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221 Cards in this Set
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Course objectives |
• How behavioral assessment fits within the field of psychological assessment. • The rationale, defining features, and theoretical underpinnings of behavioral assessment. • Interviewing techniques and strategies for critiquing one’s interviews. • How to code emotional expressions and recognize their relevance to clinical assessment. • Techniques of behavioral observation and integration of findings with other assessment methods. • Psychometric concepts of reliability and validity of measurement. • Methodological and practical issues in empirically-based assessment (EBA), and how these issues apply to selected clinical problems. |
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Introduction
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Behavior modification draws on |
1. the knowledge developed from animal and human studies and 2. scientific methods to evaluate the effects of intervention
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Behavior Modification is |
an approach to the assessment, evaluation, and alteration of behavior that focuses on the development of adaptive, prosocial behavior and the reduction of maladaptive behavior in everyday life. Best conceived broadly as a scientific approach to understanding and changing human behavior.
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Behavior Modification Key Characteristics: |
• Focus on behavior • Focus on current determinants of behavior • Focus on learning • Assessment and evaluation • Application |
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Behavior modification emphasis, focus, problem definition |
• Behavior modification emphasizes actions and performance. • The focus or problem is defined in terms of overt behavior, identify detect, or observe in some way. • Any given problem may have behaviors, feelings (affect), and thoughts (cognition) all rolled into one package. |
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Reasons overt behavior is emphasized |
• You can often intervene effectively on behavior and influence thoughts and feelings. • In everyday situations, overt behavior is often a primary concern that prompts the need to intervene • Evaluating the effectiveness of the intervention is facilitated by being able to translate problems into behaviors that reflect key aspects of the problem. • Behavior change may be a means to an end or an end itself. • Assess overt behavior directly to identify the problem or focus and to evaluate change • Direct assessment of the target problem |
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Focus and Emphasis on Current Determinants of Behavior |
• focuses on understanding causes of behavior and factors related to how individuals function and perform in every day life. • emphasizes current influences on behavior and how they can be mobilized to make changes. |
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Focus on Learning Experiences |
• Assumption that behavior can be altered by providing new learning experiences. • Behavior change programs rely on many learning theory and findings developed in research • The key feature is recognition of the plasticity of behavior or the amenability of behavior to change when systematic learning experiences are provided. |
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Assessment consists of and focuses on |
• consists of systematically measuring the current problem that is to be altered. • focuses on what the behavior or problem is and what events might be influencing that behavior |
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Assessment begins by |
clarifying the goals of the intervention expressed in concrete terms or behaviors that can be measured. Measures include direct observations and evaluations by the clients themselves
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As the program is implemented assessment continues to |
see whether change is occurring and whether the desired outcomes have been achieved.
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Evaluation consists of |
drawing inferences about whether change has occurred and whether the intervention is responsible for change.
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Evaluation emphasizes |
measuring outcome and evaluating treatment in controlled studies to decide whether treatments are effective and which ones are more effective than others.
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3 applications of assessment |
• Extend interventions to all facets of everyday life in which maladaptive behaviors are to be decreased and adaptive behaviors are to be increased • Intervening in everyday situations where changes are desired. • Paraprofessionals—people who are in frequent contact with the client, can observe behaviors in the actual situations in which they are performed and can immediately provide consequences intended to develop more adaptive behaviors. |
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Foundations of Behavior Modification |
classical conditioning, operant conditioning, modeling and observational learning
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Classical Conditioning |
concerned with stimuli that evoke responses. The process where by new stimuli gain the power to elicit respondent behavior.
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Unconditioned stimuli |
stimuli in one’s environment elicit reflex responses.
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Unconditioned responses |
unlearned (automatic) responses in response to unconditioned stimuli. The connection between the unconditioned stimulus and the unconditioned response is automatic.
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Conditioned stimulus |
at first does not elicit a response but through learning eventually comes to elicit the response. Learning occurs when one repeatedly pairs the unconditioned and conditioned stimuli
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Conditioned response |
learned response to the conditioned stimuli.
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Operant Conditioning |
the process of learning behaviors that are controlled (influenced) by their consequences.
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Operant behaviors |
behaviors controlled by consequences. Strengthened or weakened as a function of the events that follow them.
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Reinforcement |
presentation or removal of an event after a response that increases the likelihood or probability of the response
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Punishment |
Presentation or removal of an event after a response that decreases the likelihood or probability of the responses
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Extinction |
no longer presenting a reinforcing event after a response that decreases the likelihood or probably of the previously reinforced response
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Stimulus control and discrimination |
reinforcing the response in the presence of one stimulus but no in the presence of another. This procedure increases the likelihood or probability of the response in the presence of the former stimulus and decreases the likelihood or probability of the response in the presence of the latter stimulus.
