The psychosocial impact of cancer and lupus: a cross validation study that extends the generality of "benefit-finding" in patients with chronic disease.

Mohr et al. (1999) described the psychosocial effects of multiple sclerosis (MS) from the patient's perspective. Three factors emerged: demoralization, benefit-finding, and deteriorated relationships. The benefit-finding factor suggested that some patients with MS benefited from their illness. We investigated the generalizability of these results by replicating the Mohr et al. study using patients with two diseases, cancer (N = 56) and lupus (N = 31). All participants completed the questionnaire developed by Mohr et al. along with the Profile of Mood States. When the data were analyzed, results showed a three-factor solution very similar to the one reported by Mohr et al. Scores on the demoralization factor were positively related to total mood disturbance and average pain ratings and inversely related to benefit-finding. Conversely, patients who perceived more benefits from their illness suffered less. We conclude that benefit-finding is not unique to patients with MS but occurs in patients with other chronic diseases.

Labeling bias and attitudes toward behavior modification revisited.

Twenty-three years ago, Woolfolk, Woolfolk and Wilson (1977, Journal of Consulting and Clinical Psychology, 45, 184-191) described a study about labeling bias and attitudes toward behavior modification. When videotaped depictions of behavior modification procedures were described as "humanistic education", college students rated them more favorably than when the same procedures were called "behavior modification". One implication of this study is that behavioral terminology may be perceived as dehumanizing by potential consumers, leading to lower acceptance of the approach regardless of its effectiveness. With lower acceptance comes the risk of under utilization. More than two decades have passed since the Woolfolk et al. study was published so we felt the time was right to repeat the experiment with a new generation of students. In our study, two groups of college undergraduates (N = 144) gave their opinions about a 10 minute videotape that showed a therapist working with an autistic child. The therapist used behavior modification procedures to treat the child, except in one case the procedures were described as "humanistic educative therapy", and in the other as "behavior modification". An appropriate rationale was provided for each of the two conditions. Unlike Woolfolk et al., we found no differences in how the two depictions were evaluated. In both cases, they were perceived favorably regardless of what they were called, as were the personal qualities of the therapist. These results suggest that negative attitudes toward behavior modification have weakened over the last two decades, and there is wider pubic acceptance of behavioral treatments now than there was then. Implications of the study are briefly discussed.

A multinational comparison of aphasia management practices.

The effect of restructuring of healthcare on the quality, quantity, and nature of aphasia management is largely unknown. The current study is the first to examine access, diagnostic, treatment, and discharge patterns of patients with aphasia in Australia, Canada, the UK, the US private sector (US-Private), and the US Veterans Health Administration in the Department of Veterans Affairs (US-VA). The authors developed a 37-item survey to be completed by clinicians working with aphasic patients. The survey focused on eight areas: access to care, evaluation procedures, group treatment, number and duration of treatment sessions, limitations of the number of sessions, termination of treatment, follow-up practices, and resumption of treatment. 394 surveys were distributed and 175 were returned completed (44% return rate). Respondents represented a range of ages, work experiences, and work settings. There was considerable consistency among respondents from our five healthcare systems. Results suggest that patients may be routinely denied treatment in direct contradiction to the research literature. Just as we carefully monitor the progress of patients receiving our treatment, we are obliged to monitor the effects of managed care on our patients, fellow clinicians, and our profession.

The relationship between worry, sexual aversion, and low sexual desire.

The psychological trait of worry is associated with many psychiatric conditions and maladaptive ways of coping, but is relationship to sexual dysfunctions, and desire disorders in particular, is unclear. In this study, we assessed the relationship between worry, sexual aversion, and low sexual desire using the Sexual Aversion Scale, the Hurlbert Index of Low Sexual Desire, and the Penn State Worry Questionnaire. Data were collected from 138 college undergraduates. As expected, results showed a modest but significant relationship between sexual aversion and low sexual desire, which is consistent with the taxonomy of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), which lists sexual aversion disorder and hypoactive sexual desire disorder as separate but related conditions. Contrary to our prediction, however, the tendency to worry was no more related to sexual aversion than it was to low sexual desire. The relationship between these variables was significant, but it was also relatively weak. We conclude that chronic and intense worry may predispose one to certain anxiety disorders, but it does not appear to be a risk factor for sexual desire problems in nonclinical populations.

Technological applications in the treatment of acquired neurogenic communication and swallowing disorders in adults.

