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Chapter 3

PSYCH336 Class Notes.docx

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University of Waterloo
Christine Purdon

Class 1 – What is Clinical Psychology? 9/12/2011 8:47:00 PM th Class 1 – September 13 , 2011 Clinical Psychology – broad field of practice and research within the discipline of psychology  Applies psychological principles to: assessment, amelioration, rehabilitation and prevention  Of: Psychological distress, disability, dysfunctional behavior and health risk behavior  And: To the enhancement of psychological and physical well-being (some controversy with this point. US principle of Positive Psychology .. make normal people happier or make distressed people normal? Therefore, not as much focus on this last point) Mental Health Problems According to WHO (2004 stats), about 450m people suffer from mental, neurological and behavioural problems.  Cost-effective treatments exist for most disorders. However, most countries do not allocate sufficient funds to address mental, neurological and behavioural problems Mental Illness Mental illness can be costly to society.  Smith & Smith study (in press) o Prospective data on income and other social indices since 1968 (35,000 individuals, 5,000 families) o In 2007, researchers gathered retrospective self-report of childhood mental illness using structured interviews  Findings – cost of having a mental illness in childhood: o Fewer years of education o Overall income was 20% lower o 11% lower chance of being married o Estimate of total lifetime cost of all affected in survey = $2.1 trillion  However, asking for retrospective self-reports – cost may be overestimated as people were over-identified as having a childhood mental illness. Controlled for specific factors including physical illness  Canadian data: o 1,828,300 lost days of work in Ontario in 1990 due to mental illness o $14.4 billion cost to economy per annum (1992) Mental Health in the World WHO (2004) Prevalance of Disease – top 5 most prevalent diseases in the world:  TB  HIV  Intestinal nematodes  Malnutrition  Anaemia  Diabetes (why? Obesity rates are growing – factor in development of diabetes)  Unipolar depression  Bipolar depression  Schizophrenia  Alcohol Use disorders  Alzheimers  Etc. - mental illnesses are in the top 10 diseases – however, diabetes and Alzheimer’s are portrayed in the media much more *note – cardiovascular disease is the number one killer in the world Most common causes of disability WHO (2004) - top 3 causes of disability in the world:  Hearing loss  Vision problems  Mental disorders Canada’s Mental Health Strategy  There isn’t one (one of the only countries in the Western world without one) Mental Health Commission of Canada  Due to efforts of Senator Michael Kirby (red-carpeted section of the Senate, had a sister who committed suicide due to bipolar depression)  Three initiatives: o Develop a mental health strategy (a formal government- funded infrastructure for prevention and care) o Establish a Knowledge Exchange Centre o Reduce stigma associated with mental health and eradicate discrimination against those living with mental health problems *note to self – e-mail her and ask her what she meant by Princess Di being borderline “PD” Attitudes to mental illness in our society  Suspicion  Stigmatization o 1/3 of 3M depressed in Canada do not seek help o Fear of stigmatization is the key reason  Viewed as violent and dangerous o Pervasive view even though it is quite untrue  Viewed as unable to contribute to society o Patently untrue *Purdon’s notes: people with mental disorders surprisingly good at multitasking Mental Health Professions Primary care physicians (front-line)  Provide more mental health services than any other health care profession  Tend to receive the least amount of training in mental health issues Psychiatrists Clinical psychologists Counselling psychologists Social workers Psychiatric nurses “Therapists” Psychiatrists – Medical Doctor who has specialized in psychiatric medicine (“low-end” of the specialists scale) Expertise: biological approaches to understanding the persistence of mental disorders  Prescription of medication for mental illnesses (prescription privileges)  Have training in psychotherapeutic approaches (some value psychotherapy more than others)  Found in emergency, in-patient and out-patient settings (hospitals, clinics, private practice etc)  Regulated by federal and provincial medical associations Clinical Psychologists – Ph.D or Psy.D from a Clinical Psychology program  Ph.D – extremely competitive o 4-6 years of study post-BA  Courses in clinical skills and intervention  Research and statistics, including a dissertation  Production and consumption of research o 1 year full-time internship o 1 year to become licensed (typically)  Psy.D – considerably less emphasis on research training, equivalent training in clinical skills Psychologist  Licensed term – by law, can only call yourself a