Using the Millon Behavioral Medicine Diagnostic (MBMD) with Pain Patients

Transcription

1 Using the with Pain Patients Using the Millon Behavioral Medicine Diagnostic () with Pain Patients Michael Antoni, Ph.D. Anne-Marie Kimbell, Ph.D. Topics 1. Psychosocial testing with patients suffering with chronic pain. 2. The and its use with patients with chronic pain. 3. Using data from the to identify patient assets and liabilities. Copyright Pearson Inc., and/or its affiliates. All rights reserved, 1

2 Using the with Pain Patients Chronic Pain in Numbers The Cost of Chronic Pain Copyright Pearson Inc., and/or its affiliates. All rights reserved, 2

3 Using the with Pain Patients Effects of Chronic Pain Pain Experience Biological Cognitive Affective Behavioral Response Copyright Pearson Inc., and/or its affiliates. All rights reserved, 3

4 Using the with Pain Patients and Pain The measures a variety of psychosocial factors that are central to the experience of and response to pain. Affective States Personality and Coping Styles Health-Specific Attitudes and Behavior Tendencies Psychosocial Factors That Predict Surgery Outcomes Factor Optimal Outcomes Negative Outcomes Outlook Positive (Optimism) Negative (Pessimism) Coping Positive (Active, Planning, Independence) Negative (Denial, Dependency) Support Social Support Social Isolation Health Behaviors Psych Distress Health Promoting Behaviors (Exercise) Health-Defeating Behaviors (Non- Adherence, Substance Abuse) Psychiatric Issues and Stress-Related Conditions Copyright Pearson Inc., and/or its affiliates. All rights reserved, 4

5 Using the with Pain Patients : A Psychosocial Assessment Psychosocial Assessment for Pain Patients Customized for Pain Patients in a series of studies conducted over a 2-year period. Established new norms from a nationally representative pain sample. Demonstrated reliability and validity of scales. Developed Narrative Reports for two major pain populations (pre-surgical and non-surgical). Copyright Pearson Inc., and/or its affiliates. All rights reserved, 5

6 Using the with Pain Patients What is the? A multidimensional assessment designed to help clinical and health psychologists and medical professionals identify psychosocial factors that may support or interfere with a patient's course of medical treatment. Model Psychosocial characteristics and their relationship to multiple aspects of health maintenance and healthcare delivery as predictors of healthcare outcomes. Psychiatric Indications Coping Styles Stress Moderators Negative Health Habits Health Maintenance Health Care Delivery Health Outcomes Copyright Pearson Inc., and/or its affiliates. All rights reserved, 6

7 Using the with Pain Patients Seven Domains Response Patterns (3 scales) Negative Health Habits (6 scales) Psychiatric Indications (5 scales) Coping Styles (11 scales) Stress Moderators (6 scales) Treatment Prognostics (5 scales) Management Guides (2 scales) Validity Indicator and Response Patterns Scale V Validity Description Provides information about the validity of the profile. X Y Z Disclosure Desirability Debasement Measures patient s tendency to be overly frank and self-revealing, or hesitant to share personal information. Measures patient s tendency to present self in favorable manner. Measures patient s tendency to present self in unfavorable manner. Copyright Pearson Inc., and/or its affiliates. All rights reserved, 7

8 Using the with Pain Patients Negative Health Habits Scale Description N Alcohol Presence of alcohol-consumption problem. O Drug Greater use of non-prescription drugs and possible dependency. P Eating Problem with chronic overconsumption. Q R S Caffeine Inactivity Smoking Assesses if patient s consumption of caffeine is excessive. Notes if patient engages in physical exercise on a regular basis. Smokes tobacco-containing products on a regular basis. Psychiatric Indications Scale AA BB CC DD Anxiety/ Tension Depression Cognitive Dysfunction Emotional Lability EE Guardedness Description Assesses patient s level of anxiety and tension. Focuses on patient s vegetative or mood state. Assesses patient s capacity to recall past experiences, to think abstractly, and to represent events and interrelate and process them symbolically. Looks at dysregulation of affect and irritability in moods. Assesses patient s level of mistrust and defensiveness Copyright Pearson Inc., and/or its affiliates. All rights reserved, 8

