Showing papers by "David Spiegel published in 1990"

New uses of hypnosis in the treatment of posttraumatic stress disorder.

Abstract: Hypnosis is associated with the treatment of posttraumatic stress disorder (PTSD) for two reasons: (1) the similarity between hypnotic phenomena and the symptoms of PTSD, and (2) the utility of hypnosis as a tool in treatment. Physical trauma produces a sudden discontinuity in cognitive and emotional experience that often persists after the trauma is over. This results in symptoms such as psychogenic amnesia, intrusive reliving of the event as if it were recurring, numbing of responsiveness, and hypersensitivity to stimuli. Two studies have shown that Vietnam veterans with PTSD have higher than normal hypnotizability scores on standardized tests. Likewise, a history of physical abuse in childhood has been shown to be strongly associated with dissociative symptoms later in life. Furthermore, dissociative symptoms during and soon after traumatic experience predict later PTSD. Formal hypnotic procedures are especially helpful because this population is highly hypnotizable. Hypnosis provides controlled access to memories that may otherwise be kept out of consciousness. New uses of hypnosis in the psychotherapy of PTSD victims involve coupling access to the dissociated traumatic memories with positive restructuring of those memories. Hypnosis can be used to help patients face and bear a traumatic experience by embedding it in a new context, acknowledging helplessness during the event, and yet linking that experience with remoralizing memories such as efforts at self-protection, shared affection with friends who were killed, or the ability to control the environment at other times. In this way, hypnosis can be used to provide controlled access to memories that are then placed into a broader perspective. Patients can be taught self-hypnosis techniques that allow them to work through traumatic memories and thereby reduce spontaneous unbidden intrusive recollections.

Facilitating emotional coping during treatment.

Abstract: Patient resources for coping with breast cancer can be enhanced by attention to cognitive, affective, psychosomatic, and social components of the illness. The diagnosis and treatment of breast cancer constitutes an immediate confrontation with mortality, and sympathetic but direct examination of the patient's vulnerability and means of coping with it will reduce rather than amplify death anxiety. The development and pursuit of realistic goals influenced by the prognosis can help patients adjust constructively. Extremes of emotion are to be expected at times, but persistent depression and/or anxiety should be vigorously treated, including the use of appropriate psychoactive medication when the symptoms are primarily somatic (e.g., sleep disturbance and reductions in energy). Physical symptoms such as pain, nausea, and vomiting can be controlled by teaching patients such techniques as self-hypnosis, biofeedback, and systemic desensitization. Finally, a feeling of social isolation is the rule, not the exception, with cancer patients. Group and family treatment can effectively counter this. Systematic studies of such treatment interventions have shown favorable results, including significant reductions in mood disturbance and pain.

Physical Performance at work and at Leisure

Abstract: This article examines the concurrent validity of a measure of use of biological energy. The measure consists of the individual's activity patterns at work and at leisure and is weighted by a factor associated with the expenditure of biological energy. The results obtained from 85 men who had been treated for Hodgkin's disease indicated that more sedentary activity patterns are positively correlated with scores on the Fatigue subscale of the Profile of Mood States (POMS), whereas more active patterns are positively correlated with scores on the POMS Vigor subscale, self-reports of energy level, and self-ratings of health status. In addition, consistent with biological research, perceived energy levels interact with activity patterns at leisure but not at work. Using this strategy to assess an individual's physical performance at work after the diagnosis and treatment of cancer may help practitioners in rehabilitation counseling.

Minding the Need for Specialists in Brain Diseases

Abstract: A recent call for a new speciality in biologically based brain diseases is questioned on historical, empirical, and theoretical grounds. Psychiatry has oscillated between biological and psychosocial explanations for mental illness since its inception. Training in the biological basis of mental illness is and should be incorporated into psychiatric training, along with a balanced appreciation of the utility of psychotherapeutic and social intervention. Emphasis on only one aspect resurrects Cartesian dualism. Any disease, however biological in origin, is best treated by a clinician adept at multiple levels of understanding and intervention.