Graham, J. R., MMPI-2: Assessing personality and psychopathology, 5th edition. H7: Restructured Clinical (RC) and Personality Psychopathology Five (PSY-5) Scales. Pagina 156-181
The first step in constructing the RC scales was to develop a general scale labelled Demoralisation. Removal of this general factor from the clinical scales would result in a set of restructured scales that would be less intercorrelated and have greater discriminant validity.
Demoralisation is equivalent to the pleasant-unpleasant dimension of self-reported affect.
The next step was designed to identify the core component of each original scale with the general demoralisation factor removed. Factors were extracted and rotated in a manner that yielded a clear demoralization factor, which included all of the provisional Demoralisation scale items as well as items in the clinical scales that are primarily demoralisation markers, and a second factor that could be considered the substantive core for a clinical scale.
The third step involved identifying items with high loadings on the factor representing the core of each to serve as a ‘seed’ scale for each RC scale. A given seed scale was assigned those items that had the highest loadings on the scale’s core factor and that did not have salient loadings on the demoralisation factor. Overlapping items were removed, as were items that detracted from the internal consistency of a seed scale.
The 12 seed scales (demoralisation plus one for each original clinical scale except scale 5) were correlated with all other MMPI-2 items in four clinical samples. Items were selected for the RC scales if they had high correlations with a particular seed scale and low correlation with other seed scales. Items were deleted from a scale if they did not contribute to the scale’s internal consistency or appropriately correlated with conceptually relevant external criterion measures.
This resulted in restructured versions of Clinical scales 1-4 and 6-9 and a demoralisation scale.
Inter-correlations of the RC scale are lower than for the clinical scale. This makes greater discriminant validity. The scales assess similar, but not identical constructs.
The RC scales are substantially less saturated with demoralisation than are the clinical scales.
The RC scales have higher internal consistency values than the clinical scales.
In all samples the RC scales had quite acceptable internal consistency.
The stability of the RC scales over a short period of time is acceptable and in most cases greater than for the clinical scales.
Most RC scales are measuring characteristics that are similar, but not identical, to their clinical and content scale counterparts.
The RC scales are correlated with external measures.
Most RC scales and their clinical scale counterparts had correlations of similar strength with conceptually relevant external criterion measures. There was evidence for greater discriminant validity for the RC scales than for the clinical scales.
The utility of the RC scales in differential diagnosis has been demonstrated in several studies.
When interpreting any MMPI-2 scales, clinicians first need to assess the validity of test protocols.
Some of the RC scales can add to the interpretation of MMPI-2 protocols. They can clarify the meaning of elevated scores on the clinical scales and generate influences about test takers independently.
The following strategy is suggested for integrating clinical and RC scale information. Consider that for any particular Clinical scale/RC scale pair there are four possibilities: 1) Neither the clinical nor RC scale score is high. No interpretations should be made 2) both the clinical and RC scale scores are high, inferences about the core construct for the Clinical sale can be made with considerable confidence 3) the clinical scale score is high but the RC scale score not, one should be quite cautious about making inferences about that the test taker has characteristics consistent with the core construct associated with the Clinical scale . It may be a product of demoralisation.4) the clinical scale score is not high and the RC score is, inferences about characteristics related to the core construct are appropriate. The lower clinical scale is likely to result from the absence of demoralisation.
Demoralisation (RCd)
The RCd scale score provides an indication of the overall emotional discomfort and turmoil that a person is experiencing. High scores on this scale are likely also to have high scores on other RC, Clinical and Content scales.
Somatic complains (RC1)
The cardinal feature of high scores on the RC1 scale is somatic preoccupation. Low scores indicate persons who report a sense of physical well-being.
Low positive emotions (RC2)
High scores indicate a person who lacks positive emotions.
Cynicism (RC3)
Clinical scale 3 has two major components: somatic complains and avowal of excessive trust of others.
The RC3 assesses the second component.
