Chapter 3: Diagnosis and Assessment. 1. Be able to describe the purposes of diagnosis and assessment.

Transcription

1 Chapter 3: Diagnosis and Assessment LEARNING GOALS 1. Be able to describe the purposes of diagnosis and assessment. 2. Be able to distinguish between the different types of reliability and validity. 3. Be able to identify the basic features, strengths, and weaknesses of the DSM-IV-TR. 4. Be able to describe the goals, strengths, and weaknesses of psychological and neurobiological approaches to assessment. 5. Be able to discuss the ways in which culture and ethnicity impact diagnosis and assessment. Summary In gathering diagnosis and assessment information, clinicians and researchers must be concerned with both reliability and validity. Reliability refers to whether measurements are consistent and replicable; validity refers to whether assessments are tapping into what they are meant to measure. Assessment procedures vary greatly in their reliability and validity. Certain diagnostic categories are more reliable than others. Diagnosis Diagnosis, the process of assessing whether a person meets criteria for a mental disorder, is a critical aspect of the field of abnormal psychology. Having an agreed-on diagnostic system allows clinicians to communicate effectively with each other and facilitates the search for causes and treatments. Clinically, diagnosis provides the foundation for treatment planning. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is an official diagnostic system widely used 1

2 by mental health professionals. A revision of the fourth edition of the manual, referred to as DSM-IV-TR, was published in An important feature of the current DSM is its multiaxial organization. In the multiaxial classification system of DSM, Axes I and II make up the mental disorders per se; Axis III lists any physical disorders believed to have bearing on the mental disorder in question; Axis IV is used to indicate the psychosocial and environmental problems that the person experiences; and Axis V rates the person s current level of adaptive functioning. Some critics of the DSM argue against diagnosis in general. They point out that diagnostic classifications may ignore important information and may also increase stigma. Specific shortcomings of the DSM have also been identified. These include the high rates of comorbidity, the reliance on a categorical classification system, limited reliability for some disorders, and questions about the validity of a few of the diagnostic categories. Most researchers and clinicians, though, recognize that the DSM is an enormous advancement compared to historical systems. Assessment Clinicians rely on several modes of psychological and neurobiological assessment in trying to find out how best to describe a client, search for the reasons the patient is troubled, arrive at an accurate diagnosis, and design effective preventive or remedial treatments. Regardless of what assessment method is used, it inevitably reflects the paradigm of the clinician. The best assessment involves multiple types of methods. 2

3 Psychological assessments include clinical interviews, assessments of stress, psychological tests, and behavioral and cognitive assessments. Clinical interviews are structured or relatively unstructured conversations in which the clinician probes the patient for information about his or her problems. Assessing stress is key to the field of abnormal psychology. Despite difficulties with defining stress, a number of useful methods for assessing it have been developed, including the LEDS and ADE. Psychological tests are standardized procedures designed to assess personality or measure performance. Personality assessments range from empirically derived self-report questionnaires, such as the Minnesota Multiphasic Personality Inventory, to projective tests in which the patient interprets ambiguous stimuli, such as the Rorschach Test. Intelligence tests, such as the Wechsler Adult Intelligence Scale, evaluate a person s intellectual ability and predict how well he or she will perform academically. Behavioral and cognitive assessment is concerned with how people act, feel, and think in particular situations. Approaches include direct observation of behavior,interviews and self-report measures that are situational in their focus, and specialized, think-aloud cognitive assessment procedures that attempt to uncover beliefs, attitudes, and thinking patterns related to specific situations. Neurobiological assessments include imaging techniques, such as fmri that enable us to see various structures and access functions of the living brain,neurochemical assays that allow clinicians to make inferences about levels of neurotransmitters, neuropsychological tests, such as the Halstead Reitan, 3

4 which seek to identify brain defects based on variations in responses to psychological tests; and psychophysiological measurements, such as heart rate and skin conductance, which are associated with certain psychological events or characteristics. Cultural and ethnic factors play a role in clinical assessment. For example, assessment techniques developed on the basis of research with Caucasian populations may be inaccurate when used with clients of different ethnic or cultural backgrounds. Clinicians can have biases when evaluating ethnic minority patients, which can lead to minimizing or exaggerating a patient s psychopathology. Clinicians use various methods to guard against the negative effects of cultural biases in assessment. 1. Diagnostic systems allow clinicians and scientists to a. conduct psychotherapy. b. communicate accurately with one another about cases and research. c. understand the role of cultural bias. d. All of the above are correct. Answer: B Type: Applied Page: Jim was given an intelligence test in March and re-administered the same test one year later. His score both times was the same. This indicates that the intelligence test has a. high test-retest reliability. b. high interrater agreement. c. internal consistency. d. None of the above is correct. Answer: A Type: Applied Page: Generally it is impossible for measures to be a. reliable but not valid. b. valid but not reliable. 4

