Author ORCID Identifier

Defense Date


Document Type


Degree Name

Master of Science



First Advisor

Jared Keeley, Ph.D

Second Advisor

Bryce McLeod, Ph.D

Third Advisor

Gary Cuddeback, Ph.D


Diagnostic decision-making is an important component of clinical practice; however, there is substantial diagnostic unreliability within mental health diagnoses. The lack of reliability emphasizes the importance of investigating diagnostic decision-making; however, the research to date is limited, primarily relying on a vague definition of decision-making based on the dual-process model. The present study is an exploratory attempt to apply the dual-process model to explain how mental health clinicians (n = 30, 73.3% cisgender female, 96.7% psychologists) arrive at making diagnostic decisions through the use of an interactive interview mechanism. For each participant, we are able to create a figure that displays their decision-making process. The number of times participants indicated System 2 processing based on diagnostic questions and certainty rating each ranged from 0 to 9 (M = 3.10, SD = 2.41 & M = 3.07, SD = 2.53, respectively). The number of questions asked (2 to 27, M = 9.30) were significantly correlated with switching diagnostic questions (r(28) = .59, p < .001) and switching their diagnostic certainty rating (r(28) = .57, p < .001). Findings provide evidence that the interactive interview is an effective mechanism to operationalize the dual-process model. The public health significance and implications of the interactive interview lies in the potential for individual clinicians and mental health teams to better understand their diagnostic decision-making process and improve overall accuracy. Future research may provide further support for the paradigm to offer individualized training and consultation for clinicians and mental health teams to improve their decision-making process.


© Chrsitopher S. Kleva

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