Clinicians can use the computer as an effective clinical tool by incorporating what is known about neurogenic communications disorders, treatment, and technology. Computers can be used to administer activities designed by clinicians, vary stimulus characteristics, adjust response requirements, present cues, and select tasks, all in response to patient performance. Specialized devices can be used to measure small physiologic changes, help patients communicate with and control their environment, and allow clinicians to view closely what we could only imagine only a few years ago. Users of technology must focus not only on effectiveness and operational efficiency, but also ensure an optimal quality of treatment. This article reviews many of the ways technology is used in the treatment of people suffering from neurogenic communication and swallowing problems.

Technological applications in the assessment of acquired neurogenic communication and swallowing disorders in adults.

The role of technology is expanding rapidly in many aspects of the diagnostic process with patients who have neurogenic communication and swallowing disorders. In this article we discuss a broad selection of technological tools that enhance a wide range of diagnostic tasks, such as taking case histories, administering and scoring tests, performing acoustic, physiologic, cognitive, and linguistic analyses, making normative comparisons, profiling diagnostic results, and making diagnostic decisions. Clinicians are encouraged to scrutinize the relative value of all diagnostic tools to maintaining the quality of service. An appendix includes information for contacting vendors and manufacturers of the products discussed.

Reducing test anxiety and improving academic self-esteem in high school and college students with learning disabilities.

Test anxiety seems like a benign problem to some people, but it can be potentially serious when it leads to high levels of distress and academic failure in otherwise capable students. Because test anxiety is common in older students with learning disabilities (LD), it is surprising that little research has been done on ways to reduce the distress these students experience in test situations. In this study, we used a randomized pretest-posttest control group design to examine the effectiveness of a cognitive-behavioral treatment for reducing test anxiety and improving academic self-esteem in a cohort (N = 27) of high school and college students with learning disabilities (LD). All of the students participated voluntarily. They were enrolled in classes for students with learning problems. Before the study began, they complained of test anxiety and showed an elevated score on the Test Anxiety Inventory (TAI). Eleven students (85%) completed the 8-week long treatment, which consisted of progressive muscle relaxation, guided imagery, self-instruction training, as well as training in study and test-taking skills. Results showed significant improvement in the treated group which was not evident in an untreated control group (N = 16). Compared to the control group, the treated group showed significant reductions in test anxiety on the TAI, as well as improvement in study skills and academic self-esteem as measured by the Survey of Study Habits and Attitudes, and the school scale of the Coopersmith Self-Esteem Inventory. These results extend the generality of similar studies on reducing test anxiety and improving academic self-esteem in younger students. They also suggest that relief from test anxiety can be expected fairly quickly when cognitive-behavioral methods are used. Additional implications and methodological limitations of the study are discussed.

Health behaviors and pharmacotherapy.

OBJECTIVE: To review factors related to health beliefs and behavior that affect treatment adherence, and to suggest behavioral strategies for improving adherence. DATA SOURCES: We conducted MEDLINE and PSYHLIT (January 1966-October 1997) searches of English-language literature pertaining to behavioral medicine and health behavior as they relate to treatment adherence. Additional articles from these sources and reference texts were identified. DATA EXTRACTION: All articles and chapters identified were considered. The most pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS: Health care is moving into an era of disease management, and practitioners will be called upon to help patients change health-related behaviors and to improve adherence to treatment. Fundamental to this new paradigm of practice is an understanding of behavior, its relationship to health, and methods by which it can be altered. Current concepts of health behavior have been heavily influenced by social learning theory, self-efficacy theory, and a biopsychosocial view of health and disease. The intent of this review is to provide clinicians with an overview of factors that affect health-related behaviors, as well as suggestions for helping patients to improve them. As illustrations, behavioral interventions used in patients with asthma are presented. CONCLUSIONS: Adherence to treatment recommendations depends on a complex interplay of many psychological variables. An understanding of these factors, and how behavioral techniques may be used, will help healthcare providers to assist patients in improving adherence.

Working memory and aphasia.

This study investigated the relationship between working memory capacity and reading comprehension in aphasia. A measurement of working memory capacity was obtained using a modified version of Daneman and Carpenter's (1980) Reading Span Task. Sets of sentences ranging in length from one to six words were presented to 22 aphasic subjects who were required to retain the terminal words following each sentence for subsequent recognition. The maximum number of words retrieved was used as an index of working memory capacity. Two versions of the task (listening and reading) were presented depending on the subjects' ability to read. Strong positive correlations were found between working memory capacity, reading comprehension, and language function. These results support the notion that the ability of aphasic individuals to comprehend language is predictable from their working memory capacities.

