Clinical psychology

Definition of the application
 Clinical psychology is the study of mental health and well-being and includes
the study of mental health conditions and disorders.
 Clinical psychology aims to classify and diagnose, explain and treat mental
health conditions or disorders, to reduce psychological distress and enhance
and promote psychological well-being.
 Clinical psychologist work in a range of settings including hospitals, health
centres, community mental health teams, child and adolescent mental health
services (CAMHS) and social services. They work with children and adults with
mental and physical health problems, including anxiety, depression, relationship
problems and addictions.
 They undertake clinical needs assessments using psychometric tests, interviews
and direct observations of behaviour. They deliver and evaluate the
effectiveness of therapy, counselling and advice.
 Clinical psychologists often work as part of a team with, social workers, medical
practitioners and other health professionals. Most of them work for the National
Health Service, which has clearly defined career structure, but some work in
private practice.
 The work is often directly with people, both individually or in groups, assessing
their needs and providing therapies based on psychological theories and
research. Some clinical psychologists also work as trainers, teachers and
researchers at universities.

How science works
Primary and secondary data
Primary data
 Collected first hand by the researcher for a specific research purpose. It can be
qualitative or quantitative.
 An example of qualitative primary data is Brown et al. 1986 who interviews pps
and information was collected about self-esteem, life events and perceived
social support over the course of the longitudinal study.
 An example of quantitative primary data was encountered in Castner et al.
(1998) where a study of rhesus monkeys later exposed whilst in the uterus to
radiation to see whether this led to symptoms of schizophrenia later in life; here
the monkeys were observed for signs of hallucinations (a nominal scoring
system was used such as a tally chart).
 The monkeys were also given cognitive tests to see whether exposure to
radiation led to disordered thinking. These tests would have led to ratio data in
the form of scores on a standardised psychological tests and this is also a form
of primary data collection.
Secondary data
 This means that someone else has already collected the information, for a
different purpose and the information have been stored on record for use by
other researchers. The researcher will re-analyse this second hand data for a
new purpose.

 Primary data are gathered at the time of the study. E. developing the research method and setting up any situation or survey. Evaluation of primary and secondary data Primary strengths  Gathered of intended purpose therefor likely to be more focused on that purpose. Results of psychological studies are classed as secondary data and often a researcher will conduct an in-depth review of the data in the area of interest before embarking on his or her own primary data collection. which mean primary data are more likely to be valid in the sense of being up to date. First. secondary data taken from another source and have often been gathered for a different reason. then they might well have been gathered validly. so the range of pps can be wider and generalizability can be improved. However. They then interviewed the twins. Secondary data are likely to have been gathered with one purpose in mind and when used in a 'secondary' fashion they may not be seen to have credibility.  In clinical psychology. as adults. which affected their study. This is not always the case but in studies such as craft et al.  Primary data tends to be more valid in that they are gathered first hand and any operationalizing is done carefully with the purpose in mind so the data are more likely to represent real life.  Primary data is more likely to have credibility as they are gathered for a specific purpose and analysed with that purpose in mind.  Primary data are analysed directly by the researchers. such as in meta-analysis. which they often are might not be valid if used as if they are about individuals. the other had been diagnosed with it as well. This was using secondary data. secondary data can be 'raw' data and not previously analysed. However if the secondary data was originally primary data from another study. Secondary data if they are statistics from surveys. Using both types of data Gottesman and Shields (1966) used both types of data in their study to see if schizophrenia is inherited. which can bring in an element of subjectivity. including finding the pps. (2003).g. whereas secondary data is likely to be gathered some time previously. When interviewing they were gathering primary data. whereas secondary data may already have been analysed. Primary data tend to be expensive because the study has to be run completely. to assess their mental health and to find out the course of their mental disorder. they found out the mental health of pairs of identical and non-identical twins by accessing hospital records for twin where at least one of the pair had been diagnosed with a mental disorder. where they used data from many . Secondary strengths  Secondary data are cheaper because they are already there.  Secondary data can involve more pps. It could also include school reports which provide insight into an individual's life before the onset of a disorder.  A specific example of the use of secondary data in clinical psychology was Gottesman and Shields (1966) use of pre-existing diagnoses of schizophrenia and other psychiatric disorders in their twin pairs from Bethlem and Maudsley hospital. They gathered quite a lot of information about the twins and then drew conclusions about how often when at least one twin had schizophrenia or some related disorder. Gottesman and shields (1966) had to discount some of their pairs of twins because they could not be sure whether they were monozygotic or dizygotic twins. secondary data might include medical records made by doctors including diagnosis of disorders or how a patient has responded to treatment options.

