Intro To Clinical Exam 1

Front 1

What is the cardinal principle of McFall's manifesto?

Back 1

Scientific clinical psychology is the only legitimate and
acceptable form of clinical psychology

Front 2

scientific process

Back 2

the METHOD by which knowledge is gained - not just a body of knowledge that is a science but a process by which knowledge is gained.

Front 3

One of McFall's corollaries is that psych services should not be administered to the public until the satisfy four criteria. What are these criteria?

Back 3

1. The exact nature of the service must be described
2. The claimed benefits of the services must be stated explicitly
3. The claimed benefits must be validated scientifically (i.e., using pre/post measures of change)
4. Possible negative side effects that might outweigh the benefits must be ruled
out

Front 4

The following three points are made in support of which of McFall's corolaries?
1. Overriding goal should be to train clinical scientists competent for any
subsequent job
2. Less concern about acquisition of facts and more emphasis on the mastery of
scientific principles and critical thinking - science as a process
3. Scientific training integrated across settings and tasks

Back 4

The primary and overriding objective of doctoral training in clinical
psychology must be to provide the most competent clinical science possible

Front 5

nomethetic

Back 5

info obtained about a group of people; diagnoisis-based tx is driven by this.

Front 6

uses information about the individual to guide tx approach

Back 6

idiographic

Front 7

Why evaluate the effectiveness of psychotherapy? (3)

Back 7

Practice guidelines are a fact of life
- If psychologists do not define the parameters of effective practice, then
they will be defined by someone else (e.g., AMA, HMOs, etc.)
- Ethical and professional conduct

Front 8

Typical study contrasts a particular treatment to a contrast group under well-controlled conditions(as in a Randomized controlled trial, RCT).

Back 8

efficacy

Front 9

What are some features that are associated with studies of efficacy?

Back 9

a. Random assignment
b. Appropriate controls
c. Manualized treatments with fidelity checks and assurances
d. Fixed duration
e. Well operationalized outcomes
f. Typically blind assessment g. Participants typically meet criteria for a single disorder; comorbid
cases often excluded
h. Often a fixed follow-up period and standardized assessment

Front 10

Study of how clients improve under conditions of
treatment in typical clinical settings and conditions.

Back 10

effectiveness

Front 11

What problems are associated with the "efficacy" research?

Back 11

Opponents argue that approach ignores or leaves out crucial
elements in how therapy is actually done with real clients in real
settings.

Front 12

What are some of the specific arguments used against efficacy research?

Back 12

In real therapy: MISS D

Multiple presenting problems
Issues of QOL
Self correcting
Shopping for therapists occurs
Duration isn't fixed

a. "Real therapy" does not have a fixed duration
b. "Real therapy" is self-correcting. That is, if a technique is not
working another approach is substituted
c. "Real clients" often actively shop for therapy
d. "Real clients" often have multiple problems (treatment in clinical
settings does not proceed by inclusionary and exclusionary criteria)
e. "Real therapy" is concerned with improvement in general
functioning (efficacy studies focus on symptom reduction)

Front 13

What are some of the specific arguments used against effectiveness research?

Back 13

CAR
Can't establish efficacy
Alternative factors can't be controlled
Random assignment not always possible

a. Cannot establish efficacy
b. Harder to control alternative factors
c. Random assignment may not be possible

Front 14

The following heiarchy of levels of support is associated with the APA template for developing practice guidelines that are associated with what principle?
a. Better than alternative therapy (in random control trial: RCT)
b. Better than nonspecific/placebo therapy (RCT)
c. Better than no therapy (RCT)
d. Quantified clinical observation
e. Strongly positive clinical consensus
f. Mixed clinical consensus
g. Strongly negative clinical consensus
h. Contradictory evidence

Back 14

efficacy

Front 15

In terms of the APA template for developing practice guidelines, what two factors are associated primarily with effectiveness?

Back 15

feasibility and generalizability

Front 16

II. Patient acceptability
11. Patient choice
111. Probability of compliance
IV. Ease of disseminability
The above factors are associated with what element of effectiveness?

Back 16

feasibility

Front 17

The feasibility element of effectiveness emphasizes the importance of disseminability. What does this mean.

Back 17

Ease of diseminability refers to the fact that some therapies are easier to implement than others.

