1
Q
What are the three components of Psychological Assessment?
A
1) diagnosis
2 case formulation
3) treatment planning and monitoring
2
Q
What is diagnosis ?
A
creating a specialized treatment?
3
Q
what is case formulation ?
What goes into treatment planning an monitoring?
A
holistic, devleopmental, and cultural context
planning and prognosis
–> monitoring treatments
4
Q
what are some other goals alongside psychological assessment of this course?
A
- Understand then for psychological intervention
- ensuring that treatments are EFFECTIVE and COST EFFECTIVE.
-providing an ETHICAL SERVICE DELIVERY
5
Q
define clinical psychology
A
the application of psychological knowledge to alleviate distress and promote wellbeing
6
Q
what activities are included in clinical psychology?
A
- assessment
- diagnosis
- consultation
-treatment
-evalutaion
-research
-teaching
7
Q
what is the ethicical principles of clinical psych?
A
- respect for dignity of persons
1) bodily autonomy, respecting boundaries. (most important) - responsible caring
2) ensuring that we maximize benefit and minimize harm - integrity in relationships::
3) demonstrating integrity in relationships with clients, colleagues and the profession in general - responsibility to society
4) balancing responsibility between individuals and society.
8
Q
A
9
Q
What is evidence based practice?
A
- originally developed within medicine
- includes mental and behavioural heath care, social work, education, and criminal justice..
a) requires the clinician to synthesize information from research and systematically collect data on patients in question
b) emphasizes the importance of informing patients based on the best research evidence, about viable options for assessment, preveiuon or other intervention services.
++ the clinicians professional experience and patients preferences
10
Q
what are the problems with evidence based practice in psychology??
A
- group based data not applicable to individuals..
- clients cannot wait for the best research
–> file drawer problem
11
Q
what is the file drawer problem?
A
when research does not produce significant results they get pushed to the side, and typically not published… its important to acknowledge failures too.
12
Q
how many people have mental disorders worldwide?
A
450,000,000
13
Q
about half of all mental disorders begin before the age of ____
A
14
14
Q
do mental disorders increase the risk for physical disorders?
A
yes
15
Q
do health conditions increase the risk for mental disorders?
A
YES
16
Q
what is the cost of mental health in Canada per year?
A
63 billion
17
Q
Who can the origins of biopsychosocial psych be traced back too?
what else was he famous for?
A
Hippocrates
“father of modern medicine”
+ colour of bile theory
18
Q
what is the biopsychosocial approach?
A
a theoretical framework that takes into account biological, psychological, and social influences on health and illness
19
Q
What are some lifestyle factors that impact mental health?
A
- chronic stress
- Lower SES
- Diet, sleep, exorcise
- Disability
20
Q
What mental health career would most likely assess how psychology can either increase or decrease health and wellbeing
A
health psychology
21
Q
What mental health career would most likely work with prisons / offenders who have a similar pattern of offence?
A
forensic psychology
22
Q
What mental health career would most likely study specialize on things like dementia or strokes?
A
clinical neuropsychology
23
Q
What mental health career would CANT make diagnosis outside of the realm of learning disorders?
A
School psychologists
24
Q
What mental health career do you have to become a doctor first?
A
psychiatry
25
What mental health career would most likely work in places like the emergency department and mostly encounter things like suicidal ideation / panic attack / OD
psychiatric nurse
26
What mental health career can also do a degree specializing in clinical?
social work
27
What mental health career is sort of a catch all term (/Unregulated term) that deals with subthrehold individuals and day to day difficulties ?
counsellors
28
define: syndrome
a group of symptoms that frequently co-occur
29
Before Hippocrates, what did people think caused mental health problems? / what was the treatment
DEMONS.
- blood letting
- being chained over a pit of snakes
- exorcisms
30
Clinical utility & service evaluation are 2 problems clinical psych is starting to address
define: clinical utility
usefulness of assessment data to provide information that leads to a clinical outcome that is better (or faster or less expensive) than would be the case if the psychologist didnt have the assessment data
if the data leads to better treatment
31
Clinical utility & service evaluation are 2 problems clinical psych is starting to address
Define: service evaluation
activities designed to examine whether or not services work.
32
When in history did therapy and the scientific method begin to emerge??
Enlightenment period!
started to treat people humanly and with compassion
33
Why is European psychiatry important?
( freud / Charcot)
they started the movement that the mind is really powerful.
psychotherapy is typically seen as beginning with them.