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Modeling and Observational Learning |
• Observational learning occurs when an individual observes another person, referred to as a model, engage in a particular behavior. The observer learns the behavior merely by watching a model. • Whether a learned response is actually performed may depend on the consequences of the response or on the incentives associated with the response. • Example: Bandura’s Bobo Doll • The extent to which modeling stimuli influence learning and performance also depends on other factors such as the similarity of the model to the observer, the prestige, status, and expertise of the model. • The therapist or trainer often uses modeling as part of the treatment to show precisely what the desired behaviors look like and how the behaviors go together as a package. |
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Contemporary Behavior Modification |
• The social learning approach can account for a broad range of behaviors to a greater extent than accounts based on simplistic applications of one type of learning. • Behavioral interventions begin with the view that many behaviors people wish to alter can be conceptualized as operants (they operate on the environment and have consequences that affect the likelihood that they are performed in the future. |
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Two components of experimental analysis of behavior |
• A way of studying behavior: consists of focusing on one or a few individuals over time and evaluating interventions that influence behavior. • Applied behavior analysis: extension of experimental methods beyond the laboratory to applied setting generated a new area of research. Focus on antecedents and consequences that can be used to alter behavior. Cognitive processes and concepts usually do not play a role in the interventions that are used in applied settings. |
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Roediger (2004). What happened to behaviorism? |
• The decline of behaviorism could represent an intellectual revolution o The cognitive approach generated adherents at the expense of the established order, opened new techniques and methods of study and created excitement that attracted graduate students away from animal laboratories. • Behavioristic analyses were becoming too microscopic in the 1970s o Behaviorism became too focused on specific problems and lost the big picture • Many psychologists do not focus on the learning history of the organism. • There is nothing wrong with behaviorism o Anywhere that prediction and control of overt behavior is critical, one finds behavioristic analyses at work. • Behaviorism is less discussed and debated today because it won the intellectual battle. o All psychologists today (at least those doing empirical research) are behaviorists o Today, the fields of cognitive psychology and cognitive neurosciences are highly behavioral. |
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Kazdin (2001). Behavior Modification in Applied Settings: Chapter 2 |
Principles of Operant Conditioning
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Contingencies of reinforcement |
the ABCs of behavior, the relationships between behavior and the environmental events that influence behavior.
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Antecedents (A) |
stimuli, settings, and contexts that occur before and influence behaviors. The context or circumstances form part of the antecedents events and may change how we respond.
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Behaviors (B) |
the acts themselves
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Consequences (C) |
the events that follow behavior and may include influences that increase, decrease, or have no impact on what the individual does.
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Antecedents of Behavior |
setting events, prompts, high probability requests, discriminative stimuli and stimulus control
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Setting events |
contextual factors or conditions that influence behavior. often difficult to identify because they don’t necessarily occur immediately before behaviors.
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Setting events: Establishing operation |
an antecedent variable or factor that temporarily alters the effectiveness of some other event or consequence. They: 1. Alter the effectiveness of consequences (reinforcing and punishing events) and 2. Influence the frequency of behaviors that can obtain these consequences. An important agenda for intervention is to use setting events to help promote adaptive behavior.
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Prompts |
• specific antecedents that directly facilitate performance of behavior. • serve as antecedent events that help generate or initiate the desired response. • play a major role in developing behavior. • The long-term goal is to develop a behavior so that it is performed without the use of prompts. |
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Fading |
the gradual removal of a prompt.
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Requests |
• Making requests is a special type of prompt • How the request is delivered influences greatly the likelihood that there will be compliance. |
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High probability requests |
those an individual is very likely to do
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Low probability requests |
those an individual is very unlikely to do.
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Increase likelihood of compliance with a low probability request by |
Embedding it in a sequence of high probability requests
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Discriminative Stimuli and Stimulus Control |
• Stimuli often become associated with various consequences. Once these associations occur, the stimuli themselves exert control over behavior. • In operant conditioning, the stimulus increases the probability that a previously reinforced behavior will occur. • In many programs, the goal is to alter the relation between behavior and the stimulus conditions in which the behavior occurs. o Some behavior problems stem from a failure of certain stimuli to control behavior when such control would be desirable |
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Differential reinforcement |
reinforcing a response in the presence of one stimulus or situation and not reinforcing the same response in the presence of another stimulus or situation.
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Discriminative stimulus |
stimulus whose presence has been associated with reinforcement
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Nondiscriminative stimulus |
stimulus whose presence has been associated with nonreinforcement
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Stimulus control |
when responses are differentially controlled by antecedent stimuli. Stimulus control is learned.
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Behaviors: Shaping |
the reinforcement of successive approximation of the final response
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You shape behavior because |
the final behavior is not present in the repertoire of the individual.
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Reinforce behaviors that |
increasingly approximate the final goal and stops reinforcing early approximations that are well established.
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Chaining |
the process of developing the sequence of behaviors. Chaining occurs by reinforcing completion of the full sequence of behaviors, a sequence of multiple behaviors occurs.
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Chain |
a sequence of responses. Represents a combination or series of the individual responses performed in a particular order.
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Forward Chaining |
developing behaviors in the order in which they are to be performed.
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Backward Chaining |
starting with the last behavior in the sequence.
• The reason for backward chaining is because in a sequence of responses, the reinforcer usually comes only after all the behaviors are completed. • Although the sequence appears to be maintained by a single reinforcer at the end of the chain of responses, the links in the chain are assumed to take on conditioned reinforcement value. |
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Behavior change occurs when |
certain consequences are contingent on performance.
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A consequence is contingent when |
it is delivered only after the target behavior has been performed and is otherwise not available.