Front 18

1. Patient characteristics (culture, gender, development, other
issues)
11. Therapist characteristics
111. Issues of robustness when applied in clinical settings (training,
time)
IV. Contextual factors (e.g., setting)
The above factors are all associated with what element of effectiveness?

Back 18

generalizability

Front 19

When considering whether or not psychotherapy is efficacious, (Lambert &
Ogles, 2003) evaluated the following 2 questions:
1. How does psychotherapy perform compared to no tx?
2.Does therapy exceed placebo?
What did they find?

Back 19

1. psychotherapy > no tx
2. therapy > placebo, most of the time

Front 20

a method of analysis which combines the results of a number of surveys to investigate the underlying processses

Back 20

meta analysis

Front 21

An effect size of 0.8 is a large effect. In meta-analysis, what does an effect size of 0 represent?

Back 21

If effect size = 0, no difference was found between studies.

Front 22

Describe how effect size is calculated in a meta-analysis.

Back 22

effect size = (mean of tx 1 + mean of tx 2...)/ (strd dev).
Adjustments are made for sample size.

Front 23

What does an effect size of .25 mean with respect to treatment?

Back 23

An effect size = .25 means that 25% of improvement was attributable to that tx.

Front 24

What does an effect size of .25 mean with respect to treatment?

Back 24

An effect size = .25 means that 25% of improvement was attributable to that tx.

Front 25

In the Lambert &
Ogles (2003) study, what was the effect size for tx compared to the effect size for placebo

Back 25

effect size tx = 0.67
effect size placebo = 0.48

Front 26

Is Clinical significance is different than statistical significance? If so, how?

Back 26

Clinical significance refers to how the person compares to other people who don't have the disorder, whereas statistical significance refers to the degree to which a value is greater or smaller than would be expected by chance.

Front 27

Asks "How does this person compare to other people who don't have this disorder?"
"Are they less than 1 SD above reference group without psychopathology?"

-may also consider pre and post test diff

Back 27

clinical significance

Front 28

According to the Lambert article, are gains associated with psychotherapy typically maintained?

Back 28

yes

Front 29

According to the Lambert article, how much psychotherapy is necessary?

Back 29

21 sessions for 50% of patients
75% of patients respond by 40-50 sessions

Front 30

According to the Lambert article, do patients get worse? If so, what percentage?

Back 30

yes, only 5-10%

Front 31

According to the Lambert article, does efficacy research generalize to practice?

Back 31

more yes than no, but findings are mixed.

(Studies reported by Chambless article are more positive).

Front 32

According to the Lambert article, what is one way that we can see if gains are maintained?

Back 32

Use posttest scores to reflect how a person is doing a year later.

Front 33

According to Chambless, What concerns fostered the EST movement?

Back 33

The premises of this movement
are that (a) patient care can be enhanced by acquisition and use of up-to-date
empirical knowledge and (b) it is difficult for clinicians to keep up with newly
emerging information pertinent to their practice but (c), if they do not, their knowledge
and clinical performance will deteriorate over the years after their training;
consequently, (d) clinicians need summaries of evidence provided by expert reviews
and instructions on how to access this information during their routine
practice

Front 34

Criteria differ between work groups that have evaluated ESTs - Why?

Back 34

the different work groups did not use the exact same definitions. Not all groups used the task force criteria in evaluating category II & II tx, some did not list promising tx, and one did not distinguish between I and II.

Front 35

Distinguish between ESTs in category I and in category II.

Back 35

Treatments in category I are supported by at least two rigorous randomized
controlled trials (RCTs) showing their superiority to placebo control conditions
or another bona fide treatment

Treatments in category II were typically supported by at least one RCT in which
the treatment proved superior to a control condition or alternative bona fide treatment.

Front 36

What does the absence of a treatment on the list of ESTs signify?

Back 36

A treatment that does not appear on any one or all of the lists could have
several meanings: (a) the treatment in question has fared poorly in research trials,
(b) the treatment has not been examined in research trials, or (c) the treatment
was not reviewed

Front 37

On this list of ESTs, did patterns of support emerge for any type of tx?

Back 37

Cog behav or exposure based tx are supported by most of the workgroups that have looked at them.

