abnormal spychology

Bella1590

ch3.pptx

Home >Psychology homework help >abnormal spychology

Essentials of Abnormal Psychology

Eighth Edition

Chapter 3

Clinical Assessment, Diagnosis and Research in Psychopathology

Outline

Assessing Psychological Disorders

Diagnosing Psychological Disorders

Research in Psychopathology

Types of research methods

Genetic and Cultural Research

Research Ethics

Focus Questions

What are clinical assessment and diagnosis?

What are the basic components and methods of psychopathology research?

How do researchers study the role of genetics? How do researchers study behavior across time and culture?

Why are ethical principles important in research?

Assessing Psychological Disorders, Part 1

Purposes of clinical assessment

To understand the individual

To predict behavior

To plan treatment

To evaluate treatment outcome

Assessing Psychological Disorders, Part 2

Analogous to a funnel

Starts broad

Multidimensional in approach

Narrow to specific problem areas

Key Concepts in Assessment, Part 1

Reliability

Consistency in measurement

Examples include test-retest and inter-rater reliability

Validity

What an assessment measures and how well it does so

Examples include concurrent, discriminant, and predictive validity

Reliability - degree to which a measure is consistent

Inter-rater reliability- consistency across two or more raters (e.g., do different therapists watching the same video agree that the patient is depressed?)

Test-retest reliability - consistency across time

Example of validity question: Are people who get higher scores on a measure of anxiety actually more anxious?

Key Concepts in Assessment, Part 2

Standardization

Ensures consistency in the use of a technique

Provides population benchmarks for comparison

Examples include structured administration, scoring, and evaluation procedures

Concepts That Determine the Value of Clinical Assessments

FIGURE 3.1 Concepts that determine the value of clinical assessments.

The Clinical Interview and Physical Exam, Part 1

Clinical interview

Most common clinical assessment method

Structured or semistructured

Example of semistructured interview: Anxiety Disorders Interview Schedule for DSM-5 (ADIS-5) has modules pertaining to anxiety, mood, and related disorders, designed to assess DSM-5 criteria

Teaching tip: Some definitions.

Structured = you ask the exact same questions in the same order

Semi-structured (most common) Have an outline of questions that are followed, but some flexibility to ask more or less about certain areas depending on the needs of the interviewee

Clinical interviews may range from half an hour to 4+ hours depending on the needs of the patient and the purpose of the assessment. Longer assessments are necessary for some research studies and when you are trying to get a complete psychological history (e.g. previous diagnoses as well as current).

The Clinical Interview and Physical Exam, Part 2

Mental status exam

Appearance and behavior

Thought processes

Mood and affect

Intellectual functioning

Sensorium

Physical exam

“Sensorium” = the patient’s general orientation. E.g. do they know where they are and what they’re doing?

Physical exams are often the “first pit stop” in assessing mental health, because many patients visit a primary care physician first. For example, a doctor might ascertain whether panic attacks are the result of a heart or respiratory condition, or whether depression could be due to the side effects of a medication. Physical exams are not typically conducted in outpatient clinics. They are more common in inpatient or hospital settings, or in the case of mental illnesses that are likely to affect physical functioning (e.g., substance use disorders, eating disorders, somatic symptom disorders, disorders in which a patient is taking meds with a lot of side effects, e.g., schizophrenia).

Components of Mental Status Exam

Subsequent focus—possible existence of disorder characterized by intrusive, unwanted thoughts, and resistance to them.

Mental Status Exam	Frank
Appearance and behavior Over Behaviour Attire Appearance, posture, expressions	Persistent twitch Appearance appropriate
2. Thought Rate of speech Continuity of speech Content of speech	Flow and content of speech reasonable
3. Mood and affect Predominant feeling state of the individual says	Anxious mood Affect appropriate
4. Intellectual functioning Type of vocabulary Use of abstractions and metaphors	Intelligence within normal limits
5. Sensorium Awareness of surroundings in terms of person (self and clinician), time, and place – “oriented times three”	Oriented times three

FIGURE 3.2 Components of the mental status exam.

Behavioral Assessment and Observation, Part 1

Behavioral assessment

Focus on the present—here and now

Direct observation of behavior-environment relations

Purpose is to identify problematic behaviors and situations

ABCs—identify antecedents, behaviors, and consequences

Behavioral Assessment and Observation, Part 2

Behavioral observation and behavioral assessment

Can be either formal or informal

Self-monitoring vs. being observed by others

Problem of reactivity using direct observation

Reactivity = when your behavior is being observed (by yourself or someone else), it starts to change

ABCs of Observation

FIGURE 3.3 The ABCs of observation.

