Showing papers by "David Spiegel published in 2001"
TL;DR: Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.
Abstract: Background Metastatic breast cancer carries with it considerable psychosocial morbidity. Studies have shown that some patients with metastatic breast cancer experience clinically significant anxiety and depression and traumatic stress symptoms. Supportive-expressive group psychotherapy was developed to help patients with cancer face and adjust to their existential concerns, express and manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control. Methods Of 125 women with metastatic breast cancer recruited into the study, 64 were randomized to the intervention and 61 to the control condition. Intervention women were offered 1 year of weekly supportive-expressive group therapy and educational materials. Control women received educational materials only. Participants were assessed at baseline and every 4 months during the first year. Data at baseline and from at least 1 assessment were collected from 102 participants during this 12-month period, and these participants compose the study population. Results Primary analyses based on all available data indicated that participants in the treatment condition showed a significantly greater decline in traumatic stress symptoms on the Impact of Event Scale (effect size, 0.25) compared with the control condition, but there was no difference in Profile of Mood States total mood disturbance. However, when the final assessment occurring within a year of death was removed, a secondary analysis showed a significantly greater decline in total mood disturbance (effect size, 0.25) and traumatic stress symptoms (effect size, 0.33) for the treatment condition compared with the control condition. Conclusion Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.
487 citations
TL;DR: The results suggest that among these rural women with breast cancer, distress with the diagnosis of breast cancer must be carefully assessed, as women who are highly distressed about their breast cancer may not report general mood disturbance.
Abstract: This study examined distress, coping, and group support among a sample of rural women who had been recently diagnosed with breast cancer. We recruited 100 women who had been diagnosed with primary breast cancer at one of two time points in their medical treatment: either within a window up to 3 months after their diagnosis of breast cancer, or within 6 months after completing medical treatment for breast cancer. Their mean age was 58.6 years (SD = 11.6), and 90% were of white/European American ethnicity. Women completed a battery of demographic and psychosocial measures prior to being randomized into a psychoeducational intervention study, and then again 3 months later at a follow-up assessment. The focus of this article is on the women's self-reported psychosocial status at baseline. Many of the women experienced considerable traumatic stress regarding their breast cancer. However, this distress was not reflected in a standard measure of mood disturbance that is frequently used in intervention research (the Profile of Mood States). The average woman considered her diagnosis of breast cancer to be among the four most stressful life events that she had ever experienced. Also, women on average reported a high level of helplessness/hopelessness in coping with their cancer. On average, women felt that they "often" (but not "very often") received instrumental assistance, emotional support, and informational support. Women varied considerably in which kind of social group provided them with the most support, with as many reporting that they found the greatest support in spiritual/church groups or within their family units as with breast or general cancer groups. These results suggest that among these rural women with breast cancer, distress with the diagnosis of breast cancer must be carefully assessed, as women who are highly distressed about their breast cancer may not report general mood disturbance. Furthermore, the kinds of groups that rural women with breast cancer experience as most supportive need to be identified so that psychosocial interventions can be matched to breast cancer patients' individual needs.
108 citations
TL;DR: Predictions regarding sexual orientation differences were supported for results regarding body image, social support, and medical care, and not predicted were differneces in coping, indicating areas of emotional strength and vulnerability among the lesbian sample.
Abstract: In a study comparing lesbian and heterosexual women's response to newly diagnosed breast cancer, we compared data from 29 lesbians with 246 heterosexual women with breast cancer. Our hypotheses were that lesbian breast cancer patients would report higher scores of mood disturbance; suffer fewer problems with body image and sexual activity; show more expressiveness and cohesiveness and less conflict with their partners; would find social support from their partners and friends; and would have a poorer perception of the medical care system than heterosexual women. Our predictions regarding sexual orientation differences were supported for results regarding body image, social support, and medical care. There were no differences in mood, sexual activity or relational issues. Not predicted were differences in coping, indicating areas of emotional strength and vulnerability among the lesbian sample.
106 citations
TL;DR: Investigation of relationships between spirituality and immune function in 112 women with metastatic breast cancer found women who rated spiritual expression as more important had greater numbers of circulating white blood cells and total lymphocyte counts.
Abstract: This exploratory study examined relationships between spirituality and immune function in 112 women with metastatic breast cancer. Spirituality was assessed by patient reports of frequency of attendance at religious services and importance of religious or spiritual expression. White blood cell counts, absolute numbers of lymphocytes, T-lymphocyte subsets, and natural killer cells were assessed by flow cytometry. Assessments of natural killer cell activity and delayed-type hypersensitivity responses to skin test antigens provided two measures of functional immunity. In analyses controlling for demographic, disease status, and treatment variables, women who rated spiritual expression as more important had greater numbers of circulating white blood cells and total lymphocyte counts. Upon examination of relationships with lymphocyte subsets, both helper and cytotoxic T-cell counts were greater among women reporting greater spirituality.