psychologist IF: o Member of a College of Psychologists (regulatory body) – expected to work in accordance with a set of practical guidelines o Membership requires:  Basic standard of training  Pass the exam for professional practice in psychology  Pass a jurisprudence exam  Pass an oral exam Psychological Associate  M.A. in clinical psychology o 4 years of supervision post-degree o Have to do EPPP, jurisprudence exam, oral exam  Being phased out in Ontario – no one completing requirements later than 2017 will be registered as an Associate  Other provinces have MA level registration (but with different titles) Counselling and School Psychologists  Counselling Psychologists o Expertise is more in assisting in crises and with life crossroads (e.g. self-esteem, time management, career counseling)  School Psychologists o Assessment and consultation for learning, cognitive, behavioural difficulties in the classroom (particularly for children e.g. learning disabilities, behavioural plans etc) Clinical Social Workers  Focus on individuals, families, groups and communities (the patient within their larger social systems)  Area of expertise: social policy development, program planning and management  Useful in helping people access services  Advocacy  Counselling/therapy (LSW – Licensed Social Worker) Psychiatric Nurses  Expertise in case of psychiatric patients  In-patient and out-patient settings (more likely in in-patient settings) Psychotherapist  Currently, anyone can call themselves a psychotherapist o Not a licensed term, no regulatory body and therefore no accountability o Often no formal clinical training  Is in the process of changing – because psychotherapy can involve the communication of a diagnosis and some treatment, it falls under the Regulated Health Professionals Act o Gov’t is in the process of developing a governing body for psychotherapists Mental Health Across History  Mental illness poorly understood for millennia: o Demon possession, witchcraft o Punishment for immoral behaviour  Care was equally poor: o Asylums  Early asylums were concerned only with containment – patients often chained to wall or bed, poorly fed and clothed o Bethlehem or “Bedlam”  Note: Bedlam – comes from the name Bethlehem (a mental asylum in London) where tickets were sold so people could view the patients Humane treatment of mental illness  Pinel (late 19thcentury) o Paris o “moral treatment” o Removed people from chains o Treated them as sick people  They improved dramatically  Dorothea Dix (Canada) o Agitated for provision of more numerous facilities o These became highly medicalized  Centres of research rather than care *don’t really need to know the above slide in detail Contemporary treatment *don’t need to know in detail  In Canada: th o Institutions became highly crowded in the 20 century o Highly restrictive environments  1970s – deinstitutionalization o Far fewer beds in institutions, more beds in hospitals o Still far fewer beds overall between mid-70s and 80s o Increase in homelessness  Institutions today o Often grim and removed from the community o Not much contact with psychologists or psychiatrists  Many services are on an out-patient basis Activities of clinical psychologists  Some of the primary activities: assessment and diagnosis o Assessment is the major distinguishing feature of psychologists  Intervention o Therapy (to try and ameliorate problems)  Consultation o Needs assessment, program development, program evaluation, policy consultation  Prevention  Research o Understanding and treating mental health problems, psychological factors that influence physical problems  Clinical supervision  Teaching  Administration Science and Ethics  Research has a critical role in clinical psychology o Seek to understand the psychological factors involved in the development and persistence of mental health problems o Develop theories of development and persistence o Test those theories o Develop interventions based on those theories o Test the efficacy of those interventions o  science-practitioners Ethics  Bound to Canadian Code of Ethics for Psychologists o 4 general principles – very comprehensive  College of Psychologists of Ontario Standards for Professional Conduct o Specific guidelines for practicing in accordance with Code Code of Ethics  Four principles (hierarchical): o Respect for dignity of persons *primary focus (e.g. if 2 principles conflict)  The belief that each person should be treated primarily as a person and an end on him or herself, not as an object or a means to an end  Must protect confidentiality  No discrimination, degrading of others, sexual harassment, coercion  Seek informed consent o Responsible caring  Activities benefit people or at least do no harm o Integrity in relationships  Honesty, accuracy in research, relationships with fellow psychologists, avoidance of conflict of interest o Responsibility to society  Psychology will promote the welfare of human beings and society Class 2 – How do we diagnose mental illness? 