Chapter%20Three

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Chapter Three

• Clinical Research, Assessment, and Diagnosis in
  Abnormal Psychology

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Clinical Research, Assessment, and Diagnosis in
Abnormal Psychology

• Psychopathology
• Study of mental or behavioral disorders
• Etiology
• Cause or origin of a disorder

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The Scientific Method in Clinical Research

• Replication
• Results repeated in multiple studies to reduce
  the chance of findings due to experimenter bias,
  methodological flaws, or sampling errors
• Scientific method
• Provides systematic collection of data,
  controlled observation, and the testing of
  hypotheses
• Hypothesis
• Conjectural statement that usually describes a
  relationship between two variables

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The Case Study

• Case study
• Intensive study of one individual that relies on
  clinical data, such as observations,
  psychological tests, and historical and
  biographical information
• Provides detailed information about development
  and psychopathology in a specific individual
• Helps to develop a strong therapeutic
  relationship

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The Case Study (contd.)

• Limitations
• Findings cannot be generalized to others
• Data reflects theoretical perspective or bias of
  investigator
• Cannot be used to demonstrate cause and effect
  relationships

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Correlational Studies

• Statistical analysis preformed to determine the
  relationship between variables
• Positive correlation
• Increase in one variable accompanied by increase
  in the other
• Negative correlation
• Increase in one variable accompanied by decrease
  in the other

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Correlational Studies (contd.)

• Figure 3-1 Possible Correlation Between Two
  Variables The more closely the data points
  approximate a straight line, the greater the
  magnitude of the correlation coefficient r. The
  slope of the regression line rising from left to
  right in example (a) indicates a perfect positive
  correlation between two variables, whereas
  example (b) reveals a perfect negative
  correlation. Example (c) shows a lower positive
  correlation. Example (d shows no correlation
  whatsoever.

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Correlational Studies (contd.)

• Allow for the study of variable that cannot be
  controlled
• Correlations indicate the degree to which two
  variables are related, not the reason for the
  relationship
• Cannot determine cause and effect
• Factors may be influenced by an additional
  variable

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Experiments

• Experiment
• Perhaps best tool for testing cause and effect
  relationships because variables can be
  manipulated
• In its simplest form, an experiment involves
• Experimental hypothesis
• Independent variable
• Dependent variable

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Experiments (contd.)

• Experimental hypothesis
• Prediction concerning how an independent variable
  will affect dependent variable
• Independent variable
• (Possible cause) experimenter manipulates to
  determine effect on dependent variable
• Dependent variable
• Expected to change when an independent variable
  is manipulated

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Experiments (contd.)

• Experimental group
• Subjected to independent variable
• Subjective taking place in persons own mind
• Control group
• Similar in every way to experimental group except
  for exposure to independent variable
• Placebo control group
• Induces expectancy without actual treatment (no
  manipulation at all)

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Experiments (contd.)

• Additional controls in clinical research
• Blind design
• Those helping with the study are not aware of
  research
• Reduces impact of experimenter expectations
• Double-blind design
• Neither participants nor experimenters are aware
  of experimental conditions
• Reduces impact of experimenter and participant
  expectations
• Researchers attempt to increase degree of
  blindness and decrease expectancy effects

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Experiments (contd.)

• Shortcomings
• Effectiveness of blind designs depends on
  participants being truly blind
• Some variables cannot be manipulated
• Questions regarding generalizability of results

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Analogue Studies

• Replicate or simulate real-life situations under
  controlled conditions
• Used when not possible to control all variables
  in real-life situations
• Advantage allows study of phenomenon using
  experimental designs that are not possible with
  correlation studies

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Field Studies

• Behaviors and events are observed and recorded in
  their natural environment
• Sometimes used to examine catastrophic events or
  personal crises
• Offer a more realistic investigative environment

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Field Studies (contd.)

