Introduction to Clinical Assessment Flashcards Preview

PSY4406 Psychological Assessment and Intervention > Introduction to Clinical Assessment > Flashcards

Flashcards in Introduction to Clinical Assessment Deck (15):
1

In what ways can psychological assessment inform intervention and treatment planning?

  • Allowing the psychologist to identify and prioritise client needs
  • Identifing client characteristics that may help or hinder treatment outcomes
  • Considering treatment and referral options incl service matching, monitoring change
  • Predicting prognosis and treatment outcomes
  • NB: Assessment and intervention are integrated and inform each other throughout the treatment process

2

According the the NHMRC guidelines, what are the levels of quality of research findings?

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3

What factors are important to consider when interpreting the APS Literature review of evidence based treatment?

  • Level, Relevance and Strength of evidence
    • Level = See table of level of evidence (RCT vs Case study etc)
    • Relevance = extent to which findings can be applied to different settings
    • Strength = Size of treatment effect
  • Some interventions are not supported due to limited research rather than ineffective findings 
  • The best practice is for psychologists to use evidence based treatments combined with situational other factors to identify treatment efficacy

4

What are some of the evidence findings in the APS literature review?

  • Emotional Disorders
    • Depression: Level 1; CBT, Interpersonal, Brief Psychodynamic and Self Help. Level 2; Solution based, Dialectical Behaviour, Emotion focused. 
    • Bipolar: Level 2; CBT, Interpersonal, family, mindfullness, psychoeducation
  • Anxiety Disorders
    • GAD: Level 1 CBT, Level 2 psychodynamic. Level 3 mindfullness
    • Social: Level 1 CBT, Level 2 self help and psychodynamic
  • BPD; Level 1 DBT, Level 2 Schema and psychodynamic
  • Anorexia: Level 2 family therapy and psychodynamic

5

What are some of the limitations of RCTs? What are the arguments against the assumption of specific effects?

  • Lack of external validity: The real world is never as controlled as the trial
  • The concept of the placebo: RCTs are based on a medical model.
    • In psychotherapy everyone knows which treatment is being delivered - there is no true placebo
  • The Assumption of Specific Effects: assumption that each therapy has unique active ingredients. 3 Arguments against this:
    • The dodo bird verdict:  all psychotherapies have very similar, robust success (dodo from Alice in Wonderland - "you are all winners")
      • has been found in many experiments
    • Component Studies: Break down therapies into components (often compounding eg full CBT or parts). Studies find no major differences.
    • Estimates regarding effect of specific techniques on outcome: most estimates are that model/technique factors account for 15% of outcome varience.
  • Bias in experiments:  unfair comparisons and loyalty

6

What are some alternatives to RCTs that can be used to complement them?

  • Effectiveness Studies: Evaluate treatment outcomes in naturalistic settings and provide better generalisability.
  • Process Research: breaks down the factors of a treatment to determine the why and how it is effective. This facilitates a deeper understanding of the therapy in clinical settings
    • responsive to context and complex factors of theraputic alliance
  • Single subject research: addresses threats to internal and external validity. 
    • Can be used where RCT cannot eg smaller population sizes
  • Case Studies; add richness to other data by looking at very specific contexts

7

What are the differences between evidence based treatment and evidence based practice?

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8

What are the the common factors in the outcomes of psychotherapy?

There are five common factors in psychotherapy:

  • The client/extratheraputic: accounts for 87% of varience
    • The client is the agent of change
  • Therapist effects: 6-9% overall (49-69% of treatment effect) variance
    • Most of this is due to overlap with the alliance
  • The Theraputic Alliance: 5-7% (38-54% treatment) varience
  • Model Technique (delivered): belief in treatment 
    • Model alone: 1% (8% treatment effect)
    • Model delivered (including allegence and expectancy) 30% up of treatment effects
  • Feedback effect: 15-30% of treatment effects

9

What are the problems with manuals and diagnosis?