9/12/2011 8:47:00 PM What is “Abnormal”? - See profiles on slides What is “Abnormal” Behaviour? Several defining factors:  Statistical infrequency i.e. not seen all the time in general pop.  Violation of norms  Personal distress  Disability or dysfunction  Unexpectedness No specific one is sufficient. Statistical Infrequency  Behaviour that is infrequent e.g. manic episodes  Behaviour that falls outside norms o E.g. “mental retardation” diagnosed when IQ is 2+ standard deviations below the norm  IQ < 70  Not sufficient to define abnormal though o Then people with especial talent would be “abnormal” Violation of Norms  Behaviour that is: o Quite out of the ordinary o Goes against cultural/social norms  E.g. excessive hand washing, “blessing” cars on the DVP during rush hour  Not sufficient: o Political/social activists would then be “abnormal”  Labeling activists as having a mental illness has been used as an instrument of social oppression (particularly in Russia in the 70s) Personal Distress  Behaviour that causes: o Personal suffering, torment e.g. depression, psychosis  Not sufficient: o Some disorders do not necessarily involve distress o Not all distressing behaviours are signs of a disorder  E.g. training for a marathon, self-flagellation for religious penance Disability or Dysfunction  Disability/dysfunction o Impairment in an important area of life  Work, relationships, parenting  Not sufficient: o Impairment can result from physical difficulties Unexpectedness  Out of proportion with what would be expected in the context of the situation Diagnosis in Mental Illness th  Mid-20 century – came up with 2 systems 1) International Statistical Classification of Diseases, Injuries and Death (ICD) – primarily used in Europe  Published by the World Health Organization  Mental illness added in 1948 (why? Post-WWII – not enough psychiatrists, opened up field to psychologists) 2) Diagnostic and Statistical Manual of Mental Disorders  Published by the American Psychiatric Association  First edition was in 1952 DSM-IV-TR  Multi-axial o Individuals are assessed on five separate dimensions  Axis I: o Clinical disorders (excluding personality disorders and mental retardation)  Axis II: o Personality disorders and mental retardation  Axis III: o Medical conditions  Axis IV: o Psychosocial and environmental problems  Axis V: o Global Assessment of Functioning *don’t really need to know these Development of DSM  First two versions: o Diagnostic categories were based on psychoanalytic paradigm for psychopathology (neurotic and psychotic disorders)  DSM-III o Atheoretical  DSM-III-R, IV, IV-TR o All revised in accordance with empirical research on each disorder  DSM-IV-TR has a huge number of diagnostic categories In All Cases:  Symptoms must be: o Distressing for the person and/or, o Impair at least one important area of functioning  Whether person perceives them to be or not (therapist judgment) DSM-V  Due out in May 2013  Some of the major changes: o PTSD – moved from Anxiety Disorders to Trauma and Stressor Related Disorders o Hoarding – no longer a sub-type of OCD, now “Hoarding Disorder” o Personality Disorders – reduced to 6 categories, criteria simplified (one of the biggest changes) Process of Adding & Deleting Categories  Political/Economical: o Pileki, Clegg & McKay (2011)  Independence of DSM work group leaders from pharmaceutical companies?  Extent to which biological/medical models take precedence  Social: o Homosexuality was considered symptom of major personality dysfunction  Psychoanalytic viewpoint  Included in DSM and DSM II  Excluded from DSM III (1986)  Partially in response to social norms and values  Empirical o DSM-IV revisions were based on observed inadequacies in DSM-IIIR categories o Empirical research conducted by task forces to resolve difficulties with problematic categories  Homosexuality – researcher simply did not substantiate idea that homosexuality was associated with distress, dysfunction etc.  “Criteria sets and Axes for further study”  Section at back of DSM-IV  Symptom clusters that are currently being studied  To determine whether they should be included in main text Diagnostic Integrity  “Have you had any of these symptoms in the past year”, “Did you have at least 5 of these for at least 7 days, at least 12 times” o Hard for people to remember Proposed diagnosis  Premenstrual Dysphoric Disorder Controversy  Pathologizing something that is normal (kind of a “feminist argument” i.e. menstrual cycle and its impact on the body)  Women’s rights – competence could be questioned if this disorder legitimized o Used to be an excuse for not promoting women to higher levels of authority  Reliability of diagnosis o In some studies, 30-50% meet criteria o When criteria rigorously applied, only 3-5% Advantages of Diagnostic System  Research: o How can you study causes and treatment of mental illness without a classification system?  