remaining current in assessment mmpi-2-rf webinar handout · overview ¨ mmpi 1943 ¨ mmpi-2 1989...

David M. McCord, Ph.D. Western Carolina University

[email protected]

Remaining Current in Assessment: Adopting the MMPI-2-RF in your Practice

Agenda

¨  Introduction 10 min ¤  Paradigm shift ¤  Looking ahead (e.g., to MMPI-3)

¨  Features of MMPI-2-RF 20 min ¤  Development, structure, scales ¤  Criticisms and responses

¨  Case examples 40 min ¤  Cases comparing MMPI-2 and MMPI-2-RF ¤  Brief description of interpretation strategy

¨  How to switch? 5 min ¨  Q & A 15 min

1

Overview

¨  MMPI 1943

¨  MMPI-2 1989 ¤ MMPI-A 1992

¨  MMPI-2 RC Scales 2003 ¨  MMPI-2-RF 2008/2011

¤ MMPI-A-RF 2016

¨  MMPI-3 in active development

Paradigm shift in theoretical psychopathology

¨  Categorical versus dimensional models ¨  Categorical models go way back, but Kraepelin formalized our

nosology of “mental disorders” in 1921.

¨  The DSM versions and the ICD versions all reflect elaborated models of the categorical approach.

Schizophrenia Bipolar I Disorder

Major Depressive Disorder Dysthymia

Social Anxiety Disorder Posttraumatic Stress Disorder

Dissociative Identity Disorder Autism Spectrum Disorder

2

Problems with categorical models

¨  “Co-morbidity” or extensive co-occurrence ¤  (One recent patient was “accurately” diagnosed with all 10 PDs!)

¨  Imposes measurement model that does not reflect nature ¤  (Anxiousness is not dichotomous; it is a matter of degree)

¨  Limited construct validity for existing syndromes ¤  (They don’t predict much, e.g., response to medication)

¨  Heterogeneity ¤  Polythetic measurement ¤  Very diverse collection of signs and symptoms in most syndromes

The new paradigm

¨  Re-conceptualization of how we model the distribution of psychopathology in nature

¨  Symptoms, or constructs, are best viewed as dimensional.

¨  The new paradigm is to think about psychopathology as a hierarchical organization of dimensional constructs, ranging from relatively broad to relatively narrow in scope.

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Emerging models of personality and psychopathology

NIMH Research Domain Criteria

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MMPI-2-RF Model of Psychopathology

Somatic/Cognitive Emotional/Internalizing ThoughtDysfunction Behavioral/Externalizing InterpersonalFunctioning

Broad

EIDEmotional/InternalizingDysfunction

THDThoughtDysfunction BXD

Behavioral/ExternalizingDysfunction

Mid-level

RC1Somatic

Complaints

RCdDemoralization

RC2LowPositiveEmotions

RC7DysfunctinalNegativeEmotions

RC6Ideasof

Persecution

RC8Aberrant

Experiences

PSYC-rPsychoticism

RC4AntisocialBehavior

RC9HypomanicActivation

Narrow

MLSMalaise

SUISuicide/Death

Ideation

INTR-rIntroversion

/LowPositiveEmotions

STWStress/Worry

JCPJuvenileConductProblems

AGGAggression

FMLFamilyProblems

GICGastrointestinalComplaints

HLPHelplessness/Hopelessness

AXYAnxiety

SUBSubstanceAbuse

ACTActivation

RC3Cynicism

HPCHeadPainComplaints

SFDSelfDoubt

ANPAnger

Proneness

AGGR-rAggressiveness

IPPInterpersonalPassivity

NUCNeurologicalComplaints

NFCInefficacy

BRFBehaviorRestricting

Fears

DISC-rDisconstraint

SAVSocialAvoidance

COGCognitiveComplaints

MSFMultiple

SpecificFears

SHYShyness

NEGE-rNegative

Emotionality/Neuroticism

DSFDisaffiliativeness

MMPI-2-RF Overview

¨  Published 2008/2011 ¤ Authors Ben-Porath & Tellegen

¨  338 items ¨  Subset of MMPI-2 Item Pool ¨  Norms based on MMPI-2 normative sample ¨  400+ peer-reviewed publications ¨  Used widely in mental health, medical, forensic and

public safety settings

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MMPI-2-RF Overview

¨  Overall Objective: Represent the clinically significant substance of the MMPI-2 item pool with a comprehensive set of psychometrically adequate measures: Ø  Improve efficiency Ø  Enhance construct validity