Front 38

Compare the conclusions of the Chambless article to those of Lambert & Ogles.

Back 38

Chambless- "although we found no evidence that ESTs could NOT be beneficially applied
in real clinical settings by those trained or supervised in their use, treatments may need to be modified or included as part of
a broader course of treatment. More research on effectiveness is clearly a priority if clinicians are to give credence to the value of ESTs"

Lambert- most therapies are superior to placebo

Front 39

In Chambless article, were there differences among versions of treatments from similar orientation?

Back 39

Yes. In our abbreviated review of anxiety disorders and childhood
depression, we found considerable evidence of specificity, even within
cognitive and behavioral methods. Authors were not consistent in the care
they took to rule out alternative explanations for differences among
treatments, such as possible confounding discrepancies in expectancy and
the therapeutic relationship. However, in studies in which such confounds
could be discounted, treatment differences were still obtained.

Front 40

What are some of the issues associated with EST controversy?

Back 40

a. Treatment selection = ESTs require specific tx for specific problems, some people argue against this because they think that we 1) shouldn't treat based on diagnosis 2) that all tx are effective be/c they are superior to placebo 3) that intution or knowledge of indiv diff should be used.
b. Sample description = we need to describe the sample adequately. Some argue that there are not meaningful differences, so that we shouldn't use DSM to describe them.
c. Research design = some argue that RCTs are not best way to test Tx outcome
d. Standardization of treatment= refers to the use of manuals; some argue that use of manual decr quality of care received.
e. Treatment specificity= some argue that comparisons indicate that tx are equiv to one another. In metaanalyses (aggregate) differences can be hard to see, but when you look on the individual level differences are evident.
f. Effectiveness = asks if efficacy data translates to practice
g. Focus of treatment = symptom reduction vs. quality of life.

Front 41

What are the three Division 12 Task Force criteria (Chambless et al 1998) and how is each defined?

Back 41

1. Well-established treatments
I. At least two good between-group design experiments must demonstrate efficacy in one
or more of the following ways:
A. Superiority to pill or psychotherapy placebo, or to other treatment
B. Equivalence to already established treatment with adequate sample sizes
OR
II. A large series of single-case design experiments must demonstrate efficacy with
A. Use of good experimental design and
B. Comparison of intervention to another treatment
III. Experiments must be conducted with treatment manuals or equivalent clear description
of treatment
IV. Characteristics of samples must be specified
V. Effects must be demonstrated by at least two different investigators or teams

2.Probably efficacious treatments
I. Two experiments must show that the treatment is superior to waiting-list control group
OR
II. One or more experiments must meet well-established criteria IA or IB, III, and IV
above but V is not met
OR
III. A small series of single-case design experiments must meet well-established-treatment
criteria

3.Experimental treatments
Treatment not yet tested in trials meeting task force criteria for methodology

Front 42

What is meant by the phrase "tx utility of assesment"?

Back 42

assesment by itself can be helpful

Front 43

The degree to which assessment is shown to contribute to beneficial treatment
outcome

Back 43

Treatment utility of assessment

Front 44

Assessment has utility if treatment is positively influenced by the
assessment device

Back 44

Treatment utility of assessment

Front 45

Relates to the function of the assessment measure

Back 45

Treatment utility of assessment

Front 46

Barriers have existed to research on TUA. What are they?

Back 46

(1) Conceptual confusion about concepts related to TUA = people haven't been clear about what tx utility is, how you asses it, and how you use the info obtained from assesment

(2) Clinical psychology often distinguishes between the roles of diagnostician
and therapist with poor integration of assessment and treatment

(3) Beliefs that complete psychometric purity is necessary before TUA can be
shown = you don't need to have strong psychometric properties to have tx utility, it can still give us info that will benefit our tx i.e., there is face validity that will benefit discussion.

(4) Poor intellectual context for TUA; however, two trends have occurred to
make this happen
(a) Idea that one should seek to identify which treatment works best for
whom
(b) Current measures are more specific as compared to previous ones

Front 47

_____ _________ constructs are important to treatment outcome.

Back 47

Theory-oriented constructs are important to treatment outcome

Front 48

Assessment tools that measure ___________ are more likely to have
TUA

Back 48

Assessment tools that measure the construct of interest are more likely to have
TUA

Front 49

Outcome can be improved by assesment in two ways. What are they?

