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Psych 130 Week 2

by: Jennifer Fu

Psych 130 Week 2 Psych 130

Jennifer Fu

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Lecture Notes + Textbook Reading (Chapter 1&3) + Section Reading (Chapter 16)
Clinical Psychology
Sonia Bishop
Class Notes
clinical, assesment
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This 13 page Class Notes was uploaded by Jennifer Fu on Tuesday August 30, 2016. The Class Notes belongs to Psych 130 at University of California Berkeley taught by Sonia Bishop in Fall 2016. Since its upload, it has received 35 views. For similar materials see Clinical Psychology in Psychology at University of California Berkeley.

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Date Created: 08/30/16
LECTURES Lecture 2 Stigma Being Sane in Insane Places (study) - Permanent labeling once being diagnosed as mentally ill How Mad are you? (BBC documentary) - 10 participants (5 normal, 5 are diagnosed) Classification and diagnosis - DSM (Diagnostic and Statistical Manual or Mental Disorders) - DSM -5 is the current edition – only have 3 sections o Psychiatric and medical diagnosis o Psychosocial and contextual factors o Disability - DSM-5 diagnoses are reorganized to reflect new knowledge of comorbidity and shared etiology (DSM-IV used to cluster diagnoses on similarity of symptoms) Prevalence - Nearly 20% of the Americans are diagnosed with psychiatric disorders every year Ethnic & Cultural Considerations - Culture can influence o Risk factors o Types of symptoms experienced o Willingness to seek help o Availability of treatment Criticisms of the DSM - Too many diagnoses o Comorbidity - Reliability in everyday practice Inter-rater reliability - Doctors may come up with different diagnosis for the same patient Use of categories vs dimensions - Categorical classification (yes or no) - Dimensional classification (level of symptoms) Diagnosis and Assessment - Purpose: to describe problem, determine causes, make diagnosis, determine treatment, assess ongoing success of treatment, act as basis for research - Interview – structured or unstructured - Behavioral observation – formal/structured or unstructured - Psychological tests - Neuropsychological tests - Self-report personality Lecture 3 Eating disorder – has the highest death rate among all the mental illness 10% of the women suffer from Bulimia Clips on Anorexia for How mad are you - Use of psychological tests in assessment o How efficient is the assessment? § The participants overestimate their body size by around 10% § However, even for people without anorexia, they usually overestimate their body size - “normal” cognitive processes/ continuum - comorbidity - cultural issues - once ill always ill Validity is one of the two cornerstones of diagnosis and assessment Types of Validity - content validity – does the measure adequately cover the domain of interest - criterion validity – does the measure relate to a given criterion - construct validity – does test measure a construct or inferred attribute Reliability is the other cornerstone of diagnosis and assessment – refers to consistency of measurement Types of Reliability - interrater reliability – the degree to which 2 independent observers agree o for most DSM diagnostic categories, interrater reliability is relatively good - test-rest reliability – consistency of scores on a given measure at 2 different time points – only makes sense for trait and not state variables (e.g. intelligence vs mood) - alternate-form reliability – 2 versions of test, look to see if scores are consistent – useful if performance may change with repetition of test items - internal consistency reliability – test items related to each other Interview - structured o pros § matches DSM and directly assesses all relevant symptoms § questions are presented in a prescribed fashion § uses branching (answer to one determines the next question) § clear guidelines for scoring symptom severity (3pt scale) and translating symptom ratings into diagnosis § general good inter-rater reliability o cons § can be leading § arbitrary threshold for severity of symptoms - unstructured o pros § the person usually feels more at ease § a good clinician can find out more information that might not be reveled in response to a structured interview o cons § key questions might be missed or incorrectly assessed – can be hard to relate to DSM criteria Behavioral Observation - formal/structured – often used to determine course and evaluate ongoing success of neuropsychological treatment (rehabilitation after brain injury) o often used to determine course and evaluate ongoing success of neuropsychological treatment (rehabilitation after brain injury) - unstructured – may have poor inter-rater reliability/ content validity - pros o may be more sensitive to problems in every-day life than interviews and cognitive tests o can be used to assess severity of behavioral problems o can be used to track progress in therapy and rehabilitation (OCD or phobia) - cons o certain degree of subjectivity in interpretation Self-Report Questionnaires - screen for psychological problems using a personality profile with items chosen to distinguish between different patient groups and controls - assess specific traits or characteristics such as trait anxiety - assess current levels of symptomatology - all these measures are depending upon standardization - pros o quick and informative o person usually has most insight into their own subjective thoughts and feelings - cons o subject to biases in self-presentation and self-assessment (people are often less than honest with others and with themselves) o often retrospective – rely on memory o may not be useful