5 c. neither reliable nor valid. d. both reliable and valid. Answer: B Type: Applied Page: Britney was taking a test to measure levels of depression. All of the items covered typical symptoms of depression. This inventory would be said to have a. high construct validity. b. high content validity. c. high criterion validity. d. high statistical validity. Answer: B Type: Applied Page: Jackson appears to have social phobia. This diagnosis was made by looking at his scores on a particular measure of social fear. Scores like his in the past have been shown to be related to social phobia, as well as correlated with a variety of measures of social and occupational disability associated with social phobia. The measure Jackson took would be said to have a. high construct validity. b. high content validity. c. high criterion validity. d. high statistical validity. Answer: A Type: Applied Page: In 1994, the DSM-IV was published by the a. American Psychopathological and Statistical Association. b. World Health Organization. c. Congress of Mental Science. d. American Psychiatric Association. Answer: D Type: Factual Page: In 2000, the DSM-IV-TR was published a. to clarify issues surrounding prevalence rates, course, and etiology. b. to describe diagnoses in objective terms. c. to include response to treatment in the descriptions of diagnoses. d. for use by laypersons as well as professionals. Answer: A Type: Factual Page: 64 5

6 8. The letters in the abbreviation DSM refers to a. Diseases and Symptoms of the Mind. b. Diagnostic and Statistical Manual. c. Diseases and Symptoms Manual. d. Disorders and Symptoms Manual. Answer: B Type: Factual Page: The DSM-IV-TR provides diagnoses along 5 areas. These areas are called a. axes. b. classifications. c. multiple dimensions. d. differential diagnoses. Answer: A Type: Factual Page: Axes I and II are separated a. to distinguish mood disorders from psychotic disorders. b. to allow distinctions between medical conditions and psychological conditions. c. to distinguish longstanding disturbances from acute problems. d. All of the above are correct. Answer: C Type: Factual Page: In DSM-IV-TR, long-standing diagnoses such as personality disorders are identified on a. only Axis I. b. only Axis II. c. only Axis III. d. Axis II and III. Answer: B Type: Applied Page: Axis V is included to a. provide a current rating of functioning. b. estimate probability of recovery. c. assist in clarifying diagnoses made on Axis I or II. d. None of the above is correct. Answer: A Type: Applied Page: 64 6

7 13. The purpose of Axis IV is to a. identify personality disorders. b. determine acute disturbance. c. evaluate environmental and psychosocial problems. d. account for medical problems affecting mental disorders. Answer: C Type: factual Page: Without Axis IV, which of the following would not be included in the DSM-IV-TR diagnosis? a. a developmental disorder b. alcoholism c. diabetes d. homelessness Answer: D Type: Applied Page: Jose has major depression and has multiple sclerosis. He would be diagnosed on a. Axis I: major depression and Axis III: multiple sclerosis. b. Axis I: major depression; Axis II: multiple sclerosis. c. Axis I: major depression and multiple sclerosis. d. Axis II: major depression and Axis III: multiple sclerosis. Answer: A Type: Applied Page: Sheila was recently robbed and subsequently developed an acute stress disorder. She was blinded during the robbery and is now unable to find work because of her loss of sight. Using DSM-IV, how would Sheila's problems be diagnosed? a. Axis I: no diagnosis; Axis II: Acute Stress Disorder; Axis III: blindness b. Axis I: Acute Stress Disorder; Axis II: blindness c. Axis I: Acute Stress Disorder; Axis II: blindness; Axis III: Psychosocial and Environment Problem: robbery d. Axis I: Acute Stress Disorder; Axis III: blindness; Axis IV: Psychosocial and Environmental Problem: robbery Answer: D Type: Applied Page: Axis V of the DSM-IV-TR considers all but which of the following? a. social relationships b. use of leisure time c. occupational functioning 7

