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Clinical Psychology and Mental Illness > Lecture 3: Clinical Assessment & Research Methods > Flashcards

Lecture 3: Clinical Assessment & Research Methods Flashcards

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1
Q

What is reliability?

A
  • Consistency of measurement (e.g., repeated measurement should yield consistent results when used under the same conditions)
  • Reliability is measured by correlation (how closely two
    variables are related). The higher the correlation, the better the reliability.
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2
Q

What are the two components of reliability?

A
  • Sensitivity - agreement regarding the presence of a particular diagnosis
  • Specificity - agreement concerning the absence of a particular diagnosis
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3
Q

What is interrater reliability?

A

refers to the degree to which two independent observers or judges agree.

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4
Q

What is test re-test reliability?

A
  • Measures the extent to which people being observed twice or taking the same test twice score in generally the
    same way.
  • Only makes sense when the theory assumes that people will not change appreciably between testings on the variable being measured.
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5
Q

What is alternate form reliability?

A

Uses two forms of a test (see how correlated are two separate measures?)

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6
Q

What is internal consistency reliability?

A

Assesses if the items on a test are related to one another.

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7
Q

What is validity?

A

Does a measure fulfill its intended purpose?

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8
Q

What is content validity?

A

refers to whether a measure adequately samples the domain of interest.

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9
Q

What is criterion validity?

A
  • criterion validity is the extent to which a measure is related to an outcome (i.e., the criterion). Criterion validity is often divided into concurrent and predictive validity.
    • concurrent validity (comparison between the measure in question and an outcome assessed at the same time)
    • predictive validity (a point in the future)
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10
Q

What is construct validity?

A
  • is a test or measure of some characteristic or construct that is not simply defined
  • is evaluated by looking at a wide variety of data from
    multiple sources.
  • considers how well does the diagnosis relate to other
    aspects of the disorder.
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11
Q

What is case validity, when is it demonstrated and what is required?

A
  • The focus is on validity of the interpretations and decisions made with respect to a particular person.
  • Case validity would be demonstrated when the person is
    accurately assessed in their life context in a way that takes
    into account interactions between the person and situations as well as interactions of the person’s schemas.
  • Case validity requires considering the person in typical
    situations versus maximal situations (i.e., the difference between how a person usually is versus what they are capable of in atypical or extreme situations).
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12
Q

what is psychological assessment?

A
  • The collection, organization, and interpretation of information about a client and his or her situation
  • A process whereby a sequence of questions/steps aid in systematically gathering data on the client for the purpose of coming to a decision
  • Involves gathering/integrating multiple types of data from multiple sources
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13
Q

What are the two types of clinical interviews?

A
  • Unstructured

- Structured

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14
Q

What are the different kinds of psychological tests?

A
  • Severity of symptoms
  • Personality tests (e.g., MMPI)
  • Intelligence tests
  • Projective tests
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15
Q

What is the definition of interview?

A
  • any interpersonal encounter, conversational in style, in
    which one person, the interviewer, uses language as the
    principal means of finding out about another person, the
    interviewee.
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16
Q

How do paradigms influence clinical interviews and what is important in clinical interviews?

A
  • The paradigm within which an interviewer operates
    influences the type of information sought, how it is obtained, and how it is interpreted.
  • The interviewer pays attention to how the respondent
    answers—or does not answer—questions.
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17
Q

What is assessed during an unstructured clinical interview?

A
  • onset/course (when did the problems begin?)
  • severity (do the problems interfere with your life in terms of work, relationships and leisure pursuit?)
  • stressor (Do you believe that some external event brought on the problems? Have there been any stressful life events associated with the problem?)
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18
Q

What are the components of a structure interview?

A
  • Structured Clinical Interview Diagnosis (SCID)
  • Provides DSM diagnoses
  • Uses branching: the client’s response to one question determines the next question that is asked (skip method)
  • Contains detailed instructions to the interviewer concerning when and how to probe in detail and when to
    go on to questions bearing on another diagnosis.
  • Most symptoms are rated on a three-point scale of
    severity, with instructions in the interview schedule for
    directly translating the symptom ratings into diagnoses.
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19
Q

What is standardization in psychological testing?

