using the millon behavioral medicine diagnostic (mbmd ...€¦ · behavioral medicine diagnostic...

Using the MBMD with Pain Patients

Michael Antoni, Ph.D. and Anne-Marie Kimbell, Ph.D.

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

Michael Antoni, Ph.D.

Anne-Marie Kimbell, Ph.D.

Using the Millon

Behavioral Medicine

Diagnostic

(MBMD) with Pain

Patients

MBMD

Topics

Psychosocial testing with patients suffering with

chronic pain.

The MBMD and its use with patients with

chronic pain.

Using data from the MBMD to identify patient

assets and liabilities.

1.

2.

3.




MBMD

Chronic Pain in Numbers

https://www.thegoodbody.com/chronic-pain-statistics/#infographic

MBMD

The Cost of Chronic Pain




MBMD

Effects of Chronic Pain

MBMD

Pain Experience

Cognitive

Biological

Affective

Behavioral Response




MBMD

MBMD and Pain

The MBMD 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

MBMD

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

Health Promoting

Behaviors (Exercise)

Health-Defeating

Behaviors (Non-

Adherence, Substance

Abuse)

Psych

Distress

Psychiatric Issues and

Stress-Related Conditions




MBMD:

A Psychosocial

Assessment

MBMD

Psychosocial Assessment for

Pain Patients

• Customized MBMD 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 MBMD

scales.

• Developed Narrative Reports for two major pain

populations (pre-surgical and non-surgical).




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

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 ValidityProvides 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/ Tension

Assesses patient’s level of anxiety and

tension.

BB DepressionFocuses 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

ScaleMBMD

Coping StyleNon-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

ScaleMBMD

Coping StyleNon-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

J

Utilization Excess vs.

Appropriate

Utilization

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.




MBMD

Management Guide

Scale Description

LAdjustment

Difficulties

Assesses the risk of treatment

complications.

M Psych ReferralIndicates whether the patient might

benefit from psychosocial intervention.

MBMD

Pain Norms




MBMD

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.

MBMD

MBMD 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




MBMD

Reliability and Validity

Reliability Validity

• Test-Retest:

.66 - .93 for 32 Response

Patterns & Scales

• Internal Consistency:

Median alpha = .75

• Concurrent: See Study 1-3

• Predictive: See Study 4

MBMD

MBMD Validation Studies: Study 4

MBMD Prediction of Treatment Outcomes in subset of

Study 3 patients (N = 110) who completed > 15 days of

comprehensive pain treatment program.

MBMD 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




MBMD

MBMD Coping Styles and Psychiatric

Indicators by Treatment Success

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

MBMD

MBMD Customized for Pain Patients

CHRONIC PAIN NORMS

PRESURGICAL PAIN

PATIENT REPORT

NONSURGICAL PAIN

PATIENT REPORT




MBMD

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.

MBMD

Mean Using Chronic Pain Norms and

General Medical Norms Pain Norms

ScaleChronic Pain

Mean

General

Medical Mean

Mean

Diff. Cohen’s d

B Functional Deficit 19.12 10.42 8.70 1.20

C Pain Sensitivity 25.03 12.21 12.82 1.33

A Illness Apprehension 19.23 12.18 7.05 0.77

E Future Pessimism 14.60 8.83 5.77 0.73

L Adjustment Difficulties 9.42 5.90 3.52 0.77

AA Anxiety/ Tension 10.75 7.16 3.59 0.45

BB Depression 13.32 8.56 4.76 0.48

CC Cognitive Dysfunction 9.84 6.14 3.70 0.53

The scales with the highest Cohen’s d (Effect Size) are listed here..




MBMD

MBMD Prevalence Scores vs Percentile

Scores in Pain

MBMD

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 MBMD.




MBMD

Report Components

Presurgical Report Nonsurgical Report

• Graphical Profiles

• Presurgical Pain

Patient Summary

- Presurgical

Considerations

- Postsurgical

Considerations

• Interpretive Report

• Healthcare Provider

Summary


• Nonsurgical Pain

Patient Summary

• Pretreatment

Considerations

• Longer-Term

Management



Summary

MBMD

Report Components




Patient Summary

- Presurgical

Considerations

- Postsurgical

Considerations



Summary



Patient Summary

• Pretreatment

Considerations

• Longer-Term

Management



Summary




MBMD

Pain Patient Summary: PRE-SURGICAL

REPORT

PRESURGICAL

CONSIDERATIONS

POSTSURGICAL

CONSIDERATIONS

MBMD

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




MBMD

Report Components




Patient Summary

- Presurgical

Considerations

- Postsurgical

Considerations



Summary



Patient Summary

• Pretreatment

Considerations

• Longer-Term

Management



Summary

MBMD




MBMD

MBMD

LONG-TERM PATIENT BEHAVIOR

A. The likelihood that this patient will:Is classified

as:

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

High

LOW

High

Average

LOW

LOW

LOW




MBMD

Psychosocial Management Needs

Need for the Following Adjunctive Psychosocial Mgmt Is classified as:

1. Psychiatric Treatment

2. Emotional Support Group

3. Behavioral Adherence Management

High

LOW

High

The Risk for the Following Healthcare Delivery Issue Is classified as:

1. Doctor-Dependency/Self-Care problems

2. Misuse of Opioid Medications

3. Long-term Disability

High

High

High

Medical Healthcare Delivery Issues

Interpretation




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




Case Study

MBMD

Sample Report




MBMD

Sample Report

Name Male A

Age 35

Gender Male

Race White

Marital Status Divorced

Education High School Graduate

MBMD

Response Patterns and





MBMD

Psychiatric Indications and Coping

Styles: General Medical Norms

MBMD

Psychiatric Indications and Coping

Styles: Chronic Pain Norms




MBMD

Stress Moderators: General Medical

Norms

MBMD

Stress Moderators: Pain Patient Norms




MBMD

Treatment Prognostics and Management

Guides: General Medical Norms

MBMD

Treatment Prognostics and Management

Guides: Chronic Pain Norms




MBMD

Major Surgical Outcome Risks

MBMD

Presurgical Recommendations




MBMD

Post-Surgical Patient Behavior

MBMD

Clinical Presentation




MBMD

References

Barsky, A., Wyshak, G., & Klerman, G. (1986). Medical

and psychiatric determinants of outpatient medical

utilization. Medical Care, 24, 548–560.

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, 127–147.

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), 581–624.

MBMD

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. 19–24). 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, 829–835.




MBMD

Training Opportunities

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

www.PearsonClinical.com/MBMD

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


MBMD 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 MBMD to MMPI-2-RF Clinical

Scales (most coefficients = .50 – .70)




MBMD


MBMD 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 = .70 - .80

• DRAM correlations: r = .56 - .80

MBMD


MBMD Correlations with Pain Measures in

functional restoration clinic treating workers’

compensation cases (N = 161):

Dallas Pain Quest [DPQ]

• r = .50 - .60 w/MBMD Psychiatric Scales

• r = .30 - .40 w/MBMD Stress Moderators

Brief Battery for Health Improvement-2 [BBHI-2]

• r = .50 - .60 w/MBMD Psychiatric Scales

• r = .35 - .65 w/MBMD Stress Moderators

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