8 d. psychosocial problems experienced Answer: D Type: Factual Page: The multiaxial approach in DSM-IV-TR encourages clinicians to make assessment judgments a. on the most appropriate axis. b. based on ethnic and cultural considerations. c. considering a wide range of information. d. using a variety of assessment measures. Answer: C Type: Applied Page: Major improvements since the DSM-III include all of the following EXCEPT a. more specific diagnostic criteria. b. more extensive descriptions of diagnosis on Axes I and II. c. decrease in diagnostic categories. d. more emphasis on laboratory findings and results from physical exams. Answer: C Type: Applied Page: Which of the following diagnostic categories were at one time included in the DSM and were then removed from the DSM? a. homosexuality b. bipolar disorder c. panic disorder d. None of the above is correct. Answer: A Type: Factual Page: Previous editions of the DSM were criticized for their a. lack of attention to childhood disorders. b. lack of attention to cultural and ethnic variations in psychopathology. c. inability to accurately diagnose individuals with schizophrenia. d. overemphasis on mood disorders. Answer: B Type: Factual Page: Which of the following statements is TRUE? a. Culture can have a large influence on which symptoms of a given disorder are expressed. 8

9 b. For most diagnoses in the DSM-IV-TR, it is advised not to consider cultural context. c. Most symptoms of psychiatric disorders manifest themselves in similar ways across cultures. d. The DSM-II was the first edition of the DSM to consider cultural and ethnic variations in psychopathology. Answer: A Type: Factual Page: Culture bound syndromes a. are coded on Axis II. b. are listed in the appendix of the DSM. c. are only found in cultures outside the United States. d. are very, very rare. Answer: B Type: Factual Page: A dissociative episode found primarily among men that involves brooding followed by violent episodes is called a. brain fag. b. koro. c. amok. d. dhat. Answer: C Type: Factual Page: In the DSM-IV, anxiety about the penis receding into the body is termed a. amok. b. ghost sickness. c. dhat. d. koro. Answer: D Type: Factual Page: Studies of psychopathology in other cultures suggest that a. people diagnosed with a culture-bound syndrome may also meet DSM criteria for a specific disorder. b. the prevalence of eating disorders in West African adolescents is approximately the same as the prevalence in American adolescents. c. worldwide, depression is more common in men. d. koro is quite common in Native American cultures. Answer: A Type: Applied Page: 70 9

10 27. The DSM-IV-TR includes approximately different diagnostic categories. a. 300 b. 490 c. 125 d. 75 Answer: A Type: Factual Page: Some critics of the DSM-IV-TR believe that a. there are not enough different diagnoses. b. the DSM-IV-TR has pathologized too many problems without good justification. c. there is not enough comorbidity in diagnoses. d. another diagnostic category should be added titled Conditions that may be a focus of clinical attention in elderly populations. Answer: B Type: Applied Page: Comorbidity refers to a. the likelihood that a given psychological disorder will result in death. b. how long a person is expected to live with a given psychological disorder. c. the presence of a second diagnosis. d. the absence of an Axis I disorder. Answer: C Type: Factual Page: The DSM-IV-TR is an example of which approach to classification? a. categorical b. dimensional c. quantitative d. atheoretical Answer: A Type: Factual Page: Which of the following is a dimensional classification system? a. gender b. college major c. telephone number d. grade point average Answer: D Type: Applied Page: 72 10

11 32. Dr. Kline classified her patients according to hair color. Some were classified as blonde, some brunette, some red- haired. This is an example of a a. continuous classification. b. etiological classification. c. categorical classification. d. dimensional classification. Answer: C Type: Applied Page: You are relying on a dimensional classification scheme and work with individuals who struggle with delusions. Your diagnoses are going to be based upon of delusions. a. presence or absence b. social consequences c. underlying cause d. severity Answer: D Type: Applied Page: The fact that SSRI s often relieve symptoms of anxiety as well as depression suggests to some clinicians and researchers that a. SSRI s are inadequate drugs for depression. b. anxiety and depression should be part of the same diagnostic category. c. anxiety should be treated with anxiolytics. d. Axis I and II should be a dimensional diagnostic system. Answer: B Type: Applied Page: What is one reason categorical systems are popular? a. Freud was a proponent of such a system. b. They define a certain threshold for treatment. c. They describe the degree to which an entity is present. d. It is more helpful to know severity of a symptom rather than whether or not it is present. Answer: B Type: Applied Page: Caleb went to see two different psychologists about his depressive symptoms. One told him that he suffered from major depressive disorder and the other told him that he had bipolar disorder. This is an example of a problem with 11

