psychopathology exam 1 textbook.pdf

Psychopathology Chapter 1 : Abnormality Statistical concept Behaviour is judged as abnormal if it occurs infrequently in the population Exceptionality is not abnormal Ex. 15% of students reported being diagnosed for depression - although rates are high enough to not be statistica...

Psychopathology Chapter 1 : Abnormality Statistical concept Behaviour is judged as abnormal if it occurs infrequently in the population Exceptionality is not abnormal Ex. 15% of students reported being diagnosed for depression - although rates are high enough to not be statistically infrequent, both reflect a disorder in need of treatment Personal distress Anxiety and depressed patients are obviously distressed Distress is not present for all people identified experiencing psychopathology ○ Anti social behaviour - individuals encountered face more distress than individual with disorder Distress is frequent but not essential feature of abnormality Personal Dysfunction When behaviour is maladaptive (interferes with appropriate functioning, it is typically said to be abnormal Harmful dysfunction ○ Failures of internal mechanisms to perform naturally selected functions ○ To conclude behaviour is disordered: both scientific judgment that there exists a failure of designed function and a value judgment that the design failure harms the individual ○ The fact that we can also use a pen as something to chew on when we are nervous or as a weapon for self-defense does not explain why pens are designed the way they are. Thus, the failure of a pen to help protect an individual would not entail a failure of its function ○ The fact that we can also use a pen as something to chew on when we are nervous or as a weapon for self-defense does not explain why pens are  designed the way they are. Thus, the failure of a pen to help protect an individual would not entail a failure of its function Violation of Norms Criminals can engage in violation of norms, but this does not count as criteria for disorder Social norms vary over time and place ○ Depression has much higher prevalence in canada than korea or saudi arabia ○ Different cultural groups manifest psychopathology differently and have own strategies for dealing with psychological distress ○ Abnormality must be culturally relative Homosexuality used to be classified as mental disorder that violated social norms For example, the lower prevalence of depression in Asian cultures may be due to the emphasis placed on physical symptoms and avoiding the stigma of mental disorders. Diagnosis by an expert Clinical psychologists are initially trained in general psych then receive graduate training in the application to understand assessment, diagnosis, and amelioration of disorders. Psychologists can provide research but also provide treatment Psychiatrists are trained in medicine prior to doing specialized training in dealing with mental disorders Professional must diagnose - dsm-5 provides the operational criteria for the various disorders and thereby defines abnormality Biological approaches Mental disorders came to be viewed as disruptions in nervous system functioning Cabanis (1757–1808), who combined psychological and somatic factors in an account of mental disorders. ○ Provided first theoretical basis for moral therapy Heredity Benedict Augustin Morel (1809–1873), a Viennese physician, was the first to introduce “degeneration” theory. ○ Proposed that hereditary processes transmit deviations from normal functioning and that these deviations progressively degenerate over generations Charles darwin's notion of the advantageous features inheritance can have supported morels theories This idea of genetically passed down behaviour led people to identify criminals before they developed these issues - guy named lombroso said that you could identify it by persons skull ○ Only popular for a time Syndromes and the beginning of classification Emil Kraepelin - influential psychologists that published textbook clinical psychiatry - attempted to classify mental illness Classification is the foundation of where research is generation Kraepelin thought all mental disorders are biological ○ Noted that certain groups of symptoms tended to occur together, these groupings were called syndromes Could serve as a way of grouping patients Infection as a cause of mental disorder Richard Krafft-Ebing became interested in the possibility that patients with general paresis of the insane might have gotten it from infection GPI is now known to result from untreated infections by syphilis ○ People thought other illnesses had infection causes Somatogenesis: the idea that psychopathology is caused by biological factors Encouraged physical treatments Shock therapy Sudden submersion in water has been shown to help mental disturbances  ○ Occured to sakel, german physician that shock treatments could be effective in treating the insane ○ Gave patients insulin to induce coma and help with morphine withdrawal - worked for schizophrenia too Thought convulsions are what made it work Thought inducing seizures in schizo patients could help (50% recovered) Once electricity applied to head was seen to cause convulsions, coma or convulsive therapy disappeared ○ Ugo cerletti in 19138 - first patient to try Helped but Returned one year later ○ Called electroconvulsive therapy Found to be effective mostly on patients with depression, still used to this day Caused broken limbs and cracked vertebrates Use muscle relaxant Beginnings of psychopharmacology In 1950s pharmacological agents for psychiatric disorders became widely available marking the second biological psychiatry Mental illness: viewed as result of disordered brain chemistry Psychological perspectives including psychoanalysis were rejected by much of psychiatry In 1926 loewi isolated the first neurotransmitter, acetylcholine Henri laborit discovered antihistamines indeed calmness and developed chlorpromazine which has highly effective in treating manic symptoms ○ Reduced use of physical restraints and noise Deinstitutionalization: success of antipsychotic medications and antidepressants and patient rights movements led to mass discharges from institutions ○ Lack of community resources led to homelessness and inadequate support ○ 1988 canadian gov published: mental health for canadians  Chlorpromazine was safer than ECT and easier for patients to tolerate, also helped management at psychiatric clinics Pharmaceutical industry began producing neurotransmitter affecting drugs for schizo, mania, and depression - era of psychopharmacology Psychological approaches Historical popularity of psychological explanations: gained prominence in 18th century Anton mesmer ○ Worked with hysteria (now called conversion disorder) ○ Theorized histeria is caused by disturbed distribution of magnetic fluid in bodies ○ Used rods to transmit animal magnetism to realign fluids ○ Mesmers methods relief heavily on suggestion to convince patients of recovery ○ Later discredited thorugh a study by benjamin franklin, showing its effects were due to the power of suggestion rather than any physiological cause Hypnotism: Developed from Mesmer's work; James Braid, a British surgeon, coined the term hypnotism in the mid-1800s and recognized its potential in psychological treatment. Hypnotism and the birth of psychoanalysis Charcot believed history was caused by physiological factors and thought it could be fixed by hypnotism ○ Student of his claimed hysteria resulted from a break of organized system of thought Bruers approach was to let patients talk freely and let them relive the unpleasant past that were believed to cause the hysteria - this was in order to somehow exhaust the emotional problems resulted from them - called the cathartic method Behaviourism  This viewpoint of behaviourism declared that if psychology were to become a science, it must be restricted to the study of observable features ○ John B watson believed abnormal behaviour was learned and could be unlearned ○ Used pavlovs classical conditioning Chapter 2 : Theoretical Perspectives on Psychopathology : Biological Models Biological theories have primarily implicated dysfunctions in order damage to the brain - CNS , problems of control of one or another aspect of the peripheral nervous system (automatic or somatic) , or malfunctioning of the endocrine system the nervous system is divided into the CNS and the peripheral nervous system - their actions are further coordinated with activity in the endocrine system. The role of the Central Nervous System The average adult brain contrains approx 86 billion neurons and an approximately equal number of non-neuronal(glial) cells ○ Glial cells have an active role in brain function and information processing ○ These cells group together into anatomically distinct areas, which have somewhat distinctive functions ○ active interconnections throughout the brain indicate that no one area exclusively performs any one function. The hindbrain primarily directs the functioning of the autonomic nervous system, which controlsinternal activities such as digestion, cardiovascular functioning, and breathing. The midbrain is the centre of the reticular activating system, which controls arousal levels (often called the sleep–wake centre) and a;sp attentional processes.  