¨  Overall Strategy: Ø  First restructure the Clinical Scales (resulting in the

Restructured Clinical [RC] Scales) Ø  Then augment the RC Scales with needed additional

measures

Background

¨  Psychometric Challenges ¤ Common factor ¤ Item overlap ¤ Excessive correlations ¤ Heterogeneity

¨  Ad hoc solutions ¤ Code Types ¤ Subscales ¤ Supplementary Scales

¨  Challenges not addressed with MMPI-2

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Development

¨  Factor analyses of targeted item sets to: ¤  Identify and remove (to the extent needed and

feasible) a common factor - Demoralization ¤  Identify Major Distinctive Core Components

¨  Targeted item sets include: ¤ Clinical Scales ¤ Content Scales ¤  Select Subscales ¤  Supplementary Scales ¤ Various “experimental” scales

Development

¨  Correlational analyses augment Seed Scales with items contributing to convergent and discriminant patterns

¨  Scales retained IF show evidence of convergent and discriminant validity

¨  Linked to current models and conceptualizations of personality and psychopathology

¨  The paradigm has shifted ¤ NIMH RDoC Initiative ¤ MMPI-2-RF ¤ PSY-5 models

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MMPI-2-RF Overview

• 51 Scales• 9 Validity Scales• 3 Higher-Order Scales• 9 RC Scales• 23 Specific Problems Scales

• 5 Somatic/Cognitive• 9 Internalizing• 4 Externalizing• 5 Interpersonal

• 2 Interest Scales• 5 PSY-5 Scales

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MMPI-2-RF Scales

MMPI-2-RF: Validity Scales

VRIN-r: Variable Response Inconsistency – Random responding TRIN-r: True Response Inconsistency – Fixed responding

F-r: Infrequent Responses – Responses infrequent in the general population Fp-r: Infrequent Psychopathology Responses – Responses infrequent in

psychiatric populations Fs: Infrequent Somatic Responses – Somatic complaints infrequent in

medical patient populations FBS-r: Symptom Validity – Somatic and cognitive complaints associated at

high levels with over-reporting RBS: Response Bias Scale – Exaggerated memory complaints

L-r: Uncommon Virtues – Rarely claimed moral attributes or activities K-r: Adjustment Validity – Avowals of good psychological adjustment

associated at high levels with under-reporting

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MMPI-2-RF: Higher-Order Scales

Ø  EID – Emotional/Internalizing Dysfunction – Problems associated with mood and affect

Ø  THD – Thought Dysfunction – Problems associated with disordered thinking

Ø  BXD – Behavioral/Externalizing Dysfunction – Problems associated with under-controlled behavior

¨  Identical to MMPI-2 RC Scales

Ø RCd: Demoralization – General unhappiness and dissatisfaction

Ø RC1: Somatic Complaints – Diffuse physical health complaints

Ø RC2: Low Positive Emotions – Lack of positive emotional responsiveness

Ø RC3: Cynicism – Non-self-referential beliefs expressing distrust and a generally low opinion of others

Ø RC4: Antisocial Behavior – Rule breaking and irresponsible behavior

MMPI-2-RF: RC Scales

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Ø RC6: Ideas of Persecution – Self-referential beliefs that others pose a threat

Ø RC7: Dysfunctional Negative Emotions – Maladaptive anxiety, anger, irritability

Ø RC8: Aberrant Experiences – Unusual perceptions or thoughts

Ø RC9: Hypomanic Activation – Over-Activation, aggression, impulsivity, and grandiosity

MMPI-2-RF: RC Scales

¨  Somatic/Cognitive

Ø  MLS: Malaise – Overall sense of physical debilitation, poor health

Ø  GIC: Gastrointestinal Complaints – Nausea, recurring upset stomach, and poor appetite

Ø  HPC: Head Pain Complaints – Head and neck pain

Ø  NUC: Neurological Complaints – Dizziness, weakness, paralysis, loss of balance, etc.

