Predicting the completion of an integrative and intensive outpatient chronic pain treatment with the personality assessment inventory

The effects of intensive, integrative treatments for chronic pain are affected by patient compliance, and in many cases, selecting noncompliant individuals adversely impacts the cost-effectiveness of such programs. The pretreatment identification of individuals who are at risk for dropout could assist clinicians in augmenting treatments with motivational enhancement strategies for high-risk patients or using such information to select individuals who are most likely to complete a given intervention program. In this study, we tested the ability of indicators from the Personality Assessment Inventory (PAI; Morey, 1991), administered prior to treatment, to identify individuals who dropped out of a 20-day chronic pain program. Results replicate findings from outpatient psychotherapy research in finding that PAI Mean Clinical Elevation and Treatment Process Index significantly differentiated dropouts from graduates, particularly when the Treatment Rejection scale suggested patients were motivated for treatment. We discuss these results and offer recommendations for the prediction of treatment dropout in pain settings.     

Teacher expectations, classroom context, and the achievement gap

In two independent datasets with 1872 elementary-aged children in 83 classrooms, Studies 1 and 2 examined the role of classroom context in moderating the relationship between child ethnicity and teacher expectations. For Study 1 overall and Study 2 mixed-grade classrooms, in ethnically diverse classrooms where students reported high levels of differential teacher treatment (PDT) towards high and low achieving students, teacher expectations of European American and Asian American students were between .75 and 1.00 standard deviations higher than teacher expectations of African American and Latino students with similar records of achievement. In highly diverse low-PDT classrooms in Study 1 and highly diverse low-PDT mixed-grade classrooms in Study 2, teachers held similar expectations for all students with similar records of achievement. Study 3 estimated the contribution of teacher expectations to the year-end ethnic achievement gap in high- and low-bias classrooms. In high-bias classrooms, teacher expectancy effects accounted for an average of .29 and up to .38 standard deviations of the year-end ethnic achievement gap.     

Optimal Scoring of the Multidimensional Pain Inventory in a Chronic Pain Sample

The Multidimensional Pain Inventory (MPI) is one of the most commonly used self-report instruments in pain settings. The MPI can be used to classify patients into three clusters or its nine scales can be treated as dimensions in efforts to understand patient heterogeneity. Previous research suggests the existence of a fourth cluster, whose members have been labeled ‘repressors,’ that emerges with the addition of a defensiveness scale to the MPI. The current paper compared the abilities of MPI cluster and dimensional models with and without a measure of defensiveness to capture variability in validating variables related to personality, psychopathology, physical functioning, and treatment outcome in a chronic pain sample. Results suggest that dimensional models consistently outperform cluster models in explaining variance in outcome variables, and that the addition of a measure of defensiveness increments the validity offered by the MPI scales. Implications for the assessment of pain patients are discussed.

Too much to count on: impaired very small numbers in corticobasal degeneration

Patients with corticobasal degeneration (CBD) have calculation impairments. This study examined whether impaired number knowledge depends on verbal mediation. We focused particularly on knowledge of very small numbers, where there is a precise relationship between a cardinality and its number concept, but little hypothesized role for verbal mediation. We evaluated accuracy and reaction time (RT) for matching dot arrays and Arabic numerals involving smaller (2-4) and larger (5-9) cardinalities in non-aphasic patients with CBD (n=16), frontotemporal dementia (FTD; n=23), and healthy controls (n=15). CBD were less accurate and slowed at judging smaller Arabic numeral-dot array stimuli compared to FTD patients and controls. Moreover, only CBD showed longer RTs judging successively larger number-dot array pairs among the smaller cardinalities. Difficulty judging very small numbers is impaired in CBD, suggesting degraded representation of precise number knowledge that does not depend on language functioning.     

Satisfaction with care among low-income female outpatients

Patient satisfaction correlates with important health behaviors and outcomes. Little is known about satisfaction in disadvantaged populations of different racial/ethnic backgrounds. The current study evaluated demographic and psychological correlates of patient satisfaction among a low-income, multiethnic sample of female outpatients attending cervical cancer screening. Participants included 338 African American, Latina, and white women ages 18 - 49 years attending University of Texas Medical Branch Regional Maternal & Child Health Clinics. Data were obtained via self-report and chart review. Patient satisfaction was assessed using the Patient Satisfaction Questionnaire (PSQ). Total PSQ scores reflected two distinct underlying subscales (satisfaction and dissatisfaction), which differed from the original factor structure of the PSQ. Satisfaction was predicted by patient beliefs that their health is self-determined, beliefs that doctors control their health, self-esteem, and education. Dissatisfaction was predicted by patient beliefs that good health is a matter of chance/luck, self-esteem, social desirability, and income. Higher self-esteem, education, and beliefs that health is controlled by oneself or doctors correlated with higher satisfaction with care in the clinic setting. Understanding the influence of patient characteristics on perceptions of care is important for physicians to foster relationships with patients that increase feelings of satisfaction, decrease dissatisfaction, and ultimately, improve health outcomes.     

Environmental stress, psychological stress and allostatic load

The mechanism by which chronic caregiving stress results in poor health is not well understood. The objective was to determine whether such a mechanism may be allostatic load, a novel concept specifying physiological systems that may suffer cumulative wear and tear following chronic stress, leading collectively to poor health. The study examines the association of allostatic load with environmental and psychological stress in the contexts of dementia caregiving and relinquishment of care, and is a 2-year longitudinal comparison of three groups: 80 new dementia spouse caregivers, 120 veteran caregivers, and 60 non-caregivers. Data comprised allostatic load markers and environmental and psychological stress measures. Cross-lagged analyses produced a statistically significant association between psychological stress and one allostatic load component (primary mediators). Psychological stress was a better predictor of primary mediators than environmental stress. Primary mediators rose with time for caregivers, but not for non-caregivers. A greater rise was evident for caregivers who had relinquished their role by the second year, although the level of psychological stress actually declined. Primary mediators are a key component of the relationship between allostatic load and prior stress. When allostatic load is treated as an outcome of stress, it is important to distinguish environmental and psychological stress.     

Minority influence: the role of the rate of majority defection and persuasive arguments

An experiment employing the Twelve Angry Men paradigm was conducted to determine the role of the rate of majority defection to the minority position and the use of persuasive arguments by the minority on minority influence. Subjects were more influenced by the minority when it provided persuasive arguments by refuting the majority viewpoint than when the minority did not. More minority influence occurred when the minority obtained majority defectors than when the minority did not. Moreover, the rate of majority defection made a difference. Minority influence was not obtained with the initial acquisition of a single defector and the significant influence that occurred with the acquisition of four defectors was not further increased by the acquisition of additional defectors. The results for the number of majority defectors were generally consistent with Tanford and Penrod's social influence model. Finally, the issue of the number of majority defectors versus the speed at which they defect is discussed. © 1998 John Wiley & Sons, Ltd.