Biomedical subjects

M D Litt

Publications and source records attributed to M D Litt.

33 records · Page 2Linked to original sources

PubMed1992

Coping and cognitive factors in adaptation to in vitro fertilization failure.

Characteristics were identified that predict adaptation following an unsuccessful attempt at in vitro fertilization (IVF). Forty-one women and their husbands were interviewed and administered questionnaires prior to IVF and 2 weeks after notice of a positive or negative pregnancy test. Of the 36 couples who failed to conceive as a result of IVF, 6 of the women studied developed clinical depressive symptoms. Those women who reported poorest adaptation to IVF failure were more likely to have reported depressive symptoms prior to IVF, were more likely to have reported feeling a general loss of control over their lives as a result of infertility, tended to use escape as a coping strategy, and reported having felt some responsibility for their IVF failure. Dispositional optimism, as well as a sense of being partially responsible for the infertility, was protective of distress following IVF failure.

Adaptation, Psychological↗

PubMed1992

Coping with gastrointestinal endoscopy: self-efficacy enhancement and coping style.

Forty-eight men scheduled for endoscopy were assessed for preferred coping style and assigned to one of four preparation conditions: (a) relaxation plus coping self-efficacy (SE) enhancement, (b) relaxation only, (c) procedural information, and (d) no preparation. It was hypothesized that increases in SE would be associated with better behavioral and self-report assessments of coping with endoscopy, and that coping style would moderate effects of SE enhancement. Hypotheses were largely confirmed. Ss in SE enhancement preparation experienced greater increases in coping SE and greater decreases in distress before and during endoscopy than did other Ss. Changes in coping SE were negatively correlated with changes in anticipatory anxiety, and SE ratings were significantly related to distress during endoscopy. Ss classed as monitors fared most poorly with no-preparation, whereas blunters did most poorly with procedural information.

Adaptation, Psychological↗

PubMed1992

Measuring treatment process in coping skills and interactional group therapies for alcoholism.

An instrument designed to measure components of two distinct alcoholism aftercare treatments was developed and evaluated for reliability and validity. Trained judges reliably rated audiotaped samples of coping skills and interactional group therapy sessions. Coping skills groups engaged in significantly more education and skill training, problem solving, and role playing. Interactional groups showed more interpersonal learning, expression/exploration of feelings, and here-and-now focus. Groups that employed more education and skill training, less expression and exploration of feelings, and less here-and-now focus were associated with fewer members reporting subsequent drinking-related problems. None of the ratings of group activities was related to abstinence.

Adaptation, Psychological↗

PubMed1991

Matching alcoholics to coping skills or interactional therapies: two-year follow-up results.

Ninety-six subjects were recruited from an inpatient alcoholism treatment program and randomly assigned to aftercare group treatment with either coping skills training or interactional therapy. Survival analyses using 2-year outcome data provided evidence for the durability of matching interaction effects. The data supported a priori hypotheses that individuals scoring high on measures of sociopathy or global psychopathology have better outcomes in coping skills treatment, whereas patients low on these dimensions have better outcomes in interactional treatment. Contrary to the original hypothesis, patients with cognitive impairment had better outcomes in interactional treatment, and patients without cognitive impairment did better in coping skills treatment.

Adaptation, Psychological↗

PubMed1990

Reactivity to alcohol cues and induced moods in alcoholics.

It has been theorized that respondent conditioning processes in part underlie desire for alcohol and thus contribute to relapse after alcoholism treatment. One implication of this theory is that the relevant conditioned responses could be eliminated by respondent extinction, in which the alcoholic patient is exposed to alcohol-related stimuli while being prevented from consuming alcohol. However, exteroceptive cues such as the sight and smell of alcoholic beverages are not always sufficient to elicit desire for alcohol. In view of this, it has been suggested that interoceptive cues, such as mood states, may also play a role in eliciting desire for alcohol. To test this, eight alcoholic subjects were induced to experience negative or neutral moods on four separate days, and then exposed to the sight and smell of their favorite alcoholic drink, and to a neutral stimulus (seltzer water), in a within-subjects design. Results from this work indicate that: (a) negative moods can be reliably induced in the laboratory as confirmed by subjects' reports; (b) exposure to alcohol cues had no effect on desire for alcohol while subjects were in a relaxed, neutral mood state; (c) the presence of negative mood states alone appeared to be sufficient to elicit desire for alcohol in some subjects, regardless of whether alcohol or water was presented. These data argue that negative mood states may cue desire for alcohol independent of other cues. The data also suggest that reactivity to alcohol cues may be substantially reduced by relaxation.

Adult↗

PubMed1990

A comparison of methods for assessing sociopathy in male and female alcoholics.

