Lawrence F. Van Egeren

Cardiovascular changes during social competition in a mixed-motive game.

Male and female subjects played a mixed-motive game against a male confederate under either a 20% cooperative or an 80% cooperative strategy while cardiovascular responses were computer monitored. Females had larger heart rate responses than males during play against the competitive strategy, and the opposite was true during play against the cooperative strategy. Subjects who were more competitive during the game or who scored higher on a coronary-prone (Type A) behavior scale or who reported having an action orientation toward life stress tended to have larger heart rate responses during the game than the remaining subjects. The results draw attention to the importance of covert autonomic responses for understanding overt behavioral choices in mixed-motive games and to the potential utility of this behavioral model for studying the role of psychosocial factors in psychosomatic illnesses.

Efficacy of a one-month training block in psychosocial medicine for residents : a controlled study

Study objective:To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents.Design:Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching.Setting:Community-based, primary care-oriented residency program at Michigan State University (MSU).Subjects:All 28 interns from the single-track MSU residency program during 1986/87–88/89 participated in this required rotation; there was no dropout or instance of noncompliance with the study. In the follow-up study in 1989, all 13 available trainees participated. Of 20 untrained, volunteer controls, ten were second/third-year residents in the same program during 1986/87 and ten were interns from a similar MSU program in Kalamazoo, MI, during 1988/89.Teaching intervention:An experiential, skill-oriented, and learner-centered rotation with competency-based objects focused on communication and relationship-building skills and on the diagnosis and management of psychologically disturbed medical patients.Measurements and main results:The two subsets of the control group were combined because residents and training programs were similar and because means and standard deviations for the subsets were similar on all measures. By two-way analyses of variance (group×gender), the trainee group showed significantly greater gains (p<0.001) on questionnaires addressing knowledge, self-assessment, and attitudes; a mean of 15 months following training, there was no significant deterioration of attitude scores. All trainees were also able to identify previously unrecognized, potentially deleterious personal responses using a systematic rating procedure. Residents’ acceptance of the program was high.Conclusions:Intensive, comprehensive psychosocial training was well accepted by residents. It improved their knowledge, self-awareness, self-assessment, and attitudes, the latter improvement persisting well beyond training.

IMPROVING RESIDENTS CONFIDENCE IN USING PSYCHOSOCIAL SKILLS

OBJECTIVE: To evaluate an intensive training program’s effects on residents’ confidence in their ability in, anticipation of positive outcomes from, and personal commitment to psychosocial behaviors.DESIGN: Controlled randomized study.SETTING: A university- and community-based primary care residency training program.PARTICIPANTS: 26 first-year residents in internal medicine and family practice.INTERVENTION: The residents were randomly assigned to a control group or to one-month intensive training centered on psychosocial skills needed in primary care.MEASUREMENTS: Questionnaires measuring knowledge of psychosocial medicine, and self-confidence in, anticipation of positive outcomes from, and personal commitment to five skill areas: psychological sensitivity, emotional sensitivity, management of somatization, and directive and nondirective facilitation of patient communication.RESULTS: The trained residents expressed higher self-confidence in all five areas of psychosocial skill (p<0.03 for all tests), anticipated more positive outcomes for emotional sensitivity (p=0.05), managing somatization (p=0.03), and nondirectively facilitating patient communication (p=0.02), and were more strongly committed to being emotionally sensitive (p=0.055) and managing somatization (p=0.056), compared with the untrained residents. The trained residents also evidenced more knowledge of psychosocial medicine than did the untrained residents (p<0.001).CONCLUSIONS: Intensive psychosocial training improves residents’ self-confidence in their ability regarding key psychosocial behaviors and increases their knowledge of psychosocial medicine. Training also increases anticipation of positive outcomes from and personal commitment to some, but not all, psychosocial skills.

Competitive two-person interactions of Type-A and Type-B individuals

Forty subjects classified as either coronary-prone (Type A) or coronary-resistant (Type B) interacted in a mixed-motive game in pairs by pressing buttons which transmitted messages through a television screen while an electrocardiogram and digital blood volume pulse were computer monitored. Subjects could cooperate, compete, punish, reward, or withdraw during each interaction and could send 1 of 55 messages communicating feelings, requests, and intentions between interactions. Paired Type As interacted more competitively and aggressively than paired Type Bs. There were no significant differences between Type As and Type Bs in heart rate or digital vasomotor response during the interpersonal game. The behavioral results but not the physiological results confirm findings from an earlier experiment.

