Chapter 2: Assessment, Classification, and Treatment of Abnormal Behavior Flashcards
What are the steps involved in clinical interviews?
- identifying data
- description of the presenting problems
- psychosocial history
- medical/psychiatric history
- medical problems/medication
Unstructured Interview
type of clinical interview in which interviewers determine which questions to ask rather than following a standard interview format
Semi-Structured Interview
type of clinical interview in which interviewers are guided by a general outline but are free to modify the order in which questions are asked and to branch off in other directions
Structured Interview
means by which an interviewer obtains a clinical information from a client by asking a fairly standard series of questions concerning such issues as the client’s presenting complaints or problems, mental state, life circumstances and psychosocial or developmental history
Mental Status Examination
structured clinical evaluation to determine various aspects of a client’s mental functioning
Intelligence
global capacity to understand the world and cope with its challenges
trait or traits associated with successful performance on intelligence tests
Mental Age
age equivalent that corresponds to the person’s level of intelligence as measured by performance on the Stanford-Binet Intelligence Scale
Intelligence Quotient
measure of intelligence derived on the basis of scores on an intelligence test, called a quotient because it was originally derived by dividing a respondent’s mental age by her or his age
Deviation IQ
intelligence quotient derived by determining the deviation between the individual’s score and the norm (mean)
Objective Tests
tests that allow a limited, specified range of response options or answers so that they can be scored objectively
Forced-Choice Formats
method of structuring test questions that requires respondents to select among a set number of possible naswers
Validity Scales
groups of test items that serve to detect whether the results of a particular test are valid or whether a person responded in a random manner or in a way intended to create a favorable or unfavorable impression
Neuropsychological Assessment
methods of psychological assessment used to detect signs of underlying neurological damage or brain defects
Psychometric Approach
method of psychological assessment that seeks to use psychological tests to identify and measure the reasonably stable traits in an individual’s personality that are believed to largely determine his or her behavior
Behavioral Assessment
approach to clinical assessment that focuses on the objective reading or description of problem behavior rather than on inferences about personality traits
Behavioral Interview
approach to clinical interviewing that focuses on relating problem behavior to antecedent stimuli and reinforcement consequences
Self-Monitering
in behavioral assessment, the process of recording or observing one’s own behavior, thoughts, or emotions
Baseline
period of time preceding the implementation of a treatment, used to gather data regarding the rate of occurrence of the target behavior before treatment is introduced
Behavioral Rating Scale
method of behavioral assessment that involves the use of a scale to record the frequency of occurrence of target behaviors
Electrodermal Response
changes in the electrical conductivity of the skin following exposure to a stimulus
Galvanic Skin Response
measure of the change in electrical activity of the skin caused by increased activity of the sweat glands that accompanies states of sympathetic nervous system arousal, such as when a person is anxious
Electroencephalograph (EEG)
instrument for measuring the electrical activity of the brain (brainwaves)
Electromyograph (EMG)
instrument often used in biofeedback training for measuring muscle tension
Reliable
in psychological assessment, the consistency of a measuring instrument, such as a psychological test or rating scale
there are various ways of measuring reliability, such as test-retest reliability, internal consistency, and interrater reliability
Validity
with respect to tests, the degree to which a test measures the traits or constructs that it purports to measure
with respect to experiments, the degree to which an experiment yields scientifically accurate and defensible results
Culture-bound Disorders
patterns of behavior that are found within only one or a few cultural contexts
Taijin-Kyofu-Sho (TKS)
psychiatric symptom found in Japan that involves excessive fear of offending or causing embarrassment to others
Psychotherapy
method of helping involving a systematic interaction between a therapist and a client that brings psychological principles to bear on influencing the client’s thoughts, feelings, or behaviors to help that client overcome abnormal behavior or adjust to problems in living
Eclectic Orientation
adoption of principles or techniques from various systems or theories
Psychopharamacology
field of study that examines the effects of drugs on behavior and psychological functioning and explores the use of psychoactive drugs in the treatment of emotional disorders
Tolerance
physical habituation to a drug so that with frequency usage, higher doses are needed to attain similar effects
Rebound Anxiety
occurrence of strong anxiety following withdrawal from a tranquilizer
