Self-statement modification in the treatment of child behavior disorders: a meta-analysis.

Reviews 48 outcome studies that applied self-statement modification (SSM) to childhood behavior disorders. Selection criteria restricted the review to controlled experimental studies and to children with disorders of clinically relevant severity. Meta-analysis was used to provide summary information about the observed effects of SSM. Collectively, SSM outcomes surpassed no treatment and placebo treatment by roughly a half of a standard deviation, on the average. Efficacy varied considerably with length of follow-up, experience level of therapists, age of children, outcome content area, and a number of other clinical and methodological differences among the studies. These qualifiers of observed efficacy are summarized and discussed in terms of implications for further research and application of SSM in child psychotherapy.

High-tech, aggressive palliative care: in the service of quality of life.

The hospice movement grew in part as a reaction to the perception that modern medical care had become too technological at the expense of being impersonal and insensitive to human psychological and spiritual concerns. In the United States, the institutionalization of hospice care under Medicare and other reimbursement systems has further established hospice as an alternative to high-technology, high-cost care. The present paper examines the question: What if hospice care becomes itself high-technology, aggressive, costly health care in order to remain true to its goal of maximizing quality of life? Implications for the goals and philosophical underpinnings of palliative care are discussed.

Coronary heart disease risk scales and reactivity in a prevention program assessment: failure to show positive relationships.

This study was designed to evaluate relationships among the Jenkins Activity Survey, the Cook-Medley Hostility Scale, and cardiovascular reactivity measured during a semistructured interview in a hospital setting. Subjects were 201 business persons participating in a cardiovascular risk assessment interview component of a fitness program. Correlation analysis showed little evidence of significant positive relationships between self-report scores and reactivity in the total sample and among subjects with high resting blood pressures. Graphic analysis of total sample bivariate distributions, however, demonstrated patterns suggestive of nonlinear relationships. Evaluation of scatterplots and residual plots in conjunction with nonlinear and weighted least squares regression analyses nonetheless failed to reveal significant nonlinear relationships. The authors discuss implications of these findings.

Comprehensive behavioral medicine in community mental health. A needs assessment that needs assessment.

It is suggested that the massive costs incurred nationally in health care are in large part a fitting concern of Community Mental Health (CMH). There is considerable data available to suggest that as much as half of the variance in common health disorders is associated with behavioral factors. There is a rapidly growing movement to provide interventions geared toward these behavioral components in health disorders, but much of this has occurred outside of the traditional mental health environment. There are arguments to suggest that CMH should be more involved in the development of comprehensive behavioral medicine services, both in terms of the expertise and resources that it can bring to bear upon these problems, and its potential to reach segments of the population which are otherwise likely to be underserved, if served at all. Implications for CMH planning and financing are discussed, drawing upon a selective literature review and clinical illustrations.

Factor structure of the Health Concerns Questionnaire in elderly chronic pain patients.

The factor structure and psychometric properties of the Health Concerns Questionnaire were evaluated in a sample of 133 elderly chronic pain outpatients. Reliability and validity data are presented for the HCQ total scores, 3 varimax rotated factors, and 3 content scales that distinguish endorsement of medically versus psychologically oriented items.

Breast implants and illness: a model of psychological factors.

Studies of disease outcomes have not produced an explanation or an intervention for the symptoms and complaints that some women have attributed to breast implants. Reviews of the literature have found no increased risk of specific systemic disease, and no treatment recommendations have emerged. However, similar symptoms in fibromyalgia, chronic fatigue, and other contexts have been considered to be stress or behaviourally mediated, and a number of promising behavioural interventions have been developed. Aetiological, research, and treatment implications may follow from the consideration of such symptoms within a behavioural medicine model that allows for the interaction of physical and psychological influences. In the case of implants, a mass somatisation model may also help to discern the potential effects of litigation and other social influences.

Standardizing outcome data in program evaluation.

Procedures are described for standardizing outcomes in evaluations of service delivery systems. Accounting for the variability of a given device, client gains across services can be expressed in a standard metric of change. Standardized gains take on a common meaning of change regardless of the original scale and variability of the raw data. In turn, a wide range of common statistical analyses can be applied with individual client gains as the units of analysis, powerfully delineating influences on outcome variability. Implications and limitations are discussed.

Standardizing outcome data in program evaluation.

Procedures are described for standardizing outcomes in evaluations of service delivery systems. Accounting for the variability of a given device, client gains across services can be expressed in a standard metric of change. Standardized gains take on a common meaning of change regardless of the original scale and variability of the raw data. In return, a wide range of common statistical analyses can be applied with individual client gains as the units of analysis, powerfully delineating influences on outcome variability. Implications and limitations are discussed.

