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diagnosis of PDs using the five factor model
- Widiger, Costa, McCrae (2002)
- 1. obtain hierarchical and multifactorial description of an individual's general personality functioning, providing a reasonably compresensive description of person's adaptive and maladaptive traits.
- 2. identify social and occupational impairments and distress associated w/ personality traits
- 3. determine whether dysfunction and distress reach a clinically significant level of impairment
- 4. quantitative matching of the individual's personality profile to prototypic profiles of diagnostic constructs (assignment of diagnostic label for clinical utility).
frequent use of the NOS category means that existing categories lack clinical utility. REF
Clark et al. 1995
who talks about taxometric procedures to look at categorical vs dimensional?
Kessler's (2002) proposed process to revise psychiatric classification
- Two steps:
- 1. If taxometric research supports a categorical model, the disorder's diagnostic criteria and prevalence are fixed in it's internal structure.
- 2. If a dimensional model is supported, analyses attempt to identify a diagnostic threshold by examining the association between the dimension and those external, clinically relevant outcomes.
- = BOTH categ and dimens. have a place in classification.
Follette & Houts (1996)
expansion of DSM is not indicative of scientific progress
- Harmful dysfunction
- 1. condition causes harm or deprivation of benefit to the person as judged by the standards of the person's culture (value component).
- 2. condition results from the inability of some mental mechanism to perfom its natural function wherein a "natural function" is an effect that is part of the evolutionary eplanation of the existence and structure of the mental mechanism.
- Hayes & Chang (2002)
- weakened psyc practice, strengthened med use
Ethics in the age of internet
- Ethics code distinguishes between our personal and private lives (this is murkey), but states "ethics code applies only to psychologists' activities that are part of their scientific, educational, or professional roles as psychologists...activities shall be distinguished from the purely private conduct of psychologists, which is not within the purview of the Ethics Code."
- internet makes info available to public what used to be private, so increased likelihood of affecting professional life.
- Not just clients but colleagues
- Do you live in a way so as to minimize potential prof problems in future, even though this might mean altering private life?
- death, wedding, accomplishment of relatives, more public b/c of internet.
- From the Monitor on Psychology
Goldfried and Wolfe (1998): the problem with random assignment in RCTs
- the heterogeneity within groups:
- ex: depression. One might say that some are depressed because of unreasonably self-critical view of selves whereas others are depressed because of interpersonal problems whereby depressed individuals unwittingly elicit negative responses by loved ones. If comparing efficacy of CBT and Interpersonal Therapy, random assignment undermines likelihood that one will prove more efficacious because some will be appropriately matched to tx and others will not.
Better proposed way to deal with heterogeneity within class and treatment?
- Norcross and Beutler 1997, match on:
- 1. patient expectancies
- 2. stage of change
- 3. patient's resistance potential
- 4. patient's personality and coping style
Leichsenring & Rabung 2008
- effectiveness of long-term psychodynamic tx:meta-analysis
- LTP significantly superior to short-term methods w/ regarad to overall outcome, target problems, and personality functioning.
Something to know about culture and treatment (collectivist cultures and depression?)
- Stewart et al, 2004
- support for the hypothesis that self-efficacy may be less salient in collective compared with individualistic cultures and this might extend cognitive theories of depression to non-western cultures where, in Hong Kong, depressive symptoms and hopelessness were higher and self-efficacy and neg congitive errors were lower than in the US
- no words which are not definable either explicitly or by reduction sentences in terms of the empirical variables; and the validity of empirical laws involving only observables constitute both the necessary and sufficient conditions for the validity of the laws involving intervening variables.
- Whereas hypothetical constructs cannot be reduced to empirical terms, must always be discussed in terms of lawful relationships between each other, and always include excess meaning. They cannot be directly observed.
Watson's quadripartite model 2009
- Based on principle that relevant symptoms can be classified along two quantitative dimensions such that are grouped according to MAGNITUDE OF GENERAL DISTRESS and LEVEL OF SPECIFICITY (depression vs anxiety)
- Specificity=whether a particular symptom is more strongly related to traditional indicators of anxiety or depression
Sue et al. 1999
- Believe that the APA is not immune from "ethnocentric monoculturalism" and enjoying the benefits of being in the majority, white.
- to be really culturally competent, must change education from learning about victims, to learning about how much you have benefitted by being white. "unintentional privileges of Whiteness"
institutions, traditions, beliefs, and values of a population
6 goals of a classification system
- 1. Nomenclature-description of people with similar symptoms
- 2. Information retrieval-understanding and collection of information
- 3. Description-same dx, same symptoms, patterns should be unique
- 4. Prediction-dx of px allows to predict things like course and best tx
- 5. Concecpt formation-hierarchical structure, biological approach to mental disorders, helps resolve cetegorical issues.
- 6. Sociopolitical-control over classification system affects research and funding.
personal or environmental factors that increase the likelihood of developing maladaptive patterns of behavior, and can predict onset of psychopathology. Markers for underlying mechanisims.
diverse pathways lead to same outcome
who supports the same idea that cog therapy is same as behavioral therapy (exposure)--just like Jacobson's dismantling study?
- Arntz, 2002
- CT vs interoceptive exposure as treatment of panic disorder without agoraphobia.
- cognitive and exposure approaches to panic disorder are equally effective
Patient variables and outcome?
- Patient variables have not shown a consisten, robust relationship to therapeutic outcomes
- Matching patients to specific TXs based on their attributes does not produce more robust treatment effects (e.g. Project MATCH Research Group, 1993, 1997)
Therapist allegiance and outcome?