Hope for patients  Help – diagnosis has many implications for treatment Problems with Any Classification System  Either or: o Person either meets diagnostic criteria he/she does not o Implications for health insurance  Ignores: o Unique information about the person  Stigma: o Certain types of mental health problems are more stigmatized than others  Borderline Personality Disorder (more “work” for the psychologist so psychologists often reluctant to work with that person, once diagnosed) Reliability of DSM-IV  Inter-rater reliability o The proportion of agreement above chance between two clinicians diagnosing the same person o Kappa – the closer to 1.0, the better  Certain disorders (particularly the ones with objective, verifiable, overt behaviours) have higher kappas e.g. bulimia. Others that are less objective have lower kappas e.g. social phobia Class 3 – The central importance of research in clinical psychology 9/12/2011 8:47:00 PM th Class 3 – September 27 , 2011 Standard Research Terms - important for psychologists to be intelligent, informed consumers of research 1) Independent variable  Condition that is systematically varied in order to study its effects  In psychotherapy research, IV is typically “therapy condition” o Cognitive behaviour therapy vs. no therapy o Psychoanalysis vs. cognitive behavioural 2) Dependent variable  Aspect of behaviour that is observed after IV has been manipulated  In psychotherapy research, DV is some measure of “treatment effectiveness” 3) Control group  Group included in a study in order to control for other factors that may influence the dependent variable o E.g., age, education level, SES o Also have to control for aspects of the experimental paradigm Statistical Analyses Why? To determine if there are statistically significant differences between experimental and control groups on the dependent measure 1) Correlational analyses:  Extent to which two variables are associated with each other  High correlation between: height and weight, temperature and beer sales, weeks into the term and mood state  But correlation does not imply causation! o Temperature doesn’t cause beer sales, time doesn’t cause mood state  Correlation variable – r Analyses of variance 1) t-test, ANOVA (F-test), MANOVA  When your independent variable(s) is/are categorical o Male/female, clinical/nonclinical  Between subjects effects (i.e., across groups)  Within subjects effects (i.e., within groups, for example at two different time points) 2) Multiple regression analyses:  When your independent (predictor) variable(s) is/are continuous o Does state anxiety predict attention to threat? o Does it do so over and above trait anxiety? *Looking at ratio of explained variance to error variance Moderator and Mediator variables 1) Moderator variables:  Influences the direction or size of the relationship between two other variables o Number of assignments may moderate weeks / mood relationship o Time X Number of assignment interaction (*don’t really need to know this) 2) Mediator variables:  The influence of the first variable on the second is almost entirely due to a third variable, the “mediator variable”  Thirst may mediate the temperature / beer relationship o Temperature causes thirst, thirst causes increased desire for beer o Without thirst, there would be no temperature / beer relationship Research Ethics Key considerations in conducting research:  Informed consent  Confidentiality and anonymity  Responsible recruitment  Potential harm to participants versus benefits to society  Remuneration considerations o Too much remuneration is coercive  Deception o E.g. false feedback paradigms o Easy to scare people but very hard to unscare them  Responsible debriefing o Accessible, informative, reassuring Key considerations in reporting research results:  Accurate  Original o Not plagiarized o Cannot publish data you have already published  Authorship reflects contribution (i.e. order in which authors are listed) Key considerations in reviewing research:  No conflict of interest (either positive or negative)  Preserve confidentiality Research Designs 1) Single case studies, case series 2) Correlational:  Simply looking at how two factors are associated or how two naturally occurring groups differ on a factor  No manipulation of either factor 3) Quasi-experimental design: (*one of the more common types of designs seen in psychology – in situations where you are unable to randomly assign participants)  Compare people with OCD seeking treatment to those with OCD not seeking treatment on variable of interest o Not randomly assigned o Weaker design 4) Experimental:  Participants randomly assigned to a control or experimental group o E.g., suppress unwanted thought / do not suppress unwanted thought  Random assignment: o Controls for factors that might influence dependent measure Gold standard of treatment outcome research:  Randomized controlled trials o Participants randomly assigned to one of two or more treatment conditions Treatment outcome research What criteria reflect change? Symptom removal vs. quality of life  Has treatment of alcoholism been effective if person doesn’t drink but is preoccupied with staying sober? Statistical vs. clinical significant  Significant mean score differences = meaningful change in individual’s life?  