Antisocial behaviour (RC4)
RC4 measures antisocial characteristics.
Ideas of persecution (RC6)
RC6 measures persecutory thinking.
Dysfunctional negative emotions (RC7)
RC7 scores the level of negative emotions.
Aberrant experiences (RC8)
RC8 focuses on sensory, perceptual, cognitive and motor disturbances suggestive of psychotic disorders.
Hypomanic activation (RC9)
RC9 scores the level of activation and engagement with the environment.
The Personality Psychopathology Five (PSY-5) scales were constructed to assess personality traits relevant to both normal functioning and clinical problems. The conceptualization underlying the scales is similar, but not identical, to the five-factor model of personality.
The PSY-5 constructs
Five constructs were the basis for the construction of the PSY-5 scales of the MMPI-2: 1) aggressiveness, focuses on offensive and instrumental aggression 2) psychoticism, disconnection from reality, including unshared beliefs and unusual sensory and perceptual experiences, and feeling alienated and having unrealistic expectations of harm 3) constraint, risk-taking, impulsivity, and ignoring traditional moral beliefs and behaviour 4) negative, emotionality/neuroticism, a predisposition to experience negatively valenced emotions, to focus on problematic features of incoming information, to worry, be self-critical, feel guilty, and concoct worse-case scenarios 5) low positive emotionality/introversion, limited capacity to experience joy and positive engagement and being socially introverted.
Reliability of the PSY-5 scales
The internal consistency of the scale is good.
Validity of the PSY-5 scales
There is a good fit between the hypothesized model underlying the PSY-5 scales and their factor-analytic results.
There is strong support for the construct validity of the PSY-5 scales.
PSY-5 facet scales
Facet scales were developed for each of the PSY-5 scales. But, there is limited reliability and discriminant validity. Their clinical use is not recommended.
Aggressiveness
Both high and low scores are interpreted.
Psychoticism
Low scores are not interpreted.
Constraint
High and low scores are interpreted.
Negative emotionality/neuroticism
Low scores are not interpreted.
Introversion/low positive emotionality
Both high and low scores are interpreted.
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History of present illenss and interviewing about feelings - summary of chapter 5, 6, 7 of the First Interview
The first interview
Morrison, J.
You can move to the history of the present illness if there are no major problem areas to discover. Throughout the balance of history taking, listen for other clues that might point the way for further explorations.
Explore the problems that have brought the client into treatment. You might consider the areas of clinical interest you covered during free speech.
It is a convention to label as ‘illness’, whatever brings anyone in for evaluation. All problems have precipitants, symptoms, course, and other features that allow you to suggest an effective plan of action.
The present episode
Concentrate first on the current episode of illness. You need a fund of basic information as to exactly what symptoms you can expect to find in an episode of illness. For this, you need to refer to textbooks and other resources.
Describing symptoms
Learn as much as you can about each symptom your client reports. A symptom is any subjective sensation that makes the client think that something is wrong. Clarify any descriptive terms that are used.
Characterize each symptom as fully as you can. Symptoms can wax and wane with time or changes in the environment. Does the client notice such factors?
Vegetative symptoms
Vegetative symptoms are body functions that are concerned with maintaining health and vigour. Vegetative symptoms include problems with:
Sleep
Either excessive (hypersomnia) or inability to sleep (insomnia). If the client has insomnia, find out what portion of the sleep is affected; 1) early (initial insomnia), this is common 2) middle (interval insomnia), this can be found in PTSD or substance abuse 3) late (terminal insomnia), this is usually associated with more severe mental problems.
Appetite and weight change
You should learn how significant the change has been and whether this was intentional.
Energy level
Diurnal variation of mood
Clients with severe depression often feel worse upon arising and better as the day goes on. Those who are less depressed are more likely to report feeling better early in the day, but depressed by nightfall.
Sexual interest and performance
Sexual functioning usually depends upon the individual’s sense of wellbeing.