12 a. interrater reliability. b. content validity. c. internal consistency. d. construct validity. Answer: A Type: Applied Page: When Dr. Smith diagnoses a patient with schizophrenia and Dr. Jones diagnoses that same patient with obsessive-compulsive disorder, we would say that Dr. Smith and Dr. Jones have a. low validity. b. low reliability. c. low accuracy. d. low criteria. Answer: B Type: Applied Page: In order to study the reliability of a diagnostic category, we would study whether a. it acknowledges the uniqueness of each individual. b. it has explicitly stated criteria. c. patients with the label respond to treatment the same. d. diagnosticians apply it consistently. Answer: D Type: Factual Page: Reliability, as used in diagnosis, is the same as a. agreement. b. validity. c. judgment. d. utility. Answer: A Type: Factual Page: If a diagnosis helps clinicians make good predictions and informs them of the likely course of the disorder, psychologists would say that the diagnosis has a. interrater reliability. b. construct validity. c. test validity. d. internal consistency. Answer: B Type: Applied: Page: 72 12

13 41. Which of the following situations is most similar to the concept of reliability in making psychiatric diagnoses? a. You see identical twins that have identical mannerisms. b. After watching a new T.V. show, you and a friend independently decide that it is lousy. c. You're not sure what time a baseball game is on and guess it is at 1:00. You look in the T.V. guide and it is, in fact, at 1:00. d. You meet someone new at a party and decide she/he is a shy person. Sure enough, she/he hardly speaks to anyone at the party. Answer: B Type: Applied Page: A line judge in a football game calls a player for holding. The head linesman disagrees, but instead calls a player for unnecessary roughness. These referees have a problem with a. reliability. b. etiological validity. c. concurrent validity. d. predictive validity. Answer: A Type: Applied Page: A valid classification system is one that a. has clear criteria for making diagnoses. b. ensures that two or more people will agree on a classification. c. leads to accurate predictions and statements. d. has a clear purpose. Answer: C Type: Factual Page: Just before he died, several physicians were treating Joe for a stroke; an autopsy showed he had Alzheimer's disease. Joe's physicians showed a. neither reliability nor validity. b. validity but not reliability. c. reliability but not validity. d. both reliability and validity (despite very bad luck). Answer: A Type: Applied Page: Construct validity of a diagnosis refers to a. diagnoses that arise due to known medical factors. b. the consistency of diagnosing the same condition. 13

14 c. an inference regarding a diagnosis on the basis of a set of observed symptoms. d. the likelihood that two diagnosticians would come up with the same diagnosis. Answer: C Type: Applied Page: Unlike most conversations with a friend, a clinical interviewer would focus on a. structure. b. how the person responds. c. objectivity. d. humor. Answer: B Type: Applied Page: In clinical interviews, most clinicians pay particular attention to a. manner of responding. b. truthfulness. c. childhood. d. current social functioning. Answer: A Type: Factual Page: Clinical interviewers typically a. focus on observable behavior. b. highlight the importance of rapport. c. are psychodynamic in orientation. d. focus on medical conditions. Answer: B Type: Applied Page: Which of the following is true regarding interviewing the clinical interview? a. It enables one to obtain vast amounts of information. b. It is too subjective to be of much value in assessment. c. It provides the most valid information in assessment. d. Behavioral clinicians consider it unnecessary, though clinicians from other paradigms find it useful. Answer: A Type: Applied Page: Which of the following guides a clinical interview? a. time of day b. location of interview 14

15 c. paradigm used by interviewer d. structured instrument used by interviewer Answer: C Type: Applied Page: Which of the following is a structured interview? a. SRRS b. SCID c. ADE d. Rorschach Answer: B Type: Applied Page: Which of the following is not a measure of psychological stress? a. Social Readjustment Rating Scale b. Assessment of Daily Experience c. Life Events and Difficulties Schedule d. Thematic Apperception Test Answer: A Type: Factual Page: Why has the Social Readjustment Scale been criticized? a. It is a self-report measure. b. It contains items that are both outcomes and antecedents of stress. c. It contains items that most people have never experienced. d. It relies on prospective methods. Answer: B Type: Factual Page: Ava creates a scale that assesses stress during the first year of college. She plans to administer this scale to graduating seniors. What is a likely criticism of her methods? a. She will have low interrater reliability. b. She will be collecting retrospective reports which are subject to considerable distortion. c. Most graduating seniors will not have the time to complete such a scale. d. She should use a validated scale like the MMPI. Answer: B Type: Applied: Page: The ADE was most helpful in addressing which of the following issues? a. retrospective reports 15

