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Reducing misdiagnosis in mental health professions: a study of a promising practice

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Content Running head: REDUCING MISDIAGNOSIS IN MENTAL HEALTH PROFESSIONS 1

REDUCING MISDIAGNOSIS IN MENTAL HEALTH PROFESSIONS:
A STUDY OF A PROMISING PRACTICE

by

Kristy A. Hodson

___________________________________________________________________

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December 2019

Copyright 2019 Kristy A. Hodson

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DEDICATION
This dissertation is ultimately dedicated to all those who have suffered from, are suffering
from, and may have even died as a result of being misdiagnosed by mental health professionals
including my father, William (Bill) Bertolio, who passed away November 2017, and my
husband, Branddon Hodson, whose story is in the preface. Someday our future knowledge of the
biological causes of mental illness will shed a new light on all the senseless tragedies that are
occurring because of our current lack of understanding of this information. Future knowledge of
the brain and body will also illuminate the sad realities many who are suffering from mental
illness are living through because of the ignorance of the information we currently have available
to us. To all those fighting unknown or misunderstood battles, I honor you and your quest.

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ACKNOWLEDGEMENTS
I could not have completed my degree without help from the many people that supported
me and helped me through this work. Below are just a few of the people I would like to publicly
thank for the help and inspiration they provided me while I worked through this process:
Thank you to my committee members: Dr. Patricia Tobey, Dr. Ruth Chung, Dr. Mark
Pearson, as well as my assistant chair, Dr. Don Murphy. Each of you have been such a huge
support and instrumental in helping me put this all together. Thank you for your support,
knowledge, and encouragement.
Thank you to the great instructors I have had the pleasure of working with through my
courses at USC including Dr. Monique Datta, Dr. Brandon Martinez, Dr. Alexandra Wilcox,
Dr. Darline Robles, Dr. Adrian Donato, Dr. Eric Canny, Dr. Themistocles Sparangis,
Dr. Ravneet Tiwana, Dr. Richard Seder, and Dr. Raquel Sanchez. Your help and assistance was
valued and appreciated. Thank you for your dedication to your students, your passion for your
work, and for the knowledge and experiences you were willing to share with me and your other
students.
I would like to give a special thanks to Dr. Monique Datta. During my first term, I was
doubting myself and letting fear get the best of me. I emailed Dr. Datta regarding my concerns
and she called me back within a half hour of receiving my email even though it was later in the
evening. She encouraged me forward and helped me believe I could complete my degree. I will
always appreciate her for the impact that one phone call had on my life. Thank you Dr. Datta for
caring about your students and for helping me believe in myself again.
Thanks to my wonderful Cohort 8 classmates. They made my Saturday classes a delight
and I have been forever changed because of their influence. They are all wonderful people, and I
REDUCING MISDIAGNOSIS IN MENTAL HEALTH PROFESSIONS

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am honored to be among them. Thank you Cohort 8 for offering your friendship, sharing your
wisdom and experiences, and for cheering and motivating me on.
A big thank you to Dr. Daniel Amen. His courage in pushing forward with his brain-
based approach to mental health even when his own profession did not and does not fully
understand the brilliance of his work has been inspiring to me. I believe in the future he will be
regarded as one of the greatest mental health pioneers. Thank you Dr. Amen for your incredible
example, your dedication to your work, as well as your courage.
Thank you to all of the wonderful interview participants who interviewed with me for this
study. They were knowledgeable, sincere, passionate, and generous with their time and
explanations. I am grateful for the work each of them are doing to move this information
forward and to help their patients achieve brain health. I will remember them always. Thank
you interview participants for giving so much of yourself for what you believe in.
Thank you to my wonderful managers at Western Governors University. Cameron Cross,
Tommie Smith, as well as the rest of the C820 team in the College of Health Professions have
been incredibly supportive to me while I have been going through my degree program. Thank
you for believing in me, for working with me, and for helping me become my best self. You are
great examples to me of what true leadership is.
Thank you to my incredible mother, Arlene Bertolio, my many other wonderful family
members, and my amazing friends who supported me along the way. It has been said it takes a
village to raise a family, and that has been especially true as I have worked through this doctoral
program. Thank you for caring about my family, for giving us so much of your time, and for all
of your support.
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Thank you to my four wonderful children: Kaylee, McKell, Kira and Hawk. They have
been so patient with and supportive of their mom through this entire process. We now have a
new addition to our family, a golden retriever puppy named Chloe, we just adopted as a
celebration for the hard work and dedication we have ALL put in as a family to complete this
degree. I love each of you. Words cannot thank you enough.
Thank you to my brilliant husband, Branddon Hodson, who has lived a life few can fully
comprehend. His experience with mental illness is why I chose this topic for my dissertation.
His belief in me as well as his encouragement to begin a doctoral program is why I was
ultimately able to pursue my doctoral degree. Thank you, Branddon, for believing in me in the
first place.

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PREFACE
My dissertation committee asked me why I chose to focus on misdiagnosis in mental
health professions for my dissertation topic. The committee also asked me why I am so
passionate about this topic. To give context to this study, I will share a bit about my and my
husband’s story.
Just over 20 years ago, I met my husband, Branddon Hodson. Branddon was intelligent,
genuine, thoughtful, and ambitious. He was already a state champion swimmer and he managed
a pool that was independently determined to be one of the safest in the country. We decided to
get married about a year after we met in September of 1999. About a month before we were
married, my husband experienced a severe trauma at the pool he was working at. In that
moment, he said he could feel something break within his brain, and he has never felt quite the
same since. I did not notice the change in Branddon that much until just after we were married.
He developed severe OCD tendencies, he became massively depressed, and he began to suffer
from debilitating anxiety. He went from being extremely successful to not being able to
complete his terms at the university we were attending and not being able to work.
Branddon sought help from mental health professionals immediately. Although the
mental health professionals we went to were kind and caring, they were not able to help him.
We went from psychologist to psychologist, doctor to doctor, therapist to therapist without any
significant help. Often when we went to a new mental health professional, he was given a new
diagnosis and a new medication and neither helped him nor his symptoms. When he was in the
military, he was ordered to keep taking medications even though they were making him
extremely ill. I cannot begin to explain what a defeating, humiliating, and exhausting process
this was for both of us.
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Branddon was given many different diagnoses and treatments while he was sick. He
tried cognitive behavioral therapy several times, which is the traditional approach for OCD, but
every time he pushed himself past a certain fear, a more complex and challenging foe would take
its place. The mental health professionals we saw would often even blame him when the
medications and therapies did not work. They would sometimes just say he wasn’t complying
with treatment well enough. Often they would say to Branddon, “you need to stop your
behavior,” and he would say, “yes, I know I need to stop . . . how do I do that?” Usually they
had no answer that he hadn’t already tried. There were so many different treatments
recommended, so many different medications prescribed, but none of them helped and many of
them only made him worse. Branddon was ultimately diagnosed with post-traumatic stress
disorder (PTSD), obsessive compulsive disorder (OCD), massive depressive disorder (MDD),
attention deficit hyperactive disorder (ADHD), generalized anxiety disorder (GAD), and autism
spectrum disorder (ASD).
In an effort to help my husband, I obtained my master’s degree in Psychology in 2007.
Although it was a good program, I was stunned at the lack of scientific evidence backing the
various diagnoses and treatments I was learning about as well as the ambiguity in the way I
could approach treatment with my students and clients. At that time, very little was discussed in
my program regarding the biological causes of mental illness or how the brain affects behavior.
I remember very clearly the defeating moment I realized I was not going to be able to help my
husband with the information I was learning in my master’s program. It was a devastating blow
in an already challenging circumstance.
I heard about Amen Clinics while watching a PBS special. My husband, at the time, was
barely able to get out of bed and he had been sick with mental illness for over 15 years. We had
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tried everything we knew of and we were too exhausted and frustrated to try anything else, but I
finally convinced him to go out to Amen Clinics. It was a hard trek for Branddon to make. He
struggled with touching most anything, and he didn’t like to fly. He had to check into three
different hotels before he found one he could stay in. He was so stressed out, he actually missed
his exit and had driven almost an hour away before he realized where he was. Several times he
almost decided not to go to his appointment because his anxiety was almost too much to handle.
He pushed through the pain and went to the appointment anyway.
Once he walked into Amen Clinics, it gave him new hope. Amen Clinics’ brain-based
approach helped him realize he wasn’t crazy. After looking at the scans, he could clearly see the
problems within his brain. Furthermore, Amen Clinics was able to bring clarity to his situation
by dismissing the idea that his problems were OCD because his brain images highlighted a
diamond shape activity within his brain strongly associated with PTSD. Amen Clinics was able
to shed light on a very complex case. They offered hope and Branddon came back with a belief
he might feel normal again one day. After a few months he started feeling noticeably better and
after six months he was able to get out of the house and do things he had not done in years. He
often talks to me about how much Dr. Amen’s methods helped him. The S-adenosyl-L-
methionine (SAMe) he was prescribed through Amen Clinics brought relief to the pain he was
experiencing and helped him be able to function again.
Amen Clinics’ brain-based approach also changed the way I looked at my husband’s
mental illness as well. I no longer just thought he wasn’t trying hard enough, just needed a better
attitude, or that he was just making the whole thing up. Instead, I could see the disfunction going
on within his brain, and it brought more compassion into how I treated him and his illnesses.
Amen Clinics’ methods also brought clarity of Branddon’s situation to those around us. Family
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members and friends who sometimes told me I was enabling his condition or told him he just
needed to “push himself out of it” also developed a level of compassion for his mental illnesses,
and we all started to understand it was his brain that was the issue, not Branddon. This switch in
how we thought about mental illness was life-changing for all of us.
Recently we did genetic testing — which you can now do through Amen Clinics — and
found out that genetically Branddon cannot effectively process serotonin and dopamine. This
genetic condition explained why many of the medications he was prescribed by other mental
health professionals made him even more sick. It also explained and confirmed why Dr. Amen’s
SAMe recommendation had worked so well for him.
We were grateful for the help of Branddon’s Native American tribe which financially
helped us cover the costs of the scans, the supplements, and the treatments our insurance
company refused to cover. Without the tribe, we might not have been able to afford what
ultimately helped him feel better.
My husband and I are very grateful for the knowledge Amen Clinics’ brain-based
approach has had on our lives. We wish we would have had this knowledge earlier on in our
marriage because it would have helped us make better sense of his situation at the onset of
symptoms. I am grateful to be able to share a bit of our story with others who it may help. We
understand the frustration of having no answers, the sadness of not knowing what to do, and the
damage that can be done through misdiagnosis in mental health. We need to start looking at
mental illness differently. There is a better way.

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TABLE OF CONTENTS
Dedication 2
Acknowledgements 3
Preface 6
List of Tables 12
List of Figures 13
Abstract 14
Chapter 1: Overview of the Study 15
Introduction to Problem of Practice 15
Background of the Problem 16
Organizational Context and Mission 17
Organizational Performance Status 19
Description of Stakeholder Groups 20
Stakeholder Group for the Study 21
Purpose of the Project and Questions 21
Conceptual and Methodological Framework 22
Definitions 22
Organization of the Dissertation 23
Chapter 2: Literature Review 24
Influences on the Problem of Practice 24
Clark and Estes’ (2008) Knowledge, Motivation and Organizational Influences 31
Framework
Stakeholder Knowledge, Motivation and Organizational Influences 32
Summary 38
Chapter 3: Research Methodology 39
Conceptual Framework: The Interaction of Stakeholders’ Knowledge and 40
Motivation and the Organizational Context
Participating Stakeholders 43
Data Analysis 46
Credibility and Trustworthiness 46
Written Plan 48
Informed Consent 48
Data Storage 49
Location of Study 49
Context of the Study 49
Assumptions and Biases 49
Limitations and Delimitations 50
Chapter 4: Results and Findings 52
Participating Stakeholders 53
Results and Findings 57
Summary Findings 99
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Chapter 5: Discussion and Recommendations 101
Organizational Context and Mission 101
Organizational Performance Status 103
Description of Stakeholder Groups 103
Purpose of the Project and Questions 104
Recommendations for Practice to Address KMO Influences 106
Integrated Implementation and Evaluation Plan 120
Strengths and Weaknesses of the Approach 135
Limitations and Delimitations 135
Future Research 138
Conclusion 139
References 141
Appendices 147
Appendix A: Survey Items 147
Appendix B: Reducing Misdiagnosis 152
Appendix C: Sample Post-Training Survey Items Measuring Kirkpatrick 155
Levels 1 and 2
Appendix D: Sample Blended Evaluation Items Measuring Kirkpatrick 156
Levels 1, 2, 3, and 4
Appendix E: “Other Comments Regarding How SPECT Scan Imaging Has 158
Impacted Your Ability to Diagnose Mental Health Patients: (Open Ended)”
(All Comments)
Appendix F: “Other Comments Regarding How Being Affiliated With Amen 160
Clinics Has Impacted Your Ability to Diagnose Mental Health Patients
(Open Ended)” (All Responses)
Appendix G: Stories of Success From the Mental Health Professionals 162
Interviewed

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LIST OF TABLES
Table 1. Descriptive Statistics of Survey Participants 54
Table 2. Mental Health Professionals by Type 55
Table 3. Interview Participants 56
Table 4. Research Question 1 Findings and Themes 58
Table 5. Research Question 2 Findings and Themes 69
Table 6. Research Question 3 Findings and Themes 82
Table 7. Research Question 4 Findings and Themes 95
Table 8. Summary of Knowledge Influences and Recommendations 107
Table 9. Summary of Motivation Influences and Recommendations 112
Table 10. Summary of Organizational Influences and Recommendations 117
Table 11. Outcomes, Metrics, and Methods for External and Internal Outcomes 123
Table 12. Critical Behaviors, Metrics, Methods, and Timing for Evaluation 124
Table 13. Required Drivers to Support Critical Behaviors 126
Table 14. Evaluation of the Components of Learning for the Program 130
Table 15. Components to Measure Reactions to the Program 132

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LIST OF FIGURES
Figure 1. Conceptual framework 41
Figure 2. I have more information/tools to diagnose patients effectively since becoming 59
affiliated with Amen Clinics
Figure 3. The knowledge I have gained through my affiliation with Amen Clinics has 72
helped me better understand the biological causes of mental illness
Figure 4. Better understanding of how SPECT scan imaging can impact diagnosis 84
Figure 5. I have changed the way I diagnose patients because of my affiliation with 93
Amen Clinics
Figure 6. Evaluating the effectiveness of a treatment plan for a patient is important 97

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ABSTRACT
Mental illness is a significant problem within the United States. Currently, there is a lack of
biological and brain-based approaches used to diagnose patients. The purpose of this study was
to assess what tools mental health professionals utilize in order to diagnose their patients and to
determine how adding Single-Photon Emission Computed Tomography (SPECT) scan imaging
to a mental health professional’s toolbox could help increase the effectiveness of diagnostic
methods. Clark and Estes’ framework was used to study the knowledge, motivation, and
organizational (KMO) influences of Amen Clinics’ biological and brain-based approach. This
study examined: (1) the tools the mental health professionals who are affiliated with Amen
Clinics used to diagnosis patients; (2) the level of knowledge the mental heath processionals had
regarding the biological and brain-based causes of mental illness; (3) how using SPECT scan
imaging and other brain-based approaches improved patient diagnosis; and (4) the types of
accountability mental health professionals held themselves to for a correct diagnosis. This study
found that utilizing a biological and brain-based approach helped the mental health professionals
studied to build relationships with their patients and enabled them to recognize issues going on
within their patients’ brains and bodies they would not have caught otherwise. This study also
found that tools like SPECT scan imaging provided data for these mental health professionals
that were helpful in differential diagnosis, especially in complex cases, and helped their patients
to engage in treatment. By applying the New World Kirkpatrick Model, an approach is proposed
that mental health professionals can employ to utilize these biological and brain-based methods
with their patients for a more accurate and precise diagnosis.
Keywords: misdiagnosis, mental health, SPECT scan imaging, diagnosis, mental illness, brain-
based approaches, Amen Clinics
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CHAPTER 1
OVERVIEW OF THE STUDY
Introduction to Problem of Practice
Mental illness is a significant problem within the United States. The National
Association for Mental Illness (NAMI) was established in 1979 and has since grown into the
largest grass roots mental health organization in the United States. According to NAMI about 1
in 5 adults in America experience a diagnosable mental illness in any one particular year (NAMI,
2017). Also according to NAMI, about 1 in 25 adults in America experience a significant mental
illness that seriously affects that person’s ability to carry out normal activities. In addition,
NAMI cites suicide is the 10th leading cause of death in America, the second leading cause of
death for those ages 15–24, and the third leading cause of death for those who are ages 10–14
(NAMI, 2017).
With mental illness becoming an ever-increasing issue within our society, it is critical
that mental health professionals are able to diagnose and treat these illnesses as effectively as
possible. The current means of diagnosis and treatment do not adequately address the natural,
biological, environmental or genetic issues associated with the brain (Amen, 2013).
Furthermore, the main diagnostic tool for mental health professionals, the DSM, lacks
acknowledgement of these biological factors which severely limits the ability of mental health
professionals to make well-informed and helpful diagnoses for their patients (Amen, 2010).
In order to improve diagnosis and treatment of patients, current diagnostic and treatment
methods need to be examined and possible improvements to these methods need to be
considered. By evaluating and critiquing the current methods used to diagnose patients, mental
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health professionals will be able to move their models towards higher levels of validity and
reliability.
Background of the Problem
In 1980, the American Psychiatric Association adopted the Diagnostic and Statistical
Manual (DSM), claiming that it would increase the reliability of psychiatric diagnosis (Kirk &
Kutchins, 1988). The DSM provided a way for mental health practitioners to have a common set
of diagnostic criteria to aid in the diagnosis of mental health related conditions. However, Kirk
and Kutchins (1988) found there has been significant debate as to whether the DSM has been
able to reduce the amount of unintentional and intentional diagnostic errors by clinicians. The
DSM has been highly criticized because of its lack of evidence and assumptions (Braun & Cox,
2005). Furthermore, Braun and Cox (2005) go on to state that the increase of managed health
care has created incentives for mental health practitioners to misdiagnose patients in order to
obtain insurance reimbursement.
The National Institutes of Mental Health is the lead federal agency for research on mental
disorders as well as the largest scientific organization in the world. In 2005, the director of
NIMH, Thomas Insel, stated the DSM has 100% reliability and 0% validity (Amen, 2010). Insel
went on to state that in order to progress, psychology would need to understand the underlying
biology of mental disorders and develop treatments that address the core pathology. Getting to
the root cause of mental illness and labeling it correctly are key components of ensuring that
each individual is given the help they need to become healthy members of society (Amen, 2013).
Importance of a Promising Practice Project
A promising practice is an emerging organization that uses specific techniques that have
a favorable potential to combat a specific problem. It is important to explore more effective
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techniques mental health professionals can use to diagnose patients. If mental illnesses are not
diagnosed correctly, individuals are more likely to be given a wrong treatment which may
potentially make their situations worse than if they had never gone to a mental health
professional at all (Amen, 2010). If the mental health community is unable to fix how many
individuals are misdiagnosed with mental illness, society is at risk for increased unemployment
rates as well as an increased risk of substance abuse, shootings, suicides, and other crimes
throughout society (Amen, 2010, 2013).
Organizational Context and Mission
The Amen Clinics was established by Dr. Daniel Amen in 1989. Dr. Amen is a
physician, psychiatrist, ten-time New York Times bestselling author, and professor. Dr. Amen’s
focus is on brain health and brain-centered healing. The belief behind this focus is if the brain is
healthy, people are happier and healthier. The Amen Clinic seeks to optimize brain health to
enable the success of its patients in all areas of their lives. Their science-based and well-
researched processes result in more data being collected and more accurate diagnosis for the
patients they serve.
Amen Clinics, Inc. is currently one of the world leaders in using Single-Photon Emission
Computed Tomography (SPECT) scan imaging and brain imaging science to help people
struggling with mental illness. SPECT scan imaging was first developed in the 1960s and has
since been shown to be an effective tool in differential diagnosis of various neuropsychiatric
diseases as well as to provide an objective evaluation tool for mental illness (Dierckx, Otte,
DeVries, Waarde, & Leenders, 2014). SPECT scan imaging utilizes nuclear medicine and
gamma rays to provide 3D information about the brain including blood flow and lack of blood
flow to specific regions. SPECT scan imaging also looks at energy levels in certain parts of the
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brain. Amen Clinics uses SPECT scan imaging to obtain more data and information that might
be useful in evaluating patients (Amen, 2010). SPECT scan imaging allows mental health
professions the ability to see if the brain is healthy and functioning properly and aids them in
getting a better idea of various problems that might be happening within the brain. Amen Clinics
has the world’s most expansive database of brain scans related to behavior.
Amen Clinics currently has eight clinics spanning across the United States. The Amen
Clinics’ method has been developed over 22 years. Amen Clinics focuses on a four circles
approach: biological (genes, family history, diet and exercise, head injury, or environment
toxins), psychological (how you think, developmental events, attachment problems, past
emotional traumas), social (stresses experienced, health and happiness of the people you spend
time with) and spiritual (why you care, why are you on the planet, connections with past and
future generations, connections to the planet, your religious beliefs, what is important to you).
This four-circle approach helps to create a more specific, personal diagnosis with targeted
treatment based on the collection of a large amount of information, which results in the best
possible understanding of the patient and their symptoms. The Amen Clinics method also
focuses on using the least toxic, most effective treatments possible based on information
obtained by SPECT scan imaging in the bio, psycho, social, spiritual context.
In a multisite, six-month outcome study of 500 complex psychiatric patients, it was found
adding tools like SPECT scan imaging to diagnosis achieved a 75% reported significant clinical
improvement rate for the patients studied (Amen, Jourdain, Taylor, Pigott, & Willeumier, 2013).
Through studying the brain, Dr. Amen has discovered seven different types of anxiety and
depression, seven different types of ADD, six different types of addicts, and five types of
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overeaters. Being able to identify and differentiate between these different types is an important
step to moving psychology forward.
In order to assist mental health professionals in developing the skills needed to evaluate
patients using their brain-based approach, Amen Clinics has developed a Brain Health Coaching
Certification Course. This training provides practitioners with a 40-hour training course that
focuses on brain health, the latest advances in brain-health care, as well as ideas on how to
implement Amen Clinics’ methods to help assist them in achieving more accurate diagnosis and
treatment outcomes for their patients.
Organizational Performance Status
Currently the rates of mental illness in America are not improving. The current methods
used to treat mental illness by counseling psychologists are insufficient to address this growing
concern. A push for more biologically-focused and scientifically-driven mental health
professionals is needed to better ensure the best treatment methods and approaches are being
used for their patients. Furthermore, accountability metrics need to be instituted to push mental
health professionals towards more valid and reliable treatment methods. Amen Clinics currently
push for their clinicians to achieve an 80–85% significant improvement rate for their patients.
These results are significantly higher than most others in their field, especially considering that
oftentimes patients of Amen Clinics are those who have tried other methods of
psychology/psychiatry without significant success. Amen Clinics also performs before and after
scans to ensure brain function is improving with diagnosis and treatment.
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Description of Stakeholder Groups
Several stakeholders contribute to or benefit from more effective treatment of mental
illness. Three key stakeholder groups are mental health professionals, patients of these mental
health professionals, and society as a whole.
Mental health professionals are key stakeholders that contribute to the correct diagnosis
of their patients. Most of these mental health professionals work one-on-one with patients to
help them work through life-events, diagnose them with potential mental illnesses, and develop
treatment plans. Mental health professionals work in a variety of environments and with various
focuses. A large portion of mental health professionals are paid for by third party payers such as
insurance companies.
Patients are also a key stakeholder group in this performance goal because the patients
benefit by the services offered by mental health professionals. The patients are the ones who
also carry out treatment plans and work through therapies given by the clinicians. Patients also
benefit greatly by effective and correct diagnosis and treatment.
Society is the final key stakeholder group because of the toll mental illness plays in the
society in which we live. By decreasing mental illness we help people go back to work, function
normally, and live healthier lives. Police officers spend a large portion of their time dealing with
and managing mental illness. Many hospital staff also spend a significant amount of time
dealing with the mentally ill. Mental illness has considerable and nearly incalculable costs on
society. By reducing the misdiagnosis of those who are mentally ill, society will have less of a
burden to carry regarding dealing with and taking care of these individuals.
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Stakeholder Group for the Study
Although a complete analysis of the problem of practice would involve all stakeholder
groups, for practical purposes this study will be focusing in on those mental health professionals
who have gone through the Amen Clinics Brain Health Certification Course and are listed as
Amen Clinic affiliates. This study will examine how the Brain Health Certification course has
helped these mental health professionals more accurately diagnose and help their patients.
Purpose of the Project and Questions
The purpose of this project is to assess what tools mental health professionals utilize in
order to diagnose and treat their patients and to determine how adding SPECT scan imaging to
their toolbox can help to increase the effectiveness of diagnosis and treatment methods. While a
complete study would focus on all stakeholders, for practical purposes the stakeholder to be
focused on in this analysis are the mental health professionals who affiliate with Amen Clinics.
Research has been described as a systematic process which allows us to gain more
knowledge than we did before the research (Merriam & Tisdell, 2016). The project goal is to
develop a counseling framework that will improve the reliability and validity outcomes of mental
health professionals as well as to identify knowledge gaps in association with the biological and
neurological causes of mental illness.
The main stakeholder group in the study will be the mental health professionals that
affiliate with Amen Clinics by being listed as affiliates of Amen Clinics through their website.
These mental health professionals will be the focus of the interviews and surveys so their
knowledge as professionals can add to the literature that has already been collected. By focusing
in on these mental health affiliates as the main stakeholder, the study will also benefit patients
because they are directly tied to the knowledge and motivation of mental health professionals.
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This study will also utilize Clark and Estes’ (2008) gap analysis model to perform a
needs analysis for possible Knowledge, Motivation, and Organizational (KMO) gaps that could
lead to greater reliability and validity for diagnosis in the future. As such, the research questions
that guided this study were the following:
1. What tools do Amen Clinics’ mental health affiliates utilize to diagnose patients?
2. What level of knowledge do Amen Clinics’ mental health affiliates have regarding
biological and brain-based causes of mental illness?
3. How can using SPECT scan imaging and other brain-based approaches improve
patient diagnosis?
4. What types of accountability do mental health professionals hold themselves to for
correct diagnosis?
Conceptual and Methodological Framework
Clark and Estes’ (2008) gap analysis, a systematic, analytical method that helps to clarify
organizational goals and identify gaps between the actual performance level and the preferred
performance level within an organization, will be adapted for needs analysis. Assumed
knowledge, motivation and organizational needs will be generated based on personal knowledge
and related literature. These needs will be validated by using surveys and interviews, literature
review and content analysis. Research-based solutions will be recommended and evaluated in a
comprehensive manner.
Definitions
Diagnostic and Statistical Manual (DSM): The DSM is published by the American
Psychiatric Association (APA). The manual creates a common language with which to speak
regarding classification of mental disorders as well as standardized criteria.
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Mental illness: The DSM defines mental illness as the following: A clinically significant
behavioral or psychological syndrome or pattern that occurs in an individual and that is
associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or
more important areas of functioning) or with a significantly increased risk of suffering death,
pain, disability, or an important loss of freedom (American Psychiatric Association, 2013).
SPECT Scan Imaging: SPECT stands for Single-Photon Emission Computed
Tomography. This method uses nuclear medicine and gamma rays to provide 3D information
about the brain including blood flow and lack of blood flow to specific regions.
Organization of the Dissertation
Five chapters are used to organize this dissertation. This chapter provided the reader with
the key concepts and terminology commonly found in a discussion about improving treatment
outcomes for those with mental illness. Amen Clinics’ mission, goals, and stakeholders as well
as the initial concepts of gap analysis adapted to needs analysis were introduced. Chapter 2
provides a review of current literature surrounding the scope of the study. Topics surrounding
the current problems associated with ineffective diagnosis and treatment as well as the overuse of
the DSM and serotonin-based treatment methods are also addressed. Chapter 3 details the
assumed causes for this study as well as methodology when it comes to choice of participants,
data collection, and analysis. In Chapter 4, the data and results of the study are assessed and
analyzed. Chapter 5 provides solutions, based on data and literature, for closing the perceived
gaps as well as recommendations for an implementation and evaluation plan for the solutions.

