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Biomedical subjects

W B Stiles

Publications and source records attributed to W B Stiles.

At least 37 records · Page 2Linked to original sources
PubMed1994

Disabuse of the drug metaphor: psychotherapy process-outcome correlations.

The drug metaphor suggests that if a process component (e.g., interpretation) is an active ingredient of a successful psychotherapy, then administering a relatively high level of it should yield a relatively positive outcome, and levels of the process component and the outcome should be correlated across clients. Measures of 5 theoretically relevant, reliably measured verbal process components were compared with the rate of change in 3 standard symptom intensity measures across the brief treatments of 39 (mainly depressed) psychotherapy clients. The expected significant process-outcome correlations were not found. These results are discussed as they illuminate some misleading assumptions that underlie many conventional studies of psychotherapy process and outcome.

Adult↗
PubMed1993

Verbal exchanges in medical interviews: implications and innovations.

Medical interviews (consultations) are composed of verbal exchanges, complementary categories of speech by patients and clinicians that tend to occur together. Patients and clinicians employ a joint repertoire of exchanges to accomplish their goals in the encounter. The seven principal exchanges are called Exposition, Closed Question, Checking, Direction, Inquiry, Explanation, and Instruction/Contracts. We discuss how the verbal exchange structure contributes to understanding the confluence of patients' and clinicians' goals and expectations, clinicians' hypothetico-deductive method of reasoning during interviews, and establishing the patient-clinician relationship. We conclude by considering new exchanges that might make medical interviewing more effective and humane.

Communication↗
PubMed1993

Lack of synchronized seasonal variation in the intensity of psychological problems.

Temporal variation in the subjective intensity of psychological problems identified by 40 psychotherapy clients (most diagnosed as depressed) was investigated longitudinally. Each client rated the intensity of 10 individualized problems 3 times per week (on Tuesdays, Thursdays, and Sundays) for an average of 6 months. Ratings from all clients were spread over 3 years. When scores were statistically adjusted for client differences and average rate of improvement, no significant variation among months was found, regardless of problem content or client gender. Standard assessment measures administered 4 times to each client also failed to show systematic seasonal variation.

Adult↗
PubMed1993

The shape of change in psychotherapy: longitudinal assessment of personal problems.

We propose 4 parameters that describe the course of change in the subjective intensity of personal problems during psychotherapy: (a) the problem's initial severity; (b) its rate of change (deterioration or improvement); (c) its instability (day-to-day variability in intensity); and (d) its curve (change in the rate of change during treatment). We constructed indexes of these parameters for 10 individualized personal problems rated 3 times per week by each of 40 clients (most were diagnosed as depressed) over the course of their 16-session treatment and associated assessment periods. Initial severity predicted problems' reported salience to clients. The rate of change parameter was correlated (across clients) with traditional pretreatment to posttreatment outcome measures. Instability was high, and problems dealing with tension symptoms and mood were more unstable than were problems dealing with relationships or self-esteem. Cutting across problem content were large individual differences among clients in the patterns of change.

Adult↗
PubMed1993

Physician frustration in communicating with patients.

In this study, the nature of practicing physicians' "frustrating" visits was explored and a guide to help physicians identify problems in communicating with patients was developed. The study included 1,076 practicing physicians who attended a voluntary workshop on physician-patient communication. The physicians were from multiple specialties and diverse work settings geographically dispersed throughout the United States. The method included development of a preliminary item pool (descriptions of frustrating patients and occasions) by experienced physicians and teachers of medical communication, additions/deletions/revisions of items within the pool, empirical analyses to reduce redundancy and group-like items, and construct validation of the final 25-item questionnaire. Factor analysis was used to identify subscales. Physicians most often attributed communication problems to the patient rather than to their own limitations. Seven types of communication problems (subscales) were identified, including: 1) lack of trust/agreement, 2) too many problems, 3) feeling distressed, 4) lack of understanding, 5) lack of adherence, 6) demanding/controlling patient, and 7) special problems. Primary care physicians reported greater problems than specialists on four subscales. Physicians practicing in health maintenance organizations reported greater problems than physicians in fee-for-service practice on five subscales. Seven sources of frustration physicians experience in their work with patients were identified. Understanding these frustrations will allow physicians to reflect on their own experiences and potentially improve the quality of their patient visits.

Adult↗
PubMed1992

Verbal exchanges in medical interviews: concepts and measurement.

The verbal exchange theory of medical interviews (consultations) proposes that patients and clinicians employ a joint repertoire of exchanges to accomplish their goals in the encounter. The skeleton of each exchange is a set of speech acts that tend to be used together in interviews, for example, (a) clinician questions and patient yes/no answers, or (b) clinician directives and patient agreements to comply. We describe seven principal exchanges, each of which has been identified empirically in multiple studies of interviews: Exposition, Closed Question, Checking, Direction, Inquiry, Explanation, and Instruction/Contracts.

Humans↗
PubMed1992

Disclosure and anxiety: a test of the fever model.

According to the fever model of Disclosure, the relationship of Disclosure (utterances that reveal subjective information) to psychological distress is analogous to the relationship of fever to physical infection: Both are indicators of some underlying disturbance and part of a restorative process. High and moderate trait anxious university students (but not the low trait anxious students) used higher percentages of Disclosure when speaking about an anxiety-arousing topic than when speaking about a happy topic. With topic order counterbalanced, students tended to use more Disclosure during their 1st presentation than during their 2nd. These results support the fever model's suggestion that people tend to Disclose when they are distressed.