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Consequences must be ___ to alter behavior |
delivered in specific ways
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Positive Reinforcement |
refers to the increase in the likelihood or probability of a response that is followed by a favorable consequence.
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Reinforcement |
always refers to an increase in the likelihood or probability of a response when that response is immediately followed by consequences
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Positive reinforcers |
stimuli or events presented after a response that has been performed that increase the frequency of the behavior they follow. (positive→something is presented)
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Negative reinforcers (aversive events/stimuli) |
events removed after a response has been performed that increase the behavior preceding their removal.
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Rewards |
something that is given or received in return for doing something. Rewards to not necessarily increase the probability of the behaviors they follow.
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Types of Positive Reinforcers |
• Unconditioned (primary) reinforcers—reinforcing without requiring special learning or training (e.g. food) • Conditioned (secondary) reinforcers—acquire reinforcing value through learning (e.g. money). o Generalized conditioned reinforcer—when a conditioned reinforcer is paired or associated with many other reinforcers (e.g. tokens). |
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Negative Reinforcement |
refers to the increase in the likelihood or probability of a response by removing an aversive event immediately after the response has been performed.
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Positive and negative reinforcement always refers to |
an increase in behavior.
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Avoidance is involved in |
negative reinforcement. In avoidance, the behavior is performed before the negative event occurs.
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Two forms of negative reinforcement |
primary (unconditioned) and secondary (conditioned)
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In social interaction, the response of one individual is sometimes negatively reinforced because |
it terminates an aversive behavior initiated by another individual. At the same time, the aversive behavior of the other individual may be positively reinforced. E.g. a baby winning for his/her parent
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Punishment |
the presentation of or removal of a stimulus or event after a response, which decreases the likelihood or probability of the response.
• Aversive consequence presented after a response (e.g. spanking) • Removal of a positive event after a response. |
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Extinction |
the cessation of reinforcement of a response that results in a decrease in the likelihood or probability of the behavior in the future.
• No longer reinforcing a response results in the eventual reduction or elimination of the response. • A consequence that was previously provided no longer follows the response. • Extinction often involves ignoring but not all ignoring qualifies as extinction • For extinction to work, one must identify the reinforcer maintaining behavior. |
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Discrimination |
refers to the fact that an individual response differently under different stimulus conditions.
• Individuals may behave one way in a given situation or in the presence of a particular person and behave differently in another situation or in the presence of another person. |
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Generalization |
the ways in which effects of the program may extend beyond the contingency.
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Stimulus generalization |
refers to the generalization or transfer of a response to situations other than those in which training takes place.
• When a response generalizes across situations, the individual fails to discriminate in his/her performance of that response. • The degree of stimulus generalization is often a function of the similarity of new stimuli. |
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Response generalization |
the changes in behavior or responses other than those that have been trained or developed.
• Altering one response can inadvertently influence other responses. • Response generalization usually changes behaviors that are similar to the target behavior. |
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O’Brien & Haynes (1995). |
Behavioral Assessment.
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Behavioral assessment is |
a conceptual system and a collection of measurement methodologies.
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Psychodynamic assessment procedures emphasize |
the measurement of thoughts, beliefs, personality structure, and other “internal” phenomena.
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Criticisms of the psychodynamic assessment approach |
• Unobservable and unconscious internal processes are often cited as the main cause of problematic behavior. • There is a lack of research h support for the main assumptions that intrapsychich factors are the most important determinants of behavior and that examination of the intrapsychic factors leads to effective intervention. |
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8 Fundamental assumptions of the contemporary behavioral approach to assessment |
• Functionalism • Contextualism • Behavior can be most effectively understood using empirical methodologies. • Behavioral “plasticity” • Multivariate causation • Bidirectional causation • Dynamic causation • Nonlinear causation |
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Functionalism |
behavior is lawful and purposeful (provides a means through which a person can adapt to the demands of the environment.
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Target behavior |
thought of as logical and functional responses to environmental events that precede (antecedents), co.occur and/or follow (consequences) their occurrence.
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Behavioral assessments often employ |
hypothetico deductive methods to identify environmental factors that control target behaviors.
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Contextualism |
asserts that the controlling effects of environmental factors on target behaviors are often mediated by individual characteristics. Expectation that target behaviors should how significant variability across persons, situations, and time.
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SORK model of behavioral assessment |
• S—behavior analysts gather specific information about the stimuli • R—target behavior (Response) • O—biological characteristics and learning history of the person or organism • K—contingencies • C—consequences associated with a target behavior. |
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Behavior can be most effectively understood using |
empirical methodologies. Unbiased quantitative measures of observable target behaviors.
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Behavioral “plasticity" |
asserts that most target behaviors can be modified through the careful application of learning principles.
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Multivariate causation |
proposes that target behaviors are composed of many components.
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Bidirectional causation |
situational or individual factors that affect a particular behavior can, in turn, be affected by that same behavior.
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Dynamic causation |
proposes that the relationships among controlling factors and target behaviors often change over time
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Nonlinear causation |
suggests that a unit of change in a controlling variable does not always bring about a similar amount of change in the target behavior. (e.g. inverted U).