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CHAPTER 2
LITERATURE REVIEW
Mental illness negatively affects a large number of Americans. Mental illness inhibits the
ability of individuals to lead healthy lives. Those that experience mental illness often find it
challenging to carry out the minimum requirements of daily life. To those affected by severe
mental illness, it is all-encompassing and debilitating.
This chapter will start with a review of the ineffectiveness of the current methods used to
diagnosis those with mental disorders, the Diagnosis and Statistical Manual (DSM) and its role
in diagnosis, as well as the current problems associated with misdiagnosis. Next will be a review
of the role of mental health professionals, followed by the explanation of the knowledge,
motivation and organizational influences lens used in this study. Finally, this chapter will
analyze mental health professionals’ motivation and organizational influences.
Influences on the Problem of Practice
There are several influences currently associated with this Problem of Practice. Three of
the key influences of the Problem of Practice are (1) the current lack of emphasis on the variety
of biological causes of mental illness, (2) the current over-focus on the DSM, and (3) the lack of
accountability for mental health professionals today. Each of these will be discussed in this
section.
Biological Causes of Mental Illness
The current lack of understanding regarding the variety of biological causes of mental
illness could be resulting in misdiagnosis of patients. Misdiagnosis of those who have been
defined as mentally ill by mental health professionals can have damaging and long-lasting
consequences. Amen (2013) discovered when clinicians solely attribute behavior to patients’
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bad choices instead of taking into account neurological problems or deficiencies, the treatment
can make the problem worse because underlying issues are not being addressed. A case study
written by Dr. Daniel Amen describes a boy named Andrew. Andrew had developed an angry,
dangerous and unfeeling attitude towards himself and everyone around him. He randomly hit a
girl with a baseball bat on a baseball field without caring or emotion and drew pictures of
himself hanging dead from trees and drew other pictures of himself shooting other children with
guns. A SPECT scan was ordered for Andrew and through looking at the SPECT scan a cyst the
size of a golf ball in the part of the brain known for aggression was discovered. Once the cyst
was drained, Andrew immediately turned back into the happy, sweet boy he was before and has
remained that way since (Amen, 2013).
There are several biological conditions that are known to create mental illness. Urinary
tract infections have been shown to create abnormal behavior in elderly patients. In addition, a
Pediatric Autoimmune Neuropsychiatric Disorder called PANDAS is caused by strep bacteria in
children and can be cured by antibiotics. Furthermore, certain types of cancer have been shown
to increase signs of mental illness as well. Treating the behavior without addressing the
biological causes is ineffective in each of these cases. Dr. Amen stated that if patients are
ineffectively treated for neuropsychiatric disorders, it can be hurtful, expensive, and
demoralizing, because they are told they could and should fix their behavior when it might not be
possible with the biological conditions present at the time (Amen, 2010).
In addition, many soldiers in our military are being diagnosed with such illnesses as
personality disorders or just having a “bad attitude” when really they are suffering from a
treatable brain condition called Traumatic Brain Injury (TBI) (Raji et al., 2015). It is important
to distinguish between TBI and Post Traumatic Stress Disorder (PTSD), which is also common
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in our military, because the generally prescribed treatments for PTSD, such as transcranial
magnetic stimulation, which non-evasively stimulates nerve cells, have been known to cause
seizures for those with TBI (Raji et al., 2015). Another common problem associated with
patients who are misdiagnosed with mental illness is those individuals are more prone to believe
they have a disorder when their thinking might be a result of a natural variation in neuro-
functioning (Ekblad, 2013). Ekblad goes on to state that this misdiagnosis might
disproportionately focus on the weaknesses associated with their extreme neuro-function rather
than on their strengths.
By understanding the various biological causes for those who have been termed mentally
ill, mental health professionals can use neurology and other concrete sciences to identify
biomarkers which will improve the validity of diagnosis for those who have been determined
mentally ill. These biomarkers can help lead us towards creating more accurate and effective
treatments in the future.
Diagnostic and Statistical Manual
The most prevalent diagnostic tool for mental health professionals is the Diagnostic and
Statistical Manual (DSM) (Verheul, 2012). Although this tool can be useful in providing a
common vocabulary and measuring stick for mental health professionals, there are concerns
regarding this mode of diagnostic in regards to validity (Bradford, 2009). For example,
according to Cooper (2016), a counselor’s interpretation of a patient’s symptom in relation to the
DSM has been proven to be easily swayed by environmental pressures. Also, there is evidence
that insurance companies play a significant part in the level and type of diagnosis given by a
clinician (Braun & Cox, 2005). In addition, Cooper (2016) found that 86% of the time, an
individual family member was diagnosed, sometimes unnecessarily, with a mental disorder even
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when the primary reason for the appointment was family and marital problems. Furthermore, a
comparison of the different versions of the DSM found that normal behaviors are increasingly
being identified as pathological even though they were not included within the ideas of
pathology in previous versions of the DSM (Halpin, 2016). In a research article distinguishing
the difference between the different versions of the DSM, Rosenberg found some informative
statistics. According to Rosenberg, there are almost 300 different identifiable disorders in the
DSM V. Also, under the new DSM criteria, there is now a 50% chance of every American being
able to receive a diagnosable mental disorder (Rosenberg, 2013). This is significant because
being diagnosed, especially misdiagnosed, with a mental illness can affect how people view
themselves and others because of the current stigma involved with such a diagnosis.
In a survey given to over 100 clinicians, Braun and Cox (2005) reported that 70% of
clinicians surveyed stated they had intentionally misdiagnosed patients in order to fit Managed
Care Organization (MCO) insurance requirements. Cooper (2016) also found that many of these
increases are a result of powerful groups that lobby to make it easier for individuals to get
diagnosed with mental illness.
Finally, another problem associated with the DSM is that it is culturally biased towards
North America, where it originated (Caetano, 2011). Caetano stated that the cultural-centric
nature of the DSM is focused on America’s version of normal and our westernized value-
judgement of whether a behavior fits our criteria of healthy or not. For instance, Caetano stated
that the DSM’s version of addiction is not the same as in Latin American countries. The
ideologies in several areas of the DSM do not adequately convey the differences in pathology of
those in other areas of the world.
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Another limitation of the DSM is it also doesn’t address the natural, biological or genetic
issues associated with the brain (Amen, 2013). Amen (2013) also states that various biological
issues and environmental exposures could result in mental illness including diseases, lack of
nutrition, high or low functioning areas in the brain, over or under active areas of the brain, cysts
on the brain, exposure to toxins, chemical exposures, and use of drugs. Amen (2013) goes on to
argue that the DSM’s lack of acknowledgement of these biological factors severely limits the
ability of health care professionals to make well-informed and helpful diagnoses for their
patients.
As a result of the DSM deficiencies, some people who are currently diagnosed mentally
ill by mental health professionals are experiencing unintended results from the treatment
prescribed. These unintended results could have serious and chronic consequences for those
experiencing misdiagnosis from mental health professionals.
Lack of Accountability
Another influence of this Problem of Practice is the current lack of accountability
surrounding mental health. Especially in private practice, there is limited accountability holding
mental health professionals responsible for patient improvement and patient success.
According to Firestone and Shipps (2005), accountability is a commitment to answer to
another person for a performance mostly by justifying their procedures and the results. The main
accountability for mental health professionals seems to be to the primary stakeholder, the client.
There is also an accountability that lies with the third party payers that oftentimes fund the
counseling sessions. Sometimes mental health professionals work for organizations (hospitals,
universities, or other programs) that put additional accountability measures in place but this type
of accountability is not required.
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The three main forms of accountability for mental health professionals are professional,
moral and market. Professional accountability occurs when stakeholders defer judgement to
skilled and expert employers to provide recommendations and solutions for their clients
(Romzek & Dubnick, 1987). Professional accountability is the main accountability that holds
mental health professionals responsible to their clients. Professional accountability might work
better for some organizations than others and additional accountability measures might be
helpful in ensuring that the weaknesses of this type of accountability are in check.
Moral accountability assumes that the mental health professional have internalized an
internal value system that guides their practice (Firestone & Shipps, 2005). The knowledge,
motivation and organizational structure of psychology should be addressed to ensure this type of
accountability is the best for this organization. Without proper motivation and knowledge,
professional and moral accountability might not be sufficient to ensure the primary stakeholder,
the client, is getting the best care possible.
Market accountability occurs due to the pressures of competition (Firestone & Shipps,
2005). Market accountability encourages mental health professionals to stay competent so they
are enticing to clients and can keep their clientele. However, market accountability has several
flaws with it, and should be kept in check with several other types of accountability.
Unless mental health professionals work for an organization or group, once they obtain
their licenses, many of these counselors are mostly held to an inward accountability model.
Inward accountability models focus mostly on professional culture (Burke, 2004) more often
regarded as individual contractors with the client as their main stakeholder. Performance goals
are not outwardly imposed on these independent contractors in these types of situations and the
accountability is mostly left up to the individual counselor.
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Mental health professionals are held to a moral accountability as well. Oftentimes values
are strong within the psychological community. Most mental health professionals are caring,
wonderful, intelligent people who want the best for their clients. Unfortunately, moral
accountability can be insufficient without checks and balances to ensure the main stakeholders’
interests are protected. Also, it is important for other types of accountability to check moral
accountability because sometimes what seems moral is not the only factor that should be
considered.
There are many challenges to this accounting binary. For instance, the presence of
information asymmetry. Information asymmetry is when information is not evenly distributed
within the accountability relationship (Hentschke & Wohlstetter, 2004). This challenge occurs
because oftentimes the research in psychology does not funnel down to the counselors. Also, in
some instances, psychological research studies cannot be reproduced with the same results so in
these instances the reliability and validity of these studies might also be in question. There is
oftentimes a continued education requirement for mental health professionals, but these
requirements do not mean the same good information reaches all of the counselors because
counselors can choose from a wide-range of trainings they wish to attend that count for this
requirement.
Another challenge to this accountability frame is that there may be a weak incentive
problem (Hentschke & Wohlstetter, 2004). There is a weak incentive for mental health
professionals because they get paid the same whether there is improvement in their patients or
not. Even in situations where health care professionals are in organizations where there is
organizational accountability, usually treatment is determined to be effective by client report.
Sometimes the client is happy with the counselor even when no improvement has been made, so
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this kind of accountability mechanism may be flawed in determining whether actual
improvement has been made or not.
Clark and Estes’ (2008) Knowledge, Motivation and Organizational
Influences Framework
Gaps in performance are a serious problem in many industries. In order to close these
gaps, Clark and Estes’ (2008) created the GAP Analytic Conceptual Framework. This
framework is a useful tool for analyzing gaps in performance, understanding the root causes of
these issues, and determining which improvement plan should be implemented for success.
Clark and Estes’ (2008) conceptual framework identifies the knowledge, motivation, and
organizational areas that might influence areas of gaps in performance.
The Clark and Estes problem-solving process is based on (1) understanding stakeholder
goals with regard to the organizational goal, and (2) identifying assumed performance influences
in the areas of knowledge, motivation and organization based on general theory, context-specific
literature and an existing understanding of the organization.
In the following sections, each of these influences will be discussed in regards to the
knowledge, motivation, and organizational areas that might inhibit the way a counseling
psychologist diagnoses and treats their patients. The first section will address the challenges
associated with knowledge gaps in relation to diagnosis and treatment. The next section will
identify some motivational problems that could influence mental health professionals’
approaches. And the final section will be dedicated to organizational challenges that might be
influencing these undesirable outcomes. Each of these influences will be examined more
thoroughly in Chapter 3.
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Stakeholder Knowledge, Motivation and Organizational Influences
Knowledge
When analyzing a gap in performance, understanding the current knowledge and skills of
the people doing the job is critical to success (Clark & Estes, 2008). Analyzing the knowledge
and skills component of a domain includes asking what knowledge is needed to increase the
levels of effectiveness of their practice (Elmer, 2002). Elmer goes on to state that this domain
also includes the resources, incentives, and capacities needed to promote this learning
environment the best.
The goal of mental health professionals is to help those they counsel gain the skills and
knowledge they need to be able to live healthy, happy lives. In order to be able to counsel
effectively, the mental health professionals themselves need to ensure they have the right kinds
of knowledge and skills necessary to understand and help their clients achieve the best mental
health possible. Most mental health professionals are very dedicated to their patients and there
have been strides in recent years to increase the effectiveness of psychology, but even with these
efforts, mental health continues to be an overwhelming problem.
In order to close the gap, the knowledge and skills used in mental health today need to be
examined. There are four specific types of knowledge: factual, conceptual, procedural, and
metacognitive (Rueda, 2011). Understanding where the lack in knowledge and skills is
occurring in mental health is critical in order to change the current outcomes associated with
diagnosis and treatment.
Although there are many reasons and potential causes for this Problem of Practice, two
possible knowledge deficiencies will be discussed. The two that will be addressed in this study
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are the ineffectiveness of the current methods used by mental health professionals and the current
lack of knowledge surrounding the various biological causes of mental illness.
The ineffectiveness of the current methods used by mental health professionals.
Currently, self-reported symptoms and the mental health professionals’ own interpretations of
those symptoms are what drive diagnosis and treatment for mental health (Adam, 2014). Mental
health has come under scrutiny for the lack of empirical data associated with the diagnosis and
treatment for its patients. In a quantitative study of approximately 4,000 patients, one of the
largest studies of its kind, it was determined that only 31% of participants who suffered from
depression were in remission using the current methods of psychology/psychiatry, even with
medication (Amen et al., 2013). Amen and his colleagues went on to state that the current
placebo rate of remission from the same study is 30%. In another study of 118 children with
anxiety who were randomly selected to be put in either an intervention group or a wait-list
control group, the results indicated that the Cognitive Behavioral Therapy (CBT) intervention
did not reduce symptoms of anxiety on either self-reports or the parents’ reports of their child’s
anxiety symptoms (Miller, Short, Garland, & Clark, 2010).
The method of diagnosis for mental health professionals hasn’t changed significantly
since the 1800s (Amen, 2013). A theory-based measurement validation needs to be focused on
in mental health to improve outcomes to ensure the right treatments are being instituted (Hoyt,
Warbasse, & Chu, 2006).
Lack of knowledge of the biological causes of mental illness. Every day, researchers
are finding more correlations between biological illnesses and diseases and mental illness. Some
of the known biological causes for mental/brain illness include brain trauma, toxins, molds,
diseases, illnesses, infections, lack of nutrients, lack of oxygen, and lack of exercise (Amen,
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2013). Recent research regarding genetics is also changing the way we look at brain/mental
health and could significantly alter the way mental health professionals diagnose and treat
patients (State & Geschwind, 2015).
Some researchers are pushing for a precision medicine approach to neuropsychiatric
diseases based on studies that have found a link between genomic findings that show synaptic
and immunologic causes and mental health issues such as autism (Kohane, 2015). Other
researchers are suggesting that neurotoxic factors, positive neurodevelopment factors and
therapeutic interventions be considered in mental health to improve diagnosis and treatment
(Gonçalves & Perrone-McGovern, 2014). Some research has found biological links to things
like paralysis and schizophrenia and these researchers are hoping to apply these findings to other
forms of mental illness as well (Hruby, 1998) but the task of focusing on and understanding the
biological causes of mental illness has been deemed too difficult and too expensive to undertake
(Adam, 2014). Adam goes on to state that even though it will be difficult and expensive, such
intense focus on the root causes of mental illness might lead to more effective treatments in the
future and therefore it is worth the time and expense.
In order to better understand and combat these knowledge issues, mental health
professionals should utilize brain SPECT imaging as well as various other tools in order to
reduce the likelihood of misdiagnosing their patients.
Motivation
Motivation is the internal process that gets individuals started on something, keeps them
moving forward, and engages them until the completion of a project (Clark & Estes, 2008).
Clark and Estes (2008) goes on to state that motivation influences three issues relating to
process: (1) choosing to get started on a goal or project; (2) our ability to continue and persist
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with a goal until completion; and (3) how much mental exertion we are willing to invest in order
to complete the goal or project.
Analyzing motivation is key to understanding why many mental health professionals are
not utilizing the most cutting-edge research and why there is still a gap in effective care and
treatment of individuals with mental/brain illness. Motivational factors are dynamic and
interactive so there is no one specific overarching theory that covers all of the motivational
constructs (Rueda, 2011). There are many motivational factors, influences, constructs, and
theories that help us obtain a better understanding of what motivates individuals. Some of the
primary motivational influences are self-efficacy and competence beliefs, attributions and
control beliefs, value or task value influences, and goals or goal orientation influences (Rueda,
2011). The two motivational barriers that will be discussed in this section are the utility value
influence and the attribution theory influence.
Utility value. Value or task value specifically relates to the importance an individual
attaches to a task (Rueda, 2011). Rueda goes on to state that utility value refers to how useful
the task is perceived to be in accomplishing a future result or goal. There are several
complexities surrounding mental health regarding the utility value of understanding the
biological causes of mental illnesses. Two that I will discuss in this paper are (1) the current
focus on the DSM for diagnosing purposes and (2) the lack of value placed on understanding
biological causes of mental illness. Both aspects will be discussed below.
Currently, the DSM is the main method mental health professionals use to diagnose and
oftentimes treat patients. Third-party payers, like insurance companies, require a DSM diagnosis
in order to pay for services (Braun & Cox, 2005). Braun and Cox go on to state that these
requirements cause a motivating incentive for mental health professionals to over diagnosis
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patients in order to obtain funding which could be looked at as a goal or incentive for both the
counselor and the patient. Sometimes a DSM diagnosis will be made even when no diagnosis
was justified in order to gain funding from insurance companies in marriage and family
counseling sessions (Crews & Hill, 2005). In a qualitative study of 27 psychologists, several of
the cases pointed to the idea that the DSM acts to align psychologists with insurance and drug
companies (Halpin, 2016). This unintentional motivation could lead counselors to faulty
diagnosis and wrong treatment plans to address the mental health issues that are being placed
before them. Other useful tools such as brain SPECT imaging and biologically-related tests are
often not covered by insurance and therefore are discouraged in diagnosis and treatment because
the utility value is low to use these types of services for both the counselor and the patient.
Attribution theory. Attribution beliefs refer to the reasons one perceives for success or
failure and the degree of control one feels in obtaining and affecting the outcome (Rueda, 2011).
Currently, there is not a strong push on the emphasis of the mental health professional’s role in
helping clients overcome mental illness. Moves are being made in mental health for greater
accountability within the profession through Evidence Based Practice (EBP) (Sinkovics,
Richardson, & Lew, 2015), Empirically Based Treatment (EBT) and client feedback (Strong,
2017). However, demonstration of results with currently used interventions are limited and
oftentimes hard to achieve (Miller et al., 2010). Many counselors in schools particularly feel like
they do not currently possess the skills necessary to collect and analyze data to determine the
effectiveness of the treatment provided (Patrikakou, Ockerman, & Hollenbeck, 2016) which also
leads to ideas of inadequate self-efficacy towards positive self-attributions. Currently, there is
nothing that requires mental health professionals to use EBP or EBT or to show the effectiveness
of their treatment. There are varied diagnosis and treatments prescribed by mental health
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professionals and many of them have been found to have limited effectiveness. Significant
initiatives have been instituted to try to use EBP to promote accountability, but empirical
evidence demonstrating that implementation of these initiatives has led to system-wide
improvements is still limited (Katsikis, 2014).
Organizational Influences
General theory. Organizational barriers are defined as problems dealing with obstacles
within the organization’s control (Clark & Estes, 2008). Clark and Estes (2008) goes on to state
that such barriers include problems surrounding things like processes, resources, procedures,
inadequate facilities, missing tools, or cultural mindsets that prevent or delay work. Cultural
models and cultural settings play an important role in understanding the organizational
influences that effect change. Both cultural settings and cultural models should be examined to
pinpoint potential barriers to organizational success.
Cultural models are defined as shared schema and overarching understandings of how the
world operates or should operate (Gallimore & Goldenberg, 2001). Organizational culture
should be analyzed and considered in order to better determine gaps in performance and to close
those gaps effectively (Clark & Estes, 2008). Two cultural models that should be evaluated
within this problem of practice are the current methods used to diagnose patients and the need for
the organization to require more biologically-based and data-driven methods.
Gallimore and Goldenberg (2001) define cultural settings as practices that are set up
when individuals within the organization come together to carry out an activity which they deem
as valuable. Two cultural settings that should be examined are the need to provide an
accountability structure for patient success and the need to establish clearly defined goals for
patient improvement.
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Summary
Mental illness is becoming an increasing problem within the United States. The current
methods being used to address this growing concern are inadequate and ineffective. Chapter 1
addressed the importance of solving this problem of practice. Chapter 2 examined the
importance of understanding the various biological causes of mental illness, the current
deficiencies presented with the current prevailing methods of diagnosis, and the lack of
accountability in mental health today. Chapter 3 will present the study’s methodological
approach.

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CHAPTER 3
RESEARCH METHODOLOGY
Mental illness is a significant problem within the United States. The current methods
used by mental health professionals to diagnose patients are not sufficient. A more biologically
driven framework is needed to ensure more correct and useful diagnoses are given to patients. In
this chapter, the research design and methods for data collection and analysis for this study will
be presented. The research questions that are addressed in this study are:
1. What tools do Amen Clinics’ mental health affiliates utilize to diagnose patients?
2. What level of knowledge do Amen Clinics’ mental health affiliates have regarding
biological and brain-based causes of mental illness?
3. How can using SPECT scan imaging and other brain-based approaches improve
patient diagnosis?
4. What types of accountability do mental health professionals hold themselves to for
correct diagnosis?
This chapter will provide a conceptual framework for this study. Next it will discuss the
different methods that will be used for data collection, the participating stakeholders, and the
sampling criteria and rationale for each type of method used. Then it will address the credibility
and trustworthiness of the study as well as the validity and reliability of the information
presented. The chapter will end with a discussion on the limitations and delimitations of the
study.
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Conceptual Framework: The Interaction of Stakeholders’ Knowledge and Motivation
and the Organizational Context
A conceptual framework is displayed visually or in writing. It explores key aspects of the
research and examines the relationships among those key aspects that support the study
(Maxwell, 2013). The purpose of the conceptual framework is to help a researcher assess and
refine goals, construct and justify their research, and identify potential validity threats to their
theories and research (Maxwell, 2013).
This conceptual framework provides an over-arching structural outline which will utilize
the Clark and Estes Gap Analysis Theoretical Framework (Clark & Estes, 2008). The Clark and
Estes framework focuses on knowledge, motivation, and organizational influences in order to
identify gaps in performance in regards to organizational goals. Various knowledge and
motivation components that could be affecting the lack of validity and reliability surrounding
mental health professionals have been presented in previous sections. This section will outline
the conceptual framework of this study, how the different components interact, and how these
different aspects relate to the stakeholder and organizational goals.
The conceptual framework presented below will outline the different knowledge,
motivation and organizational components that influence a mental health professional’s ability
and willingness to incorporate biological and neurological causes of mental illness into their
counseling methods to provide greater accuracy and validity in patients’ diagnoses and how
these components lead to the achievement of stakeholder goals. Figure 1 illustrates this
conceptual framework.

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Figure 1. Conceptual framework.