106 citations
TL;DR: In this paper, the authors examined the relationship between sexual revictimization and interpersonal problems in a sample of adult survivors of childhood sexual abuse diagnosed with post-traumatic stress disorder.
Abstract: This study examined the relationship between sexual revictimization and interpersonal problems in a sample of adult survivors of childhood sexual abuse diagnosed with post-traumatic stress disorder. Fifty-two treatment-seeking women participated in this study. Research participants completed the Sexual Experiences Survey to assess sexual revictimization within the past 6 months and completed the Inventory of Interpersonal Problems (IIP). Revictimized participants reported overall greater interpersonal problems compared with nonrevictimized participants. Post hoc analyses showed significantly higher interpersonal problem scores for revictimized participants on the Hard to Be Assertive and Too Responsible subscales. On the circumplex IIP, revictimized participants were more socially avoidant, nonassertive, and overly nurturant.
95 citations
TL;DR: Evidence that 2 especially promising mechanisms, one immune, one endocrine, may mediate the relationship between stress and social support on the one hand and cancer progression on the other is examined.
Abstract: The bulk of cancer research has productively focused on the pathophysiology of the disease, emphasizing tumor biology, especially tumor characteristics such as DNA ploidy and estrogen/progesterone receptor status as predictors of disease outcome, at the expense of studying the body's psychophysiological reactions to tumor invasion. These reactions are mediated by brain/body mechanisms, including the endocrine, neuroimmune, and autonomic nervous systems. Although a large portion of the variance in any disease outcome is accounted for by the specific local pathophysiology of that disease, some variability must also be explained by 'host resistance' factors, which include the manner of response to the stress of the illness. The evidence of links between social support, stress, emotional state, and immune and endocrine function is growing. Here we examine evidence that 2 especially promising mechanisms, one immune, one endocrine, may mediate the relationship between stress and social support on the one hand and cancer progression on the other. We chose natural killer (NK) cells and cortisol because they are particularly good examples of mediating mechanisms for which there is solid basic and clinical evidence. NK cells are of great interest because they are involved in tumor surveillance, and because their activity can be measured in vitro.
91 citations
TL;DR: How much does mind matter in the outcome of cancer?
Abstract: How much does mind matter in the outcome of cancer? The extent to which treatment of the emotional aspects of cancer affects disease progression is ultimately an empirical question. There are those who believe that controlling cancer requires a simple exertion of mind over matter, but that one might cure cancer in the body by vanquishing it in the mind is clearly wishful thinking. Indeed, the popular psychological notion that you get cancer because of some deep emotional need for it has needlessly made many patients with cancer feel guilty. Others say that the mind has no role at all: . . .
89 citations
TL;DR: Attempts to use Rind et al.'s study to argue that an individual has not been harmed by sexual abuse constitute a serious misapplication of its findings.
Abstract: B. Rind, P. Tromovitch, and R. Bauserman (1998) examined the long-term effects of childhood sexual abuse (CSA) by meta-analyzing studies of college students. The authors reported that effects "were neither pervasive nor typically intense" and that "men reacted much less negatively than women" (p. 22) and recommended value-neutral reconceptualization of the CSA construct. The current analysis revealed numerous problems in that study that minimized CSA-adjustment relations, including use of a healthy sample, an inclusive definition of CSA, failure to correct for statistical attenuation, and misreporting of original data. Rind et al.'s study's main conclusions were not supported by the original data. As such, attempts to use their study to argue that an individual has not been harmed by sexual abuse constitute a serious misapplication of its findings. Language: en
88 citations
TL;DR: It is suggested that revictimization serves to prime preexisting "trauma" memory networks, thereby amplifying the impact of childhood sexual trauma on selective attention toward trauma-related stimuli.
75 citations
TL;DR: In this paper, a pilot study was conducted among women who have been sexually abused as children and who meet the criteria for current PTSD as a result of that abuse, and CSA survivors with PTSD were randomly assigned to one of three conditions: (1) a trauma-focused group psychotherapy, (2) a present-focused Group Psychotherapy, and (3) a waiting list no-treatment control condition.
Abstract: Summary Childhood sexual abuse (CSA) is a prevalent problem and the psychological and behavioral consequences are great. Despite this, we are still in the early stages of understanding how best to treat survivors of childhood sexual abuse. One fundamental question for treating CSA survivors is whether it is necessary or helpful for psychotherapists to focus on working through survivors' memories of childhood trauma in order to reduce current distress and improve functioning, or is it better to focus on current problems in living? Consequently, a pilot study was conducted among women who have been sexually abused as children and who meet the criteria for current PTSD as a result of that abuse. CSA survivors with PTSD were randomly assigned to one of three conditions: (1) a trauma-focused group psychotherapy, (2) a present-focused group psychotherapy, and (3) a waiting list no-treatment control condition. In this article, preliminary data on the question of whether group treatment of either type is better t...
