THE MMPI 2 RF. Overview of the MMPI-2-RF. Agenda. Overview of the MMPI-2-RF. Overview of the MMPI-2-RF 9/8/2016. Psychometric Rationale & Properties

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1 1 Agenda 2 THE MMPI 2 RF Introduction and Overview of the MMPI-2-RF Examination of psychometric properties Psychometrics, Psychopathological Convergence, and Setting Specific Utility Mapping the MMPI-2-RF onto pathological models Setting-specific utility Overview of the MMPI-2-RF 4 3 Overview of the MMPI-2-RF 338-item restructured version of MMPI-2 Released in 08 Subset of MMPI-2 item pool Norms based on MMPI-2 sample MMPI-3? Approximately 6 th grade reading level Majority of the MMPI-2-RF items fall between the 5 th and 7 th grades Per reported data (Dahlstrom et al., 1994) Flesch-Kincaid Reading Level = 4.5 PAI = ~ 4.3 Flesch-Kincaid Reading Level Additional problems with likert-type responding ( Sometimes I ) MCMI-III = ~ 5.6 Flesch-Kincaid Reading Level 73% of items have a reading level of 7 th grade or above (Akeson & Mattson, in process) Overview of the MMPI-2-RF minutes for booklet administration Less time needed for computer administration Audio Administration (Computer or CD) Linear T Scores Validity Scales and the 2 Interest Scales Uniform T Scores All other substantive scales No K correction offered Lack of empirical support Only uses NON-GENDERED scores Why? 6 Psychometric Rationale & Properties 1

2 Why Restructure the Clinical Scales? Why Restructure the Clinical Scales? 7 8 Although it has long been recognized that the Clinical Scales (CSs) contain compelling and interpretively meaningful information, they are not psychometrically optimal when used as aggregate measures of psychopathology. (Ben-Porath, 12) Why? Higher than expected intercorrelations Substantial item overlap between scales Heterogeneous item content Intercorrelations CS 7 (measure of emotional dysfunction) and CS 8 (disordered thinking) correlate, on average, around. While these two constructs DO co-occur they do not, and should not, do so at this rate Item Overlap CS 7 and CS 8 share 17 items MMPI-2 Item 31 is keyed True on five of the eight original CSs Heterogeneous Item Content Ambiguous scale interpretation The problem of the subtle items AND criterion keying Development of the RC Scales (Ben-Porath, 12) Tellegen (1985) Affective Circumplex 9 10 Capture Demoralization Demoralization is characterized by an unhappy, dysphoric mood, a sense of helplessness and inability to cope with one s current circumstances, and general dissatisfaction with one s condition (Sellbom et al., 08) Isolate the construct and measure once A demoralization-like construct had previously been thought to be the elusive MMPI 1 st Factor Thought to be the cause of the intercorrelations between the CSs Development of the RC Scales (Ben-Porath, 12) Internal Consistency of the Clinical and Restructured Clinical Scales of the MMPI-2/MMPI-2-RF (Normative Sample) (Graham, 12) 11 Factor Analyze MMPI-2 Clinical Scales Identify distinctive core components In general, the RC Scales directly relate to the corresponding Clinical Scales; however, this is not always the case Construct Seed Scales for each core component Based on factor analytic and correlational data Deriving Final RC Scales Entire MMPI-2 item pool utilized, internal reliability examined, aimed at providing non-overlapping items 12 Internal Consistency Coefficients (Alpha) Scale Men Women MMPI-2 (n = 82) MMPI-2-RF (n = 1138) MMPI-2 (n = 111) MMPI-2-RF (n = 1462) --- / RCd (dem) Hs / RC1 (som) D / RC2 (lpe) Hy / RC3 (cyn) Pd / RC4 (asb) Mf / Pa / RC6 (per) Pt / RC7 (dne) Sc / RC8 (abx) Ma / RC9 (hpm) Si /