The forebrain controls thought, speech, perception, memory, learning, and planning - makes us self-conscious beings ○ Some disorders have been directly linked to brain damage ○ Parkinsons or alzheimers is linked to the loss of brain cells Can be from head injuries, diseases Various imaging techniques, such as computerized axial tomography (CAT scans), magnetic resonance imaging (MRI), and positron emission tomography (PET scans), have all enabled the detailed examination of brain functioning. Neurotransmitters: chemical substances that carry messages from one neuron to the next in pathways of nervous activity within the brain Nerve cells are not connected to one another, so activity in one neuron does not directly stimulate activity in other neurons Step 1: ○ Dendrites receive other information from other neurons. Each dendrite can have many different branches Step 2:  ○ The dendrites pass the information to the cell body, where the information is processed Step 3: ○ The cell body sends instructions to the body through axons which transmit instructions from the dendrites. Step4: ○ Chemicals called neurotransmitters are released by the axon & cross the gap to the dendrite of another nerve cell. The gap is the synapses Step 5: ○ Neurotransmitters bond with the connecting dendrites and triggers the connecting neuron to send an impulse Neurotransmitters include dopamine, serotonin, norepinephrine, and gaba Pleasure seeking behaviours associated with dopamine activity and serotonin activity is related to the constraint of behaviour - they create a balance in behaviour Neurotransmitters released into synapse can: Bind to receptor sites on dendrites, activating or inhibiting impulses in post-synaptic neuron. Be deactivated by substances in the synaptic cleft before reaching dendrites. Undergo reuptake back into the releasing axon. Psychopathology can result from disturbances in neurotransmitter systems Too much/too little neurotransmitters produced or released  Too many/too few receptors on dendrites excess/deficit of neurotransmitter-deactiviting substances in synapse Reuptake process being too rapid/too slow ○ These disturbances can cause over- or under-excitation in brain circuits, leading to abnormal functioning. ○ Schizophrenia may result from overactivity in the dopamine system, causing individuals to over-assign importance to irrelevant stimuli. Drugs that help schizo seem to lower dopamine - doesnt mean correct cause Neurotransmitter activity and behaviour influence each other Brain plasticity: The ability of intact brain cells to compensate for damaged cells and take over their function ○ allows the brain to reorganize its circuitry, influences by experiences like hormones, diet, aging, stress, and maturation ○ Brain plasticity can be influenced by a number of experiences that occur pre- and postnatally through hormones, diet, aging, stress, disease, and maturation The Role of the Peripheral Nervous System The peripheral nervous system includes: ○ Somatic Nervous System: controls muscles ○ Autonomic nervous system - has to parts Sympathetic nervous system and the parasympathetic nervous system These two systems function together to produce balanced activity in a variety of bodily functions such as heart rate, digestive and eliminatory processes, sexual arousal, breathing, and so on. - In times of stress they function antagonistically During stress or threat the sympathetic nervous system redies the body for action - fight or flight - deep breathing, heart rate  During this, the parasympathetic nervous system shuts down digestive processes, since energy given to this function would be wasted in a time of emergency Individuals differ in both the strength and the duration of their response to threat, and this variability has been related to the person’s propensity to develop psychophysiological disorders The ANS (more particularly, the sympathetic nervous system) is involved in fear and anxiety reactions. Thus, an overreactive ANS may increase readiness to acquire phobias or other anxiety or trauma-related disorders. Individuals who have panic attacks take longer to unlearn conditioned fear response The Role of the Endocrine System Aspects of the CNS interact with endocrine system that maintains appropriate levels of hormones Two disorders are known to be related to malfunctioning endocrine glands. ○ Cretinism, a disorder involving a dwarflike appearance and intellectual deficits, is a result of a defective thyroid gland.  ○ Hypoglycemia, which results from the pancreas failing to produce balanced levels of insulin or glycogen, produces experiences that mimic anxiety, and some patients who report to anxiety disorder clinics are in fact suffering from hypoglycemia. Another system studied to links of depression and anxiety is the hypothalamic pituitary adrenal (HPA Activated during stressors Release of cortisol into blood stream Short term threat mode Genetics and Behaviour People used to believe genetics determined all behaviour Behavioural genetics offer insight into the biological bases of abnormal functioning ○ Not whole contributor - liability not certainty Genotype environment interaction: Genes may influence behaviours that contribute to environmental stressors - risk factor to psychopathology Behavioural research into the genetic bases of mental disorders typically takes one of three forms: family (or pedigree) studies, twin studies, and adoption studies. Concordant: the similarity of diagnosis in a pair of twins Concordance: when the disorder that characterizes one person, called the index case, also occurs in another person, the two are said to display in concordance More recent techniques for studying genetic influences include genetic linkage studies and research methods in molecular biology. ○ most of these cases, multiple gene defects appear to interact with environmental factors to produce the disorder Psychosocial Theories Freud suggested behaviour is motivated by unconscious processes acquired during the formative years of life Cognitive, behavioural, socio-cultural humanist Psychodynamic theories Sigmund freud ○ Founder of psychodynamic school of thought Claim that unconscious forces of which the person is unaware control behaviour ○ Traumatic experiences early in life become repressed Levels of consciousness ○ Conscious: what we are currently aware of ○ Preconcious: holds info not presently within our awareness but can be brought ○ Unconscious: contains majority of our memories, can only be raised with great difficulty For Freud, the unconscious was the most important level of the mind. ○ All of our biological drives, particularly sexual and aggressive drives, reside at this level, as do our traumatic memories. Traumatic memories were kept out of awareness using defence mechanisms Structure of personality in constant conflict Levels of awareness ○ Id: present at birth, contains instinctual drives - demand gratification without concern or consequences (pleasure principle) ○ Ego: The ego develops to curb the desires of the id so that the individual does not suffer any unpleasant consequences. ○ Superego: moral standards of society - the moral principle ○ Ego attempts to satisfy id while not offending principles