Clinical Focus

  • Medical Director, Stanford Center for Integrative Medicine
  • Psychiatry, Child and Adolescent
  • Psychiatry

Administrative Appointments

  • Jack, Lulu & Sam Willson Professor, Stanford School of Medicine. (2002 - Present)
  • Associate Chair, Stanford University School of Medicine - Psychiatry and Behavioral Sciences (2000 - Present)
  • Professor of Psychiatry and Behavioral Sciences, with tenure., Stanford University School of Medicine. (1991 - Present)
  • Associate Professor of Psychiatry and Behavioral Sciences., Stanford University School of Medicine. (1987 - 1991)
  • Associate Research Psychiatrist., University of California, San Francisco. (1986 - 1991)
  • Associate Professor of Psychiatry and Behavioral Sciences., Stanford University School of Medicine. (1982 - 1987)

Honors & Awards

  • Member, Institute of Medicine of the National Academies (2012)
  • Arthur M Sutherland Award for Lifetime Achievement, International Psycho-Oncology Society (2011)
  • Marmor Award for Advancement of the Biopsychosocial Model in Psychiatry., American Psychiatric Association. The American Psychological Association. (2004)
  • The Division 30 Award for Distinguished Contributions to Professional Hypnosis., The American Psychological Association. (2003)
  • Ernest R. Hilgard Award for Scientific Excellence for 2002., The International Society of Hypnosis. (2003)
  • Distinguished Life Fellow,in recognition of significant contributions to Psychiatry., American Psychiatric Association. (2006)
  • Best Paper on the Application of Hypnosis., American Psychological Association. (2002)
  • Distinguished Achievement Award,the founding editor of the Progress in Psychiatry Series 1986-2002., American Psychiatric Publishing, Inc (2002)
  • Henry Guze Award for Best Research Paper., Society for Clinical and Experimental Hypnosis. (2001)
  • Mc Govern Award Lecturer on the Art and Science of Medicine,, Baylor. (1999)
  • Docteur Honoris Causa., de l'Universite de la Mediterranee (1999)
  • Meritorious Service Award., Northern California Psychiatric Society. (1997)
  • Special Keynote Address Award., American Society for Therapeutic Radiology and Oncology. (1997)
  • Rockefeller Foundation Visiting Scholar., Bellagio Study and Conference Center. Italy. (1997)
  • Burroughs Wellcome Visiting Professor., Royal Society of Medicine. UK. (1997)
  • The Edward A. Strecker, M. D. Award., The Institute of Pennsylvania Hospital and Jefferson Medical College. (1995)
  • One for the Heart Award., Mid-Peninsula Hospice. (1995)
  • Pierre Janet Writing Award., International Society for the Study of Dissociation. (1994)

Professional Education

  • Residency:Cambridge Hosp/Harvard Med Sch (1974) MA
  • Board Certification: Psychiatry, American Board of Psychiatry and Neurology (1976)
  • Fellowship:Lab of Community Psychiatry (1974) MA
  • Residency:Massachusetts Mental Health Center (1974) MA
  • Medical Education:Harvard Medical School (1971) MA
  • B.A., Yale College, Philosophy (1967)
  • M. D., Harvard Medical School., Medicine (1971)

Research & Scholarship

Current Research and Scholarly Interests

Dr. Spiegel's research interests involve stress and health: cognitive control over somatic functions, including cancer progression, the response to traumatic stress, and the perception of pain and anxiety. He is currently conducting a large scale study of the relationships among sleep disturbance, diurnal stress hormone patterns, and breast cancer survival, sponsored by the National Cancer Institute. This work is based upon earlier evidence from his laboratory that loss of circadian variation in cortisol, indicative of HPA dysfunction, predicts early mortality with breast cancer.

Dr. Spiegel is also continuing study of the relationship between the acute response to trauma, including dissociative symptoms, and the development of post-traumatic stress disorder. He is also evaluating various methods of treating these symptoms.

Dr. Spiegel is carrying out studies of the neurophysiological components of hypnosis by studying brain correlates of hypnotic perceptual alteration, using PET, fMRI and diffusion tensor imaging. His research program is designed to examine neurophysiological and peripheral mechanisms through which psychological and social support may influence physical health.

Clinical Trials

  • Intellectual Impairment in Women With Breast Cancer Recruiting

    RATIONALE: Breast cancer and its treatment may cause changes in a patient's ability to think, learn, and remember. Gathering information about a woman's genes, brain function, and personal history may help doctors learn more about the disease and plan the best treatment. PURPOSE: 1. To determine changes in brain function that occur following breast cancer chemotherapy. 2. To gain further understanding of the individual differences in brain function changes and recovery based on demographic, medical and treatment variables.

    View full details

  • Acupuncture for Sleep Disruption in Cancer Survivors Not Recruiting

    The proposed study will recruit 60 women with breast cancer who finished undergoing treatment who complain of persistent insomnia problems that began with onset of their cancer diagnosis. The eligible women would be randomized and stratified by sleep problems to two arms: (Acupuncture Arm vs. Sham Acupuncture) with a goal of having 48 patients complete the study (we anticipate about 20% attrition rate). The study interventions will begin after patients completed their treatment. The placebo control for acupuncture will be a validated sham acupuncture control Assessments will be made with daily diaries and with weekly questionnaires. PSG data will be collected on the subsample of the population. Data will be gathered via pencil-and-paper measures before, during, immediately following, one month following the completion of treatment and six months after the conclusion of treatment. In addition, actigraphy data (objective sleep continuity data) will be acquired prior to and following treatment

    Stanford is currently not accepting patients for this trial. For more information, please contact David Spiegel, (650) 723 - 6421.

    View full details

  • Sleep, Circadian Hormonal Dysregulation, and Breast Cancer Survival Not Recruiting

    Recent research provides evidence that disrupted circadian rhythms, including hormonal patterns and sleep, are associated with increased risk of breast cancer incidence and faster progression to mortality. We have observed that a loss of normal diurnal cortisol rhythm associated with more awakenings during the night predicts early mortality with metastatic breast cancer. Other recent studies have shown that nighttime shift work is associated with higher breast cancer incidence, and in a murine model disrupting circadian cortisol cycles produced a doubling of implanted tumor growth. There is also recent evidence that abnormal clock genes are associated with cancer. However, it is not clear whether sleep disruption per se affects breast cancer progression, or whether such an effect is mediated by hormonal and immune dysregulation of this prevalent and hormone-mediated cancer. We propose to study sleep disruption as a prognostic factor in the progression of metastatic breast cancer. We will also examine sleep patterns in association with disrupted circadian rhythms of cortisol, ACTH, and melatonin as well as measures of immune function known to be salient to breast cancer progression. These are natural killer cell cytoxicity and specific cytokine, IL-6. We plan to recruit 105 women 45 years through 75 years with metastatic or recurrent breast cancer and 20 age and SES-matched controls for a two-week at home sleep study with Actiwatch and two nights of in-home EEG monitoring, followed by 28 hours of continuous blood sampling and one night of EEG sleep monitoring in our lab at Stanford. This will provide a full examination of circadian hormones associated with sleep patterns. We will relate these assessments to the subsequent course of breast cancer progression. Results of this study will provide specific evidence regarding how improved sleep management may affect the course of breast cancer. Aim 1: To study 24-hr diurnal rhythms of HPA axis hormones and melatonin in women with metastatic or recurrent breast cancer. Hypothesis 1: Women with metastatic or recurrent breast cancer will have reduced amplitude and disrupted phase of 24-hr diurnal rhythms of cortisol, ACTH, and melatonin. Aim 2: To describe sleep disruption in women with metastatic breast cancer and examine psychosocial, endocrine, and immune factors that may be associated with sleep disruption. Hypothesis 2: Women with metastatic or recurrent breast cancer will have a higher incidence of both at home and laboratory-examined sleep disruption than control women without breast cancer. Hypothesis 3: Poorer sleep quality will be associated with more pain, more emotional suppression in response to stressors, less emotional support, greater depression and anxiety, and greater perceived and traumatic stress. Hypothesis 4: Poorer sleep quality and quantity of sleep and daytime sleepiness and fatigue will be associated with abnormal circadian neuroendocrine (i.e., cortisol, ACTH, and melatonin) and immune patterns (i.e., suppressed day and night time NK activity and loss of NK rhythms; increased day time IL-6 levels and /or loss of IL-6 rhythm). Aim 3: To study the relationship between sleep disruption and survival time among metastatic and recurrent breast cancer patients. Hypothesis 5: Poorer sleep quality and quantity of sleep will predict shorter survival. Hypothesis 6: Reduced diurnal amplitude and an abnormal phase of cortisol will predict shorter survival. Explanatory Aim 4: To investigate whether sleep disruption mediates the relation of psychosocial factors to health outcomes.

    Stanford is currently not accepting patients for this trial. For more information, please contact Bita Nouriani, (650) 723 - 8479.

    View full details

  • Functional Magnetic Resonance Imaging (MRI) of Hypnosis and Mindfulness Meditation Not Recruiting

    Hypnotic trance and mindfulness meditation have both been shown to have benefits for physical health. The current study seeks to determine if there are distinct patterns of brain activity that correlate with hypnotic trance, mindfulness meditation or both, and to relate these patterns to measurable markers of physical well-being. Precise neuroimaging of heightened attentional states will guide future researchers and practitioners toward more effective techniques of mind/body control.

    Stanford is currently not accepting patients for this trial. For more information, please contact Matthew P White, MD, 650-725-5598.

    View full details

  • Stress, Diurnal Cortisol, and Breast Cancer Survival Not Recruiting

    The purpose of this study is to learn about the effects of stress on hormones, the relationship between these hormones and cancer progression.

    Stanford is currently not accepting patients for this trial. For more information, please contact Bita Nouriani, (650) 723 - 8479.

    View full details

  • Management of Insomnia in Breast Cancer Patients Not Recruiting

    Primary Objective: 1. To provide preliminary data on the effects of armodafinil and Brief Behavioral Therapy for Insomnia (BBT-I) (alone or in combination) on insomnia in breast cancer patients receiving chemotherapy. Secondary Objectives: 1. To provide preliminary data on the influence of armodafinil and BBT-I (alone or in combination) on cancer-related fatigue (CRF) in breast cancer patients receiving chemotherapy. 2. To provide preliminary data on the influence of armodafinil and BBT-I (alone or in combination) on QOL in breast cancer patients receiving chemotherapy. 3. To provide preliminary data on influence of armodafinil and BBT-I (alone or in combination) on endocrine and inflammatory physiological markers (measured by cortisol and inflammatory cytokines markers)

    Stanford is currently not accepting patients for this trial. For more information, please contact Oxana Palesh, PhD, MPH, 650-725-7011.

    View full details


2013-14 Courses

Postdoctoral Advisees


Journal Articles

  • Bedtime misalignment and progression of breast cancer. Chronobiology international Hahm, B., Jo, B., Dhabhar, F. S., Palesh, O., Aldridge-Gerry, A., Bajestan, S. N., Neri, E., Nouriani, B., Spiegel, D., Zeitzer, J. M. 2014; 31 (2): 214-221


    Disruption of circadian rhythms, which frequently occurs during night shift work, may be associated with cancer progression. The effect of chronotype (preference for behaviors such as sleep, work, or exercise to occur at particular times of day, with an associated difference in circadian physiology) and alignment of bedtime (preferred vs. habitual), however, have not yet been studied in the context of cancer progression in women with breast cancer. Chronotype and alignment of actual bedtime with preferred chronotype were examined using the Morningness-Eveningness Scale (MEQ) and sleep-wake log among 85 women with metastatic breast cancer. Their association with disease-free interval (DFI) was retrospectively examined using the Cox proportional hazards model. Median DFI was 81.9 months for women with aligned bedtimes ("going to bed at preferred bedtime") (n = 72), and 46.9 months for women with misaligned bedtimes ("going to bed later or earlier than the preferred bedtime") (n = 13) (log rank p = 0.001). In a multivariate Cox proportional hazard model, after controlling for other significant predictors of DFI, including chronotype (morning type/longer DFI; HR = 0.539, 95% CI = 0.320-0.906, p = 0.021), estrogen receptor (ER) status at initial diagnosis (negative/shorter DFI; HR = 2.169, 95% CI = 1.124-4.187, p = 0.028) and level of natural-killer cell count (lower levels/shorter DFI; HR = 1.641, 95% CI = 1.000-2.695, p = 0.050), misaligned bedtimes was associated with shorter DFI, compared to aligned bedtimes (HR = 3.180, 95% CI = 1.327-7.616, p = 0.018). Our data indicate that a misalignment of bedtime on a daily basis, an indication of circadian disruption, is associated with more rapid breast cancer progression as measured by DFI. Considering the limitations of small sample size and study design, a prospective study with a larger sample is necessary to explore their causal relationship and underlying mechanisms.

    View details for DOI 10.3109/07420528.2013.842575

    View details for PubMedID 24156520

  • Trauma and dissociation: implications for borderline personality disorder. Current psychiatry reports Vermetten, E., Spiegel, D. 2014; 16 (2): 434-?


    Psychological trauma can have devastating consequences on emotion regulatory capacities and lead to dissociative processes that provide subjective detachment from overwhelming emotional experience during and in the aftermath of trauma. Dissociation is a complex phenomenon that comprises a host of symptoms and factors, including depersonalization, derealization, time distortion, dissociative flashbacks, and alterations in the perception of the self. Dissociation occurs in up to two thirds of patients with borderline personality disorder (BPD). The neurobiology of traumatic dissociation has demonstrated a heterogeneity in posttraumatic stress symptoms that, over time, can result in different types of dysregulated emotional states. This review links the concepts of trauma and dissociation to BPD by illustrating different forms of emotional dysregulation and their clinical relevance to patients with BPD.

    View details for DOI 10.1007/s11920-013-0434-8

    View details for PubMedID 24442670

  • Which symptoms matter? Self-report and observer discrepancies in repressors and high-anxious women with metastatic breast cancer. Journal of behavioral medicine Giese-Davis, J., Tamagawa, R., Yutsis, M., Twirbutt, S., Piemme, K., Neri, E., Taylor, C. B., Spiegel, D. 2014; 37 (1): 22-36


    Clinicians working with cancer patients listen to them, observe their behavior, and monitor their physiology. How do we proceed when these indicators do not align? Under self-relevant stress, non-cancer repressors respond with high arousal but report low anxiety; the high-anxious report high anxiety but often have lower arousal. This study extends discrepancy research on repressors and the high-anxious to a metastatic breast cancer sample and examines physician rating of coping. Before and during a Trier Social Stress Test (TSST), we assessed affect, autonomic reactivity, and observers coded emotional expression from TSST videotapes. We compared non-extreme (N = 40), low-anxious (N = 16), high-anxious (N = 19), and repressors (N = 19). Despite reported low anxiety, repressors expressed significantly greater Tension or anxiety cues. Despite reported high anxiety, the high-anxious expressed significantly greater Hostile Affect rather than Tension. Physicians rated both groups as coping significantly better than others. Future research might productively study physician-patient interaction in these groups.

    View details for DOI 10.1007/s10865-012-9461-x

    View details for PubMedID 23085787

  • Psychosocial correlates of sleep quality and architecture in women with metastatic breast cancer SLEEP MEDICINE Aldridge-Gerry, A., Zeitzer, J. M., Palesh, O. G., Jo, B., Nouriani, B., Neri, E., Spiegel, D. 2013; 14 (11): 1178-1186


    Sleep disturbance is prevalent among women with metastatic breast cancer (MBC). Our study examined the relationship of depression and marital status to sleep assessed over three nights of polysomnography (PSG).Women with MBC (N=103) were recruited; they were predominately white (88.2%) and 57.8±7.7 years of age. Linear regression analyses assessed relationships among depression, marital status, and sleep parameters.Women with MBC who reported more depressive symptoms had lighter sleep (e.g., stage 1 sleep; P<.05), less slow-wave sleep (SWS) (P<.05), and less rapid eye movement (REM) sleep (P<.05). Single women had less total sleep time (TST) (P<.01), more wake after sleep onset (WASO) (P<.05), worse sleep efficiency (SE) (P<.05), lighter sleep (e.g., stage 1; P<.05), and less REM sleep (P<.05) than married women. Significant interactions indicated that depressed and single women had worse sleep quality than partnered women or those who were not depressed.Women with MBC and greater symptoms of depression had increased light sleep and reduced SWS and REM sleep, and single women had worse sleep quality and greater light sleep than married counterparts. Marriage was related to improved sleep for women with more depressive symptoms.

    View details for DOI 10.1016/j.sleep.2013.07.012

    View details for Web of Science ID 000326625400021

    View details for PubMedID 24074694

  • An Eye for an I: A 35-Year-Old Woman With Fluctuating Oculomotor Deficits and Dissociative Identity Disorder JOURNAL OF YOUTH STUDIES Bhuvaneswar, C., Spiegel, D. 2013; 16 (4): 351-370
  • Patients With DID Are Found and Researched More Widely Than Boysen and VanBergen Recognized. journal of nervous and mental disease Brand, B. L., Loewenstein, R. J., Spiegel, D. 2013; 201 (5): 440-?

    View details for DOI 10.1097/NMD.0b013e31828e10d1

    View details for PubMedID 23639895

  • A Systematic Review of PTSD Prevalence and Trajectories in DSM-5 Defined Trauma Exposed Populations: Intentional and Non-Intentional Traumatic Events PLOS ONE Santiago, P. N., Ursano, R. J., Gray, C. L., Pynoos, R. S., Spiegel, D., Lewis-Fernandez, R., Friedman, M. J., Fullerton, C. S. 2013; 8 (4)


    We conducted a systematic review of the literature to explore the longitudinal course of PTSD in DSM-5-defined trauma exposed populations to identify the course of illness and recovery for individuals and populations experiencing PTSD.We reviewed the published literature from January 1, 1998 to December 31, 2010 for longitudinal studies of directly exposed trauma populations in order to: (1) review rates of PTSD in the first year after a traumatic event; (2) examine potential types of proposed DSM-5 direct trauma exposure (intentional and non-intentional); and (3) identify the clinical course of PTSD (early onset, later onset, chronicity, remission, and resilience). Of the 2537 identified articles, 58 articles representing 35 unique subject populations met the proposed DSM-5 criteria for experiencing a traumatic event, and assessed PTSD at two or more time points within 12 months of the traumatic event.The mean prevalence of PTSD across all studies decreases from 28.8% (range =3.1-87.5%) at 1 month to 17.0% (range =0.6-43.8%) at 12 months. However, when traumatic events are classified into intentional and non-intentional, the median prevalences trend down for the non-intentional trauma exposed populations, while the median prevalences in the intentional trauma category steadily increase from 11.8% to 23.3%. Across five studies with sufficient data, 37.1% of those exposed to intentional trauma develop PTSD. Among those with PTSD, about one third (34.8%) remit after 3 months. Nearly 40% of those with PTSD (39.1%) have a chronic course, and only a very small fraction (3.5%) of new PTSD cases appears after three months.Understanding the trajectories of PTSD over time, and how it may vary by type of traumatic event (intentional vs. non-intentional) will assist public health planning and treatment.

    View details for DOI 10.1371/journal.pone.0059236

    View details for Web of Science ID 000317383200003

    View details for PubMedID 23593134

  • Disinformation About Dissociation Dr Joel Paris's Notions About Dissociative Identity Disorder JOURNAL OF NERVOUS AND MENTAL DISEASE Brand, B., Loewenstein, R. J., Spiegel, D. 2013; 201 (4): 354-356

    View details for DOI 10.1097/NMD.0b013e318288d2ee

    View details for Web of Science ID 000316945100016

    View details for PubMedID 23538984



    In this review, the role of hypnosis and related psychotherapeutic techniques are discussed in relation to the anxiety disorders. In particular, anxiety is addressed as a special form of mind/body problem involving reverberating interaction between mental and physical distress. The history of hypnosis as a therapeutic discipline is reviewed, after which neurobiological evidence of the effect of hypnosis on modulation of perception in the brain. Specific brain regions involved in hypnosis are reviewed, notably the dorsal anterior cingulate gyrus and the dorsolateral prefrontal cortex. The importance of hypnotizability as a trait, stable variability in hypnotic responsiveness, is discussed. Analogies between the hypnotic state and dissociative reactions to trauma are presented, and the uses of hypnosis in treating posttraumatic stress disorder, stressful situations, and phobias as well as outcome data are reviewed. Effects of hypnosis on control of somatic processes are discussed, and then effects of psychosocial support involving Supportive-Expressive Group Therapy and hypnosis on survival time for cancer patients are evaluated. The evidence indicates an important role for hypnosis in managing anxiety disorders and anxiety related to medical illness.

    View details for DOI 10.1002/da.22046

    View details for Web of Science ID 000317600800008

    View details for PubMedID 23423952

  • Diurnal cortisol rhythm as a predictor of lung cancer survival BRAIN BEHAVIOR AND IMMUNITY Sephton, S. E., Lush, E., Dedert, E. A., Floyd, A. R., Rebholz, W. N., Dhabhar, F. S., Spiegel, D., Salmon, P. 2013; 30: S163-S170


    Poorly coordinated diurnal cortisol and circadian rest-activity rhythms predict earlier mortality in metastatic breast and colorectal cancer, respectively. We examined the prognostic value of the diurnal cortisol rhythm in lung cancer.Lung cancer patients (n=62, 34 female) were within 5 years of diagnosis and had primarily non small-cell lung cancer, with disease stage ranging from early to advanced. Saliva collected over two days allowed calculation of the diurnal cortisol slope and the cortisol awakening response (CAR). Lymphocyte numbers and subsets were measured by flow cytometry. Survival data were obtained for 57 patients. Cox Proportional Hazards analyses were used to test the prognostic value of the diurnal cortisol rhythm on survival calculated both from study entry and from initial diagnosis.The diurnal cortisol slope predicted subsequent survival over three years. Early mortality occurred among patients with higher slopes, or relatively "flat" rhythms indicating lack of normal diurnal variation (Cox Proportional Hazards p=.009). Cortisol slope also predicted survival time from initial diagnosis (p=.012). Flattened profiles were linked with male gender (t=2.04, df=59, p=.046) and low total and cytotoxic T cell lymphocyte counts (r=-.39 and -.30, p=.004 and .035, respectively). After adjustment for possible confounding factors, diurnal slope remained a significant, independent predictor of survival.Flattening of the diurnal cortisol rhythm predicts early lung cancer death. Data contribute to growing evidence that circadian disruption accelerates tumor progression.

    View details for DOI 10.1016/j.bbi.2012.07.019

    View details for Web of Science ID 000316510800019

    View details for PubMedID 22884416

  • Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys BIOLOGICAL PSYCHIATRY Stein, D. J., Koenen, K. C., Friedman, M. J., Hill, E., McLaughlin, K. A., Petukhova, M., Ruscio, A. M., Shahly, V., Spiegel, D., Borges, G., Bunting, B., Caldas-de-Almeida, J. M., de Girolamo, G., Demyttenaere, K., Florescu, S., Maria Haro, J., Karam, E. G., Kovess-Masfety, V., Lee, S., Matschinger, H., Mladenova, M., Posada-Villa, J., Tachimori, H., Viana, M. C., Kessler, R. C. 2013; 73 (4): 302-312


    Although the proposal for a dissociative subtype of posttraumatic stress disorder (PTSD) in DSM-5 is supported by considerable clinical and neurobiological evidence, this evidence comes mostly from referred samples in Western countries. Cross-national population epidemiologic surveys were analyzed to evaluate generalizability of the subtype in more diverse samples.Interviews were administered to 25,018 respondents in 16 countries in the World Health Organization World Mental Health Surveys. The Composite International Diagnostic Interview was used to assess 12-month DSM-IV PTSD and other common DSM-IV disorders. Items from a checklist of past-month nonspecific psychological distress were used to assess dissociative symptoms of depersonalization and derealization. Differences between PTSD with and without these dissociative symptoms were examined across a variety of domains, including index trauma characteristics, prior trauma history, childhood adversity, sociodemographic characteristics, psychiatric comorbidity, functional impairment, and treatment seeking.Dissociative symptoms were present in 14.4% of respondents with 12-month DSM-IV/Composite International Diagnostic Interview PTSD and did not differ between high and low/middle income countries. Symptoms of dissociation in PTSD were associated with high counts of re-experiencing symptoms and net of these symptom counts with male sex, childhood onset of PTSD, high exposure to prior (to the onset of PTSD) traumatic events and childhood adversities, prior histories of separation anxiety disorder and specific phobia, severe role impairment, and suicidality.These results provide community epidemiologic data documenting the value of the dissociative subtype in distinguishing a meaningful proportion of severe and impairing cases of PTSD that have distinct correlates across a diverse set of countries.

    View details for DOI 10.1016/j.biopsych.2012.08.022

    View details for Web of Science ID 000314634000004

    View details for PubMedID 23059051

  • Using the Science of Psychosocial Care to Implement the New American College of Surgeons Commission on Cancer Distress Screening Standard JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Wagner, L. I., Spiegel, D., Pearman, T. 2013; 11 (2): 214-221


    The American College of Surgeons (ACoS) Commission on Cancer (CoC) has advanced a new patient-centered accreditation standard requiring programs to implement psychosocial distress screening and referral for psychosocial care. The field of psychosocial oncology has advocated for routine distress screening as an integral component of quality cancer care since the NCCN Distress Management Panel first recommended this practice in 1999. Accreditation standards have a significant impact on practice patterns and quality of care. The new ACoS CoC Psychosocial Distress Screening Standard provides a unique opportunity to integrate the science of psychosocial care into clinical practice. National organizations, including the American Psychosocial Oncology Society, the Association of Oncology Social Work, the Cancer Support Community, and LIVESTRONG, can offer valuable guidance and resources. This article reviews ACoS CoC requirements, highlighting key research findings and providing practical considerations to guide programs with implementation. Although screening for distress encompasses many domains, this article reviews the evidence linking depression-one aspect of distress-and cancer outcomes to highlight the profound influence psychosocial care delivery can have on promoting medical outcomes and quality cancer survivorship. The authors describe distress screening program accomplishments at Northwestern University, including the electronic administration of NIH Patient Reported Outcomes Measurement Information System computerized adaptive testing item banks. Electronic medical record integration facilitates real-time scoring, interpretation, provider notification, and triage for psychosocial care. Roughly one-third of patients have requested assistance with psychosocial needs. As ACoS CoC programs implement psychosocial distress screening and management, the emerging field of implementation science can guide future clinical program developments and research priorities.