9 Using the with Pain Patients Coping Styles Scale Coping Style Non-Psychiatric Aspects of DSM Disorder 1 Introversive Schizoid 2A Inhibited Avoidant 2B Dejected Depressive 3 Cooperative Dependent 4 Sociable Histrionic 5 Confident Narcissistic 6A Nonconforming Antisocial 6B Forceful Sadistic 7 Respectful Compulsive 8A Oppositional Negativistic 8B Denigrated Masochistic Coping Styles Scale Coping Style Non-Psychiatric Aspects of DSM Disorder 1 Introversive Schizoid 2A Inhibited Avoidant 2B Dejected Depressive 3 Cooperative Dependent 4 Sociable Histrionic 5 Confident Narcissistic 6A Nonconforming Antisocial 6B Forceful Sadistic 7 Respectful Compulsive 8A Oppositional Negativistic 8B Denigrated Masochistic Copyright Pearson Inc., and/or its affiliates. All rights reserved, 9

10 Using the with Pain Patients Coping Styles and Millon s Personality Theory Self-Other Self (low) Other (high) Dependent Personalities Self (high) Other (low) Independent Personalities C o p i n g S t y l e s Passive Cooperative Confident Active Sociable Oppositional Stress Moderators Scale A B C D E F Illness Apprehension vs. Illness Acceptance Functional Deficits vs. Functional Competence Pain Sensitivity vs. Pain Tolerance Social Isolation vs. Social Support Future Pessimism vs. Future Optimism Spiritual Absence vs. Spiritual Faith Description Patients focus on and awareness of changes in their bodies. Patients perception that they are unable to perform activities of daily living. Patients tendency to be overly sensitized and reactive to mild to moderate pain. Patients perception of social supports in their lives. Patients outlook toward their future health status. Degree to which patients lack religious or spiritual resources for dealing with the stressors and fears of the medical condition. Copyright Pearson Inc., and/or its affiliates. All rights reserved, 10

11 Using the with Pain Patients Treatment Prognostics Scale G Interventional Fragility vs. Interventional Resilience Description Predicts whether patients will be able to adjust emotionally to the demands of physically and psychologically stressful protocols. H I Medication Abuse vs. Medication Conscientiousness Information Discomfort vs. Information Receptivity Predicts likelihood that patients will have problems with or will misuse prescribed medication. Assesses a patient s lack of receptivity to specific details about diagnostic, prognostic, and treatment procedures and outcomes. Treatment Prognostics Scale J Utilization Excess vs. Appropriate Utilization Description Assesses the likelihood that a patient will use medical services more than the average patient with a similar medical condition. K Problematic Compliance vs. Optimal Compliance Identifies patients who resist following medical recommendations. Copyright Pearson Inc., and/or its affiliates. All rights reserved, 11

12 Using the with Pain Patients Management Guide Scale L M Adjustment Difficulties Psych Referral Description Assesses the risk of treatment complications. Indicates whether the patient might benefit from psychosocial intervention. Pain Norms Copyright Pearson Inc., and/or its affiliates. All rights reserved, 12

13 Using the with Pain Patients Pain Patient Norms Sample Demographics 1,200 pain patients from seven user sites across the US 648 females (54%) 552 males (46%) For both genders, the majority of patients were in their 40s or 50s (60.5% of males, 51.9% of females), with relatively few younger than 30 or older than 69. Pain Norm Sample User sites represent patients from all geographical areas of the U.S. being seen in the following settings: Private Practice Multidisciplinary Pain Clinics Hospital-based Pain Clinics Headache, Spinal Cord Treatment Patients represent a variety of races/ethnicities, ages, and education levels Copyright Pearson Inc., and/or its affiliates. All rights reserved, 13

14 Using the with Pain Patients Reliability and Validity Reliability Test-Retest: for 32 Response Patterns & Scales Validity Concurrent: See Study 1-3 Predictive: See Study 4 Internal Consistency: Median alpha =.75 Validation Studies: Study 4 Prediction of Treatment Outcomes in subset of Study 3 patients (N = 110) who completed > 15 days of comprehensive pain treatment program. scales with strongest predictive validity for poor treatment outcomes: Psychiatric Indicators: Depression, Cog Dysfunction and Guardedness Coping Styles: Nonconforming, Forceful, Oppositional Stress Moderators: Future Pessimism, Pain Sensitivity Management Guides/Treatment Prognostics: Adjustment Difficulties, Psych Referral, Utilization Excess Copyright Pearson Inc., and/or its affiliates. All rights reserved, 14

