Showing papers by "David Spiegel published in 2002"

Bridging psychology and biology. The analysis of individuals in groups.

Abstract: Biological systems are particularly prone to variation, and the authors argue that such variation must be regarded as important data in its own right. The authors describe a method in which individual differences are studied within the framework of a general theory of the population as a whole and illustrate how this method can be used to address three types of issues: the nature of the mechanisms that give rise to a specific ability, such as mental imagery; the role of psychological or biological mediators of environmental challenges, such as the biological bases for differences in dispositional mood; and the existence of processes that have nonadditive effects with behavioral and physiological variables, such as factors that modulate the response to stress and its effects on the immune response.

Change in emotion-regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy.

Abstract: Four relatively independent emotion-regulation constructs (suppression of negative affect, restraint, repression, and emotional self-efficacy) were tested as outcomes in a randomized trial of supportive-expressive group therapy for women with metastatic breast cancer. Results indicate that report of suppression of negative affect decreased and restraint of aggressive, inconsiderate, impulsive, and irresponsible behavior increased in the treatment group as compared with controls over 1 year in the group. Groups did not differ over time on repression or emotional self-efficacy. This study provides evidence that emotion-focused therapy can help women with advanced breast cancer to become more expressive without becoming more hostile. Even though these aspects of emotion-regulation appear trait-like within the control group, significant change was observed with treatment.

Coping, social support, and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS.

Abstract: The purpose of this study was to examine psychosocial correlates of adjustment to HIV/AIDS in a sample of 137 HIV-positive persons (78 men and 59 women). Multiple regression analysis was used to examine relationships between perceived quality of general social support, three attachment styles, and three coping styles with total score on Positive States of Mind Scale (PSOMS), our measure of adjustment. The influence of demographic and medical status variables was also accounted for. PSOMS total score was significantly associated with greater satisfaction with social support related to HIV/AIDS, more secure attachment style, and less use of behavioral disengagement in coping with HIV/AIDS. These results indicate that for people with HIV or AIDS, those individuals who are more satisfied with their relationships, securely engaged with others, and more directly engaged with their illness are more likely to experience positive adjustment. Implications for physical health outcome and opportunities for intervention are discussed.

Sleep disturbances in women with metastatic breast cancer

Abstract: We examined sleeping problems in women with metastatic breast cancer in relation to depression, social support, and salivary cortisol. Ninety-seven women with metastatic breast cancer were drawn from a larger study on the effects of group therapy on quality of life and survival. This study is based on the baseline assessments conducted prior to randomization into treatment conditions. Sleep, depression symptoms, and social support were assessed by self-reporting. Cortisol was assessed from saliva samples taken over a 3-day period. Medical status and demographic characteristics were also examined in relation to each sleep variable in multiple regression analysis. Most women (63%) reported one or more types of sleep disturbance and 37% reported using sleeping pills in the previous 30 days. Problems with falling to sleep were significantly related to greater pain and depressive symptoms. Problems of waking during the night were significantly associated with greater depression and less education. Problems in waking/getting up were significantly associated with greater depressive symptoms and less social support. Sleepiness during the day was not significantly related to the variables in the regression model. Fewer hours of sleep were significantly associated with metastases to the bone, higher depressive symptoms, and more social support. Women who reported sleeping 9 or more hours per night, compared to those who reported a moderate amount of sleep (6.5-8.5 hours), had significantly lower 9 p.m. cortisol levels. Use of sleeping pills was more frequent among women reporting greater pain and depressive symptoms. These results suggest that women with metastatic breast cancer who are at higher risk for having sleeping problems are those who are less educated, in pain, depressed, have bony metastases, or lack social support.

Traumatic Stress Symptoms Among Women with Recently Diagnosed Primary Breast Cancer

Abstract: This study examined the concurrent and longitudinal relationships between traumatic stress symptoms and demographic, medical, and psychosocial variables among women recently diagnosed with primary breast cancer. Participants were 117 women drawn from a parent study for women recently diagnosed with primary breast cancer. At baseline, the Impact of Event Scale (IES) total score was related to intensity of postsurgical treatment and lower emotional self-efficacy. At the 6-month follow-up, the IES total score was significantly related to younger age, to the increased impact of the illness on life, and to the baseline IES total score assessment. These results suggest that it is important to intervene for traumatic stress symptoms soon after the diagnosis of breast cancer. Furthermore, these results suggest women at greatest risk are those who are younger, who receive postsurgical cancer treatment, who are low in emotional self-efficacy and whose lives are most affected by having cancer.

