James G. Hollandsworth

Evaluating the impact of medical treatment on the quality of life: A 5-year update

A comparison of the studies investigating the impact of medical care on quality of life over a recent 5-year period (1980-1984) with those appearing during the preceding 5 years from 1975 to 1979 [1]reveals; that (a) 3 times as many (69 as compared to 23) appeared during the time span, that (b) almost two-thirds (60%) of the recent studies included a subjective measure of quality of life as compared to only 1 in 10 for the previous 5-year period, but that (c) one-shot, case studies designs still predominate. On the other hand, (d) the use of control groups doubled from 1981 to the present, although (c) the majority of studies continues to use samples of convenience (e.g. consecutive patients or treatment survivors) rather than employing random assignments or random sampling. Nevertheless, (f) the average size of samples has doubled from 90 to 178, and (g) whereas almost all of the studies in the earlier review concluded that the intervention being studied improved quality of life, now approx. 1 in 5 report negative outcomes with another 30% reporting mixed results. It is concluded that in spite of increasing methodological sophistication, investigation of the impact of medical care on quality of life will be hindered until there is better agreement as to what constitutes adequate assessment of the construct. Suggestions for how a consensus might be attained are discussed.

Using videotape modeling to prepare children psychologically for surgery: Influence of parents and costs versus benefits of providing preparation services.

Sixty pediatric patients having first-time elective surgery participated in this study. Surgery preparation using videotape procedures was employed. The research design included two viewing conditions (with parent present and without parent present) and three treatment procedures (adult-narrated videotape, peer-narrated videotape, and control/no-videotape condition). Results suggested that children who viewed the videotape with their parent present exhibited less preoperative arousal compared to children who did not. The patients undergoing preparation using the videotape model exhibited less arousal, less self-reported anxiety, and less behaviorally rated anxiety when compared to patients who did not view the videotape preparation. There was no difference between the patients who viewed the adult-narrated versus the peer-narrated videotape. In addition, parents who viewed the videotape or whose children viewed the videotape without them exhibited less arousal prior to the operation than parents who did not and whose children did not view the videotape preparation. Finally, a cost-benefit analysis revealed that preparation services could reduce individual and overall medical costs.

Relative effectiveness of education alone versus stress inoculation training in the treatment of dental phobia

In order to evaluate the relative effectiveness of the educational component of stress inoculation training (SIT) versus the procedure as a whole, 24 dental phobics were randomly assigned to one of four conditions: education alone; coping skills plus application training; coping skills, application training and education; and wait-list control. Pre-and postmeasures of dental anxiety and state-trait anxiety were obtained. In addition to posttreatment measures of pain tolerance (ischemic muscle pain and cold pressor tasks), all subjects were monitored as to whether they scheduled and completed an actual dental appointment. No significant differences were observed between the four experimental conditions in terms of the anxiety and pain tolerance measures. Significantly more subjects from the three treatment conditions scheduled posttreatment dental appointments than subjects from the wait-list control group. However, significantly more subjects from the two treatments which involved training in and application of coping skills went through with the scheduled appointments as compared to subjects from the education-alone condition. These findings would indicate that education may motivate individuals to take initial steps in seeking health care but may be insufficient in terms of getting patients to follow through with this process.

The effects of physical fitness and exercise on cardiac awareness

This experiment was run to further evaluate the role of individual difference factors in perception of heart beats (cardiac awareness). The present study examined 24 male subjects who showed high and moderate levels of physical fitness. Cardiac awareness was examined using Brener-Jones type discrimination trials. Subjects discriminated first while standing quietly on a treadmill (32 trials), then while walking briskly on a motorized treadmill (32 trials), and finally during recovery from exercise (elevated HR but behavioral quiescence) (16 trials). Results showed that only the moderate fitness group showed heightened awareness during exercise, while both groups showed greater than chance awareness during recovery from exercise. Neither group was highly aware while resting before exercise. These results fail to support notions that high fitness distance runners are highly aware of cardiac function during exercise. A number of reasons for this finding are discussed.

