Assessment issues in psychosocial interventions Steve Wood Lecturer

Client involvement in assessment Problem statements Functional analysis Subjective ratings of distress/impact Self-assessment Self-monitoring

Problem Statements detailed description of main affective, physiological, behavioural & cognitive symptoms initial impression of frequency in preceding week & month estimation of severity impact on functioning in broad areas occupation home management private leisure social leisure relationships Next

Problem Statements Should focus directly on difficulties that: Have been identified by the client during the semi-structured assessment interview Have been written, whenever possible, in the client's own words; this helps reduce the use of jargon and provides meaning to the client Describe the problem in observable behaviours Indicate the impact and consequences the problem has on the client's life-style. Example

“Well, my main problem is that meeting people makes me very anxious.” Your role is help the client convert this… Into something like this… “In terms of your mental health, how would you describe your main problem at the moment?” “My main problem is my feelings of anxiety and images of making a fool of myself, accompanied by sweating, muscle tension and nausea and an urge to run away whenever I have to meet unfamiliar people. The anxiety and physical symptoms are quite severe and it occurs at least twice each week. This is affecting my employment, as I have to deal with personal enquiries by members of the public; I have stopped going out socially and my friends have started not to invite me; and it is causing rows between myself and my partner.” “Well, my main problem is that meeting people makes me very anxious.”

Activity You have asked the client what they see as their main current problem in relation to their mental health. Take each of the following potential responses and refine it into a more useful PROBLEM STATEMENT “My main problem is… …I can’t get out because of my panic attacks.” …I’m so miserable I can’t stop crying.” …I worry over the slightest thing and it’s wearing me down.” …the voices get in the way of everything I try to do.” …I can’t stop worrying about my heart.” Remember that a good problem statement needs to encompass – a precise description of how it affects the client’s thoughts, feelings, body, behaviour frequency severity effects on functioning in the following broad areas – occupation, home management, private leisure, social leisure, relationships Back

Activity Read the information about the cognitive model of either panic disorder or health anxiety Imagine yourself as someone who has that problem Being as specific as you can, and giving examples, write a description of how it might affect your thoughts emotions body behaviour and what the linkages between these might be Back

Functional analysis 5W Impact Presenting problem Course FIDO What makes it worse?; makes it better? Where is the problem worse?; better? 5W When is the problem worse?; better? With whom is the problem worse?; better? Why do you think you have this problem? Avoidance What do you find yourself doing less of because of this problem? Impact Presenting problem Behavioural increases What do you find yourself doing more of because of this problem? Over the time you have had this problem, has it got any better?; worse? Course Is there anything you have found that leaves you feeling better?; worse? How often have you experienced this over the last month, week, day? Frequency On a 0-8 scale, where 8 is the most intense, where would you place this feeling ? FIDO Intensity Duration How long does the feeling last before it goes away? Back Occurrence Are there particular instances when it occurs?

Subjective Ratings Subjective ratings of distress/conviction/impact SUDS Subjective Units of Distress Use any scale the client is comfortable with, e.g. 0-10, 0-100 can be used during assessment and in-session Strength of belief – 0-100 scale Work & Social Adjustment Scale Client rates severity of effect of problem on scale from 0 (no effect) to 8 (extremely severe effect) Life domains rated – occupation home management private leisure social leisure relationships Back

Self-assessment May be used in self-help interventions May be used to supplement clinician-administered instruments Should involve client and family/carers if possible Enables client to develop greater understanding of their problem Example Back

Self-monitoring Introduce as early as possible Underlines client’s active role in treatment process Assists socialisation into the model Appropriate self-monitoring measures – general – mood diary, symptom monitoring depression - dysfunctional thoughts record panic – daily panic diary health anxiety – health anxiety thoughts record generalised anxiety – worrying thoughts record OCD – dysfunctional thoughts record See Wells, 1997 for more detailed information and examples Back

References & Further Reading Bellack, A.S. (1986) Schizophrenia: behavior therapy’s forgotten child. Behaviour Therapy, 17, 199-214. Bentall, R. (1990) The syndromes and symptoms of psychosis: or why you can’t play 20 questions with the concept of schizophrenia and hope to win. In R. Bentall (Ed.) Reconstructing schizophrenia. London: Routledge. Bentall, R. (2003) Madness explained: psychosis and human nature. London: Penguin. Berrios, G. 91991) Delusions as “wrong” beliefs: a conceptual history British Journal of Psychiatry, 159, 6-13. Chadwick, P., Birchwood, M., Trower, P. (1996) Cognitive therapy for delusions, voices and paranoia. Chichester: John Wiley & Sons. Gamble, C. & Brennan, G. (2006) Assessments: a rationale for choosing and using. In C. Gamble & G. Brennan (Eds.) Working with Serious Mental Illness (2nd. Ed.). Edinburgh: Elsevier. Mundt, J., Marks, I., Shear, M.K. & Greist, J. (2002) The Work and Social Adjustment Scale: a simple measure of impairment in functioning British Journal of Psychiatry, 180, 461-464. Wells, A. (1997) Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester: John Wiley & Sons. * * * *