CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
Chapter 8:

Behavior therapy (classical and operant conditioning)

o Originated in 50s and 60s
o Relied heavily on classical and operant conditioning; focused
almost exclusively on overt behavior and environment (ex. Bell
and pad system)
o Operant conditioning: occurs when certain behaviors are
strengthened or weakened by the rewards or punishments that
follow those behaviors. For instance, a person who has had bad
experiences at parties or other social situations will try to avoid
such situations or leave them as soon as possible in order to
reduce anxiety. These avoidance or escape behaviors are
reinforced by the rewarding sense of relief and anxiety reduction
that follows them.
o Classical conditioning: occurs when a neutral stimulus (such as a
musical tone) comes just before another stimulus (such as a pinprick) that automatically triggers a reflexive response (such as a
startle reaction). If the two stimuli are paired often enough, the
startle reaction begins to occur in response to the previously
neutral musical tone.
o Unconditioned stimulus; pairing unconditioned stimulus with
response
First, second, and third waves of behavior therapy (differences
between them)
o First wave: initial behavioral therapies behavior is learned
o Second wave: integrating more mental representations into
theories and practices (responding to perception of environment)
o Third wave: focused on functional relations between behavior
and thoughts
Maladaptive and adaptive reaction
Reinforcement vs. punishment

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

What are three goals of behavioral assessment?

o Gather detailed information about clients:
Behavior
Environmental circumstances under which those behaviors
occur
Reinforcers and consequences that maintain the behavior
Functional analysis/assessment (ABCs or SORCs)
o (Antecedents, Behaviors, Consequences)
o (Stimulus, Organism, Response, and Consequences)

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
Stimulus: antecedent conditions and environmental
conditions that elicit behavior (watching television,
smelling food, walking by fridge)
Organism: internal physiological responses, emotions and
cognitions (sensation of hunger, anxiety, concern about
weight)
Response: overt behavior engaged in by the person
(avoidance of food followed by binging)
Consequences: what happens as a result of behavior
(satiation, reducing in anxiety, increase in guilt)
Is behavioral assessment concerned with developmental history or how
behavior started?
o Not concerned with developmental history or how behavior
started
o Interested in what is maintaining the behavior
What are two goals of behavioral therapy discussed during class?
o Help the client to modify maladaptive behaviors as well as
maladaptive thoughts and emotions that come with them
o Replace maladaptive behaviors with more adaptive ones (i.e.
finding a way to deal with life stress without drinking)
Describe each type of behavioral therapy techniques: progressive
relaxation training, systematic desensitization, exposure therapy,
social skills training, assertiveness training, behavioral activation
o Progressive relaxation training: involves tensing and relaxing
various groups of muscles while focusing on sensations of
relaxation that follows.
Useful for hypertension, headache, insomnia
Similar to mindfulness meditation-both focus on
nonjudgemental awareness of bodily experiences may be
that cognitive aspects of mindfulness mediation are active
component
Used in conjunction with systematic desensitization
o Systematic desensitization: used with phobias primarily- pairs
relaxed sensations with frightening stimui (en vivo exposure;
exposure hierarchy)
o Exposure therapy: directly expose clients to anxiety-provoking
stimulus not intended to prevent anxiety
Flooding- exposing client to the most feared stimulus right
away- can be very upsetting to client
Must maintain exposure until anxiety recedes otherwise
anxiety is negatively enforced

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
In case of OCD, exposure of client to anxiety-provoking
stimulus without allowing them to engage in rituals that
reduce anxiety
Measure SUDS (subjective units of distress) to gauge
progress
Keys to successful exposure therapy: encourage client to
tolerate somewhat longer and more intense exposure,
space exposures close together, vary kinds of exposure, do
exposure in varied contexts and environments
o Social skills training: encompasses teaching/rehearsing wide
range of skills necessary for successful social interactions
(teaching to shake hands/job interview)
o Assertiveness training: type of skills training in which therapists
teach/rehearse communication skills designed to help clients be
more effective at saying what they would like to say in a
scenario. (drink refusal)
o Behavioral activation: helps clients to recognize their fear and
tendency to avoid making changes and help them engage in
more positive behaviors
Clients may feel like cant do things until they feel better.
In fact, it can work backwards engaging in normal
activities can improve affect (hanging out with friends
when depressed)
Other types of behavioral therapy techniques
o sobriety sampling: community reinforcement technique to
encourage sobriety
o token economies: Clients are reinforced with tokens that act as
currency to purchase desired rewards (e.g., snacks, television
time) when they perform designated behaviors.
o contingency contracting: A form of contingency management,
contingency contracting involves a formal, often written
agreement between client and therapist regarding the clients
behaviors.
o safety planning: suicide prevention, if you feel this do this
4 Principles for cognitive therapy discussed during class (Ellis and
Beck)
o It is not events, but our interpretations of events that produce
our responses, including maladaptive ones
o Our interpretations can be accurate or inaccurate, adaptive or
maladaptive
o Inaccurate and maladaptive interpretation results for prior
experiences and are often patterned and habitual