    View details for Web of Science ID 000314795200011

    View details for PubMedID 23411387

  • Dissociative Disorders in DSM-5 ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, VOL 9 Spiegel, D., Lewis-Fernandez, R., Lanius, R., Vermetten, E., Simeon, D., Friedman, M. 2013; 9: 299-326


    The rationale, research literature, and proposed changes to the dissociative disorders and conversion disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are presented. Dissociative identity disorder will include reference to possession as well as identity fragmentation, to make the disorder more applicable to culturally diverse situations. Dissociative amnesia will include dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia but does not always include confused wandering or loss of personality identity. Depersonalization disorder will include derealization as well, since the two often co-occur. A dissociative subtype of posttraumatic stress disorder (PTSD), defined by the presence of depersonalization or derealization in addition to other PTSD symptoms, is being recommended, based upon new epidemiological and neuroimaging evidence linking it to an early life history of adversity and a combination of frontal activation and limbic inhibition. Conversion disorder (functional neurological symptom disorder) will likely remain with the somatic symptom disorders, despite considerable dissociative comorbidity.

    View details for DOI 10.1146/annurev-clinpsy-050212-185531

    View details for Web of Science ID 000321742100013

    View details for PubMedID 23394228

  • An eye for an I: a 35-year-old woman with fluctuating oculomotor deficits and dissociative identity disorder. International journal of clinical and experimental hypnosis Bhuvaneswar, C., Spiegel, D. 2013; 61 (3): 351-370


    Abstract Physiologic changes, including neurological or pseudo-neurological symptoms, occur across identity states in dissociative identity disorder (DID) and can be objectively measured. The idea that dissociative phenomena might be associated with changes in brain function is consistent with research on the brain effects of hypnosis. The authors report a case of psycho-physiologic differences among 4 alter personalities manifested by a 35-year-old woman with DID. Differences in visual acuity, frequency of pendular nystagmus, and handedness were observed in this patient both when the alter personalities appeared spontaneously and when elicited under hypnosis. The authors consider several diagnostic possibilities for these findings and discuss whether prevailing treatment recommendations for DID patients could possibly be modified to ameliorate such visual and neurologic symptoms.

    View details for DOI 10.1080/00207144.2013.784115

    View details for PubMedID 23679117

  • Fatigue and weight loss predict survival on circadian chemotherapy for metastatic colorectal cancer. Cancer Innominato, P. F., Giacchetti, S., Moreau, T., Bjarnason, G. A., Smaaland, R., Focan, C., Garufi, C., Iacobelli, S., Tampellini, M., Tumolo, S., Carvalho, C., Karaboué, A., Poncet, A., Spiegel, D., Lévi, F. 2013


    BACKGROUND: Chemotherapy-induced neutropenia has been associated with prolonged survival selectively in patients on a conventional schedule (combined 5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX2]) but not on a chronomodulated schedule of the same drugs administered at specific circadian times (chronoFLO4). The authors hypothesized that the early occurrence of chemotherapy-induced symptoms correlated with circadian disruption would selectively hinder the efficacy of chronotherapy. METHODS: Fatigue and weight loss (FWL) were considered to be associated with circadian disruption based on previous data. Patients with metastatic colorectal cancer (n?=?543) from an international phase 3 trial comparing FOLFOX2 with chronoFLO4 were categorized into 4 subgroups according to the occurrence of FWL or other clinically relevant toxicities during the initial 2 courses of chemotherapy. Multivariate Cox models were used to assess the role of toxicity on the time to progression (TTP) and overall survival (OS). RESULTS: The proportions of patients in the 4 subgroups were comparable in both treatment arms (P?=?.77). No toxicity was associated with TTP or OS on FOLFOX2. The median OS on FOLFOX2 ranged from 16.4 (95% confidence limits [CL], 7.2-25.6 months) to 19.8 months (95% CL, 17.7-22.0 months) according to toxicity subgroup (P?=?.45). Conversely, FWL, but no other toxicity, independently predicted for significantly shorter TTP (P?

    View details for PubMedID 23633399

  • Introduction to Special Issue of Psychoneuroendocrinology "Enduring effects of Traumatic Stress: Molecular and Hormonal Mechanisms" Psychoneuroendocrinology Yehuda, R., Hildebrandt, T., Spiegel, D. 2013

    View details for PubMedID 23849599

  • Palliative Care JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Levy, M. H., Adolph, M. D., Back, A., Block, S., Codada, S. N., Dalal, S., Deshields, T. L., Dexter, E., Dy, S. M., Knight, S. J., Misra, S., Ritchie, C. S., Sauer, T. M., Smith, T., Spiegel, D., Sutton, L., Taylor, R. M., Temel, J., Thomas, J., Tickoo, R., Urba, S. G., Von Roenn, J. H., Weems, J. L., Weinstein, S. M., Freedman-Cass, D. A., Bergman, M. A. 2012; 10 (10): 1284-1309


    These guidelines were developed and updated by an interdisciplinary group of experts based on clinical experience and available scientific evidence. The goal of these guidelines is to help patients with cancer experience the best quality of life possible throughout the illness trajectory by providing guidance for the primary oncology team for symptom screening, assessment, palliative care interventions, reassessment, and afterdeath care. Palliative care should be initiated by the primary oncology team and augmented by collaboration with an interdisciplinary team of palliative care experts.

    View details for Web of Science ID 000309901900009

    View details for PubMedID 23054879

  • Functional Brain Basis of Hypnotizability ARCHIVES OF GENERAL PSYCHIATRY Hoeft, F., Gabrieli, J. D., Whitfield-Gabrieli, S., Haas, B. W., Bammer, R., Menon, V., Spiegel, D. 2012; 69 (10): 1064-1072


    Focused hypnotic concentration is a model for brain control over sensation and behavior. Pain and anxiety can be effectively alleviated by hypnotic suggestion, which modulates activity in brain regions associated with focused attention, but the specific neural network underlying this phenomenon is not known.To investigate the brain basis of hypnotizability.Cross-sectional, in vivo neuroimaging study performed from November 2005 through July 2006.Academic medical center at Stanford University School of Medicine.Twelve adults with high and 12 adults with low hypnotizability.Functional magnetic resonance imaging to measure functional connectivity networks at rest, including default-mode, salience, and executive-control networks; structural T1 magnetic resonance imaging to measure regional gray and white matter volumes; and diffusion tensor imaging to measure white matter microstructural integrity.High compared with low hypnotizable individuals had greater functional connectivity between the left dorsolateral prefrontal cortex, an executive-control region of the brain, and the salience network composed of the dorsal anterior cingulate cortex, anterior insula, amygdala, and ventral striatum, involved in detecting, integrating, and filtering relevant somatic, autonomic, and emotional information using independent component analysis. Seed-based analysis confirmed elevated functional coupling between the dorsal anterior cingulate cortex and the dorsolateral prefrontal cortex in high compared with low hypnotizable individuals. These functional differences were not due to any variation in brain structure in these regions, including regional gray and white matter volumes and white matter microstructure.Our results provide novel evidence that altered functional connectivity in the dorsolateral prefrontal cortex and dorsal anterior cingulate cortex may underlie hypnotizability. Future studies focusing on how these functional networks change and interact during hypnosis are warranted.

    View details for Web of Science ID 000309412800009

    View details for PubMedID 23026956



    Clinical and neurobiological evidence for a dissociative subtype of posttraumatic stress disorder (PTSD) has recently been documented. A dissociative subtype of PTSD is being considered for inclusion in the forthcoming Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) to address the symptoms of depersonalization and derealization found among a subset of patients with PTSD. This article reviews research related to the dissociative subtype including antecedent, concurrent, and predictive validators as well as the rationale for recommending the dissociative subtype.The relevant literature pertaining to the dissociative subtype of PTSD was reviewed.Latent class analyses point toward a specific subtype of PTSD consisting of symptoms of depersonalization and derealization in both veteran and civilian samples of PTSD. Compared to individuals with PTSD, those with the dissociative subtype of PTSD also exhibit a different pattern of neurobiological response to symptom provocation as well as a differential response to current cognitive behavioral treatment designed for PTSD.We recommend that consideration be given to adding a dissociative subtype of PTSD in the revision of the DSM. This facilitates more accurate analysis of different phenotypes of PTSD, assist in treatment planning that is informed by considering the degree of patients' dissociativity, will improve treatment outcome, and will lead to much-needed research about the prevalence, symptomatology, neurobiology, and treatment of individuals with the dissociative subtype of PTSD.

    View details for DOI 10.1002/da.21889

    View details for Web of Science ID 000307012000005

    View details for PubMedID 22431063


    View details for DOI 10.1002/da.21984

    View details for Web of Science ID 000307012000001

    View details for PubMedID 23150141

  • Stress, Coping, and Circadian Disruption Among Women Awaiting Breast Cancer Surgery ANNALS OF BEHAVIORAL MEDICINE Dedert, E., Lush, E., Chagpar, A., Dhabhar, F. S., Segerstrom, S. C., Spiegel, D., Dayyat, E., Daup, M., McMasters, K., Sephton, S. E. 2012; 44 (1): 10-20


    Psychological distress and coping related to a breast cancer diagnosis can profoundly affect psychological adjustment, possibly resulting in the disruption of circadian rest/activity and cortisol rhythms, which are prognostic for early mortality in metastatic colorectal and breast cancers, respectively.This study aims to explore the relationships of cancer-specific distress and avoidant coping with rest/activity and cortisol rhythm disruption in the period between diagnosis and breast cancer surgery.Fifty-seven presurgical breast cancer patients provided daily self-reports of cancer-specific distress and avoidant coping as well as actigraphic and salivary cortisol data.Distress and avoidant coping were related to rest/activity rhythm disruption (daytime sedentariness, inconsistent rhythms). Patients with disrupted rest/activity cycles had flattened diurnal cortisol rhythms.Maladaptive psychological responses to breast cancer diagnosis were associated with disruption of circadian rest/activity rhythms. Given that circadian cycles regulate tumor growth, we need greater understanding of possible psychosocial effects in cancer-related circadian disruption.

    View details for DOI 10.1007/s12160-012-9352-y

    View details for Web of Science ID 000308822700005

    View details for PubMedID 22450856

  • Mind matters in cancer survival PSYCHO-ONCOLOGY Spiegel, D. 2012; 21 (6): 588-593


    The very name "psycho-oncology" implies interaction between brain and body. One of the most intriguing scientific questions for the field is whether or not living better may also mean living longer.Randomized intervention trials examining this question will be reviewed.The majority show a survival advantage for patients randomized to psychologically effective interventions for individuals with a variety of cancers, including breast, melanoma, gastrointestinal, lymphoma, and lung cancers. Importantly, for breast and other cancers, when aggressive anti-tumor treatments are less effective, supportive approaches appear to become more useful. This is highlighted by a recent randomized clinical trial of palliative care for non-small cell lung cancer patients.There is growing evidence that disruption of circadian rhythms, including rest-activity patterns and hypothalamic-pituitary-adrenal (HPA) axis function, affects cancer risk and progression. Women with metastatic breast cancer have flatter diurnal cortisol patterns than normal, and the degree of loss of daily variation in cortisol predicts earlier mortality. Mechanisms by which abnormal cortisol patterns affect metabolism, gene expression, and immune function are reviewed. The HPA hyperactivity associated with depression can produce elevated levels of cytokines that affect the brain. Tumor cells can, in turn, co-opt certain mediators of inflammation such as NFkB, interleukin-6, and angiogenic factors to promote metastasis. Also, exposure to elevated levels of norepinephrine triggers release of vascular endothelial growth factor, which facilitates tumor growth.Therefore, the stress of advancing cancer and management of it is associated with endocrine, immune, and autonomic dysfunction that has consequences for host resistance to cancer progression.

    View details for DOI 10.1002/pon.3067

    View details for Web of Science ID 000304813800003

    View details for PubMedID 22438289

  • Evaluation of the Evidence for the Trauma and Fantasy Models of Dissociation PSYCHOLOGICAL BULLETIN Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardena, E., Frewen, P. A., Carlson, E. B., Spiegel, D. 2012; 138 (3): 550-588


    The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.

    View details for DOI 10.1037/a0027447

    View details for Web of Science ID 000303301500008

    View details for PubMedID 22409505

  • Where Are We Going? An Update on Assessment, Treatment, and Neurobiological Research in Dissociative Disorders as We Move Toward the DSM-5 JOURNAL OF TRAUMA & DISSOCIATION Brand, B. L., Lanius, R., Vermetten, E., Loewenstein, R. J., Spiegel, D. 2012; 13 (1): 9-31


    This article provides an overview of the process of developing the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association with a focus on issues related to the trauma-related disorders, particularly the dissociative disorders (DD). We also discuss the highlights of research within the past 5 years in the assessment, treatment, and neurobiological basis of trauma disorders. Recent research shows that DD are associated with severe symptoms as well as a higher rate of utilization of mental health treatment compared with other psychiatric disorders. As a result, DD, like other complex posttraumatic disorders, exact a high economic as well as personal burden for patients and society. The latest research indicates that DD patients show a suboptimal response to standard exposure-based treatments for posttraumatic stress disorder as well as high levels of attrition from treatment. An emerging body of research on DD treatment, primarily of naturalistic and open trials, indicates that patients who receive specialized treatment that addresses their trauma-based, dissociative symptoms show improved functioning and reduced symptoms. Recent studies of the underlying neurobiological basis for dissociation support a model of excessive limbic inhibition in DD that is consistent with the phenomenology and clinical presentation of these patients. We are optimistic that the forthcoming DSM-5 will stimulate research on dissociation and the DD and suggest areas for future studies.

    View details for DOI 10.1080/15299732.2011.620687

    View details for Web of Science ID 000302222900002

    View details for PubMedID 22211439

  • Psychiatric disorders among cancer patients. Handbook of clinical neurology Ciaramella, A., Spiegel, D. 2012; 106: 557-572

    View details for DOI 10.1016/B978-0-444-52002-9.00033-4

    View details for PubMedID 22608644

  • Dissociative disorders in DSM-5. Depression and anxiety Spiegel, D., Loewenstein, R. J., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., Cardeña, E., Brown, R. J., Dell, P. F. 2011; 28 (12): E17-45


    We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria.This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders.We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should include derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category.There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.

    View details for DOI 10.1002/da.20923

    View details for PubMedID 22134959

  • Dissociative disorders in DSM-5 DEPRESSION AND ANXIETY Spiegel, D., Loewenstein, R. J., Lewis-Fernandez, R., Sar, V., Simeon, D., Vermetten, E., Cardena, E., Dell, P. F. 2011; 28 (12): E17-E45

    View details for DOI 10.1002/da.20923

    View details for Web of Science ID 000297552900001

  • Conversion Disorder: Current problems and potential solutions for DSM-5 JOURNAL OF PSYCHOSOMATIC RESEARCH Stone, J., LaFrance, W. C., Brown, R., Spiegel, D., Levenson, J. L., Sharpe, M. 2011; 71 (6): 369-376


    Conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) describes neurological symptoms, including weakness, numbness and events resembling epilepsy or syncope, which can be positively identified as not being due to recognised neurological disease. This review combines perspectives from psychiatry, psychology and neurology to identify and discuss key problems with the current diagnostic DSM-IV criteria for conversion disorder and to make the following proposals for DSM-5: (a) abandoning the label "conversion disorder" and replacing it with an alternative term that is both theoretically neutral and potentially more acceptable to patients and practitioners; (b) relegating the requirements for "association of psychological factors" and the "exclusion of feigning" to the accompanying text; (c) adding a criterion requiring clinical findings of internal inconsistency or incongruity with recognised neurological or medical disease and altering the current 'disease exclusion' criteria to one in which the symptom must not be 'better explained' by a disease if present, (d) adding a 'cognitive symptoms' subtype. We also discuss whether conversion symptoms are better classified with other somatic symptom disorders or with dissociative disorders and how we might address the potential heterogeneity of conversion symptoms in classification.

    View details for DOI 10.1016/j.jpsychores.2011.07.005

    View details for Web of Science ID 000297830100001

    View details for PubMedID 22118377

  • A REVIEW OF ACUTE STRESS DISORDER IN DSM-5 DEPRESSION AND ANXIETY Bryant, R. A., Friedman, M. J., Spiegel, D., Ursano, R., Strain, J. 2011; 28 (9): 802-817


    Acute stress disorder (ASD) was introduced into DSM-IV to describe acute stress reactions (ASRs) that occur in the initial month after exposure to a traumatic event and before the possibility of diagnosing posttraumatic stress disorder (PTSD), and to identify trauma survivors in the acute phase who are high risk for PTSD. This review considers ASD in relation to other diagnostic approaches to acute stress responses, critiques the evidence of the predictive power of ASD, and discusses ASD in relation to Adjustment Disorder. The evidence suggests that ASD does not adequately identify most people who develop PTSD. This review presents a number of options and preliminary considerations to be considered for DSM-5. It is proposed that ASD be limited to describing severe ASRs (that are not necessarily precursors of PTSD). The evidence suggests that the current emphasis on dissociation may be overly restrictive and does not recognize the heterogeneity of early posttraumatic stress responses. It is proposed that ASD may be better conceptualized as the severity of acute stress responses that does not require specific clusters to be present.

    View details for DOI 10.1002/da.20737

    View details for Web of Science ID 000295105100006

    View details for PubMedID 21910186

  • DISSOCIATIVE DISORDERS IN DSM-5 DEPRESSION AND ANXIETY Spiegel, D., Loewenstein, R. J., Lewis-Fernandez, R., Sar, V., Simeon, D., Vermetten, E., Cardena, E., Dell, P. F. 2011; 28 (9): 824-852


    We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria.This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders.We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Should Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category.There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.

    View details for DOI 10.1002/da.20874

    View details for Web of Science ID 000295105100008

    View details for PubMedID 21910187

  • CLASSIFICATION OF TRAUMA AND STRESSOR-RELATED DISORDERS IN DSM-5 DEPRESSION AND ANXIETY Friedman, M. J., Resick, P. A., Bryant, R. A., Strain, J., Horowitz, M., Spiegel, D. 2011; 28 (9): 737-749


    This review examines the question of whether there should be a cluster of disorders, including the adjustment disorders (ADs), acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and the dissociative disorders (DDs), in a section devoted to abnormal responses to stress and trauma in the DSM-5. Environmental risk factors, including the individual's developmental experience, would thus become a major diagnostic consideration. The relationship of these disorders to one another is examined and also their relationship to other anxiety disorders to determine whether they are better grouped with anxiety disorders or a new specific grouping of trauma and stressor-related disorders. First how stress responses have been classified since DSM-III is reviewed. The major focus is on PTSD because it has received the most attention, regarding its proper placement among the psychiatric diagnoses. It is discussed whether PTSD should be considered an anxiety disorder, a stress-induced fear circuitry disorder, an internalizing disorder, or a trauma and stressor-related disorder. Then, ASD, AD, and DD are considered from a similar perspective. Evidence is examined pro and con, and a conclsion is offered recommending inclusion of this cluster of disorders in a section entitled "Trauma and Stressor-Related Disorders." The recommendation to shift ASD and PTSD out of the anxiety disorders section reflects increased recognition of trauma as a precipitant, emphasizing common etiology over common phenomenology. Similar considerations are addressed with regard to AD and DD.

    View details for DOI 10.1002/da.20845

    View details for Web of Science ID 000295105100002

    View details for PubMedID 21681870

  • Racial disparities in traumatic stress in prostate cancer patients: secondary analysis of a National URCC CCOP Study of 317 men SUPPORTIVE CARE IN CANCER Purnell, J. Q., Palesh, O. G., Heckler, C. E., Adams, M. J., Chin, N., Mohile, S., Peppone, L. J., Atkins, J. N., Moore, D. F., Spiegel, D., Messing, E., Morrow, G. R. 2011; 19 (7): 899-907


    African American men have the highest rates of prostate cancer of any racial group, but very little is known about the psychological functioning of African American men in response to prostate cancer diagnosis and treatment.In this secondary analysis of a national trial testing a psychological intervention for prostate cancer patients, we report on the traumatic stress symptoms of African American and non-African American men.This analysis includes 317 men (African American: n = 30, 9%; non-African American: n = 287, 91%) who were enrolled in the intervention trial, which included 12 weeks of group psychotherapy and 24 months of follow-up. Using mixed model analysis, total score on the Impact of Events Scale (IES) and its Intrusion and Avoidance subscales were examined to determine mean differences in traumatic stress across all time points (0, 3, 6, 12, 18, and 24 months). In an additional analysis, relevant psychosocial, demographic, and clinical variables were added to the model.Results showed significantly higher levels of traumatic stress for African American men compared to non-African American men in all models independently of the intervention arm, demographics, and relevant clinical variables. African Americans also had a consistently higher prevalence of clinically significant traumatic stress symptoms (defined as IES total score ? 27). These elevations remained across all time points over 24 months.This is the first study to show a racial disparity in traumatic stress specifically as an aspect of overall psychological adjustment to prostate cancer. Recommendations are made for appropriate assessment, referral, and treatment of psychological distress in this vulnerable population.

    View details for DOI 10.1007/s00520-010-0880-3

    View details for Web of Science ID 000291357100005

    View details for PubMedID 20414685

  • A Comparison of Trauma-Focused and Present-Focused Group Therapy for Survivors of Childhood Sexual Abuse: A Randomized Controlled Trial PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY Classen, C. C., Palesh, O. G., Cavanaugh, C. E., Koopman, C., Kaupp, J. W., Kraemer, H. C., Aggarwal, R., Spiegel, D. 2011; 3 (1): 84-93

    View details for DOI 10.1037/a0020096

    View details for Web of Science ID 000289034000012

  • Mind Matters in Cancer Survival JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Spiegel, D. 2011; 305 (5): 502-503

    View details for DOI 10.1001/jama.2011.69

    View details for Web of Science ID 000286810700025

    View details for PubMedID 21285429

  • Marital Status Predicts Change in Distress and Well-being in Women Newly Diagnosed With Breast Cancer and Their Peer Counselors BREAST JOURNAL Wittenberg, L., Yutsis, M., Taylor, S., Giese-Davis, J., Bliss-Isberg, C., Star, P., Spiegel, D. 2010; 16 (5): 481-489


    We conducted a nonrandomized study matching 42 women newly diagnosed with breast cancer (sojourners) with 39 trained breast cancer survivors (navigators) who provided one-on-one peer counseling for 3-6 months. Because little is known about how marital status might impact participants in such an intervention, we tested whether being married/partnered buffered navigators and sojourners from distress at baseline and over time. We examined baseline and slopes over time for change in depression and trauma symptoms, and emotional well-being. We were particularly concerned that being matched with a newly diagnosed breast cancer patient might trigger a re-experiencing of trauma symptoms for the navigator, so we examined a re-experiencing subscale. All participants completed baseline, 3-, 6-, and 12-month assessments. Our hypotheses were tested in separate Analyses of Variance (married versus not) for the 39 sojourners and 34 navigators who provided baseline assessments, and the 29 sojourners and 24 navigators who were matched and provided at least one follow-up. We found no significant baseline associations for navigators or sojourners. Being single/not married was associated with increasing depression symptoms over time in both navigators and sojourners compared with being married/partnered. By 12 months, these increases crossed above the clinical cut-off for significant depression symptoms. Single status did not predict increasing trauma symptoms over time. However, being single/not married predicted a significant increase in navigators' re-experiencing of trauma symptoms. Over time, married sojourners increased significantly in emotional well-being, whereas single/not married navigators did not differ from married navigators. In addition to providing ongoing training and emotional support to navigators, our findings indicate the importance of providing additional support for women who are not married or partnered.

    View details for DOI 10.1111/j.1524-4741.2010.00964.x

    View details for Web of Science ID 000281667100005

    View details for PubMedID 20642458

  • Regulation of circadian rhythms and hypothalamic-pituitary-adrenal axis: an overlooked interaction in cancer LANCET ONCOLOGY Innominato, P. F., Palesh, O., Dhabhar, F. S., Levi, F., Spiegel, D. 2010; 11 (9): 816-817

    View details for Web of Science ID 000282412000011

    View details for PubMedID 20816374

  • Sexual Violence, Posttraumatic Stress Disorder, and the Pelvic Examination: How Do Beliefs About the Safety, Necessity, and Utility of the Examination Influence Patient Experiences? JOURNAL OF WOMENS HEALTH Weitlauf, J. C., Frayne, S. M., Finney, J. W., Moos, R. H., Jones, S., Hu, K., Spiegel, D. 2010; 19 (7): 1271-1280


    Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted.This descriptive, cross-sectional study examines the relationship between sexual violence, PTSD, and women's negative reactions to the pelvic examination. Additional analyses highlight how maladaptive beliefs about the safety, necessity, and utility of the pelvic examination may contribute to these reactions. Materials andA total of 165 eligible women veterans were identified via medical record review and mailed a survey that assessed: (1) background information; (2) history of sexual violence; (3) current symptoms of posttraumatic stress disorder; (4) fear, embarrassment, distress, and pain during the pelvic examination; and (5) core beliefs about the examination. Ninety women (55% response rate) completed the survey.Women with both sexual violence and PTSD reported the highest levels of examination related fear: chi(2) = 18.8, p < .001; embarrassment: chi(2) = 21.2, p < .001; and distress: chi(2) = 18.2, p < .001. Beliefs that the examination was unnecessary or unsafe or not useful were more commonly reported in this group and were associated with higher levels of examination-related fear and embarrassment.Women with sexual violence and PTSD find the pelvic examination distressing, embarrassing, and frightening. Efforts to develop interventions to help reduce distress during the examination are warranted.

    View details for DOI 10.1089/jwh.2009.1673

    View details for Web of Science ID 000279428800007

    View details for PubMedID 20509787

  • Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype AMERICAN JOURNAL OF PSYCHIATRY Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., Spiegel, D. 2010; 167 (6): 640-647


    In this article, the authors present evidence regarding a dissociative subtype of PTSD, with clinical and neurobiological features that can be distinguished from nondissociative PTSD. The dissociative subtype is characterized by overmodulation of affect, while the more common undermodulated type involves the predominance of reexperiencing and hyperarousal symptoms. This article focuses on the neural manifestations of the dissociative subtype in PTSD and compares it to those underlying the reexperiencing/hyperaroused subtype. A model that includes these two types of emotion dysregulation in PTSD is described. In this model, reexperiencing/hyperarousal reactivity is viewed as a form of emotion dysregulation that involves emotional undermodulation, mediated by failure of prefrontal inhibition of limbic regions. In contrast, the dissociative subtype of PTSD is described as a form of emotion dysregulation that involves emotional overmodulation mediated by midline prefrontal inhibition of the same limbic regions. Both types of modulation are involved in a dynamic interplay and lead to alternating symptom profiles in PTSD. These findings have important implications for treatment of PTSD, including the need to assess patients with PTSD for dissociative symptoms and to incorporate the treatment of dissociative symptoms into stage-oriented trauma treatment.

