PSYC 2300 Ch 4+5

Assessment

process of gathering info about a person’s symptoms and their causes

Diagnosis

a label for a set of symptoms that can often occur together

Reliability

the consistency of an assessment measure

• a good tool will yield the same results each time

  • which 2 are reliable…?

Types of Reliability

Test-Retest, Alt Form, Internal, Interrater/Interjudge(reliability)

Test-Retest

test produces similar results when given the two points in time

• greater the correlation → the greater the test reliability

• participants are tested on two occasions and the two scores are correlated

Alternate Form reliability

1. - two versions of the same test produce similar results

2. - different items

Internal Reliability

1. - how well items are concrete

2. - symbol ≥ .7

3. - diff parts of same test produce similar results

4. True–false and multiple-choice tests yield consistent scores no matter who evaluates them, but other tests require that the evaluator make a judgment.

5. If the rules for interpretation are not spelled out and applied consistently, different judges may give different ratings to the same drawing.

Interrater/Interjudge

1. - two or more raters/judges who admin. and score a test come to similar conclusions

2. - interview and clinicians

Validity

accuracy of a tool’s result

• an assessment tool must accurately measure what it is supposed to measure

• If the rules for interpretation are not spelled out and applied consistently, different judges may give different ratings to the same drawing.

Four Specific types of Validity

Face, Predictive, concurrent, Construct

Face Validity

test appears to measure what it is supposed to measure

• an assessment tool should not be used unless it has high predictive validity or concurrent validity.

• ex. The test gathers information about the children’s parents—their personal characteristics, smoking habits, and attitudes toward smoking—and on that basis identifies high-risk children. To establish the test’s predictive validity, investigators could administer it to a group of elementary school students, wait until they were in high school, and then check to see which children actually did become smokers.

Predictive Validity

test predicts behavior it is supposed to measure

concurrent validity

test yields the same results as other measures of the same behavior, thoughts, or feelings

1. new test, older test

2. GPA

3. parents

• ex. Participants’ scores on a new test designed to measure anxiety, for example, should correlate highly with their scores on other anxiety tests (Comer et al., 2022) or with their behavior during clinical interviews.

construct validity

test measures what it is supposed to measure, not something else

The ones with the best precision and accuracy is

• high acc, high pre

• high acc, low pre

To standardize a technique

To standardize a technique is to set up common steps to be followed whenever it is administrated

• one must standardize scoring, and interpretation

• prevents influence of subjective interpretation (bias), inconsistencies, and ind. variability

Clinical interviews

• intakes are often are the first contact btwn client and clinician

  • used to collect detailed info, esp personal history, about a client

• may include a mental status exam

  • appearance and behavior

  • thought process

  • mood and effect

  • intellectual functioning

  • orientation

• Structured and unstructured

• They may also ask about the person’s expectations of therapy and motives for seeking it.

• Naturalistic and Analog Observations

Unstructured Interview

• ask questions based on own judgement

• focus on whatever topics they considered most important

• The lack of structure allows the interviewer to follow leads and explore relevant topics that could not have been anticipated before the interview

• psychodynamic and humanistic clinicians

structured interview

clinicians ask prepared questions

• A structured format ensures that clinicians will cover the same kinds of important issues in all of their interviews and enables them to compare the responses of different individuals.

• cognitive-behavioral clinicians

Symptoms of a panic attack

1. heavy breathing

2. less eye contact

3. rapid breathing and heart rate

clinical tests

used to gather info about psychological functioning from which broader info is inferred

Cons: . Such tests might sound convincing, but most of them lack reliability, validity, and standardization. That is, they do not yield consistent, accurate information or reveal where we stand in comparison with others.

Most often used clinical tests

• projective tests

• personality inventories

• psychophysiological tests

• neuroimaging and neuropsychological tests

• intelligence tests

Projective Tests

• presents ambiguous stimuli

• triggers the projection of one’s inner dynamics

• reveals unconscious motives\

Ex. The Rorschach test, the Thematic Apperception Test, sentence-completion tests, and drawings.

