Clinical case formulations (CCFs) can be organized and communicated in several ways but one of the most effective is through CCF causal diagrams (CCFCDs). Haynes et al., Psychological Assessment, 2020, 32, 541 illustrated how the psychometric evaluation of CCFCDs could be facilitated by assigning quantitative values to the clinician’s judgments in a CCF. Although quantification could facilitate the psychometric evaluation CCFCDs, it is less clear that it can help clinicians make decisions about the best treatment foci. This article presents an open-source computer program (Clinical Case Formulation Causal Diagram Calculator, CCFCDC) for the path analyses of quantified CCFCDs, based on the free computing language Python, to assist in clinical decision making. The operation, examples, assets, and limitations of the CCFCDC are discussed in the context of measurement principles, precision, and uncertainty in clinical judgments. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Judgments about a client's behavior problems and treatment goals, and the factors that influence them, are elements of most clinical case formulations (CCFs). These judgments are designed to guide clinicians' selection of the most effective intervention foci. Despite their importance, CCFs have undergone infrequent psychometric evaluations. We describe a model to promote and facilitate the psychometric evaluation of CCFs with quantified causal diagrams. This article presents the conceptual foundations, path analyses, benefits, and limitations of quantified causal diagrams. We first present concepts of causality and causal diagrams that are applicable to CCF and psychopathology. We propose that clinical case formulations causal diagrams can strengthen a science-based approach to clinical assessment, facilitate the psychometric evaluation of CCFs, enhance the specificity, precision, and communicability of clinicians' judgments, help the clinician select the most effective intervention foci, predict the effects of changes in causal variables, and emphasize the importance of "uncertainty" in CCFs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Comprehensive assessment of couple distress requires a systematic, dynamic, and culturally sensitive approach. Understanding the implications of couple distress necessitates a conceptual framework that extends beyond individual considerations and evaluates the broader relational and sociocultural context from which couple distress emerges. This chapter explicates a multifaceted assessment model used to guide assessment in primary domains of couple functioning (cognitive, affective, and behavioral) that operate at multiple ecological levels (individual, dyad, nuclear family, extended family, community, and cultural systems). Assessment methods and techniques suitable for evaluating behavioral, cognitive, and affective components of couple distress are described. Brief screening measures and methods for the diagnosis of couple distress are highlighted, as well as essential cultural and therapeutic considerations. We advocate that couple assessment strategies and specific methods should be tailored to partners' unique constellation of presenting difficulties while also explicating general recommendations and potential areas for future research.

Native Hawaiians, compared to other ethnic groups in Hawai'i, have significantly higher mortality rates and die at a younger average age from cardiovascular disease (CVD). This may be partially explained by elevated cardiovascular responses to racial stressors. Our study examined the degree to which blood pressure (BP) and heart rate (HR) reactivity and recovery, and ratings of subjective distress to racial stressors, differ as a function of Native Hawaiian college students' levels of perceived racism. This study had three phases. Phase 1 involved the development of a blatant and subtle racial stressor. Phase 2 involved assigning 132 students into high- or low-perceived racism groups based on scores on two perceived interpersonal racism measures. Phase 3 involved a psychophysiology laboratory experiment conducted with 35 of the 132 students. BP, HR, and subjective distress were measured during exposure to the blatant and subtle racial stressors. Systolic blood pressure (SBP) recovery following exposure to both stressors was significant for both groups. Although not significant, three trends were observed among the high-perceived racism group, which included: (1) greater reactivity to exposure to the subtle stressor than to the blatant stressor, (2) incomplete HR recovery following exposure to both stressors, and (3) incomplete SBP and diastolic blood pressure recovery following exposure to the subtle stressor. Participants also reported significantly greater subjective distress following exposure to the blatant than to the subtle stressor. Specific interventions, such as increased self-awareness of physiological responses to racial stressors, targeted at at-risk individuals are necessary to reduce a person's risk for CVD.