Body dissatisfaction adjusted for weight: The body illusion index

The current study extends earlier observations that body dissatisfaction is positively associated with body weight for eating disorder patients and for nonpatient college women. An adjustment to the Eating Disorder Inventory (EDI) Body Dissatisfaction score (i.e., the “Body Illusion Index” or “Bll”) is proposed to statistically eliminate the effects of relative body weight on Body Dissatisfaction scores and to systematically increase Body Dissatisfaction scores at lower relative weights. The adjustment results in a mean adjusted body dissatisfaction score for the anorexia nervosa patients more closely resembling that for bulimia ner-vosa patients and differing significantly from normal weight college women. The “Body Illusion Index” addresses the different meanings and clinical significance that body dissatisfaction implies for individuals at different weights.

Interpersonal and electrocardiographic responses of Type A's and Type B's in competitive socioeconomic games.

Forty-eight subjects classified as either Type A (coronary-prone) or Type B (coronary-resistant) exchanged points worth money with a computer-simulated opponent while an electrocardiogram was computer-monitored and scored. Type As were more aggressive during the socioeconomic exchanges than were Type Bs. The more aggressive a subject during the interactions the greater was the shift toward depression of the ST segment of the electrocardiogram. Despite the relationship between aggression and ST response, and the greater aggressiveness of Type As during the interactions, Type As and Type Bs did not differ significantly in ST response.

Cardiovascular consequences of expressing anger in a mutually-dependent relationship.

Abstract Twenty males were harrassed by a confederate of the experimenters while solving anagrams. Following this experience they played a mixed-motive, interpersonal game with the confederate. In comparison with non-harrassed controls the harrassed subjects expressed more anger at the end of the task. While solving anagrams they also exhibited greater increases in systolic blood pressure and heart rate and greater decreases in finger pulse amplitude and pulse wave transit time. The post- harrassment adjustment of cardiovascular behavior during the interpersonal games was contingent upon the subjects aggression guilt, level of exploitativeness, and uncertainty concerning the consequences of exploiting the confederate. The greater the subjects aggression guilt the less anger he expressed at the end of the anagrams task and the less he exploited the confederate. The more a subject exploited the confederate the lower his diastolic blood pressure at the end of the game. The greater the uncertainty of consequences of behavior the faster the transmission of pulses and the smaller the drop in blood pressure during the game. The potential utility of interpersonal games for studying behavioral and biological adjustments during post-anger interpersonal transactions in a mutually-dependent relationship is illustrated.

Behavioral science and medical education: A biobehavioral perspective

Abstract A model for the teaching of behavioral science in medical schools is described. In this approach attention is concentrated on behavioral (psychological, social, cultural) factors linking the individual with physical illness and the medical care system. These factors are organized by means of an illness behavior model. The student is encouraged to view illness as a behavioral construct (i.e. as a behavioral discontinuity in the patients life) as well as a biomedical construct (i.e. as a biological disruption of functioning) and to understand the dynamic interaction between these two systems of organization. The ideal institutional setting and ideal faculty for teaching medical behavioral science are discussed.

A Behavioral Framework for the Study of Human Disease

A frame of reference for studying human disease is presented. An individuals social behavior serves as the orienting theme. Special forms of social behavior are in effect what tie an individual to his physical and social space, and alterations here can lead to disease. Causes of disease can thus be linked to behaviors of the individual. Although associated with basic changes in the psysiologies and chemistries of the individual, disease invariably comes to affect the individuals behavior and adaptation. Different ways in which such behavioral changes can be conceptualized are discussed. The individual relies on these behavioral changes as the data for evaluating his disease and deciding about medical treatment. A model of how an individual processes information about illness and makes decisions designed to alleviate his condition is presented. Finally, the rationale and value of keeping behavior and adaptation in mind when studying disease are discussed.

The Analysis of Continuous Data

After tackling the problems of gathering a batch of observations according to some systematic plan, the scientist faces the problem Eve brought Adam—the troubling fact of choice. What treatments should be applied to the data, arithmetically or graphically? Why these treatments rather than some others? What principles can aid in making the choices? How can we organize our thinking about the overall process of data analysis?