This study compared four methods for assessing sociopathy in alcoholics. A total of 79 male and 39 female inpatient alcoholics were administered the following scales: (1) the NIMH Diagnostic Interview Schedule (DIS) which provides a DSM-III diagnosis of antisocial personality disorder (APD) and an antisocial symptom count; (2) the Hare Psychopathy Checklist; (3) the Socialization scale from the California Psychological Inventory (CPI-So); and (4) the MMPI-168 Psychopathic Deviate (Pd) scale. Factor analysis for the four continuous measures (DIS symptom count, Hare, CPI-So, MMPI-168 Pd) resulted in a one factor solution, implying that all four scales measure a single underlying construct. The CPI-So had the highest loading, indicating that this measure has the strongest degree of association with the underlying construct of sociopathy. Results of a discriminant function analysis indicated that only the CPI-So reliably discriminated between alcoholics diagnosed APD and non-APD by the DIS. These findings indicate that CPI-So is a valid and easily administered continuous measure of sociopathy in alcoholic patients.

Adult↗

PubMed1989

Matching alcoholics to coping skills or interactional therapies: posttreatment results.

This study tested the hypothesis that patients could be matched to effective treatments on the basis of certain pretreatment characteristics. Specifically, it was hypothesized that those Ss who showed more sociopathy, more psychopathology, and greater neuropsychological impairment would have better outcomes when treated with coping skills training and, conversely, that those with less impairment in these areas would have better outcomes with interactional treatment. Ninety-six male and female Ss were recruited from an inpatient alcoholism treatment program and randomly assigned to 1 of these 2 types of aftercare group treatment. Linear and logistic regression analyses partially confirmed the hypotheses. Coping skills training was more effective for Ss higher in sociopathy or psychopathology, and interactional therapy was more effective for Ss lower in sociopathy. Generally, both treatments appeared equally effective for Ss lower in psychopathology. Contrary to expectations, those more neuropsychologically impaired appeared to have better outcomes after interactional therapy.

Adult↗

PubMed1988

Self-efficacy and perceived control: cognitive mediators of pain tolerance.

The cold-pressor task was used with 102 female undergraduates in 2 experiments to determine (a) whether self-efficacy has validity as a true causal determinant of behavior change or is a correlate of change that has already occurred and (b) how perceptions of control and self-efficacy interact to determine choice behavior, persistence, and the impact of an aversive stimulus. Results of Experiment 1 indicate that self-efficacy expectations affected performance beyond what would have been expected from past performance alone. Changes in self-efficacy expectations predicted changes in cold-pressor tolerance. These findings suggest that self-efficacy expectations can be causal determinants of behavior in an aversive situation. Results of Experiment 2 indicate that self-efficacy was separable from control and that performance was best if both high levels of perceived control and self-efficacy were present. These findings support the notion that self-efficacy expectations can mediate the desirability of providing control, in that those who benefit most from control are those who are most confident they can exercise it.

Adaptation, Psychological↗

PubMed1987

Cognitive-behavioral intervention for irritable bowel syndrome.

A 41-year-old white man with a 2-year history of irritable bowel syndrome (IBS) was referred for psychological treatment. At the time of assessment he was being treated with Metamucil and Darvocet N-100s with little success. A detailed psychosocial assessment indicated several areas for cognitive-behavioral intervention. Nine months after the patient began treatment, the frequency of IBS episodes had greatly reduced, he was off narcotic pain medication, and his general health was improved as measured by clinic and emergency room visits. We suggest that psychological interventions of the type described here can be an efficacious and cost-effective treatment for IBS.

Adult↗

PubMed1986

Mediating factors in non-medical treatment for migraine headache: toward an interactional model.

The inadequacy of traditional (i.e. pharmacological) treatment for migraine headache has led to the development of numerous non-medical interventions (e.g. biofeedback, relaxation, cognitive-behavioral programs). All of these non-medical interventions have produced at least some success in reducing migraine headache parameters. However the mechanism of treatment efficacy is unclear, with a number of not mutually exclusive relationships proposed. Purported mediators of successful outcome in these treatments include specific control of vascular activity, general reduction of autonomic arousal, biochemical changes, cognitive, affective, and behavioral change, therapist contact and support, and credibility and placebo expectancy. The present paper attempts to discuss and evaluate the mechanisms of change that have been proposed as mediators of successful treatment of migraine headache. An interactional model of adaptive change as a function of treatment is presented. The implications of the model for assessment and treatment are discussed. It is suggested that the interactional model may be applicable to the treatment of a range of chronic pain problems.

Arousal↗

PubMed1985

Seeking urgent pediatric treatment: factors contributing to frequency, delay, and appropriateness.

The present study explored the factors that contribute to mothers' decisions to seek urgent medical attention for their children when symptoms are not of a traumatic nature. One hundred mothers seeking treatment for their children at a prepaid clinic completed a questionnaire eliciting their expectations regarding the course of their children's problems, seriousness of the problems, perceived responsibility for the symptoms, and extent to which a variety of factors contributed to their decisions to seek treatment. Demographic data and information about each child's symptoms and medical history were also obtained. Four major "reasons for seeking treatment" factors were identified: family history of the presenting complaint, worry regarding the symptoms, situational variables, and the extent of the child's illness behavior. The appropriateness of the visit, delay in seeking treatment, and frequency of mothers' use of the pediatric clinic were predicted by the nature of the presenting symptoms (particularly the presence of fever), the ages of the mother and child, and two of the reasons for seeking treatment factors (i.e., family history and child's illness behavior). The present study suggests that mothers pay more attention to presenting symptoms and to the children's behavior than to psychosocial stressors in deciding to seek urgent care.