67 citations
TL;DR: The results support the discriminant validity of repressive-defensiveness, suppression, restraint, and distress constructs in the total sample of metastatic breast cancer patients, and the stability over 1 year in the control group.
Abstract: A longstanding hypothesis links affective and behavioral inhibition with cancer incidence and progression though it does not clarify psychometric distinctions among related constructs. We hypothesized that repressive-defensiveness, suppression, restraint, and distress would be separable factors in our sample of metastatic breast cancer patients. Our results support the discriminant validity of these constructs in our total sample, and the stability over 1 year in our control group. Using factor analysis, we found 4 separate factors at our prerandomization baseline corresponding closely to hypothesized constructs. Additionally, associations in a multi-trait, multi-occasion (baseline and 1 year) matrix met each of the 3 Campbell and Fiske (1959) criteria of convergent and discriminant validity. Future research testing the links between psychological, physiological, and survival outcomes with affective inhibition in cancer patients will be clearer when informed by these distinctions.
TL;DR: In this article, a longitudinal study examined symptoms of acute stress disorder (ASD) and posttraumatic stress disorder following exposure to threat and loss during a major flood and found that exposure to losses and ASD symptoms, but not threat, predicted the development of PTSD symptoms.
Abstract: This longitudinal study examined symptoms of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) following exposure to threat and loss during a major flood. One hundred and thirty-one persons completed an initial survey from one to three months post-flood assessing ASD symptoms and exposure to flood-related threat and losses; 74 of these persons completed a one-year follow-up assessing PTSD symptoms. Results showed that threat and loss were both significantly related to ASD symptoms. Exposure to losses and ASD symptoms, but not threat, predicted the development of PTSD symptoms. These results suggest that stressor characteristics, such as loss and threat, may be differentially related to shorter and longer-term trauma responses. These results extend previous research by showing that ASD symptoms predict those of PTSD among disaster survivors and that stressor characteristics together with acute symptoms predict long-term distress.
TL;DR: Assembly of the carbocyclic core of CP-263,114 has been accomplished efficiently and in high yield with key steps include a phenolic oxidation/intramolecular Diels-Alder sequence, tandem radical cyclization, and the late-stage fragmentation of a densely functionalized isotwistane skeleton.
TL;DR: Does coping make a difference in disease progression when medical prognostic variables are taken into account?
TL;DR: It is concluded that survival of Opti-flow catheters was significantly better than that of Hickman catheter from 30 to 90 days, which is a clinically relevant period when patients are waiting for maturation of a permanent access or replacement of a failed access.
01 Jan 2001
01 Jan 2001
TL;DR: It is described how hypnosis can be integrated into biomedical treatment for acute and chronic pain and indications and contraindications, preparation of patients, and technique are described.
Abstract: While there is a consensus that psychosocial factors play an important role in the experience of pain, clinical interventions for acute and chronic pain remain primarily biomedical. This pattern persists despite a body of recent empirical work supporting the effectiveness of a number of behavioral and relaxation interventions for these problems. One of these interventions is hypnosis. We briefly discuss hypnotic analgesia and describe how hypnosis can be integrated into biomedical treatment for acute and chronic pain. Special attention is given to indications and contraindications, preparation of patients, and technique.
TL;DR: In this article, the authors evaluated acute dissociative experiences in reaction to a recent stress ful event among 102 male Viet Nam vets seeking help for posttraumatic stress dis or der (PTSD) at a Vet-En Affairs treat ment cen ter.
Abstract: This study ex am ined the prev a lence of acute dissociative re ac tions to a re cent stress ful event among 102 male Viet nam vet er ans seek ing help for posttraumatic stress dis or der (PTSD) at a Vet erans Affairs treat ment cen ter. Prior to treat ment, pa tients com pleted a bat tery of ques tion naires, in clud ing the Stan ford Acute Stress Re ac tion Ques tion-naire to assess acute dissociative experiences in reaction to a recent stress ful event. Most (80%) com bat vet er ans re ported ex pe ri enc ing five acute dissociative symptoms in the previous month in reaction to this event. These symp toms were pos i tively as so ci ated with be ing Af ri can American or Hispanic/Latino, hav ing been phys i cally abused in childhood, choosing acom bat-related intrusion ex peri ence as themost stressful re cent event, com bat-re lated trau matic stress symp toms, and hav ing service connected disability. These results have both theoretical and clinicalimplications.
