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Showing papers by "David Spiegel published in 2007"


Journal ArticleDOI
TL;DR: Baseline CAC score was a significant predictor of mortality after adjustment for age, race, gender, and diabetes with increased mortality proportional to baseline score with greater risk of death for patients treated with calcium-containing phosphate binders persisted after full multivariable adjustment.

753 citations


Journal ArticleDOI
TL;DR: In this paper, a cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and posttraumatic growth in breast cancer survivors (n = 65).
Abstract: Diagnosis and treatment of cancer has been associated with both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG). This cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and PTG in breast cancer survivors (n = 65). In this sample, symptoms of PTSD and reports of PTG were common and were not significantly related to one another. Greater social constraints on talking about breast cancer and perception of cancer as a traumatic stressor were associated with greater PTSD symptomatology. Younger age and perception of cancer as a traumatic stressor were associated with greater PTG. Findings suggest the central role of subjective appraisal in adjustment to cancer. Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes.

270 citations


Journal ArticleDOI
01 Sep 2007-Cancer
TL;DR: This study was designed to replicate the earlier finding that intensive group therapy extended survival time of women with metastatic breast cancer.
Abstract: BACKGROUND. This study was designed to replicate our earlier finding that intensive group therapy extended survival time of women with metastatic breast cancer. Subsequent findings concerning the question of whether such psychosocial support affects survival have been mixed. METHODS. One hundred twenty-five women with confirmed metastatic (n = 122) or locally recurrent (n = 3) breast cancer were randomly assigned either to the supportive-expressive group therapy condition (n = 64), where they received educational materials plus weekly supportive-expressive group therapy, or to the control condition (n = 61), where they received only educational materials for a minimum of 1 year. The treatment, 90 minutes once a week, was designed to build new bonds of social support, encourage expression of emotion, deal with fears of dying and death, help restructure life priorities, improve communication with family members and healthcare professionals, and enhance control of pain and anxiety. RESULTS. Overall mortality after 14 years was 86%; median survival time was 32.8 months. No overall statistically significant effect of treatment on survival was found for treatment (median, 30.7 months) compared with control (median, 33.3 months) patients, but there was a statistically significant intervention site-by-condition interaction. Exploratory moderator analysis to explain that interaction revealed a significant overall interaction between estrogen-receptor (ER) status and treatment condition (P = .002) such that among the 25 ER-negative participants, those randomized to treatment survived longer (median, 29.8 months) than ER-negative controls (median, 9.3 months), whereas the ER-positive participants showed no treatment effect. CONCLUSIONS. The earlier finding that longer survival was associated with supportive-expressive group therapy was not replicated. Although it is possible that psychosocial effects on survival are relevant to a small subsample of women who are more refractory to current hormonal treatments, further research is required to investigate subgroup differences. Cancer 2007. © 2007 American Cancer Society.

221 citations


Journal ArticleDOI
TL;DR: Sixteen questions specific to Internet-based HIV prevention survey research are identified and strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed.
Abstract: The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

188 citations


Journal ArticleDOI
TL;DR: Depression, especially worsening depression, was associated with the greatest number of types of negative change in self-reported sleep disturbances and the relationships found between sleep disturbance and depression, pain, and life stress suggest specific ways to address the problem of sleep disturbance for women with metastatic breast cancer.

173 citations


Journal ArticleDOI
TL;DR: A history of stressful or traumatic life events may reduce host resistance to tumor growth and is consistent with a possible long-lasting effect of previous life stress on stress response systems such as the hypothalamic-pituitary-adrenal (HPA) axis.

96 citations


Journal ArticleDOI
TL;DR: Magnesium carbonate was generally well-tolerated in this selected patient population, and was effective in controlling serum phosphorus while reducing elemental calcium ingestion.

