Chapter 7: Behavioral Assessment

Chapter 7: Behavioral Assessment

• Behavioral assessment measures and understands a person's behavior based on learning theory - operant and classical conditioning.
• It focuses on pinpointing a specific problem or target behavior.
• Direct observation is used to understand the response within the context of the client's history and environment.

Goals of Behavioral Assessment

• To obtain a sample of the individual that represents the behaviors and situations of interest.
• Aims to measure the target behavior, which is the behavior that causes issues.
• To conduct a functional analysis to understand the relation between the target behavior and its situational factors.
• Situational factors encompass antecedents, or stimulants/conditions that trigger the behavior, and consequences that follow the behavior.
• It uses an idiographic approach to assessment, in contrast to the nomothetic approach of diagnostic assessment.
• Continuous assessment throughout treatment is also important.
• Treatment success is assumed if the problematic behavior stops, but the functional analysis is incomplete if it does not.

Simple Functional Analysis

• Amber skips lunch and dinner to try and loose weight. She wakes up in the middle of the night and feels hungry. She eats ice cream from the fridge and no longer feels hungry, but feels bad about breaking her diet.
• The antecedents for this situation are skipping lunch and dinner and waking up in the middle of the night hungry.
• The behavior is eating ice cream from the fridge.
• The consequences are no longer feeling hungry, and feeling bad about breaking her diet.

Behavioral Observations

• This is a primary assessment that involves a clinician or researcher directly monitoring (seeing, hearing) and systematically documenting an individual's or group's behavior in a natural setting.
• Natural settings include at home, in the classroom, within a peer group, or on the playground.
• Contrived conditions also apply in a laboratory or clinic.
• An observer documents the behavior, including its antecedents, consequences, frequency, length, and/or intensity.

Defining the Target Behavior

• It has to be an active and observable response.
• Behavioral manifestations should be directly observed, if it is not observable.
• It has to be defined as specifically as possible for better validity and reliability.
• It should be more specific than general like "aggression".

Coding Approaches: Interval Coding

• Observer records whether the target behavior happens within a specific period of time.
• This is preferable when behavior is long/or infrequent, or starting/ending point is unclear.

Coding Approaches: Event Recording

• Each occurrence of the target behavior is recorded by the observer.
• This is preferable when the behavior's starting/ending point is clear.

Observation Settings: Naturalistic observation

• Observations are carried out in the individual's normal environment.
• This maximizes ecological validity, the extent to which the observations represent how a person generally acts.
• The downside is that the target behavior is never certain to occur, and the specific cause of the behavior can not be determined.

Observation Settings: Controlled observation

• An environment is designed so the behavior is likely to happen.
• Behavioral approach task is used to measure fear and avoidance by making the individual approach a feared situation until they can’t proceed.
• The upside is environment can be manipulated and can effect behavior.
• The downside is it can cause reactivity, where the individual changes behavior because they know they are being observed.

Self-Monitoring

• Clients maintain systematic and organized logs or diaries over some predetermined time period.
• Methods encompass paper/pencil, notecards, apps, or other systems.
• The upside is it is cheaper, more practical, and can address internal feelings/sensations.
• The downsides are patients could lie, it is time-consuming and upsetting, and is difficult for children.

Cognitive Behavioral Assessment

• This incorporates thoughts in the assessment process.
• In the activating event a "something happens".
• The belief/stuck point dictates "I tell myself something".
• The consequence indicates "I feel something".

Chapter 8: Intelligence Assessment

• What is intelligence?
• Adjustment or adaptation to the environment
• The ability to learn.
• Abstract thinking.
• There is no agreed-upon definition.

Spearman's Two-Factor Theory of Intelligence

• There is a general intelligence factor or "g".
• Specific factors include arithmetic, spatial, logical, and mechanical intelligence.

Cattell's Theory of Intelligence

• Fluid and crystalized intelligence are the two components of Spearman's theory.
• Fluid ability dictates a person's genetically based intellectual capacity and culture-free mental skills.
• Global reasoning and the ability to learn new things fall into this category.
• People with fluid intelligence think abstractly and solve problems.
• Crystalized ability involves intellectual capacities obtained through culture-based learning.
• Prior learning, past experiences, and facts are all part of this category.
• Crystallized intelligence increases with age.

Multiple Intelligences

• Linguistic.
• Logical-mathematical
• Musical.
• Spatial.
• Bodily-kinesthetic.
• Naturalistic.
• Interpersonal.
• Intrapersonal.