TL;DR: The DSM-IV-TR as mentioned in this paper is the state-of-the-art in the field of psychophysics and has been used extensively in the last few decades to study the effects of psychotherapy on human health.
Abstract: My fa ther, Dr. Her bert Spiegel, once de scribed psy chi a try as the “study of the dis eases of the o ries.” Men tal health pro fes sion als at tempt to un der stand and treat com plex syn dromes that are of ten largely com posed of symp toms that can only be known through re ports by the pa tient, as op posed to “signs,” ob serv able phe nom ena such as blood pres sure and heart rate. One re sponse to this chal lenge could be di ag nosed as “dichotomania,” a pre oc cu pa tion with the pre ci sion of our own de scrip tion of cat e go ries. None the less, psy chi a try and psy chol ogy have, in fact, made great strides in achiev ing a com mon lan guage of men tal dis or ders, most no ta bly in the Di ag nos tic and Sta tis ti cal Man ual, cur rently in its fourth edi tion, with text re vi sion (DSM-IV-TR; Amer i can Psy chi at ric As so ci a tion, 2000). While this elab o rate cat e go ri za tion has been crit i cized, it is at least pre cise, de fin ing lists of symp toms re quired for a di ag no sis based upon ex ten sive re search. There fore, the re li abil ity of psy chi at ric di ag no sis has im proved, even though the va lid ity of par tic u lar symp tom de scrip tions can al ways be chal lenged.
Journal Article•
Journal Article•
TL;DR: Notre impression est que cette intervention apporte une aide utile aux patients, parce qu'elle favorise une reinsertion sociale, offre un espace d'expression des emotions and humanise les soins.
Abstract: Les auteurs decrivent une experience originale de trois annees d'ateliers de nutrition pour des patients atteints de cancer. Cette intervention associe une information sur les aspects nutritionnels du cancer a un soutien psychosocial, pour attenuer les consequences psychologiques et nutritionnelles du cancer. L'atelier, dirige par deux equipes specialisees, l'une en oncologie medicale, l'autre en sante publique, est propose a des patients en cours de traitement specifique ou en suivi post-therapeutique. Lors d'une meme journee, les patients recoivent une information sur nutrition et cancer, une education dietetique et un soutien psychosocial avec un groupe de parole type soutien-expression. A ce jour, l'evaluation de cette intervention est uniquement subjective. Cinquante-six patients ont participe a au moins un atelier, pour une majorite de femmes (91 %), et dix-neuf ateliers ont eu lieu. Notre impression est que cette intervention apporte une aide utile aux patients, parce qu'elle favorise une reinsertion sociale, offre un espace d'expression des emotions et humanise les soins. Notre experience montre qu'il est possible de proposer une intervention psychosociale de groupe en institution dans le contexte culturel mediterraneen. Une etude est en cours afin d'evaluer objectivement les effets de cette intervention.
Journal Article•
TL;DR: The authors describe an original experience with 3 years of a nutritional workshop for cancer patients, which combine an information about nutritional aspects of cancer with psychosocial support, to buffer psychological and nutritional consequences of cancer.
Abstract: The authors describe an original experience with 3 years of a nutritional workshop for cancer patients. This intervention combine an information about nutritional aspects of cancer with psychosocial support, to buffer psychological and nutritional consequences of cancer. The workshop, leaded by two specialized teams, one in medical oncology, the other in public health, is proposed to patients during and after a specific treatment. In one day, it provided information about nutrition and cancer, diet education and psychosocial support with supportive-expressive group. At this day, the evaluation of this intervention is only subjective. Fifty-six patients participated in at least one workshop, with majority of women (91%). Nineteen workshops were leaded with average participant number of 7 per workshop the third year. The authors believe that nutritional workshops are of great help for cancer patients, by enhancing social reinsertion, giving opportunity of emotional expression and humanizing the treatment. Our experience show it is possible to propose psychosocial intervention in institution in the context of Mediterranean country. We are leading currently a study that will permit a more systematic evaluation of the effects of this intervention.
TL;DR: It is found that despite some overlap between high and lowhypnotizable simulators, high hypnotizables reported more primary process material in hypnotic dream reports.
Abstract: Dr. Lynn reports some second thoughts about an article he published in 1994, in which he described the use of a high hypnotizable/simulator design to study hypnotic dream and hidden observer reports. He found that despite some overlap between highand lowhypnotizable simulators, high hypnotizables reported more primary process material in hypnotic dream reports. He also describes two highly effective interventions involving a hypnotic suggestion of a hidden observer, one in the clinical, one in the forensic setting. These cases are particularly compelling because of their sophisticated use of hypnosis in conjunction with sound psychotherapeutic principles, and their positive outcome.