These symptoms are found in so many of the serious mental disorders that they serve as a screening tool. Look especially for change from previous normal functioning.
Consequences of illness
Mental disorder can interfere
.....read more Oude onaangepaste schema's en diagnostiek en voorlichting - samenvatting van een gedeelte uit hoofdstuk 1 en 2 uit Schemagerichte therapie handboek voor therapeutenSchemagerichte therapie Handboek voor therapeuten
Young, J. E., Klosko, J. S., & Weishaar, M. E..
H1, H2
De geschiedenis van het construct schema
Binnen de cognitieve ontwikkeling is een schema een patroon dat over de werkelijkheid of ervering heen wordt gelegd om het individu in staat te stellen: 1) deze te verklaren 2) de perceptie te mediëren 3) reacties te sturen.
Een schema is een abstracte voorstelling van de typerende kenmerking van een gebeurtenis. Het dient als leidraad voor het interpreteren van informatie en het oplossen van problemen.
Schema’s worden steeds verder uitgewerkt en op latere levenservaringen toegepast.
Cognitieve consistentie is het instand houden van een stabiele visie op iemand zelf en de wereld, ook als deze in werkelijkheid onnauwkeurig of vertekend is.
Een schema kan positief of negatief en functioneel of dysfunctioneel zijn. Schema’s kunnen zowel in de kindertijd als in het latere leven ontstaan.
De definitie van een schema volgens Young
Young denkt dat sommige schema’s, met name die zijn ontstaan door schadelijke ervaringen in de kindertijd, de kern uitmaken van persoonlijkheidsstoornissen.
Een oud, onaangepast schema is: 1) een breed algemeen verbreid schema 2) bestaat uit herinneringen, emoties, cognities en lichamelijke gewaarwordingen 3) heeft betrekking tot het zelf en relaties met anderen 4) ontstaan tijdens kindertijd of adolescentie 5) in de loop van de tijd verder uitgebreid 6) disfunctioneel.
Disfunctioneel gedrag is een reactie op het schema.
Kenmerken van oude onaangepaste schema’s
In volwassenheid worden schema’s geactiveerd door gebeurtenissen die als gelijk worden gezien als die in de jeugd.
Oude onaangepaste schema’s zijn het effect van schadelijke ervaringen. Deze schema’s bestaan voort door het verlangen naar consistentie.
Mensen voelen zich aangetrokken tot gebeurtenissen die hun schema’s activeren. De schema’s worden als ‘waar’ beschouwd en hebben invloed op de wijze waarop latere ervaringen worden verwerkt.
Schema’s beginnen als een op werkelijkheid gebaseerde voorstelling van de omgeving van het kind. Het disfunctionele karakter van het schema blijkt als cliënten in hun contact met andere mensen aan hun schema’s vast blijven houden (hoewel de perceptie niet juist is).
Schema’s zijn dimensioneel, zij verschillen in heftigheid en omvang. Hoe heftiger het schema, hoe groter het aantal situaties dat het activeert. Des te strenger het schema, des te heviger het negatieve affect wanneer het wordt opgeroepen en des te langer het aanhoudt.
Restructured Clinical (RC) and Personality Pathology Five (PSY-5) scales - summary of chapter 7 of MMPI-2 assessing perosnality and psychopathologyGraham, J. R., MMPI-2: Assessing personality and psychopathology, 5th edition. H7: Restructured Clinical (RC) and Personality Psychopathology Five (PSY-5) Scales. Pagina 156-181
The first step in constructing the RC scales was to develop a general scale labelled Demoralisation. Removal of this general factor from the clinical scales would result in a set of restructured scales that would be less intercorrelated and have greater discriminant validity.
Demoralisation is equivalent to the pleasant-unpleasant dimension of self-reported affect.
The next step was designed to identify the core component of each original scale with the general demoralisation factor removed. Factors were extracted and rotated in a manner that yielded a clear demoralization factor, which included all of the provisional Demoralisation scale items as well as items in the clinical scales that are primarily demoralisation markers, and a second factor that could be considered the substantive core for a clinical scale.