Effects of psychotherapy on cancer survival.

Abstract: The possibility that psychotherapy could extend survival time for cancer patients has attracted attention among clinical investigators interested in the mind–body connection, among cancer patients seeking the best possible outcome and among the general public. A small number of randomized trials have been conducted, and they have produced conflicting results. Does emotional support affect the course of cancer? What physiological pathways might mediate such an effect? Given what we now know, should we change the standard of care for cancer patients?

Psychosocial intervention for lesbians with primary breast cancer.

Abstract: This study examined the effects of a Supportive-Expressive group therapy intervention offered to lesbians with early stage breast cancer. Twenty lesbians diagnosed with breast cancer in the previous 12-months were recruited and assessed at baseline, and at 3, 6, and 12 months after the group intervention. During the 12-week intervention, group members focused on the problems of a new diagnosis, coping with the illness and treatment, mood changes, coping responses and self-efficacy, improving relationships with family, friends and physicians, the impact of the illness on life, pain and sleep, and changes in body image and sexuality. A within-subject slopes analysis was conducted on data collected for each woman over the first year. As predicted, women reported reduced emotional distress, intrusiveness, and avoidance, and improved coping. There were significant changes in their social support, but in the unexpected direction. Instrumental support and informational support declined. However, conflict in family relations also declined, while trends were found towards more cohesiveness and expressiveness. Participants reported less pain and better sleep. There were no changes in body image, sexuality, or attitudes toward health-care providers. These results suggest that Supportive/Expressive group intervention appears to be helpful for lesbians with breast cancer.

An example of maximizing survey return rates. Methodological issues for health professionals.

Abstract: Obtaining a high response rate in survey research can bolster statistical power, reduce sampling error, and enhance the generalizability of the results to the population surveyed. We describe a mail survey designed to achieve a high return rate of completed questionnaires from members of the American Psychological Association who were engaged in clinical practice. We adapted the Total Design Method for survey research and were able to achieve a high response rate (68%) among health professionals. This was not an experiment in which we assessed the best method to increase survey response rates, hence we cannot empirically evaluate how each of the steps influenced our overall response rate. Future research is needed to identify the relative effectiveness of each of these principles in enhancing survey response rates. Research is also needed to distinguish general principles that apply across populations fromthose that must be tailored to spe cific subpopulations.

Maladaptive Coping Strategies in Relation to Quality of Life Among HIV+ Adults

Abstract: This study examined relationships between coping strategies and psychological quality of life (QOL) among people living with HIV/AIDS (N = 141). Participants completed baseline assessments, which included a demographic survey, the Brief COPE, the MOS-HIV, and a medical history questionnaire. Additionally, we obtained CD4 count information from medical charts. After controlling for demographic and AIDS-related factors, hierarchical multiple regression analyses indicated that maladaptive coping strategies used to deal with the stress of living with HIV/AIDS significantly lowers psychological quality of life as defined by cognitive functioning, mental health, and health distress. Developing adaptive coping skills to increase adaptive coping behaviors for dealing with living with HIV/AIDS may be a particularly effective intervention strategy to improve QOL. Future research must use methodological designs that can evaluate the influence of coping on QOL over time.

HIV: effectiveness of complementary and alternative medicine

Abstract: Outcome studies examining the efficacy of CAM among people living with HIV-AIDS are often conducted among small sample sizes with very little follow-up data or time points. Generalizability of many of the study findings is further limited by participant attrition. It is difficult to conduct clinical studies on chronically ill patients without participants dropping out, typically because the study demands coupled with their illness become too burdensome. Several studies have been conducted that include control groups, double-blind designs, and randomization. These scientifically sound studies have demonstrated promising results that strongly indicate a need for further research with larger samples in a prospective research design so that safety and efficacy can be determined over time. Many of the studies with small sample sizes reported trends, but did not find statistical significance. Increasing sample sizes in future studies is necessary to evaluate the scientific merit of these trends. Moreover, researchers need to evaluate the clinical and statistical significance in CAM use. The psychologic benefits of taking CAM should not be underestimated. For the purposes of this article, the authors did not include psychologic outcomes; however, there is evidence suggesting that decreasing depression can decrease HIV-related somatic complaints [69]. Studies need also to examine the effectiveness of CAM on psychologic outcomes and physical outcomes. This article and the authors' own research (Gore-Felton C et al, unpublished data) have revealed a high prevalence of alternative supplement use in conjunction with HIV medication, indicating an urgent need to understand the health benefits and the health risks of alternative supplements among patients with HIV and AIDS. Patients and physicians need more empirically based research to examine the toxicities, interactions, and health benefits of CAM. Many patients do not report the use of CAM to their physicians and very few physicians record treatments in the clinical record [70]. This will likely change as CAM becomes more widely recognized as a legitimate medical intervention; however, controlled outcome studies among large, diverse samples of people living with HIV-AIDS are needed. Health care providers need to assess the use of herbal and alternative therapy practices by their patients. Some patients may not be aware that they are taking a supplement or plant-based herb. Furthermore, some patients may believe that they are using something innocuous and even healthy simply because it came from a health food store. Understanding the contraindications of alternative therapies is necessary to prevent deleterious outcomes and to facilitate the safe and efficacious use of CAM in the management of HIV disease and related symptoms. As the epidemic in the United States continues to rise among women and minority populations, clinical research trials must include ethnically diverse patient populations that are gender balanced. Current available studies indicate that many CAM interventions may improve the quality of life of people living with HIV-AIDS; however, further studies using longitudinal, controlled designs are needed to accurately assess the safety of such interventions.