Psychologists are aiming for both Research in Action *see slides for remaining notes (included in version on ACE) *KNOW RESEARCH TERMS FOR FINAL EXAM Class 4 – Assessment overview and interview/observational assessment methods 9/12/2011 8:47:00 PM th Class 4 – October 4 , 2011 Assessment Process of:  Collecting information about an individual in a systematic, objective, empirical way Purposes of Assessment:  Custody evaluation (CP prefers not to get involved with this – ending up in court or being sued as a psychologist is often related to custody evaluations)  Screening  Prognosis/prediction o Seen often in forensic psychology (related to criminals) e.g. likelihood of reoccurrence of crime (e.g. sex offenders) or movement from max to min security prison  Treatment planning, progress and outcome In all cases, assessment will involve some/all of the following:  Intellectual functioning o e.g. after a TBI, nature of injury, what programs are they eligible for, insurance purposes  Personality o Used often forensically  Behaviour  Diagnosis/psychopathology Tools of assessment:  Interview and observation  Measures of personality o Objective – standardized test e.g. paper+pencil tests  Score is compared to a series of norms o Projective – a test where the idea is that the personality is projected onto an external stimuli (e.g. Rorschach test)  Measures of cognitive functioning – examples include: o IQ tests o Memory tests o Neuropsychological tests – designed to determine whether there are problems in any areas of the brain therefore try to address all the lobes (primarily the frontal lobes i.e. executive functioning)  E.g. Wisconsin card-sorting task  Specific measures of pathology/maladaptive behaviour o Symptom measures *Note – can be very expensive to start out as a psychologist if you want to go into assessment as the kits involved are very expensive Assessment is meant to be objective – therefore, psychologists require the following of tests: Standardization Definition – consistency in procedure across clinicians and testing situations Therefore, need to reduce:  Variability in testing situations: o Detailed instructions for administration  WAIS, WISC, WMS (Weschler tests), manner in which GRE is administered o Structured test responses  E.g. MMPI versus Rorschach  Variability in scoring tests o Detailed scoring instructions  WAIS, WISC, WMS  Exner system for scoring the Rorschach However,  Testing is a social situation  Responses can vary according to the same factors that vary performance in a social situation Clinicians must follow standards of administration and scoring  Tempting to go off-script and provide further information or encouragement during administration Scoring errors:  Rorschach scoring: o Overall mean accuracy in scoring was only 65%  Guarnaccia et al. (2001) IF the scoring procedures are even followed:  Many clinicians use their own “system” Psychometric Considerations  Norms o A score on its own is rather meaningless o Beck Anxiety Inventory (BAI)  Score = 24 .. what does this mean?  Compare this score to scores obtained from 242 nonclinical individuals (obtained by Gillis, Hagga & Ford (1995))  M = 7, SD = 8  Therefore, a score of 24 is +2 SDs above the mean  Therefore, this person has a higher BAI score than 84% of nonclinicals Norms Norms are only good if they are:  Normative o i.e. based on large and truly normative samples (varying population)  Few norms for minority groups  *Note – check out David Suzuki vs. Phillipe Rushton  Reflect the norm o Rorschach norms were developed based on 5,800 people across the world o But there were erratic differences within and across countries  And the Rorschach is affected by many extraneous factors, including the layout of the room itself o The norms overpathologize, particularly children  According to these norms, the scores of children with no known behaviour or emotional problems puts them in the highly disturbed range Reliability - see slide Types of Validity - see slide Validity To what extent does the measure actually assess what it is supposed to assess?  E.g. Beck Anxiety Inventory – supposed to be a measure of anxiety  First, what is anxiety? o Cognitive – worry, anxious apprehension etc. o Somatic – shortness of breath, muscle tension etc. o Behavioural – restlessness, agitation, pacing etc.  