A
  • Responses of person being assessed are compared to test norms that have been established
  • Test norms; The test is administered to many people and the responses are analyzed to establish how a group of people tend to respond. Provides a comparison context which is used to interpret an individual’s score.
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20
Q

What are personality inventories?

A
  • The person is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her.
  • The best-known and most frequently used and researched psychological test in the United States is the Minnesota Multiphasic Personality Inventory (MMPI)
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21
Q

What are behavioural tests?

A
  • A cardinal feature of major depression is anhedonia
    • the lack of reactivity to pleasurable stimuli.
  • Impaired reward processing in depression
  • Probabilistic reward task is used to assess anhedonia
  • Asked to identify which face has a long mouth and which one has a short mouth. People without anhedonia are able to figure out how to make quite a bit of money on this task. People with anhedonia are not interested/ don’t care enough to try
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22
Q

What are projective personality tests?

A

a psychological assessment device in which a set of standard stimuli, ambiguous enough to allow variation in responses, is presented to the individual.
- e.g., Rorschach ink blot test, thematic apperception test

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23
Q

What is the projective hypothesis?

A

As the stimulus materials are unstructured, the client’s responses will be determined primarily by unconscious processes and will reveal his or her true attitudes, motivations, and modes of behaviour.

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24
Q

What are intelligence tests?

A
  • Alfred Binet, a French psychologist, originally constructed mental tests to help the Parisian school board predict which children were in need of special schooling.
  • An intelligence test, often referred as an IQ (intelligence
    quotient) test, is a standardized means of assessing a
    person’s current mental abilities.
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25
Q

How are intelligence tests used?

A
  • To predict how well a child will perform in school
  • To diagnose learning disabilities and to identify areas of
    strengths and weaknesses for academic planning
  • To help determine whether a person has Intellectual
    Disability
  • To identify intellectually gifted children
  • In neuropsychological evaluations:
    – Example: repeat IQ testing of a person believed to be suffering from a degenerative dementia so that the levels of deterioration of mental ability can be monitored over time
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26
Q

What is emotional intelligence?

A
  • Reflected in such abilities as delaying gratification and being sensitive to the needs of others (Goleman, 1995).
  • Emotional intelligence may also be an important protective factor in terms of levels of adjustment.
  • In Canadian university students, emotional intelligence was found to predict anxiety, depression, and life satisfaction, among other variables, above and beyond traditional measures of personality and coping
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27
Q

What are the components of a cognitive behavioural case formulation?

A
  • activating situation (e.g., oppurtunity to achieve personal goal)
  • Schemas (e.g., I am incapable and undeserving)
  • Mood (e.g., depressed, discouraged)
  • Mood and Schema influenced by thoughts (e.g., if i take action I will fail, others will be critical, it is hopeless to try) and failure to achieve goal (e.g., job dissatisfaction, isolation)
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28
Q

What are the different types of brain imaging techniques used in biological assessment?

A
  • Computerized axial tomography (CT Scan)
  • Magnetic resonance imaging (MRI)
  • Functional magnetic resonance imaging (fMRI)
  • Positron emission tomography (PET scan)
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29
Q

What are the goals of neuropsychological assessment?

A
  • To measure as reliably, validly, and completely as possible the behavioural correlates of brain functions
  • To identify the characteristic profile associated with a
    neurobehavioural syndrome (differential diagnosis)
  • To establish possible localization, lateralization, and etiology of a brain lesion
  • To determine whether neuropsychological deficits are present (i.e., cognitive, perceptual, or motor) regardless of diagnosis
  • To describe neuropsychological strengths, weaknesses, and strategy of problem-solving
    -To assess the patient’s feelings about his or her syndrome
  • To provide treatment recommendations (i.e., to client, family, school)
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30
Q

What is the D2 test of visual attention?

A
  • The D2 Test of attention is used to assess the client’s ability to sustain focused attention, engage in selection, and visual scanning speed.
  • The client is asked to cross out any instance of the letter
    “d” that has two marks above it or below it.
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31
Q

what is a test used for dementia?