    View details for Web of Science ID 000278269500008

    View details for PubMedID 20360318

  • Compassionate care during the endless hours. The journal of supportive oncology Rabow, M. W., Spiegel, D., Rosenbaum, E. H. 2010; 8 (3): 134-136

    View details for PubMedID 20552927

  • Dissociation in the DSM5 JOURNAL OF TRAUMA & DISSOCIATION Spiegel, D. 2010; 11 (3): 261-265

    View details for DOI 10.1080/15299731003780788

    View details for Web of Science ID 000279449600001

    View details for PubMedID 20603761



    This study assessed whether high hypnotizability is associated with posttraumatic stress and depressive symptoms in a sample of 124 metastatic breast cancer patients. Hypnotic Induction Profile Scores were dichotomized into low and high categories; posttraumatic intrusion and avoidance symptoms were measured with the Impact of Events Scale (IES); hyperarousal symptoms with items from the Profile of Mood States; and depressive symptoms with the Center for Epidemiologic Studies-Depression Scale. High hypnotizability was significantly related to greater IES total, IES intrusion symptoms, and depressive symptoms. A logistic regression model showed that IES total predicts high hypnotizability after adjusting for depressive symptoms and hyperarousal. The authors relate these results to findings in other clinical populations and discuss implications for the psychosocial treatment of metastatic breast cancer.

    View details for DOI 10.1080/00207140903310790

    View details for Web of Science ID 000274085500003

    View details for PubMedID 20183737



    This study assessed a range of benefits from participation in a brief existential intervention consisting of a semi-structured videotaped interview with cancer patients and their families designed to illuminate a life legacy for the family (the Life Tape Project [LTP]). Results indicated the majority reported intervention-specific benefits, especially in the areas of symbolic immortality (passing on personal values and philosophy), self-reflection and growth, and improved family cohesion and communication. Participants, particularly those who had perceived their cancer as a threat of death, serious injury, or threat to their physical integrity, and responded with intense fear or helplessness, also reported more general reductions in mood disturbance, improvements in aspects of well-being (including overall quality of life), satisfaction with the understanding they received, and enhanced cancer-related posttraumatic growth. In short, the LTP is a brief, inexpensive, existential intervention that can yield broad positive psychosocial changes for a majority of participants.

    View details for DOI 10.2190/OM.62.3.c

    View details for Web of Science ID 000288501600003

    View details for PubMedID 21495534

  • Does improving mood in depressed patients alter factors that may affect cardiovascular disease risk? JOURNAL OF PSYCHIATRIC RESEARCH Taylor, C. B., Conrad, A., Wilhelm, F. H., Strachowski, D., Khaylis, A., Neri, E., Giese-Davis, J., Roth, W. T., Cooke, J. P., Kraemer, H., Spiegel, D. 2009; 43 (16): 1246-1252


    To determine if improvement in mood would ameliorate autonomic dysregulation, HPA dysfunction, typical risk factors and C-reactive protein in depressed patients with elevated cardiovascular disease risk (CVD), 48 depressed participants with elevated cardiovascular risk factors were randomized to a cognitive behavioral intervention (CBT) or a waiting list control (WLC) condition. Twenty non-depressed age and risk-matched controls were also recruited. Traditional risk factors (e.g., lipids, blood pressure) and C-reactive protein were assessed pre- and post-treatment six months later. Subjects also underwent a psychophysiological stress test while cardiovascular physiology was measured. Salivary cortisol was measured during the day and during the psychological stress test. At post-treatment, the CBT subjects were significantly less depressed than WLC subjects. There was no significant difference in change scores on any of the traditional risk factors or C-reactive protein, cortisol measures, or cardiovascular physiology, except for triglyceride levels and heart rate, which were significantly lower in treatment compared to control subjects. The normal controls exhibited no change in the variables measured during the same time. A significant improvement in mood may have little impact on most traditional or atypical risk factors, cortisol or cardiophysiology.

    View details for DOI 10.1016/j.jpsychires.2009.05.006

    View details for Web of Science ID 000272860300002

    View details for PubMedID 19577757

  • Depression, cortisol, and suppressed cell-mediated immunity in metastatic breast cancer BRAIN BEHAVIOR AND IMMUNITY Sephton, S. E., Dhabhar, F. S., Keuroghlian, A. S., Giese-Davis, J., McEwen, B. S., Ionan, A. C., Spiegel, D. 2009; 23 (8): 1148-1155


    Cancer treatment is known to have significant immuno-suppressive/dysregulatory effects. Psychological distress and depression, which often accompany cancer diagnosis and treatment, can also suppress or dysregulate endocrine and immune function. Cell-mediated immunity (CMI) is critical for protection against a host of pathogens to which cancer patients may be particularly susceptible. CMI is also important for defense against some tumors. This study explored relationships among depressive symptoms, cortisol secretion, and CMI responses in 72 women with metastatic breast cancer. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D). Saliva was sampled throughout the day over a 3-day period to obtain a physiologic index of diurnal cortisol concentrations and rhythmicity, which is associated with breast cancer survival time. CMI for specific antigens was measured following intradermal administration of seven commonly encountered antigens (tuberculin, tetanus, diphtheria, Streptococcus, Candida, Trichophyton, and Proteus). Analyses adjusting for relevant medical and treatment variables indicated that women reporting more depressive symptoms showed suppressed immunity as measured by lower average induration size. Women with higher mean diurnal cortisol concentrations also showed suppressed immunity as indicated by a decreased number of antigens to which positive reactions were measured. This study highlights the relationships among depression, stress, and immune function in the context of advanced breast cancer.

    View details for DOI 10.1016/j.bbi.2009.07.007

    View details for Web of Science ID 000271754700016

    View details for PubMedID 19643176

  • Regional Brain Activation during Verbal Declarative Memory in Metastatic Breast Cancer CLINICAL CANCER RESEARCH Kesler, S. R., Bennett, F. C., Mahaffey, M. L., Spiegel, D. 2009; 15 (21): 6665-6673


    To determine the neurofunctional basis of verbal memory dysfunction in women with metastatic breast cancer. This objective was based on previous research suggesting memory and other cognitive deficits in this population. We attempted to determine if verbal memory impairments were related to the most commonly studied disease parameters including adjuvant chemotherapy and chronic stress-related disruption of limbic system structures.We used functional magnetic resonance imaging to test our hypothesis that women with breast cancer would show significantly lower brain activation during verbal declarative memory tasks compared with age and education-matched healthy female controls. We also assessed several stress-related variables including diurnal cortisol levels to test our hypothesis that women with breast cancer would show higher stress and this would contribute to brain activation deficits during memory tasks.Women with breast cancer had significantly lower prefrontal cortex activation during the memory encoding condition compared with controls. However, the breast cancer group showed significantly greater activation than controls during the recall condition in multiple, diffuse brain regions. There were no significant differences between the groups in stress-related variables. Women who were treated with cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy showed lower prefrontal cortex activation during memory encoding.These results suggest that women with metastatic breast cancer may be at risk for verbal memory impairments as a result of altered functional brain activation profiles. These findings may be associated with chemotherapy type and/or other aspects of the breast cancer disease process.

    View details for DOI 10.1158/1078-0432.CCR-09-1227

    View details for Web of Science ID 000271300200024

    View details for PubMedID 19843664

  • Effects of Supportive-Expressive Group Therapy on Pain in Women With Metastatic Breast Cancer HEALTH PSYCHOLOGY Butler, L. D., Koopman, C., Neri, E., Giese-Davis, J., Palesh, O., Thorne-Yocam, K. A., DiMiceli, S., Chen, X., Fobair, P., Kraemer, H. C., Spiegel, D. 2009; 28 (5): 579-587


    To examine whether a group intervention including hypnosis can reduce cancer pain and trait hypnotizability would moderate these effects.This randomized clinical trial examined the effects of group therapy with hypnosis (supportive-expressive group therapy) plus education compared to an education-only control condition on pain over 12 months among 124 women with metastatic breast cancer.Pain and suffering, frequency of pain, and degree of constant pain were assessed at baseline and 4-month intervals. Those in the treatment group also reported on their experiences using the hypnosis exercises.Intention-to-treat analyses indicated that the intervention resulted in significantly less increase in the intensity of pain and suffering over time, compared to the education-only group, but had no significant effects on the frequency of pain episodes or amount of constant pain, and there was no interaction of the intervention with hypnotizability. Within the intervention group, highly hypnotizable participants, compared to those less hypnotizable, reported greater benefits from hypnosis, employed self-hypnosis more often outside of group, and used it to manage other symptoms in addition to pain.These results augment the growing literature supporting the use of hypnosis as an adjunctive treatment for medical patients experiencing pain.

    View details for DOI 10.1037/a0016124

    View details for Web of Science ID 000269832800009

    View details for PubMedID 19751084

  • Shame, Guilt, and Posttraumatic Stress Disorder in Adult Survivors of Childhood Sexual Abuse at Risk for Human Immunodeficiency Virus Outcomes of a Randomized Clinical Trial of Group Psychotherapy Treatment JOURNAL OF NERVOUS AND MENTAL DISEASE Ginburg, K., Butler, L. D., Giese-Davis, J., Cavanaugh, C. E., Neri, E., Koopman, C., Classen, C. C., Spiegel, D. 2009; 197 (7): 536-542


    This study evaluated the effectiveness of group psychotherapy in reducing levels of shame and guilt in adult survivors of childhood sexual abuse at risk for HIV, and whether such reductions would mediate the effects of treatment on posttraumatic stress disorder (PTSD) symptoms. One hundred sixty-six women were randomized into 3 conditions: a trauma-focused group, a present-focused group, and a waitlist group. Women received 6 months of treatment and were assessed at pretreatment (T1), immediately posttreatment (T2), and 6 months posttreatment (T3). Both treatment conditions resulted in reduced shame and guilt. The treatment effect on PTSD symptoms was mediated by changes in shame, but it was not associated with changes in guilt. These findings suggest that, when treating childhood sexual abuse survivors' PTSD, it is important to address the negative self-appraisals, such as shame, that commonly accompany such symptoms.

    View details for DOI 10.1097/NMD.0b013e3181ab2ebd

    View details for Web of Science ID 000268040900010

    View details for PubMedID 19597362

  • Sexual Adjustment and Body Image Scale (SABIS): A New Measure for Breast Cancer Patients BREAST JOURNAL Dalton, E. J., Rasmussen, V. N., Classen, C. C., Grumann, M., Palesh, O. G., Zarcone, J., Kraemer, H. C., Kirshner, J. J., Colman, L. K., Morrow, G. R., Spiegel, D. 2009; 15 (3): 287-290


    The purpose of this study was to develop and validate a self-report measure of body image and sexual adjustment in breast cancer patients: the Sexual Adjustment and Body Image Scale (SABIS). Three hundred and fifty three women diagnosed with primary breast cancer that had completed initial surgical treatment completed the SABIS and five measures of psychological, psychosocial, and sexual functioning. Psychometric properties of the SABIS were examined and it was found to be a reliable and valid means of assessing body image and sexuality in breast cancer patients following surgery.

    View details for DOI 10.1111/j.1524-4741.2009.00718.x

    View details for Web of Science ID 000265899300011

    View details for PubMedID 19645784

  • Psychosocial Predictors of Resilience After the September 11, 2001 Terrorist Attacks JOURNAL OF NERVOUS AND MENTAL DISEASE Butler, L. D., Koopman, C., Azarow, J., Blasey, C. M., Magdalene, J. C., DiMiceli, S., Seagraves, D. A., Hastings, T. A., Chen, X., Garlan, R. W., Kraemer, H. C., Spiegel, D. 2009; 197 (4): 266-273


    The terrorist attacks of September 11, 2001 inflicted distress beyond those directly exposed, thereby providing an opportunity to examine the contributions of a range of factors (cognitive, emotional, social support, coping) to psychological resilience for those indirectly exposed. In an Internet convenience sample of 1281, indices of resilience (higher well-being, lower distress) at baseline (2.5-12 weeks post-attack) were each associated with less emotional suppression, denial and self-blame, and fewer negative worldview changes. After controlling for initial outcomes, baseline negative worldview changes and aspects of social support and coping all remained significant predictors of 6-month outcomes, with worldview changes bearing the strongest relationship to each. These findings highlight the role of emotional, coping, social support, and particularly, cognitive variables in adjustment after terrorism.

    View details for DOI 10.1097/NMD.0b013e31819d9334

    View details for Web of Science ID 000265249600008

    View details for PubMedID 19363383

  • Vagal regulation, cortisol, and sleep disruption in women with metastatic breast cancer. Journal of clinical sleep medicine Palesh, O., Zeitzer, J. M., Conrad, A., Giese-Davis, J., Mustian, K. M., Popek, V., Nga, K., Spiegel, D. 2008; 4 (5): 441-449


    To determine the relationship between hypothalamic pituitary axis (HPA) dysregulation, vagal functioning, and sleep problems in women with metastatic breast cancer.Sleep was assessed by means of questionnaires and wrist actigraphy for 3 consecutive nights. The ambulatory, diurnal variation in salivary cortisol levels was measured at 5 time points over 2 days. Vagal regulation was assessed via respiratory sinus arrhythmia (RSA(TF)) during the Trier Social Stress Task.Ninety-nine women (54.6 +/- 9.62 years) with metastatic breast cancer.Longer nocturnal wake episodes (r = 0.21, p = 0.04, N=91) were associated with a flatter diurnal cortisol slope. Sleep disruption was also associated with diminished RSA(TF). Higher RSA baseline scores were significantly correlated with higher sleep efficiency (r = 0.39, p = 0.001, N=68) and correspondingly lower levels of interrupted sleep (waking after sleep onset, WASO; r = -0.38, p = 0.002, N=68), lower average length of nocturnal wake episodes (r = -0.43, p < 0.001, N=68), and a lower self-reported number of hours of sleep during a typical night (r = -0.27, p = 0.02, N=72). Higher RSA AUC was significantly related to higher sleep efficiency (r = 0.45, p < 0.001, N=64), and a correspondingly lower number of wake episodes (r = -0.27, p = 0.04, N=64), lower WASO (r = -0.40, p = 0.001, N=64), and with lower average length of nocturnal wake episodes (r = -0.41, p = 0.001, N=64). While demographics, disease severity, and psychological variables all explained some portion of the development of sleep disruption, 4 of the 6 sleep parameters examined (sleep efficiency, WASO, mean number of waking episodes, average length of waking episode) were best explained by RSA.These data provide preliminary evidence for an association between disrupted nocturnal sleep and reduced RSA the subsequent day, confirming an association between disrupted nocturnal sleep and flattened diurnal cortisol rhythm in women with metastatic breast cancer. They suggest that the stress-buffering effects of sleep may be associated with improved parasympathetic tone and normalized cortisol patterns during the day.

    View details for PubMedID 18853702

  • Breast cancer and psychosocial factors: Early stressful life events, social support, and well-being PSYCHOSOMATICS Ginzburg, K., Wrensch, M., Rice, T., Farren, G., Spiegel, D. 2008; 49 (5): 407-412


    The allostasis theory postulates that stress causes the body to activate physiologic systems in order to maintain stability.The authors sought to examine the relationship between earlier stress and later development of breast cancer (BC).Authors correlated discrete and interactive relationships of stressful life events, social support, and well-being during childhood and adolescence with the occurrence of BC in adulthood among 300 women with primary BC and 305 matched control subjects.BC patients and control subjects reported similar childhood experiences. Yet, although childhood stressful life events were associated with reports of less family support and well being among the controls, those in the BC group who experienced high stress in early childhood actually expressed higher levels of family support and well-being than did those who had experienced lower levels of stress.These findings may reflect a tendency toward a repressive coping style among the BC group, which may be either a risk factor for the disease or a result of having it.

    View details for Web of Science ID 000259590500006

    View details for PubMedID 18794509

  • Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: A randomized pilot trial JOURNAL OF CLINICAL PSYCHOLOGY Butler, L. D., Waelde, L. C., Hastl, T. A., Chen, X., Symons, B., Marshall, J., Kaufman, A., Nagy, T. F., Blasey, C. M., Seibert, E. O., Spiegel, D. 2008; 64 (7): 806-820


    This randomized pilot study investigated the effects of meditation with yoga (and psychoeducation) versus group therapy with hypnosis (and psychoeducation) versus psychoeducation alone on diagnostic status and symptom levels among 46 individuals with long-term depressive disorders. Results indicate that significantly more meditation group participants experienced a remission than did controls at 9-month follow-up. Eight hypnosis group participants also experienced a remission, but the difference from controls was not statistically significant. Three control participants, but no meditation or hypnosis participants, developed a new depressive episode during the study, though this difference did not reach statistical significance in any case. Although all groups reported some reduction in symptom levels, they did not differ significantly in that outcome. Overall, these results suggest that these two interventions show promise for treating low- to moderate-level depression.

    View details for DOI 10.1002/jclp.20496

    View details for Web of Science ID 000256994900002

    View details for PubMedID 18459121

  • Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease JOURNAL OF PSYCHIATRIC RESEARCH Conrad, A., Wilhelm, F. H., Roth, W. T., Spiegel, D., Taylor, C. B. 2008; 42 (9): 769-777


    Depression is a risk factor for cardiovascular disease (CVD) perhaps mediated by hypothalamic-pituitary-adrenal (HPA) axis or vagal dysregulation. We investigated circadian mood variation and HPA-axis and autonomic function in older (55 years) depressed and nondepressed volunteers at risk for CVD by assessing diurnal positive and negative affect (PA, NA), cortisol, and cardiopulmonary variables in 46 moderately depressed and 19 nondepressed volunteers with elevated CVD risk. Participants sat quietly for 5-min periods (10:00, 12:00, 14:00, 17:00, 19:00, and 21:00), and then completed an electronic diary assessing PA and NA. Traditional and respiration-controlled heart rate variability (HRV) variables were computed for these periods as an index of vagal activity. Salivary cortisols were collected at waking, waking+30min, 12:00, 17:00, and 21:00h. Cortisol peaked in the early morning after waking, and gradually declined over the day, but did not differ between groups. PA was lower and NA was higher in the depressed group throughout the day. HRV did not differ between groups. Negative emotions were inversely related to respiratory sinus arrhythmia in nondepressed participants. We conclude that moderately depressed patients do not show abnormal HPA-axis function. Diurnal PA and NA distinguish depressed from nondepressed individuals at risk for CVD, while measures of vagal regulation, even when controlled for physical activity and respiratory confounds, do not. Diurnal mood variations of older individuals at risk for CVD differ from those reported for other groups and daily fluctuations in NA are not related to cardiac autonomic control in depressed individuals.

    View details for DOI 10.1016/j.jpsychires.2007.08.003

    View details for Web of Science ID 000256651600009

    View details for PubMedID 17884093

  • Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: When being nice does not suffice JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Lang, E. V., Berbaum, K. S., Pauker, S. G., Faintuch, S., Salazar, G. M., Lutgendorf, S., Laser, E., Logan, H., Spiegel, D. 2008; 19 (6): 897-905


    To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events.For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (> or =50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment.Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118).Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.

    View details for DOI 10.1016/j.jvir.2008.01.027

    View details for Web of Science ID 000256416300014

    View details for PubMedID 18503905

  • Losing sleep over cancer JOURNAL OF CLINICAL ONCOLOGY Spiegel, D. 2008; 26 (15): 2431-2432

    View details for DOI 10.1200/JCO.2008.16.2008

    View details for Web of Science ID 000255970300005

    View details for PubMedID 18487562

  • Emotional well-being does not predict survival in head and neck cancer patients - A Radiation Therapy Oncology Group Study CANCER Spiegel, D., Kraemer, H. C. 2008; 112 (10): 2326-2327

    View details for DOI 10.1002/cncr.23435

    View details for Web of Science ID 000255437300034

    View details for PubMedID 18338746

  • What is the placebo worth? BMJ (Clinical research ed.) Spiegel, D., Harrington, A. 2008; 336 (7651): 967-968

    View details for DOI 10.1136/bmj.39535.344201.BE

    View details for PubMedID 18390494

  • Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial PSYCHO-ONCOLOGY Classen, C. C., Kraemer, H. C., Blasey, C., Giese-Davis, J., Koopman, C., Palesh, O. G., Atkinson, A., DiMiceli, S., Stonisch-Riggs, G., Westendorp, J., Morrow, G. R., Spiegel, D. 2008; 17 (5): 438-447


    The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community settings, to determine whether highly distressed patients were most likely to benefit and whether therapist's training or experience was related to outcome.Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were randomly assigned to receive supportive-expressive group therapy or to an education control condition. Participants were recruited from two academic centers and nine oncology practices, which were members of NCI's Community Clinical Oncology Program (CCOP) and were followed over 2 years.A 2x2x19 analysis of variance was conducted with main effects of treatment condition, cohort, and baseline distress and their interactions. There was no main effect for treatment condition after removing one subject with an extreme score. Highly distressed women did not derive a greater benefit from treatment. Therapist training and psychotherapy experience were not associated with a treatment effect.This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer. Future studies might productively focus on women with higher initial levels of distress.

    View details for DOI 10.1002/pon.1280

    View details for Web of Science ID 000256463200003

    View details for PubMedID 17935144

  • Exploring emotion-regulation and autonomic physiology in metastatic breast cancer patients: Repression, suppression, and restraint of hostility PERSONALITY AND INDIVIDUAL DIFFERENCES Giese-Davis, J., Conrad, A., Nouriani, B., Spiegel, D. 2008; 44 (1): 226-237


    We examined relationships between three emotion-regulation constructs and autonomic physiology in metastatic breast cancer patients (N = 31). Autonomic measures are not often studied in breast cancer patients and may provide evidence of an increase in allostatic load. Patients included participated as part of a larger clinical trial of supportive-expressive group therapy. Systolic and diastolic blood pressure and heart rate were assessed at a semi-annual follow-up. We averaged 3 resting assessments and used measures of Repression, Suppression, Restraint of Hostility, and Body Mass Index as predictors of autonomic response. We found that higher repression was significantly associated with higher diastolic blood pressure, while higher restraint of hostility was significantly associated with higher systolic blood pressure. A repressive emotion regulation style may be a risk factor for higher sympathetic activation possibly increasing allostatic load, while restraint of hostility may be a protective factor for women with metastatic breast cancer.

    View details for DOI 10.1016/j.paid.2007.08.002

    View details for Web of Science ID 000251045000021

  • The effects of cognitive behavior therapy on depression in older patients with cardiovascular risk. Depression and anxiety Strachowski, D., Khaylis, A., Conrad, A., Neri, E., Spiegel, D., Taylor, C. B. 2008; 25 (8): E1-10


    This study examined the effect of a cognitive behavior therapy (CBT) therapy intervention designed to reduce depression in older patients with elevated cardiovascular disease (CVD) risk. Forty-eight depressed patients with elevated CVD were randomized to a 16-week individual CBT intervention (n = 23) or a wait-list control (WLC) group (n = 25). Pre- and post-treatment measures of depression were obtained during office visits, and measures of positive and negative affect were obtained during laboratory psychological stress testing and at five points during the day. At post-treatment, the CBT subjects were significantly less depressed than WLC subjects on the Hamilton Depression Inventory (F = 52.8, P<.001, ES = 1.85) and the Beck Depression Inventory (F = 17.1, P = <.001, ES = 0.85). Fifty-seven percent (13/23) of subjects in the CBT treatment were considered to be in remission (on the basis of a clinical interview) at post compared to only 4% (1/25) in the WLC (chi(2) = 9.0, P =.003). Treatment subjects reported significantly less stress on the Perceived Stress Scale (F = 23.2, P<.001). CBT significantly improved mean positive affect during the day (F = 12.7, P =.0001) but there were no significant differences in mean negative affect (F = 1.8, P =.19). CBT significantly reduced negative affect (F = 7.1, P =.01) during psychological stress testing but did not affect positive affect. CBT is an effective treatment for reducing depression and increasing positive affect in patients at risk for CVD, but the results vary by time of measurement and measurement setting.

    View details for PubMedID 17377961

  • Breast cancer as trauma: Posttraumatic stress and posttraumatic growth JOURNAL OF CLINICAL PSYCHOLOGY IN MEDICAL SETTINGS Cordova, M. J., Giese-Davis, J., Golant, M., Kronenwetter, C., Chang, V., Spiegel, D. 2007; 14 (4): 308-319
  • The mind prepared: Hypnosis on surgery JOURNAL OF THE NATIONAL CANCER INSTITUTE Spiegel, D. 2007; 99 (17): 1280-1281

    View details for DOI 10.1093/jnci/djm131

    View details for Web of Science ID 000249553700002

    View details for PubMedID 17728211

  • Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer - A randomized prospective trial CANCER Spiegel, D., Butler, L. D., Giese-Davis, J., Koopman, C., Miller, E., DiMiceli, S., Classen, C. C., Fobair, P., Carlson, R. W., Kraemer, H. C. 2007; 110 (5): 1130-1138


    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.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.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.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.

    View details for DOI 10.1002/cncr.22890

    View details for Web of Science ID 000249191100025

    View details for PubMedID 17647221

  • Stress history and breast cancer recurrence JOURNAL OF PSYCHOSOMATIC RESEARCH Palesh, O., Butler, L. D., Koopman, C., Giese-Davis, J., Carlson, R., Spiegel, D. 2007; 63 (3): 233-239


    There is mixed evidence regarding the possible association between a history of stressful or traumatic life events and more rapid breast cancer progression.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 event-screening 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 "stressful events."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 [chi2 (2, N=94)=6.09, P<.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).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.