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Inaccurate and maladaptive thoughts often occur automatically

and lead to a variety of negative emotions and problematic
behaviors
What is cognitive mediation and realism?
o Cognitive meditation: most basic notion in cognitive therapy is
that normal and abnormal behavior is triggered by our
interpretation of events, not events themselves
o Realism: contrary to constructivism in humanistic and
psychodynamic approaches, there is an objective reality
Define schema and be able to provide an example
o Schema: organized knowledge structures that influence how we
perceive, interpret and recall information (e.g. going to dentist,
alleys are dangerous) can lead to stereotypes. A depressed
person is likely to interpret new information consistent with their
schema. (I got an invite to a party b.c. they feel bad for me)
Is automatic thought same as unconscious thought? NO
o Automatic thoughts: habitual thoughts, including maladaptive
thoughts
What is negative attributional style?
o Depressed persons regularly explain negative events in a way
that is most damaging to their self-esteem and sense of hope
More likely to attribute negative events to factors that are
internal, stable and global (stable-likely to remain; globalaffect all areas of life)
What is cognitive distortion? Is it automatic? What are examples of
cognitive distortions (e.g. all-or-nothing thinking, catastrophizing, etc.)?
o Automatic, self-defeating thoughts
o All or nothing thinking: if Im not perfect Ive failed
o Catastrophizing: blowing things out of proportion
o Mental filter: only paying attention to certain types of events
o Jumping to conclusions: mind reading and fortune telling
Role of therapist and goals of cognitive therapy
o Role of therapist: providing empathy and support while educating
client about how maladaptive schemas, self-defeating beliefs,
negative attributional styles, and other important cognitive
features contribute to and maintain psychological disorders.
o Goal of therapy: Identify, Refute and Replace
What is rational emotive behavior therapy
o ABCs: Activating event, Belief system, and subsequent
Consequences
o In short, Albert Ellis proposed that psychological problems result
not from external stress but from the irrational ideas people hold,

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

which lead them to insist that their wishes must be met in order
for them to be happy.
o The therapists task in REBT is to attack these irrational,
unrealistic, self-defeating beliefs and to instruct clients in more
rational or logical thinking patterns that will not upset them
(Active, challenging, demonstrative, abrasive)
What is cognitive behavioral therapy?
o Shared theory of behavioral and cognitive therapists used in
interventions
Are cognitive behavioral therapy sessions usually structured? Give
three examples of what commonly occurs during a session. YES
o Structured sessions:
Review goals and strategies of therapy
Review homework progress
Identify specific problems and their associated thoughts to
which CBT is applied
Summarize progress
Assign homework for next session
o As therapy progresses, techniques might evolve as well
What is dialectical behavior therapy? Provide three examples discussed
during class.
o Form of CBT used with clients who display the impulsive
behavior, mood swings, fragile self image, and stormy
interpersonal relationships associated with BPD
o Examples of components:
Mindfulness
Distress tolerance
Emotion regulation
Interpersonal effectiveness

Chapter 9:

Can clinical interventions also be helpful for groups, couples and

families? YES
What are therapeutic factors of group therapy? List six factors
discussed during class
o Sharing new information
From two sources: other group members and therapist
o Instilling hope
Group members can comment on positive changes in other
group members
o Universality
Group members can learn they are not alone in their fears

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Altruism
Gives group members a chance to see they can help other
people
o Interpersonal learning
Ideal setting to learn new interpersonal skills
o Group cohesiveness
One of the most important factors underlying beneficial
effects of group therapy members accept one another***
What are characteristics of group therapy?
o Usually consist of 6-12 people
o Sessions 1-2 hours
o Usually homogenous on some dimensions (e.g. diagnosis and
problem severity) and heterogeneous on other dimensions (e.g.
problem duration, personality characteristics)
o Use CBT 5x more often than others
o Useful for:
Depression and anxiety in adults
PTSD in veterans
Alcohol abuse in college students
Coping with cancer
Grief interventions for children who survived trauma
How is couples and family therapy different from normal therapy for
one individual?
o Focus is on disturbed relationships rather than on individuals who
happen to be in a relationship
o When able to help family change its functioning, change can be
more lasting with each member supporting and encouraging
ongoing change
Which group of married couples reports the highest level of marital
satisfaction? (e.g., young couples, families with preschool children,
families with primarily school-aged children, families with adolescents
or older couples).
o Young couples 35%
o Families with preschoolers 20%
o Families with primary school children 15%
o Families with adolescents 25%
o Older couples 40%

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

What is the most common reason couples seek treatment?

According to Gottmans research, which factors predict early divorce?

o Criticism: stating ones complaints as a defect in ones partners
personality, i.e. giving the partner negative trait attributions. Ex.
You always talk about yourself. Youre so selfish
o Contempt: statements that come from a relative position of
superiority. Contempt is the greatest predictor of divorce and
must be eliminated. Ex. Youre an idiot
o Defensiveness: self-protection in the form of righteous
indignation or innocent victim-hood. Defensiveness wards off a
perceived attack. Ex. Its not my fault that were always late; its
your fault
o Stonewalling: emotional withdrawal from interaction. Ex. The
listener does not give the speaker the usual nonverbal signals
that the listener is tracking the speaker
What is the central focus in couples therapy?
o Improving the communication skills. This may include tasks such
as teaching the couple to:
Accept mutual responsibility for working on their problems

