Psychology and mind-body segregation: Are we part of the problem?

Despite advances in behavioral medicine and health psychology, the health care system and medical education continue to show resistance to a truly biopsychosocial model of medical practice. Psychologists in medical settings have generally been identified as challenging the concept of mind-body duality and the segregation of biologic and psychosocial sciences in medicine. However, examples are presented of how psychologists contribute to and perpetuate mind-body segregation via exclusive theoretical conceptualizations, arbitrary definitions of professional behavior, and dogmatic constraints on the limits of psychology's field of knowledge.     

Family-centered intensive case management: A step toward understanding individualized care

New York State's initial attempt at individualizing services occurred within the context of an experiment. We randomly assigned children 5–12 years old who were referred for out-of-home placement in treatment foster care to either treatment foster care, Family-Based Treatment (n=15), or to Family-Centered Intensive Case Management (FCICM) (n=27). FCICM used teams of case managers and parent advocates to provide in-home services. Flexible service dollars, respite care, and behavior management skills training were available to assist teams in individualizing care. Preliminary outcomes indicate that children in FCICM are doing as well or better than children assigned to FBT in their functioning and symptom reduction. Parents of children in FCICM have made gains, although not at a statistically significant level, in behavior management skills and family strengths that allow them to provide care for their children at home.     

Matching adolescents with foster mothers and fathers: An evaluation of the role of temperament

We tested the notion that better foster care adjustment would be observed when the temperaments of mothers and fathers were matched with those of adolescent foster children. We hypothesized that families in which foster parents and foster children had high (easy) scores on subscales of the Revised Dimensions of Temperament Scale (DOTS-R) would also report higher family functioning and higher foster care adjustment than parents and children from families in which one or both family members had low (difficult) scores on these scales. The hypotheses were supported when the mothers and fathers family assessments were used but rejected when the observations of the case managers and adolescents were tested. Methodological and substantive explanations for the findings are discussed and recommendation for foster care practice and continuing research are provided.     

A biopsychosocial therapeutic approach in a private outpatient clinic in Portugal

Patients with chronic stress and ambiguous symptoms are likely to be more frequent in primary care. Somatizers represent 75.8% of the patients in this study and executives 56% of the sample. Job stressors were present in 78.3% of executive men. This scenario suggests that the primary care physician has to be academically better prepared to fully understand and deal with stress problems in daily clinical practice. The physician must have skills to deal with stress at a curative and preventive level, extending those skills to the workplace.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

Increasing senior citizen participation in a community-based nutritious meal program

Two experiments were conducted to compare the effects of several prompting and reinforcement procedures on the participation of elderly citizens in a nutritious meal program. Experiment I employed a variation of the multiple-baseline design across three groups of approximately 60 households each. Elderly persons not previously participating in the program were introduced to the following conditions: (1) public service radio announcements for four weeks to advertise the meal program and the availability of free transportation, (2) a home visit that served as a personal invitation and a second prompt for participation, (3) a followup telephone call, and (4) an incentive menu for participation, which was sent through the mail. Results indicated that the home visits and incentives were both effective as recruitment procedures and superior to other conditions; however, incentives proved to be the most cost-effective intervention. Experiment II used a variation of the multi-element design to compare the effects of scheduled activities and incentives in maintaining higher levels of participation by those persons who had attended the meal program at least once in the past, but whose current rate of participation was low. Results showed that activities improved attendance levels somewhat and that incentives substantially increased the number of meal program participants. Data from these experiments thus indicate that relatively inexpensive procedures may be used effectively to increase the extent to which elderly persons make use of potentially beneficial community-based services.     

Behavioral contrast as differential time allocation

In Experiment I, hooded rats were exposed to multiple variable-interval schedules of reinforcement in which manipulanda and reinforcement magazines at opposite ends of the experimental chamber were associated with the different components. Time allocated to each component was measured by recording the time spent by the subject in the appropriate half of the chamber. Positive behavioral contrast was observed for the comparison between multiple variable-interval 30-second variable-interval 30-second and multiple variable-interval 30-second variable-interval 90-second conditions for both response frequency and time allocation measures, but not for mean local response rate (response frequency per time allocated to a component). In Experiment II, rats were exposed to multiple variable-time schedules in which reinforcement was response independent. Time allocated to each component was measured for two conditions, multiple variable-time 30-second variable-time 30-second and multiple variable-time 30-second variable-time 90-second. Positive behavioral contrast of time allocation was exhibited. The results indicated that time allocation was differentially sensitive to changes in reinforcement probability, and that behavioral contrast may result from the differential allocation of time to the different components of the multiple schedule.     

Concurrent schedules: Effects of time- and response-allocation constraints

Five pigeons were trained on concurrent variable-interval schedules arranged on two keys. In Part 1 of the experiment, the subjects responded under no constraints, and the ratios of reinforcers obtainable were varied over five levels. In Part 2, the conditions of the experiment were changed such that the time spent responding on the left key before a subsequent changeover to the right key determined the minimum time that must be spent responding on the right key before a changeover to the left key could occur. When the left key provided a higher reinforcer rate than the right key, this procedure ensured that the time allocated to the two keys was approximately equal. The data showed that such a time-allocation constraint only marginally constrained response allocation. In Part 3, the numbers of responses emitted on the left key before a changeover to the right key determined the minimum number of responses that had to be emitted on the right key before a changeover to the left key could occur. This response constraint completely constrained time allocation. These data are consistent with the view that response allocation is a fundamental process (and time allocation a derivative process), or that response and time allocation are independently controlled, in concurrent-schedule performance.     

Do medical decision analyses' largest gains grow from the smallest trees?

Some decision analysts recommend reserving their models for careful, complete study of complex problems. Others believe simple problem analyses provide the greatest gains. To clarify these issues, I tested: (1) whether simple published analyses compared to complex ones, produced results as non-intuitive; and (2) whether non-intuitiveness represented analytic gain (or equivalently, intuitive loss). Very limited data also examined (3) the gain from adding model intricacy for a given problem vs. selecting more complex problems for analysis. To assess two non-intuitiveness measures, 75 subjects (33 physicians and 42) non-physicians stated their intuitive preferences in 40 (22 published and 18 unpublished) medical dilemmas. For both physicians and non-physicians, simpler models (those with lees than 30 terminal branches in the decision tree) had about one third the non-intuitiveness of more complex ones. Three tests also supported the premise that analyses outperform intuition, therefore that on average the formers' non-intuitiveness reflects less analytic gain. In addition, for different models of the same problem, tree complexity did not correlate with gain. Thus, simpler trees may not generally gain less because they inadequately describe problems. Instead, simpler analyses may represent simpler problems, with more similar intuitive and formal solutions. If so, these findings may help us avoid some costly but unnecessary simple analyses.     

BEHAVIORAL ASSESSMENT FOR PEDIATRIC INTENSIVE CARE UNITS1

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.