    View details for DOI 10.1016/jjpsychores.2007.05.012

    View details for Web of Science ID 000249309300003

    View details for PubMedID 17719359

  • Evidence of dissociative amnesia. Psychological medicine Spiegel, D. 2007; 37 (7): 1064-1065

    View details for PubMedID 17451626

  • Conducting Internet-based HIV/STD prevention survey research: Considerations in design and evaluation AIDS AND BEHAVIOR Pequegnat, W., Rosser, B. R., Bowen, A. M., Bull, S. S., DiClemente, R. J., Bockting, W. O., Elford, J., Fishbein, M., Gurak, L., Horvath, K., Konstan, J., Noar, S. M., Ross, M. W., Sherr, L., Spiegel, D., Zimmerman, R. 2007; 11 (4): 505-521


    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.

    View details for DOI 10.1007/s10461-006-9172-9

    View details for Web of Science ID 000247241100001

    View details for PubMedID 17053853

  • A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer BIOLOGICAL PSYCHOLOGY Palesh, O. G., Collie, K., Batiuchok, D., Tilston, J., Koopman, C., Perlis, M. L., Butler, L. D., Carlson, R., Spiegel, D. 2007; 75 (1): 37-44


    Sleep disturbances are common among women with breast cancer and can have serious consequences. The present study examined depression, pain, life stress, and participation in group therapy in relation to sleep disturbances in a sample of women with metastatic breast cancer.Ninety-three women with metastatic breast cancer participated in a large intervention trial examining the effect of the group therapy on their symptoms. They completed measures of depression, pain, life stress, and sleep disturbance at baseline, 4, 8 and 12 months.The results showed that higher initial levels of depression at baseline predicted problems associated with getting up in the morning, waking up during the night, and daytime sleepiness. Increases in depression over the course of 12 months were associated with fewer hours of sleep, more problems with waking up during the night and more daytime sleepiness. Higher levels of pain at baseline predicted more problems getting to sleep. Increases in pain predicted more difficulty getting to sleep and more problems waking up during the night. Greater life stress at baseline predicted more problems getting to sleep and more daytime sleepiness.Depression, pain, and life stress scores were each associated with different types of negative change in self-reported sleep disturbances. Depression, especially worsening depression, was associated with the greatest number of types of negative change. 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 and show how different types of disturbed sleep may be clinical markers for depression, pain, or life stress in this population.

    View details for DOI 10.1016/j.biopsycho.2006.11.002

    View details for Web of Science ID 000245832000006

    View details for PubMedID 17166646

  • Post-traumatic stress disorder: medicine or politics (not both) LANCET Spiegel, D., Vermetten, E. 2007; 369 (9566): 992-992

    View details for Web of Science ID 000245286500026

    View details for PubMedID 17382824

  • Effects of age on responsiveness to adjunct hypnotic analgesia during invasive medical procedures PSYCHOSOMATIC MEDICINE Lutgendorf, S. K., Lang, E. V., Berbaum, K. S., Russell, D., Berbaum, M. L., Logan, H., Benotsch, E. G., Schulz-Stubner, S., Turesky, D., Spiegel, D. 2007; 69 (2): 191-199


    To assess the effects of age on responsiveness to self-hypnotic relaxation as an analgesic adjunct in patients undergoing invasive medical procedures.Secondary data analysis from a prospective trial with 241 patients randomized to receive hypnosis, attention, and standard care treatment during interventional radiological procedures. Growth curve analyses, hierarchical linear regressions, and logistic regressions using orthogonal contrasts were used for analysis. Outcome measures were Hypnotic Induction Profile scores, self-reported pain and anxiety, medication use, oxygen desaturation < or =89%, and procedure time.Hypnotizability did not vary with age (p = .19). Patients receiving attention and hypnosis had greater pain reduction during the procedure (p = .02), with trends toward lower pain with hypnosis (p = .07); this did not differ by age. As age increased, patients experienced more rapid pain control with hypnosis (p = .03). There was more rapid anxiety reduction with attention and hypnosis (p = .03). Trends toward lower final anxiety were also observed with attention and hypnosis versus standard care (p = .08), and with hypnosis versus attention (p = .059); these relationships did not differ by age. Patients requested and received less medication and had less oxygen desaturation < or =89% with attention and hypnosis (p < .001); this did not differ by age. However, as age increased, oxygen desaturation was greater in standard care (p = .03). Procedure time was reduced in the attention and hypnosis groups (p = .007); this did not vary by age.Older patients are hypnotizable and increasing age does not appear to mitigate the usefulness of hypnotic analgesia during invasive medical procedures.

    View details for DOI 10.1098/PSY.0b013e31803133ea

    View details for Web of Science ID 000244804800011

    View details for PubMedID 17289823

  • PTSD and Vietnam veterans SCIENCE Vermetten, E., Bremner, J. D., Skelton, L., Spiegel, D. 2007; 315 (5809): 184-184

    View details for Web of Science ID 000243407400012

    View details for PubMedID 17218506

  • Fractal analysis of EEG in hypnosis and its relationship with hypnotizability INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS Lee, J., Spiegel, D., Kim, S., Lee, J., Kim, S., Yang, B., Choi, J., Kho, Y., Nam, J. 2007; 55 (1): 14-31


    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.

    View details for DOI 10.1080/00207140600995810

    View details for Web of Science ID 000242557700002

    View details for PubMedID 17135061

  • Scientific study of the dissociative disorders PSYCHOTHERAPY AND PSYCHOSOMATICS Dalenberg, C., Loewenstein, R., Spiegel, D., Brewin, C., Lanius, R., Frankel, S., Gold, S., Van der Kolk, B., Simeon, D., Vermetten, E., Butler, L., Koopman, C., Courtois, C., Dell, P., Nijenhuis, E., Chu, J., Sar, V., Palesh, O., Cuevas, C., Paulson, K. 2007; 76 (6): 400-401

    View details for DOI 10.1159/000107570

    View details for Web of Science ID 000250094100013

    View details for PubMedID 17917478

  • The relationship of child maltreatment and self-capacities with distress when telling one's story of childhood sexual abuse. Journal of child sexual abuse Palesh, O., Classen, C. C., Field, N., Kraemer, H. C., Spiegel, D. 2007; 16 (4): 63-80


    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.

    View details for PubMedID 18032246

  • Commentary: Reversing amnesia about hypnosis AMERICAN JOURNAL OF CLINICAL HYPNOSIS Spiegel, D. 2007; 49 (3): 181-182

    View details for Web of Science ID 000243289200004

    View details for PubMedID 17265972

  • Wedding hypnosis to the radiology suite PAIN Spiegel, D. 2006; 126 (1-3): 3-4

    View details for DOI 10.1016/j.pain.2006.09.009

    View details for Web of Science ID 000243012200002

    View details for PubMedID 17055649

  • Loneliness within a nomological net: An evolutionary perspective JOURNAL OF RESEARCH IN PERSONALITY Cacioppo, J. T., Hawkley, L. C., Ernst, J. M., Burleson, M., Berntson, G. G., Nouriani, B., Spiegel, D. 2006; 40 (6): 1054-1085
  • The effect of peer counseling on quality of life following diagnosis of breast cancer: An observational study PSYCHO-ONCOLOGY Giese-Davis, J., Bliss-Isberg, C., Carson, K., Star, P., Donaghy, J., Cordova, M. J., Stevens, N., Wittenberg, L., Batten, C., Spiegel, D. 2006; 15 (11): 1014-1022


    Women with breast cancer express the greatest need for counseling at the time of diagnosis and report that the intervention they want is to be able to speak with someone who has the same cancer, but has lived through the crisis of treatment and is leading a 'normal' life. We conducted an observational study of a 6-month peer-counseling intervention testing outcomes for both newly diagnosed women (Sojourners) and peer counselors (Navigators) as a first step toward the goal of validating a peer navigator program. Significant improvement in the Sojourners was observed in trauma symptoms, emotional well-being, cancer self-efficacy, and desire for information on breast cancer resources. Navigators maintained baseline levels of the outcome variables, but increased in dissatisfaction with their interactions with their medical team and increased emotional suppression. Our findings indicate that peer navigation may halt a decline in quality of life that is commonly found in the first year following breast cancer diagnosis. In addition, Navigators were not adversely affected by their experience; however, careful training and supervision of Navigators is crucial to overall success. Randomized clinical trials are needed to demonstrate the efficacy of peer navigator programs.

    View details for DOI 10.1002/pon.1037

    View details for Web of Science ID 000242187400007

    View details for PubMedID 16555366

  • Stress sensitivity in metastatic breast cancer: Analysis of hypothalamic-pituitary-adrenal axis function PSYCHONEUROENDOCRINOLOGY Spiegel, D., Giese-Davis, J., Taylor, C. B., Kraemer, H. 2006; 31 (10): 1231-1244


    The normal diurnal cortisol cycle has a peak in the morning, decreasing rapidly over the day, with low levels during the night, then rising rapidly again to the morning peak. A pattern of flatter daytime slopes has been associated with more rapid cancer progression in both animals and humans. We studied the relationship between the daytime slopes and other daytime cortisol responses to both pharmacological and psychosocial challenges of hypothalamic-pituitary-adrenal (HPA) axis function as well as DHEA in a sample of 99 women with metastatic breast cancer, in hopes of elucidating the dysregulatory process. We found that the different components of HPA regulation: the daytime cortisol slope, the rise in cortisol from waking to 30 min later, and cortisol response to various challenges, including dexamethasone (DEX) suppression, corticotrophin releasing factor (CRF) activation, and the Trier Social Stress Task, were at best modestly associated. Escape from suppression stimulated by 1mg of DEX administered the night before was moderately but significantly associated with flatter daytime cortisol slopes (r=0.28 to .30 at different times of the post DEX administration day, all p<.01). Daytime cortisol slopes were also moderately but significant associated with the rise in cortisol from waking to 30 min after awakening (r=.29, p=.004, N=96), but not with waking cortisol level (r=-0.13, p=.19). However, we could not detect any association between daytime cortisol slope and activation of cortisol secretion by either CRF infusion or the Trier Social Stress Task. The CRF activation test (following 1.5mg of DEX to assure that the effect was due to exogenous CRF) produced ACTH levels that were correlated (r=0.66, p<.0001, N=74) with serum cortisol levels, indicating adrenal responsiveness to ACTH stimulation. Daytime cortisol slopes were significantly correlated with the slope of DHEA (r=.21, p=.04, N=95). Our general findings suggest that flatter daytime cortisol slopes among metastatic breast cancer patients may be related to disrupted feedback inhibition rather than hypersensitivity in response to stimulation.

    View details for DOI 10.1016/j.psyneuen.2006.09.004

    View details for Web of Science ID 000243095800010

    View details for PubMedID 17081700

  • Reduced hippocampal and amygdalar volume in dissociative identity disorder: not such clear evidence. American journal of psychiatry Spiegel, D. 2006; 163 (11): 2014-?

    View details for PubMedID 17162771

  • Effects of quality of life and coping on depression among adults living with HIV/AIDS JOURNAL OF HEALTH PSYCHOLOGY Gore-Felton, C., Koopman, C., Spiegel, D., Vosvick, M., Brondino, M., Winningham, A. 2006; 11 (5): 711-729


    This prospective study examined the effect of maladaptive coping strategies and psychological quality of life (QOL) on depression at two time points in a diverse sample of persons living with HIV/AIDS (N = 85). The use of maladaptive coping strategies to deal with the stress of living with HIV/AIDS, particularly engaging in various kinds of avoidant behaviors, was significantly associated with greater depression at baseline and increased depression at three months. QOL was the single most important predictor of depression. In an effort to develop effective clinical methods aimed at decreasing depression among adults living with HIV, future studies need to focus on improving quality of life and increasing adaptive coping strategies associated with the stress of living with HIV/AIDS.

    View details for DOI 10.1177/1359105306066626

    View details for Web of Science ID 000240771400006

    View details for PubMedID 16908468

  • Palliative care. Clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network Levy, M. H., Back, A., Bazargan, S., Benedetti, C., Billings, J. A., Block, S., Bruera, E., Carducci, M. A., Dy, S., Eberle, C., Foley, K. M., Harris, J., Knight, S. J., Milch, R., Rhiner, M., Slatkin, N. E., Spiegel, D., Sutton, L., Urba, S., Von Roenn, J. H., Weinstein, S. M. 2006; 4 (8): 776-818

    View details for PubMedID 16948956

  • Association of coping style, pain, age and depression with fatigue in women with primary breast cancer PSYCHO-ONCOLOGY Reuter, K., Classen, C. C., Roscoe, J. A., Morrow, G. R., Kirshner, J. J., Rosenbluth, R., Flynn, P. J., Shedlock, K., Spiegel, D. 2006; 15 (9): 772-779


    The purpose of this study was to explore the relative contributions of coping, depression, pain and age, in the experience of cancer related fatigue. A total of 353 women treated for primary breast cancer were assessed within one year of diagnosis using the Profile of Mood States, the Hospital Anxiety and Depression Scale and the mini-Mental Adjustment to Cancer Scale. Fatigue was positively associated with depression and pain, but inversely related to age. In contrast to our expectations, fighting spirit was not associated with less fatigue. A relationship between coping style and cancer-related fatigue was found exclusively for 'positive reappraisal', a combination of fighting spirit and fatalism. Detectable only in multivariate analysis together with depression, the results suggest a weak association between coping and fatigue. The relationship between cancer related fatigue, age and coping styles requires further exploration within longitudinal studies.

    View details for DOI 10.1002/pon.1012

    View details for Web of Science ID 000240670300003

    View details for PubMedID 16362999

  • Depression and stress reactivity in metastatic breast cancer PSYCHOSOMATIC MEDICINE Giese-Davis, J., Wilhelm, F. H., Conrad, A., Abercrombie, H. C., Sephton, S., Yutsis, M., Neri, E., Taylor, C. B., Kraemer, H. C., Spiegel, D. 2006; 68 (5): 675-683


    Cancer-related distress due to the psychological and physical challenges of metastatic breast cancer (MBC) may result in symptoms of depression, which negatively affects quality and may influence quantity of life. This study investigated how depression affects MBC stress reactivity, including autonomic (ANS) and hypothalamic-pituitary-adrenal (HPA) axis function.Forty-five nondepressed and 45 depressed patients with MBC underwent a modified Trier Social Stress Test (TSST) while affect, cardiovascular, respiratory, and cortisol responses were measured.At study entry, depressed compared with nondepressed patients had significantly lower log cortisol waking rise levels (p = .005) but no other HPA differences. Positive affect (p = .025) and high-frequency heart-rate variability (lnHF) (p = .002) were significantly lower at TSST baseline in depressed patients. In response to the TSST, depressed patients reported significantly lower positive (p = .050) and greater negative affect (p = .037) and had significantly reduced lnHF (p = .031). In secondary analyses, at TSST baseline both low-frequency (lnLF) (p = .002) and very-low-frequency (lnVLF) (p = .0001) heart rate variability were significantly lower in the depressed group. In secondary analyses during the TSST, those who were depressed had significantly lower lnVLF (p = .008) and did not increase aortic impedance reactivity as much as did the nondepressed during the stressor (p = .005).Depression in patients with MBC was associated with alterations in autonomic regulation, particularly reductions in respiratory sinus arrhythmia, a measure of cardiac vagal control, at baseline and during the TSST. In addition, depression was associated with blunted HPA response to awakening. Both MBC groups had relative cortisol hyporesponsiveness to acute stress.

    View details for DOI 10.1097/01.psy.0000238216.88515.e5

    View details for Web of Science ID 000241205700006

    View details for PubMedID 17012520

  • Self-report and linguistic indicators of emotional expression in narratives as predictors of adjustment to cancer JOURNAL OF BEHAVIORAL MEDICINE Owen, J. E., Giese-Davis, J., Cordova, M., Kronenwetter, C., Golant, M., Spiegel, D. 2006; 29 (4): 335-345


    Emotional expression and cognitive efforts to adapt to cancer have been linked to better psychological adjustment. However, little is known about the relationship between linguistic indicators of emotional and cognitive coping efforts and corresponding self-report measures of related constructs. In this study, we sought to evaluate the interrelationships between self-reports of emotional suppression and linguistic indicators of emotional and cognitive coping efforts in those living with cancer. Seventy-one individuals attending a community cancer support group completed measures of emotional suppression and mood disturbance and provided a written narrative describing their cancer experience. Self-reports of emotional suppression were associated with more rather than less distress. Although linguistic indicators of both emotional expression and cognitive processing were generally uncorrelated with self-report measures of emotional suppression and mood disturbance, a significant interaction was observed between emotional suppression and use of cognitive words on mood disturbance. Among those using higher levels of emotional suppression, increasing use of cognitive words was associated with greater levels of mood disturbance. These findings have implications for a) the therapeutic use of emotion in psychosocial interventions and b) the use of computer-assisted technologies to conduct content analysis.

    View details for DOI 10.1007/s10865-006-9061-8

    View details for Web of Science ID 000239354200004

    View details for PubMedID 16845583

  • Emotional expression and diurnal cortisol slope in women with metastatic breast cancer in supportive-expressive group therapy: A preliminary study BIOLOGICAL PSYCHOLOGY Giese-Davis, J., DiMiceli, S., Sephton, S., Spiegel, D. 2006; 73 (2): 190-198


    We examined coded emotional expression during an initial therapy session and its association with a known physiological risk factor for early death, aberrant diurnal cortisol slope, in women with metastatic breast cancer. Out of 64 women with metastatic breast cancer randomized to a multi-site clinical intervention trial of supportive-expressive group therapy (SET), a subsample of 29 met eligibility criteria for this study. We tested whether longer mean durations of primary negative affect (fear, sadness, and anger) expression were associated with steeper diurnal cortisol slopes after adjusting for speaking time, repressive-defensiveness, anxiety, and the interaction between repressive-defensiveness and anxiety. We found that steeper cortisol slopes were related to lower repressive-defensiveness and greater primary negative affect expression in line with a priori hypotheses. Additionally we explored whether coded positive affect, defensive/hostile affect, constrained anger, and the interaction between primary negative affect and repressive-defensiveness explained additional variance in diurnal cortisol patterns.

    View details for DOI 10.1016/j.biopsycho.2006.04.003

    View details for Web of Science ID 000240396000011

    View details for PubMedID 16750288

  • The abuse-related beliefs questionnaire for survivors of childhood sexual abuse CHILD ABUSE & NEGLECT Ginzburg, K., Arnow, B., Hart, S., Gardner, W., Koopman, C., Classen, C. C., Giese-Davis, J., Spiegel, D. 2006; 30 (8): 929-943


    To evaluate the psychometric properties of a new measure, the Abuse-Related Beliefs Questionnaire (ARBQ), designed to assess abuse-related beliefs among adult survivors of childhood sexual abuse (CSA). Study 1 examined the structure of the scale, and Study 2 evaluated its reliability and validity.One hundred and seventy female CSA survivors recruited into a group psychotherapy intervention study were administered the ARBQ in Study 1. A subsample of 45 women completed the ARBQ again 12 months later. In Study 2, 70 women from a health maintenance organization who identified themselves as survivors of CSA completed the ARBQ along with the Trauma Symptom Checklist-40 (TSC-40) and the Symptom Checklist 90R (SCL-90-R).Three reliable ARBQ subscales emerged in Study 1: Guilt, Shame, and Resilience. Twelve-month test-retest reliability was high (r=.60-.64). The internal consistency of the subscales was further supported in Study 2, and validity was demonstrated by moderate to high correlations with the distress measures.The results indicate that the ARBQ has good psychometric characteristics, supporting the feasibility of its use in measuring abuse-related beliefs in research on survivors of CSA. A next step for validation of the ARBQ would be to evaluate its sensitivity in measuring changes in studies of interventions for treating CSA survivors.

    View details for DOI 10.1016/j.chiabu.2006.01.004

    View details for Web of Science ID 000240582000007

    View details for PubMedID 16934330

  • Psychophysiological and cortisol responses to psychological stress in depressed and nondepressed older men and women with elevated cardiovascular disease risk PSYCHOSOMATIC MEDICINE Taylor, C. B., Conrad, A., Wilhelm, F. H., Neri, E., DeLorenzo, A., Kramer, M. A., Giese-Davis, J., Roth, W. T., Oka, R., Cooke, J. P., Kraemer, H., Spiegel, D. 2006; 68 (4): 538-546


    The objective of this study was to compare psychophysiological and cortisol reactions to psychological stress in older depressed and nondepressed patients at risk for cardiovascular disease (CVD).Forty-eight depressed participants and 20 controls with elevated cardiovascular risk factors underwent a psychological stress test during which cardiovascular variables were measured. Salivary cortisol was collected after each test segment. Traditional (e.g., lipids) and atypical (e.g., C-reactive protein) CVD risk factors were also obtained.At baseline, the groups did not differ on lipid levels, flow-mediated vasodilation, body mass index, or asymmetric dimethylarginine. However, the depressed patients had significantly higher C-reactive protein levels. Contrary to our hypothesis, there were no differences in baseline cortisol levels or diurnal cortisol slopes, but depressed patients showed significantly lower cortisol levels during the stress test (p = .03) and less cortisol response to stress. Compared with nondepressed subjects, depressed subjects also showed lower levels of respiratory sinus arrhythmia (RSA(TF)) during the stress test (p = .02).In this sample, older depressed subjects with elevated risk for CVD exhibited a hypocortisol response to acute stress. This impaired cortisol response might contribute to chronic inflammation (as reflected in the elevated C-reactive proteins in depressed patients) and in other ways increase CVD risk. The reduced RSA(TF) activity may also increase CVD risk in depressed patients through impaired autonomic nervous system response to cardiophysiological demands.

    View details for DOI 10.1097/01.psy.0000222372.16274.92

    View details for Web of Science ID 000239330600005

    View details for PubMedID 16868262

  • Design decisions to optimize reliability of daytime cortisol slopes in an older population AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Kraemer, H. C., Giese-Davis, J., Yutsis, M., Neri, E., Gallagher-Thompson, D., Taylor, C. B., Spiegel, D. 2006; 14 (4): 325-333


    The daytime log-cortisol slope appears to be of growing importance in studying the relationship between stress and health. How best to estimate that slope with minimal burden to the participants and the cost of the study is a decision often made without empiric foundation.In 50 older participants, the authors examined cortisol assay comparability across laboratories, assay reliability, test-retest reliability of slopes, and comparability of slope estimates for two, three, and four samples per day.The authors demonstrate in an older sample that 1) assay reliability is a relatively minor issue, that one assay per saliva sample suffices; 2) the use of a sample obtained at wake time for each participant appears to be a preferred anchor for the slope estimate in comparison to a sample 30 minutes postwake time; 3) self-reported times appear preferable to automatic time recording; and 4) test-retest reliability of slopes, however, is not sufficiently high to base a slope estimate on one day; minimally two days and preferably three should be required.Whether these conclusions apply to other populations, or using other protocols, is not assured, but the study itself provides a model that can be used to check research decisions. Unnecessarily imposing a burdensome protocol has both ethical and scientific ramifications and should be carefully avoided.

    View details for Web of Science ID 000236540800005

    View details for PubMedID 16582041

  • Recognizing traumatic dissociation AMERICAN JOURNAL OF PSYCHIATRY Spiegel, D. 2006; 163 (4): 566-568

    View details for Web of Science ID 000236541200002

    View details for PubMedID 16585425

  • Improving methods of assessing natural killer cell cytotoxicity INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH Sephton, S. E., Kraemer, H. C., Neri, E., Stites, D. P., Weissbecker, I., Spiegel, D. 2006; 15 (1): 12-21


    Natural killer (NK) cells are a class of lymphocytes important in immune resistance to viral and other serious diseases. The cytotoxic function, or 'killing activity' of NK cells has become important in studies of the effects of stress and other psychosocial factors on physical health. Unfortunately, research on NK cell function has been plagued by discrepancies in the methods of interpreting NK cytotoxicity data. We briefly review some of the variations in measuring NK cell activity and present a new model for interpreting these results, introducing maximal target cell lysis (A) and the slope of the cytolytic curve (k) as parameters that attempt to make full use of the information and the statistical power in NK cell cytotoxicity data. Examples of these interpretation methods are presented using NK cytotoxicity data from a group of metastatic breast cancer patients. This approach will be useful in applications of NK cell measurement in psychoneuroimmunology research.

    View details for DOI 10.1002/mpr.26

    View details for Web of Science ID 000237427900002

    View details for PubMedID 16676682

  • Letter to the Editor. DSM-1V-TR The American Journal of Psychiatry Spiegel D. 2006; 163 (9): 1464
  • Recognizing Traumatic Dissociation American Journal of Pyschiatry Spiegel D. 2006; 163: 566-568
  • The life tape project: Increasing family social support and symbolic immortality with a brief existential intervention for cancer patients and their families. OMEGA-JOURNAL OF DEATH AND DYING Rosenbaum, E., Garlan, R. W., Hirschberger, N., Siegel, A. L., Butler, L. D., Spiegel, D. 2006; 53 (4): 321-339
  • Loneliness within a nomological net: An evolutionary perspective Juornal of Research in Personality Cacioppo J T, Hawkley L C, Ernst J M, Burleson M, Bernston G G, Nouriani B, Spiegel D. 2006; 40 (6): 1054-1085
  • Letter to the Editor Desgragation mentale The American Journal of Pyschiatry Spiegel D. 2006; 163 (9): 1464
  • A randomized controlled trial of psychosocial interventions using the psychophysiological framework for Chinese breast cancer patients JOURNAL OF PSYCHOSOCIAL ONCOLOGY Chan, C. L., Ho, R. T., Lee, P. W., Cheng, J. Y., Leung, P. P., Foo, W., Chow, L. W., Sham, J. S., Spiegel, D. 2006; 24 (1): 3-26


    This study aimed to investigate the psychophysiological outcomes of different psychosocial interventions for breast cancer patients. Participants were randomly assigned into 3 intervention groups, namely, Body-Mind-Spirit (BMS), Supportive-Expressive (SE), and Social Support Self-Help (SS) groups; a no-intervention group was used as control. Salivary cortisol was used as the physiological stress marker. Distress level, mental adjustment, emotional control, and social support were measured. Data were collected at baseline, 4 month, and 8 month. Preliminary results indicated that BMS intervention produced the greatest and the most sustained effects. It enhanced positive social support, reduced psychological distress, emotional control, and negative mental adjustment. Total salivary cortisol was lowered after 8 months. Most participants in SE groups indicated the treatment helpful, but changes in psychophysiological outcomes were not statistically significant. Participants in SS groups seemed less likely to benefit from the intervention. The no intervention control group indicated a reduction in social support. These outcomes suggest that active professional intervention is more likely to yield therapeutic effects. In particular, psychosocial intervention attending to the spiritual dimension contributes to positive outcomes.

