Clinical Psychology- University of Iowa Exam 1

Characteristics of scientific Clinical Psychology

Claims can be tested empirically

Measurement strategies are:

1) Objective

2) Reliable

3) Valid

4) Useful

Findings can be replicated independently

Potential alternative explanations for findings

Steps are taken to guard against undue influence of personal beliefs

Strength of claims reflects strength of evidence

What is abnormality?

Rare

Deviation from social norms:

-culture

-situational context

-age

-sex

Distress

Functional impairment

Risk/Harm to self or others

What is a mental disorder?

Clinically significant abnormal behavior or psychological syndrome

Criteria for mental disorder

Distress: painful or upsetting

Disability: impairment in functioning

Increased Risk: of death, pain disability, loss of freedom

Goal of DSM

To define different "mental disorders" to make sure people get the services they need

Mental disorder are " " defined

Socially (not biologically)

Strengths of the DSM

Facilitates communication about disorders

Ideally guides treatment selection

Diagnosis used to justify payment of services

Promotes research in psychopathology

psychopathology

Epidemiology: disorder distribution in population

Etiology: causes of disorders

Course: how disorder plays out over time

Treatment: development and evaluation

Lifetime prevalence of mental disorders

46%

Concerns about DSM

Heterogeneity (variability) of symptoms profiles, etiologies within diagnosis

Many disorder subtypes and features not based on empirical data

Substantial comorbidity of diagnoses

Coverage of disorders

Potential bias

Inter-rater reliability

Consistency of diagnostic judgements across raters/ therapists

Cohen's Kappa

index of inter-rater reliability of classification

0-0.4: poor

0.41-0.75: fair

0.76-1.0: excellent

Test-retest reliability

Consistency of diagnostic judgments across time

Categorical approach

abnormality is binary (present or absent)

Dimensional approach

abnormality lies on a continuum

may provide more valid portrayal of many clinical phenomena

ADHD is a " " disorder

dimensional

Goals of Research

1) Description

2) Prediction

3) Understanding

4) Application

Hypothesis

a proposed explanation for a phenomenon

ex) expected link between alcohol consumption, impulsivity, and sexual aggression

Forms of Hypotheses

Correlational

causal

mediation

interaction

Correlational Hypothesis

two variables are associated with one another

"Alcohol us and impulsivity associated with SA"

Causal Hypothesis

Variable(s) causes another variable

"Alcohol use and impulsivity cause SA"

Mediation Hypothesis

one variable at least partially explains (accounts for) relationship between two other variables

Answers "why?" or "how?" questions

"Impulsivity mediates link btw alcohol and SA"

How do you know it is mediation?

When you remove to mediator the correlation between alcohol consumption and sexual aggression goes down

Interaction Hypothesis

one variable influences relationship btw two other variables

Strength of relationship btw alcohol and SA varies depending on how high in impulsivity

Once we have a research question and hypothesis, what do we do?

Design a study to test our question

Internal Validity

Extent to which causal interpretations justified and alternative causal explanations ruled out

External Validity

Generalizability of findings beyond study

As internal validity increases, external validity......

decreases

Case Study

detailed description of links btw variables for a small number of people

Internal Validity: low b/c you cant control you are just observing

External Validity: low,small sample size is not applicable on large scale

Example of case study?

Evaluate whether alcohol related to impulsivity in interview with two students alleged to have exhibited SA

Correlational studies

Examine associations btw two variables (predictor and outcome) for multiple people

Correlation coefficient, r

represents two aspects of association:

1) Direction: positive or negative

2)Magnitude: weak or strong

What does direction of the correlation coefficient mean?

Positive association if r is positive: as the predictor increases the outcome increases

Negative association if r is negative: as the predictor decreases the outcome increases

Which correlation is stronger? r= 0.44 or r= -0.62

r= -0.62

Magnitude is stronger as the absolute value of r increases

There's a strong positive association between the number of fire trucks sent to a fire, the larger the fire. Why can't we infer that the number of fire engines sent to a fire causes the size of the fire?

Direction of effect (reverse causation)

The size of the fire causes the number of fire engines sent to the fire

Why can't we infer causality?

1) Direction of effect

2) Third variable

ex: lack of pirates causing global warming (time)

How do we test causality?

