Psych Testing Psychology -Ecological Momentary Assessment - Mhealth Psych testing

CALI VERBA LEARNA TES[CVLT]GLOBAL SCORESCALIFORNIA VERBAL LERANING TEST Werner 1937 Werner Objected use of global scores based only on the number of right ro wrong items. Global assessment fofucntioing – a numeric scale used by meantl health clinicans and pohsicans to rate subjectively the socalaoccpuatoinal and psycholgoicalifunctoioing of an indivual – GAF scale – Global assessment of Functionoing. How well one is meeting various problems in living – Scores range from 100 to 1 (severely impaired). The scale was cinldued in DSM –IV but replaced in DSM 5 with WHODAS – WHO disability assessment schedule A survey or interview with detailed items The whodas is more deatlied and objective

CALI VERBA LEARNA TES[CVLT]CALIFORNIA VERBAL LERANING TEST Werner favorered tests that asses how problems are solved in addition to assessing overall level of achievement Modern cognitive psychology has identified many levels of human information processing Contemporary cognitive psychology suggest that many factors determine performance eon any given tasks One needs to find out twhich aspects of the human information processing system are defiective Which aspects are functioning well. This information is essential in designing rehabilitation strategies for patients who have selective problems. Q: What needs to be known about the human information processing system when designing rehabilitation strategies for patients who have selective problems? A: Which aspects and areas are function well, and which are defective.

CALI VERBA LEARNA TES[CVLT]CALIFORNIA VERBAL LERANING TEST Pg 460 SVLT – Valifaonia Verbal learning test –builds on computer science – cog psych Psych testing Test determines how errors are made in learning tasks Intent is to identify different strategies Processes Errors SVLT assesses various variables including levels of reall Recognition Semantic and serial strategies Variables including levels of recall Recognition Semantic Serial strategies Serial position effects Learning rates across trails Consistency of item recall across trials Degree of vulnerability to proactive and retroactive interference Retention of information over short and long delays Learning errors in recall and cognition

SHOPPING LIST[CVLT]CALIFORNIA VERBAL LERANING TEST California verbal learning test- Shopping list 16 itesm orally One word per second Repeat the list Reapeatd throughout 5 trials Hihghly anxious – poor results 20 minutes later tested again against anxiety bias Microcomputer ad;ministration or Pencial and paper Assists test administrators Pen touch or enter response directly into the computer using a single key Speeds up scring process Aquicistion rate Serial position Discirminability Learning performance Emprical findings Diversity of deficits identified by CVLT could not be identified using more tarational psychometric tests

1. 5 Trials2. 16 words given3. second interference elist4. 16 words5. tested immediately6. tested after 20 min[CVLT]CALIFORNIA VERBAL LERANING TEST California verbal learning test- Inconsistent recall across trials characterizes patients with amnesia caused by frontal lob pathology Other features from experiemetnalcognpsycyh 5 trials to exposure 16 word list and a second interference list of 16 words given. Subjects tested immediately Tested again after 20 minutes Free recall Cued recall Recognition for the first list Correlated with Weschler memory scale Suggetss independent factors flor learning stratgegy Acquisition rate - obtanability Serial psotion Discriminability – able to discriminate between items Learning performance

[CVLT]CALIFORNIA VERBAL LERANING TEST California verbal learning test- Used to compare patients with Alsheimers disease Korsakoff’s syndrome Huntingtons disease Alzheimer's disease ids a serious neurological disorder Causes inability to form short term memories Korsakoff’s syndrome is an organic brain disorder often associated with longer term alcohol use Alzheimershuntingtons may score about the same on measures or recall and memory tests Differ in measures of forgetting Studies of brain pathology show that these two disease affect different parts of the brain SVLT allows a more precise eval of the nature of the problems that do other tests When representative of these three diagnostic groups are compared – Alzheimer – Korsakoff's appear quit similar with comparable scores for recall, Learning Forgetting Semantic cluttering Several other cognitive factors

[CVLT]CALIFORNIA VERBAL LERANING TEST Alzheimer's and Krosakoff’s were similar though scored much lower than Huntington’s patients Measrures of retention Intrusion And recognition These measures can help us understand the properties of the tests Immediate recall testing Long delay free recall Different among patient populations.

[CVLT]CALIFORNIA VERBAL LERANING TEST Study demonstrated that test of executive functioiong can discriminate between conditions that have differen anatomical underpinnings MRI was used to locate sections fo the brain that had reduced vlumes Adults with dm;entio associated with thegrontal lobes made more rule iovlatoin errors in copmparison to those with alxiehermsdiesaese Healthy adults who were about the same age. Long delay savings require that subejhxts learn a list of wor Long delay they are given the free recall test. Results are reported as the average number of correct responses Huntingtonspatiens have singifcally higher recall than those with alzhiermers

VALIDITY[CVLT]CALIFORNIA VERBAL LERANING TEST California verbal learning test-

Huntington's disease – a subcortical dmentioa • Alzheimer's disease is associated with cortical lesions • CVLT – helpful in identifying the location of the organic problem [CVLT]Brain / Deficit impairment locations

CVLT – helpful in identifying the location of the organic problem • 1994 – Delis and collegues released a children’s version fo the CVLT the CVLT – C • CVLT – C for children 5-1 yoa. • Indivually administered test can be used to evaluate mil to sever learning disabilities • Ttention deficit ADD • Mental retardation • Other nuerolgoical disorders • Provides info for the diagnosis fo psychiatric disorders • SVLT-C asses both recall and recognition of the words. • Inlcudes Monday and Tuesday list – • 15 words on Monday • 15 wors on Tuesday • After interference list – • Again tested on non verbal test is administered followed by test of long dely • Free recall • Long dealy cued recall • Test designed to assess recognition fo the words that were administered the day before. [CVLT - C]Brain / Deficit impairment locations

CVLT – helpful in identifying the location of the organic problem • Several different scores. • Serial position effect • Learning rate • Consitency of item recall • Practive vs. retroactive interference • Retention over long and short delya • Sstandardized on a large national sample • SVLT – C provides substantlyly more diagnostic inforaion [CVLT - C]Brain / Deficit impairment locations

ANAM – Automated neuropsychological test Metrics test system • Automated neuropsychological test p • Designed by DOD

ANAM – Automated neuropsychological test Metrics test system • Automated neuropsychological test p • Designed by DOD • Provides quick computerized interpretation of nueropsych tests • Evaluates changes in human performance • Exposed to different environmental circumstances • Used in vaiety of clinical populations • Studies pof patient with MS, • Lupus – systemic auto immune disease in which the boyd’s immune system mistankelyattaks the body’s ealthy tissue • Most common and sever is SLE – systemic lupus ertheatosus • Affects internal organs • Parkinsons • Alzhierms • Brain injury • Migrain headaches

ANAM – Automated neuropsychological test Metrics test system • Studies show – can be efficiently used to screen people with goc changes and that it may be valuable tool for monitoring cog changes as diseases progress. • Includes variety of tasks • Code substitution • Code substitution recognition • Matching two samples • Mathematics • Running memory • Logical reasoning • Evaluate military personal who are deployed to combat • Establish a baseline for all soldiers so that I t can be determined whether new injuries cause changes in mental status. • Studies have suggested that the mathe and running memory tsasks are associated with measures that would be expected to correlate with cong functioning

ANAM – Automated neuropsychological test Metrics test system • Time limited attention tasks • Working memory tasks • Concerns about how people interact with computers • Computer mouse keyboard features vary across people • Studies show that results from ANAM are not always the same as those obtained using paper and pencil tests or test administered by trained examiner • ANAM has been used extensively to evaluate the effects f heard injury in athletes. • Reasonably good evidence for validity • Neuropsych testing is important to neuropsychology • Linked closely to basic research in both nueroscience and cog psych • We expect this field to continue its rapid development over the next few decades

Test anxiety common • A major disadvantage to taking tests and being scored and evaluated by testing materials. • Common problem among students • Sepcific test anxiety • Theory and measurement ANXIETY AND STRESS ASSESSMENT

Stress- response to situations that involve demands, constraints, or opportunities • We all experience psych stress at some point • Debilitating proble for some • Interferes with all aspects for some • Stres helps still others to acoomplish important goals. • Biomedical sicences • Sychological stress can interfrere with performance on mental and academic test 50%-80% of all illnesses • Medical invetiagors now believe that stress in s involved in - ANXIETY AND STRESS ASSESSMENT

3 types of psychological stress • FRUSTRATION • CONFLICTPRESSURE • Something blocking attainment of a goal • Frustatoin • CONFLICT – type of stress that occurs when we ;must make a choice between two or more important goals – • PRESSURE – speed up activities • External pressure occurs when your professor assigns a log to extra reading right before the meidtretm exam internal pressure occurs when no such reading is assigned but you take in on your self ANXIETY AND STRESS ASSESSMENT

ANXIETY AND STRESS ASSESSMENT • State Trait Anxiety Inventory – • State anxiety is an emotional reaction that varies from one situation to another • Trait anxiety is a personality characteristic • STAI (State trait anxiety inventory) • STAI – provides two separate scores – • One for state anxiety _ A state • Another for trait anxiety – A Trait • 20 items • 4 point scale • Subjects indicate how they generally feel about each item

ANXIETY AND STRESS ASSESSMENT • STAI state trait anxiety inventory – 20 items • 4 point scale • Similar set of item used to evaluate the a state • Good evidence exists for validity • Reliability • Test retests reliabilities high .73-.83 • Restest which is supposed to be inconsistent over time – • .16-.54 over time

ANXIETY AND STRESS ASSESSMENT • STAI is correlated with Taylor Manifest Anxiety scale • Associated with another trait anxiety scale • Known as the instate for personality ad ability testing • OPAT anxiety scale • Taylor and the Institute for personality and ability testing IPAT ranged form .75-.85 • Quite impressive • Used to identify high levels of state and trait anxiety among patients with multiple sclerosis • Useful for the eval of cog and somatic anxiety

ANXIETY AND STRESS ASSESSMENTSTAI trait scale • STAI -

ANXIETY AND STRESS ASSESSMENT • State Trait Anxiety Inventory – • State anxiety is an emotional reaction that varies from one situation to another • Trait anxiety is a personality characteristic • STAI (State trait anxiety inventory) • STAI – provides two separate scores – • One for state anxiety _ A state • Another for trait anxiety – A Trait • 20 items • 4 point scale • Subjects indicate how they generally feel about each item

STAI • Shown to be useful for estimating anxiety trajectories • Patients receiv colorectal cacner • For evaluating the role of anxiey for people who have difficulty skeeeping • Measures the same thing as other scales chemotherapy and breast colerectoralcacner • Patietns undergone major surgery showedless state anxiety after they had been told they were recoverin gweel.

STAI State trait anxiety Inventory • Patietns schedule o undergo surgery study – • Before and after medical procedures • Patients who had undergone the major surgery – showed less satate anxiety after they had been told there were erecoging well. • State anxiety flutates with the situation – • Test constructors said it would • Trait anxiety was not affecte by the situtoin it remained the same before and after surgery • People high in trait anxiety continued to respon in an anxioius way even in situation sthat evoked little or no ancity among people • Two components clearly assess different aspets of anxiety • STAI is useful because behavior is influed by both situations p • Personality traists • Eavluatedtaobbao use = whowed that smoking I sinfluencedby situations such as enhoyment and stimulation and it managed iemotionsamonth those with high levels of trait anxiety. • Translated into differenlanagues

STAI State trait anxiety Inventory • State anxiety fluctuates with the situation • Trait anxious – continued to respond in an anxious way • Situations that evoked little or no anxiety among people in trait anxiety • STAI evaluate tobacco use – showed that smoking is influence by situations, • Enjoyment and stimulation • That it managed emotions amount hose with high levels of trait anxiety.

STAI State trait anxiety Inventory • Adult and childrens versions • Good psychometric evals • Koren version used to evaluate medical students • Modest evidence fothevalidity of parent reports of their chilren’sanciety.

Taylor Manifest Anxiety Scale -

MEASURES OF COPING Patients with better coping skills were able to see more meaning I n life which in turn was related to better outcomes in both pHySIcal and mental health status.

WAYS OF COPING SCALE The ways of Coping Scale 68 item checkliost Choose those thoughts and actions that they use to deal with stressful situations 7 subscales organized into problem focused Emotion focused Strategies .

1. WAYS OF COPING SCALE/ 2.COPING INVENTORY TEST Emotion focused strategies- focus on ways of Dealing with emoTIONnal responses to stress Related measure is the COPING INVENTORY - . 33 item measure from clinical interview data Three categories of items Activities and attitudes that people use to avoid stress Second involves items that characterize stragies working though stressful events Third category considers socialization responses or how each strategy would help the respondent cope with a specific stressful event.

COPING INVENTORY TEST (Hammer and Marting, 1985) Coping Inventory test – hammer and marting 1985 Useful in research both adults and adolesencets for example on e study demonstrated that having good coping capabilities is important whether or not you are under stress

ECOLOGICAL MOMENTARY ASSESSMENT Computerized Psycholgical tests are designed to evaluate traits which are constant over the course of time Measures of state nacieyt are presumed to be reliable Measuring today is different than tomorrow?

ECOLOGICAL MOMENTARY ASSESSMENT E<MA. Toady last wekek tomorrow all different Memory fades over time Recalaffet virtually all autobiographical information Tehcnicaldevleopments have made it possible to obtain inforaition on an ongoing basis One can obtain information repeatedly and average the results to get an overall impression of stress Info be assessed with reference to a pracialare event Suppose that you wanted to determine if levls of perciegevd stress coicinde with particular stressors. Collects information on a continuing basis Uses computer technology – Equiepemnetnmight measure blodd pressure or hormanl state at specific points in time. Prompted to record ifoariton about mood symptoms or fatige

ECOLOGICAL MOMENTARY ASSESSMENT EMA. Subject prompted to record info about mood Symptoms Fatigue Collected in clinics Offices Laboratories Not necessarily the situations in which people ornigalyepxeirnece life events. Info collected in subjects natural environment Substantial numbers of repeated observations Shows or highlights vairablity of the subject over time.

ECOLOGICAL MOMENTARY ASSESSMENT EMA. Studies of the co use of alcohol and tobacco illustrate the use of EMA Traitional studies of alcohol consumption might actually moiss much of the inofamtion about drinking because theassessment is typically done during the day Alcohol consumption often occurs int eh evening EMA allOWS the continual assessment of these behaviors

ECOLOGICAL MOMENTARY ASSESSMENT EMA. EmAallos assessment of these behaviors in subjctes own environment 57 subjects given minicomputers Randomly promted them to reord their behaivors Study showed that drinking was likely to occur between 8pm and midnight Smoking was more than twixe as likely when subjects had been drinking as when they had not Smoking and drinking were linked Investigators use tehcnolgoy cell phones otherwise to collect finoration in natural enviornemnts Studies have used daily assessment sito evaluate life stress in one study 74 patients with arthritis rated stress mood and pain for 75 days Stressors were linked to pain mostly on days after stressors occurred Life stress may amplify relationships between life events and pain Further technical developments such as the ema should significantly improve the assessment of variable behaviors pain and emotions.

DEPRESSOIN Major depressive disorders are the leading cause of disability among ewomen worldwide Depression among women is also associated with a variety of differen health care conditions 9% of Pregnant women experience depression 10% of women who have recently given birth meet the criteria for major episode of depression

DEPRESSioN Maternal depression can have important impacts on young children Afectsyoing mothers interact with their children May result in increased risks of behagioral or emotional probelsm early in life Children of depressed mtoerhs have greater difficulty in school performance Peer realtioship Development of social skills

DEPRESSioN Physicians needed to consider whether it was necessary to screen for depression among pregnant women and women how have recently given birth Decision is taken very seriously an Must be based on the very scientific evidence US task is often evaluated by the us preventative services task force – USPSTF – united states preventive task force Independent group of physicians and behavioral scientists appoint by the director a federal agency known as the agency for healthcare research and quality Recommendations of the task force depend on the latest scientific evidence Recommendations of the task force are very impaornt because they affect how primary physicians are paid.

DEPRESSION – USPSTF U.S. PREVENTATIVE SERVICES TASK FORCE Ask for evidence that something valuable will result from identifying cases Evidence required to lead to diagnosis and treatments that will result in a remedy for the condition Screening for maternal depression Task force reviewed everything in the published literature that addressed the question of Whether or not screening for depression in primary care for pregnant and postpartum women resulted in improved health outcomes Patient health questionnaire PHQ is used to evaluate and minor depressive symptoms Considers both the frequency and severity of different symptoms

DEPRESSION – EDINBURGH POSTNATAL DEPRESSOIN SCALE (EPDS) Review began with the evaluation of measures of depression that can be applied tin primary care settings Edinburh postnatal depression scale (EPDS) Most appropriate screening tool for prenatal and postnatal depression 5398 women that had evaluated the EPDS averaged across studies that cutoff score of 13 indicated a threshold of mdd Across the studies the application of the epds resulted in a high likelihood of detecting women who were juede to be clinically depressed through other more intensive methods Sensitivity was .79 and specificity – was .87 Epds functional well for low income and African American women Capable of identifying both major and minor depression in pregnant women Diagnosis only part of the task

DEPRESSION – EDINBURGH POSTNATAL DEPRESSOIN SCALE (EPDS) After diagnosis – task force asked whether treatment with either psychotherapy or antidepressant medications resulted in improved health outcomes They systematically reviewed all published studies in the literature. Cognitive Behavior therapy resulted in a significant likelihood or remission from depression and short term benefits on a variety of outcomes Increasing the duration of therapy also appeared to improve outcomes Antidepressant medications also helped the women but medicine use was associated with more harm

DEPRESSION – EDINBURGH POSTNATAL DEPRESSOIN SCALE (EPDS) Multiple choice test agreeability On basis of this review the task force concluded that there is value in screening all adults Including pregnant and postpartum women for depression High certainty for at least a moderate benefit Epds or related instruments can be accomplished in primary care practices and has the potential to identify women in need of help For women who are identified as candidates of intervention cbt and other treatments are available tand these treatment are associated with significant reductions in depressive symptoms .

DEPRESSION – EDINBURGH POSTNATAL DEPRESSOIN SCALE (EPDS) Treatmens are available and are associated with significant ruductions in depressive symptoms Screening and treatment are available to women who have health insurance and the services are covered without the need for the woman to ake a copayment

NIH TOOLBOX Many measures are proprietary – Trend towards making measures publicly available NIH largest supporter of biomedical and behavioral research in the world’ Focused on biological research Significant behavioral program and has become increasingly interested in psychological and behavioral measures State of the art measures for assessing cognitive Emotional Motor Sensory functioning for people ages 3-85

NIH TOOLBOX Rational for developing the toolbox realization that people use many different ;measures to evaluated the same constructs in clinical studies Results It was very hard to compare results across different studies Toolbox offers well validated measures Serves as common currency Different investigations can be compared with on e another Provides measures that can assess neuroglical and behavioral function over the course of time The Measures are appropriate for different developmental stages and can be used for evaluating the effects of treatments and interventions

NIH TOOLBOX Summaries the content of the four demands that make up the toolbox 1. Cognition – cognition domains of the tool Box cover mental processes required for thinking remembering problem solving and language

Psych Testing Psychology -Ecological Momentary Assessment - Mhealth Psych testing