Testing in Health Psychology and Health Care

Question 1

Clinical Neuropsychology

Answer 1

This field is a scientific discipline that focuses on psychological impairments of the central nervous system and their remediation

defined as the scientific discipline that studies the relationship between behavior and brain functioning in the realms of cognitive, motor, sensory, and emotional functioning

Question 2

activities of neuropsychologists include:

Answer 2

identification, description, multivariate quantification, and treatment of diseases of the brain and spinal cord

Question 3

A multidisciplinary endeavor, clinical neuropsychology overlaps:

Answer 3

neurology, psychiatry, and psychometric testing in the following ways:

Neuropsychology and neurology both focus on sensations and perceptions and on motor movements

Neuropsychology and psychiatry both study mood and adaptations to psychosocial situations

Finally, neuropsychology and psychometrics both use psychological tests.

Neuropsychology differs from these other clinical disciplines because it is finely specialized, focusing on attention, memory, learning, language and communication, spatial integration, and cognitive flexibility

neuropsychology is a field of study that actively attempts to relate brain dysfunction and
damage to observable and measurable behavioral functioning

Question 4

The practice of clinical neuropsychology has benefited from remarkable advances in neuroimaging:

Why does neuroimaging not solve the field?

Answer 4

many people assumed that improvements in brain scanning would eliminate the need for clinical neuropsychology. If tumors can be easily detected with CT or magnetic resonance imaging (MRI), why would we need functional tasks to determine if there was a lesion in the brain? As the field of neuroimaging advanced, it became increasingly clear that behavior and functional assessments were important

One of the problems was that there is remarkable variability among people in the structure of their brains–remarkable variability from person to person in how their brains are structured and organized

identification of a lesion or tumor does not necessarily relate to functioning.

Similarly, people may have important functioning problems that are not clearly traced to specific regions of the brain. Neurologists now believe that performance on neuropsychological tests gives them clues about which part of the brain to examine

neuropsychology is able to detect problems that are often missed even with the latest neuroimaging devices.

Question 5

neuropsychological testing can detect…

Answer 5

EARLIEST STAGES - Alzheimer’s disease and other clinical problems in their earliest stages and tests are now used to detect a wide range of clinical problems

EFFECTS OF TBI - remains the primary method to diagnose the effects of minor traumatic injury

MEMORY - unclear how much we will ever be able to understand about human memory and thought on the basis of physiology alone.

MOTIVATION - Beyond physiologic findings, motivation or desire to perform well can profoundly affect performance

Question 6

The roots of clinical neuropsychology can be traced to studies by

Answer 6

The roots of clinical neuropsychology can be traced to studies by Pierre Broca and Carl Wernicke in the 19th century
—functions such as the recognition of speech were localized in the left hemisphere ofthe brain.

By the first decade of the 20th century, Brodmann had developed the first functional map of the cerebral cortex

Benton, Tuber, and Geschwind developed methods for associating function with different areas of the brain

Early neuropsychologists, including Luria and Reitan, used psychological tests to estimate areas of brain damage. - , major advances in brain imaging reduced the need for these types of services. MRI and CT scanning now allow clinicians to examine the brains of living people.

Question 7

. In 1970, neuropsychology was
viewed as a new field characterized by

Answer 7

In 1970, neuropsychology was viewed as a new field characterized by rapid growth

1970s and early 1980s, research in neuropsychology exploded, and a practice specialty rapidly developed.

Question 8

Using powerful measurement techniques, neuropsychologists have developed many procedures for:

Answer 8

identifying the relationship between brain
problems and behavioral problems

Question 9

Neuropsychologists are quite specialized.

Answer 9

Some focus on brain dysfunction in
children whereas others work with adults or older adults

Neuropsychologists focus mainly on brain dysfunction, but some are actively developing interventions for those who suffer brain injuries or related problems

also study how cognitive processes are affected by mental illness

as well as alcohol abuse

or serious diseases such as AIDS

Some neuropsychologists prefer to use batteries of psychological tests, whereas others prefer specific tasks derived from experimental psychology

Question 10

Neuropsychological assessment has been used to evaluate specific problems in memory.

Answer 10

memory is a heterogeneous phenomenon; scientists make distinctions among memory systems such as short- and long-term memory.

Shortterm memory occurs when one recollects or produces material immediately after it has been presented.

The capacity for short-term memory is probably limited; without repetition, one can hold information only a few minutes.

Conversely, longterm memory may be stored for a long time (more than a few days), and the capacity for long-term memory is quite large.

Question 11

Examiners use a variety of clinical techniques to measure memory dysfunction, including the

How is short term memory assessed?

