Showing papers by "David Spiegel published in 1992"

Effects of Psychosocial Support on Patients with Metastatic Breast Cancer

Abstract: This article reviews evidence that psychosocial support may influence the progression of cancer, as indicated by differences in length of survival. Psychotherapeutic methods that have proved to be effective involve direct confrontation of fears; expression of affect, including aegative feelings; provision of social support; and training in self-hypnosis for analgesia. Possible mechanisms for this psychosocial effect on progression of disease include changes in diet and exercise, better use and provision of health care, and positive effects on the sensitivity of the endocrine and immune systems to stress. The author reviews the limitations of these theories and offers suggestions for future research.

Changes in marital and sexual functioning in long‐term survivors and their spouses: Testicular cancer versus hodgkin's disease

Abstract: This study compares the effects of the cancer experience on various aspects of marital and sexual functioning (e.g., communication, emotional support, body image, sexual satisfaction and frequency) for two groups of long-term cancer survivors (testicular cancer and Hodgkin's disease) and their spouses. Comparisons between the two patient groups showed significantly more survivors of Hodgkin's disease than testicular cancer reporting the emergence of special issues and changes in the marital relationship. No differences emerged between the spouse groups on sexual functioning variables; however, spouses of survivors of Hodgkin's disease were more likely than spouses of survivors of testicular cancer to report the development of special issues and communication difficulties. A substantial proportion of both survivor groups disclosed negative changes in body image and sexual frequency. Majorities of both survivors and spouses acknowledged that the illness had drawn them closer together. When representative marital/sexual functioning variables were used to predict Family Environment Scale (FES) scores for survivors and for spouses, changes in the spouse's importance, influence of the illness on the relationship, and changes in sexual frequency emerged as significant predictors. The clinical significance of long-term changes in marital and sexual functioning for the couple and the need for therapeutic interventions are discussed.

Do psychosocial factors influence the course of breast cancer? A review of recent literature, methodological problems and future directions

Abstract: The course of breast cancer is highly variable, and only part of the variability in progression rate can be predicted by clinicopathological factors. It is suggested that some of the variation may be ascribed to behavioral factors, but their importance in determining progression of breast cancer is still controversial. Several groups have found an association between progression of breast cancer and psychosocial factors including stressful life events, the expression of negative emotions—anger and anxiety—the presence of hopelessness, social support, and participating in psychosocial counselling. However, other groups failed to confirm these results. Here we review psycho-oncology research studies with breast cancer patients including those employing cross-sectional, longitudinal and experimental designs. Results of these studies, methodological problems and future directions for this line of research are discussed.

Hypnosis and related techniques in pain management.

Abstract: Hypnosis has been used successfully in treating cancer patients at all stages of disease and for degrees of pain. The experience of pain is influenced not only by physiological factors stemming from disease progression and oncological treatment, but also from psychosocial factors including social support and mood. Each of these influences must be considered in the successful treatment of pain. The successful use of hypnosis also depends upon the hypnotizability of patients, their particular cognitive style, their specific motivation, and level of cognitive functioning. While most patients can benefit from the use of hypnosis, less hypnotizable patients or patients with low cognitive functioning need to receive special consideration. The exercises described in this chapter can be successfully used in groups, individual sessions, and for hospice patients confined to bed. Both self-hypnosis and therapist guided hypnosis exercises are offered.

Deposition and Removal of Cutaneous Beta2-Microglobulin

Abstract: These studies were designed to track the cutaneous deposition of beta2-micro-globulin (β2M) in patients on chronic hemodialysis, patients with chronic renal insufficiency and patients with successful renal transplants. Immunoperoxidase staining of skin biopsies from dialysis patients demonstrated significantly increased amounts of β2M compared to controls (p 2M content and the years of dialysis treatment. Renal transplant recipients had decreased skin content of β2M compared to hemodialysis patients. There was no difference in the skin β2M content in patients with chronic renal insufficiency not on hemodialysis and controls. No dialysis patient had amyloid in the skin by Congo red stain. We conclude that β2M accumulates in the skin of patients on chronic hemodialysis. This β2M is not in the form of amyloid. Successful renal transplantation allows for the removal of β2M from the skin indicating that β2M not in the form of amyloid can be mobilized from tissue sites.

A case of probable dissociative disorder.

Abstract: The case of a patient with symptoms suggestive of a dissociative disorder is presented. The consultant reviews the diagnosis of multiple personality disorder (MPD) as defined in DSM-III-R and DSM-IV in relation to the patient's dissociative states, hallucinations, memory loss, and other symptoms. He then highlights the distinctions among MPD, schizophrenia, borderline personality disorder, major depression, and complex partial seizures. After presenting the conceptualization of MPD as a chronic posttraumatic stress disorder, he concludes with a review of treatment approaches that address the traumatic history and that involve hypnosis to gain access to and control dissociative states.