Abnormal Psych Hand Out Ch03

11Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 3, 5e – Chapter 3Slides & Handouts by Karen Clay Rhines, Ph.D.Slides & Handouts by Karen Clay Rhines, Ph.D.

Chapter 3 Chapter 3 HandoutsHandouts

Clinical Assessment, Diagnosis, and Clinical Assessment, Diagnosis, and TreatmentTreatment

2Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 3, 5e – Chapter 3

Clinical Assessment: How Clinical Assessment: How and Why Does the Client and Why Does the Client

Behave Abnormally?Behave Abnormally? What is assessment?What is assessment?

______________________________________________________________________________

______________ assessment is used to ______________ assessment is used to determine how and why a person is determine how and why a person is behaving abnormally and how that person behaving abnormally and how that person may be helpedmay be helped

Focus is _____________ – on an individual personFocus is _____________ – on an individual person

Also may be used to evaluate treatment Also may be used to evaluate treatment progressprogress


Clinical Assessment: How Clinical Assessment: How and Why Does the Client and Why Does the Client

Behave Abnormally?Behave Abnormally? The specific tools used in an assessment The specific tools used in an assessment

depend on the clinician’s theoretical depend on the clinician’s theoretical orientationorientation

Hundreds of clinical assessment tools Hundreds of clinical assessment tools have been developed and fall into three have been developed and fall into three categories:categories: Clinical interviewsClinical interviews

TestsTests

ObservationsObservations


Characteristics of Characteristics of Assessment ToolsAssessment Tools

To be useful, assessment tools must To be useful, assessment tools must be _________ and have clear _________ be _________ and have clear _________ and _________ and _________ To standardize a technique is to set up To standardize a technique is to set up

common steps to be followed whenever common steps to be followed whenever it is administeredit is administered

One must standardize _____________ , One must standardize _____________ , ___________ , and _______________ ___________ , and _______________



Reliability refers to the Reliability refers to the _______________ _______________ of a testof a test A good test will yield the same results in the A good test will yield the same results in the

same situationsame situation

Two main types:Two main types: __________________ reliability__________________ reliability

To test for this type of reliability, a subject is tested on two To test for this type of reliability, a subject is tested on two different occasions and the scores are correlated – the different occasions and the scores are correlated – the higher the correlation, the greater the test’s reliabilityhigher the correlation, the greater the test’s reliability

__________________ reliability__________________ reliability Independent judges agree on how to score and interpret a Independent judges agree on how to score and interpret a

particular testparticular test



Validity refers to the Validity refers to the __________ __________ of a test’s of a test’s resultsresults A good test must accurately measure what it is A good test must accurately measure what it is

supposed to be measuringsupposed to be measuring

Three specific types:Three specific types: ________________ – a test appears to measure what it is ________________ – a test appears to measure what it is

supposed to measure; does not necessarily indicate true supposed to measure; does not necessarily indicate true validityvalidity

________________ – a test accurately predicts future ________________ – a test accurately predicts future characteristics or behaviorcharacteristics or behavior

________________ – a test’s results agree with independent ________________ – a test’s results agree with independent measures assessing similar characteristics or behaviormeasures assessing similar characteristics or behavior


Clinical InterviewsClinical Interviews

Face-to-face encounters Face-to-face encounters Often the first contact between a client and Often the first contact between a client and

a clinician/assessora clinician/assessor

Used to collect detailed information, Used to collect detailed information, especially personal history, about a especially personal history, about a clientclient

Allow the interviewer to focus on Allow the interviewer to focus on whatever topics they consider most whatever topics they consider most importantimportant



Conducting the interviewConducting the interview Focus depends on theoretical orientationFocus depends on theoretical orientation

Can be either Can be either ______________________ or or ______________________ In unstructured interviews, clinicians ask In unstructured interviews, clinicians ask

open-ended questionsopen-ended questions

In structured interviews, clinicians ask In structured interviews, clinicians ask prepared questions, often from a published prepared questions, often from a published interview scheduleinterview schedule