Answer 11

Wechsler Memory Scale–Revised (WMS-R), the Memory Assessment Scales (MAS), the Randt Memory Test (RMT), and the LuriaNebraska battery.

Short-term memory is best assessed using verbal tests. These include the immediate recall span, the digit span, and several word tests

The techniques used to assess short-term memory include tests that evaluate memory for specific stories or memory for lists of unrelated words

Question 12

Significant progress has been made in linking performance on neuropsychological tests to specific clinical problems

alcoholic dementia

Huntingtons and alzheimers

Answer 12

alcoholic dementia, which is caused by long-term chronic alcoholism, is characterized by dysfunction in visuospatial skills.

Huntington’s disease (retrograde amnesia with equally deficient recall of events from all decades) perform much better on recognition than do patients with Alzheimer’s disease (more severe difficulties with recall for recent events and less for long-term memories)

Question 13

Study that used neuropsychological evaluations compared recently detoxified alcoholics with nonalcoholic controls who were the same age and with recovering alcoholics who had been abstinent for at least 18 months.

Answer 13

The groups were comparable in education, age, and IQ.

However, comparisons on learning and retention of new information differed

Recently detoxified alcoholics scored lower on measures of immediate recall, 20-minute delayed recall, and recognition than did comparable subjects who had been off alcohol for 18 months

Both groups of former alcoholics performed
more poorly that did the nonalcoholic controls.

These findings suggest that there may be some recovery of learning and memory when alcoholics are abstinent for
18 months or more.

However, chronic alcohol use may permanently affect some neuropsychological functioning

Question 14

New research also challenges the idea that functional problems are related to specific locations within the brain.

Answer 14

New evidence suggests that complex cognitive,
perceptual, and motor functioning are determined by neural systems rather than specific single structures.

There are complicated circuits and dense interconnections between different locations in the brain.

Neuropsychological evaluation estimates localized problems as well as problems with the brain’s complex interconnections.

Question 15

most studied areas of neuropsychology is the identification of deficits in the left or right hemisphere of the brain.

Answer 15

Evidence for left hemisphere control of language in right-handed individuals comes from studies on brain damage, studies of brain stimulation during surgery for patients with epilepsy, and from evaluation of people who have suffered a stroke on one side of the brain.

However, approximately two-thirds of left-handed people have language organized on the left side of the brain, approximately 20% have language organized in the right hemisphere, and the remainder appear to have language represented on both sides.

Question 16

Trained neuropsychologists can identify specific problems.

Wernicke’s aphasia

Answer 16

Wernicke’s aphasia is characterized by impaired verbal comprehension and ability to repeat information- damage to Wernicke’s area of the brain (the superior temporal gyrus), problems monitoring their language output, and often have difficulty with the syntax of their spoken sentences.

Sometimes people affected by Wernicke’s aphasia utter unintelligible strings of words that can be confused with schizophrenic symptoms.

Question 17

Neuropsychological tests can also be used to diagnose motor problems.

Answer 17

right-handed people who have damage to their right hemisphere often develop spatial disorders such as the inability to copy or draw objects or difficulties assembling certain objects

Some individuals may develop specific problems associated with right hemisphere damage, such as dressing apraxia - People with this condition have difficulty identifying the top or the bottom of a garment, and sometimes the left or the right side as well.

Although these individuals may function well in other aspects of their lives, they have a great deal of difficulty dressing

Question 18

Neuropsychologists are also skilled at identifying which aspects of the information-processing systems may be damaged.

Answer 18

Information retrieval and storage are related but different function

Some people have problems in recall or retrieval of information.

Tests can be used to determine whether the problem is in recognition or actual retrieval of information. - Recognition might be evaluated using multiple-choice format items.
difficulty recognizing information = deficiencies in storage = medial temporal lobes or the diencephalic system.

Impaired retrieval of information may be associated with problems in the frontal lobes, for example.

Question 19

Left hemisphere damage deficits

Answer 19

Word memory problems

right left disorientation

finger agnosia

problems recognizing written words

problems performing calculations

problems with detailed voluntary motor activities, not explained by paralysis

problems dressing

Question 20

Right hemisphere damage

Answer 20

visual spatial deficits

Impaired visual perception

neglect

difficulty writing

problems with spatial calculations

problems with gross coordinated voluntary motor not explained by paralysis activities

Inability to recognize a physical deficit

Question 21

Developmental Neuropsychology

Answer 21

Sometimes, neuropsychological testing is done to provide a baseline - child who is undergoing intense medical therapy or a child with a serious medical illness such as epilepsy may face neurological changes over time.