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Goals of Behavioral Assessment |
• Goal 1: Generating operational definitions of target behaviors and controlling factors. • Goal 2: Identifying and evaluating relationships among target behaviors and controlling factors. |
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Goal one: The dimensions of greatest relevance fall into the following areas: |
1. Content: cognitive verbal, affective physiological, and overt motor response systems. 2. Magnitude or intensity of responding 3. Temporal characteristics 4. Level of reduction
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Goal one: Situational controlling factors are located “outside” of the individual. |
1. Physical inanimate factors 2. Physical animate factors (e.g. people, pets) 3. Individual controlling factors
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Goal two: Identifying and evaluating relationships among target behaviors and controlling factors. Functional analysis |
relationships among target behaviors and controlling factors are identified and evaluated. Emphasizes the identification of causal functional relationships.
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Sampling procedures should |
allow the behavior analyst to infer efficiently and validly how a person behaves in the unsampled natural environment.
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Data Collection Strategies objective |
to develop procedures that will minimize costs and maximize representativeness, sensitivity and reliability of the obtained information.
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Event recording |
a procedure in which the simple occurrence of a target behavior or controlling factor-target behavior interaction is recorded during a specific period of time.
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Interval recording |
when using this procedure the behavior analyst divides time into intervals. If the target behavior is observed, then the entire interval is recorded as an occurrence of the event.
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Real time recording |
involves measuring time at the beginning and end of each target behavior occurrence and/or controlling factor-target behavior interaction.
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Momentary time recording |
analogous to taking snapshots of behavior across time and place.
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Two Data Recording Locations |
1. Natural settings 2. Analog setting: designed to stimulate the natural environment |
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Behavioral Assessment Interviewing |
Sample a broad range of behaviors (semantic content, paralinguistic responses, nonverbal overt motor responses, and affective-physiological responses.
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Behavioral observation |
closely tied to the empirical assumptions that the most useful data will be obtained through direct observation and quantification of target behaviors and controlling factor-target behavior interactions.
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Nonparticipant observation definition and limitations |
use trained observers to code behavior. Limitations: usually restricted to recording overt motor behavior, nonparticipant observation is expensive because of the necessary training.
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Errors that can result from nonparticipant observation |
• Insufficient specification of the target behaviors, controlling factors, and sampling procedure • Error resulting from the use of human judges who often modify measurement criteria, can become fatigued and inattentive, and may have biases • Reactive effects: client behaviors often change when they become the focus of systematic observation |
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Participant Observation |
usually present in the client’s natural environment prior to the implementation of the behavioral assessment.
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Advantage of participant observation |
Potential for enhanced ecological validity because it is often less reactive and observers can record behavior in a range of natural settings
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Limitations of participant observation |
restricted to the measurement of overt behavior, participant observers may be more likely to make recording errors, some participant observers may be more biased.
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Self Monitoring definition and limitation |
an assessment method in which clients observe and record their own behavior. Accuracy may be limited.
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Questionnaires advantages and limitations |
• Advantages: inexpensive, easily obtained, administered and interpreted, broad clinical applicability. • The biggest problem with questionnaires is that item wording and the manner in which summary scores are computed typically violate the fundamental behavioral assumption of contextualism. |
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Product of Behavior and Archival Data |
circumstantial evidence that a target behavior has occurred.
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Behavioral assessment data collection standards |
Efforts should be made to use at least two assessment methods in combination with behavioral interviewing.
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Three Methods Used to Evaluate Assessment Data |
1. Intuitive evaluation: involve forming subjective estimates of the size and importance of relationships between target behaviors and controlling factors. 2. Statistical Evaluation (Including Conditional probability analyses: mathematical statements that describe the likelihood that a target behavior will occur given that some controlling behavior has occurred.) 4. Time series analysis: requires that repeated measures of target behaviors be obtained across time.
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The assessment interview is |
the single most important means of data collection during the psychological evaluation
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Goals of the interview |
oGather information that can’t easily be obtained through other means
oEstablish a relationship conducive to obtaining info oDevelop greater understanding in both interviewer and interviewee regarding problem behavior oProvide direction and support in helping the interviewee deal with problem behaviors. oObtain a psychological portrait of the person oConceptualize what is causing the person’s current difficulties oMake a diagnosis oFormulate a treatment plan |
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Issues Related to Reliability and Validity |
o Highly structured interviews were more reliable o In many situations, a free-form, open-ended approach may be the only way to obtain some types of information o Interviewer bias • Clients who are considered to express warmth may be seen as more competent or mentally healthy than they actually are. • First impressions have been found to bias later judgments • Physical attractiveness may result in practitioners’ either deemphasizeing pathology or exaggerating pathology o Interviewees may present themselves in a more favorable light. o Adding structure to interviews and paying close attention to the procedure by which decision are made typically results in higher levels of validity. |
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Assets and Limitations of unstructured/semistructured interviews |
Advantages: provide clinicians with the opportunity to assessment process when the clinician can observe the client in an open, ambiguous situation. The flexibility inherent in interviews is their strongest advantage over standardized tests.
Weaknesses of unstructured and semistructured interviews: Interviewer biases, Inconsistent questioning |
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Assets and limitations of structured interviews |
Advantages: Structured interviews allow for the development of reliable ratings, reduces information variance, and uses consistent diagnostic criteria. Structured interviews are often comprehensive and reduce the likelihood that you will miss a diagnosis.
