level for.I would also say for students, itis important if a person, especiallyfor a PhD in clinical psychology,to make sure that not only they'regetting research experience-- that's been the case nowfor 30, 40 years-- but also being involved at an authorshiplevel, getting one's name on at least one,

    • 37:19

      AMY WENZEL [continued]: if not more than one publication.I recently was looking at a discussionon one of my listservs at the criterianow for programs to admit people into PhD programs.And it does seem like now it is the normfor successful applicants who get into these PhD programsto have the least one publication on their curriculum

    • 37:41

      AMY WENZEL [continued]: vitae.That might seem scary to a number of students,but it really isn't.Certainly doing some research, doing an honors thesis,or being very heavily involved in a professor's laboratoryas an undergrad could very readily lead to a publication.And a lot of students these days take one or two yearsoff in between undergrad and graduate school,

    • 38:02

      AMY WENZEL [continued]: and the objective is to get a research position.So as a full time research assistant,if they're devoted specifically to one study,it could be likely that they makeenough of an intellectual contributionthat they could actually be included as an author.I would say at the graduate level regarding publishing,now these days it is important for graduate studentsto make sure that they are a first author-- have

    • 38:24

      AMY WENZEL [continued]: a first author publication.What that means is that they are the people who are spearheadingthe manner in which the paper comes together,the writing, the conceptual framework.And that really shows people at the next level,either who are evaluating them for postdoctoral fellowshipsor for faculty positions, that they have the ability

    • 38:45

      AMY WENZEL [continued]: to write a peer reviewed journal article.They have the ability to be successful,and that they'll be able to carry that through on their ownas a junior faculty member.[If a student could read one book,journal paper or bulletin in this field to inspireor motivate them, what would it be, and why?]So what would I recommend to a studentto consult to either read or look at a websitein order to just inspire them to continue?

    • 39:05

      AMY WENZEL [continued]: I mean, I have to say for people who go onto get a PhD in clinical psychology,I strongly recommend that they go back and read the old worksof a man named Paul Meehl.He's not around anymore.He has been deceased for about 10 years or even more than 10years.But he was just such a forward thinkerin the field of clinical psychology,and it really, really makes such a terrific argument

    • 39:27

      AMY WENZEL [continued]: for making sure that our clinical judgment is basedon data and evidence as opposed to subjective sensesand whatnot.And he talks a lot about how to translate thatinto our clinical work.There is a new edition of a book that I highly recommend.This is actually just coming out this fall.And that is a book called The Science and Pseudosciencein Clinical Psychology.

    • 39:48

      AMY WENZEL [continued]: The first author is Scott Lilienfeld.And he's actually another person whois quite inspirational to me.He is a person who, a part of his scholarshipis to really bring attention to ideasin psychology and research that he views as pseudoscientific.What we mean by pseudoscientific isthat it's not using good research methodology.

    • 40:10

      AMY WENZEL [continued]: It's based on false assumptions.Or where the researchers are not necessarily being transparentin terms of how they conducted their workor how it's being translated.And he's really set out to expose some of this,not because he's trying to bring other researchers down,but because he wants to retain the integrity of the field.And so his first book came out in 2004.

    • 40:32

      AMY WENZEL [continued]: Lots of chapters by very well respected in the fieldto really help people, students in particular,understand what has an empirical basis, and what doesn't?The new edition's coming out in 2014.I would say for people specificallywho want to become cognitive behavioral therapists, whowant to engage in evidence-based practice, Judith Becks'

    • 40:53

      AMY WENZEL [continued]: book, Cognitive Therapy: Basics and Beyondnow in its second edition is reallythe standard text in the field.And so I would highly encourage peoplewho want to become proficient in that particular approachto therapy to read the book.Although honestly there are a number of wonderful booksout there on cognitive behavioral therapy--even some books that I've written-- as well as bookson acceptance and commitment therapy,

    • 41:14

      AMY WENZEL [continued]: books on behavioral activation, whichis another type of therapy that hasits roots in cognitive behavioral therapy,but is also considered a third wave approach writtenby people who have tremendous clinical experience,but have much, much scientific grounding.So the reader can really understand the sciencethat goes into the development and the executionof the treatment.