Ø  COG: Cognitive Complaints – Memory problems, difficulties concentrating

MMPI-2-RF: Specific Problems (SP) Scales

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¨  Internalizing (RCd Facets):

Ø SUI: Suicidal/Death Ideation – Direct reports of suicidal ideation and recent attempts

Ø HLP: Helplessness/Hopelessness – Belief that goals cannot be reached or problems solved

Ø SFD: Self-Doubt – Lack of self-confidence, feelings of uselessness

Ø NFC: Inefficacy – Belief that one is indecisive and inefficacious


MMPI-2-RF: Specific Problems (SP) Scales ¨  Internalizing (RC7 Facets):

Ø STW: Stress/Worry – Preoccupation with disappointments, difficulty with time pressure

Ø AXY: Anxiety – Pervasive anxiety, frights, frequent nightmares

Ø ANP: Anger Proneness – Becoming easily angered, impatient with others

Ø BRF: Behavior-Restricting Fears – Fears that significantly inhibit normal behavior

Ø MSF: Multiple Specific Fears – Fears of blood, fire, thunder, etc.

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¨  Externalizing: RC4 Facets Ø  JCP: Juvenile Conduct Problems – Difficulties

at school and at home, stealing

Ø  SUB: Substance Abuse – Current and past misuse of alcohol and drugs

RC9 Facets Ø  AGG: Aggression – Physically aggressive,

violent behavior

Ø  ACT: Activation – Heightened excitation and energy level


¨  Interpersonal: Ø  FML: Family Problems – Conflictual family

relationships Ø  IPP: Interpersonal Passivity – Being unassertive

and submissive Ø  SAV: Social Avoidance – Avoiding or not enjoying

social events Ø  SHY: Shyness – Bashful, prone to feel inhibited

and anxious around others Ø  DSF: Disaffiliativeness – Disliking people and

being around them

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Ø AES: Aesthetic-Literary Interests – Literature, music, the theater

Ø MEC: Mechanical-Physical Interests – Fixing and building things, the outdoors, sports

MMPI-2-RF: Interest Scales

MMPI-2-RF: PSY-5 Scales

¨  Revised versions of dimensional model of personality pathology developed by Allan Harkness and John McNulty: Ø  AGGR-r: Aggressiveness-Revised – Instrumental,

goal-directed aggression Ø  PSYC-r: Psychoticism-Revised – Disconnection

from reality Ø  DISC-r: Disconstraint-Revised – Under-controlled

behavior Ø  NEGE-r: Negative Emotionality/Neuroticism-Revised –

Anxiety, insecurity, worry, and fear Ø  INTR-r: Introversion/Low Positive Emotionality-Revised –

Social disengagement and anhedonia

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A brief summary of criticisms of the MMPI-2-RF, especially vis-à-vis the MMPI-2, and substantive responses to those criticisms.

Criticisms and Responses

Loss of code-type empirical database

¨  The criticism here is that due to substantial structural changes reflected in the RC Scales, the vast literature on code types can no longer be used. ¤  This statement is true. The published code-type interpretations should no longer

be used with the MMPI-2-RF RC Scales profiles. ¤  However, this “criticism” fails to recognize that the code-type approach itself

was an early effort to cope with the failure of the test to perform as originally intended. That is, the heterogeneity of content within scales, and the excessive overlap of items and constructs across scales make the “single scale, single syndrome” aspiration unattainable.

¤  Code types helped somewhat in detecting signal from noise, but the Clinical Scales themselves remain psychometrically flawed.

¤  The MMPI-2-RF substantive scales predict the replicated empirical correlates of the code types with psychometrically improved scales that are linked to contemporary concepts and models in the personality and psychopathology literature.

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“Construct Drift”

¨  The RC scales measure things that are different from those measured by the parent Clinical Scale. ¤  The response here is that indeed, each RC scale is more homogeneous and

focused than its Clinical Scale counterpart. This is intentional, as it enhances precision and discriminant validity. Scale 3 is the most often cited example here.

¤  Whether or not one fully endorses the new hierarchical-dimensional paradigm, one inescapable fact is that you cannot adequately measure a multi-dimensional syndrome with a single scale.

¤  The MMPI-2-RF re-conceptualizes psychopathology as a hierarchically organized set of dimensional constructs, each focused on an important, distinct, and relatively homogeneous element.

¤  Nathan Weed has famously addressed this criticism by noting that one person’s “drift” may be another person’s “zeroing in” or “fleshing out.”

Excessive number of normal-range profiles

¨ The RC Scales result in a higher proportion of within-normal-limits profiles. ¤  This was an early claim, subsequently debunked, based on a large dataset

that included a disproportionately high number of job applicants and custody litigants who typically tend toward underreporting.

¤  It is true that RC Scale profiles tend to include a smaller number of clinically elevated scales, owing to the removal of demoralization from every scale.