Question 22

Neuropsychological assessment of children presents unique challenges

Answer 22

1- Earlier brain injury may be missed until children reach the age where they are challenged with new types of problem.
—a young child with a brain injury may adapt well to most situations, but she may later have problems with, say, her geometry class, which would require more complex visual–perceptual functioning than she had encountered before

2 - brain plasticity
—human brain is remarkable in its potential to reorganize in response to injury.
—-Although recovery is often impressive, it usually is not complete, and these problems are often hard to evaluate using neuropsychological tests.

Question 23

Neuropsychological tests for children differ widely

Answer 23

General and Adaptive functioning: Child
Development Inventory, Child Behavior Checklist, Reynolds Depression Scale, and Children’s State-Trait Anxiety Scale

second group of measures estimates attention and executive function - different aspects of info processing - Trail Making Tests, for example, scatter sequential numbers (e.g.,
1, 2, 3, 4) around different locations on a sheet of paper. The child is asked to draw
lines to connect the numbers in sequence. Part B of the test adds scattered sequential
letters, and the child must, for example, start at 1, go to A, then go to 2, then B, and
so on. The test evaluates several cognitive skills, including attention, sequencing, and
thought processing.

Question 24

Attention and executive function are believed to be separate

Answer 24

Executive function includes volition, such as forming and executing a goal, planning, and taking action to complete a task, self-control, self-monitoring

Question 25

four different factors of mental processing and
related them to specific anatomical regions in the brain

Answer 25

focus execute - child’s ability to scan information and respond in a meaningful way.

sustain - describes the child’s capacity to pay close attention for a defined interval of time.

encode and is related to information
storage, recall, and mental manipulation

shift, refers to the ability to be flexible.

Question 26

Dyslexia

Answer 26

specific reading disorder characterized by difficulties in decoding single words.

may have a genetic base and may result from
difficulties in processing phonemes

affects approximately 4% of school-aged
children and approximately 80% of children identified as having a learning disability

identification of a disability means that considerable attention will be devoted to the child at enormous public expense - public health problem

Question 27

neuropsychological evaluations have been used for a variety of other purposes

Answer 27

has been used to determine if people are faking illness

detection of malingering for adults who have traumatic brain injury.

65 patients who had previous brain injury were referred for a neuropsychological evaluation. Twenty-eight of these patients had been identified as having exaggerated their cognitive dysfunction in order to gain greater benefits or to escape reassignment to work.

Question 28

determine the seriousness of concussions among athletes

Answer 28

One application of clinical neuropsychology is the development of a concussion resolution index (CRI) to track the recovery following a sports-related concussion.

CRI is made up of six subtests, including reaction time, visual recognition, and speed of information processing.

Validity studies show that the CRI is associated with other neuropsychological tests.
For example, it correlates with the grooved pegboard test.

computer-based test can identify ongoing neuropsychological difficulties in cases where symptom reports and clinical examinations are normal

Question 29

identifying the cognitive consequences of early brain lesions

Answer 29

high-risk infants show poor performance on tests of verbal ability, coordination, visual–spatial ability, and the like by the time they are 3 years old

children have been in accidents involving head injuries, neurological tests often show
no remaining problems. Nevertheless, neuropsychological tests of intellectual abilities
often show that these functions remain somewhat impaired

Question 30

Developmental neuropsychology is a difficult field because it requires several levels of assessment

seven-step model that is used by neuropsychologists in the development of rehabilitation plans.

Answer 30

1. application of formal tests to determine the nature of the problem.
2. an assessment of the environment, such as the demands of the school environment and other academic expectations.

3/4. formulation of treatment plans, which involve a prediction of the short- and long-term consequences of the brain problem and the chances that intervention will make a difference.

5. availability of resourcesis there a family member who can assist in treatment?
6. e development of a realistic
   treatment plan that considers the information gained in Steps 1 to 5
7. , evaluating progress made in the course of clinical care

Question 31

Halstead-Reitan Neuropsychological Battery

Answer 31

1935, Ward Halstead opened a laboratory to study the impact of impairments of brain function on a wide range of human abilities.

observations from formal and social settings

full battery includes many psychological tests and sometimes requires 8 to 12 hours to administer.

often receive the full Minnesota Multiphasic Personality Inventory (MMPI) to evaluate their emotional state in response to a medical situation. - includes a full WAIS

Question 32

A large number of studies validate the Halstead and Reitan procedures

Answer 32

performance on specific subtasks of the Halstead-Reitan battery is associated with
dysfunction in one of the two hemispheres of the brain - tactile, visual, and auditory problems on one side of the body reflect damage in the opposite hemi of the brain.

