Barbara G. Melamed

Mother-child patterns of coping with anticipatory medical stress.

Maternal influences on childrens fear and coping behaviors during a medical examination were studied in a pediatric outpatient clinic using the Dyadic Prestressor Interaction Scale (DPIS) to measure anticipatory reactions just prior to contact with the physician. Analysis of 50 mother-child dyads, including children from 4 to 10 years of age, revealed that the behaviors emitted by mother and child are likely to influence the childs ability to tolerate the medical experience. Maternal use of distraction and low rates of ignoring were associated with lower child distress and increased prosocial behaviors. Childrens active exploration of the situation was more likely to occur when mothers provided their children with information, and was less likely when mothers reassured their children. Maternal reassurance of children and overt maternal agitation were associated with more maladaptive child responses. Age trends were also found in interactive patterns. Younger children were more likely to receive reassurance from mothers when they showed attachment. There was a stronger association between mothers information giving and childs exploring for children under 5 years, 9 months of age. Results supported the usefulness of the DPIS for investigation of child management techniques in this situation. Theoretical extension to attachment and stranger-approach situations was made. Suggestions for future studies to clarify the reciprocity of interactions or to determine causal direction between mother and child behaviors, as well as to evaluate the specificity or generality of these findings, were provided.

Necessary considerations for surgery preparation: age and previous experience.

&NA; While the number of hospitals incorporating psychologic preparation for surgery is increasing, little research has been done to determine whether providing information, the most common preparation, is uniformly beneficial. This study compared the effects of presenting hospital‐relevant and irrelevant information on information acquisition, physiologic responsivity (heart rate, palmar sweating), self‐report of medical concern, and observed anxiety, considering the factors of age and experience. Fifty‐eight children between the ages of 4 and 17 scheduled for elective surgery were shown either a hospital‐relevant slide tape information package or an unrelated film the night prior to surgery. Results support the effectiveness of hospital‐relevant information as improving the childrens experience and recovery from hospitalization for surgery. However, age and previous experience also affect the amount of information acquired, with older and experienced children having more information. Children under the age of 8 who had at least one previous surgery experience reported increased medical concerns if they viewed the hospital‐relevant presentation. The findings suggest that the provision of information can be helpful, but is contraindicated for young, experienced children who might be better prepared utilizing alternative strategies.

The effect of varied physician affect on recall, anxiety, and perceptions in women at risk for breast cancer: an analogue study.

Evaluated the effect of varied physician affect on subject recall, anxiety, and perceptions in a simulated tense and ambiguous medical situation. Forty women at risk for breast cancer viewed videotapes of an oncologist presenting--with either worried or nonworried affect--mammogram results. Although the mammogram results and the oncologist were the same in both presentation, analyses indicated that, compared to the women receiving the results from a nonworried physician, the women receiving the results from a worried physician recalled significantly less information, perceived the clinical situation as significantly more severe, reported significantly higher levels of state anxiety, and had significantly higher pulse rates. These results suggest that physician affect plays a critical role in patient reaction to medical information. Implications for compliance research, patient satisfaction, and physician training are discussed.

Emotional imagery in simple and social phobia: fear versus anxiety

In a first study, phobic volunteer subjects (N = 60) reacted psychophysiologically with greater vigor to imagery of their own phobic content than to other fearful or nonaffective images. Imagery heart rate responses were largest in subjects with multiple phobias. For simple (dental) phobics, cardiac reactivity was positively correlated with reports of imagery vividness and concordant with reports of affective distress; these relationships were not observed for social (speech) phobics. In a second study, these phobic volunteers were shown to be similar on most measures to an outpatient clinically phobic sample. In an analysis of the combined samples, fearful and socially anxious subtypes were defined by questionnaires. Only the fearful subtype showed a significant covariation among physiological responses, imagery vividness, and severity of phobic disorder. This fearful-anxious distinction seems to cut across diagnostic categories, providing a heuristic perspective from which to view anxiety disorders.

Blood phobics and nonphobics : psychological differences and affect during exposure

This study compared psychological dimensions of blood phobics and nonphobic controls, examined affect in response to phobic and neutral stimuli, and investigated the relationship between reported feelings of faintness and blood pressure. Blood phobics (24 adults with extreme Mutilation Questionnaire scores) and 24 nonphobics completed several psychological measures and viewed one of two 60 sec surgery scenes and a 60 sec neutral scene in counterbalanced order. Subjective, psychophysiologic, and motoric measures of affect were assessed. On questionnaires, phobics reported greater anxiety sensitivity, empathic distress, fear and insecurity, and nightmares, but no difference in autonomic arousal, muscle tension, motion sickness, or other empathy domains. During surgery scenes, phobics had more negative affect than controls; however, phobics were more anxious during only one of the two surgeries, and often only when the surgery was presented prior to the neutral scene. Fainting did not occur, and self-reported feelings of faintness were unrelated to blood pressure changes. The findings highlight the lack of information on blood phobic stimulus properties, faintings relationship to self-reports and blood pressure, and the specific emotion experienced in blood phobia.