the DSM IV TR and other diagnostic systems such as the ICD 10 operationalize mental disorders using lists of symptoms.studies that used the same questionnaire. therefore the diagnosis is consistent. they had a lot more data than if they gathered the information first hand. By using the hospital records over a number of years were able to access a lot of detail about pairs of twins that otherwise would have been hard.  Cohen's kappa in another figure used when talking about reliability of diagnosis. then this should successfully predict that they will experience relief if given a known treatment for this particular disorder and that people given this diagnosis will respond to the treatments in similar ways.  Secondly psychologists argue about the predictive validity of the various diagnoses. to put together p. or both. Definition of schizophrenia . Validity  Validity refers to the extent to which a measure of a psychological variable measures what it sets out to measure and that the measurement is not simply a reflection of the testing situation but of the persons behaviour. then validity of diagnosis is limited in It is possible that the distinctions made between disorders are false. This is known as inter-rather reliability. in their everyday life. however some psychologists feel that these lists do not have construct validity. Reliability and validity Reliability  Reliability refers to the consistency with which a measure of psychological variable identifies the same thing.  For example. in Rosenhan's (1973) each of the pseudo patients reported the exact same symptoms and in 7 out of 8 cases. E.  Reliability can also be assessed by seeing whether the same individual is given the same diagnosis when assessed at several intervals. if not impossible.  A diagnosis of mental disorder is considered reliable if more than one psychologist gives the same diagnosis to the same Individuals.  This is often measured using PPVs (positive predictive value) which is basically a percentage which tells us the percentage of people who keep the same diagnosis over time. the same diagnosis was applied. Studies gathering primary data are often limited in the number if people they involve. although again this is not always the case. (schizophrenia) suggesting reliability. if a person is given a certain diagnosis. that when symptoms are similar across different disorders. this is a decimal which again shows the proportion of people who keep the same diagnosis.  Finally a diagnosis can be said to have concurrent validity if the individual is assessed using two or more different techniques and the same disorder is identifies using each technique.  Secondary data tends to consist of more data too. for example self-rating. family or teacher observations and psychological testing.g. either by cost or to make the study manageable. when gathering primary data it is often the case that the numbers that can be involved are limited. if not validity in diagnosis. Gottesman and Shield (1966).  With regard to the diagnosis of mental disorders. This is called test-retest reliability. thinking and emotions more generally.

then it may be that the disorder has a genetic component. alogia (lack of speech and avolition (lack of purposeful behaviour) Using twin studies to research schizophrenia One way of finding out whether a disorder has a genetic component is to see whether it runs in families. delusions. In a twin study. MZ concordance is 100% MZ concordance is significantly less than 100% The disorder is genetically caused The disorder has an environmental component . emotions and behaviours that can lead the the person withdrawing from social life and becoming unable to function  The condition includes positive and negative symptoms. An alternative approach is to do a twin study. disorganised language and motor behaviour while negative symptoms include affective flattening. Consequently. Schizophrenia is a psychotic condition that affects approximately 1% of people at some point in their lives worldwide  It affects the same number of males and females but the age of onset is earlier for males  The condition is more common in those from lower social economic backgrounds and those living in urban as opposed to rural communities  This condition will only be diagnosed if symptoms have been present for at least six months  Symptoms include disturbances to a person’s thoughts. family members typically share similar environments. it must therefore be because their genes are more similar. This looks at the concordance rate (degree of similarity) of twins with respect to the disorder being considered. both types of twin pair grow up in identical environments. we look for the following features: Feature Interpretation MZ concordance is significantly higher than DZ concordance The disorder has a genetic component MZ concordance is same or similar to DZ concordance The disorder is environmentally caused. this cannot be because their environments are more similar than those of DZ twins. So if we discover that MZ twins have a higher concordance. When interpreting twin study data. MZ (identical) and DZ (non-identical) twins are compared. Concordance rates means the probability of one twin having the disorder if the other already has it expressed as a percentage. positive symptoms include hallucinations. increased risk amongst close relative may simply indicate that that are exposed to the same set of environmental risks. Whilst MZ twins have a greater degree of genetic similarity. If relatives of sufferers have a higher than average risk of getting the disorder themselves. However.

