overview of the millon behavioral medicine diagnostic...

Overview of the Millon Behavioral Medicine Diagnostic (MBMD)

Michael Antoni, Ph.D.

Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 1


Overview of the

Millon Behavioral

Medicine Diagnostic

(MBMD)

MBMD

Topics

Psychosocial testing in behavioral medicine.

The Millon Behavioral Medicine Diagnostic (MBMD).

Using data from the MBMD to inform treatment choices.

1.

2.

3.




MBMD

Sir William Osler, Eminent 19th Century Clinician

“the good physician will treat the disease, but the

great physician will treat the patient.”

Dr. Jacob Bigelow defining the great physician (1835)

“One who not only understands physical

diagnosis, but also understands the patient who

has that diagnosis . . . Not all patients with the

same diagnosis . . . [are] the same person.”

MBMD

21st Century Medicine

• Medical diseases affect millions of lives and consume

billions of dollars.

• Healthcare costs for management of chronic diseases are

astronomical.

• A substantial proportion of healthcare costs are for

treatment of conditions with psychosocial sources.

• Clinical behavioral medicine interventions may reduce the

frequency of medical utilization once we identify patients

most likely to benefit.

(Regier, 1994)




MBMD

Billion $ Questions in Medicine

What patient characteristics

predict optimal medical

outcomes?

Use of preventative

medicine techniques

Optimal response to

therapeutic procedures

What psychosocial

processes reduce success

of medical treatments?

Psychiatric Issues

Pain, outlook, and

personality

Negative health

behaviors

MBMD

Billion $ Questions in Medicine

Need to start by asking basic questions:

• What patient characteristics bring people into the

healthcare setting? Which characteristics do they bring

with them into this setting?

• Which of these can work for or against the success of

medical interventions like surgery?

• How can we quickly assess these characteristics in a

reliable and valid manner?

• How can we change those characteristics that are

modifiable to better prepare the patient for surgery or

other medical treatments?




MBMD

Psychosocial Factors and Health

Maintenance Indicators

Health Preservation and

Primary Prevention of

Disease

Patient Responses to

Diagnosis and

Treatment

• Risk behaviors and

primary prevention

• Preventative health

behaviors

• Emotional response to

diagnosis

• Adjustment to chronic

disease

• Physical course of

disease

MBMD


Care Delivery Indicators

Medical utilization and

health care costs

Treatment Success and

Recovery Time

Outcomes

• ER visits

• Repeat visits for same

symptoms

• # Days hospitalized

• Complications after

treatment (e.g., fatigue,

infection)

• Failed treatments (e.g.,

transplants, bypass

surgeries)

• Delayed return to work




MBMD


Affective and

psychiatric

disordersCognitive

appraisals

Coping

strategies Resources Life Context

Depression

Anxiety

Self-efficacy

Optimism/

pessimism

Perceived

control

Active

behavior

Avoidance

Denial

Social

Economic

Familial

Spiritual

Stressful

events

Perceived

stress level

Functional

capacity

MBMD

AXIS I

Clinical Presentation

(Anxiety, Dysthymia

= Fever, Cough)

Interactive Nature of the DSM-IV Multiaxial System




MBMD

AXIS III & IV

Medical & Psychosocial

AXIS I


(Anxiety, Dysthymia

= Fever, Cough)

(Marital, Economic, Health

= Infectious Agents)


MBMD


AXIS III & IV

Medical & Psychosocial

AXIS II

Personality Dynamics

AXIS I


(Anxiety, Depression

= Fever, Cough)

(Coping Style=

Psychic Immune

System)

(Marital, Economic, Health

= Infectious Agents)




MBMD

Questions . . . and Answer

Which psychological factors

can work for or against the

success of medical

interventions like surgery, or

medications?

How can we quickly assess

these characteristics in a

reliable and valid manner?

Use a multi-modal instrument

that integrates information

from multiple domains to

inform clinical judgment.