of superego Psychosexual stages of development Believed sexual desires were the most important determinants of behaviour Sexual pleasure, or the expression of libidinal energy, was focused on different body parts, which Freud called erogenous zones ○ These zones differed at each stage  Defence Mechanisms The ego uses defence mechanisms to allow the expression of libidinal desires in a distorted or symbolic form. ○ The id, however, does its best to break through these defences, so that psychic energy is used up in this almost constant conflict between the ego and the id. Patients acceptance of the analysts account of the origin of distress was called insight Freuds Influence Little empirical support  Attempts to test frueds ideas run into the problem that no matter what the results are, they can be explained within theory Most influential - let us talk about sexual related topics and unconcious problems People have modified his ideas Behavioural theories First introduced by John Watson - all things are learned Classic conditioning - response is transferred from one stimulus to another Ex: Watson and Rayner (1920) demonstrated that classical conditioning could instill a fear of a white rat in an 11-month-old boy identified as Little Albert. This boy was first shown a white rat, to which he displayed no fear; in fact, he appeared to enjoy trying to play with it. After several presentations like this to ensure that Little Albert was not fearful of the rat, Watson and Rayner followed the rat’s appearance by making a sudden loud noise close behind the boy. This loud noise startled and upset Little Albert. After seven presentations of the rat (the CS) paired with the sudden loud noise (the UCS), Little Albert displayed a conditioned fear response to the rat. Classical conditioning alone cant explain all phobias Mowrer - Two-factor theory of conditioning: two types of learning take place in the acquisition of phobias ○ 1: classical conditioning - person establishes bad feelings towards stimulus ○ 2: person avoids the cs to prevent feeling afraid ○ Escape behaviour is negatively reinforced by the consequent reduction in fear, and the person soon learns that avoiding the stimulus altogether eliminates the distress.  ○ Once a person has acquired a classically conditioned fear of a harmless stimulus, they begin to escape from the stimulus whenever it appears. B.F skinner - operant conditioning: some consequences encourage repetition of behaviour that produces them, while other consequences do the opposite ○ Reinforcement: when a behaviour decreases in frequency as a result of punishment ○ Social learning theory Bandura and Walters - majority of these experiences occur within a social context and are primarily acquired vicariously - by observation of others rather than by direct personal experience. ○ it was shown that children could learn to be aggressive by observing others being rewarded for aggression Banduras theory emphazised importance of cognitive processes such as perceiving the behaviour of others and storing such information in memory a number of individual characteristics (expectations, abilities, appraisals, feelings, and so on) appear to influence different responses to stimuli.  ○ The loss of a job, for example, does not invariably trigger depression; an individual’s appraisal of the situation also contributes to their feelings and responses. Cognitive theories Cognitive behavioural theory: both thinking and behaviour are learned and can be changed Share 3 principles ○ Tinking affects emotion and behaviour ○ Thoughts can be monitored and changed ○ By altering ones thoughts a person will experience desired behavioural and emotional change Rational-emotive behaviour therapy ○ Albert ellies ○ When faced with unfavourable life circumstances humans tend to make themselves feel miserable and behave in self-defeating ways - construct irrational beliefs ○ ABC model of human disturbance which states that the consequences (C) of life events (e.g., symptomatology, negative affect) are not contingent upon the activating event (A) per se, but are mediated by one’s beliefs (B) about these experiences ( Ellies believed we had a number of distinctive irrational beliefs that contribute to emotional disturbance ○ (e.g., things must always go right; I must be loved and have approval at all times). - These beliefs are considered maladaptive because they are expressed in absolutist terms Cognitive theory and therapy Aaron beck - founder of cognitive model cognitive model states that emotions and behaviours are heavily influenced by individual perceptions or cognitive appraisals of events - three levels of cognition ○ 1: schemas  ○ 2: information processing and intermediate beliefs ○ 3: automatic thoughts Schemas ○ Internal representations of stored information and experiences ○ Organize new information in a meaningful way and help to determine how we perceive and understand what goes on around us. Negative schemas - i am bad, i am unlovable ○ Young (1999) described a set of core beliefs, which he has labelled Early Maladaptive Schemas (EMS), that originate from repetitious, aversive experiences in childhood. ○ ○ These schemas do not become active till it is triggered by negative life events this person might start to pay attention to cues that are suggestive of unlovability and disqualify information that does not fit that expectation and belief.  ○ Content specificity: distinct cognitive content is related to different types of disorders - Ex. depression is related to thoughts of deprivation and loss, whereas anxiety is related to themes of threat Automatic thoughts: frequent thoughts that pop into our minds that are not accompanied by conscious appraisal ○ Ex: Every skill involved in driving becomes a conscious and sometimes frightening task for the young driver. As people become more adept at driving, however, these skills become easier to carry out and the processes become increasingly automated such that individuals are able to sing along to music, carry on a conversation, and enjoy the landscape as they perform the multiple tasks involved with manipulating their vehicle. ○ Stem directly from an individuals core beliefs or schemas in interaction with the environment ○ Ex. someone has passed you in hallway, automatic thought is they dont like me - perhaps from schemas of being unlovable cognitive therapy aims to help clients shift from unhealthy appraisals to more realistic and adaptive ones. ○ Treatment is collaborative and involves designing specific learning experiences to teach clients how to monitor automatic thoughts; understand the relationships among cognition, affect, and behaviour ○ examine the validity of automatic thoughts; develop more realistic and adaptive cognitions; and alter underlying beliefs, assumptions, and schemas Third-Wave Approaches to CBT Research has focused on the investigation of mindfulness as a form of clinical intervention Mindfulness is the awareness that arises through paying attention in a particular way on purpose in the present moment and nonjudgmental DBT therapy  Mindfulness based interventions have good impact on an individuals psychological health ○ Changes in cognitive and emotional reactivity ○ mindfulness training desensitizes individuals such that distressing situations that may otherwise have been avoided, along with accompanying thoughts and emotions, become less distressing Humanistic and Existential theories Also called phenomenological approach ○ French philosopher Maurice Merleau-Ponty (1908–1961) - it is through experience that people form their sense of themselves and of the world. ○ Accumaltion of perceptions of the world Sense of self ○ Life is a continuous synthesis of experience that progressively refines our sense of self - this provides our basis for our choices of action These choices represent the expression of our free will. Humanistic views most eminent advocates of humanistic psychology were Carl Rogers (1902–1987) and Abraham Maslow (1908–1970). ○ Emphjaized dignity and the potential of humans and saw experience as providing the basis for improving oneself - Rogers ideas have been called person-centered theory Person is the central importance in understanding behaviour Rogers believed self-fulfillment