Lecture 13 - Clinical Psychology

Why does psychological assessment exist? (2)

• because intuition is powerful, but often wrong

• psychodiagnostics is attempt to replace guesswork with systematic, reliable and evidence-based methods

Diagnostic cycle

observation

• exploration and first thoughts about creation and persistence of problem behavior

induction

• formulation of theory and hypotheses

deduction

• derivation of testable predictions from hypotheses

testing

• application of relevant diagnostic measurements

evaluation

• determination whether predictions are met

clinical interview

• A procedure in which questions are adjusted in accord with the answers the interviewee provides; used to collect detailed information about a person’s history, current symptoms, and functioning.

Process of diagnostics applied to clinical psychology

exploration phase

What should be done during the exploration phase in addition?(6)

take debiasing pause:

• availability heuristics may occur → recency bias, vividness bias, anchoring

• cannot be eliminated, but

→ slow down decision-making

→ differential, structured diagnostics

→ knowledge and intervision

vividness bias

• our minds overweight most striking, emotional, or prestigious information, causing us to neglect subtle yet equally important details

anchoring

• tendency to rely too heavily on the first piece of information encountered when making decisions → e.g. sticking to first hypothesis even though new information/evidence pointing in other direction occurs

induction phase

Types of questions in induction (5)

• recognition

• explanation

• prediction

• indication

• evaluation

recognition questions (Which question? Which principles?) (3)

• What are the (level of the) problems?

• all-or-nothing principle: clients is or isn’t assigned to diagnostic category → e.g. using SCID interview

• more-or-less principle: client is given profile of scores for number of dimensions → e.g. using MMPI

explanation questions (Which question? Which main elements?) (2)

• Why do the problems exist or perpetuate?

• 3 main elements of explanation questions: main problem, explanatory condition, connection between main problem and explanatory condition (usually causal)

prediction questions (Which question? What to pay attention to here? How do you then make predictions?) (3)

• How will problems develop in the future?

• large error margins!

• what can help: assessment (e.g. ipsative)

indication questions

• How can the problems be resolved?

evaluation questions

• Have the problems been adequately resolved by the intervention?

deduction phase

PA instruments for deduction phase (5)

• structured and semi-structured interviews

• Self- and informant-report questionnaires

• IQ tests and neuropsychological tests

• Observational rating scales

• (Projective tests)

Measurement strategies for testable predictions (3)

• representative group (normative)

• predefined standard (criterion)

• individual themselves (ipsative)

testing phase

What is the outcome of the testing phase? (2)

• interpreted results → might give rise to new hypotheses

• observational data → how does client perform task? has an appropriate working relationship been established?

evaluation phase

What are the products of the evaluation phase? (2)

• report for referrer that contains results of diagnostic examination

• verbal report to clients

What should you pay attention to in the report for the referrer? (3)

• substantiate claims

• distinction between facts/interpretation of facts/conclusions

• quality of sources is weighted

What should you pay attention to in the verbal report to clients? (2)

• acquaint client with diagnostician’s framework

• when done well, can be motivating for client

Under which circumstances does the PA (psychological assessment)/cycle work well? (2)

• most recognition questions, based on criteria or norms

• evaluation using norms, reduction scores, …

Under which circumstances does the PA/Cycle not work well/is it problematic? (2)

• explanation, prediction, indication without (sufficient) models or data

• most explanation questions rely on clinical judgement

Client standard rights within PA (NIP ethics code) (6)

→ client has to be informed on that

• information on working relationship

• access to and copy of report

• correction, addition, deletion report

• block sending out report

• right to delete PA report/file

structured interview

• A clinical interview in which the questions and the order of presentation are set, with standardized wording and scoring, to increase reliability of diagnosis.

Minnesota Multiphasic Personality Inventory-3 (MMPI-3)

• A widely used self-report personality inventory with validity and clinical scales designed to assess a broad range of emotional and behavioral problems.

standardization

• The process of establishing norms and uniform procedures for administering and scoring a psychological test, allowing comparison of an individual’s score with a reference group.

Big Five Inventory-2 (BFI-2)

• A self-report questionnaire that measures the five major dimensions of personality (the Big Five): neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness.

NEO Personality Inventory (NEO-PI)

• A personality inventory designed to assess the Big Five personality traits and their facets.

intelligence test

• A standardized test designed to measure intellectual abilities such as reasoning, problem solving, and knowledge; often yields an intelligence quotient (IQ).

neuropsychological tests

• Tests used to measure cognitive functions (e.g., memory, attention, language, motor skills) that rely on specific brain systems, to help infer possible brain dysfunction.

ecological momentary assessment (EMA)

• A method of repeatedly sampling people’s behaviors and experiences in real time and in their natural environments, typically using electronic devices.

magnetic resonance imaging (MRI)

• A technique for measuring brain structure by using magnetic fields and radio waves to produce high-resolution images of the brain.

functional magnetic resonance imaging (fMRI)

• A technique for measuring brain activity by detecting changes in blood flow and oxygenation while a person performs tasks or is at rest.

BOLD

• Acronym for blood oxygen level–dependent signal; the fMRI signal that reflects changes in blood oxygenation associated with neural activity.

PET scan

• Positron emission tomography; a brain-imaging technique that measures metabolic activity (often glucose metabolism or receptor binding) by tracking radioactive tracers.

SPECT

• Single photon emission computed tomography; a brain-imaging technique similar to PET that uses radioactive tracers to measure blood flow and activity, typically with lower resolution than PET.

transcranial magnetic stimulation (TMS)

• A noninvasive technique that uses magnetic fields applied to the scalp to induce electrical currents in the cortex, temporarily modulating neural activity in targeted brain regions.

transcranial direct current stimulation (tDCS)

• A noninvasive brain stimulation technique in which a weak direct electrical current is applied via electrodes on the scalp to alter cortical excitability in targeted regions.