Biopsychosocial Framework Slides Clinical Psychology Unit 1
The Biopsychosocial
Model in Action
"Moving beyond linear causality to understand the multidimensional origins of psychopathology."
The Twin Paradox
Twin A
Raised in stable home
High social support
No clinical diagnosis
Twin B (Identical)
History of early trauma
Substance use environment
Diagnosed Schizophrenia
Essential Question: If DNA is identical, why are the outcomes different?
The Biopsychosocial Framework
Biological
Genetics, Neurochemistry, Brain Structure, Hormones
Psychological
Cognitions, Emotions, Coping Styles, Personality
Social
Culture, SES, Relationships, Trauma, Environment
Diathesis-Stress Model
The Diathesis
The underlying vulnerability or predisposition (Genetic, early trauma, etc.)
The Stress
The environmental trigger (Life events, chronic pressure, physical illness)
Outcome: Pathogenesis
When stress exceeds the individual's coping threshold given their diathesis.
Dynamic Interplay
Risk Factors
• Genetic loading (Heritability)
• Neurodevelopmental delays
• Adverse Childhood Experiences
• Low Social Economic Status (SES)
• Cognitive distortions (Rumination)
Protective Factors
• Strong social support networks
• Cognitive flexibility / Resilience
• High self-efficacy
• Early intervention/treatment
• Emotional regulation skills
Diagnosis is not destiny; it is a balance of these forces.
Twin Study Analysis Worksheet Case Analysis: The Twin Paradox
Lesson 1: Biopsychosocial Dynamics & Epigenetic Interplay
Clinical Psychology Lab
Name:
Date:
Clinical Objective
Analyze the discordant outcomes of Monozygotic (MZ) twins to evaluate the weight of environmental stress against genetic diathesis in the pathogenesis of mental disorders.
Case Brief: The "Genain" Variable
Twin A: "Marcus"
Biological: MZ twin, positive for high-risk schizophrenia-linked alleles.
Developmental: Adopted at age 2 into a stable, middle-class family with high emotional warmth.
Clinical Status: No psychiatric diagnosis; maintains stable employment and healthy marriage.
Twin B: "Elias"
Biological: MZ twin, identical genetic profile to Marcus.
Developmental: Remained in biological home; experienced chronic neglect and physical abuse until age 14.
Clinical Status: Diagnosed with Schizophrenia (Paranoid type) at age 21 after a stressful transition to college.
1 Deconstructing the Diathesis
Define the specific 'diathesis' shared by both twins and explain how the 'stress' differed. Use clinical terminology from the slide deck.
2 Epigenetic Considerations
How might environmental factors (e.g., neglect) lead to "differential gene expression" in Elias but not Marcus? Propose a biological mechanism.
3 Protective Factor Mapping
Identify three specific protective factors in Marcus's life. Categorize them as Biological, Psychological, or Social.
Biological
Psychological
Social
4 Theoretical Synthesis
Based on this case, argue for or against the statement: "Genetics is the primary driver of psychopathology." Support your answer with evidence from the case brief.
Case ID: TWIN-DISC-2026-A | Ethical Review Pending
Neurobiology Pathogenesis Slides Clinical Psychology Unit 2
Neurobiology of
Psychopathology
Evaluating the biological substrates of mental illness and the pharmacological model.
The Biological Imperative
Key Assumption:
"Psychological symptoms are the phenotypic expression of underlying neurobiological dysfunction."
Structural
Anatomy & Pathways
Chemical
Neurotransmission
Neurotransmitters & Pathogenesis
Serotonin (5-HT)
Primary Association:
Mood regulation, sleep, appetite.
Low levels linked to: Major Depression, Anxiety.
Dopamine (DA)
Primary Association:
Reward, motivation, motor control.
Excess linked to: Schizophrenia (Positive symptoms).
GABA / Glutamate
Primary Association:
Inhibition vs. Excitation.