    View details for DOI 10.1300/J077v24n01_02

    View details for Web of Science ID 000240391200002

    View details for PubMedID 16803749

  • Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors. Journal of trauma & dissociation Ginzburg, K., Koopman, C., Butler, L. D., Palesh, O., Kraemer, H. C., Classen, C. C., Spiegel, D. 2006; 7 (2): 7-27


    This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties-discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.

    View details for PubMedID 16769663

  • Disengagement and social support moderate distress among women with a family history of breast cancer BREAST JOURNAL Turner-Cobb, J. M., Bloor, L. E., Whittemore, A. S., West, D., Spiegel, D. 2006; 12 (1): 7-15


    Using a cross-sectional, exploratory design, this pilot study analyzed the relationships between familial history of breast cancer and psychological distress in order to evaluate who is more distressed and to assess the possible need for intervention. Coping style, social support, and family relations were investigated as potential moderators of these relationships. Participants were 45 women with a familial history of breast cancer recruited from the Family Registry for Breast Cancer (FRBC) at the Northern California Cancer Center (NCCC). Contrary to previous reports of similar cohorts, the overall level of psychological distress in this cohort was comparable to normative samples. The number of relatives with breast cancer was related to distress as measured by the State-Trait Anxiety Inventory (STAI) scale, but there was no significant differentiation in distress associated with the number of first-degree as compared to second- and third-degree relatives with breast cancer. Having more relatives that had died from breast cancer was associated with greater distress on a number of measures. The number of first-degree relative deaths, including maternal death, was also associated with distress. Positive and network support, disengagement coping responses, and family cohesion were each significant moderators of the impact of family history on distress. This association between distress and disengagement is similar to that found in metastatic breast cancer patients themselves, and the findings suggest a subgroup that merits and might respond to more intensive intervention to provide support and facilitate emotional expression.

    View details for Web of Science ID 000235532900003

    View details for PubMedID 16409581

  • The relationship between depression and medical illness PATIENT CARE Katon, W. J., Wulsin, L. R., Spiegel, D. 2005; 39 (10): 12-?
  • Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS AIDS PATIENT CARE AND STDS Ashton, E., Vosvick, M., Chesney, M., Gore-Felton, C., Koopman, C., O'Shea, K., Maldonado, J., Bachmann, M. H., Israelski, D., Flamm, J., Spiegel, D. 2005; 19 (9): 587-598


    This study examined social support and maladaptive coping as predictors of HIV-related health symptoms. Sixty-five men and women living with HIV/AIDS completed baseline measures assessing coping strategies, social support, and HIV-related health symptoms. The sample was primarily low-income and diverse with respect to gender, ethnicity, and sexual orientation. Three, 6, and 12 months after completing baseline assessments, physical health symptoms associated with HIV disease were assessed. After controlling for demographic characteristics, CD4 T-cell count, and baseline HIV-related health symptoms, individuals reporting lower increase in HIV-related health symptoms used less venting (expressing emotional distress) as a strategy for coping with HIV. However, when satisfaction with social support was added to the model, the use of this coping strategy was no longer significant, and individuals reporting more satisfying social support were more likely to report lower increase in their HIV-related health symptoms, suggesting that social support is a robust predictor of health outcomes over time independent of coping style and baseline medical status. These findings provide further evidence that social support can buffer deleterious health outcomes among individuals with a chronic illness. Future research needs to examine mediating pathways that can explain this relationship.

    View details for Web of Science ID 000232058300006

    View details for PubMedID 16164385

  • Mood disorders in the medically ill: Scientific review and recommendations BIOLOGICAL PSYCHIATRY Evans, D. L., Charney, D. S., Lewis, L., Golden, R. N., Gorman, J. M., Krishnan, K. R., Nemeroff, C. B., Bremner, J. D., Carney, R. M., Coyne, J. C., DeLong, M. R., Frasure-Smith, N., Glassman, A. H., Gold, P. W., Grant, I., Gwyther, L., Ironson, G., Johnson, R. L., Kanner, A. M., Katon, W. J., Kaufmann, P. G., Keefe, F. J., Ketter, T., Laughren, T. P., Leserman, J., Lyketsos, C. G., McDonald, W. M., McEwen, B. S., Miller, A. H., Musselman, D., O'Connor, C., Petitto, J. M., Pollock, B. G., Robinson, R. G., Roose, S. P., Rowland, J., Sheline, Y., Sheps, D. S., Simon, G., Spiegel, D., Stunkard, A., Sunderland, T., Tibbits, P., Valvo, W. J. 2005; 58 (3): 175-189


    The purpose of this review is to assess the relationship between mood disorders and development, course, and associated morbidity and mortality of selected medical illnesses, review evidence for treatment, and determine needs in clinical practice and research.Data were culled from the 2002 Depression and Bipolar Support Alliance Conference proceedings and a literature review addressing prevalence, risk factors, diagnosis, and treatment. This review also considered the experience of primary and specialty care providers, policy analysts, and patient advocates. The review and recommendations reflect the expert opinion of the authors.Reviews of epidemiology and mechanistic studies were included, as were open-label and randomized, controlled trials on treatment of depression in patients with medical comorbidities. Data on study design, population, and results were extracted for review of evidence that includes tables of prevalence and pharmacological treatment. The effect of depression and bipolar disorder on selected medical comorbidities was assessed, and recommendations for practice, research, and policy were developed.A growing body of evidence suggests that biological mechanisms underlie a bidirectional link between mood disorders and many medical illnesses. In addition, there is evidence to suggest that mood disorders affect the course of medical illnesses. Further prospective studies are warranted.

    View details for DOI 10.1016/j.biopsych.2005.05.001

    View details for Web of Science ID 000231057100001

    View details for PubMedID 16084838

  • Anticipating loss and other temporal stressors predict traumatic stress symptoms among partners of metastatic/recurrent breast cancer patients PSYCHO-ONCOLOGY Butler, L. D., Field, N. P., Busch, A. L., Seplaki, J. E., Hastings, T. A., Spiegel, D. 2005; 14 (6): 492-502


    This study examined pre- and post-loss levels of posttraumatic stress symptoms (intrusion and avoidance) in partners of metastatic/recurrent breast cancer patients, and the relationship of these symptoms to past, current, and anticipatory stressors. The results indicate that 34% (17/50) of the partners experienced clinically significant symptom levels prior to the patients' deaths. Prior to loss, partners' symptoms were positively associated with their current level of perceived stress and anticipated impact of the loss; whereas following loss, partners' symptoms were predicted by higher pre-loss levels of symptoms, past family deaths, and anticipated impact of the loss. Limitations and treatment implications of the present research and directions for future research are discussed.

    View details for DOI 10.1002/pon.865

    View details for Web of Science ID 000229977300006

    View details for PubMedID 15452896

  • Breast cancer and problems with medical interactions: Relationships with traumatic stress, emotional self-efficacy, and social support PSYCHO-ONCOLOGY Han, W. T., Collie, K., Koopman, C., Azarow, J., Classen, C., Morrow, G. R., Michel, B., Brennan-O'Neill, E., Spiegel, D. 2005; 14 (4): 318-330


    This investigation examined relationships between breast cancer patients' psychosocial characteristics (impact of the illness, traumatic stress symptoms, emotional self-efficacy, and social support) and problems they perceived in their medical interactions and their satisfaction with their physicians. Participants were 352 women enrolled in a multicenter trial of the effects of group therapy for women with recently diagnosed primary breast cancer. The findings reported here are from a cross-sectional analysis of baseline data gathered prior to randomization. Problems interacting with physicians and nurses were associated with greater levels of cancer-related traumatic stress (p < 0.01), less emotional self-efficacy for cancer (p < 0.05), less satisfaction with informational support from family, friends, and spouse, and a tendency to perceive those sources of support as more aversive (p < 0.05). Women who were less satisfied with emotional support from their family, friends and spouse were less likely to feel satisfied with their physicians (p < 0.05). These patient characteristics identify women with primary breast cancer who are likely to experience difficulty in their interactions with nurses and physicians and to be less satisfied with their physicians.

    View details for DOI 10.1002/pon.852

    View details for Web of Science ID 000228401200007

    View details for PubMedID 15386762

  • Updates on controversial design and analysis decisions for research on the diurnal slope of cortisol Ann Behav Med Giese-Davis J, Kraemer H C, Neri E, Spiegel D. 2005; 29 (Supplement): S112
  • Patient empowerment through supportive care. Oncologistics Fourth Quarter Rosenbaum E, Spiegel D. 2005: 41-43
  • Initiating a community-based supportive care program Community Oncology Rosenbaum E, Gautier H, Fobair P, Spiegel D. 2005; 2 (1)
  • Hypnosis reduces distress and duration of an invasive medical procedure for children PEDIATRICS Butler, L. D., Symons, B. K., Henderson, S. L., Shortliffe, L. D., Spiegel, D. 2005; 115 (1): E77-E85


    Voiding cystourethrography (VCUG) is a commonly performed radiologic procedure in children that can be both painful and frightening. Given the distress that some children experience during the VCUG and the need for children to be alert and cooperative during the procedure, finding a psychological intervention that helps children to manage anxiety, distress, and pain is clearly desirable. This study was designed to examine whether relaxation and analgesia facilitated with hypnosis could reduce distress and procedure time for children who undergo this procedure.Forty-four children who were scheduled for an upcoming VCUG were randomized to receive hypnosis (n = 21) or routine care (n = 23) while undergoing the procedure. The sample consisted of 29 (66%) girls and 15 (34%) boys with a mean age of 7.6 years (SD: 2.5; range: 4-15 years). Ethnic/racial backgrounds were 72.7% white, 18.2% Asian, 4.5% Latino, 2.3% black, and 2.3% Filipino. The mean number of previous VCUGs was 2.95 (SD: 2.51; mode: 2; range: 1-15). Potential participants were identified through computerized hospital records of upcoming VCUGs. Parents were contacted by telephone and invited to participate if their child was eligible. To be eligible for the study, the child must have undergone at least 1 previous VCUG, been at least 4 years of age at that time, and experienced distress during that procedure, and both the child and the participating parent had to be English speaking. Each eligible child and parent met with the research assistant (RA) before the day of the scheduled procedure for an initial assessment. Children were queried regarding the degree of crying, fear, and pain that they had experienced during their most recent VCUG. Parents completed a series of parallel questions. Immediately after this assessment, those who were randomized to the hypnosis condition were given a 1-hour training session in self-hypnotic visual imagery by a trained therapist. Parents and children were instructed to practice using the imaginative self-hypnosis procedure several times a day in preparation for the upcoming procedure. The therapist was also present during the procedure to conduct similar exercises with the child. The majority (83%) of those who were randomized to the routine care control group chose to participate in a hospital-provided recreation therapy program (offered as part of routine care). The program includes demonstration of the procedure with dolls, relaxation and breath work training, and assistance during the procedure. On the day of the VCUG, the RA met the family at the clinic before the procedure, and both the child and the parent rated the child's present level of fearfulness. During the procedure, the RA recorded observational ratings of the child's emotional tone and behavior and timed the overall procedure and its phases. Immediately after the VCUG, the child was asked how much crying, fear, and pain he or she had experienced during the procedure; the parent rated the child's experience on the same dimensions and also how traumatic the procedure had been (both generally and compared with their previous one), and the medical staff rated the degree of procedural difficulty. Outcomes included child reports of distress during the procedure, parent reports of how traumatic the present VCUG was compared with the previous one, observer ratings of distress during the procedure, medical staff reports of the difficulty of the procedure overall, and total procedural time.Results indicate significant benefits for the hypnosis group compared with the routine care group in the following 4 areas: (1) parents of children in the hypnosis group compared with those in the routine care group reported that the procedure was significantly less traumatic for their children compared with their previous VCUG procedure; (2) observational ratings of typical distress levels during the procedure were significantly lower for children in the hypnosis condition compared with those in the routine care condition; (3) medical staff reported a significant difference between groups in the overall difficulty of conducting the procedure, with less difficulty reported for the hypnosis group; and (4) total procedural time was significantly shorter-by almost 14 minutes-for the hypnosis group compared with the routine care group. Moderate to large effect sizes were obtained on each of these 4 outcomes.Hypnotic relaxation may provide a systematic method for improving the overall medical care of children with urinary tract abnormalities and may be beneficial for children who undergo other invasive medical procedures. Because the VCUG is an essential part of the evaluation of urinary tract infections and vesicoureteral reflux in children, lower distress during the procedure may improve patient and family compliance with initial as well as follow-up evaluations. These findings augment the accumulating literature demonstrating the benefits of using hypnosis to reduce distress in the pediatric setting. The present findings are noteworthy in that this study was a controlled, randomized trial conducted in a naturalistic medical setting. In this context, we achieved a convergence of subjective and objective outcomes with moderate to large effect sizes, including those that may have an impact on patient care and procedure cost, that were consistently supportive of the beneficial effects of hypnosis-a noninvasive intervention with minimal risk. The findings, therefore, have immediate implications for pediatric care. Limitations of this study include the lack of participant and staff blindness to the child's condition assignment, which could have introduced bias into reports. However, the objective procedural time differences between groups were consistent with the other, more subjective outcome findings. The sample was also small and primarily white in ethnic/racial makeup, which may have restricted our ability to detect some differences and may limit the generalizability of findings to more representative samples. In addition, the sample comprised children who had already undergone at least 1 VCUG during which they had had difficulty. Consequently, additional research is needed to determine whether hypnosis would be helpful to those who are undergoing their first VCUG. Additional limitations, clinical observations, and directions for future research are also discussed.

    View details for DOI 10.1542/peds.2004-0818

    View details for Web of Science ID 000226083700012

    View details for PubMedID 15629969

  • Patient satisfaction with breast cancer care: Relationships with traumatic stress, emotional self-efficacy and social support. Psycho-Oncolog Han W T, Collie K, Koopman C, Azarow J, Classen C, Morrow G R, Michel B, Brennan-O'Neil E, Spiegel D. 2005; 14: 318-333
  • Treatment of acute traumatic stress reactions. Journal of trauma & dissociation Spiegel, D. 2005; 6 (2): 101-108


    This paper calls for a broadening of the context within which we study responses to traumatic stress, the course of recovery, components of effective interventions, and assessments of outcome. Acute stress reactions to trauma as a spectrum include anxiety, dissociative, and depressive symptoms. The course of these symptoms may vary, with fluctuations between intrusion (positive) and avoidance/numbing/dissociative (negative) symptoms that may complicate assessment, treatment-seeking, and course of recovery. Components of effective treatments including affect management, cognitive restructuring, and social integration are discussed. Finally, a broader view of outcome assessment in such research is called for, including not just reduction in psychopathological symptoms but attention to coping styles, affect management, resilience, social reorganization, and sensitivity to subsequent trauma.

    View details for PubMedID 16150672

  • A randomized trial of the efficacy of group therapy in changing viral load and CD4 counts in individuals living with HIV infection INTERNATIONAL JOURNAL OF PSYCHIATRY IN MEDICINE Belanoff, J. K., Sund, B., Koopman, C., Blasey, C., Flamm, J., Schatzberg, A. F., Spiegel, D. 2005; 35 (4): 349-362


    This randomized pilot study evaluates whether seropositive patients who are randomly assigned to receive a supportive-expressive group therapy plus education intervention show greater improvements in increased immune function and decreased viral load compared to those randomly assigned to an education-only intervention.Fifty-nine individuals who had been HIV-seropositive for at least 6 months prior to inclusion in the study and had been receiving standard pharmacologic treatment were entered in a prospective randomized trial of the effects of weekly supportive-expressive group therapy on changes in immune status. Participants were matched for AIDS status and sex and randomized to receive weekly sessions of group psychotherapy plus educational materials on HIV/AIDS, or to receive the educational materials alone. Participants were assessed before treatment and then 12 weeks later.Individuals who were randomized to group therapy showed a statistically significant increase in CD4 count and decrease in HIV viral load. Among individuals randomized to the education only condition, no significant change occurred in CD4 count or viral load.These results provide preliminary data suggesting that HIV-seropositive individuals who receive supportive-expressive group psychotherapy may experience concomitant improvements in CD4 cell count and viral load. Further research with a larger sample should examine the possible underlying mechanisms of such benefits.

    View details for Web of Science ID 000236681800004

    View details for PubMedID 16673835

  • Sleep disturbances among HIV-positive adults - The role of pain, stress, and social support JOURNAL OF PSYCHOSOMATIC RESEARCH Vosvick, M., Gore-Felton, C., Ashton, E., Koopman, C., Fluery, T., Israelski, D., Spiegel, D. 2004; 57 (5): 459-463


    Investigate the relationships between pain, stress, social support, and sleep disturbance among a diverse sample of HIV-positive adults.Participants (N = 146) completed self-report measures on pain, stress, social support, and sleep disturbance. CD4 T-cell count was obtained from medical records.Greater pain and stress were associated with greater sleep disturbance. Greater assistance from friends was associated with greater sleep disturbance, whereas greater understanding from friends regarding participants' HIV-related stress was associated with less sleep disturbance.As expected, pain was significantly associated with sleep disturbance. Additionally, psychosocial variables were strongly associated with sleep. The type of support from friends differentiated whether the support was positively or negatively associated with sleep problems. Social support, depending on the type, may not always be helpful for adults living with HIV/AIDS. Future studies need to examine factors that may mediate the relationship between psychosocial constructs and healthy sleep.

    View details for DOI 10.1016/j.jpsychores.2004.03.003

    View details for Web of Science ID 000225987500008

    View details for PubMedID 15581649

  • The interaction of social network size and stressful life events predict delayed-type hypersensitivity among women with metastatic breast cancer INTERNATIONAL JOURNAL OF PSYCHOPHYSIOLOGY Turner-Cobb, J. M., Koopman, C., Rabinowitz, J. D., Terr, A. I., Sephton, S. E., Spiegel, D. 2004; 54 (3): 241-249


    This study examined relationships between social support, stressful life events and antigen-specific cell-mediated immunity. Participants were 72 women with documented metastatic breast carcinoma, who completed self-report measures of social support and life stress. Immune response was assessed using the delayed type hypersensitivity (DTH) skin test. Number of positive antigens was significantly related to the interaction of social network size and stressful life events (p<0.05). Number of positive antigens was greater for women who had experienced a high frequency of stressful life events but who reported a larger network of support. However, social network size was inversely related to DTH response among women who had experienced fewer stressful life events. Average induration size was not significantly related to the quality of social support, life stress per se, or their interactions. The relationship between social network size and immune response in women with metastatic breast cancer depends on prior stressful life experience.

    View details for DOI 10.1016/j.ijphyscho.2004.05.010

    View details for Web of Science ID 000223879200004

    View details for PubMedID 15331215

  • Repression and high anxiety are associated with aberrant diurnal cortisol rhythms in women with metastatic breast cancer HEALTH PSYCHOLOGY Giese-Davis, J., Sephton, S. E., Abercrombie, H. C., Duran, R. E., Spiegel, D. 2004; 23 (6): 645-650


    Previous research has provided evidence of autonomic, endocrine, and immunological dysregulation in repressers and a possible association with cancer incidence and progression. Recently published data from the authors' laboratory demonstrated that flatter diurnal cortisol slopes were a risk factor for early mortality in women with metastatic breast cancer. In the current analysis of this same sample (N=91), the authors tested differences at baseline between groups scored using the Weinberger Adjustment Inventory on diurnal cortisol slope and mean cortisol levels. When compared with self-assured and nonextreme groups, the represser and high-anxious groups had a significantly flatter diurnal slope. Diurnal slope was similar for repressers and high-anxious groups. Groups did not differ on mean cortisol levels, nor did they differ on intercept (morning) values.

    View details for DOI 10.1037/0278-6133.23.6.645

    View details for Web of Science ID 000224913800011

    View details for PubMedID 15546233

  • Placebos in practice BRITISH MEDICAL JOURNAL Spiegel, D. 2004; 329 (7472): 927-?

    View details for Web of Science ID 000224773200001

    View details for PubMedID 15499085

  • Flattened cortisol rhythms in metastatic breast cancer patients PSYCHONEUROENDOCRINOLOGY Abercrombie, H. C., Giese-Davis, J., Sephton, S., Epel, E. S., Turner-Cobb, J. M., Spiegel, D. 2004; 29 (8): 1082-1092


    Allostatic load, the physiological accumulation of the effects of chronic stressors, has been associated with multiple adverse health outcomes. Flattened diurnal cortisol rhythmicity is one of the prototypes of allostatic load, and has been shown to predict shorter survival among women with metastatic breast cancer. The current study compared diurnal cortisol slope in 17 breast cancer patients and 31 controls, and tested associations with variables previously found to be related to cortisol regulation, i.e, abdominal adiposity, perceived stress, social support, and explicit memory. Women with metastatic breast cancer had significantly flatter diurnal cortisol rhythms than did healthy controls. Patients with greater disease severity showed higher mean cortisol levels, smaller waist circumference, and a tendency toward flatter diurnal cortisol rhythms. There were no relations between cortisol slope and psychological or cognitive functioning among patients. In contrast, controls with flatter rhythms showed the expected allostatic load profile of larger waist circumference, poorer performance on explicit memory tasks, lower perceived social support, and a tendency toward higher perceived stress. These findings suggest that the cortisol diurnal slope may have important but different correlates in healthy women versus those with breast cancer.

    View details for DOI 10.1016/j.psyneuen.2003.11.003

    View details for Web of Science ID 000222702100014

    View details for PubMedID 15219660

  • Cytotoxic T lymphocyte count and survival time in women with metastatic breast cancer. breast journal Blake-Mortimer, J. S., Sephton, S. E., Carlson, R. W., Stites, D., Spiegel, D. 2004; 10 (3): 195-199


    While prognostic factors in early stage breast cancer are well documented, few studies have examined predictors of the rate of metastatic progression. The purpose of this study was to examine cytotoxic T-cell lymphocyte (CTL) count as a marker of disease status in women with metastatic breast cancer. This study examined CTL subset counts as predictors of subsequent survival in 113 women with metastatic or recurrent breast cancer. Samples were measured by flow cytometry using monoclonal antibodies for cell surface antigens for percentages and absolute numbers of CTLs (CD3/CD8), total lymphocytes, T cells (CD3), helper T cells (CD3/CD4), and total white blood cell (TWC) count. Higher CTL counts emerged as a significant predictor of longer survival up to 7 years later (Wald = 7.40, p = 0.007; Cox regression model). The relationship of higher CTL count with enhanced survival was independent of the effects of medical treatment. CTLs were significantly associated with TWC count (r = 0.42, p < 0.001). However, TWC count was not associated with subsequent survival time. Higher CTL count was associated with Karnofsky performance status (r = 0.27, p = 0.004). However, after adjustment for the Karnofsky score, the CTL count/survival relationship remained significant (Wald = 4.33, p = 0.038). In conclusion, there is a robust relationship between CTL count and survival that is independent of the effects of medical treatments, TWC count, and Karnofsky performance status. Moreover, a reduced CTL count may be a mediator or marker of more rapid disease progression in metastatic breast cancer.

    View details for PubMedID 15125744

  • Cancer supportive care, improving the quality of life for cancer patients. A program evaluation report SUPPORTIVE CARE IN CANCER Rosenbaum, E., Gautier, H., Fobair, P., Neri, E., Festa, B., Hawn, M., Andrews, A., Hirshberger, N., Selim, S., Spiegel, D. 2004; 12 (5): 293-301


    As medical care for cancer has become more specialized in diagnosis, treatment has become more technical and fragmented. In order to help cancer patients and their families, we developed a coordinated program called the Stanford Cancer Supportive Care Program (SCSCP) at the Center for Integrative Medicine at Stanford Hospital and Clinics. The Stanford Cancer Supportive Care Program was initiated in 1999 to provide support for cancer patients, addressing the need for improved physical and emotional well-being and quality of life. This paper is a program evaluation report.The number of patient visits grew from 421 in 1999 to 6319 in 2002. This paper describes the utilization of the SCSCP program as assessed by 398 patient visit evaluations during a 9-week period, January 2002 to March 2002. During this time we collected attendance records with demographic data and anonymous questionnaires evaluating each program. Patients were asked to evaluate how the program helped them regarding increase of energy, reduction in stress, restful sleep, pain reduction, sense of hopefulness, and empowerment.Over 90% of the patients using the SCSCP felt there was benefit to the program. Programs were chosen based on a needs assessment by oncologists, nurse managers, social workers, and patients. Massage, yoga, and qigong classes had the highest number of participants. Qualitative data showed benefit for each program offered.This evaluation of a free cancer supportive care program initiated in a hospital outpatient setting provides initial evidence of patient satisfaction and improvement in quality of life.

    View details for DOI 10.1007/s00520-004-0599-0

    View details for Web of Science ID 000220967200002

    View details for PubMedID 14991388

  • False and recovered memories in the laboratory and clinic: A review of experimental and clinical evidence CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE Gleaves, D. H., Smith, S. M., Butler, L. D., Spiegel, D. 2004; 11 (1): 3-28
  • The interaction of social network size and stressful life events predict delayed-type hypersensitivity among women with metastatic breast cancer. International Journal of Psychophysiology Turner-Cobb J M, Koopman C, Rabinowitz J D, Terr A I, Sephton S E, Spiegel D. 2004; 54 (3): 241-19
  • Placebos in Practice, Editorial British Medical Journal Spiegel, D. 2004; 329: 927-928
  • Hypnosis: Brief interventions offer key to managing pain and anxiety Current Psychiatry Spiegel D. 2004; 3 (4): 49-52
  • Cancer supportive care, improving the quality of life for cancer patients. A program evaluation report. Support Care Cancer Rosenbaum E, Gautier H, Fobair P, neri E, Festa B, Hawn M, Andrews A, Hirschberger N, Selim S, Spiegel D. 2004; 12 (5): 293-301
  • Commentary on "Meta-analysis of the effects of psychosocial interventions on survival time and mortality in cancer patients." by Geir Smedslund and Gerd Inger Ringdal. Journal of Psychosomatic Research Spiegel, D. 2004; 57: 133-135
  • Editorial; Placebos in practice BMJ Spiegel D. 2004; 329: 927-928
  • Mood disturbance in community cancer support groups - The role of emotional suppression and fighting spirit JOURNAL OF PSYCHOSOMATIC RESEARCH Cordova, M. J., Giese-Davis, J., Golant, M., Kronnenwetter, C., Chang, V., McFarlin, S., Spiegel, D. 2003; 55 (5): 461-467


    In this cross-sectional study, we tested whether the coping styles of emotional suppression and fighting spirit were associated with mood disturbance in cancer patients participating in professionally led community-based support groups even when demographic, medical, and group support variables were taken into account.A heterogeneous sample of 121 cancer patients (71% female, 29% male) completed the Courtauld Emotional Control Scale (CECS), the Mini-Mental Adjustment to Cancer Scale (Mini-MAC), a measure of perceived group support, and the Profile of Mood States (POMS).Consistent with hypotheses, lower emotional suppression and greater adoption of a fighting spirit, in addition to older age and higher income, were associated with lower mood disturbance. Gender, time since diagnosis, presence of metastatic disease, time in the support group, perceived group support, cognitive avoidance, and fatalism were unrelated to mood disturbance.Expression of negative affect and an attitude of realistic optimism may enhance adjustment and reduce distress for cancer patients in support groups.