Neuroleptics
group of antipsychotic drugs used in the treatment of schizophrenia, such as the phenothiazines
Antidepressants
types of drugs that act to relieve depression
tricyclics, MAO inhibitors, SSRIs, and SNRIs are the major classes of antidepressants
Tricyclics
group of antidepressant drugs that increase the activity of norepinephrine and serotonin in the brain by interfering with the reuptake of these neurotransmitters by transmitting neurons
Monoamine Oxidase (MAO) Inhibitors
antidepressants that act to increase the availability of neurotransmitters in the brain by inhibiting the actions of an enzyme, monoamine oxidase, that normally breaks down or degrades neurotransmitters (norepinephrine and serotonin) in the synaptic cleft
Selective Serotonin-Reuptake Inhibitors (SSRIs)
type of antidepressant medication that prevents serotonin from being taken back up by the transmitting neuron, thus increasing its action
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
type of antidepressant medication that works specifically on increasing levels of serotonin and norepinephrine by interfering with the reuptake of those chemicals by transmitting neurons
Placebo
inert medication or form of bogus treatment intended to control for the effect of expectancies
Electroconvulsive Therapy
induction of a convulsive seizure by means of passing an electric current through the head; used primarily in the treatment of severe depression
Repetitive Transcranial Magnetic Stimulation (rTMS)
a procedure that uses strong magnetic pulses to stimulate the brain
Displacement
in psychodynamic theory, a type of defense mechanism that involves the transferring of impulses toward threatening or unacceptable objects onto more acceptance or safer objects
Transference Relationship
in psychoanalysis, a client’s transfer or generalization to the analyst of feelings and attitudes the client holds toward important figures in his or her life
Countertransference
in psychoanalysis, the transfer of feelings that the analyst holds towards other persons in her or his life onto the client
Systematic Desensitization
behavior therapy technique for overcoming phobias by means of exposure (in imagination or by means of pictures or slides) to progressively more fearful stimuli while one remains deeply relaxed
Gradual Exposure
in behavior therapy, a method of overcoming fears through a stepwise process of direct exposure to increasingly fearful stimuli
Token Economies
behavioral programs, in institutional settings, in which a controlled environment is constructed such that people are reinforced for desired behaviors by receiving tokens that may be exchanged for desired rewards or privileges
Person-Centered Therapy
Carl Rodger’s method of psychotherapy, emphasizing the establishment of a warm, accepting therapeutic relationship that frees clients to engage in a process of self-exploration and self-acceptance
Unconditional Positive Regard
in Carl Rodger’s view, the expression of unconditional acceptance of another person’s basic worth as a person, regardless of whether one approves of all the behavior of the other person
the ability to express unconditional positive regard is considered a quality of an effective person-centered therapist
Meta-Analysis
statistical technique for combining the results of different studies into an overall average
in psychotherapy research, meta-analysis is used to compute the average benefit or size of effect associated with psychotherapy overall, or with different forms of therapy, in relation to control groups
Non-Specific Treatment Factors
characteristics that are not specific to any one form of psychotherapy but tend to be shared by psychotherapies, such as the attention a client receives from a therapist and the therapist’s encouragement of the client’s sense of hope and positive expectancies
Civil Commitment
legal process involved in placing an individual in a psychiatric institution, even against his or her will
Legal Commitment
legal process involved in confining a person found “not criminally responsible on account of mental disorder” in a psychiatric institution
Confidentiality
the principle of safeguarding information so that it remains secret and is not disclosed to other parties
Duty to Warn
obligation imposed on therapists to worn third parties of threats made against them by the therapists’ clients
Insanity Defense
form of legal defense in which a defendant in a criminal case pleads guilty but not criminally responsible on the basis of having a mental disorder
NCRMD
not criminally responsible on account of a mental disorder
NGRI
a person found not guilty by reason of insanity
Why is the assessment of abnormal behaviors important?
a careful assessment provides a wealth of information about a client’s personality, behavior, and cognitive functioning
this information helps clinicians acquire a broader understanding of their clients’ problems and recommend appropriate forms of treatment
What are the measures of reliability of assessment?
internal consistency (questionnaires need to return consistent results)
temporal stability (consistent over the course of time (practice effects decrease the stability, test-retest reliability)
interrater reliability (different observers get the same results)
What are the measures of validity of assessment?