Sternberg's Triarchic Theory of Intelligence

• Componential: An analytical approach to thinking, which means higher scores would characterize someone who is a good test taker.
• Experiential: Creative thinking that characterizes people who can take separate elements of experience and combine them insightfully.
• Contextual: People who are practical, know how to “play the game," and can successfully manipulate the environment.

Intelligence Quotient (IQ)

• Ratio IQ:
• Made by Alfred Binet, who developed the first IQ test. He coined the term mental age to describe the abilities that should be mastered by a certain age.
• Stern developed the idea of IQ, which is the ratio of a person's mental age to their chronological age (IQ = MA/CA × 100).
• Deviation IQ
• Developed by Wechsler, comparing an individual's performance to their peers.

IQ Scores: Heritability

• About 30-80% of IQ is genetically determined.

IQ Scores: Stability

• The heritability of intelligence is not stable across the lifespan.
• It ranges from 20% in infancy to 60% in adulthood, and 80% in old age.

The Wechsler Scales

• David Wechsler developed the Wechsler-Bellevue Intelligence Scale in 1939
• These are developed to be more applicable to adults.
• Wechsler Adult Intelligence Scale (WAIS) is used for people 16+.
• The WAIS-5 newest version came out in 2024.
• Full scale includes Verbal Comprehension, Visual Spatial Ability, Fluid Reasoning, Working Memory, and Processing Speed.

Full Scale Wechsler Scales

• Verbal comprehension.
• Visual spatial ability.
• Fluid reasoning.
• Working memory.
• Processing speed.

Wechsler Intelligence Scale for Children (WISC)

• Used for children 6-17
• The full scale measures Verbal Comprehension, Visual Spatial, Fluid Reasoning, Working Memory, and Processing Speed.

Wechsler Preschool and Primary Scale of Intelligence (WPPSI)

• They are for ages 2.5 to 7 years and 7 months old.
• For ages 2:6-3:11 the verbal comprehension assesses receptive vocabulary, information, and picture naming.
• For ages 4:0-7:7, the verbal comprehension assesses information, similarities, vocabulary, and comprehension.

Cultural Bias in Intelligence Testing

• Exposure to discrimination.
• Lower-quality schooling.
• Poverty.
• People are not at ease in testing situations
• They may be less trusting of adult testers (many of whom might be members of a majority group).
• The testing items themselves may be biased.

Chapter 9: Diagnosis, Case Formulation, and Treatment Planning

• What is abnormal?
• Deviant: Behaviors that are rare or atypical, often based on cultural expectations that lead to stigmatizing minority groups
• Distressing: Emotional pain associated with symptoms; it is hard to characterize and some people who arguably need help don't report distress
• Dysfunctional: Symptoms create problems in their life, and it is unclear who makes this judgment call or what the expected level of functioning is.

History of the DSM

• 1845 - Jean-Etienne-Dominique Esquirol classified mental illness.
• 1883 - Emil Kraepelin developed a classification system for dementia and manic-depressive disorder
• 1917 - The American Medico-Psychological Association published the Statistical Manual for Institutions for the Insane.
• 1952 - The American Psychological Association published the first DSM.
• 1968 - DSM-II published.
• 1980 - DSM-III was published, renaming diagnoses and creating diagnostic criteria.
• 1987 - DSM-III-R Published
• 1994 - DSM-IV was published, requiring distress or impairment for diagnosis
• 2000 - DSM-IV-TR was published.
• 2013 - DSM -5 was published
• 2022 - DSM-5-TR published

Major Depressive Episode DSM-5-TR Criteria

• Five or more of the following symptoms must be present during the same two-week period and represent a change from previous functioning. Must include either a depressed mood or loss of interest/pleasure.
• Depressed mood most of the day, nearly every day, as indicated by either subjective report or observations from others.
• Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
• Significant weight loss or weight gain, or decrease or increase in appetite nearly every day.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day.
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive guilt nearly every day.
• Diminished ability to think or concentrate, or indecisiveness, nearly every day.
• Recurrent thoughts of death, suicidal ideation, or suicide attempt.
• The symptoms cause clinically significant distress or impairment in important areas of functioning.
• It is not attributable to substance use or another medical condition.
• Sign: Outwardly observable phenomena, such as observations of depression being tearful.
• Symptom: A subjective experience, such as feeling sad, empty, or hopeless.