for people with limited cognitive abilities o reliability and validity can vary widely Cognitive Style Questionnaires - used to assess attitudes, interpretations, schema about the world - ex. Dysfunctional attitude scale (DAS) – “people will think less of me if I make a mistake” – individuals with depression score higher - ex. World assumptions scale (WAS) – scores distinguish people with/without PTSD after trauma - it can provide insight into cognitive mechanisms disrupted in different disorders Self-observation - self-monitoring o not completed online - ecological momentary assessment o completed online - Limitations o behavior can be altered by self-monitoring § but sometimes it can be beneficial • ex. In addiction – self-monitoring reduces smoking Psychological Tests - used to assess different aspects of psychological or cognitive function o ex. The body image test shown in How mad are you? Neuropsychological Tests - two main purposes o diagnosis/ characterization of profile of deficits o rehabilitation planning and evaluation - two main approaches o fixed-battery – large predetermined set of tests that assess a variety of abilities and have been shown to be sensitive to brain damage – good for profiling strengths and weakness – lots of normative data o flexible, process-oriented approach – selects tests for in-depth evaluation of relevant cognitive abilities – allow more detailed analysis of language, attention skills – easier to incorporate new and improved measures derived from research advances - limitations - some cognitive functions can be hard to assess - findings in the clinic may not predict real-world behavior or problems Neuroimaging - look directly for altered brain structure (volume, connectivity) or function (activity, connectivity) - structure can be assessed with o CT (X-ray computed tomography) o MRI – better resolution, more expensive o Tractography – way of imaging fiber connections among regions - Function can be assessed with o PET – ligand studies of neurotransmitter function o fMRI – good for linking changes in task performance to changes in brain activity o EEG – can assess instantaneous changes in brain electrical properties in response to stimuli - Limitation o More valuable at the group level than at the individual level o People may trust it too much Appropriate assessment method must be chosen based on - Initial symptom presentation - Relevant circumstances (ER, out-patient visit, counseling session, etc) - Person’s abilities and comprehension level Typically, multiple assessment methods will be used in combination to maximize effectiveness and accuracy DISCUSSION READING Chapter 16: Psychological Treatment Psychodynamic Treatment - Emphasize the importance of early parental relations and unconscious motivations in the genesis of symptoms – help the clients develop insight - The core goal is to provide insight and self-understanding - Concentrate on problematic and symptomatic features Experiential Therapies (Humanistic therapy?) - Believe that humans are innately good - Emphasize the creative and expressive aspects of people the goal is to provide a safe relationship so that clients can explore their emotions - Empathize with the clients - Approaches o Client-centered therapy § They key is the attitude and style of the therapist rather than specific techniques § Help clients to listen to their own internal feelings and needs rather than responding to externally imposed demands § Unconditional positive regard o Gestalt therapy § Help clients to be aware of how they block themselves from experiencing their emotions and satisfying their needs focus on what a client is doing in the session, without delving into the past § Compared to client-centered, it emphasizes on techniques instead of the therapist attitude o Emotion-focused therapy § The goal is for a client to become more aware of their maladaptive emotions and learn how to regulate emotions Behavioral Therapies - Approaches o Exposure – used for anxiety disorders – unlearn the contingency of associating certain behavior with punishment/embarrassment o Operant technique – manipulating rewards and punishment – therapists move away from continuous schedules of reinforcement once desired behavior is occurring regularly o Behavioral activation therapy – help a person engage in tasks that provide an opportunity for positive reinforcement Cognitive Treatment - Emphasize on how people construct themselves and the world is a major determinant of psychological disorders - Help clients to be more aware of their maladaptive thoughts, but to avoid immediate, impulsive reactions to the emotion - Approaches o Rational-emotive behavior therapy (REBT) o Cognitive behavior therapy (CBT) o Dialectical behavior therapy o Mindfulness-based cognitive therapy – meditation o Acceptance and commitment therapy Couples Therapy - Destructive interaction patterns within relationship o Demand-withdraw cycle - Approaches o Psychoanalytical therapy – attend to possible unconscious factors in each person’s behavior toward the other o Behavioral couple therapy (BCT) – focus on maladaptive behavioral patterns that are being unwittingly reinforced in the relationship – focuses on communicating training o Integrative couple behavioral therapy (ICBT) – focuses on acceptance Family Therapy Treatment needs to be both efficacious (works under the best possible conditions) and effective (how well it works in the real world) Randomized controlled trials (RCT) – typically focus on treating people who have a certain DSM diagnosis – randomization with a comparison condition Treatment outcome studies test whether a treatment works Common problems in treatment outcome studies - Non-representative samples - Variability across therapists - Treatment manuals constrain therapist - Lack of generalization to the real world Traditional psychoanalysis has not been shown to have efficacy due to lack of control groups Cognitive behavioral treatment appears to offer more relief for anxiety disorders than experiential treatments Process research focus on how a treatment works Common factors approach - Researchers try to understand the common ingredients that help all forms of therapy succeed - Common ingredients o Therapeutic alliance (working alliance) – describes the collaborative relationship between therapist and client Mechanisms of change research - Focus on mechanisms of change that might operate within specific forms of therapy Stepped care – refers to the practice of beginning treatment efforts with the least expensive intervention possible and moving on to more expensive interventions only if necessary Efficacy- whether a treatment works under the purest of conditions Efficiency – how well the treatment works in the real world TEXTBOOK READING Chapter 1 Psychopathology – the field concerned with the nature, development, and treatment of mental disorders One challenge people face is to remind objective Stigma – the destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner The four characteristics of stigma - A label is applied to a group of people that distinguishes them from others - The label is linked to deviant or undesirable attributes by society - People with the label are seen as essentially different from those without the label, contributing to an “us” versus “them” mentality - People with the label are discriminated against unfairly Fighting against stigma - Decrease parity in insurance coverage - Eliminate discriminatory laws - Prepare the patients for future employment - Decriminalization - Provide housing - Increase personal contact - Educate people about mental illness Definition of mental disorder - The disorder occurs within the individual - It causes personal distress or disability - It is not a culturally specific reaction to an event - It is not primarily a result of social deviance or conflict with society - Key characteristics: personal distress, disability, violation of social norms, dysfunction Personal distress - A person’s behavior may be classified as disordered if it causes him or her great distress - Not all disorders cause distress (ex. Antisocial personality) - Not all behaviors that causes distress is disordered Disability - Impairment in some important area of life - Disability alone cannot be used to define mental disorder Violation of social norm - The violation alone is not necessarily signs of a mental disorder Dysfunction - It is difficult to identify which internal mechanism is contributing to the disorder Chapter 3 Diagnosis and assessment are the first step in the study and treatment of psychopathology Diagnosis can help a person begin to understand why certain symptoms are occurring – it can be a huge relief for the patients Diagnosis is important for research on causes and treatments To help make the correct diagnosis, clinicians and researchers use a variety of assessment procedures – beginning with a clinical interview The two cornerstones of diagnosis and assessment are reliability and validity Reliability – consistency of measurement - Inter-rater reliability – degree to which two independent observers agree on what they have observed o Ex. Patients are interviewed by two different doctors. Researchers examine whether the doctors agree about the diagnosis - Test-retest reliability – measures the extent to which people being observed twice or taking the same test twice receive similar scores o It makes sense only when we can assume that the people will not change appreciably between test sessions on the underlying variable being measured o It’s better used for intelligence test than emotional test o Ex. A group of high school students is given the same IQ test 2 years in a row - Internal consistency reliability – assesses whether the items on a test are related to one another - Alternate-form reliability – the extent to which scores on the two forms of the test are consistent Validity – whether a measure measures what it is supposed to measure - Validity is related to reliability – unreliable measures will not have good validity – however, reliability does not guarantee validity - Content validity – whether a measure adequately samples the domain of interest - Criterion validity – evaluated by determining whether a measure is associated in an expected way with some other measure o Concurrent validity – if both variables are measured at the same point in time o Predictive validity – evaluate the ability of the measure to predict some other variable that is measured at some point in the future § Ex. A group of high school students is given an IQ test, and their scores are correlated with a different IQ test they took the year before (poor validity) - Construct validity – it is relevant when we want to interpret a test as a measure of some characteristic or construct that is not observed simply or overtly – it is evaluated by looking at a wide variety of data from multiple sources – it is an important part of the process of theory testing o Ex. A measure of the tendency to blame oneself is developed, and researchers then test whether it predicts depression, whether it is related to childhood abuse, and whether it is related to less assertiveness in the workplace DSM-IV includes five axes – multiaxial classification system to require judgements on each of the five axes, forcing the diagnostician to consider a broad range of information Diagnosis provides the first step in thinking about the causes of symptoms, so it