61 citations


Book
01 Jan 2007
TL;DR: In this article, a review of the empirical literature on the relationship between dissociation and posttraumatic stress disorder can be found, with a focus on the biological and psychological aspects of dissociation.
Abstract: Contributors. Preface. Introduction. Part I: Conceptual Domain of Dissociation. Relationship between trauma and dissociation: a historical analysis. Attachment, disorganization, and dissociation. Memory and attentional processes in dissociative identity disorder: a review of the empirical literature. Relationships between dissociation and posttraumatic stress disorder. Perceptual processing and traumatic stress: contributions from hypnosis. Part II: Neurobiology of Trauma and Dissociation. Translational research issues in dissociation. Neuroendocrine markers of early trauma: implications for posttraumatic stress disorders. Symptoms of dissociation in healthy military populations: why and how do war fighters differ in response to intense stress? Peritraumatic dissociation: time perception and cerebellar regulation of psychological, interpersonal, and biological processes. Posttraumatic stress disorder symptom provocation and neuroimaging: heterogeneity of response. Psychobiology of traumatization and trauma-related structural dissociation of the personality. Part III: Contemporary Implications for Assessment and Treatment. Psychiatric approaches to dissociation: integrating history, biology, and clinical assessment. Psychological assessment of posttraumatic dissociation. Dissociative identity disorder: issues in the iatrogenesis controversy. Applications of innate affect theory to the understanding and treatment of dissociative identity disorder. Trauma, dissociation, and impulse dyscontrol: lessons from the eating disorders field. Treatment of traumatic dissociation. Afterword. Index.

61 citations


Journal ArticleDOI
TL;DR: It is suggested that non-traditional risk factors, such as inflammation and malnutrition measured during the first 18 months of dialysis, are important determinates of survival in new dialysis patients.
Abstract: Background. Patients receiving dialysis therapy for end-stage kidney failure have a high cardiovascular mortality that can only be partially explained by traditional risk factors. Methods. This study was a post hoc analysis of a prospectively gathered data set from a randomized trial comparing outcomes in new haemodialysis patients treated with sevelamer or calcium-containing phosphate binders. Patients were followed from the time of enrollment until death or censor on 31 December 2005. Median follow-up was 3.6 years. Demographics, cardiovascular risk factors, laboratory data, medication use and severity of vascular calcification were available at baseline and over the first 18 months of dialysis. Results. Baseline predictors of mortality included age, creatinine, heart rate, iPTH, C-reactive protein (CRP), coronary and aortic calcium scores and the presence of aortic valve calcification. Over the first 18 months, averages of diastolic blood pressure, BUN, creatinine, albumin, phosphorus, iPTH and CRP were all significantly different between survivors and non-survivors. A stepwise multivariable adjusted Cox regression model demonstrated that low BUN and albumin and high CRP along with the use of calcium-containing phosphate binders (rather than sevelamer) were the strongest predictors of mortality in patients new to haemodialysis. Conclusions.These findings suggest that non-traditional risk factors, such as inflammation and malnutrition measured during the first 18 months of dialysis, are important determinates of survival in new dialysis patients. In addition, the unique risk factor for dialysis patients, the use of calcium-containing phosphate binders, was associated with a higher mortality rate in patients new to dialysis.

51 citations


Journal ArticleDOI
TL;DR: The dehalogenation of alkyl iodides, as well as the chemoselective deoxygenation of a secondary alcohol in the presence of variousAlkyl and aryl halides, can be accomplished employing a trialkylborane/air/water system.