May include a mental status examMay include a mental status exam



Limitations:Limitations: May lack May lack __________________________________ or accuracy or accuracy

Interviewers may be biased or may Interviewers may be biased or may make mistakes in judgmentmake mistakes in judgment

Interviews, particularly Interviews, particularly ______________________________ ones, may lack reliabilityones, may lack reliability


Clinical TestsClinical Tests

Devices for gathering information Devices for gathering information about a few aspects of a person’s about a few aspects of a person’s psychological functioning, from psychological functioning, from which broader information can be which broader information can be inferredinferred

More than 500 different tests are in More than 500 different tests are in useuse They fall into six categories … They fall into six categories …



1.1. _________________ tests_________________ tests Require that subjects interpret vague and Require that subjects interpret vague and

ambiguous stimuli or follow open-ended ambiguous stimuli or follow open-ended instructioninstruction

Mainly used by ______________Mainly used by ______________ practitionerspractitioners

Most popular:Most popular: Rorschach TestRorschach Test

Thematic Apperception TestThematic Apperception Test

Sentence Completion TestSentence Completion Test

DrawingsDrawings


Clinical Test: Rorschach Clinical Test: Rorschach InkblotInkblot


Clinical Test: Clinical Test: Thematic Apperception Thematic Apperception

TestTest


Clinical Test: Clinical Test: Sentence-Completion TestSentence-Completion Test

““I wish ___________________________”I wish ___________________________”

““My father ________________________”My father ________________________”


Clinical Test: DrawingsClinical Test: Drawings

Draw-a-Person (DAP) test:Draw-a-Person (DAP) test: ““Draw a person”Draw a person”

““Draw another person of the opposite Draw another person of the opposite sex”sex”



1.1. Projective testsProjective tests Strengths and weaknesses:Strengths and weaknesses:

Helpful for providing “supplementary” Helpful for providing “supplementary” informationinformation

Have rarely demonstrated much Have rarely demonstrated much ________________________________

May be biased against __________________May be biased against __________________



2.2. ________________ inventories________________ inventories Designed to measure broad personality Designed to measure broad personality

characteristicscharacteristics Focus on behaviors, beliefs, and feelingsFocus on behaviors, beliefs, and feelings Usually based on self-reported responsesUsually based on self-reported responses Most widely used: Minnesota Most widely used: Minnesota

Multiphasic Personality InventoryMultiphasic Personality Inventory For Adults: MMPI (original) or MMPI-2 (1989 For Adults: MMPI (original) or MMPI-2 (1989

revision)revision) For Adolescents: MMPI-A For Adolescents: MMPI-A


Clinical Test: MMPIClinical Test: MMPIMinnesota Multiphasic Personality Minnesota Multiphasic Personality

InventoryInventory Consists of more than 500 self-Consists of more than 500 self-

statements that can be answered statements that can be answered “true,” “false,” or “cannot say”“true,” “false,” or “cannot say” Statements describe physical concerns; Statements describe physical concerns;

mood; morale; attitudes toward mood; morale; attitudes toward religion, sex, and social activities; and religion, sex, and social activities; and psychological symptomspsychological symptoms

Assesses careless responding & lyingAssesses careless responding & lying


Clinical Test: MMPIClinical Test: MMPIMinnesota Multiphasic Personality Minnesota Multiphasic Personality

InventoryInventory Comprised of ten clinical Comprised of ten clinical

scales:scales: Hypochondriasis (HS)Hypochondriasis (HS)

Depression (D)Depression (D)

Conversion hysteria (Hy)Conversion hysteria (Hy)

Psychopathic deviate (PD)Psychopathic deviate (PD)

Masculinity-femininity (Mf)Masculinity-femininity (Mf)

Scores range from 0 – 120Scores range from 0 – 120 Above 70 = deviantAbove 70 = deviant

Graphed to create a “profile”Graphed to create a “profile”

Paranoia (P)Paranoia (P)

Psychasthenia (Pt)Psychasthenia (Pt)