34
define: efficacy
evidence that a treatment has been shown to work under research conditions that emphasized internal validity
35
define: effectivness
evidence that a treatment has been shown to work in real world conditions
36
define: effectiveness
evidence that a treatment has been shown to work in real world conditions
37
what does clinical psychology have in common with other mental health professions?
focuses on assessment and intervention in the prevention and treatment of emotional / behavioural and neurological problems.
38
History:
who conceptualized mental disorders and diagnostic systems?
Kraepelin
- devoted his career to create scientifically based classification system in response to the primitive treatment methods in the 1800s
- coined the term syndromes (groups of symptoms that co-occur)
- classified schizophrenia (one of his major accomplishments)
- structure of DSM is because of his work
39
History:
Who emphasized intelligence's importance in the devlopment of clinical psych?
--> wanted all children to maximize their potential to learn and grow
Binet
- wanted children with limited cognitive abilities to receive best education possible
- wanted to find a way to be able to identify the group of children with limited intelligence
- Binet-Simon scale of intelligence / 50 test of mental skills, between ages of 3-13
- scientifically based test for human intelligence
40
History:
Who developed tests to evaluate personality?
Rorschach
- based on self-description
- a persons reaction to a stimuli shows their personality characteristics
- inkblot test [a projective test]
41
What are the three ways that we assess mental health disorders?
1) data from mutliple sources / methods
2) should use measures that have scientific support
3) assessment should drive treatment / recommendations
42
What are the three waves of devleopment of various theoretical orientation?
1) psychoanalysis
- Freud / jung / Adler
2) behaviourism
- John Watson / little Albert
3) humanistic
- carl rogers
(pscho behaviour is human)
43
Who critiqued the effectiveness of psychotherapy, and thus highlighted the importance in researching / evaluating therapy outcomes?
Hans Eysenck
44
what is an example of evidence based treatments?
when meta-analysis was created, it was found that psychotherapy was super effective (80%) of people improved compared to a group that didn't have treatment
45
what yields long term benefits of enhancing wellbeing and reducing problems?
prevention
46
how does prevention work?
preventing physical and mental problems by reducing risk factors and enhancing protective factors
47
What does assessment involve?
- evaluating the psychological functioning of an individual or a realationship. (couple / parent / ect)
- evaluating whether behaviour problems are serious enough for intervention (specialzed programs).
- intensity / frequency / duration of certain behaviours.
- plays an important role in the planning / monitoring and evaluation of intervention
- formulating diagnosis
** assessment can be done though lots of methods such as: interviews, self report measures, observations, performance on taks, and reports from informants**
48
What does intervention involve?
- psychotherapy
- talk therapy
- 40% of profession goes into intervention
- CBT
49
define: clinical consultation
the provision of information, advice, and recommendations about how to best assess, understand or treat a client
50
define: organizational consultation:
services to an organization focused on devloping a prevention or intervention program, evaluating how well an oranization is doing in providing a health care or related service, or providing an opinion on policies on health care services set by an organization
51
What is therapy?
evidence based treatment backed by science to treat clinically significant disorders
52
what is counsoling?
more for life changes or sub threshold problems
53
What are dead persons goals (lol)
goals we can only achieve when we are dead
- no more anxiety
- they are unrealistic and not ethical to pursue with a client
54
Why do many clients only attend a few sessions?
- effective treatment should be time limited
- long term therapy is not the goal
- get people out and make them believe they CAN be healded
55
What are the PROS of clinical psychologist not prescribing medication?
- easier on psychologist
- brain behaviour links
- could be as competent as other healthcare providers
- offer comprehensive service es
- remote or underserved areas
56
What are the CONS of clinical psychologist not prescribing medication?
- may lead to greater prescribing as it is quicker in the short term
- not sole focused on psychological interventions
- extend training or drop something else?
57
What should psychologists know about drugs? (even if they aren't prescribing)
- classes of drugs for different problems
- efficacy of drugs and of drugs in combination with psychological treatment
- how a drug is started or stopped
- side effects
58
why is staying healthy important for clinical psychologists??
- you become a container for clients to dump
- not immune to stress
- exposed to suffering and stressors
- ethical responsibility to ensure own issues do not interfere with client
(how are clients impacting you, need to be self aware and reflective)
59
what are 4 ways that you can stay healthy as a clinical psychologist?
Balance
Priorities
Consultation - advice or guidance / with colleagues
Time management - boundaries
60
what is the most popular fiend of psychology?
clinical
61
what are the two pillars of clinical psychology?
science and ethics
62
define: informed consent
an ethical principle to ensure ht person who is offerenced services or who participates in research what is being done and agrees to particpate
63
define: scientist-practioner model
a training model that emphasizes competencies in both research and provision of psychological services
- * most common *
- balance of science and practice
- boulder model
phd
64
what is the clinical scientist model?
a training model that strongly promotes the development of research skills
strongest focused on the development of research
clinical research
phd
65
what is the practitioner-scholar model?
training models hat emphasizes clinical skills and competencies as a research consumer
"research consumer"
clinical
INTERVENTION + assessment
psy.d
66
define: accreditation
a process designed to ensure that training programs maintain standards that meet the professions's expectations for the education of clinical psychologists
--> an accredited university program.. not all of them are.