Acute stress reactions to everyday stressful life events among sexual abuse survivors with PTSD.

Abstract: This study examined symptoms of Acute Stress Disorder (ASD), which is often thought of as a precursor to PTSD, among 54 women who already had PTSD for childhood sexual abuse for which they were seeking treatment. We examined the prevalence of ASD symptoms as well as their relationships to trauma symptoms measured by the Trauma Symptom Checklist-40. The ASD diagnosis requires the occurrence of a traumatic life event as well as meeting specific symptoms criteria. We found that fourty-four percent of participants met all symptom criteria for ASD, but only three of these 24 participants described a traumatic life event. Moreover, ASD symptoms were significantly related to trauma symptom scores. These findings suggest that a significant proportion of women with PTSD for childhood sexual abuse may be highly symptomatic for everyday stressful events that would not be experienced as traumatizing to others. Thus, these individuals need assistance in coping with everyday life stressors that do not involve a serious threat or injury in addition to needing help to alleviate their trauma symptoms.

Recent Stressful Life Events, Sexual Revictimization, and Their Relationship With Traumatic Stress Symptoms Among Women Sexually Abused in Childhood

Abstract: This cross-sectional study examined whether previous life stressors are associated with current traumatic stress symptoms in women who were sexually abused in childhood. Fifty-eight treatment-seeking women, sexually abused in childhood and meeting criteria for current posttraumatic stress disorder (PTSD) in response to their childhood sexual abuse, participated in this study. Participants were administered a structured interview to assess PTSD as well as selfreport measures to assess acute stress reactions, other trauma-related symptoms, sexual revictimization as an adult, and recent stressful life events. Recent stressful life events were shown to be associated with PTSD symptoms, acute stress disorder (ASD) symptoms, and other trauma-related symptoms. Sexual revictimization was associated with trauma-related symptoms but not PTSD symptoms or ASD symptoms. Implications for clinical intervention and future research are discussed.

The Influence of Social Support, Coping and Mood on Sexual Risk Behavior among HIV-Positive Men and Women.

Abstract: The purpose of this study was to examine the relationships between social support, coping, mood and sexual risk behavior. Participants were 122 HIV-positive adults (60 women and 62 men). All participants were assessed on sexual risk behavior, perceived partner social support, coping with HIV/AIDS and mood. The results showed that sexual risk behavior was associated with male gender, education, perceived support of their partners and the use of emotion-focused coping style to deal with living with HIV and AIDS. Intervening with partners and developing effective coping strategies may decrease risk among HIV-positive men and women. Indeed, effective HIV prevention interventions must consider the social, psychological and cultural context in which sexual risk behavior occurs and develop strategies that intervene on these psychosocial factors.

Acute stress reactions to recent life events among women and men living with HIV/AIDS.

Abstract: Objective:This study examined the prevalence of acute stress reactions to recent life events among persons living with HIV/AIDS. A second aim was to investigate the relationship of acute stress rea...

Acute stress reactions following the assassination of Mexican presidential candidate Colosio

Abstract: Considerable evidence suggests that exposure to traumatic events increases the risk of developing anxiety-spectrum disorders in response to later traumatization. We conducted a survey in Guadalajara, Mexico to assess factors associated with acute stress reactions to the assassination of a political figure. Participants included 86 adults who completed the Stanford Acute Stress Reaction Questionnaire (SASRQ) and measures of the perceived impact of the assassination, exhibited emotional behavior following the assassination, and had exposure to a specific prior disaster (a gas pipeline explosion). The results suggest that acute stress reactions can occur in response to an assassination, and that those most susceptible are those most emotionally invested, those who engage in emotional behavioral responses, and those whose lives have been affected by a previous potentially traumatic event.