Schizophrenia (Sc)Schizophrenia (Sc)

Hypomania (Ma)Hypomania (Ma)

Social introversion Social introversion (Si)(Si)



2.2. Personality inventoriesPersonality inventories Strengths and weaknesses:Strengths and weaknesses:

Easier, cheaper, and faster to administer than Easier, cheaper, and faster to administer than projective testsprojective tests

________________ scored and standardized________________ scored and standardized Appear to have greater validity than Appear to have greater validity than

projective testsprojective tests Measured traits often cannot be directly examined – Measured traits often cannot be directly examined –

how can we really know the assessment is correct?how can we really know the assessment is correct?

Tests fail to allow for __________________ in Tests fail to allow for __________________ in responsesresponses



3.3. Response inventories Response inventories Usually based on self-reported Usually based on self-reported

responsesresponses

Focus on one specific area of Focus on one specific area of functioningfunctioning

Affective inventories (example: Beck Affective inventories (example: Beck Depression Inventory)Depression Inventory)

Social skills inventoriesSocial skills inventories

Cognitive inventoriesCognitive inventories

22Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 3, 5e – Chapter 3Handout 22



3.3. Response inventoriesResponse inventories Strengths and weaknesses:Strengths and weaknesses:

Increasing in use and numberIncreasing in use and number

Not all have been subjected to careful Not all have been subjected to careful standardization, reliability, and/or validity standardization, reliability, and/or validity procedures (BDI and a few others are procedures (BDI and a few others are exceptions)exceptions)



4.4. ____________________ tests ____________________ tests Measure physiological response as an Measure physiological response as an

indication of psychological problemsindication of psychological problems Includes heart rate, blood pressure, body Includes heart rate, blood pressure, body

temperature, galvanic skin response, and temperature, galvanic skin response, and muscle contractionmuscle contraction

Most popular is the __________ (lie Most popular is the __________ (lie detector)detector)



4.4. Psychophysiological tests Psychophysiological tests Strengths and weaknesses:Strengths and weaknesses:

Require expensive equipment that must be Require expensive equipment that must be tuned and maintainedtuned and maintained

Can be inaccurate and unreliableCan be inaccurate and unreliable



5.5. ____________________________ tests____________________________ tests Neurological tests __________ assess brain Neurological tests __________ assess brain

function by assessing brain structure and function by assessing brain structure and activityactivity

Examples: EEG, PET scans, CAT scans, MRIExamples: EEG, PET scans, CAT scans, MRI

Neuropsychological tests __________ assess Neuropsychological tests __________ assess brain function by assessing cognitive, brain function by assessing cognitive, perceptual, and motor functioningperceptual, and motor functioning

Most widely used is the Bender Visual-Motor Most widely used is the Bender Visual-Motor Gestalt TestGestalt Test


Clinical Test: Clinical Test: Bender Visual-Motor Bender Visual-Motor

Gestalt TestGestalt Test



5.5. Neurological and Neurological and neuropsychological testsneuropsychological tests

Strengths and weaknesses:Strengths and weaknesses: Can be very accurateCan be very accurate

At best, though, these tests are general At best, though, these tests are general screening devicesscreening devices Best when used in a battery of tests, each Best when used in a battery of tests, each

targeting a specific skill areatargeting a specific skill area



6.6. _______________________ tests_______________________ tests Designed to measure intellectual Designed to measure intellectual

abilityability

Composed of a series of tests Composed of a series of tests assessing both verbal and nonverbal assessing both verbal and nonverbal skillsskills

Generate an ______________________ Generate an ______________________ (IQ)(IQ)



6.6. Intelligence testsIntelligence tests Strengths and weaknesses:Strengths and weaknesses:

Are among the most carefully produced of Are among the most carefully produced of all clinical testsall clinical tests

Highly standardized on large groups of Highly standardized on large groups of subjectssubjects

Have very high reliability and validityHave very high reliability and validity

Because intelligence is an inferred quality, Because intelligence is an inferred quality, it can only be measured indirectlyit can only be measured indirectly