- regulatory bodies (CPA)
- met standards
- protects public...
affects students
- same standard of knowledge
- highest standard of training available by clinical psychology
*** UBC has an accredited Counceling program***
67
define: licensure
regulation to ensure minimal requirement for academic and clinical training are met and that practitioners provide ethical and competent services; regulation of the profession helps to ensure the public is protected when receiving services
Involves:
- continued education
- annual fee
- jurisprudence exam
- degree
- supervised practice
- EPPP ( exam for professional practice in psychology)
68
What is validity?
does the classification scheme capture the nature of the entity?
does this effectively or accurately capture what an anxiety disorder is?
(want to make sure the description captures anxiety and not something like depression)
69
define: utility (again?)
how useful is the classification system
does the classification system actually help us treat people?
70
what is a categorical approach to classification
an entity is determined to be either a member of a category or not.
qualitative difference between members and non-members..
red or green
dead or alive
MDD or not.
71
what is a dimensional approach to classification?
classified entities differ in the extent to which they possess certain characteristics or properties.
arranged on a continuum
e.g., weight, height, neuroticism, autism, depression, body dysmorphia
--> anything that has a severity specifier
72
what is the purpose of a classification system?
- concisely, briefly, communicate to others a set of symptoms that would otherwise take a along time to describe if we didn't have a pre-understanding of it.
- common language: allows us to communicate with other health professionals without having to describe a whole set of symptoms
- ethology: indicate the causes of condition
- prognosis: how the disorder could develop
- comorbidity: co-existing problems
- reflects best current scientific knowledge
- informs treatment (evidence based)
- key term for further research
- framework for reimbursement or eligibility to special programs
73
define: diagnostic system
a classificaition based on rules used to organize and understand diseases and disorders
74
define: prototype model
members of a diagnostic category may differ in the degree to which they represent the concepts underlying the category
e.g., dogs are more prototypic of the category "mammal" than platypuses.
- not all people receiving the same prognosis will have the same symptoms.
75
what is: the result of applying the decision-making rules of a diagnostic system to the symptoms of a specific individual?
diagnosis lol
76
how do you determine if a behaviour is normal or abnormal?
- requires evaluation of culture and context (biggest thing)
- developmental milestones
- when it causes distress, disfunction
- societal norms
77
define: developmental psychopathology
a framework for understanding problem behaviour in relation to the milestones that are specific to each stage of life
78
how does the definition of a mental disorder differ from the diagnosis of a physical disorder??
physical disorder
- cluster of symptoms that cause disress
- clear etiological path
- confirmed by marker identification in X ray, lab test, scan..
Mental disorder
- self reported clusters of symptoms
- ethology Is less clear
- no clear typical markers.
79
how do you define a disorder?
clinically significant disturbance in an individuals cognition, emotional regulation or behaviour that reflects a disfunction in psychological, biological or developmental processies underlying mental functioning
80
define: harmful dysfunction
the behaviours associated with a mental disorder are dysfunctional, and the dysfunction causes hard to the individual to to those around them.
81
define: dyscontrol
the impairment resulting form a disorder must be involuntary or not readily controlled
82
what explores the individual differences in the emergence of psyholigal disorders?
etiological research
83
will a diagnosis be made if it doesn't cause clinically signifiant distress?
nope
if it doesn't cause impairment to distress probably won't get a diagnosis
84
what does the research on vulnerability to mental disorders show??
biological vulnerability --> exposure to stressor --> absence of or disruption of protective factors
Biological vulnerability = genetics, DNA, personality traits.
- High genetic loading (passed down through families [e.g., bipolar])
Exposure to stressors = ACE's (adverse childhood events)
- abuse, neglect, disruption of stability, illness, death
85
what does graduate training in clinical psychology involve?
coursework, supervised practicum, doctoral dissertation and a full time internship
86
Describe the first edition of the DSM
128 diagnosis - 132 pages... cost $3
created post world war 2 in 1952
psychodynamic in approach..
87
what were the main diagnosis of DSM-2 (1968)
- Schizophrenia (and its subtypes [catatonic, paranoid, ect]
- Mood disorders (depression, manic-depressive disorder)
- Neurosis (Anxiety)
- Personality disorders
88
What were the biggest changes from DSM 1 to DSM2?