is achieved by accepting oneself, being honest in all interactions, trusting experience, and relying on oneself for personal evaluations Rogers believed distressing life events distort a persons perception of their subsequent experiences Distorted self views leads to dysfunctional behaviour  Maslow essentially believed that people are good and they behave dysfunctionally as a result of experience that has diverted them from the path of self-actualization ○ Hierarchy of needs that when fully satisfied, results in the actualization of a persons potential - Existential views Individuals awareness of their own existence is a critical feature of human functioning - we also know we will die Responsibility for our choices and actions - we must take responsobility ○ This makes us anxious L ife becomes a search for meaning. ○ Making the effort to seek meaning is said to reflect the “courage to be” - alternative is to give up the struggle and become full of despair. Treatment, therefore, is directed at confronting clients with their responsibility for their actions and assisting them in finding meaning in their lives. Socio-cultural influences Role of society or close others in maintenance of mental health disorders Stigma differences between a person’s preferred way of viewing eelf and negative stereotypes about mental illness (e.g., that mental illness means you’re “crazy” or  weak) cause one to anticipate negative consequences of disclosing one’s symptoms (e.g., being labelled, having a record, experiencing stigma and shame) ○ people avoid talking about mental health concerns and dont seek help ○ Members of the Black community, face a threat of “double stigma” - concerns about compounding the stigma associated with being a racial minority and the stigma of having a mental illness Public stigma: perception held by group or society Self-stigma: self labelling negative Social Support Social support is a significant factor in preventing or redu cing intensity of psychological problems and that the absence of this support is a factor in mental dysfunction ○ lack of social support has been associated with longer recovery times in individuals with depression A meta-analytical study found that social isolation, loneliness, and living alone result in increases in the likelihood of mortality by 29%, 26%, and 32%, Gender Gender-specific socialization processes render men and women differentially likely to acquire one or another disorder Sexual minority adults are at higher risk of psychiatric disorders ○ Eating disorders more common in girls Need to be thin in western culture - socio cultural factors ○ Ex: dependent personality disorder is characterized by dependency and submissiveness, whereas antisocial personality disorder involves aggressiveness and self-interest. Very few men are diagnosed with dependent personality disorder and very few women are considered to have antisocial personality disorder. This sharp difference may be due to biases in the diagnostic criteria or clinicians’ gender-related expectations ○ Gender roles (agressiveness in males, passivity in females) Race and Poverty  People who identify as bipoc can be concentrated in poorer areas ○ Excluded from oppurtonuties of the dominant group President Trump’s 2017 attempted travel ban targeting refugees from six Muslim-majority countries to prevent them from entering the United States. These prejudices and resulting lack of opportunities create stress in the lives of people who identify as BIPOC in the same way that poverty does. Poverty is significant risk factor ○ Adolescents from families that are socio-economically disadvantaged are two to three times more likely to develop a mental health problem the poverty dimensions of education, food insecurity, housing, social class, socio-economic status, and financial stress demonstrate the strongest and most consistent associations with a variety of mental illnesses it might also be that people with mental health problems gravitate to the lower end of the socio-economic spectrum. it may be that professionals in higher income brackets are more apt to apply denigrating diagnoses (for example, antisocial personality disorder or schizophrenia) to patients lower in socio-economic status, while reserving more acceptable diagnoses (for example, chronic fatigue syndrome) for those higher in socio-economic status. Integrative theories Interaction of various biological, environmental, and social factors - all have influence in how a disorder emerges Systems theory Proposes that the whole is more than the sum of its parts, whereas reductionism says that the whole is the sum of its parts ○ Sees causation as the combined effect of multiple factors - bidirectional  Ex: persistent misbehaviour of a child appears to influence parental behaviour such that the parents’ actions worsen the child’s behaviour ○ Same result can arise from one of many causes Diathesis-Stress Perspective A predisposition to developing a disorder interacting with the new experiences of stress causes mental disorders ○ Underlies the onset of all disorder Not biological or psychological - a diagnosis may be either - same with stressors example of a biological diathesis: the role played by genetics in schizophrenia, mood disorders, and alcoholism. ○ Dysfunctions of the central or peripheral nervous system or of the endocrine system may have a genetic basis or may be caused by events such as problems during gestation or birth, but in either case would be seen as a biological diathesis. Psychological diatheses may arise as a result of temperament, childhood abuse, inappropriate parenting, or social and cultural pressures. ○ People with dissocaitve identity disorder appears to come from childhood sexual abuse ○ Socio-cultural body standards - eating disorders A predisposition will not produce a disorder without the trigger of some stress - biological or psychological ○ Not a single factor The Biopsychosocial model Declares that disorders cannot be understood as resulting from the influence of one factor, be it psychological, social, or biological ○ Each factor into account - different disorders place different emphases ○ example,:Mann, Tackett, and Tucker-Drob (2018) have integrated research findings to strongly suggest that genetics and environment interact to determine one’s liability for rule-breaking and aggressive behaviour.  brain functions have been shown both to influence and to be influenced by psychological and social processes; the relationship is reciprocal Chapter 3: Classification and Diagnoses Diagnostic systems for mental disorders serves many important functions ○ Providing description for different disorders Features of panic disorder, how is it different from depression or schizopphrenia Gives us vocabulary to communicate on disorders ○ psychopathology researchers rely on diagnostic systems to identify individuals who meet criteria for a particular disorder and to exclude individuals who do not meet the criteria for that disorder in order to study the specific disorder of interest. Research findings give us better ideas ○ Important for clinical intervention What type of treatment patient will receive depending on problem To gather information required for proper diagnosis -assesment ○ Procedure through whcih information is gathered systematically in the evaluation of potential disorders Allows diagnosis If a certain number of these criteria or indicators are reliably present, the person is diagnosed with that disorder. The Perfect Diagnostic System The perfect diagnostic system would classify disorders on the basis of presenting systems (patterns of behaviour), etiology (history of the development of symptoms and underlying causes(, prognosis (future development or maintenance of symptoms, and response to treatment(how well treamtents work) ○ each problem or symptom would be found in only one diagnostic category; there would be no overlap Unfortunately it is not so neat human beings are incredibly complex, rapidly changing, and socially embedded organisms.  