Selecting treatment foci in clinical case formulations: Estimating the clinical benefits of modifying causal variables.

Clinical case formulations (CCFs) can be organized and communicated in several ways but one of the most effective is through CCF causal diagrams (CCFCDs). Haynes et al., Psychological Assessment, 2020, 32, 541 illustrated how the psychometric evaluation of CCFCDs could be facilitated by assigning quantitative values to the clinician's judgments in a CCF. Although quantification could facilitate the psychometric evaluation CCFCDs, it is less clear that it can help clinicians make decisions about the best treatment foci. This article presents an open-source computer program (Clinical Case Formulation Causal Diagram Calculator, CCFCDC) for the path analyses of quantified CCFCDs, based on the free computing language Python, to assist in clinical decision making. The operation, examples, assets, and limitations of the CCFCDC are discussed in the context of measurement principles, precision, and uncertainty in clinical judgments. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A proposed model for the psychometric evaluation of clinical case formulations with quantified causal diagrams.

Judgments about a client's behavior problems and treatment goals, and the factors that influence them, are elements of most clinical case formulations (CCFs). These judgments are designed to guide clinicians' selection of the most effective intervention foci. Despite their importance, CCFs have undergone infrequent psychometric evaluations. We describe a model to promote and facilitate the psychometric evaluation of CCFs with quantified causal diagrams. This article presents the conceptual foundations, path analyses, benefits, and limitations of quantified causal diagrams. We first present concepts of causality and causal diagrams that are applicable to CCF and psychopathology. We propose that clinical case formulations causal diagrams can strengthen a science-based approach to clinical assessment, facilitate the psychometric evaluation of CCFs, enhance the specificity, precision, and communicability of clinicians' judgments, help the clinician select the most effective intervention foci, predict the effects of changes in causal variables, and emphasize the importance of "uncertainty" in CCFs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Preliminary Study of the Relationship between Perceived Racism and Cardiovascular Reactivity and Recovery in Native Hawaiians.

Native Hawaiians, compared to other ethnic groups in Hawai'i, have significantly higher mortality rates and die at a younger average age from cardiovascular disease (CVD). This may be partially explained by elevated cardiovascular responses to racial stressors. Our study examined the degree to which blood pressure (BP) and heart rate (HR) reactivity and recovery, and ratings of subjective distress to racial stressors, differ as a function of Native Hawaiian college students' levels of perceived racism. This study had three phases. Phase 1 involved the development of a blatant and subtle racial stressor. Phase 2 involved assigning 132 students into high- or low-perceived racism groups based on scores on two perceived interpersonal racism measures. Phase 3 involved a psychophysiology laboratory experiment conducted with 35 of the 132 students. BP, HR, and subjective distress were measured during exposure to the blatant and subtle racial stressors. Systolic blood pressure (SBP) recovery following exposure to both stressors was significant for both groups. Although not significant, three trends were observed among the high-perceived racism group, which included: (1) greater reactivity to exposure to the subtle stressor than to the blatant stressor, (2) incomplete HR recovery following exposure to both stressors, and (3) incomplete SBP and diastolic blood pressure recovery following exposure to the subtle stressor. Participants also reported significantly greater subjective distress following exposure to the blatant than to the subtle stressor. Specific interventions, such as increased self-awareness of physiological responses to racial stressors, targeted at at-risk individuals are necessary to reduce a person's risk for CVD.

Does a pre-intervention functional assessment increase intervention effectiveness? A meta-analysis of within-subject interrupted time-series studies.

This study examined the relative effectiveness of interventions based on a pre-intervention functional behavioral assessment (FBA), compared to interventions not based on a pre-intervention FBA. We examined 19 studies that included a direct comparison between the effects of FBA- and non-FBA-based interventions with the same participants. A random effects meta-analysis of effect sizes indicated that FBA-based interventions were associated with large reductions in problem behaviors when using non-FBA-based interventions as a reference intervention (Effect size=0.85, 95% CI [0.42, 1.27], p<0.001). In addition, non-FBA based interventions had no effect on problem behavior when compared to no intervention (0.06, 95% CI [-0.21, 0.33], p=0.664). Interestingly, both FBA-based and non-FBA-based interventions had significant effects on appropriate behavior relative to no intervention, albeit the overall effect size was much larger for FBA-based interventions (FBA-based: 1.27, 95% CI [0.89, 1.66], p<0.001 vs. non-FBA-based: 0.35, 95% CI [0.14, 0.56], p=0.001). In spite of the evidence in favor of FBA-based interventions, the limited number of comparative studies with high methodological standards underlines the need for further comparisons of FBA-based versus non-FBA-based interventions.