Visual and verbal modes of information processing and their relation to the effectiveness of cognitively-based anxiety-reduction techniques

Abstract This study examined the interaction between preferred modes of information processing (visual and verbal) and two cognitively-based anxiety-reduction techniques. One technique was based on the use of images as a coping strategy while the other employed a self-instructional approach. Thirty-six subjects reporting high levels of dental fear were assigned to one of three groups (two types of treatment and a no-treatment control). One-half of the subjects in each group had been identified as preferring the visual mode of information processing while for the other half the verbal mode was preferred. After treatment, subjects viewed an anxiety-inducing videotape depicting a visit to the dentist. Results indicated that, while both treatments were significantly effective in reducing self-reports of discomfort while viewing the videotape, there was no significant interaction between the type of treatment and preferred cognitive mode. The results were interpreted as indicating that treatment may override individual cognitive styles. Furthermore, the data suggested that the normal individual has the ability to adapt to divergent and non-preferred forms of information processing.

Visual and verbal modes of information processing and cognitively-based coping strategies: An extension and replication

Abstract This study was designed to investigate the interaction between the use of an imaginallybased vs a verbally-based coping strategy with subjects who were selected on the basis of strong preferences for either visual or verbal modes of information processing. Forty-eight female students were subjected to a cold-pressor task. Measures of pain tolerance, pain threshold and a pain rating were obtained. The findings indicated that there was not a significant relationship between preferred cognitive style and the types of coping strategy provided. However, the treatments combined were found to be significantly more effective than the no-treatment condition on all three dependent measures. A structured debriefing revealed that use of visual vs verbal coping strategies did not differ as a function of treatment type or preferred cognitive style. It was concluded that individuals may demonstrate considerable flexibility in adapting to different types of cognitively-based coping strategies.

Unsuccessful use of massed practice in the treatment of Gilles de la Tourette's syndrome.

An 18-yr.-old female suffering from motor tics and compulsive utterances of an obscene word engaged in massed practice for the coprolalia. Self-recorded frequency counts of the obscenity indicated no substantial decrease from baseline. Unobtrusive monitoring of the rate of coprolalic outbursts in the therapeutic setting indicated a marked increase as treatment progressed. This observation coupled with an improved articulation of the obscenity resulted in terminating the massed practice after eight sessions. The continued use of supportive therapy and chemotherapy (haloperidol) also proved unsuccessful. Social contingencies beyond the control of the therapists were suspected to play an important role in maintaining these behaviors.

Implementation and Evaluation of a Drug Education Program for a Pharmacy School Curriculum

As the result of a perceived need for some type of classroom attempt at approaching the subject of drug use in society, an interdisciplinary class was begun at the School of Pharmacy at the University of North Carolina. Using funding from Project SPEED, a NIDA contract with the Student American Pharmaceutical Association, and continuing then for a three year period, the program was able to substantiate both a significant change in the cognitive levels of knowledge about drugs and its effect in society, as well as significant changes in attitudes of students to that of a more accepting attitude toward drug users as well as greater desire for social change related to stereotypes and current social policy.

Physiology and Behavior Therapy

Our look at behavior therapy from a physiological perspective is about to end. We have reviewed some preliminary concepts, discussed some basic issues, and applied this thinking to several clinical problems. The central theme has been that behavior is a complex, multidetermined, interactive phenomenon for which no single explanation is sufficient.

O2 consumption, heart rate and subjective ratings under conditions of relaxation and active coping

Abstract Oxygen consumption, respiratory rate, minute volume, heart rate (HR) and subjective ratings from 12 graduate students were monitored under conditions of relaxation and active coping. The controlled, within- S s, cross-over design consisted of the two experimental conditions alternating between three control periods. The relaxation condition consisted of an autogenic procedure which the S s had practiced daily for more than a week. The active-coping condition involved avoidance of an aversive noise during a reaction-time task. In terms of O 2 consumption, there was a slight (3%) but nonsignificant decrease during relaxation. There was a trend for HR to increase during active coping, although this finding was attenuated by the presence of a subset of S s who responded with a marked and unexpected decrease in HR under this condition. Subjective ratings obtained at 1-min intervals throughout the experiment indicated that the S s achieved significant levels of subjective relaxation during the procedure. The results of the study failed to support the presence of a hypometabolic state during relaxation as proposed by Benson.