Rorschach inkblot test

• most widely used projective test

• use is controversial

Thematic Apperception Test (TAT)

• inner feelings and interests appear in stories made up about ambiguous forces

• measures affiliation and achievement motivation

Draw-A-Person (DAP) Test

• kinetic drawing

• draw a tree, house, person

• projective drawing

Projective tests pros and cons

• strengths

  • until 1950s, most commonly used tests for personality assessment

  • now used to gain supplementary info

• limitations

  • reliability and validity not consistently shown

Personality inventories

• questionaries meant to assess people’s typical ways of thinking, feeling, and behavior

• broad, general constructs - typically dimensional

• big five (Openness, Conscientiousness, Extraversion, Agreeableness and Neuroticism)

• Minnesota Multiphasic Pers Inv. (MMPI)

  • athoretical emperical derivation

  • 567 items

• The MMPI-3 consists of 335 self-statements, to be labeled “true,” “false,” or “cannot say” by the test-taker

the statements make up over 50 scales, on each of which an individual can score from 0 to 120. When people score above 70 on a scale, their functioning on that scale is considered deviant.

• Profile types: Self-doubt, worry, anger proneness, Aggression, Activation, Psychoticism

4-6-8 Profile

Scale 4: Psychopathic

• lying

• manipulation

• lack of empathy

Scale 6: Paranoia

• suspiciousness

• externalization of blame

• hypervigilance

Scale 8: Schizophrenia

• alienation

• social detachment

• unusual thinking

Myer Briggs

• Type of personality inventory

• intro/extroverted, judging/feeling, etc.

• NOT used in clinical psychology settings

Symptoms Questionnaires

• usually based on self-reported responses

  • however, often will get parent, teacher, or other etc.

Intelligence tests

• very high validity and reliability

• intended to measure maximum level of dx

Classification Systems

set of syndromes and the rules for determining whether an ind. dx are part of dx

• DSM-5, ICD-11

  • Differences between the two:

    • they don’t agree with each other

    • DSM doesn’t have psychosis, ICD does

Fun Fact

there’s more than 500 disorders in the DSM! 128 → 542

categorical, dimensional

DSM-5 requires clinicians to revise ___ and ____ as part of a proper diagnosis

Categorical info

refers to the name of category (disorder) indicated by the client’s symptoms

(NEW****)Dimensional info

how severe a client’s symptoms are and how dysfunctional the client is

Can diagnosis and labeling cause harm?

• Misdiagnosis is always a concern

  • major issue is reliance on clinical judgement

• also present is the issue of labeling stigma

  • diagnosis may be a self-fufilling prophecy

Central nervous system’s physiological and emotional response

• a serious, specific threat to one’s well-being of FEAR

• a vague sense of threat of danger is ANXIETY

Most common mental disorders in US

• in any given year, 19% of americans experiences an anxiety dx (… past year PY prevalence)

• about 31% lifetime prevalence (LT prevalence)

• about 37% seek treatment

Generalized Anxiety Disorder

• person is continuously tense and uneasy

• dizziness, sweating, heart palpitations

• no obvious medication reason (rule out)

DSM-V Criteria for GAD

1. excessive anxiety and worry, occurring more days than not for at least 6 months

2. the person finds it difficult to control worry

3. the anxiety and worry are associated with 3+ of six symptoms (symptoms present for more days than not for past 6 months)

   • restlessness or feeling keyed up on edge

   • difficulty concentrating or mind blank

   • irritability

   • muscle tension

   • sleep disturbance

   • easily fatigued

4. cause significant distress or impairment in social, occupational or other important areas of functioning

5. disturbance not attributable to physiological effects of substance

6. disturbance not better explained by another mental disorder

Recent Study: the prevalence of undiagnosed anxiety

• GAD-7

• 30% says that more than half of their days bothered by feeling something awful might happen

  • THIS WILL BE ON THE QUIZZZZZZ

• median GAD-7 score was 16 → 50% ≤ 16 and 50% ≥ 16

• active treatment is warranted for scores greater than 16

• MORE THAN HALF OF THIS SAMPLE WOULD LIKELY BENEFIT FROM SEEING A CLINICIAN WHETHER THEY HAVE GAD

• anxienty levels in the population that were above typical levels durings the pandemic

• do not seem to be declining

• QUESTION - is anxiety a REASONABLE response to the pandemic and the current divisible political climate?