6.6. Intelligence testsIntelligence tests Strengths and weaknesses:Strengths and weaknesses:

Performance can be influenced by Performance can be influenced by nonintelligence factors (e.g., ____________ , nonintelligence factors (e.g., ____________ , ____________ , ______________________)____________ , ______________________)

Tests may contain _________ in language or Tests may contain _________ in language or taskstasks


Clinical ObservationsClinical Observations

Systematic observation of behaviorSystematic observation of behavior

Several kinds:Several kinds: NaturalisticNaturalistic

AnalogAnalog

Self-monitoringSelf-monitoring



Naturalistic and analog observationsNaturalistic and analog observations Naturalistic observations occur in ____________ Naturalistic observations occur in ____________

environmentsenvironments Can occur in homes, schools, institutions (hospitals Can occur in homes, schools, institutions (hospitals

and prisons), and community settingsand prisons), and community settings Tend to focus on parent–child, sibling–child, or Tend to focus on parent–child, sibling–child, or

teacher–child interactionsteacher–child interactions Observations are generally made by Observations are generally made by

“________________” and reported to a clinician“________________” and reported to a clinician

If naturalistic observation is impractical, If naturalistic observation is impractical, analog observations are used in analog observations are used in ____________________________________



Naturalistic and analog observationsNaturalistic and analog observations Strengths and weaknesses:Strengths and weaknesses:

Reliability is a concernReliability is a concern Different observers may focus on different aspects Different observers may focus on different aspects

of behaviorof behavior

Validity is a concernValidity is a concern Risk of “overload,” “observer drift,” and observer Risk of “overload,” “observer drift,” and observer

biasbias

______________________ may also limit validity______________________ may also limit validity

Observations may lack _____________________ validityObservations may lack _____________________ validity



Self-monitoringSelf-monitoring People observe themselves and People observe themselves and

carefully record certain behaviors, carefully record certain behaviors, feelings, or cognitions as they occur feelings, or cognitions as they occur over timeover time



Self-monitoring Self-monitoring Strengths and weaknesses:Strengths and weaknesses:

Useful in assessing infrequent behaviorsUseful in assessing infrequent behaviors

Useful for observing overly frequent behaviorsUseful for observing overly frequent behaviors

Provides a means of measuring private thoughts or Provides a means of measuring private thoughts or perceptionsperceptions

Validity is often a problemValidity is often a problem

Clients may not receive proper training and instructionClients may not receive proper training and instruction

Clients may not record information accuratelyClients may not record information accurately

When people monitor themselves, they often change When people monitor themselves, they often change their behaviortheir behavior


Diagnosis: Does the Client’s Diagnosis: Does the Client’s Syndrome Match a Known Syndrome Match a Known

Disorder?Disorder? Using all available information, clinicians Using all available information, clinicians

attempt to paint a “_______________”attempt to paint a “_______________” Influenced by their _________________ Influenced by their _________________

Using assessment data and the clinical Using assessment data and the clinical picture, clinicians attempt to make a picture, clinicians attempt to make a ________________________________ A determination that a person’s problems A determination that a person’s problems

reflect a particular disorder or syndromereflect a particular disorder or syndrome

Based on an existing _________________ Based on an existing _________________


Classification SystemsClassification Systems

Lists of categories, disorders, and Lists of categories, disorders, and symptom descriptions, with guidelines symptom descriptions, with guidelines for assignmentfor assignment Focus on clusters of symptoms Focus on clusters of symptoms

(syndromes)(syndromes)

In current use in the US: DSM-IV-TRIn current use in the US: DSM-IV-TR Diagnostic and Statistical Manual of Diagnostic and Statistical Manual of

Mental Disorders (4th edition), Text Mental Disorders (4th edition), Text RevisionRevision


DSM-IV-TRDSM-IV-TR

Published in 1994, revised slightly in Published in 1994, revised slightly in 20002000

Lists approximately 400 disordersLists approximately 400 disorders Listed in the inside back flap of your textListed in the inside back flap of your text

