Item response theory and the measurement of clinical change

An instrument's sensitivity to detect individual-level change is an important consideration for both psychometric and clinical researchers. In this article, we develop a cognitive problems measure and evaluate its sensitivity to detect change from an item response theory (IRT) perspective. After illustrating assumption checking and model fit assessment, we detail 4 features of IRT modeling: (a) the scale information curve and its relation to the bandwidth of measurement precision, (b) the scale response curve and how it is used to link the latent trait metric with the raw score metric, (c) content-based versus norm-based score referencing, and (d) the level of measurement of the latent trait scale. We conclude that IRT offers an informative, alternative framework for understanding an instrument's psychometric properties and recommend that IRT analyses be considered prior to investigations of change, growth, or the effectiveness of clinical interventions.     

Exploring the hand test with medically ill children and adolescents

Pediatric psychologists use the tools of assessment to evaluate the psychological functioning of youth with chronic and acute medical illnesses. This study is an exploration of the use of a performance-based measure, the Hand Test (HT; Wagner, 1983), with pediatric medical patients. A sample of medical inpatients (n = 27) and psychiatric outpatients (n = 24) were administered the HT, a self-report measure, and a parent-report behavior rating scale. Results indicate that the psychiatric group scored higher than the medical group on HT Aggression, Withdrawal, and Pathological scores. The Aggression (d = 0.90) and Pathological (d = 0.80) variables were particularly robust in differentiating between groups, but the Crippled variable did not differ between groups. Hierarchical logistic regression demonstrated the incremental validity of the HT over behavior ratings alone in the classification of clinical groups. Analyses indicated that the HT can add important information in the differentiation of medically ill children from those with psychological disturbance.     

What you see is what you set: sustained inattentional blindness and the capture of awareness

This article reports a theoretical and experimental attempt to relate and contrast 2 traditionally separate research programs: inattentional blindness and attention capture. Inattentional blindness refers to failures to notice unexpected objects and events when attention is otherwise engaged. Attention capture research has traditionally used implicit indices (e.g., response times) to investigate automatic shifts of attention. Because attention capture usually measures performance whereas inattentional blindness measures awareness, the 2 fields have existed side by side with no shared theoretical framework. Here, the authors propose a theoretical unification, adapting several important effects from the attention capture literature to the context of sustained inattentional blindness. Although some stimulus properties can influence noticing of unexpected objects, the most influential factor affecting noticing is a person's own attentional goals. The authors conclude that many--but not all--aspects of attention capture apply to inattentional blindness but that these 2 classes of phenomena remain importantly distinct.     

Types of high self-esteem and prejudice: how implicit self-esteem relates to ethnic discrimination among high explicit self-esteem individuals

There is increasing recognition that high self-esteem is heterogeneous. Recent research suggests that individuals who report having high self-esteem (i.e., have high explicit self-esteem) behave more defensively to the extent that they have relatively low implicit self-esteem. The current studies test whether individuals with high explicit self-esteem are more likely to discriminate ethnically, as a defensive technique, to the extent that they have relatively low implicit self-esteem. The results support this prediction. Among participants with high explicit self-esteem, all of whom were threatened by negative performance feedback, those with relatively low implicit self-esteem recommended a more severe punishment for a Native, but not a White, student who started a fist-fight. In Study 2, this pattern was not apparent for participants with relatively low explicit self-esteem.     

Differentiating avoidant and depressive personality disorders

The purpose of this study was to test a priori predictions about the way in which avoidant personality disorder (APD) can be differentiated from depressive personality disorder (DPD) in a clinical population. Psychiatric outpatients were administered two measures of DPD, including the SCID-II for other DSM-IV Axis II personality disorders, along with criterion measures upon which the two disorders would be differentiated. APD was found to be most strongly associated with state and trait measures of anxiety, while DPD was most strongly associated with state and trait measures of hostility. Individuals with DPD had higher mean scores on measures of hostility than those without DPD, and individuals with APD had higher mean scores on measures of anxiety than those without APD. However, DPD measures were also significantly correlated with state and trait measures of anxiety and APD with measures of depressive symptoms. Furthermore, anxiety was found to be higher in some groups of individuals with DPD than those with APD. It is concluded that the level of hostility in this DPD population appears to be an important symptom by which to differentiate the two disorders and that a reconsideration of including DPD criterion #4 -- prone to brooding and worrying -- may be justified. Furthermore, the SCID-II interview may be better at differentiating DPD and APD than a self-report measure of DPD.     