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Figure 1 outlines the relationship between the different factors influencing mental health
professionals’ knowledge and use of the biological causes of mental illness in counseling
patients and the influence these initiatives may have on the achievement of the stakeholder goal.
The framework describes some of the knowledge, motivation and organizational influences that
are helping increase patient outcomes as well as achievement of stakeholder goals.
Organizationally, the current methods of diagnosis and treatment need to be closely examined in
order to find those areas that are negatively affecting patient outcomes. Some of the
organizational models that will be examined are the breadth and levels of effectiveness of the
current methods used to diagnose and treat patients through Amen Clinics. Another
organizational model that will be examined is the current focus on biologically-based and data-
driven methods. Furthermore, the study will examine the structure of accountability for patient
outcomes and the importance of providing clearly defined goals for patient improvement. This
organizational framework will show the importance of a solid base for more biologically and
neurologically focused mental health professionals. This new framework will also focus on the
knowledge components of increasing mental health professionals’ knowledge of the biological
causes of mental illness, their understanding of cognitive neuroscience and symptoms of mental
illness and their understanding of the root causes of mental illness and patients’ brain health.
This knowledge focus will work in conjunction with the focus on motivational components as
well. The motivational areas that will be focused in on for patient success are the understanding
of the value of utilizing a more brain-based approach to mental illness through tools like SPECT
scan imaging and understanding how their own knowledge and understanding significantly
affects their patient outcomes. Also, the study will focus on the importance of fully engaging in
these approaches to reach the highest patient improvement results possible. These knowledge
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and motivational components will work together to create positive patient improvement rates that
will lead to more accurate diagnoses and treatment outcomes. Also, this framework will provide
a more equal weight between naturalism, humanism, and behaviorism in diagnosis and
treatment. This knowledge, motivational, and organizational focus will also drive the
stakeholder goal forward as well ensure that health care professionals utilize more accurate
diagnosis methods for their patients.
Participating Stakeholders
The purpose of this project is to assess what tools mental health professionals utilize in
order to diagnose their patients and to determine how adding SPECT scan imaging to their
toolbox can help to increase the effectiveness of diagnosis methods. The information from the
quantitative study was used to identify knowledge, motivation and organizational influences that
may impact gaps in performance (Clark & Estes, 2008). The study also explored how adding
SPECT scan imaging as well as other biologically based tools to a mental health professional’s
toolbox can help to increase the effectiveness of diagnosis methods. Lastly, this tool will be
utilized to better understand the methods of accountability felt by mental health professionals.
Survey Sampling Criteria and Interview Rationale
Criterion 1. Amen Clinics affiliate — the participant must be listed as an affiliate of
Amen Clinics on Amen Clinics website to ensure the mental health professional has experience
and knowledge regarding Amen Clinics methods.
Criterion 2. Two years of counseling history — the participant must have at least two
years of counseling experience with patients to ensure the mental health professional is
experienced and knowledgeable in the field.
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Qualitative Data Collection and Instrumentation
A mixed-methods data gathering approach and analysis was conducted to study the health
care professionals’ assets in the areas of knowledge, motivation and organizational resources. A
mixed-methods approach uses both qualitative and quantitative methods to collect data (Creswell
& Creswell, 2018). Mixed-methods approaches are used when a variety of approaches are
needed in order to obtain the breadth and depth of information required for the study. The
stakeholders’ assets were studied by using surveys, interviews, and content analysis. Because
the study evaluated and tested current theory, a deductive approach was used through a
quantitative method (Creswell & Creswell, 2018). This study also utilized a multi-faceted,
inductive approach with a focus on the meaning, context, and process of diagnosis and treatment
which required a qualitative component as well (Creswell & Creswell, 2018).
The study was conducted in an explanatory sequential method in order to conduct
quantitative data collection first, then utilize that data to perform a qualitative data collection,
and finally use the combined information to interpret the research findings (Creswell & Creswell,
2018). Utilizing multiple methods of data collection decreased the likelihood the study would
result in insubstantial claims (McEwan-Adkins & McEwan, 2003). This mixed-methods
approach greatly adds to the knowledge we already have regarding mental illness diagnosis and
treatment outcomes.
Surveys
The survey was administered through emailing counselors listed as affiliates on the Amen
Clinics’ website. The survey was administered in English. There were 24 questions with a
compilation of nominal, ordinal, and interval scales of measurement as well as open-ended
questions to ensure the best fit for the intended responses. Each of the 24 questions tied back to
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the research questions and conceptual framework. The 24 questions were piloted through two
professionals in the field of psychology and three other colleagues to ensure the questions were
asked in a way that better ensured the validity and reliability of the data received.
Interview Sampling Criteria (Recruitment)
This study utilized qualitative interviews to determine how and why mental health
professionals determined their diagnosis outcomes. The qualitative interview method was
chosen to ensure a purposeful response from an intended population (Maxwell, 2013). The
reasoning for utilizing at least ten individuals in this sample was to allow for enough answers to
include variability but not too many interviews that they may run into redundancy (Merriam &
Tisdell, 2016). To ensure the interview is capturing the targeted information, the interview
questions were derived through focusing on the four research questions as well as the conceptual
framework for the study.
Interview protocol. This study utilized a semi-structured interview process with open-
ended questions (Merriam & Tisdell, 2016). Twenty-four interview questions were asked in a
sequential way and in an intentional manner to pull out the needed information from the
participants. Probing questions were also utilized as well as probes such as silence, bunched
utterances, and head nodding to ensure a safe, receptive environment (Merriam & Tisdell, 2016).
Eight interviews were held through the Zoom platform and two interviews were held over the
phone and recorded through Zoom so the interviewees could choose where they felt most
comfortable holding the interview, which better ensured a safe environment (Maxwell, 2013).
Interview procedures. Willing participants were identified through a question on the
survey. Out of the 22 participants who were willing to participate in the interview, 10
interviewees were randomly selected for a qualitative interview.
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Interviews were conducted July 16 through August 16, 2019. Interviews lasted between
30 minutes and an hour and a half. With permission of the interviewees, the interviews were
recorded using the Zoom platform. Hand written observational notes were also taken to capture
other important data such as body language and environment notes. The information was kept
confidential and protected and then further analyzed after the interviews of all participants had
been conducted. A $25 gift card was offered to those who completed the interview. Interview
information remained confidential and was generalized without any names being associated with
interview answers or responses.
Data Analysis
Data from the survey for this study were collected and analyzed through the Qualtrics
platform. Data from the interviews were recorded and transcribed through the Zoom platform.
A thorough open coding process was used to analyze the qualitative data and bring out emerging
influences. Various codes were created and referenced against the knowledge, motivation and
organizational influences for this study. After coding and analysis, a framework of best
practices, solutions, and recommendations that may be utilized by other organizations to
decrease misdiagnosis in mental health professions was presented in Chapter 5 of this study.
Credibility and Trustworthiness
Credibility, or internal validity, is the extent to which research findings match reality
(Merriam & Tisdell, 2016). Trustworthiness denotes the ethics of the actual researcher (Merriam
& Tisdell, 2016). Ethics is a major concern in any research study (Merriam & Tisdell, 2016).
After all, the quality of the information obtained in research largely depends on the individual
researcher (Patton, 2016).
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To increase credibility and trustworthiness, several different strategies were utilized.
This study used non-directing, open-ended questions to minimize any predetermined responses
that could be given through the interviewing process (Patton, 2016). Furthermore, biases and
subjectivity were checked throughout the study to ensure the information and its conclusions
were not swayed by the individual researcher’s previously held beliefs and expectations
(Maxwell, 2013). Through asking non-directing questions, awareness of potential bias and
subjectivity and through peer review, this study was better ensured to produce the most credible
and trustworthy conclusions possible.
Validity and Reliability
Reliability is the degree to which a measurement tool measures something on a constant
basis (Salkind, 2017). Validity is the property of the tool measuring what it says it measures
(Salkind, 2017). Measures were considered to ensure this study was held to reliability and
validity standards as well. For instance, the questions for the study were reviewed by five
recipients who pilot tested the survey to ensure the questions made sense to the recipient and to
better ensure the questions targeted the intended measures (Creswell & Creswell, 2018).
Furthermore, both quantitative and qualitative research was conducted to provide triangulation of
data to further ensure the validity of the data that was received.
Ethics
Ethics is a major concern in any research study (Merriam & Tisdell, 2016). The quality
of the information obtained in research largely depends on the individual researcher (Patton,
2016). Quantitative and qualitative research were used to collect data for this study so there are
many ethical considerations that needed to be taken into account. Over 400 quantitative surveys
were emailed, and out of those that responded, 10 mental health professionals were interviewed
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to determine what counseling approaches were used and how adding SPECT scan imaging and
other biological elements to their toolboxes influenced diagnoses of their patients. Because
counseling is usually at the core of a mental health professional’s livelihood, it was imperative
that the highest respect was given to all participants. Observers in research are to behave as
guests in the private spaces in which they observe and their manners should be good and their
ethics should be strict (Merriam & Tisdell, 2016). To better ensure ethical standards were met
for this study, several ethical items were examined to ensure the study was held to the rigor
needed to ensure the validity and reliability of the data. The next section will discuss a few of
these ethical issues at play and how they were addressed.
Written Plan
In order to ensure the study was logical and well thought out, a written plan of attack was
developed for the study. Krueger and Casey (2009) stated that plans should include the purpose,
background information, types of information needed, types of participants to be invited,
numbers of groups to be conducted, plan of action, products or deliverable, timeline, and budget.
Although this article was written specifically in regard to focus groups, a written plan was also
conducted for this study to help ensure a rigorous and well thought out interviewing process.
Informed Consent
Each participant verbally agreed to an informed consent in which the purpose and detail
of the study and the reasons for the questions was clearly outlined. The answers were kept
confidential as well as their names in relation to involvement in the study. The informed consent
was used to ensure that participants understood that participation in the study was completely
voluntary and they could stop their participation at any time. Also, in the informed consent, the
permission to record was outlined and approved verbally while interviewing. Informed consent
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is a critical aspect of a research study and during the study all aspects of the plan were fully
disclosed to each participant.
Data Storage
Data received was stored in a locked filing cabinet that was used only for the purpose of
the study. All data including hard files, notebooks, recorders, and electronic copies were stored
in the cabinet and the key was kept in a secure place away from the cabinet.
Location of Study
All interviews were held through the Zoom platform. Through Zoom, many of the health
care professionals were able to be interviewed in their own offices, so many potential threats that
could have been felt through the interviewing process were alleviated. Also, conducting the
interviews in their office allowed the information to be gathered in the most non-threatening
environment possible.
Context of the Study
Since this research study was conducted by someone outside of the field, there did not
seem to be confusion on dual roles. Also, because of this lack of affiliation with the mental
health community, there did not seem to be any pressure for participants to answer the questions
in a certain way.
Assumptions and Biases
Assumptions and biases are important to be aware of and thought about in regard to
research. The assumptions going into the study were that by looking at SPECT scan imaging
and the biological causes of mental illness a mental health professional would be better able to
diagnose their patients. Care has been taken to ensure these biases did not lead to the
participants answering in any particular way. By asking non-directing, open-ended questions
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any predetermined responses that may be given through the interviewing process were
minimized (Patton, 2016).
Limitations and Delimitations
There are several anticipated limitations of this study. Limitations are those things that
we cannot control that we know will be a part of the study (Merriam & Tisdell, 2016).
Delimitations are boundaries that are put on the study that may affect the output (Merriam &
Tisdell, 2016). Some of the major limitations and delimitations are outlined below.
Limitations
The biggest limitation to this study was if the mental health professionals were truthful in
their responses. Since this data was based off mental health professionals’ personal reports, there
may be a possibility for the data to be skewed. Some mental health professionals might not want
to move towards areas of accountability and they also might not want to be responsible for
understanding the biological causes of mental illness. These factors as well as others that are
undetermined might influence how they answered the survey and interview questions. Also, the
information discussed may have pushed mental health professionals outside of their comfort
zones. Another limitation of the study was that it was impossible to reach all mental health
professionals so the study might not be as valid of a sample size as if there was mandatory
participation from all mental health professionals. Furthermore, there were limited numbers of
mental health professionals who were willing to give up their time in order to participate in a
qualitative interview, so this limited number of mental health professionals might also have
limited the amount of data received.
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Delimitations
Some delimitations regarding the study were the limited amount of questions that were
asked and the number of mental health professionals that were interviewed. The limited nature
of the questions asked could have minimized the data received. Furthermore, the limited amount
of surveys and interviews could also have limited the type of information received.

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CHAPTER 4
RESULTS AND FINDINGS
The purpose of this study was to assess what tools mental health professionals utilize in
order to diagnose their patients and to determine how adding SPECT scan imaging to a mental
health professional’s toolbox could help to increase the effectiveness of diagnosis methods. Data
from this dissertation were collected in a promising practice study specifically examining the
knowledge, motivation, and organizational influences surrounding the Amen Clinics and how
mental health professionals are applying the methods of Amen Clinics to more accurately
diagnose patients. To understand these influencers, the researcher studied mental health care
professionals affiliated with Amen Clinics through surveys and interviews.
Chapter 2 validated the identified assumed influences through an in-depth literature
review. Chapter 3 provided the conceptual framework as well as the methodology plan for this
study. This chapter presents a discussion of the results and findings of the study organized by
knowledge, motivation, and organizational influences as they relate to the conceptual framework
of the study. The following four questions guided this promising practice study:
1. What tools do Amen Clinics’ mental health affiliates utilize to diagnose patients?
2. What level of knowledge do Amen Clinics’ mental health affiliates have regarding
biological and brain-based causes of mental illness?
3. How can using SPECT scan imaging and other brain-based approaches improve
patient diagnosis?
4. What types of accountability do mental health professionals hold themselves to for
correct diagnosis?
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Participating Stakeholders
Although a complete analysis of the problem of practice would involve all stakeholder
groups, for practical purposes this study focused in on those mental health professionals who are
listed as affiliates on Amen Clinics’ website. Because of this focus, each time the term mental
health professional (MHP) is used in this chapter, it will be in reference to the mental health
professionals who are affiliated with Amen Clinics who participated in this study. This study
examined how being affiliated with Amen Clinics’ methods has impacted diagnosis for the
mental health professionals interviewed.
Survey Participants
The data for this study were collected from 51 (n = 51) responses to a survey sent to 445
mental health care professionals listed as affiliates on Amen Clinics’ website. Data collection
for the survey occurred over a two-week period. Descriptive statistics of those that participated
in the survey (n = 51) by gender and race are listed in Table 1.
Also, the study broke responses down into six different types of mental health
professionals: psychiatrist; psychologist; LPC, LPCC or LCPC; LCSW, LICSW or MSW;
wellness center counselor; and other mental health professional. Six of the ‘other mental health
professionals’ were Licensed Marriage and Family Therapists and four identified themselves as
certified brain health coaches. Some of the other titles specified were RNs, physical therapists,
executive or life coaches, and naturopathic physicians. Table 2 delineates the types of mental
health care professionals that responded to the survey.
The number of years each participant had worked as a mental health professional was
also collected. Sixteen respondents stated they had been working in mental health for over 20
years, 14 respondents stated they had been working in mental health between 11 and 19 years,
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and 14 respondents stated they had worked in mental health between 1 and 10 years. The range
of years participants had worked as mental health professionals was from 2 to 47 years.

Table 1
Descriptive Statistics of Survey Participants (N = 51)
Variable Number Percentage
Gender
Male 14 27.45%
Female 36 70.59%
Other 0 0%
Choose not to Identify 1 1.96%
Race
White 40 78.43%
Hispanic or Latino 1 1.96%
Black or African American 2 3.92%
Native American or American Indian 0 0%
Asian/Pacific Islander 1 1.96%
Other 1 1.96%
Choose Not To Identify 6 11.76%

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Table 2
Mental Health Professionals by Type (N = 51)
Variable Number Percentage
Type of Mental Health Professional
Psychiatrist 1 2.08%
Psychologist 7 14.58%
LPC, LPCC or LCPC 8 16.67%
LCSW, LICSW or MSW 3 6.25%
Wellness Center Counselor 3 6.25%
Other Mental Health Professional 26 54.17%
Didn’t Answer Question 3

Interview Participants
Out of the 51 survey participants that responded, 22 stated they would be willing to take
part in a 30–60 minute interview regarding the topic. Ten of the 22 interested interviewees were
randomly chosen for an interview. The semi-structured interviews were conducted through the
Zoom platform or by telephone. To more accurately capture what was said, each interview was
recorded and a transcript was also generated through Zoom. The interviews were coded and
analyzed to identify key themes and trends as they related to the knowledge, motivation and
organizational influences surrounding the guiding questions for the study.
Interviewees had an impressive background of experience ranging from managing their
own successful clinics to running efficient and effective private practices. Interview participants
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by pseudonym, years worked as a Mental Health Professional (MHP), years affiliated with Amen
Clinics and the types of training/s received through Amen Clinics are outlined in Table 3.

Table 3
Interview Participants (n = 10)
Pseudonym
Years worked as
a mental health
professional
Years
affiliated with
Amen Clinics
Type of training received through
Amen Clinics
Psychologist #1 13 years 12 years Brain Health Certification Course
Psychologist #2 45 years 2 years Brain Health Certification Course
Psychologist #3 34 years 26 years Completed several workshops and
trainings through Amen Clinics
Psychologist #4 51 years 21 years Completed several workshops and
trainings through Amen Clinics
LCSW #1 14 years 5 years Brain Health Certification Course
LPC #1 20 years 8 years Brain Health Certification Course
LPC #2 10 years 4 years Brain Health Certification Course
LMFT #1 20 years 5 years Brain Health Certification Course
LMFT #2 10 years 4 years Brain Health Certification Course
Life Coach #1 4 years 8 years In process: Brain Health
Certification Course

Interviews for this study took place over a month-long period following the survey. The
interviews took between 30 minutes and 1–1/2 hours to complete. Twenty-five-dollar gift cards
were offered to all who completed interviews for the study as a thank you for their time. Many
of the research participants expressed they didn’t do the interview for the gift card; they were just
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excited to share their experiences with Amen Clinics. Psychologist #4 insisted that the
researcher keep the gift card because he remembered what it was like to be a struggling college
student and Psychologist #3 asked the interviewer to send the $25 to a charity of her choice.
Results and Findings
In this section, findings and themes gathered from the data analysis will be segmented by
research questions. Findings and themes have been drawn from the data by applying the Clark
and Estes (2008) knowledge, motivation and organizational framework. Each of the findings
and themes were substantiated by the conceptual framework, supported through a literature
review, and validated through this research study. The four research questions as well as the
findings and themes that were discovered through the analysis of the data for this study will be
discussed below.
Research Question 1
Research question 1 asked: What tools do Amen Clinics’ mental health affiliates utilize
to diagnose patients? Three main findings regarding this question that align with the KMO
framework were: (1) mental health professionals have an in-depth knowledge of various tools to
help them diagnose patients more effectively; (2) mental health professionals are motivated to
keep using the tools because of the utility value of the tools provided to them; (3) the
organization has cultural models and settings in place to support the MHPs in utilizing the tools
provided to them. Table 4 outlines these three findings as well as the themes under each finding.
Each of these findings and themes will be discussed in this section.

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Table 4
Research Question 1 Findings and Themes
RQ1. What tools do Amen Clinics’ mental health affiliates utilize to diagnose patients?
Findings Themes
Finding 1: MHPs have an
in-depth knowledge of
various tools to help them
diagnose patients more
effectively
1. MHPs utilize Amen Clinics’ Brain Health Coaching
Certification Course and other brain-based trainings
2. MHPs utilize SPECT scan imaging
3. MHPs utilize Amen Clinics’ questionnaires and checklists
4. MHPs utilize Amen Clinics’ pamphlets, brochures, and
books
Finding 2: MHPs are
motivated to keep using
the tools because of the
utility value of the tools
provided to them
1. MHPs have experienced positive results through utilizing
these tools
2. The tools have helped MHPs build relationships with their
patients by reducing shame and uniting them both against a
common enemy: the brain
3. The tools have helped MHPs’ patients to engage in
treatment
Finding 3: The
organization has cultural
models and settings in
place to support the MHPs
in utilizing the tools
provided to them
1. Amen Clinics provides a cultural model which encourages
mental health professionals to use the tools supplied to
them
2. Amen Clinics provides a cultural setting which supplies
many tools to help mental health professionals

Mental health professionals have an in-depth knowledge of various tools to help
them diagnose patients more effectively. The amount and quality of Amen Clinics’ resources
were a recurring finding from the interviews. Out of the participants surveyed, when asked the
statement “I have more information/tools to diagnose patients effectively since becoming
affiliated with Amen Clinics,” 70.59% stated they strongly agreed, 21.57% stated they somewhat
agreed, 5.88% stated they neither agreed nor disagreed, 1.96% stated they somewhat disagreed,
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and 0% stated they strongly disagreed. Figure 2 shows the visual representation of the survey
question.

Figure 2. I have more information/tools to diagnose patients effectively since becoming
affiliated with Amen Clinics.