However, BAI tends to be better at assessing panic as opposed to anxiety – therefore, lacking in validity Validity and Reliability Validity:  A test that is unreliable cannot be valid  E.g. if test-retest is low, obviously measuring something different each time  How can it measure what it says it’s measuring if scores are so different? INTERVIEWING AND OBSERVATION Professionalism - see slide - qualities that psychologists should imbibe – clients are vulnerable and deserve this treatment Unstructured Interviews Used clinically for three reasons: i) To build rapport  Especially when working with children ii) To gather basic information about:  Client’s history and presenting problem  Context of client’s problem o However, not completely unstructured because the therapist will have a mental list of topics he/she will want to cover/obtain iii) To make observations  Client’s demeanor, mood, frame of mind  Overall wellbeing o As inferred by dress, manner  What client is like interpersonally o Can help you put their self-report in perspective Effective Clinical Interviewing Relaxed, conversational style  But not unprofessional or casual Nonjudgmental warmth is critical Open-ended questions  “tell me more about”, “what happened next?” “what was that like for you” o Avoid: “why?” “it must have been” “did you” Communicating understanding:  Paraphrasing o Re-stating what the client said in your own words  Reflection o Reflecting client’s own words with validating statements  Summaries o Summarizing what the client has said so far Structured Interviewing - see slide Cultural Issues  Psychological work is inherently social  Different cultural groups have different social norms  One must be aware of and sensitive to relevant cultural differences o Bear in mind that there is a shared humanity as well  “Culture” does not vary just across country of origin o E.g. military culture Addressing Sensitive Topics Tone is:  Matter-of-fact, not casual or flippant  Straightforward  Nonjudgmental  Respectful Personal reaction is kept under wraps Interviewing Children/Adolescents Developmental considerations  Age-appropriate language  Must avoid leading questions e.g “your mother slapped you, didn’t she?” rather should ask “When your mother saw the broken plate, what did she do next?”  Age-appropriate setting o Therapist will often sit on the floor with the child or at a child- sized desk o May talk while playing a game o May use props such as puppets or pictographs Systematic Observation Psychologists are always observing May also gather observations from other sources (with permission!)  Schools, parents, spouses Sometimes naturalistic observation is used  When working with children o To assess ADHD o To assess problematic behaviour  Looking for antecedents and consequences, in particular o To assess family functioning Self-Observation Self-monitoring  Psychologists often ask clients to keep a diary of a specific behaviour or mood  Structured is best! Class 5 – Intellectual and cognitive measures of assessment 9/12/2011 8:47:00 PM th Class 5 – October 11 , 2011 *will discuss neuropsychological assessment in class (not outlined much in the textbook) What is Intelligence? Spearman  intelligence is innate, global factor  accounts for all individual differences in skills and abilities  Two factors: o General factor (g) o Specific factors (s)  Responsible for unique aspects of performance on any given task Cattell  Two types of intelligence: o Fluid intelligence  Ability to solve problems without drawing on prior experiences or formal learning o Crystallized intelligence  What we have learned Sternberg  Triarchic theory (tri – three, hierarchy) o Compenential  Executive functions (frontal lobes)  Planning, monitoring and evaluating  Performance (i.e. solving a problem)  Knowledge acquisition  Encoding, combining and comparing information o Experiential  Influence of task novelty or unfamiliarity on the process of problem solving o Contextual  Adaptation, alteration of the environment, selection of a different environment Gardner  Multiple intelligences o Ranging from bodily-kinesthetic (e.g. sports) to spiritual - different ideas re: intelligence. However, we don’t actually know what “intelligence” is – is a construct that psychologists attempt to define Assessing Intelligence When assessing intelligence, we are looking for information that:  allows for the identification of skills or disabilities that enhance or interfere with functioning in the environment Intelligence Tests Weschler Scales  Weschler Preschool and Primary Scale of Intelligence (WPPSI-III) (2.5-5)  Weschler Intelligence Scales for Children (WISC-IV) (5+)  Weschler Adult Intelligence Scales (WAIS-IV) (14+) - Most commonly used measures of intelligence - Can be used for 2.5 – 90 years of age - Psychometric properties are strong and have been carefully improved over the years  Reliability of Full Scale IQ is .97 (one of the highest reliabilities seen on any test) Norms for Weschler Scales Norms for Weschler scales:  Based on age norms from 1700 people representing the full demographic of the US, according to census data  Canadian norms now exist o Use of American norms with Canadians results in underestimation of cognitive impairment US/Canada differences:  In US samples: o There are pronounced effects of education, sex and ethnicity  In Canada: o Effect of education is one-third that in US samples o Sex and ethnic differences virtually non-existent