Showing papers by "David Spiegel published in 2000"
TL;DR: Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality, and suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.
Abstract: Background : Abnormal circadian rhythms have been observed in patients with cancer, but the prognostic value of such alterations has not been confirmed. We examined the association between diurnal variation of salivary cortisol in patients with metastatic breast cancer and subsequent survival. We explored relationships between cortisol rhythms, circulating natural killer (NK) cell counts and activity, prognostic indicators, medical treatment, and psychosocial variables. Methods Salivary cortisol levels of 104 patients with metastatic breast cancer were assessed at study entry at 0800, 1200, 1700, and 2100 hours on each of 3 consecutive days, and the slope of diurnal cortisol variation was calculated using a regression of log-transformed cortisol concentrations on sample collection time. NK cell numbers were measured by flow cytometry, and NK cell activity was measured by the chromium release assay. The survival analysis was conducted by the Cox proportional hazards regression model with two-sided statistical testing. Results Cortisol slope predicted subsequent survival up to 7 years later. Earlier mortality occurred among patients with relatively "flat" rhythms, indicating a lack of normal diurnal variation (Cox proportional hazards, P =. 0036). Patients with chest metastases, as opposed to those with visceral or bone metastases, had more rhythmic cortisol profiles. Flattened profiles were linked with low counts and suppressed activity of NK cells. After adjustment for each of these and other factors, the cortisol slope remained a statistically significant, independent predictor of survival time. NK cell count emerged as a secondary predictor of survival. Conclusions Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality. Suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.
1,028 citations
TL;DR: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures and Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
467 citations
TL;DR: Satisfying social relationships were associated with more positive outlooks on life, more secure attachments and interactions with others, more autonomic activation when confronting acute psychological challenges, and more efficient restorative behaviors.
443 citations
TL;DR: This work presents data from multiple datasets and analyses supporting the reliability and construct, convergent, discriminant, and predictive validity of the SASRQ.
Abstract: A reliable and valid measure is needed for assessing the psychological symptoms experienced in the aftermath of a traumatic event. Previous research suggests that trauma victims typically experience dissociative, anxiety and other symptoms, during or shortly after a traumatic event. Although some of these symptoms may protect the trauma victim from pain, they may also lead to acute stress, posttraumatic stress, or other disorders. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was developed to evaluate anxiety and dissociation symptoms in the aftermath of traumatic events, following DSM-IV criteria for acute stress disorder. We present data from multiple datasets and analyses supporting the reliability and construct, convergent, discriminant, and predictive validity of the SASRQ.
284 citations
TL;DR: Observed changes in subjective experience achieved during hypnosis were reflected by changes in brain function similar to those that occur in perception, supporting the claim that hypnosis is a psychological state with distinct neural correlates and is not just the result of adopting a role.
Abstract: OBJECTIVE: This study was designed to determine whether hypnosis can modulate color perception. Such evidence would provide insight into the nature of hypnosis and its underlying mechanisms. METHOD: Eight highly hypnotizable subjects were asked to see a color pattern in color, a similar gray-scale pattern in color, the color pattern as gray scale, and the gray-scale pattern as gray scale during positron emission tomography scanning by means of [15O]CO2. The classic color area in the fusiform or lingual region of the brain was first identified by analyzing the results when subjects were asked to perceive color as color versus when they were asked to perceive gray scale as gray scale. RESULTS: When subjects were hypnotized, color areas of the left and right hemispheres were activated when they were asked to perceive color, whether they were actually shown the color or the gray-scale stimulus. These brain regions had decreased activation when subjects were told to see gray scale, whether they were actually s...
279 citations
TL;DR: Greater quality of social support is associated with lower cortisol concentrations in women with metastatic breast cancer, which is indicative of healthier neuroendocrine functioning and may have clinical implications in the treatment of breast cancer.