A

1) name and address for subsequent recall (e.g., John Brown, 42 West Street Kensington.). Allow for a maximum of 4 attempts/repeats.
2) time orientation (what is the date exactly)
3a) Clock Drawing (Please mark in all the numbers to indicate the hours of a clock. Correct spacing required i.e. even spaces between numbers and 12, 3, 6, and 9 in correct places)
3b) Please mark in hands to show 10 minutes past
eleven o’clock (11:10).
4) information (can you tell me something that happened in the news recently [i.e., within the last week and be specific])
5) recall (what was the name and address I asked you to remember)

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32
Q

What are psychophysiological assessments?

A

Concerned with the bodily changes that accompany psychological events or that are associated with a person’s psychological characteristics.
- Measures such as heart rate, tension in the muscles, blood flow in various parts of the body, and brain waves to study the physiological changes that occur when people are afraid, depressed, asleep, imagining, solving problems, and so on.
- The assessments described here are not sensitive enough to be used for diagnosis; they can, however, provide important information.
- Examples of psychophysiological test instruments are:
electrocardiogram, electrodermal responding, and EEG.

33
Q

How do we classify abnormal behaviour?

A

The DSM (diagnostic statistics manual)

34
Q

What is a diagnosis?

A
  • The person’s problem is classified within one of a set

of recognized categories of abnormal behavior and is labeled accordingly

35
Q

What is dimensional classification?

A
  • based on the premise that behaviour does not exist in
    categories, but rather along dimensions
  • Mental disorders are examples of normal traits amplified to an extreme
36
Q

What is categorical classification?

A
  • i.e. the DSM
    • The DSM is a categorical classification that divides mental disorders into types based on criteria sets with defining features
37
Q

What is the DSM5 system?

A
  • The DSM is a system for diagnosing and classifying individuals who are exhibiting abnormal behaviours (thoughts, emotions)
  • Criteria for diagnosis is highly detailed and specific
    • Essential Features – features that “define” it
    • Associated Features – usually present
    • Diagnostic Criteria – a list of symptoms (Essential & Associated) that must be present
    • Differential Diagnosis – how to distinguish this disorder from others.
38
Q

What is a presenting problem?

A
  • The reason for the visit

- The condition that is chiefly responsible for the ambulatory care medical services received during the visit)

39
Q

What is a principle diagnosis?

A
  • based on the presenting problem
  • When more than one diagnosis is given (i.e., comorbidity), the principle diagnosis is the condition that is primarily responsible for causing the individual to be admitted for care
40
Q

What are severity specifiers?

A
  • indicate the level of disability or impairment, rating the intensity, frequency, duration, symptom count.
  • i.e. Mild, Moderate, Severe
41
Q

What are course specifiers?

A
  • indicate the progression of the illness

- i.e. in partial remission, in full remission

42
Q

What was the Old DSM system?

A
  • The Earlier DSM (the fourth edition) was a multi-axial classification system
  • Five “axes” – each person is rated on five distinct dimensions (axes), each of which refers to a different
    domain in the person’s functioning
43
Q

What were the 5 axes of diagnoses in the old DSM system?

A
  • Axis I - Clinical syndrome
  • Axis II - Personality disorders & Intellectual Disability
  • Axis III - General medical disorders
  • Axis IV - Psychosocial/environmental problems
  • Axis V - Global assessment of functioning
44
Q

Why were early versions of the DSM criticized?

A
  • Early editions of DSM were criticized for lack of consideration of culture and ethnicity.
45
Q

How did the DSM-IV-TR try to improve the lack of consideration for culture and ethnicity

A
  • DSM-IV-TR introduced culture-bound syndromes:
  • Example: Koro—condition reported in south and east Asia intense anxiety that the penis or nipples will recede into the body, possibly leading to death
  • Culture-bound syndromes eliminated in DSM-5 replaced with “cultural syndromes,” “cultural idioms,” and “cultural explanations”
46
Q

How did the DSM 5 try to improve the lack of consideration for culture and ethnicity?

A
  • DSM-5 elaborated four specific themes to be considered in making cultural formulation:
    • Cultural identity
    • Cultural consideration of distress
    • Cultural features of vulnerability and resilience
    • Cultural features of the relationship between clinician and patient
47
Q

What are the criticisms of diagnosis?