15 Using the with Pain Patients Coping Styles and Psychiatric Indicators by Treatment Success Lattie, E., Antoni, M.H., Millon, T. Kamp, J. & Walker, M. (2013). Coping Styles and Psychiatric Indicators and Response to a Multidisciplinary Pain Treatment Program. J. Clinical Psychology in Medical Setting, 20, DOI /s Customized for Pain Patients CHRONIC PAIN NORMS PRESURGICAL PAIN PATIENT REPORT NONSURGICAL PAIN PATIENT REPORT Copyright Pearson Inc., and/or its affiliates. All rights reserved, 15

16 Using the with Pain Patients Chronic Pain Norms Chronic Pain Norms allow clinicians to interpret a patient s scores in the context of a large sample of chronic pain patients. Caution: Do not interpret a patient s scores solely with reference to chronic pain patients because doing so has the potential to be misleading. So, we provide scores relative to BOTH General Validation Sample and Pain Patient Sample. Mean Using Chronic Pain Norms and General Medical Norms Pain Norms Scale Chronic Pain Mean General Medical Mean Mean Diff. Cohen s d B Functional Deficit C Pain Sensitivity A Illness Apprehension E Future Pessimism L Adjustment Difficulties AA Anxiety/ Tension BB Depression CC Cognitive Dysfunction The scales with the highest Cohen s d (Effect Size) are listed here.. Copyright Pearson Inc., and/or its affiliates. All rights reserved, 16

17 Using the with Pain Patients Prevalence Scores vs Percentile Scores in Pain Norms to Use: General Medical Norms and Chronic Pain Norms Scores relative to the general medical norms should constitute the primary basis for interpreting the scores of pain patients who take the. Copyright Pearson Inc., and/or its affiliates. All rights reserved, 17

18 Using the with Pain Patients Report Components Presurgical Report Graphical Profiles Presurgical Pain Patient Summary - Presurgical Considerations - Postsurgical Considerations Interpretive Report Healthcare Provider Summary Nonsurgical Report Graphical Profiles Nonsurgical Pain Patient Summary Pretreatment Considerations Longer-Term Management Interpretive Report Healthcare Provider Summary Report Components Presurgical Report Graphical Profiles Presurgical Pain Patient Summary - Presurgical Considerations - Postsurgical Considerations Interpretive Report Healthcare Provider Summary Nonsurgical Report Graphical Profiles Nonsurgical Pain Patient Summary Pretreatment Considerations Longer-Term Management Interpretive Report Healthcare Provider Summary Copyright Pearson Inc., and/or its affiliates. All rights reserved, 18

19 Using the with Pain Patients Pain Patient Summary: PRE-SURGICAL REPORT PRESURGICAL CONSIDERATIONS POSTSURGICAL CONSIDERATIONS PRESURGICAL CONSIDERATIONS A. Patient-Provider Communications B. Major Surgical Outcome Risks C. Secondary Surgical Outcome Risks D. Patient Assets for Positive Outcomes E. Predicted Block Prognostic Category F. Presurgical Recommendations Copyright Pearson Inc., and/or its affiliates. All rights reserved, 19

20 Using the with Pain Patients Report Components Presurgical Report Graphical Profiles Presurgical Pain Patient Summary - Presurgical Considerations - Postsurgical Considerations Interpretive Report Healthcare Provider Summary Nonsurgical Report Graphical Profiles Nonsurgical Pain Patient Summary Pretreatment Considerations Longer-Term Management Interpretive Report Healthcare Provider Summary Copyright Pearson Inc., and/or its affiliates. All rights reserved, 20

21 Using the with Pain Patients LONG-TERM PATIENT BEHAVIOR A. The likelihood that this patient will: 1. Change unhealthy body mechanics 2. Avoid stressful behavior 3. Complete a follow-up behavioral management plan 4. Comply with general medical regimen 5. Show good judgment in an exercise program 6. Avoid long-term general health complications 7. Maintain paced and progressive activity gains Is classified as: High LOW High Average LOW LOW LOW Copyright Pearson Inc., and/or its affiliates. All rights reserved, 21

22 Using the with Pain Patients Psychosocial Management Needs Need for the Following Adjunctive Psychosocial Mgmt 1. Psychiatric Treatment 2. Emotional Support Group 3. Behavioral Adherence Management Is classified as: High LOW High Medical Healthcare Delivery Issues The Risk for the Following Healthcare Delivery Issue 1. Doctor-Dependency/Self-Care problems 2. Misuse of Opioid Medications 3. Long-term Disability Is classified as: High High High Interpretation Copyright Pearson Inc., and/or its affiliates. All rights reserved, 22