Pros of the DSM

• More easily communicate with peers in the field as a "shorthand".
• Is is easier to study groups with similar symptoms.
• Suggests which types of treatment are likely to be the most effective.

Cons of the DSM

• Reliability.
• Descriptive Criteria.
• Ambiguous Criteria.
• Sociocultural Context.
• Categorization.
• Overinclusiveness.
• Medical Model.
• Stigma.

Research Domain Criteria (RDoc)

• A framework that promotes research based on genetics, neuroscience, and behavioral science.
• Its goal is to develop an objective diagnostic system of “biotypes”.
• It is supported by genes, molecules, cells, brain circuits, physiology, behavior, and self-reported experiences.
• It is dimension-based, rather than category-based, a “bottom-up” approach, and grounded in biological theory.
• The drawbacks are this relies on psychological disorders resting on brain dysfunction, that psychological disorders are primarily based on brain dysfunction, privileges biological methodology, and assumes that identified domains are markers of distress/disfunction.

Case Formulation

• It requires a hypothesis about the particular psychological mechanisms by giving rise to and maintaining an individual's distress and dysfunction.
• Four elements must be considered: The problem list, the mechanisms, the predisposing factors, and precipitants.
• Case formulation is an educated guess about what is going on for the client.
• This can be iterative, meaning the formulation is tested and revised.
• The strengths are rooted in cognitive-behavioral theory that has been tested by research, and is tailored to each specific client with a dimensional approach.
• The weaknesses are that reliability and validity is unknown, and clinicians must educate themselves continuously.

Chapter 10: Overview of Treatment Research and Practice

• Evidence-based Approaches: Behavioral, Cognitive-Behavioral, Dialectical, and Mindfulness/Acceptance-Based
• Other Approaches: Psychodynamic and Client-Centered

Evidence Based Approaches - Behavioral

• Uses techniques derived from learning theory to modify behaviors associated with target problems.

Evidence Based Approaches - Cognitive-Behavioral

• Focuses on identifying and modifying maladaptive thinking and behavioral patterns.

Evidence Based Approaches - Dialectical

• Focuses on developing skills for coping with stress, regulating strong emotions, and improving relationships with others.

Evidence Based Approaches - Mindfulness/Acceptance-Based

• Uses metaphors and experiential exercises based on relational frame theory to promote a healthier relationship with unwanted thoughts and feelings.

Other Approaches - Psychodynamic

• Focuses on gaining insight into unconscious psychological forces thought to underlie traget problems.

Other Approaches - Client-Centered

• Uses the client-therapist relationship and unconditional positive regard to promote full growth potential.

Treatment Success: Potential Methods

• Potential informants (patient, clinician, third parties).
• Potential methods (behavioral, self report, personality, intelligence).
• Potential times (pre-treatment, during treatment, posttreatment, follow up).

Treatment Efficacy

• It is the evaluation of how well a treatment performs under research conditions.
• Achieved through case studies, a single group pre-post, and random controlled trials.
• Studies require internal validity, and the results from multiple are then combined in a statistically significant meta-analysis.
• People with comorbid conditions and multiple treatment rounds tend to be excluded.

Randomized controlled trials

• Clients have an equal chance of being in any of the study conditions, which eliminates bias and improves generalizability.
• The sample population being studied should be carefully selected with homogeneous client groups for a particular target problem or disorder.
• Manualized treatment and well-trained therapists are used so the clients are getting the best and most consistent care in the study.
• Personnel who asseses the clients during the study are kept unaware of which treatment they are receiving to reduce bias.
• Control groups allow researchers to estimate the true effects of an active treatment and weed out any placebo effects.

Treatment Effectiveness

• This is an evaluation of how well a treatment performs in a real world setting.
• Has external validity, such as the ability to generalize study findings to people and settings outside the study.
• It is impossible to know whether clients would improve on their own or if patients were doing other things to improve.

Common Factors on Mental Health Treatment

• Types of treatments sometimes lead to the same outcomes/
• Therapeutic qualities include alliance between client and practitioner, client's expectations or hope and specific techniques that stimulate healthy action.

Specific Factors on Mental Health Treatment

• Theories and procedures need to be particular to an approach.
• RCTs must be head to head comparisons where treatments are superior to others.
• Dismantling studies investigate treatments that have multiple components, with the end goal of identifying techniques strongly associated with treatment benefits.