50 citations


Journal ArticleDOI
TL;DR: Although EF has been touted as the standard treatment of high-energy pediatric tibia fractures, a close analysis revealed a high rate of problems such as long union times (especially ages ≥12), malunion, leg length discrepancy, and pin track infection.
Abstract: External fixation (EF) of tibia fractures has been associated with nonunions and malunions at our large pediatric trauma center. This study was designed to determine the successes and shortcomings of EF, especially with respect to maintenance of alignment and time to union. We believe that this will contribute to the limited amount of literature examining the complications associated with this treatment modality in the pediatric population. Thirty-one consecutive high-energy tibia fractures treated with EF over 4.5 years were analyzed. There were 22 boys and 9 girls (4-17 years old; mean, 11.9 years). Mean length of follow-up was 15 months. Of the 31 fractures analyzed, 19 were open fractures (12 closed, 3 grade I, 9 grade II, and 7 grade III). Of 30 fractures, 3 required skin graft, whereas 7 required fasciotomy. Mean duration of EF was 3.2 months. Mean time to union was 4.8 months. For complication rates, 4 of 30 had delayed union, 2 of 30 had nonunion, 8 of 30 had minor malunion, 3 of 30 had major malunion, 3 of 30 had leg length discrepancy, 8 of 30 had pin track infection, 3 of 30 had wound infection, 2 of 30 had osteomyelitis, and 4 of 30 required surgery for nonunion. Time to union differed between those aged 11 years or younger and those aged 12 years or older (means of 3.2 and 6.0 months, respectively; P = 0.001). Union time also differed between those with closed or grade I open fractures and those with grade II or III open fractures (3.9 and 5.7 months, respectively; P = 0.035). Leg length discrepancy rate differed between children aged 11 years or younger and those aged 12 years or older (3/13 and 0/18, respectively; P = 0.05). Although EF has been touted as the standard treatment of high-energy pediatric tibia fractures, our close analysis revealed a high rate of problems such as long union times (especially ages >or=12), malunion, leg length discrepancy (especially ages

Journal ArticleDOI
TL;DR: It is found that the application of the fractal analysis technique can demonstrate the electrophysiological correlations with hypnotic influence on cerebral activity.
Abstract: Fractal analysis was applied to study the trends of EEG signals in the hypnotic condition. The subjects were 19 psychiatric outpatients. Hypnotizability was measured with the Hypnotic Induction Profile (HIP). Fifty-four sets of EEG data were analyzed by detrended fluctuation analysis (DFA), a well-established fractal analysis technique. The scaling exponents, which are the results of fractal analysis, are reduced toward white noise during the hypnotic condition, which differentiates the hypnotic condition from the waking condition. Further, the decrease in the scaling exponents during hypnosis was solely associated with the eye-roll sign within specific cortical areas (F3, C4, and O1/2) closely related to eye movements and attention. In conclusion, the present study has found that the application of the fractal analysis technique can demonstrate the electrophysiological correlations with hypnotic influence on cerebral activity.

Journal Article
TL;DR: In this paper, the authors assessed all-cause mortality in 127 patients new to hemodialysis assigned to calcium-containing binders or sevelamer after a median follow-up of 44 months from randomization.

Book
01 Jan 2007
TL;DR: Complementary and alternative treatments in mental health care: overview and significant trends and legal, regulatory, and ethical issues; and nonconventional biological treatments.
Abstract: Contributors. Preface. Introduction. Part I: Background Issues. Complementary and alternative treatments in mental health care: overview and significant trends. Legal, regulatory, and ethical issues. Patient safety. Integrative approaches. Part II: Review of the Evidence and Clinical Guidelines. Nonconventional biological treatments. Western herbal medicines. Nutritional supplements. Omega-3 essential fatty acids. Chinese medical treatments. Homeopathy. Ayurvedic treatments. Lifestyle and women's issues. Nutrition. Physical activity, exercise, and mental health. Integrative medicine treatments for depression in women. Spirituality, mindfulness, and mind-body practices. Mindfulness training and meditation. Religious beliefs, spirituality, and intention. Yoga. Qigong. Appendices. Index.

Journal ArticleDOI
12 Jan 2007-Science
TL;DR: In his Perspective “Psychiatric casualties of war” (18 Aug.), R. J. McNally notes that a new study by B. P. Dohrenwend et al. (“The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods,” Reports, 18 Aug., p.979) revised downward from 15.2.
Abstract: In his Perspective “Psychiatric casualties of war” (18 Aug., p. [923][1]), R. J. McNally notes that a new study by B. P. Dohrenwend et al. (“The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods,” Reports, 18 Aug., p. [979][2]) revised downward from 15.2

