In Ellis's REBT, which element is held to cause the emotional consequence (C)?

The belief (B) about the activating event

The activating event (A) itself

The belief (B) about the activating event

Which set correctly lists Rogers's core conditions for therapeutic change?

Congruence, unconditional positive regard, empathic understanding

Free association, interpretation, working through

Acceptance, defusion, committed action

Mindfulness-Based Cognitive Therapy (MBCT) was developed chiefly to:

Prevent relapse in recurrent depression

Treat childhood conduct problems through play

Analyse ego states in transactions

Prevent relapse in recurrent depression

Which of the following statements about classification systems are correct? Select all that apply.

ICD-11 is published by the World Health Organization

DSM-5-TR (2022) added prolonged grief disorder

DSM-5 abolished the five-axis system of DSM-IV

ICD-11 retains the ten categorical personality-disorder types of ICD-10 unchanged

ICD-11 is published by the World Health Organization

DSM-5-TR (2022) added prolonged grief disorder

DSM-5 abolished the five-axis system of DSM-IV

In a Mental Status Examination, "affect" refers to:

The observed expression of emotion, including its range and appropriateness

The content of the patient's thoughts

Orientation to time, place and person

The patient's own report of a sustained emotional state

The observed expression of emotion, including its range and appropriateness

Wolpe's systematic desensitisation is based on the principle of:

Reciprocal inhibition — relaxation is incompatible with anxiety

Transference of feelings onto the therapist

Differentiation of self within the family

Assertion (A): Acceptance and Commitment Therapy does not try to eliminate unwanted thoughts. Reason (R): ACT aims to increase psychological flexibility, so that people can notice difficult thoughts through cognitive defusion and still act in line with their values. Choose the correct option.

Both A and R are true, and R is the correct explanation of A

Both A and R are true, but R is not the correct explanation of A

Psychopathology and Psychotherapies: the Concept of Abnormality, the Mental Status Examination, Classification in DSM-5-TR and ICD-11, Causes, and Sixteen Therapies from Psychoanalysis to Family Therapy

The clinical block of Unit 9 reads: "Psychopathology: Concept, Mental Status Examination, Classification, Causes. Psychotherapies: Psychoanalysis, Person-centered, Gestalt, Existential, Acceptance Commitment Therapy, Behavior therapy, REBT, CBT, MBCT, Play therapy, Positive psychotherapy, Transactional Analysis, Dialectic behavior therapy, Art therapy, Performing Art Therapy, Family therapy." The document prints "Dialectic behavior therapy"; the therapy is dialectical behaviour therapy (DBT), developed by Marsha Linehan, and "Acceptance Commitment Therapy" is Acceptance and Commitment Therapy (ACT). This chapter is written at the level of the syllabus — concepts, classification systems, research-based causal models and the principles of each therapy — and is not clinical guidance.

1. The concept of psychopathology and the Mental Status Examination

No single criterion defines abnormality. Statistical rarity counts giftedness as abnormal; violation of social norms varies across cultures and eras; personal distress misses people who harm others without distress; and maladaptiveness (impaired functioning) depends on context. Clinicians therefore combine the "four Ds" — deviance, distress, dysfunction and danger — and Wakefield's definition of disorder as a harmful dysfunction (a failure of a natural mechanism that causes harm as judged by social values). Critics include Thomas Szasz ("the myth of mental illness") and David Rosenhan, whose pseudo-patients (1973) were admitted and labelled despite behaving normally. Explanatory models are biological, psychodynamic, behavioural, cognitive, humanistic–existential and sociocultural, integrated in the diathesis–stress and biopsychosocial models.