In this section, the findings for the knowledge influences regarding what tools mental
health affiliates utilize to diagnose patients will be examined. The four main themes that were
discovered in relation to this knowledge finding were: (1) mental health professionals utilize
Amen Clinics’ Brain Health Coaching Certification Course; (2) mental health professionals
utilize SPECT scan imaging; (3) mental health professionals utilize Amen Clinics’
questionnaires and checklists; and (4) mental health professionals utilize Amen Clinics’
pamphlets, brochures, and books. Each of these themes will be discussed below.
Mental health professionals utilize Amen Clinics’ Brain Health Coaching Certification
Course and other brain-based trainings. Eight of the 10 interview participants stated they have
taken or were in the process of taking Amen Clinics’ Brain Health Coaching Certification Course
or had received other trainings through Amen Clinics. The two that hadn’t taken the certification
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course had been working with Dr. Amen for so long they were grandfathered in because of their
background in neurology as well as workshops they had attended through Amen Clinics. The
courses these mental health professionals had taken had provided them with an in-depth look at
brain health and how to apply SPECT scan imaging to their patients. The Brain Health Coaching
Certification Course offers recorded lectures as well as numerous resources to help mental health
professionals understand how to apply brain-focused approaches to their own patients. The
course teaches affiliates how to read SPECT scan images and teaches them how those images
correlate with mental health related challenges. Psychologist #2 stated:
since taking the brain health certification course, I have become very attuned to the
biological causes of mental illness. Before I just trusted the doctor to give them the
proper medications. I didn’t know anything about what was going on in the brain. Now I
have went on and studied many additional people and other things and I’m learning more
and more and more about neuropsychology. I think that’s where it is and I think that a lot
of therapists are starting to get on board with it now.
Many of the mental health professionals that were interviewed stated how helpful the
certification course and workshops were and highly recommended these workshops to other
mental health professionals.
Mental health professionals utilize SPECT scan imaging. The mental health
professionals studied utilized SPECT scan imaging as a tool to help with improving differential
diagnosis. The mental health professionals interviewed discussed how SPECT scan imaging had
been a useful tool to them in gathering data around brain function and to better determine if there
was too much activity in the brain or too little. The type of data they received through SPECT
scan imaging proved to be important to their ability to diagnosis their patients more accurately.
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Psychologist #3 stated, “A SPECT scan is a useful tool to help piece the puzzle together. SPECT
scans add another dimension to our whole protocol, they provide a great benefit to clinical
treatment, and they are remarkably helpful.” In addition, Psychologist #4 stated:
seeing people’s problems, knowing their history, getting a scan and being able to see how
that scan elucidates what’s going on with the patient so we could make sense out of what
people were struggling with really was eye opening, not only for us as therapists, but also
for our clients.
SPECT scan imaging will also be discussed under research question 3. Since many of the
research participants emphasized SPECT scan imaging as being such a useful tool, the researcher
included SPECT scan imaging in this section as well.
Mental health professionals utilize Amen Clinics’ questionnaires and checklists. One
of the criticisms that emerged about SPECT scan imaging was those who sometimes needed it
most were not able to afford it. To combat this problem, many of the mental health professionals
interviewed used Amen Clinics’ questionnaires and checklists. These questionnaires and
checklists correlate with the different areas of the brain so mental health professions and patients
could obtain a better idea of what might be going on within the brain without a scan.
Psychologist #4 stated:
I use a checklist with virtually every person that comes into my office, whether they ever
get a scan or not. We have the patient as well as someone else (a spouse, family member,
or friend) fill out the checklist and then we discuss it in-depth with the patient. It
provides so much fodder for discussion and it opens up so many doors. It helps me
identify issues going on within the brain, and it also helps me see other things like
communication issues that may be present for the couple.
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In addition, Psychologist #2 stated about the questionnaires: “I think they do a pretty good job of
identifying which areas of the brain are having difficulty and therefore I use them quite often.”
Furthermore, Psychologist #4 stated:
I work with clients who struggle to make their $20 copay. They can’t afford SPECT
scans. But the brain system checklist is just a phenomenally useful tool for us in so many
different ways, and it does generally seem to correlate pretty well with the scans. After
20 years of doing this, I’ve got a pretty good idea of what their scans are going to look
like after receiving their checklists. Occasionally we get surprised, but not too often.
The mental health affiliates interviewed stated the questionnaires and checklists are
focused on different areas of the brain. The mental health professionals who use these
questionnaires and checklists are well-versed in which questions correlate with the different parts
of the brain and they use these tools to help evaluate and diagnose their patients more effectively.
Mental health professionals utilize Amen Clinics’ pamphlets, brochures, and books.
Many interviewees mentioned the usefulness of the Atlas books and other resources and
approaches provided to them through Amen Clinics. Psychologist #2 stated:
if patients cannot afford a scan of their own, I often show clients a book of pictures of all
the different kinds of conditions and what those conditions look like on scans. It moves
them when they see the images, you know, when they look.
In addition, LPC #1 stated:
We’ve got the SPEC scan Atlas books and pictures throughout out office. So everyone
who comes in gets their own personal assessment and then we go over it with them with
the associated materials. We use a lot of his material as handouts and homework.
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In addition, interviewees stated that after completing the checklists, patients were able to
start seeing themselves more accurately and it opened their minds to seeing their behavior from a
more objective point of view. Psychologist #4 stated: “the checklists help patients to be able to
see themselves a little more fully and a little more in-depth as they start to learn to see
themselves through family members’ eyes.” This process has helped many of the mental health
professionals interviewed and the checklists and questionnaires were highly recommended by
those who used them.
Lastly, it is important to note the mental health affiliates stated the tools provided
information and data they could then use to discover more information about the patient.
Psychologist #3 stated:
Tools are only as good as the clinician using them. One of the things about using tools is
that they should not only answer questions you have, they should pose new questions.
Through these tools, you don’t just look for answers, you should look for new questions.
You always can learn something new.
The tools and resources provided by Amen Clinics were very useful in helping the mental
health professionals interviewed get a better understanding of the brain and brain health so they
could better help their patients. The next section discussed what motivated the mental health
professionals interviewed to keep using the tools provided to them.
Mental health professionals are motivated to keep using the tools because of the
utility value of the tools provided to them. Utility value, or the value one places to the task on
future goals was an important motivational influence for the participants studied. Many of the
mental health professionals interviewed had been using Amen Clinics’ methods for a significant
amount of time. Two of the interviewees had been using Amen’s methods for over 20 years and
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another for over 10 years. The three motivational themes that were discovered in this finding in
relation to utility value were: (1) mental health professionals have experienced positive results
through utilizing these tools; (2) the tools have helped mental health professionals build
relationships with their patients by reducing shame and uniting them both against a common
enemy: the brain; and (3) the tools have helped mental health professionals’ patients to engage in
treatment. Each of these motivational themes will be discussed below.
Mental health professionals have experienced positive results through utilizing these
tools. When asked what motivated the participants in the study to keep using Amen Clinics’
methods, interview participants expressed a derivative of the same concept: because it works or
it makes sense. LPC #1 stated: “It just makes sense; and it’s science. So when you can start
showing people and talk in the terms like Dr. Amen talks, it just makes such a difference in
motivating clients to make these positive brain-healthy changes.” In addition, LMFT #1 stated:
“traditional psychology and the DSM is just outdated. It’s based on symptom clusters . . . it
doesn’t incorporate the whole picture.” Furthermore, Psychologist #3 stated: “It’s kind of a
business principle. If you want to work with people you follow the most efficient route
possible.”
Knowing these mental health professionals are helping their patients and seeing these
positive results motivated the mental health affiliates studied to use and keep using Amen
Clinics’ tools to more accurately diagnose and treat their patients. Psychologist #4 stated:
“Helping people feel better, function better, have great lives, and fulfill their potential; that is
what our professions are all about and Amen Clinics’ methods help me do that more effectively
and more efficiently.” Seeing and experiencing these positive results for themselves was a
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significant motivator for the mental health professionals interviewed to keep using Amen
Clinics’ methods.
The tools have helped mental health professionals build relationships with their
patients by reducing shame and uniting them both against a common enemy: the brain.
Research participants stated that using Amen Clinics’ methods often helped theses clinicians
build relationships with their patients. LMFT #2 stated: “for me it helps with aligning with the
client so I don’t come across as judgmental.” In addition, LPC #1 stated:
before working with Amen Clinics my tougher clients might have stated ‘this might have
worked for you, but it’s just not for me.’ Now we don’t have that because I’m showing
them pictures of their brain and explaining to them that it isn’t you, it’s how your brain
works, and you can do it, you can make these changes. That’s been a big turning point
for me.
In addition, Psychologist #4 stated:
the checklists allow us to catch things early on that may generally take about 3–6 months
to identify down the road without them. We are able to start working on practical things
that can make a difference in a person’s life now as opposed to the more traditional type
of approach which is generally to get a lot of history and background and look for trauma
in the past and all of that. I’m now more inclined to try and get change happening
quickly, and then as people build trust with me and as they start becoming hopeful and
more energized, then it’s easier to look at some of the past trauma.
Furthermore, Life coach #1 stated: “Once you understand the brain, then you don’t have to have
a feeling of shame. Once you know what it is, then you can work at controlling it.” The
effectiveness this brain-focused approach has had in helping mental health professionals build
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effective relationships with their patients is a driving motivating factor for many of the mental
health professionals interviewed.
The tools have helped mental health professionals’ patients to engage in treatment.
Patient ‘buy-in’ for treatment is important to patient outcomes. Many of the research
participants stated when patients could see how their behavior was affecting their own brains
they were more willing and more motivated to take action. For example, LPC #1 stated: “The
benefit is the understanding that patients have when they actually see an image of their brain.
They buy into their treatment plan better. I found it especially useful for 18–25 year old
substance users.” In addition, Psychologist #2 stated:
When patients see what is possibly going on in their brains, I think it motivates them.
For one thing, it takes away the misperceptions in the world . . . the negative things that
are said about people who have their conditions and the guilt they feel about the fact that
they just can’t ‘snap out of it’ or that they can’t ‘just stop thinking about it.’ Those kinds
of statements frustrate me because I think ‘you think that if they could do that they
wouldn’t have done that already?’
Furthermore, Psychologist #4 stated:
for many clients, Amen’s methods have taken away some of the shame, the guilt feelings
and the self-blame for their symptoms and their problems and has made them much more
involved in their treatments and much more willing to take medication.
Helping to create ‘buy in’ for their patients as well as helping patients engage in treatment is a
significant motivating force for these mental health affiliates to continue using Amen Clinics’
methods. The next section will discuss the organizational influences which helped the mental
health professionals interviewed to utilize the tools provided to them.
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The organization has cultural models and settings in place to support the mental
health professionals in utilizing the tools provided to them. Cultural models and settings are
important in providing support for its members. Two key themes that were discovered in this
finding were: (1) Amen Clinics provides a cultural model which encourages mental health
professionals to use the tools supplied to them; and (2) Amen Clinics provides a cultural setting
which supplies many tools to help mental health professionals. These two organizational themes
will be discussed below.
Amen Clinics provides a cultural model which encourages mental health professionals
to use the tools supplied to them. Amen Clinics’ cultural model of encouraging the use of the
tools supplied to mental health professionals has been transformational for many of the
participants interviewed. Amen Clinics’ cultural model has changed the way many of the mental
health professionals studied view mental health. Psychologist #4 stated: “when I first heard
about Amen’s methods I thought ‘if this is for real, this is going to revolutionize the way we
think about therapy.’” For the mental health professionals that participated in this study, Amen
Clinics’ cultural model of encouraging them to use the tools supplied to them has definitely
revolutionized the way they think about diagnosis and treatment. These brain-based approaches
have helped these mental health professionals to obtain a clearer picture of the individual and
their circumstances. SPECT scan imaging has helped mental health professionals have an
objective view in very complex and challenging cases.
Amen Clinics provides a cultural setting which supplies many tools to help mental
health professional. The cultural setting Amen Clinics provides which supplies tools to help
mental health professionals transformed the way many of the participants approached
counseling. LMFT #2 stated:
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After I finally completed all the madness of interning and licensing and all the craze, I
just happened to pick up ‘Change your brain, change your life.’ Once I started reading it,
I couldn’t put it down. I kind of threw it against the wall when I got done like ‘why
didn’t I get this in grad school?’ After I took the class I was just 100% in at that point.
In addition, LPC #2 stated: “becoming affiliated with Amen was a no brainer for us. We wanted
to learn more. We needed to learn more because it transformed the way that we did everything.”
From SPECT scan imaging, to courses and trainings, to questionnaires and checklists, the tools
that were provided by Amen Clinics helped these mental health professionals towards more
efficient and effective diagnosis for their patients.
The tools the mental health professionals utilized were found to be instrumental in
helping them diagnose patients more effectively. Through these knowledge, motivation, and
organizational influences, mental health professionals were able to utilize these tools to move
towards more accuracy and precision in diagnosis.
Research Question 2
Research question 2 asked: What level of knowledge do Amen Clinics’ mental health
affiliates have regarding biological and brain-based causes of mental illness? The three main
findings that align with the KMO framework that emerged from the data were: (1) mental health
professionals have an in-depth knowledge of the biological and brain-based causes of mental
illness; (2) mental health professionals are motivated to understand the biological causes of
mental illness because of its intrinsic value; and (3) the organization has cultural models and
settings in place to support the mental health professionals in understanding the biological and
brain-based causes of mental illness. Table 5 outlines these three findings as well as the key
themes under each finding. Each of these findings and themes will be discussed in this section.
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Table 5
Research Question 2 Findings and Themes
RQ2. What level of knowledge do Amen Clinics’ mental health affiliates have regarding
biological and brain-based causes of mental illness?
Findings Themes
Finding 1. MHPs have
an in-depth knowledge
of the biological and
brain-based causes of
mental illness
1. MHPs prefer to evaluate patients rather than just diagnose
2. MHPs have a greater understanding of the biological causes
of mental illness
3. MHPs have a greater understanding of the cognitive
neuroscience of mental illness
4. MHPs have a greater understanding of the root causes of
mental illness
Finding 2. MHPs are
motivated to
understand the
biological causes of
mental illness because
of its intrinsic value
1. MHPs enjoy educating and helping their patients understand
what might be going on inside of their bodies and brains
2. MHPs enjoy the challenge of figuring out what is going on
with the individual on a deeper level
Finding 3. The
organization has
cultural models and
settings in place to
support the MHPs in
understanding the
biological and brain-
based causes of mental
illness
1. Amen Clinics provides a cultural model which encourages
MHPs to understand the biological and brain-based causes of
mental illness
2. Amen Clinics provides a cultural setting which supplies
information and resources to help MHPs understand the
biological and brain-based causes of mental illness

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Mental health professionals have an in-depth knowledge of the biological and brain-
based causes of mental illness. Understanding the biological and brain-based causes of mental
illness is important in distinguishing between different mental health related disorders. Four key
themes that emerged from the knowledge finding were: (1) mental health professionals prefer to
evaluate patients rather than just diagnose; (2) mental health professionals have a greater
understanding of the biological causes of mental illness; (3) mental health professionals have a
greater understanding of the cognitive neuroscience of mental illness; and (4) mental health
professionals have a greater understanding of the root causes of mental illness. Each of these
knowledge themes will be discussed below.
Mental health professionals prefer to evaluate patients rather than just diagnose. The
difference between diagnosing and evaluating patients was discussed by several of the mental
health affiliates interviewed. Many of the research participants were uneasy with the term
diagnosis; they preferred to think of themselves as investigating or evaluating their patient’s
symptoms rather than just diagnosing or labeling the person. Psychologist #4 stated:
all I care about is people feeling better and functioning better. I don’t really care at all
about diagnosis. Diagnosis is primarily good for shorthand when communicating with
other clinicians. It’s sort of a grab bag of symptoms. But it’s important to realize that it
is just the beginning. For instance, we might say to each other that I’m working with
somebody that is depressed, but then we start talking about how that depression manifests
itself in that patient.
The mental health professionals interviewed seemed to understand the need for using the
DSM, and some even recognized the value the DSM was able to offer as data to include in the
evaluation, but they often turned the discussion back to the importance of really evaluating the
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patient rather than just labeling them with a diagnosis based on limited information on symptoms
alone. LPC #1 stated: “I’ve never been one for liking to label people, but the DSM is what we
have to use, so that’s what we use.” In addition, LMFT #1 stated: “The DSM provides a good
overview to get a picture of things, but I think it’s so limiting.” Furthermore, Psychologist #4
stated:
The main reason I need a diagnosis through the DSM is for insurance reimbursement.
The most common diagnosis therapists put down for insurance billing is ‘anxiety disorder
not otherwise specified’ because they know what they put in their file is going to follow
this person for the rest of their lives.
By focusing on evaluating their patients, the mental health professionals interviewed were able to
come upon a more accurate picture of what might be going on with their patients rather than just
diagnosing them based on symptoms alone.
Mental health professionals have a greater understanding of the biological causes of
mental illness. The mental health professionals studied believed understanding the biological
causes of mental illness was important to diagnosis. In fact, 100% of the respondents to the
survey stated they strongly agreed (88.24%) or somewhat agreed (11/76%) to the statement ‘it is
important to understand the biological causes of mental illness in order to approach a more
accurate diagnosis.’ Furthermore, the mental health affiliates studied had a robust knowledge of
the biological causes of mental illness. Those that responded to the survey stated they strongly
agreed (80.39%) or somewhat agreed (15.69%) the knowledge they had gained through their
affiliation with Amen Clinics had helped them better understand the biological causes of mental
illness (Figure 3).
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Figure 3. The knowledge I have gained through my affiliation with Amen Clinics has helped me
better understand the biological causes of mental illness.

Because of the in-depth knowledge they had regarding the biological causes of mental
illness, the mental health professionals studied didn’t just look for symptoms and system clusters
to determine a diagnosis. Instead they searched for the reasons behind the symptoms.
Psychologist #3 stated:
Evaluating the biological causes of mental illness when diagnosing a patent is absolutely
essential. If you skip that, it’s like you are skipping 60% of who a person is in my book.
For instance, if the problem is a hormonal imbalance in their thyroid they could give the
appearance of being depressed, lethargic, or unhappy. You could treat them upside down
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and backwards with antidepressants or cognitive therapy, but you need to know they
don’t have a thyroid problem first.
By seeking to uncover the biological or brain-based reasons for mental illness, these mental
health professionals can get a more accurate picture of the patient’s mental health.
Many participants stated they requested bloodwork for their patients to first rule out
biological causes such as over or under active thyroid, hormone imbalances, genetic biomarkers,
and diseases. Also, many research participants asked in-depth questions of their patients to get a
better sense of sleep patterns, exercise approaches, food habits, and home and work life
influences so they could get a better feel of what might be exacerbating the mental health
symptoms. Psychologist #3 stated: “gaining this type of information up front leads to a more
complete understanding of what is going on with the patient.” In addition, LCSW #1 stated:
I start out by asking things like, ‘are you staying hydrated? What are you eating? How
much are you sleeping? Those kinds of things because of course you are going to be
paranoid if you haven’t slept in a week; most everyone will be paranoid if they haven’t
slept in a week. So I have to look at the biological stuff that is going on first. Then I
look at the emotional space.
By understanding the biological causes of mental illness, the mental health professionals studied
were able to more accurately evaluate patients so they could come upon the most helpful
diagnosis possible. This focus on the biological causes of mental illness has led to more accurate
diagnosis as well as more effective treatment plans for their patients.
Mental health professionals have a greater understanding of the cognitive
neuroscience of mental illness. The mental health professionals interviewed had an in-depth
understanding of the cognitive neuroscience and symptoms of mental illness. LMFT #1 stated:
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“I never really thought about brain function, but now I understand everything is brain function.”
In addition, Psychologist #1 stated:
to me when I think about mental it goes to the brain. So, to me the quicker you can get
the information about what’s going on with the brain, the better. My goal is to treat
people quick and get them back up on the horse so they can ride off into what they’re
supposed to be doing.
Furthermore, Psychologist #2 stated:
we need to start treating the brain as an organ, like the heart or the pancreas. If we have
problems with those we take care of them. No one thinks there’s something wrong with
us. We just work to fix it.
Many of the research participants could expertly talk about brain function and how brain
function correlates to the different symptoms their patients exhibited. This understanding of the
cognitive neuroscience of mental illness helped them to evaluate and diagnose patients more
effectively.
Mental health professionals have a greater understanding of the root causes of mental
illness. The mental health professionals studied had a comprehensive understanding of the root
causes of mental illness. For instance, all of the research participants interviewed understood
that brain function affects behavior and if patients could improve brain function they were better
able to improve behavior. Life coach #1 stated: “Don’t focus on the behavior. Focus on what’s
actually going on and you are going to fix the behavior.” In addition, Psychologist #2 stated:
“I’m always looking at information instead of just their behavior. I talk with my patients about
Amen’s information and their diagnosis. Then they start to become curious and they want to
know more.” The mental health professionals that participated in the study focused on
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discovering the root causes of what might play into the patients’ symptoms first so they could
most effectively diagnose and treat the patient. Oftentimes they tried to determine the health of
the brain, the health of the body, and the underlying conditions that needed to be treated first.
For instance, Psychologist #1 stated: “A lot of psychiatrists are labeling or diagnosing people
with bipolar disorder and it’s really trauma. If you treat the trauma, then all the bipolar
symptoms go away.”
Furthermore, many of the affiliates in the study understood a healthy lifestyle was a key
component of a patient’s mental health. Psychologist #3 stated: “just the health of your brain is
so important to mental health in terms of how you are feeding it and how you are exercising it.
People don’t think about the need to exercise your brain.” When these mental health
professionals better understood the potential root causes of symptoms they were best able to get
to the actual problem of what might be going on instead of just focusing in on the symptoms.
The ability to go beyond the symptoms to figure out what might be going on at the root of the
issue was a key theme of the research participants who were interviewed.
By understanding the biological and brain-based causes of mental illness, the mental
health professionals studied were able to come upon a more accurate diagnosis for their patients.
In the next section, the motivation behind understanding the biological causes of mental illness
will be discussed.
Mental health professionals are motivated to understand the biological causes of
mental illness because of its intrinsic value. The two motivational themes that were
discovered in this finding in relation to intrinsic value were: (1) mental health professionals
enjoy educating and helping their patients understand what might be going on inside of their
bodies and brains; and (2) mental health professionals enjoy the challenge of figuring out what is
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going on with the individual on a deeper level. Both motivational themes will be discussed
below.
Mental health professionals enjoy educating and helping their patients understand
what might be going on inside of their bodies and brains. The ability for one to engage in a
task because it is personally rewarding is important to motivation. When my interview
participants could see the positive results coming from understanding Amen Clinics’ methods,
they also developed an internal desire to continue using the approaches beyond external reward
because they realized how important the information was in changing their patients’ lives.
Psychologist #4 stated:
even though I am old enough to retire, I work more now than I did when I was younger. I
love what I do now that I can be helpful to people and I love watching people get better.
It’s just so rewarding.
LPC #1 stated:
when we educate our patients and take them through the testing, they’ve got better
information and they are much more motivated to do the things to improve their brain
health habits because now they understand why it matters. For example, it is one thing to
encourage someone to exercise because you can fit into smaller jeans, but it’s different
when you say you have to exercise five times a week because we’ve got to get that blood
flow up to your brain so it will work better.
The enjoyment the mental health professionals felt by educating and helping their patients
understand themselves from a more objective frame helped motivate them forward in using a
more brain-based approach to mental health.
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Mental health professionals enjoy the challenge of figuring out what is going on with
the individual on a deeper level. Engaging in work that is challenging and rewarding is a
motivating force for many of the mental health professionals interviewed. Psychologist #3
stated: “I never found therapy boring because it was like an adventure, trying to find out what
this person’s story was and what was going on with them, how they relate, and how they felt.”
In addition, LPC #2 stated:
sometimes we play a little game where we like to speculate what the SPECT scans are
going to look like. Usually we are on point with what we end up seeing, which is really
exciting. It further validates this work as well when you can actually guess what the scan
is going to look like and then actually see it on the frame. That’s incredible.
Furthermore, Psychologist #3 stated:
I broke the curve at the University of Maryland in neurology. I was interested in learning
all I could about the brain. I am currently taking a course in paleontology and
astrophysics. Why am I doing that? Because I want to stretch my brain a little. I want to
learn some new things that are hard.
This unquenchable thirst for knowledge seemed to be a consistent trait amongst many of the
affiliates I interviewed.
Motivation is a driving force for change. Through intrinsic value, many of the mental
health professionals interviewed were motivated to keep gaining a better understanding of the
biological causes of mental illness and to continue using these biological and brain-based
methods. The next section will discuss the organizational influences surrounding the knowledge
the mental healthcare professionals had regarding the biologic and brain-based causes of mental
illness.
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The organization has cultural models and settings in place to support the MHPs in
understanding the biological and brain-based causes of mental illness. Two key themes that
were discovered in this organizational finding were: (1) Amen Clinics provides a cultural model
which encourages mental health professionals to understand the biological and brain-used causes
of mental illness; and (2) Amen Clinics provides a cultural setting which supplies information
and resources to help mental health professionals understand the biological and brain-based
causes of mental illness. Both organizational themes will be discussed below.
Amen Clinics provides a cultural model which encourages mental health professionals
to understand the biological and brain-based causes of mental illness. Amen Clinics’ cultural
model, which encourages and supports understanding of the biological causes of mental illness,
has positively impacted the mental health professionals studied. Psychologist #4 stated: “by
understanding Amen’s methods, I now don’t just look for symptoms and symptom clusters, but I
seek to gain a more correct understanding of symptomology.” In addition, Amen Clinics’ work
has helped those interviewed understand the root causes of the symptoms patients may be
experiencing. For instance, LMFT #1 stated:
I had a young girl come in to see me for weight loss. Amen Clinics taught me how sugar
is kind of soothing to certain parts of the brain and so eating sugar is oftentimes not even
a conscious decision. We are going to reach for something when we are tired to give us
energy. By understanding the biology, I was able to help her understand her issue in a
deeper way and then started our therapy by focusing on things like sleep first.
Furthermore, Dr. Amen’s cultural model of helping mental health professionals
understand the brain-based causes of mental illness has had significant impacts on these mental
health professionals as well as society as a whole. LPC #1 stated: “The work Dr. Amen has done
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just showed me that the brain is an organ that’s meant to be steered and most of us have just been
going along for the ride.” In addition, Psychologist #3 stated:
I really like Dr. Amen for his work with NFL players and helping bring the risk that
concussions and brain injuries pose to the consciousness of Americans with young kids;
helping them recognize they shouldn’t bash their heads together in crazy ways playing
sports. Concussions hurt your brain and having multiples can cause significant problems
within the brain. Coaches didn’t think much about that before and now they are much
more conscious about it and that alone is saving lots of misery and trouble for people. I
could just go on and on about how Amen Clinics has changed the way I approached my
practice as well as the impact this information could have on society as a whole.
Amen Clinics’ biological and brain-based cultural model has significantly helped these mental
health professionals to use and keep using these methods of diagnosis and treatment. By
providing an effective framework, these mental health professionals have been able to achieve
success with their patients. Appendix F includes all open-ended responses to the survey
question, ‘other comments regarding how being affiliated with Amen Clinics has impacted your
ability to diagnose mental health patients.’
Amen Clinics provides a cultural setting which supplies information and resources to
help mental health professionals understand the biological and brain-based causes of mental
illness. Amen Clinics supplies a lot of resources to help mental health professionals better
understand the biological and brain-based causes of mental illness. These resources help the
mental health professionals studied understand their patients better and look for root causes of
symptoms they wouldn’t have been able to identify before. LPC #2 stated:
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I always thought it was kind of ridiculous when I tried to diagnose patients before
becoming affiliated with Amen Clinics because you can have the same symptom and fit
into multiple different categories. It really doesn’t mean anything to me when you have a
diagnosis because it doesn’t solve the problem.
Many of the mental health professionals have significantly changed how they approach their
practices as a result of the resources provided to them through Amen Clinics’ cultural setting.
Psychologist #2 stated:
I changed my intake questionnaire drastically after the Amen’s course. I’ve now added
questions like how much water do they drink and how much exercise do they do; how
many hours of sleep they get as well as questions about alcohol and smoking. I also ask
about possible brain injury which I never thought about asking before.
In addition, Psychologist #4 stated:
by understanding Amen Clinics’ methods I was able to see a whole new side of the
human bio. There are so many variables that go into mental illness. We try to get a
broad picture of what is going on with the person from blood work to symptom
presentation to variability of presentation.
Furthermore, Amen Clinics’ cultural setting of providing resources to help mental health
professionals understand brain-based causes of mental illness was also impactful to those
interviewed. Psychologist #1 stated:
I went through a doctoral program so the fact that I didn’t feel like I got a good brain
educational until I went through Amen Clinics’ information was disappointing to me. Dr.
Amen has this stuff down. I think most psychologists and marriage and family therapists
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aren’t as aware as I am just because unless you put the time in, you just don’t think about
it.
By providing a cultural setting which supplies information and resources to help mental health
professionals understand the biological and brain-based causes of mental illness, these mental
health professionals had a great framework with which to improve patient diagnosis.
Research Question 3
Research question 3 asked: How can using SPECT scan imaging and other brain-based
approaches improve patient diagnosis? Three key findings that aligned with the KMO
framework that emerged from the data were: (1) mental health professionals have an in-depth
knowledge of SPECT scan imaging and they use this knowledge to improve patient diagnosis;
(2) mental health professions are motivated to keep using SPECT scan imaging to improve
patient diagnosis because of utility value, attribution, and self-efficacy; and (3) the organization
provides cultural models and cultural settings to assist mental health professionals in
understanding and applying SPECT scan imaging to improve patient diagnosis. Table 6 outlines
these three findings as well as the key themes under each finding. Each of these findings and
themes will be discussed in this section.

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Table 6
Research Question 3 Findings and Themes
RQ3. How can using SPECT scan imaging and other brain-based approaches improve
patient diagnosis?
Findings Themes
Finding 1. MHPs have
an in-depth knowledge
of SPECT scan imaging
and they use this
knowledge to improve
patient diagnosis
1. SPECT scan imaging helps MHPs understand brain function
and how brain function relates to mental illness
2. SPECT scan imaging helps MHPs with differential diagnosis
especially in complex cases
3. SPECT scan images provide MHPs with additional data they
wouldn’t get otherwise which results in more accuracy and
precision in diagnosis
Finding 2. MHPs are
motivated to keep using
SPECT scan imaging to
improve patient
diagnosis because of
utility value, attribution,
and self-efficacy
1. MHPs value the utility of SPECT scans in helping them get a
clearer picture of what might be going on with the patient
2. MHPs believe the effort they put into understanding SPECT
scan images can help them improve how they diagnose
patients
3. MHPs believe they are capable of understanding SPECT
scan imaging and applying it to patient diagnosis
Finding 3. The
organization provides
cultural models and
cultural settings to assist
MHPs in understanding
and applying SPECT
scan imaging to improve
patient diagnosis
1. Amen Clinics provides a cultural model which encourages
the use of SPECT scans in patient diagnosis
2. Amen Clinics provides a cultural setting which supplies
resources to help MHPs understand SPECT scan imaging
and how it applies to patient diagnosis

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Mental health professionals have an in-depth knowledge of SPECT scan imaging
and they use this knowledge to improve patient diagnosis. The in-depth knowledge the
mental health professionals studied had regarding SPECT scan imaging was a key finding in the
data pulled from this study. Three key themes that emerged from this knowledge finding were:
(1) SPECT scan imaging helped MHPs understand brain function and how brain function relates
to mental illness; (2) SPECT scan imaging helps MHPs with differential diagnosis especially in
complex cases; (3) SPECT scan imaging provides mental health professionals with data they
wouldn’t get otherwise. Each of these key findings will be discussed below.
SPECT scan imaging helped mental health professionals understand brain function
and how brain function relates to mental illness. For the individuals studied, a major part of
understanding brain function was gaining an understanding of SPECT scan imaging.
Psychologist #3 stated:
I feel like a lot of people are in the dark ages around this kind of work and the concept is
so simple. Why not look at the brain when brain functioning is so critical in so much of
what we do?
In addition, LCSW #1 stated: “SPECT scan imaging gives me better, more accurate and
individualized information.” Understanding SPECT scan imaging changed the way many of
these mental health professionals thought about mental health. Furthermore, the additional
information SPECT scan imaging provided to these mental health professionals helped them gain
a better understanding of their patients.
On the survey, when asked ‘The knowledge I have gained since becoming affiliated with
Amen Clinics has helped me better understand how using SPECT scan imaging can impact
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patient diagnoses,’ 40 of the 51 respondents stated they strongly agreed and 7 stated they
somewhat agreed to the question (Figure 4).