Specific Phobias

• 9% PY

• 13% LT

• Women outnumber men 2:1

• at most, 32% seek treatment

Checklist for specific phobias

• marked, disproportionate, persistent fear of particular object or situation; lasting at least 6 months

• exposure to fear

Uncommon to Common fears (top to down)

• being alone

• flying

• storms

• water

• blood

• enclosed species

• animals

• heights

Two Kinds of Conditioning

Classical and Operant

Two-Factor Model (Work)

there are certain factors in the workplace that cause job satisfaction while a separate set of factors cause dissatisfaction, all of which act independently of each other

Phobia (behavior-evolutionary explanation)

a persistent and irrational fear of a specific situation, object, or activity, which is either avoided or endured

• some specific phobias are more common than others

• species-specific biological predisposition to develop certain fears: preparedness

• explain why some phobias (animals, heights, darkness are more common than meat, houses, paper)

Treatment

• systematic desensitization

  • teach relaxion skills

  • create fear hierarchy

  • pair relaxation with feared objects or situations

  • since relaxation is incompatible with fear, the relaxation response is thought to substitute for fear response

• other behavioral treatments

  • flooding

    • where a person confronts their most feared stimulus at full intensity, all at once

  • modeling

    • actual contact with feared object

  • Virtual Reality Exposure Therapy: very effective

Social Anxiety disorder

• only 40% seek treatment

• pronounced, disproportionate, and repressed anxiety

• avoidance of feared situations

• significant distress and impairment

• spotlight effect

Cause of social anxiety disorder

• cognitive-behavioral perspective

  • both cognitive and behavioral factrs

  • anticipation of social disasters and dread of social situations

Panic Disorder

• periodic, short bouts of panics that occur suddenly, reached a peak within minutes and gradually passes

• person experiences sudden episodes of intense dread and often lives in fear of when the next attack will strike

  • emotion about future emotions

• 59% seek treatment

• 3% PY

• twice as common among cisgender women and men

• at least a month of continual concern of additional attacks

• a month of dysfunctional behavior changes

hyperactive panic circuit

• amygdala

• hippocampus

• ventromedial nucleus of hypothalmus

• central gray matter

• locus coerulelus

Clinical assessment

used to determine whether, how, and why a person is behaving in a dysfunctional manner and how that person may be helped.

• enables clinicians to evaluate people’s progress after they have been in treatment for a while and decide whether the treatment should be changed.

• Three types: clinical interviews, tests, and observations

standardize

set up common steps to be followed whenever the tool is administered

Before any assessment technique can be fully useful…

it must meet the requirements of standardization, reliability, and validity.

Cognitive-behavioral interviewers

_____ try to identify information about the stimuli that trigger responses, consequences of the responses, and/or assumptions and interpretations that influence the person

Humanistic clinicians

_____ ask about the person’s self-evaluation, self-concept, and values

Biological clinicians

_____ look for signs of biochemical or brain dysfunction

sociocultural interviewers

_____ ask about the family, social, and cultural environments

mental status exam

a set of questions and observations that systematically evaluate the client’s awareness, orientation with regard to time and place, attention span, memory, judgment and insight, thought content and processes, mood, and appearance

interview schedule

a standard set of questions designed for all interviews

Limitations of clinical interviews

Although interviews often produce valuable information about people

• they sometimes lack validity, or accuracy

• Interviewers too may make mistakes in judgment that slant the information they gather

