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Clinical Research, Assessment, and Classification of Abnormal Behavior

The Scientific Method in Clinical Research

Scientific method

Systematic data collection, controlled observation, and testing hypotheses

Hypothesis

Tentative explanation for certain facts or observations

Theory

Group of principles and hypotheses that together explain some aspect of a particular area of inquiry

Importance of Replication

Replication

Repeating results under similar test conditions

Replicating research has resulted in changes to previous findings described as “conclusive” in mass media

Examples:

Childhood vaccines may cause autism (not supported)

Antidepressants raise suicide risk in children and adolescents (needs further research)

Characteristics of Clinical Research

Development of hypotheses about relationships

Potential for self-correction

Consideration for reliability and validity

Use of operational definitions

Acknowledgement of base rates

Evaluation based on statistical significance

Case Study

Intensive study of one individual

Relies on clinical data

Observations

Medical and psychological tests

Historical and bibliographic information

Can determine characteristics, course, and outcome of a rare disorder

Used to study therapeutic or diagnostic techniques

Correlational Studies

Statistical analysis to determine correlation between variables

Allow analysis of variables that cannot or should not be controlled

Types of correlation

Positive correlation

Negative correlation

No correlation

Experiments

Best tool for testing cause-and-effect relationships

Components of a simple experiment

Experimental hypothesis

Independent variable

Manipulated by the experimenter

Dependent variable

Expected to change as a result of manipulating the independent variable

Types of Groups in an Experiment

Experimental group

Group exposed to an independent variable

Control group

Similar in every way to experimental group but not exposed to independent variable

Placebo group

Participants receive an inactive substance

Additional Controls in Experimental Research

Design of the experiment

Single-blind design

Participants unaware of purpose of research

Double-blind design

Participant and individual working directly with the participant unaware of the experimental conditions

Some variables cannot be manipulated

Example: child abuse

Correlational studies are appropriate

Analogue Studies

Investigation that attempts to simulate real-life situation under controlled conditions

Used when not possible to control all variables in real-life situations or when ethical, legal, or moral issues preclude other types of studies

e.g., to test effects of lack of control on depression, exposing rats to uncontrollable negative events

Field Studies

Behaviors and events are observed and recorded in their natural environment (e.g., after floods, earthquakes, and war)

The main technique is observation

Also uses interviews, questionnaires, and review of existing data

Observers must be highly trained

Avoid disrupting the natural environment

Biological Research Strategies

Methods for studying biological processes involved in mental illness

Endophenotypes

Twin comparisons

Genetic studies

Study of the epigenetic processes

The Endophenotype Concept

Endophenotypes: measurable characteristics

Characteristic must be heritable

Occur more frequently in affected families than in the general population

Examples: anatomical or chemical differences in the brain, eye-tracking irregularities

Guide prevention and early treatment efforts

Twin Studies

Monozygotic (identical) twins

Share the same DNA

Have different fingerprints

Develop more differences from one another as they age

Fraternal twins

Share same childhood environments

Often used to evaluate hereditary versus environmental influences on development

Genetic Linkage Studies

Goal: determine whether a disorder follows a genetic pattern

If disorder is genetically linked:

Individuals closely related to person with disorder (proband) more likely to display disorder

Penetrance

Proportion of individuals with a particular genotype who manifest the phenotype

Epigenetic Research

Study of environmental factors that influence whether or not a gene is expressed

Builds on idea that certain environmental factors have greatest impact during sensitive periods in development

Epigenetic changes can leave an imprint on eggs or sperm

Affects traits inherited by future generations

Epidemiological Survey Research

Examines rate and distribution of mental disorders in the population

Prevalence

Percentage of individuals in targeted population with a particular disorder during a specific period of time

Incidence

Number of new cases of a disorder that appear in an identified population within a specific period of time

Reliability

Degree to which a test or procedure yields the same results repeatedly under the same circumstances

Test-retest reliability

Same results when given at two different points in time

Internal consistency

Various parts of measure yield similar or consistent results

Reliability (cont’d.)

Interrater reliability

Consistency of responses when scored by different test administrators

Validity

Extent to which a procedure actually performs its designed function

Predictive validity

How well a test predicts a person’s behavior or response

Construct validity

How well a test or measure relates to the characteristics or disorder in question

Validity (cont’d.)