Describes criteria for diagnoses, key Describes criteria for diagnoses, key clinical features, and related features clinical features, and related features which are often but not always presentwhich are often but not always present


The DSM-IV-TRThe DSM-IV-TR

Most widely used classification Most widely used classification system in the US system in the US

__________________________ Uses 5 axes (____________________) to Uses 5 axes (____________________) to

develop a full clinical picturedevelop a full clinical picture

People usually receive a diagnosis on People usually receive a diagnosis on either Axiseither Axis I or Axis II, but they may I or Axis II, but they may receive diagnoses on bothreceive diagnoses on both


Lifetime Prevalence of Lifetime Prevalence of DSM-IV-TR DiagnosesDSM-IV-TR Diagnoses



Axis I Axis I Most frequently diagnosed disorders, Most frequently diagnosed disorders,

except personality disorders and mental except personality disorders and mental retardationretardation


Major Axis I Diagnostic Major Axis I Diagnostic CategoriesCategories

Anxiety disordersAnxiety disorders Mood disordersMood disorders

Disorders first diagnosed in Disorders first diagnosed in infancy and childhoodinfancy and childhood

Substance-related disordersSubstance-related disorders

Schizophrenia and other Schizophrenia and other psychotic disorderspsychotic disorders

Delirium, dementia, Delirium, dementia, amnestic, and other cognitive amnestic, and other cognitive

disordersdisorders

Mental disorders due to a Mental disorders due to a general medical conditiongeneral medical condition

Somatoform disordersSomatoform disorders

Factitious disordersFactitious disorders Dissociative disordersDissociative disorders

Other conditions that are the Other conditions that are the focus of clinical attentionfocus of clinical attention

Eating disordersEating disorders

Sexual and gender identity Sexual and gender identity disordersdisorders

Impulse-control disordersImpulse-control disorders

Adjustment disordersAdjustment disorders Sleep disordersSleep disorders



Axis IIAxis II Personality disorders and mental Personality disorders and mental

retardationretardation Long-standing problemsLong-standing problems

Axis IIIAxis III Relevant general medical conditions Relevant general medical conditions

Axis IVAxis IV Psychosocial and environmental problemsPsychosocial and environmental problems



Axis VAxis V Global assessment of psychological, Global assessment of psychological,

social, and occupational functioningsocial, and occupational functioning Current functioning and highest functioning Current functioning and highest functioning

in in past yearpast year

00––100 scale100 scale


Is DSM-IV-TR an Effective Is DSM-IV-TR an Effective Classification System?Classification System?

Classification systems are judged by their Classification systems are judged by their reliability and validity reliability and validity

Here reliability = different diagnosticians Here reliability = different diagnosticians agreeing on a diagnosis using the same agreeing on a diagnosis using the same classification systemclassification system DSM-IV-TR has greater reliability than any DSM-IV-TR has greater reliability than any

previous editionsprevious editions Used field trials to increase reliabilityUsed field trials to increase reliability

Reliability is still a concernReliability is still a concern


Is DSM-IV-TR an Is DSM-IV-TR an Effective Classification Effective Classification

System?System? The validity of a classification system The validity of a classification system

is the accuracy of information that the is the accuracy of information that the diagnostic categories providediagnostic categories provide ____________ validity is of the most use ____________ validity is of the most use

clinicallyclinically DSM-IV-TR has greater validity than any DSM-IV-TR has greater validity than any

previous editionsprevious editions Conducted extensive literature reviews and Conducted extensive literature reviews and

ran field studiesran field studies

Validity is still a concernValidity is still a concern


Is DSM-IV-TR an Is DSM-IV-TR an Effective Classification Effective Classification

System?System? Beyond concerns about reliability and Beyond concerns about reliability and

validity, a growing number of validity, a growing number of theorists believe that two fundamental theorists believe that two fundamental problems weaken the DSM:problems weaken the DSM: Basic assumption that disorders are Basic assumption that disorders are