• Interviews, particularly unstructured ones, may also lack reliability

• a clinician’s race, gender, age, and appearance may influence a client’s responses. some researchers believe that interviewing should be discarded as a tool of clinical assessment

Sentence-Completion Test

the test-taker completes a series of unfinished sentences, such as “I wish …” or “My father …” - The test is considered a good springboard for discussion and a quick and easy way to pinpoint topics to explore

Drawings

On the assumption that a drawing tells us something about its creator, clinicians often ask clients to draw human figures and talk about them

• Evaluations of these drawings are based on the details and shape of the drawing, the solidity of the pencil line, the location of the drawing on the paper, the size of the figures, the features of the figures, the use of background, and the comments made by the respondent during the drawing task.

Draw-A-Person (DAP) Test

Cons of projective tests

In recent years, however, clinicians and researchers have relied on them largely to gain “supplementary” insights

• practitioners who follow the newer models have less use for the tests than psychodynamic clinicians do.

• Even more important, the tests have not consistently shown much reliability or validity.

• In reliability studies, different clinicians have tended to score the same person’s projective test quite differently. Similarly, in validity studies, when clinicians try to describe a client’s personality and feelings on the basis of responses to projective tests, their conclusions often fail to match the self-report of the client, the view of the psychotherapist, or the picture gathered from an extensive case history

• projective tests are sometimes biased against people of color and other marginalized persons

Profile

When the scale scores are considered side by side, a pattern takes shape, indicating the person’s general personality.

Self-doubt

Items suggesting that the person has feelings of uselessness and low self-confidence

Worry

Items showing an excessive preoccupation with possible negative outcomes.

Anger Proneness

Items that characterize hostility and impatience with others.

Aggression

Items that suggest a pattern of hostile actions and violent behavior.

Activation

Items that suggest elevated energy and excitement levels.

Psychoticism

Items that suggest the person is disconnected from reality.

Pros and cons of personality inventories (and MMPI-3)

Pros

• Because they are computerized or paper-and-pencil tests, they do not take much time to administer and they are objectively scored.

• Most of them are standardized, so one person’s scores can be compared with those of many others.

• Moreover, they often display greater test–retest reliability than projective tests.

• have more validity, or accuracy, than projective tests

Cons

• they can hardly be considered highly valid

• the personality traits that the tests seek to measure cannot be examined directly.

• despite the fact that the MMPI-3 designers have used more diverse standardization groups, this and other personality tests continue to have certain cultural limitations.

In the end, they can help clinicians learn about people’s personal styles and disorders as long as they are used in combination with interviews or other assessment tools

Response Inventories

ask people to provide detailed information about themselves, but these tests focus on one specific area of functioning. Clinicians can use the inventories to determine the role that such factors play in a person’s disorder.

• affective, social skill, cognitive

Pros and cons of response inventories

Both the number of response inventories and the number of clinicians who use them have increased steadily in the past 35 years

Cons

• With the notable exception of the Beck Depression Inventory and some others, few of the tests have been subjected to careful standardization, reliability, and validity procedures

• Often they are created as a need arises, without being tested for accuracy and consistency.

Affective inventories

_____ measure the severity of such emotions as anxiety, depression, and anger.

• Beck Depression Inventory

Beck Depression Inventory

people rate their level of sadness and its effect on their functioning. For social skills inventories, used particularly by behavioral and family-social clinicians, respondents indicate how they would react in a variety of social situations

social skills inventories

used particularly by behavioral and family-social clinicians, respondents indicate how they would react in a variety of social situations

Cognitive inventories

reveal a person’s typical thoughts and assumptions and can help uncover counterproductive patterns of thinking.

