Assessment & Interviewing - MIDTERM

What is the purpose of an MSE?

provides a brief overview of all the major symptoms (e.g., mental & emotional state, cognitive functioning) a patient may be experiencing

What domains are assessed within an MSE?

respondent appearance, behavior, mood, affect, thought processes, thought content, perceptual disturbances (psychosis), cognitive processes (memory, orientation), & insight/judgement

How is the information from an MSE obtained?

1) information is elicited from the respondent during the interview (responses to prompts/questions)

2) What the clinician observes about the respondent (body language, appearance)

Validity

Answers the question: Is this measure accurate?

exists on a continuum

central to validity = establishing a relevant criterion

Different types of validity

Content Validity

Construct Validity

Convergent Validity

Discriminant Validity

Predictive Validity

Incremental Validity

Content Validity

the extent to which the content of an assessment tool adequately and comprehensively measures the construct or trait it is intended to assess. In other words, it assesses how well the items or questions within an assessment instrument represent the domain or content area of interest.

Construct Validity

supported via a combination of supportive qualitative evidence related to content validity and quantitative support of criterion validity

Theoretical validity - unifying form of validity regarded as a combination of content and criterion validity

Convergent Validity

addresses how well a scale correlates with other established scales measuring similar constructs at the same time. It is typically expressed using the coefficient r

Discriminant Validity

addresses the extent to which a scale does not correlate with a measure it should not correlate with

i.e., measures the “signal-to-noise” ratio of a measure

Predictive Validity

addresses how well a scale administered now correlates with some outcome in the future

measures the validity of a measure over time

criterion can be a behavioral outcome or a future measure

Incremental Validity

addresses the extent to which any additional scale contributes additional information beyond extant scales or indices to predict a relevant outcome

forces clinicians to ask: “Is this scale administering? Does it show/add something new to what is currently available?”

Reliability

consistency of results

Forms of reliability

Test-Retest Reliability

Inter-Rater Reliability

Internal Consistency

Test-Retest Reliability

the extent to which an examinee’s scores today are associated with their scores on the same test at some future time

Primarily relevant for characteristics that should be stable

High test-retest reliability over extended periods of time on symptom measures may be a red flag (e.g., depression levels should fluctuate over time, not remain stable)

Inter-Rater Reliability

the extent to which two separate raters agree on a score

Very relevant when a scale relies on some level of clinician judgment; less relevant for self-report inventories

Measured by kappa coefficient for categorical constructs and ICCs for constructs that exist on a continuum

Internal Consistency

the strength of the intercorrelation between the items in a scale

is measuring how well a measure defines a certain construct and whether or not this remains consistent throughout a measure

Low internal consistency tells you the scale isn’t tapping a single, homogenous construct

Sensitivity vs. Specificity

Sensitivity - proportion of all people who truly have a condition and are correctly identified as having it TP/(TP+FN)

Specificity - proportion of people who truly do not have a disease who are correctly identified as NOT having it TN/(FP+TN)

PPV vs. NPV

PPV = TP/(TP+FP)

NPV = TN/(TN+FN)

Norms

a set of standardized data that provide a basis for comparing an individual's performance on a psychological or educational assessment with the performance of a representative group of people

Norms, specific criterion-related cutoff scores, or both are needed to properly interpret a respondent’s results on a psychological assessment

Validity Generalization

the extent to which the validity evidence for a particular assessment tool or test can be applied to different populations or situations beyond the specific group for which the test was originally developed

Clinical Utility

practical value and usefulness of an assessment measure or instrument

test materials vs. test data

9.04 Test data refers to raw and scaled scores, client/patient responses to test questions or stimuli and psychologists’ notes and recordings concerning client/patient statements and behavior during an examination. Those portions of test materials that include patient/client responses are included in the definition of test data.