Abstract: Objective: This study used a cross-sectional design to examine the relationships between social support, both quantity (number of people) and quality (appraisal, belonging, tangible, and self-esteem), and neuroendocrine function (mean and slope of diurnal salivary cortisol) among women with metastatic breast cancer; Methods: Participants (N = 103) were drawn from a study (N = 125) of the effects of group therapy on emotional adjustment and health in women with metastatic breast cancer. They completed the Interpersonal Support Evaluation List and the Yale Social Support Index and provided saliva samples for assessment of diurnal cortisol levels on each of 3 consecutive days. Diurnal mean levels were calculated using log-transformed cortisol concentrations, and the slope of diurnal cortisol variation was calculated by regression of log-transformed cortisol concentrations on sample collection time. Results: Mean salivary cortisol was negatively related to the Interpersonal Support Evaluation List subscales of appraisal, belonging, and tangible social support. No association was found between quantitative support or the esteem subscale of the Interpersonal Support Evaluation List and mean salivary cortisol. Measures of qualitative and quantitative social support were not associated with the diurnal cortisol slope. Conclusions: Results show that greater quality of social support is associated with lower cortisol concentrations in women with metastatic breast cancer, which is indicative of healthier neuroendocrine functioning. These results may have clinical implications in the treatment of breast cancer.
255 citations
Book•
07 Jan 2000TL;DR: This extraordinary resource celebrates and expands on Dr. David Spiegel's discovery that a shared intimacy with mortality creates very different concerns in the patient from those that apply in conventional settings.
Abstract: This extraordinary resource celebrates and expands on Dr. David Spiegel's discovery that a shared intimacy with mortality creates very different concerns in the patient from those that apply in conventional settings. Spiegel and Classen introduce mental health professionals to the awareness as well as the tools they will need to facilitate groups coping with existential crises. The result is a model for helping that actually helps.
200 citations
TL;DR: It is indicated that HIV-positive persons who experience the greatest stress in their daily lives are those with lower incomes, those who disengage behaviourally/ emotionally in coping with their illness, and those who approach their interpersonal relationships in a less secure or more anxious style.
Abstract: The purpose of this study was to examine the relationships of coping, attachment style and perceived social support to perceived stress within a sample of HIV-positive persons. Participants were 147 HIV-positive persons (80 men and 67 women). Multiple regression analysis was used to examine the relationships of the demographic variables, AIDS status, three coping styles, three attachment styles and perceived quality of general social support with total score on the Perceived Stress Scale (PSS). PSS score was significantly associated with less income, greater use of behavioural and emotional disengagement in coping with HIV/AIDS, and less secure and more anxious attachment styles. These results indicate that HIV-positive persons who experience the greatest stress in their daily lives are those with lower incomes, those who disengage behaviourally/ emotionally in coping with their illness, and those who approach their interpersonal relationships in a less secure or more anxious style.
136 citations
TL;DR: Results showed that patients were less distressed when they rated the relationship higher in Cohesion--Expression and in Conflict and when their partners reported lower mood disturbance.
Abstract: This study examined mood disturbance among women with metastatic breast cancer in relationship to partnership status, relationship quality, and partner's coping and mood disturbance. These associations were examined within a total sample of 125 metastatic breast cancer patients and a subsample of 48 of these patients and their partners. Partnered and single women were indistinguishable in mood disturbance when household income was statistically controlled. Results also showed that patients were less distressed when they rated the relationship higher in Cohesion--Expression and in Conflict and when their partners reported lower mood disturbance. One possible implication of these results is that in relationships in which a woman has metastatic cancer, she may benefit from open engagement of difficulties and conflict. Furthermore, alleviating her distress may be better achieved by focus on the couple relationship rather than her individual coping.
135 citations
Journal Article•
TL;DR: It is suggested that many dialysis patients carry excess extracellular fluid post dialysis despite achieving their clinical dry weight, and the resistance ratio derived from bioimpedance spectroscopy may be a useful clinical tool in determining dry weight.
Abstract: Material: Restoration of body water compartments to normal by ultrafiltration is a major goal of hemodialysis. Dry weight is the term used to define normal body water in dialysis patients, but it is limited, as it is based solely on clinical observations. Bioimpedance spectroscopy can accurately measure the resistance of body fluid compartments. The ratio of the resistances of the intracellular to extracellular water should reflect the relative volume of these compartments. As dialysis patients accumulate excess fluid in their extracellular compartment, this ratio may prove useful in the evaluation of dry weight. Methods: We measured the resistances of the intracellular and extracellular fluid compartments in normal subjects to define the normal ratio of the resistances of these compartments. Women had a slightly higher ratio than men (women: 2.41 ± 0.23 vs. men: 2.08 ± 0.23 vs. p < 0.0001). The ratios determined in the normal population were taken as the normal physiologic ratio and were used to define physiologic dry weight. We then compared dialysis patients both pre- and post-dialysis to this normal population. Results: We found that most patients (67%, n = 18) had an elevated ratio pre-dialysis suggesting excess extracellular fluid. Of the 38 treatments in which patients achieved their clinical dry weight, 19 (50%) had persistently elevated R i /R e ratios, suggesting they had not reached physiologic dry weight. Conclusion: These data suggest that many dialysis patients carry excess extracellular fluid post dialysis despite achieving their clinical dry weight. Furthermore, the resistance ratio derived from bioimpedance spectroscopy may be a useful clinical tool in determining dry weight.