Dysregulation linked to: Anxiety, Seizures, OCD.
Neuroanatomical Landmarks
Prefrontal Cortex (PFC)
Executive function, decision making, emotional regulation. Reduced volume in chronic MDD.
Amygdala
Fear processing and emotional salience. Over-active in Anxiety and PTSD.
Hippocampus
Memory formation and spatial navigation. Atrophy seen in prolonged Stress/Depression.
Basal Ganglia
Motor control and procedural learning. Dysfunction in OCD and Tourette’s.
Correlation ≠ Causation
Does a chemical imbalance cause depression, or is the chemical imbalance a result of living a depressed life?
Biological Reductionism
Risk of ignoring systemic and psychological factors.
Pharmacological Model
Effective for many, but does not address the 'Why'.
Discussion: The fMRI Illusion
Neuroimaging Critique Lab Neuroimaging Critique Lab
Lesson 2: Evaluating Biological Substrates in Psychopathology
Diagnostic Lab 02
Investigator:
Date:
Task: You are provided with two theoretical fMRI summaries. Your goal is to move beyond the visual "proof" of these images and apply critical evaluation to the neurobiological findings. Remember: An image of a brain is not an image of a mind.
Exhibit A: fMRI Scan 102 MDD CATEGORY
High Amygdala Activity
Low PFC Metabolism
Findings Summary
Significant hyperactivity in the limbic system (amygdala) when exposed to negative stimuli. Concomitant hypoactivity in the dorsolateral prefrontal cortex (dlPFC) during emotional regulation tasks.
Exhibit B: fMRI Scan 103 NON-CLINICAL CONTROL
Standard Amygdala Latency
Robust PFC Recruitment
Findings Summary
Baseline limbic activity within standard deviations. Efficient PFC activation during emotional inhibition tasks. High neural connectivity between the PFC and the amygdala.
Problem of Reverse Inference
If the amygdala is active during a task, we often infer the person is "feeling fear." Why is this inference logically dangerous in clinical research?
State vs. Trait
Do these scans represent a permanent brain "brokenness" (Trait) or a temporary physiological response to a current mood episode (State)? How could a researcher tell the difference?
The Therapeutic Implication
A patient looks at Exhibit A and says, "My brain is just wired wrong; therapy won't help." Using the concept of Neuroplasticity, provide a clinical rebuttal.
Ref: Biological Psychiatry Vol 44 FOR ACADEMIC USE ONLY
Learning Theories Slides Clinical Psychology Unit 3
Learning & Cognition:
The Etiology of Behavior
"Uncovering how maladaptive patterns are acquired, reinforced, and maintained."
Conditioned Fear: Watson’s Legacy
The Process:
Neutral Stimulus (White Rat)
Unconditioned Stimulus (Loud Noise)
Conditioned Response (Fear)
Generalization (Fear of anything white/fuzzy)
The Clinical takeaway:
"Phobias are not irrational 'brain glitches'; they are highly successful (if maladaptive) learning events."
Maintenance via Reinforcement
Negative Reinforcement
Removal of an aversive stimulus increases the behavior.
Example: Avoidance of social situations reduces anxiety, reinforcing the "Avoidance" strategy in Social Anxiety Disorder.
Positive Reinforcement
Addition of a rewarding stimulus increases the behavior.
Example: Sympathy or attention gained during depressive episodes can (unintentionally) reinforce depressive behavior.
The Cognitive Lens: Beck’s Triad
1
Negative view of the Self
2
Negative view of the World
3
Negative view of the Future
Cognitive Distortions
Maladaptive learning isn't just about actions; it's about the interpretive filters we use to process reality.
Learned Helplessness
Seligman & Maier (1967)
When an individual faces uncontrollable aversive events, they develop a perceived lack of agency.
"Why try? Nothing I do matters anyway."
Internal Attribution
"It's my fault."
Stable Attribution
"It will always be this way."
