Clinical

Assessment,
Diagnosis, and
Research
Methods
  Purposes of Clinical Assessment
Assessing  To understand the individual
Psychological  To predict behavior
Disorders
 To plan treatment
 To evaluate treatment
outcome
  Analogous to a Funnel
Assessing
Psychological  Starts broad
Disorders
 Multidimensional in approach
(continued)
 Narrow to specific problem
areas
  Reliability
 Consistency is measurement
 Examples include test-retest
and inter-rater reliability
II.
Key Concepts  Validity
in  What an assessment approach
Assessment measures and how well it does
so
 Examples include concurrent,
discriminant, and predictive
validity
  Standardization and Norms
 Ensures consistency in the use
of a technique
Key Concepts  Provides population
in
benchmarks for comparison
Assessment
(continued)  Examples include structured
administration, scoring, and
evaluation procedures
 III.
Domains of
Assessment:  Clinical Interview
The Clinical  Most common clinical
Interview and assessment method
Physical
Exam  Structured or semi-structured
  Mental Status Exam
Domains of
Assessment:  Appearance and behavior
The Clinical  Thought processes
Interview and
Physical  Mood and affect
Exam  Intellectual functioning
(continued)
 Sensorium
 Physical Exam
  Behavioral Assessment
 Focus on the present – Here
and now
Domains of
Assessment:  Direct observation of behavior-
Behavioral environment relations
Assessment  Purpose is to identify
and
problematic behaviors and
Observation
situations
 Identify antecedents,
behaviors, and consequences
  Behavioral Observation and
Domains of
Assessment: Behavioral Assessment
Behavioral  Can be either formal or
Assessment informal
and  Self-monitoring vs. being
Observation
(continued) observed by others
 Problem of reactivity using
direct observation
  Psychological Testing
Domains of  Must be reliable and valid
Assessment:  Projective Tests – Roots in
Psychological Psychoanalytic Tradition
Testing and
Projective  Project aspects of personality
Tests onto ambiguous test stimuli
 Require high degree of
inference in scoring and
interpretation
 Domains of
Assessment:  Examples
Psychological
Testing and  The Rorschach Inkblot Test,
Projective Thematic Apperception Test
Tests  Reliability and validity data
(continued) tend to be mixed
  Objective Tests – Roots in Empirical
Tradition
Domains of  Test stimuli are less ambiguous
Assessment:  Require minimal clinical inference in
Psychological scoring and interpretation
Testing and  Objective Personality Tests
Objective
Tests  Minnesota Multiphasic Personality
Inventory (MMPI, MMPI-2, MMPI-
A)
 Extensive reliability, validity, and
normative database
 Objective Intelligence Tests
Domains of
 Nature of intellectual
Assessment:
Psychological functioning and IQ
Testing and  The deviation IQ
Objective
 Verbal and performance
Tests
(continued) domains
 https://stanfordbinettest.com/
quiz/quick-quiz/question/1
  Purpose and Goals
 Assess broad range of skills and
Domains of abilities
Assessment:
Neuropsycholo  Goal is to understand brain-
gical Testing behavior relations
 Examples
 The Luria-Nebraska and
Halstead-Reitan Batteries
 Domains of
Assessment:  Problems with Neuropsychological
Neuropsycholo Tests
gical Testing  False Positives
(continued)
 False Negatives
  Neuroimaging: Pictures of the
Brain
Domains of
Assessment:  Allows for a window on brain
Neuroimagin structure and function
g and Brain  Imaging Brain Structure
Structure
 Computerized axial
tomography (CAT or CT scan)
 Utilizes X-rays
 Domains of  Magnetic resonance imaging
Assessment: (MRI)
Neuroimagin
g and Brain  Utilizes strong magnetic
Structure fields
