Causal Reasoning during Reading of Clinical Reports
in Clinicians
Subtitle here
Pedro L. CobosAmanda FloresEstrella González-Martín Francisco J. López &Antonio GodoyFacultad de PsicologíaUniversidad de Málaga
Causal Reasoning During Reading of Clinical Reports in cliniciansIntroduction
The main question
How are causal reasoning processes involved in diagnosing DSM-IV disorders?
Kim & Ahn’s (2002) study:
The Causal Status Effect
Causal Reasoning During Reading of Clinical Reports in clinicians
Kim & Ahn’s (2002) study
Depression
Sadness
Fatigue
Suicide thoughts
Weight alterations
Motor activity problems
Low pleasure in daily activities
Worthlessness and blame feelings
Sleep problems
Lack of concentration
Introduction
Previous work
Causal Reasoning During Reading of Clinical Reports in clinicians
Kim & Ahn (2002)’ study
1. Sadness
2. Worthlessness and blame feelings
3. Low pleasure in daily activities
4. Sleep problems
5. Lack of concentration
6. Motor activity problems
7. Fatigue
8. Suicide thoughts
9. Weight alterations
Depression
+ peripheral
+ central
Introduction
Previous work
Causal Reasoning During Reading of Clinical Reports in clinicians
Kim & Ahn (2002)’ study
Clinical judgements modulated by causal reasoning
More central diagnostic criteria are …
… more important to diagnosis
… better remembered
Introduction
Previous work
Causal Reasoning During Reading of Clinical Reports in clinicians
To extend Kim and Ahn’s results by using on-line measures to detect causal reasoning processes during reading of clinical reports.
Introduction
Our main goal
Causal Reasoning During Reading of Clinical Reports in clinicians
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.
Introduction
Our main goal
Why using on-line measures during reading of clinical reports?
Causal Reasoning During Reading of Clinical Reports in clinicians
Introduction to the experimental strategy:
From text comprehension studies
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
Assumptions and empirical findings behind the logic
Causal Reasoning During Reading of Clinical Reports in clinicians
INCONSISTENT TEXT
Preliminary information
Filler information
Final sentence
Target 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.
Introduction to the experimental strategy:
The inconsistency paradigm (Albrecht & O´Brien, 1993)
Causal Reasoning During Reading of Clinical Reports in clinicians
CONTROL TEXT
Preliminary information
Filler information
Final sentence
Target 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.
Introduction to the experimental strategy:
The inconsistency paradigm (Albrecht & O´Brien, 1993)
Causal Reasoning During Reading of Clinical Reports in clinicians
INCONSISTENT CLINICAL REPORT
• Diagnosis and symptoms
• Filler information
• Final sentence
Target sentence:
Absent criterion: Central / Peripheral
Introduction to the experimental method:
The inconsistency paradigm (Albrecht & O´Brien, 1993)
Causal Reasoning During Reading of Clinical Reports in clinicians
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.
Introduction to the experimental strategy:
The inconsistency paradigm (Albrecht & O´Brien, 1993)
Causal Reasoning During Reading of Clinical Reports in clinicians
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.
Introduction to the experimental strategy:
The inconsistency paradigm (Albrecht & O´Brien, 1993)
Causal Reasoning During Reading of Clinical Reports in clinicians
Experimental strategy
Inconsistency
Paradigm
Manipulation of causal status of DSM-IV
diagnostic criteria
Processes measured:- Comprehension- On-line access- On-line inferences- On-line integration
Causal Reasoning During Reading of Clinical Reports in clinicians
Experimental strategy
Additionally,
For each clinical report, participants in our experiments rated the degree of agreement with the diagnosis stated in the preliminary information.
Causal Reasoning During Reading of Clinical Reports in clinicians
InconsistencyControl
(No inconsistency)
CentralReading timeJudgement
Reading timeJudgement
PeripheralReading timeJudgement
Reading timeJudgement
IV 2CausalStatus
IV 1 Degree of inconsistency
Experimental strategy
Design
Causal Reasoning During Reading of Clinical Reports in clinicians
Hypothesis
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.