Content validity

How well a test measures what it is intended to measure

Assesses all areas known to be associated with a particular disorder

Standardization

Standard administration

Professionals administering a test must follow common rules or procedures

Standardization sample

Group of people who initially took the measure

Performance is used as standard or norm

Test-takers should be similar to the standardization sample for test to be valid

Assessment Techniques

Psychological assessment

Gathering information and drawing conclusions

Traits, abilities, emotional function, and more

Four main assessment methods

Observations

Interviews

Psychological tests and inventories

Neurological tests

Interviews

Observe client and collect data about the person’s life history, current situation, and personality

Analyze

Verbal behavior

Nonverbal behavior

Content

Process of communication

Types of Interviews

Interviews vary in degree of structure and formality

Structured interviews

Common rules and procedures

Standard series of questions

Disadvantage: limit conversation

Advantage: collect consistent and comprehensive information

Observations

Controlled (analogue) observations

e.g., laboratory, clinic

Naturalistic observations

Natural setting (e.g., classroom, home)

Usually in conjunction with an interview

Children’s social behavior can be observed in a controlled setting like a clinic office or in a naturalistic setting like the playground.

Mental Status Examination

Objective: evaluate client’s cognitive, psychological, and behavioral functioning

Uses questions, observations, and tasks

Clinician considers the appropriateness and quality of the client’s responses

Forms tentative opinion of diagnosis and treatment needs

Psychological Tests and Inventories

Standardized tools

Measure characteristics such as personality, social skills, and more

Projective personality tests

Test taker presented with ambiguous stimuli and asked to respond in some way

Rorschach Technique

Thematic Apperception Test (TAT)

Sentence-completion test

Draw-a-person test

Self-Report Inventories

Used to assess depression, anxiety, or emotional reactivity

May involve completion of open-ended sentences

Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2)

Interpretation is complicated

The Ten MMPI-2 Clinical Scales and Sample MMPI-2 Tests (Partial)

Figure 3.1 The 10 MMPI- 2 Clinical Scales and Sample MMPI- 2 Tests

Shown here are the MMPI- 2 clinical scales and a few of the items that appear on them. As an example, answering “no” or “false” (rather than “yes” or “true”) to the item “I have a good appetite” would result in a higher scale score for hypochondriasis, depression, and hysteria. These sample questions do not pertain to some of the MMPI categories such as paranoia, hypomania, and social introversion.

Intelligence Tests

Primary functions

Obtain intelligence quotient (IQ), or estimate of current level of cognitive functioning

Provide clinical data

Wechsler scales

Assess verbal and perceptual reasoning, working memory, processing speed

Stanford-Binet scales

More complicated; uses basal and ceiling

Criticisms of Intelligence Tests

Fail to consider the effects of culture, poverty, discrimination, and oppression

Do not consider multidimensional attributes of intelligence

Have a poor level of predictive validity

Do not accurately predict future behaviors or achievement

Motivation and work ethic may matter more

Tests for Cognitive Impairment

Bender-Gestalt Visual-Motor Test

Involves copying geometric designs

Halstead-Reitan Neuropsychological Test Battery

Differentiates patients with brain damage

Can provide valuable information about the type and location of the damage

The Nine Bender Designs

Figure 3.3 The nine Bender designs The figures presented to participants are shown on the left. The distorted figures drawn by participants that are possibly indicative of brain damage are shown on the right.

Neurological Tests

Allows noninvasive visualizations of brain structures

Electroencephalograph (EEG)

Computerized axial tomography (CT)

Magnetic resonance imaging (MRI)

Functional MRI (fMRI)

Magnetoencephalography (MEG)

Positron emission tomography (PET)

Diagnosing and Classifying Abnormal Behavior

Psychiatric classification system

Similar to a catalogue, with detailed descriptions of each disorder

Patterns of behavior are distinctly different

Each category accommodates symptom variations

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Widely used classification system

DSM-I (1952): Identified 106 mental disorders

DSM-II (1968): Identified 182 disorders

DSM-III (1980): 265

DSM-III-R: 292

DSM-IV (1994): 297

DSM-V (2013): no significant increase in disorders, but many changes

Revisions (DSM-II, DSM-III, DSM-III-R, DSM-IV, DSM-5) attempt to increase reliability and validity

DSM-5 Disorders – Categories and Features

Table 3.3 DSM-5 disorders (continues)

DSM-5 Disorders – Categories and Features (cont’d.)

Table 3.3 DSM-5 disorders (cont’d.)

Evaluation of the DSM-5

More people meet criteria for diagnosis

e.g., alcohol use disorder criteria less strict

Influence of outside forces

e.g., 70% of professionals who developed DSM-5 had direct ties to drug companies

Medicalization of some issues

e.g., gambling disorder; premenstrual dysphoric disorder

Cross-cultural applicability concerns

Review

What kinds of studies are used in the field of abnormal psychology?

What kind of tools do clinicians use to evaluate a client’s mental health?

How are mental health problems categorized or classified?