The Mental Status Examination — a structured, here-and-now description of mental functioning
MSE component	What is observed or assessed
Appearance and behaviour	Grooming, dress, eye contact, psychomotor activity, attitude toward the examiner
Speech	Rate, volume, quantity and fluency
Mood and affect	Mood is the patient's reported sustained emotional state; affect is the observed expression — its range, intensity, stability and appropriateness
Thought	Form or process (for example flight of ideas, loosening of associations, tangentiality) and content (for example delusions, obsessions, preoccupations)
Perception	Hallucinations (perception without a stimulus) and illusions (misperception of a real stimulus)
Cognition	Consciousness; orientation to time, place and person; attention and concentration (for example serial sevens); immediate, recent and remote memory; abstraction (interpreting proverbs); general information
Insight and judgement	Awareness that one has a problem and understanding of its nature; capacity to make sound decisions

2. Classification and causes

Two systems are used. The American Psychiatric Association's DSM-5 (2013) abolished DSM-IV's five-axis system and added dimensional elements; its text revision, DSM-5-TR (2022), updated the descriptive text and added prolonged grief disorder. The World Health Organization's ICD-11, adopted by the World Health Assembly in 2019 and in effect from 1 January 2022, places mental disorders in Chapter 06, "Mental, behavioural or neurodevelopmental disorders", and replaced categorical personality-disorder types with a single diagnosis graded by severity plus trait domains. Major groupings in both include neurodevelopmental disorders (intellectual disability, autism spectrum disorder, ADHD, specific learning disorder), schizophrenia and other psychotic disorders, bipolar and depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders (including PTSD), dissociative disorders, somatic symptom disorders, feeding and eating disorders, substance-related disorders, neurocognitive disorders and personality disorders.

Causes of psychopathology
Level of cause	Examples from research
Biological	Genetic liability (higher concordance in identical twins for schizophrenia and bipolar disorder); neurotransmitter hypotheses — dopamine in psychosis, serotonin and norepinephrine in depression, GABA in anxiety; structural findings such as enlarged ventricles in schizophrenia; HPA-axis dysregulation in depression.
Psychological	Unconscious conflict (psychodynamic); conditioning and avoidance (Mowrer's two-factor account of phobias); Beck's cognitive triad of negative views of the self, the world and the future, maladaptive schemas and distortions; learned helplessness and hopelessness.
Social and cultural	Poverty, adversity and discrimination; family expressed emotion (criticism, hostility, over-involvement), which predicts relapse in schizophrenia; culture-bound idioms of distress.
Integrative	The diathesis–stress model (a vulnerability activated by stress) and the biopsychosocial model (Engel, 1977).

3. Psychodynamic, humanistic–existential and behavioural–cognitive therapies

Therapies named in the syllabus (I)
Therapy	Founder	Core principles and techniques
Psychoanalysis	Sigmund Freud	Making the unconscious conscious through free association, dream analysis and interpretation of resistance and transference; insight and working through.
Person-centred therapy	Carl Rogers	Non-directive; growth follows when the therapist provides three core conditions — congruence (genuineness), unconditional positive regard and accurate empathic understanding.
Gestalt therapy	Fritz and Laura Perls	Awareness in the here and now, taking responsibility, completing "unfinished business"; the empty-chair technique and exaggeration exercises.
Existential therapy	Rollo May, Viktor Frankl, Irvin Yalom	Confronting the givens of existence — death, freedom, isolation and meaninglessness (Yalom); Frankl's logotherapy uses paradoxical intention and dereflection to help find meaning.
Behaviour therapy	Joseph Wolpe; Skinner and others	Systematic desensitisation (relaxation paired with a graded anxiety hierarchy — reciprocal inhibition), exposure and response prevention for OCD, flooding, aversion therapy, token economies and modelling.
REBT	Albert Ellis (1955)	The ABC(DE) model: an Activating event does not cause the emotional Consequence directly; the Belief about it does. Irrational beliefs — absolutist "musts", awfulising, low frustration tolerance — are Disputed to produce a new Effect.
Cognitive behaviour therapy	Aaron T. Beck	Identifying and testing automatic thoughts and cognitive distortions (all-or-nothing thinking, overgeneralisation, catastrophising, personalisation) through collaborative empiricism, Socratic questioning and behavioural experiments.