Journal ArticleDOI
TL;DR: While short‐term or adjuvant use of magnesium carbonate appears safe and effective as a phosphate binder, more studies are needed to evaluate the long‐term effects on vascular calcification, bone histology, and mortality.
Abstract: Magnesium is predominantly an intracellular cation that plays a critical role in cellular physiology Serum levels are often slightly elevated in patients on chronic hemodialysis and older reports suggests that total body stores may also be increased, based on bone biopsies in patients treated with higher dialysate magnesium levels than are currently in use today Several studies have shown that magnesium, particularly in the form of magnesium carbonate, is an effective phosphate binder and can decrease patients' exposure to calcium Retrospective studies suggest that magnesium may prevent vascular calcification in dialysis patients, although this remains controversial and has not been evaluated prospectively Magnesium may reduce arrhythmias postoperatively and, while it may theoretically reduce arrhythmic death in dialysis patients, this hypothesis has never been tested While short-term or adjuvant use of magnesium carbonate appears safe and effective as a phosphate binder, more studies are needed to evaluate the long-term effects on vascular calcification, bone histology, and mortality

Journal ArticleDOI
TL;DR: Older patients are hypnotizable and increasing age does not appear to mitigate the usefulness of hypnotic analgesia during invasive medical procedures.
Abstract: Objectives:To assess the effects of age on responsiveness to self-hypnotic relaxation as an analgesic adjunct in patients undergoing invasive medical procedures.Material and Methods:Secondary data analysis from a prospective trial with 241 patients randomized to receive hypnosis, attention, and stan

Journal ArticleDOI
TL;DR: It is interesting to speculate more deeply on the possible mean-ings of a surge in publications, rather than assuming that one meaning (‘fad’) must apply.
Abstract: I t is interesting to speculate more deeply on the possible mean-ings of a surge in publications (publication of a key book, new findings, publication of the important consensus statements, etc.), rather than assuming that one meaning (‘fad’) must apply. In fact, nonempirical opinion and review papers nearly tripled during the ‘bubble’ period of Pope et al. and then fell off signifi-cantly. In contrast,

Journal ArticleDOI
TL;DR: The distress in response to their narrative was both predicted and mediated by the survivors' self-capacities and other forms of child maltreatment beyond child sexual abuse.
Abstract: This study examined the impact of telling one's story of childhood sexual abuse and its relationship with the survivor's self-capacities and history of other child maltreatment. The baseline data were collected from 134 female CSA survivors who were participating in a large intervention study. Participants were given 10 minutes to describe their childhood sexual abuse and completed a post-interview questionnaire assessing post-traumatic stress symptoms and their emotional response. The distress in response to their narrative was both predicted and mediated by the survivors' self-capacities and other forms of child maltreatment beyond child sexual abuse.

Journal ArticleDOI
TL;DR: A randomized trial conducted among 200 patients who underwent excisional breast biopsy or lumpectomy for breast cancer reported less pain, nausea, fatigue, discomfort, and emotional upset than did patients in the control group, and doing good also meant doing well, in that the use of hypnosis was considered.
Abstract: In 1846, a Scottish surgeon named James Esdaile reported 80% surgical anesthesia using hypnosis as the sole anesthetic for amputations in India. His work caused sufficient stir that when ether anesthesia was demonstrated in what is now called the Ether Dome at the Massachusetts General Hospital on October 16 of that same year, a surgeon strode to the front of the amphitheater and said, “Gentlemen, this is no humbug,” to distinguish his surgical team’s demonstration from Esdaile’s report. It has taken us a century and a half to rediscover the fact that the mind has something to do with pain and can be a powerful tool in controlling it: the strain in pain lies mainly in the brain. In this issue of the Journal, Montgomery et al. ( 1 ) report the results of a randomized trial conducted among 200 patients who underwent excisional breast biopsy or lumpectomy for breast cancer. Patients were assigned to either routine anesthesia plus nondirective empathic listening (the control condition) or a very brief 15-minute presurgery hypnosis session. The hypnosis, which the authors describe in very cursory fashion, consisted of “a relaxationbased induction (including imagery for muscle relaxation), suggestions for pleasant visual imagery, suggestions to experience relaxation and peace, specifi c symptom-focused suggestions (i.e., to experience reduced pain, nausea, and fatigue), a deepening procedure, and instructions for how patients could use hypnosis on their own following the intervention session.” This brief hypnotic preparation was suffi cient to produce a statistically signifi cant reduction in the use of propofol and lidocaine; yet despite this, patients in the intervention group reported less pain, nausea, fatigue, discomfort, and emotional upset than did patients in the control group. Doing good also meant doing well, in that the use of hypnosis