Figure 4. The knowledge I have gained since becoming affiliated with Amen Clinics has helped
me better understand how using SPECT scan imaging can impact patient diagnosis.

Furthermore, all of the participants interviewed stated their knowledge of SPECT scan
imaging had positively impacted how they diagnose or evaluate patients. This in-depth
knowledge of SPECT scan imaging had a significant impact on the mental health professionals
studied.
SPECT scan imaging helped mental health professionals with differential diagnosis
especially in complex cases. Although SPECT scan imaging doesn’t answer all questions, the
knowledge of SPECT scan imaging has added clarity around symptoms and diagnosis for many
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of the mental health professionals interviewed. Psychologist #3 stated: “especially when a
complex array of symptoms are manifesting, SPECT scan imaging allows clinicians the ability to
gain critical information for a more accurate differential diagnosis.” In addition, Psychologist #3
stated:
I would only refer people that were usually difficult diagnostically. I would say to
people, I could spend maybe a year trying to figure out what is really going on with you
or we could take a look at some things using a scan and we can exclude them right off
and get going on treatment. And we can also identify things maybe that might take a
long time to pick up. We can do the psychological testing, but in the meantime, I can
show you the pictures of the scans and I can interpret them and you can have your own
copy. Through the scans we will have some basic concepts of what is going on here.
The people I referred were consistently happy with the results of this. I never had
anybody get upset about it or decide it was a waste of their time to have.
Furthermore, LPC #1 stated:
When you get into things like ADD, it’s way different when you realize there’s several
different types versus just treating it like it is one. It’s also very different when
differentiating the type of depression you are dealing with. Depression is very different
when you are looking at it from the SPECT way. Also, understanding the role of the
temporal lobes is important because if they are in play you know you need to address
those first even if they are not the highest scoring item. You must get the brain balanced
before you move on to anything else. I think that is the key factor.
Through understanding cognitive neuroscience and SPECT scan imaging, Amen Clinics’
mental health affiliates gained a better understanding of their patients which lead to greater
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success and better diagnostic outcomes. Appendix E includes all open-ended responses to the
survey question, ‘other comments regarding how SPECT scan imaging has impacted your ability
to diagnose mental health patients.’
SPECT scan imaging helps mental health professionals with differential diagnosis
especially in complex cases. Those interviewed stated how SPECT scan imaging allowed them
to identify high or low functioning areas of the brain as well as over or under activity in the
anterior cingulate gyrus, limbic system, and basal ganglia. SPECT scan imaging also helped
these mental health professionals identify traumatic brain injury, tumors, diseases or even strokes
in their patients. Psychologist #4 stated: “SPECT gives objective evidence to what therapists and
psychiatrists have known their whole careers; that this is all muddy. Everybody looks a little bit
different because everybody’s brain is just a little bit different.” SPECT scan imaging allowed
the mental health professionals studied to obtain an objective view at a subjective process.
A few of the mental health professionals interviewed discussed how SPECT scan
imaging allowed them to see how a patient reacts during stress in contrast to when they are more
relaxed through two tests: the baseline test as well as the concentration test. By looking at both
tests, these mental health professionals had a better idea of what exacerbates their patients’
symptoms and these tests also help them get a better feel for what they needed to start with first.
For example, Psychologist #4 stated: “what we have learned over the years is that when someone
is really anxious, their ADD symptoms get worse, depression is worse . . . memory, learning,
everything is worse, so we have to treat anxiety first and foremost.” LPC #2 stated: “I wish it
were a quick fix, but it’s not, but at least you have the data.”
The mental health professionals interviewed were asked if there was a time when SPECT
scan imaging hadn’t been helpful diagnosing a patient. Most respondents stated they could not
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think of a time when SPECT scan imaging hadn’t been at least helpful in diagnosing a patient.
Psychologist #3 stated: “The only time it hasn’t been effective is where people refuse to follow
through with the protocol or when they are basically non-compliant.”
Although SPECT scan imaging seems to have been helpful to the participants in the
study, most interviewees stated the biggest downside to SPECT scan imaging is how expensive it
is. Because of the expense, oftentimes the patients who need it most are not able to afford it.
Life coach #1 stated: “Sometimes scans can be very expensive. But then again, it’s really about
breaking up those entrenched value judgements about what we should pay for and what
insurance should pay for.”
Another consideration with SPECT scan imaging is that expectations need to be properly
managed. LMFT #1 stated:
Sometimes people get disappointed. It’s important to let patients know it is just the first
step. Some people feel like it is just a scam, mostly because expectations are not well-
managed. They think they are going to come in and they are going to get this diagnosis
and it’s going to change their life. But they do not realize that it involves them doing
something, and if they are not willing to do those things, it is not going to help.
When patients are able and willing to follow through with the methods provided, the participants
in the study found SPECT scan imaging to be a useful and even critical tool in achieving more
accurate evaluations and diagnosis of their patients.
SPECT scan imaging provides mental health professionals with additional data they
wouldn’t get otherwise which results in more accuracy and precision in diagnosis. Many of
the mental health professionals interviewed stated that SPECT scan imaging provided them with
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information and data they wouldn’t have received if it wasn’t for SPECT scan imaging.
Psychologist #4 stated:
Individuals with overactivity in the basal ganglia are going to have a stronger response to
stressors in their environment than those who do not. Also, patients that have left
temporal lobe damage often have a very short fuse. They get angry very quickly but
calm down very quickly and in 10 minutes they are calm, and they can’t understand why
everybody else is still upset.
By understanding the patient might be having overactivity in the basal ganglia or temporal lobe
issues, these mental health affiliates can target those areas of the brain first.
Because of the data received through SPECT scans, many of the mental health
professionals interviewed stated that the scans often brought clarity to confusing situations.
Psychologist #4 stated: “The scan becomes the objective manifestation of subjective things that
people are presenting when they walk into your office.” Being able to see the brain and talk with
patients about their own brain significantly changed how many of those interviewed diagnosed
patients.
Because of the value of the information that SPECT scan adds towards understanding a
patient’s mental health, several of the mental health professionals interviewed stated they
thought it was sad that the knowledge of SPECT scan imaging wasn’t standard among mental
health professionals. LCSW #1 stated: “scans really should be like going in for a checkup. It is
just too informative to not get earlier.” Some of the mental health professionals even considered
the information they received through SPECT scans to be imperative to the mental health field.
LMFT #2 stated: “It should be malpractice in the mental health profession to not give someone a
brain scan, especially in complex cases. It’s crazy. Really wrong . . . wrong people are
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suffering, lives are harmed because they simply won’t look.” By gathering all the information
possible, including information from SPECT scan imaging, mental health professionals were
better able to diagnose patients accurately. In the next section, what motivated mental health
professionals to keep using SPECT scan imaging will be discussed.
Mental health professionals are motivated to keep using SPECT scan imaging to
improve patient diagnosis because of utility value, attribution, and self-efficacy. Three key
motivational themes that were discovered through analyzation of the data for this finding were:
(1) mental health professionals value the utility of SPECT scans in helping them get a clearer
picture of what might be going on with the patient; (2) mental health professionals believe the
effort they put into understanding SPECT scan images can help them improve how they diagnose
patients; and (3) mental health professionals believe they are capable of understanding SPECT
scan imaging and applying it to patient diagnosis. Each of these motivational themes will be
discussed below.
Mental health professionals value the utility of SPECT scans in helping them get a
clearer picture of what might be going on with the patient. The usefulness of SPECT scan
imaging in helping mental health professionals get a clearer picture of the patient’s situation was
a common theme among the mental health professionals interviewed. LCSW #1 stated:
getting the training and reading the SPECT scans helped me better understand where my
patients were coming from. It was so helpful. For instance, you can treat someone for
depression all day long but if they have a brain injury you are not going to get anywhere
with their depression. You need to actually treat the brain injury first.
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In addition, Psychologist #2 stated:
of course, as a cognitive behavioral therapist, I understood that our thoughts make a big
difference, but to be able to have a structure that actually identifies thoughts and
challenges them then allows patients to reframe those thoughts and work through
cognitive behavioral therapy better. It really works.
Through seeing the usefulness of brain-based approaches to mental health, many of the health
care participants felt SPECT scan imaging gave them valuable information so they were
motivated to continue forward with the tools and techniques.
Mental health professions believe the effort they put into understanding SPECT scan
images can help them improve how they diagnose patients. Attributions, or how people
attribute cause to effect, is important when looking at motivational influences. When the mental
health professionals interviewed could see the positive results of their own efforts they had put
into understanding the information, they were more willing to push forward with applying the
information. Psychologist #2 stated:
It works. It really helps me to do a better job. It helps me with my clients. So I am
motivated to keep using Amen’s methods all the time and the success I have seen with
my patients motivates me to learn more and more and more.
In addition, LPC #1 stated: “I spent a lot of time educating myself so I could educate other
people about their brains, how to have a better brain, and how it matters in their life.”
Understanding the mental health professionals had control over more effective and more accurate
diagnosis was a huge motivating force behind continuing to use these brain-based approaches.

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Mental health professions believe they are capable of understanding SPECT scan
imaging and applying it to patient diagnosis. Understanding the more time and effort they put
into understanding these methods had a direct impact on their patients outcomes seemed to
motivate these mental health professionals forward in continuing to use these brain-based
methods. LPC #1 stated: “I just felt it was the most fascinating work to come along in our field
in a long time and immediately I signed up and just immersed myself in his material. It just
makes such a difference.”
Understanding the mental health professionals were capable of understanding and
applying brain-based methods of diagnosing to their patients was a motivating factor in
continuing to use these approaches. The organizational models and settings that influenced the
mental health professionals to utilize SPECT scan imaging are discussed in the following
section.
The organization provides cultural models and cultural settings to assist mental
health professionals in understanding and applying SPECT scan imaging to improve
patient diagnosis. Two key themes that were discovered through this organizational finding
were: (1) Amen Clinics provides a cultural model which encourages the use of SPECT scans in
patient diagnosis; and (2) Amen Clinics provides a cultural setting which supplies resources to
help mental health professionals understand SPECT scan imaging and how it applies to patient
diagnosis. Both organizational themes will be discussed below.
Amen Clinics provides a cultural model which encourages the use of SPECT scans in
patient diagnosis. Dr. Amen is famous for saying, “How do you know unless you look?” This
idea has changed the way many of the mental health affiliates studied viewed mental illness and
how they approached diagnosis and treatment. After seeing the brain and the correlations
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between brain images and behavior, mental health professionals see their clients fundamentally
differently. Amen clinics has a culture of understanding that guessing isn’t ok. It can be cruel
and demoralizing for those who suffer from biological causes of mental illness. Psychologist #4
stated:
SPECT scans created a revolution in our whole approach to what we’re looking for and
how we think about people from the moment we start interacting with them. We are
always thinking in terms of those systems of the brain.
In addition, Psychologist #3 stated:
Dr. Amen presented a set of scans in Baltimore, Maryland at a conference. It was the
first indication of how ADD actually functions or dysfunctions in the brain when you
know baseline and then the concentration. With concentration the bottom half of the
prefrontal cortex dropped out for people with ADD. It was amazing to see that for the
first time ever.
For the mental health affiliates studied, the brain-focused cultural model of Amen Clinics has
changed the way they look at brain health as well as how they diagnose patients. In a survey
question which stated, “I have changed the way I diagnose patients because of my affiliation
with Amen Clinics,” 43.14% strongly agreed, 31.37% somewhat agreed, and 25.49% neither
agreed or disagreed (Figure 5). This brain-based cultural model has had an impact on these
mental health affiliates studied. The support these mental health professionals are given through
Amen Clinics has been instrumental in their efforts towards more accurate diagnosis.

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Figure 5. I have changed the way I diagnose patients because of my affiliation with Amen
Clinics.

Amen Clinics provides a cultural setting which supplies resources to help mental
health professionals understand SPECT scan imaging and how it applies to patient diagnosis.
Amen Clinics provides many resources to help mental health professionals understand and apply
SPECT scan imaging. These resources are very effective and engaging. Psychologist #3 stated:
“once I took a workshop with Dr. Amen back in the early ‘90s, I was totally enamored with the
idea of SPECT scans and understanding how the brain works and doesn’t work.” In addition,
Psychologist #3 stated: “After working with Dr. Amen, I always considered the scans more
validating to my diagnosis. For people with extreme difficulty, I thought it was very valuable.”
These valuable resources created by Amen Clinics have helped these mental health professionals
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continue towards more brain-based diagnosis for their patients. Appendix G includes ‘stories of
success from the mental health professionals interviewed.’
Research Question 4
Research question 4 asked: What types of accountability do mental health professionals
hold themselves to for correct diagnosis? The three main findings that aligned with the KMO
framework that emerged from this study were: (1) mental health professionals are knowledgeable
about the types of accountability they are held to for correct diagnosis; (2) mental health
professionals are motivated to be accountable for correct diagnosis for their patients; and (3) the
organization has cultural models and settings in place to support their internal mental health
professionals towards accountability for more correct diagnosis. Table 7 outlines these three
findings as well as the key themes under each finding. Each of these findings and themes will be
discussed in this section.

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Table 7
Research Question 4 Findings and Themes
RQ4. What types of accountability do mental health professionals hold themselves to for
correct diagnosis?
Findings Themes
Finding 1. MHPs are
knowledgeable about the types
of accountability they are held
to for correct diagnosis
1. MHPs understand the different types of accountability
they are held to for patient success
2. MHPs hold themselves to different types of
accountability
Finding 2. MHPs are
motivated to be accountable
for correct diagnosis for their
patients
1. There are few imposed incentives to reduce
misdiagnosis in mental health professions unless it is
through an outside agency or business
Finding 3. The organization
has cultural models and
settings in place to support
their internal MHPs towards
accountability for more correct
diagnosis
1. Amen Clinics provides a cultural model which
supports accountability for their internal MHPs for
more correct patient diagnosis
2. Amen Clinics provides a cultural setting which
collects metrics for their internal MHPs which
encourages realistic and achievable results

Mental health professionals are knowledgeable about the types of accountability
they are held to for correct diagnosis. Two main themes came out of this knowledge finding:
(1) mental health professionals understand the different types of accountability they are held to
for patient success; and (2) mental health professionals hold themselves to different types of
accountability. Both knowledge themes will be discussed below.
Mental health professionals understand the different types of accountability they are
held to for patient success. The Amen Clinics’ mental health affiliates studied seemed to have a
clear knowledge of the accountability they are being held to for correct diagnosis. When asked if
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they knew of any accountability mental health professionals were held to for correct diagnosis,
Psychologist #2 stated:
not short of malpractice. I haven’t been held accountable. I mean we have to follow the
code of ethics and we are not supposed to practice outside of the area of our expertise but
no one’s actually holding us accountable.
In addition, Psychologist #3 stated: “only through legal action against them.” The mental health
professionals interviewed seemed to clearly understand the accountability they were being held
to, but the level of accountability in mental health professions seemed to be a very low standard.
Mental health professionals hold themselves to different types of accountability. The
mental health professionals that were interviewed held themselves to internal accountability
standards. Some mental health professionals also created accountability metrics within their own
organization to drive more accurate diagnosis for the counselors that worked within their clinics.
These different types of accountability are needed but may not be sufficient to drive home the
needed change towards more accurate and precise diagnosis. In the next section, the
motivational influences for accountability towards more correct diagnosis will be discussed.
Mental health professionals are motivated to be accountable for correct diagnosis
for their patients. Evaluating treatment plans is important to the individuals surveyed. In a
question asking survey participants about the statement ‘Evaluating the effectiveness of a
treatment plan for a patient is important,’ 90.2% of survey participants strongly agreed and
9.80% of survey participants somewhat agreed (Figure 6).

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Figure 6. Evaluating the effectiveness of a treatment plan for a patient is important.

However, the motivation in place to hold mental health professionals to evaluating
treatment plans was more challenging to identify. One theme that emerged from the
motivational data from the study was there are few imposed incentives to reduce misdiagnosis in
mental health professions unless it is through an outside agency or business. This motivational
theme will be discussed below.
There are few imposed incentives to reduce misdiagnosis in mental health professions
unless it is through an outside agency or business. Many of the mental health professionals
interviewed did not feel the motivation for accountability towards correct patient diagnosis was
in place. LCSW #1 stated: “I think the hard part that people in private practice have a problem
with is staying accountable and staying up to date. We can really let ourselves slide if we allow
ourselves to.” This lack of proper motivation towards correct diagnosis could negatively affect
progress towards promising practices because there is little incentive for mental health
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professionals to try out new and innovative solutions with their patients. In order to progress,
mental health professionals could benefit by stricter measures of accountability toward more
accurate diagnosis. In the next section, the organizational influences surrounding accountability
will be discussed.
The organization has cultural models and settings in place to support their internal
mental health professionals towards accountability for more correct diagnosis.
Organizations provide the key frameworks needed to initiate change. Two key themes that
emerged from this organizational finding were: (1) Amen Clinics provides a cultural model
which supports accountability for their internal mental health professionals for more correct
patient diagnosis; and (2) Amen Clinics provides a cultural setting which collects metrics for
their internal mental health professionals which encourages realistic and achievable results.
Each of these organizational themes will be discussed below.
Amen Clinics provides a cultural model which supports accountability for their
internal mental health professionals for more correct patient diagnosis. Mental health
professions in general need to be held to higher levels of accountability for patient success.
Often without accountability, the necessary motivation is not in place to drive excellence.
Organizations like Amen Clinics are holding mental health professionals accountable to more
accurate and precise methods of diagnosis. The information gained through Amen Clinics helps
drive accountability through increased knowledge. LPC #2 stated: “The more I know the harder
this gets because I can’t just sit back and listen to people’s problems.” By driving accountability
in mental health professions, mental health professionals will feel more responsibility to find the
most effective methods possible to diagnose and treat patients.
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Amen Clinics provides a cultural setting which collects metrics for their internal
mental health professionals which encourages realistic and achievable results. Amen Clinics
often gets some of the hardest mental health related cases because many of their patients have
tried other means first and are going to Amen Clinics as a last resort. Even with these
challenging cases, Amen Clinics pushes its staff to an 80–85% significant improvement rate.
This accountability encourages its counselors to utilize the best, most effective treatments for
their patients, to find the root causes of what is going on with their patients, and to find SPECT
scan supported treatments to help their patients feel better and live happier, healthier lives.
Summary Findings
This chapter presented a summary of the data collected through an explanatory,
sequential, mixed-methods study with the purpose to assess what tools mental health
professionals utilize in order to diagnose their patients and to determine how adding SPECT scan
imaging to a mental health professional’s toolbox could help to increase the effectiveness of
diagnosis methods.
The key findings and themes discovered through analysis of the data are represented in
Tables 4–7 found within the chapter. The tables provide a tabulation of the key findings and
themes surrounding the KMO influences for each of the four guiding research questions for this
study.
In addition, Appendix E includes all open-ended responses to the survey question ‘other
comments regarding how SPECT scan imaging has impacted your ability to diagnose mental
health patients.’ Appendix F includes all open-ended responses to the survey question ‘other
comments regarding how being affiliated with Amen Clinics has impacted your ability to
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diagnose mental health patients.’ Appendix G includes ‘stories of success from the mental
health professionals interviewed.’
Chapter 5 provides recommendations for organizations and individuals to utilize for more
brain-based approaches to improve diagnosis in mental health professions. It will also provide a
framework for other mental health professionals to use to achieve more accurate diagnosis of
their patients in the future.

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CHAPTER 5
DISCUSSION AND RECOMMENDATIONS
Organizational Context and Mission
The Amen Clinics was established by Dr. Daniel Amen in 1989. Dr. Amen is a
physician, psychiatrist, ten-time New York Times bestselling author, and professor. Dr. Amen’s
focus is on brain health. The belief behind this focus is if the brain is healthy, people are happier
and healthier. The Amen Clinics seeks to optimize brain health to enable the success of its
patients in all areas of their lives. Their science-based and well-researched process results in
more accurate diagnosis and higher than average significant improvement rates for the patients
they serve.
Amen Clinics, Inc. is currently one of the world leaders in using Single-Photon Emission
Computed Tomography (SPECT) scan imaging and brain imaging science to help people
struggling with mental illness. SPECT scan imaging was first developed in the 1960s and has
since been shown to be an effective tool in differential diagnosis of various neuropsychiatric
diseases as well as to provide an objective evaluation tool for mental illness (Dierckx et al.,
2014). SPECT scan imaging utilizes nuclear medicine and gamma rays to provide 3D
information about the brain including blood flow and lack of blood flow to specific regions.
SPECT scan imaging also looks at energy levels in certain parts of the brain. SPECT scan
imaging allows mental health professionals the ability to see if the brain is healthy and
functioning properly and aids them in getting a better idea of various problems that might be
happening within the brain. Amen Clinics has the world’s most expansive database of brain
scans related to behavior.
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Amen Clinics currently has eight clinics spanning across the United States. The Amen
Clinics’ method has been developed over 22 years. Amen Clinics focuses on a four-circle
approach: biological (genes, family history, diet and exercise, head injury, or environment
toxins), psychological (how you think, developmental events, attachment problems, past
emotional traumas), social (stresses experienced, health and happiness of the people you spend
time with) and spiritual (why you care, why are you on the planet, connections with past and
future generations, connections to the planet, your religious beliefs, what is important to you).
This four-circle approach helps to create a more specific, personal diagnosis with targeted
treatment based on the collection of a large amount of information, which results in the best
possible understanding of the patient and their symptoms. The Amen Clinics method also
focuses on using the least toxic, most effective treatments possible based on information
obtained by SPECT scan imaging in the bio, psycho, social, spiritual context.
In a multisite, six-month outcome study of 500 complex psychiatric patients, it was found
adding tools like SPECT scan imaging to diagnosis achieved a 75% reported significant clinical
improvement rate for the patients studied (Amen et al., 2013). Through studying the brain, Dr.
Amen has discovered seven different types of anxiety and depression, seven different types of
ADD, six different types of addicts, and five types of overeaters. Being able to identify and
differentiate between these different types is an important step to moving psychology forward.
In order to assist mental health professionals in developing the skills needed to evaluate
and treat patients more accurately, Amen Clinics has developed a Brain Health Coaching
Certification Course. This training provides practitioners with a 40-hour training course that
focuses on brain health, the latest advances in brain-health care, as well as ideas on how to
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implement Amen Clinics’ methods to help assist mental health professionals to more accurately
evaluate and treat their patients.
Organizational Performance Status
Currently the rates of mental illness are staggering and do not show signs of improving.
The current methods used to treat mental illness by counseling psychologists are insufficient to
address this growing concern. A push for more biologically-focused and scientifically-driven
mental health professionals is needed to better ensure more effective treatment methods and
approaches are being used for patients. Furthermore, accountability metrics need to be instituted
to push mental health professionals towards more valid and reliable treatment methods. Amen
Clinics currently pushes their clinicians to achieve an 80–85% significant improvement rate for
their patients. These results are higher than most others in their fields, especially considering
that oftentimes patients of Amen Clinics are those who have tried other methods of
psychology/psychiatry without significant success and tend to be some of the more challenging
cases.
Description of Stakeholder Groups
Several stakeholders contribute to or benefit from more effective treatment of mental
illness. Three key stakeholder groups are mental health professionals, patients of these mental
health professionals, and society as a whole.
Mental health professionals are key stakeholders that contribute to the correct diagnosis
of their patients. Most of these mental health professionals counsel one-on-one with patients to
help them work through life-events, diagnose or evaluate them with potential mental illnesses,
and develop treatment plans. Mental health professionals work in a variety of environments and
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with various focuses. A large portion of mental health professionals are paid by third-party
payers such as insurance companies.
Patients are also a key stakeholder group in this performance goal because the patients
benefit by the services offered through mental health professionals. The patients are the ones
who also carry out treatment plans and work through therapies given by the clinicians. Patients
also benefit greatly by effective and correct diagnosis and treatment.
Society is the final key stakeholder group because of the toll mental illness plays in the
society in which we live. By improving mental illness we help people go back to work, function
normally, and live healthier lives. Police officers spend a large portion of their time dealing with
and managing mental illness. Many hospital staff also spend a significant amount of time
dealing with the mentally ill. Mental illness has considerable and nearly incalculable costs on
society. By reducing the misdiagnosis of those who are mentally ill, society will have less of a
burden to carry regarding dealing with and taking care of these individuals.
Stakeholder Group for the Study
Although a complete analysis of the problem of practice would involve all stakeholder
groups, for practical purposes this study focused in on those mental health professionals who are
listed as Amen Clinic affiliates on Amen Clinics’ website. This study examined how SPECT
scan imaging and Amen Clinics’ methods of brain-focused mental health has helped these
mental health professionals more accurately diagnose and treat their patients.
Purpose of the Project and Questions
The purpose of this project is to assess what tools mental health professionals utilize in
order to diagnose and treat their patients and to determine how adding SPECT scan imaging to
their toolbox can help to increase the effectiveness of diagnosis and treatment methods. While a
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complete study would focus on all stakeholders, for practical purposes the stakeholder to be
focused on in this analysis are the mental health professionals who affiliate with Amen Clinics.
Research has been described as a systematic process which allows us to gain more
knowledge than we did before the research (Merriam & Tisdell, 2016). The project goal is to
develop a counseling framework that will improve the reliability and validity outcomes of mental
health professionals as well as to identify knowledge gaps regarding the biological and
neurological causes of mental illness for mental health professionals.
The main stakeholder group in the study were the mental health professionals who are
listed as affiliates of Amen Clinics through their website. These mental health professionals
were the focus of the interviews and surveys. Their knowledge as professionals added to the
literature that has already been collected. By focusing in on these mental health affiliates as the
main stakeholder, the study also benefited patients because they are directly tied to the
knowledge and motivation of mental health professionals.
This study also utilized Clark and Estes’ (2008) gap analysis model to perform a needs
analysis for possible Knowledge, Motivation, and Organizational (KMO) gaps that could lead to
greater reliability and validity for diagnosis in the future for mental health professionals. As
such, the research questions that guided this study are the following:
1. What tools do Amen Clinics’ mental health affiliates utilize to diagnose patients?
2. What level of knowledge do Amen Clinics’ mental health affiliates have regarding
biological and brain-based causes of mental illness?
3. How can using SPECT scan imaging and other brain-based approaches improve
patient diagnosis?
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4. What types of accountability do mental health professionals hold themselves to for
correct diagnosis?
Recommendations for Practice to Address KMO Influences
Knowledge Influences and Recommendations
The data for the knowledge influences were collected from a mixed-methods approach of
surveys and semi-structured interviews with mental health professionals who have affiliation
with Amen Clinics. Three assumed knowledge influences were confirmed through the data
analysis: knowledge of biological causes of mental illness, understanding of cognitive
neuroscience and symptoms of mental illness, and understanding of the root causes of mental
illness. Table 8 represents these assumed knowledge influences as well as the validation and the
priority of each of the three assumed knowledge influences.