Psychological Testing: Projective Tests, Part 1

Psychological testing

Must be reliable and valid

Projective tests

Rooted in psychoanalytic tradition

Used to assess unconscious processes

Project aspects of personality onto ambiguous test stimuli

Require high degree of inference in scoring and interpretation

Technology Tip: This APA web site contains information and useful links related to psychological testing, including the ethics of testing. http://www.apa.org/science/testing.html

Psychological Testing: Projective Tests, Part 2

Examples

The Rorschach inkblot test; Thematic Apperception Test

Reliability and validity data tend to be mixed

TAT = You see an ambiguous picture and tell a story about it.

The idea of projective tests is that when you’re presented with ambiguous stimuli, the way you interpret them says something about your personality

Rorschach Inkblot

FIGURE 3.4 This inkblot resembles the ambiguous figures presented in the Rorschach test.

Objective Tests and Personality Tests

Objective tests

Roots in empirical tradition

Test stimuli are less ambiguous

Require minimal clinical inference in scoring and interpretation

Personality tests

Minnesota multiphasic personality inventory (MMPI)

Extensive reliability, validity, and normative database

Technology Tip: Visit Dr. James Butcher’s MMPI Research Project website at the University of Minnesota for more information about the MMPI and its various incarnations: http://www1.umn.edu/mmpi/

Ch. 3 of the textbook has an extensive and interesting discussion of the MMPI.

Psychological Testing and Objective Tests

Intelligence tests

Nature of intellectual functioning and IQ

Originally developed as a measure of degree to which children’s performance diverged from others in their grade

The deviation IQ

Compare a person’s scores against those of other people who are of the same age

Verbal and performance domains

Technology Tip: A site containing historical information related to intelligence testing: http://www.intelltheory.com/

Neuropsychological Testing, Part 1

Purpose and goals

Assess broad range of skills and abilities

Goal is to understand brain-behavior relations

Examples

The Luria-Nebraska and Halstead-Reitan batteries

Designed to assess for brain damage

Test diverse skills ranging from grip strength to sound recognition, attention, concentration

Technology Tip: This site contains information and links about neuropsychology and neuropsychological assessment: http://www.neuropsychologycentral.com/index.html

Neuropsychological Testing, Part 2

Problems with neuropsychological tests

False positives: Mistakenly shows a problem where there is none

False negatives: Fails to detect a problem that is present

Neuroimaging and Brain Structure, Part 1

Neuroimaging: pictures of the brain

Two objectives

Understand brain structure

Understand brain function

Technology Tip: This site contains a series of excellent links to resources related to neuroimaging, neuroanatomy, and their relation to psychopathology: http://www.neuropsychologycentral.com/interface/content/links/page_material/imaging/imaging_links.html#a

Neuroimaging and Brain Structure, Part 2

Imaging brain structure

Computerized axial tomography (CAT or CT scan)

Utilizes X-rays

Magnetic resonance imaging (MRI)

Utilizes strong magnetic fields

Better resolution than CT scan

Neuroimaging and Brain Function

Imaging brain function

Positron emission tomography (PET)

Single photon emission computed tomography (SPECT)

Both involve injection of radioactive isotopes

Isotopes react with oxygen, blood, and glucose in the brain

Functional MRI (fMRI)—brief changes in brain activity

Psychophysiological Assessment, Part 1

Psychophysiological assessment

Assess brain structure, function, and activity of the nervous system

Psychophysiological assessment domains

Electroencephalogram (EEG)—brain wave activity.

ERP—Event-related potentials = brain response to a specific experience (e.g., hearing a tone)

Heart rate and respiration—cardiorespiratory activity

Electrodermal response and levels—sweat gland activity

EEG = Electroencephalogram

Alpha waves – awake, resting patterns

Delta waves – asleep, relaxed patterns

Panic attacks – delta wave activity during wakefulness may indicate localized dysfunction

Psychophysiological Assessment, Part 2

Uses of routine psychophysiological assessment

Disorders involving a strong physiological component

Examples

PTSD, sexual dysfunctions, sleep disorders

Headache and hypertension

Diagnosing Psychological Disorders: Foundations in Classification, Part 1

Diagnostic classification

Classification is central to all sciences

Assignment to categories based on shared attributes or relations

Diagnosing Psychological Disorders: Foundations in Classification, Part 2

Idiographic strategy

What is unique about an individual’s personality, cultural background, or circumstances