Journal ArticleDOI
TL;DR: Dan Stein and colleagues (Jan 13, p 139) purport to integrate medical and sociopolitical models of posttraumatic stress disorder (PTSD); there are both conceptual and empirical problems with this attempt.

Journal ArticleDOI
TL;DR: All that Kirsch and colleagues are harping on is that a formal hypnotic induction is not needed to elicit hypnotic response among hypnotizable people, why results are often comparable when hypnotic suggestions are given with and without a formal induction.
Abstract: All that Kirsch and colleagues are harping on is that a formal hypnotic induction is not needed to elicit hypnotic response among hypnotizable people. That is why results are often comparable when hypnotic suggestions are given with and without a formal induction. Furthermore, many of the so-called ‘nonstate’ studies do not take hypnotizability into account. Differences of any kind, with or without a hypnotic induction, are unlikely to emerge among people who are not at least somewhat hypnotizable. It may indeed be the case that many people are not aware of slipping in and out of hypnotic states because it is such a natural shift in consciousness among those with the capacity. People do so spontaneously during intense experiences of absorption (Tellegen and Atkinson, 1974; Tellegen, 1981), traumatic stress (Spiegel, 1991; Spiegel, 2001; Butler, Duran, et al., 1996), or ‘flow.’ (Csikszentmihalyi, 1991; Csikszentmihalyi, 1997). Those with the ability may not identify it as particularly unusual because it is part of their routine cognitiveexperiential landscape. From the article: “When controlling for the effect of nonhypnotic suggestion, it is crucial that the exact same suggestion is given in both the hypnotic and nonhypnotic conditions. People can be remarkably sensitive to the wording of imaginative suggestions. If the wording is not the same in both conditions (e.g., Kosslyn, Thompson, et al., 2000; Iani, Ricci, et al., 2006), it can confound the nature of the induction of hypnosis and the nature of the suggestion. With such ambiguity, it is impossible to know whether differences in response are due to hypnosis or to differences in the wording of the suggestion.” Talk about ambiguity – I cannot make sense of the meaning of this paragraph, especially as a co-author of the Kosslyn et al. study. By definition, the



01 Jan 2007
TL;DR: A history of stressful or traumatic life events may reduce host resistance to tumor growth and is consistent with a possible long-lasting effect of previous life stress on stress response systems such as the hypothalamic-pituitary-adrenal (HPA) axis.
Abstract: Background: There is mixed evidence regarding the possible association between a history of stressful or traumatic life events and more rapid breast cancer progression. Method: Retrospective reports of past experiences of traumatic life events were assessed among 94 women with metastatic or recurrent breast cancer. A traumatic event assessment was conducted using the eventscreening question from the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for the DSM-IV-TR (SCID; 2002). Each reported event was judged by two independent raters to determine whether it met DSM-IV-TR PTSD A1 criteria for a traumatic event. Those events that did not meet such criteria were designated bstressful events.Q Results: Nearly 42% of the women in the sample were judged to have experienced one or more traumatic events; 28.7% reported only stressful events. A Kruskal– Wallis test found significant differences in disease-free interval among the three groups [v 2 (2, N=94)=6.09, Pb.05]. Planned comparisons revealed a significantly longer disease-free interval among women who had reported no traumatic or stressful life events (median=62 months) compared to those who had experienced one or more stressful or traumatic life events (combined median=31 months). Conclusions: A history of stressful or traumatic life events may reduce host resistance to tumor growth. These findings are consistent with a possible long-lasting effect of previous life stress on stress response systems such as the hypothalamic-pituitary-adrenal (HPA) axis. D 2007 Elsevier Inc. All rights reserved.