Showing papers by "David Spiegel published in 1997"

The Economic Impact of Psychotherapy: A Review

Abstract: Objective: The authors reviewed data involving the impact of providing psychotherapy for psychiatric disorders on costs of care. Method: In a search of the MEDLINE database limited to peer-reviewed papers published from 1984 through 1994, 686 articles were identified. Forty-one articles, covering 35 studies, were found in which the intervention tested was psychotherapeutic and the study included measures of outcome that had some implications for cost. The exclusion criteria for reviewing these studies included absence of a comparison group, a focus on medical disorders instead of psychiatric illnesses, and outcomes that did not include cost data or measures from which costs could be inferred. On this basis, 18 of the 35 studies were selected for analysis. The studies were categorized according to whether or not subjects were randomly assigned to study groups. Two reviewers independently read each study to identify the following characteristics: inclusion criteria, exclusion criteria, types of interventions, main outcome variables, sample size, and statistical tests for significant differences between treatments. Outcomes had to include actual cost accounting or data on medical care utilization or work functioning. Results: The findings of eight (80%) of the 10 clinical trials with random assignment and all eight (100%) of the studies without random assignment suggested that psychotherapy reduces total costs. Conclusions: Psychotherapy appears to have a beneficial impact on a variety of costs when used in the treatment of the most severe psychiatric disorders, including schizophrenia, bipolar affective disorder, and borderline personality disorder. Much of that impact accrues from reductions in inpatient treatment and decreases in work impairment. (Am J Psychiatry 1997; 154:147‐155)

Trauma, dissociation, and memory

Abstract: Dissociation is a failure to integrate aspects of identity, memory, perception, and consciousness. Individuals with dissociative disorders usually report a history of exposure to traumatic stressors. Dissociative symptoms are included in the DSM-N definition of posttraumatic stress disorder (PTSD) and are required for a diagnosis of acute stress disorder. Several appealing models for a neural basis of dissociation have recently appeared and are reviewed.

Imagery and hypnosis in the treatment of cancer patients.

Abstract: Many patients with cancer often seek some means of connecting their mental activity with the unwelcome events occurring in their bodies, via techniques such as imagery and hypnosis. Hypnosis has been shown to be an effective method for controlling cancer pain. The techniques most often employed involve physical relaxation coupled with imagery that provides a substitute focus of attention for the painful sensation. Other related imagery techniques, such as guided imagery, involve attention to internally generated mental images without the formal use of hypnosis. The most well-known of these techniques involves the use of "positive mental images" of a strong army of white blood cells killing cancer cells. Despite claims to the contrary, no reliable evidence has shown that this technique affects disease progression or survival. Studies evaluating more broadly defined forms psychosocial support have come to conflicting conclusions about whether or not these interventions affect survival of cancer patients. However, 10-year follow-up of a randomized trial involving 86 women with cancer showed that a year of weekly "supportive/expressive" group therapy significantly increased survival duration and time from recurrence to death. This intervention encourages patients to express and deal with strong emotions and also focuses on clarifying doctor-patient communication. Numerous other studies suggest that suppression of negative affect, excessive conformity, severe stress, and lack of social support predict a poorer medical outcome from cancer. Thus, further investigation into the interaction between body and mind in coping with cancer is warranted. [ONCOLOGY 11(8):1179-1195, 1997]

Relateralizing hypnosis: or, have we been barking up the wrong hemisphere?

Abstract: Research and theory over the past couple decades have suggested that the right cerebral hemisphere might be the focus of brain activity during hypnosis. Recent evidence from electrodermal responding, visual event-related potentials, and Stroop interference, however, can make a case for a role of the left hemisphere in some hypnotic phenomena. Although hemispheric activation on hypnotic challenge may depend in large part on the kind of task the challenge might involve, several general aspects of hypnosis might be more appropriately seen as left-rather than right-hemisphere brain functions. Among these are concentrated attentional focus and the role of language in the establishment of hypnotic reality. A left-hemisphere theory of hypnosis is discussed in light of recent findings and theories about a left-hemisphere basis for synthetic or generational capabilities (Corballis, 1991) and a neuro-evolutionary model of a left-hemisphere dopaminergic activation system for the implementation of predetermined motor programs (Tucker & Williamson, 1984).

Effectiveness of a training program for enhancing therapists' understanding of the supportive-expressive treatment model for breast cancer groups.

Abstract: This study evaluated a training program for leaders of supportive- expressive psychotherapy groups for breast cancer patients. Twenty-four mental health/medical cancer care professionals completed two training phases and were tested for their understanding of the treatment model. Participants' understanding was enhanced as a result of the training program. This study demonstrates that a brief training program can improve therapists' understanding of the treatment model and demonstrates an effective method of evaluation. Future research should examine how performance on these tests generalizes to performance when leading a supportive-expressive group.

Understanding risk assessment by cancer patients.

Abstract: teasing out longitudinally a variety of causal sequences and time-lagged effects among the multiple factors in our refined stress models’ (pp. 69–70). I would like to believe that this is true, but as yet I cannot see how to cross the logical gap between person-based systems models and the analysis of statistical aggregates at the variable level. In summary, I believe that the strengths of Somerfield’s article lie in his attention to the continuing gaps between theory, research and practice, and in his advocacy of multiple, targeted methods to capture the richness of particular stress and coping processes. However, I prefer to interpret these gaps as indicating serious dislocations between the avowed and actual practices of coping researchers, and accordingly suggest the need for more radical solutions which can be derived from a closer examination of the implications of adopting a person-based systems approach.

Women's Health: The psychophysiology of breast cancer: Disease, hormones, immunity, and stress

Abstract: Breast cancer is a public health problem in the United States, with an estimated 182,000 new cases occurring in women in 1994. For most women, a diagnosis of breast cancer marks the beginning of a lifelong struggle. The disease and treatments become physical-psychological stressors whose effects linger long after the individual is tumor-free. This chapter examines the inherent psychosocial stressors that accompany a cancer diagnosis and the psychophysiologic effects that may occur as a result of these stressors. The physiologic and psychological stressors have been shown to profoundly influence neuroimmunoendocrine functioning. Some recent evidence indicates that psychosocial interventions designed to alleviate the cancer patients distress may affect disease progression and survival time, as well as improve quality of life. Three domains that may play a role in moderating health outcome are personality and coping characteristics, level of emotional expression, and social support.