Knowledge of disease and dietary compliance in patients with end-stage renal disease.

Noncompliance is a common problem in patients with end-stage renal disease. In this study, we assessed the relationship between knowledge of disease and dietary compliance in a cohort of 56 dialysis patients. Based on a health belief model of adherence, we predicted that dialysis patients who knew more about kidney disease and its treatment would be more complaint than those who knew less about these matters. We also examined the relationship between dietary compliance and patients' emotional well-being. We used a composite measure of compliance consisting of serum K, P, and interdialytic weight gain. A 30-item "Kidney Disease Questionnaire" was used to assess patients' knowledge of their illness. Contrary to prediction, compliers did not score higher on the knowledge questionnaire; in fact, the observed correlation of .32 was in the opposite direction. In the same vein, we found no relationship between compliance and emotional well-being. These results, although somewhat surprising, add to a growing body of research which indicates that medical compliance involves more than educating patients about the mechanisms and treatment of their illness.

The efficacy of computer-provided reading treatment for chronic aphasic adults.

We examined the effects of computer-provided reading activities on language performance in chronic aphasic patients. Fifty-five aphasic adults were assigned randomly to one of three conditions: computer reading treatment, computer stimulation, or no treatment. Subjects in the computer groups used computer 3 hours each week for 26 weeks. Computer reading treatment software consisted of visual matching and reading comprehension tasks. Computer stimulation software consisted of nonverbal games and cognitive rehabilitation tasks. Language measures were administered to all subjects at entry and after 3 and 6 months. Significant improvement over the 26 weeks occurred on five language measures for the computer reading treatment group, on one language measure for the computer stimulation group, and on none of the language measures for the no-treatment group. The computer reading treatment group displayed significantly more improvement on the Porch Index of Communicative Ability "Overall" and "Verbal" modality percentiles and on the Western Aphasia Battery Aphasia "Quotient" and "Repetition" subtest than the other two groups. The results suggest that (a) computerized reading treatment can be administered with minimal assistance from a clinician, (b) improvement on the computerized reading treatment tasks generalized to non-computer language performance, (c) improvement resulted from the language content of the software and not stimulation provided by a computer, and (d) the computerized reading treatment we provided to chronic aphasic patients was efficacious.

Effects of AIDS counseling and risk reduction training on the chronic mentally ill.

The chronic mentally ill are a high-risk group for HIV infection. In this study 27 chronic mentally ill psychiatric outpatients were randomly assigned to either an AIDS education and risk reduction training group or to a no-treatment control group. Training was conducted during four 2-hour group meetings that were scheduled over 4 days. Treated patients were instructed on modes of HIV transmission and high-risk groups and practices. They were instructed on the importance of using condoms and also taught problem-solving and refusal skills to cope with high-risk sexual and drug and alcohol situations. Assessments were made immediately before and after training as well as during a 2-week follow-up. Participants who received training showed significant improvement in their knowledge about AIDS, their confidence to deal with high-risk situations, and on behavioral measures of coping in high-risk situations. No such improvement was noted in the control group. There was also evidence of maintenance over the 2-week follow-up. Although the magnitude of change was small, the results of the study are encouraging considering the brevity of treatment, the high degree of risk and difficulty faced with this patient population, and the fact that even a small amount of behavior change can make the difference between encountering and avoiding the HIV virus.

"Difficult patients" as family physicians perceive them.

The physician patient relationship is an important part of medical care. This study examined events that can jeopardize that relationship, i.e., patients' behaviors and attributes that physicians find frustrating. Data were collected from practicing family physicians (N-34) using a 32 item questionnaire developed by the author. Items were drawn from previous research on the behaviors of difficult patients and checked for relevance by two family physicians before the study began. Coefficient alpha was 92. Participants were predominantly male physicians who had been in practice for an average of 18 years. They were asked to indicate if they found specific patients' characteristics frustrating or annoying by using a 9 point scale with endpoints of "not at all frustrating or annoying" (1) and "very frustrating or annoying" (9). The physicians rated half of the listed patients' attributes as at least moderately frustrating (mean rating > 61. Over 80% of the physicians were frustrated by patients who expected to "cure," brought up new symptoms at the last moment, appeared to be malingering or refused to take responsibility for their health. They were least frustrated by disease related conditions such as degenerative or chronic illnesses. The physicians' ratings were unrelated to their years of experience. Results are discussed in relation to changing disease patterns which have occurred in this country over the last half century.