75 citations
TL;DR: It is shown that breast cancer survivors use guided imagery as a vehicle for reconnecting to the self, to make sense of their experiences with breast cancer, and as a tool for managing cancer pain.
TL;DR: Higher strain was observed at the bone–screw interface in both end screws of an anterior solid rod construct during lateral bending, which correlates with the clinically observed failure location, and suggests that physiologic range loading may predispose to failure at the end levels.
Abstract: Study design This in vitro biomechanical study examines segmental anterior vertebral screw strain and solid rod construct stiffness with and without the addition of multilevel, threaded cortical bone dowels in a bovine model. Objective To determine whether strain at the bone-screw interface is higher at the end levels during physiologic range loading, and whether solid interspace support decreases segmental strain on the implant. Summary of background data Anterior instrumentation provides greater correction and preserves distal motion segments. However, nonunion and implant failure are observed more frequently than with posterior segmental instrumentation, and when observed, loss of fixation occurs at the end levels. Methods Eight calf spines underwent mechanical testing in the following sequence: 1) intact condition, 2) anterior release with anterior solid rod and bicortical rib grafts, and 3) anterior release with anterior solid rod and threaded cortical bone dowels (L2-L5). Instrumented vertebral screws were used to assess strain within the vertebral body by the near cortex, whereas an anterior extensometer spanning the instrumented segments was used to measure segmental displacements to calculate construct stiffness. The protocol included axial compression (-400 N), right lateral bending (4 Nm (Newton-meter), away from the implant), and left lateral bending (4 Nm, toward the implant). Statistical analysis included a one-way analysis of variance and a Student-Newman-Keuls post hoc test. A pilot study was performed using four additional specimens loaded for 4000 cycles to investigate macroscopic loosening after fatigue loading. Results In lateral bending toward the implant, the strain was higher at both end levels, with no differences between the rib and dowel reconstructions. The stiffness values were greater than the intact values for both groups. In lateral bending away from the implant, the strain also was higher at both end screws, and the dowel group had less strain at these levels than the rib group. Both groups were stiffer than the intact condition, and the dowel group was stiffer than the rib group. Axial compressive strain also was higher at the end levels, but this difference did not reach statistical significance. The rib group did not reach intact stiffness values, whereas the dowel group was stiffer than the intact condition. The fatigue study showed gross loosening at one or both end levels in all cases. Conclusions Higher strain was observed at the bone-screw interface in both end screws of an anterior solid rod construct during lateral bending, which correlates with the clinically observed failure location. This suggests that physiologic range loading may predispose to failure at the end levels. Disc space augmentation with solid implants increased construct stiffness in all three load paths and decreased strain at the end levels in lateral bending away from the implant. Future implant modifications should achieve better fixation at the end screws, and the current model provides a means to compare different strategies to decrease strain at these levels.
TL;DR: Observations suggest an association between ischiopagus and pyopagus conjoined twins and congenital vertebral anomalies, and their coexistence is explained best by a nonspecific teratogenic insult during early embryogenesis.
Abstract: A review of clinical records and radiographs revealed that five of 10 patients with conjoined twinning (three of six ischiopagus and two of two pyopagus twins) had congenital vertebral anomalies including hemivertebrae (3), multiple thoracic anomalies (1), right hemisacral agenesis (1), and three lumbar vertebra (1). No mirror image anomalies were identified, and different regions of the spine were involved in the two cases in which both twins had anomalies. Coexisting visceral and musculoskeletal anomalies included dextrocardia (3), atrial septal defect (1), congenital vertical talus (2), Sprengel's deformity (1), and multiple unilateral foot anomalies (1). Hip subluxation or dislocation was seen in five of eight ischiopagus or pyopagus twins after separation and required femoral and pelvic osteotomies. Lumbar scoliosis not associated with congenital vertebral anomalies was seen in two ischiopagus twins. These observations suggest an association between ischiopagus and pyopagus conjoined twins and congenital vertebral anomalies, and their coexistence is explained best by a nonspecific teratogenic insult during early embryogenesis.