This study examined the relative effectiveness of interventions based on a pre-intervention functional behavioral assessment (FBA), compared to interventions not based on a pre-intervention FBA. We examined 19 studies that included a direct comparison between the effects of FBA- and non-FBA-based interventions with the same participants. A random effects meta-analysis of effect sizes indicated that FBA-based interventions were associated with large reductions in problem behaviors when using non-FBA-based interventions as a reference intervention (Effect size = 0.85, 95% CI [0.42, 1.27], p < 0.001). In addition, non-FBA based interventions had no effect on problem behavior when compared to no intervention (0.06, 95% CI [− 0.21, 0.33], p = 0.664). Interestingly, both FBA-based and non-FBA-based interventions had significant effects on appropriate behavior relative to no intervention, albeit the overall effect size was much larger for FBA-based interventions (FBA-based: 1.27, 95% CI [0.89, 1.66], p < 0.001 vs. non-FBA-based: 0.35, 95% CI [0.14, 0.56], p = 0.001). In spite of the evidence in favor of FBA-based interventions, the limited number of comparative studies with high methodological standards underlines the need for further comparisons of FBA-based versus non-FBA-based interventions.

AbstractHealth psychology and behavioral medicine are interdisciplinary fields devoted to developing and integrating the biomedical, behavioral, psychological, and social sciences and approaches to better understand health and illness, and to applying these sciences and approaches to prevention, diagnosis, treatment, and rehabilitation. They have a wide range of research and clinical foci and applications across an array of health‐related behavior problems and goals across multiple contexts and settings. Behavioral and psychophysiological assessments and treatments, as well as multimethod, multimodal, and multisource assessments, are emphasized. Their conceptual and scientific foundation is based on the biopsychosocial model, behavior change theories, and personality constructs. Their historical and philosophical foundation predates psychology as a distinct discipline. Developing areas in the field include sociocultural applicability, translational research, health disparities, new and emerging technologies in providing health care, accessibility of health psychology to the public, and the public health needs of less developed countries.

Abstract Behavioral observation is useful for the assessment of persons with limited verbal abilities, the measurement of persons' behavior in their natural environments, and the measurement of functional relations among contemporaneously occurring behaviors and environmental events. It is particularly useful for measuring clinically important sequences of interactions between persons and for examining how these sequences influence behavior and vary across contexts. Systematic behavioral observation is often applied within time‐series correlational or experimental (e.g., ABAB ) designs. The validity and clinical utility of behavioral observation data depend on selecting the best coding schemes, methods of recording behavior and events, time‐sampling strategies, subjects to observe, observation settings (e.g., analog or in the participants' natural environment), observers (e.g., participant or nonparticipant), and data analytic strategies for a given assessment context. Observer accuracy is an important dimension of behavioral observation and can be evaluated in several ways (e.g., Cohen's κ).

OBJECTIVE:This study describes the development, content validity, and convergent validity of the Loss of Control over Eating Scale (LOCES).METHOD:An initial pool of 56 items covering 13 facets of loss-of-control eating was assembled by reviewing qualitative literature, clinical descriptions, and research on binge eating. Eating disorder experts (n = 34) and eating disorder clients (n = 22) rated each proposed item's clarity and relevance to the construct of loss-of-control eating, rated 13 facets for their relevance to the construct, and provided open-ended feedback about the items and facets. Based on the experts' and clients' quantitative and qualitative feedback, scale items were clarified, 28 items were added, and 10 were deleted. University students (n = 476; 70% female, mean age = 20.4 years) completed the resulting 74-item questionnaire, rating how often they had the experience identified in the item while eating in the last 4 weeks. They also completed the measures of eating disturbance, general distress, functional impairment, and general self-control.RESULTS:The resulting 24-item LOCES (Cronbach's α = .96) retained items with highest item-total correlations and coverage of the 12 construct facets that experts rated as important. The LOCES was significantly correlated with eating disturbances, general distress, functional impairment, and general self-control. Three subfactors were identified: behavioral, cognitive/dissociative, and positive/euphoric aspects of loss-of-control eating. A brief, seven-item version of the LOCES was developed and validated.DISCUSSION:A thorough process of development, content validation, and psychometric evaluation in multiple samples yielded the multifaceted LOCES and its brief form. These instruments may be useful in assessing loss-of-control eating in both clinical and nonclinical settings.