content validity (testing on the same content)
criterion validity (why are we doing this test? it’ll be useful for us)
construct validity (instrument that measures something like intelligence that is a social construct)
What are the sociocultural and ethnic factors in the assessment of abnormal behavior?
assessment techniques may be reliable and valid in one culture, but not in another
most diagnostic instruments consider culture to some degree, but most fail to provide adequate norms for different cultural and ethnic groups
interviewers need to be sensitive to problems that can arise when interviews are conducted in a language other than the client’s mother tongue
What is a clinical interview?
differences in theoretical approaches
interview formats: unstructured, semi-structured, structured
close-ended vs. open-ended questions
What are the different definitions of intelligence on intelligence tests?
Wechsler (1975): comprehension and adaptation
Terman (1916): intelligence quotient (IQ = MA/CA x 100)
What are the problems with the measure of intelligence quotient?
differing level of variance at different ages
What are self-report tests of personality?
Minnesota Multiphasic Personality Inventory (MMPI-II): true or false questions computers produce profiles, can tell when they’re dishonest
Millon Clinical Multiaxial Inventory (MCMI)
irrationally derived questions show characteristics of mental illness when picked
What are projective tests of personality?
stimulus that is relatively neutral is shown to a patient so they reveal unconscious things about themselves by describing the image
Rorschach inkblot Test
Thematic Apperception Test (TAT)
Black Test
What are methods of neuropsychological assessment?
used to evaluate whether or not psychological problems reflect underlying neurological damage or brain defects
Halstead-Reitan Neuropsychological Battery
Luria-Nebraska Battery
What are methods of behavioral assessment?
focuses on the objective recording and/or description of behavior
functional analysis (what purpose does the behavior serve?)
behavioral interview (ask fluid questions about behavior)
reactivity (when we start measuring something when the person knows will change frequency of behavior)
self-monitoring (people will find loopholes to justify behaviors to not help them)
analogue measures
behavioral rating scales (can be done by a third party)
What is cognitive assessment?
involves the assessment of cognitions (thoughts, beliefs, and attitudes)
What are methods of cognitive assessment?
thought diaries
cognition checklist
dysfunctional attitudes scale
What are methods of physiological measurement?
examines people’s physiological responses
Galvanic skin response (GSR): change in electrical stimulus on skin during anxiety
electroencephalograph (EEG): brain wave activity
electromyograph (EMG): measures muscle tension
measures of sexual arousal (PPG and VPP): measure of blood flow to genitals
What are the steps of proper assessment?
testing (by itself) =/= assessment
proper assessment = clinical history and observation + measurement + expert knowledge + formulation
strengths must be considered as equally important, can’t just focus on pathology
How do we classify abnormal behavior?
classification systems for abnormal behavior date back to ancient times
the most modern system of classification (the DSM-5) emerges out of the work of Kraeplin in the 19th century
classification is at the core of the scientific enterprise
labels make communication about psychological disorders possible
What are the current systems of classification?
Diagnostic & Statistical Manual of Mental Disorders (DSM)
International Statistical Classification of Diseases and Related Health problems (ICD)
Chinese Classification of Mental Disorders (CCMD)
How does the DSM classify abnormal behavior?
classifying disorders, not people
an attempt to define and discover actual diseases (mental or psychological disorders)
strictly speaking, the term disease process is reserved for conditions with well understood cause and course
inherently medical view
most medical disorders do not qualify as genuine disease processes, which doesn’t disqualify them as forms of illness
they are clinical pictures, or syndromes
What are the features of the DSM?
specific diagnostic criteria are used
abnormal behavior patterns that share features are grouped together
What are the goals of re-constructing the DSM-5?