MBMD:

A Psychosocial

Assessment for

Medical Patients




MBMD

What is the MBMD?

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.

MBMD

Overview of the MBMD

• 165-item self-report inventory that takes only 20–25 mins to

complete; helps reduce patient resistance.

• Helps identify a patient’s psychological assets and liabilities in

healthcare settings (e.g., pre-surgical psychological evaluation)

and helps guide treatment recommendations.

• Includes a quick computer-generated report and a one-page

Healthcare Provider Summary to facilitate communication

between the psychologist and medical staff.

• Offers a choice of reports for population specific groups in the

areas of general medical, bariatrics, and pain.




MBMD

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

MBMD Model

MBMD

Seven MBMD Domains


(6 scales)Response Patterns

(3 scales)


(5 scales)

Stress Moderators

(6 scales)

Coping Styles

(11 scales)

Management Guides

(2 scales)

Treatment Prognostics

(5 scales)




MBMD

Validity Indicator and

Response Patterns

Scale Description

V Validity Provides information about the validity of the profile.

X Disclosure

Measures patient’s tendency to be overly frank and

self-revealing, or hesitant to share personal

information.

Y DesirabilityMeasures patient’s tendency to present self in

favorable manner.

Z DebasementMeasures patient’s tendency to present self in

unfavorable manner.

MBMD


Scale Description

N Alcohol Presence of alcohol-consumption problem.

O DrugGreater use of non-prescription drugs and possible

dependency.

P Eating Problem with chronic overconsumption.

Q CaffeineAssesses if patient’s consumption of caffeine is

excessive.

R InactivityNotes if patient engages in physical exercise on a

regular basis.

S SmokingSmokes tobacco-containing products on a regular

basis.




MBMD


Scale Description

AAAnxiety/

TensionAssesses patient’s level of anxiety and tension.

BB Depression Focuses on patient’s vegetative or mood state.

CCCognitive

Dysfunction

Assesses patient’s capacity to recall past

experiences, to think abstractly, and to represent

events and interrelate and process them

symbolically.

DDEmotional

Lability

Looks at dysregulation of affect and irritability in

moods.

EE GuardednessAssesses patient’s level of mistrust and

defensiveness

MBMD

Coping Styles

Scale MBMD 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




MBMD

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

MBMD

Stress Moderators

Scale Description

AIllness Apprehension vs.

Illness Acceptance

Patients’ focus on and awareness of changes

in their bodies.

BFunctional Deficits vs.

Functional Competence

Patients’ perception that they are unable to

perform activities of daily living.

CPain Sensitivity vs. Pain

Tolerance

Patients’ tendency to be overly sensitized and

reactive to mild to moderate pain.

DSocial Isolation vs. Social

Support

Patients’ perception of social supports in their

lives.

EFuture Pessimism vs.

Future Optimism

Patients’ outlook toward their future health

status.

FSpiritual Absence vs.

Spiritual Faith

Degree to which patients lack religious or

spiritual resources for dealing with the

stressors and fears of the medical condition.




MBMD


Scale Description

G

Interventional Fragility

vs. Interventional

Resilience

Predicts whether patients will be able to

adjust emotionally to the demands of

physically and psychologically stressful

protocols.

H

Medication Abuse vs.

Medication

Conscientiousness

Predicts likelihood that patients will have

problems with or will misuse prescribed

medication.

I

Information Discomfort

vs. Information

Receptivity

Assesses a patient’s lack of receptivity to

specific details about diagnostic,

prognostic, and treatment procedures and

outcomes.

MBMD


Scale Description

JUtilization Excess vs.

Appropriate Utilization

Assesses the likelihood that a patient will

use medical services more than the

average patient with a similar medical

condition.

KProblematic Compliance

vs. Optimal Compliance

Identifies patients who resist following

medical recommendations.




MBMD

Management Guide

Scale Description

L Adjustment DifficultiesAssesses the risk of treatment

complications.

