Barry Blackwell

Relation of heart rate control to heartbeat perception

The relation of heartbeat perception to voluntary control of heart rate (HR) and to learning of enhanced HR control during feedback was studied in three experiments. In Experiment I heartbeat perception was unrelated to voluntary control of HR but was negatively correlated with HR learning. Experiments II and III showed that heartbeat perception was unrelated to either initial voluntary control or learning and suggested that sampling error accounted for the negative correlation in Experiment I. Experiment I also demonstrated that learned increases in HR are retained for at least 10 weeks following feedback training. Autonomic Perception Questionnaire scores were not predictive of voluntary HR control or learning.

A learning theory model of chronic illness behavior: theory, treatment, and research.

&NA; Over 300 patients have been treated on an inpatient psychosomatic service employing a learning model of chronic illness behavior. This model stresses social reinforcement and avoidance of occupational and social activities in the development of a syndrome characterized by somatic complaints and care‐eliciting interpersonal behaviors. Preliminary studies showed that patients reinforced others for care‐giving responses but showed improved tolerance of experimental pain and lower rates of drug use when care‐taking responses were minimized and self‐control encouraged. Treatment was designed to involve the patient in his own care, including behavior modification techniques to reduce symptomatology, social skills training, and family therapy. One‐year follow‐up shows that most patients achieve self‐set goals, with generalization of beneficial treatment effects. Patients who return to an intact family show continuing decreases in somatic complaints and increases in achievement orientation. Treatment failures are characterized by lack of an intact family and return to the medical care system.

Anxiety and anger in hypertension

Abstract The relationship of anxiety and anger to blood pressure was studied in hypertensive patients under environmental conditions by having them take their own blood pressure 4 times daily for 7 weeks and rate their anxiety and anger at those times on simple analog scales. Anxiety was more highly correlated to blood pressure than anger. Within-subject correlations between anxiety and systolic blood pressure were r = 0.05-0.79 with a median of 0.36; between anxiety and diastolic blood pressure r = -0.05-0.66 with a median of 0.27; between anger and systolic blood pressure r = -0.01-0.51 with a median of 0.19; between anger and diastolic blood pressure r = -0.07-0.51 with a median of 0.17. The effect of diazepam on blood pressure was also investigated. Diazepam had no observable effect on blood pressure, but neither, at the dose used (15 mg/day), did it lower anxiety in these mildly anxious subjects.

A Behavioral Conceptualization of Psychosomatic Illness: Psychosomatic Symptoms as Learned Responses

The purpose of this chapter is to review existing theories of etiology of psychosomatic disorders and to describe a theory of psychosomatic etiology based on learning theory. This task carries with it an obligation to define what is meant by psychosomatic symptoms or psychosomatic disorders because these terms have become controversial. Some writers have proposed that the term psychosomatic be applied to all illnesses, since susceptibility to and recovery from most illnesses seem to be influenced by psychological and social variables (Wolf & Goodell, 1976). Others have proposed that the term psychosomatic be dropped as useless (Lader, 1972) because it is both misleading and too inclusive. Many contemporary writers lump together under the term psychosomatic a variety of symptoms that have traditionally been distinguished, such as conversion reactions, hypochondriacal behaviors, somatopsychic disorders, and psychological disturbances produced directly by insult to or degenerative changes in the nervous system (e.g., Wright, 1977).

Treatment adherence: A contemporary overview

Abstract A review of recent research and developing concepts in treatment adherence makes clear that, since many factors contribute to poor adherence, there is no simple recipe for routine management. Some suggestions for detecting the problem are discussed, as are three goals for obtaining improved adherence—better patient comprehension, adequate supervision and, ultimately, the patients independent involvement in treatment without supervision.

Flooding treatment of phobias: Does chronic diazepam increase effectiveness?

Abstract Flooding was combined with either chronic diazepam (15 mg/day) or placebo in the treatment of small animal phobias. Diazepam had no effect on the length of time required for successful treatment. This result is consistent with animal studies showing that tranquilizers do not enhance the effects of response prevention as a method of eliminating conditioned fears, but this result contrasts with human studies showing that flooding effects are enhanced if treatment sessions follow single doses of tranquilizers. It is suggested that differences in experimental outcome are attributable to whether flooding sessions overlap the waxing and waning of the drugged state.

Humanizing the student-cadaver encounter

In a recently accredited medical school, the curriculum, which emphasizes the psychologic and social aspects of disease, includes innovative features aimed toward training students to provide humanistic health care in underserved areas. As part of this curriculum, an educational experiment was designed to explore issues concerning the medical students first exposure to a cadaver. The authors describe the experiment as it evolved over a three-year period, and they discuss its value based on student evaluation and faculty opinion.

Panel 4: phase IV investigations.

Premarketing evaluation of drugs inevitably leaves important questions unanswered. This is the result of the limited number of patients studied, the limited duration of study particularly relative to the length of time the drug may be used, and the restricted subject populations in which new drugs are tested. Such populations are composed of volunteer patients with uncomplicated diagnoses, chosen from selected subgroups of the population who are taking no other medications and who show good compliance to the study drugs. Conclusions may be reached that are of limited generalizability to

Relating literature to medicine: blending humanism and science in medical education.

There is a need to add a humanistic component to scientific aspects of medical education. It must be adequately organized and evaluated to compete successfully in an already overcrowded curriculum. This study reports an educational experiment involving three consecutive freshmen classes in a new community-based medical school. A specialist in literature and a psychiatrist teach a two-week course to first-year students in which themes and topics relevant to medical practice are explored through selected readings and patient interviews that are integrated into daily experiential groups. The outcome of the course and similarities and differences between years are explored in relation to group sessions, class composition, reading assignments, and patient interviews.

Counselling and compliance

Abstract Treatment compliance is an area of expanding scope. Health-care providers from a variety of disciplines are becoming involved in strategies to improve patient comprehension and to secure sustained compliance. This paper discusses both theoretical and pratical aspects of the problem of compliance.