Back 49

(1) Assessment helps identify mechanism that changes the way the treatment
is implemented - leading to a better outcome
(2) Assessment itself is therapeutic

Front 50

There are three ways with which one can demonstrate tx utility. What are they?

Back 50

1. Methodology of manipulated assessment = A single group of participants is randomly divided into two or more
subgroups, and either the collection of or availability of assessment data is
varied systematically

2.Methodology of manipulated use of assessment information = The same assessment information is available for all participants, but the
researcher manipulates the way the information is used
(a) Treatment matching to assessment information or not
(b) Treatment matched to diagnosis or not

3.Methodology of obtained differences in assessment information = (1) Participants are divided into groups nomandomly on the basis of
assessment difference - participants then receive one type of treatment
(2) If the outcome differs between the groups, TAU differences have been
shown
(a) Measure effects of standard treatment for those with high versus low scores
on a particular variable (moderator of treatment)

Front 51

Assessment data are at issue in this way of demonstrating tx utility

Back 51

Methodology of manipulated assessment

Front 52

A single group of participants is randomly divided into two or more
subgroups, and either the collection of or availability of assessment data is
varied systematically

Back 52

Methodology of manipulated assessment

Front 53

The same assessment information is available for all participants, but the
researcher manipulates the way the information is used

Back 53

Methodology of manipulated use of assessment information

Front 54

In what two ways does Methodology of manipulated use of assessment information manipulate the way info is used?

Back 54

(a) Treatment matching to assessment information or not
(b) Treatment matched to diagnosis or not

Front 55

Participants are divided into groups nomandomly on the basis of
assessment difference - participants then receive one type of treatment

Back 55

Methodology of obtained differences in assessment information

Front 56

Participants are divided into groups nomandomly on the basis of
assessment difference - participants then receive one type of treatment. If the outcome differs between the groups, ______________.

Back 56

TAU differences have been shown.

Front 57

Measure effects of standard treatment for those with high versus low scores
on a particular variable (moderator of treatment)

Back 57

Methodology of obtained differences in assessment information

Front 58

In Methodology of obtained differences in assessment information, you Measure effects of standard treatment for those with high versus low scores. What is an example of a type of finding that could be derived from this?
on a particular variable (moderator of treatment)

Back 58

Those with low scores benefited more than those with high scores, for example.

Front 59

In terms of TAU, how important are the psychometric properties of an instrument?

Back 59

In terms of TAU, psychometric properties of an instrument are less important
- a psychometrically poor measure can have treatment utility

Front 60

Does the addition of a set of information to other information leads to an increase in validity for each of the following?
i) Nonverbal cues
ii) Borderline personality disorder
iii) Psychopathy
iv) Family interviews
i) MMPI and MMPI-2
ii) Personality Assessment Inventory
iii) Psychopathic personality inventory
iv) Measures of adaptive and maladaptive personality features
v) Informant-rated personality inventories
-projective techniques (comp to clinical judgement)
-self-report inventories

Back 60

yes = increases incremental validity, helpful

i) Nonverbal cues = no
ii) Borderline personality disorder = y
iii) Psychopathy = sometimes; addition of 1 instrument for psychopathology leads to an increase in incremental validity, but addition of more psychopathology instruments after that is not any more helpful.
iv) Family interviews=y, particularly when assesimg personality disorders
i) MMPI and MMPI-2 = y
ii) Personality Assessment Inventory = y
iii) Psychopathic personality inventory=y
iv) Measures of adaptive and maladaptive personality features=y
v) Informant-rated personality inventories=y
-projective techniques (comp to clinical judgement)=this info does not help and, at worst, damages validity
-self-report inventories = y

Front 61

How does assessment aid in diagnosis?

Back 61

?assesment leads to precise diagnosis

Front 62

what is the role of assessment in treatment decisions?

Back 62

assesment->diagnosis->EST

Front 63

Specific diagnoses have demonstrated treatment utility of assesment. What are these?

Back 63

i) Unipolar depression = assesment and matched tx helpful
ii) Social or interpersonal problems = via social skills training and systematic desensitization
iii) Phobic disorders=either social skills training or systematic desensitization

For phobic disorders, know that the addition of assesments do not increase tx utility any more than only one (like just in vivo exposure, only muscle relaxation, etc).