23 Using the with Pain Patients Prevalence Score (PS) PS Interpretation/ Interpretive Benchmarks < 35 Asset Moderate or Present Liability 85+ Marked or Prominent Liability Interpretive Model A. Review Patient Information B. Analyze Modifying Indices C. Analyze Sections of Profile D. Integrate Profile 1. Medical condition 2. Clinical Observations and Interviews 3. Other test results 4. Background and demographics gender, age, etc. 1. Validity 2. Disclosure 3. Desirability 4. Debasement 1. Psychiatric Indications 2. Coping Styles 3. Stress Moderators 4. Treatment Prognostics 1. Analyze Patterns 2. Assess importance of minor score variations 3. Noteworthy Responses 4. Healthcare Provider Summary Copyright Pearson Inc., and/or its affiliates. All rights reserved, 23

24 Using the with Pain Patients Case Study Sample Report Copyright Pearson Inc., and/or its affiliates. All rights reserved, 24

25 Using the with Pain Patients Sample Report Name Male A Age 35 Gender Male Race White Marital Status Divorced Education High School Graduate Response Patterns and Negative Health Habits Copyright Pearson Inc., and/or its affiliates. All rights reserved, 25

26 Using the with Pain Patients Psychiatric Indications and Coping Styles: General Medical Norms Psychiatric Indications and Coping Styles: Chronic Pain Norms Copyright Pearson Inc., and/or its affiliates. All rights reserved, 26

27 Using the with Pain Patients Stress Moderators: General Medical Norms Stress Moderators: Pain Patient Norms Copyright Pearson Inc., and/or its affiliates. All rights reserved, 27

28 Using the with Pain Patients Treatment Prognostics and Management Guides: General Medical Norms Treatment Prognostics and Management Guides: Chronic Pain Norms Copyright Pearson Inc., and/or its affiliates. All rights reserved, 28

29 Using the with Pain Patients Major Surgical Outcome Risks Presurgical Recommendations Copyright Pearson Inc., and/or its affiliates. All rights reserved, 29

30 Using the with Pain Patients Post-Surgical Patient Behavior Clinical Presentation Copyright Pearson Inc., and/or its affiliates. All rights reserved, 30

31 Using the with Pain Patients References Barsky, A., Wyshak, G., & Klerman, G. (1986). Medical and psychiatric determinants of outpatient medical utilization. Medical Care, 24, Bruns, D., & Disorbio, J. M. (2009). Assessment of biopsychosocial risk factors for medical treatment: A collaborative approach. Journal of Clinical Psychology in Medical Settings, 16, Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), References Regier, D. (1994). Healthcare reform: Opportunities and challenge. In S. Blumenthal, K. Matthews, & S. Weiss (Eds.), New research frontiers in behavioral medicine: Proceedings of the national conference (pp ). Washington, DC: Government Printing Office. Scheier, M. F., Matthews, K., Owens, J., Schultz, R., Bridges, M., Magovern, G., & Carver, C. S. (1999). Optimism and rehospitalization after coronary artery bypass graft surgery. Archives of Internal Medicine, 159, Copyright Pearson Inc., and/or its affiliates. All rights reserved, 31

32 Using the with Pain Patients Training Opportunities Online Training Available (earn up to 3 APA CE credits) PearsonClinical.com/ Customer Support (USA) (Canada) Copyright Pearson Inc., and/or its affiliates. All rights reserved, 32

33 Using the with Pain Patients Appendix Validation Studies: Study 1 Correlations with MMPI-2 in Chronic Pain patients at hospital-based pain clinic over three-year period (N = 596) Most coefficients =.50.70; strongest correlations with MMPI Content Scales Also related to MMPI-2-RF Clinical Scales (most coefficients =.50.70) Copyright Pearson Inc., and/or its affiliates. All rights reserved, 33

34 Using the with Pain Patients Validation Studies: Study 2 Psychiatric Indicators Scales Correlations with Symptom Checklist-90 Revised (SCL-90), and Distress and Risk Assessment Method (DRAM) in private practice setting as part of pre-treatment evaluation (N = 170) SCL-90 correlations: r = DRAM correlations: r = Validation Studies: Study 3 Correlations with Pain Measures in functional restoration clinic treating workers compensation cases (N = 161): Dallas Pain Quest [DPQ] r = w/ Psychiatric Scales r = w/ Stress Moderators Brief Battery for Health Improvement-2 [BBHI-2] r = w/ Psychiatric Scales r = w/ Stress Moderators Copyright Pearson Inc., and/or its affiliates. All rights reserved, 34