Overview of the Millon Behavioral Medicine Diagnostic (MBMD) Topics

Overview of the Millon Behavioral Medicine Diagnostic (MBMD) Michael Antoni, Ph.D.

Overview of the Millon Behavioral Medicine Diagnostic (MBMD)

Michael Antoni, Ph.D.

Topics

1. Psychosocial testing in behavioral medicine.

2. The Millon Behavioral Medicine Diagnostic (MBMD).

3. Using data from the MBMD to inform treatment choices.

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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.”

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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)

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Billion $ Questions in Medicine

What patient characteristics What psychosocial predict optimal medical processes reduce success outcomes? of medical treatments?

Use of preventative medicine techniques Psychiatric Issues

Optimal response to Pain, outlook, and therapeutic procedures personality

Negative health behaviors

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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?

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Psychosocial Factors and Health Maintenance Indicators

Health Preservation and Patient Responses to Primary Prevention of Diagnosis and Disease Treatment • Risk behaviors and • Emotional response to primary prevention diagnosis

• Preventative health • Adjustment to chronic behaviors disease

• Physical course of disease

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Psychosocial Factors and Health Care Delivery Indicators

Medical utilization and Treatment Success and health care costs Recovery Time Outcomes • ER visits • Complications after treatment (e.g., fatigue, • Repeat visits for same infection) symptoms • Failed treatments (e.g., • # Days hospitalized transplants, bypass surgeries)

• Delayed return to work

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Psychosocial Factors and Health

Affective and psychiatric Cognitive Coping disorders appraisals strategies Resources Life Context Social Stressful Self-efficacy Active events Depression behavior Economic Optimism/ Perceived Anxiety pessimism Avoidance Familial stress level Perceived Denial Spiritual Functional control capacity

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Interactive Nature of the DSM-IV Multiaxial System

AXIS I Clinical Presentation

(Anxiety, Dysthymia = Fever, Cough)

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Interactive Nature of the DSM-IV Multiaxial System

AXIS III & IV Medical & Psychosocial

AXIS I Clinical Presentation

(Anxiety, Dysthymia = Fever, Cough)

(Marital, Economic, Health = Infectious Agents)

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Interactive Nature of the DSM-IV Multiaxial System

AXIS III & IV Medical & Psychosocial

AXIS II Personality Dynamics

AXIS I Clinical Presentation

(Anxiety, Depression = Fever, Cough)

(Coping Style= Psychic Immune System) (Marital, Economic, Health = Infectious Agents)

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Questions . . . and Answer

Which psychological factors can work for or against the How can we quickly assess success of medical these characteristics in a interventions like surgery, or reliable and valid manner? medications?

Use a multi-modal instrument that integrates information from multiple domains to inform clinical judgment.

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MBMD: A Psychosocial Assessment for Medical Patients

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.

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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.

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MBMD 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

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Seven MBMD Domains

Response Patterns Negative Health Habits (3 scales) (6 scales)

Psychiatric Indications Coping Styles (5 scales) (11 scales)

Stress Moderators Treatment Prognostics (6 scales) (5 scales)

Management Guides (2 scales)

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Validity Indicator and Response Patterns

Scale Description

V Validity Provides information about the validity of the profile.

Measures patient’s tendency to be overly frank and X Disclosure self-revealing, or hesitant to share personal information.

Measures patient’s tendency to present self in Y Desirability favorable manner.

Measures patient’s tendency to present self in Z Debasement unfavorable manner.

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Negative Health Habits

Scale Description N Alcohol Presence of alcohol-consumption problem.

Greater use of non-prescription drugs and possible O Drug dependency.

P Eating Problem with chronic overconsumption.

Assesses if patient’s consumption of caffeine is Q Caffeine excessive. Notes if patient engages in physical exercise on a R Inactivity regular basis. Smokes tobacco-containing products on a regular S Smoking basis.

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Psychiatric Indications

Scale Description Anxiety/ AA Assesses patient’s level of anxiety and tension. Tension BB Depression Focuses on patient’s vegetative or mood state.