Adult↗

PubMedDate not supplied

A model of pain and anxiety associated with acute stressors: distress in dental procedures.

Many acute stressful experiences are not inherently very harmful, yet are associated with great pain and anxiety. The characteristics and experiences that the person brings to the situation are more important than any objective characteristics of the experience itself in determining how aversive the experience will be. Dental procedures are excellent examples of this type of stressor. Drawing primarily on the literature related to dental procedures, the present article discusses the nature of pain and anxiety in the face of an acute stressor, and presents the dispositional and situational factors that contribute to the perception of an acute stressor as aversive. A model is presented illustrating how the various factors interact. It is argued that, in addition to being descriptive, the model is also prescriptive of measures that may be taken to ameliorate the distress of persons subjected to acute stressors like dental procedures.

Arousal↗

PubMedDate not supplied

Relationship between role-play measures of coping skills and alcoholism treatment outcome.

Alcoholic clients were given role-play tests, involving various social and drinking-related scenarios, before and after two types of aftercare treatment. The assessments were used both to evaluate the effects of treatment and to determine whether any dimensions of pretreatment role-play performance interact with treatment type to predict treatment outcome. Eighty-nine patients were randomly assigned to aftercare group treatment involving either interactional therapy or coping skills training. Clients in both treatments experienced declines in their urge to drink during the role-play scenes from pre- to posttreatment, and these declines were related to reductions in heavy drinking. Three pretreatment role-play variables interacted with type of treatment to predict outcome: observer-rated skill, observer-rated anxiety, and self-reported urge to drink. In general, those patients who did better in the role plays had better drinking outcomes following interactional therapy. Those who experienced more difficulty in the role plays fared best with coping skills training. The results suggest that role-play measures could be used for patient-treatment matching, although it remains to be determined whether they will be superior to more easily assessed patient characteristics.

Adaptation, Psychological↗

PubMedDate not supplied

Self-efficacy as a moderator of perceived control effects on cardiovascular reactivity: is enhanced control always beneficial?

We have found that enhanced control has an attenuating effect on cardiovascular reactivity when effort of responding is maintained constant; however, not all individuals will react to increased control in the same manner. In the present study, 40 subjects engaged in a mental arithmetic task under high control (self-paced) and low control (externally paced) conditions. Subjects' self-efficacy concerning this task was assessed. As expected, significant main effects were found for control condition, with high control producing smaller blood pressure and heart rate changes than low control (11.4 vs. 20.4 mm Hg (systolic blood pressure), 4.4 vs. 11.4 mm Hg (diastolic blood pressure), and 6.2 vs. 7.9 beats per minute (heart rate)). No main effects were found for self-efficacy. However, the interaction between control and self-efficacy was significant for systolic blood pressure and heart rate and marginally significant for diastolic blood pressure; post hoc tests showed that this was due to the effect of self-efficacy classification under high control conditions; subjects with low self-efficacy for the mental arithmetic task evidenced cardiovascular changes that were significantly greater than those of the high self-efficacy group (8.0 vs. 14.8 mm Hg (systolic blood pressure), 2.7 vs. 6.1 mm Hg (diastolic blood pressure), and 5.2 vs. 7.1 beats per minute (heart rate). The data suggest that the reactivity observed during active coping is due in part to the effort of responding and in part to the match between the demands of the task and certain mastery-related attributes of the individual.

Adolescent↗

PubMedDate not supplied

Multidimensional causal model of dental caries development in low-income preschool children.

Despite the decline in the incidence of dental caries in the United States over the past several years, the condition remains a significant problem for the nation's poor children. Efforts to identify the factors responsible for caries development in samples of children of low socioeconomic status have primarily focused on a limited number of variables, and those have been predominantly biological (mutans streptococci, for example). Resulting models of caries development have usually shown good sensitivity but poor specificity. They have had limited implications for treatment. In an effort to produce a comprehensive model of caries development, 184 low-income preschool children were clinically assessed for mutans streptococci and for decayed, missing, or filled surfaces of deciduous teeth twice, first at age 4 years (baseline) and again a year later (year 1 assessment). As the clinical assessments were being done, caretakers were being interviewed to obtain data from five domains: demographics, social status, dental health behaviors, cognitive factors such as self-efficacy (self-confidence) and controllability, and perceived life stress. Data were analyzed using a structural equations modeling approach in which variables from all domains, plus baseline decayed missing and filled surfaces and baseline mutants, were used together to create a model of caries development in the year 1 assessment. Results confirmed earlier work that suggested that caries development at a 1-year followup was strongly dependent on earlier caries development. Early caries development in this sample was determined in part by mutans levels and by dental health behaviors. These behaviors themselves were accounted for partly by a cognitive factor. The results support the advantages of employing multidimensional models and provide some direction for intervention to reduce caries incidence.

Causality↗