is the first step in planning treatment Clinical interviews are used to make diagnoses of psychopathology based on symptoms Major changes in DSM-5 include severity ratings Criticisms of the DSM - Too many diagnoses o One side effect of the huge number of diagnostic categories is a phenomenon called comorbidity, which refers to the presence of a second diagnosis - Reliability of the DSM in everyday practice - How valid are diagnostic categories o Diagnose only have construct validity if they help make accurate predictions Why DSM should lump diagnoses - High comorbidity – many different diagnoses are related to the same causes, symptoms of many different diagnoses respond to the same treatments A valid diagnosis should help predict - etiology - course - social functioning - treatment Psychological Assessment Clinical Interviews - clinical interview is different from a casual conversation because the interviewer pays attention to how the respondent answers questions - interviewer must obtain the trust of the client - reliability for unstructured clinical interviews is probably lower than structured interviews - structured interview o used to collect standardized information, particularly for making diagnostic judgments based on the DSM o ex. Structured Clinical Interview for Axis I of DSM-IV (SCID) § also a branching interview § achieves good interrater reliability for most diagnostic categories – however, a bit low for some of the anxiety disorders - In practice, most clinicians review the DSM symptoms in an informal manner without using a structured interview - Unstructured interview o Cons: tend to miss comorbid diagnoses that often accompany a primary diagnosis – lower reliability Stress can be conceptualized as the subjective experience of distress in response to perceived environmental problems Assessment of Stress - Live Events and Difficulties Schedule (LEDS) – most comprehensive measure of life stress o Semi-structured o Designed to address a number of problems in life stress assessment including § The need to evaluate the importance of any given life event in the context of a person’s life circumstances (ex. Pregnancy for 14 and 38 years old) § Exclude life events that might just be consequences of symptoms § Include a set of strategies to carefully date when a life stressor occurred o Takes a long time - Self-report checklist o Used when clinicians want a quicker way to assess stress o There is a great deal of variability in how people view the life events General Adaptation Syndrome (GAS) - Set the stage for our current conceptualizations of stress - 3 phases of the response for stress o phase 1: the alarm reaction – ANS (autonomic nervous system) activated by stress o phase 2: resistance – damage occurs or organism adapts to stress o phase 3: exhaustion – organism dies or suffers irreversible damage - the emphasis was on the body’s response, not the environmental events that trigger that response - current conceptualizations of stress emphasize that how we perceive the environment determines whether a stressor is present The two most common types of psychological tests are personality tests and intelligence tests Personality Tests - Self-Report Personality Inventories o The client is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to them o Standardization – statistical norms for the test can be established by administering the test to many people o Minnesota Multiphasic Personality Inventory (MMPI) § Designed to detect a number of psychological problems § Widely used to screen large groups of people for whom clinical interviews are not feasible § Include validity scales – designed to detect deliberately faked responses (ex. I approve of every person I meet) – person who endorse a large number of the statements in the lie scale might be attempting to present themselves in a good light - Projective Personality Tests o A psychological assessment tool in which a set of standard stimuli – inkblots or drawings – ambiguous enough to allow variation in responses is presented to the person o Projective hypothesis - because the stimuli materials are unstructured and ambiguous, the person’s responses will be determined primarily by unconscious process and will reveal their true attitudes, motivations, and modes of behavior o Thematic Apperception Test (TAT) – a person is shown a series of black-and- white pictures one-by-one and asked to tell a story related to each § Low score for both reliability and validity o Rorschach Inkblot Test – the best-known projective technique § A person is shown 10 inkblots one at a time, and asked to tell what the blots look like Intelligence Tests - A way of assessing a person’s current mental ability - It is based on the assumption that a detailed sample of a person’s current intellectual functioning can predict how well they will perform in school - Mostly administered individually - Wechsler Adult Intelligence Scale - Beyond predicting school performance, intelligence tests are also used for: o Diagnosing learning disorders and identifying areas of strengths and weaknesses for academic planning o Helping determine whether a person has intellectual developmental disorder (formerly known as mental retardation) o Identifying intellectually gifted children so that appropriate instruction can be provided o Neuropsychological evaluations - Highly reliable and have good criterion validity - Stereotype threat can be a factor in poor IQ score The frequencies of problematic behavior as determined by questionnaire or interview studies may be underestimates and that social problems such as needle sharing and unsafe sex may be considerably more common than most people believe Behavioral and Cognitive Assessment - Focus o