Relational frame theory,acceptance and commitment therapy,and a functional analytic definition of mindfulness

The present article interprets mindfulness from the point of view of the effects of language and cognition on human action. Relational Frame Theory is described to show how human suffering is created by entanglement with the cognitive networks made possible by language. Mindfulness can be understood as a collection of related processes that function to undermine the dominance of verbal networks, especially involving temporal and evaluative relations. These processes include acceptance, defusion, contact with the present moment, and the transcendent sense of self. Each of these components of mindfulness are targeted in Acceptance and Commitment Therapy, and there is some evidence that they underlie the therapeutic changes induced by this approach. The relation between the present approach to mindfulness and other approaches is discussed.     

Attentional inhibition has social-emotional consequences for unfamiliar faces

Visual attention studies often rely on response time measures to show the impact of attentional facilitation and inhibition. Here we extend the investigation of the effects of attention on behavior and show that prior attentional states associated with unfamiliar faces can influence subsequent social-emotional judgments about those faces. Participants were shown pairs of face images and were asked to withhold a response if a transparent stop-signal cue appeared over one of the faces. This served to associate the cued face with an inhibitory state. Later, when asked to make social-emotional choices about these face pairs, participants chose uncued faces more often than cued faces as "more trustworthy" and chose cued faces more often than uncued faces as "less trustworthy." For perceptual choices, there was no effect of how the question was framed (which face is "on a lighter background" vs. "on a darker background"). These results suggest that attentional inhibition can be associated with socially relevant stimuli, such as faces, and can have specific, deleterious effects on social-emotional judgments.     

Perceptions of self and of ideal mates: Similarities and differences across the sexes

For 19 mating-relevant traits, single males (N= 53) and single females (N= 86) rated (a) themselves relative to their same-sex peers, (b) their perceptions of the qualities desired by members of the opposite sex in an ideal partner, and (c) the qualities desired in their own ideal romantic partner. Several themes emerged from the data. First, males’ and females’ judgments of what members of the opposite-sex seek were generally accurate. Second, males and females both feel that they fall short of perceived opposite-sex expectations in a few areas. Third, both males and females desire an ideal partner better than themselves, but this is especially true for females. These findings are discussed in terms of evolutionary social psychological principles.     

A retrospective examination of outpatient commitment in New York

Outpatient commitment (OC) is a growing trend in mental health treatment. The impetus for this movement has been partly due to the public perception that some mentally ill outpatients are prone to violence as result of poor treatment compliance. Numerous studies have shown that poor treatment compliance is associated with increased hospitalization, substance abuse, homelessness, and contact with the criminal justice system. This study examined treatment effectiveness, demographic variables, hospital utilization, and violence among 100 OC participants in New York. Results indicate that OC can be an effective means of increasing treatment compliance and reducing hospitalization and encounters with the criminal justice system.     

The collaborative assessment and management of suicidality versus treatment as usual: a retrospective study with suicidal outpatients

The Collaborative Assessment and Management of Suicidality (CAMS) is a novel clinical approach used to identify, assess, and manage suicidal outpatients (Jobes & Drozd, 2004). The results of a retrospective study evaluating the impact of CAMS versus treatment as usual (TAU) on suicidal outpatients are presented. Patients in the CAMS treatment group (n = 25) resolved their suicidality significantly more quickly than TAU patients (n = 30). CAMS was also significantly associated with decreased medical health care utilization in the 6 months after the start of suicide-related mental health treatment. These results provide promising preliminary support for the effectiveness of CAMS and a foundation for prospective research.