A multicomponent minimal intervention health promotion program: preliminary results.

This article reports two preliminary studies examining whether a minimal intervention cardiac risk education program incorporating behavioral components to enhance self-efficacy could effectively change health behaviors. The first study utilized a quasi-experimental design in evaluating workshop outcome among 131 AFL-CIO union members. A MANCOVA performed on self-report and physiological outcome measures suggested a significant difference between treatment and waiting list control groups, primarily in the area of nutrition. In the second true experimental study, participants were 307 "at-risk" employees of a local school system. A MANCOVA at a four month follow-up revealed significant differences in several reported health behaviors including Type A behavior, smoking, and nutrition. Results also showed the program's effectiveness was consistent across sex, age, and severity of participants' health risk. Implications for further research on the cost-effectiveness of brief health promotion interventions are discussed in light of the observed impact and the high level (80%) of employee interest and participation.

Scale properties of the Holtzman inkblots.

Scaling techniques were presently applied to perceptions of inkblots, to empirically delineate the relationship between their stimulus properties and the nature of verbal associations elicited in projective testing. The Holtzman Inkblot Technique (HIT) was administered in group form to a relatively diverse group of college students. Subjects also individually rated the similarity of pairs of the HIT inkblots. Similarity judgments were analyzed via a multidimensional scaling (MDS) approach which recovered dimensions of variations among blots. The MDS procedures also captured variation across subjects in their utilization of blot stimulus properties. MDS solutions generally reflected differences among the blots along dimensions of physical characteristics of the blots. Differences in responsiveness of subjects to these characteristics appeared to reliably reflect meaningful substantive distinctions among subjects, many of which were not captured by traditional HIT variables. Implications were discussed in terms of further MDS applications and possible re-evaluation of HIT variables or procedures.

Program evaluation in terminal care.

The expansion of hospice care brings new challenges for accountability, program evaluation, and research. The present paper attempts to examine (a) the various goals, tasks, and conceptual models of program evaluation relevant to terminal care, and (b) the applicability of two illustrative evaluation strategies: experimental designs and time-series analysis.

The responses of dissociative patients on the thematic apperception test.

This study compared the responses of dissociative inpatients and general inpatient psychiatric controls on the Thematic Apperception Test (TAT; Murray, 1943). We found the stories of dissociative participants to be characterized by a greater interpersonal distance and more trauma and dissociation responses than those of the controls. No significant differences were found regarding total number of emotional references, although references to positive emotions were almost nonexistent for the dissociative group. A post hoc analysis of the data found the testing behaviors of dissociative participants to be characterized by switching, trance states, intrainterview amnesias, and affectively loaded card rejections. Questions were raised regarding the relevancy of the findings to clinical practice and how they might explain some of the controversies surrounding the diagnosis of dissociative identity disorder (DID).

Evaluating minimal intervention health promotion in a clinical context.

This article has two objectives. The first objective is to summarize the evaluation of a minimal intervention cardiovascular health promotion program offered to a sample of forty-seven persons having percutaneous transluminal coronary angioplasty procedures. The second objective is to highlight several issues concerning the utility of small-scale program evaluation in a clinical context, as exemplified by this study. Results of a four month follow-up evaluation of the intervention showed significant findings in the areas of knowledge gain and lifestyle behavior change; these findings are illustrated through binomial effect size displays. The study failed to demonstrate statistically significant results on several measures of physiological and self-reported risk factors. Difficulties in interpreting results due to methodological limitations raise issues concerning the utility of conducting program evaluation efforts with limited resources. Dilemmas often confronted in small-scale evaluation projects and the importance of considering their relative, practical utility are discussed.

Psychological profiles distinguishing litigating and nonlitigating pain patients: subtle, and not so subtle.

Chronic pain patients in the midst of litigation over settlement for their injuries were examined as a naturally occurring group where one might expect various distortions or differences in test findings on the Minnesota Multiphasic Personality Inventory-Revised (MMPI-2). Similar groups of 43 chronic pain patients in litigation and 45 not in litigation were examined on 10 key MMPI-2 variables selected a priori. Multivariate analysis of variance revealed a significant difference between groups (p = .036). Litigators were most distinct in endorsing more obvious and fewer subtle symptoms. A conversion profile was also more salient for litigators once the obvious versus subtle differences were taken into account. Implications for use of the MMPI-2 and for clinical work with litigious patients are examined.