The third step involved identifying items with high loadings on the factor representing the core of each to serve as a ‘seed’ scale for each RC scale. A given seed scale was assigned those items that had the highest loadings on the scale’s core factor and that did not have salient loadings on the demoralisation factor. Overlapping items were removed, as were items that detracted from the internal consistency of a seed scale.
The 12 seed scales (demoralisation plus one for each original clinical scale except scale 5) were correlated with all other MMPI-2 items in four clinical samples. Items were selected for the RC scales if they had high correlations with a particular seed scale and low correlation with other seed scales. Items were deleted from a scale if they did not contribute to the scale’s internal consistency or appropriately correlated with conceptually relevant external criterion measures.
This resulted in restructured versions of Clinical scales 1-4 and 6-9 and a demoralisation scale.
Inter-correlations of the RC scale are lower than for the clinical scale. This makes greater discriminant validity. The scales assess similar, but not identical constructs.
The RC scales are substantially less saturated with demoralisation than are the clinical scales.
The MMPI-2 restructured clincial scales (RC) and restraints to innovation - summary of an article by Stephen and Kamphuis Stephen E. Finn & Jan H. Kamphuis (2006) The MMPI–2 Restructured Clinical (RC) Scales and Restraints to Innovation, or "What Have They Done to My Song?", Journal of Personality Assessment, 87:2, 202-210
The RC scales are a set of nine non-overlapping scales designed to measure the common factor (Demoralisation) and unique components of the eight original Clinical Scales.
The RC scales are robust.
Comparing like with like: multivariate scales and ‘syndromal fidelity’
A loss of ‘multivariate structure’ is a critique of the RC scales.
There are several reasons why unifactorial scales may be preferred over syndromal scales: 1) syndromes are generally not true traxa and go through changes in definitions over time. Unifactorial scales have better chance of being useful over time 2) Syndromes consist of subdomains, which are better assessed by multiple-separate measures than by one composite amalgam.
Confusing the Nature of the clinical scales, content scales, RC scales and the DSM-IV
The DSM-IV criteria define a disorder, whereas the MMPI-2 clinical scale items are heterogeneous fallible indicators of syndromes.
The main thing the RC and content scales have in common is their high internal consistency and subsequent face validity.
Item composition and the ‘credibility’ of the RC scales
The RC scales were not a priori meant to be the same as the clinical scales. The idea was to use factor analyses to reshuffle the MMPI-2 items such that eight non-overlapping scales would emerge that captured unique components of the original Clinical scales.
Other purely empirical ways to solve the Clinical scale covariation problem
There are other, possibly superior ways to attack Clinical scale covariation. It is an empirical question whether these are better.
On the nature of DEM and Construct Drift
Dem is the theoretically inspired and depressively biased marker that simultaneously overextracts and underetracts unwanted variance from the Clinical Scales, in turn resulting in construct drift in the next step of the RC Scales’ derivation. Construct drift is relative to some other target construct. The RC scales describe related but different constructs than the original clinical scales.
The RC scales show meaningful relations to the Clinical scales but are not identical nor ‘proxies’ for the Clinical scales nor were they meant to be. They aim
.....read more The MMPI - summary of part of chapter 7 of Handbook of psychological assessmentGroth-Marnat, G. Handbook of Psychological Assessment, Wiley, Pagina 213-226, 240-269, 295-297, 302-304
Chapter 7. Minnesota Multiphasic Personality Inventory
The Minnesota Multiphasic Personality Inventory (MMPI) is a standardised questionnaire that elicits a wide range of self-descriptions scored to give a quantitative measurement of an individual’s level of emotional adjustment and attitude toward test taking.
The MMPI test format consisted of affirmative statements that could be answered ‘True’ or ‘False’.