- atheoretical (not tied to any one school of thought)
- descriptive (what is observable in the patient’s presentation)
- Polythetic (same condition can look subtly different)
- Good interrater reliability (agreement between clinicans)
What is the reliability of the DSM system?
really hasn’t improved much since DSM-III
estimates may be inflated due to focus on high severity populations
What is the validity of the DSM system?
can be inadvertently sacrificed in the interests of maximizing reliability
realism vs. instrumentalism
when you try to simplify things to improve reliability you lose some characteristics of the disorder
What is predictive validity?
diagnosis –> disease course, treatment options, and clinical outcomes
What are the major changes made to the DSM-5?
dimensional rather than categorical (depends on the nature of the disorder)
reorganizing in a developmental lifespan fashion
criterion changes and replacement of DSM-IV disorders with more relevant disorders
What are the sociocultural factors of abnormal behavior classification?
reliability and validity of assessment tools may be culture-specific
disentangling psychopathology from sociocultural factors
issues of translation
What are culture-bound syndromes?
patterns of psychological distress that are limited to one or only a few cultures
What is Tajinn-kyofu-sho (TKS)?
is a common disorder seen in Japan, characterized by an excessive fear that one will behave in embarrassing ways or offend other people
Who can carry out treatments of abnormal behavior?
mental health professionals
clinical psychologist
psychiatrist
social workers
psychiatric nurses
family physicians
What are methods of biological therapies?
medication (inexpensive, easy to take, good side effects)
electroconvulsive therapy
psychosurgery
deep brain stimulation
What is deep brain stimulation?
electrodes implanted much like a heart pacemaker
effect depends on location of electrodes
What are methods of psychodynamic therapies?
free association (tell me what first comes to mind)
transference (treating someone like someone else in your life)
modern psychodynamic approaches
What are methods of behavior therapy?
systematic desensitization (teach coping techniques to increase relaxation)
gradual exposure (fear hierarchy isn’t as quantifiable)
token economies (identify a set of behaviors that given tokens to exchange for rewards)
modelling
What are humanistic-existential therapies?
person-centered therapy (Rodgers)
emotion-focused therapy (Greenberg)
What are cognitive-behavior therapies?
Ellis’ rational emotive therapy
Beck’s cognitive therapy
Meichenbaum’s cognitive-behavioral therapy
What is computer therapy?
computerized clinical interviews have been used for more than 30 years (CASPER)
computer programs are as capable as skilled clinicians of obtaining information from clients and reaching an accurate diagnosis, and are less expensive and more time-efficient
the most basic form of e-therapy is through email correspondence and generally addresses less serious problems
text messaging and chat rooms
computer video-conferencing between therapists and clients (huge since onset of pandemic)
lots of apps including CBT and self-help
What is the indigenous healing perspective?
mental wellness as balance of physical, mental, emotional, spiritual
mental wellness as a continuum
mental wellness as multileveled: individual, family, community
Does psychotherapy work?
the results of some 375 controlled studies comparing various types of therapies (psychodynamic, behavioral, humanistic, etc.) against control groups showed that the average psychotherapy client in these studies was better off than 75-80% of the clients who remained untreated
establishing the superiority of one approach versus another is more problematic, depends on many factors including type of disorder
it appears that both specific and nonspecific factors are involved in accounting for therapeutic change
What is a therapeutic alliance in psychotherapy?
the variable that stands out more than any other as important to successful psychotherapy is the quality of the therapeutic alliance
correlation with outcome is typically in the range of 0.20
describes virtually all aspects of the relationship between client and therapist
What is civil commitment?
mental health act: form 1, 8, 10
having a mental disorder alone is not enough
patient must have a mental disorder or appear to be suffering from a mental disorder
patient likely to cause harm to themselves or others
unsuitable for admission to a facility other than as a formal patient
What is legal commitment (NCRMD: not criminally responsible on account of mental disorder)?
clear evidence
imminent risk
limited time
What is the overprediction of dangerousness?
due to inaccurate predictions in general
psychopathy: psychopathy checklist
the post hoc problem (hindsight is 20/20)
leaping from the general to the specific
How do you define dangerousness?
base-rate problems: rare events are difficult to predict
unlikelihood of disclosure of direct threats of violence
behavior in the community from behavior in the hospital
What is the legal bases of the insanity defence?
the M’Naughten rule
NGRI (not guilty by reason of insanity)
R. v. swain (1991)
NCRMD (not criminally responsible on account of mental disorder)
not criminally responsible reform act (2014)
When is someone unfit to strand trial?
incapable of participating in their own defense
can’t distinguish between pleas
doesn’t understand the purpose of trial
cannot communicate with counsel rationally or make critical decisions on counsel’s advice
is unable to take the stand to testify