(continued)  Better resolution than CT
scan
  Imaging Brain Function
 Positron emission tomography
(PET)
Domains of  Single photon emission
Assessment: computed tomography (SPECT)
Neuroimagin  Both involve injection of
g and Brain radioactive isotopes
Function  Isotopes react with oxygen,
blood, and glucose in the brain
 Functional MRI (fMRI) – Brief
changes in brain activity
  Psychophysiological Assessment
 Assess brain structure, function,
and activity of the nervous
system
Domains of  Psychophysiological Assessment
Assessment: Domains
Psychophysiologic  Electroencephalogram (EEG) –
al Assessment Brain wave activity
 Heart rate and respiration –
Cardiorespiratory activity
 Electrodermal response and
levels – Sweat gland activity
  Uses of Routine
Psychophysiological Assessment.
Domains of
Assessment:
 Disorders involving a strong
Psychophysiologica emotional component
l Assessment  Examples
(continued)
 PTSD, sexual dysfunctions, sleep
disorders
 Headache and hypertension
 IV.
Diagnosing  Diagnostic Classification
Psychological  Classification is central to all
Disorders: sciences
Foundations
in  Assignment to categories
Classification based on shared attributes or
relations
  Terminology of Classification
Diagnosing Systems
Psychological  Taxonomy – Classification in a
Disorders:
Foundations scientific context
in  Nosology – Taxonomy in
Classification psychological/medical
(continued) phenomena
 Nomenclature – Nosological
Labels (e.g., panic disorder)
  Categorical vs. Dimensional
V.
Issues with Approaches
Classifying  Classical (or pure) categorical
and approach – Strict categories
Diagnosing  Dimensional approach –
Psychological
Disorders Classification along dimensions
 Prototypical approach – Combines
classical and dimensional views
  Two Widely Used Classification
Systems
 ICD-10
Issues with  International Classification of
Classifying Diseases and Health Related
and Problems (ICD-10)
Diagnosing  Published by the World Health
Psychological Organization
Disorders  DSM-IV & DSM-IV-TR
(continued)
 Diagnostic and Statistical
Manual of Mental Disorders
(DSM-IV and DSM-IV-TR)
  Basic Characteristics
 Five axes – Full clinical
VI. presentation
The DSM-IV-
 Clear inclusion and exclusion
TR
criteria for disorders
 Disorders are categorized under
broad headings
 Empirically-grounded, prototypic
approach to classification
  The Five DSM-IV Axes
 Axis I
 Axis II
 Axis III
The DSM-IV-
TR  Axis IV
(continued)  Axis V
 Other Unique Features of the
DSM-IV
  The Problem of Comorbidity
 Defined as two or more
disorders for the same person
Unresolved  High comorbidity is the rule
Issues in the
clinically
DSM-IV-TR
 Threatens the validity of
separate diagnoses
 Labeling Issues and Stigmatization
  Clinical Assessment and Diagnosis
VII.
Summary of  Aims to fully understand the
Clinical client
Assessment  Aids in understanding and
and
Diagnosis ameliorating human suffering
 Based on reliable, valid, and
standardized information
Summary of  Dangers of Diagnosis
Clinical  Reification & stigmatization
Assessment
and  Clinical Assessment and Diagnosis
Diagnosis  The core of abnormal
(continued) psychology
 A multidimensional perspective
  Questions Driving a Science of
Psychopathology
 What problems cause distress
VIII.
Conducting or impair functioning?
Research in  Why do people behave in
Psychopathology
unusual ways?
 How can we help people
behave in more adaptive ways?
  Starts with a Hypothesis or
IX. “Educated Guess”
Basic
Components  Not all hypotheses are testable
of Research  Hypotheses in science are
formulated so that they are
testable
  Research Design
 A method to test hypotheses