A
  • Once a person is diagnosed, it becomes a defining feature of their life – giving psychiatrists control over the person’s life
  • Creates a false distinction between “normal” and “abnormal” (where do you draw the line on fuzzy concepts such as “depression”?)
  • Diagnosis creates an “artificial” boundary between different behavioural categories (i.e. schizophrenia vs. depression) – and people are often not just one or the other
  • Diagnosis is not explanation – diagnosing or labelling a person as “suffering from depression” – does not explain the underlying causes (but we often think it does)
  • A diagnosis can reduce the person to an illness (mental health workers and/or society may just perceive the illness, and no longer see the person)
48
Q

What was Rosenhann’s experiment on the impact of diagnosis?

A
  • Eight “pseudopatients” (three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife)
  • all clinically sane
  • Gained secret admission to 12 different hospitals
  • One symptom - Claimed to hear voices – the voices said “empty” or “hollow” or “thud”
  • Once admitted – the pseudopatients acted normally and reported no symptoms
  • Length of hospitalization ranged from 5-52 days
  • Each was released with a diagnosis of “schizophrenia in remission” – none were classified as “sane”
  • What might this imply for a person who might have been admitted for a legitimate (and temporary) reason?
49
Q

What does science mean?

A
  • Science is the pursuit of systematized knowledge through observation
  • Latin scire – means “to know”
50
Q

Why are testability and replicability important?

A
  • A hypothesis must be amenable to systematic testing that could show it to be false
  • What is observed must be replicable
  • it must occur under prescribed circumstances not once, but repeatedly.
51
Q

What is a theory?

A

a set of propositions meant to explain a class of phenomena.

52
Q

What is the role of theory?

A

Primary goal of science is to advance theories to account

for data, often by proposing cause–effect relationships.

53
Q

What is a hypothesis?

A

Expectations about what should occur if a theory is true.

54
Q

What is operationism?

A
  • Each concept takes as its meaning a single observable
    and measurable operation.
  • Each theoretical concept would be nothing more than
    one particular measurable event.
  • However - if each theoretical concept is operationalized
    in only one way, its generality is lost.
  • The need for multiple measures that tap into different facets of a concept
55
Q

What is a case study?

A
  • The detailed study of one individual, based on a paradigm
  • Providing detailed descriptions (Collecting historical and biographical information, Often includes details of therapy sessions, Several case studies can be compared and analyzed for common elements through a specific method)
56
Q

How can case studies be advantageous/useful ?

A
  • The case study as evidence: Particularly useful to negate a universal theory or law. Not useful to rule out alternative hypotheses.
  • Generating hypothesis: Exposure to a large number of cases may allow the clinician to notice
    similarities of circumstances and outcomes
  • Psychotherapy Training: Use in teaching practitioners to learn new techniques or therapeutic orientation
57
Q

What is qualitative research?

A
  • Qualitative research is similar to case study research in that the focus is on the unique and rich experiences of a small group of people who are studied in depth.
  • Descriptive accounts with a subjective, idiographic emphasis are the focus rather than quantitative research
58
Q

What is epidemiology?

A
  • Study of frequency and distribution of a disorder in a population
    • Data are gathered about the rates of a disorder and its possible correlates in a large sample or population
    • Provides a general picture of a disorder
59
Q

What 3 features of a disorder does epidemiological research focus on determining?

A
  • Prevalence: Proportion of a population that has the disorder at a given point or period of time
  • Incidence: The number of new cases of the disorder that occur in some period, usually a year
  • Risk factors: Conditions or variables that, if present, increases the likelihood of developing the disorder
  • Knowledge about risk factors can give clues to the causes of disorders
60
Q

What is the correlational method?

A
  • Is there a relationship between or among two or more variables?
61
Q

How is correlation measured?

A
  • Correlation coefficient (r)
    • May take any value between +1.00 and -1.00
    • Measures magnitude and direction of relationship
  • Statistical Significance
  • Likelihood results of an investigation are due to chance
  • Often set in psychology at p =.05
62
Q

How is the correlational method applied to clinical psychology?

A
  • Whenever we compare people given one diagnosis with those given another or with people without a psychological diagnosis, the study is correlational.
    • Often investigations in abnormal psychology are not recognized as correlational, perhaps because participants come to a laboratory for testing.
63
Q

What are the limitations of the correlational method?