16 b. prospective reports c. internal consistency d. clinical interviews Answer: A Type: Applied: Page: An advantage of the Life Events and Difficulties Schedule (LEDS) over other life stress assessments is that a. it is a very structured interview. b. it takes a shorter time to complete. c. it allows for the evaluation of life events in the context of a person s unique life circumstances. d. it relies less on determining when an event actually occurred. Answer: C Type: Factual: Page: The Bedford College Life Events and Difficulties Schedule (LEDS) was designed to measure stress a. in response to major life changing events. b. in the context of the individual s circumstances. c. as it occurs in the individual s routine daily life. d. over especially long periods of time. Answer: B Type: Factual Page: The LEDS has led researchers to conclude that a. life events are robust predictors of several psychological and medical symptoms. b. stress is mediated by one s childhood experiences. c. a given life event has the same impact across individuals. c. the correlation between life events and stress is low. Answer: A Type: Factual Page: You have developed a new personality inventory that will be used to match roommates in order to minimize conflict. You are almost ready to market the test, but first must administer it to several hundred individuals to establish normative information. This phase of test development is referred to as a. branching. b. psychometrics. c. validation. d. standardization. 16

17 Answer: D Type: Applied Page: These types of tests have not traditionally been standardized. a. intelligence tests b. objective Personality tests c. projective Personality Tests d. All of the above have been standardized. Answer: C Type: Applied Page: You decide that you wish to use the MMPI to form a scale within the instrument to distinguish potential professional wrestlers from those without the potential to be wrestlers. Using the same method as that used to develop the MMPI, you would a. identify items that were about wrestling. b. identify items that distinguish pro wrestlers from non-wrestlers. c. find all the items that wrestlers answered as true regarding themselves. d. look for consistency among items endorsed by wrestlers as true. Answer: B Type: Applied Page: The MMPI is an example of a (n) a. projective test. b. personality inventory. c. intelligence test. d. structured clinical interview. Answer: B Type: Factual Page: One reason for revising the MMPI was to a. make scoring easier and more reliable. b. accommodate changes in DSM criteria. c. eliminate objectionable wording. d. reduce possibilities for cheating. Answer: C Type: Factual Page: Which of the following was not a change made in the revised version of the MMPI? a. Increase representation from different racial groups in the norm sample. b. Alter the format for answering questions. c. Alter the norm sample to reflect the composition of the US. d. Altering items to make the content more current. 17

18 Answer: B Type: Applied Page: Which of the following is a limitation of computer generated scoring of the MMPI? a. Competency of the professionals interpreting the score report. b. Competency of the professionals who developed the computer-generated scoring program. c. Ability of the computer to handle respondents who fake-bad. d. Usefulness of computer- generated report in developing comprehensive reports Answer: A Type: Applied Page: The MMPI detects individuals attempting to fake the test by a. including special scales to detect lying. b. inferring the lying behavior from answers left blank. c. re-administering the test. d. examining highly unusual responses. Answer: A Type: Applied Page: Compared to the original MMPI, the MMPI-2 a. is almost identical except for the deletion of sexist wording and updated language on some items. b. has a much larger and more diverse standardization sample. c. has completely new scales and norms. d. has turned out to be much less valid at discriminating psychiatric patients. Answer: B Type: Factual Page: Which of the following is an example of an item that might be included in the MMPI lie scale? a. "Sometimes I feel nauseous for no apparent reason." b. "I enjoy reading detective novels." c. "I have never used a foul word." d. "I often walk after dinner." Answer: C Type: Applied Page: How does the MMPI attempt to determine if a particular person is responding to the test in a valid way? a. By having a large enough standardization sample. 18

19 b. By conducting the interview in a structured and standardized way. c. By including special validity scales to detect response biases. d. By providing ambiguous stimuli so the person does not know which answer is right or wrong. Answer: C Type: Applied Page: The projective hypothesis assumes a. responses to highly structured tasks reveal hidden attitudes and motivations. b. preferences for unstructured stimuli reveal unconscious motives. c. unstructured stimuli provoke anxiety. d. responses to ambiguous stimuli are influenced by unconscious factors. Answer: D Type: Applied Page: The projective hypothesis is derived from which paradigm? a. neuroscience b. cognitive c. psychoanalytic d. diathesis-stress Answer: C Type: Factual Page: Dr. Gallagher was interpreting the results of a Rorschach test, and reported that the client was probably fixated at the anal stage because he saw bathroom items in many of the cards. This is an example of a. the projective hypothesis. b. the unreliability of the Rorschach. c. the Exner scoring system. d. a standardized interpretation. Answer: A Type: Applied Page: The stimulus materials in the Thematic Apperception Test are ambiguous a. to increase the likelihood that the individual is not giving responses that are consciously mediated. b. for greater precision. c. to increase rapport. d. to create discomfort in the client and thereby encourage a closer relationship with the therapist. Answer: A Type: Applied Page: 82 19