Multiple interacting events and processes contribute to both resilience and to symptoms, making mental disorders particularly difficult to study Characteristics of strong diagnostic systems Reliability: must give the same measurement for a given thing every time Inter-rater reliability - extent to which two clinicians agree on the diagnosis of particular patient Validity: determined by whether a diagnostic category is able to predict mental disorders accurately Concurrent validity: ability of diagnostic category to estimate an individuals present standing factors related to the disorder but not themselves as part of the diagnostic criteria ○ EX: although significant academic underachievement and a downward drift in socio-economic status are not diagnostic items for schizophrenia, they are clearly found in most people with schizophrenia. If an assessment of siblings of people diagnosed with schizophrenia, who do not have schizophrenia themselves, revealed that they had better education and higher income, this would be an indication of concurrent validity Predictive validty: ability of a test to predict the future course of an individuals development The History of Classification of Mental Disorders World Health Organization’s decision to add mental health disorders to the International List of the Causes of Death.  ○ In 1948, the list was expanded to become the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD), a comprehensive listing of all diseases, including psychopathology. inadequacies of the ICD system - the American Psychiatric Association published its own classification system, the Diagnostic and Statistical Manual (DSM), in 1952. ○ Not very good including second edition Example: DSM-I contained 106 categories of disorders that fell under the rubric of three major categories (organic brain syndromes, functional disorder, and mental deficiency). influenced by psychoanalytic theory, focused on internal unobservable processes, were not empirically based, and contained few objective criteria Further versions of DSM became atheuroetical: moved away from endorsing any one theory of psychology DSM-III-R was developed to be polythetic: an individual could be diagnosed with certain subset of symptoms without having to meet all criteria DSM-III and IIII - evaluating and rating patients on five different axes, or areas of functioning DSM-5 ○ ensure that participants represented diverse socio-economic, cultural, and ethnic backgrounds. ○. In addition to reliability of the diagnoses, these field trials assessed the validity and utility of the diagnoses and set out to establish improved criteria. DSM-5: Organizational structure Section 1 ○ Historical background, summary of development, intro to relevant issues Section 2  ○ Psychological disorders that have been recognized for centuries because of bizarre symptoms or diffuclty they pose to everyday life Schizo, mood disorders, personality disorders ○ Life circumstances that might contiubate to symptom onset Section 3: ○ Contains optional measures to aid clinical decision making and increase sensitivity to patients cultural context Ex: WHO Disability Assessment Schedule 2.0 (WHODAS), a self-report questionnaire that assesses a person’s level of functioning and impairment across six domains, including understanding and communicating, getting around/mobility, basic self-care, getting along with other people, life activities (at home, work, or school), and participation in society. ○ Outline for Cultural Formulation - framework for assessing the cultural features of an individual’s clinical presentation. Cultural identity , cultural conceptualizations of distress ○ The Cultural Formulation Interview (CFI) help clinicians collect cultural information to reduce misdiagnosis, - accurately assess severity of problems, facilitate treatment planning, and enhance the person-centredness of the assessment by grounding it in the patient’s experience. ○ includes dimensional symptom-based assessment tools - “Cross-Cutting Symptom Measures,” aimed at assisting clinicians in identifying additional problems that patients may be experiencing and that may be important for determining diagnosis, treatment, and prognosis. ○ pending further empirical support on certain disorders. Examples include caffeine use disorder, internet gaming disorder, and suicidal behaviour disorder, among others. Issues in the Diagnosis and Classification of Psychopathology  two main arenas of controversy. ○ One body of opinion objects to classification per se, and suggests that any classification system for mental disorders is irrelevant at best and inappropriate at worst. ○ The second type of opposition targets the DSM in particular. Against classification Medical model ○ Some professionals argue the diagnostic process is flawed because it follows the medical model. ○ They claim medical disorders are valid due to clear physical indicators (e.g., lesions). ○ Most mental disorders lack these obvious physical signs, so critics argue diagnoses are just social control. ○ Wakefield (1992) counters this by noting that some medical disorders (e.g., trigeminal neuralgia) also lack physical abnormalities but are still classified based on symptoms. ○ Wakefield suggests that we may eventually discover physical causes for mental health disorders. Stigmatization Diagnosis unfairly stigmatizes ○ “a schizophrenic,” rather than as a complex individual with skills and interests. Discourages patients from seeking help Not classifcation problem but societies reaction to mental disorders ○ Guide public to being educated on disorders ○ interventions, such as providing education about mental health or contact (either in person or recorded) with people who have experienced mental health issues, can reduce stigma in the general population Promising evidence stigma is decreasing Loss of information  A common criticism of diagnosis is that labels result in loss of information. ○ Dichotomizing complex traits into simple labels reduces nuance, similar to statistical loss when a continuous variable is categorized. ○ Labels, whether positive (e.g., "smart") or negative (e.g., "lazy"), oversimplify a person's complexity. A diagnosis (e.g., depression) doesn't capture all the qualities of an individual, potentially leading to false assumptions. ○ diagnoses help mental health professionals communicate efficiently and patients understand their condition, providing relief. The key takeaway is that diagnostic labels shouldn't be abandoned but used thoughtfully and with care. Rosenhan’s 1973 study showed that psychiatric labels can be powerful and misleading. ○ Pseudo-patients faked auditory hallucinations to gain admission to psychiatric hospitals. ○ After admission, they stopped showing symptoms but were still confined and eventually discharged with psychiatric diagnoses. ○ Mental health professionals interpreted normal behavior as symptom management, illustrating the bias labels can create. Gender Bias in DSM DSM-II were strongly influenced by psychoanalytic theory, which has been charged with sexism Some writers have claimed that the DSM describes many psychiatric disorders in a fashion that makes a diagnosis more probable for women even when no pathology is involved ○ in turn influenced by societal norms that value stereotypical masculine behaviour, such as assertiveness and goal-directed behaviour feminine behaviours are considered secondary to mental health and may even be seen as signs of emotional immaturity and psychopathology  ○ some seem to correspond to exaggerated female stereotypes (e.g., histrionic personality disorder and dependent personality disorder) and thus may be diagnosed more frequently in women than in men. Another criticism of the DSM is that it does not take life circumstances sufficiently into account, ○ psychological problems can be attributed largely to the individual. Much of the research on conduct disorder is confined to boys. the DSM-5/DSM-5-TR ○ includes a “gender-related diagnostic issues” section for most disorders that describes research findings on how the onset, etiology, prevalence, and presentation of a disorder differ across women and men. Cultural Bias in the DSM DSM-5/DSM-5-TR has striven to be atheoretical and to take cultural differences into account. Certain syndromes appear only within a particular culture. ○ The DSM-5-TR lists 10 syndromes that appear to be culture-bound. Taijin kyofusho, a syndrome found primarily in Japan and Korea, is characterized by an excessive