3 13 Reliability and Validity Comparisons between several varying clinical samples provide data that the RC Scales show: Comparable or improved reliability Substantially reduced saturation with Demoralization Substantially reduced inter-correlations Comparable or improved convergent validity Substantially improved discriminant validity 14 Reliability and Validity Subsequent studies have provided additional evidence supporting the use of the RC Scales Replicated in: College counseling settings (Sellbom, Ben-Porath, & Graham, 06) Community-dwelling veterans (Simms et al., 05) Outpatient sample (Wallace, A., & Liljequist, L., 05) Private practice (Sellbom, Graham, & Schenck, 06) Substance abuse treatment patients (Forbey & Ben-Porath, 07) Bariatric surgery candidates (Wygant et al., 07) Inpatients (Handel & Archer, 08) College students (Osberg et al., 08) Hierarchical Structure of the RF Substantive Scales 3 Higher-Order Scales (H-O) 9 Restructured Clinical (RC) Scales Foundational Basis 23 Specific Problems (SP) Scales 5 Somatic/Cognitive 9 Internalizing 4 Externalizing 5 Interpersonal 2 Interest Scales 5 PSY-5 Scales 9 Validity Scales 16 Diagnostic Construct Validity 17 Mapping the MMPI-2-RF 18 Psychopathological Convergence Studies show the MMPI-2-RF scales: Map onto normal personality models MPQ (Sellbom & Ben-Porath, 05) NEO-PI-R (Sellbom, Ben-Porath, & Bagby, 08) As well as current models of psychopathology Sellbom, Ben-Porath, & Bagby (08) Sellbom, Ben-Porath, Lilienfeld, Patrick, & Graham (05) Sellbom, Ben-Porath, & Stafford (07) Quilty, Sellbom, Tackett, & Bagby (09) Watson (05) Wolf, Miller, Orazem, Weierich, Castillo, Milford, Kaloupek, Keane (08) Good predictors of future problematic behavior in law enforcement candidates (Sellbom, Fischler, & Ben-Porath, 07) And failure to complete substance abuse tx (Mattson, Powers, Halfaker, Akeson, & Ben-Porath, 12) Equally valid for African Americans and Caucasians (Castro et al., 08) 3

4 Empirical Model (Watson, 05) 19 Internalizing Convergence Internalizing Disorders Dysthymic Disorder Generalized Anxiety Associations with Demoralization Dysthymic Disorder Generalized Anxiety Internalizing Distress Post-Traumatic Stress Major Depressive Social Phobia Internalizing Distress (RCd) Post-Traumatic Stress Major Depressive Social Phobia Fear Specific Phobia Agoraphobia Fear (RC7) Specific Phobia Agoraphobia Panic Disorder Panic Disorder Diagram adapted from Krueger (1999) and Watson (05) Obsessive Compulsive (Sellbom, Ben-Porath, & Bagby, 08) Obsessive Compulsive Associations with Negative Activation Dysthymic Disorder Generalized Anxiety Associations with Positive Activation Dysthymic Disorder Generalized Anxiety Internalizing Distress (RCd) Post-Traumatic Stress Major Depressive Social Phobia Internalizing Distress Post-Traumatic Stress Major Depressive Social Phobia Fear (RC7) Specific Phobia Agoraphobia Fear Specific Phobia Agoraphobia Panic Disorder Panic Disorder (Clark, 05; Sellbom et al., 08; Watson, 05) Obsessive Compulsive (Clark, 05; Sellbom et al., 08; Watson, 05) Obsessive Compulsive 4

5 25 Externalizing Convergence Externalizing Disorders Substance Abuse Alcohol Dependence Drug Dependence Externalizing Antisocial Behavior Aggression, Callousness, Excitement-Seeking Conduct Disorder (Krueger et al., 02; Krueger et al., 07) Constraint (reversed) 26 Externalizing Convergence 27 Sellbom, Ben-Porath, & Stafford (09 SPA Presentation) Using samples of: 21,836 men in correctional settings 1,065 men and women in forensic contexts 2 male and female college students Found: Variance on the externalizing domain corresponds with the hierarchical framework of the MMPI-2-RF BXD associated with a broad range of externalizing facets Best marker of general impulsivity/disinhibition RC scales show a more distinct pattern Specific facet information and specific markers (e.g., RC9 & Narcissism) SP scales show unique differential pattern of associations JCP juvenile delinquency; SUB alcohol and drug dependence; AGG trait aggression; ACT trait activation 28 Setting-Specific Utility Medical Settings Medical Settings Bariatric Surgery Candidates 29 The technical manual (Tellegen & Ben-Porath, 08) contains: Empirical correlates Medical comparison groups In addition, you can select appropriate comparison groups when using the MMPI-2-RF in medical settings Bariatric Surgery Candidates Spine Surgery/Spinal Cord Stimulator Candidates Factors associated with poor outcome, including ability to maintain focus on self-care when faced with adversity: Maladaptive (acting out) behavior (BXD, RC4, AGG) Affective instability (RCd, RC7, SUI, AXY) Depression (RC2, SFD) Low Stress tolerance (MLS, STW, AXY, SUB) Increased risk for suicidal ideation/intent and lifetime substance abuse problems (Tarescavage et al., 13) 5