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Table 8
Summary of Knowledge Influences and Recommendations
Assumed
Knowledge
Influence
Validated
as a Gap?
Yes, High
Probability
or No
(V, HP, N)
Priority?
Yes, No
(Y, N) Principle and Citation
Context-Specific
Recommendation
Mental health
professionals lack
proficient
knowledge of the
biological causes
of mental illness.
(D)
HP Y Managing intrinsic
load by segmenting
complex material into
simpler parts and pre-
training, among other
strategies, enables
learning to be
enhanced (Kirschner,
Paas, & Kirschner,
2009).
Provide mental health
professionals in-
depth information on
the biological causes
of mental illnesses.
Mental health
professionals lack
understanding of
cognitive
neuroscience and
symptoms of
mental illness.
(D)
HP Y To develop mastery,
individuals must
acquire component
skills, practice
integrating them, and
know when to apply
what they have
learned (Schraw &
McCrudden, 2006).
Provide mental health
professionals job aids
developed to assist
them in defining and
integrating what they
learn into their
diagnostic processes.
Mental health
professionals lack
understanding of
the root causes of
mental illness and
patients’ brain
health. (D)
HP Y Information learning
meaningfully and
connected with prior
knowledge is stored
more quickly and
remembered more
accurately because it
is elaborated with
prior learning (Schraw
& McCrudden, 2006).
Provide mental health
professionals with an
information pamphlet
outlining root causes
of mental illness and
how they relate to
patient brain health.
* Knowledge type for each influence: (D)eclarative; (P)rocedural; (M)etacognitive

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Increasing declarative knowledge of the biological causes of mental illness. The data
from this study found that 80.39% of respondents strongly agreed and 15.69% somewhat agreed
that the knowledge they had gained through their affiliation with Amen Clinics helped them
better understand the biological causes of mental illness. Only two respondents stated they
neither agreed nor disagreed and no study participants stated that they disagreed or strongly
disagreed with the statement. In order to close this declarative knowledge gap between mental
health professionals and those affiliated with Amen Clinics, a recommendation rooted within
cognitive load theory will be utilized. Kirschner et al. (2009) found that it is easier for learners
to manage intrinsic load if the information is broken into smaller segments. There are so many
different biological causes of mental illness, it is important not to overwhelm mental health
professionals and to provide an effective way for them to learn and understand this information.
It is recommended that mental health care professionals be provided in-depth information on the
biological causes of mental illnesses in a way that enhances learning by breaking the information
into simpler, more manageable parts.
An intense focus on the root causes of mental illness is essential because it leads to more
effective diagnosis and treatment outcomes (Adam, 2014). Clark and Estes (2008) stated
oftentimes people are unaware of their own lack of knowledge and skills. When clinicians solely
attribute behavior to patients’ bad choices instead of considering neurological problems or
deficiencies the treatment can make the problem worse because underlying issues are not being
addressed (Amen, 2013). Furthermore, if patients are ineffectively treated for neuropsychiatric
disorders, it can be hurtful, expensive, and demoralizing, because they are told they could and
should fix their behavior when it might not be possible with the biological conditions present at
the time (Amen, 2010). An intense focus on the root causes of mental illness is essential because
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it leads to more effective diagnosis and treatment outcomes (Adam, 2014). By helping mental
health professionals identify their own lack of understanding of the various biological causes of
mental illness and how this deficiency could result in misdiagnosis, they will be more willing to
learn new information that will better help their patients, especially if that information is broken
into simpler, more manageable parts.
Increasing understanding of cognitive neuroscience and symptoms of mental illness.
Many of the participants studied felt they didn’t gain a good understanding of the brain until they
learned about the Amen Clinics’ method. Psychologist #1 stated: “I went through a doctoral
program so the fact that I didn’t feel like I got a good brain educational until I went through
Amen Clinics’ information was disappointing to me.” In order to close this declarative
knowledge gap between the symptoms-based diagnostic method of the DSM and a diagnostic
method based upon cognitive neuroscience, a recommendation from information processing
system theory will be utilized. Schraw and McCrudden (2006) found that to develop mastery,
individuals must first acquire the competent skills, then they must practice integrating these
skills, and finally they must know when to apply what they have learned in their own situations.
This idea is important, especially surrounding understanding cognitive neuroscience because this
transition will be complex and challenging. It is recommended that mental health professionals
be given job aids that are specifically developed to assist them in defining the key components
surrounding SPECT scan imaging and other cognitive tools and then they must be given
opportunities to apply the concepts within their own practice so they can integrate what they
learn into their diagnostic processes.
Most mental health professionals are caring individuals who want to see their patients
succeed. Clark and Estes (2008) stated that people will more quickly and easily understand
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information and push towards goals they deem valuable to them. Successfully identifying
different types of mental illnesses is critical to diagnosing patients effectively. Using the current
methods of symptoms-based diagnosis, some patients are being diagnosed unnecessarily with
mental disorders (Cooper, 2016). Under the new DSM V, there is now a 50% chance of every
American being able to receive a diagnosable mental disorder (Rosenberg, 2013). It is important
that mental health care professionals understand the cognitive neuroscience behind mental illness
so they can more effectively diagnose the problem. By providing mental health professionals
with more effective ways to diagnose patients and then allowing them opportunities to integrate
what they have learned, success is most likely to be achieved.
Increase understanding of the root causes of mental illness and patients’ brain
health. Many of the research participants stated understanding the root causes of mental illness
was important to diagnosing patients. All respondents stated they either strongly agreed or
agreed that a healthy lifestyle such as exercising, drinking water, eating healthy, supplements,
etc., is critical for improved patient outcomes. However, there is a significant gap in knowledge
of how these root causes affect brain health. In order to bridge this gap, an idea from
information processing system theory will be utilized. Schraw and McCrudden (2006) found
that information that is learned meaningfully as well as information that is connected with prior
knowledge allows learners to store information more quickly and remember content more
accurately because it is elaborated with prior learning. Most mental health professionals
currently utilize the DSM, so it is important to link new information surrounding root causes to
the concepts in the DSM. It is recommended that mental health professionals be provided with
an information pamphlet outlining the root causes of mental illness and how these concepts relate
to the DSM.
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Clark and Estes (2008) state poor communication is a very common source of knowledge
issues. Poor communication of the recent advances in mental health could be causing this gap in
knowledge. Recent research regarding genetics is changing the way we look at mental health
(State & Geschwind, 2015). Some researchers are pushing for a precision medicine approach to
neuropsychiatric diseases based on studies that have found a link between genomic findings that
show synaptic and immunologic causes with mental health issues such as autism (Kohane,
2015). Other researchers are suggesting that neurotoxic factors, positive neurodevelopment
factors and therapeutic interventions be considered in mental health to improve diagnosis and
treatment (Gonçalves & Perrone-McGovern, 2014). Some research has found biological links to
things like paralysis and schizophrenia (Hruby, 1998). By clearly and uniformly communicating
this procedural knowledge to mental health care professionals on how to utilize this new research
for patient success, they will be better able to diagnose their patients in the future.
Motivation Influences and Recommendations
The data for the motivation influences were collected from surveys and interviews
gathered from health care professionals affiliated with Amen Clinics. All three assumed
motivation influences were validated. As seen in Table 9, the assumed motivation influences
are: (1) utility value, (2) attributions and (3) self-efficacy. Each of these areas are discussed in
this section as well as context-specific recommendations based on the identified core principles.

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Table 9
Summary of Motivation Influences and Recommendations
Assumed
Motivational
Influence
Validated as
a Gap?
Yes, High
Probability,
No
(Y, HP, N)
Priority?
Yes, No
(Y, N) Principle and Citation
Context-Specific
Recommendations
Mental health
professionals need to
recognize the
usefulness of utilizing
the biological and
neurological causes of
mental illness through
tools like SPECT
scan imaging. (Utility
Value)
HP Y Rationales that discuss
the importance and
utility value of the
learning and work can
help learners to develop
the desired positive
values (Eccles, 2006;
Pintrich, 2003).
Provide mental health
professionals with specific
examples of how adding
SPECT scan imaging to
their tool box can be useful
to them as an aid for
correct diagnosis.
Mental health
professionals need to
attribute to own
efforts the success or
failure of patient
outcomes. (A)
HP Y Provide feedback that
emphasizes the process
of learning, including the
need for effort, potential
self-control of learning,
and strategies
(Anderman &
Anderman, 2009).
Providing attribution re-
training to ensure mental
health professionals
understand how the effort
they put in impacts patient
outcomes through
successful knowledge
acquisition.
Mental health
professionals need to
believe they are
capable of
understanding and
applying the root
causes of mental
illness to patient
diagnosis and
success. (SE)
HP Y Provide opportunities to
observe a credible,
similar model engaging
in behavior that has
functional value
(Pajares, 2006).
Provide mental health
professionals instruction
on how to effectively use
SPECT scan imaging for
patient success, they
should observe and engage
with others who already
know how to effectively
use this tool (models), they
should be provided
opportunities to implement
what they have learned
through guided practice,
and they should be
provided immediate
feedback to help them
build their self-efficacy in
relation to SPECT scan
imaging.

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Mental health professionals need to recognize the usefulness of tools like SPECT
scan imaging as an aid in correct diagnosis. When asked about the statement, I did not fully
understand the usefulness of SPECT scan imaging before becoming affiliated with Amen
Clinics, 64.71% of respondents surveyed stated they strongly agreed and 11.76% stated they
agreed. In order to close this motivational gap in utility value, a solution rooted in expectancy
value theory will be utilized. Eccles (2006) and Pintrich (2003) found that rationales that discuss
the importance and utility value of the work can help learners to develop the desired positive
values (Eccles, 2006; Pintrich, 2003). Because most mental health professionals have a genuine
interest in their patients’ success, it is important to help them understand the value and usefulness
of using SPECT scan imaging in their own practice. Therefore, the recommendation is mental
health care professionals are provided with specific examples of how adding SPECT scan
imaging to their toolbox can be useful to them as an aid in correct diagnosis.
SPECT scan imaging is relatively new and few mental health professionals are aware of
how this tool can help them distinguish between various forms of mental illness. SPECT scan
imaging was first developed in the 1960s and has since been shown to be an effective tool in
differential diagnosis of various neuropsychiatric diseases as well as to provide an objective
evaluation tool for mental illness (Dierckx et al., 2014). SPECT scan imaging allows mental
health professions the ability to see if the brain is healthy and functioning properly and aids them
in getting a better idea of various problems that might be occurring within the brain (Amen,
2010). By providing mental health professionals examples of how adding SPECT scan imaging
to their tool box can help aid them in correct diagnosis of their patients, they will be able to
better see the usefulness of this approach and work toward understanding the biological causes of
mental illness for increased patient success.
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Mental health professionals should attribute patient outcomes to their own efforts.
Several of the mental health professionals interviewed stated before becoming affiliated with
Amen Clinics, they didn’t feel like their own effort would necessarily have a significant impact
on patient outcomes. LPC #1 stated: “before I learned about Amen Clinics there was something
missing. It was sort of like feeling around in the dark.” In order to close this motivational gap, a
solution rooted in attribution theory will be utilized. Anderman and Anderman (2009) found that
we should provide feedback that emphasizes the process of learning, including the need for
effort, potential self-control of learning, and strategies. The recommendation is that mental
health care professionals should be provided attribution retraining in order to ensure they
understand how the effort they put in impacts patient outcomes through successful knowledge
acquisition.
Many health care professionals are doing the best they can with the information that is
given to them. Some mental health professionals feel inadequate in understanding the biological
causes of mental illness and so they shy away from putting effort into a non-traditional approach
(Amen, 2010). Furthermore, understanding the new tools being developed for more accurate
diagnosis in mental health is time consuming and can feel overwhelming (Adam, 2014). A key
component of motivation is determining how much mental exertion one is willing to invest into a
project (Clark & Estes, 2008). By providing attribution retraining and helping mental health
professionals to understand how the effort they put in impacts patient success, they will be more
likely to engage in the knowledge acquisition process.
Mental health care professionals need to believe they are capable of understanding
and applying the root causes of mental illness to patient diagnosis and success. Self-efficacy
is a significant motivating force for individuals (Clark & Estes, 2008); however, 47.26% of those
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surveyed responded they strongly agreed or somewhat agreed that before becoming affiliated
with Amen Clinics they felt hesitant to apply SPECT scan imaging to patient diagnosis. In order
to close this motivational gap, self-efficacy theory will be utilized. Pajares (2006) stated that the
greatest success is found when you provide opportunities to observe a credible, similar model
engaging in behavior that has functional value. Mental health professionals need to feel like they
are capable of understanding the information and achieving results. Therefore, the
recommendation is that mental health professionals are provided with instruction on how to
effectively use SPECT scan imaging for patient success. They should be allowed opportunities to
observe and engage with others who already know how to effectively use this tool, they should
be provided opportunities to implement what they have learned through guided practice, and they
should be provided immediate feedback to help them build their self-efficacy in relation to
SPECT scan imaging.
Currently, understanding the causes of mental illness through the methods provided is
complex with many unknown variables. The task of focusing on and understanding the
biological causes of mental illness has been deemed too difficult and too expensive to undertake
for many mental health professionals (Adam, 2014). Furthermore, many mental health
professionals such as counselors in schools feel like they do not currently possess the skills
necessary to collect and analyze data to determine the effectiveness of a treatment provided
(Patrikakou et al., 2016). SPECT scan imaging has been found to be useful in reducing the
guesswork around mental health and allowing mental health professionals the opportunity to see
the organ that they treat (Amen, 2010). By providing a scaffolding process that will allow
mental health professionals instruction, engagement opportunities, guided practice and
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immediate feedback, they will be best able to transition from the current methods used to
diagnose patients to more biologically driven methods of diagnosis and evaluation.
Organizational Influences and Recommendations
The data for the organization influences were collected from surveys and interviews
gathered from responses from health care professionals affiliated with Amen Clinics. Both
assumed organizational influences were validated. As shown in Table 10, the assumed
organization influences are the incentives linked to the DSM and the lack of accountability of
many health care professionals. In this section, both organizational influences will be discussed
as well as context-specific recommendations based on guiding core principles.

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Table 10
Summary of Organizational Influences and Recommendations
Assumed
Organizational
Influence
Validated
as a Gap?
Yes, High
Probability,
No
(Y, HP, N)
Priority?
Yes, No
(Y, N) Principle and Citation
Context-Specific
Recommendations
Many mental
health
professionals
rely on funding
based on
diagnosis from
the Diagnostic
and Statistical
Manual. (CS)
HP Y Effective organizations
insure that organizational
messages, rewards,
policies and procedures
that govern the work of
the organization are
aligned with or are
supportive of
organizational goals and
values (Clark & Estes,
2008).
Provide mental
health professionals
incentives for
focusing on other
resources than the
DSM.
Many mental
health
professionals
lack an
accountability
structure for
patient success.
(CS)
HP Y Vicarious reinforcement
and punishment can
increase or decrease
behaviors and learning
(Mayer, 2011).
Provide mental
health professionals
an accountability
structure that allows
them to set
productive goals for
themselves,
challenging but
achievable, and
encourage self-
evaluation.

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Cultural settings.
Mental health professionals rely on funding based on the Diagnostic and Statistical
Manual (DSM). Several of the participants interviewed, unless they were cash pay, stated they
had to diagnose using the DSM in order to receive funding through insurance. Psychologist #4
stated: “The main reason I need a diagnosis through the DSM is for insurance reimbursement.”
However, 49.02% of those who responded to the survey strongly agreed and 27.45% agreed they
did not think the DSM provided them with enough information to diagnose patients effectively.
Clark and Estes (2008) found that effective organizations ensure that organizational messages,
rewards, policies and procedures that govern the work of the organization are aligned with or
supportive of organization goals and values. The DSM currently focuses on symptoms-based
methods to diagnose patients and this systems-based approach is limited in its views and its
outcomes. The recommendation is that mental health professionals be provided incentives for
focusing on other resources than the DSM.
The National Institutes of Mental Health is the lead federal agency for research on mental
disorders as well as the largest scientific organization in the world. In 2005, the director of
NIMH, Thomas Insel, stated the DSM has 100% reliability and 0% validity (Amen, 2010). Insel
went on to state that in order to progress, psychology would need to understand the underlying
biology of mental disorders and develop treatments that address the core pathology (Amen,
2010). However, more than 10 years later, the DSM is still the most prevalent diagnostic tool for
mental health professionals (Verheul, 2012). One of the major reasons why the DSM is still
widely-used today is because of the link between insurance requirements and the DSM (Braun &
Cox, 2005). By providing incentives for utilizing resources other than the DSM, mental health
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professionals will be more likely to focus on other methods that are more biologically-based
which will improve patient diagnosis and treatment success.
Mental health professionals lack an accountability structure for patient success. All
survey respondents strongly agreed (90.20%) or somewhat agreed (9.80%) that evaluating the
effectiveness of treatment plans for a patient was important. However, several of the mental
health professionals interviewed felt accountability for correct diagnosis was limited. When
asked if they were held to any time of accountability for correct diagnosis, Psychologist #2
stated:
not short of malpractice. I haven’t been held accountable. I mean we have to follow the
code of ethics and we are not supposed to practice outside of the area of our expertise but
no one is actually holding us accountable.
In addition, LCSW #1 stated: “I think the hard part that people in private practice have a
problem with is staying accountable and staying up to date. We can really let ourselves slide if
we allow ourselves to.” In order to close this organizational gap a solution from social cognitive
theory will be utilized. Mayer (2011) found that vicarious reinforcement and punishment can
increase or decrease behaviors and learning. Mental health care professionals need to be held to
some type of accountability metric for patient success. Therefore, the recommendation is that
mental health professionals be provided an accountability structure that allows them to set
productive goals for themselves, challenging but achievable, and encourage self-evaluation.
According to Firestone and Shipps (2005), accountability is a commitment to answer to
another person for a performance mostly by justifying their procedures and the results. Unless
mental health professionals work for an organization or group, once they obtain their licenses,
many of these counselors are mainly held to an inward accountability model. Inward
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accountability models focus mostly on professional culture (Burke, 2004), more often regarded
as individual contractors with the client as their main stakeholder. Performance goals are not
outwardly imposed on these independent contractors in these types of situations and the
accountability is mostly left up to the individual counselor. By providing mental health
professionals with an accountability structure as well as encouraging self-evaluation, they are
more likely to achieve better results and improved patient success.
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
Over 50 years ago, Donald Kirkpatrick first started to develop his original four levels for
evaluating training programs he then used as the framework for his book, Evaluating Training
Programs: The Four Levels (Kirkpatrick, 1994). Kirkpatrick’s framework for evaluating
training programs became one of the most widely used training evaluation models in the world.
The New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) is an expansion of the
original work. This new model addressed the modernization of the learning and working
landscape that characterizes the business world we live in. The New World Kirkpatrick Model’s
design is the framework that will be used for this integrated implementation and evaluation plan.
The New World Kirkpatrick Model includes the original four levels of evaluation with a
few differences. Each of the four levels has been reframed and are shown in reverse order to
emphasize the importance of Levels 3 and 4 and to optimize results (Kirkpatrick & Kirkpatrick,
2016).
The New World Kirkpatrick Model starts with Level 4 in order to examine and evaluate
the degree to which the intended outcomes occur as a result of the training, support, and
accountability that is provided (Kirkpatrick & Kirkpatrick, 2016). Next, with Level 3, the model
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examines the level at which the employees are able to transfer the knowledge they learned from
training to their job through monitoring, encouraging, rewarding, and reinforcing (Kirkpatrick &
Kirkpatrick, 2016). Level 2 is then applied to examine the degree to which employees learn the
information through knowledge, skills, attitudes, confidence, and commitment to do the tasks in
the new way (Kirkpatrick & Kirkpatrick, 2016). Finally, Level 1 examines the level with which
employees are engaged in the learning experience, how much they find the training relevant, and
how satisfied they are with the training received (Kirkpatrick & Kirkpatrick, 2016).
Organizational Purpose, Need and Expectations
Amen Clinics was established by Dr. Daniel Amen to help mental health professionals
better see the organ they treat. Amen Clinics seeks to optimize brain health to enable the success
of its patients in all areas of their lives. Amen Clinics is currently one of the world leaders in
using Single-Photon Emission Computed Tomography (SPECT) scan imaging and brain imaging
science to help people struggling with mental illness. SPECT scan imaging was first developed
in the 1960s and has since been shown to be an effective tool in differential diagnosis of various
neuropsychiatric diseases as well as to provide an objective evaluation tool for mental illness.
Currently, one in five adults in America will experience a mental illness in any one
particular year. The current methods used to treat mental illness by mental health professionals
are insufficient to address this growing concern. The main method of diagnosis, the Diagnostic
and Statistical Manual (DSM) has been criticized for its lack of evidence and symptoms-based
focus (Amen, 2010; Braun & Cox, 2005) because it doesn’t address the natural, biological, or
genetic issues associated with the brain (Amen, 2013). The director of the National Institutes of
Mental Health, Thomas Insel, stated that in order to progress, psychology would need to
understand the underlying biology of mental disorder and address the core pathology (Amen,
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2010). A push for more biologically-focused and scientifically-driven mental health
professionals is needed to better ensure the best treatment methods and approaches are being
used for their patients. Furthermore, accountability metrics need to be instituted to push mental
health professionals towards more valid and reliable treatment methods.
Level 4: Results and Leading Indicators
In Level 4, the New World Kirkpatrick Model examines the degree to which the intended
outcomes occur as a result of the training, support, and accountability that is provided
(Kirkpatrick & Kirkpatrick, 2016). Such results are best measured through observable outcomes,
evaluated by metrics or leading indicators, and measured with specific detailed methods.
Leading indicators are short term observations and measurements that lend evidence towards
showing that the critical behaviors identified are on track to create a positive impact on the
desired outcome or result (Kirtpatrick & Kirkpatrick, 2016). External outcomes are related to
outcomes outside of the organization such as customers, clients/patients, or market and industry.
Internal outcomes are related to outcomes internal to the organization such as the individual,
team, department or organization. Table 11 shows the external and internal outcomes associated
with Level 4 as well as the outcomes, metrics, and methods used to evaluate these outcomes.

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Table 11
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
Patient significant
improvement rates.
Percentage of patients with
significant improvement
rates.
Monthly review of patient
significant improvement
reports.
Patients take Amen’s brain
health questionnaires
through organization’s
website.
Percentage of patients who
have completed Amen’s
questionnaires through
organization’s website.
Semi-annual review of
patient questionnaires
completed through website.
Internal Outcomes
Mental health professionals
take Amen’s brain health
certification course.
Number of certificates of
completion awarded to
mental health professionals.
Monthly review of mental
health professionals who
have taken Amen’s brain
health certification course.
Mental health professionals
make referrals for SPECT
scan imaging, blood work,
and genetic testing.
Number of referrals for
SPECT scan imaging, blood
work, and genetic testing.
Employee survey 60 days
after training is complete.
Mental health professionals
encourage their patients to
take Amen’s questionnaires.
Number of completed
patient questionnaires.
Semi-annual survey of mental
health professionals’
experience with using the
questionnaires.

Level 3: Behavior
Critical behaviors. Critical behaviors are behaviors that are specific, observable and
achievable that connect the key stakeholder to the outcome (Kirkpatrick & Kirkpatrick, 2016).
Table 12 shows six critical behaviors mental health professionals must perform in order to
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accomplish the desired result. Table 12 also shows the measurement or metric that will be used
to assess the behavior as well as the method and timing for the metrics.