Assesses patient’s capacity to recall past Cognitive experiences, to think abstractly, and to represent CC Dysfunction events and interrelate and process them symbolically. Emotional Looks at dysregulation of affect and irritability in DD Lability moods. Assesses patient’s level of mistrust and EE Guardedness defensiveness

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Coping Styles

Non-psychiatric aspects Scale MBMD Coping Style 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

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Coping Styles and Millon’s Personality Theory

Self-Other

Self (low) Self (high) Other (high) Other (low) Dependent Independent Personalities Personalities

Coping Styles

Passive Cooperative Confident

Active Sociable Oppositional

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Stress Moderators

Scale Description Illness Apprehension vs. Patients’ focus on and awareness of changes A Illness Acceptance in their bodies. Functional Deficits vs. Patients’ perception that they are unable to B Functional Competence perform activities of daily living. Pain Sensitivity vs. Pain Patients’ tendency to be overly sensitized and C Tolerance reactive to mild to moderate pain. Social Isolation vs. Social Patients’ perception of social supports in their D Support lives. Future Pessimism vs. Patients’ outlook toward their future health E Future Optimism status. Degree to which patients lack religious or Spiritual Absence vs. F spiritual resources for dealing with the Spiritual Faith stressors and fears of the medical condition.

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Treatment Prognostics

Scale Description Predicts whether patients will be able to Interventional Fragility adjust emotionally to the demands of G vs. Interventional physically and psychologically stressful Resilience protocols.

Medication Abuse vs. Predicts likelihood that patients will have H Medication problems with or will misuse prescribed Conscientiousness medication. Assesses a patient’s lack of receptivity to Information Discomfort specific details about diagnostic, I vs. Information prognostic, and treatment procedures and Receptivity outcomes.

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Treatment Prognostics

Scale Description Assesses the likelihood that a patient will Utilization Excess vs. use medical services more than the J Appropriate Utilization average patient with a similar medical condition.

Problematic Compliance Identifies patients who resist following K vs. Optimal Compliance medical recommendations.

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Management Guide

Scale Description Assesses the risk of treatment L Adjustment Difficulties complications. Indicates whether the patient might benefit M Psych Referral from psychosocial intervention.

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Administration Scoring Interpretation

Administration

English Spanish

Paper and Computer Pencil

Audio Recordings Available

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Scoring

Computer Scoring (Q-global®, Q Local™, Mail-in, Fax) • Interpretive Report • Profile Report

Hand Scoring

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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

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Prevalence Score (PS)

Interpretation/ PS Interpretive Benchmarks

< 35 Asset

75-84 Moderate or Present Liability

85+ Marked or Prominent Liability.

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MBMD Interpretive Model

A. B. C. D. Review Patient Analyze Modifying Analyze Sections Integrate Information Indices of Profile Profile

1. Medical 1. Validity 1. Psychiatric 1. Analyze condition 2. Disclosure Indications Patterns 2. Clinical 3. Desirability 2. Coping Styles 2. Assess Observations 4. Debasement 3. Stress importance and Interviews Moderators of minor 3. Other test score 4. Treatment results variations Prognostics 4. Background 3. Noteworthy and Responses demographics 4. Healthcare gender, age, Provider etc. Summary

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Sample Report

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Response Patterns and Negative Health Habits

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Psychiatric Indications and Coping Styles

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Stress Moderators

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Treatment Prognostics and Management Guides

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Training Opportunities

Online Training Available (earn up to 3 APA CE credits) www.PearsonClinical.com/MBMD

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Questions?

Visit PearsonClinical.com/MBMD

Customer Support 800-627-7271 (USA) 866-335-8418 (Canada)

Appendix

Sample Test Report Narrative Sections

• General Medical Report

• Bariatric Report

• Pain Report

• Pre-surgical

• Non-surgical

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Sample General Medical Report

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Sample General Medical Report (contd.)

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Sample Bariatric Report

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Sample Pre-Surgical Pain Report

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Sample Pre-Surgical Pain Report (contd.)

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Sample Non-Surgical Pain Report

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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.

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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.

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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

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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.

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References for Validity of the MBMD in Clinical Settings

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.

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References for Validity of the MBMD in Clinical Settings

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.

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Validity Studies on the 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

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