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Primacy Effect

People often make judgments about other people very quickly

Making judgments quickly sufficient, and those judgments may frequently be correct, but when a client seeks help, they might object to learn that the mental health professional very quickly formed impressions that were unlikely to change


Awareness of Cognitive Processes

Judgments, feelings, and motives occur largely outside the realm of cognitive awareness

It can be difficult for mental health professionals to know exactly how they make clinical judgments and decisions

If clinicians are often unaware of how they make judgments, this can make it difficult for them to correct errors in judgment

Clients are also trying to better understand their feelings and motives even if these feelings and modes occur largely outside the realm of cognitive awareness


Affect Heuristic

People often make judgments and decisions based on their feelings

Gut instinct, intuition

Clinicians to often become overconfidently satisfied with their judgments

To counter their overconfidence, rather than being told to attend to their feelings, they are typically advised to
1. Consider more alternatives
2. Ask more questions
3. Attend more closely to criteria when making diagnoses


Representativeness Heuristic

Judgment is made by deciding if person is representative of a category

Although mental health professionals are supposed to attend to criteria when making diagnoses, the representativeness heuristic is sometimes more descriptive of what actually occurs


Availability Heuristic

Information that can be more easily remembered will have a greater influence on judgment

Often, negative information is more salient and more easily remembered, affecting judgment


Confirmatory Hypothesis Testing

Tendency to seek, use, and remember information that can confirm, but not refute an initial hypothesis

Confirmatory Bias – occurs when confirmatory hypothesis testing leads to mistakes in judgment


Causal Reasoning

When clinicians make diagnoses, their influence not only by diagnostic criteria but also their implicit causal theories

e.g. study – clinicians weigh diagnostic criteria more heavily when the criteria described symptoms and behaviors that were part of their implicit causal model for disorder

*this is not supposed to occur – clinicians making DSM diagnoses are supposed to weigh each criterion equally


Past Behavior Heuristic

When clinicians cannot construct compelling case formulation to help them make predictions, they may simply decide that the best predictor of future behavior is past behavior


Covariation Misestimation / Illusory Correlation

When an individual believes that two classes of events are correlated when in reality they are:
-not correlated
-correlate to a lesser extent than believed
-or correlated in the reverse direction from which is reported


Anchoring and Adjustment Effect

Clinician can be influenced by whether an item of information is collected early or late in the course of psychotherapy

-e.g. therapist rated clients as more maladjusted and having a worse prognosis when information about suicidal ideation or anorexia was presented in the first session rather than in the summary of the fourth session

Clinicians can also be influenced by the range of clients with whom they work
-e.g. when two patients on different psychiatric units had a similar level of adjustment, the ratings of adjustment made by clinical staff varied as a function of the level of adjustment of other patients on the unit


Halo Effect

When a salient characteristic of a patient inappropriately influence judgments about a patient's other characteristics

E.g. Observation of depressed nonverbal behavior should not cause clinicians to make severe ratings for symptoms of depression that are not reflected by nonverbal behavior


Hindsight Bias

When individuals overestimate the likelihood that they would have predicted an outcome after they have become aware of the outcome


Conjunction Effect

When individuals rate the likelihood of events A and B both occurring as greater than the likelihood of event A occurring OR the likelihood of event B occurring


Client Characteristics

Judgments and decisions made by mental health professionals are said to be biased when their accuracy varies as a function of the group membership of the client


Gender Bias

Clinicians are significantly less likely to attribute traits that characterize "normal adults" to women than to men

However, clinicians are not biased to view female clients as being less psychologically healthy than male clients

Gender bias may occur for the differential diagnosis of antisocial personality disorder (men) & histrionic personality disorder (women)


Social Class Bias

Lower SES clients are less likely to be referred for psychotherapy

When referred, low SES clients are more likely to be seen for supportive therapy rather than insight oriented therapy

Social class bias is not evident when clinicians describe clients or make diagnoses


Racial Bias

Racial bias is more pervasive than gender bias and social class bias

Racial bias most recently occurs with the diagnosis and treatment of psychotic patients

e.g. white patients with a psychotic mood disorder were more likely to be correctly diagnosed in black and Hispanic patients with a psychotic disorder

Blacks were less likely than whites to receive treatment in accordance with recommended practices


Context Effects

To a surprising extent, the type of treatment provided depends just as much on the particular clinic where client is seen as it does on empirical evidence about what type of treatment works best for what type of patient

The strongest predictor of both admission and involuntary commitment was whether the individual was self referred or accompanied. Individuals were almost always committed when the police were involved or when the first steps of the commitment had already been taken

e.g. Rosenhan (1973)

e.g. diagnoses of conduct disorder decreased by 80% when contextual information suggests that a use problematic behaviors disappeared when he was not in a dangerous environment filled with gang violence


Clinical Judgment, general

It is difficult to learn from clinical experience in part because clinicians often do not receive accurate feedback on whether their judgments are right or wrong, but also because clinicians are not always aware of how social factors affect their judgments, and because cognitive processes are imperfect

Cognitive heuristics are related to making snap judgments because they all involve using a simple rule to make judgments

Cognitive biases they occur more frequently when clinicians make snap judgments

It is natural to form impressions quickly, but clinicians should collect additional information and consider alternative hypotheses, particularly statistical prediction rules

Evidence-based treatment--It is important to avoid using treatments that subjectively feel like it's working without knowing exactly how/why