Nomothetic strategy

Often used when identifying a specific psychological disorder, to make a diagnosis

Idiographic – determination of individual, unique features or attributes

Nomothetic – determination of general classes and common attributes – involves the study of large groups with shared features

Diagnosing Psychological Disorders: Foundations in Classification, Part 3

Terminology of classification systems

Taxonomy—classification in a scientific context

Nosology—taxonomy in psychological/medical phenomena

Nomenclature—labels in a nosological system (e.g., “panic disorder” “depressive disorders”)

Taxonomy – Classification in a scientific context

Nosology – Taxonomy in psychological / medical contexts

Nomenclature – Nosological labels (e.g., panic disorder)

Issues with Classifying and Diagnosing Psychological Disorders, Part 1

Categorical and dimensional approaches

Classical (or pure) categorical approach—strict categories (e.g., you either have social anxiety disorder or you don’t)

Dimensional approach—classification along dimensions (e.g., different people have varying amounts of anxiety in social situations)

Prototypical approach—combines classical and dimensional views

Prototypical approach - categorical approach that combines features of the other approaches. Identifies essential features of a psychological disorder so that it can be classified, but allows for nonessential variations that do not necessarily change the classification (e.g., there are several ways one could meet criteria for major depression or panic disorder, but still get the diagnosis). The DSM-5 is based on this approach.

Issues with Classifying and Diagnosing Psychological Disorders, Part 2

Widely used classification systems

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Updated every 10–20 years

Current edition (released May 2013): DSM-5

Previous edition called DSM-IV-TR

ICD-10

International Classification of Diseases (ICD-10)

Published by the World Health Organization (WHO)

History of the DSM, Part 1

Prior to 1980, diagnoses were made based on biological or psychoanalytic theory

Introduction of DSM-III in 1980 revolutionized classification

Classification newly relied on specific lists of symptoms, improving reliability and validity

Diagnoses classified along five “axes” describing types of problems (e.g., disorder categories, health problems, life stressors)

Previously, psychopathology was categorized along five axes. Axis I = Clinical syndromes (most psychological disorders). Axis II = personality disorders and mental retardation (more pervasive), Axis III = relevant medical conditions. Axis IV = Relevant life stressors. Axis V = Global assessment of functioning (0-100 rating). DSM-5 no longer uses the axis system. This information is still taken into account by clinicians, but it’s not discussed in terms of axes.

History of the DSM, Part 2

DSM-IV introduced in 1994

Eliminated previous distinction between psychological vs. organic mental disorders

Reflected appreciation that all disorders are influenced by both psychological and biological factors

DSM-IV-TR (“text revision” of DSM-IV) incorporated new research and slightly altered criteria accordingly

The DSM-5

Basic characteristics

Removed axial system

Clear inclusion and exclusion criteria for disorders

Disorders are categorized under broad headings

Empirically grounded, prototypic approach to classification

DSM-5 represented some changes to classification. One major change is that the Axis system used in DSM-IV-TR was eliminated.

For a detailed outline of all changes in DSM-5, see Boettcher et al. 2013 – A Student’s Guide to Important Changes in DSM-5, part of the instructor resources for Barlow/Durand Abnormal Psychology and Durand/Barlow Essentials of Abnormal Psychology.

Unresolved Issues in DSM-5, Part 1

The problem of comorbidity

Defined as two or more disorders for the same person

High comorbidity is extremely common

Emphasizes reliability, maybe at the expense of validity (i.e., may artificially “split” diagnoses that are very similar)

Discussion Tip: Have students discuss how these problems have changed over time and across diagnoses. Are there differences within this culture in terms of demographic factors (i.e., SES, ethnicity, geography, age)?

Unresolved Issues in DSM-5, Part 2

Dimensional classification

DSM was intended to move toward a more dimensional approach, but critics say it does not improve much from DSM-IV

Labeling issues and stigmatization

Some labels have negative connotations and may make patients less likely to seek treatment

Summary of Clinical Assessment and Diagnosis

Clinical assessment and diagnosis

Aims to fully understand the client

Aids in understanding and ameliorating human suffering

Based on reliable, valid, and standardized information

Conducting Research in Psychopathology

Questions driving a science of psychopathology

What problems cause distress or impair functioning?