A
  • Problems of Causality
  • Critical drawback of correlational research: Does not allow determination of cause-effect relationship. Correlation between two variables tells us only that they are related or tend to co-vary with each
  • Directionality problem: How can we tell which is the cause and which is the effect? Correlation does not imply causation. Prospective, longitudinal design helps resolve the directionality issue. High-risk method: individuals with a predisposition are studied
  • Third-variable problem: Some unforeseen factor that actually accounts for the correlation
64
Q

What is a developmental trajectory model?

A 
Collecting multiple observations of a particular behaviour
over time (longitudinal)
65
Q

What is group based trajectory modelling?

A
  • is based on evidence that it is impossible to distinguish clear subgroups of participants in a sample even though it really is important to distinguish these groups because:
    • need to consider differing developmental factors
    • best treatment options for people in subgroups
    • use a complicated procedure called latent class growth analysis to identify these subgroups and then use multivariate statistical techniques to establish growth curves
    • Researchers using this approach can examine predictors of class membership as well as predictors of growth within a particular class
66
Q

What is experience sampling?

A
  • an intensive longitudinal design
  • Experiencing sampling is used to examine thoughts,
    feelings, and behaviours in their natural, spontaneous context.
  • The data that result can show the unfolding of temporal within-person processes, both descriptively and in terms of causal analysis
  • Example is the link between daily triggering situations
    and subsequent body checking behaviours among
    people with anorexia nervosa.
67
Q

What is the gold standard for determining causality?

A

Experimental methods generally considered most powerful tool for determining causal relationships between events

68
Q

What are the 2 essentials of an experiment?

A
  1. random assignment of participants to different conditions

2. manipulation of IV and measurement of DV

69
Q

What is the experimental method most commonly used for in the field of psychopathology?

A

In the field of psychopathology, the experiment is most often used to evaluate the effects of therapies (e.g., RCTs).

70
Q

What are the basic features of experimental study methods?

A
  1. Researcher typically begins with an experimental hypothesis
  2. Investigator chooses an independent variable (IV) that can be manipulated (different conditions – often experimental vs. control)
  3. Participants are assigned to the conditions by random assignment
  4. Researcher arranges for the measurement of dependent variable (DV)
  5. Analyze the data to determine if there has been an experimental
71
Q

What is a single subject experimental design?

A
  • Participants are studied one at a time and experience a manipulated variable such as a specific therapeutic treatment (there is no control group)
  • Reversal design or ABAB design
72
Q

What is the ABAB design?

A
  • Measurement of a specific behaviour at different times:
    – During an initial time period (no treatment), the baseline (A)
    – During a period when treatment is introduced (B)
    – During a reinstatement of the condition that prevailed in the baseline period
    (A)
    – During the re-introduction of the experimental (treatment) manipulation (B)
  • The ABAB design is most appropriate when it is assumed that the effects of manipulations are temporary.
73
Q

What is a mixed designs experimental method?

A
  • The combination of experimental and correlational designs
  • Classificatory or correlational variables (e.g., having
    PTSD or not) are not manipulated nor created by the researcher
  • Experiments demand the manipulation of a variable (e.g., three types of treatment for major depression)
74
Q

What is a meta analysis?

A
  • Used in psychotherapy research
  • Involves the review of many studies in order to determine the effects of treatment
  • Interesting because it is a way to examining published and unpublished studies, and combining the results into a common format and then determining the extent of improvement, using a statistic called effect size
75
Q

When does a categorical system work best?

A
  • A categorical system works best when:
    • all members of a diagnostic class are homogeneous,
    • when there are clear boundaries between classes,
    • and when the different classes are mutually exclusive
  • None of which apply to the DSM
76
Q

What are high levels of emotional intelligence associated with?

A
  • High levels of emotional intelligence are associated negatively with alexithymia, a condition of reduced emotional awareness that is a risk factor for a variety of adjustment problems.
  • High levels of emotional intelligence are associated with greater levels of subjective well-being and reduced proneness to depression
77
Q

What should a diagnosis have?

A
  • Diagnosis should have “clinical utility” – meaning that
    it should help clinicians to determine the prognosis, treatment plans, and potential treatment outcomes for their patients
78
Q

What are classificatory variables?

A

Variables that are already present and are simply measured by the researcher (i.e., disordered or not disordered, age, sex, social class, etc.).

Clinical Psychology and Mental Illness (4 decks)

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