M Psych ReferralIndicates whether the patient might benefit

from psychosocial intervention.

Administration

Scoring

Interpretation




MBMD

Administration

English Spanish

Paper and

PencilComputer

Audio Recordings Available

MBMD

Scoring

Hand Scoring

Computer Scoring

(Q-global®, Q Local™, Mail-in, Fax)

• Interpretive Report

• Profile Report




MBMD

Available Reports

General Medical Report*

Bariatric Report*

Pain Patient Report*Customized reports for pre-surgical and nonsurgical patients.

* Sample reports available on PearsonClinical.com/MBMD

MBMD

Prevalence Score (PS)

PS

Interpretation/

Interpretive Benchmarks

< 35 Asset

75-84 Moderate or Present Liability

85+ Marked or Prominent Liability.




MBMD

MBMD Interpretive Model

1. Medical condition

2. Clinical Observations and Interviews

3. Other test results

4. Background and demographics gender, age, etc.

A.

Review Patient

Information

1. Validity

2. Disclosure

3. Desirability

4. Debasement

B.Analyze Modifying

Indices

1. Psychiatric Indications

2. Coping Styles

3. Stress Moderators

4. Treatment Prognostics

C.Analyze Sections

of Profile

D.Integrate

Profile

1. Analyze Patterns

2. Assess importance of minor score variations

3. Noteworthy Responses

4. Healthcare Provider Summary

MBMD

Sample Report




MBMD

Response Patterns and


MBMD

Psychiatric Indications and

Coping Styles




MBMD

Stress Moderators

MBMD

Treatment Prognostics and

Management Guides




MBMD

Training Opportunities

Online Training Available (earn up to 3 APA CE credits)

www.PearsonClinical.com/MBMD

Questions?

Visit PearsonClinical.com/MBMD

Customer Support

800-627-7271 (USA)

866-335-8418 (Canada)

http://www.pearsonclinical.com/MBMD

http://www.pearsonclinical.com/psychology/products/100000231/millon-behavioral-medicine-diagnostic-mbmd.html#tab-details




Appendix

MBMD

Sample Test Report Narrative Sections

• General Medical Report

• Bariatric Report

• Pain Report

• Pre-surgical

• Non-surgical




MBMD

Sample General Medical Report

MBMD

Sample General Medical Report (contd.)




MBMD

Sample Bariatric Report

MBMD

Sample Pre-Surgical Pain Report




MBMD

Sample Pre-Surgical Pain Report (contd.)

MBMD

Sample Non-Surgical Pain Report




MBMD

References on Role of Psychosocial

Assessment in Medical Settings

Antoni, M.H. & Millon, T. (2013). Psychometric Developments in

Psychosocial Assessment in Behavioral Medicine Settings . In D.

Modofsky (Ed), Wiley Handbook of Behavioral Medicine. NY: Wiley.

Antoni, M.H. (2012) The Millon Behavioral Medicine Diagnostic.

In M. Gellman & R. Turner (Eds), The Encyclopedia of Behavioral

Medicine. New Delhi: Springer.

Millon, T. (1969). Modern psychopathology. Philadelphia:

Saunders.

MBMD

References on Millon’s Theory and the

MBMD

Millon, T. (1981). Disorders of personality: DSM-III, Axis II.

New York: Wiley.

Millon, T. (1990). Toward a new personology: An evolutionary

model. New York: Wiley.

Millon, T., Antoni, M., Millon, C., Minor, S., & Grossman, S.

(2006). Millon Behavioral Medicine Diagnostic (MBMD) Manual (2nd

ed.). Minneapolis, MN: NCS Pearson, Inc.




MBMD

Selected References for MBMD

Predictive Validity Studies

Lattie , E., Antoni, M.H., Millon, T. Kamp, J. & Walker, M. (2013).