Front 64

What is the difference between functional and causal variables?

Back 64

Functional relationship - when there is shared variance between two variables
there is a functional relationship (only condition for establishing this kind of
relationship)

Causal relationships are indicated when 4 conditions are satisfied:
(1) Correlation - there is covariance between the variables (functional
relationship - i.e., functional relationships is a necessary but not sufficient
condition for a causal relationship - all causal variables are functional
variables but not all functional variables are causal variables)
(2) Temporal precedence - the causal variable reliably precedes its effect
(a) A functional relationship between two variables when one reliably
precedes the other does not necessarily indicate a causal relationship
(3) Logical connection - there is a logical mechanism for the causal
relationship
(4) Third variables ruled out - alternative explanations for the observed
covariance can be reasonably excluded

Front 65

exists when when there is shared variance between two variables

Back 65

functional relationship

Front 66

Causal relationships are indicated when 4 conditions are satisfied. What are they?

Back 66

(1) Correlation - there is covariance between the variables (functional
relationship - i.e., functional relationships is a necessary but not sufficient
condition for a causal relationship - all causal variables are functional
variables but not all functional variables are causal variables)
(2) Temporal precedence - the causal variable reliably precedes its effect
(a) A functional relationship between two variables when one reliably
precedes the other does not necessarily indicate a causal relationship
(3) Logical connection - there is a logical mechanism for the causal
relationship
(4) Third variables ruled out - alternative explanations for the observed
covariance can be reasonably excluded

Front 67

there is covariance between the variables (functional
relationship - i.e., functional relationships is a necessary but not sufficient
condition for a causal relationship - all causal variables are functional
variables but not all functional variables are causal variables)
The above statement reflects what concept?

Back 67

correlation

Front 68

functional relationships is a necessary but not sufficient
condition for a causal relationship. What does this mean?

Back 68

all causal variables are functional
variables but not all functional variables are causal variables)

Front 69

the causal variable reliably precedes its effect

Back 69

temporal precedence

Front 70

A functional relationship between two variables when one reliably
precedes the other _____ a causal relationship

Back 70

A functional relationship between two variables when one reliably
precedes the other does not necessarily indicate a causal relationship

Front 71

there is a logical mechanism for the causal
relationship

Back 71

Logical connection

Front 72

alternative explanations for the observed
covariance can be reasonably excluded

Back 72

third variable ruled out

Front 73

What are the Methods of assessing causal relationships?

Back 73

i) Rational derivation - identification of possible causal variables by examining
the literature on a particular problem or disorder
ii) Causal markers - a causal marker is an index of the strength of a causal
relation between 2 variables
iii) Manipulation - causal hypotheses are tested by systematically
varying/manipulating a hypothesized causal variable and observing the effect
on the targeted behavior problem.
iv) Time Series Measurement - with these methods, a targeted behavioral
problem and one or more hypothesized causal variables are measured
concurrently and frequently across time.
v) Conditional probability analysis - can be used to estimate the probability of
occurrence of a behavioral problem, given the occurrence of hypothesized
causal variables (the probability that Behavior Problem A will occur given the
occurrence of Event B).
vi) Markov chain analysis - characterizes the transitional probabilities of a
behavior when, given the present state of that behavior, previous states have
no effects on future states

Front 74

identification of possible causal variables by examining
the literature on a particular problem or disorder

Back 74

Rational derivation

Front 75

is an index of the strength of a causal
relation between 2 variables

Back 75

Causal markers

Front 76

causal hypotheses are tested by systematically
varying/manipulating a hypothesized causal variable and observing the effect
on the targeted behavior problem.

Back 76

manipulation

Front 77

with these methods, a targeted behavioral
problem and one or more hypothesized causal variables are measured

Back 77

Time Series Measurement

Front 78

can be used to estimate the probability of
occurrence of a behavioral problem, given the occurrence of hypothesized
causal variables (the probability that Behavior Problem A will occur given the
occurrence of Event B).

Back 78

Conditional probability analysis

Front 79

characterizes the transitional probabilities of a
behavior when, given the present state of that behavior, previous states have
no effects on future states

Back 79

Markov chain analysis