Weaknesses: Structured interviews take a lot of time, May overlook the idiosyncrasies and richness of the person, May not create enough rapport for the client to feel comfortable |
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Interviewer style is influenced by |
theoretical orientation and practical considerations
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The goal of a client centered interview is to |
create the type of interpersonal relationship most likely to enhance this self change.
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Behavioral interviews are relatively structured because |
they are directed toward obtaining specific information that would help to design strategies based on altering external conditions.
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The goal of the diagnostic interview is |
to develop a specific diagnosis.
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Any series of questions should |
be followed with a certain degree of flexibility, to allow exploring unique but relevant areas that arise during the interview.
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Important for clinicians to |
express sincerity, acceptance, understanding, genuine interest, warmth, and a positive regard for the client during the interview, attend to nonverbal aspects of communication during the interview, An intermediate amount of note taking is recommended.
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In the initial phase of the interview the clinician should |
discuss the purpose, confidentiality, structure, types of information, activities, fees, etc that will be part of the interview.
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Directive vs. Nondirective Interviews |
• If time is limited the interviewer needs to be direct and to the point. • Clients will respond differently to directive and nondirective tactics, interviewers should be sensitive to what works well for the client. |
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Sequence of Interview Tactics |
• Interviewers should begin with open ended questions and after observing the client’s responses, use more direct questions to fill in gaps in their understanding. • Open ended questions require clients to comprehend, organize, and express themselves with little outside structure. o Verbal fluency, level of assertiveness, tone of voice, energy level, hesitations, and areas of anxiety can be noted. • Interviewer responses that show an intermediate level of directiveness are facilitation, clarification, empathy, and confrontation • Sometimes interviewers may wish to confront, or at least comment on, inconsistencies in a client’s information or behavior. o The purpose of confrontations during assessment is to obtain more in-depth information about the client. |
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Comprehensiveness |
The basic focus of an assessment interview should be to define the problem behavior and its causes.
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Avoidance of “Why” Questions |
It’s best to avoid why questions because they are likely to increase the client’s defensiveness
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Nonverbal Behaviors |
Interviewers should be aware of their own as well as their clients’ nonverbal behaviors
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Concluding the Interview |
An interviewer might help to ensure observance of time constraints by alerting the client when only 5-10 minutes remain
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Mental Status Exam |
o The mental status exam reviews the major systems of psychiatric functioning o General Appearance and Behavior • Clothing, posture, gestures, speech, personal care/hygiene, any unusual physical features • Facial expressions, eye contact, activity level, degree of cooperation, physical attractiveness, and attentiveness. o Feeling (Affect & Mood) • Mood: refers to the dominant emotion expressed during the interview • Affect: refers to the client’s range of emotions • Inferred from the content of the client’s speech, facial expressions, and body movements o Perception: client’s perception of themselves, note any illusions or hallucination |
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Mental Status Exam Contd. |
Thinking
• Intellectual functioning: typical involves reading and writing comprehension, general fund of knowledge, ability to do arithmetic, and the degree to which the client can interpret the meaning of proverbs • Note the degree to which the client’s thoughts and expressions are articulate versus incoherent. • assessment made in the context of a client’s educational level, socioeconomic status, and familiarity and identification with a particular culture • Orientation: ability of clients to be oriented can vary in the degree to which they know who they are (person), where they are (place), and when current and past events have occurred or are occurring (time). • Sensorium: how intact a person’s physiological processes are to receiving and integrating information o Level of consciousness: hyperarousal and excitement to drowsiness and confusion. • Insight and Judgment • Clients vary in their ability to interpret the meaning and impact of their behavior on others • Vary in their ability to provide for themselves, evaluate risks, and make plans. |
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Interpreting Interview Data |
o Involves clinical judgment o One method of organizing interview information is to use the info to develop a coherent narrative of the person’s life. o Can also organize interview data around various domains. • Domains can include: mood & affect, cognitions, level of resistance, symptom patterns, or coping style. |
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Structured Interviews |
Developed to reduce the problems associated with open-ended interviews. Structure the stimuli presented to the person and reduce the role of clinical judgment.
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Criterion variance |
the amount of error caused by vague guidelines for exclusion or inclusion in different categories.
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Information variance |
the variability in amount and type of information derived from interviews with patients.
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Schedule for Affective Disorders and Schizophrenia (SADS) |
A clinician administered, extensive, semistructured interview that has been the most widely used structured interview for clinical research purposes.
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Primary strength of SADS |
lies in obtaining fine detail regarding different subtypes of affective subtypes of affective disorders and schizophrenia.
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The interview rates clients on |
six gradations of impairment from which diagnoses are reached using the clear, objective categories derived from Research Diagnostic Criteria (RDC).
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Adult Version of the SADS |
• Designed to be administered in two different parts, the first focusing on the client’s present illness and the second on past episodes. • Three versions: SADS (regular), SADS L (lifetime: diagnosing disorders throughout a lifetime), and SADS C (version that measures changes) • Administration involves more than 200 items, takes 1.5 to 2 hrs. • End product includes the following 8 summaries: o Mood and ideation o Endogenous features o Depressive-associative features o Suicidal ideation and behavior o Anxiety o Manic syndrome o Delusions-hallucination o Formal thought disorder • SADS has demonstrated excellent reliability |
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Child Version of the SADS |
(Kiddie SADS P, K SADS P) for kids ages 6 to 18 years old, Good reliability
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Weakness of the SADS |
narrow band of diagnosis compared with the SCID or DIS, administration requires extensive training.