    View details for DOI 10.1016/S0022-3999(03)00510-5

    View details for Web of Science ID 000186350200009

    View details for PubMedID 14581101

  • Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? BRAIN BEHAVIOR AND IMMUNITY Sephton, S., Spiegel, D. 2003; 17 (5): 321-328


    Psychosocial factors may modulate the course of cancer, but few data have been gathered on the biological mechanisms by which these effects may be mediated. We briefly review evidence of psychosocial effects on cancer progression and discuss one potential pathway that may underlie these effects: the disruption of neuroendocrine and immune circadian rhythms. Circadian system alterations occur in tumor tissue, tumor-bearing animals, and cancer patients with greater disruption seen in more advanced cases. Rhythm alterations include diminished amplitude, phase shifts, period changes, and erratic peaks and troughs in endocrine, metabolic, immunological, and rest- activity cycles. Psychosocial factors can engender dysregulation of circadian function. Cancer-related circadian dysregulation may also be driven by genetic factors, environmental and behavioral influences, and effects of the tumor on host clock regulation. There are several mechanisms by which circadian disruption might hasten tumor growth: via direct effects of altered hormone levels on tumor cells, effects on tumor versus host metabolism, neuroimmune effects resulting in cancer-relevant immunosuppression, or reduced efficacy and tolerability of cancer treatments for which the timing of administration is based upon the assumption of normal circadian rhythms. Emerging data in the human and animal literature suggest that circadian regulation may be an important prerequisite for the maintenance of host defenses against cancer. Thus, stress-related circadian disruption may have negative implications for cancer prognosis. Psychosocial effects on cancer progression may be measured, and possibly mediated, by disruption of circadian function.

    View details for DOI 10.1016/S0889-1591(03)00078-3

    View details for Web of Science ID 000185220300002

    View details for PubMedID 12946654

  • Adverse short-term effects of attention-control treatment on hypnotizability: A challenge in designing controlled hypnosis trials INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS Koch, T., Lang, E. V., Hatsiopoulou, O., Anderson, B., Berbaum, K., Spiegel, D. 2003; 51 (4): 357-368


    Characteristics of patients in test and attention-control groups should be comparable and be unaffected by the intervention to be tested in clinical trials. The authors assessed whether this is the case for measures of hypnotizability in the postoperative period. One hundred and forty-six patients undergoing percutaneous peripheral vascular or renal interventions were randomized into 2 groups. One group received structured empathic attention during their procedures; the other was guided to self-hypnotic relaxation. Hypnotizability was assessed postoperatively by the Hypnotic Induction Profile. The eye-roll scores, which measure the biological hypnotic potential, were not significantly different, but the average induction scores, which measure the expression of the hypnotic performance, were significantly lower in the attention group than the hypnosis group (4.9 vs. 5.9). The authors conclude that patients who were aided by an external focus intraoperatively are postoperatively less able or willing to follow suggestions measuring hypnotizability than patients who had guidance to self-hypnotic relaxation.

    View details for Web of Science ID 000185728000003

    View details for PubMedID 14594184

  • Depression and cancer: Mechanisms and disease progression BIOLOGICAL PSYCHIATRY Spiegel, D., Giese-Davis, J. 2003; 54 (3): 269-282


    Depression and cancer commonly co-occur. The prevalence of depression among cancer patients increases with disease severity and symptoms such as pain and fatigue. The literature on depression as a predictor of cancer incidence is mixed, although chronic and severe depression may be associated with elevated cancer risk. There is divided but stronger evidence that depression predicts cancer progression and mortality, although disentangling the deleterious effects of disease progression on mood complicates this research, as does the fact that some symptoms of cancer and its treatment mimic depression. There is evidence that providing psychosocial support reduces depression, anxiety, and pain, and may increase survival time with cancer, although studies in this latter area are also divided. Psychophysiological mechanisms linking depression and cancer progression include dysregulation of the hypothalamic-pituitary-adrenal axis, especially diurnal variation in cortisol and melatonin. Depression also affects components of immune function that may affect cancer surveillance. Thus, there is evidence of a bidirectional relationship between cancer and depression, offering new opportunities for therapeutic intervention.

    View details for DOI 10.1016/S0006-3223(03)00566-3

    View details for Web of Science ID 000184451800014

    View details for PubMedID 12893103

  • Correlates of sexually transmitted disease infection among adults living with HIV INTERNATIONAL JOURNAL OF STD & AIDS Gore-Felton, C., Vosvick, M., Bendel, T., Koopman, C., Das, B., Israelski, D., Herrera, M., Litzenberg, K., Spiegel, D. 2003; 14 (8): 539-546


    This study examined the prevalence of sexually transmitted diseases (STDs) as well as the relationships between STDs and coping strategies used to deal with the stress of living with HIV among adults. The sample comprised 179 men and women, 58% were Caucasian, 54% were male, more than half (61%) were diagnosed with AIDS, 43% were heterosexual, and 39% reported an STD post-HIV diagnosis. Logistic regression analysis indicated that individuals reporting longer time elapsed since HIV diagnosis and greater use of emotion-focused coping were more likely to report STDs. There was an interaction effect between time and coping such that the less time that elapsed since HIV diagnosis and the more an individual used emotion-focused coping, the more likely they were to report an STD. Tailoring interventions to address specific stressors associated with length of time living with HIV, may be a particularly effective prevention strategy.

    View details for Web of Science ID 000184475400011

    View details for PubMedID 12935384

  • Social support, substance use, and denial in relationship to Antiretroviral treatment adherence among HIV-infected persons AIDS PATIENT CARE AND STDS Power, R., Koopman, C., Volk, J., Israelski, D. M., Stone, L., Chesney, M. A., Spiegel, D. 2003; 17 (5): 245-252


    This study examined the relationship of adherence to antiretroviral treatment with three types of social support (partner, friends, and family) and use of two coping strategies (denial and substance use). Participants were 73 men and women with HIV infection drawn from a larger sample of 186 clinical trial patients. Based on inclusion criteria, parent trial participants taking antiretroviral therapies, and those with complete data on self-reported measures of adherence were considered eligible for the present study. Overall, 26% of participants were found to be nonadherent, which was defined as one or more missed doses of treatment in the prior 4-day period. Logistic regression analysis was conducted to determine associations of sociodemographic and psychosocial variables with adherence to antiretroviral regimen. Results indicated that heterosexual participants (p < 0.01) and participants of Latino ethnicity (p < 0.05) were significantly more likely to report missed medications. Perceived satisfaction with support from a partner was associated with taking antiretroviral therapy as prescribed, whereas satisfaction with support from friends and from family was not significantly related to adherence. Examination of coping strategies showed that participants reporting drug and alcohol use (p <.05) to cope with HIV-related stress were more likely to be nonadherent. These findings call for adherence interventions designed to address barriers and strengths, such as community norms or traditional cultural values, specific to certain populations. Furthermore, couple-based approaches enlisting partner support may help persons living with HIV to adhere to antiretroviral regimens.

    View details for Web of Science ID 000182801700005

    View details for PubMedID 12816618

  • Psychological distress and pain significantly increase before death in metastatic breast cancer patients PSYCHOSOMATIC MEDICINE Butler, L. D., Koopman, C., Cordova, M. J., Garlan, R. W., DiMiceli, S., Spiegel, D. 2003; 65 (3): 416-426


    This study was designed to examine the course of psychological distress and pain from study entry to death in 59 women with metastatic breast cancer participating in a randomized trial of the effects of group psychotherapy on psychosocial outcomes and survival. It was hypothesized that psychological distress would increase significantly before death independent of changes in pain.Data were collected as part of a larger study (N = 125). Analyses were based on data from a subset of women who had died and for whom we had data from at least three assessments. Mean levels of mood, trauma symptoms, depression symptoms, well-being, and pain over three time points were examined: at baseline (T1), the second-to-last assessment before death (T2), and the last assessment before death (T3).Results indicate that while psychological distress remained relatively constant or declined from T1 to T2, means on all measures significantly changed in the hypothesized direction from T2 to T3. Neither self-reported pain, nor the passage of time, appeared to account for these changes. Additionally, participation in group psychotherapy did not have a significant impact on this change in distress proximal to death.Results suggest that specialized end-stage clinical interventions are particularly needed for cancer patients as they approach death. Moreover, intervention studies for patients with deteriorating illnesses may need to take this "spike" in psychological distress and pain proximal to death into account to avoid Type II errors in evaluations of psychological outcomes.

    View details for DOI 10.1097/01.PSY.0000041472.77692.C6

    View details for Web of Science ID 000183160300014

    View details for PubMedID 12764215

  • Developing a free supportive care program for cancer patients within an integrative medicine clinic SUPPORTIVE CARE IN CANCER Rosenbaum, E., Gautier, H., Fobair, P., Andrews, A., Hawn, M., Kurshner, R., Festa, B., Kramer, P., Manuel, F., Hirschberger, N., Selim, S., Spiegel, D. 2003; 11 (5): 263-269


    The cancer patient's journey not only includes a threat to one's life, but the need to face many medical and emotional challenges. The free Cancer Supportive Care Program (CSCP) within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics has been identified as a successful model for helping patients to deal with these challenges. Its programs include informational lectures, support groups, chair massages, exercise, alternative modality classes, a Life Tapes Project, an informational website, and a bimonthly newsletter available free to anybody touched by cancer. Now in its third year, this program benefits from a blending of leadership resources, availability of space, institutional agreement on patient need and funds from private and corporate donations. By presenting the basic premises of the Cancer Supportive Care program and outlining specifics about the program, institutions in various national and international demographic regions may implement similar programs according to their resources and the needs of patients. It is our hope that the CSCP can become a model for the development of similar programs in various parts of the United States and abroad.

    View details for DOI 10.1007/s00520-003-0439-7

    View details for Web of Science ID 000183194400001

    View details for PubMedID 12690540

  • Alternative therapies: a common practice among men and women living with HIV. journal of the Association of Nurses in AIDS Care : JANAC Gore-Felton, C., Vosvick, M., Power, R., Koopman, C., Ashton, E., Bachmann, M. H., Israelski, D., Spiegel, D. 2003; 14 (3): 17-27


    This study examined the prevalence and factors associated with alternative therapy use in an ethnically diverse, gender-balanced sample of persons living with HIV/AIDS. More than two thirds (67%) of the participants who were taking HIV-related medications were also taking an alternative supplement. Half of the sample (50%) reported that they took one or more multivitamins, 17% reported using mineral supplements, 12% reported using Chinese herbs, and 12% reported using botanicals. Substantial proportions of the sample also reported using acupuncture (31%), massage (23%), and meditation (28%) to specifically treat HIV-related symptoms. Women were four times more likely to use alternative therapies than men. Also, Caucasians were nearly four times more likely to use alternative treatments compared to other ethnic groups. The results of this study indicate a strong need to assess individual patients' use of alternative treatment approaches as well as to further investigate their efficacy among HIV-positive patients.

    View details for PubMedID 12800809

  • Negative and positive visual hypnotic hallucinations: Attending inside and out INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS Spiegel, D. 2003; 51 (2): 130-146


    Hypnotic perceptual alteration affects brain function. Those hypnotic instructions that reduce perception by creating an illusory obstruction to it reduce brain response to perception in the cognate sensory cortex, as measured by event-related potential (ERP) amplitude and regional blood flow (PET). Those hypnotic instructions that affect the subject's reaction to perception activate the anterior attentional system, especially the anterior cingulate cortex in PET studies. Hypnosis involves activation without arousal and may be particularly mediated via dopaminergic pathways. Hypnotic alteration of perception is accompanied by measurable changes in both perceptual and attentional function of those specific regions of the brain that process these activities, modulated by the nature of the specific hypnotic instruction. Positive obstructive hallucinations seem to allow for a hypnotic focus inward, activating the functioning of attentional neural systems and reducing perceptual ones.

    View details for Web of Science ID 000185533500004

    View details for PubMedID 12908748

  • Perceptions of family relationships associated with husbands ambivalence and dependency in anticipating losing their wives to metastatic/recurrent breast cancer JOURNAL OF LOSS & TRAUMA Blake-Mortimer, J., Koopman, C., Spiegel, D., Field, N., Horowitz, M. 2003; 8 (2): 139-147
  • Living in the face of death: interviews with 12 terminally ill women on home hospice care. Palliative & supportive care Grumann, M. M., Spiegel, D. 2003; 1 (1): 23-32


    To determine how home hospice patients deal with their impending death and whether there is a need for greater involvement of mental health professionals in the care of patients dying at home.In a pilot study, 12 female home hospice patients with advanced cancer and a median survival time of 42 days were assessed using structured interviews and brief questionnaires. Topics of inquiry included facing death, fear of death, pain, fatigue, depression, and anxiety. Three key themes were extracted from the information reported by the women: (1) confronting the issue of death, (2) fear of dying and death and its correlates, and (3) spirituality/religious faith and its role in mitigating fear of death.First, all subjects reported thinking about their approaching death. For half of them, this thought was bothersome and these women were frequently troubled by unresolved issues and higher anxiety, pain, and fatigue. The majority of the subjects expressed a desire to actively discuss their impending death. Second, more than half of the patients reported being afraid of death and high death anxiety was associated with fear of dying in pain, high peak or usual pain, unresolved issues, and difficulty in parting with family in death. Third, most subjects experienced their religious faith as an important source of comfort and strength.A substantial subgroup of home hospice patients expressed problems dealing with their approaching death. These problems are amenable to psychological treatment, such as fear of death, unresolved issues, parting with family, and pain. The findings, thus, highlight the need for close collaboration of mental health professionals with home hospice institutions.

    View details for PubMedID 16594285

  • Electronic support groups for breast carcinoma - A clinical trial of effectiveness CANCER Lieberman, M. A., Golant, M., Giese-Davis, J., Winzlenberg, A., Benjamin, H., Humphreys, K., Kronenwetter, C., Russo, S., Spiegel, D. 2003; 97 (4): 920-925


    A recent Pew Charitable Trust study found that 52,000,000 individuals used the Internet to obtain health/medical information. Clinical trials of face-to-face breast carcinoma support groups show evidence of 1) improvement in quality of life, 2) reduction of psychologic symptoms, 3) improvement in coping responses, and 4) a reduction in pain. To the authors' knowledge, a few studies published to date have investigated Internet-delivered electronic support groups (ESGs) for cancer. The most sophisticated is the Comprehensive Health Enhancement Support System (CHESS) program, which provides integrated information, referral, and a newsgroup-based social support program. However, to the authors' knowledge, no studies published to date have examined the impact of a breast carcinoma ESG in a clinical trial.Sixty-seven women completed the initial baseline questionnaires, 32 of whom accepted the authors' invitation and began the groups. With regard to geographic location, 49% lived in rural/small towns, 41% lived in medium-sized cities, and 10% lived in large cities. Diagnostic stages of disease were: Stage I, 22%; Stage II, 56%; Stage III, 12%; and other forms, 10%. There were 4 intervention groups, of which 8 participants led by trained Wellness Community (TWC) (a national agency) leaders met for 1.5 hours once a week for 16 weeks. Student t tests for paired outcome data were computed using baseline and postgroup scores.The results of the current study indicated that breast carcinoma patients significantly reduced depression (Center for Epidemiologic Studies-Depression [CES-D] scale) and Reactions to Pain. They also demonstrated a trend toward increases on The Posttraumatic Growth Inventory (PTGI) in two subscales: New Possibilities and Spirituality. Counterintuitively, breast carcinoma patients appeared to demonstrate an increase in emotional suppression. Postinterview results indicated that approximately 67% of patients found the group to be beneficial. Those who withdrew from the groups (20%) demonstrated low scores in their ability to contain anxiety and appeared to be more likely to suppress their thoughts and feelings regarding their illness.The findings of the current study are encouraging, particularly because it was conducted through TWC, a national agency willing to make this type of intervention readily available at no cost. A limitation of the current study was the lack of randomization and a control group comparison. Although the authors were not able to demonstrate effectiveness without the addition of a control condition, the analysis of pregroup and postgroup outcomes suggests that a randomized trial is worthwhile. Women with a devastating disease will join and commit themselves to an online support group. In addition, because a large percentage of these women were from rural locations, this type of intervention may hold promise for those who have limited access to support groups.

    View details for DOI 10.1002/cncr.11145

    View details for Web of Science ID 000180795500004

    View details for PubMedID 12569591

  • Perceptions of family relationships associated with husbands' ambivalence and dependency in anticipating losing their wives to metastic/recurrent breast cancer Journal of Loss and Trauma Blake-Mortimer J, Koopman C, Spiegel D, Field N, & Horowitx M. 2003; 8: 139-147
  • Hypnosis and traumatic dissociation: Therapeutic opportunities Journal of Trauma and Dissociation Spiegel D 2003; 4 (3): 73-90
  • Relationship of functional quality of life to strategies for coping with the stress of living with HIV/AIDS PSYCHOSOMATICS Vosvick, M., Koopman, C., Gore-Felton, C., Thoresen, C., Krumboltz, J., Spiegel, D. 2003; 44 (1): 51-58


    The authors examined factors associated with four dimensions of functional quality of life (physical functioning, energy/fatigue, social functioning, and role functioning) in 142 men and women living with HIV/AIDS. Participants completed the Brief COPE inventory and the Medical Outcomes Study Health Survey, with HIV-relevant items added. Greater use of maladaptive coping strategies was associated with lower levels of energy and social functioning. Pain severe enough to interfere with daily living tasks was associated with a lower level of functional quality of life on all four quality of life dimensions. Interventions aimed at developing adaptive coping strategies and improving pain management may improve functional aspects of quality of life in persons living with HIV/AIDS.

    View details for Web of Science ID 000180171100007

    View details for PubMedID 12515838

  • Social support substance use and denial in relationship to antiretroviral treatment adherenece among HIV-infected persons Aids Patient Care and STDs Power R, Koopman C, Volk J, israelski D. M, Stone L, Chesney M. A, Spiegel D. 2003; 17 (5)
  • Recent stressful life events, sexual revictimization, and their relationship with traumatic stress symptoms among women sexually abused in childhood JOURNAL OF INTERPERSONAL VIOLENCE Classen, C., Nevo, R., Koopman, C., Nevill-Manning, K., Gore-Felton, C., Rose, D. S., Spiegel, D. 2002; 17 (12): 1274-1290
  • The influence of social support, coping with mood on sexual risk behavior among HIV-positive men and women JOURNAL OF HEALTH PSYCHOLOGY Gore-Felton, C., Koopman, C., Turner-Cobb, J. M., Duran, R., Israelski, D., Spiegel, D. 2002; 7 (6): 713-722


    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.

    View details for Web of Science ID 000179174100007

    View details for PubMedID 22113412

  • Depressive symptomatology in relation to emotional control and chronic pain in persons who are HIV positive REHABILITATION PSYCHOLOGY Lagana, L., Chen, X. H., Koopman, C., Classen, C., Kimerling, R., Spiegel, D. 2002; 47 (4): 402-414
  • Sleep disturbances in women with metastatic breast cancer. breast journal Koopman, C., Nouriani, B., Erickson, V., Anupindi, R., Butler, L. D., Bachmann, M. H., Sephton, S. E., Spiegel, D. 2002; 8 (6): 362-370


    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.

    View details for PubMedID 12390359

  • Mesmer minus magic: Hypnosis and modem medicine INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS Spiegel, D. 2002; 50 (4): 397-406


    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.

    View details for DOI 10.1177/002071402237723

    View details for Web of Science ID 000178121100009

    View details for PubMedID 12362955

  • Acute stress reactions following the assassination of Mexican presidential candidate Colosio JOURNAL OF TRAUMATIC STRESS Maldonado, J. R., Page, K., Koopman, C., Butler, L. D., Stein, H., Spiegel, D. 2002; 15 (5): 401-405


    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.

    View details for Web of Science ID 000177968900008

    View details for PubMedID 12392228

  • Comorbidity of depression with other medical diseases in the elderly BIOLOGICAL PSYCHIATRY Krishnan, K. R., DeLong, M., Kraemer, H., Carney, R., Spiegel, D., Gordon, C., McDonald, W., Dew, M. A., Alexopoulos, G., Buckwalter, K., Cohen, P. D., Evans, D., Kaufmann, P. G., Olin, J., Otey, E., Wainscott, C. 2002; 52 (6): 559-588


    A major factor in the context of evaluating depression in the elderly is the role of medical problems. With aging there is a rapid increase in the prevalence of a number of medical disorders, including cancer, heart disease, Parkinson's disease, Alzheimer's disease, stroke, and arthritis. In this article, we hope to bring clarity to the definition of comorbidity and then discuss a number of medical disorders as they relate to depression. We evaluate medical comorbidity as a risk factor for depression as well as the converse, that is, depression as a risk factor for medical illness. Most of the disorders that we focus on occur in the elderly, with the exception of HIV infection. This review focuses exclusively on unipolar disorder. The review summarizes the current state of the art and also makes recommendations for future directions.

    View details for Web of Science ID 000178297000007

    View details for PubMedID 12361669

  • Psychosocial intervention for lesbians with primary breast cancer PSYCHO-ONCOLOGY Fobair, P., Koopman, C., DiMiceli, S., O'Hanlan, K., Butler, L. D., Classen, C., Drooker, N., Davids, H. R., Loulan, J., Wallsten, D., Spiegel, D. 2002; 11 (5): 427-438


    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.

    View details for DOI 10.1002/pon.624

    View details for Web of Science ID 000178355000007

    View details for PubMedID 12228876

  • Change in emotion-regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Giese-Davis, J., Koopman, C., Butler, L. D., Classen, C., Cordova, M., Fobair, P., Benson, J., Kraemer, H. C., Spiegel, D. 2002; 70 (4): 916-925


    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.

    View details for DOI 10.1037//0022-006X.70.4.916

    View details for Web of Science ID 000177347400006

    View details for PubMedID 12182275

  • Traumatic stress symptoms among women with recently diagnosed primary breast cancer JOURNAL OF TRAUMATIC STRESS Koopman, C., Butler, L. D., Classen, C., Giese-Davis, J., Morrow, G. R., Westendorf, J., Banerjee, T., Spiegel, D. 2002; 15 (4): 277-287


    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.

    View details for Web of Science ID 000176806000002

    View details for PubMedID 12224799

  • Coping, social support, and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS JOURNAL OF BEHAVIORAL MEDICINE Turner-Cobb, J. M., Gore-Felton, C., Marouf, F., Koopman, C., Kim, P., Israelski, D., Spiegel, D. 2002; 25 (4): 337-353


    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.

    View details for Web of Science ID 000176226700002

    View details for PubMedID 12136496

  • How to launch a national Internet-based panel study quickly: lessons from studying how American are coping with the tragedy of September 11, 2001? CNS spectrums Butler, L. D., Seagraves, D. A., Desjardins, J. C., Azarow, J., Hastings, A., Garlan, R. W., DiMiceli, S., Winzelberg, A., Spiegel, D. 2002; 7 (8): 597-603


    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.

    View details for PubMedID 15094696

  • An example of maximizing survey return rates - Methodological issues for health professionals EVALUATION & THE HEALTH PROFESSIONS Gore-Felton, C., Koopman, C., Bridges, E., Thoresen, C., Spiegel, D. 2002; 25 (2): 152-168


    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 from those that must be tailored to specific subpopulations.

    View details for Web of Science ID 000177001300002

    View details for PubMedID 12026750

  • HIV: effectiveness of complementary and alternative medicine PRIMARY CARE Power, R., Gore-Felton, C., Vosvick, M., Israelski, D. M., Spiegel, D. 2002; 29 (2): 361-?


    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.

    View details for Web of Science ID 000176753700008

    View details for PubMedID 12391716

  • Effects of psychotherapy on cancer survival NATURE REVIEWS CANCER Spiegel, D. 2002; 2 (5): 383-389


    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?

    View details for DOI 10.1038/nrc800

    View details for Web of Science ID 000180446600016

    View details for PubMedID 12044014

  • Bridging psychology and biology - The analysis of individuals in groups AMERICAN PSYCHOLOGIST Kosslyn, S. M., Cacioppo, J. T., Davidson, R. J., Hugdahl, K., Lovallo, W. R., Spiegel, D., Rose, R. 2002; 57 (5): 341-351


    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.

