Using the Millon Behavioral Medicine Diagnostic to Delineate Treatment Outcomes in Rehabilitation

Patients undergoing rehabilitation have been evidenced to improve in different ways depending on their coping styles. Amplifiers, Repressors, and Social Copers are examples of patients who present differently in rehabilitation settings and tend to have differing levels of success in their response to treatment. The current study examined the differential treatment outcomes of three coping style groups undergoing multidisciplinary rehabilitation. A sample of 59 patients suffering from injuries associated with chronic pain were assessed using the Multidimensional Pain Inventory, Beck Depression Inventory, and Beck Anxiety Inventory before, during, and after multidisciplinary pain management treatment. Coping style groups derived from the Millon Behavioral Medicine Diagnostic consisting of Amplifiers, Repressors, and Social Copers were compared with regard to reductions in depression, anxiety, pain, functional impairment, and associated outcomes. Repeated measures ANOVA revealed that Amplifiers, Repressors, and Social Copers had varying levels of success in the treatment program. Hierarchical linear modeling analyses revealed the coping style groups to have significantly different change curves from pre to post-treatment in depression, anxiety, pain severity, functional impairment, affective distress, life control, social support, and soliciting help from others. These findings support prior research emphasizing the value of tailoring treatments in rehabilitation settings toward patients’ coping styles in order to maximize outcomes. A program (provided in either SAS or SPSS syntax) that will compute MBMD coping style group membership will be provided upon request. Request by e-mail to: dcipher@hsc.unt.edu or by fax to: +1-817-7352270.     

The Institute on Human Values in Medicine: Its Role and Influence in the Conception and Evolution of Bioethics

For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in defining thefield, training faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education.     

An examination of vicarious reinforcement processes in children

The primary purpose of the present investigation was to examine vicarious reinforcement processes in children. More specifically, the effects on one child of observing another same-sex child receive direct reinforcement were explored across three different age levels. Subjects were 216 children, randomly assigned to experimental or control conditions. For the control condition, neither child in the same-sex, same-age dyad received reinforcement for performance on the experimental task. For the experimental condition, one child in each dyad received direct social reinforcement for performance, while the other child received no social reinforcement for similar performance. Although children who observed other children receive direct social reinforcement initially increased performance (as predicted by vicarious reinforcement hypotheses), their performance soon decreased and was characterized by verbal and nonverbal responses which appeared to interfere with task performance (e.g., “Hey, I can do them too”, “Look at mine”, “There's no use in trying”). It appeared as if these observing children were being punished for their performance. Such effects were more pronounced for older than younger children; however, they were observed equally in boys and girls. Results were discussed in terms of vicarious reinforcement and “implicit punishment” hypotheses. Implications for applied settings were also addressed.     

Context and companion's behavior as determinants of cooperation and competition in school-age children

Information about the social context and a companion's actions were studied as determinants of cooperation and competition in middle childhood. In Experiment 1, first-, third-, and fifth-grade children were told that they would play a board game with another same-age, same-sex child (actually a bogus companion). The experimenter's instructions established shared rewards or winner-take-all as outcome conditions. Preprogrammed responses—100% cooperative or 100% competitive—provided information about the companion's actions. Results revealed that the companion's responses alone determined cooperation and competition among the first graders. Third graders used both types of information. Fifth graders, however, demonstrated a bias to respond cooperatively whenever a cooperative cue was present. In Experiment 2, first-grade subjects were given extra rehearsal of the game strategies, a scorekeeping procedure for use during the game, or a combination of the two. Results indicated that, under these conditions, younger subjects were able to use the instructions about reward distribution as well as the companion's actions in guiding their social behavior.     

The effects of verbal feedback and listener type on the speech of preschool children

The present study simultaneously assessed the relative contributions of feedback indicative of comprehension and the apparent age of the listener, either an adult or a doll which resembled a toddler, in a 2 (listeners) × 2 (types of feedback, C = comprehension, NC = noncomprehension) design. Two groups of children, a 3-year-old (N = 13, 7 boys, 6 girls) and a 5-year-old group (N = 12, 6 boys, 6 girls) were asked to tell stories to both the adult and doll in both C and NC conditions. The doll was constructed with an internal speaker such that it could actually carry on a conversation with the children. The conversations were taped, transcribed, and scored for mean length of utterance (MLU), transitional utterance length to each C and NC signal, and the proportion of child questions, exact self-repetitions, repetition and reductions, and rephrases/elaborations. The data analysis revealed that all children appropriately modified the length of their utterances (MLU) in the doll condition but not in the adult condition, indicating that they were sensitive to both the feedback and the nature of their listeners. Older children were more likely than younger children, and girls more likely than boys to adjust the length of their utterances appropriately to each type of feedback, slightly increasing the length of the subsequent utterance to a C signal and decreasing the length to an NC signal. The younger children were also more likely to respond with a simple repetition to NC cues from the adult.     

Bilingualism and brain functional asymmetry

The task of the neural organization of the native language, acquired by a direct method and of another language, studied at school, performed correspondingly by the left and the right hemispheres, was studied in the bilingual patient after unilateral electroconvulsive therapy used in psychiatry. It was established that in such a bilingual type the right hemisphere is concerned with the formation of deep semantic structures of the native language while the left hemisphere is responsible for the formation of second language deep structures and of surface structures of both languages. The effect of language learning method on cerebral organization of bilingualism is postulated.     

A note on the "word-order problem" in agrammatism

This brief note has two parts. First, it presents an analysis of the ability of English agrammatic patients to assign the thematic roles of agent, instrument, theme, and locative to noun phrases in active and passive sentences and prepositional phrases. Data regarding this ability have been presented by Schwartz, Saffran, and Marin (Brain and Language, 10, 149-262 (1980) regarding comprehension, and by Saffran, Schwartz, and Marin (Brain and Language, 10, 263-280 (1980) regarding production. These authors claim their data show that English agrammatic aphasics do not map "word order" onto thematic information. However, a very simple set of principles accounts for all their results, including results which are discrepant in their treatment, but requires that English agrammatics assign thematic roles to NPs in part by virtue of the position of an NP in a sentence or a phrase. In the second part of this note, several issues raised by this re-analysis are briefly discussed.     

Irrelevance of mitigating circumstances in retaliatory behavior at high levels of excitation

Subjects were aggressively instigated by a provoker. They then performed either a nonstrenuous or a strenuous task in order to be placed in either a moderate or an extreme state of sympathetic arousal. Following the task, they either learned or did not learn about mitigating circumstances behind the provoker's behavior. This information was received prior to the provision of an opportunity to retaliate. Under conditions of moderate arousal, mitigating circumstances were found to reduce retaliation. In contrast, these circumstances failed to exert any appreciable effect on retaliation under conditions of extreme arousal. In addition, the induction of extreme arousal was observed to increase retaliatory behavior. The findings were considered to support a model of hostility and aggression that postulates a specific interdependency of cognitive and excitatory processes.