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Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 1
Michael Antoni, Ph.D.
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 2
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)
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 3
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?
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
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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
Psychosocial Factors and Health
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
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 5
MBMD
Psychosocial Factors and Health
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
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
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MBMD
AXIS III & IV
Medical & Psychosocial
AXIS I
Clinical Presentation
(Anxiety, Dysthymia
= Fever, Cough)
(Marital, Economic, Health
= Infectious Agents)
Interactive Nature of the DSM-IV Multiaxial System
MBMD
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)
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 7
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
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 8
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 9
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
Negative Health Habits
(6 scales)Response Patterns
(3 scales)
Psychiatric Indications
(5 scales)
Stress Moderators
(6 scales)
Coping Styles
(11 scales)
Management Guides
(2 scales)
Treatment Prognostics
(5 scales)
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 10
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
Negative Health Habits
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 11
MBMD
Psychiatric Indications
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
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 12
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 13
MBMD
Treatment Prognostics
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
Treatment Prognostics
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 14
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
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 15
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
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 16
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 17
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
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 18
MBMD
Response Patterns and
Negative Health Habits
MBMD
Psychiatric Indications and
Coping Styles
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 19
MBMD
Stress Moderators
MBMD
Treatment Prognostics and
Management Guides
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 20
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)
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 21
Appendix
MBMD
Sample Test Report Narrative Sections
• General Medical Report
• Bariatric Report
• Pain Report
• Pre-surgical
• Non-surgical
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 22
MBMD
Sample General Medical Report
MBMD
Sample General Medical Report (contd.)
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 23
MBMD
Sample Bariatric Report
MBMD
Sample Pre-Surgical Pain Report
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 24
MBMD
Sample Pre-Surgical Pain Report (contd.)
MBMD
Sample Non-Surgical Pain Report
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 25
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 26
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 27
MBMD
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.
MBMD
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.
Overview of the Millon Behavioral Medicine Diagnostic (MBMD)
Michael Antoni, Ph.D.
Copyright © 2017. Pearson Inc., and/or its affiliates. All rights reserved, 28
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