Causal Reasoning During Reading of Clinical Reports in cliniciansExperiment 1
Method: participants
Years of practice averaged 17
Most of them cognitive-behavioural
17 clinicians
Causal Reasoning During Reading of Clinical Reports in clinicians
Target + Post-target Reading times
Experiment 1
Results
00
1.900
2.300
2.700
3.100
3.500
Inconsist Control Inconsist Control
CENTRAL PERIPHERAL
Mseg
Deg. Incons. F(1,16)=10.70, p=.005Caus. 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
Causal Reasoning During Reading of Clinical Reports in cliniciansExperiment 1
Results
Judgements (0-100 Agreement)
0102030405060708090
100
Inconsist Control Inconsist Control
CENTRAL PERIPHERAL
Judgem
ent
s
Deg. Incons. F(1,16)=51.40, p<.001Caus. 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
Causal Reasoning During Reading of Clinical Reports in cliniciansExperiment 1
Results
Clinicians
Inconsistency affected by causal status
Affected by inconsistency
Tiempos de lectura y juicios en la misma líneaClinicians rely on causal theories in on-line reasoning during reading of clinical
reports
Causal Reasoning During Reading of Clinical Reports in clinicians
Discussion
The achieved goals
Replication of Kim & Ahn’s (2002) resultsCausal status effect in diagnostic judgements
ExtensionWe 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
Causal Reasoning During Reading of Clinical Reports in clinicians
Discussion
The achieved goals
MethodologicalWe have shown the usefulness of reading comprehension
techniques to study on-line clinical reasoning processes
BUT
Causal Reasoning During Reading of Clinical Reports in clinicians
Discussion
The causal status effect found may be a conceptual centrality effect or a statistical effect.
Causal Reasoning During Reading of Clinical Reports in clinicians
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.
Experiment 2 (almost ready to be run)
Strategy
Causal Reasoning During Reading of Clinical Reports in cliniciansExperiment 2 (almost ready to be run)
Strategy
Body sensations
Emotions
Fear of gaining weight
Cognitive distortions
Altered self-perception of size, weight, and
silhouette
Diet Vomiting Laxative abuse
Weight loss
Amenorrhea
Yellow buttons include DSM-IV diagnostic criteria Toro y Vilardell
(1989)
An example based on anorexia nervosa
Causal Reasoning During Reading of Clinical Reports in cliniciansExperiment 2 (almost ready to be run)
Strategy
Fear of gaining weight
Altered self-perception of size, weight, and
silhouette
Weight loss
Amenorrhea
Yellow buttons include DSM-IV diagnostic criteria Toro y Vilardell
(1989)
An example based on anorexia nervosa
Tem
pora
l ord
er
Causal Reasoning During Reading of Clinical Reports in clinicians
CONSISTENT CLINICAL REPORT
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.
Experiment 2 (almost ready to be run)
Strategy: The reading task
An example based on anorexia nervosa
Target sentence
Causal Reasoning During Reading of Clinical Reports in clinicians
INCONSISTENT CLINICAL REPORT
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.
Experiment 2 (almost ready to be run)
Strategy: The reading task
An example based on anorexia nervosa
Target sentence
Causal Reasoning During Reading of Clinical Reports in clinicians
We expect to find longer reading times for the target sentence in the inconsistent than in the consistent clinical report.
Experiment 2 (almost ready to be run)
Strategy: The reading task
Hypothesis
Causal Reasoning During Reading of Clinical Reports in clinicians
Please, indicate the order in which symptoms appeared in the client:
Experiment 2 (almost ready to be run)
Strategy: The memory task
Altered self-perception of weight
Fear of becoming fat
Amenorrhea
A B C
First
Middle
Last
An example based on anorexia nervosa
Causal Reasoning During Reading of Clinical Reports in clinicians
¿To what extent do you agree with the diagnosis of anorexia nervosa?
Experiment 2 (almost ready to be run)
Strategy: The diagnostic judgement task
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<
0
OK
An example based on anorexia nervosa
Causal Reasoning During Reading of Clinical Reports in clinicians
We expect to find higher ratings of agreement in the consistent than in the inconsistent clinical report.
Experiment 2 (almost ready to be run)
Strategy: The reading task
Hypothesis
Causal Reasoning During Reading of Clinical Reports in clinicians
¿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
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<
0
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0
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<
0
Causal Reasoning During Reading of Clinical Reports in clinicians
¿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
Causal Reasoning During Reading of Clinical Reports in clinicians
¿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
Causal Reasoning During Reading of Clinical Reports in clinicians
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.
Experiment 2 (almost ready to be run)
Strategy: The reading task
Hypothesis
Causal Reasoning During Reading of Clinical Reports in clinicians
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