How to Launch a National Internet-Based Panel Study Quickly: Lessons From Studying how Americans are Coping With the Tragedy of September 11, 2001

Abstract: This article reports on the planning, development, and implementation of a large national Internet-based panel study of how Americans are coping with the terrorist attacks of September 11, 2001 The study was designed to determine predictors and correlates of risk and resilience, both cross-sectionally and longitudinally In order to acquire timely and meaningful data, we developed/adapted an extensive set of measures, obtained human subjects approval, and posted a research Web site just 17 days after the attacks This article describes the major hurdles we confronted and the guidelines we recommend regarding these topics, including the methodological trade-offs inherent in Internet-based research, information technology requirements and tribulations, human subjects issues, selection of measures and securing permission for their use, and the challenges of participant recruitment We also discuss issues that we did not anticipate, including the survey intervention We focus not on findings, but on the concrete procedural, administrative, technical, and scientific challenges we encountered and the solutions we devised under considerable time and resource pressures

Mesmer minus magic: hypnosis and modern medicine.

Abstract: The implications and effects of the French commission that passed judgment on Mesmer's work is examined in light of the pioneering role of hypnosis as the first Western conception of a psychotherapy, the ancient philosophical debate between idealism and empiricism, and the conflict in modern medicine between biotechnological emphasis on cure and the need for care as many previously terminal illnesses are converted to chronic diseases. The panel's report is interpreted as negative about the literal theory of animal magnetism but actually supportive of the potential therapeutic power of suggestion and “positive thinking.” This aspect of hypnosis is described as a forerunner of modern cognitive therapies of depression and other illnesses. The panel exerted a constructive effect in applying scientific method and rigorous evaluation to hypnotic treatment, an application of Enlightenment philosophy that presaged the Flexner era in modern medicine. Both hypnosis and medicine ultimately benefited.

Emotion regulation and metastatic breast cancer

Abstract: For many years, researchers and clinicians have speculated that poor emotion regulation or the lack of emotional expression predicts earlier death from cancer. A number of empirical articles have supported this contention, but confusion among researchers about emotion regulation constructs has made it difficult to replicate studies and to target interventions toward specific change in behavior or emotional processing. Recently, a number of researchers have developed more specific self-report instruments, have conducted studies designed to estimate the separability of various aspects of emotion regulation, and have begun to understand the relationship between self-report of emotions and behavioral observation of expression. This increasing clarity will allow more specific tests of associations with physiological functioning and survival. It will also allow greater specificity in targeting interventions.

Reduced emotional control as a mediator of decreasing distress among breast cancer patients in group therapy

Abstract: There is evidence that emotional distress and its management may be related to cancer incidence and progression. In turn, the diagnosis and treatment of cancer inevitably elicits a range of emotions, including anxiety, fear, sadness, and anger. Management of such emotions constitutes an understandable problem for cancer patients, and provides a therapeutic opportunity. Here we examine cancer as a stressor and review the design of Supportive–Expressive group psychotherapy as a means of helping cancer patients confront existential concerns and express emotions related to them. We review evidence that suppression of emotion is associated with greater distress among cancer patients. This suggests that a psychotherapy designed to encourage emotional expression should reduce distress. This is what has been observed in several randomized trials of Supportive–Expressive Group Psychotherapy.

A collaborative practice model for the care of hemodialysis patients: Assessment of outcomes

Abstract: The care of end-stage renal disease (ESRD) patients is becoming increasingly complex. This paper outlines a collaborative practice model for primary and specialty care delivery to ESRD patients where nephrologists, nurse practitioners, and registered nurses collaborate to provide ESRD care and much of the primary care to chronic dialysis patients. The study population is derived from a university-based practice and is drawn primarily from two hospitals. Two chronic hemodialysis facilities provided care for the 186 current patients (as of December 31, 2000). Outcome data showed that for the 4 calendar years encompassed by the study (1997 through 2000), the gross mortality rates for the practice were 16.2%, 13.5%, 12.1%, and 9.5%, respectively, including all deaths. This paper demonstrates that a collaborative practice model for the care of ESRD patients-one that employs advanced practice nurses and registered nurses-allows nephrologists to provide care to a large number of patients while maintaining high-quality care and excellent clinical outcomes.