Global Attribution
"Everything I do is ruined."
Behavioral Chain Workshop Behavioral Chain Workshop
Lesson 3: Mapping the Acquisition & Maintenance of Pathology
Analysis Protocol 03
Analyst:
Date:
Learning Objective
Deconstruct a complex clinical symptom into its conditioning components. Identify the Antecedents (triggers), the Behavior (symptom), and the Consequences (reinforcement) that maintain the pathology.
Phase 1: Selecting the Target
Select one of the following clinical presentations for your analysis:
Social Phobia (Avoidance)
Compulsive Hand-Washing
Binge Eating Episode
Target Behavior to Analyze:
Specify your chosen behavior here...
Phase 2: The ABC Functional Analysis
A Antecedent
Environmental & Internal Triggers (What happened right before?)
B Behavior
The Clinical Symptom (Specific, observable actions/thoughts)
C Consequence
Reinforcement (Short-term gain? Anxiety reduction? Reward?)
Phase 3: Theoretical Interpretation
1. Type of Reinforcement
Identify if this behavior is maintained by Positive Reinforcement or Negative Reinforcement. Explain your logic.
2. Cognitive Distortions
Identify one cognitive distortion (e.g., Catastrophizing, Overgeneralization) likely occurring during this chain.
Reference: Behavioral Case Formulation (O'Donohue, 2013) FOR CLINICAL SIMULATION ONLY
Social Roots Slides Clinical Psychology Unit 4
Social Roots of Pathology
"Analyzing the impact of ACEs, poverty, and systemic factors on mental health trajectories."
Epidemiology & Etiology
The Question:
"Why do certain zip codes have higher rates of schizophrenia than others?"
Social Drift Hypothesis
Social Causation Theory
The ACE Study: Felitti et al. (1998)
Abuse
• Emotional
• Physical
• Sexual
Neglect
Household Dysfunction
• Substance Use
• Incarceration
• Domestic Violence
Dose-Response Relationship:
The higher the ACE score, the greater the risk for mental & physical illness in adulthood.
Beyond the Individual
Structural Violence
Systemic poverty, lack of access to care, and discrimination as chronic stressors that alter HPA-axis function.
Minority Stress Model
Unique, additive stressors faced by marginalized populations that predict psychopathology independent of genetics.
The "Why" of Diagnosis
"A diagnosis may describe a patient's symptoms, but their social context describes their condition."
Biologizing the Social
How does "Social Stress" become "Biological Pathology"?
Epigenetics
Gene silencing via methylation
HPA Axis
Cortisol flooding/burnout
Inflammation
Systemic immune response
Next: Population Data Analysis
ACEs Impact Analysis Epidemiological Impact Analysis
Lesson 4: Trauma-Informed Etiology & Social Determinants
Public Health File 04
Investigator:
Date:
Clinical Objective
Evaluate the relationship between Adverse Childhood Experiences (ACEs) and long-term psychiatric morbidity. Students will interpret risk ratios and connect sociological data to psychological theory.
Reference Data: Adult Health Outcomes (n=17,000)
Outcome Category ACE Score 0 ACE Score 4+ Depressive Episodes 14% 51% Suicide Attempts 1.1% 12.2% Substance Use Disorder 4% 28% Severe Sleep Disturbance 9% 24%
Observation:
Note the non-linear escalation. An ACE score of 4 or more is associated with a nearly 12-fold increase in suicide attempts compared to a score of 0. This suggests that trauma is not merely additive, but multiplicative in its impact on the developing nervous system.
1 Statistical Inference
Calculate the "Relative Risk" (RR) for Substance Use Disorder between an ACE score of 0 and 4+. How many times more likely is an individual with 4+ ACEs to develop a SUD? What does this imply for prevention?
2 The Physiological Mechanism
Using what you learned in Lesson 2 (Neurobiology), explain how chronic exposure to 4+ ACEs might lead to permanent changes in the HPA-Axis. How does this biological change manifest as "psychological symptoms"?