Difficulty on the right side of the body indicates a problem in the left side of the brain

the battery can locate tumors or lesions in the right or left hemisphere of the brain and in the front or back portion of the brain in a significant number of cases.

Question 33

Components of the Halstead-Reitan Neuropsychological Battery for Adults

Answer 33

Chart on 456

Question 34

Critics of the Halstead-Reitan battery

Answer 34

the major advantage of the test may not be worth the effort in applying the measures.

battery can assist in localizing injury in either the left or right hemisphere of the brain

this advantage may be meager in relation to the many hours it takes to complete the
test. New methods of brain imaging - more efficient

Question 35

Luria-Nebraska Neuropsychological Battery

Answer 35

Recognized for many years as an expert on the functions of the human brain

Luria did not acknowledge that any single area was solely responsible for any particular
behavior

Instead, Luria saw the brain as a functional system, with a limited number of brain areas involved in each behavior. Each area in the functional system might be considered a necessary link in a chain. If any link is injured, the total system will break down

Question 36

Luria - pluripotentiality

Answer 36

that any one center in the brain can be involved in several different functional systems - , one center in the brain may be involved in both visual and tactile senses.

she also felt that multiple systems might be responsible for the same behavior.

if a child’s injury affects one system, another system may take over

Question 37

In practice, Luria applied his theory clinically to make intuitive judgments about deficits in functional systems.

Answer 37

Because he did not use a standardized procedure, the amount of time he spent testing individuals varied greatly. -
difficult for others to repeat the exact steps

Luria had used to reach conclusions
about particular patients.

Question 38

Reitan (1976) criticized Luria on the grounds that

Answer 38

Luria’s opinion was the only known evidence for the validity of the tests.

Question 39

Although Luria’s procedures were widely regarded as important, they did not meet the psychometric standards of many U.S. psychologists.

To face these criticisms, Golden (1981) developed a standardized version of Luria’s procedures.

Answer 39

Golden worked at the University of Nebraska,
the test has become known as the Luria-Nebraska Neuropsychological Battery.

269 items that can be administered in approximately 24 hours. The items are divided into 11 subsections; A similar test for children has also been
developed

Question 40

Luria-Nebraska Neuropsychological Battery is scored by

Answer 40

finding a standardized performance level for each of the 11 subtests.

three more scores are reported.
1- pathognomonic scale consists of 32 items found in previous studies to be highly sensitive to brain dysfunction

two scores indicate whether dysfunction is in the right or the left hemisphere of the brain. They are taken from the sections of the battery that independently test the function of the right or left side of the body

Question 41

A variety of studies (summarized by Golden, 1981) have demonstrated that the Luria-Nebraska battery can make fine distinctions in neuropsychological functions.

Answer 41

Many of these studies used the battery to estimate the area of the brain damaged
by a tumor or lesion.

confirmation of localization is made by surgery, angiogram, or CT scan. In one study, the Luria-Nebraska battery localized problems in 22 of 24 right hemisphere and 29 of 36 left hemisphere
cases

Some evaluations of the Luria-Nebraska battery are highly encouraging, whereas others show that these tests give little more information than do IQ tests

Question 42

One of the ongoing debates among neuropsychologists concerns

Answer 42

the value of qualitative versus quantitative approaches.

Question 43

The Halstead-Reitan is an example of a

Answer 43

a fixed quantitative battery

Psychologists using this approach simply follow
a set of standardized procedures.

Question 44

Qualitative approaches allow

Answer 44

Qualitative approaches allow greater flexibility
in the assessment process.

Often the measures are designed to identify a specific information-processing problem and the psychologist can choose the components
that may address specific clinical problems

California Verbal Learning Test is an example

Question 45

For decades, psychologists have known that people can get a wrong response for
different reasons.

What did Werner object to a purpose instead?

Answer 45

Werner (1937) objected to the use of global scores based only on the number of right or wrong items

Instead, Werner favored tests that assess how problems are solved in addition to assessing overall level of achievement

Question 46

Contemporary cognitive psychology suggests that

Answer 46

many factors determine performance on any given task

not enough to know that there is an impairment in cognitive functioning. Instead, one needs to know which aspects of the human information-processing system are defective
and which aspects are functioning well.

This information is essential in designing
rehabilitation strategies for patients who have selective problems.

