The technology boom of the late twentieth century and early twenty-first century was not lost on psychologists and behavior therapists. Researchers have been quick to recognize the potential computers offer in the assessment and treatment of individuals with mental health problems. Efforts to computerize the assessment process, or some component of it, have been made by researchers in all the major theoretical orientations. Computer applications take many forms and are not easily categorized. However, in psy chological and behavioral assessment, the following types of applications have emerged.
Computer-assistant programs include software that assists clinicians in collecting client data and/or making diagnostic decisions. For example, researchers have designed computerized behavior observation systems to facilitate naturalistic and analog observation of individuals. Expert systems are computer-assistant programs that include algorithm structures that are designed to simulate diagnostic-decision making. For example, one group of researchers created a smoking cessation expert system that analyzed assessment data, integrated the information, and made individualized recommendations for treatment strategies in a short report. Case formulation software helps clinicians organize important variables operating in a client's life and assists the clinician in developing hypotheses about client functioning. Stephen Haynes and his colleagues have developed a computer program that helps clinicians identify target behavior problems, the effects of those problems, and the causal variables that precede the behavior problems.
Researchers have also developed programs that interactively administer interviews. Direct computer interviews are software programs that administer traditional paper-and-pencil questionnaires or structured interviews without the clinician present. These programs typically aggregate data and print reports that assist clinicians in making diagnostic and treatment decisions. Clients may complete the interviews at the beginning of treatment or throughout treatment. For example, Albert Farrell and his colleagues have developed a software program that clients complete at each treatment session to help clinicians monitor client behavior problems.
Virtual reality programs are often used to simulate challenging or feared environments for individuals and can be used in both assessment and treatment contexts. For example, researchers have developed virtual reality programs for phobic individuals that simulate experiences with a feared stimulus. Recently, one research team concluded that phobic individuals are readily immersed in virtual environments and report levels of fear and anxiety similar to what one would expect to see in an exposure therapy session. From a treatment perspective, initial results suggest that exposure therapy conducted via virtual reality is at least as effective as in vivo exposure. Virtual reality systems have also been used with disabled children to assess acquisition of motor behaviors.
Self-monitoring computer programs have taken a variety of formats prior to the computer revolution. Ecological momentary assessment, or EMA, refers to the collection of self-monitoring or psychophysiological data in the client's natural environment. Researchers often use handheld computers to administer one or more questionnaires to an individual several times per day at scheduled intervals. The questionnaires are typically brief and usually take no more than a few minutes. Researchers then examine the data for relationships between variables of interest (e.g., mood level and activity). One of the most interesting results from EMA studies thus far is the lack of congruence between client ratings of their own behavior in the natural environment and clinician ratings of client behavior in a structured interview. For example, one group of researchers found in individuals diagnosed with Obsessive-Compulsive Disorder that mean clinician ratings of client symptom severity were almost one standard deviation higher than levels reported by clients in their natural environment.
Computer-based test interpretations (CBTIs) are software programs that generate interpretive reports after assimilating data that are collected by a clinician or a computer. For example, a client might complete a paper-and-pencil administration of a psychological test (e.g., the Minnesota Multiphasic Personality Inventory). The clinician then enters the client's responses into the computer program, and the software generates an interpretive report based on a predetermined algorithm. Alternatively, report generation may be included as an additional feature of a direct computer interview. CBTIs can greatly expedite the process of report writing, but critics argue that they are not sensitive to an individual's unique circumstances, use report-writing rules that are of questionable validity, and tend to produce reports that vague and not clinically meaningful. Most researchers have concluded that CBTIs can be valuable adjuncts to, rather than substitutes for, more individualized clinical assessment and judgment.
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