Basic  Independent variable

Components  The variable that causes or
of Research influences behavior
(continued)
 Dependent variable
 The behavior influenced by
the independent variable
  Internal Validity vs. External Validity
 What is internal validity?
 What is external validity?
Consideration  Ways to Increase Internal Validity by
s in Research Minimizing Confounds
Design  Use of control groups
 Use of random assignment
procedures
 Use of analog models
 Relation Between Internal and
External Validity
  Statistical Methods – Branch of
Mathematics
 Helps to protect against biases
in evaluating data
Statistical vs.  Statistical vs. Clinical Significance
Clinical  Statistical significance – Are
Significance results due to chance?
 Clinical significance – Are results
clinically meaningful?
 Statistical significance does not
imply clinical meaningfulness
  Balancing Statistical vs. Clinical
Statistical vs. Significance
Clinical  Evaluate effect size
Significance
(continued)  Evaluate social validity
 Generalizability and the Patient
Uniformity Myth
  Case Study Method
 Extensive observation and
detailed description of a client
 Foundation of early historic
X. developments in
psychopathology
Studying
Individual  Limitations
Cases  Lacks scientific rigor and suitable
controls
 Internal validity is typically weak
 Often entails numerous
confounds
  The Nature of Correlation
 Statistical relation between two
or more variables
Research by  No independent variable is
Correlation
manipulated
 Range from –1.0 to 0 to +1.0
 Negative vs. positive correlation
  Limitations
 Does not imply causation
 Problem of directionality

Research by  Epidemiological Research -- An

Correlation Example of the Correlational
(continued) Method
 Incidence, prevalence, and
course of disorders
 Examples - AIDS, trauma
following disaster
 These three graphs represent
hypothetical correlations
between age and sleep problems
  Nature of Experimental Research
 Manipulation of independent
variables
Research by  Attempt to establish causal
Experiment relations
 Group Experimental Designs
 Control groups
 Placebo vs. double-blind
controls
  Comparative Treatment Designs
Research by  Type of group design
Experiment  Compare different forms of
(continued)
treatment in similar persons
 Addresses treatment process
and outcome
  Nature of Single Subject Design
 Rigorous study of single cases
 Varied experimental conditions
and time
 Repeated measurement
Single-Case
Experimental  Evaluation of variability, level,
Designs and trend
 Premium on internal validity
 Types of Single-Subject Design
 Withdrawal designs
 Multiple baseline designs
 Genetic  Behavioral Genetics
Research  Interaction between genes,
Strategies experience, and behavior
 Phenotype vs. genotype
  Strategies Used in Genetic Research
 Family studies –
Behaviors/emotional traits in
family members
Genetic  Adoptee studies – Separate
Research
environmental from genetic
Strategies factors
(continued)
 Twin studies – Psychopathology
in fraternal vs. identical twins
 Genetic linkage and association
studies – Sites of defective genes
  Rationale and Overview
Studying
Behavior  How does the problem or
Over Time behavior change over time?
 Important in prevention and
treatment research
  Time-Based Research Strategies
 Cross-sectional designs and the
cohort effect
Studying  Longitudinal designs the cross-
Behavior
generational effect
Over Time
(continued)  Sequential designs – Combine
both strategies
 Assets and Liabilities of Time-
Based Research Strategies
Two research designs
  Value of Cross-Cultural Research
 Overcoming ethnocentric
research
 Assets and Liabilities of Cross
Studying Cultural Research
Behavior  Assets
Across  To clarify how
Cultures psychopathology manifests in
different ethnic groups
 Problems with cross-cultural
research
 Limited by available measures
  Components of a Research
Program
The Nature of  Set of inter-related research
Programmatic questions
Research and
Research  Draw on several
Ethics methodologies in finding
answers
 Conducted in stages, often
involving replication
  Research Ethics: Institutional Review
Boards & the APA Ethics Code
 Role of Institutional Review Boards
XI.  Informed consent – Historical
The Nature of evolution post WWII
Programmati  Competence – Ability to provide
c Research consent
and Research  Voluntarism – Lack of coercion
Ethics  Full information – Necessary
(continued) information to make an informed
decision
 Comprehension – Understanding
about benefits and risks of
participation
  Nature of Research
 Establishing and testing
Summary of hypotheses
Research
Methods  Value of Research Designs
 Varies depending on the
questions posed
  Abnormal Psychology Is Founded
in the Scientific Method
 Understand the nature of
abnormality and human
suffering
Summary  Understand the causes of
(continued) psychological disorders
 Understand the course of
psychological disorders
 Understand how to prevent
and treat psychological
disorders
  Replication Is the Corner Stone of
Summary Science and Programmatic
(continued) Research
 Research Must Occur in the
Context of Ethical Considerations
and Values