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
Maintain focus on current relationship problems rather than
old grudges
Express preferences rather than demands
Negotiate compromises
What should a therapist NOT do in order to avoid becoming
triangulated during a couples therapy? Give 5 examples.
o Do NOT become triangulated (in the middle of the clients
disagreements)
o Do not take sides
o Do not proceed until the problem and goal have been clarified
o Do not discuss problems abstractly and non-concretely
o Do not discount problems, even small ones
o Do not get hooked in the past
o Do not the couple take charge of the session
What are goals of community psychology?
o Understanding individual and social problems (how does
community affect indv)
o Preventing behavioral dysfunction
o Creating lasting societal change
What is community reinforcement and family training (CRAFT)?
o Community Reinforcement Approach and Family Training
Designed to help concerned significant others (CSOs) to
engage treatment-refusing substance abusers into
treatment
CSO can play a powerful role in helping to engage
substance user who is in denial to submit to treatment
Motivational as opposed to confrontational
More than two thirds of family members who use CRAFT
successfully engage their substance using loved one in
treatment
Using CRAFT increases odds of CSOs seeing it through until
success
Define the 3 types of prevention interventions and give an example of
each: universal prevention (Good Behavior Game), selective
prevention, indicated prevention
o Universal prevention: intervention applied to entire population,
regardless of risk (no stigma attached, but expensive) e.g.
preventing aggression in young children
o Selective prevention: intervention applied to people with risk
factors for disorder, but who have not yet developed disorder
o Indicated prevention: intervention applied to people with early
signs of disorder but do not reach threshold for clinical diagnosis

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o GBG(universal): played initially for 10 minutes among first

graders. Increased as the year went on. If everyone was good on
a team theyd be rewarded. Earlier chances you have to
intervene the better chance you have at altering the childs
behavioral trajectory
Example of a popular self-help group
o AA- Members assist one another by exchanging information,
providing social support, and discussing mutual problems
What is Bibliotherapy?
o Reading books about how to deal with psychological problems
(dieting)

Chapter 10:

3 research goals when studying individual treatments

o Determine efficacy of specific treatment
o Compare the relative effectiveness of different treatments
o Assess the specific components of treatment that are related for
specific changes
Difference between efficacy and effectiveness
o Efficacy: how well the therapy works in tightly controlled
experimental condition
o Effectiveness: how well therapy works in the real world (e.g.
community settings)
What are three conceptual approaches to research-informed
treatment?
o Identify treatments that work
o Identify participant and relationship variables that contribute to
effective change
o Integrate knowledge from these two areas: treatments that work
in consideration of therapist and client factors (empirically based
practice)
Independent vs. dependent variables
o Independent variables: variables manipulated by experimenter
Usually type of treatment
o Dependent variables: factors in which changes are to be
observed
Usually symptoms of psychological disorders
Within-subjects and between-subjects designs
o Within-subject design
Same participants get variations in independent variable
Dependent variable is measured at multiple time points

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
Case study is an example of within-subjects design in
treatment outcome research
o Between-subjects design
Experimental group compared to control group
Clients randomly assigned to groups
Usually involves measurements of dependent variable at
multiple points
What is dismantling research?
o Examines which component of treatment protocol is active
component
Leads to more streamlined treatments
What is eye movement desensitization and reprocessing (EMDR)? Does
EMDR work?
o A psychotherapy treatment originally designed to alleviate the
distress with traumatic memories (Shapiro 1995,2001)
o It works better than no treatment for relieving PTSD symptoms
o Probably works better than supportive listening (no intervention
from therapist)
o It does NOT work better or faster than behavioral or CBT
interventions (e.g. exposure)
o The eye movements do NOT improve effectiveness
What is a randomized clinical trial and what does it require?
o Gold standard for outcome research
o RCTs require large, relatively homogeneous samples of clients
and clinical problems, random assignment of clients to
conditions, carefully monitored treatment regimens, fidelity
checks and multiple evidence based measures of dependent
variables (e.g. symptoms)
o CONSORTS Enrollment, Allocation, Follow up, Analysis
What is box score reviews?
o The traditional approach to summarizing outcome research has
been the narrative, or box score, review
o In a box score review, researchers make categorical judgments
about whether each outcome study yielded positive or negative
results and then tally the number of positive and negative
outcomes.
What is meta-analysis and effect size?
o Meta analysis: outcomes in different studies are quantified by
calculating effect sizes
a quantitative technique that standardizes the outcomes of
a large number of studies so they can be compared or
combined

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Effect sizes: the magnitude or size of the experimental treatment

or difference between two groups
.2 to < .5 = small effect size
.5 to < .8 = medium effect size
.8+ = large effect size
Empirically supported treatments (ESTs) : when is a treatment
considered well-established and when is a treatment considered
probably efficacious
o Well established / efficacious and specific
At least two good between group design experiments
demonstrating efficacy in one or more of the following
ways:
Superior (statistically significant) to pill or
psychological placebo or to another treatment
Equivalent to an already established treatment in
experiments with adequate sample sizes
OR A large series of single case design experiments (n>9)
demonstrating efficacy. These experiments must have:
Used good experimental designs and
Compared the intervention to another treatment as
an IA
Further criteria for I & II
Experiments must be conducted with treatment
manuals
Characteristics of the client samples must be clearly
specified
Effects must have been demonstrated by at least two
different investigators or investigating teams
o Well-established/efficacious and specific (i.e., supported by at
least two rigorous randomized controlled trials in which
treatment showed superiority to placebocontrol conditions or
another bona fide treatment, or by a large series of rigorous
single-case experiments),
o Probably efficacious/possibly efficacious (i.e., supported by at
least one rigorous randomized controlled trial in which treatment
showed superiority to placebocontrol conditions or another bona
fide treatment, or by a small series of rigorous single-case
experiments), or
o Promising (i.e., supported by studies whose research designs
produced less convincing evidence than those in the first two
categories
List critiques of EST standards.