Experiment! Manipulate the IV and hold everything else constant to see if the IV affects the DV

Pros and cons of correlational studies

Pros: In comparison to case studies, external and internal validities increase

Cons: very hard to be confident about causality, "third" variable may explain observed relationships

Internal validity weaker than experimental designs

Experimental Studies

Examine effect of experimentally manipulated

Between-Subject Design

Randomly assign people to two groups receiving two different manipulations, compare the two groups results

Within-Subject Design

Everyone receives all levels of the manipulation, compare each individual to their personal results on each manipulation

Pros and Cons Experimental studies

Pros: relative to case and correlational studies, internal validity increases

Cons: external validity varies across studies

Cross-Sectional Design

Evaluates sample at single time

Longitudinal Design

follows same person over time

Psychometrics

Adequacy of psychological measurement strategies

1) Reliability: consistency of measurement

2) Validity: accuracy of measurement

Test-Retest Reliability

Consistency of responses over time (r > 0.7 good)

Inter-rater Reliability

Consistency of judgements across raters (kappa > 0.75)

Internal Consistency

Consistency of responses across items on measure

(Cronbach's alpha: 0.6-0.7 acceptable, 0.7-0.8 good, 8-1.0 very good)

Concurrent Validity

association of measure with another measure of the same concept at same point in time

RMAS: associated with likelihood of self-reported aggression at same point in time

Predicitve Validity

association of measure with another measure of same concept at future point in time

RMAS: predicts self-reported future aggression

Incremental Validity

Extent to which measure predicts more than what already could predict

RMAS: predicts increase rates of self reported sexual aggression above rates predicted by psychopathic traits

The relationship between reliability and validity

Measure must be reliable in order to be valid

MDD DSM-5 Criteria highlights

Five or more of the following symptoms have been present during the same 2-week period; at least one of the symptoms include depressed mood or loss of interest or pleasure

Lifetime prevalence of MDD

16% will suffer at some point in lifetime

Current prevalence of MDD

6% are currently suffering

Disability- Adjusted Life Years (DALYs)

years of life lost+years lived with disability

purpose: comparing impairment of disorders, diseases, injuries, and conditions

Depression is 11th

Biological influences on MDD

Genes

Neurotransmitter Systems

Neurophysiology

Neuroendocrine System

Behavior genetics

Study of degree to which genes and environment influence behavior

Helps establish heritability of mental illnesses

Depression ~37%

Molecular genetics

Study of influence of specific genes and environment on behavior

Neurotransmitter System

NTs released into synaptic gap to bind with receptors on post-synaptic membrane

Abnormalities in number and sensitivity of receptors for MONOAMINE neurotransmitters may be implicated in MDD

Norepinephrine

controls heart rate, blood pressure, respiration

Role in Body's reaction to threat

Serotonin

Info processing, movement coordination

Inhibition, restraint

Regulation of eating, sex, aggression, emotional reactions

Dopamine

Aid in exploratory and pleasure-seeking behaviors

Structural Studies

Focus on whether fewer cells or connections in brain region

CAT scan or MRI scan

Structural and Functional Activation Studies

Focus on whether change in activity of brain regions

fMRI scan or PET scan

Prefrontal Cortex function in a patient with MDD

Involved: complex cognition, approach-related goals

MDD: decrease in volume of gray matter, decrease metabolic activity

Anterior cingulate in a patient with MDD

Involved: stress response, emotional expression

MDD: Increased activity

Amygdala in a patient with MDD

Involved: emotional processing

MDD: Increased activity

Hippocampus in a patient with MDD

Involved: Memory

MDD: decreased volume, decreased activity

Hypothalamic-pituitary-adrenal (HPA) axis in patients with MDD

HPA hyperactivity and increased cortisol levels (stress hormone)

Physiological events that contribute to MDD

Stressful Life Events

Negative Cognitive Styles

Maladaptive Attributional Style

Stressful Life Events

~90% of those who develop MDD had experienced a stressful event

Only 20-50% of those experiencing severe event become depressed

Diathesis-stress model

Stress interacts with vulnerability factors (or diatheses) to cause depression

Fan-shaped interaction

Diatheses

stable (chronic) vulnerabilities that increase risk for mental illness

ex) genetics

Acute Stress

stressful life events prior to depression

ex) losing a friend

The influence of a predisposing risk factor interacting with stress (moderator) effects level of depression, is what kind of hypothesis?`

Interaction

Beck's Cognitive Theory

Depression results from negative interpretation of everyday events

Beck's "cognitive triad"

Negative views about self/world/future

Social & Cultural Dimensions of MDD

Person's sex

>women are twice as likely to develop MDD

Perceived Social Support

> low social support may decrease ability to handle stressful life events

Reinforcement

increases the frequency of a behavior

Men versus women in regards to suicide

Suicide is 4-5 times more likely among men

Suicide attempts 3 time more common among women

Suicidal thoughts more common among women

Most common method: Men (gun), women (poison)

Affect of race on suicide

Suicide rates higher for caucasian as opposed to non

Rates higher for Native Americans

Highest rates of suicide in US Adults?

Caucasian males over 75

Heritability of suicide

43% - note it is more inheritable than depression

Serotonin levels in people who are likely to commit suicide

low levels related to impulsive and aggressive behavior

Best predictor of suicide

previous suicide attempts

30-fold risk for male adolescents

3-fold risk for female adolescents

Claims can be tested

Empirically

clinical ___ is more prevalent than clinical science

pseudoscience

majority of clients receive treatments without

empirical support