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Diagnostic Interview Schedule (DIS) |
• Highly structured • To be administered by nonprofessional interviewers for epidemiological studies. • Computerized administration and scoring is available. • When compared with psychiatrists, nonprofessional interviewers tended to overdiagnose major depression. |
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The Diagnostic Interview Schedule for Children (DISC) |
• Can be given as a child or parent interview. • Poor test retest reliability for child interview. • Good reliability and validity among clinical samples involving parent interviews. |
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Diagnostic Interview for Children and Adolescents |
• Administered to ages 6 to 17 • Semi-structured, organized around different themes such as behavior at home and school and interpersonal relationships with peers. • Administered with children and parents. • Reliability is variable • Most effective for assessing relationship problems, less effective for academic difficulties, and least effective for assessing school problems, somatic complaints, and neurotic symptoms. |
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Structured Clinical Interview for the DSM IV (SCID) |
• The SCID is a clinician administered, comprehensive instrument that adheres closely to the DSM IV decision trees for diagnosis. • There is some flexibility built in so administration can be tailored to different populations and contexts. • Clinical judgments are important throughout the interview. • Most comprehensive structured interview available. • Wide variation of reliability. |
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Morganstern (1988) |
Behavioral Interviewing
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Goals of Assessment |
Tied to the ultimate goals of assessment and behavior therapy. Assessment is a continuing process. Major goal is the accurate identification of a client’s problem.
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The behavioral interview gathers |
info that enables the clinician to define and fully understand the nature and context of an individual’s problematic behaviors.
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Behavior microanalysis |
define the antecedents, behaviors, and consequences (ABCs)
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Behavior macroanalysis |
establishes possible relationships between the client’s presenting problems.
• Important to identify the right problem to address, don’t always stop with the first problem identified. • Clinicians should not attempt to assess everything in the background and present situations of their clients. |
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Problem Identification |
Accurate, complete, and sophisticated problem identification is the most important goal of behavioral interviewing.
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Behavioral assessment vs. behavioral analysis |
difference between the methods of assessment and the process of synthesizing the information obtained.
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Defining Target Behaviors |
Clinicians should gather extensive information from clients that describe their problems and strengths in terms of the client’s affect, cognitions, and behavior, especially as they relate to the client’s interpersonal functioning.
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Establishing Treatment Goals and Priorities |
• Presenting problems must be conceptually integrated, and preliminary treatment goals and priorities must be established. • The highest treatment priority is often different from the client’s initial complaint. |
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Four philosophical guidelines influencing target behavior selection: |
• Behavior should be altered if it is dangerous to the client or others • Target behaviors should be altered so that the client’s reinforcers are maximized • Undesirable behaviors should be decreased by substituting desirable behaviors • Target behaviors should maximize the flexibility of the client’s skills for achieving long-term individual and social benefits. |
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Validating Target Behavior Selection |
Behavioral interviewing and assessment is seen as a process that generates working hypotheses for problem identification and treatment rather than static treatment choices.
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Ethical Issues |
• Determining the client’s goals • Degree of therapist influence on the selection of goals • The decision of whether to accept the goals of the client and intervene or to refuse treatment when it is ethically necessary to do so. • Clients sometimes request a technique that the therapist is not able to use. |
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Interviewer Client Relationship Variables |
An atmosphere of warmth and acceptance will facilitate the goal of assessment
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Behavioral interviewing Methods and Procedures: Specification of the problem |
• Once the problem area has been broadly defined, a thorough behavioral analysis is derived including a careful description of the behavior itself, as well as the antecedent and consequent variables. • Information gathered in the interview can be supplemented by observations during the interview and in natural settings. • Clinicians should be “ignorant” when it comes to understanding what a client means by such words as uptight, heavy, angry, together, spaced out, freaky, dependent, mellow, passive, etc. o Ask clients to operationalize what they mean. |
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Behavioral interviewing Methods and Procedures: Redefinition of Problems |
Reinterpretation of the client’s problems in a social learning framework.
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Clients should be provided with |
information about possible intervention strategies, length of treatment, and the financial and emotional cost of therapy.
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Morganstern. (1998). |
Behavioral Interviewing.
