The role of catastrophizing in the pain and depression of women with fibromyalgia syndrome.

OBJECTIVE: Although 2 recent studies have found associations between catastrophizing and poor medical outcomes in patients with fibromyalgia syndrome (FMS), neither assessed these findings in comparison with a similar group of patients with chronic pain. Our study examined the complex relationships between depression, catastrophizing, and the multidimensional aspects of pain in women with FMS and compared these relationships with those in women with rheumatoid arthritis (RA). METHODS: Sixty-four FMS patients and 30 RA patients completed the Coping Strategies Questionnaire (CSQ), the Beck Depression Inventory II (BDI-II), and the McGill Pain Questionnaire. RESULTS: Compared with subjects with RA, FMS subjects scored significantly higher on the catastrophizing subscale of the CSQ. FMS patients also earned higher scores on overall depression and on the cognitive subscale of the BDI-II. Furthermore, the relationship between catastrophizing and depression was significant in the FMS group only. Regression analyses revealed that in FMS, catastrophizing as a measure of coping predicted patients' perception of pain better than demographic variables such as age, duration of illness, and education. CONCLUSION: Cognitive factors, such as catastrophizing and depressive self-statements, have a more pronounced role in the self-reported pain of patients with FMS than in patients with RA. Clinically, this indicates that treating pain and depression in FMS by adding cognitive therapy and coping skills components to a comprehensive treatment program may improve the outcomes obtained with pharmacologic interventions.

Issues on functional analysis in behavioral assessment.

The rebirth of interest in functional analysis is described. Clarification among conflicting terms is offered as a way of facilitating research in the area. Three phases of functional approach to assessment are identified: (a) descriptive, (b) interpretive, and (c) verification. Five assessment methods common to assessment, generally, are shown to be useful in both descriptive and verification phases. Evaluation of functional approaches requires attention to the psychometric adequacy of these methods. Accuracy, reliability, and validity concepts are reviewed briefly and their application to functional strategies is described. The use of treatment validity in the functional analysis of functional analysis is mentioned as the ultimate strategy for evaluating the adequacy of this assessment approach. The paper ends with a discussion of problems of multiple control of behavior, behavioral classification systems, training parents and other mediators in the functional approach, cost-effectiveness, and the place of functional analysis in a reorganized health care delivery system.

Differences in abusive, at-risk for abuse, and control mothers' descriptions of normal child behavior.

Differences in the descriptions of normal child behavior were assessed for mothers at-risk for abuse (N = 18) and control (N = 20) mothers, and compared to a criterion group of currently abusive mothers (N = 5). Three segments of each of nine videotaped scenes were rated by the mothers. At-risk mothers rated more segments as negative (M = 11.1) than did control mothers (M = 7.0), and were more like the abusive mothers who were the most negative of all (M = 16.4). When type of scene (e.g., noncompliant, mildly aversive, daily activities, child unattended) was analyzed, the at-risk mothers rated more of the mildly aversive (p less than .05) and child unattended (p less than .05) scenes as negative than did the controls. Abusing mothers rated significantly more segments as negative (p less than .05) than the other groups on all but noncompliant scenes. When specific risk factors were examined, insularity and directly observed negative interactions between mothers and their own child were significantly related to total segments rated as negative (p less than .02; p less than .05, respectively). The study was conceptualized and results discussed in terms of faulty stimulus discrimination; specifically, overgeneralizing from negative stimuli on the part of troubled mothers.

Social desirability and the measurement of psychological well-being in elderly persons.

The discriminant validity of two commonly used measures of life satisfaction was investigated. The Philadelphia Geriatric Center Morale Scale, the Life Satisfaction Index-B, and two theoretically unrelated self-report measures were completed by 60 alumni of West Virginia University, aged 66 to 86 years. Convergent validity of the Philadelphia Geriatric Center Morale Scale and the Life Satisfaction Index-B was established (r = .64, p less than .0001), but both also correlated significantly with a measure of social desirability (r = .70 and .58, respectively, p less than .0001). The need for more basic work on measurement of life satisfaction in elderly persons was discussed.

Reduction of residential consumption of electricity through simple monthly feedback.

Feedback has been widely used in efforts to control the consumption of electricity. Previous efforts, however, have used forms of feedback that seem economically impractical. The present study examined the effects of a feasible program of monthly feedback. Forty matched nonvolunteer participants were randomly divided into two groups: a no-contact control group and a monthly feedback group. In an A-B-A design, the data showed a clear decrease in electricity consumption for the feedback group during the feedback phase. The effect was maintained during a 4-mo intervention period. Withdrawal of the feedback was associated with a return to higher levels of electricity consumption.