    View details for DOI 10.1037//0003-066X.57.5.341

    View details for Web of Science ID 000175513800001

    View details for PubMedID 12025764

  • Re: Night shift work, light at night, and risk of breast cancer JOURNAL OF THE NATIONAL CANCER INSTITUTE Spiegel, D., Sephton, S. 2002; 94 (7): 530-530

    View details for Web of Science ID 000177454500015

    View details for PubMedID 11929957

  • Emotion regulation and metastatic breast cancer International Congress Series Giese-Davis J, Spiegel D. 2002; 1241: 31-35
  • Maladaptive coping strategies in relation to quality of life among HIV+ adults. AIDS and Behavior Vosvick M, Gore-Felton C, Koopman C, Thoresen C, Krumboltz J & Spiegel D. 2002; 6 (1): 97-106
  • Acute stress in response to the terrorist attacks on September 11, 2001 CPA BUlletine de l'APC Spiegel D, Butler L. 2002; 34 (4)
  • Psychological morbidity among breast cancer survivors: A longitudinal study. Rehabilitation Psychology Lagana L, Whealin J, Carpio F, Koopman C, Classen C, Spiegel D. 2002; 47 (3): 370
  • Acute stress reactions to recent life events among women and men living with HIV/AIDs INTERNATIONAL JOURNAL OF PSYCHIATRY IN MEDICINE Koopman, C., Gore-Felton, C., Azimi, N., O'Shea, K., Ashton, E., Power, R., De Maria, S., Israelski, D., Spiegel, D. 2002; 32 (4): 361-378


    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 reactions among HIV-infected men and women to posttraumatic stress disorder (PTSD) symptoms to previous traumatic life events.Participants included 64 HIV-seropositive persons (33 men and 31 women) drawn from a larger study examining the effects of group therapy on quality of life and health behavior. These individuals were assessed at baseline on demographic and medical status characteristics and (PTSD) symptoms andthen randomly assigned to either receive group therapy plus education or education alone. Three months later they were assessed for acute stress reactions to recent life events.Nearly a third (31.3 percent) of the participants reported levels of acute stress reactions to recent life events that met all symptom criteria for the diagnosis of acute stress disorder. However, only 9.4 percent of the respondents described a recent stressful life event that was threatening to the life or physical integrity of themselves or others. Acute stress reactions to recent life events were significantly and positively related to experiencing PTSD symptoms to prior traumatic life events. Acute stress did not differ significantly by gender, AIDS status, or whether or not participants had received 12 weeks of group therapy.A subset of individuals with HIV/AIDS experience high levels of acute stress reactivity to life events considered non-traumatic. HIV-infected individuals who react strongly to ongoing life stressors are more likely to have developed PTSD symptoms in response to previous traumatic life events.

    View details for Web of Science ID 000183005200005

    View details for PubMedID 12779186

  • Emotion regulation and metastatic breast cancer PSYCHO-NEURO-ENDOCRINO-IMMUNOLOGY (PNEI) Giese-Davis, J., Spiegel, D. 2002; 1241: 31-35
  • Reduced emotional control as a mediator of decreasing distress among breast cancer patients in group therapy PSYCHO-NEURO-ENDOCRINO-IMMUNOLOGY (PNEI) Spiegel, D., Giese-Davis, J. 2002; 1241: 37-40
  • Mind matters - Group therapy and survival in breast cancer. NEW ENGLAND JOURNAL OF MEDICINE Spiegel, D. 2001; 345 (24): 1767-1768

    View details for Web of Science ID 000172656100008

    View details for PubMedID 11742052

  • The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998) PSYCHOLOGICAL BULLETIN Dallam, S. J., Gleaves, D. H., Cepeda-Benito, A., Silberg, J. L., Kraemer, H. C., Spiegel, D. 2001; 127 (6): 715-733


    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.

    View details for DOI 10.1037//0033-2909.127.6.715

    View details for Web of Science ID 000172113200002

    View details for PubMedID 11726068

  • Is the placebo powerless? NEW ENGLAND JOURNAL OF MEDICINE Spiegel, D., Kraemer, H., Carlson, R. W. 2001; 345 (17): 1276-1276

    View details for Web of Science ID 000171773100011

    View details for PubMedID 11680452

  • Psychoneuroimmune and endocrine pathways in cancer: effects of stress and support. Seminars in clinical neuropsychiatry Spiegel, D., Sephton, S. E. 2001; 6 (4): 252-265


    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.

    View details for PubMedID 11607921

  • Nutritional workshops for cancer patients: a pilot approach BULLETIN DU CANCER Mouysset, J. L., Baciuchka-Palmaro, M., Ichou, M., Duffaud, F., Neulat, G., Dudoit, E., Bagarry-Liegey, D., Tramoni, M., Spiegel, D., Marco, J. L., Favre, R. 2001; 88 (10): 959-964


    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.

    View details for Web of Science ID 000172210600006

    View details for PubMedID 11713033

  • Revictimization and information processing in women survivors of childhood sexual abuse JOURNAL OF ANXIETY DISORDERS Field, N. P., Classen, C., Butler, L. D., Koopman, C., Zarcone, J., Spiegel, D. 2001; 15 (5): 459-469


    This study examined the effect of sexual revictimization on information processing of trauma-related stimuli in a sample of child sexual abuse (CSA) survivors diagnosed with posttraumatic stress disorder (PTSD). Fifty-one treatment-seeking women participated in this study. Participants completed the Sexual Experiences Survey regarding sexual revictimization in the last 6 months and performed a modified emotional Stroop task in which they named the colors of neutral words (e.g., apple), general threat words (e.g., malignant and death), and sexual/victimization words (e.g., penis and abuser). As predicted, the revictimized participants (n = 16) took significantly longer to color-name sexual/victimization words than did the nonrevictimized participants. These results suggest that revictimization serves to prime preexisting "trauma" memory networks, thereby amplifying the impact of childhood sexual trauma on selective attention toward trauma-related stimuli.

    View details for Web of Science ID 000171096600007

    View details for PubMedID 11583077

  • Spiritual expression and immune status in women with metastatic breast cancer: an exploratory study. breast journal Sephton, S. E., Koopman, C., Schaal, M., Thoresen, C., Spiegel, D. 2001; 7 (5): 345-353


    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.

    View details for PubMedID 11906445

  • Interpersonal problems and their relationship to sexual revictimization among women sexually abused in childhood JOURNAL OF INTERPERSONAL VIOLENCE Classen, C., Field, N. P., Koopman, C., Nevill-Manning, K., Spiegel, D. 2001; 16 (6): 495-509
  • Mind matters - Coping and cancer progression JOURNAL OF PSYCHOSOMATIC RESEARCH Spiegel, D. 2001; 50 (5): 287-290


    The idea that having an 'attitude' about cancer makes a difference in its course is a popular but controversial one. Most oncologists and surgeons believe that tumor type and stage, general health, and medical treatment are all that account for the variance in outcome. Many patients and their families believe that having the right attitude makes a difference in the course of disease. This leads us to two empirical questions: (1) Does coping make a difference in disease progression when medical prognostic variables are taken into account? and (2) What constitutes the 'right attitude'?

    View details for Web of Science ID 000169097400008

    View details for PubMedID 11399287

  • Supportive-expressive group therapy and life extension of breast cancer patients: Spiegel et al. (1989). Advances in mind-body medicine Spiegel, D., Cordova, M. 2001; 17 (1): 38-41

    View details for PubMedID 11270061

  • Symptoms of acute stress disorder and posttraumatic stress disorder following exposure to disastrous flooding. Journal of Trauma and Dissociation Waelde L, Koopman C, Rierdan J, Spiegel D. 2001; 2 (2): 37-52
  • Distress, coping, and social support among rural women recently diagnosed with primary breast cancer. breast journal Koopman, C., Angell, K., Turner-Cobb, J. M., Kreshka, M. A., Donnelly, P., McCoy, R., Turkseven, A., Graddy, K., Giese-Davis, J., Spiegel, D. 2001; 7 (1): 25-33


    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.

    View details for PubMedID 11348412

  • Letter to Editor New England Journal of Medicine Spiegel D. 2001; 345 (11): 841-842
  • A preliminary report comparing trauma-focused and present-focused group therapy against a wait-listed condition among childhood sexual abuse survivors with PTSD. Journal of Aggression, Maltreatment and Trauma Classen C, Koopman C, Nevill-Manning K, Spiegel D 2001; 4 (2): 265-288
  • Acute dissociative reactions in veterans with PTSD Jounral of Trauma & Dissociation Koopman C, Drescher K, Bowles S, Fusman F, Blake D, Dondershine H, Chang V, Butler L, Spiegel D. 2001; 2 (1): 91-111
  • Supportive-expressive group therapy and life extension of breast cancer patients. Advances in Mind-Body Medicine Spiegel D, Cordova M. 2001; 17 (1): 38-41
  • Comparison of lesbian and heterosexual women's response to newly diagnosed breast cancer PSYCHO-ONCOLOGY Fobair, P., O'Hanlan, K., Koopman, C., Classen, C., DiMiceli, S., Drooker, N., Warner, D., Davids, H. R., Loulan, J., Wallsten, D., Goffinet, D., Morrow, G., Spiegel, D. 2001; 10 (1): 40-51


    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.

    View details for Web of Science ID 000166703200004

    View details for PubMedID 11180576

  • Acute stress reactions to everyday stressful life events among sexual abuse survivors with PTSD. Journal of child sexual abuse Koopman, C., Gore-Felton, C., Classen, C., Kim, P., Spiegel, D. 2001; 10 (2): 83-99


    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.

    View details for PubMedID 15149937

  • Informed dissent regarding hypnosis and its not-so-hidden observers: Comment on Lynn AMERICAN JOURNAL OF CLINICAL HYPNOSIS Spiegel, D. 2001; 43 (3-4): 303-303

    View details for Web of Science ID 000167115500014

    View details for PubMedID 11269632

  • Interpersonal problems and their relationship to sexual revictimization among women sexually abused in childhood. Journal of Interpersonal Violence Classen C, Field N, Koopman C, Nevill -Manning K, Spiegel D. 2001; 15 (6): 495-509
  • Traumatic stress, pain and self-efficacy are related to breast cancer patients' satisfaction with care Psychosomatic Medicine Azarow J, Jan W, Koopman C, Classen C, Morrow G, Spiegel D. 2001; 63 (1): 1130
  • Real effects of real child sexual abuse. Sexualtiy and Culture Spiegel D. 2001; 4 (4): 99-105
  • Who is in Procrustes' bed? Sexuality and Culture Spiegel D. 2001; 5 (2): 79-86
  • Comparison of lesbian and heterosexual women's response to newly diagnosed breast cancer. Pyscho-oncology Fobair P, O'Hanlan K, Koopman C, Classen C, Dimiceli S, Drooker N, Warner D, Heather R, Davids H. R, Loulan J, Wallsten D, Goffinet D, MorrowG, Spiegel D. 2001; 10 (1): 40-51
  • Deconstructing the dissociative disorders: For whom the bell tolls Journal of Trauma & Dissociation Spiegel D. 2001; 2 (1): 51-57
  • Book Review: Breast Cancer: society shapes an epidemic. The New England Journal of Medicine Spiegel D. 2001; 344 (17): 1337-1338
  • Closure? The execution was just the start. The Washington Post, Sunday April 29th Spiegel D. 2001; B3
  • New DSM-IV diagnosis of acute stress disorder AMERICAN JOURNAL OF PSYCHIATRY Spiegel, D., Classen, C., Cardena, E. 2000; 157 (11): 1890-1890

    View details for Web of Science ID 000165095100044

    View details for PubMedID 11058507

  • Relationships of perceived stress to coping, attachment and social support among HIV-positive persons AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV Koopman, C., Gore-Felton, C., Marouf, F., Butler, L. D., Field, N., Gill, M., Chen, X. H., Israelski, D., Spiegel, D. 2000; 12 (5): 663-672


    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.

    View details for Web of Science ID 000089953400013

    View details for PubMedID 11218551

  • Psychometric properties of the stanford acute stress reaction questionnaire (SASRQ): A valid and reliable measure of acute stress JOURNAL OF TRAUMATIC STRESS Cardena, E., Koopman, C., Classen, C., Waelde, L. C., Spiegel, D. 2000; 13 (4): 719-734


    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.

    View details for Web of Science ID 000165392000011

    View details for PubMedID 11109242

  • Psychologists' beliefs and clinical characteristics: Judging the veracity of childhood sexual abuse memories PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE Gore-Felton, C., Koopman, C., Thoresen, C., Arnow, B., Bridges, E., Spiegel, D. 2000; 31 (4): 372-377
  • Hypnotic visual illusion alters color processing in the brain AMERICAN JOURNAL OF PSYCHIATRY Kosslyn, S. M., Thompson, W. L., Costantini-Ferrando, M. F., Alpert, N. M., Spiegel, D. 2000; 157 (8): 1279-1284


    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.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 [(15)O]CO(2). 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.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 shown the color or gray-scale stimuli. These results were obtained only during hypnosis in the left hemisphere, whereas blood flow changes reflected instructions to perceive color versus gray scale in the right hemisphere, whether or not subjects had been hypnotized.Among highly hypnotizable subjects, observed changes in subjective experience achieved during hypnosis were reflected by changes in brain function similar to those that occur in perception. These findings support the claim that hypnosis is a psychological state with distinct neural correlates and is not just the result of adopting a role.

    View details for Web of Science ID 000088520100016

    View details for PubMedID 10910791

  • Diurnal cortisol rhythm as a predictor of breast cancer survival JOURNAL OF THE NATIONAL CANCER INSTITUTE Sephton, S. E., Sapolsky, R. M., Kraemer, H. C., Spiegel, D. 2000; 92 (12): 994-1000


    : 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.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.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.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.

    View details for Web of Science ID 000087735600012

    View details for PubMedID 10861311

  • Social support and salivary cortisol in women with metastatic breast cancer PSYCHOSOMATIC MEDICINE Turner-Cobb, J. M., Sephton, S. E., Koopman, C., Blake-Mortimer, J., Spiegel, D. 2000; 62 (3): 337-345


    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.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.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.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.

    View details for Web of Science ID 000087277600007

    View details for PubMedID 10845347

  • Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial LANCET Lang, E. V., Benotsch, E. G., Fick, L. J., Lutgendorf, S., Berbaum, M. L., Berbaum, K. S., Logan, H., Spiegel, D. 2000; 355 (9214): 1486-1490


    Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study.241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures.Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min).Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.

    View details for Web of Science ID 000086830100009

    View details for PubMedID 10801169

  • Psychologists' beliefs and clinical characteristics: Judging the veracity of childhood sexual abuse memories. Professional Psychology: Research and Practice Gore-Felton C, Koopman C, Thorensen C, Arnow B, Bridges E. Spiegel D. 2000; 31 (4): 372-377
  • Diurnal cortisol rhythm as a predictor of breast cancer survival Journal of the National Cancer Institute Sephton, S.E., Sapolsky, R. M., Kraemer, H.C., Spiegel, D. 2000; 92 (12): 994-1000
  • Suffer the children: Longterm effects of sexual abuse. Society Spiegel D. 2000; 37 (4): 18-20
  • Uses of guided imagery for pain control by african-american and white women with metastatic breast cancer. Integrative medicine : integrating conventional and alternative medicine Moore, R. J., Spiegel, D. 2000; 2 (2): 115-126


    Understanding the meanings patients attach to their experiences can help clinicians and researchers to more adequately address a patient's experience with cancer pain. Indeed, many patients seem to desire to and benefit from attaching meaning to the disease and its treatment. In particular, many patients are drawn to guided imagery as a tool in the management of cancer-related anxiety and pain. Using excerpts from African-American and White women's breast cancer narratives, we show 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. Cancer pain increases the disruption in the connection between the body and the mind that is already part of the illness experience. Guided imagery can be regarded as one response to this problem, and may be understood as an attempt to reconnect mind and body in a manner that increases the sense of control, thereby alleviating the suffering of the survivor.

    View details for PubMedID 10882885

  • The relationship between pain and coping styles among HIV-positive men and women PSYCHOLOGY & HEALTH Hart, S., Gore-Felton, C., Maldonado, J., Lagana, L., Blake-Mortimer, J., Israelski, D., Koopman, C., Spiegel, D. 2000; 15 (6): 869-879
  • Affective engagement and couple's adjustment to metastatic breast cancer. Journal of Family Psychology Giese-Davis J, Hermanson K, Koopman C, Spiegel D. 2000; 14 (2): 372-377
  • The price of abusing children and numbers Sexuality and Culture Spiegel D. 2000; 4 (2): 63-66
  • The relationship between pain and coping styles among HIV-positive men and women. Psychology and Health Hart S, Gore-Felton C, Maldonado J, Lagana L, Blake-Mortimer J, Israelski D, Koopman C, Spiegel D. 2000; 15 (15): 869-879
  • Efficacy and cost-effectiveness of group psychotherapy for patients with cancer. ONE (Oncology Economics) spiegel D. 2000; 1 (5): 53-58
  • Hypnotizability and the use of traditional dhami-jhankri healing in Nepal INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS Biswas, A., See, D., KOGON, M. M., Spiegel, D. 2000; 48 (1): 6-21


    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.

    View details for Web of Science ID 000084384600002

    View details for PubMedID 10641429

  • Reducing stress in the stressed out world of cancer Coping with Cancer Diamond S., Rosenbaum E, Spiegel D. 2000; 14 (4): 14-15
  • Letter to the Editor Am J Psychiatry Spiegel D., Classen C, Cardena E. 2000; 157 (11): 1890
  • Group psychotherapy for recently diagnosed breast cancer patients: A multicenter feasibility study PSYCHO-ONCOLOGY Spiegel, D., Morrow, G. R., Classen, C., Raubertas, R., STOTT, P. B., MUDALIAR, N., Pierce, H. I., Flynn, P. J., Heard, L., Riggs, G. 1999; 8 (6): 482-493


    As many as 80% of breast cancer patients report significant distress during initial treatment, yet there is little in the way of systematic psychotherapeutic interventions for women coping with the stress of a recent diagnosis of breast cancer. The literature on psychotherapeutic treatment of cancer patients provides uniform evidence for an improvement in mood, coping and adjustment as a result of group therapy. The present study examined the feasibility of implementing a manualized treatment, supportive-expressive group psychotherapy, in busy oncology practices across the US. This intervention was applied to women with primary breast cancer in a manner which tests not only the efficacy of the approach but also its accessibility to group therapists not previously experienced in its use. One hundred and eleven breast cancer patients within 1 year of diagnosis were recruited from ten geographically diverse sites of the National Cancer Institute's Community Clinical Oncology Program (CCOP) and two academic medical centers. Two therapists from each site were trained in supportive-expressive group psychotherapy. Training consisted of participation in a workshop, reading a treatment manual, and viewing explanatory videotapes. Each patient participated in a supportive-expressive group that met for 12 weekly sessions lasting 90 min. Assessment of mood disturbance was made at entry, 3, 6, and 12 months. Results indicated a significant 40% decrease in the Total Mood Disturbance (TMD) scores of the Profile of Mood States (POMS) (ANOVA F [2,174]=3.98, p<0.05). The total symptom score of the Hospital Anxiety and Depression Scale (HADS) was likewise significantly reduced over the 6-month period (F [2, 174]=5.2, p<0.01). Similarly, the total score of the Impact of Event Scale (IES) was significantly reduced (F [2,174]=4.0, p<0.05). There was substantial uniformity of treatment effect across sites. Outcome was independent of stage of disease (I vs. II). We conclude that this treatment program can be effectively implemented in a community setting and results in reduced distress among breast cancer patients.

    View details for Web of Science ID 000084530300003

    View details for PubMedID 10607981

  • Traumatic stress, life events, and emotional support in women with metastatic breast cancer: Cancer-related traumatic stress symptoms associated with past and current stressors HEALTH PSYCHOLOGY Butler, L. D., Koopman, C., Classen, C., Spiegel, D. 1999; 18 (6): 555-560


    This study examined levels of intrusion and avoidance symptoms and their relationships to past life stress, current emotional support, disease-related variables, and age in 125 women with metastatic breast cancer. The results indicate that a sizable proportion of these women experienced clinically significant levels of intrusion and avoidance symptoms related to their cancer, particularly those with both more stressful past life events and higher current levels of aversive emotional support. Additionally, both types of symptoms were associated with shorter time since recurrence, and avoidance symptoms were associated with smaller emotional support networks. These results indicate that metastatic breast cancer is an emotionally traumatic event for a significant proportion of women, particularly those with past life stressors and unsupportive social environments.

    View details for Web of Science ID 000084078100001

    View details for PubMedID 10619528

  • Improving the quality and quantity of life among patients with cancer: A review of the effectiveness of group psychotherapy EUROPEAN JOURNAL OF CANCER Blake-Mortimer, J., Gore-Felton, C., Kimerling, R., Turner-Cobb, J. M., Spiegel, D. 1999; 35 (11): 1581-1586


    Cancer patients suffer from a number of psychosocial problems related to the progression of their disease as well as standard medical interventions. Fortunately, there is empirical evidence suggesting that group psychotherapy is effective at ameliorating psychological distress and in some cases improving survival. For this literature review we examined the psychological morbidity, particularly anxiety and depression, among cancer patients. Further, we conducted a critical examination of the current evidence regarding the effectiveness of group psychotherapy for improving the quality as well as the quantity of life in cancer patients. Finally, we explored the specific components of effective group psychotherapy, which has been associated with enhanced survival. We conclude that there is compelling evidence indicating that group psychotherapy improves the quality of life of cancer patients. Furthermore, there is a growing body of evidence suggesting that group psychotherapy improves survival of cancer patients.

    View details for Web of Science ID 000083402300006

    View details for PubMedID 10673965

  • A review of acute stress reactions among victims of violence: Implications for early intervention AGGRESSION AND VIOLENT BEHAVIOR Gore-Felton, C., Gill, M., Koopman, C., Spiegel, D. 1999; 4 (3): 293-306
  • Embodying the mind in psychooncology research. Advances in mind-body medicine Spiegel, D. 1999; 15 (4): 267-273

    View details for PubMedID 10555399

  • Psychologists' beliefs about the prevalence of childhood sexual abuse: The influence of sexual abuse history, gender, and theoretical orientation CHILD ABUSE & NEGLECT Gore-Felton, C., Arnow, B., Koopman, C., Thoresen, C., Spiegel, D. 1999; 23 (8): 803-811


    This study examined the influence of sexual abuse history, gender, theoretical orientation, and age on beliefs about the prevalence of childhood sexual abuse among clinical and counseling psychologists.A mail survey design was used in this study. Participants were randomly selected from the American Psychological Association membership database. There were 615 psychologists who completed self-report measures on beliefs about the prevalence of childhood sexual abuse and demographic characteristics.Overall, clinicians' scores on the prevalence of childhood sexual abuse were moderate. There were significant gender differences on beliefs, suggesting that women were more likely believe that childhood sexual abuse is a common occurrence compared to men. Multiple regression analysis indicated that clinician characteristics (history of sexual abuse, gender, and theoretical orientation) were significantly related to beliefs about the prevalence of childhood sexual abuse. However, these characteristics only accounted for a small amount of the overall variance predicting beliefs.These results suggest that clinicians do not hold extreme beliefs regarding the prevalence of childhood sexual abuse. Moreover, certain clinician characteristics are associated with their beliefs, which in turn, may impact their clinical judgment and treatment decisions. Furthermore, much of the variance was unaccounted for in the model indicating that psychologists' beliefs are complex and are not unduly influenced by their personal characteristics. Implications for clinical practice and future research are discussed.

    View details for Web of Science ID 000081643300008

    View details for PubMedID 10477240

  • A 43-year-old woman coping with cancer JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Spiegel, D., Parker, R. A. 1999; 282 (4): 371-378

    View details for Web of Science ID 000081596800033

    View details for PubMedID 10432035

  • Effects of hypnotizability on performance of a stroop task and event-related potentials PERCEPTUAL AND MOTOR SKILLS Nordby, H., Hugdahl, K., Jasiukaitis, P., Spiegel, D. 1999; 88 (3): 819-830


    The effect of hypnotizability on verbal reaction times and event-related potentials during performance of a Stroop color-naming task was studied. The Stroop stimuli (colored words) were randomly presented to 5 high and 5 low hypnotizable subjects in the right and left peripheral visual fields during both waking state and hypnotic induction conditions. Unlike studies in which the Stroop stimuli were foveally presented to the subjects, the highly hypnotizable subjects did not show prolonged verbal reaction times in either waking or hypnotic conditions. There was a marked deterioration in performance accuracy, however, for highly hypnotizable subjects during hypnosis. Event-related potentials indicated that the highly hypnotizable subjects showed a reduced P3a amplitude and a decreased N2b latency to the visual stimuli in both waking and hypnotic conditions, suggesting a lack of orienting to or disengagement from peripherally occurring stimuli.

    View details for Web of Science ID 000081127100015

    View details for PubMedID 10407889

  • Cunning but careless: Analysis of a non-replication PSYCHO-ONCOLOGY Kraemer, H., Spiegel, D. 1999; 8 (3): 273-275

    View details for Web of Science ID 000081023100010

    View details for PubMedID 10390741

  • The Fox guarding the clinical trial: Internal vs. external validity in randomized studies PSYCHO-ONCOLOGY Goodwin, P. J., Pritchard, K. I., Spiegel, D. 1999; 8 (3): 275-275

    View details for Web of Science ID 000081023100011

    View details for PubMedID 10390742

  • The patient, the physician, and the truth HASTINGS CENTER REPORT Whitney, S. N., Spiegel, D. 1999; 29 (3): 24-25

    View details for Web of Science ID 000081231600010

    View details for PubMedID 10420301

  • Healing words - Emotional expression and disease outcome JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Spiegel, D. 1999; 281 (14): 1328-1329

    View details for Web of Science ID 000079628700039

    View details for PubMedID 10208150

  • Cunning but careless: Analysis of a non-Replication Psycho-Oncology Spiegel D. 1999; 8: 273-274
  • Acute stress reactions to actual or threatened violence: Implications for ealy intervention. Aggression and Violent Behavior: A Review Journal Gore-Felton C, Gill M, Koopman C, Thorensen C, Spiegel D. 1999; 4: 293-306
  • Nonpharmacologic analgesia and anxiolysis for interventional radiological procedures SEMINARS IN INTERVENTIONAL RADIOLOGY Lang, E. V., Lutgendorf, S., Logan, H., Benotsch, E. G., Laser, E., Spiegel, D. 1999; 16 (2): 113-123
  • Nonpharmacologic analgesia and anxiolysis for interventional radiological procedures Seminars in Interventional Radiology Lang E V, Lutgendorf S, Logan H, Benotsch E G, Laser E, Spiegel D. 1999; 16: 113-123
  • Enhancing women's lives: The role of support groups among breast cancer patients The Journal for Specialists in Group Work Gore-Felton C, Spiegel D. 1999; 24 (3): 274-287
  • La hipnosis y los trantornos postraumaticos Anales de Psicologia Cardena E, Maldonado J, Galdon M, Spiegel D. 1999; 15 (1): 147-155
  • Repressed memory syndrome (Transcript of the Panel Discussion) Pyshiatric Update Fink P, Bloom S, Spiegel D. 1999; 19 (1): 1-9
  • Commentary: Deconstructing self-destruction PSYCHIATRY-INTERPERSONAL AND BIOLOGICAL PROCESSES Spiegel, D. 1999; 62 (4): 329-330

    View details for Web of Science ID 000085315000006

    View details for PubMedID 10693228

  • Commentary: The patient. the physician, and the truth The Hastings Report Spiegel D. 1999; 29 (3): 24-25
  • From courtroom to couch - Working with repressed memory and avoiding lawsuits PSYCHIATRIC CLINICS OF NORTH AMERICA Scheflin, A. W., Spiegel, D. 1998; 21 (4): 847-?