Psychophysiological Tests

• The measuring of physiological changes has since played a key role in the assessment of certain psychological disorders

• This practice began three decades ago, after several studies suggested that states of anxiety are regularly accompanied by physiological changes, particularly increases in heart rate, body temperature, blood pressure, skin reactions (galvanic skin response), and muscle contractions

• polygraph

polygraph/lie detector

Electrodes attached to various parts of a person’s body detect changes in breathing, perspiration, and heart rate while the person answers questions.

• control and test questions

control questions

questions whose answers are known to be yes

Cons of Psychophysical Tests

• Many require expensive equipment that must be carefully tuned and maintained

• psychophysiological measurements can be inaccurate and unreliable

• The laboratory equipment itself—elaborate and sometimes frightening—may arouse a participant’s nervous system and thus change their physical responses.

• Physiological responses may also change when they are measured repeatedly in a single session

Neuroimaging and Neuropsychological Tests

If a psychological dysfunction is to be treated effectively, it is important to know whether the primary cause of the dysfunction is a physical irregularity in the brain.

• brain surgery, biopsy, and X-ray

• neuroimaging, or brain-scanning, techniques

electroencephalogram (EEG)

records brain waves, the electrical activity that takes place within the brain as a result of neurons firing

• placed on the scalp send brain-wave impulses

• Pro: helpful in identifying the presence of electrical activity across different regions of the brain

• Con: it does not offer enough resolution to pinpoint precisely where in the brain this activity is occurring

computerized axial tomography (CT or CAT scan)

in which X-rays of the brain’s structure are taken at different angles and combined

positron emission tomography (PET scan)

a computer-produced motion picture of chemical activity throughout the brain

magnetic resonance imaging (MRI)

a procedure that uses the magnetic property of certain hydrogen atoms in the brain to create a detailed picture of the brain’s structure.

functional magnetic resonance imaging (fMRI)

converts MRI pictures of brain structures into detailed pictures of neuron activity, thus offering a picture of the functioning brain

• generated enormous enthusiasm among brain researchers due to better quality photos

neuropsychological tests

measure cognitive, perceptual, and motor performances on certain tasks; clinicians interpret significantly atypical performances as an indicator of underlying brain irregularities

Bender Visual-Motor Gestalt Test

consists of nine cards, each displaying a simple geometrical design. Patients look at the designs one at a time and copy each one onto a piece of paper. Later they try to redraw the designs from memory.

• Notable errors in accuracy by individuals older than 12 are thought to reflect organic brain impairment

battery/series

of neuropsychological tests, each targeting a specific skill area

intelligence

“the capacity to judge well, to reason well, and to comprehend well”

• Because intelligence is an inferred quality rather than a specific physical process, it can be measured only indirectly

Intelligence test

consisting of a series of tasks requiring people to use various verbal and nonverbal skills

• The general score derived from this and later intelligence tests is termed an intelligence quotient (IQ).

• Created by Alfred Binet and his associate Théodore Simon

Pros of Intelligent Tests

• intelligence tests play a key role in the diagnosis of intellectual developmental disorder, and they can also help clinicians identify other difficulties

• the most carefully produced of all clinical tests

• Because the tests have been standardized on large groups of people, clinicians have a good idea how each individual’s score compares with the performance of the population at large.

• These tests have also shown very high reliability

• the major IQ tests appear to have fairly high validity

Cons of Intelligent Tests

• Factors that have nothing to do with intelligence, such as low motivation or high anxiety, can greatly influence test performance

• IQ tests may contain cultural biases in their language or tasks that place people of one background at an advantage over those of another background

• test examiners may hold biases about various groups that can have a negative impact on test administration or scoring. Any or all of these variables can lead to IQ scores that are inaccurately low for members of certain racial, ethnic, and other marginalized groups.

Naturalistic clinical observations

• Usually take place in homes, schools, institutions such as hospitals and prisons, or community settings

• In the treatment of children and families, most naturalistic clinical observations focus on parent–child, parent–parent, sibling–sibling, peer–peer, or teacher–child interactions and on fearful, aggressive, or disruptive behavior

participant observers

key people in the client’s environment—and reported to the clinician.