- switched from psychoanalysis to biology
- psychopharmacology (brain involved in mental illness) [spyhalis was a big indicator of this]
-development of more humane treatments.
89
What was the biggest change in DSM-3?
replace psychoanalytical diagnosis and atheoretical
(theoretical means the understanding of mental illness is not being driven like theory like psychoanalytic and being driven by evidence and research instead.
90
What did Feigner contribute to DSM-3?
created diagnostic criteria!
- more objective way to diagnose..
- looked at clinically significant symptoms and then using them as a threshold to meet sets of symptoms in a disorder.
- Feigner criteria: Criterion A, B, C, D
- Made DSM much more consensus based and theoretical
91
What new diagnosis were added to DSM3?
- ADD (adhd), PTSD, new anxiety disorders
92
Changes between DSM3 and DSM3-R are pretty substantial.. what were they :)
- 228 disorders --> 253 in text revision
- 174 were defined using feigner criteria
- Addition of sleep disorders
93
What were some of the highlighted differences in DSM4?
- 383 categories (886 pages); 201 categories defined using diagnostic criteria
- 17 categories that needed further study
- added global assessment of Relational Functioning Scale, and a Social and occupational functioning assessment scale
- 3 scales added to the DSM4
- not used anymore but important to know about.
94
is the DSM5 based on a categorical approach to classification?
yaaaaaa
95
Tell me a little about the DSM-5
- development began in 1999, published in 2013
- 541 diagnostic categories, 947 pages.. 199$$
- cultural and gender specific information was added, updated many diagnoses...
- Hoarding disorder wad added under OCD
96
Who critiqued DSM-5 for pathologizing what is otherwise normal human behaviour
++ critical of big pharmas involvement
and wrote a book called saving normal?
Allan Frances
97
Biggest changes in DSM-5-TR?
- organized in a lifespan perspective
- includes prevalence, comorbidity, course, ect.
- base rates (how often a diagnosis occurs in a population)
-cuture and gender specific information
-put in codes for disorders that are used in ICD
98
Tell me about the ICD
- published by World Health Organization
- sometimes can better account for someone's symptoms.. includes things like C-PTSD, instead of just ptsd.
- covers ALL health issues (mental / physical)
- FREE online.
- used to assess prevalence.
99
How do psychologists stay current?
- conferences
- editor in a journal
- peer review
100
what is the POLYTHETIC nature of disorders?
- people with the same diagnosis may show it in different ways
- fuels inadequate diagnostic reliability
101
why are are disorders polythetic?
- gender differences
- people can have differences symptoms (Criteria A, B, and then one of C or D)
- so looks different between peopl
102
What are challenges in diagnosis?
- keeping up with science
- medicalization in ordinary life
- inadequate diagnostic reliability
- polytheistic nature of disorders
- comorbidity
103
define: comorbidity
when a person receives a diagnosis for two or more disorders at the same point in time
104
diagnosis of a mental disorder requires not h only that behaviours are abnormal but also that they cause harm to the individual and are outside of the individuals control.
fun fact
105
What is prevention designed to do?
prevent a problem before they start!
+
trying to keep an unhealthy behaviour from developing.
106
What is health promotion!!?
designed to increase activities or lifestyles that increase health :)
want to increase engaging in new activities or activities that will promote their health over time.
107
what are some general focuses of prevention?
- smoking
- drinking in excess
- unhealthy eating
108
why dont we do prevention more often
- effects occur over years, not immediately
- we have a reactive health care system opposed to preventative
109
what was the estimated cost of mental health disorders?
2.5 trillion dollars.. yeehaw
110
when is prevention the most successful?
early in life
111
what is a psychologists role in prevention programs?
consulting... help to develop the program not necessarily to develop it.
112
why is there generally a peer component to prevention programs?
information is better received when it comes from someone similar to you
113
why are children / adolescents the best target for prevention?
more time to develop healthy skills, more time to prevent disorders from developing
114
what are the tree main types of prevention? *****
universal
Selective
Indicated
115
what is universal prevention?
targets everyone
- everyone in a a certain population would receive the program or education..
- highly populated and widespread
- very few GOOD programs..
e.g., seatbelts / no indoor smoking / masks are an example of a great prevention programs
116
what are selective prevention programs?
provides prevention to AT RISK youth and targets specific features..
- may not have signs of a disorder but are at higher risk than the population
- develop coping skills and put in protective factors
e.g., kids who are at risk of dropping out of school
117
What is indicated prevention program?
most specific..
- targets people who are showing sub-clinical signs of some type of problem... e.g., showing sighs of early substance abuse.
