Showing papers by "David Spiegel published in 1996"
TL;DR: Effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course.
Abstract: Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.
308 citations
TL;DR: Fighting spirit and emotional expressiveness were found to be associated with better adjustment in women with metastatic or recurrent breast cancer, and no conclusions regarding a causal relationship between adjustment and emotional expressesiveness or adjustment and fighting spirit were possible.
Abstract: The aim of this study was to determine whether psychological adjustment to advanced breast cancer was positively associated with expressing emotion and adopting a fighting spirit and negatively associated with denial and fatalism. Total mood disturbance on the Profile of Mood States was used as the measure of psychological adjustment. The Courtauld Emotional Control Scale measured emotional expression, and the Mental Adjustment to Cancer measured fighting spirit, denial, and fatalism. The sample included 101 women with a diagnosis of metastatic or recurrent breast cancer. Fighting spirit and emotional expressiveness were found to be associated with better adjustment. No association was found between mood disturbance and denial or fatalism. Because this was a cross-sectional study, no conclusions regarding a causal relationship between adjustment and emotional expressiveness or adjustment and fighting spirit were possible.
246 citations
TL;DR: High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress, according to several lines of evidence converge in support of the role of autohypnosis in pathological dissociation.
Abstract: OBJECTIVE The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience. METHOD To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed. RESULTS Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process. CONCLUSIONS High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.
203 citations
TL;DR: There is a nonrandom relationship among various psychosocial factors and cancer incidence and progression that can only partially be explained by behavioral, structural, or biological factors.
Abstract: The impact of psychosocial factors on the incidence and progression of cancer has become an area that demands attention. In this article recent evidence of psychosocial effects on cancer incidence and progression is reviewed in the context of past research. Psychosocial factors discussed include personality, depression, emotional expression, social support, and stress. Mechanisms that could mediate the relationship between psychosocial conditions and cancer incidence and progression are also reviewed. These include alterations in diet, exercise, and circadian cycles; variations in medical treatment received; and physiological mechanisms such as psychoendocrinologic and psychoneuroimmunologic effects. We conclude that there is a nonrandom relationship among various psychosocial factors and cancer incidence and progression that can only partially be explained by behavioral, structural, or biological factors. Suggestions for future research are discussed.
121 citations
TL;DR: Self-hypnotic relaxation can reduce drug use and improve procedural safety and benefit did not correlate with hypnotizability.
Abstract: The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.
111 citations
01 Jan 1996
TL;DR: The proposal for a new diagnostic entity requires very careful consideration of the benefits and risks that such a decision entails, and it is incumbent upon the advocates of the diagnosis to show that their proposal will not simply add to the profusion of diagnoses, but rather that the disorder cannot be reasonably accommodated by the existing nosology.
Abstract: The proposal for a new diagnostic entity requires very careful consideration of the benefits and risks that such a decision entails. On the one hand, if a condition that is prevalent in a substantial percentage of the population goes undiagnosed or misdiagnosed, the affected individuals will lack proper diagnosis and treatment of their condition. In turn, the lack of recognition of the diagnostic entity might prevent the proper research designed to understand the condition, its treatment, and its clinical and social ramifications. On the other hand, carelessly introducing new diagnostic entities brings the risk of pathologizing what may be innocuous or even appropriate reactions to the misfortunes of life. Further, even if the symptomatology of the diagnosis can be considered “pathological,” it is still incumbent upon the advocates of the diagnosis to show that their proposal will not simply add to the profusion of diagnoses, but rather that the disorder cannot be reasonably accommodated by the existing nosology.
80 citations
TL;DR: The data suggest that hemodialysis patients carry their excess fluid volume primarily in the extracellular compartment and that bioimpedance spectroscopy coupled with a stable measure of lean tissue such as bone mineral content can determine the degree of relative excess hydration.
63 citations
TL;DR: In this article, the authors examined the relationship between dissociative symptoms experienced in the immediate aftermath of the Oakland/Berkeley firestorm and contact with the fire, life events, demographic variables, and actions taken after learning about the fire.
Abstract: This study examined relationships between dissociative symptoms experienced in the immediate aftermath of the Oakland/Berkeley firestorm and contact with the fire, life events, demographic variables, and actions taken after learning about the fire. One hundred eighty-seven participants completed self-report measures about their experiences during and immediately following the fire. Dissociative symptoms were significantly related to contact with the fire, sex, and stressful life events. Also, dissociative symptoms were significantly related to engaging in certain activities, such as trying to get closer to the fire and going into blocked-off areas and crossing police barricades. These results suggest that dissociative symptoms may merit special attention in intervention focusing on the immediate aftermath of disaster.
60 citations
TL;DR: The results are discussed in terms of Farah's model of a left hemisphere mechanism for image generation, and how highly hypnotizable subjects might use this mechanism to comply successfully with the suggestion of a hallucinated visually opaque barrier.
27 citations
TL;DR: The authors found no relationship between psychological distress, as measured by the Symptom Check List- 90-Revised (SCL-90-R), and recurrence of disease in or survival of patients with breast cancer.
