How Robust is the Influence of Causal Explanation on Clinical Judgments? Assessments in Structured Clinical Interviews

ABSTRACT

When causal life-event explanations for disorder symptoms are available, clinicians tend to explain away those symptoms (Ahn, Novick, & Kim, 2003; Meehl, 1973), eschewing formal diagnostic guidelines such as the DSM-5 (American Psychiatric Association, 2013). We asked whether this effect is attenuated in the context of a structured diagnostic clinical interview procedure, which deliberately directs evaluators' attention to symptoms alone, or whether it is robust enough to continue to emerge. Across two experiments, lay evaluators given causal life-event explanations for disordered behaviors gave them lower judgments of abnormality and need for treatment compared to evaluators not given such explanations, regardless of whether they used a structured clinical interview. Thus, causal life-event explanations may have significant impact on clinical evaluations regardless of the mode of assessment. Implications for the clinical utility of structured interviews and the role of life-event context in diagnosis and classification are discussed.

KEYWORDS:

• Assessment
• clinical
• diagnostic and nosological systems

Acknowledgments

We thank Neal Pearlmutter, John Coley, and Susan Latiff for helpful feedback on an earlier draft of this manuscript. We also thank Anthony Formicola, Alexandra Peterson, Jacqueline Kenitz, Jamie Kotcher, Katharine Quain, and Dillon Smith for their assistance with study stimulus creation and data collection, and Hannah Lumberg and Julie Nagler for proofreading.

Author Notes

Mason R. Jenkins, MA, is a doctoral candidate in the Psychology Department at Northeastern University. His research focuses on causal reasoning in applied contexts such as clinical judgment. His work also addresses the influence of causal reasoning on counterfactual thinking.

Nancy S. Kim, PhD, is an associate professor in the Psychology Department at Northeastern University. Her research addresses how people's prior knowledge, beliefs, and expectations influence mental health assessment, memory for patients' symptoms, and decisions about treatment.

Notes

¹ Complete case transcripts are provided in the supplemental materials.

² Although the SCID-5 had not yet been released when construction of study materials began, we wrote the vignette materials such that they would have had the same diagnoses using either the DSM-IV-TR (i.e., SCID-I) or the DSM-5 (i.e., SCID-5).

³ Kim and LoSavio (2009) previously ruled out the possibility that vignette length, not causal explanations, drives the “understanding it makes it normal” effect. They showed that clinicians only “explained away” abnormal behaviors (relative to a no-causal-explanation control) when they were prefaced by a causal explanation judged to be plausible. An equally long, but implausible explanation (which was thereby judged to be non-causal) had no effect on judgments. In addition, they found that only externally-controlled explanations, and not internally-controlled ones, drive the effect.