- more intensive / frequent program is indicated for these people..
- efficacious, but less on longer term..
- inspired by motivational therapies.
118
what is internal validity?
the extent to which the interpretations drawn from the results of a study canoe justified and alternative interpretations can be reasonably ruled out
119
what is external validity?
the extent to which the interpretations drawn from he results of a study can be GENERALIZED beyond the narrow boundaries of the specific study.
120
what is statistical conlsuysion validity?
the extent to which the results of a study are accurate and valid based on the type of statical procedures USED in the research
121
what is the risk reduction model?
attempts to understand the risk factors within the individual, but also looks at things in the environment (life / context) that puts them iat a higher risk, and what we can do to reduce that risk
122
Risk reduction model
What are individual factors?
genetics, physical problems, temparment, prenatal environment, intergenerational trauma.
123
Risk reduction model,
What are risk factors in the school / work context?
toxic environment, bullying, how much time you have to dedicate to work, falling behind
124
Risk reduction model,
What are risk factors in family / social context
divorce, separation of families, hisory of physical or mental illness within family memebers, modelling from parents, parenting styles, peer influences, lack of social support.
125
Risk reduction model,
What are risk factors that involve life events and situations and community and cultural factors?
stigma associated with mental health, low SES, immigration
126
define: protective factors
- prevents the development or worsening of some type of disorder / problem
- buffer between stress and the negative outcome
- e.g., support systems, close family relationships, stable home, medical access, financial security, education, food security, exercising, adequate sleep..
127
how do we evaluate the effectivness of prevention?
*** looking at Incident Rates, or Number Needed To Treat (NNT) *****
incident rates = did less go on to develop the program over time compared to those who didnt get the program?
NNT = how many needed to be given the program to prevent one adverse outcome?
e.g., 5:1
128
define: community psychology
a branch of psychology that focuses on research and practice on the reciprocal relations between the individual and the community in which they live
129
what is the risk reduction model?
an approach to prevention that reduces risks and promotes protective factors
130
what are two programs that promote evidence based parenting?
home visiting programs (for single, teenage moms)
incredible years
(for parents who have children with conduct problems)
131
What is Owlets?
prevention of violence program
Norway
training teachers on how to respond to instances of bullying
132
what its he fast track program?
identified kindergarten kids who are at risk for being bullies, bring in social skills and emotional regulation techiques..
super effective, still has positive effects in grade 8
133
what is the most effective way to reduce violence for kids?
get parents involved in a prevention curriculum
134
What is the difference between internalizing and externalizing behaviours?
internalizing = depression / anxiety / low mood
externalizing = acting out / being agressive
135
why do we want to prevent internalizing a disorder?
the longer someone experiences a disorder the more issues they will have / the harder time they will have coping across time
136
what is a program that helps to stop internalizing anxiety disorders for kids?
coping koalas program..
50% reduction in incidences of anxiety disorders after 10 group sessions and 3 parent sessions.
- coping strategies which help prevent pathologizing
- transfer of skills / development of skills to manage anxiety
- being in a group of people who experience the same thing is super helpful.
137
what type of programs show to be the most effective in preventing the internalization of depression?
universal, selected, indicated?
selective / indicated are somewhat helpful.
NNT: 22:1
universal programs dont show alot of positive effects.
138
what are some ways that universal prevention programs help with substance use?
- smokin gbans
- not being able to drink in certain spaces
139
what happens if prevention becomes too restrictive with substances?
- prohibition
- unregulated substance use
- withdrawal / death
- unwanted side effects like blindness
- negative effects
140
what is a good example of a prevention program for substance use (what kind of skills)
- enhancing generic skills, drug refusal skills, reducing biased drinking norms,
141
what components do the most successful prevention programs have? x5
1) evidence based
- designed to target known risk and protective factors in the development of psychopathology
2) promoting principles like adult-child relationships,
- allow children opportunity to be rewarded for appropriate behaviour
- mild corrective feedback for innnapropriate beahvouir.
- facilitate development of social networks
3) programs are usually multifaceted involving components that operate at levels of individual, family, school, community, or legal systems. (allows the same message to be conveyed across different situations)
4) developed as an expansion of an efficacious treatment that was modified to fit people with subclinical issues.
5) offered in a convenient context. (minimizes obsticals by participants
142
was critical incident distress debriefing a successful prevention program related to loss and trauma?
why / why not
not really,
can be really harmful to make people talk about a trauma right after it happened..
comparing your traumatic experience to someone else's isn't necessary
want people to access support for trauma when they are ready for it
143
Was DARE effective?
lol no
144
Clinical Psych
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