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

Psychotherapeutic intervention in angina: II. Implications for research and practice

The second of a two-part series, this article draws on the clinical and research literature reviewed in the first article to formulate guidelines for research and clinical practice. In future research, the complex heterogeneity of coronary artery disease (CAD) must be recognized in more rigorous descriptive, comparative, and physiologic correlative studies of psychosocial etiology. Pseudoangina is largely unexamined by systematic study and therefore warrants research on several of its aspects. Similarly, systematic research on intervention in anginoid pain is virtually nonexistent and obviously warranted. Clinical guidelines include the emphasis of didactic, supportive approaches, detailed focus on several aspects of the pain, early and extended psychotherapeutic availability, recognition and treatment of underlying specific psychopathology, and somatic interventions aimed at presumed pathophysiologic mechanisms.

Consequences of nonverbal expression of pain: patient distress and observer concern

Two studies examined the effects on others of nonverbal expressiveness of pain. Subjects viewed one of three videotapes of a simulated doctor-patient interview, with identical verbal content but different levels of expressiveness, and then completed a rating form. In Study I subjects were 44 senior nursing students. High nonverbal expressiveness yielded significantly higher ratings of patient pain and distress and observer concern. These variables also were inversely related to amount of nursing experience. Expressiveness had no significant effects on psychological support or nursing aids recommended for the patient. In Study II, 88 female undergraduates were categorized as low, medium or high on a measure of their need to nurture others. Irrespective of nurturance, ratings of patient distress, but not pain, were significantly higher in the high expressive condition. Nonverbal expressiveness of pain appears to influence ratings of the patient's affective state (distress) and the observer's affective response (concern).

Labelling in hypertension: a review of the behavioural and psychological consequences

Recent evidence has suggested that the detection and treatment of hypertension can result in adverse psychological and behavioural consequences. Furthermore, there is evidence to suggest that these consequences may outweigh the gains in the case of mild hypertension where the benefit of treatment has not yet been established. This paper reviews the literature to date regarding the behavioural and psychological changes which have occurred upon the detection and labelling of hypertension. In addition, an explanation is posed which may resolve some of the contradictory findings with regard to the phenomenon. Finally, a strategy to alleviate, or at least minimize, the deleterious labelling of individuals as "hypertensive" is proposed for testing in future experiments.

Differential diagnosis of anxiety disorders

The literature comparing panic disorder with natural fear, hypoglycemia, hyperthyroidism, pheochromocytoma, the hyperventilation syndrome, the mitral valve prolapse syndrome and partial complex seizures is briefly reviewed. Some features of each of these syndromes may clinically resemble panic disorder. It is concluded that: a) patients with panic disorder should be medically evaluated. b) the diagnosis of panic disorder should be based on a broad system, rather than on symptoms alone. c) diagnostic systems should include a category for "organic anxiety syndromes".

Potential biobehavioral mechanisms of recurrent abdominal pain in children

To explain why otherwise healthy children experience recurrent episodes of abdominal pain (the recurrent abdominal pain syndrome, or RAP), it has been hypothesized that the child with RAP demonstrates: (1) a deficit in autonomic nervous system recovery to stress, and/or (2) an enhanced behavioral and subjective response to pain. To evaluate the validity of these assumptions, children with RAP (9-14 years) and hospital and healthy controls matched for age, sex, ethnicity and SES were exposed to a cold pressor stimulus (0 +/- 1 degree C). Autonomic (peripheral vasomotor and heart rate), somatic (forearm EMG), subjective (pain intensity and distress), and behavioral (facial expression) responses were recorded during baseline, stressor and recovery periods. At all 4 levels of observation, the cold pressor stimulus resulted in significant autonomic, somatic, subjective and behavioral arousal. However, no significant differential response across the 3 groups was noted for any measure and, in particular, no recovery deficit in autonomic arousal was demonstrated. These findings do not support the assumption of a differential response to an acute laboratory induced stress in children with RAP compared to control children.

Learned illness behavior in patients with irritable bowel syndrome and peptic ulcer

Chronic illness behavior is defined by frequent visits to physicians, multiple somatic complaints, and disability disproportionate to physical findings. The prevalence of chronic illness behavior in people with irritable bowel syndrome and peptic ulcer was studied in a telephone survey of 832 people from metropolitan Cincinnati. People with irritable bowel syndrome (8% of the sample) were more likely than people with peptic ulcer (10% of the sample), and also more likely than the general population, to have multiple somatic complaints, to view their colds and flus as more serious than those of other people, and to consult a physician for minor illnesses. People with peptic ulcer were not different from the rest of the population in these regards. Chronic illness behavior appears to be learned; people who recalled being given gifts or special foods when they had a cold or flu as a child were more likely to exhibit chronic illness behavior and also more likely to have irritable bowel syndrome. These results suggest that social learning may contribute to the etiology of irritable bowel syndrome but not peptic ulcer.

The token economy: a decade later

In the last decade, the token economy has been extended widely across populations and behaviors in treatment, rehabilitation, educational, and community settings. Outcome research has expanded as well to include large-scale program evaluations and comparative and combined treatment studies of the token economy. In a previous review (Kazdin & Bootzin, 1972), several obstacles were identified for the effective application of the token economy. These included identifying procedures to enhance program efficacy, to train staff, to overcome client resistance, and to promote long-term maintenance and transfer of training. The present paper discusses recent advances in research and reviews progress on the major issues identified previously. New issues have become salient in the last decade that pertain to the extension of the token economy to institutional settings. The demands for maintaining the integrity of treatment, the ability to integrate token economies within existing institutional constraints, and the disseminability of the procedures on a large scale are major issues that may dictate the future of the token economy.