4. Third-wave, creative, positive and systemic therapies

Therapies named in the syllabus (II)
Therapy	Founder	Core principles and techniques
Acceptance and Commitment Therapy (ACT)	Steven Hayes	Building psychological flexibility through six processes: acceptance, cognitive defusion, contact with the present moment, self-as-context, values and committed action. Thoughts are observed rather than disputed.
Mindfulness-Based Cognitive Therapy (MBCT)	Segal, Williams and Teasdale (2002)	An eight-week group programme combining MBSR-style mindfulness with cognitive therapy, designed to prevent relapse in recurrent depression by teaching decentring from negative thoughts.
Dialectical behaviour therapy (DBT; "Dialectic behavior therapy" in the syllabus)	Marsha Linehan	Developed for borderline personality disorder; balances the dialectic of acceptance and change; individual therapy plus skills training in four modules — mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
Play therapy	Anna Freud, Melanie Klein; Virginia Axline	Play is the child's natural language: psychoanalytic play therapy interprets play, and Axline's child-centred play therapy applies Rogers's conditions through eight basic principles of acceptance and permissiveness.
Positive psychotherapy	Martin Seligman, Tayyab Rashid and Acacia Parks (2006); separately Nossrat Peseschkian	Rather than only reducing symptoms, builds positive emotion, engagement, meaning and character strengths (exercises such as gratitude letters and "three good things"). Peseschkian's earlier positive psychotherapy is a transcultural, resource-oriented approach.
Transactional Analysis	Eric Berne	Three ego states — Parent, Adult and Child; transactions that are complementary, crossed or ulterior; psychological games (Games People Play, 1964) and life scripts; the life positions popularised as "I'm OK — You're OK".
Art therapy	Margaret Naumburg, Edith Kramer	Visual art-making as a medium of expression, symbolic communication and processing of experience that is hard to put into words.
Performing art therapy	J. L. Moreno (psychodrama) and others	Drama therapy and psychodrama (a protagonist enacts situations with auxiliary egos, using role reversal and doubling), dance and movement therapy, and music therapy.
Family therapy	Minuchin, Bowen, Haley, Satir, the Milan group	The family as a system in which the "identified patient" carries its dysfunction: structural therapy (Minuchin — boundaries, enmeshment and disengagement), Bowenian (differentiation of self, triangulation, the genogram), strategic (Haley), experiential (Satir) and Milan systemic therapy.

🧠 Dispute or defuse?

REBT and Beck's CBT change the content of thoughts by disputing or testing them. The third-wave therapies — ACT, MBCT and DBT — change the person's relationship to thoughts: noticing them, accepting them and acting on values anyway.

Key takeaways

Abnormality is judged by deviance, distress, dysfunction and danger, or as harmful dysfunction (Wakefield); Szasz and Rosenhan criticised psychiatric labelling; the diathesis–stress and biopsychosocial models integrate causes.
The Mental Status Examination covers appearance and behaviour, speech, mood and affect, thought form and content, perception, cognition, and insight and judgement.
DSM-5 (2013) dropped the multiaxial system and DSM-5-TR (2022) added prolonged grief disorder; ICD-11 (in effect from 2022) places mental disorders in Chapter 06 and grades personality disorder by severity.
Psychoanalysis uses free association and transference; Rogers's core conditions are congruence, unconditional positive regard and empathy; Gestalt works in the here and now; Wolpe's desensitisation rests on reciprocal inhibition; Ellis's REBT follows ABC(DE); Beck's CBT tests automatic thoughts.
ACT builds psychological flexibility, MBCT prevents depressive relapse, DBT ("Dialectic behavior therapy" in the syllabus) teaches four skill modules, TA analyses Parent–Adult–Child ego states, and play, art, performing-art, positive and family therapies complete the list.

Practice questions (10)

Attempt each one before opening the answer. Every explanation names the tempting wrong option as well as the right one, because that is where marks are lost.

