Chest pain without coronary artery disease: An exploratory comparison with panic disorder

Recent reports have indicated similarities between patients with persistent chest pain of nonorganic origin and patients with panic disorder. In order to explore this association further, we administered a structured interview and three self-report measures (State-Trait Inventory, Beck Depression Inventory, and SCL90-R) to three subject groups: (1) a sample with persistent chest pain (CP; n=14) who had been screened and found to have normal coronary arteries, (2) a sample of patients with panic disorder (PD; n=14), and (3) a sample of matched normals (n=14). CP patients were considered to be free of coronary artery disease (CAD) following normal cardiac catheterization and/or normal thallium stress tests and were not diagnosed initially with panic disorder. PD patients were diagnosed with a standardized psychiatric interview and were free of organic causes of panic. Using an exploratory data analytic approach, the results indicated that both CP and PD samples reported increased levels of state and trait anxiety (p <.0001), depression (p <.01), and somatization (p <.0001) compared with normals. CP patients differed from PD patients in their less frequent use of anxiolytic medication (p <.01) and lower levels of reported panic anxiety and phobic avoidance (p <.0001). These data suggest that persistent chest pain in the absence of CAD shares some features with panic disorder, yet differs from panic in key ways as well. The results are discussed in light of the role of anxiety in contributing to symptom labeling.This research was supported by Grant 86G-491 from the American Heart Association, Texas Affiliate, to J.G.B. H.T. is the recipient of USPHS Research Career Development Award K04-HL-0122246.     

Assessing the relationship of Type A beliefs to cardiovascular disease risk and psychosocial distress

Investigators have begun to take a multimodal approach to the assessment and treatment of psychosocial risk factors for cardiovascular disease (CVD). For instance, cognitive responses have become the focus of contemporary research along with continued examination of overt Type A behaviors. Price (1982) has outlined a set of beliefs purportedly associated with Type A behavior and subsequent CVD risk. The current study examines the validity of this belief set as represented by a newly developed measure, the Type A Cognitive Questionnaire (TACQ). Subjects were 221 employed adults participating in a worksite CVD risk reduction program. They completed the TACQ as part of a pretreatment CVD risk screening protocol. As hypothesized, TACQ scores were significantly associated with Type A behavior, hostility, physiological mediators of CVD, and psychosocial distress. Discussion addresses continued refinement of the Type A belief construct.     

Expert evidence by psychologists: Sometimes problematic and often premature

This article provides a critical review of two major types of expert evidence: (a) clinical assessments, and (b) generalizations drawn from psychological research. Strong arguments both for and against both types of testimony have been offered by legal experts and psychologists. These arguments are evaluated and the conclusion is drawn that there are two fundamental problems for psychologists in the role of expert. First, the types of assessments clinicians are asked to make (e.g., concerning the accused's mental state at the time of committing the offense) may exceed the capacity of the discipline; such assessments are problematic. Second, the research foundation that psychologists employ in court does not always apply to the court situation in the way experts imply; the application of laboratory research findings to real world contexts is sometimes premature. The article concludes with an admonition that psychologists should adopt a more conservative response to requests to provide expert evidence.     

Brief group psychotherapy at retirement

Brief group psychotherapy as a method of treating psychological aftereffects of retirement is still in its infancy. It is therefore still possible to outline the whole field in overview. This paper examines the dynamics of aging and the relevant literature, discusses the conceptual issues involved, and describes techniques employed with this specific population. The typical cluster of complaints is portrayed, the psychological stressors associated with retirement are analyzed, and the various group-therapeutic modalities developed to counteract them are described. Furthermore, the rationale, process and characteristics of short-term group psychotherapy in the treatment of adjustment difficulties to retirement are reviewed. The clinical application of this approach, the therapist's particular roles and the therapeutic impact of this method are delineated.He would like to thank his co-therapist, Mrs. Sophie Bielawski, Reg. O.T., for her support and helpful observations and Drs. J. Regan and E. Sunday for their advice on methodolody.     

Automated data collection using bar code

Using bar code technology to automate data collection provides a rapid and reliable alternative to paper-and-pencil tracking or keyboard entry into pocket or laptop computer. An array of bar code symbols is printed on a data menu, with a unique symbol corresponding to each possible observation. Bar code symbols are scanned using hand-held readers, which record the event, log the observation time, and store data for transfer to a personal computer. Advantages of the bar code monitoring system include: (1) ease of use by staff with minimal technical training, (2) reduced data entry errors and increased entry speed, (3) reliable portable operation, and (4) low-cost hardware. While the bar code system described here is used for behavioral monitoring in a residential treatment setting for the developmentally disabled, with minimal modification this system can be adapted for use in a wide variety of research and clinical applications.     

Frequency analysis of electromyographically measured covert speech behavior

Eleven subjects were asked to silently read slides of the letters “P” and “T,” and to view meaningless control slides similarly as they were presented visually. One-eighth-second electromyographic excerpts were sampled from the baseline and response periods. The data were then transformed into the frequency domain for inferential analyses. The mean power spectral frequencies for the response period were significantly lower than those for the base-line in the overall analysis. There were, however, no significant changes from baseline as a function of kind of stimulus (T, P, or Control) or muscle activated (lips or tongue). It was concluded that there was a generalized responding, not unique to the processing of the specific stimuli studied. Frequency analysis of EMG measures of covert behavior holds some promise of yielding unique information not available through traditional analysis procedures, but more sensitive methods than those used here would be required to demonstrate this.     

ACQUISITION,GENERALIZATION, AND MAINTENANCE OF QUESTION-ANSWERING SKILLS IN AUTISTIC CHILDREN

We conducted an investigation to evaluate the effects of a training strategy for teaching autistic students generalized responses to three forms of wh— questions (what, how, and why). Students were taught, using modeling and reinforcement procedures, to answer questions with magazine pictures as the referents. Each question form was divided into two or more subcomponents reflective of common social usage and was taught within the context of a modified multiple probe design across subcomponents. Following acquisition of each subcomponent, generalization to natural context and storybook questions was assessed; additional probes were conducted to assess responding over time and whether acquisition of responses to questions promoted question-asking skills. Results showed that the picture training procedure was effective in teaching a generalized response to questions for which the relevant cue was visible, whereas specific generalization programming was required for situations in which the relevant cue was not visible. All acquired responses were durable over time.