Deck 13: Critical Thinking in Clinical Reasoning and Diagnosis

Question 1

Self-reports of symptoms, behavioral observations, results of psychological tests, and psychological interviews are used:

A) by therapists to treat mental disorders.
B) to show that a diagnosis is the cause of a mental disorder.
C) to evaluate clients as part of clinical assessment.
D) by psychiatrists, but not typically by clinical psychologists, to make diagnostic decisions.

Answer 1

to evaluate clients as part of clinical assessment.

Question 2

When a person questions whether someone has a severe psychological problem-especially when deciding whether the person's behavior is abnormal-it is important to:

A) consult a neuroscientist about the behavior.
B) have the questioner consider if he or she might engage in the behavior.
C) take into account the context of the behavior.
D) have the questioner imagine someone he or she knows engaging in the behavior.

Answer 2

take into account the context of the behavior.

Question 3

According to the text, which one of the three basic, preliminary questions helps to decide if a person has a severe psychological problem?

A) Is the problem or situation one that is likely to terminate soon?
B) Is the problem something that the person has experienced before?
C) Does the problem cause the person to experience distress?
D) Does the problem run in the family or is it similar to a relative's problem?

Answer 3

Does the problem cause the person to experience distress?

Question 4

Freud proposed that through the defense mechanism of repression, the ego pushes unpleasant, threatening experiences outside of conscious awareness so that they cannot be later accessed from memory. Not only did some people come to accept this psychological misconception as true, but they also began to speak of the ego and the unconscious as if they were actual parts of the mind. This is like the thinking error of _____, which people make when they assume that a psychological disorder such as generalized anxiety disorder is objectively real.

A) reification
B) sweeping generalization
C) confirmation bias
D) the Barnum effect

Question 5

Describing depression as the "common cold" of mental disorders may be a good analogy if:

A) it is shown that many people who think they have depression are wrong.
B) people recover from depression in a few days just as they would recover from a common cold.
C) people take into account that mental disorders are likely to occur often, just as some physical disorders do.
D) people consider that, like a common cold, depression is not as serious a mental disorder as are other disorders.

Question 6

According to the textbook, a diagnosis of a mental disorder BEST means that a clinician has:

A) found the cause of a client's problem.
B) understands the client's problem well enough to make a diagnosis even if the client disagrees with the assessment.
C) found a label that may or may not correspond to a cluster of symptoms of a client's problem.
D) identified a therapy for treating a client's psychological problem.

Question 7

McNally (2011) compared the number of diagnoses and pages in the DSM prior to DSM-5. What is the trend in terms of the number of diagnoses and pages in these different editions of the DSM?

A) Later editions had more diagnostic categories and more pages than earlier ones.
B) Earlier editions had more diagnostic categories and pages, while later ones had fewer.
C) Some earlier editions have more diagnostic categories and pages, while some had fewer.
D) There is no trend in the number of diagnostic categories and pages in the different editions.

Question 8

A _____ consists of a set of symptoms, signs, behaviors, and other features that go together and have a specific outcome and course.

A) disease
B) psychological problem
C) syndrome
D) constellation of symptoms

Question 9

According to the text, it is a misconception to think that diagnostic labels are always bad, because for some people:

A) being stigmatized by a name for a mental disorder makes clients stronger.
B) receiving a diagnosis makes it possible for clients to find their own diagnosis.
C) knowing the name for their mental disorder encourages clients to talk more about it.
D) having a name they can identify for what they are experiencing is something that clients like.

Question 10

A young woman said to her friend, "My problem is I don't have good self-esteem. If my therapist could help me have good self-esteem, then I would be able to get what I need from other people. I am afraid that my low self-esteem is just part of my personality, and I will not get better." Which of the following BEST describes the thinking error the young woman is making?

A) The Barnum effect
B) Reification
C) Behavioral confirmation
D) Inappropriate reasoning by representativeness

Question 11

Examining the concept of abnormal behavior from a broad perspective reveals it is:

A) simply behavior that is very unusual.
B) a controversial concept across cultures and among experts.
C) widely agreed upon among experts in psychology and psychiatry.
D) not a useful concept because no single definition for it.

Question 12

Based on the text, which is the MOST reasonable explanation for the recent substantial increase in the occurrence of autism in the population?

A) person trying to find his or her way through a maze in the dark.
B) person trying to put together a puzzle with many pieces, and some of the pieces are missing.
C) scientist who is testing hypotheses without the benefit of any statistical tools.
D) student trying to do what a trained scientist has been doing after many years of conducting research.

Question 13

An advantage of the view that psychological disorders are on a continuum and differ by degree is that this view is:

A) the approach taken by the DSM-5, so most clinicians have learned about it in their undergraduate and graduate training.
B) supported by research showing that the more symptoms a person has, the more likely the person will later develop a disorder.
C) more likely to stigmatize people with a negative diagnostic label when compared to a categorical approach.
D) based on the assumption that people can be classified as having one mental disorder versus having another disorder.

Question 14

According to your textbook, which question is one of the fundamental, preliminary questions that helps to decide whether a person has a severe psychological problem?

A) Is the problem abnormal-for example, excessive, long-lasting, unusual behavior?
B) Is the problem something that the client has complained about before to clinicians or other professionals?
C) Does anyone else know about the client's situation?
D) Is the problem one for which an evidence-based treatment can be applied?

Question 15

Extensive and vivid coverage by media of homicides committed by people with severe psychological problems may contribute to the misconception that people with mental disorders are more violent than those without the disorders. The thinking error of _____ MOST likely contributes to this biased view.

A) hindsight bias
B) inappropriate use of the availability heuristic
C) post hoc ("after this, therefore because of this") reasoning
D) reification

Question 16

The DSM basically takes a _____ approach to the diagnosis of mental disorders.

A) categorical
B) continuous
C) quantitative
D) continuous and quantitative

Question 17

When the media provide extensive coverage of horrific murder cases and vividly describe multiple homicides by people with severe psychological problems, this may contribute to:

A) the misconception that people with mental disorders are more violent than those without the disorders.
B) the conclusion that many more people have mental disorders than actually suffer from them.
C) an underestimation of the difficulty of the task of correctly diagnosing people with mental disorders.
D) the reification of mental disorders.

Question 18

Which component of clinical assessment is especially involved in evaluating various aspects of psychological functioning?

A) The use of interview data from family members
B) The use of projective tests
C) A mental status examination
D) A collection of case history information

Question 19

If someone argues that sadness differs from minor depression and from major depression to some degree along a quantitative dimension, then that person is most likely viewing these differences:

A) as categorical.
B) as continuous.
C) as the way the DSM does, in terms of diagnostic categories.
D) in a qualitative way.

Question 20

The acronym "M-A-D" can help you remember three fundamental, preliminary questions that can help you decide whether someone has a severe psychological problem. These letters stand for:

A) malevolent, abnormal, disturbing.
B) maladaptive, abnormal, deleterious.
C) mistaken, abnormal, delusional.
D) maladaptive, abnormal, distressing.

Question 21

Which description is accurate concerning the mental status examination?

A) It is another name for the diagnosis of a mental disorder.
B) It involves assessment of a person's attitude, mood, emotion, motor function, and cognition.
C) It is primarily what a clinician uses to decide whether a client has recovered from after receiving a particular psychotherapy.
D) It is mostly based on a client's self-report of his or her own mental functioning and why the person has sought help.

Question 22

In clinical settings, the Barnum effect is likely to be a problem when a clinician:

A) writes case descriptions that are very general.
B) does not follow the DSM criteria in diagnosing a disorder.
C) treats mental disorders that are not easily diagnosed.
D) uses behavioral confirmation to understand a client's problem.

Question 23

To make a good diagnosis of a client, a clinician should:

A) make a differential diagnosis based on ample, valid information obtained from the client.
B) use backward reasoning that emphasizes the clinician's vast experience with a disorder.
C) conduct assessments that use multiple projective techniques to isolate the client's real problem.
D) use only forward reasoning and select a diagnosis that is most likely to be helped by a therapy that is supported by the best research.

Question 24

Which statement is TRUE about comorbidity?

A) The case of Andrea Yates shows a person diagnosed with both major and minor depression.
B) Comorbidity refers to the fact that people who are depressed are often morbid about more than one thing.
C) Substance abuse disorder is most often associated with the diagnosis of another disorder.
D) Comorbidity presents few problems for the differential diagnosis of mental disorders.

Question 25

Preconceptions, stereotypes, and expectations are MOST closely associated with:

A) thinking errors made when relying too much on knowledge and experience.
B) relying too much on acquiring information during clinical assessment,
C) thinking errors involving a misunderstanding of the meaning of a diagnosis.
D) relying too much on data from information from psychological tests and the mental status exam.

Question 26

When trying to diagnose Tanika's problem, her psychologist observed that she was showing delusions and other serious thought disturbances. Her psychologist then used the DSM-5 to check whether Tanika had a history of a communication disorder and signs of depression as a way to:

A) determine whether Tanika had a mental disorder.
B) conduct a differential diagnosis of Tanika.
C) make sure that Tanika was not suicidal.
D) use excessive backward reasoning with the DSM-5.

Question 27

When a clinician makes a differential diagnosis, the clinician has:

A) found the diagnosis that is correct and that would be diagnosed the same way by other clinicians making such a diagnosis.
B) considered the consequences of diagnosing a person a certain way-that is, in a way that differentially depends on the diagnosis.
C) shown that the client's signs, symptoms, and behaviors best fit the criteria for a certain diagnostic label and not some other label.
D) decided to use an approach to diagnosis that is controversial and inconsistent with a critical thinking approach to clinical practice.

Question 28

Andrea Yates, who murdered her children, was diagnosed with postpartum depression, had flat affect (showed little emotional response), experienced social withdrawal, and had delusions and other psychotic symptoms associated with schizophrenia. Taken together, these facts and symptoms suggest that she:

A) was incorrectly diagnosed with depression.
B) was showing signs of comorbidity of mental disorders.
C) had no real grounds for an insanity plea.
D) may have also suffered from an anxiety disorder that went undetected.

Question 29

Both psychosis and delusions:

A) are mild mental disorders, and the media exaggerates their importance.
B) appear only in persons with schizophrenia.
C) may occur in some cases of depression.
D) seldom involve thought disorder and disconnection from conventional reality.

Question 30

As the text explains, it was difficult to diagnose Andrea Yates, who murdered her children, because she:

A) was originally diagnosed with minor depression.
B) was uncooperative in her clinical interviews.
C) showed no remorse for the killings and was diagnosed with antisocial personality disorder.
D) showed signs and symptoms of more than one disorder.

Question 31

Imagine that a clinical psychologist tries to follow good practices in clinical assessment. Which is probably the BEST series of steps to follow if interviews with a client suggest that he may be experiencing depression?

A) First, screen with the MMPI, then follow up with the Beck Depression Inventory.
B) Test the client with the Beck Depression Inventory and several other measures of positive mood to see whether he is manic-depressive.
C) First, screen with the Beck Depression Inventory, then follow up with the MMPI.
D) Conduct further interviews with the client and ask him if he believes he is depressed.

Question 32

A reliable test or measure is one that:

A) shows results that are similar to the ones expected.
B) measures what it was intended to measure.
C) demonstrates consistency in scores obtained.
D) is logical and does not show any logical fallacies.

Question 33

Similar to the general descriptions of traits found in horoscopes, clinicians sometimes write case descriptions that could apply to anyone. When people endorse these as good descriptions of a person, this is referred to as:

A) reification.
B) backward reasoning.
C) forward reasoning.
D) the Barnum effect.

Question 34

Andrea Yates, who murdered her children, was diagnosed with postpartum depression, had attempted suicide, had shown symptoms of psychosis and delusions, and had been treated repeatedly by mental health professionals. Yet her defense of "not guilty by reason of insanity" failed. Why might this outcome surprise many people?

A) The "insanity" plea succeeds only 15% of the time.
B) Someone who commits murder should spend time in prison.
C) Yates had no real grounds for an insanity plea.
D) Yates has also suffered from an anxiety disorder that went undetected.

Question 35

Suppose a clinician has done a differential diagnosis of a mental disorder for a client. This means that the clinician has:

A) understood the client's problem well enough to make a correct diagnosis.
B) found the cause of the client's psychological problems.
C) made a diagnosis of the disorder that other clinicians would accept.
D) labeled the client's problem with a diagnostic label by excluding other labels.

Question 36

Jerry believes that the terrorist group Al Qaeda is monitoring his every thought, seeking to divide his personality into units that it can control. Jerry further believes that God has ordered him to go on a secret mission to prevent the terrorists from listening to his or other people's thoughts. For a preliminary hypothesis of how Jerry should be diagnosed, which disorder description BEST fits his symptoms?

A) Schizophrenia, because of Jerry's apparent psychosis and delusions
B) Anxiety disorder, because Jerry seems fearful of being watched
C) Dissociative identity disorder, because Jerry seems to have a split personality
D) A phobia, because Jerry has delusions that have caused his fear

Question 37

Matt, the creative writer described in this chapter, reported in a clinical interview that sometimes swarms of ideas came into his head and that his girlfriend was listening to him from behind the walls and making them ring by hitting them. Based on information provided in the text, the BEST preliminary diagnosis is that Matt has:

A) an anxiety disorder, because his thoughts are disordered and he has difficulty concentrating.
B) schizophrenia, because he is showing signs of disordered thought and psychosis.
C) dissociative identity disorder, because his personality is split.
D) a kind of schizophrenia, which means he has a split personality.

Question 38

When clinicians pay too little attention to client data and too much attention to their theoretical conceptions and preconceptions of clients' problems, they are depending too much on:

A) forward reasoning.
B) backward reasoning.
C) the Barnum effect.
D) reification.

Question 39

Some clinicians use the "Draw-a-Person" test, a projective test based on the assumption that the pictures people draw reveal something about their unconscious motives. For example, a clinician might assume that a respondent drawing a person with large eyes is showing signs of paranoia (when people are fearful their eyes are wide). The thinking of this clinician is influenced by the:

A) representativeness heuristic.
B) availability heuristic.
C) hindsight bias.
D) confirmation bias.

Question 40

Validity in testing or measurement is demonstrated when a measure:

A) produces results that are similar to the ones expected.
B) is shown to be measuring what it is intended to measure.
C) demonstrates consistency in scores obtained through multiple administrations.
D) is logical and does not show any logical fallacies.

Question 41

Should we try to reduce superstition and magical thinking? Examine both the pro and con positions on this question, using research on superstition as evidence to support a position whenever it is appropriate.

Question 42

Suppose someone drawing a conclusion from the research on expertise noted that many studies have found that people show more expert-like performance after considerable, deliberate practice in various domains such as chess, musical performance, mathematics, acting, and memory performance. The person then concludes that psychotherapists show more expert performance after years of practice, which is:

A) a faulty conclusion because some people are just naturally better therapists even without much experience.
B) a good conclusion that follows reasonably from all of the evidence in various domains.
C) a faulty conclusion based on a sweeping generalization and is not supported by research.
D) probably a good conclusion as long as the research supporting it in the other areas of expertise is of high quality.

Question 43

Clinicians (psychologists and psychiatrists) are more likely to make diagnoses that are unreliable when they have:

A) paid attention to a lot of information about the client.
B) been trained as psychologists and not as psychiatrists.
C) diagnosed clients showing signs of psychosis and social withdrawal.
D) not paid attention to all the diagnostic criteria in the DSM.

Question 44

When clinicians are overly influenced by their preconceptions about clients and their clinical experience, they may be more likely to show which problem in clinical judgment?

A) The Barnum effect
B) Reification
C) Excessive forward reasoning
D) Excessive backward reasoning

Question 45

Explain how abnormal behavior is defined and how mental disorders are diagnosed by those using the DSM system. Compare this DSM view to alternative ways of defining abnormal behavior.

Question 46

Explain how to engage in good thinking and assessment practices that are more likely to lead to a correct diagnosis of a mental disorder, including how to avoid thinking errors that may occur during the assessment phase.

Question 47

What are psychological explanations for how people acquire and maintain superstitious behaviors, as when college students use a lucky pen to take a test?

Question 48

Clinicians are more likely to make reliable diagnoses when they consistently apply:

A) a theoretical approach to psychotherapy, such as psychoanalytic theory.
B) the appropriate DSM criteria to make a diagnosis.
C) backward reasoning and not forward reasoning.
D) their clinical intuition to make the right diagnosis.