Adaptation, Psychological↗
PubMed1990

Correlations of session evaluations with treatment outcome.

Do evaluations of psychotherapy sessions predict treatment outcome? Clients (n = 40) and their therapists rated each session (n = 16 per client) of their brief therapy on the Session Evaluation Questionnaire (SEQ), which yields indices of session Depth (power, value) and Smoothness (comfort, safety). External raters rated tape-recordings of half of the sessions. SEQ ratings by one of two principal therapists were strongly correlated with client improvement on self-report measures; those of the other therapist were not. Clients' SEQ ratings did not show the expected correlations with improvement. External raters' ratings of session Smoothness were significantly correlated with client improvement on some measures.

Female↗
PubMed1989

Evaluating medical interview process components. Null correlations with outcomes may be misleading.

A standard criterion for judging the value of a medical interview process component, such as physician information giving, is the degree to which it correlates with positive outcomes, such as patient satisfaction, compliance, or symptom relief. There is a serious problem, however, with this use of correlations. Physicians and patients, like any human beings, give and respond to signals as to what each requires in the interaction. Any such appropriate responsiveness tends to attenuate (and may even reverse) the process-outcome correlation. Under optimum conditions, process components covary with patient requirements but not with outcomes. Thus, for expertly conducted interviews, the expected correlation of process components with outcomes approaches zero, even for components that are causally related to those outcomes.

Humans↗
PubMed1988

Interactions of depressed college students with their roommates: not necessarily negative.

Coyne's (1976b) interactional theory of the social environment's role in maintaining depression suggests that depressed people create negative affect in others. This leads to a pattern of interactions between depressed individuals and others that is aversive to both parties and becomes a vicious circle. We examined interactions of 15 depressed and 15 nondepressed college students with their roommates. On questionnaires, roommates did indicate more rejection, dislike, and avoidance of the depressed students than of the nondepressed students, consistent with Coyne's theory, and depressed-student-roommate interactions were more personally involved (higher percentage of self-disclosure) and less positive than nondepressed-student-roommate interactions. The moods of both depressed students and their roommates were worse than those of controls before the interaction but, contrary to expectation, improved over the course of the interaction, whereas the moods of nondepressed students and their roommates did not change significantly. Implications of these results for Coyne's theory are discussed.

Adolescent↗
PubMed1987

Patient exposition and provider explanation in routine interviews and hypertensive patients' blood pressure control.

Hypertensive patients' expressing themselves in their own words (Exposition) and providers' giving information (Explanation) during medical interviews were hypothesized to be associated with subsequent blood pressure control. Transcripts of routine return visits to clinics in low-income areas of Houston, TX, were coded using the Verbal Response Modes (VRM) system. VRM indexes of Patient Exposition and Provider Explanation were tested in relation to systolic and diastolic blood pressure obtained during home interviews 2 weeks after the clinic visits. Patient Exposition was significantly correlated with reductions in systolic and diastolic blood pressure from clinic visit to home interview, and Provider Explanation was significantly correlated with lower diastolic blood pressure at home interview. The results suggest that patients' and providers' verbal behavior in medical interviews should be included in predictive models of blood pressure control.

Adult↗
PubMed1985

Patient exposition and physician explanation in initial medical interviews and outcomes of clinic visits.

To replicate an earlier study and explore associations between verbal behaviors in patient-physician interactions and outcomes of care, 102 visits to a medicine walk-in clinic were tape-recorded, transcribed, and coded according to the Verbal Response Mode (VRM) system. Questionnaires given before and after the clinic visit and telephone interviews 1 week and 4 weeks after the visit were used to measure patient satisfaction, compliance, and change in symptoms. Data were collected on patients' sociodemographic characteristics, illness characteristics, and health beliefs. Two verbal exchanges were examined: in the medical history, the Patient Exposition exchange, which was measured as the frequency with which patients make statements about their illnesses in their own words; and in the conclusion, the Physician Explanation exchange, which was measured as the percentage of physician statements that are factual. These verbal indexes showed correlations with patient satisfaction, thus replicating the earlier study, but no significant correlations with compliance. Analysis of variance showed that the association between verbal exchanges and patient satisfaction remained after controlling for physician differences and for patient age, education, and belief in the controllability of the illness.

Adult↗
PubMed1984

Dimensions of psychotherapy session impact across sessions and across clients.

The Session Evaluation Questionnaire measures two dimensions of participants' perceptions of psychotherapy sessions, depth and smoothness, and two dimensions of post-session mood, positivity and arousal. In ratings by therapists and in ratings by clients, the same dimensions were identified as underlying variation across sessions and variation across clients. Thus these 'impact' dimensions can be used for session-level comparisons with process variables and for client-level comparisons with outcome variables, possibly permitting two-stage inferences from process to impact to outcome.

Adolescent↗
PubMed1984

Client disclosure and psychotherapy session evaluations.

Clients' percentage of disclosure (first person, subjective utterances) was compared with evaluative session ratings by clients, therapists, and an external rater across 43 psychotherapy sessions. In contrast to observers' perceptions, participants' perceptions of session depth and value were not correlated with client disclosure. Sessions high in disclosure (relative to the client's usual level) were rated from all three perspectives as relatively rough, unpleasant, difficult, and dangerous.

Adult↗