• Limitations
• Cannot be used to determine cause and effect
  relationships
• Many factors affecting real-life situations makes
  it impossible to control and distinguish all
  possible variables (difficult to interpret)
• Observer can never be sure their presence did not
  influence interactions they observed

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Biological Research Strategies

• Genetics and epigenetics
• Focus on influence of specific genes in
  development of psychopathology
• Epigenetics
• Shedding light on how the environment influences
  or programs gene expression
• Genetic linkage studies
• Attempts to determine whether a disorder follows
  a genetic pattern

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Biological Research Strategies (contd.)

• Endophenotypes
• Measurable characteristics (neurochemical,
  cognitive, etc.) that can give clues regarding
  specific genes involved in a disorder
• Characteristics must be heritable
• Seen in family members who do not have the
  disorder
• Occur more frequently in affected families than
  in the general population

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Biological Research Strategies (contd.)

• Epidemiological survey research
• Study of the rate and distribution of mental
  disorders in the population
• Prevalence
• Percentage of individuals in targeted population
  with a particular disorder during a specific
  period of time
• Incidence
• Number of new cases of a disorder that appear in
  an identified population within a specific period
  of time
• Important in analyzing possible causal factors

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Assessment of Abnormal Behavior

• Therapists collect and organize information about
  a persons current condition and past history to
  better understand symptoms and mental state
• Psychodiagnosis
• Description of an individual's psychological
  state and inferences about possible causes of
  distress

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Reliability and Validity

• Reliability
• Degree to which a procedure yields the same
  results repeatedly under the same circumstances
• Test-retest reliability
• Same results when given at two different points
  in time
• Internal consistency
• Various parts of measure yield similar or
  consistent results
• Inter-rater reliability
• Consistency of responses when different raters
  administer measure

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Reliability and Validity (contd.)

• Validity
• Degree to which an instrument measures what it
  was developed to measure
• Predictive validity
• Is measure able to predict how a person will
  behave, respond, or perform
• Construct validity
• Is measure related to phenomena related to
  measure

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Reliability and Validity (contd.)

• Standardization
• Crucial to reliability and validity of tests
• Administration of all testing requires that
  common rules and procedures are followed
• Requires a comparison group to which an
  individuals test performance can be compared

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Assessing Abnormal Behavior

• Assessment
• Process of gathering information and drawing
  conclusions about an individuals traits, skills,
  abilities, emotional functioning, and
  psychological problems of an individual
• Principal means of assessment
• Observations
• Interviews
• Psychological tests and inventories
• Neurological tests

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Assessing Abnormal Behavior (contd.)

• Observations
• Controlled (analogue) observations
• Made in laboratory, clinic, or other contrived
  setting
• Naturalistic observations
• Made in natural setting (schoolroom, office,
  hospital ward, home)
• Can be highly structured and specific or less
  formal
• Observe appearance and behavior

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Assessing Abnormal Behavior (contd.)

• Interviews
• Observe client and collect data about the
  persons life history, current situation, and
  personality
• Analyze
• Verbal behavior
• Nonverbal behavior
• Content
• Process of communication

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Assessing Abnormal Behavior (contd.)

• Interviews
• Vary in degree of structure and formality with
  which they are conducted
• Mental status examination
• Evaluate individuals cognitive, psychological,
  and behavioral functioning
• Useful diagnostic tool
• Fallible and subjective

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Assessing Abnormal Behavior (contd.)

• Psychological tests and inventories
• Standardized instruments used to assess
• Personality
• Maladaptive behavior
• Social skills
• Intellectual abilities
• Vocational interests
• Cognitive impairment

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Assessing Abnormal Behavior (contd.)

• Projective personality tests
• Test taker is presented with ambiguous stimuli
  and is asked to respond to them in some way
• Rorschach Technique
• Thematic Apperception Test (TAT)
• Sentence-completion test
• Draw-a-person test
• Limited support for interpretations of TAT,
  Rorschach, and draw-a-person test
• Questionable cultural relevance

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Assessing Abnormal Behavior (contd.)

• Self-report inventories
• Test taker answers specific written questions or
  selects specific responses from a list of
  alternatives
• Minnesota Multiphasic Personality Inventory (MMPI
  and MMPI-2)
• Most widely used
• Beck Depression Inventory (BDI)

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Assessing Abnormal Behavior (contd.)

