M1: Chapter 3 Flashcards
What was the most predominant theoretical orientation among members of the Society of Clinical Psychologists in 2010?
Cognitive (31%)
Followed by eclectic-integrative (22%), psychodynamic (18%), and behavioural (15%)
Define reliability in the context of assessment.
The extent to which a test or classification system produces the same scientific observation each time it is applied.
What is inter-rater reliability?
The relationship between the judgements that at least two raters make independently about a phenomenon.
What does test-retest reliability measure?
The extent to which people being observed twice or taking the same test twice score in generally the same way.
ex. intelligence tests.
What is alternate-form reliability?
The extent to which scores on two forms of a test are consistent.
Ulike test-retest reliability because this uses DIFFERENT tests (not the same ones).
Define internal consistency reliability.
The degree to which items on a test are related to one another.
What is validity in assessment?
The extent to which a measure fulfills its intended purpose.
True or False: Unreliable measures will have good validity.
False!
Unreliable measures will NOT have good validity → ex. an unreliable measure of coping is not likely to properly measure to how a person adjusts to a stressful life experience.
What is content validity?
The extent to which a measure adequately samples the domain of interest.
Ex. a measure of life stress based on a list of many life experiences → content validity would be high if most stressful events people experience are captured by the list.
What is criterion validity?
The extent to which a measure is associated in an expected way with some other measure (the criterion).
Both measures may be concurrent and measured at the same time → concurrent validity
OR
Assessed by evaluating the measures ability to predict some other variable that is measured in the future → predictive validity
Define construct validity.
The extent to which scores or ratings on an assessment instrument relate to other variables or behaviours according to some theory or hypothesis.
Important aspect of theory testing!
Ex. On an anxiety-proneness questionnaire → the construct validity is whether the variation we observe within a self-report test of anxiety proneness is really due to individual differences in anxiety proneness.
What does case validity refer to?
The extent to which the formulation of a case accurately encompasses the multiple influences that contribute to distress and dysfunction.
Focus on the validity of the interpretations/decisions made within a specific person!
What is a clinical interview?
A conversation between a clinician and a client aimed at determining diagnosis, history, causes for problems, and possible treatment options.
The paradigm of the interviewer operates from will influence the type of information sought out and how its interpreted!
What would psychoanalytically trained clinicians broadly focus on during a clinical interview?
They inquire about the person’s childhood and life experiences.
What would the focus be of behaviorally trained clinicians in clinical interviews?
Current environmental conditions related to changes in behavior.
What technique do humanistic therapists use to facilitate client sharing during an interview?
Empathy techniques and often providing a simple summary statement to sustain momentum in sharing.
What is the reliability of initial clinical interviews like?
Low, as different interviewers may reach different conclusions.
Not possible to establish relaibility or validity during initial interviews.
What is a structured interview?
An interview where questions are set out in a prescribed fashion for the interviewer.
Helps make diagnostic decicions based on standardized criteria
These interviews allow for standardized information in diagnosis.
What does SCID stand for? What is it?
Structured Clinical Interview for DSM-5 Disorders.
This is a branching interview - where the response to one question determines the next one being asked.
Most symptoms are rated on a scale of 1-3 of severity.
The use of structured interviews is essential in order to improve the —— of the diagnosis
VALIDITY
(ensuring the diagnosis is being measured the way it is intended)
What is evidence-based assessment?
Developed to align with the developments in evidence-based treatments.
An assessment that selects measures based on reliability, validity, and reading level required.
What is the concern that led to the development of evidence-based assessment?
That many clinicians opt for measures with less research support.
What are psychological tests?
Standardized procedures designed to measure performance on a task or assess personality.
Can be used as supplementary information to arrive at a diagnosis.
Ex. a client with schizophrenia may be very guarded during an interview and does not reveal information regarding delusional beliefs → psychological tests may alert the clinician to the possible presence of schizophrenia.
Psychological tests can allow for standardization. What is standardization?
The process of constructing an assessment procedure that has norms and meets the various psychometric criteria for reliability and validity.
Response of the person on psychological tests can be compared to the statistical norms (test norms!) because the information is standarzied
What are test norms?
The means (typical scores) that are normative or usual for a particular population.
The assessment of an individual is based partly on how their scores compare with the typical score for the population. (able to do so because psychological tests are standardized).
What are 3 basic types of personality tests?
- Personality inventories (MMPI, MMPI-2)
- Projective Personality Tests (InkBlot test, TAT)
- Intelligence Tests (Stanford–Binet test, Wechsler Adult Intelligence Scale)
What is a personality inventory?
A self-report questionnaire where an examinee indicates if statements apply to them or not.
What is the Minnesota Multiphasic Personality Inventory (MMPI)?
A long personality inventory used to detect psychological problems.
Designed to detect multiple psychological problems at once.
Provides profiles to be used in combination with a therapist’s evaluation to diagnose a client.
Example of a MMPI-2 profile
If someone answered a large number of items in a section of this scale similarly to a certain diagnostic group, that persons behaviour was expected to resemble that diagnostic group.
What was the purpose of developing MMPI-2?
To improve validity and be more representative of racial minorities. (used a much larger sample)
What is the MMPI-2 Lees-Haley Fake Bad Scale?
What is the issue with this scale?
introduced to indentify people who are faking bad (intentionally responding to items in a way to create a negative impression → trying to seem more distressed and disturbed than reality)
Issue with this scale is that is misclassified too many people as fakers when they were not actually faking it!
Now renamed the Symptom Validity Scale
What is a projective test? Given that, what is a projective hypothesis?
Projective test = a psychological assessment using standardized but vague stimuli (ex. inkblots) assuming that unstructured material will allow unconscious motivations and fears to be uncovered
(sharp decline in the use of them in current pracice)
Projective hypothesis = views unstructured stimuli (like inkblots) are NEEDED in order to reveal true unconscious motives/conflicts
Clearly derived from the psychoanalytic paradigm - reveal things people are unwilling to express.
What is the Rorschach InkBlot Test?
A projective test where examinees interpret a series of inkblots.
Seems to have considerable validity in identifying people with schizophrenia or at risk for developing it.
What is the Thematic Apperception Test (TAT)?
A projective test with a set of black-and-white pictures each depicting a potentially emotion-laden situation → examinee instructed to make up a story about each situation.
Critics feel the tests “overpathologize” respondents to make them appear more sick and dangerous when tests are used in court.
What are intelligence tests? What can they be used for
A standardized means of assessing a person’s current mental ability.
Used to assess mental ability, diagnose learning disabilities, and identify gifted children, and in neuropsychogical evalutations.
IQ scores less than 70 deems the person as having subaverage intellectual functioning
Data indicates that IQ scores can reflect —— threat.
Stereotype theat!
The tendency for test scores to flucuate out of concern from minorities that the scores will be used to further bias or be interpreted from a prejudiced viewpoint.
What does cultural bias in intelligence testing refer to? How can we reduce this bias?
The degree to which tests have content NOT representative for various cultural backgrounds.
Reduce this bias with race norms (revised norms on a psychological measure that have been adjusted for various racial or cultural groups)
What is test-irrelevant thinking?
A component of test anxiety involving an inability to concentrate due to mind-wandering.
What was the main relaibility issue found in studies looking at Indigenous children’s IQ scores?
Internal consistency reliability
Due to children not understanding numerous items & that items focused on certain abilities and skills children were not familiar with (compared to the majority population)
What is Cognitive-Behavioural Case Formulation?
A process where a cognitive-behavioural therapist attempts to ascertain how the various problems experienced by a client are related.
Goal is to discover the overt behaviours and underlying schemata to focus on in therapy.
What is the key purpose of cognitive-behavioural theory?
To explain how a client’s problems relate to one another to help the therapist select treatment “targets”.
List the 5 components of a cognitive-behavioural case formulation.
- Problem List
- Diagnosis
- Working Hypothesis
- Strengths and Assets
- Treatment Plan
What does the Problem List in cognitive-behavioural case formulation include?
A list of ALL difficulties the client is having in multiple domains, described in cognitive, behavioural, and mood components (consistent with Beck’s cognitive theory).
Is a diagnosis required in cognitive-behavioural case formulations?
No, but it can be helpful for initial hypotheses about the case.
What does the Working Hypothesis describe in cognitive-behavioural case formulation?
Hypotheses about the negative schemas causing the problems and the origins of circumstances contributing to these schemas.
The working hypothesis “tells a story” that describes a relationship between all the components of the problem list
What role do Strengths and Assets play in cognitive-behavioural case formulation?
They help develop the working hypothesis, enhance the treatment plan, and determine realistic treatment.
What is the Treatment Plan in cognitive-behavioural case formulations?
Treatment is based directly on the information and hypotheses from the cognitive-behavioural case formulation.
Review this table of the summary of psychological assessment methods:
What is a CT Scan?
computerized axial tomography
A method of diagnosis using X-rays taken from different angles analyzed by computer to produce cross-sectional images.
Tells us info about the STRUCTURE of the brain (still images)
What is the purpose of Magnetic Resonance Imaging (MRI)?
To measure the structure or activity of the living brain.
Person is placed inside a large circular magnet that causes hydrogen atoms to move → the return of the atoms to their original positions when the current to the magnet is turned off is translated by a computer into pictures of brain tissue.
Only shows us structure of brain, but can show activity with fMRI
How does Functional Magnetic Resonance Imaging (fMRI) differ from MRI?
fMRI measures metabolic changes in the brain by taking images so quickly, tha images show the brain AT WORK rather than just the structure alone.
fMRI can provide useful info for CBT by seeing where brain activity occurs before and after therapy.
Ex. fMRI helped reveal that there was less activation in the frontal lobes in people with schizophrenia when performing a cognitive task.
What can a PET scan? What can it indicate?
A computer-generated picture of the living brain → created by analysis of radioactive particles from isotopes injected into the bloodstream (more expensive and invasive!)
Can indicate sites of seizures, brain cancers, dementia, strokes, trauma from head injuries, and disturbance of psychoactive drugs in the brain.
What is the role of brain imaging in clinical diagnosis?
It often plays a vital role in establishing diagnosis but cannot make diagnoses on their own.
Ex. Study showed that CT scan data had an influence on diagnosis/treatment in 10-15% of the clients bein assessed for memory disorders and dementia
What is the difference between a neurologist and a neuropsychologist?
Neurologist = a physician who studies the nervous system, especially its structure, functions, and abnormalities
Neuropsychologist = a psychologist who studies how dysfunctions in the brain affect the way we behave, think, and feel.
What are neuropsychological tests?
Psychological tests developed by Neuropsychologists that can detect impairment in different parts of the brain –> can assess behavioural disturbances caused by brain dysfunctions
Ex. Halstead-Reitan battery or Luria-Nebraska battery
What is the Halstead-Reitan battery?
A neuropsychological test battery that includes four specific tests to detect brain damage:
-
Tactile Performance Test: Time
(blindfolded clients fit various blocks into spaces on a board) -
Tactile Performance Test: Memory
(asked to draw the board above from memory) -
Category Test
(test the ability to abstract a principle from a non-verbal array of events) -
Speech Sounds Perception Test
(listen to a series of nonsense words, and select the word they heard from a set of alternatives).
What is the Luria-Nebraska battery used for?
To determine a large range of abilities and patterns of scores that can reveal damage to various parts of the brain.
A high criterion validity has been found in this battery.
Which specific neuropsychological test is believed to identify effects of brain damage that are not yet detectable by neurological examination?
The Luria-Nebraska battery
What is a main advantage of the Luria-Nebraska battery neuropsychological test?
Can control for educational level so a less-educated person does not get a lower score as a result.
Who is Byron P. Rourke?
A neuropsychologist that has made groundbreaking research on the neuropsychological assessment of people with learning disabilities.
Psychophysiology is the discipline concerned with the ———–.
bodily changes that accompany psychological events or characteristics!
Use measures like heart rate, muscle tension, and blood flow to study changes that occur when people are afraid, depressed, asleep, etc.
What are two ways to assess autonomic nervous system activity?
Electrocardiogram = a recording of the electrical activity of the heart, made with an electrocardiograph.
Electrodermal responding = a recording of the minute electrical activity of the sweat glands on the skin, allowing the inference of an emotional state (sweat-gland activity increases with anxiety, fear, anger, etc.)
What is the purpose of an Electroencephalogram (EEG)?
To graphically record electrical activity of the brain.
A way to measure brain activity.
To get the best idea of what’s happening in one’s brain when using brain-imaging techniques is to have the person engage in….
in a form of behaviour/cognitive activity!!
Ex. If interested in psychophysiological responses of clients with OCD → would study the clients brain when presenting stimuli (like dirt) that would bring up problematic behaviours.
Review this table that summarizes biological assessment methods
What is the Diagnostic and Statistical Manual of Mental Disorders (DSM)?
a publication of the American Psychiatric Association that is an attempt to delineate specific and discrete syndromes or mental disorders.
The current one is the fifth edition (DSM-5).
5 “constituencies” (involved areas) of the DSM-5 (provide a clear sense of the multiple ways why diagnosis and classification of disorders matter).
What are these 5 areas?
Who contributed ideas to the widely accepted classification scheme for abnormal behavior?
Emil Kraepelin.
WHO added ————- to the international list of causes of death in 1939?
mental disorders
Was not widley accepted - the WHO’s classifications of mental illnesses were simply listing diagnostic categories (the actual behaviours were not specified)
What major innovation was introduced in DSM-III?
The use of multiaxial classification.
*it was not kept in DSM-5
What is multiaxial classification? What were the 5 axes?
Classification with several dimensions, each involved in categorizing.
- Axis I: All diagnostic categories except personality disorders and mental retardation
- Axis II: Personality disorders and mental retardation
- Axis III: General medical conditions
- Axis IV: Psychosocial and environmental problems
- Axis V: Current level of functioning
Which axes in the multiaxial classification system made up the classification of abnormal behaviour?
Axis I and II
Axis I. = All diagnostic categories except personality disorders and mental retardation
Axis II. = Personality disorders and mental retardation
What is classified as a mental disorder?
A behavioral or psychological syndrome associated with current distress and/or disability.
With what focus was the DSM developed originally?
developed originally by physicians who applied a medical model to diagnoses & assumed categorical diagnoses correspond to the underlying symptoms, treatments, and prognoses.
many argue if DSM categories actual exist in reality, and others feel certain disorders exist but are not recognized in DSM.
What is Internet Addiction Disorder (IAD)?
Excessive and out-of-control internet use that interferes with daily living.
high levels of neuroticism and lower levels of agreeableness predict IAD.
Male gender, young age, university-level education, and an unsatisfactory financial situation were positively associated with problematic Internet use.
What are the four components proposed for inclusion of IAD in the DSM?
- Excessive use
- Withdrawal symptoms
- Tolerance
- Negative repercussions.
What is the difference between categorical and dimensional classification?
- Categorical classification = assessment whether a person is a member of a discrete grouping (a yes-no approach).
- Dimensional classification = placing a person on a continuum.
How does the dimensional classification system work?
Works by assessing clients on the relevant dimensions
Possibly involves plotting the location of the client in a system of coordinates defined by their score on the dimension.
Approach allows for the possibility that people may experience a number of symptoms for a disorder but do not meet the number of symptoms required for an actual diagnosis!
Ex. dimensional approach used in RDoC, and also in personality measures within the DSM
What are the two components of diagnostic inter-rater reliability?
- Sensitivity = reflects the agreement between assessors regarding the presence of a specific diagnosis.
- Specificity = reflects the agreement between assessors concerning the absence of a specific diagnosis.
What does this chart demonstrate?
Shows inter-rater reliability
On the above line, there is high inter-rater reliability, making the diagnosis reliable
Prior to the DSM-III, diagnostic reliability was not present.
What is a kappa value?
A statistic that reflects the extent to which 2+ raters select the same category when evaluating a person.
In psych, the extent to which two clinicians agree about diagnoses when evaluating the same people.
A kappa over .70 is considered good!
DSM-5 trials show that there is lots of variability in inter-rater reliability. Which disorders have the highest and lowest kappa values?
Disorders with a high kappa value were PTSD, ASD, and borderline personality disorder.
Disorders that had questionable inter-rater reliability (low kappa) were major depressive disorder and generalized anxiety disorder.
*Results tended to be more favourable for disorders that more easily related to dimensional assessments.
What is construct validity in the context of diagnosis?
The extent to which accurate statements and predictors can be made about a category once it has been formed. → “To what extent does the construct enter into a network of lawful relationships?”
A diagnosis has greater construct validity when it has a high number and high strength of relationships to the diagnosis.
The most important validity for diagnosis!
The DSM represents a ——– classification.
[categorical]
What was a major change in DSM-IV compared to its predecessor?
It completed a ‘text revision’ (DSM-IV-TR) with major changes to diagnostic categories and criteria.
What major improvements were made in the DSM-III?
Improvements included:
* Extensive descriptions of characteristics and symptoms
* Attention to cultural differences in symptoms
* Precise specific diagnostic criteria
These changes aimed to create more reliable and valid diagnostic categories.
How did the DSM-IV-TR enhance cultural sensitivity?
It enhanced cultural sensitivity by:
* Including discussions of cultural and ethnic factors for each disorder
* Providing a general framework for evaluating culture and ethnicity
* Describing culture-bound syndromes in an appendix.
What changes were made in the DSM-5 regarding cultural assessment?
Changes included:
* Expanded descriptions of culture
* Added cultural elements in mental disorder definitions
* Removal of Axis IV
* Changes in language and cultural assessment.
What was the outline for cultural information?
Guide designed in the DSM-4 to facilitate treatment planning while being sensitive to differences in ethnocultural backgrounds and context
Has had little impact, where very few clinicians are familiar with.
DSM-5 now has the CFI (cultural formulation interview).
What is the Cultural Formulation Interview (CFI)?
The CFI is a semi-structured interview that assesses:
* Cultural definition of the problem
* Cultural perceptions of cause, context, and support
* Cultural factors affecting self-coping and past help-seeking
* Cultural factors affecting current help-seeking.
What are DSM-5 V Codes?
V Codes are conditions or significant factors that are not disorders but influence treatment, such as:
* Homelessness
* Child maltreatment
* Divorce.
This replaces the removal of Aix IV (used to indicate psychosocial stressors)
What were some objectives of the DSM-5?
Objectives included:
* Focus on validity of diagnosis
* Eliminate disparities with WHO’s ICD
* Reduce ‘not otherwise specified’ diagnoses
* Supplement categorical approach with dimensional ratings
* Simplify the DSM for clinical usefulness for doctors in primary care.
Name two new disorders added in the DSM-5.
- Binge eating disorder
- Disruptive mood dysregulation disorder (DMDD).
Provide an overview of changes in DSM-5
- New disorders added
- New criteria for existing disorders
- New superordinate categories combining previous categories
- New conceptualizations of current disorders
- New names for existing disorders
- New dimensional ratings within disorders
- New emphasis on suicidality
- New manual format reflecting age span (chapters for childhood disorders at the beginning and later chapters for disorders found in older adults)
What is Disruptive Mood Dysregulation Disorder (DMDD)?
DMDD reflects the link between hostile anger and depression, typically applied to children with 3+ temper tantrums a week.
Epidemiology eveidence reveals the controversy of DMMD as it only had a prevelence of 1%, but also had high levels of comorbidity
True or False: Asperger’s Syndrome is recognized as a separate disorder in the DSM-5.
False. Asperger’s Syndrome is no longer recognized separately; it falls under Autism Spectrum Disorder.
What was the main reason for excluding bereavement from the criteria for major depressive disorder?
The exclusion was made to ensure clinicians recognize when depression is a result of grief.
How are personality disorders categorized in the DSM-5?
Personality disorders are considered categories, not dimensions.
A controversial change –> many feel that a dimensional approach is more appropriate due to low inter-rater reliabilities for personality disorder categories.
What are 5 of the main controversial changes in the DSM-5?
- Autism spectrum disorder is a new overarching category (Asperger’s syndrome now just considered ASD)
- Disruptive mood dysregulation disorder was created
- Bereavement (grief) was excluded from the diagnostic criteria for major depressive disorder.
- Personality disorders are considered categories, not dimensions.
- Some disorders (e.g., non-suicidal self-injury) were omitted.
What is epidemology, prevalence, and lifetime prevalence?
Epidemiology = the study of the frequency and distribution of illness in a population
A focus of epidemiology is to determine prevalence = the percentage of a population that has the disorder at a given time.
Lifetime prevalence = is the proportion of a sample that has NEVER had a specific disorder.
What criticism did Allen Frances have regarding DSM-5 changes?
Frances argued the changes would medicalize and pathologize normal behaviors, benefiting the pharmaceutical industry.
What does the term ‘diagnostic inflation’ refer to in the context of DSM-5?
Diagnostic inflation refers to the increased prevalence of disorders such as autism and ADHD due to changes in diagnostic habits.
What Allen Frances beleived was occuring due to the changes made in DSM-5.
What is the National Institute of Mental Health (NIMH) stance on DSM-5 categories?
NIMH does NOT support research based on DSM-5 categories is looking towards creating new criteria reflecting genetics and neuroscience.
What issue arises with the comorbidity of DMDD?
DMDD has high levels of comorbidity with depressive disorders and oppositional defiant disorder.
True or False: All clinicians find the DSM useful for their practice.
False. About 3 in 10 clinicians feel it is not useful.
What is comorbidity?
The co-occurance of two disorders, like having anxiety disorder and major depressive disorder.
Ex. DMDD has high levels of comorbidity with both depressive disorders and oppositional defiant disorder! (partly why it’s addition to the DSM-5 is controversial)