Table 12
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s) Method(s) Timing
1 Mental health professionals
will successfully complete
Amen Clinics’ brain health
certification course within one
year.
Number of mental health
professionals that obtain
Amen Clinics’ brain
health certification
course.
Annual report Annual
2 Mental health professionals
will set aside one hour a
month to review new material
on the biological causes of
mental illness.
Number of hours reported
by the health care
professional.
Improving
misdiagnosis in
mental health
survey
Semi-
annual
3 Mental health professionals
will set aside an hour a month
to observe and engage with
others who have taken Amen’s
certification course.
Numbers of hours
reported by the health
care professional.
Improving
misdiagnosis in
mental health
survey
Semi-
annual
4 Mental health professionals
will collect and analyze Amen
Clinics’ questionnaires before
diagnosing each patient.
Number of mental health
professionals that utilize
Amen’s website for
questionnaires.
Annual report Annual
5 Mental health professionals
will collect data on patient
significant improvement rates
within a year.
Number of mental health
professionals that report
collecting data on patient
improvement rates.
Improving
misdiagnosis in
mental health
survey
Semi-
annual
6 Mental health professionals
will lobby to have other
methods than the DSM
covered by insurance.
Number of mental health
professionals that report
lobbying insurance
companies.
Improving
misdiagnosis in
mental health
survey
Semi-
annual

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Required drivers. To successfully support the critical behaviors needed to achieve the
desired results, four key drivers are required. Required drivers operate together to drive the
performance of critical behavior. The four required drivers are reinforcing, encouraging,
rewarding and monitoring (Kirkpatrick & Kirkpatrick, 2016). Table 13 shows the required
drivers needed in order to achieve the desired results for this problem of practice. The first
column outlines the needed method, the second column outlines the timing of the needed
method, and the third column outlines the critical behaviors that will support the method.

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Table 13
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical
Behaviors
Supported
1, 2, 3, etc.
Reinforcing
Mental health professionals be provided in-depth information on the
biological causes of mental illnesses in a way that enhances learning by
breaking the information into simpler, more manageable parts.
Annually 1, 2, 3, 4
Mental health professionals to be given job aids that are specifically
developed to assist them in defining the key components of Amen’s methods.
Mental health professionals must also be given opportunities to apply the
concepts within their own practice so they can integrate what they learn into
their diagnostic processes.
Annually 1, 2, 3, 4
Provide mental health professionals with an information pamphlet outlining
the root causes of mental illness and how these concepts relate to the DSM.
Annually 1, 2, 3, 4
Encouraging
Mental health professionals are provided with specific examples of how
adding SPECT scan imaging to their toolbox can be useful to them as an aid
in correct diagnosis.
Annually 1, 2, 3, 4
Provide mental health professionals with attribution retraining to ensure they
understand how the effort they put in impacts patient outcomes through
successful knowledge acquisition.
Annually 1, 2, 3, 4
Provide mental health professionals with opportunities to observe and engage
with others who already know how to effectively use this tool. They should
be provided opportunities to implement what they have learned through
guided practice. They should also be provided immediate feedback to help
them build their self-efficacy in relation to SPECT scan imaging.
Quarterly 3
Rewarding
Provide mental health professionals with different levels of credential based
on going through Amen’s certification course as well as continued education
and training material.
Quarterly 1, 2, 3, 4
Provide different status for mental health professionals who maintain an 80%
significant improvement rate or higher in patient success.
Quarterly 1, 2, 3, 4,
5, 6
Monitoring
Mental health professionals be provided incentives for focusing on other
resources than the Diagnostic and Statistical Manual (DSM).
Annually 6
Mental health professionals are provided an accountability structure that
allows them to set productive goals for themselves, challenging but
achievable, and encourage self-evaluation.
Annually 5
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Organizational support. Organizational support is critical to achieving the desired
results for this problem of practice. Specifically, the organization will need to foster a new
culture geared around understanding the recent developments surrounding the biological causes
of mental illness and work to enact change that will support this new mindset. Mental health
professionals will also need to ensure they are being held to standards of patient success. Also, a
cultural shift away from solely focusing on the Diagnostic and Statistical Manual (DSM) for
diagnosis will be required in order to steer mental health professionals away from the symptoms-
based focus of the DSM to more of a biologically-based focus of evaluating patients.
The following sections will discuss the remaining two levels of the New World
Kirkpatrick model and how reactions and learning will be used to achieve the results and
behaviors that will be required to improve this problem of practice.
Level 2: Learning
The second level in the New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016)
refers to learning. This level focuses on the degree to which the learners, in this case mental
health professionals, embrace the intended knowledge, skills, attitude, confidence, and
commitment needed to do the tasks in the desired way. Level 2 is defined and measured by the
learning goals discussed in the sections below.
Learning goals. Below are the learning goals for mental health professionals seeking to
become more biologically and neurologically focused. Mental health professionals are
encouraged to complete the Brain Health Coaching Certification Course (BHCCC) through
Amen Clinics. The BHCCC allows mental health professionals to earn 50 Continuing
Education/Continuing Medical Education credits. At the end of the training, mental health care
professionals should be able to:
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1. Identify specific brain regions and how each region relates to behavior. (F)
2. Analyze the different subtypes of various disorders including depression, anxiety,
ADD, and addictions. (F)
3. Apply neuroimaging to patient cases. (P)
4. Explain the gut-brain connection and how it impacts patient behavior. (F)
5. Be confident on how to apply brain-focused treatments to patients. (self-efficacy)
6. Demonstrate how to coach patients to brain health. (M)
7. Describe the importance of utilizing SPECT scan imaging to patients. (value)
Program. The learning goals listed above will be achieved through an in-depth home
study course containing more than 40 hours of unique, in-depth training from Dr. Amen. In
order to engage learning and development, participants should also attend a five-hour live
webinar which will allow mental health professionals to experience more personalized and
engaging instruction.
In addition to the knowledge participants will gain through the brain health certification
course and the live online webinars, mental health professionals who complete Amen’s course
will be provided access to an online suite of clinical tools and resources including:
• Brain Health Coaching Course (10 hours of video and over 1,000 course slides)
• Opening the Mind, Healing the Brain Course (10 hours of video)
• The Clinician’s Brain Science Toolbox (over 180 pages)
• Images of Human Behavior Brain SPECT Atlas (over 300 brain SPECT images and
26 pages of detailed scientific references)
Along with going through the online course and live webinars, mental health
professionals should also voluntarily come together and work with content experts and others
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who have already been through the course so they can obtain guided learning while they are
practicing these new tools with their own patients. Trainers should make themselves available
one-on-one to help mental health professionals who may need additional assistance.
Evaluation of the components of learning. Level 2 is the level with which participants
gain the knowledge, skills, attitude, confidence and commitment needed based on their
participation of the training attended. Learning should be geared towards what is needed to
obtain the behaviors and results described in Levels 3 and 4. Table 14 lists the ways that
declarative knowledge, procedural skills, attitudes, confidence, and commitment will be
evaluated through his program as well as the proposed timing for each element.

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Table 14
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge — “I know it.”
Post knowledge check At the end of completing the online
certification course
Knowledge checks throughout live online
webinars
Periodically during live online webinars
and throughout the online certification
course
Procedural Skills — “I can do it right now.”
Knowledge checks on how to read brain SPECT
images with peers during workshop
During live online webinars
Application of concepts to real-world patients and
scenarios
During live online webinars
Retrospective post-test assessment survey asking
participants about their level of proficiency before
and after training
At the end of completing the online
certification course and the live online
webinars
Post training application test At the end of the live online webinars
Attitude — “I believe this is worthwhile.”
Reflect on how the material relates to their current
or past patients
Periodically during live online webinars
Post-training question about value of task to be
implemented on the job
At the end of the live online webinars
Discussion of the value of what participants are
being asked to do on the job
Periodically during live online webinars
Confidence — “I think I can do it on the job.”
Discussion with participants At the end of the live online webinars
Survey using scaled items regarding confidence in
applying new skills on the job
At the end of the live online webinars
Commitment — “I will do it on the job.”
Discussion with participants At the end of the live online webinars
Survey using scaled items regarding commitment
to applying new skills on the job
At the end of the live online webinars
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Level 1: Reaction
Level 1 is the level with which participants find the training favorable, engaging, and
relevant (Kirkpatrick & Kirkpatrick, 2016). Both formative and summative methods are utilized
to evaluate the reaction of the training. Formative methods allow instructors to utilize immediate
feedback so they can adjust their teaching approach to meet learners’ needs, respond to learners’
concerns, as well as resolve distractions and discomforts of learners while they are going through
training. Summative methods are used in gathering data on the overall satisfaction participants
have with the program, the total engagement level felt through the methods provided, as well as
the perceived quality of instruction. Table 15 shows how Level 1 components will be evaluated
as well as the proposed time frame for each component.

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Table 15
Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement
Completion of online modules by required
deadlines
During online brain certification
course
Attendance of live training At the beginning of live online
webinars
Observation of participants by instructor During live online webinars
Relevance
Post-training evaluation inquiring about
relevance
After each section of the brain
certification training module
Brief “pulse-check” with participants Periodically through live online
webinars
Customer Satisfaction
Post-training evaluation inquiring about
satisfaction with online certification course
After completion of online
certification course
Post-training evaluation inquiring about training
with live online webinars
After completion of live online
webinars

Evaluation Tools
Immediately following the program implementation. Level 1 and Level 2 learning
engagement, relevance, and customer satisfaction will be measured in two ways. The first is
through administration of a survey to all participants immediately following the online portion of
the course. The second type of evaluation will be done by the instructor during the live online
sessions through pulse-checks as well as through observation. Instructors will ask participants
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during the live sessions questions regarding how these concepts apply to their work, whether the
information is relevant, and they will also observe whether participants were engaged and
satisfied in the training. Examples of the survey questions that will be used to evaluate Levels 1
and 2 at the end of the training are found in Appendix C.
Delayed for a period after the program implementation. Approximately six weeks
after the mental health professional has received the certification, and then again at 16 weeks, the
organization will administer a survey containing open and scaled items using Kirkpatrick’s
Blended Evaluation Approach to measure all four levels of the New World Kirkpatrick model.
Examples of the survey questions that will be used to evaluate Levels 1, 2, 3 and 4 are found in
Appendix D.
Data Analysis and Reporting
Information alone isn’t useful unless the data is analyzed and reported in an informative
way that engages the intended audience and shows the relevance of its results. The purpose of
this dissertation is to show how adding SPECT scan imaging to a mental health professional’s
toolbox can help increase the effectiveness of diagnostic outcomes. In order to increase
motivation, successful outcomes will be communicated early and often. The results of the
findings will be presented monthly in the organization’s newsletter as well as in a yearly annual
report.
Levels 1, 2, 3, and 4 should be reported using pie charts, tables and graphs in a way that
will best depict how utilizing SPECT scan imaging and brain-based practices will be useful to
mental health professionals. By presenting the data in a way that is visually appealing, engaging,
and informative, the results of these programs will be most effectively disseminated.
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Summary
Reducing misdiagnosis in mental health professions is a challenging but important
problem of practice to address. In order to provide appropriate recommendations, this study
utilized the New World Kirkpatrick model (Kirkpatrick & Kirkpatrick, 2016) to plan, implement
and evaluate recommendations in order to best achieve stakeholder and organizational goals. By
integrating implementation and evaluation using the New World Kirkpatrick model,
organizations can train in a more efficient and effective way so that data is collected and
analyzed throughout the process to better influence outcomes and maximize program results.
Starting with Level 4, the Kirkpatrick model examined how the initiatives impacted the
mental health professional’s ability to achieve the intended results and targeted outcomes of the
training. In Level 3, the Kirkpatrick model examined the degree to which mental health
professionals can apply what they learned to their own practices through monitoring,
encouraging, rewarding and reinforcing their behavior. Level 2 of the model focused on the
knowledge, skills, attitude, confidence, and commitment of each mental health professional to do
the tasks in the proposed way. Finally, Level 1 examined the level at which the mental health
professional felt they were engaged in the learning experience provided, believed it was relevant
to their own work, and measured how satisfied they were with the program overall (Kirkpatrick
& Kirkpatrick, 2016).
The framework of this study based on the Kirkpatrick model provides a blueprint for
mental health professionals to gain a better understanding of the biological causes of mental
illness and how the brain affects behavior. By following the framework in this study, it is
anticipated that mental health professionals will be able to reduce misdiagnosis and drive their
practice towards higher levels of accuracy and precision.
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Strengths and Weaknesses of the Approach
While the Clark and Estes (2008) model provided a robust framework to analyze
knowledge, motivation and organizational influences, this model is specifically designed to
analyze performance gaps within organizations. In the case of this promising practice study,
there were no performance gaps to analyze, but rather organization and performance excellence
to be understood, explored and examined; therefore, the application of the Clark and Estes
(2008) model was not a superior fit for this study. However, the combinations of the Clark and
Estes (2008) conceptual pillars of knowledge, motivation, and organizational influences with the
New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) provided a robust performance
improvement framework with specific best practices that can be considered for adoption and
adaption by various types of mental health organizations and mental health professionals to
reduce misdiagnosis in mental health professions.
Limitations and Delimitations
Limitations
To further protect the credibility and trustworthiness of the study, limitations to the study
must be disclosed (Maxwell, 2013). Limitations include elements of the study that cannot be
controlled (Maxwell, 2013). For this study, three key limitations have been identified which the
researcher had no control over: (1) the truthfulness of the responses of the participants; (2) the
reflexivity and subjectivity of the researcher; and (3) the limited respondents (Merriam &
Tisdell, 2016).
These limitations were mitigated as much as possible throughout the study. First,
regarding the truthfulness of the participants, the survey was conducted confidentially with no
incentives attached. The survey participants and interviewees who offered up their valuable time
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did so at their own expense. A $25 gift card was offered as a thank you for interview
participants’ time; however, many of the interviewees stated they didn’t need or want the gift
card, but instead wanted to share their positive experiences they had with a method that
significantly impacted how they diagnosed patients and how they conducted their practices. Two
participants declined the $25 gift card.
To address the second limitation, it should be noted, the researcher’s previous positive
experience with Amen Clinics through her husband’s challenging situation could have
influenced the tone of the study. Although actions were taken to minimize bias as much as
possible to provide a meaningful and robust analysis, this past positive experience is what drove
the researcher to conduct the study and analysis and this experience could have impacted the
perception of the researcher. However, it should also be noted that the researcher employed
various methods to ensure the rigor of the material presented (Merriam & Tisdell, 2016). The
researcher fully understood that she only had one story, so her focus was on gathering as much
data as possible to discover if the data supported or didn’t support her experience on a broader
scale.
For the third limitation, only a limited number of respondents answered the survey. A
survey was sent to over 450 email addresses listed as affiliates on Amen Clinics’ website. Only
51 responded to the survey. It is worth noting that over 40 emails came back as undeliverable so
the website’s affiliates might not be up-to-date. Furthermore, several individuals from the
affiliate list emailed the researcher stating they didn’t diagnose so they didn’t feel it was
appropriate to answer the survey. Others emailed the researcher stating they didn’t feel like they
had enough information about SPECT scan imaging to be of value to the study. Although there
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might be reasons for a lower response rate, a higher response rate might have resulted in more
data presented.
Delimitations
Study delimitations refer to the boundaries set in the study by the researcher and must be
disclosed to protect the validity and reliability of the study (Merriam & Tisdell, 2016). The key
delimitations for this study were: (1) limited time and interviewees, (2) limited questions, and
(3) type of study conducted.
Due to the nature of this study, time was limited. The surveys were open for two weeks.
If the survey would have remained open for a longer period, it might have allowed more
respondents to answer the survey. Furthermore, the interviews were all conducted within a
month. It is important to consider because of the limited resource of time for this study, only 10
of the 22 respondents who were willing to be interviewed were able to be interviewed for this
study. Although the data from the interviews was diverse and rich in content, a larger group of
interviews could have presented an even richer pool of data and analysis.
Another key limitation regarding the study was the limited amount of questions that were
asked and the number of mental health professionals that were interviewed. The limited nature
of the questions asked could minimize the data received. Furthermore, the limited amount of
surveys and interviews could also limit the type of information received.
Although there were various approaches that could be used for this study, it was
determined that a mixed-methods data gathering and analysis approach would be best to assess
the health care professionals’ assets in the areas of knowledge, motivation and organizational
resources (Creswell & Creswell, 2018). By utilizing a multi-faceted, inductive approach with a
focus on the meaning, context, and process of diagnosis (Creswell & Creswell, 2018) through
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multiple methods of data collection, this delimitation was reduced by reducing the likelihood that
the study would result in insubstantial claims (McEwan-Adkins & McEwan, 2003).
Future Research
Considering the limitations and delimitations of the study, several recommendations for
future research emerged. The first recommendation would be to conduct a longitudinal study
which compares traditional approaches in psychology against Amen Clinics’ biological and
brain-based approach. This research would allow for more in-depth data to be drawn from the
study which would include observations that would occur over time.
The second recommendation for future research would be to conduct studies surrounding
how Amen Clinics’ methods impact treatment and outcomes rather than just diagnosis. To
determine the actual impacts of Amen Clinics methods on treatment and outcomes, it would be
beneficial to collect additional data surrounding the effectiveness of Amen Clinics methods on
patients. This research should include mental health professionals as well as patients, their
family members and acquaintances. This research would create added value through multiple
perspectives which would allow for a better picture of how these approaches impact patients as
well as their families.
The third recommendation for future research would be to explore the implications of
insurance requirements on the use of Amen Clinics methods. One of the emerging themes that
came out of the data was many of the people who needed SPECT scan imaging were not able to
afford it because insurance companies do not currently cover the costs. To allow Amen Clinics
methods to be utilized more in the future, confronting the insurance barriers to these methods
will be necessary.
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The fourth recommendation is to gather data from those who do not currently embrace
this new approach. There are currently some who seem skeptical of Amen Clinics methods.
This departure away from an emphasis on the DSM and traditional approaches within
psychology towards a more biological and brain-based approach would be a significant reform
and would require a substantial change in culture within the mental health community.
Exploring perceptions of mental health professionals and patients to this change could lend
valuable insight to mental health professionals moving forward.
The last recommendation would be to conduct comparison research surrounding what
types of accountability have the greatest impact on patient success in mental health professions.
Because the stakeholder group of focus for this study was outside of Amen Clinics organization,
the study wasn’t best suited to collect data on the effects of accountability on reducing
misdiagnosis. Future comparative research could explore this idea further and provide valuable
information regarding this topic.
Conclusion
Mental health problems within the United Stated are becoming an increasing problem.
The purpose of this promising practice study was to use the Clark and Estes (2008) model to
analyze and evaluate the knowledge, motivation, and organizational influences that allow Amen
Clinics’ mental health affiliates to achieve more accurate and precise diagnoses for their patients.
The purpose of this study was to assess what tools mental health professionals utilize in order to
diagnose their patients and to determine how adding SPECT scan imaging to a mental health
professional’s toolbox could help to increase the effectiveness of diagnosis methods.
A literature review was conducted and presented to show the importance of the problem
of practice as well as to support the need for better tools and practices in mental health.
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Assumed knowledge, motivation and organizational influences were identified and verified
against related literature. Data was collected and analyzed through a mixed methods approach of
quantitative surveys and interviews. Assumed knowledge findings were discussed as well as
motivational influences and organizational influences that improved the ability for these
affiliates to diagnose mental illness more efficiently and effectively.
Lastly, the study outlined a blueprint of recommendations to serve as a framework
available for adaption and adoption by other mental health professionals to achieve more
accurate diagnosis for their patients in the future. It is anticipated that deliberate and systematic
application of the recommendations outlined in this study can decrease misdiagnosis and
improve mental health results.

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APPENDIX A
SURVEY ITEMS
KMO Influences
Research
Question / Data
Type
KMO
Construct
Survey Item (question
and response)
Scale of
Measurement
Potential
Analysis
Visual
Representation
Demographics
— Sample
Description
NA Are you a Mental Health
Professional? (yes, no)
Nominal Percentage,
Frequency,
Mode

Demographics
— Sample
Description
NA In what position do you
currently work in the
mental health profession?
(Psychiatrist,
Psychologist, LPC, LPCC
or LCPC, LCSW, LICSW
or MSW, Wellness Center
Counselor, Other mental
health professional: please
specify___)
Nominal Percentage,
Frequency,
Mode
Table
Demographics
— Sample
Description
NA Have you taken the Amen
Clinics Brain Health
Coaching Certification
Course? (yes, no)
Nominal Percentage,
Frequency,
Mode

What tools do
Amen Clinics’
mental health
affiliates utilize
to diagnose
patients?
O-CS I have more
information/tools to
diagnose patients
effectively since
becoming affiliated with
Amen Clinics. (Strongly
Disagree, Somewhat
Disagree, Somewhat
Agree, Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
What level of
knowledge do
Amen Clinics’
mental health
affiliates have
regarding
biological and
brain-based
causes of mental
illness?
K-F The knowledge I have
gained through my
affiliation with Amen
Clinics has helped me
better understand the
biological causes of
mental illness. (Strongly
Disagree, Somewhat
Disagree, Somewhat
Agree, Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
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Research
Question / Data
Type
KMO
Construct
Survey Item (question
and response)
Scale of
Measurement
Potential
Analysis
Visual
Representation
What level of
knowledge do
Amen Clinics’
mental health
affiliates have
regarding
biological and
brain-based
causes of mental
illness?
M-GO A healthy lifestyle such as
exercising, drinking
water, eating healthy,
supplements, etc., is
critical for improved
patient outcomes.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
What level of
knowledge do
Amen Clinics’
mental health
affiliates have
regarding
biological and
brain-based
causes of mental
illness?
M-GO The knowledge I have
gained through Amen
Clinics has helped me
better understand the
importance of a healthy
lifestyle such as
exercising, drinking
water, eating healthy,
supplements, etc., on
mental health. (Strongly
Disagree, Somewhat
Disagree, Somewhat
Agree, Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
What tools do
Amen Clinics’
mental health
affiliates utilize
to diagnose
patients?
K-F I mainly use the
Diagnostic and Statistical
Manual (DSM) to
diagnose patients because
of insurance requirements.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range

What tools do
Amen Clinics’
mental health
affiliates utilize
to diagnose
patients?
K-F I do NOT think the DSM
provides me with enough
information to diagnose
patients effectively.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
REDUCING MISDIAGNOSIS IN MENTAL HEALTH PROFESSIONS

149
Research
Question / Data
Type
KMO
Construct
Survey Item (question
and response)
Scale of
Measurement
Potential
Analysis
Visual
Representation
What tools do
Amen Clinics’
mental health
affiliates utilize
to diagnose
patients?
O-CM I have changed the way I
diagnose patients because
of my affiliation with
Amen Clinics. (Strongly
Disagree, Somewhat
Disagree, Somewhat
Agree, Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
How can using
SPECT scan
imaging and
other brain-
based
approaches
improve patient
diagnosis?
K-F I am familiar with Single-
Photon Emission
Computed Tomography
(SPECT) scan imaging.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range

How can using
SPECT scan
imaging and
other brain-
based
approaches
improve patient
diagnosis?
K-F I did not fully understand
the usefulness of SPECT
scan imaging before
becoming affiliated with
Amen Clinics. (Strongly
Disagree, Somewhat
Disagree, Somewhat
Agree, Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
How can using
SPECT scan
imaging and
other brain-
based
approaches
improve patient
diagnosis?
M-GO Before becoming
affiliated with Amen
Clinics, I felt hesitant to
apply SPECT scan
imaging to the patient
diagnostic process.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
How can using
SPECT scan
imaging and
other brain-
based
approaches
improve patient
diagnosis?
K-F The knowledge I have
gained since becoming
affiliated with Amen
Clinics has helped me
better understand how
using SPECT scan
imaging can impact
patient diagnosis.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
REDUCING MISDIAGNOSIS IN MENTAL HEALTH PROFESSIONS

150
Research
Question / Data
Type
KMO
Construct
Survey Item (question
and response)
Scale of
Measurement
Potential
Analysis
Visual
Representation
How can using
SPECT scan
imaging and
other brain-
based
approaches
improve patient
diagnosis?
K-F Understanding SPECT
scan imaging has
significantly changed the
way I diagnose patients.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
How can using
SPECT scan
imaging and
other brain-
based
approaches
improve patient
diagnosis?
K-F Understanding SPECT
scan imaging has changed
the way I discuss mental
illness with my patients.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Nominal Percentage,
Frequency,
Mode
Table
What types of
accountability
do mental health
professionals
hold themselves
to for correct
diagnosis?
M-GO Evaluating the
effectiveness of a
treatment plan for a
patient is important.
(Strongly Disagree,
Somewhat Disagree,
Somewhat Agree,
Strongly Agree)
Ordinal Percentage,
Frequency,
Mode,
Median,
Range
Table
How can using
SPECT scan
imaging and
other brain-
based
approaches
improve patient
diagnosis?
K-F Other comments
regarding how SPECT
scan imaging has
impacted your ability to
diagnose mental health
patients: (open ended)
Open ended Open
coding
Table
What tools do
Amen Clinics’
mental health
affiliates utilize
to diagnose
patients?
K-F Other comments
regarding how being
affiliated with Amen
Clinics has impacted your
ability to diagnose mental
health patients: (open
ended)
Open ended Open
coding
Table
Demographics
— Sample
Description
NA How long have you been a
mental health
professional? (open
ended)
Open ended Open
coding
Table
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Research
Question / Data
Type
KMO
Construct
Survey Item (question
and response)
Scale of
Measurement
Potential
Analysis
Visual
Representation
Demographics
— Sample
Description
NA I am: (Male, Female,
Other, Choose Not To
Identify)
Nominal Percentage,
Frequency,
Mode
Table
Demographics
— Sample
Description
NA I am: (White, Hispanic or
Latino, Black or African
American, Native
American or American
Indian, Asian/Pacific
Islander, Other, Choose
Not To Identify)
Nominal Percentage,
Frequency,
Mode
Table
NA NA Thank you for your time
spent taking this survey.
Are you willing to engage
in a 30–60 minute
interview discussing the
impacts of SPECT scan
imaging on diagnoses in
mental health? Ten
interested participants will
be randomly selected to
participate in an
interview. Each of those
who engage in the
interview will receive a
$25 gift card. Interviews
will be conducted through
the Zoom platform. (yes,
no)
Nominal NA NA
NA NA If you answered yes to the
previous question, please
include your contact
information below. If you
would prefer not to
include your personal
information here, you can
email your contact
information directly to me
at khodson@usc.edu.
Thanks! (Name, Address,
Address 2, City, State,
Postal Code, Email)
Nominal NA NA
K-F = Knowledge-Factual, M-GO = Goal Orientation, O-CM = Cultural Models, O-CS = Cultural Settings

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APPENDIX B
REDUCING MISDIAGNOSIS
Interview Protocol
The purpose of this project is to assess what tools mental health professionals utilize in order to
diagnose their patients and to determine how adding SPECT scan imaging to their toolbox
impacts diagnosis methods.