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Too narrow and exclusive

First, required two randomized clinical trials and later
broadened to accept well designed and replicated studies
o Gold standard is still RCTs. Best for reducing confounds, but may
not generalize to real world
o Also, later revised empirical validated to empirical support
o Usually use manuals
o Hundreds of treatments not on the list. Many widely practiced
o Skill of therapist, quality of relationship
o Scarcity of research on underserved populations. Aloso,
homogeneity of DSM disorders studied
What is evidence based practice (EBP)
What are nonspecific factors of psychotherapy?
o Therapist factors
Factors found to be demonstrably effective:
Higher levels of empathy
Collecting client feedback
Factors considered to be probably effective:
Positive regard toward the client
Strong goal consensus with client
A sense of collaboration with the client
o Client factors
Beneficial characteristics:
Clients who are open and offer higher levels of
disclosure and lower levels of resistance
Clients with higher symptoms of depression showed
greater gains than those with lower levels of
depression
Clients with strong positive expectations that
treatment will be successful
o Relationship variable
Therapist factors that are considered effective or probably effective.
o Positive regard toward the client
o Strong goal consensus with client
o A sense of collaboration with the client
Client factors associated with positive treatment outcomes.
o Clients who are open and offer higher levels of disclosure and
lower levels of resistance
o Clients with higher symptoms of depression showed greater
gains than those with lower levels of depression
o Clients with strong positive expectations that treatment will be
successful

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

What is dissemination?
o Making information about EBP available to other practitioners
and the public, encouraging implementation of evidence based
techniques

Chapter 11:

Characteristics of child clinical psychology

o Referral process
Kids dont come into treatment on their own
o Confidentiality
Kids dont have same rights to confidentiality
With adolescents, sometimes set ground rules with client
and parents saying you wont disclose what adolescents say
unless it would be potentially harmful to kid or someone
else
o Contexts of behavior
Children have almost no control over their environment
How is treating children different from treating adults?
o When working with children, it is important to consider the
context of their behavior. A childs relationship to the
environment is quite different from an adults. For example,
adults usually have some amount of control over where they live,
what type of job they have, when they go to bed and wake up,
with whom they spend their time, what they eat, and how they
run their lives. Children and adolescents, for the most part, have
less control over these things, and sometimes no control.
Especially with younger children, the decisions that their parents
make for them are the ones with which they must live (e.g., day
care or school settings, activities, food choices, daily routines,
access to other children as potential friends). Thus, most clinical
work and research has to consider the limited power that
children have to structure or change their environments.
Ones temperament is largely determined by which factor?
o Genetically
Problems associated with difficult temperament
o Stormy peer relationships
o Academic difficulties in first grade
o Conduct problems from 4-13
o Increased behavioral problems at 14
o Challenging personality traits by 26
o Generalized anxiety disorder (GAD) at 32

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

What are examples of developmental considerations in clinical child

psychology (e.g. normal age of bed-wetting, normative discontent)?
o Children 2-4 fear imaginary creatures and dark; 5-7 fear natural
disasters; 8-11 fear poor academic & athletic performance; 12-18
fear peer rejection
o By age 5, most kids do not wet bed
o Overwhelming majority of adolescent girls experience poor body
image normative discontent
o Parent-child interactions are bidirectional
Childs temperament and behavior influences parents
behavior
Parental tolerance and responses alter childs behavior
o Reinforcement trap
Parent reinforces childs poor behavior by giving reward
Parents behavior is reinforced because child has stopped
misbeheaving
Risk factors for child behavior problems
o Temperament
o Interparental Conflict
Parents verbal arguments and fighting are associated with
increased emotional and behavioral problems, especially
externalizing problems
Triangulation makes it worse
Sometimes divorce is best for kids
o Physical abuse
In most states, defined as any action that leaves a mark of
injury on a childs skin
Between 9-25% of kids in US are abused each year. Rates
are much higher in clinical samples
Associated with: conduct disorder, oppositional defiant
disorder, aggression, depression, anxiety disorders, poor
social competence, poor academic performance
o Sexual Abuse
About 25.3% of women and 7.5% of men were sexually
abused before age 18 in U.S.
75-90% of incidents perpetrated by a family member or
someone known to the family
Associated with: depression, suicide attempts, future
sexual victimization, poor coping, health problems
Difference between behavior rating scales and clinical interviews for
children
o Behavior rating scales

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
Generally, list of child problem behaviors e.g. fidgets,
easily distracted, shy and withdrawn
Child, parent or teacher usually rate each behavior
Some focus on specific disorder e.g. Child DepressionInventory; some cover various areas of child behavior
problems e.g. Child Behavior Checklist
Clinical Interviews:
71% of clinical child and adolescent psychologists said
clinical interview was most important aspect of clinical
assessment
Goals of unstructured child interview:
Establish rapport
Evaluate childs understanding of a problem and
reason for referral
Evaluate childs explanation of problem
Obtain description of feelings
Observe child during interview
are internalizing and externalizing disorders?
Among the many types of disorders in children, ADHD, ODD, and
CD are considered examples of externalizing disorders, largely
because the behavioral manifestations are external to the child
(thereby more noticeable to others, such as parents and
teachers). Depressive disorder and anxiety disorders are
considered internalizing disorders because the experience is
largely within the childs own subjective experience, and mild
forms of these disorders are not necessarily noticeable to others.
The externalizing factor refers to acting-out behaviorsuch as
hyperactivity, aggression, and delinquencythat is aversive to
others in the childs environment. The internalizing factor refers
to problems in which the child experiences depression, anxiety,
somatic problems, and other significant discomfort that may not
be evident, let alone disturbing, to others.