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Purposes of behavioral interviewing: |
• Therapeutic relationship is established • Essential preliminary clinical decisions are made • Therapist begins to gather information that informs ultimate treatment goals and priorities |
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Goals of assessment: |
• Major goal=accurate identification of a client’s problems (including nature and context) • Define the Antecedents, Behaviors, and Consequences (ABCs) • Defining the client’s problems often involves going beyond what the client first presents as the problem (although, one should balance this advice with the tendency to probe about everything) |
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Problem identification and target selection issues: |
• Recognize the difference between behavioral assessment and behavioral analysis (both should be balanced within behavioral interviewing) o Behavioral assessment should be objective, structured, reliable, and valid o Behavioral analysis should be clinical, subjective, flexible, and changing • Once presenting probs are identified, they must be conceptually integrated, and priorities and goals for treatment must be defined. o Often, the highest treatment priority is different from client’s initial complaint o Behaviors which are dangerous or very serious should be top priorities, but there is more room for clinical judgment beyond that guideline • Behavioral interviewing and assessment is seen as a process which generates working hypotheses for problem identification. As these problems change, treatment choices should be modified accordingly. |
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Ethical issues: |
Issues include the determination of the client’s goals, the degree of therapist influence on the selection of these objectives, and the decision of whether to accept the selection of these objectives and intervene or to refuse treatment when ethically necessary. The therapist plays a role in identifying problems, determining goals, etc. Thus, therapist bias (goals, desires, values) may influence the interview process. Problems may arise when the client insists on a technique that is ineffective, hence a specific problem goes beyond the realm of therapy, or when it’s revealed that the client is unable or unwilling to change.
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Interviewer client relationship variables: |
• Bellack & Hersen argue that, of all therapeutic schools, behavior therapy puts the most emphasis on the alliance with the client • Empathy, warmth, genuineness, and honesty are important therapist characteristics, but they are not enough (behavioral techniques must also be applied). • Effective treatment outcomes depend on 1) thorough and accurate assessment, 2) continuance in therapy, 3) compliance with therapeutic suggestions, 4) effect treatment methods. |
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Starting the interview |
• Helpful for therapist to make introductory remarks (helps structure the rest of the interview, set expectations) • Helpful to just listen, but it is important to ask questions to direct and clarify what’s being said • Use techniques such as reflecting and paraphrasing, direct questioning, probes, and provisional statements |
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Preparing the client for assessment |
Clients need to be prepared that an assessment is taking place and the purpose of such an assessment (particularly because the assessment process delays the initiation of therapy)
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Specification of the problem |
Help the client specify the problem by: asking about reasons client came for treatment, clarifying what happens before and after the behavior, helping clients track the behavior
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Redefinition of problems |
The assessment process is a reinterpretation of the client’s problems in a social learning framework/behavioral framework
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Closing the interview |
Allow a sufficient amount of time, provide client with a summary of the information that’s been obtained, an explanation of additional information that’s needed, and a reasonable estimate re: the likelihood of a successful intervention
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Kanfer & Schefft. (1988). |
Entering the Therapy Process.
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10 decision points a person faces leading up to, during, and after therapy |
• First 3 lead up to person’s appearance at a clinic • Second 3 are considerations about whether and how to implement decision to seek treatment |
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10 decision points a person faces leading up to, during, and after therapy with possible exit reasons |
1. Person notices problem 2. Defines and evaluates problem: Defines as trivial, not due to self, or not solvable by action 3. Decides to seek help: Lacks confidence or resources 4. Seeks help: Finds conditions for treatment not favorable 5. Is diagnosed or advised: Defines as not solvable by action or finds 6. Decides to accept treatment: Finds expectations not met 7. Responds to treatment: Considers task completed 8. Makes needed changes: Is affected by changes in external events or considers task completed 9. Stops treatment: Feels improvement sufficient at this time 10. Maintains change pattern: Finds distress relieved and devotes energy to other problems |
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Shea. (1988). |
The Dynamic Structure of the Interview.
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The clinical interview is |
a dynamic process, driven by the immediate needs of the clinician and the person seeking help. The interview undergoes a continuous process of change.
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Phase One: The Introduction Goal |
decrease patient’s anxiety, give a sense of control to the patient
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Phase Two: The Opening Goals |
• Patient has 2 goals: 1) determine whether it’s ok to share personal matters with clinician, 2) determine which personal matters to share • Clinician has 4 goals (PACE): o Patient’s perspectives and conscious agenda o Assessment of the patient’s mental status o Clinician’s perspective of the patient’s problems and unconscious agenda o Evaluation of the interview itself. |
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Phase Two: Look specifically for 3 types of “bad” intvws: |
1. Shut down interview, 2. Wandering interview, 3. Rehearsed interview
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Shut down interview |
short utterances, long response time, poor eye contact.
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Techniques for opening up a shut down interview |
• Use variable verbalizations (neither open nor closed ended) o Swing question: ask patient if they would like to answer the question asked o Qualitative questions: inquiry about state of patient (e.g., how’s your job going? How’s your mood been?) o Statements of inquiry: complete sentence followed by a question mark (e.g., you say you were 5th in your class?) o Empathic statements o Facilitory statements (e.g., uh-huh, go on, I see) • Give a series of open ended questions/gentle commands • Follow up on topics the client shows interest in • Avoid difficult/sensitive topics • Pick topics that gather general background info • Avoid starting questions with “can you tell me…?” • Increase attempts at eye contact, reinforce verbalizations with head nods, facilitory statements • Avoid long pauses before asking next question • Avoid “why” questions and typical “shrink” questions such as “how are you feeling as we talk about this..?” |
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Wandering interview: |
rapid speech, tangential, few breaks in speaking.
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Techniques for focusing the wandering interview |
• Increase ratio of closed ended questions • Use gentle structuring to return to a topic that led to a tangent • Avoid head nodding or other facilitory behavior • Increase focusing with statements such as “this is important…” • Tell the patient what is needed (e.g., we don’t have much time and we need to focus on this area now…) |
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Rehearsed interview: |
early diagnostic statements, quick/unsolicited review of history.