All answers will be kept confidential and pseudonyms will be used to ensure the information you
share will be revealed in a way that will not affiliate you with this study. You can decide not to
answer any question you don’t wish to answer just by requesting that we skip that question.
Furthermore, you can withdraw from the study at any time by asking to be withdrawn.

Is it alright if I record this session so I can most accurately capture what is said? Thank you. I
would like to begin by asking just a few questions about you and your counseling methods.

1. How long have you been working as a mental health professional? (Knowledge)
(Background/Demographic Question)
“Thank you, now . . .”

2. How long have you been affiliated with Amen Clinics? (Knowledge)
(Background/Demographic Question)
“In what way are you affiliated with Amen Clinics?” (probe)
“Thank you.”

3. Have you taken the Amen’s Brain Health Coaching Certification Course? (Knowledge)
(Background/Demographic Question)
“Thank you.”

4. What motivated you to become affiliated with Amen Clinics? (Motivational, Knowledge)
(Interpretive)

5. Before you began working with Amen Clinics, how did you feel about the effectiveness of
the tools you had to help you diagnose your patients? (Knowledge, Organizational,
Motivational) (Feeling Question) (Interpretive Question)
“Do you have any examples of when you didn’t feel like you had all of the tools you need
to help your patients?” (probe)
“What other approaches had you used?” (probe)
“Thanks, now . . .”

6. How has the knowledge you have gained through working with Amen Clinics changed
how you diagnose patients? (Knowledge question)
“Do you have any examples?” (probe)
“Thank you.”
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7. If applicable, what motivates you to keep using Amen Clinics’ methods? (Motivational,
Knowledge) (Interpretive)
“Thank you.”

8. Describe what a recent initial session might look like with a new patient. (What kind of
information do you gather from your patients, what forms do they fill out, what do you try
to determine? etc.) (Organizational, Knowledge) (Experience and Behavior Question)
“Thanks. Now I would like to move on to understanding how you go about diagnosing
your patients . . .”

9. What kinds of information do you take into account while diagnosing a patient?
(Knowledge question)
“Thanks.”

10. How would you determine if the diagnosis was accurate? (Knowledge, Organizational)
(Experience and Behavior Question)

“Thank you. This next question is regarding SPECT scan imaging. SPECT scan imaging looks
at blood flow to the brain and energy levels in certain parts of the brain. SPECT scan imaging
allows mental health professionals to see if the brain is healthy and functioning properly and
allows mental health professionals to get a better idea as to various problems that might be
happening within the brain.”

11. How familiar are you with SPECT scan imaging?
“Where and when did you first hear about SPECT scan imaging?” (probe)
“Thank you.”

12. How has the knowledge you have learned about SPECT scan imaging changed how you
diagnose patients? (Knowledge) (Opinion Question)
“Do you have any examples?” (probe)
“Thanks.”

13. How important is it for you to understand the biological causes of mental illnesses in
diagnosing patients? (Knowledge, Motivational) (Experience and Behavior Question)
“Thank you for all of the information you have provided this far. We just have a few
questions remaining . . .”

14. How do you evaluate your effectiveness in diagnosing patients? (Organizational,
Motivational) (Knowledge Question)
“Thank you.”

15. Could you give an example of when understanding SPECT scan imaging has not been
helpful in diagnosing a patient? (Knowledge, Motivation) (Opinion question)
“Thank you so much. This last question is a general question to get your opinion of the
most ideal situation possible . . .”
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16. Please describe what you think the most ideal diagnostic method would be like for
mental health. (Knowledge) (Opinion Question) (Ideal Position Question)

“Thank you again for all of your information you provided for me today. Again, I will ensure
your answers are kept confidential and anonymous. Please feel free to reach out to me if you
have any further questions or concerns about the study or if I can help in any way. I will also be
sending you the $25 gift card to the address you submitted to me in the survey. Do you have any
other questions for me? Thank you again for your time. I really appreciate your time and your
help with this important study.”

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APPENDIX C
SAMPLE POST-TRAINING SURVEY ITEMS MEASURING KIRKPATRICK
LEVELS 1 AND 2
1. The training held my interest. (Level 1 engagement)
Strongly Disagree, Disagree, Agree, Strongly Agree

2. This training was relevant to the work I do. (Level 1 relevance)
Strongly Disagree, Disagree, Agree, Strongly Agree

3. Please explain the likelihood that you are going to recommend today’s training to other mental
health professionals. (Level 1 customer satisfaction)

4. Please identify the nine principles of ‘Change your brain; change your life.’ (Level 2
declarative knowledge)

5. How do you plan to apply what you learned today to your patients? (Level 2 procedural
knowledge)

6. Understanding how to read and interpret Brain SPECT images is valuable to my work as a
mental health professional. (Level 2 attitude)
Strongly Disagree, Disagree, Agree, Strongly Agree

7. I feel confident I can read and interpret a brain SPECT image with my next patient. (Level 2
confidence)
Strongly Disagree, Disagree, Agree, Strongly Agree

8. I am committed to applying my knowledge of how to read and interpret brain SPECT imaging
with my patients going forward. (Level 2 commitment)
Strongly Disagree, Disagree, Agree, Strongly Agree

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APPENDIX D
SAMPLE BLENDED EVALUATION ITEMS MEASURING KIRKPATRICK
LEVELS 1, 2, 3, AND 4
The training information has been applicable to my recent work. (Level 1 relevance)
Strongly Disagree, Disagree, Agree, Strongly Agree

What information was most relevant? (Level 1 relevance)

What information was least relevant? (Level 1 relevance)

What information should be added to this training in the future to increase its relevance to mental
health professionals? (Level 1 relevance)

What information, if any, do you feel was missing from training? (Level 2 knowledge, skills)

How has your confidence using what you learned changed since training? (Level 1 confidence)

I have successfully applied what I learned in training to my work. (Level 3 transfer)
Strongly Disagree, Disagree, Agree, Strongly Agree

If you selected Strongly Disagree or Disagree for #7 above, please indicate the reasons (check all
that apply): (Level 3 transfer)
What I learned is not relevant to my work.
I do not have the necessary knowledge and skills.
I do not feel confident applying what I learned to my work.
I do not believe applying what I learned will make a difference.
No one is tracking what I am or am not doing anyway.
Other (please explain):

What else, if anything, do you need in order to successfully apply what you learned? (Level 3
transfer)

I feel encouraged to apply what I learned because of my patients’ success. (Required drivers —
encouraging)
Strongly Disagree, Disagree, Agree, Strongly Agree

I have time with my peers to share success stories and troubleshoot challenges related to what I
learned. (Required drivers — encouraging)
Strongly Disagree, Disagree, Agree, Strongly Agree

I am incentivized to apply what I learned. (Required drivers — encouraging)
Strongly Disagree, Disagree, Agree, Strongly Agree

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I have been or will be rewarded for successfully applying what I learned. (Required drivers —
rewarding)
Strongly Disagree, Disagree, Agree, Strongly Agree

I have my own performance goals related to what I learned. (Required drivers — reinforcing,
monitoring)
Strongly Disagree, Disagree, Agree, Strongly Agree

I am held accountable for applying what I learned and making progress. (Required drivers —
monitoring)
Strongly Disagree, Disagree, Agree, Strongly Agree

I am already seeing positive results from applying what I learned. (Level 4 results)
Strongly Disagree, Disagree, Agree, Strongly Agree

I see a positive impact in the following areas as a result of applying what I learned (check all that
apply): (Results and learning indicators)
Decreased misdiagnosis
Decreased trial-and-error regarding medications recommended
Increased significant improvement rates of patients
Decreased ambiguity on how to help patients achieve mental health success
Increased confidence with diagnosis given

Please provide one or more examples of positive outcomes from applying this training: (Level 4
results)

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APPENDIX E
“OTHER COMMENTS REGARDING HOW SPECT SCAN IMAGING HAS IMPACTED
YOUR ABILITY TO DIAGNOSE MENTAL HEALTH PATIENTS: (OPEN ENDED)”
(ALL COMMENTS)
“The information I gained by becoming an affiliate has dramatically changed the way I work for
the better. The majority of my clients very appreciate understanding what is happening in their
brain in relation to why they have come for therapy. They feel less guilty about their symptoms.
Their image of themselves improves from the beginning and improves early in treatment. Seeing
examples in scans before and after gives them hope they have never had. I have a better idea of
what methods to use. I have more clients in recovery or remission.”

“It is crucial for us all to have better brain health education. What Dr. Amen has done in his 30
years of research and work with clients has given us as health care practitioners a better more
clear road map of brain health issues. This is crucial for the future of ALL health care
practitioners to learn and utilize in their interactions, diagnosis, education, and treatment plans
with clients.”

“SPECT scan imaging has given me a much better way to identify, treat and discuss mental
health with my patients. Having images to show patients helps them to see what they are dealing
with as a medical issue rather than a character flaw.”

“It has helped me teach people how to better understand their brains and gets away from them
seeing themselves as broken or crazy, helping them have a narrative and rationalization for what
is occurring in their subjective world of awareness.”

“My clinic has seen several clients with chronic persistent mental illness get their life together
because of hope a SPECT scan helped reframe their symptoms and subsequently result in
utilization of better approaches. For the severely mental ill, it feels barbaric not to use a
SPECT.”

“Since understanding brain function (and working at the Amen Clinic in Atlanta) it has
completely changed how I look at people and how I work with them. I also make the brain
function the enemy not the person and that helps with couples as well as individuals.”

“It adds another dimension to how I look at the etiology of mental disorders.”

“Over activity in the basal ganglia can cover up other emotional/mental health issues. A scan
gives me an overview of the extent of a person’s problems. Further, it becomes easier to talk to
clients about the interaction among the different brain related problems they may have. It is that
interaction that can make it difficult to come up with a treatment plan, apart from a scan.”

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“While I am not qualified to diagnose, I am able to strongly recommend a SPECT scan to clients
after using the ‘Toolkit’ with questionnaires, and other information to help them see the value of
incorporating this wonderful tool which will facilitate a far superior outcome than anything else
could.”

“SPECT scan imaging has been a critical tool in helping with accurate diagnosing of many of my
patients — particularly those with complex co-morbidity and/or treatment resistance.”

“My two sons have been scanned and I got scanned years ago when I was certified in the Amen
Clinics’ Comprehensive Five Day Brain — SPECT — scan course. We went through 100 scans
in that course. The understanding I gained not only for myself and sons was so helpful. With
my clients — I am able to assess symptoms and consider options of what could be going in with
their brain that I would want to rule out before using psychotherapy with them. I also took his
Healing ADD and Sex in the Brain courses also — and utilize suggestions in both of those
materials.”

“It’s an excellent tool but not covered by Medicare or Medical so patients who need it the most
can’t get it. Summary it’s too expensive and so cost prohibitive”

“SPECT scan imaging helps the client understand where the damage occurred from a TBI, etc.
The SPECT is highly valuable in client compliance, encouragement, treatment plan.”

“As a Brain Health Coach with the Amen Clinics, it’s so much easier to help consumers
understand the reality of specific issues. Therefore, the person coming to me knows ‘It’s not all
in their head,’ as they might have believed or been told. They can see the damage and then will
more likely address wellness; a change of lifestyle.”

“SPECT is a powerful diagnostic tool; however, so is an MRI-DTI that will explain nerve fiber
tract injury. Using them both together would give us more information in developing a treatment
plan for Hyperbaric Oxygen Treatment, Neurofeedback, and nutrient optimization.”

“The Brain Health Coaching Certification completely changed the way I view diagnosis. I wish
all my clients could afford SPECT scan imaging as I recommend it almost 100%.”

“I have had clients believe they have ADHD, and yet after a SPECT scan it’s actually high levels
of anxiety with ADD-like symptoms.”

“As an RN, I am unable to make a Dx — but the understanding I’ve gained through the Amen
Clinic course, and learning about SPECT scans, has been a boost to my already holistic
mindset/approach — and fosters my making referrals, and recommendations as a Coach.”

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APPENDIX F
“OTHER COMMENTS REGARDING HOW BEING AFFILIATED WITH AMEN CLINICS
HAS IMPACTED YOUR ABILITY TO DIAGNOSE MENTAL HEALTH PATIENTS (OPEN
ENDED)” (ALL RESPONSES)
“The knowledge we have acquired with the Amen Clinics has transformed the way we look and
work with mental health. I’ve seen my clients express relief when I share with them the whole
mind-body connection and focus more on looking for the root cause of the symptoms instead of
staying on the surface with a diagnosis. I do not talk about diagnosing in my sessions and if
anything I urge my clients not to be concerned with a diagnosis as it’s a flawed and ineffective
way of addressing mental health symptoms.”

“Amen Clinics increased my understanding and knowledge of brain related issues and problems
that affect treatment choices.”

“Being affiliated with the Amen Clinics helps widen my knowledge landscape and allows me
wonderful support through my Amen Clinic contact as I try to navigate referrals and
recommendations.”

“I used to see a lot of children who were in the ADHD Spectrum. They might be mis-diagnosed
and be put on the wrong psychotropics, or many psychotropics. Then, comes the changing of
psychotropics. I would watch them take on side effects of the medications; this often hides the
original problem. Also, without having the information that there are ‘7 Types of ADD,’
treatment was very limited. I now have directed my Coaching with more Functional, Holistic
wellness. I also have an Advanced Technician Certificate with the L.I.F.E System Biofeedback.
In the Fall, I’m going to do a workshop in Sedona, Arizona, on ‘The Female Brain.’ There are
endless options that open up.”

“Perhaps most importantly, I have learned the importance of calming the basal ganglia before
treating other problems. Many males present with self described depression. After a scan, many
of these males have overactive basal ganglias, that have been misperceived as depression.
Because I treat anxiety differently than I treat depression, clarifying this has been incredibly
important. Once the anxiety is treated, the subjective sense of being depressed often goes away.
Anxiety makes every other brain problem worse. Also, scans help people to stop blaming
themselves. This is often critical in treating depression.”

“SPECT scanning and Dr. Amen’s approach has added breadth to my diagnostic capabilities and
understanding of mental health issues in my patients and people in general.”

“In the more recent years however, I’ve moved more towards using QEEG and neurofeedback
(in conjunction with diet, lifestyle and supplements) because it offers a more effective and non-
invasive powerful tool in seeing what is going on for each person AND delivering targeted
treatment. I highly recommend looking into this.”
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“It takes away the miserable trial and error of trying one drug after another and makes it possible
to see and treat the area of the brain which is actually the source of the trouble.”

“I had a client who was in a car accident whose car rolled down a cliff — his behavior after the
accident was consistent with someone with hippocampus injury — to realize that a SPECT scan
can confirm and treat his behaviors is the answer for his situation. Talk therapy would not be the
solution — in fact would possibly be unethical to be taking the clients money for such a situation
when medical attention is needed. I appreciate the thorough history the Amen Clinic provides —
they also are great at recommending nutritional recommendations, exercise, supplements —
besides only prescribing meds — but even on the meds, seeing the brain scan results for ADD
their Rx protocol is correlated to the scan — such better results. For instance, a patient who has
over-focused ADD — too much activity in the anterior cingulate gurus — to give them a
stimulant would cause them to become more anxious and worried — a GP probably wouldn’t
know that decreasing high protein foods and using Effexor would be best — even trying 5-HTP
may improve symptoms. I give my clients a handout of the different types of ADD from the
Amen Clinic to educate them and encourage them to get a referral.”

“I am located in an MUA and health shortage rural mountain area. Nearest most services are a
mile away. 80% of my clients are on Medicare, SSDI or Cover CA. They are for the most part
poor, some very poor. Getting a SPECT scan is no more possible than buying a Tesla or taking a
week’s vacation to HI. So only one client has been able to get scans. I use the questionnaires
and photos from Amen resources I have to do my work. This is very sad. My clients don’t even
seem to be aware of the parts of the brain and how they are under or over functioning.”

“The important tools to healing the brain and how behavior is related to different areas of the
brain and to treat these areas affected with the right tools.”

“Exploring the patient first biologically through SPECT, MRI-DTI, and lab work better equips
Integrated Practitioners to treat an underlying injury, a medical condition, and or both. The
above diagnostic tools provide best practice in developing a psychosocial spiritual treatment plan
for recovery that is individualized specifically for person-centered care.”

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APPENDIX G
STORIES OF SUCCESS FROM THE MENTAL HEALTH PROFESSIONALS
INTERVIEWED
Psychologist 2:
“One of my clients was depressed and she was taking a specific medication. At the time I was
taking the Amen’s certification course. I had just heard Dr. Amen talk about the different types
of depression and the need to identity which type a patient has. So I gave her the questionnaire
and after looking at her answers I could see that she didn’t have the type of depression that the
medication she was on helps. So I mentioned to the patient, ‘here are the kinds of problems that
somebody with this type of depression has on that specific medication,’ and she said, ‘these are
exactly the symptoms that my medication gives me.’ She then started on the different
antidepressant and she got much better.”

“One of the patients who could afford the SPECT scans was struggling but I couldn’t quite
pinpoint what it was. After looking at his brain scans and seeing his brain we realized he had a
form of dementia. What happened with him on the medications and the supplements he got from
Dr. Amen was amazing. He’s so much better and he is so grateful.”

Psychologist #3:

“A woman came to me on 90 milligrams of Prozac. She was having problems getting out of bed
in the morning and going to work. This person had a PhD in the area of economics. First of all,
I thought this is ridiculous that somebody should be giving her 90 milligrams of Prozac and she
can’t get up out of bed in the morning. It was also significantly apparent to me that she had
ADD and was suffering from depression. She had been beaten when she was a teenager with a
club by somebody on the head and she still was able to show me the scars from that so I knew
there was significant problems there as well. So I said, ‘we got to find out first off what kind of
damage there is from this first injury, and secondly, you are on too much Prozac.’ We need to
get this figured out. She was willing to go to the clinic. The scans showed the ADD and brain
anxiety was very prominent. The scans also indicated she had depression. The other tests came
back saying she had a hormonal imbalance which was part of this picture as well. She also had
severe light sensitivity, so it was a pretty complex picture. But once I knew about all of this, I
could develop a better treatment plan based upon the scans, my observations, her background,
and her experiences. I referred her and worked with a psychiatrist in our center to reestablish a
better protocol on depressive medications known to treat both depression and anxiety and she did
much better. No more problems getting up and going to work. She had a more positive attitude.
And we added something to help with her ADD. We checked into her hormone imbalance to get
some help for that from a physician. And she did quite well. But she was in really rough shape
when I first saw her.”

“I sent a young man to the Amen Clinics who was extremely disturbed. I couldn’t figure out
whether he was schizophrenic, extreme biopolar, or if he had some kind of insidious brain
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163
damage. He was writing in a very psychotic way. He was on overdoses of medications three
times what the clinical doses are supposed to be. I talked with Dr. Amen and we got him
scanned. We both looked at the scans and strategized. We determined that he was really not
doing okay and we wouldn’t be able to find out what was really going on with him until we got
him off all of his meds. So I spent a year and a half, with his local physician in another state, and
we worked diligently to reduce his meds in a very comprehensive and logical way. So after a
year and a half he was off all his meds accept an ADD med, and it was amazing. The
transformation within him was incredible. He could speak. He wasn’t doing his little finger
ticks and other things he was doing. His logic and his writing improved. He wrote like a real
human being instead of somebody who was psychotic. His speech changed. It was
transformational in so many ways. It was just incredible. Before he came to see me he had
flunked out of college. After he started doing better. He went back to school and right now he
has one more course to finish his degree.”

Psychologist #4:

“There was a college age woman that came in and wanted to be evaluated for ADD. She
presented herself at the end of her junior year. She said ‘I think I have ADD because now that I
am in upper level courses, I am having trouble reading my textbooks. I think I’m pretty smart,
but I’m getting some Cs and some Bs but I am having trouble concentrating.’ Once she
completed her brain system checklist, I saw that she had tons of anxiety. I know that if I asked a
physician to start a round of ADD medication, the type she would be prescribed would have sent
her anxiety over the top because she would have been put on a stimulant medication. Based on
my knowledge of Amen Clinics methods and what I recommended, a doctor I worked very
closely with was able to give her a different drug that is actually an anti-convulsant medication
with no side effects. She decided to go out of the country for a statistics class. She emailed me
from out of the country and stated, ‘there is no way I could be doing this without this new
medication. There is no way I could still be here.’ After the new medication she did much
better.”

“Another student came in who wasn’t doing well on her current medication for ADD. We
realized by looking at the checklist that she had been placed on the wrong medication so we took
her off of that medication and she started doing so much better. Not only did she start getting As
because she’s a very bright and capable girl, she also got into a lot of the major universities from
around the world. She applied for a Master’s in Computer Science program and she was
accepted. These achievements would have been challenging for someone without ADD. If I
never would have met Daniel Amen then that wouldn’t have happened for her. I would have just
done stress management or worked on communication skills and she would have been frustrated
the whole rest of her life. Amen Clinics’ methods work and they change lives.”

LCSW #1:

“I was working with a male in his 30s for eight years. He has clinical depression. His father
died when he was young. He comes from a long line of people that did not take care of their
health. Yet he was always inspired to run Iron Mans and exercise and work out, but he had
severe depression. While working with him I realized his depression wasn’t 100% depression;
REDUCING MISDIAGNOSIS IN MENTAL HEALTH PROFESSIONS

164
he had some ADD symptoms as well. Through discussing some of the brain SPECT imaging
information we were able to dissect out some of things that were firing and what wasn’t and we
were able to get him on the right cocktail of medications. He is now completing tasks, he’s got a
killer job in New York, he’s super happy, and it’s been really inspiring to see.”

LMFT #2:

“I was just kind of watching my husband’s cognitive ability get slower. He’s a very bright man;
Stanford graduate. Bright thinker. I just kind of watched as his responses got slower and I just
was feeling more anxious. Then I took the Brain Health Coaching Class and read one of Dr.
Amen’s books. We both got SPECT scans. The resting versus the concentration scan was
remarkable. He had a toxic pattern, but not from any drugs or drinking because we don’t do
drugs or drink alcohol. The toxicity had to do with not getting enough oxygen at night. The
doctor said, you can exercise and take the right medications and eat raw foods, but you are not
getting enough oxygen when you are sleeping, and it’s not going to get a whole lot better until
you get enough oxygen at nights. Once he did, within two months there was a night and day
difference in my husband.”

“A friend of mine was depressed and kind of suicidal. He was in his mid 50s at this point and we
raised the money to send him to get a brain scan. The doctor said, based on a SPECT scan, ‘no
wonder you are not doing very well, you have ADD and there is a big hole right there in the
prefrontal cortex and this medication is the wrong medication for your deep limbic system.’ So
we put him on the right mediation for his brain and 30 days later there was so much more clarity
in his voice and he was doing so much better.”

LPC #2:

“Our first case we took to Amen Clinics was a boy about four or five. He had lots of behavior
issues, lots of ADD type symptoms, he would faint at a moment’s notice; weird things like that.
But we were trying to advocate for him in the school system; minimally on the ADD because he
kept failing tests. And so we went in and we tried to talk with them about what was going on
and some interventions they could try and the school administrators all thought it was just a
bunch of baloney. When we were able to bring in the SPECT scan and then talk to them about
the scan and then talk to them about interventions, they slowly warmed up and started to trust us.
Then we started to see positive results when they finally started to listen to us. His academics
went up and he started to do better.”

Life coach #1:

“One boy I knew was very volatile, one day he body slammed a girl for poking fun at him at the
school bus; another time he went from apartment to apartment with a butcher knife looking for
some boys that had teased him on the bus for something that he was wearing; soon after that he
was found in the middle of the street because he heard voices telling him to kill himself. He
went to Amen Clinics and got his brain scanned and they discovered he had a traumatic brain
injury. When he was five the family had gone bowling and somehow his head made contact with
the bowling ball and it damaged his temporal lobes. You could see it on the scans. Not only
REDUCING MISDIAGNOSIS IN MENTAL HEALTH PROFESSIONS

165
that, but when the family members heard the diagnosis, everybody cried because the boy said,
‘it’s not my fault? It’s something that happened to me?’ He started following the treatment plan
from Amen Clinics. He was supposed to be in an institution for 12 months, but after going to
Amen he only had to be in the institution for three months. He was released because he was on
the honor roll the entire time with no incidents.”

Abstract (if available)

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Asset Metadata

Creator Hodson, Kristy Ann (author)

Core Title Reducing misdiagnosis in mental health professions: a study of a promising practice

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 11/13/2019

Defense Date 10/11/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Amen Clinics,brain-based approaches,Diagnosis,Mental Health,mental illness,misdiagnosis,OAI-PMH Harvest,SPECT scan imaging

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tobey, Patricia (committee chair), Chung, Ruth (committee member), Pearson, Mark (committee member)

Creator Email kannhodson@gmail.com,khodson@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-233619

Unique identifier UC11674876

Identifier etd-HodsonKris-7920.pdf (filename),usctheses-c89-233619 (legacy record id)

Legacy Identifier etd-HodsonKris-7920.pdf

Dmrecord 233619

Document Type Dissertation

Rights Hodson, Kristy Ann

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA