Causal Reasoning during Reading of Clinical Reports in Clinicians

1. Causal Reasoning during Reading of Clinical Reports in Clinicians Pedro L. Cobos Amanda Flores Estrella González-Martín Francisco J. López & Antonio Godoy Facultad de Psicología Universidad de Málaga Subtitle here

2. Introduction The main question How are causal reasoning processes involved in diagnosing DSM-IV disorders? Kim & Ahn’s (2002) study: The Causal Status Effect

3. Worthlessness and blame feelings Suicide thoughts Low pleasure in daily activities Lack of concentration Sadness Fatigue Weight alterations Sleep problems Motor activity problems Introduction Previous work Kim & Ahn’s (2002) study Depression

4. + central + peripheral Introduction Previous work Kim & Ahn (2002)’ study Depression • Sadness • Worthlessness and blame feelings • Low pleasure in daily activities • Sleep problems • Lack of concentration • Motor activity problems • Fatigue • Suicide thoughts • Weight alterations

5. Introduction Previous work Kim & Ahn (2002)’ study Clinical judgements modulated by causal reasoning More central diagnostic criteria are … … more important to diagnosis … better remembered

6. Introduction Our main goal To extend Kim and Ahn’s results by using on-line measures to detect causal reasoning processes during reading of clinical reports.

7. Introduction Our main goal Why using on-line measures during reading of clinical reports? If causal theories play an important role in clinicians’ reasoning, one would expect: On-line measures during reading of clinical reports allows to study these processes. • Rapid and efficient access to causal theories to … • relate new data with previous information … • in an on-line and semi-automatic manner … • in more natural conditions … • without inducing the use of causal theories.

8. Introduction to the experimental strategy: From text comprehension studies Assumptions and empirical findings behind the logic Good readers search for local and global coherence in texts Causal theories are fundamental in this search for coherence Solving coherence problems takes time and resources

9. Introduction to the experimental strategy: The inconsistency paradigm (Albrecht & O´Brien, 1993) INCONSISTENT TEXT Preliminary information Filler information Final sentence John is diagnosed with the avoidant personality disorder by a clinician. He lives in a populated area in the centre of the town and works as an IT teacher. He spends a lot of hours at work. He views himself as socially skilled and personally appealing. Once the session had been finished a new appointment was arranged. Target sentence

10. Introduction to the experimental strategy: The inconsistency paradigm (Albrecht & O´Brien, 1993) CONTROL TEXT Preliminary information Filler information Final sentence John is diagnosed with the sleepwalking disorder by a clinician. He lives in a populated area in the centre of the town and works as an IT teacher. He spends a lot of hours at work. He views himself as socially skilled and personally appealing. Once the session had been finished a new appointment was arranged. Target sentence

11. Introduction to the experimental method: The inconsistency paradigm (Albrecht & O´Brien, 1993) • INCONSISTENT CLINICAL REPORT • Diagnosis and symptoms • Filler information •  • Final sentence Target sentence: Absent criterion: Central / Peripheral

12. Introduction to the experimental strategy: The inconsistency paradigm (Albrecht & O´Brien, 1993) INCONSISTENT CENTRAL John is diagnosed with the avoidant personality disorder by a clinician. He lives in a populated area in the centre of the town and works as an IT teacher. He spends a lot of hours at work. He views himself as socially skilled and personally appealing. Once the session had been finished a new appointment was arranged.

13. Introduction to the experimental strategy: The inconsistency paradigm (Albrecht & O´Brien, 1993) INCONSISTENT PERIPHERAL John is diagnosed with the avoidant personality disorder by a clinician. He lives in a populated area in the centre of the town and works as an IT teacher. He spends a lot of hours at work. He gets easily involved in new activities. Once the session had been finished a new appointment was arranged.

14. Inconsistency Paradigm Experimental strategy Manipulation of causal status of DSM-IV diagnostic criteria • Processes measured: • - Comprehension • - On-line access • On-line inferences • On-line integration

15. Experimental strategy For each clinical report, participants in our experiments rated the degree of agreement with the diagnosis stated in the preliminary information. Additionally,

16. Experimental strategy IV 1 Degree of inconsistency Design IV 2 Causal Status

17. Clinicians were expected to efficiently access and use their causal theories in a clinical report reading task Longer reading times in the inconsistency than in the control condition Lower agreement judgements in the inconsistency than in the control condition Greater inconsistency effect in the central than in the peripheral condition. Greater inconsistency effect in the central than in the peripheral condition. Hypothesis

18. 17 clinicians • Years of practice averaged 17 • Most of them • cognitive-behavioural Experiment 1 Method: participants

19. Experiment 1 Results Target + Post-target Reading times Deg. Incons. F(1,16)=10.70, p=.005 Caus. St. x Deg. Incons. F(1,16)=9.59, p=.007 Deg. Incons. F(1,16)=11.39, p=.004 Deg. Incons. F(1,16)=4.46, p=.051 3.500 3.100 2.700 Mseg 2.300 1.900 00 Inconsist Control Inconsist Control CENTRAL PERIPHERAL

20. Experiment 1 Results Judgements (0-100 Agreement) Deg. Incons. F(1,16)=51.40, p<.001 Caus. St. x Deg. Incons. F(1,16)=4.76, p=.044 Deg. Incons. F(1,16)=31.44, p<.001 Deg. Incons. F(1,16)=43.23, p<.001 100 90 80 70 Judgements 60 50 40 30 20 10 0 Inconsist Inconsist Control Control CENTRAL PERIPHERAL