In order to describe and understand possible problems associated with deafblindness we applied a functional analysis case formulation strategy and Functional Analytic Clinical Case Diagrams (FACCD). We collected clinical assessment data from deafblind persons who were experiencing multiple psychological problems as reported by their healthcare professionals. The data were collected after the healthcare professionals were trained in functional analyses and in applying FACCD. The 21 deafblind persons assessed by healthcare professionals were reported to have 3–11 psychological problems. Two case examples are given to illustrate the complexity of a deafblind person's life situation and the functional relations among problems and possible causal variables. Thus, in addition to vision, hearing and communication problems, deafblindness can be associated with other psychological problems that may benefit from more precise psychological assessment and treatment. We found that the functional analysis and FACCD were useful in helping assess and understand persons with visual and hearing difficulties, especially when there are indications of concomitant psychological problems.

El presente trabajo muestra qué información debe recogerse para realizar el análisis funcional de un caso clínico, qué características debe poseer dicha información, cómo pueden integrarse los datos disponibles y cómo se pueden representar gráficamente los juicios clínicos para que ayuden en la elección del tratamiento. El análisis funcional consiste en la integración de variables y relaciones causales con los problemas del cliente y con los objetivos del tratamiento. Presentamos un caso práctico ilustrativo de evaluación conductual, de integración en un análisis funcional de los datos obtenidos y de su representación gráfica mediante un diagrama causal. El análisis funcional y su representación gráfica se presentan de forma que sirvan para comunicar con claridad el análisis funcional a otras personas, para enseñar a formular casos clínicos y para elegir el mejor enfoque para el tratamiento. El análisis funcional es dinámico, hipotético e idiográfico y su validez puede restringirse a determinadas situaciones o contextos. This article reviews what information needs to be gathered to carry out the functional analysis of a clinical case, what the scientific characteristics of this information are, how to integrate available information, and how to graphically represent clinical judgments to make treatment decisions. Functional analysis is the integration of important, modifiable, causal variables and causal relations associated with a client's behavior problems and intervention goals. We present a clinical case to illustrate the applications of behavioral assessment methods and to show how data obtained in the assessment process can be integrated into a functional analysis. Functional Analytic Clinical Case Diagrams (FACCD), which are causal diagrams of a functional analysis, are also introduced. The functional analysis and FACCD are designed to efficiently communicate the functional analysis to others, as an aid in teaching case formulations, and to assist in selecting the most beneficial intervention focus with a client. The functional analysis is a dynamic, hypothesized, idiographic clinical case formulation. The validity of a functional analysis can be confined to particular settings or contexts.

AbstractCouple distress has a high prevalence as well as high comorbidity with a broad range of emotional, behavioral, and physical health problems. Marriage and relationship problems also influence individuals' response to treatment for a wide range of psychological disorders. Hence, clinicians need to be skilled in conducting clinical assessment involving relationships in order to provide effective interventions, whether working primarily with individuals, couples, or the broader family system. This article first introduces brief screening measures and clinical methods for diagnosing couple distress in clinical as well as research applications. It then conceptualizes and assesses couple distress for the purpose of planning and evaluating treatment. The article also reviews empirical findings regarding behavioral, cognitive, and affective components of couple distress, and specific techniques derived from clinical interviews, behavioral observations, and self-reports. Finally, it considers emerging technologies for assessing intimate relationships and makes recommendations for future research.

AbstractThis article presents a case study of a family with marital, substance-use, mood, external-stressors, and parent–child difficulties to illustrate the principles and methods of pretreatment behavioral assessment. Several guiding principles are discussed: an emphasis on identifying functional relations relevant to behavior problems and treatment goals, especially those that help us explain behavior problems; a multimodal focus during assessment, attending to overt behavior, thoughts, emotions, and physiology; the importance of the conditional and contextual nature of behavior; an emphasis on temporally contiguous and environmental events, thoughts, and emotions in triggering and maintaining behavior problems; the dynamic nature of behavior problems and causal variables; an emphasis on specificity and precision of measurement; and individual differences in the elements, correlates, and causes of behavior problems. A diverse set of methods is congruent with the principles of behavioral assessment and includes behavioral interviews and questionnaires, observation in natural and analog environments, and self- and instrument-aided monitoring of behavior and events in natural and analog environments.