Why do people behave in unusual ways?

How can we help people behave in more adaptive ways?

Basic Components of Research, Part 1

Starts with a hypothesis or “educated guess”

Not all hypotheses are testable

Hypotheses in science are formulated so that they are testable

Basic Components of Research, Part 2

Research design

A method to test hypotheses

Independent variable

The variable that causes or influences behavior

Dependent variable

The behavior influenced by the independent variable

Independent variable – The variable that causes or influences behavior

Dependent variable – The change influenced by the independent variable

Considerations in Research Design

Internal validity vs. external validity

Internal validity: Extent to which results of a study are due to the independent variable

External validity: Extent to which results of a study are generalizable to the population it’s studying

Ways to increase internal validity by minimizing confounds

Use of control groups

Use of random assignment procedures

Use of analog models

Control group: A comparison group of similar composition that is usually not manipulated in the same way as the group under study, or they are “healthy/normal”

EXAMPLES: In a study of anxiety treatment, compare anxious patients who are treated with anxious patients who do NOT receive treatment.

In a study of information processing, compare the performance of people who are depressed with the performance of people who are NOT depressed.

Analog model: Recreating the phenomenon under study in laboratory conditions

Statistical versus Clinical Significance, Part 1

Statistical methods—branch of mathematics

Helps to protect against biases in evaluating data

Statistical vs. clinical significance

Statistical significance—are results due to chance?

Clinical significance—are results clinically meaningful?

Statistical significance does not imply clinical meaningfulness

Statistical significance = a result is unlikely to have occurred by chance.

Clinical significance = a result actually matters.

These are not always the same thing. When you have a really big sample size, you can achieve statistical significance if there is a small but consistent result across the whole group. But for any individual in that group, it might be a pretty meaningless result.

For example, take a group of 1000 insomniacs. If a new intervention helped all of them sleep an additional 10 minutes per night, that would probably be statistically significant. But for any one of them, the difference between 5 hours of sleep and 5 hours + 10 minutes of sleep will not make much of an impact on their functioning (i.e., not clinically significant).

Technology Tip: This site contains several links to pseudoscientific issues in psychology, and abnormal psychology in particular. http://www.psychology.org/links/Resources/Pseudoscience/

Statistical versus Clinical Significance, Part 2

Balancing statistical versus clinical significance

Evaluate effect size

Evaluate social validity

Patient uniformity myth

Researchers sometimes mistakenly see all participants as one homogenous group

Generalizability

The extent to which results are applicable to the larger population being studied

Studying Individual Cases

Case study method

Extensive observation and detailed description of a client

Foundation of early historic developments in psychopathology

Limitations

Lacks scientific rigor and suitable controls

Internal validity is typically weak

Often entails numerous confounds

Teaching Tip: Present a case study from the video library or your own clinical experience.

Research by Correlation, Part 1

Assess the degree to which levels of certain variables are linked to levels of other variables

Example: Higher levels of education are linked to higher levels of income

The nature of correlation

Statistical relation between two or more variables

No independent variable is manipulated

Range from –1.0 to 0 to +1.0

Negative vs. positive correlation

Discussion Tip: Have students generate situations in which a correlational design is necessary and cannot be avoided due to natural or ethical constraints.

Research by Correlation, Part 2

Necessary in situations where you can’t manipulate variables

Limitations

Does not imply causation

Problem of directionality

Epidemiological research—an example of the correlational method

Incidence, prevalence, and course of disorders

Examples are AIDS, trauma following disaster

Correlations

Figure 3.6

FIGURE 3.6 These three graphs represent hypothetical correlations between age and sleep problems.

Research by Experiment, Part 1

Nature of experimental research

Manipulation of independent variables

Attempt to establish causal relations

Group experimental designs

Control groups

Placebo: Some participants are given an inactive treatment (e.g., sugar pill), but participants don’t know which treatment they are getting

Double-blind: Participants and assessors are unaware of what kind of treatment participants are getting

Research by Experiment, Part 2

Comparative treatment designs

Type of group design

Compare different forms of treatment in similar persons

Addresses treatment process and outcome

Single-Case Experimental Designs, Part 1

Nature of single subject design

Rigorous study of single cases

Varied experimental conditions and time

Repeated measurement

Evaluation of variability, level, and trend

Premium on internal validity

Single-Case Experimental Designs, Part 2

Types of single-subject design

Withdrawal designs

Stop treatment to see if behavior/symptoms return to the way they were before treatment