Weschler Scales Verbal IQ  Vocabulary, comprehension Performance IQ  Puzzles, designs Full Scale IQ  Verbal + Performance  Mean = 100, SD = 15 Together, they tend to measure four underlying aspects of “intelligence”:  Verbal comprehension  Perceptual reasoning  Working memory  Processing speed Underlie both verbal and performance scales Interpretation Examine full scale IQ  Provides an overall indication of mental abilities in comparison with the normative group Interpret factor scores:  Each of the four domains  Is there a specific deficit? Interpret crystallized versus fluid intelligence Examine variability both within and between subtests of the scale Limitations of the Weschler Scales Meaning of norms outside North America Test abilities in academically relevant areas  Do not measure abilities in social, artistic or emotional domains Administration and scoring:  Results are only meaningful if both have been done correctly Cognitive Assessment Scales Assess very specific aspects of intellectual functioning:  Memory deficits  Visual-spatial processing difficulties Weschler Memory Scale WMS-IV – very difficult to administer Assesses episodic memory:  Episodic memory o Person’s memory for direct experiences In testing:  Examinee presented with auditory and visual stimuli and required to respond o E.g. recall as many details of a story, identify whether or not a face appeared in a previous set of faces shown, repeat number/letter sequences When are Intelligence Tests Administered? After brain injury etc.:  To assess current level of functioning  To assess nature and severity of decline in functioning Children:  Identified as potentially “gifted” or as potentially “delayed”  To obtain special services  To distinguish motivational/attentional problems from problems related to ability In clinical setting:  When unclear what behaviours result from mental illness vs. ability  To interpret other types of test results (e.g. Rorschach) Neuropsychological Assessment Tests designed to:  Identify organic brain problems Assumption:  Some functions are localized to some degree in specific parts of the brain  E.g. expressive speech – left frontal lobe  Neuropsychological tests assess functioning  Specific impairments in functioning imply damaged or deficits in specific areas of the brain Neuropsychological Tests Typically:  A battery of tests is given  E.g. Bender-Gestalt, WAIS-R, memory tests, tactile tests, set- switching tests etc (don’t need to know the names of these tests) Examples of batteries:  Halstead-Reitan  Boston Process Approach o Results interpreted in light of subject’s approach to problem- solving Very long to administer and score Reliability & Validity Reliability  Difficult to assess  Tests take place over several days  Conditions can deteriorate (often due to tiredness)  However, reliability thought to be adequate Validity  Neuropsych tests should be able to pinpoint specific areas of damage  Validity for identifying areas later identified as lesions by MRI & CAT scan is good When are Neuropsych Tests Performed? After head trauma To assess learning disabilities Differential diagnosis  Psychotic or brain-damaged?  Depression or dementia? Case planning  Planning interventions Class 6 – Self-report and projective measures of assessment 9/12/2011 8:47:00 PM th Class 6 – October 18 , 2011 Assessment Recap Purpose of diagnosis and symptom assessment:  Treatment planning  Eligibility for disability  Forensic purposes Purpose of intellectual, cognitive and neuropsych assessments:  General functioning  Eligibility for special programs  Treatment planning  Forensic purposes What is Personality and why would we want to assess it? Personality traits:  Tendency to consistently behave in specific ways Predicting behaviour:  Given that someone has a particular trait, how might they behave in a particular situation? o Of particular interest to forensic and custody assessments  What are the genetic versus environmental influences on stable traits? o How much can people change? Trait versus State How well do personality traits predict situational behaviour? Mischel (1968)  Correlation between trait scores and actual behaviour: 0.30 o What does this mean? Only 9% of the variance in behaviour can be explained by personality traits (as assessed by existing measures) Example: Trait versus State Anxiety Nelson, Purdon, Quigley, Carriere, & Smilek (submitted):  Examined attentional biases to threat in high versus low trait- anxious people o Eye Tracking Attention Task – fixation cross  image pair with both a neutral and threatening image on screen for 3 seconds  fixation cross  14 different image pairs  Couple of different variables – fixation (which image was looked at first) o Findings:  HTA (high trait anxiety) seem to try and avoid the threatening image more – HOWEVER, what’s the flow? Although participant may be HTA, may be in a different state when they enter the room for the test  To ac
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