Computed tomography findings in ruptured arteriovenous malformations of the corpus callosum.

Computed tomography (CT) is of proven value in the evaluation and localization of intracranial hemorrhage. The recognition of various patterns of subarachnoid, intracerebral, and intraventricular hemorrhage is necessary in order to provide accurate localization and to predict probable etiology of the bleed. We present three cases with angiographically proven ruptured arteriovenous malformations involving the midline of the corpus callosum. The clinical presentation and CT findings are discussed. We believe this represents a distinctive pattern of hemorrhage specific for this entity.

Multiple-baseline analysis of a token economy for psychiatric inpatients.

Twelve behaviors selected for reinforcement among 16 chronic psychiatric inpatients were divided into four classes: (a) personal hygiene, (b) personal management, (c) ward work, and (d) social skills. A token economy program was introduced for each class in a sequential, cumulative, multiple-baseline format. Corrections were included for methodological deficiencies frequently enountered in past studies. Treatment variables were systematically monitored, and target behavior rates, levels of global individual functioning, general ward behavior, and off-ward behavior were assessed during baseline, implementation, and probe periods. Results indicated abrupt and substantial increases in performance of most target behaviors, significant improvements in global individual functioning (p less than .025), positive changes in general ward behavior, and increases in social interaction during off-ward activities. The findings provide strong evidence for the efficacy of a token economy and indicate that the multiple-baseline design can be a useful method for evaluating token economy programs.

Developing and maintaining social interaction in profoundly retarded young males.

Social interaction was increased in five profoundly retarded males using formal training, stimulus control, and rewarded generalization procedures. Seven behaviors were monitored for each boy to determine whether correlated changes occurred in maladaptive behaviors as social interaction varied over the several phases of a withdrawal design that included multiple-baseline features. All five boys increased their social interaction and reduced unoccupied and self-stimulatory behavior. These changes were maintained as continuous reinforcement was reduced to a single response-contingent reinforcer per 15-minute session. Four follow-up probes showed the stability of the changes.

Reducing residential electrical energy use: payments, information, and feedback.

Monetary payments, energy information, and daily feedback on consumption were employed to reduce electricity use in four units of a university student housing complex. A combined multiple-baseline and withdrawal design permitted both within- and between-unit comparisons. Payments produced immediate and substantial reductions in consumption in all units, even when the magnitude of the payments was reduced considerably. Feedback also produced reductions, but information about ways to conserve and about the cost of using various appliances did not. It was also found that, in general, payments combined with either information or feedback produced no greater effect than payments alone.

Training correct utensil use in retarded children: modeling vs. physical guidance.

Modeling and physical guidance were compared for teaching 24 retarded males (mean age = 13.5, mean IQ = 25.3) to use a knife, fork, and spoon. Initial premeal training methods resulted in no improvement over baseline. The methods were revised to extend throughout meals, and a third method (physical guidance with praise) replaced a former control procedure. Methods involving physical guidance produced significant improvement while modeling did not. All groups then received physical guidance with praise which resulted in their achieving similar levels of performance. Follow-up observations revealed that correct utensil use continued under maintenance conditions.

The marked item technique: a practical procedure for litter control.

Unobtrusively marked items of litter were placed among existing trash on the grounds of a federal youth correctional facility. Inmates voluntarily collected trash and deposited it at a central location, where they were given money or special privileges for each piece of marked litter found. A multiple-baseline design with litter counts in three areas revealed successive reductions of 55%, 88%, and 71% after 17, 22, and 36 days of baseline, respectively. A fourth area served as a baseline-only control, and revealed no systematic changes. Advantages of the procedure over previously devised techniques were discussed and applications in other areas of pollution control suggested.

Assessing the effectiveness of programmed generalization.

Issues related to assessing change and retention of change were discussed. An alternative analysis was suggested for the data of a recent study by Walker and Buckley (1972). These authors had found that peer reprogramming, equating stimulus conditions, teacher training, and control groups maintained 77, 74, 69, and 67%, respectively, of appropriate behavior produced in a token economy. Their analysis made no use of baseline levels. Two analyses incorporating baseline scores were suggested. One involved change scores; the other, analysis of covariance using baselines as the covariate. Problems with the data made a clear preference difficult, but it was concluded that either analysis would have resulted in conclusions different from those of Walker and Buckley.