Multiple baseline designs

Start treatment at different times in different conditions (e.g., in home vs. school settings)—see if changes occur in conjunction with introduction of treatment

Single-Case Experimental Design

Figure 3.7

Example of what we can learn from single-case experimental research

FIGURE 3.7 The top graph seems to show Wendy’s anxiety dropping significantly after treatment (measuring level). However, when you look at repeated measures before and after treatment, the middle graph reveals little change because her anxiety fluctuated a great deal (measuring variability). A different scenario is illustrated in the bottom graph (measuring trend), where her anxiety also varied. In general, there was a downward movement (improved anxiety) even before treatment, suggesting that she might have improved without help. Examining variability and trend can provide more information about the true nature of the change.

Multiple Baseline Design

Figure 3.8

FIGURE 3.8 This figure shows how a multiple baseline design was used to illustrate that the treatment—functional communication training—was responsible for improvements in the children’s behaviors. The circles represent how often each child exhibited behavior problems (called challenging behavior), and the blue-shaded areas show how often they communicated without help from the teacher (referred to as unprompted communication). (From Durand, V. M., 1999. Functional communication training using assistive devices: recruiting natural communities of reinforcement, Journal of Applied Behavior Analysis, 32(3), 247–267. Reprinted by permission of the Society for the Experimental Analysis of Human Behavior.)

Genetic Research Strategies, Part 1

Behavioral genetics

Interaction between genes, experience, and behavior

Phenotype vs. genotype

Genotype: Genetic makeup

Phenotype: Observable characteristics (e.g., eye color, degree of shyness)

Genetic Research Strategies, Part 2

Strategies used in genetic research

Family studies—behaviors/emotional traits in family members

Adoptee studies—separate environmental from genetic factors

Twin studies—psychopathology in fraternal vs. identical twins

Genetic linkage and association studies—sites of defective genes

Technology Tip: The Online Mendelian Inheritance in Man database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and colleagues at Hopkins (http://www.ncbi.nlm.nih.gov/sites/entrez?db=OMIM).

Studying Behavior over Time, Part 1

Rationale and overview

How does the problem or behavior change over time?

Important in prevention and treatment research

Studying Behavior over Time, Part 2

Time-based research strategies

Cross-sectional designs and the cohort effect

Longitudinal designs and the cross-generational effect

Sequential designs—combine both strategies

Assets and liabilities of time-based research strategies

Cohort effect: Systematic differences in participants may simply be due to their age group. E.g. kids growing up during the AIDS crisis probably have unique opinions about STIs. (This isn’t because they’re in their 30s and 40s but rather because they heard about serious STIs as children)

Cross-generational effect - trying to generalize findings to groups whose experiences are very different from those of the study participants.

Research Design

Figure 3.9

FIGURE 3.9 Two research designs, longitudinal & cross-sectional: Same people followed across time; people of different ages viewed at the same time.

Studying Behavior across Cultures

Value of cross-cultural research

Overcoming ethnocentric research

Assets and liabilities of cross-cultural research

Assets

To clarify how psychopathology manifests in different ethnic groups

Problems with cross-cultural research

Limited by available measures

Programs of Research

Components of a research program

Set of interrelated research questions

Draw on several methodologies in finding answers

Conducted in stages, often involving replication

Allows for more nuanced, complete picture of a phenomenon

Replication is critical

Protects against fluke results

Research Ethics, Part 1

Institutional review boards (IRBs) & the APA ethics code

Oversee the rights of human subjects participating in research

Make sure research and data are handled responsibly

Technology Tip: This is the online version of the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct. http://www.apa.org/ethics/code.html

Research Ethics, Part 2

Ethical principals

Informed consent—historical evolution post-WWII

Competence—ability to provide consent

Voluntarism—lack of coercion

Full information—necessary information to make an informed decision

Comprehension—understanding about benefits and risks of participation

Summary of Research Methods, Part 1

Nature of research

Establishing and testing hypotheses

Research design

Varies depending on the questions posed

Each has unique benefits and drawbacks

Summary of Research Methods, Part 2

Abnormal psychology is founded in the scientific method

Understand the nature of abnormality and human suffering

Understand the causes of psychological disorders

Understand the course of psychological disorders

Understand how to prevent and treat psychological disorders

Summary of Research Methods, Part 3

Replication is the cornerstone of science and programmatic research

Research must occur in the context of ethical considerations and values