Question 47

California Verbal Learning Test (CVLT)

Answer 47

builds on research in psychological testing, cognitive psychology, and computer science

The test determines how errors are made in learning tasks. In other words, the intent is to identify different strategies, processes, and errors that are associated with specific deficits.

test attempts to link memory deficits with impaired performance on specific tasks for people who have known neurological problems

assesses various variables, including levels of recall and recognition, semantic and serial strategies, serial position effects, learning rates across trials, consistency of item recall across
trials, degree of vulnerability to proactive and retroactive interference, retention of
information over short and long delays, and learning errors in recall and recognition

one component - the subject is asked to imagine that he or she is going to go shopping. Then the subject receives a list of items to buy. The examiner lists 16 items orally at a pace of approximately one word per second. The respondent is asked to repeat the list. This process is repeated through a series of five trials

Question 48

Performance on these CVLT tasks are analyzed in many ways

Answer 48

Learning across trials gives the test taker considerable information.

Those who are highly anxious may perform poorly on the first trial but improve as the task is repeated

However, adults with limited learning capacity may do relatively well on early trials but reach a plateau where repeated trials do not reflect improved performance - may also have inconsistent recall across trials - abandon one strategy and adopt another.

Studies have demonstrated that inconsistent recall across trials characterizes patients
with amnesia caused by frontal lobe pathology

Question 49

CVLT is that one can administer it either in a paper-and-pencil form or with a microcomputer

Answer 49

Computer does not replace test administrators - assists them. Examiner can
enter responses directly into the computer using a single key or a light pen to touch
the words on a monitor screen - facilitates and speeds up the scoring process

Question 50

CVLT’s validity

Answer 50

the test correlates with other measures such as the Wechsler memory scale

factor analysis studies of the CVLT suggest independent factors for learning strategy, acquisition rate, serial position, discriminability, and learning performance.

The diversity of deficits identified by the CVLT could not be identified using more-traditional psychometric tests

Question 51

CVLT has been used to compare patients with Alzheimer’s disease, Korsakoff ’s syndrome, and Huntington’s disease

Answer 51

Alzheimer’s disease neurological disorder- inability to form short-term memories.

Korsakoff ’s syndrome - organic brain disorder often associated with long-term alcohol use
that also results in the loss of short-term memory.

Huntington’s disease is an inherited disorder emerging in adulthood and associated with memory loss

The nature of the deficit differs

patients with Alzheimer’s and Huntington’s
may score about the same on measures of recall and memory tests but may differ in
measures of forgetting - these
two diseases affect different parts of the brain.

Question 52

An advantage of the CVLT

Answer 52

allows a more precise evaluation of the nature of the problems than do other tests.

Question 53

When representative groups of patients from these three diagnostic groups are compared on the CVLT

Answer 53

Alzheimer’s disease and Korsakoff ’s syndrome- similar, with comparable scores for recall, learning and forgetting, semantic clustering, and several other cognitive factors.

However, each of these groups performed at a lower level than did patients with Huntington’s disease on measures of retention, intrusion errors, and recognition

Question 54

Studies of patients with Huntington’s disease, Alzheimer’s disease, and other neuropsychological impairments can help us understand properties of the tests.

Answer 54

Immediate recall and long-delayed recall were highly correlated r=.8 ) for normal patients and for patients with Huntington’s disease - the two variables were correlated only .36 for patients with Alzheimer’s
disease.

These findings are critically important because we often assume that the correlations among variables are the same for all patient group

suggest that the very nature of the association among variables is different in different patient populations

challenges the idea that measures have the same validity for different patient groups

Question 55

. Another study demonstrated
that tests of executive functioning can discriminate between conditions that have
different anatomical underpinnings

Answer 55

MRI was used to locate sections of the brain
that had reduced volumes.

Adults with dementia associated with the frontal lobes made more rule violation errors in comparison to those with Alzheimer’s disease or healthy adults who were about the same age

Question 56

Long-delay savings

Answer 56

require that subjects learn a list of words.

Then, after a long delay, they are given a
free-recall test.
The results are reported as the average number of correct responses.

Huntington’s patients have significantly higher recall than do those with Alzheimer’s disease but fewer correct responses than controls.

These results are consistent with the neuroanatomy of the illnesses. Huntington’s disease is a subcortical dementia, whereas Alzheimer’s disease is associated with cortical
lesions.