__________________________ different from normal different from normal behaviorbehavior

Reliance on _____________ diagnostic Reliance on _____________ diagnostic categoriescategories


Can Diagnosis and Can Diagnosis and Labeling Labeling

Cause Harm?Cause Harm? Misdiagnosis always a concernMisdiagnosis always a concern

Major issue is reliance on __________________Major issue is reliance on __________________

Also present is the issue of Also present is the issue of ______________________________ Diagnosis may be a self-fulfilling prophecyDiagnosis may be a self-fulfilling prophecy

Because of these problems, some Because of these problems, some clinicians would like to cease the clinicians would like to cease the practice of diagnosispractice of diagnosis


Treatment: How Might the Treatment: How Might the Client Be Helped?Client Be Helped?

Treatment decisions Treatment decisions Begin with assessment information and Begin with assessment information and

diagnostic decisions to determine a treatment diagnostic decisions to determine a treatment planplan

Use a combination of ___________________________Use a combination of ___________________________

Other factors:Other factors: ______________________________________________________________________________________

______________________________________________________________________________________

General state of clinical knowledge – currently General state of clinical knowledge – currently focusing on ___________________________________________focusing on ___________________________________________


The Effectiveness of The Effectiveness of TreatmentTreatment

More than 400 forms of therapy in More than 400 forms of therapy in practice, but is therapy effective?practice, but is therapy effective? Difficult question to answer:Difficult question to answer:

How do you define success?How do you define success?

How do you measure improvement?How do you measure improvement?

How do you compare treatments – How do you compare treatments – treatments differ in range and complexity; treatments differ in range and complexity; therapists differ in skill and knowledge; therapists differ in skill and knowledge; clients differ in severity and motivation…clients differ in severity and motivation…



Controlled clinical research and Controlled clinical research and therapy outcome studies typically therapy outcome studies typically assess one of the following questions:assess one of the following questions: Is therapy Is therapy in generalin general effective? effective?

Are Are particularparticular therapies generally therapies generally effective?effective?

Are Are particularparticular therapies effective for therapies effective for particularparticular problems? problems?



Is therapy generally effective?Is therapy generally effective? Research suggests that therapy is Research suggests that therapy is

generally more effective than generally more effective than ____________ or _____________________ or _________

In one major study using ____________ , In one major study using ____________ , the average person who received the average person who received treatment was better off than 75% of treatment was better off than 75% of the untreated subjectsthe untreated subjects




Is therapy generally effective?Is therapy generally effective? Some clinicians are concerned with a Some clinicians are concerned with a

related question: Can therapy can be related question: Can therapy can be harmful?harmful? Has this potentialHas this potential

Studies report ~5% get worse with Studies report ~5% get worse with treatmenttreatment



Are particular therapies generally Are particular therapies generally effective?effective? Generally, therapy-outcome studies lump all Generally, therapy-outcome studies lump all

therapies together to consider their general therapies together to consider their general effectivenesseffectiveness

One critic has called this the “__________________”One critic has called this the “__________________”

It is argued that scientists must look at the It is argued that scientists must look at the effectiveness of ______________ therapies effectiveness of ______________ therapies

There is a movement (“______________”) to look at There is a movement (“______________”) to look at __________________ among therapies__________________ among therapies



Are particular therapies effective for Are particular therapies effective for particular problems?particular problems? Studies now being conducted to examine Studies now being conducted to examine

effectiveness of specific treatments for specific effectiveness of specific treatments for specific disorders:disorders:

“ “ ______ specific treatment, by ______, is the most effective ______ specific treatment, by ______, is the most effective for ______ individual with ______ specific problem, and for ______ individual with ______ specific problem, and under ______ set of circumstances?”under ______ set of circumstances?”

Recent studies focus on the effectiveness of Recent studies focus on the effectiveness of combined approaches – ________________ combined combined approaches – ________________ combined with certain forms of _______________ – to treat with certain forms of _______________ – to treat certain disorderscertain disorders

Education

Abnormal Psych Hand Out Ch03