Abnormal PsychologyAbnormal Psychology

Oltmanns and EmeryOltmanns and Emery

Presentation by:Presentation by:Mani RafieeMani Rafiee

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Chapter FourChapter Four

Assessment of Abnormal BehaviorAssessment of Abnormal Behavior

• Basic Issues in AssessmentBasic Issues in Assessment

• Types of Assessment ProceduresTypes of Assessment Procedures

• Assessing Psychological SystemsAssessing Psychological Systems

• Assessing Biological SystemsAssessing Biological Systems

Chapter OutlineChapter Outline

• Assessment is the process of gathering information from a new patient.

• Diagnosis refers to the identification or recognition of a disorder on the basis of its characteristic symptoms.

OverviewOverview

Basic Issues in AssessmentPurposes of Clinical Assessment

• Psychological assessment is the process of collecting and interpreting information that will be used to understand another person.

• Three primary goals guide most assessment procedures: making predictions, planning treatments, and evaluating treatments.

• Different assessment procedures are likely to be employed for different purposes.

Basic Issues in Assessment

Assumptions About Consistency of Behavior

• Psychologists must be concerned about the consistency of behavior across time and situations.

• They want to know if they can generalize, or draw inferences about the person’s behavior in the natural environment on the basis of the samples of behavior that are obtained in their assessment.

Basic Issues in Assessment

Assumptions About Consistency of Behavior (continued)

• Psychologists typically seek out more than one source of information when conducting a formal assessment.

• Because we are trying to compose a broad, integrated picture of the person’s adjustment, we must collect information from several sources and then attempt to integrate these data.

• One way of evaluating the possible meaning or importance of this information is to consider the consistency across sources.

Basic Issues in AssessmentEvaluating the Usefulness of Assessment

Procedures

• In the case of assessment procedures, reliability can refer to various types of consistency.

• For example, the consistency of measurements over time is known as test–retest reliability.

• The internal consistency of items within a test is known as split-half reliability.

Basic Issues in Assessment

Evaluating the Usefulness of Assessment Procedures (continued)

• The validity of an assessment procedure refers to its meaning or importance.

• Is the person’s score on this test or procedure actually a reflection of the trait or ability that the test was designed to measure?

Basic Issues in Assessment

Evaluating the Usefulness of Assessment Procedures (continued)

• Interviews, observational procedures, and personality tests must be carefully evaluated for cross-cultural validity.

Types of Assessment Procedures

• The most useful assessment procedures are likely to vary from one problem to the next.

• Assessment procedures that are useful in evaluating the effectiveness of a drug treatment program for hospitalized depressed patients may be quite different from those used to predict the need for medication among hyperactive schoolchildren.

Assessing Psychological Systems

Interviews

• The clinical interview is the most commonly used procedure in psychological assessment.

• Most of the categories that are defined in DSM are based on information that can be collected in an interview.

• Interviews provide an opportunity to ask people for their own descriptions of their problems.

• Interviews also allow clinicians to observe important features of a person’s appearance and nonverbal behavior.

Assessing Psychological Systems

Structured Interviews

• Structured interviews, in which the clinician must ask each patient a specific list of detailed questions, are frequently employed for collecting information that will be used to make diagnostic decisions and to rate the extent to which a person is impaired by psychopathology.

Assessing Psychological Systems

Advantages of the Clinical Interview as an Assessment Tool:

1. The interviewer can control the interaction.

2. By observing the patient’s nonverbal behavior, the interviewer can try to detect areas of resistance. In that sense, the validity of the information may be enhanced.

3. An interview can provide a lot of information in a short period of time.

Assessing Psychological Systems

Limitations of the Clinical Interview as an Assessment Tool:

1. Some patients may be unable or unwilling to provide a rational account of their problems.

2. People may be reluctant to admit experiences that are embarrassing or frightening.

3. Subjective factors play an important role in the interpretation of information provided in an interview.

Assessing Psychological Systems

Observational Procedures

• Observational skills play an important part in most assessment procedures.

Assessing Psychological SystemsObservational Procedures (continued)

• Observational procedures may be either informal or formal.

• Informal observations are primarily qualitative. • The clinician observes the person’s behavior and the

environment in which it occurs without attempting to record the frequency or intensity of specific responses.

• Although observations are often conducted in the natural environment, there are times when it is useful to observe the person’s behavior in a situation that the psychologist can arrange and control.

Assessing Psychological Systems

Rating Scales

• A rating scale is a procedure in which the observer is asked to make judgments that place the person somewhere along a dimension.

Assessing Psychological Systems

Behavioral Coding Systems

• Rather than making judgments about where the person falls on a particular dimension, behavioral coding systems focus on the frequency of specific behavioral events.

• Some adult clients are able to make records and keep track of their own behavior—a procedure known as self-monitoring.

Assessing Psychological SystemsPersonality Tests and Self-Report Inventories

• Because of their structure, personality inventories are sometimes referred to as “objective tests.”

• They consist of a series of straightforward statements; the person being tested is typically required to indicate whether each statement is true or false in relation to himself or herself.