The CVLT may be helpful in identifying the location of the organic problem

Question 57

children’s version of the CVLT, the CVLT-C

Answer 57

children aged 5 to 16

individually administered

can be used to evaluate mild to severe learning disabilities, attention deficit disorder (ADD), mental retardation, and other neurological disorders.

provides information for the diagnosis of psychiatric disorders

Like the adult version, the CVLT-C assesses both recall and recognition of words.

several different scores, including total recall, learning strategy, serial position effect, learning rate, consistency of item recall, proactive and
retroactive interference, and retention over long and short delays.

standardized on a large national sample

Internal consistency and alpha reliabilities for the test are generally high (usually above .80 for all age levels).
Validity studies consistently show that the test is moderately correlated (between .32 and .40) with the Revised Wechsler Intelligence Scale for Children

Question 58

Automated Neuropsychological Testing
Automated Neuropsychological Metrics (ANAM)

Answer 58

ANAM was developed by the U.S. Department of Defense - evaluate changes in human performance when people were exposed to difficult environmental circumstances

now been used in a variety of clinical
populations, including studies of patients with multiple sclerosis, lupus, Parkinson’s
disease, Alzheimer’s disease, brain injury, migraine headache

responsive to cognitive changes that result from neurological disorders.

ANAM can efficiently screen people
with cognitive changes and that it may be a valuable tool for monitoring cognitive
changes as diseases progress

Question 59

ANAM includes a variety of different tasks

Answer 59

code substitution, code substitution recognition, matching two samples, mathematics, running memory, and logical reasoning

Reliability of performance on these tasks tends to be in the moderate range with few coefficients above .8.

Question 60

ANAM has been used to evaluate military personnel who are deployed to combat

Answer 60

baseline for all soldiers so that it can be determined whether new injuries caused changes in mental status

Baseline scores are relatively stable with moderate reliabilities over a short interval

In addition to applications in the military, the ANAM has been used extensively to
evaluate the effects of head injury in athletes

Question 61

, some concerns have been raised about how people interact with computers

Answer 61

Familiarity with computer mouse and keyboard features varies across people, and some studies
show that results from ANAM are not always the same as those obtained using
paper-and-pencil tests or tests administered by a trained examiner

Question 62

Stress

Answer 62

Stress is a response to situations that involve demands, constraints, or opportunities

Question 63

Psychological stress has three components:

Answer 63

Frustration occurs when the attainment of a goal is blocked. Though frustration takes different forms, the principle remains the same.

Conflict is a type of stress that occurs when we must make a choice between two or more important goals, such as deciding between going to law school and going to graduate school in psychology

pressure to speed up activities

Question 64

anxiety

Answer 64

Exposure to stressful situations can cause an observable reaction

an emotional state marked by worry, apprehension, and tension

amount of anxiety you experience depends in part on the intensity of the stress-producing stimulus as you perceive it or your evaluation of a situation

Question 65

State anxiety

Answer 65

emotional reaction that varies from one situation to another

Question 66

Trait anxiety

Answer 66

personality characteristic

Question 67

Spielberger to develop the statetrait anxiety theory, which in turn led to the development of the State-Trait Anxiety Inventory (STAI)

Answer 67

STAI provides two separate scores: one for state anxiety (A-State) and another for trait anxiety (A-Trait).

20 items. On a 4-point scale, subjects indicate how they generally feel about each item.

Question 68

Good evidence exists for the validity and the reliability of the STAI

Answer 68

Test– retest reliabilities range from .73 to .86 for the trait scale. The state scale, which is
supposed to be inconsistent over time, indeed has low test–retest reliability (.16 to .54).

Validity studies show that the STAI can be used to make several important and useful generalizations.

concurrent validity studies have shown that
the STAI trait scale correlates well with other measures of trait anxiety - STAI
trait scale is significantly correlated with the Taylor Manifest Anxiety Scale, Institute for Personality and Ability Testing (IPAT) Anxiety Scale

Question 69

To give a test a positive recommendation, we must also find discriminant evidence for construct validity

Answer 69

patients scheduled to undergo surgery took the STAI before and after the medical procedure. Patients who had undergone major surgery showed less state anxiety after they had been told they were recovering well than they had before the operation. This finding demonstrates that state anxiety fluctuates with the situation—just as the test constructors said it would

Question 70

Measures of Coping

Ways of Coping Scale

Answer 70

68-item checklist

Individuals choose those thoughts and actions that they use to deal with stressful situations.

includes seven subscales for problem solving,
growth, wishful thinking, advice seeking, minimizing threat, seeking support, and
self-blame.

seven subscales can be divided into
problem-focused and emotion-focused strategies for dealing with stressful situations.

Problem-focused strategies involve cognitive and behavioral attempts to change the
the course of stress; these are active methods of coping.
Emotion-focused strategies do not attempt to alter the stressor but instead focus on ways of dealing with the emotional responses to stress

Question 71

Coping Inventory

Answer 71

a 33-item measure derived from clinical interview data.

three categories of items, t

1- describes activities and attitudes that people
use to avoid stress.
2- involves items that characterize strategies for working through stressful events
3 - socialization responses, or how each strategy would help the respondent cope with a specific stressful event.