fear that one will embarrass or offend others. ○ Several studies found that clinicians shown a case summary were more likely to diagnose the patient with schizophrenia if told the patient was Black. Politics and DSM homosexuality was included as a diagnostic category in the DSM until the release of DSM-III in 1980 The Prevalence of Mental Disorders One in 3 canadians will experience mental health disorder in lifetime Mental disorders are leading cause of disability in canada Globally, it is estimated that one-third of the world’s population has some form of mental disorder and, of those individuals, about two-thirds receive no treatment, even in high-income countries  Depression is now the leading cause of disability worldwide Chapter 4: Psychological Assessment and Research Methods Diagnosis is from psychological assessment: a systematic gathering and evaluation of information pertaining to an individual with suspected abnormal behaviour ○ not a single score but a set of scores placed within the context of the history, referral information, behavioural observations, and circumstances of an individual to provide a comprehensive understanding of that individual A good assessment tool depends on two things: ○ (1) an accurate ability to measure some aspect of the person being assessed ○ (2) knowledge of how people in general fare on such a measure, for the purpose of comparison. Assessment tools: Striving for the whole picture Sometimes patients have difficulty reporting on their own internal states, even when they can accurately describe their observable behaviour. ○ Fortunately, psychological assessment tools are available to fill in many of the missing pieces. Reliability and Validity Test-retest reliability: the degree to which a test yields the same results when it is given more than once to the same person ○ Correlating scores - higher the relationship (correlation coefficient), the greater the reliability Alternate form reliability: To do this, the test designers prepare two forms of the same test ○ develop questions that would test that construct, and then word those questions in a slightly different way to create a comparable second version of the test that correlates highly with the first test. Internal consistency: degree of reliability within a test - what extent do different parts of the test yield the same results?  ○ Measure of internal consistency: split-half reliability - evaluated by comparing responses on odd-numbered test items with responses on even-numbered test items ○ Coefficient alpha: calculated by averaging the intercorrelations on test - higher the better Face validity: user of a test believes that the items on that test resemble the characteristics associated with the concept of being tested ○ Ex: suppose that a test for assertiveness asks questions like “How do you react when you are overcharged in a store? When someone cuts in front of you in a line?” Because such behaviours seemingly relate to the general concept of assertiveness, the test would have face validity. Content validity: requires a tests content include a representative sample of all behaviours thought to be related to the construct that the test is designed to measure ○ Ex. construct of depression, design should address such features Criterion Validity: some qualities are easier to reconogize than to define completely ○ Gives higher scores to people already known to have greater ability in the area it tests Artistic ability is easier to recognize than define completely Construct validity: importance of a test within a specific theoretical framework and can only be understood in the context of that framework ○ useful when the construct to be measured is abstract, such as self-esteem. To design a measure of self-esteem, for example, you could draw from theories that predict self-esteem. Clinical versus actuarial prediction Clinical approach: argues that there is no substitute for the clinician's experience and personal judgement ○ Guided by intuition from professional experience  Actuarial approach: They rely exclusively on statistical procedures, empirical methods, and formal rules in evaluating data. ○ Objective and empirical Biological assessment Brain imaging techniques The EEG uses electrodes placed on various parts of scalp to measure brains electrical activity ○ patients may be asked to carry out a variety of visual or auditory tasks to see how their brains respond. Since we know so much about normal brain patterns, deviations in a particular part of the brain might be considered an indication of a problem for further investigation. Neuroimaging techniques can provide both structural and functional information concerning the physiological health of the central nervous system Computed tomography(CT) Computerized axial tomography (CAT scan) ○ this procedure, a narrow band of X-rays is projected through the head and onto scintillation crystals, which are much more sensitive than X-ray film. ○ Each separate exposure produces a matrix of dark and light areas, which are later combined by a computer to produce a highly detailed tomography ○ can identify structures such as cerebral vasculature, ventricles, grey and white matter, and some subcortical structures such as the thalamus and basal ganglia. CT scans can be used to look at changes in structural abnormalities before and after the treatment of a disorder. ○ Ex. stem cell transplants are being increasingly used to help treat the symptoms of autism Magnetic Resonance Imaging(MRI) A strong homogeneous magnetic field is produced around the patient’s head.  ○ Prief pulses of radio waves - causes electrons to move in certain way When waves are turned off, electrons return to normal By adding a small magnetic gradient to the field, the frequency of radio wave transmission by atoms within the brain is altered to correlate with the gradient, allowing scientists to determine the location of the radio source. Some findings including the decreased grey matter volume in the frontal lobes of individuals with schizophrenia Dynamic view of metabolic changes occurring in brain ○ they found that patients with schizophrenia had reduced connectivity between the medial prefrontal cortex and the dorsal anterior cingulate cortex. ○ Among patients with depression, reduced connectivity was found between the medial prefrontal cortex and the ventral prefrontal emotional encoding regions Recent studies have used this echnology to look at dynamic changes in individuals’ response to stimuli over a period of time. ○ Children with anxiety disorders initially process threatening stimuli with more vigilance than healthy children, but avoid threatening stimuli more than healthy children Positron Emission Tomography (PET) Combination of computerized tomography and radioisotope imaging. ○ Radiation is generated by injected or inhaled radioisotopes, which are common elements or substances that have had the atom altered to be radioactive. ○ Isotopes with half-lives of minutes to hours are required for a PET scan. As the substance is used in brain activity, radiation is given off and detected by the PET equipment.  Ligand: a common molecule present in the chemical bonding that characterizes neurotransmission, allows the PET scan to show the distribution of various neurotransmitters within the brain while CT scans and MRIs can produce a static image of the brain’s anatomy, PET scans and fMRIs produce a dynamic image of the functioning brain Neuropsychological assessments Neuropsychological assessments are used to determine relationship between behaviour and brain function. Some screening tests: ○ Bender Visual-Motor Gestalt Test ○ Repeatable Battery of the Assessment of Neuropsychological Status ○ Montreal Cognitive Assessment ○ and the screening elements of the Halstead-Reitan Neuropsychological Test Battery Psychological Assessment Clinical interviews ○ This method allows the clinician to better understand what symptoms are occurring, what they look like, the circumstances under which they are occurring, and how they are affecting the individual. Unstructured interviews tend to be open-ended, allowing the interviewer to pursue a specific line of questioning or to follow the patient’s lead Main advantage is Rapport: mutual understanding and trust between clinician and patient Main criticism is its poor reliability and validitaty ○ The clinician’s own theoretical orientation and personality greatly influence the type of information sought. For example, a behavioural therapist might focus on immediate circumstances surrounding a patient’s problem, whereas a psychodynamic therapist might focus on childhood experiences.  ○ Tend to only uncover information that fits their theoretical orientation Structured interviews A number of structured interviews have been developed that strictly prescribe the wording of questions and the interpretation of responses. researchers are able to obtain the information they need without having to rely on the judgments of individual lay interviewers Increase reliability but jeopardize rapport Semi-structered interviews Clinicians have some ideas on what questions to ask and wording to use, however by an outline that lists certain dimensions of the patient’s functioning that need to be covered. Mental status examination: screens for patients’ emotional, intellectual, and neurological functioning Structured Clinical Interview for DSM-5 Disorders the interviewer is instructed to ask a specific question. Patient responses are rated, and the interviewer is instructed to carry on with another set of questions depending on the patient’s response. ○ A “yes” response from the patient leads to a very different set of questions than a “no” response. Rating Scales Encourages reliability and objectivity ○ The most useful rating scales are those that enable a rater to indicate not only the presence or absence of a trait or behaviour but also its prominence or degree. Assessment of intelligence Galton believed that pure intelligence could best be measured by studying physiological cues ○ for example, the speed of response to a flash of light—an attribute later known as sensory intelligence  During an assessment interview, a clinician obtains information about various aspects of a patient’s situation, behaviour, and personality makeup. ○ usually conducted face to face and may have a relatively open structure or be more tightly controlled, depending on the goals and style of the clinician. The French psychologist Alfred Binet ○ His approach was to take a child’s mental age, which was determined by the child’s successful performance on age-grouped tests that had been normed, divide it by the child’s chronological age, and multiply the quotient by 100. This would result in an intelligence quotient (IQ) - stanford-binet intelligence scales WAIS-IV ○ Designed to measure diverse aspects of intelligence and consists of 10 core subtests and five supplementary subtests: four verbal comprehension tests, three working memory tests, five perceptual reasoning tests, and three processing speed tests ○ WELL DESIGNED RESEARCH TOOL good test-retest and split-half reliability and concurrent validity, and readily distinguish between the intellectually gifted, those with learning disorders, and individuals with intellectual disabilities IQ scores have to be evaluated within the context of ethnic, age, gender, and culturally appropriate norms. Personality assessment personality assessments usually describe various characteristics that make up an individual’s unique personality Projective test A person is presented with an ambiguous stimulus will project onto that stimulus on their unconscious motives, needs, drives, and personality characteristics Rorschach inkblot test  game of dripping ink on paper and folding the paper to make symmetrical figures. ○ people saw different things in the same inkblot, and he believed that their “percepts” reflected their personality. Each inkblot is on a separate card - handed to the respondent in a particular sequence. ○ Initially, most clinicians used their own clinical approach to interpreting the results of a Rorschach examination generally use the content of a patient’s responses to the inkblots (e.g., “I see two people fighting”), as well as colour, shading, texture, and movement in the interpretation of results. Exner system was developed to increase reliability and validity by standardizing the scoring of responses The Rorschach Performance Assessment System (R-PAS) was developed to improve the test by providing an evidence-based approach to administration, coding, and interpretation ○ used in ways that extend beyond what is warranted based on the empirical literature Thematic apperception test (TAT) consists of drawings on cards depicting ambiguous social interactions (see Figure 4.6). Individuals are asked to construct stories about the cards. ○ The validity and reliability of scoring techniques are open to the same criticisms as the Rorschach inkblot test. Advantage of projective tests is recieving meaningful material not easily obtained by self-report questionnaires or interviews. ○ No bias Disadvantage: it appears that clinicians tend to interpret responses in a way that confirms their own clinical assumptions, without empirical validation of their accuracy Personality inventories  accepted procedures such as standardization, establishment of norms, clinical and control groups, and statistically validated methods of interpretation. Minnesota multiphasic personality inventory The most widelt used objective test of personality - multiphasic refers to it assessing many aspects of personality ○ Detect sources of invalidity, carelessness, defensiveness. New one focuses on main clinical disorders ○ “True,” “False,” or “Cannot Say ○ Example, a question would appear on the depression scale only if there was a clear difference between the responses of a group of depressed people and a group of people who were not depressed Many items on objective tests like the MMPI-3 are clearly indicative of disturbed thoughts and feelings. The transparency of these items opens the opportunity for faking. The K scale measures a subtler form of distortion, called psychological defensiveness or guardednes - tendency to conceal genuine feelings about sensitive issues to create a favourable impression. MCMI the Millon Clinical Multiaxial Inventory (MCMI) was developed to help clinicians make diagnostic judgments about personality disorders and other clinical syndromes Personality assessment inventory self-administered, objective inventory of adult personality. There are 4 validity scales, 11 clinical scales, 5 treatment-consideration scales (e.g., suicidality, aggressiveness), and 2 interpersonal scales. ○ has 27 critical items that serve as indicators of potential crisis situations. Clinicians should note and follow up on these items during their assessments of the individual. ○ people do not give accurate reports about themselves.  ○ Many researchers supported Mischel’s view, arguing that predicting a person’s behaviour requires knowledge of both the person’s typical behaviour patterns and the characteristics of the setting, sometimes called the person-situation interaction Behavioural and cognitive assessment have suggested that the best predictor of future behaviour is past behaviour. As a result, a number of techniques arose to assess behaviour itself. Observational techniques One form of behavioural observation employs behaviour rating scales—a preprinted sheet on which the observer notes the presence, absence, and/or intensity of targeted behaviours, usually by checking boxes or by filling in coded terms. often observe children’s problem behaviours in relation to the antecedents (what happens before the behaviour) and consequences (what happens after the behaviour). In vivo observation: clinician may go into a persons everyday environment to record a running narrative of events (writing, recording) sometimes create an analogue observational setting, an artificial setting in an office or laboratory constructed to elicit specific classes of behaviour in individuals. Validity may be undermined by reactivity, the change in behaviour often seen when people know they are being observed or recorded. Cognitive behavioural assessment way in which individuals process information and think about it can tell psychologists a lot about how maladaptive behaviour develops determine ○ (1) how biases in information processing are related to the development of mental disorders, (2) who might be at