The Loss of Control Over Eating Scale: development and psychometric evaluation.

OBJECTIVE: This study describes the development, content validity, and convergent validity of the Loss of Control over Eating Scale (LOCES). METHOD: An initial pool of 56 items covering 13 facets of loss-of-control eating was assembled by reviewing qualitative literature, clinical descriptions, and research on binge eating. Eating disorder experts (n = 34) and eating disorder clients (n = 22) rated each proposed item's clarity and relevance to the construct of loss-of-control eating, rated 13 facets for their relevance to the construct, and provided open-ended feedback about the items and facets. Based on the experts' and clients' quantitative and qualitative feedback, scale items were clarified, 28 items were added, and 10 were deleted. University students (n = 476; 70% female, mean age = 20.4 years) completed the resulting 74-item questionnaire, rating how often they had the experience identified in the item while eating in the last 4 weeks. They also completed the measures of eating disturbance, general distress, functional impairment, and general self-control. RESULTS: The resulting 24-item LOCES (Cronbach's α = .96) retained items with highest item-total correlations and coverage of the 12 construct facets that experts rated as important. The LOCES was significantly correlated with eating disturbances, general distress, functional impairment, and general self-control. Three subfactors were identified: behavioral, cognitive/dissociative, and positive/euphoric aspects of loss-of-control eating. A brief, seven-item version of the LOCES was developed and validated. DISCUSSION: A thorough process of development, content validation, and psychometric evaluation in multiple samples yielded the multifaceted LOCES and its brief form. These instruments may be useful in assessing loss-of-control eating in both clinical and nonclinical settings.

Análisis funcional en evaluación conductual y formulación de casos clínicos / The functional analysis in behavioral assessment and case formulation

El presente trabajo muestra qué información debe recogerse para realizar el análisis funcional de un caso clínico, qué características debe poseer dicha información, cómo pueden integrarse los datos disponibles y cómo se pueden representar gráficamente los juicios clínicos para que ayuden en la elección del tratamiento. El análisis funcional consiste en la integración de variables y relaciones causales con los problemas del cliente y con los objetivos del tratamiento. Presentamos un caso práctico ilustrativo de evaluación conductual, de integración en un análisis funcional de los datos obtenidos y de su representación gráfica mediante un diagrama causal. El análisis funcional y su representación gráfica se presentan de forma que sirvan para comunicar con claridad el análisis funcional a otras personas, para enseñar a formular casos clínicos y para elegir el mejor enfoque para el tratamiento. El análisis funcional es dinámico, hipotético e idiográfico y su validez puede restringirse a determinadas situaciones o contextos (AU)

This article reviews what information needs to be gathered to carry out the functional analysis of a clinical case, what the scientific characteristics of this information are, how to integrate available information, and how to graphically represent clinical judgments to make treatment decisions. Functional analysis is the integration of important, modifiable, causal variables and causal relations associated with a client´s behavior problems and intervention goals. We present a clinical case to illustrate the applications of behavioral assessment methods and to show how data obtained in the assessment process can be integrated into a functional analysis. Functional Analytic Clinical Case Diagrams (FACCD), which are causal diagrams of a functional analysis, are also introduced. The functional analysis and FACCD are designed to efficiently communicate the functional analysis to others, as an aid in teaching case formulations, and to assist in selecting the most beneficial intervention focus with a client. The functional analysis is a dynamic, hypothesized, idiographic clinical case formulation. The validity of a functional analysis can be confined to particular settings or contexts (AU)

Idiographic assessment: conceptual and psychometric foundations of individualized behavioral assessment.

Idiographic assessment is the measurement of variables and functional relations that have been individually selected, or derived from assessment stimuli or contexts that have been individually tailored, to maximize their relevance for the particular individual. This article first reviews various definitions and clinical applications of idiographic assessment. Several properties of behavior problems and causal relations provide the conceptual basis for idiographic assessment: (a) differences across persons in the attributes, response systems, and dimensions of a behavior problem, and (b) differences across persons in the causal relations relevant to a particular behavior problem. Because of these individual differences, nomothetic measures often reflect variance that is irrelevant to the targeted construct for the individual. We present a psychometric framework for idiographic assessment by first summarizing why the psychometric principles used to develop standardized measures of nomothetic constructs can create incongruity between the nomothetic measure and the characteristics of the targeted construct for an individual. We then develop a psychometric framework for idiographic assessment that combines components of multilevel modeling (random effects) and confirmatory factor analyses applied to repeated measurements of each individual. We also provide a step-by-step guide for the development and evaluation of an idiographic assessment instrument.