6 Spine Surgery / Spinal Cord Stimulator Chronic Pain Risk factors: Pain Sensitivity (RC1, MLS, HPC, NUC) Depression (RCd, RC2, SUI) Anxiety (RCd, RC7, STW, AXY) Anger (RC7, ANP, AGG) Catastrophizing ([low]k-r, RCd, MLS) Disability-seeking (Fs, FBS-r, MLS) Low self-esteem (SFD) Excessive guardedness (L-r, K-r) Similar risk factors as the Spinal Surgery group; however: Profiles tend to be more elevated and chronic More likely to be involved in disability claims Chronic pain samples generally exhibit higher levels of co-elevated internalizing psychopathology scales Chronic pain patients tend to report higher levels of depression, amotivation, and helplessness Ms. G - Chronic Pain MMPI-2-RF Validity Scales Ms. G - Chronic Pain MMPI-2-RF Higher-Order (HO) and Restructured Clinical (RC) Scales 1 1 VRIN-r TRIN-r F-r Fp-r Fs FBS-r RBS L-r K-r VRIN -r T RIN -r F-r Fp-r Fs FBS-r RBS L-r K-r EID THD BXD RCd RC1 RC2 RC3 RC4 RC6 RC7 RC8 RC9 EID THD BXD RCd RC1 RC2 RC3 RC4 RC6 RC7 RC8 RC9 EID THD BXD RCd RC1 RC2 RC3 RC4 RC6 RC7 RC8 RC9 33 F 34 Mean Mean Ms. G - Chronic Pain Ms. G - Chronic Pain 1 MMPI-2-RF Somatic / Cognitive and Internalizing Scales 1 MMPI-2-RF Externalizing, Interpersonal, and Interest Scales Ms. G - Chronic Pain DSF AES MEC NFC STW AXY ANP BRF 35 MLS GIC HPC NUC COG SUI HLP SFD NFC STW AXY ANP BRF MSF MLS GIC HPC NUC COG SUI HLP SFD NFC STW AXY ANP BRF MSF Mean JCP SUB AGG ACT FML IPP SAV SHY DSF AES MEC JCP SUB AGG ACT FML IPP SAV SHY DSF AES MEC Mean

7 Ms. G - Chronic Pain MMPI-2-RF Personality Psychopathology Five (PSY-5) Ms. P Pre-surgical Spine Evaluation AGGR-r PSYC-r DISC-r NEGE-r INTR-r AGGR-r PSYC-r DISC-r NEGE-r INT R-r AGGR-r PSYC-r DISC-r NEGE-r INTR-r Mean

8 Ms. F - Somatization

9 49 52 Ms. K Psychogenic Non-Epileptic Seizures

10 Ms. W - Conversion 10

11 Setting-Specific Utility Forensic Settings 65 11

12 Forensic Settings Daubert Criteria Challenges New tests typically provide some material for attorneys to attack Admissibility of a test especially a new test Weight of the evidence/opinion based on the results See Ben-Porath (12) for responses to specific challenges based on the MMPI-2-RF Has the MMPI-2-RF been tested? Has it been subjected to peer review? What is the MMPI-2-RF s known or potential error rate? Are there standards for controlling the MMPI-2-RF? Is the MMPI-2-RF generally accepted? Has the MMPI-2-RF been tested? Has the MMPI-2-RF been peer reviewed? 69 Empirical data available in the Technical Manual Intercorrelations between the scales Correlations between the RF and the existing MMPI-2 Empirical correlates are available for both criminal and civil forensic settings Comparison groups to aid in interpretation and report writing include: Pre-Trial Forensic Disability Claimants Child Custody Parental Fitness Prison Inmates There are over 0 peer-reviewed publications on the MMPI-2-RF Topics Include: General Assessment and Diagnostic Utility Validity Correctional Settings Forensic Settings Mental Health Settings Medical Settings Other Non-Clinical Settings 71 The MMPI-2-RF s error rate? 72 Are there standards for controlling the MMPI-2-RF? Data on reliability and standard error of measurement (SEM) of MMPI-2-RF scale scores address this question directly Available in Technical Manual Chapter 3 Available for both Normative and Clinical samples Classification accuracy statistics Sensitivity, Specificity, Positive and Negative Predictive Powers Available in peer reviewed classification studies (e.g., malingering detection research) YES! Standardized administration and scoring guidelines Standardized interpretive approach Reliability of interpretation between raters is higher 12