In Ellis's REBT, which element is held to cause the emotional consequence (C)?
1. The activating event (A) itself
2. The therapist's disputing (D)
3. Unconscious transference
4. The belief (B) about the activating event
Show answer
Answer: D — The belief (B) about the activating event
In the ABC model, emotional consequences follow from beliefs about events, not from the events themselves; therapy disputes irrational beliefs to produce a new effect (E). Transference is a psychoanalytic concept.
Which of the following are skills modules of dialectical behaviour therapy (printed "Dialectic behavior therapy" in the syllabus)? Select all that apply.
1. Genogram construction
2. Free association
3. Interpersonal effectiveness
4. Distress tolerance
Show answer
Answer: C — Interpersonal effectiveness; D — Distress tolerance
Linehan's four DBT modules are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Free association is psychoanalytic, and the genogram belongs to Bowenian family therapy.
Which set correctly lists Rogers's core conditions for therapeutic change?
1. Parent, Adult, Child
2. Congruence, unconditional positive regard, empathic understanding
3. Free association, interpretation, working through
4. Acceptance, defusion, committed action
Show answer
Answer: B — Congruence, unconditional positive regard, empathic understanding
Rogers held that genuineness, unconditional positive regard and accurate empathy are necessary and sufficient for change. The other sets belong to psychoanalysis, ACT and Transactional Analysis respectively.
Mindfulness-Based Cognitive Therapy (MBCT) was developed chiefly to:
1. Treat childhood conduct problems through play
2. Analyse ego states in transactions
3. Prevent relapse in recurrent depression
4. Restructure family boundaries
Show answer
Answer: C — Prevent relapse in recurrent depression
Segal, Williams and Teasdale designed MBCT as an eight-week programme to help people who have recovered from depression notice and step back from negative thinking, reducing relapse.
In Transactional Analysis, the ego state that processes information objectively and deals with reality in the here and now is the:
1. Adult
2. Superego
3. Child
4. Parent
Show answer
Answer: A — Adult
Berne's Adult ego state is the rational, reality-testing part; the Parent holds taught rules and attitudes, and the Child holds felt feelings and impulses. The superego is Freud's concept.
Which of the following statements about classification systems are correct? Select all that apply.
1. ICD-11 retains the ten categorical personality-disorder types of ICD-10 unchanged
2. ICD-11 is published by the World Health Organization
3. DSM-5-TR (2022) added prolonged grief disorder
4. DSM-5 abolished the five-axis system of DSM-IV
Show answer
Answer: B — ICD-11 is published by the World Health Organization; C — DSM-5-TR (2022) added prolonged grief disorder; D — DSM-5 abolished the five-axis system of DSM-IV
The first three statements are correct. ICD-11 replaced the categorical personality-disorder types with a single diagnosis graded by severity (mild, moderate, severe) with optional trait-domain specifiers.
In a Mental Status Examination, "affect" refers to:
1. The content of the patient's thoughts
2. Orientation to time, place and person
3. The patient's own report of a sustained emotional state
4. The observed expression of emotion, including its range and appropriateness
Show answer
Answer: D — The observed expression of emotion, including its range and appropriateness
Affect is what the examiner observes; mood is what the patient reports. Orientation belongs to cognition, and thought content to the thought section of the MSE.
Wolpe's systematic desensitisation is based on the principle of:
1. Reciprocal inhibition — relaxation is incompatible with anxiety
2. Transference of feelings onto the therapist
3. Differentiation of self within the family
4. Disputing irrational "musts"
Show answer
Answer: A — Reciprocal inhibition — relaxation is incompatible with anxiety
Pairing deep relaxation with a graded hierarchy of feared situations replaces anxiety with a competing response, which Wolpe called reciprocal inhibition. The other options describe psychoanalysis, REBT and Bowen's family therapy.
Assertion (A): Acceptance and Commitment Therapy does not try to eliminate unwanted thoughts. Reason (R): ACT aims to increase psychological flexibility, so that people can notice difficult thoughts through cognitive defusion and still act in line with their values. Choose the correct option.
1. Both A and R are true, and R is the correct explanation of A
2. Both A and R are true, but R is not the correct explanation of A
3. A is true, but R is false
4. A is false, but R is true
Show answer
Answer: A — Both A and R are true, and R is the correct explanation of A
Both are true and R explains A: because the goal is flexibility rather than symptom removal, ACT changes the person's relationship to thoughts instead of their content.
The empty-chair technique, in which a client addresses an imagined person or part of the self, is characteristic of:
1. REBT
2. Person-centred therapy
3. Structural family therapy
4. Gestalt therapy
Show answer
Answer: D — Gestalt therapy
Fritz Perls's Gestalt therapy uses the empty chair to bring unfinished business into present awareness. Person-centred therapy is non-directive, REBT disputes beliefs, and structural family therapy works on family boundaries.