20 74. The Rorschach Inkblot Test is an example of a(n) a. intelligence test. b. diagnostic inventory. c. neuropsychological test. d. projective test. Answer: D Type: Factual Page: In an effort to make the Rorschach more objective, researchers have focused a. more on how respondents identify form over symbolic content. b. on methods of standardizing symbolic content. c. on methods for diagnosis with different diagnostic groups. d. their energy on training clinicians in methods for making objective conclusions. Answer: A Type: Applied Page: Under what circumstances are respondents more likely to report engaging in illegal behaviors? a. When the exam is a face-to-face interview. b. When the exam is computer administered. c. When the exam is self-report. d. When the respondent is in the presence of other examinees. Answer: B Type: Applied Page: You are being tested, and the examiner is showing you pictures and you are asked to tell complete stories about the photos. You are probably taking a. the Rorschach. b. the MMPI-2. c. the Thematic Apperception Test. d. The Wechsler Adult Intelligence Scale III. Answer: C Type: Applied Page: Brian is taking a test inquiring about high-risk sex behaviors. Under which circumstance will Brian be more likely to give answers endorsing more high-risk sex behaviors? a. in a paper-and-pencil format. b. when the test is given as an interview. c. when the test is computer-administered. 20

21 d. in a one-to-one self-report setting. Answer: C Type: Applied Page: Intelligence tests were originally developed for the purpose of a. determining which psychiatric patients could benefit from "talk" therapy. b. predicting which children have special academic needs. c. determining the age at which a child should enter school. d. segregating people of low intelligence so they would not have children. Answer: B Type: Factual Page: Intelligence tests were originally designed to measure a. brain dysfunction. b. innate aspects of IQ. c. cognitive effectiveness. d. academic potential. Answer: D Type: Factual Page: The construct validity of intelligence tests is limited by a. how psychologists define intelligence. b. the nature of the population tested with the instruments. c. their generally low reliability. d. None of the above choices are correct. Answer: A Type: Factual Page: Two children are administered the same IQ test. Assuming all factors to be equal except racial differences between the children, what factor has been found to explain any difference in scores between these children? a. stereotype threat b. role stereotype c. attention difficulties d. None of these. There should not be any difference. Answer: A Type: Applied Page: Average intelligence is associated with a score of approximately a b

22 c d. Average intelligence cannot be determined. Answer: C Type: Factual Page: A group of 8th grade boys and a group of 8th grade girls are administered the same math test. According to this phenomenon, the girls might perform more poorly than the boys. a. stereotype threat. b. standardization. c. gender awareness. d. self-monitoring. Answer: A Type: Applied Page: Awareness of stereotypes tends to develop a. in infancy. b. between ages c. in early adolescence. d. between ages 4-6. Answer: B Type: Factual Page: Before taking an IQ test, one group of African American students (Group A) is told that African Americans tend to do poorly on IQ tests, while the other group of African American students (Group B) is told nothing. Group A performs significantly worse on the IQ test than Group B. This is likely a result of a. self-monitoring. b. chance. c,. stereotype threat. d. ethnic awareness. Answer: C Type: Applied Page: Compared to traditional personality assessment, behavioral assessment a. does not use self-report data because of its lack of reliability. b. relies more heavily on self-report data. c. focuses on situational determinants rather than traits. d. focuses on what a person says, rather than how it is said. Answer: C Type: Factual Page:

23 88. Why do behavioral assessors sometimes set up contrived situations in which to observe behavior? a. They do not think the setting is an important influence on people's behavior. b. Such assessments avoid the problem of reactivity. c. They want to see how people respond in unusual situations. d. It is often difficult to control the conditions in natural settings. Answer: D Type: Factual Page: What behavioral assessment procedure creates the most reactivity? a. self-monitoring b. personality inventory c. projective test d. structured clinical interview Answer: A Type: Factual Page: Joe s therapist has him keep a log of everything he eats as part of a weight loss program. This is an example of the behavioral assessment technique of a. self-monitoring. b. reactivity. c. direct observation. d. ecological momentary assessment. Answer: A Type: Factual Page: Miranda is trying to quit smoking. As part of her behavioral assessment, she is asked to maintain a diary and record what occurred before, during and immediately following each time she smoked a cigarette, in real time. In order to do this, she had structured record sheets for each day. This type of assessment is referred to as a. ecological momentary assessment. b. self-report. c. direct observation. d. behavioral interview. Answer: A Type: Applied Page: Cognitive assessment measures are usually used to a. identify psychopathology. b. explore the projective hypothesis. c. test theories about how people think. 23