• Figure 3-2 The 10 MMPI-2 Clinical Scales and Some
  MMPI-2 Items Shown here are the MMPI-2 clinical
  scales and a few of the items that appear on
  them. As an example, answering no or false
  (rather than yes or true) to the item I have
  a good appetite would result in a higher scale
  score for hypochondriasis, depression, and
  hysteria.
• Source Adapted from Dahlstrom Welsch, (1965).
  These items from the original MMPI remain
  unchanged in the MMPI-2.

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Assessing Abnormal Behavior (contd.)

• Limitations of self-report inventories
• Fixed number of choices hinder accurate
  presentation
• Unique response sets may distort results
• Interpretations of responses may be inaccurate if
  culture context is not addressed
• Cultural factors may shape way a trait or
  characteristic is viewed

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Assessing Abnormal Behavior (contd.)

• Intelligence tests
• Obtain intelligence quotient (IQ), or estimate of
  current level of cognitive functioning
• Wechsler scales
• Stanford-Binet scales

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Assessing Abnormal Behavior (contd.)

• Table 3-2 Items Similar to Those for the Wechsler
  Adult Intelligence Scale-IV

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Assessing Abnormal Behavior (contd.)

• Criticisms of intelligence tests
• Popularized as measuring innate intelligence, but
  actually reflect cultural and social factors
• Predictive validity
• Inadequacies of current conceptions of IQ tests
• Misses multidimensional attributes of intelligence

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Assessing Abnormal Behavior (contd.)

• ABC Video Measure of IQ Can IQ tests accurately
  measure how smart you are or determine your
  future success? The theory of multiple
  intelligence may explain why traditional IQ tests
  may not always be an accurate measure of
  intelligence.

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Assessing Abnormal Behavior (contd.)

• Tests for cognitive impairment
• Detect and assess cognitive impairment
• Bender-Gestalt Test
• Halstead-Reitan Neuropsychological Test Battery
• Are widely used and have been found to be
  effective and valid in evaluating cognitive
  impairment due to brain damage

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Assessing Abnormal Behavior (contd.)

• Figure 3-4 The Nine Bender Designs The figures
  presented to participants are shown on the left.
  The distorted figures drawn by an individual with
  suspected brain damage are shown on the right.
• Source L. Bender, (1938)

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Assessing Abnormal Behavior (contd.)

• Neurological tests
• Electroencephalograph (EEG)
• Computerized axial tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan
• Increase diagnostic accuracy and understanding
  when coupled with psychological tests

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Assessing Abnormal Behavior (contd.)

• ABC Video MRI as a Lie Detector Learn about the
  experimental use of Functional Magnetic Resonance
  Imaging to map activity in the region of the
  brain used for deception.

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Diagnosis and Classification of Abnormal Behavior

• Classification system
• Provides distinct categories, indicators, and
  diagnostic names for particular patterns of
  behavior, thought processes, and emotional
  disturbances
• Means of diagnosing disorders
• Facilitates communication between mental health
  professionals
• Forms foundation for research

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Diagnostic and Statistical Manual of Mental
Disorders (DSM)

• Widely used classification system
• Lists all officially designated mental disorders
  and the characteristics or symptoms needed to
  confirm diagnosis
• Traditionally a categorical system but most
  recently proposed as a dimensional model

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Diagnostic and Statistical Manual of Mental
Disorders (contd.)

• DSM-5
• Dimensional system
• Disorders lie on a continuum with normality at
  one end
• Includes culturally focused interview
• Comorbidity
• The co-occurrence of different disorders

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Evaluation of the DSM Classification System

• Positive aspects of DSM-5
• Moves away from a categorical system and towards
  a dimensional system
• Developed to increase reliability and validity
• Criticisms of DSM-5
• Lowers diagnostic thresholds
• Inclusion of questionable new disorders
• Cultural concerns
• Focus on resilience
• Should strengths be assessed?