Dentists' voice control: Effects on children's disruptive and affective behavior.

Voice control, a punishment technique based on loud commands, has been used widely in pediatric dentistry. This study examined whether (a) loudness is a necessary component of the technique, (b) voice control actually reduces childrens disruptive behavior, and (c) after treatment, childrens negative affect increases. Subjects were forty 3 1/2- to 7-year-olds who posed potential behavior problems and who were scheduled for cavity restoration. Children were assigned randomly to either loud- or normal-voice groups. Children who were assigned to either group but who were not disruptive formed a nonexperimental control group. Prior to and after treatment, children reported their feelings using the Self-Assessment Mannequin. Disruptive behavior was scored using the Behavior Profile Rating Scale. Results indicated that, following loud, but not normal voice commands, children reduced their disruptive behavior (p less than .004) and self-reported lower arousal (p less than .09) and greater pleasure (p less than .10). Theoretical and practical implications of these findings are discussed.

The Assessment and Treatment of Children’s Fears

While fear is a necessary and often “healthy” response to a wide variety of situations, at times it can become so debilitating as to be maladaptive. Careful distinctions involving terms such as fear, phobia, and anxiety are not always made. However, there seems to be some general consensus that fear connotes a differentiated response to a specific object or situation. Anxiety is a more diffuse, less focused response, perhaps best described as apprehension without apparent cause. A phobia is a special form of fear that (1) is out of proportion to the demands of the situation, (2) cannot be explained or reasoned away, (3) is beyond voluntary control, and (4) leads to avoidance of the feared situation (Marks, 1969).

Relationship between parental discipline and children's ability to cope with stress

A questionnaire was developed to assess the use of disciplinary methods by parents regarding their childrens approach to fearful situations. The predictive validity of this tool was evaluated by correlational analyses with the assessment of fear (behavioral, subjective, and physiological) in their children during hospitalizations for surgery. The results confirmed the usefulness of the questionnaire. Parents who reported use of positive reinforcement, modeling, and persuasion as ways of encouraging the child to deal with fearful situations had children who were low in anxiety during the actual stressful life experience. The reported use of punishment, force, or reinforcement of dependency was correlated with higher anxiety. Differences in the use of these methods by mothers and fathers are reported. The reliability of the questionnaire and its relationship to social desirability and the sex of the child are discussed.

Information seeking and interactive videodisc preparation for third molar extraction

Patient response to interactive videodisc preparation for third molar extraction surgery was examined as a function of self-reported information-seeking style. Amount learned was compared among patients informed via an interactive videodisc, noninteractive videotape of the same material, or surgeon only. Anxiety levels and satisfaction with preparation were compared between the videodisc and videotape groups. At consultation, patients (n = 35) were randomly assigned to either the disc- or the tape-viewing group. First, subjects completed a demographic survey, state anxiety scale, quiz on knowledge about third molars and surgery risks and complications, and information-seeking scales. Immediately after viewing the video, subjects completed another anxiety scale and a multiple-choice quiz covering the material presented. Subsequently, another 25 patients undergoing the routine (surgeon-only) consultation procedure were given the same multiple-choice quiz following consultation. Quiz scores differed significantly among the groups; mean percent correct for the tape-viewing subjects was 85; for disc-viewing subjects 72.6; for surgeon-only subjects, 40. Self-rated information seeking was unrelated to amount of video viewed by disc subjects (on average, 64% of the videodisc was viewed), and disc subjects who rated themselves higher in information-seeking achieved the lowest postpreparation quiz scores. Subjects in the disc group were significantly more satisfied with the amount of preparation than the tape group. Although disc group subjects were significantly less knowledgeable following consultation than were tape group subjects, interactive videodisc preparation for third molar extraction appears to have some advantages over more traditional approaches. Further research is needed to determine whether this approach to preparing patients is suitable for widespread clinical use.

Technological and medical advances: implications for health psychology.

Behavioral telehealth, health informatics, organ and tissue transplantation, and genetics are among the areas that have been affected by advances in technology and medicine. These areas illustrate the opportunities and the challenges that new developments can pose to health psychologists. Each area is discussed with respect to implications for practice, research, public policy, and education and training: recommendations are provided.