What
o

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

What does family interaction measure focus on?

o Family history of psychopathology
o Parental psychopathology
o Marital relationship and interparental conflict
o Childrearing methods and disciplinary patterns
o Stress and perceived support
What is a commonly used treatment for anxiety disorder, depression
and ADHD in children and adolescents?
o CBT
Tailored to childs cognitive abilities, life situation and
limited control over life
o CBT with Antidepressants
o Behavioral Therapy

Chapter 12:

What is health psychology?

o Study of psychological influences on how people stay healthy,
why they become ill, and how they respond they do get ill
o Rapidly growing branch of psychology
Sometimes a track within clinical
Sometimes a major focus
o Behavioral medicine
Biopsychosocial model
Consistent with modern health problems
Difference in causes of deaths in the 1900 and the 20th century.
o 1900 most deaths were from diseases rooted in public or
community health problems: pneumonia, TB, diarrhea
o 20th century most deaths due to individual behavior & lifestyle
Definition of stress

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Sometimes used to dexcribe what happens to us a stimulus. In

this case we call the stimulus the stressor
o Sometimes used to describe our response to what happens to us
a response. Either our physical or psychological response
Fight or flight response and general adaptation syndrome
o Hans Selye (1956) called activation of the sympathetic nervous
system during stress the general adaptation syndrome, or GAS.
The GAS begins with an alarm reaction, which is often called the
fight-or-flight response because it helps us combat or escape
stressors. The alarm reaction releases into the bloodstream a
number of stress hormones, including adrenal corticosteroids,
catecholamines (e.g., adrenaline), and endogenous opiates (the
bodys natural painkillers). These hormones increase heart rate,
blood pressure and respiration, pupillary dilation, muscle tension,
release of glucose and lipid reserves, and concentration of
attention on the stressor. If the stressor persists, or if new ones
occur in quick succession, alarm is followed by the stage of
resistance, during which less dramatic but more continuous
biochemical efforts to cope with stress can have harmful
consequences. For example, prolonged release of stress
hormones can create chronic high blood pressure, damage
muscle tissue, and inhibit the bodys ability to heal.

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

Define psychoneuroimmunology
o Multidisciplinary field focusing on interactions among behavior,
the nervous system, the endocrine system, and the immune
system
o Stress can affect the immune system, which can contribute to
illness
Describe the study conducted by Janice Kiecolt-Glaser discussed during
class
o Couples came in for two visits. During each visit, both the
husband and wife were fitted with a small suction device, which
created eight tiny uniform blisters on their arms. Skin removed
over blister, placed bubble over, each given questionnaire
gauging stress. Wounds took day longer to heal after arguments
than they did the initial supportive discussion. Couples with high
levels of hostility needed two days longer for wound healing,
compared to those whose hostility appeared low. Showed
suppression of the immune system
How to measure stress (typical physiological and self-report measures
used)
o Physiological measures:

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
blood pressure, heart rate, galvanic skin response,
respiration rate, hormone levels
o Self report measures:
life events scale- checklist of life events
everyday hassle scale measures daily hassles
(experiences of every day living that may be threatening to
a persons well being)
Describe problem- and emotion-focused coping
o Problem-Focused coping
Involves changing the source of stress
For example, if you dont do well on a test, then making a
study schedule and following it would be an example of
problem-focused coping
o Emotion-Focused coping
It doesnt involve changing the source of the stress, but
changing your emotional response to the stressor
For example, if you dont do well on a test, rather than
making a study guide you eat chocolate or drink beer while
you think about how you did on the test
Protective factors for stress
o Optimism
o Resilience
o Faith and Hope
o Subjective well being
o Social support
Relationship between & illness is weaker for individuals
who perceive high levels of social support

Risk-factors for cardiovascular disease

o Stress: workplace and home stress, financial stress, and major
life events are the types of stress that impact risk of attack
Define positive stress and give an example
o Taking advantage of the stress you feel in a situation? Germany
and world cup?
How might stress cause heart disease? Give three examples discussed
during class
o Increases heart rate
o Raises blood pressure
o The immune system increases inflammation, which increases
coronary artery disease

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o The repeated release of cortisol can make the development of

plaque in arteries more likely
o Stress, anxiety and depression all increase risk
o Hostility (an attitude) and anger (an emotion) both increase risk
Define different types of pain (acute, chronic and pre-chronic)
o Acute pain: is ordinarily adaptive (a good thing), lasts a relatively
short period of time, and includes pain from cuts, burns, and
other physical trauma
o Chronic pain: endures beyond the time of normal healing, is
relatively constant, is often reinforced by other people, and may
either go away or evolve into chronic pain
o Prechronic pain: is experienced between acute and chronic pain
and is critical because during this time the pain may either go
away or evolve into chronic pain
o Health psychologists often work with prechronic and chronic pain
What are the treatment goals for those who experience pain?
o Help patients perceive less pain
o Cope with psychological distress associated with pain
o Decrease impairment of day to day functioning
o Develop strategies for living effectively with chronic pain
o Biofeedback, relaxation training, and CBT are effective for
headache and chronic pain
What is treatment adherence?
o The extent to which patients adhere to medical advice and
treatment regimens is called compliance or adherence (Rodin &
Salovey, 1989). Research on the impact of adherence on medical
outcomes makes it clear that adhering to treatment advice is
importantclients can even end up worse than when they began
if they fail to adhere to treatment. Adherence can be affected by
several factors, including the severity and chronicity of the
disease, patient age, the quality of the doctorpatient
relationship, patients perceptions of probable outcomes, and the
type and complexity of treatment prescribed.