MBMD Coping Styles and Psychiatric Indicators and Response to a

Multidisciplinary Pain Treatment Program. J. Clinical Psychology in

Medical Setting, 20, 515 -525. DOI 10.1007/s10880-013-9377-9

Cruess, D., Benedict, C., Lattie, E., Molton,I., Kissinger,D.,

Kava, B., Manoharan,M., Soloway, M. & Penedo, F. (2013): Millon

Behavioral Medicine Diagnostic (MBMD) Predicts Health-Related

Quality of Life (HrQoL) Over Time Among Men Treated for Localized

Prostate Cancer. Journal of Personality Assessment, 95, 54 - 61.

DOI:10.1080/00223891.2012.681819

MBMD

References for Validity of the MBMD

in Clinical Settings

Burbridge, C., Cruess, D. G., Antoni, M. H., & Meagher, S.

(2011). Using the Millon Behavioral Medicine Diagnostic (MBMD) to

evaluate the need for mental health services in association with

biomarkers of disease status among HIV positive men and women.

Journal of Clinical Psychology in Medical Settings, 18, 30–38.

Cruess, D. G., Localio, A. R., Platt, A. B., Brensinger, C. M.,

Christie, J. D, Gross, R., Parker, C. S., Price, M., Metlay, J. P., Cohen,

A., Newcomb, C. W., Strom, B. L., & Kimmel, S. E. (2010). Patient

attitudinal and behavioral factors associated with warfarin non-

adherence at outpatient anticoagulation clinics. International Journal

of Behavioral Medicine, 17, 33–42.




MBMD



Farrell, K., Shen, B. J., Mallon, S., Penedo, F. J., & Antoni, M. H.

(2011). Utility of the Millon Behavioral Medicine Diagnostic to predict

medication adherence in patients diagnosed with heart failure.

Journal of Clinical Psychology in Medical Settings, 18, 1–12.

Harper, R. G., Wager, J., & Chacko, R. C. (2010). Psychosocial

factors in noncompliance during liver transplant selection. Journal of

Clinical Psychology in Medical Settings, 17, 71–76.

MBMD



Lavoie, K. L., Bouthillier, D., Bacon, S. L., Lemière, C., Martin, J.,

Hamid, Q., Ludwig, M., Olivenstein, R., & Ernst, P. (2010).

Psychologic distress and maladaptive coping styles in patients with

severe vs moderate asthma. Chest, 137, 1324–1331.

Pereira, D. B., Christian, L. M., Patidar, S., Bishop, M. M., Dodd,

S. M., Athanason, R., Wingard, J. R., & Reddy, V. S. (2010). Spiritual

absence and 1-year mortality after hematopoietic stem cell

transplant. Biology of Blood and Marrow Transplantation, 16, 1171–

1179.




MBMD

HIV/AIDS patients on antiviral medications (Cruess et al., 2007, 2010)

• MBMD predicts Highly Active Antiretroviral therapy (HAART) adherence and psy adjustment

Heart Failure patients on low salt-diet and medication regimen (Farrell et al., 2011)

• MBMD predicts CHD medication adherence in Heart Failure patients

Liver transplant candidates being screened (Harper et al., 2010)

• MBMD predicts non-adherence to lifestyle change

CVD patients on anti-coagulant regimen (Cruess et al., 2009)

• MBMD predicts adherence to Warfarin

Bone Marrow Transplant patients on immune suppressive therapy (Pereira et al., 2010)

• MBMD predicts survival time after transplant

Acquired Brain Injury patients in Rehab Program (Beck et al., 2010)

• MBMD predicts outcomes in treatment program

Asthma patients under treatment (LaVoie et al., 2010)

• MBMD predicts distress in asthma patients

Prostate Cancer patients after surgery or radiation treatment (Cruess et al. 2013)

• MBMD predicts health-related quality of life and sexual and urinary fxn after treatment

Chronic Pain patients in Comprehensive Pain Mgmt Program (Lattie et al., 2013)

• MBMD predicts success in pain mgmt intervention

Validity Studies on the MBMD

overview of the millon behavioral medicine diagnostic...

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