June 1, 2012

Concepts of Causality in Psychopathology: Applications in Clinical Assessment, Clinical Case Formulation and Functional Analysis

Stephen N. Haynes, PhD; William H. O’Brien, PhD; Joseph Keawe‘aimoku Kaholokula, PhD; and Cilia Witteman, PhD

Journal of Unified Psychotherapy and Clinical Science

This paper discusses and integrates concepts of causality in psychopathology, clinical assessment, clinical case formulation and the functional analysis. We propose that identifying causal variables, relations and mechanisms in psychopathology and clinical assessment can lead to more powerful and efficient interventions. Four criteria must be met in order to infer a causal relation between two variables: (a) covariation between the variables, (b) temporal precedence of the causal variable over the effect, (c) the exclusion of plausible alternative explanations, and (d) a logical basis for inferring a causal relation. These are challenging criteria to meet in clinical assessment. They require multivariate time-series assessment or manipulation strategies with measures that are sensitive- to-change. The bidirectional and dynamic nature of causal relations and the role of the clinician in deriving causal judgments present further challenges to causal inference in clinical assessment. We emphasize the functional analysis as a model of clinical case formulation. The functional analysis emphasizes the specificity of constructs and requires that we identify the mechanisms that explain the causal relations—the means through which a causal effect operates. In sum, concepts of causality provide a scientific foundation and methodological guidance for clinical assessment, clinical case formulation, and the functional analysis.

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