BOOK REVIEW Behavioral
Medicine (Springer ,Medicine)
Series on Behavior Therapy
conclude that none of the methods described provides a complete assessment of patient’s pain experiences; therefore, multiple measures are needed to evaluate chronic pain. The chapter concludes with a plea for physicians and other health care professionals who treat chronic pain patients to develop skills in behavior measurement. This chapter is succinct, informative, and clinically useful. In the final chapters the editor points out that ratings are “largely inaccurate” and behavioral observations depend upon observer reliability. Behavioral physics, “the branch of behavioral measurement that assesses the physical forces associated with the emission and omission of overt behavior enhances accuracy”. Instruments such as the actometer, pedometer, stabilimeter, photoelectric cell, ultrasound devices, electronic accelerometers and load transducers are discussed in detail, Numerous formulas and tables dot the chapters on human activity. The use of electronic mechanical devices in the behavioral measurement of human activity is equated with the dawn of modern medical science when diseases began to be thought of in terms of measurements integral to the natural or physical sciences. Fo: clinicians the last chapter is the most interesting one in the book. The use of various instruments to study brain damaged children, hyperactive children, behavioral disorders, obesity, and anorexia nervosa illustrate clinical applications in a fascinating way. The use of an actometer with hyperactive children who have been treated with methylphenidae (Ritalin) and placebo is innovative. AS in most edited books, repetition is unax.oidable and some chapters are tedious reading, but this volume underscores the necessity for clinicians to validate their work by measurement of results. The evolution of behavioral medicine into a position of prominence depends upon objective assessment. Although clinicians may find this book trying, it is worth reading. Researchers in behavioral medicine will do well to add it to their libraries.
The purpose of the book is “to advance the state of measurement in the multidisciplinary field of behavioral medicine”, and this view is emphasized by the usage of the root word “measure” more than 130 times in the intitial chapter. Chapter 2 describes the measurement of obesity including densitometry, inert gas uptake, total body water, total body potassium, anthropometry, and weight. The behavioral, cognitive and emotional factors related to obesity are briefly discussed. In this chapter the authors comprehensively cover the subject of assessment and include an appendix entitled “common formulas used in the assessment of obesity status”. The chapter on smoking behavior summarizes data on rate and topography measures and correctly concludes that biochemical measurement (carbon monoxide, thiocyanate, and nicotine) is a more accurate assessment of smoking behavior upon health. In the chapter on acohol abuse a broad spectrum behavioral approach is endorsed in “the SORC framework” (Ssituational antecedents, O-organismic variables, Cconsequences maintaining drinking and R-response). While traditional behavioral assessment models are important, the authors stress the need for more objective physiological measures of drinking behavior such as blood alcohol level. and liver function tests which they point out can also be misleading. A blending of self-report and observation together with physiological measurements can best assess alcohol abuse. An interesting sidelight to this chapter is the assessment of female drinkers and the relationship between blood alcohol level, hormones and the menstrual cycle. In Chapter 5, ambulatory activity in chronic disease, the observation is made that many medical decisions; e.g., surgery, use of medications, choice of medical procedures are determined by subjective observations of doctors and nurses. Motion measurements, for example, the use of a pedometer can be useful in treatment decisions concerning arthritis, cirrhosis, coronary heart disease, chronic pulmonary disease, obesity and schizophrenia and depression. In Chapter 6, a multidimensional schema for chronic pain consists of the measurement of overt motor behaviors, cognitive responses, and physiological variables. The authors
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