    • 41:35

      AMY WENZEL [continued]: [How do you think about the public impact of your ownresearch, and how do you assess the contribution of abnormalpsychology and psychopathology research to society at large?]I would say at least on a weekly basisI will get an email from someone, usually a postpartumwoman, actually, because I've writtena number of books on this topic as well,who are just struggling with anxietyand who are just thanking me that I have done this researchand written these books and whatnot,oftentimes giving me the feedback that they thought they

    • 41:58

      AMY WENZEL [continued]: were going crazy, thought they were struggling alone,and they didn't realize how many womenstruggle with the same thing.And so those sorts of messages and emailsthat I get from people-- of course on the one hand,I don't want to be getting those emailsbecause I don't want people to be struggling or suffering.But I do recognize that my work is having a big impactjust simply on shedding light on a very significant

    • 42:20

      AMY WENZEL [continued]: public health problem that really hadn't been givena lot of attention before.And then secondly, my goal is to translatecognitive behavioral principles of treatmentto that population, so it really gives them some hopethat something can be done.Really the same is the case, though-- I'vedone a lot of research on cognitive processesand cognitive behavioral therapy for suicidal patients.

    • 42:40

      AMY WENZEL [continued]: I get the same messages from families where familieswill come to my practice because one of their family membershas made a suicide attempt or has chronic suicidal ideation.And a lot of clinicians out therewon't accept those patients into the practice.So the fact that not only do I do that,but I've been able to research these phenomenaand really quickly help them understand,

    • 43:01

      AMY WENZEL [continued]: conceptualize what's happening with their patientand sort of how to help them can be a tremendous benefit.In terms of the benefit to societywith the study of abnormal psychology and psychopathology,I mean, I think it's very clear that there are just millionsand millions of people who are struggling with mental healthproblems.And the more research that's done,the more we understand these problems.

    • 43:23

      AMY WENZEL [continued]: So again, the whole issue is demystified.The behavior is seen a bit more logicallythan it would otherwise, given that the behavior at timescan be a bit more abnormal.And again, it's associated with effective treatments.And so we know now that while some forms of mental healthdisorders are chronic, that doesn't mean that a person has

    • 43:44

      AMY WENZEL [continued]: to be experiencing them at a very high or acute levelfor the rest of their lives.They can absolutely get treatment, experienceremission, and then prepare in a relapse preventionway, a preventive way, in order to minimize the likelihoodthat there's a recurrence of the particular symptoms,even in times that are difficult and times of stressor challenge or disappointment.

    • 44:05

      AMY WENZEL [continued]: [Where do you see the field of abnormal psychologyand psychopathology heading in the next several years,and what are your hopes for its future?]In terms of research I really seea lot of collaboration, not only across institutions but alsocollaboration with neuroscientistsin order to continue to uncover the biological substrateassociated with mental health disorders.Although I should say, not every single mental health disorder

    • 44:27

      AMY WENZEL [continued]: absolutely has to have a biological substrateor an abnormal biological process.And that's actually another criticism of the DSMwas that they were defining mental health disordersas biopsychosocial types of issues,necessitating that everyone had a biological underpinning.I see a lot of cross-cultural work going on,which is really exciting.

    • 44:48

      AMY WENZEL [continued]: Because we can't necessarily assumethat the manifestation of mental health disorders thatwere determined by the DSM-5 committeemanifest in the same way in ethnic minoritiesand individuals in other countrieswhere there might be culture bouncesyndromes going on there.So in fact, we're really trying to highlightthe cultural aspects of psychopathology

    • 45:10

      AMY WENZEL [continued]: in the encyclopedia that I'm examining.I had mentioned earlier research on the mechanisms of change,and that's very important for me to elucidate not justthat our therapies work, but why they work.And once we know the means by which they work,we can then refine our strategiesand really hone in on these processes

    • 45:30

      AMY WENZEL [continued]: in order to make therapy more efficient,to make therapy more complete in terms of what it's targeting.[MUSIC PLAYING]

Amy Wenzel Discusses Abnormal Psychology/Psychopathology

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Abstract

Professor Amy Wenzel discusses the fields of psychopathology and abnormal psychology, particularly highlighting her work in postpartum anxiety and suicidality. She explains the controversies surrounding the new DSM, including the medicalization of everyday experiences and the writers' ties to the pharmaceutical industry. She also explores therapeutic innovations and where she sees psychology headed.

SAGE Video Experts
Amy Wenzel Discusses Abnormal Psychology/Psychopathology

Professor Amy Wenzel discusses the fields of psychopathology and abnormal psychology, particularly highlighting her work in postpartum anxiety and suicidality. She explains the controversies surrounding the new DSM, including the medicalization of everyday experiences and the writers' ties to the pharmaceutical industry. She also explores therapeutic innovations and where she sees psychology headed.

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