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Cases

Case #1 – Mr. B

¨ Mr. B is a 47-year-old married man admitted for outpatient treatment with complaints of depression and suicidal ideation. He recently lost his job and has a history of several previous hospitalizations. He presents with depressed mood, decreased energy, tearfulness, and suicidal thoughts. He was hospitalized for several days, treated with antidepressant medication, and released with diagnosis of recurrent MDD.

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MMPI-2-RF Model of Psychopathology

Somatic/Cognitive Emotional/Internalizing ThoughtDysfunction Behavioral/Externalizing InterpersonalFunctioning

Broad

EIDEmotional/InternalizingDysfunction

THDThoughtDysfunction BXD

Behavioral/ExternalizingDysfunction

Mid-level

RC1Somatic

Complaints

RCdDemoralization

RC2LowPositiveEmotions

RC7DysfunctinalNegativeEmotions

RC6Ideasof

Persecution

RC8Aberrant

Experiences

PSYC-rPsychoticism

RC4AntisocialBehavior

RC9HypomanicActivation

Narrow

MLSMalaise

SUISuicide/Death

Ideation

INTR-rIntroversion

/LowPositiveEmotions

STWStress/Worry

JCPJuvenileConductProblems

AGGAggression

FMLFamilyProblems

GICGastrointestinalComplaints

HLPHelplessness/Hopelessness

AXYAnxiety

SUBSubstanceAbuse

ACTActivation

RC3Cynicism

HPCHeadPainComplaints

SFDSelfDoubt

ANPAnger

Proneness

AGGR-rAggressiveness

IPPInterpersonalPassivity

NUCNeurologicalComplaints

NFCInefficacy

BRFBehaviorRestricting

Fears

DISC-rDisconstraint

SAVSocialAvoidance

COGCognitiveComplaints

MSFMultiple

SpecificFears

SHYShyness

NEGE-rNegative

Emotionality/Neuroticism

DSFDisaffiliativeness

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Case #2 – Ms. D

¨ Ms. D is a 27-year-old single woman referred for treatment by a friend who suggested she get help with regard to history of childhood sexual abuse. She has had outpatient therapy (unsuccessful) in the past but no hospitalizations. She has a history of drug abuse and prostitution. The therapist identified family problems, authority problems, and projection of blame as target issues. She dropped out of treatment after the 4th session.

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Case #3 – Mr. E

¨ Mr. E is a 32-year-old male admitted to an inpatient unit following presenting with significant agitation, religious preoccupation, and psychotic symptoms. He had an extensive history of substance abuse problems and multiple treatment programs. At intake he was intoxicated from a recent crack cocaine binge and was paranoid and suspicious with ideas of reference and obsessional thinking. Discharged to rehab with diagnoses of substance dependence and substance-induced psychosis.

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Case #4 – Ms. F

¨ Ms. F is a 62-year-old divorced woman admitted to an inpatient unit after presenting with paranoid thinking, loose associations, and reported auditory hallucinations. She had a long history of treatment for paranoid schizophrenia. At intake she was tearful, complaining that “the voices” were disrupting her life. She was treated for 2 weeks and discharged to community-based care with diagnosis of paranoid schizophrenia.

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MMPI-2-RF INTERPRETATION STRATEGY

Standard Interpretation Guidelines

¨  MMPI-2-RF Manual for Administration, Scoring, and Interpretation

¨  Ben-Porath 2012 “Interpreting the MMPI-2-RF”

¨  McCord 2018 “Assessment Using the MMPI-2-RF”

¨  All three of these sources include essentially identical interpretation rules, guidelines, and score ranges.

¨  The Interpretation Worksheet is on your screen, and Page 7 plus your selected source of guidelines are handy.

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MMPI-2-RF Interpretation

¨  Substantive Scale Interpretation ¤ Begin with Higher-Order Scales

n  If only one is elevated, use it as starting point then interpret all RC, Specific Problems, PSY-5 scales in that area

n When interpreting RC Scales: n  proceed in order of elevation n  incorporate relevant SP and PSY-5 Scales

n  If more than one H-O Scale is elevated, use highest as starting point, then proceed to next highest

n  If no H-O Scale is elevated, proceed to RC Scales and interpret by domain, in order of elevation, incorporating relevant SP and PSY-5 scales

MMPI-2-RF Interpretation

¨  Substantive Scale Interpretation ¤ Once all H-O and RC Scales are covered:

n  Interpret any remaining elevated SP Scales n  Interpret Interpersonal and Interest scales n  If relevant, add diagnostic and treatment

considerations along the way

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Excerpted from Interpreting the M

MPI-2-RF by Yossef S. Ben-Porath. C

opyright © 2012 by the Regents of the

University of M

innesota. Reproduced by permission of the U

niversity of Minnesota Press.