3 Systemic Intervention
If 1 in 8 people in the general population have an ACE score of 4+, is psychopathology primarily an "individual problem" or a "social health problem"? Argue for a shift in clinical practice based on this data.
Data Source: CDC-Kaiser Permanente ACE Study CONFIDENTIAL RESEARCH DOCUMENT
Case Formulation Framework Slides Clinical Psychology Capstone
Crafting the
Case Formulation
"Moving from 'What' to 'Why': Synthesizing multidimensional data into a clinical narrative."
The Crucial Distinction
Diagnosis
A descriptive label based on clusters of symptoms.
Focus: "The What"
"Patient meets criteria for Panic Disorder."
Formulation
A theoretical hypothesis of the origins and maintenance of the distress.
Focus: "The Why"
"Panic developed following a biological diathesis triggered by job loss and maintained by avoidance."
The 5 Ps of Case Formulation
Presenting Problem
What is the current distress?
Predisposing Factors
Diathesis: Genetics, early trauma, history.
Precipitating Factors
Triggers: Stressors that "kicked it off."
Perpetuating Factors
Maintenance: Why doesn't it go away?
Protective Factors
Resilience: Strengths and supports.
The Mystery Patient Dossier
Your Lab Task
You will receive a clinical dossier for Case ID: ALPHA-09.
Review intake interviews
Analyze medical/genetic history
Identify socio-economic stressors
Synthesize into a 5-P Formulation
"The formulation is a working hypothesis. It must be evidence-based, theoretically sound, and person-centered."
Warning:
Avoid 'Doctor-Speak'. Write a narrative that helps us understand the person, not just the disease.
Tell the Patient's Story
"The goal of clinical psychology is not to solve a puzzle, but to understand a life."
Final Workshop Commencing
Case Formulation Project Dossier Confidential
Dossier
Case ID: ALPHA-09-SYNTHESIS
Restricted Academic Access
Mystery Patient: "Leo"
Subject: 24-year-old male presenting with severe social withdrawal and auditory hallucinations.
Clinical Presentation
Leo was brought to the clinic by his sister. He has spent the last 6 months confined to his room, covering the windows with aluminum foil to "prevent signal leakage." He reports hearing a "low-frequency hum" that sometimes tells him he is "the last beacon." He has neglected personal hygiene and lost 15 lbs.
Biological History
Paternal uncle was hospitalized multiple times for "unspecified psychosis." Leo was a premature birth (32 weeks) with minor neurodevelopmental delays in speech. Recent blood work shows significantly elevated cortisol levels.
Social & Environmental Context
Leo grew up in a high-crime neighborhood with frequent police presence. He was bullied severely in middle school. Six months ago, he was laid off from his first steady job as a data entry clerk due to "budget cuts." This layoff coincided with the end of a 3-year relationship.
Protective Factors
Leo has a very supportive older sister who is a nurse. Prior to his withdrawal, he was an avid runner and found great peace in nature. He is highly intelligent and, when stable, shows strong insight into his emotional states.
End of Dossier Briefing | Proceed to Formulation
5-P Case Formulation Report
Case Analysis: ALPHA-09 (Leo)
Presenting Problem
The "What"
Summarize current symptoms and level of functioning...
Predisposing
The Diathesis
Identify genetic, developmental, and early trauma factors...
Precipitating
The Stressors
What specific life events triggered the current episode?
Perpetuating
The Maintenance
What behaviors or cognitions are keeping the problem alive?
Protective
The Resilience
Identify strengths, supports, and internal resources...
Integrative Narrative
In 300-500 words, tell Leo's story. Explain the interplay between his biological vulnerability (Uncle's history, birth complications), his psychological state (insight, runner), and his social reality (crime, bullying, job loss). How did these forces converge to create his current "mystery"?