Abstract: In this issue of the Journal, Tross et al. (7) report on an exceptionally fine study of the relationship between psychological distress and both disease-free and overall survival in women with stage II breast cancer. Their report is noteworthy not only for the rigor of its methods but especially for the open-minded and balanced way in which it is written. The authors found no relationship between psychological distress, as measured by the Symptom Check List-90-Revised (SCL-90-R), and recurrence of disease in or survival of patients with breast cancer. Their study was conducted on a large subsample of patients in the Cancer and Leukemia Group B (CALGB) national clinical trial of adjuvant therapy for stage II breast cancer. Two hundred eighty women, 31% of the total sample, were entered in the study. Even a casual examination of the survival curves for these women shows little support for the idea that distress, as measured by the SCL-90-R, is associated with longer or shorter disease-free or overall survival time. In their report, Tross et al. note the limitations of their study. Although their study was prospective in design, the psychosocial component was apparently retrospective, a useful add-on to an intervention trial. Another important issue is sample bias. The authors were able to assess fewer than a third of the total sample, although it was a sizable number of women. Some of the reasons for this subsample selection, i.e., patient refusal and attrition, might have restricted the range of distress found, thereby reducing the ability of the study to detect a relationship between variance in distress and survival. Indeed, Tross et al. noted that the sample of patients was relatively nondepressed. Being depressed might be a reason for refusal to fill out additional questionnaires. Other reasons, such as a tendency to be uncooperative, have been reported to be associated with longer survival (2). Thus, patients who participated in the study might be self-selected for lacking the depression that might predict poorer outcome or the feistiness that other authors (7,3) have found to predict better outcome.
23 citations
01 Jan 1996
TL;DR: While the interest in and concern with dissociative disorders have grown exponentially in the last decade, with annual conventions, a journal exclusively devoted to dissociation, monographs, and so forth, this state of affairs represents more a rediscovery of concepts and phenomena than a brand new area of inquiry.
Abstract: While the interest in and concern with the dissociative disorders have grown exponentially in the last decade, with annual conventions, a journal exclusively devoted to dissociation, monographs, and so forth, this state of affairs represents more a rediscovery of concepts and phenomena than a brand new area of inquiry (cf. Spiegel & Cardena,1991; van der Kolk & van der Hart, 1989). Hysteria, a concept closely connected with the dissociative disorders, can be traced back at least to Pharaonic Egypt (cf. Kihlstrom, 1994). Closer to our times, just about every one of the forebears of modern psychopathology studied disorders involving a “disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment” (American Psychiatric Association, 1994, p. 477). For example, Breuer and Freud, Pierre Janet, William James, and Morton Prince, among a longer list of distinguished psychologists at the turn of the century, all described fascinating cases of pronounced shifts in identity, memory, somatic reactivity, and consciousness.
TL;DR: A 25-year-old Asian-American single woman, diagnosed with chronic paranoid schizophrenia since age 19, was referred from the inpatient psychiatric unit for evaluation of atypical hallucinations, and expressed a delusional belief that she was controlled by an attractive, popular male former high school teacher who was now sexually obsessed with her.
Abstract: A 25.year-old Asian-American single woman, diagnosed with chronic paranoid schizophrenia since age 19, was referred from the inpatient psychiatric unit for evaluation of atypical hallucinations. She had been admitted 3 days earlier after an intentional overdose of 32 over-the.counter sleeping pills. In the emergency room the patient suffered a witnessed grand mal selzure without incontinence, which was followed by a brief period of confusion and combativeness. A computerized tomogra phy (CT) scan of the brain and an EEG at the referring hospital were reportedly normal. A repeat EEC at our hospital demonstrated intermittent asymmetry with posterior right-hemisphere background slowing, which was considered artifact. The patient expressed a delusional belief that she was controlled by an attractive, popular male former high school teacher who had put a curse on her family before her birth and was now sexually obsessed with her. When her eyes were closed, the patient experienced auditory hallucinations and a single visual hallucination consisting of the man’s face in a black spot that wandered throughout her field of vision. She constantly experienced vivid tactile hallucinations of this man molesting her genitally but not having intercourse with her, and she believed that he videotaped her showering and masturbating in order to show these
TL;DR: This research highlights the need to understand more fully the rationale behind the continued use of CCOP in patients with a history of central giant cell granuloma.
Abstract: David Spiegel, M.D.,l Gary R. Morrow, M.S., Ph.D.,2 Catherine Classen, Ph.D.,l Gail Riggs, M.S.W.,2 Phillip B. Stott, M.D.,3 Narayan Mudaliar, M.S.W.,4 H. Irving Pierce, M.D.,' Patrick J. Flynn, M.D.,6 and Laura Heard, R.N.7 'Department of Psychiatry, Stanford School of Medicine; 'University of Rochester Cancer Center; Kalamazoo CCOP; Wichita CCOP; 'Northwest CCOP; 6Metro-Minnesota CCO P; 7Virginia Mason Research Center