TL;DR: The results suggest that denial as a coping strategy appears to be signficantly associated with pain for persons with HIV/AIDS, and point to the possibility of psychological intervention in order to modify maladaptive coping styles and to ameliorate pain in this population.
Abstract: Pain in HIV/AIDS patients is associated with compromised quality of life and emotional adjustment. Although previous findings support a relationship between coping styles and subjective pain for various groups of chronically-ill persons, little research has examined the associations between coping and pain in HIV-positive or AIDS patients. The purpose of this study was to explore the relationship between pain and coping styles among 105 HIV-positive participants (32 women and 73 men) in a randomized clinical trial designed to examine the effect of group psychotherapy on quality of life and health behavior. Participants completed the Brief COPE, the pain scale from the Medical Outcomes Study-HIV, and a demographic and medical questionnaire. Multiple regression analysis, with pain as the dependent variable, showed that participants who reported coping through denial reported greater pain severity (p < 0.0001). These results suggest that denial as a coping strategy appears to be signficantly associa...
TL;DR: It is concluded that hypnotic phenomena as measured in the West might be an important component of the dhami-jhankri's treatment in the East.
Abstract: This study examined the role of hypnotic responsiveness in the practice of a dhami-jhankri, a traditional Nepali healer. The hypnotic capacity of 248 male patients was measured in an allopathic (Western) clinic, an Ayurvedic (ancient Hindu healing art) clinic, and a dhami-jhankri's practice. Hypnotizability was assessed using the Hypnotic Induction Profile (HIP). The Induction scores of the HIP were significantly higher among the dhami-jhankri's patients than among either the Ayurvedic or allopathic patients. Furthermore, patients who returned to the dhami-jhankri were more highly hypnotizable than first-time dhami-jhankri patients. In addition, treatment satisfaction as reported by dhami-jhankri patients was positively correlated with HIP scores. The authors conclude that hypnotic phenomena as measured in the West might be an important component of the dhami-jhankri's treatment in the East.
TL;DR: A mini-forum was published in the Spring 2000 issue of SexualiO' & Culture that invited the authors of the original article, as well as several other authors, to discuss the merits and pitfalls of that article.
Abstract: Editor's Note: In 1998, the Psychological Bulletin -a peer-reviewed journal of the American Psychological Association (APA)-published an article entitled \"A Meta-Analytic Examination of Assumed Properties of Child Sexual Abuse Using College Samples,\" One of the conclusions of the article was that sexual relationships between adults and children may be much less harmful to children than generally believed. In an unprecedented action, the Congress of the United States, and later the APA itself, condemned the article. In consideration of the importance of these events, the editors of SexualiO' & Culture invited the authors of the original article (Drs. Rind, Tromovitch, and Bauserman), as well as several other authors, to discuss the merits and pitfalls of that article. This mini-forum was published in the Spring 2000 issue (Volume 4, Number 2). One of the authors, Dr. Spiegel, presented methodological objections to the original study, to which the authors were allowed to reply. Dr. Spiegel's reply to their reply appears here.
01 Jan 2000
TL;DR: As advances in medical treatment extend life with cancer, converting it from a terminal to a chronic disease, problems in coping with the illness and its treatment become more important, and the doctor-patient relationship has the potential to undermine.
Abstract: As advances in medical treatment extend life with cancer, converting it from a terminal to a chronic disease, problems in coping with the illness and its treatment become more important. Finding means of helping people live with a chronic life threat, cope with the side effects of arduous treatments, and manage the personal, social and vocational consequences of disease-related disability is of growing importance. These encouraging trends have brought problems with them, however. Growing interest in the mind/body connection in the popular literature has fueled a growing appetite for complementary and alternative treatments and ideas, some of which are useful, while others are potentially harmful (Spiegel, Stroud et al. 1998). Recent studies show that more than forty percent of Americans utilize complementary treatments, and most do so in addition to rather than in place of conventional medical care (Eisenberg, Davis et al. 1998). However, two-thirds of patients who utilize such treatments do not tell their physicians that they are doing so (Eisenberg, Kessler et al. 1993). This has the potential to undermine the doctor-patient relationship (Spiegel 1999).