Cancer awareness and self-examination practices in young men and women.

Participants in this study (N = 178) were poorly informed about risk factors, warning signs, and self-examination (SE) practices for two common cancers in young adults, testicular cancer in men and breast cancer in women. Compared to women, men were less likely to know about, see the importance of, or practice SE. We found no relationship between internal locus of control, hypochondriasis, and loneliness, on the one hand, and cancer knowledge and SE, on the other. The best predictors of cancer awareness and SE were fear of developing cancer and self-rated confidence that SE was being done correctly. The results are consistent with a health belief model and self-efficacy theory of health behavior.

AIDS knowledge and high risk behaviors in the chronic mentally ill.

Chronic mentally ill adults are a high risk group for AIDS. In the present study, we used a questionnaire to assess AIDS knowledge, attitudes, and risk behaviors in 54 men and women who were clients at a "drop in" center for mentally ill adults. Most of the subjects were suffering from schizophrenia and about one-third of them had co-existing drug problems. Results showed widespread misunderstandings about AIDS transmission, high risk groups, and practices. Many of the subjects had been treated for STDs such as syphilis and gonorrhea and were engaging in behaviors that increased their vulnerability to AIDS. These include casual sex, anal sex, sex with an IV drug user, or sex in exchange for money, drugs, or a place to sleep. Subjects expressed a moderately high level of concern about acquiring AIDS/HIV, and 15% of those tested (5/33) said they already had the illness. We observed a significant correlation between misinformation about AIDS and the frequency of high risk behaviors. We also detected ambivalence about using condoms and i.v. drugs. Although males and females did not differ in AIDS knowledge or risk behaviors, the AIDS knowledge of both groups was significantly lower than a comparison sample of public high school students. Taken together, the results underscore the immediate need for comprehensive AIDS assessment, education, and prevention in this segment of the population.

Anxiety and its determinants in patients undergoing magnetic resonance imaging.

This study assessed anxiety reactions in 40 adults outpatients undergoing MRI. Ninety-five percent of the patients completed the procedure although 37% reported moderate to severe anxiety. It is concluded that (a) anxiety in patients undergoing MRI is a multifaceted phenomenon involving fear of enclosed places (claustrophobia), pain, the unknown, as well as apprehension about what the test might reveal, and (b) the best way to avoid traumatizing the patient is to assess these variables in advance of the procedure. Methods to reduce anxiety can then be tailored to the needs of the patient.

Sexual fears are increasing.

This study compared scores from three samples of college students (N = 810) on the Sexual Aversion Scale, a measure of sexual anxiety based on DSM-III-R criteria for diagnosing sexual aversion disorder. Measurements were taken in 1988, 1991, and 1992. There was a significant increase in sexual anxiety during this period, most of it attributable to fear of acquiring AIDS. Although the women reported more sexual anxiety than the men over-all, there was no difference on fear of AIDS. These findings could foreshadow an increase in sexual dysfunctions and desire disorders.

Brief report: recent findings on the Sexual Aversion Scale.

This study provides additional information on the psychometric properties of the Sexual Aversion Scale (SAS). Results suggest a positive relationship between sexual aversion, generalized anxiety, and history of sexual victimization. Variables such as age and religiosity were unrelated to scores on the SAS, although females reported significantly more sexual anxiety than males. The factor structure of the SAS is described and suggests that sexual aversion is a multifaceted problem with at least three and possibly four different dimensions.

Brief report: an empirically derived educational program for detecting and preventing skin cancer.

College and high-school students were administered a questionnaire to assess their knowledge about skin cancer, and afterward an educational program was designed to correct the identified deficiencies. Results showed that the students were relatively uniformed about how to recognize and prevent skin cancer--high-school students more so than college students--but that their knowledge of the disease (e.g., risk factors, preventive measures, and identification of "warning signs" for early detection) increased significantly after training. Some forgetting was noted at a 2-week follow-up but knowledge levels were still significantly higher than baseline. If these findings are representative of the general population, more preventive education will be needed in this area. This is especially true because the potentially deadly melanoma appears to be increasing at an alarming rate.