21. Experiment 1 Results Clinicians Affected by inconsistency Inconsistency affected by causal status Clinicians rely on causal theories in on-line reasoning during reading of clinical reports Tiempos de lectura y juicios en la misma línea

22. Discussion The achieved goals Replication of Kim & Ahn’s (2002) results Causal status effect in diagnostic judgements Extension We have provided evidence of on-line causal reasoning in clinicians … in a natural and ecologically valid task (reading clinical reports) … without inducing the use of causal theories … and taking behavioural measures in a non-intrusive way

23. Discussion The achieved goals Methodological We have shown the usefulness of reading comprehension techniques to study on-line clinical reasoning processes BUT

24. Discussion The causal status effect found may be a conceptual centrality effect or a statistical effect.

25. Experiment 2 (almost ready to be run) Strategy • We have created inconsistencies to obtain the inconsistency effect by manipulating the temporal order of symptom appearance. • We have selected common disorders that are explained by well known theories according to which symptoms can be causally linked. • We have added new tasks: • The reading task. • The memory task. • The diagnostic judgement task. • The treatment task.

26. Experiment 2 (almost ready to be run) Strategy An example based on anorexia nervosa Emotions Fear of gaining weight Body sensations Cognitive distortions Altered self-perception of size, weight, and silhouette Diet Vomiting Laxative abuse Weight loss Yellow buttons include DSM-IV diagnostic criteria Toro y Vilardell (1989) Amenorrhea

27. Experiment 2 (almost ready to be run) Strategy An example based on anorexia nervosa Fear of gaining weight Altered self-perception of size, weight, and silhouette Temporal order Weight loss Yellow buttons include DSM-IV diagnostic criteria Toro y Vilardell (1989) Amenorrhea

28. CONSISTENT CLINICAL REPORT Experiment 2 (almost ready to be run) Strategy: The reading task An example based on anorexia nervosa A. realizes that she needs help for a problem and, eventually, decided to request the aid of a clinical psychologist. The last appearing symptom was amenorrhea. Filler sentence 1. Before, she had been suffering from altered self-perception of weight. Filler sentence 2. The first appearing symptom was an intense fear of becoming fat. Filler sentences 3-6. After the assessment process, A. received the diagnosis of anorexia nervosa. The clinical psychologist encouraged A. to start with the treatment process as soon as possible. Target sentence

29. INCONSISTENT CLINICAL REPORT Experiment 2 (almost ready to be run) Strategy: The reading task An example based on anorexia nervosa A. realizes that she needs help for a problem and, eventually, decided to request the aid of a clinical psychologist. The first appearing symptom was amenorrhea. Filler sentence 1. Later on, she started to suffer from altered self-perception of weight. Filler sentence 2. The last appearing symptom was an intense fear of becoming fat. Filler sentences 3-6. After the assessment process, A. received the diagnosis of anorexia nervosa. The clinical psychologist encouraged A. to start with the treatment process as soon as possible. Target sentence

30. Experiment 2 (almost ready to be run) Strategy: The reading task Hypothesis We expect to find longer reading times for the target sentence in the inconsistent than in the consistent clinical report.

31. Please, indicate the order in which symptoms appeared in the client: Experiment 2 (almost ready to be run) Strategy: The memory task An example based on anorexia nervosa A Altered self-perception of weight B Fear of becoming fat C Amenorrhea First Middle Last

32. ¿To what extent do you agree with the diagnosis of anorexia nervosa? Experiment 2 (almost ready to be run) Strategy: The diagnostic judgement task An example based on anorexia nervosa < < 0 OK

33. Experiment 2 (almost ready to be run) Strategy: The reading task Hypothesis We expect to find higher ratings of agreement in the consistent than in the inconsistent clinical report.

34. ¿To what extent do you think that an hormone treatment based on progesterone will eliminate the following clients’ symptoms? Altered self-perception of weight Fear of becoming fat Amenorrhea Experiment 2 (almost ready to be run) Strategy: The treatment decision-making task An example based on anorexia nervosa < < 0 < < 0 < < 0

35. ¿To what extent do you think that a treatment based on the comparison between the self-perception of the body and its actual size, silhouette and weight will eliminate the following clients’ symptoms? Altered self-perception of weight Fear of becoming fat Amenorrhea Experiment 2 (almost ready to be run) Strategy: The treatment decision-making task An example based on anorexia nervosa < < 0 < < 0 < < 0

36. ¿To what extent do you think that a treatment in which the client is faced to the possibility of gaining weight and learn how to cope with its consequences will eliminate the following clients’ symptoms? Altered self-perception of weight Fear of becoming fat Amenorrhea Experiment 2 (almost ready to be run) Strategy: The treatment decision-making task An example based on anorexia nervosa < < 0 < < 0 < < 0

37. Experiment 2 (almost ready to be run) Strategy: The reading task Hypothesis The treatment that operates directly on the symptom with the highest causal status in the disorder will receive, in general, higher ratings of efficacy in the consistent than in the inconsistent clinical report.

38. If you had to choose one treatment among the three just mentioned to eliminate the maximum number of symptoms, which one would you prefer? Experiment 2 (almost ready to be run) Strategy: The treatment decision-making task An example based on anorexia nervosa

39. Thank you very much Subtitle here