Question 72

Ecological Momentary Assessment

Answer 72

allow you to collect information continuing basis

The equipment might measure blood pressure or hormonal state at specific points in time.

subject might be prompted to record information about mood, symptoms, or fatigue.

One of the advantages of EMA is that the information is collected in the subject’s natural environment. The EMA method usually involves a substantial number of repeated observations and shows variability within the subject over time

Question 73

Studies of the co-use of alcohol and tobacco illustrate the use of EMA.

Answer 73

Traditional studies of alcohol consumption might actually miss much of the
information about drinking because the assessment is typically done during the day,
whereas alcohol consumption often occurs in the evening

allows the continual assessment of these behaviors in the subject’s own environment. In one study, 57 subjects were given minicomputers that randomly prompted them to record their behavior - drinking was likely to occur between 8 PM and midnight

Smoking was more than twice as likely when subjects had been drinking as when they had not

Question 74

Depression

Answer 74

Because of the importance of depression in young mothers, primary care physicians needed to consider whether it was necessary to screen for depression among pregnant women and women who have recently given birth.

Task force reviewed published literature that addressed the question of whether or
not screening for depression in primary care for pregnant and postpartum women
resulted in improved health outcomes.
The outcomes were defined as decreased
depressive symptoms, decreased deaths associated with suicide, reduced suicide
attempts, reduced thoughts of suicide, improved physical functioning, improved
quality of life, and improved health status.

Patient Health Questionnaire (PHQ)
In addition to the PHQ, the committee
identified the Edinburgh Postnatal Depression Scale (EPDS) as the most appropriate
screening tool for prenatal and postnatal depression

cognitive behavior therapy resulted in a significant likelihood of remission from
depression and short-term benefits on a variety of outcomes. Increasing the duration of therapy also appeared to improve outcomes

concluded that there is value in
screening all adults, including pregnant and postpartum women, for depression

Question 75

National Institutes of Health (NIH) Toolbox

Answer 75

significant behavioral program and has become increasingly interested in psychological and behavioral measures.

developed public domain state-of-the-art measures for assessing cognitive, emotional, motor, and sensory functioning for people ages 3 to 85.

Toolbox offers well-validated measures that can serve as a common currency so that results from different investigations can be compared with one another

Ultimately, the goal of the toolbox is to provide measures that can assess neurological and behavioral function over the course of time.

chart 471

Question 76

many definitions of health, we find two common themes

Answer 76

everyone agrees that premature mortality is undesirable, so one aspect of health
is the avoidance of death

quality of life is important. In other words,
disease and disability are of concern because they affect either life expectancy or life quality

Question 77

two major approaches to quality-of-life assessment

Answer 77

psychometric: attempts to provide separate measures for the many different dimensions of quality of life. Sickness Impact Profile (SIP). The SIP is a 136-item measure that yields 12 different scores displayed in a format similar to an MMPI profile.

Decision theory - attempts to weight the different dimensions of health to provide a single expression of health status.
Supporters of this approach argue that psychometric methods fail to consider that different health problems are not of equal concern

using the psychometric approach, one will
often find that some aspects of quality of life improve while others get worse. For
example, a medication might reduce high blood pressure but also produce headaches
and impotence.

Question 78

Common Methods for Measuring Quality of Life
SF-36

Answer 78

Perhaps the most commonly used outcome measure in the world today is the Medical Outcome Study Short Form-36

includes eight health concepts: physical functioning, role-physical, bodily pain, general health perceptions, vitality, social functioning, role-emotional, and mental health

SF-36 can be either administered by a trained interviewer or self-administered.

SF-36 has become the most commonly used behavioral measure in contemporary medicine

Question 79

SF-36 advantages

Answer 79

brief, and there is substantial evidence
for its reliability and validity.

can be machine scored and has been
evaluated in large population studies

reliability and validity of the SF-36 are
well documented

Question 80

SF-36 also presents some disadvantages

Answer 80

does not have age-specific questions, and one cannot clearly determine whether it is equally
appropriate across age levels

Question 81

Nottingham Health Profile (NHP)
Common Methods for Measuring Quality of Life

Answer 81

2 parts-

The first includes 38 items divided into six categories: sleep, physical mobility, energy, pain, emotional reactions, and social isolation. Items within each section are rated in terms of relative importance. Items are rescaled in order to allow them to vary between 0 and 100 within each section

second part of the NHP includes seven statements related to the areas of life most affected by health: employment, household activities, social life, home life, sex life, hobbies and interests, and holidays
respondent indicates whether or not a health condition has affected his or her life in these areas.