What are techniques to improve adherence?

o Education
Clear instructions of treatment
o Modification of treatment plans
E.g. pairing doses of meds with daily habits
o Behavior modifications
Electronic reminders

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

Contingency contracts

Chapter 14:

Forensic psychology areas of interest

o Competence to stand trial and take criminal responsibility
o Predicting dangerousness of defendants
o Psychological damages in civil trials
o Competencies in civil areas
o Psychological autopsies and criminal profiling
o Child custody and parental fitness
What is criminal competence?
o Whether defendant has sufficient present ability to consult with
his lawyer with a reasonable degree of rational understanding,
and whether he has a rational as well as factual understanding of
proceedings against him.
Most defendants are found to be competent or incompetent?
o 70-90% of defendants found to be competent, if not usually have
serious mental illness (e.g. schizophrenia)
If a defendant is found to be incompetent, what may happen to minor
and serious charges?
o Minor charges may be dropped
o Serious charges defendant may be sent to institution for
treatment to restore competence (can last up to 4-6 months)
Most defendants become competent after psychotropic
meds and they return to jail to await trial
If still not competent, defendant may be evaluated for
commitment
What is insanity?
o Suffering from serious mental disease or defect at the time of the
crime and: (a) lacked the capacity to understand criminality or
wrongfulness of act; OR (b) could not regulate behavior
according to law
Two ways to qualify for not guilty by reason of insanity plea
o NGRI
Guilty But Mentally Ill (GBMI)
o 20 states allow GBMI
o verdict only available to those who plead NGRI
o juries usually render GBMI verdicts when defendants may not
have been sane enough to be held legally responsible for actions
but were culpable enough to warrant punishment

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o usually sentenced to same period of confinement as any other

defendant but supposed to get mental health treatment in
correctional facility rarely get adequate treatment
What is civil competence?
o Does a person have the ability to understand information
relevant to making a particular decision and then an informed
decision
Handling financial affairs
Making decisions about accepting or refusing medical
treatment
Executing a will that directs how property should be
distributed to heirs
Psychological autopsies
o Psychologists called to give opinions about a deceased persons
state of mind prior to death
o When insurance companies want to determine whether death
was suicide
o Workers compensation cases when stressful work situation or
work-related trauma led to suicide or accidental death
o To decide whether deceased person had mental capacity to
execute or modify a will
Criminal profiling
o Used to determine who committed a crime
o FBI Behavioral Analysis Unit
1000 cases per year
Research how certain types of violent offenders: select and
approach victims, react to crimes, shared
demographic/family characteristics, personality features
o Should be cautious inaccurate profiles are common, and
methods used by profilers havent been objectively or
systematically defined
How is child custody determined?
o Clinical and social histories, standardized testing for parents and
kids, observation of parent-child interactions, interviews with
people who know family, review of documents (e.g. medical
records)
o Termination of parental rights:
Abandoned kids > 6 months
Convicted of murder or extreme hard to other kids
Be physically or mentally unfit to care for child
Have not remedied situation that first caused child to come
into contact with child welfare

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

Abuse
Gross neglect
Drug or alcohol addiction
What is the role of an expert witness?
o Expert witnesses from psychology testify about topics in criminal
trials, civil litigation, and domestic disputes.
o Insanity, criminal competency, sentencing, eyewitness
testimony, civil commitment, psychological damages in civil
cases, guardianship and conservatorship, child custody, adoption
and termination of parental rights, professional malpractice, and
mitigating psychosocial factors in litigation.

Chapter 15:

Purpose of an ethics code

o Establishing the integrity of a profession
o Public trust
o Enforcement value
What are the differences between ethical standards and ethical
principles?
o
Ethical principles listed by APA (i.e., Principles A-E)
o Principle A: Beneficence and and Nonmalificence
Maximize benefit and minimize harm
o Principle B: Fidelity and Responsibility
To accept responsibility for ones professional behavior, set
and follow high professional standards, form relationships
of trust, and consult with colleagues
o Principle C: Integrity
The general obligation to be truthful and honest
o Principle D: Justice
Fairness and justice entitle all people to access and benefit
from competent and biased psychologists contributions
o Principle E: Respect for Peoples Rights and Dignity
Self-determination, confidentiality and privacy
10 standards of ethics
o Resolving Ethical Issues.
This first section contains standards about how
psychologists are to resolve ethical questions or
complaints.
o Competence.
This section states that psychologists must be trained in
their specific area of expertise and that they must continue

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

to keep current in their field in order to maintain

competence. This section also addresses the issue of when
psychologists have personal problems or conflicts that limit
their ability to practice in a competent manner.
Human Relations.
These ethical standards deal with such topics as preventing
unfair discrimination, sexual or other harassment, multiple
relationships, conflict of interest, providing informed
consent, and avoiding termination of clinical services when
it is not in the best interest of the client.
Privacy and Confidentiality.
These rules cover psychologists obligations to protect their
clients rights to confidentiality and privacy.
Advertising and Other Public Statements.
Standards that control the way psychologists publicize their
services and their professional credentials are presented
under this category.
Record Keeping and Fees.
This section provides guidance on documenting
professional work, maintaining and disposing of
confidential records, fees, referrals, and other financial
arrangements.
Education and Training.
This section contains several ethical standards that control
psychologists conduct as they teach and supervise
students.
Research and Publication.
Standards that control researchers activities are included
in this section, such as receiving approval from the
Institutional Review Board before conducting research,
obtaining voluntary informed consent from human research
participants, debriefing participants, providing publication
credit for coauthors, sharing research data, and conducting
reviews of scholarly work.
Assessment.
Rules pertaining to the use and interpretation of tests are
listed.
Therapy.
Rules about the structuring, conduct, and termination of
therapy are identified here. Specific standards prohibit
psychologists from having sexual intimacies with current
clients or the relatives and significant others of current

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
clients and from accepting persons as clients if they have
had previous sexual intimacies with them. Furthermore,
psychologists should not have sexual intimacies with
former therapy clients for at least 2 years after the
termination of therapy, and even then only if the
psychologist can demonstrate that no exploitation of the
client has occurred.

What are reasons for malpractice suits against clinical psychologists?

Ethical violations
o A special professional relationship existing
o Clinician was negligent in treating client
o Client suffered harm
o Therapists negligence caused harm
Competence
o Area of specialized content and supervised practice
o Ethical obligation for continued education

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Obligation for continuing awareness of own personal functioning

and refrain from offering services when competence is
compromised
Informed consent
o Ethical and legal obligation
o Informed consent implies having access to and comprehending
all the information that might reasonably influence a persons
decision
o Client must be competent, age of 18, cognitive ability, and
psychologically mature to comprehend risks and benefits
o Documentation required: written and verbal
o Should include:
Limits to confidentiality; involvement of any third parties;
the nature, purpose and duration of the psychological
assessment and/or intervention; and issues pertaining to
billing
Difference between privacy, confidentiality, and privilege
o Privacy refers to the right to choose for themselves the
circumstances, timing and the extent to which information about
them and their behavior may be shared with or withheld from
others
o Confidentiality refers to the ethical responsibility of psychologists
and other health professionals to protect clients and research
participants from unauthorized disclosure of protected
information
o Privilege, a legal right, prevents certain categories of information
from disclosure in court proceedings
What are the components of official psychology treatment records?
o Demographic information
o Dates of services and consultation
o Session summaries
o Psychological test results
o Correspondence
o Diagnostic problem information
o Treatment plan
o State regulations to retain at least 5 years for adults and 1 year
after childs 18th birthday
o (HIPAA) federal law allows access to patients records EXCEPT
psychotherapy notes; not part of medical record, kept separately
Importance of Jaffe v. Redmond (1996) case
o Privilege

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE
Information produced within the context of
psychotherapeutic encounters is generally protected from
compelled disclosure by state privilege or federal case law
Client may wave right
Importance of Tarasoff v. Regents of the University of California case
o Obligation to wave right to report child abuse or harm to others
Term multiple relationships when applying to a psychologist
o Defined as a psychologist holding a professional role with a
person while simultaneously fulfilling another role with the same
person
o Might affect objectivity, competence and effectiveness or when
risk or harm or exploitation exists
Examples of vulnerable populations
o Children, adults with cognitive impairment, prison population,
pregnant women, some ethnic groups
Function of the Institutional Review Board (IRB)
o Protects interest of research participants through oversight and
regulation based on ethical, scientific and legal standards
What are the beliefs and attitudes, knowledge, and skills of culturally
competent counselors?
o Counselors awareness of own assumptions, values and biases
o Understanding the worldview of the culturally different client
o Developing appropriate intervention strategies and techniques
o Beliefs and Attitudes:
Sensitive to their own cultural heritage; value & respect
differences
Aware of how experiences, attitudes & values influence
psychological processes
Able to recognize limitation of competence & expertise
Comfortable with differences between themselves & clients
Aware of negative emotional reactions toward other ethnic
or racial
Are aware of stereotypes they may hold towards other
groups
Respect clients religious and/or spiritual beliefs about
physical and mental functioning
Respect indigenous helping practices and community helpgiving networks
Value bilingualism and dont view it as an impediment to
counseling
o Knowledge of

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Skills

Suicide:

Own racial and cultural heritage and how it affects

definitions of abnormality and counseling
How oppression, racism, discrimination and stereotyping
affect them and their work
Their social impact on others
The particular group they are working with
How race, culture, ethnicity, etc. affect personality
formation, manifestation of psych disorders, help-seeking
behaviors, appropriateness of counseling approaches
Sociopolitical influences on life of racial and ethnic
minorities (e.g. immigration issues, poverty, racism)
Institutional barriers to mental health treatment
Potential bias in assessment procedures
Minority family structures, hierarchies, values and beliefs
Relevant discriminatory practices at social and community
level affecting psychological wellbeing of population
Seek consultation
Seek further training or education
Refer out to more qualified individuals
Combination of these
Constantly seeking to understand themselves as racial and
cultural beings actively seeking nonracist identity
Familiarize themselves with current research
Become actively involved with minority individuals outside
of counseling settings so perspective is more than
academic or helping exercise
Are able to send and receive both verbal and nonverbal
messages accurately and appropriately
Can help clients determine whether a problem arises
from racism or bias in others so clients dont blame
themselves
Take responsibility for interacting in the language
requested by the client may require a translator or
referral
Have training and expertise in traditional assessment and
testing instruments and awareness of cultural limitations
Should work to eliminate biases, prejudices, and
discriminatory processes
Educate their clients about goals, expectations, legal rights
and counselors orientation

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

Suicide rates are increasing particularly in what age group? (e.g.,

young, middle-aged, old)
o When you consider relative causes of death:
Suicide is among the leading causes of death for young
people
o When you consider the number of deaths from suicide:
Middle-aged adults accounted for the largest proportion of
suicide deaths (56%) in 2011
o Suicide rates increasing, particularly among women

List risk factors for suicide

o Family history of suicide
o Family history of child maltreatment
o Previous suicide attempt(s)
o History of mental disorders, particularly clinical depression
o History of alcohol and substance abuse
o Feelings of hopelessness
o Impulsive or aggressive tendencies
o Cultural and religious beliefs (e.g. belief that suicide is noble
resolution of a personal dilemma)
o Local epidemics of suicide
o Isolation, a feeling of being cut off from other people
o Barriers to accessing mental health treatment
o Loss (relational, social, work or financial)

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Physical illness
o Easy access to lethal methods
o Unwillingness to seek help because of the stigma attached to
mental health and substance abuse disorders or to suicidal
thoughts
List protective factors for suicide
o Effective clinical care for mental, physical and substance abuse
disorders
o Easy access to a variety of clinical interventions and support for
help seeking
o Family and community support (connectedness)
o Support from ongoing medical and mental health care
relationships
o Skills in problem solving, conflict resolution, and nonviolent way
of handling disputes
o Cultural and religious beliefs that discourage suicide and support
instincts for self-preservation
What are stressors associated with suicide?
o triggers: stressful events, mood and thought changes, alcohol
and other drug use, and modeling
o Immediate stresses:
Loss of loved one
Loss of job
Natural disaster
o Long term stresses
Serious illness-especially those which cause great pain or
sever disability
Abusive environments from which there is little or no hope
of escape
Approximately ____% of suicides can be traced to diagnosable mental
illnesses. What are some of the mental illnesses?
o 90% of suicides can be traced diagnosable mental illnesses
major depression
bipolar disorder
schizophrenia
personality disorders, particularly borderline personality
disorder
o Comorbidity of disorders increases suicide risk
o Anorexia nervosa > 40x than general population
Lifetime risk 18-27%
o Schizophrenia estimated lifetime risk 14-22%
Higher rates for the paranoid type

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

What are the gender differences at rates of attempted suicide and

completed suicide?
o Women 3x more likely to ATTEMPT
o Men 3x more likely to COMPLETE
Men account for 78% of suicide deaths
Men use more violent methods (shooting) as opposed to
(pills)
66% males, 40% females use guns to commit suicide
What is the relationship between age and suicide risk?
o In Western society, elderly more likely to commit suicide than
people in any other age group ( especially White men)
What may be the contributory factors which make elderly more likely
to commit suicide than people in any other age group?
o Illness and pain
o Loss of close friend and relatives
o Loss of control of ones life
o Fear of becoming a burden
o Loss of social status
o Access to more violent means = higher success rate
What are ethnic differences in suicide rates?
o In U.S. rate of 12 per 100,000 for Whites is twice as high as
African American, Hispanic Americans and Asian Americans
Exception is Native Americans, 1.5x higher than national
average
What is the relationship between marital status and suicide rates?
o Divorced men 2x more likely than not divorced
o Being single or widowed had no effect on suicide risk
What is the relationship between alcohol and suicide?
o 33.4% tested positive for alcohol
o 23.8% positive for antidepressants
o 20% tested positive for opiates, including heroin and pain killers
How is suicide studied? What are the two different strategies used to
overcome obstacles?
o Many believe estimates are low, accidental deaths may be
intentional
o Estimates difficult to obtain because of society, relatives refuse
to acknowledge that loved one took own life
o Retrospective analysis- a kind of psychological autopsy
o Studying people who survive their suicide attempts
How do you assess suicide risks? What components do you assess?
o Intent/thought suicidal ideation
o Plan

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE

o Means specificity, access

o History nature of past attempts, lethality, efforts made in
attempt to conceal
o Motivation to die reasons, triggering events, beliefs about
death, expression of anger, desire for revenge, end physical
suffering or future atrophy or death
o Reasons to live
o Relationship support
Describe the 10 steps to reducing suicide risk.
o 1) Screen all clients for suicidal risk during initial contact and
remain alert to this issue throughout the therapy.
o 2) Work with the suicidal client to arrange an environment that
will not offer easy access to the instruments the client might use
to commit suicide.
o 3) Work with the client to create an actively supportive
environment.
o 4) While not denying or minimizing the client's problems and
desire to die, also recognize and work with the client's strengths
and (though temporarily faint) desire to live.
o 5) Make every effort to communicate and justify realistic hope.
o 6) Explore any fantasies the client may have regarding suicide.
o 7) Make sure communications are clear and evaluate the
probable impact of any interventions.
o 8) When considering hospitalization as an option, explore the
drawbacks as fully as the benefits,
o the probable long-term and the immediate effects of this
intervention.
o 9) Be sensitive to negative reactions to the client's behavior.
o 10) Perhaps most importantly, communicate caring.
What is civil commitment law?
o Every state has their own
o Legal declaration of mental illness
o When can a person be placed in a hospital?
Person is a danger to self or others (imminent danger)
Person cannot care for own needs (gravely disabled)
o 72 hour hold/5150
What is imminent suicide?
o Implying the foreseeability of an inherently unpredictable act
o Legal construct in clinical guise, which can be used to justify
emergency psychiatric resources or intrusion into patients civil
liberties
o Prone to false positives

CLINICAL PSYCHOLOGY FINAL EXAM

STUDY GUIDE