Clinical assessment applications of ambulatory biosensors.

Ambulatory biosensor assessment includes a diverse set of rapidly developing and increasingly technologically sophisticated strategies to acquire minimally disruptive measures of physiological and motor variables of persons in their natural environments. Numerous studies have measured cardiovascular variables, physical activity, and biochemicals such as cortisol in psychopathology and treatment research. The physiological concomitants of many behavior and medical disorders and the benefits of a multimethod assessment strategy provide strong rationales for clinical applications of ambulatory biosensor measurement. A number of psychometric dimensions of evaluation are important in clinical applications of biosensor measurement, including accuracy and validity, reliability and consistency, clinical utility, incremental validity and utility, sensitivity to change, generalizability, cost benefits, and the conditional nature of dimensions of biomeasure evaluation. The authors review ambulatory biosensor methods and make recommendations for use of the technology.

Ethnic differences in the relationship between depressive symptoms and health-related quality of life in people with type 2 diabetes.

OBJECTIVE: To examine ethnic differences in the relationship between depressive symptoms and specific aspects of heath-related quality of life in people with type 2 diabetes. DESIGN: Cross-sectional data from 190 people with type 2 diabetes of Native Hawaiian (50%), Filipino (16%), Japanese (18%), and mixed-ethnic (16%) ancestries from the rural community of North Kohala, Hawai'i were examined in this study. Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) scale. Health-related quality of life was measured with the Short Form-36 Health Survey (SF-36). Eight health-related quality of life constructs were examined: Physical Functioning, Role-Physical Functioning, Role-Emotional Functioning, Social Functioning, Bodily Pain, Vitality, General Health, and Health Transition. RESULTS: Hierarchical regression analyses of the interaction between ethnicity and the SF-36 subscales of Physical Functioning, Role-Emotional Functioning, Bodily Pain, Vitality, and General Health indicated statistically significant associations with CES-D scores after controlling for sociodemographic factors, glycemic status, and social support. CONCLUSION: Ethnicity moderated the relationship between depressive symptoms and the health-related quality of life aspects of physical and role-emotional functioning, bodily pain, vitality, and general health perception in people with type 2 diabetes. This relationship was strongest for Filipinos followed by Native Hawaiians and people of mixed-ethnic ancestries.

Evidence-based approaches to assessing couple distress.

This article describes a conceptual framework for couple-based assessment strategies grounded in empirical findings linking couple distress to a broad range of both individual and relationship characteristics. These characteristics can contribute to, exacerbate, or result from relationship problems. On the basis of these findings, the authors articulate specific targets of clinical inquiry reflecting relationship behaviors, cognitions, and affect as well as features of individual distress. Guided by this framework, empirically supported assessment strategies and techniques emphasizing relationship functioning across diverse methods are proposed, including the clinical interview, analog behavioral observation, and both self- and other-report measures. Discussion concludes with specific recommendations regarding clinical assessment of couple distress and directions for further research.

El papel de la Psicología en el desarrollo de tratamientos apoyados empíricamente para los trastornos conductuales en adultos / The role of Psychology in the development of empirically supported treatments for adult behavior disorders

El objetivo de este artículo fue examinar el papel de los psicólogos en el desarrollo y evaluación de tratamientossocio-conductuales y cognitivos apoyados empíricamente para los trastornos conductuales en adultos. Se hanidentificados 117 estudios recientemente publicados, con ensayos clínicos controlados, que evaluaban la efectividaddel tratamiento cognitivo-conductual y psicosocial para los trastornos depresivo mayor, bipolar, por uso dealcohol, esquizofrenia y de ansiedad. El 62% de los primeros autores de estos estudios eran PSD (Doctores en Psicología);el 22% eran MDs (Doctores en Medicina). Se advierten algunas limitaciones a las inferencias que sepueden derivar de este estudio

The goal of this article was to examine the role of psychologists in the development and evaluation of empiricallysupported cognitive and social-behavioral treatments for adult behaviour disorders. One hundred seventeen recentlypublished controlled clinical trial studies were identified that evaluated the effectiveness of cognitive-behavioraland psychosocial treatment for major depressive, bipolar, alcohol, schizophrenia, and anxiety disorders.Sixty-two percent of the first authors of these studies were PhDs; twenty-two percent were MDs. Limitations of inferencesfrom this study were noted

The STRS (shortness of breath, tremulousness, racing heart, and sweating): A brief checklist for acute distress with panic-like autonomic indicators; development and factor structure.