NHP has considerable evidence for its reliability
and validity.

NHP is consumer-based and arises from definitions of health offered by individuals in the community. Furthermore, this scale uses language that is easily interpreted by people in the community and conforms to minimum reading requirements

difficult to compare the dimensions directly with one another
some evidence that the NHP is more reliable for studies of elderly adults living in the community

Question 82

observable health states are weighted by
quality ratings for the desirability of these conditions

Answer 82

Human value studies have been conducted to place the observable states onto a preference continuum, with an anchor of 0 for death and 1.0 for completely well

weights are highly stable over a 1-year period and consistent across diverse groups of raters

system has been used to evaluate many different health-care programs. For example, it was used to demonstrate that a new medication for patients with arthritis produced an average of .023 QALY per year, whereas a new medication for acquired immunodeficiency syndrome (AIDS) produced nearly .46 of these units per year.

Question 83

mHealth and New Mobile Technologies

Answer 83

mHealth is defined as diverse applications of wireless and mobile technologies designed to improve health research, health-care services, and health outcomes. - wireless device carried by or on the person that can be used to transmit health data/information - sensors, monitors, mobile phones

Devices used for mHealth are portable, real-time systems that provide a rich, potentially continuous data stream and capture information in the context of real, everyday life experiences.

Question 84

mHealth technologies benefits

Answer 84

likely to play a major role in advancing our
approach to measuring behavioral and environmental exposures in everyday life

Medical diagnosis might also undergo major changes. - health workers can take images of skin problems and use cell phone technologies to beam images back to major medical centers around the globe.

mHealth can help with treatment, such as chronic disease management.

Question 85

The 2015 Medical College Admissions Test (MCAT)

Answer 85

MCAT is administered by computer, and the current version tests physical and biological sciences, verbal reasoning, and writing skills. The test is quite demanding and it takes 5.5 hours to complete

2015, the MCAT underwent significant change
new section focusing on several conceptual areas from the behavioral and social sciences.- medical scientists have come to recognize that health outcomes, to a large extent, are determined by the circumstances in which people live, relationship between economic hardship and how long people live.
e greater the economic hardship, the shorter the life expectancies of community residents.

Question 86

new subtest, “Psychological, Social, and Biological Foundations of Behavior,” will measure Behavioral and Social Science (BSS) MCAT

Answer 86

Test takers will have 95 minutes to complete the new section primarily composed of brief stimulus paragraphs illustrating behavioral and social science constructs followed by a total of approximately 55 multiple-choice questions.

Components of the section include five core content areas:
(1) ways that individuals perceive, think about, and react to the world;

(2) factors that influence behavior and
behavior change;

(3) factors that influence how we think about ourselves and others;

(4) ways in which culture and social differences influence well-being; and

(5) ways in which social stratification affects access to resources and well-being.

Question 87

In addition to the importance of behavioral approaches to disease prevention, there has been significant progress in biobehavioral approaches to the management of illness.

Answer 87

Systematic studies emphasize the value of cognitive and behavioral interventions to treat mental illness and substance abuse and to
aid in the management in chronic illnesses such as diabetes and heart failure.

behavioral and social sciences form the core of evaluations of cognitive impairment, many neurological diseases, and the gene−environment interaction.

Question 88

disparities in health outcomes among racial and ethnic groups persist.

Answer 88

Los Angeles, for example, the difference in life expectancy between African American men and Asian American women is a full 19 years.

Disparities in life expectancy between income, race, sex, or age subgroups are usually traceable to differences in tobacco use, obesity, physical activity, alcohol use, and risky
sexual behavioral

Question 89

new MCAT also includes a section on critical analysis and reasoning.

Answer 89

added to replace the writing samples sections- writing samples were not valid predictors of
medical school success.

new critical analysis and reasoning skills section uses traditional test formats and presents passages that need to be read. Test items then
assess the test takers’ ability to comprehend the topics in the passages.

Question 90

The roots of clinical neuropsychology can be traced to studies by Pierre Broca and Carl Wernicke in the 19th century

Answer 90

—functions such as the recognition of speech were localized in the left hemisphere ofthe brain.

Question 91

By the first decade of the 20th century, Brodmann had developed

Answer 91

the first functional map of the cerebral cortex

Question 92

Benton, Tuber, and Geschwind developed

Answer 92

methods for associating function with different areas of the brain

Question 93

Early neuropsychologists, including Luria and Reitan, used

Answer 93

psychological tests to estimate areas of brain damage. - , major advances in brain imaging reduced the need for these types of services. MRI and CT scanning now allow clinicians to examine the brains of living people.