24 d. measure people's intelligence. Answer: C Type: Factual Page: Xavier is recording his thoughts each time he feels depressed. This is also referred to as a assessment. a. projective b. behavioral c. cognitive d. neuropsychological Answer: C Type: Applied Page: Which of the following is an advantage of the Articulated Thoughts in Simulated Situations cognitive assessment procedure, in which subjects talk out loud about their thoughts during a tape-recorded scene? a. The ambiguous stimuli enable the clinician to tape unconscious stimuli. b. The increased structure provides more detailed information than would be possible in a self-report questionnaire. c. The subject's thoughts about specific situations can be taped in an immediate way. d. All of the above are correct. Answer: C Type: Factual Page: An example of a self-report cognitive assessment consistent with Beck s theory of depression is a. Internal-External Attribution Questionnaire. b. Dysfunctional Attitudes Scale. c. Attributional Style Questionnaire. d. Cognitive Thought Record. Answer: B Type: Factual Page: Which is most similar to an X-ray? a. MRI b. EEG c. CT scan d. PET scan Answer: C Type: Factual Page: PET and MRI are specific types of 24

25 a. projective tests. b. personality inventories. c. neuropsychological tests. d. neurological tests. Answer: D Type: Factual Page: Functional MRI (fmri) differs from ordinary MRI in that a. fmri records metabolic changes in the brain. b. ordinary MRI can only be done annually. c. fmri relies upon other tests to assess brain function. d. ordinary MRI is invasive Answer: A Type: Factual Page: PET is to CT scan as a. structure is to function. b. function is to structure. c. cognitive is to behavioral. d. projective is to objective. Answer: B Type: Applied Page: As part of a biological assessment, Emma is asked to provide a urine analysis, which is examined for levels of metabolites of different neurotransmitters. This is a type of a. neurological test. b. neurotransmitter assessment. c. metabolic assessment. d. PET test. Answer: B Type: Applied Page: A common method assessing neurotransmitters is a. analyzing metabolites. b. CT scan. c. X-ray. d. measuring dopamine. Answer: A Type: Factual Page: One of the problems with measuring metabolites from blood or urine is that 25

26 a. the presence of a given metabolite tends to be overestimated. b. this type of measuring does not reflect levels of neurotransmitters in the brain. c. the presence of a given metabolite tends to be underestimated. d. blood and urine samples are not always easy to collect. Answer: B Type: Factual: Page: One of the major problems with drawing conclusions from metabolite studies is that a. they are inaccurate. b. metabolite levels change significantly over time. c. they are correlational. d. they provide little data. Answer: C Type: Factual Page: Which of the following is a common way of studying neurotransmitters in the brain? a. Observe electrical activity in specific areas of the brain. b. Measure metabolic byproducts in the urine. c. Study individuals genetically unable to produce neurotransmitters. d. Direct observation during brain surgery. Answer: B Type: Factual Page: To compensate for the correlational problem of metabolite studies, Paul should consider running a study where he a. measures metabolites over time using a CT scanner. b. administers drugs that increase or decrease the brain levels of neurotransmitters. c. examines whether individuals with depression also have low levels of serotonin. d. examines whether individuals with schizophrenia also have low levels of dopamine. Answer: B Type: Applied Page: Current results from brain imaging studies a. are useful in diagnosing psychopathology. b. indicate that most disorders affect only a tiny portion of the brain. c. suggest that most psychopathology is due to deficits in the frontal lobe. d. are not strong enough for these methods to be used in diagnosing psychopathology. Answer: D: Type: Factual Page: 91 26

27 107. Which kind of assessment is illustrated here? Dr. Lee assesses the possibility that Joe has brain damage by measuring Joe's performance on a number of tasks including copying symbols, remembering numbers, and recognizing nonsense syllables. a. physiological assessment b. neurological assessment c. psychological assessment d. neuropsychological assessment Answer: D Type: Applied Page: Which of the following are designed to measure behavioral disturbances resulting from brain dysfunction? a. brain imaging techniques b. electrocardiograms c. neuropsychological tests d. neurotransmitter assessment Answer: C Type: Factual Page: Which of the following specializes in medical diseases that affect the nervous system? a. neuropsychologist b. neurologist c. psychiatrist d. psychologist Answer: B Type: Factual Page: Amelia went to see a specialist who specifically studies how dysfunctions of the brain affect the way people think, feel and behave. Amelia most likely visited a(n) a. internist. b. psychiatrist. c. neuropsychologist. d. neurologist. Answer: C Type: Applied Page: The Halstead-Reitan and Luria-Nebraska are specific types of a. personality inventories. b. intelligence tests. c. neuropsychological assessments. 27