Aspects of the environment that might contribute to symptoms o Characteristics of the person o The frequency and form of problematic behaviors o Consequences of problem behaviors - Methods o Direct observation of behavior § Since it is difficult to observe most behavior as it actually takes place, many therapists contrive artificial situations in their consulting rooms § The behavioral assessment procedures yielded data that could be used to measure the effects of treatment o Self-observation § Self-monitoring - used to collect a wide variety of data of interest to both clinicians and researchers § Ecological momentary assessment (EMA) – involves the collection of data in real time as opposed to the more usual methods of having people reflect back over some time period and report on recently experienced thoughts, moods, or stressors § Although self-observation can provide accurate measurement of behaviors, considerable research indicates that behavior may be altered by the very fact that it is being self-monitored § Reactivity – the phenomenon wherein behavior changes because it is being observed § Therapeutic interventions can take advantages of the reactivity that is a natural by-product of self-monitoring – smoking, anxiety, depression, and health problems have all undergone beneficial changes in self-monitoring studies o Cognitive-Style questionnaires § Used to help plan targets for treatment as well as to determine whether clinical interventions are helping to change overly negative thought patterns § Ex. Dysfunctional attitude scale (DAS) – contain items such as “People will probably think less of me if I make a mistake” § Good construct validity Neurobiological Assessment Brain Imaging - CT/ CAT scan (computerized axial tomography) o Helps to assess structural brain abnormalities o X-ray and radioactivity o The resulting images can show the enlargement of ventricles (a sign of brain tissue degeneration) and the locations of tumors and blood clots - Magnetic resonance imaging (MRI) o Superior to the CT scan because it produces pictures of higher quality and does not rely on even the small amount of radiation required by a CT scan o The magnetic causes the hydrogen atoms in the body to move providing electromagnetic signal - Functional MRI (fMRI) o Allows researchers to measure both brain structure and brain function o Measures blood flow in the brain – called the BOLD signal (blood oxygenation level dependent) - Positron emission tomography (PET scan) o Expensive ad invasive procedure o Allows both brain structure and brain function – the measurement of brain structure is not as precise as with MRI/fMRI Neurotransmitter assessment - Postmortem studies – can be directly measured - For participants who are alive, most of the research has relied on indirect assessments - One common method involves analyzing the metabolites of neurotransmitters that have been broken down by enzymes - Metabolite – typically an acid, is produced when a neurotransmitter is deactivated – they are found in urine, blood serum and cerebrospinal fluid - Problem o when measuring metabolites from blood or urine, the measures are not direct reflections of levels of neurotransmitters in the brain o even with CSF fluid, metabolites reflect activity throughout the brain and spinal cord, rather than regions that are directly involved in psychopathology o correlational Neuropsychological assessment - used in conjunction with the brain imaging techniques – to detect brain dysfunction and help pinpoint specific areas of behavior that are impacted by problems in the brain - the tests are based on the idea that different psychological functions rely on different areas of the brain - Halstead-Reitan neuropsychological test battery o Tactile performance test – time o Tactile performance test – memory o Speech sounds perception test o The test battery is valid for detecting behavior changes linked to brain dysfunction - Luria-Nebraska battery o Highly reliable o Criterion validity has been established by findings that test scores can correctly distinguish 86% of neurological patients and controls o A particular advantage is that one can control for educational level so that a less educated person will not receive a lower score solely because of limited educational experience Psychophysiological Assessment - Concerned with the bodily changes that are associated with psychological events - Not sensitive enough to be used for diagnosis - It can provide important information about a person’s reactivity and be used to compare individuals - Electrocardiogram (EKG) – each heartbeat generates electrical changes, which can be recorded by electrodes placed on the chest that convey signals to an electrocardiograph or a polygraph - Electro-dermal responding (skin conductance) - Electroencephalogram (EEG) – measure brain activity Cautions for neurobiological assessment - Many of the measurements do not differentiate clearly among emotional states - Brain-imaging techniques do not allow researchers to manipulate brain activity and then measure a change in behavior - There is not a one-to-one relationship between a score on a given neuropsychological test or a finding on an fMRI scan the one hand and psychological dysfunction on the other - In attempting to understand the neurocognitive consequences of any brain dysfunction, one must understand the preexisting abilities that the patient had prior to diagnosis with a mental disorder Cultural and Ethnic Diversity and Assessment - Cultural bias in assessment – notion that a measure developed for one culture or ethnic group may not be equally reliable and valid with a different cultural or ethnic group


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