• Some personality inventories are designed to identify personality traits in a normal population, and others focus more specifically on psychological problems.

Assessing Psychological Systems

Personality Tests and Self-Report Inventories (continued)

• The most extensively used personality Inventory is the Minnesota Multiphasic Personality Inventory (MMPI).

• The inventory was revised several years ago, and it is currently known as the MMPI-2.

• The MMPI-2 is based on a series of more than 500 statements that cover topics ranging from physical complaints and psychological states to occupational preferences and social attitudes.

Assessing Psychological Systems

Advantages of MMPI-2

1. The MMPI-2 provides information about the person’s test-taking attitude, which alerts the clinician to the possibility that clients are careless, defensive, or exaggerating their problems.

2. The MMPI-2 covers a wide range of problems in a direct and efficient manner.

Assessing Psychological Systems

Advantages of MMPI-2 (continued)

3. Because the MMPI-2 is scored objectively, the initial description of the person’s adjustment is not influenced by the clinician’s subjective impression of the client.

4. The MMPI-2 can be interpreted in an actuarial fashion, using extensive banks of information regarding people who respond to items in a particular way.

Assessing Psychological Systems

Limitations of MMPI-2

1. The test is not particularly sensitive to certain forms of psychopathology, especially those that have been added with the publication of DSM-III and DSM-IV-TR.

2. The test depends on the person’s ability to read and respond to written statements.

3. Some studies have found that profile types are not stable over time.

Assessing Psychological Systems

Other Self-Report Inventories

• Many other questionnaires and checklists have been developed to collect information about adjustment problems, including subjective mood states such as depression and anxiety, patterns of obsessive thinking, and attitudes about drinking alcohol, eating, and sexual behavior.

• The format of most self-report inventories is similar to that employed with objective personality tests like the MMPI-2.

• The primary difference is the range of topics covered by the instrument.

Assessing Psychological Systems

Other Self-Report Inventories (continued)

• Self-report inventories usually don’t include validity scales, and they may not be standardized on large samples of normal subjects prior to their use in a clinical setting.

• Self-report inventories can lead to serious problems if they are used carelessly.

Assessing Psychological Systems

Projective Personality Tests

• In projective tests, the person is presented with a series of ambiguous stimuli.

• The best known projective test, introduced in 1921 by Hermann Rorschach, a Swiss psychiatrist, is based on the use of inkblots.

• Projective techniques such as the Rorschach test were originally based on psychodynamic assumptions about the nature of personality and psychopathology.

Assessing Psychological Systems

Projective Personality Tests (continued)

• Considerable emphasis was placed on the importance of unconscious motivations —conflicts and impulses of which the person is largely unaware.

Assessing Psychological Systems

Projective Personality Tests (continued)

• The Thematic Apperception Test (TAT) consists of a series of drawings that depict human figures in various ambiguous situations.

• The person is asked to describe the identities of the people in the cards and to make up a story about what is happening.

Assessing Psychological Systems

Advantages of Projective Tests

1. Some people may feel more comfortable talking in an unstructured situation than they would if they were required to participate in a structured interview or to complete the lengthy MMPI.

2. Projective tests can provide an interesting source of information regarding the person’s unique view of the world, and they can be a useful supplement to information obtained with other assessment tools.

Assessing Psychological Systems

Limitations of Projective Tests

1. Lack of standardization in administration and scoring is a serious problem.

2. Some projective procedures, such as the Rorschach, can be very time-consuming.

Assessing Biological Systems

Psychophysiological Assessment

• The autonomic nervous system is highly reactive to environmental events and can provide useful information about a person’s internal states, such as emotion.

• Recording procedures have been developed to measure variables such as respiration rate and heart rate.

Assessing Biological Systems

Psychophysiological Assessment (continued)

• If several physiological responses are measured at the same time, they may not all demonstrate the same strength, or even direction, of response.

• Moreover, physiological measures frequently disagree with the person’s own subjective report.

• Therefore, as with other assessment procedures, physiological recordings should be used in conjunction with other measures.

Assessing Biological Systems

Advantages of Physiological Procedures

Psychophysiological recording procedures do not depend on self-report and, therefore, may be less subject to voluntary control.

Assessing Biological Systems

Limitations of Physiological Procedures

1. The recording equipment and electrodes may be frightening or intimidating to some people.

2. There are generally low correlations between different autonomic response systems.

3. Physiological reactivity and the stability of physiological response systems vary from person to person.

4. Physiological responses can be influenced by many other factors.

Assessing Biological Systems

Brain Imaging Techniques

• Precise measures of brain structure can be obtained with magnetic resonance imaging (MRI).

• In MRI, images are generated using a strong magnetic field rather than X rays.

• Positron emission tomography (PET) is one scanning technique that can be used to create functional brain images.

• This procedure is much more expensive than the other imaging techniques because it requires a nuclear cyclotron to produce special radioactive elements.

Assessing Biological Systems

Brain Imaging Techniques (continued)

• The newest and most exciting method of imaging brain functions involves functional MRI (fMRI).

• In fMRI, a series of images is acquired in rapid succession.