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Techniques for handling rehearsed interview |
• Disrupt the client’s flow by asking for behavioral incidents (forces reflection and provides background info) • Interrupt clients to get more details about affectively charged topics |
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Phase Three: The Body of the Interview |
Need to be flexible in order to maintain rapport, build relationship, and get appropriate amount of information
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Phase Four: The Closing of the Interview |
• Certain tensions may arise in the interviewee (e.g., “can this person help?” “what have we accomplished?”) • Major goal of clinician: solidify patient’s desire to return for second session |
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Phase Five: The Termination of the Interview |
Consists of closing words and gestures
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Ekman. (2003). |
Emotions Across Cultures.
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Ekman’s research supports |
the hypothesis that emotions are universally understood. Did a lot of work in preliterate, isolated cultures to get these results.
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Emotions understood (and not) across cultures |
happiness, anger, disgust, and sadness. Fear and surprise were indistinguishable for individuals in preliterate cultures
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The Facial Action Coding System (FACS) |
is Ekman’s system for measuring facial movements. Using the FACS, Ekman identified micro expressions: very fast facial movements that indicate leakage (revealing an emotion a person is trying to conceal)
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Ekman concludes people can experience the same emotion but in different ways. Differences include |
• Speed of emotional onset • Strength of emotional response • Duration of the emotional response • Time to recovery • Frequency of emotional episodes • Extent to which one can control what he/she says and does during an emotional episode • Ability to signal to others how we’re feeling • Events that most readily trigger emotions |
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Haynes & O’Brien. (2000) |
Principles and Practice of Behavioral Assessment.
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Behavioral observation: |
systematic recording of behavior by an external observer. (Behavioral approach to assessment.)
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Assumptions in behavioral observation strategies: |
• The systematic recording of carefully defined, quantifiable, and publicly accessible behaviors will yield information (particularly with respect to functional analysis) • Direct observation of behavior requires less inference and is less prone to error • Observing behavior may better inform treatment selection than other forms of assessment |
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Goals of all behavioral observation strategies: |
measure behavior, identify functional relations
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Things that must be operationalized in order to facilitate observation |
Behaviors, Causal variables, and relations.
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Elements of behavioral observation methods: |
(See handout)
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Types of observers: |
1. Nonparticipant observation systems use trained observation technicians. 2. Participant observers are people who are normally part of the client’s natural environment.
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Observation settings: (important to consider because of how context affects behavior) |
• Naturalistic observation settings are not manipulated and capture natural occurrence of behaviors. • Analogue observation involves assessor systemically varying aspect(s) of causal variables while observational measures of behaviors are collected. |
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Manual for the ASEBA school age forms and profiles: The DOF |
by Achenbach, T. M. & Rescola, L.A. (2001)
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The DOF is designed to assess |
problems and on-task behavior observed in settings such as classrooms, group activities and recess.
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Observer writes |
• narrative description of child’s behaviors and interactions while observing child for 10 minutes • At the end of each 1 minute observation interval, the child is also scored as being on-task or not on task. • At the end of the 10 minute period, the observer scores the child on the 96 problem items. • Recommend 3 to 6 10 minute observations • Complete the DOF for two control children in addition to the target child. |
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DOF has six syndrome scales, plus internalizing and externalizing groupings and total problem |
• Withdrawn-inattentive • Nervous-obsessive • Depressed • Hyperactive • Attention demanding • Aggressive • Internalizing • Externalizing • There are clinical cutoffs for each syndrome • DOF sores significantly discriminate between referred and non-referred children. |
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Evaluating Psychological Tests |
by Groth-Marnat (2003)
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Important to evaluate tests you plan to be using on the following dimensions |
theoretical orientation, practical considerations, standardization, reliability, validity
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Theoretical orientation |
Do you adequately understand the theoretical construct the test is supposed to be measuring? Do test items correspond to the theoretical description of the construct?
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Practical considerations |
Ability of examinee, Length
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Standardization |
1. Is the population to be tested similar to the population the test was standardized on? 2. Was the size of the standardization sample adequate? 3. Have specialized subgroup norms been established? 4. How adequately do the instructions permit standardized administration?
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Reliability |
1. Are reliability estimates high? (.90 for clinical, .7 for research) 2. What implications do the relative stability of the trait, the method of estimating reliability and the test format have on reliability?
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Four methods of assessing reliability |
1. Test retest 2. Alternate forms 3. Split half 4. Interscorer
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The best form of reliability is dependent on |
the variable being measured and the purposes for which the test is used
• If highly stable trait, test retest method is best. • If trait is subject to fluctuations, split half reliability best |
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Things that increase reliability |
1. Longer tests 2. Multiple choice rather than T/F 3. Low SEM (standard error of measurement) 4. Measuring stable traits of a person rather than changeable states
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Validity |
What criteria and procedures were used to validate the test?
• Will the test produce accurate measurements in the context and for the purpose you would like to use it for? • A test cannot be valid in any abstract or absolute sense, but rather in a particular context for a particular group of people • While a test can be reliable without being valid, it cannot be valid without being reliable. |