risk for processing information in a biased, or possibly pathological, way, and  (3) how much cognitive-behavioural treatments eliminate or reduce information processing biases ○ “real-time” assessments of people’s thoughts can provide a useful sample of how people are processing events in their daily lives - recording, writing Measures of individuals’ vulnerability to disorders such as depression are invaluable in creating prevention programs CBT emphasizes the modification of unhelpful automatic thoughts and dysfunctional attitudes Self-Monitoring Patient is assessor ○ the frequency with which they perform various acts, and sometimes the circumstances surrounding these occurrences and their response to them ○ technique depends on a competent, diligent, and motivated person to monitor themself. Self-monitoring is useful and cost-effective in many types of behavioural intervention programs ○ By recording such data as soon as possible after a panic attack, more accurate information about the frequency, duration, and context of the panic attacks may be gleaned Research methods Research validates the tools used in assessment. One of the primary goals of clinical research is the description (defined as the specification and classification of an event) of clinical phenomena. All scientific research can be divided into two broad categories: experimental methods and non-experimental methods. Experimental Methods Variables are manipulated and the effects of these manipulations on other variables are determined ○ participants are randomly assigned to experimental and control groups. ○ Random assignment: equal probability of being chosen  Independent variable ○ Exposed to a variable that is being manipulated - experimental group Dependent ○ Behavioural response on measures the researchers hypothesize would be affected by the manipulation of the independent variable Experimental effect ○ Differences in a dependent variable are found to occur as a function of manipulation of the independent variable Pre test and post test ○ comprehensive picture of the effects of manipulating the independent variable, participants were assessed prior to and following treatment completion To help patient bias A placebo is a substance that looks and feels like the substance being tested but does not contain the active ingredient Double blind procedure: neither the participants nor the experimenters knew who was getting an active or a control treatment. Internal validity: the degree of changes in the dependent variables are a result of the manipulation of the independent variable external validity: generalizability of the findings, or the degree to which the findings in the investigation apply to other individuals in other settings. Pros and Cons of controlled experiment Strengths ○ Allows conclusions to be made Weakness ○ most difficult research strategy to implement because of the need to control for so many factors ○ Unethical: ex: treatment for HIV - research required that some participants be provided with active medication that was withheld from  the control group of patients. Is it ethical to withhold treatment from a seriously ill population? Quasi-Experimental methods participants in the experimental group are not randomly assigned but selected on the basis of certain characteristics ○ there is no manipulation of independent variables. A confound occurs when two or more variables exert their influence simultaneously, making it impossible to accurately establish the causal role of either variable. Pros and Cons The quasi-experimental: Allows for analysis of aspects of psychological disorders that cannot be studied by experiment. Experience has demonstrated that it is difficult to match participants on all factors but the one in question. Non-Experimental Methods Correlational method: measures the degree of relationship between two variables ○ behaviour is not manipulated, just measured quantitatively and then analyzed statistically ○ Requires large number of participants ○ Results in correlation coefficient -1.00 - 1.00 ○ Positive cor: increase in one variable is associated with increase in the other Neg is a decrease in the other Applications Useful when experimental manipulation is impossible or unethical (maternal smoking) Cannot infer causality from correlation - possible interpretations ○ Variable A may cause B ○ Variable B may cause A  ○ A third variable may influence both Longitudinal studies: Examine early factors preceding disorders Resource intensive and require large sample size High risk method: focuses on individuals with elevated risk for developing a disorder Case study method Purpose: provides a detailed description of an individuals current problem and its relation to their past What can you do: ○ Learn details of what took place ○ Generate ideas about why it occurred ○ Disprove an always or never What cant you do: ○ Prove a general law ○ Demonstrate correlation or causation Single subject designs Intensive investigation of an individual participant Uses observable and quantifiable behaviours Systematically applies quantifiable interventions and measures their effects ABAB design A(baseline): behaviour measurement in natural environment B(intervention): controlled introduction of treatment A(reversal):P removing treatment, back to baselin B(final treatment): reintro of treatment ABAB challenges Ethical concerns in reinstating ineffective contingencies to prove others work Participants reluctance to discontinue effective treatments for research integrity Generalizability and single subject designs Results from single subject designs are not generalizable  ○ May not apply to others Epidemiology in research Study of incidence and prevalence of disorders Incidence: new cases over a time period Indemnities disorder frequency, development, and risk factors Example: ○ Canadian community health survey Tracks health status Limits of epidemiolgy ○ Cannot easily infer cause and effect ○ Requires large participant numbers, time, and money Nature vs nurture debate Genetic disorders ○ Some due to mutation not inheritance Family studies ○ Index case or proband used for comparison ○ Concordance rates (twins) Adoption studies Control for environment by comparing adoptees with biological and adoptive parents Limitations: ○ Difficulty in obtaining complete information about biological parents ○ No control for prenatal environmental factors ○ No large sample sizes Gene-environment interactions Passive correlation ○ Environment shaped by biological parents traits Evocative correlation ○ Individuals traits evoke specific environmental responses Active correlation  ○ Individuals select environments aligning with their genotype Genes and environment both play important role Statistical Vs clinical significance A measure of whether the results of an experiment are likely due to chance Standard: in psychology p-value is set at.05 meaning results have less than 5% probability of occurring by chance if there is no real effect Clinical vs. statistical significance Statistical sig: indicates that the results are unlikely due to chance Clinical sig: refers to the practical importance of treatment outcomes in real-life settings Can have statistically significant results but not have improvements Importance of clinical significance Treatments must show real value to patients beyond statistical metrics Cost and side effects may make a treatment with minor statistical significance less desirable Real-world effectiveness may differ from controlled experimental settings Approaches to evaluate clinical sig Social validity: evaluating qualitative changes in patients life Subjective input: gathering feedback from patients and close ones to them Normative comparison: comparing results to non disturbed samples to asses practical impact Effect size Definition: a statistic that measures the strength of an effect Recent trends: increasing emphasis on reporting effect sizes alongside clinical data to better understand the impact of interventions Rationale: provides a clearer picture of how strong an effect is, using p-value data Current practices Practical outcomes are becoming increasingly required in journals over statistical significance Both effect size and clinical significance when research reporting