13 73 Is the MMPI-2-RF generally accepted? 74 Use of the MMPI-2-RF: Forensic and Correctional Contexts Increasingly so Basis in the Frye Standard MMPI-2-RF is increasingly being used in: Forensic Contexts Medical Evaluations Public Safety (Law Enforcement) Screenings The MMPI-2-RF has also been included in several recent book publications by experts in personality assessment Assessment of Psychopathy (Wygant, Applegate, &Wall, 14) MMPI-2-RF substantive scales associate with specific indices from the Psychopathic Personality Inventory (PPI) BXD Hierarchy As well as STW, BRF, MSF, IPP, SAV, SHY, DSF Risk Assessments (Wygant, Applegate, &Wall, 14) State vs. trait violence proclivities (or both) Fearlessness, interpersonal dominance, criminal history, severe mental health symptoms, substance abuse Public Safety Candidates Setting-Specific Utility Major Issues: Screening applicants versus Selecting applicants Public Safety Screenings Profile score evaluation Undesirable characteristics Screening vs Selection of Candidates Evaluation of Profile Scores Screening Typically done after a conditional offer of employment is given Selection Cannot involve medical procedures that can identify disabilities (e.g., MMPI/MMPI-2/MMPI-2-RF), unless in an exempted setting Impact of the Americans with Disabilities Act (ADA) Excessive Guardedness L-r K-r Lack of guardedness is also a red flag How much guardedness is too much? Psychopathology Problematic or concerning arrangements of substantive scales No adjustments for detecting psychopathology (T > 65) Undesirable Characteristics Moderate elevations on certain scales Low scores on other scales 13

14 Mr. C - Law Enforcement Example MMPI-2-RF Validity Scales Mr. C Law Enf. Norm Mr. C - Law Enforcement Example MMPI-2-RF Higher-Order (HO) and Restructured Clinical (RC) Scales Mr. C Law Enf. Norm 1 1 VRIN-r TRIN-r F-r Fp-r Fs FBS-r RBS L-r K-r EID THD BXD RCd RC1 RC2 RC3 RC4 RC6 RC7 RC8 RC9 EID EID THD THD BXD BXD RCd RCd RC1 RC1 RC2 RC2 RC3 RC3 RC4 RC4 RC6 RC6 RC7 RC7 RC8 RC8 RC9 RC9 Mr. C Law Enf. Norm Mean F MMPI-2-RF Norm Mean Mr. C Law Enf. Norm Mean MMPI-2-RF Norm Mean Mr. C - Law Enforcement Example MMPI-2-RF Somatic/Cognitive and Internalizing Scales Mr. C Law Enf. Norm 1 Mr. C - Law Enforcement Example MMPI-2-RF Externalizing, Interpersonal, and Interest Scales Mr. C Law Enf. Norm Law Enforcement Example DSF AES MEC NFC STW AXY ANP BRF 81 MLS GIC HPC NUC COG SUI HLP SFD NFC STW AXY ANP BRF MSF HPC NUC COG SUI HLP SFD NFC STW AXY ANP BRF MSF MLS GIC Mr. C Law Enf. Norm Mean MMPI-2-RF Norm Mean JCP SUB AGG ACT FML IPP SAV SHY DSF AES MEC JCP SUB AGG ACT FML IPP SAV SHY DSF AES MEC Mr. C Law Enf. Norm Mean MMPI-2-RF Norm Mean Mr. C - Law Enforcement Example MMPI-2-RF Personality Psychopathology Five (PSY-5) Mr. C Law Enf. Norm 1 84 Questions? Curtis Mattson, PsyD curtis.mattson@gmail.com 83 AGGR-r PSYC-r DISC-r NEGE-r INTR-r AGGR-r PSYC-r DISC-r NEGE-r INTR-r AGGR-r PSYC-r DISC-r NEGE-r INTR-r Mr. C Law Enf. Norm Mean MMPI-2-RF Norm Mean

Agenda. The MMPI-2-RF (Restructured Form) Forensic Practice Briefing. Disclosure

Agenda. The MMPI-2-RF (Restructured Form) Forensic Practice Briefing. Disclosure The MMPI-2-RF (Restructured Form) Forensic Practice Briefing Yossef S. Ben-Porath Department of Psychology Kent State University Kent, OH ybenpora@kent.edu Disclosure Yossef Ben-Porath is a paid consultant