28 d. neurological procedures. Answer: C Type: Factual Page: Two people the same age, Sarah and Carrie, were administered the Luria-Nebraska neuropsychological test battery. Sarah graduated with a Ph.D., while Carrie did not complete high school. Assuming all other factors equal, the scores they receive on the Luria-Nebraska a. should differ. Sarah should score higher based on education. b. should differ. Carrie should score higher as it is not based on education. c. should not differ since education level is controlled for. d. It is impossible to predict the differences from the information provided. Answer: C Type: Applied Page: Why should we not expect a one-to-one relationship between psychological and physical measures of brain functioning? a. They cannot measure brain functioning during normal daily activity. b. Little is known about the functioning of individual neurons. c. Psychological measures have low reliability and validity. d. Individuals differ in how well they cope with brain dysfunctions. Answer: D Type: Applied Page: Psychophysiology is the study of a. somatic treatments for psychological problems. b. the neurological basis of psychological problems. c. bodily changes associated with psychological events. d. phenomena such as extrasensory perception. Answer: C Type: Factual Page: Heart rate and skin conductance is preferable as psychophysiological measures as they a. do not interfere with other things the person is doing. b. can differentiate between different emotions. c. indicate unconscious motivations. d. are more objective than other psychological measures. Answer: A Type: Factual Page: A problem with some psychophysiological assessments is 28

29 a. clients are unwilling to have the electrodes attached for measurement. b. the measures do not clearly differentiate between emotional states. c. each instrument determines the base rate of reliability. d. the assessments are highly dependent on situational factors, rather than enduring features. Answer: B Type: Applied Page: Cultural bias is problematic in assessment in that a. most psychological tests have been rendered invalid when used with different cultures. b. a lack of awareness of cultural factors can create difficulties in reaching conclusions from assessment. c. clinicians cannot be aware of different cultures in evaluation. d. cultural differences cloud objectivity. Answer: B Type: Applied Page: In reviewing cultural and ethnic diversity issues in assessment, the text concludes that a. psychologists routinely over estimate psychological problems when assessing people from other cultures. b. psychologists routinely under estimate psychological problems when assessing people from other cultures. c. new DSM criteria encourage culture-specific diagnoses. d. psychology has identified the issue but not the solution. Answer: D Type: Factual Page: Jose, a Puerto Rican living in New York, was being assessed by Dr. Jones, an American doctor. Jose casually states that he feels there are spirits surrounding him. Dr. Jones may a. misdiagnose him as schizophrenic if he fails to take cultural factors into account. b. ignore this information if he fails to take cultural factors into consideration. c. correctly diagnose him as schizophrenic if he considers cultural factors. d. None of these choices are correct. Answer: A Type: Applied Page: If a clinician is informed that a prospective client, who is seeing things that are not actually there, is black and in a lower income bracket, the clinician is more likely to a. suggest a diagnosis of mood disorder. 29

30 b. suggest a diagnosis of schizophrenia. c. suggest that there is a good prognosis for treatment. d. recommend a second opinion. Answer: B Type: Applied Page: If a Hispanic client is being examined by an assessor from a different cultural background, the examiner should a. schedule fewer sessions to remain objective. b. refer the client to a psychiatrist. c. obtain a different test battery. d. schedule additional sessions to ensure adequate rapport. Answer: D Type: Applied Page: The best way for clinicians to avoid bias in the diagnosis of patients from ethnic minority groups is to a. avoid seeing such patients in their practice. b. avoid diagnosing such patients. c. employ only those personality measures which have been specifically designed for that ethnic group. d. learn to consider and test alternative hypotheses when evaluating clients from different ethnic groups. Answer: D Type: Applied Page: Essay questions: 1. Critically consider methods for clinicians to be more culture sensitive in their assessment procedures. 2. Discuss the methods used to develop scales on the MMPI Compare the relative contributions to assessment of personality by objective and projective assessments. 4. Describe three types of validity and the means of identifying each for an assessment instrument. 5. Describe a dimensional approach to diagnosis. Explain how such a diagnostic approach would be either superior or inferior to the current approach to diagnosis. 6. Discuss the importance of establishing high interrater reliability in a diagnostic model. As part of this discussion, indicate some limitations that remain even when high interrater reliability has been established. 7. What are the criticisms of classification? How would you recommend reforming the DSM-IV to address these criticisms? 8. Given the cultural differences noted in making different diagnoses, what does this say about the DSM-IV in general? Does this reflect anything important about the validity of the diagnoses? 30

31 9. What are the pros and cons of having a diagnostic system? 10. Discuss the positive features of having more disorders formally listed in the DSM, such as the conditions proposed for further study in the appendix of DSM-IV-TR. 31