An Interview With the Authors of the SPECTRA

This week, Sierra Iwanicki, PhD, project director, spoke to Mark A. Blais, PsyD, and Samuel Justin Sinclair, PhD, the coauthors of the SPECTRA: Indices of Psychopathology to gain more insight into the development and uses of this instrument.

What motivated you to create the SPECTRA?

Mark A. Blais, PsyD: Several factors combined to motivate the SPECTRA's development. Like most psychologists, we were concerned about the shortcomings of the DSM's categorical diagnostic system (e.g., excessive comorbidity, arbitrary thresholds, and within-disorder heterogeneity) and the problems this system created for psychological assessment. Therefore, we were excited by the emergence of multivariate research exploring the structure of adult psychopathology. And as this research accumulated, we became convinced that an instrument based on a hierarchical dimensional model of psychopathology would have great utility for clinical assessment. Unfortunately, to our knowledge, none of the existing psychological inventories were fully congruent with the hierarchical model. Confident that the hierarchical model of psychopathology had significant clinical utility, we decided to develop the SPECTRA. With funding from the Massachusetts General Hospital's Department of Psychiatry, we undertook a rigorous development process that resulted to the SPECTRA's publication in the spring of 2018.

How does the SPECTRA differ from other broadband psychological inventories?

Blais: The SPECTRA differs from other broadband inventories conceptually and interpretatively. Based on contemporary hierarchical models, the SPECTRA was designed to assess psychopathology at three clinically meaningful levels or bandwidths. The 12 clinical scales provide a narrow-band assessment of constructs similar to DSM disorders. The three higher-order scales reorganize symptoms into the broader dimensions of Internalizing, Externalizing, and Reality-Impairing psychopathology. At the broadest level, the SPECTRA's Global Psychopathology Index (GPI) yields a single overarching measure of psychiatric burden and vulnerability. Interpretively, the SPECTRA's three levels of assessment provide unique information about a patient's clinical presentation, course of illness, and prognosis. We suggest employing an interpretive strategy that moves from the global, GPI, through to the three broad dimensions, and down to the specific clinical scales. This approach allows the examiner to write a concise description of severity and prognosis (GPI), complexity and treatment focus (dimensional scales), and current symptom expression (clinical scales).   

What kinds of settings/contexts might the SPECTRA have utility for mental health providers?

Samuel Justin Sinclair, PhD: As our understanding of psychopathology and diagnosis have advanced with the emergence of the hierarchical dimensional model, we believe an instrument like the SPECTRA has broad clinical utility. Clinically speaking, the SPECTRA organizes psychopathology in a unique way that informs a more differentiated understanding of etiology, complexity, and burden. As such, we see utility in comprehensive outpatient clinical assessments (like the ones we conduct in our own practice), where the referral questions and clinical presentations are usually complex. In this context, the SPECTRA offers important information about current symptom expression (e.g., what specifically the patient is experiencing), as well as valuable information about complexity (e.g., elevations in multiple spectra domains) and general burden (i.e., the p factor). Such information is valuable for treatment planning, both in terms of specific targets to focus on (e.g., PTSD symptoms) and also breadth and intensity of services that may be indicated. We also believe the SPECTRA has utility for inpatient or acute treatment contexts, where a more focal psychological assessment may be useful. Given the SPECTRA's lower patient burden (i.e., it is roughly 75% shorter than most other broadband instruments), it may be ideal in these specific types of acute care settings. In fact, we recently published a study assessing the validity and utility of the SPECTRA in an inpatient setting, and the results suggested it performed quite well. Similarly, we have also recently explored the validity of the SPECTRA in a sample of incarcerated individuals with serious mental illness and found good evidence for validity when compared with the specific type and number of SCID-5 diagnoses. Finally, given the SPECTRA's ability to assess psychopathology and functioning at different levels, we believe the instrument has considerable utility in treatment/outcomes monitoring. As a psychometrically sound, low-burden assessment conceptually aligned with contemporary models of psychopathology and research, we believe there are a wide array of different application possibilities with an instrument like the SPECTRA.

What is the p factor and how is it relevant to clinical assessment?

Blais: The p factor represents one of the most exciting and valuable insights revealed by contemporary psychopathology research. Similar to Spearman's general factor of cognitive ability (e.g., g factor), the p factor is an overarching general factor of psychopathology. As the g factor reflects overall cognitive ability, the p factor seems to represent, from low to high, overall psychiatric burden. Therefore, it has the potential to be a reliable single index of a patient's overall psychiatric burden and impairment. The p factor emerges statistically from the positive correlations observed among measures of psychopathology. The statistical p factor is robust and widely replicated. Our conceptual understanding of the p factor is still evolving, but research shows that subjects high on p factor suffer more functional impairment, have greater comorbidity, evidence neurocognitive dysfunction, and are more likely to experience a suboptimal or atypical response to treatment. The SPECTRA, with GPI, is the only broadband inventory specifically designed to generate a validated p-factor measure.

How does the SPECTRA assess psychopathology in a way that is useful for clinicians?

Sinclair: As noted above, the SPECTRA provides unique clinical information at the different levels of the psychopathology hierarchy. At the lowest level, clinicians are able to see where and to what degree patients are expressing primary psychopathology—at the level of the DSM-5 syndromes. However, at the spectra level, clinicians are better able to see how a person's psychopathology may cluster—and whether this tends to reflect more within-domain (or spectra) symptomatology, or across domains. This information may inform clinical decision making in different ways. For example, to the extent that a person is highly distressed, anxious, and depressed—with multiple elevations across these scales, but all within the Internalizing domain—specific classes of pharmacologic and/or types of psychotherapeutic interventions may be indicated. However, in cases where psychopathology is expressed across multiple spectra (with higher p-factor scores), it may signal greater levels of diagnostic complexity, burden, and impairment in functioning—which would suggest that treatment may need to be multimodal, sequenced, and of longer duration and/or intensity. In contrast to other broadband instruments that assess clinical constructs (e.g., depression, mania) as specific or independent entities, the SPECTRA's hierarchical dimensional assessment of psychopathology makes it unique—offering valuable information across different levels of psychopathology. 

What are some important things clinicians should know about the SPECTRA?

Sinclair: We believe the conceptual model described earlier is probably what makes the tool most unique and best aligned with contemporary models of psychopathology. However, the instrument is also quite brief—and at just 96 items, it may be something to consider when testing conditions or context do not allow for longer instruments. Likewise, in addition to the core clinical scales and hierarchical dimensions that are assessed, the SPECTRA also contains several supplemental scales assessing suicidal ideation, cognitive concerns, and adaptive psychosocial functioning. The cognitive concerns scale was designed to be disorder agnostic and is meant to assess the types of general cognitive problems (e.g., organization/attention, memory, language) people may experience respective of etiology. This scale helps assess level of functioning, as perceived cognitive difficulties negatively impact motivation, persistence, and confidence. It also functions as a brief screener that can inform decisions about pursuing more formal neuropsychological assessment. In addition, the SPECTRA's adaptive psychosocial functioning scale was also developed to assess environmental resources (financial and housing), coping strengths, and social support—all of which may be useful for informing treatment recommendations and estimating prognosis. The psychosocial functioning scale was developed from a more positive psychology perspective. We wanted the SPECTRA to focus not only on deficits, but also on strengths and resources. The SPECTRA's supplemental scales provide clinically valuable information above and beyond psychopathology—information that allows us better insight into a person's functioning and where and how we might be able to help as psychologists.

Learn more about the SPECTRA