9.11 Test materials refers to manuals, instruments, protocols and test questions or stimuli and does not include test data

you are NOT ALLOWED to disclose test materials in court. However, with a release of information, you ARE allowed to disclose test data

MMPI basics

most widely used psychological test in the world

567 self-reported true or false items

developed in 1943 to assist in psychiatric diagnosis, with validity scales embedded into the measure

MMPI Norms

original normative sample for MMPI - gathered from data in 1943

typical person part of this sample - 35 years old, white, middle class, average of 8 years formal education

original sample also included people or friends visiting loved ones in the hospital

important considerations: lack of diversity within the sample, mental status of most individuals who were part of the sample (e.g., people visiting loved ones in the hospital are usually not in the best state of mind —> could skew results)

MMPI-2 Normative Sample

accumulated data by using the 1980 census for participant solicitation

There were 7 total testing sites across several states, resulting in a total of 2,600 participants

much broader range of ethno-racial identities, ages, education levels, marital status, income levels, and mental health statuses compared to original MMPI

MMPI-2 Validity Scales

Cannot Say (CNS)

Variable Response Inconsistency (VRIN)

True Response Inconsistency (TRIN)

Infrequency (F)

Infrequency - Backside (Fb)

Infrequency - Psychopathology (Fp)

Fake Bad Scale (FBS)

Lie (L)

Correction (K)

Superlative (S)

MMPI-2 Cannot Say (CNS) Validity Scale

measures the number of items an individual fails to answer

high number of unanswered questions may indicate confusion, refusal to respond, or carelessness

MMPI-2 Variable Response Inconsistency (VRIN) Validity Scale

Evaluates inconsistent responding to pairs of items with similar content

can identify individuals who may be responding randomly or inconsistently

MMPI-2 True Response Inconsistency (TRIN) Validity Scale

Assesses inconsistencies in responding to pairs of items that are opposite in content but should be endorsed in the same direction (23 pairs of items that are semantically inconsistent)

can help detect individuals who answer inconsistency or indiscriminately

it reflects a tendency toward “yea-saying” (high scores) or “nay-saying” (low scores)

MMPI-2 Infrequency (F) Validity Scale

measures the frequency of rare or unusual symptoms or experiences

high scores on this scale suggest the possibility of exaggeration of psychological symptoms

MMPI-2 Infrequency - Backside (Fb) Validity Scale

Aimed at identifying individuals who might be exaggerating or providing an overly positive portrayal of themselves on the second half of the test

MMPI-2 Infrequency - Psychopathology (Fp) Validity Scale

Focuses on the frequency of psychological symptoms and atypical behaviors

Intends to detect individuals who may be exaggerating or endorsing symptoms that are infrequent and atypical, even for people with genuine psychological issues

MMPI-2 Fake Bad (FBS) Validity Scale

Used to assess whether an individual is exaggerating or feigning psychological symptoms or problems to appear more distressed or dysfunctional than they actually are

MMPI-2 Lie (L) Validity Scale

Measures the tendency to present oneself in a socially desirable manner

High scores may indicate attempts to minimize difficulties or present a favorable self-image

MMPI-2 Correction (K) Validity Scale

Assesses self-control and interpersonal relationships

high K score indicates that the person may be defensive or trying to present themselves in an overly favorable light

MMPI-2 Superlative (S) Validity Scale

Assesses an individual’s tendencies to present themselves in an unrealistically positive light

MMPI-2 Clinical Scales

1. Hypochondriasis (Hs)

2. Depression (D)

3. Hysteria (Hy)

4. Psychopathic deviate (Pd)

5. Masculinity-femininity (Mf)

6. Paranoia (Pa)

7. Psychasthesia (Pt)

8. Schizophrenia (Sc)

9. Hypomania (Ma)

0. Social introversion (Si)

MMPI-2 Clinical Scale 1: Hypochondriasis (Hs)

Measures concerns about physical health and the tendency to exaggerate or over report physical symptoms

MMPI-2 Clinical Scale 2: Depression (D)

Assesses depressive symptoms, including sadness, hopelessness, and loss of interest or pleasure in activities

MMPI-2 Clinical Scale 3: Hysteria (Hy)

Assesses emotional and psychosomatic symptoms, including anxiety, conversion symptoms, and other forms of emotional distress

commonly compared to/with scale 1 (Hs)

MMPI-2 Clinical Scale 4: Psychopathic Deviate

Assesses antisocial behaviors, aggression, and difficulties with impulse control and authority figures; measure of rebelliousness

associated with difficulty incorporating morals of society

MMPI-2 Clinical Scale 5: Masculinity-Femininity (Mf)