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Excerpted from the MMPI-2-RF Manual for Administration, Scoring, and Interpretation by Yossef S. Ben-Porath and Auke Tellegen. Copyright © 2008, 2011 by the Regents of the University of Minnesota. Reproduced by permission of the University of Minnesota Press.


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MMPI-2-RF: Standard Comparison Groups ¨  MMPI-2-RF Normative (Men & Women) ¨  Outpatient, Community Mental Health Center (Men & Women) ¨  Outpatient, Independent Practice (Men & Women) ¨  Psychiatric Inpatient, Community Hospital (Men & Women) ¨  Psychiatric Inpatient, VA Hospital (Men) ¨  Substance Abuse Treatment, VA (Men) ¨  Sexual Addiction Treatment Evaluee (Men) ¨  Bariatric Surgery Candidate (Men & Women) ¨  Spine Surgery Candidates (Men & Women) ¨  Spinal Cord Stimulator Candidates (Men & Women) ¨  Chronic Pain (Men & Women) ¨  Epilepsy Monitoring Unit Evaluee (Men & Women) ¨  College Counseling Clinic (Men & Women) ¨  College Student (Men & Women) ¨  Forensic, Disability Claimant (Men & Women) ¨  Forensic, Independent Neuropsychological Examination (Men & Women) ¨  Forensic, Pre-trial Criminal (Men & Women) ¨  Forensic, Child Custody (Men & Women) ¨  Forensic, Parental Fitness (Men & Women) ¨  Prison Inmate (Men & Women) ¨  Sex Offender (Child Victim) Evaluee (Men) ¨  Personnel Screening, Law Enforcement (Men, Women & Combined) ¨  Personnel Screening, Corrections Officer (Men, Women & Combined) ¨  Personnel Screening, Clergy Candidates (Men, Women, & Combined) ¨  Personnel Screening, Firefighter Candidates (Men, Women, & Combined) ¨  Personnel Screening, Dispatcher Candidate (Men, Women, Combined)

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Report Options

¨  Score Report ¨  Interpretive Report

¤ Quick demo?

¨  Spine Surgery Candidate Interpretive Report ¨  Spinal Cord Stimulator Candidate Interpretive Report ¨  Police Candidate Interpretive Report

How to Switch?

Webinars ¨  MMPI-2-RF: Basic Overview, presented by Dustin B. Wygant,

PhD -  Offered via live broadcast, or recorded for viewing at your

convenience, this webinar presentation provides a brief overview of the rationale for, and methods used to develop the MMPI-2-RF, and the various materials available to score and interpret the test.

Workshops ¨  MMPI Workshops & Symposium, June 12-15, 2019 in

Minneapolis, MN -  Choose from a variety of full-day tracks, including an Introduction

to the MMPI-2-RF and Advanced MMPI-2-RF Interpretation. -  For more information, visit www.upress.umn.edu/test-division

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How to Switch?

Online Independent Study Modules ¨  Earn up to 4 APA CE Credits (for a nominal fee).

Information to obtain CE is included with the Online Independent Study lectures. -  Introduction and Overview of the MMPI-2-RF -  Documentation and Features of the MMPI-2-RF -  Scales of the MMPI-2-RF -  MMPI-2-RF Interpretation with Case Examples

How to Switch?

Complimentary Product Trial via Q-global ¨  MMPI-2-RF Interpretive Report: Clinical Settings (2 reports) ¨  Technical Manual (digital) ¨  Manual for Administration, Scoring, and Interpretation (digital) ¨  User’s Guide for Reports (digital)

¤  For more information, contact [email protected]

MMPI-2-RF Interpretation Worksheet ¨  Standard template guiding interpretation of validity and

substantive scales using the transparent guidelines in the MMPI-2-RF Manual for Administration, Scoring and Interpretation (University of MN Press, 2008/2011), Interpreting the MMPI-2-RF (Ben-Porath, 2012), or Assessment Using the MMPI-2-RF (McCord, 2018).

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Questions?

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remaining current in assessment mmpi-2-rf webinar handout · overview ¨ mmpi 1943 ¨ mmpi-2 1989...

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