- Allegiance is important predictor of positive outcome!
- review of treatment comparison studies by Luborsky et al. 1999-composite measure of allegiance explained 69% of variance in outcome.
- Reid 1997
- Jacobson and Truax (1991)
- Moving someone outside the range of dysfunctional population or into range of functional.
Kazdin and Nock 2003
Mechanisms are important to identify in psychotherapy outcome studies
Ethics: General Principles
- A. Beneficence and Nonmaleficence
- B. Fidelity and Responsibility
- C. Integrity
- D. Justice
- E. Respect for peoples' rights and dignity
Beneficence and nonmaleficence
do no harm
Fidelity and responsibility
B. Fidelity and Responsibility: trustworthy relationship, make sure others adhere to ethics code, probono work.
C. Integrity: promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology. Minimize harm.
D. Justice: all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.
Respect for peoples' rights and dignity
E. Respect for people's rights and dignity: respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination. Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making. Respect cultural differences.
What is important for researchers to do in treatment outcome studies?
We know that treatment is better than no treatment, placebo, tau. But there are issues with generalizability, clinical change, and cost. What we should be doing are replication studies. In these, we should be sure to use the same measures as other people to increase comparative value. Should collaborate w/ other clinicians, and address cost issues.
Problems with meta-analyses?
- File-drawer: studies are not published if they do not have significant results most of the time.
- Studies are not ranked by quality, they are usually ranked by size.
Another way that the internet has affected mental health:
- A term called "psychotainment": entertainment of psych disorders. May be sensationalizing, or making it easier for individuals to seek treatment.
- Untrained, or not well-trained individuals on television as therapists
- This is how public sees therapy
- Usually downplays treatment and is seen as quick fix
- Has to appeal to audience so therapist is in difficult place.
General SZ info
- 1% prevalence, same for both sexes, worldwide
- poor interpersonal function--worse in males.
- About 10% males are married and about 50% females (might be because of later age of onset and possible estrogen effect)
- Inability to identify emotions in themselves and others, in images
- Poor memory, poor attention
- Social Skills training--low generalizability
- Can't hold jobs-about 15% of them have jobs
- Med compliance issue--CT can help with med compliance and pill counting.
- Family therapy--EE is a relapse factor.
- schizotypic individuals carry gene for sz but not all phenotypic expression
- Symptoms such as eye tracking dysfunction, perceptual aberration.
- Higher rates of schizotypics in families of sz
SZ neurodevelopmental origins
- Hippocampus, frontal lobe, basal ganglia, ventricular enlargement. Irregular pruning.
- Attentional problems, learning, memory, information processing, intelligence, cognitive deficits.
- Motor delays, interpersonal problems.
- 2nd trimester influenza, birth complications.
computerized assessments, pros and cons
- pros: 100% reliability, faster administration and scoring, most cost effective, less error in data entry, less problems with interaction with administrator and test taker (decreases in administrator bias)--except you have to also think about different diagnoses and the more paranoid folk who wonder where info is going if on a computer.
- cons: barnum effect, some people have problems with computers, still need some clinical judgement, not entirely actuarial.
- Clinical vs. actuarial decision making
- actuarial: algorithms
- clinical: experience, memory, heuristics (remember all the biases that go into these things)
- Meta-analysis by Grove shows that actuarial judgments are superior or equivalent to clinical judgment but clinicians hesitate to use them.
- Representativeness heuristic: recognize one major symptom of a disorder and feel that this is the dx, fail to assess other sx.
- preconceptions: confirmation bias, low ses, must have low IQ, seek evidence to support our impressions
- Garb says: stay on top of research, use algorythms when you can, seek supervision, decrease reliance on memory, test alternatives and BE AWARE OF BASE RATES!
Knowles and Condon
- always testee and tester interaction
- item meaning/interpretation changes across context
- inter-rater: raters measure the same individual and correlate scores
- test-retest: same ind takes same test on multiple occasions and correlate scores
- alternate forms: test broken into parts and same individual takes both parts and correlate scores
- split half: test broken into parts and same individual takes both parts and correlate scores.
- Internal consistency: average intercorelations between items
- Attentuation problem: validity decreased if internal consistency really high when items overlap and are similar.
convergent vs discriminant validity
test is correlated with some theoretically related construct vs. test is poorly correlated with some theoretically unrelated construct.
predicting presence of disorder when it is really present
predicting absence of disorder when it is really not present
What is important to keep in mind when thinking about someone's culture as a mediator of pathology?
People belong to many cultures, do not pidgeon hole them to one (sex, age, religion) when they belong to many others (sex, age religion...)
Who talks about the importance of studying empirically supported relationships (ESRs) instead of ESTs?
- Messer, 2004
- look at common factors of all treatments, treatment alliance, collaboration, empathy.
Expectancies and Tx outcome
- Safren, Heimberg, & Juster (1997)
- CBT group tx for social phobia
- after pretreatment severity accounted for, expectancies significantly predicted improvement among treatment completers. (Expectancy ratings didn't differ between those who dropped out and those who did not).
Therapist Variables and outcome
- Crits-Cristoph et al. 1991
- Meta-analysis of variables
- Looked at: use of manual, level of experience, length of treatment, type of treatment (ct, bt, psychodynamic)
- 15 studies
- use of manual and more experienced therapists associated w/ small differences between threapists
- experience not a variable that incluences outcome.
Blashfield and Livesly
- Why a categorical system is necessary
- common language
- consistant w/ human thinking
- may be true underlying categories (taxon, meehl)