Measures stereotypical gender role behaviors and interests

assesses how well an individual’s self-presentation aligns with traditional gender expectations; largely not relevant today

elevated T score ≥ 65 for men = lack of stereotypical masculine interests

elevated T score ≥ 65 for women = may be rejecting traditional feminine role

MMPI-2 Clinical Scale 6: Paranoia (Pa)

Assesses suspiciousness, hostility, and mistrust of others

high T scores on scale 6, especially when it is the highest scale in the profile, indicates a potential for psychotic behavior

moderate elevations are less indicative of psychotic behavior, but more indicative of paranoid orientation

MMPI-2 Clinical Scale 7: Psychasthenia (Pt)

Measures obsessive-compulsive symptoms, such as doubts, compulsions, and excessive worrying

higher T score (≥ 70) = greater turmoil & discomfort

MMPI-2 Clinical Scale 8: Schizophrenia (Sc)

Assesses symptoms of thought disorder, social withdrawal, and perceptual disturbances

elevated T score of ≥  75 suggest the possibility of a psychotic disorder

not all elevated scores indicate a psychotic disorder - may be in extreme emotional turmoil or endorsing deviant items as a cry for help

diagnosis of schizophrenia should not rely solely on elevated score on scale 8

MMPI-2 Clinical Scale 9: Hypomania (Ma)

Assesses symptoms related to bipolar or manic episodes, such as elevated mood, energy, and impulsivity (assesses both mania and hypomania)

moderate elevations are not likely to be associated with severe symptoms

extreme elevations = T > 80, may suggest a manic episode

MMPI-2 Clinical Scale 0: Social Introversion (Si)

Assesses introverted and socially withdrawn behavior and discomfort in social situations

low scorers tend to be sociable and extroverted

high scorers tend to worry, feel irritable, and be anxious

MMPI-2 Harris-Lingoes Scale

7 of the clinical scales are heterogeneous, meaning that there are several other factors that can elevate them

tell the clinician more about why a certain clinical scale is elevated; they should not be interpreted in isolation

general rule of thumb: if “parent” clinical scale is > 65, look to HL scales to see why it is elevated

NonContent-Based Scales within the MMPI-2

Cannot Say (CNS)

Variable Response Inconsistency (VRIN)

True Response Inconsistency (TRIN)

Positive Impression Management

Correction (K) and Lie (L) Scales

When an individual wants to appear more socially desirable, virtuous, moral, and socially responsible

Negative Impression Management

Infrequency (F), Infrequency - Backside (Fb) & Infrequency - Psychopathology (Fp) scales

When an individual wants to appear more psychologically distressed than they actually are

Why would an F scale be elevated on a particular profile?

If F scale is elevated → likely that an individual is exaggerating their psychological symptoms; indicates they were answering the scale in a way that does not appear to make any sense

if F is elevated → next step is to check VRIN (random responding), TRIN (fixed responding; yay or nay saying), & Fp (intentional overreporting)

F is invalid if T ≥ 120

1st step in MMPI-2 Interpretation

Check:

Lie (L)

Infrequency (F)

Defensiveness/Correction (K)

No interpretation should happen until we know how the individual approached the testing

Classical Test Theory

an individual’s “true score” is theoretical → we cannot truly know it

true score = average score after an infinite # of independent administrations

use observed score

Item Response Theory

how individual items within the test perform

avoids assumption that all items on a test will perform the same

probability that a person will endorse an item depends on:

1. their standing on characteristic measure

2. difficulty/severity of the item

Implicit vs. Explicit Referral Questions

implicit = involve unacknowledged motives for obtaining an evaluation

explicit = articulate specific motives + goals of the referral source

Test Accuracy Statistics

sensitivity

specificity

What is the average T-score for all scales within the MMPI-2?

T = 50

What is T-score indicates an elevation for all clinical scales within the MMPI?

T ≥ 65

Interpretive Strategy for MMPI-2 Validity Scales

Step 1: Check F, L, & K

Step 2: If F is elevated → is it due to random responding? → check VRIN

Step 3: If not VRIN → is it due to fixed responding? → check TRIN

Step 4: If not TRIN → is it due to intentional exaggeration/fabrication? → check Fp

Step 5: If none of the above → elevation is most likely due to serious symptomatology/distress