Treatment Process

• In the initial contact, people must be able to establish rapport and answer patient questions.
• Assessment, conceptualization, and treatment planning require avoiding culturally based assessments against minoritized groups.
• A contract must be established between clinical practitioners and the patients of what a treatment will look like.
• In Termination, evaluation, and follow-up, termination sessions must be planned based on whether the patient is still benefitting from treatment, and must at times include follow up sessions called booster sessions.
• Patients must be informed of the thearpist's qualifications, payment, and confidentiality/limits during informed consent.
• During the implementation phase, implementors must be providing psychoeducation, managing emotional distress, assigning work and practice between sessions, and fostering optimism and self-efficacy.

Applying for Evidence Based Treatment and Practice

Evidence-based treatment is an intervention or technique that has produced significant change in clients in controlled trials.

• Evidence-based practice is a broader category that includes science and client expertise.
• Some clinicians ignore research because they assume clinical judgement is better.

Dissemination

• The process of ensuring that these interventions are adopted and implemented into routine clinical practice by clinical psychologists and other mental health professionals.
• Challenges include therapist resistance, cost of education, and time needed for education.

Chapter 11 Behavioral Interventions

• Behavioral Treatment: Treats disorders based on the principles of conditioning or learning.
• It uses a more scientific approach in nature by deemphasizing the role of inferred (i.e., unobservable) variables in behavior.

Important names in the history of behavioral treatment

• John B. Watson and Rosalie Rayner's Little Albert Experiment.
• Mary Cover Jones removing fears.
• Joseph Wolpe developing systematic desensitization.
• B. F. Skinner's operant conditioning experiments

Five Guiding Principles

• All behavior can be understood through operant and classical conditioning
• It doesn't need to identify an underlying motive or need to know how the behavior was developed in the first place
• Most behavior can be modified and replaced with adaptive behavior through learning principles. Treatment methods are tailored to each client

Stages of Behavioral Interventions

• Target definition and baseline assessment
• Define the target in behavioral terms, assess target behavior in terms of frequency, severity, and duration
• Functional analysis and treatment planning
• Identify antecedents and consequences for behavior
• Implementation
• Skills are learned and practiced, which can include “field trips” and homework assignments
• Outcome assessment
• Frequently re-administer measurement methods from baseline assessment
• Reformulation (as necessary)
• The functional analysis and treatment plan get revised if behavior isn’t changing

Other Considerations in Behavioral Interventions

• The client-practitioner relationship is to help the clients work harder.
• Culture can influence behavior.

Types of behavior interventions that treat deficicts

• Social skills Training and assertiveness Training.
• Goal is to improve communications skills and social interactions.
• It’s common for this to train people to use their voices, so they can express themselves more effectivel

Applications: Modifying Behavior with Rewards and Consequences

• Contingency management is an example of a behavior therapy that uses operant conditioning techniques, which attempt to control a behavior by manipulating its consequences.
• Some additional examples of behavior therapy include: shaping, time-out, contracting, and grandma's role or the Premack principle.
• Token economies are used to establish rewards for behaviors that you were looking to increase, either through an object or symbol.
• It is better to change behavior immediately.

Applications: Reducing Clinical Anxiety and Fear

• Exposure therapy is the process of reducing or eliminating a conditioned fear that requires clients to continually confront what is causing them fear.
• Patients develop an exposure hierarchy, or a list of feared body sensations, stimulitahsts will be confronted.
• During an exposure, the client must tolerate the fear until it subsides, called habituation.
• Another tool is progressive muscle relaxation which entails tensing then relaxing various muscle groups ( e.g., facial muscles, arm muscles, leg muscles).

Applications: Improving Depressed Mood

• Behavioral Activation: A type of behavioral treatment where clients are helped to engage in everyday activities and decrease engagement in potentially upsetting activities.

Applications: Modifying Habit Behaviors

• Habit reversal training occurs by:
  • Awareness training where a patient keeps a log of each time they engage in the target behavior.
  • Stimulus control where you change the environment around a behavior.
  • Competing response practice where the patient responds to urge by engaging in another behavior that would be impossible to perform if engaging in target behavior.
• Another step in behavior therapy is Cue exposure where there is exposure to stimulus while resisting the usual response.
• Next there is aversive conditioning where a person pairs an unpleasant stimulus to an undesirable behavior.
  • In covert sensitization, patients imagine themselves participating in a undesired behavior and then Averse events occurring;

Applications: Improving Sexual Functioning

• Sensate focus involves a series of structured touching and discovery exercises that a couple performs together to extinguish performance-related anxiety, enhance communication, and learn about one's own and their partner's sexual response