even in the womb  MZ twins are typically closer than DZ twins.  With increasing numbers of multiple births. a naturally occurring manipulation of an independent variable. MZ twins are not exactly the same. One twin is typically larger and more robust than the other. therefore MZ twins may both share a gene or cluster of genes which predispose them to schizophrenia however. and it is possible that systems such as the DSM are only valid for certain sub-types of schizophrenia  In studies of separated twins.  MZ twins can experience differences in terms of environmental experiences. their parents are more likely to dress them similarly and they are always the same sex. first observable in his difference is first observable during pre-natal development..Strengths of twin studies  Twins provide a perfect way of controlling for genetic inheritance as MZs always share 100% and DZ share 50%. regardless of zygosity. However. all these factors mean that people will treat them more similarly and therefore it may not be right to assume that both MZ and DZ twin pair share equally similar environments.  Genes turn on and off at different point in life and in interaction with differing environmental experiences (epigenetic modification).. it is possible to replicate the findings of twin studies with large samples in many different world cultures. this not strictly true as . Because both types of twin pair are born at the same time into the same environment it is assumed that each member of a twin pair is exposed to exactly the same set of environmental influences. in this case schizophrenia. yet both have the same environmental experience (control of confounding variables) meaning that the effect of nature over nurture can be studied effectively. MZ environments may be more similar than DZs  Even though genetically identical. only one twin may be exposed to the environmental circumstances which trigger that gene to start affecting the person’s thinking and behaviour (cross reference to nature-nurture debate)  The validity of the findings of twin studies still rely on the validity and reliability of the measures used to ascertain the degree of similarity on the certain characteristic in question. their fingerprints are different. records of multiple births means that researchers can easily find large sample with which to test their hypotheses Weaknesses of twin studies  One of the grounding assumptions of the twin study methodology concerns the degree of similarity between the environments of MZ and DZ twins. increasing the reliability and generalisability of the findings. whereby similarity in developmental outcomes must be due to genes and not to similar environments are problematic as often .

24 MZ pairs and 33 DZ pairs o 62 individual participating twins. where the patients had left the hospital but subsequently been diagnosed with schizophrenia  In the end they had a sample of o 52 pairs of twin where one twin was a member of the sample and 5 additional pairs where both twins were members of the sample (i. 47 had been diagnosed with schizophrenia (born between 1893 and 1945)  The researchers also identified several more twin pairs. Boklage (1977)noted that if MZ twins were both right handed. they both had schizophrenia). aged between 19-64. i. genetic by comparing the concordance rates between MZ and DZ twin pairs where one of the twins already had a diagnosis of schizophrenia  To replicate findings of previous research that had suggested that this was the case. thus o 57pairs represented in the sample.e. 3 were from overseas which might have invalidated the diagnoses of schizophrenia.the environments that they are placed in are actually more similar than the researches have credited  Genetic inheritance in schizophrenia may be a more complex issue than twin studies would at first have us believe. there had been 392 patients who said they were same-sex twins. and three more had unclear diagnosis of zygocity (MZ /DZ status)  Further secondary data was collected using the hospital records of the twins to . the concordance rate was only 25%! Example of a twin study: Gottesman and Shields (1966) Aim  To explore the extent to which schizophrenia is a heritable condition. of these patients. the concordance rate for schizophrenia was 92% but if one was right handed and the other left-handed. mean average 37 o There were 6 additional twin pairs who were not allowed to be in the sample.  To explore the extent to which siblings of individuals with schizophrenia suffer from other psychiatric disorders or at least form some psychological abnormality.e. o 31 male and 31 female. and to see whether this varies between MZ and DZ twin pairs Procedure Collection of secondary data:  Hospital records for 16 consecutive years of admissions to the Maudsley and Bethlem Royal Joint Hospital were examined and out of approx 45000 patients in total.

Validity of MZ/DZ diagnosis: Blood tests. personality test and tests of thought disorder. has another clinical disorder or is psychiatrically abnormal One twin has schizophrenia and the other is ‘normal’ MZ( %) 42 54 DZ(% ) 9 18 79 45 21 55 In addition the researchers found a gender difference in that the concordance rates were slightly higher for females compared with males. assessment of physical resemblance Collection Results The researchers analyzed the concordance rates relating to four potential outcomes. between 75% and 91% in MZs but only 22% for DZs. the samples sizes were very small and so this findings may not be reliable They also found that in the most severe cases of schizophrenia. Conclusion Genes appear to play an important role in schizophrenia because the concordance rate is higher in MZ twins than DZ twins. i. individuals may inherit.find out about their case histories and identify references to diagnoses of schizophrenia Collection of primary data  More data was collected by the researchers themselves using semi-structured interviews from which verbal behavior could be analyzed. however.  Both twins have schizophrenia  one twin has schizophrenia and the other has another psychiatric diagnosis  one twin has schizophrenia and the other has some psychiatric abnormality picked up within the researchers’ own primary data collection  one twin has schizophrenia yet the other has no detectable mental health problems. Gottesman and Shields (1966) support a diathesis-stress model of schizophrenia where by a predisposition is inherited but is only triggered under certain environmental circumstances. .e. the concordance rate was much higher. fingerprint analysis. normal Grade Both schizophrenic Co-twin either schizophrenic or has another clinical disorder Co-twin either schizophrenic. However environmental factors must also be important.