BACKGROUND: Peritraumatic response, as currently assessed by Posttraumatic Stress Disorder (PTSD) diagnostic criterion A2, has weak positive predictive value (PPV) with respect to PTSD diagnosis. Research suggests that indicators of peritraumatic autonomic activation may supplement the PPV of PTSD criterion A2. We describe the development and factor structure of the STRS (Shortness of Breath, Tremulousness, Racing Heart, and Sweating), a one page, two-minute checklist with a five-point Likert-type response format based on a previously unpublished scale. It is the first validated self-report measure of peritraumatic activation of the autonomic nervous system. METHODS: We selected items from the Potential Stressful Events Interview (PSEI) to represent two latent variables: 1) PTSD diagnostic criterion A, and 2) acute autonomic activation. Participants (a convenience sample of 162 non-treatment seeking young adults) rated the most distressing incident of their lives on these items. We examined the factor structure of the STRS in this sample using factor and cluster analysis. RESULTS: Results confirmed a two-factor model. The factors together accounted for 68% of the variance. The variance in each item accounted for by the two factors together ranged from 41% to 74%. The item loadings on the two factors mapped precisely onto the two proposed latent variables. CONCLUSION: The factor structure of the STRS is robust and interpretable. Autonomic activation signs tapped by the STRS constitute a dimension of the acute autonomic activation in response to stress that is distinct from the current PTSD criterion A2. Since the PTSD diagnostic criteria are likely to change in the DSM-V, further research is warranted to determine whether signs of peritraumatic autonomic activation such as those measured by this two-minute scale add to the positive predictive power of the current PTSD criterion A2. Additionally, future research is warranted to explore whether the four automatic activation items of the STRS can be useful as the basis for a possible PTSD criterion A3 in the DSM-V.

Incremental validity of new clinical assessment measures.

The authors address conceptual and methodological foundations of incremental validity in the evaluation of newly developed clinical assessment measures. Incremental validity is defined as the degree to which a measure explains or predicts a phenomenon of interest, relative to other measures. Incremental validity can be evaluated on several dimensions, such as sensitivity to change, diagnostic efficacy, content validity, treatment design and outcome, and convergent validity. Indices of incremental validity can vary depending on the criterion measures, comparison measures, and individual differences in samples. The authors review the rationale for, principles, and methods of incremental validation, including the selection of comparison and criterion measures, and address data analytic strategies and the conditional nature of incremental validity evaluations in the selection of measures. Incremental validity contributes to, but is different from, cost-benefits, which reflect the cost of acquiring the data and the benefits from the data. The impact of an incremental validity index on whether a measure is selected will be moderated by the cost of acquiring the new data, the importance of the measured phenomenon, and the clinical utility of the new data.

Biological, psychosocial, and sociodemographic variables associated with depressive symptoms in persons with type 2 diabetes.

Studies have found an association between glycemic status and indices of health-related quality of life in people with diabetes mellitus and comorbid depression. No study to date has examined the relative strength of influences of glycemic status and health-related quality of life on depression in people with diabetes mellitus, nor have important moderators in this relationship been examined. This study examined the relative strength of correlations between glycemic status and health-related quality of life and depressive symptoms and the degree to which those correlations were moderated by sociodemographic variables in 146 people with type 2 diabetes. Depressive symptoms were measured with the Centers for Epidemiological Studies--Depression (CES-D) scale. Health-related quality of life was measured with the SF-36 Health Survey. Hemoglobin A1c (HbA1c) was used as a measure of glycemic status and body mass index and waist-hip ratio were measured. Results indicated that SF-36 scores accounted for a greater proportion of the variance in CES-D scores. The association between CES-D and SF-36 scores was moderated by HbA1c, sex, education, marital status, and social support. The implications and limitations of these results were discussed in the context of past studies.

Assessment of quality of life in a multicultural cancer patient population.

Quality of life (QOL) is increasingly assessed in cancer patients. In this article, the authors examined the psychometric performance of a commonly used QOL questionnaire, the Quality of Life Questionnaire--Cancer 30 (QLQ-C30; N. K. Aaronson et al., 1993), in multiethnic cancer patients. Content validation studies in patients and clinicians identified possible new items. Multiple-group confirmatory factor analysis supported equivalent structure across ethnic groups (Caucasians and Asian/Pacific Islanders [APIs]). A higher order QOL factor appeared to directly affect functioning scales and symptom count. Exploratory factor analysis examined effects of new items. Ten factors were extracted, 6 consistent with the original instrument and 4 reflecting potentially new aspects of QOL: Positive Social Support, Coping, Existential Well-Being, and Sexuality/Intimacy. The QLQ-C30 appears appropriate for use in API cancer patients. Further work needs to ensure that it includes all important domains.