  • Diagnosis
    • DSM lacks internal reliability ( a lot)
    • There is no 'baseline' normal model of mental health
    • Diagnosis provides little information that effects treatment 
  • Manualisation
    • High adherance to manuals is inversely correlated with theraputic alliance and interpersonal skills
    • Manuals depend on specific effects (which are not well suported)

10

What is Behavioural Assessment? What are some of the core assumptions?

  • ABC model of behavioural assessment: direct investigation of problematic behaviour by examining antecedents and consequences
    • Antecedent (what happened prior) Behaviour (of concern) Consequences
  • Behaviours follow the principles of conditioning (operant and classical)
    • eg punishment, extinction, positive and negative reinforcement
  •  Behaviour can be overt (actions) or covert (thoughts) but both are:
    • directly or indirectly observable and measureable
    • influenced by behavioural modification
    • reflective of the context or environment  

11

How should target behaviours be identified and defined?

  • Target behaviours must be observable or measureable. Complex behaviours should be partitioned into modes (affective, motor, cognitive) 
  • Consider:
    • Will the behaviour be reinforced after treatment?
    • Is the behaviour age appropriate?
    • What might replace the behaviour? (eg self harm and distress tolerance)
    • Is the behaviour related to another problem? 
  • Use operational definitions of the behaviour; state exactly what is done
    • Be objective and unambiguous, minimise inferences and avoid labels such as "tantrum" or "being a bad sport"
  • Assess related factors - ABC Approach. Emotional cognitive physical and environmental factors and consequences. 

12

What six factors need to be considered when observing behavior?

  1. Topography: the specific moves involved in making the response.
    • Pictures are often useful for this eg height of arm raised. 
  2. Amount of behaviour
    • Frequency of behaviour in given time: measured using frequency or cumulative graphs (when comparing  2+ behaviours or when changes are small)
    • Relative Duration of behaviour: ie minutes in an hour 
  3. Intensity of behaviour: ususally measured with an instrument ie voice meter
  4. Stimulous Control; degree of corrolation between behaviour and response
    • eg ABLA tests response to instruction (verbal, imitation etc)
  5. Latency; time between stimulus and response 
  6. Quality of behaviour: A refinement of one or more of the above factors depending on target behaviours

13

What are some examples of behavioural techniques?

  • Behavioural Modification: increasing or decreasing behaviour based on learning principles (particularly operant conditioning)
    • Relies on a highly controlled environment to avoid conflicting reinforcement
    • Adapted to "behavioural self control" to preserve a collaborative relationship with the therapist
    • Differential reinforcement: a process where one behaviour is reinforced while an alternate (DRA) or incompatible (DRI) behaviour is simultaneously put on extinction
      • Used with autistic children. NB Avoid punishment
  • Systematic Desentisation: based on classical conditioning and generalisation principles, but also operative (avoidance behaviour)
    • The client is re-exposed to conditioned stimuli without the fear inducing elements. 

14

What is the Cognitive model in CBT?

  • Dr Beck identified common thoughts in depressed patients which when addressed helped overcome depression. 
  • The central premise of the cognitive model is that conscious thoughts, beliefs and assumptions are central to the development of of common disorders such as anxiety and depression
  • The cognitive model says responses are mediated by perception of events which are distorted when individuals are distressed
  • Situations lead to automatic thoughts which lead to emotional behavioural and physiological reactions. 

15

What are the central principles of CBT?

  • Case formulation: With the patient, problematic situations and feelings are understood in terms of thoughts. FActors that may have precipitated the problem are sometimes considered too
  • Non Interpretive stance: therapist does not interpret or offer alternative meanings and advice directly
  • Collaborative approach: clients offer input and ideally lead the process
  • Socratic questioning: therapist takes a curious stance rather than a challenging one
  • Empiricism: each intervention is treated as an experiment with hypothesis and new data
  • Explicit and specific: qualitative measures are used to guage process
  • Role of self practice: homework is central
  • Goal oriented and problem focused: client identifies goals to work toward
  • Structured, time-limited approach: maximise efficiency and effectiveness
  • Flexible, client centred approach: integrate other therapies if needed