The original MMPI had 13 scales. The recent MMPI-2 and MMPI-A have maintained the original 10 clinical/personality scales as well as the original 3 validity scales. The total number of validity scales has been increased.
The clinical and personality scales are known by their scale numbers and scale abbreviations. Additional options are available to refine the meaning of the clinical scales as well as provide additional information 1) content scales, scales based on item content 2) Harris-Lingoes subscales, for the clinical and personality scales based on clusters of content-related items 3) critical scales, assessment of items and item clusters that relate to relevant dimensions 4) supplementary scales, empirically derived new scales.
The content for the majority of MMPI questions are relatively obvious and deal largely with psychiatric, psychological, neurological, or physical symptoms. Some questions are psychologically obscure because the underlying process they are assessing is not intuitively obvious.
After a test profile has been developed, the scores are frequently arranged or coded in a way that summarizes and highlights significant peaks and valleys. To accurately interpret the test, both the overall configuration of the different scales and the relevant demographic characteristics of the client must be taken into consideration. In many instances, the same scaled score on one test profile can mean something quite differently on another person’s profile when the elevations of lowerings of other scales are considered.
The scales represent measures of personality traits rather than simply diagnostic categories. It is useful to consider that the scales indicate clusters of personality variables.
The MMPI was developed to be an aid in assessing adult patients during routine psychiatric case workshops and could accurately determine the severity of their disturbances. The developers were interested in developing an objective estimate of the change produced by psychotherapy or other variables in the patient’s life.
Empirical criterion keying refers to the development, selection, and scoring of items within the scales based on some external criterion of reference. If a clinical population was given a serious of questions to answer, the individuals developing
.....read more The case formulation model - summary of chapter 1 and 3 of Cognitive therapy in practice: a case formulation approachPersons. J. B. Cognitive therapy in practice: A case formulation approach. H1 & H3.
Psychological problems occur at two levels
The case formulation model conceptualizes psychological problems as occurring at two levels: 1) overt difficulties, ‘real life’ problems, like depressed moods or panic attacks 2) underlying psychological mechanisms,the psychological deficits that underlie and cause the overt difficulties. They can often be expressed in terms of one (or a few) irrational beliefs about the self.
Overt difficulties
At a ‘macro’ level, overt difficulties include such things as depression, relationship difficulties, obesity and fears. These are problems as they might be described in the clients own terms.
At a ‘micro’ level, problems can be described in terms of three components: 1) cognitions 2) behaviours 3) moods. All three components of problems usually reflect the irrational, maladaptive nature of the underlying mechanism.
Cognitions
A cognitive component can be found for nearly every problem clients report. Negative mood states usually involve negative automatic thoughts. Automatic thoughts are related to problematic behaviours.
Cognitions can involve thoughts, images, (day)dreams and memories.
Behaviour
Three types of behaviours are considered in the case formulation model 1) overt motor behaviours, such things as spending hours in bed, overeating and arguing with others 2) physiological responses, such things as increased heart rate, dizziness, insomnia 3) verbal behaviours, like continual request for reassurance.
Behavioural components of a client’s problems are usually best described as problematic or maladaptive.
Mood
The term ‘mood’ refers to the client’s subjective report of his emotional experience.
Relationships among the components
Synchrony: Usually a problem in one component indicates that problems in other components are also present. An underlying deficit is usually manifested in all three components at the overt level, not just one or two. If this isn’t the case, the problem is desynchronous.
Interdependence: The synchronous relationship suggest that a change in any one component is likely to produce changes in the other components. These interdependent relationships are indicated by the arrows connecting behaviour, cognitions and mood.
Underlying mechanisms
The underlying psychological mechanism is a problem or deficit that produces, or is responsible for, the individual’s overt difficulties. The therapist’s ideas about the underlying cognitions operating in any given case are best viewed as working hypotheses.
Underlying beliefs are often well-expressed in an ‘if-then’ format. Sometimes they are simpler, blanked statements.
Sometimes the client’s central problem
.....read more
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