    Hundreds of lawsuits have been filed during the last decade against therapists who work with patient having repressed memories. These lawsuits claim that therapists are engaged in "repressed memory" therapy, which does not retrieve memories, but instead actually imparts false beliefs, which serve as "pseudo-memories". This article explores the issues of repressed, false, and implanted memories. Advice is given concerning good therapeutic practice and the avoidance of legal liability.

    View details for Web of Science ID 000077479000009

    View details for PubMedID 9890126

  • ECT in dissociative identity disorder and comorbid depression JOURNAL OF ECT Debattista, C., Solvason, H. B., Spiegel, D. 1998; 14 (4): 275-279


    Dissociative identity disorder (DID), previously named multiple personality disorder, is a diagnosis often complicated by comorbid major depression. We report on four cases of DID associated with severe self-destructive behavior and comorbid major depression treated with electroconvulsive therapy (ECT). In three of the patients, ECT appeared to be helpful in treating the comorbid depression without adversely affecting the DID. The potential risks of using ECT in patients with DID are reviewed.

    View details for Web of Science ID 000084422900011

    View details for PubMedID 9871851

  • Representations of self in women sexually abused in childhood CHILD ABUSE & NEGLECT Classen, C., Field, N. P., Atkinson, A., Spiegel, D. 1998; 22 (10): 997-1004


    This exploratory study examined the self representations of 27 women sexually abused in childhood and their association with symptomatology.Twenty-seven self-identified female survivors of childhood sexual abuse completed the Trauma Symptom Checklist-40, Beck Depression Inventory, State-Trait Anxiety Inventory and a measure designed to elicit subjects' self-generated descriptors of selves.Discrepancies in views of current self when compared to ideal or future selves were positively correlated with all symptom measures. Discrepancies in representations of current self compared to views of who they were when they were with their perpetrator were negatively correlated with trait anxiety. Self integration, as defined in this study, was negatively correlated with symptoms.This study suggests that cognitive representations of self are an important indicator of adjustment in survivors of childhood sexual abuse.

    View details for Web of Science ID 000075826900007

    View details for PubMedID 9793722

  • Imagery and hypnotizability revisited INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS KOGON, M. M., Jasiukaitis, P., Berardi, A., Gupta, M., Kosslyn, S. M., Spiegel, D. 1998; 46 (4): 363-370


    The objective of this study was to correlate computer-generated imagery tasks and a self-report measure of imagery ability with hypnotizability, hypothesizing that computer-generated imagery tasks would be better predictors of hypnotizability than will the self-report measure. Hypnotizability of 43 subjects was assessed using the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C. Imagery ability was assessed by the Visual Vividness Imagery Questionnaire (VVIQ) and by computer-generated imagery tasks measuring the ability to generate, maintain, and transform images. Although there was no correlation between the VVIQ and hypnotizability, the less hypnotizable subjects made twice as many mistakes in the spatial imagery tasks than did the more hypnotizables, but this difference was not statistically significant. The relationships among hypnotic performance, hypnotizability, and imagery functions are complex.

    View details for Web of Science ID 000076031900004

    View details for PubMedID 9780527

  • Hypnosis. The Harvard mental health letter / from Harvard Medical School Spiegel, D. 1998; 15 (3): 5-6

    View details for PubMedID 9723018

  • Consistency of memory among veterans of operation desert storm AMERICAN JOURNAL OF PSYCHIATRY Spiegel, D. 1998; 155 (9): 1301-1301

    View details for Web of Science ID 000075723000040

    View details for PubMedID 9734564

  • A tale of two methods: Randomization versus matching trials in clinical research PSYCHO-ONCOLOGY Spiegel, D., Kraemer, H. C., Bloom, J. R. 1998; 7 (5): 371-375

    View details for Web of Science ID 000076732900002

    View details for PubMedID 9809328

  • Acute stress disorder as a predictor of posttraumatic stress symptoms AMERICAN JOURNAL OF PSYCHIATRY Classen, C., Koopman, C., Hales, R., Spiegel, D. 1998; 155 (5): 620-624


    Using the DSM-IV diagnostic criteria for acute stress disorder, the authors examined whether the acute psychological effects of being a bystander to violence involving mass shootings in an office building predicted later posttraumatic stress symptoms.The participants in this study were 36 employees working in an office building where a gunman shot 14 persons (eight fatally). The acute stress symptoms were assessed within 8 days of the event, and posttraumatic stress symptoms of 32 employees were assessed 7 to 10 months later.According to the Stanford Acute Stress Reaction Questionnaire, 12 (33%) of the employees met criteria for the diagnosis of acute stress disorder. Acute stress symptoms were found to be an excellent predictor of the subjects' posttraumatic stress symptoms 7-10 months after the traumatic event.These results suggest not only that being a bystander to violence is highly stressful in the short run, but that acute stress reactions to such an event further predict later posttraumatic stress symptoms.

    View details for Web of Science ID 000073412500009

    View details for PubMedID 9585712

  • Complementary medicine WESTERN JOURNAL OF MEDICINE Spiegel, D., Stroud, P., Fyfe, A. 1998; 168 (4): 241-247


    The widespread use of complementary and alternative medicine techniques, often explored by patients without discussion with their primary care physician, is seen as a request from patients for care as well as cure. In this article, we discuss the reasons for the growth of and interest in complementary and alternative medicine in an era of rapidly advancing medical technology. There is, for instance, evidence of the efficacy of supportive techniques such as group psychotherapy in improving adjustment and increasing survival time of cancer patients. We describe current and developing complementary medicine programs as well as opportunities for integration of some complementary techniques into standard medical care.

    View details for Web of Science ID 000073259300002

    View details for PubMedID 9584661

  • Social support, life stress, pain and emotional adjustment to advanced breast cancer PSYCHO-ONCOLOGY Koopman, C., Hermanson, K., Diamond, S., Angell, K., Spiegel, D. 1998; 7 (2): 101-111


    The purpose of this study was to examine relationships between emotional adjustment to advanced breast cancer, pain, social support, and life stress. The cross-sectional sample was compromised of 102 women with metastatic and/or recurrent breast cancer who were recruited into a randomized psychosocial intervention study. All women completed baseline questionnaires assessing demographic and medical variables, social support, life stress, pain, and mood disturbance. Three types of social support were assessed: (1) number of persons in support system; (2) positive support; and (3) aversive support. On the Profile of Mood States (POMS) total score, we found significant interactions between life stress and social support; having more people in the patient's support system was associated with less mood disturbance, but only among patients who had undergone greater life stress. Also, aversive social contact was significantly related to total mood disturbance (POMS), and having more aversive social contact was particularly associated with total mood disturbance (POMS) among patients who had undergone greater life stress. Pain intensity was associated with greater total life stress, and was not significantly related to social support. These results are consistent with the 'buffering hypothesis' that social support may shield women with metastatic breast cancer from the effects of previous life stress on their emotional adjustment; however, aversive support may be an additional source of life stress associated with emotional distress. Also, pain is greater among women with greater life stress, regardless of social support.

    View details for Web of Science ID 000073345600004

    View details for PubMedID 9589508

  • Hypnosis and implicit memory: Automatic processing of explicit content AMERICAN JOURNAL OF CLINICAL HYPNOSIS Spiegel, D. 1998; 40 (3): 231-240


    Kenneth S. Bowers, in whose honor this issue is written, was, in his own words, "seriously curious" (Bowers, 1983 (originally published 1976)) about hypnosis throughout his career. He brought a lively intellect and an engaging and lucid writing style reminiscent of Freud's (forgive me, Ken, I'm referring to style, not content), and a set of serious questions to the phenomenon of hypnosis. We are indebted to him for his many contributions to the field.

    View details for Web of Science ID 000071666200006

    View details for PubMedID 9470234

  • Acute stress reactions to a patient threat ANXIETY STRESS AND COPING Koopman, C., Zarcone, J., Mann, M., Freinkel, A., Spiegel, D. 1998; 11 (1): 27-45
  • Gettting there is half the fun: Relating happiness to health Psychological Inquiry Spiegel D. 1998; 9 (1): 66-68
  • The role of alternative health care in traditional medicine Federation Bulletin; The Journal of Medical Licensure and Discipline Spiegel D. 1998; 84 (3): 166-168
  • Acute stress reactions to a patient threat Anxiety, Stress and Coping Koopman C, Zarcone J, Mann M, Freinkel A, Spiegel D. 1998; 11: 27-45
  • Psychosocial interventions in cancer: Needs, methods, and outcome Psychosocial Interventions Spiegel D, Diamond S. 1998: 386-395
  • Effects of psychosocial treatment in prolonging cancer survival may be mediated by neuroimmune pathways NEUROIMMUNOMODULATION Spiegel, D., Sephton, S. E., Terr, A. I., Stites, D. P. 1998; 840: 674-683


    Research has provided growing evidence of links between the social environment and cancer progression. Indeed, social support in the form of marriage, frequent daily contact with others, and the presence of a confidant may all have protective value against cancer progression. Furthermore, retrospective data suggest that major stressful life events are more prevalent in patients with relapse or malignancy, and thus may contribute to cancer morbidity. Initial studies of the effects of psychosocial intervention with cancer patients have provided some promising results. In three randomized prospective trials, protective effects of psychosocial interventions on cancer progression have been confirmed, while one matching and one randomized study showed no survival effect after psychosocial treatment. Though more research is clearly needed in this area, this body of evidence suggests that psychosocial factors have potentially powerful modulating effects on the course of disease. Here we review evidence of one possible mechanism whereby psychosocial factors may influence disease-resistance capabilities: the neuroimmune connection. Suppressive effects of stress on immune function are well documented, and these effects have been shown to be modulated by social support. Thus, it is reasonable to hypothesize that supportive social relationships may buffer the effects of cancer-related stress on immunity, and thereby facilitate the recovery of immune mechanisms that may be important for cancer resistance. Data addressing this hypothesis are reviewed.

    View details for Web of Science ID 000074444500064

    View details for PubMedID 9629294

  • Using our heads: Effects of mental state and social influence on hypnosis Contemporary Hypnosis Spiegel D. 1998; 15 (3): 175-177
  • Social support., life stress, pain and emotional adjustment to advanced breast cancer Psycho-Oncology Koopman C, Hermanson K, Diamond S, Angell K, Spiegel D. 1998; 7 (2): 101-111
  • Imagery and hypnosis in the treatment of cancer patients. Oncology (Williston Park, N.Y.) Spiegel, D., Moore, R. 1997; 11 (8): 1179-1189


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

    View details for PubMedID 9268979

  • Effects of medical and psychotherapeutic treatment on the survival of women with metastatic breast carcinoma CANCER KOGON, M. M., Biswas, A., Pearl, D., Carlson, R. W., Spiegel, D. 1997; 80 (2): 225-230


    The authors previously reported a statistically significant effect of psychosocial intervention on survival time of women with metastatic breast carcinoma. In this study, the authors investigated whether this effect could be explained by differences in the medical treatment patients received subsequent to their group participation or differences in causes of death.Of the original 86 study participants, medical treatment charts for 61 and death certificates for 83 were available for further analysis. The authors reviewed the course of the medical treatment they received subsequent to their entry into the randomized psychotherapy trial.Although there were no statistically significant differences with regard to chemotherapy and hormone therapy between the control and treatment groups, women in the control group tended to have received more adrenalectomies, although this procedure did not account for the difference in survival time between the control group and the treatment group. Furthermore, women in the control group developed more bone and lung metastases than the women in the treatment group.Differences in disease course between the control and treatment groups appeared to be independent of any differences in medical treatment received.

    View details for Web of Science ID A1997XJ01600009

    View details for PubMedID 9217034

  • Effectiveness of a training program for enhancing therapists' understanding of the supportive-expressive treatment model for breast cancer groups. The Journal of psychotherapy practice and research Classen, C., Abramson, S., Angell, K., Atkinson, A., Desch, C., Vinciguerra, V. P., Rosenbluth, R. J., Kirshner, J. J., Hart, R., Morrow, G., Spiegel, D. 1997; 6 (3): 211-218


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

    View details for PubMedID 9185066

  • The economic impact of psychotherapy: A review AMERICAN JOURNAL OF PSYCHIATRY Gabbard, G. O., Lazar, S. G., Hornberger, J., Spiegel, D. 1997; 154 (2): 147-155


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

    View details for Web of Science ID A1997WF15000003

    View details for PubMedID 9016261

  • Psychosocial aspects of breast cancer treatment. Seminars in oncology Spiegel, D. 1997; 24 (1): S1-36 S1 47


    Social stress, psychological distress, and psychosocial support effect the adjustment of breast cancer patients, influence their experience of and adherence to medical treatment, and may effect the course of the disease. The literature indicates that levels of distress, depression, and anxiety are substantially elevated among patients with breast cancer. These problems persist in a sizable minority of patients even years after diagnosis. Coping styles are related to adjustment and, in some studies, survival time. The nature of the relationship with physicians affects adjustment to the illness, satisfaction with treatment outcome, and adherence to medical treatment protocols, which can influence relapse and survival. In many but not all studies, serious life stress adversely affects medical outcome. Social support in general and structured psychotherapy in particular have been shown to positively affect both adjustment and survival time. Clear and open communication, expression of appropriate emotion, and collaborative planning and problem-solving enhance adjustment and improve outcome. Conversely, influences that isolate breast cancer patients from others or undermine support can have adverse medical and psychological consequences.

    View details for PubMedID 9045314

  • Memories: True or false American Psychologist Spiegel D. 1997; 52 (9): 995-996
  • Acute stress disorder symptoms among female sexual abuse survivors seeking treatment Journal of Child Sexual Abuse Koopman C, Gore-Felton C, Spiegel D. 1997; 6 (3): 65-85
  • The need for psychotherapy in the medically ill Psychoanalytic Inquiry Spiegel D, Lazar S. 1997; Supplement: 45-50
  • Trauma, dissociation, and memory PSYCHOBIOLOGY OF POSTTRAUMATIC STRESS DISORDER Spiegel, D. 1997; 821: 225-237

    View details for Web of Science ID A1997BJ18D00019

    View details for PubMedID 9238207

  • Block should identify his goals and document his effects Advances; The Journal of Mind-Body Health Spiegel D. 1997; 13 (1): 47-49
  • Coping styles associated with psychological adjustment to advanced breast cancer HEALTH PSYCHOLOGY Classen, C., Koopman, C., Angell, K., Spiegel, D. 1996; 15 (6): 434-437


    The aim of this study was to determine whether psychological adjustment to advanced breast cancer was positively associated with expressing emotion and adopting a fighting spirit and negatively associated with denial and fatalism. Total mood disturbance on the Profile of Mood States was used as the measure of psychological adjustment. The Courtauld Emotional Control Scale measured emotional expression, and the Mental Adjustment to Cancer measured fighting spirit, denial, and fatalism. The sample included 101 women with a diagnosis of metastatic or recurrent breast cancer. Fighting spirit and emotional expressiveness were found to be associated with better adjustment. No association was found between mood disturbance and denial or fatalism. Because this was a cross-sectional study, no conclusions regarding a causal relationship between adjustment and emotional expressiveness or adjustment and fighting spirit were possible.

    View details for Web of Science ID A1996VY32100005

    View details for PubMedID 8973923

  • Hypnotizability and traumatic experience: A diathesis-stress model of dissociative symptomatology AMERICAN JOURNAL OF PSYCHIATRY Butler, L. D., Duran, R. E., Jasiukaitis, P., Koopman, C., Spiegel, D. 1996; 153 (7): 42-63


    The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience.To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed.Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process.High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.

    View details for Web of Science ID A1996UV12300008

    View details for PubMedID 8659641

  • Left hemisphere superiority for event-related potential effects of hypnotic obstruction NEUROPSYCHOLOGIA Jasiukaitis, P., Nouriani, B., Spiegel, D. 1996; 34 (7): 661-668


    Twenty-two highly hypnotizable subjects were run in a visual target detection task which compared hypnotic obstruction of the left and right visual fields over separate blocks. The visual event-related potentials (ERPs) to non-target stimuli revealed that hypnotic obstruction reduced the P200 component to stimuli in the right hemifield, but did not affect P200 for stimulation in the left hemifield. The earlier P100 and N100 were also reduced to hypnotic obstruction but not as preferentially for either hemifield, while the P300 was not significantly changed. Right visual field left hemisphere P200 reduction predicted suppression of behavioral response (button press) to hypnotically obstructed targets in both hemifields. The results are discussed in terms of Farah's model of a left hemisphere mechanism for image generation, and how highly hypnotizable subjects might use this mechanism to comply successfully with the suggestion of a hallucinated visually opaque barrier.

    View details for Web of Science ID A1996UQ41700005

    View details for PubMedID 8783218

  • Cancer and depression BRITISH JOURNAL OF PSYCHIATRY Spiegel, D. 1996; 168: 109-116


    Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.

    View details for Web of Science ID A1996UQ60700014

    View details for PubMedID 8864156

  • Psychological distress and disease course for women with breast cancer: One answer, many questions JOURNAL OF THE NATIONAL CANCER INSTITUTE Spiegel, D. 1996; 88 (10): 629-631

    View details for Web of Science ID A1996UK18600002

    View details for PubMedID 8627635

  • Psychosocial influences on cancer incidence and progression HARVARD REVIEW OF PSYCHIATRY Spiegel, D., Kato, P. M. 1996; 4 (1): 10-26


    The impact of psychosocial factors on the incidence and progression of cancer has become an area that demands attention. In this article recent evidence of psychosocial effects on cancer incidence and progression is reviewed in the context of past research. Psychosocial factors discussed include personality, depression, emotional expression, social support, and stress. Mechanisms that could mediate the relationship between psychosocial conditions and cancer incidence and progression are also reviewed. These include alterations in diet, exercise, and circadian cycles; variations in medical treatment received; and physiological mechanisms such as psychoendocrinologic and psychoneuroimmunologic effects. We conclude that there is a nonrandom relationship among various psychosocial factors and cancer incidence and progression that can only partially be explained by behavioral, structural, or biological factors. Suggestions for future research are discussed.

    View details for Web of Science ID A1996UN34500002

    View details for PubMedID 9384968

  • A 25-year-old woman with hallucinations, hypersexuality, nightmares, and a rash AMERICAN JOURNAL OF PSYCHIATRY Stein, S. L., Solvason, H. B., Biggart, E., Spiegel, D. 1996; 153 (4): 545-551

    View details for Web of Science ID A1996UC47800015

    View details for PubMedID 8599404

  • Hypnotic assessment and treatment of trauma-induced psychosis: The early psychotherapy of H. Breukink and modern views Hypnotherapie, jaargang van der Hart O, Spiegel D. 1996; 17 (4): 7-26
  • Effect of group therapy on women with primary breast cancer The Breast Journal Spiegel D, Morrow G, Classen C, Riggs G, Stott P, Mudalier N, Pierce H, Flynn P, Heard L. 1996; 2 (1): 104-106
  • PSYCHIATRY DISABUSED NATURE MEDICINE Spiegel, D. 1995; 1 (6): 490-491

    View details for Web of Science ID A1995RN10100002

    View details for PubMedID 7585100


    View details for Web of Science ID A1995RE04300011

    View details for PubMedID 7610219

  • Commentary Journal of Psychosocial Oncology Spiegel D. 1995; 13 (1/2): 115-121
  • The pros and cons of dissociative identity (Multiple Personality) disorder Jrnl Prac Psych and Behav Hlth Spiegel D. 1995; 1 (3): 158-166


    During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the person's quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.

    View details for Web of Science ID A1995QB90300002

    View details for PubMedID 7712057

  • Sexuality and spousal support among women with advanced breast cancer The Breast Journal Zarcone J, Smithline L, Koopman C, Kraemer H C, Spiegel D. 1995; 1 (1): 52-57
  • Dr Spiegel and colleagues reply. Letter to the editor American Journal of Pyschiatry Spiegel D, Koopman C, Freinkel A, Kraemer H: 1995; 152 (9): 1405
  • PAIN AND DEPRESSION IN PATIENTS WITH CANCER CANCER Spiegel, D., Sands, S., Koopman, C. 1994; 74 (9): 2570-2578


    Although the existence of a relationship between depression and pain in patients with cancer has been known for many years, the influence of one upon the other is still poorly understood. It has been thought that depressed individuals complain of pain more because of their psychiatric illness. Evidence from two studies indicate that pain may induce clinical depression.In the first study, the authors examined both current and lifetime psychiatric diagnoses among patients with cancer who had high and low pain symptoms to examine the strength of the relationship between depression and cancer pain. The sample consisted of 72 women and 24 men, with 39 women and 9 men in the high pain group, and 33 women and 15 men in the low pain group. In the second study, 35 patients with metastatic carcinoma of the breast were examined for pain intensity and frequency and mood disturbance.The prevalence of depressive disorders of all types was found to be significantly higher in the high pain than in the low pain group across measures, 33 versus 13% (chi-square [degrees of freedom = 1] = 5.90, P < 0.05). Furthermore, there was a significantly higher history of major depression in the low pain group than in the high pain group (chi-square [degrees of freedom = 1] = 3.86, P < 0.05). Also, in comparison with patients in the low pain group, patients in the high pain group were significantly more anxious and emotionally distressed. In the second study, pain intensity correlated significantly with fatigue, vigor, and total mood disturbance, and pain frequency correlated significantly with fatigue, vigor, and depression.This study confirms the high concomitant occurrence of pain and psychiatric morbidity and suggests that pain may play a causal role in producing depression.

    View details for Web of Science ID A1994PP48500026

    View details for PubMedID 7923013



    During the last decade, clinicians, courts, and researchers have been faced with exceedingly difficult questions involving the crossroads where memory, traumatic memory, dissociation, repression, childhood sexual abuse, and suggestion all meet. In one criminal case, repressed memories served as the basis for a conviction of murder. In approximately 50 civil cases, courts have ruled on the issue of whether repressed memory for childhood sexual abuse may form the basis of a suit against the alleged perpetrators. Rulings that have upheld such use underscore the importance of the reliability of memory retrieval techniques. Hypnosis and other methodologies employed in psychotherapy may be beneficial in working through memories of trauma, but they may also distort memories or alter a subject's evaluation of their veracity. Because of the reconstructive nature of memory, caution must be taken to treat each case on its own merits and avoid global statements essentially proclaiming either that repressed memory is always right or that it is always wrong.

    View details for Web of Science ID A1994PH04000012

    View details for PubMedID 7960295



    The first execution in California since 1976 took place recently in the San Quentin Prison gas chamber. Eighteen journalists were invited as media eyewitnesses. The authors postulated that witnessing this execution was psychologically traumatic and that dissociative and anxiety symptoms would be experienced by the journalists.To investigate the prevalence and specific nature of these symptoms, questionnaires were sent to all the journalists about a month after the execution. The questionnaire contained 17 items assessing dissociative symptoms from the authors' questionnaire of 35 highly intercorrelated acute stress items. Fifteen of 18 of the witnesses returned the questionnaire. Items were endorsed on a scale of 0 ("have not experienced") to 5 ("very often experienced") and analyzed as being dichotomously present or absent. The mean age of the respondents was 37.6 (SD = 8.6) and mean years as a journalist were 15.2 (SD = 9.0). Nine subjects were men and six were women.Journalists witnessing the execution endorsed an average of 5.0 dissociative items, ranging from "I saw, heard, or felt things that were not really there" (endorsed by no one) to "I felt estranged or detached from other people" (endorsed by 60%). This prevalence of reported dissociative symptoms is comparable to that seen among persons who endured the recent Oakland/Berkeley, Calif., firestorm.The experience of being an eyewitness to an execution was associated with the development of dissociative symptoms in several journalists.

    View details for Web of Science ID A1994PE36600016

    View details for PubMedID 8067490



    The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire.Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire.Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events.These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

    View details for Web of Science ID A1994NN75500015

    View details for PubMedID 8184999

  • Editorial Introduction to Part 11; Clinical description in the sesquicentennial anniversary supplement American Journal of Psychiatry Spiegel D. 1994; 151 (6): 90-96
  • Editorial: Krebs und depression (Cancer and Depression) Verhaltenstherapie Spiegel D. 1994; 4: 81-88
  • Acute stress disorder and dissociation Australian Journal of Clinicial and Experimental Hypnosis Spiegel D, Koopman C, Classen C: 1994; 22 (1): 11-23

    View details for Web of Science ID A1993LP66900010

    View details for PubMedID 8331680



    This study examined the relation of smoking and medical history, social support, and hypnotizability to outcome of a smoking cessation program.A consecutive series of 226 smokers referred for the smoking cessation program were treated with a single-session habit restructuring intervention involving self-hypnosis. They were then followed up for 2 years. Total abstinence from smoking after the intervention was the criterion for successful outcome.Fifty-two percent of the study group achieved complete smoking abstinence 1 week after the intervention; 23% maintained their abstinence for 2 years. Hypnotizability and having been previously able to quit smoking for at least a month significantly predicted the initiation of abstinence. Hypnotizability and living with a significant other person predicted 2-year maintenance of treatment response.These results, while modest, are superior to those of spontaneous efforts to stop smoking. Furthermore, they suggest that it is possible to predict which patients are most likely and which are least likely to respond to such brief smoking cessation interventions.

    View details for Web of Science ID A1993LL39800018

    View details for PubMedID 8317582



    The role of hypnotizability assessment in the differential diagnosis of psychotic patients is still unresolved. In this article, the pioneering work of Dutch psychiatrist H. Breukink (1860-1928) during the 1920s is used as early evidence that hypnotic capacity is clinically helpful in differentiating highly hypnotizable psychotic patients with dissociative symptomatology from schizophrenics. Furthermore, there is a long tradition of employing hypnotic capacity in the treatment of these dissociative psychoses. The ways in which Breukink used hypnosis for diagnostic, prognostic, and treatment purposes are summarized and discussed in light of both old and current views. He felt that hysterical psychosis was trauma-induced, certainly curable, and that psychotherapy using hypnosis was the treatment of choice. Hypnosis was used for symptom-oriented therapy, as a comfortable and supportive mental state, and for the uncovering and integrating of traumatic memories. For the latter purpose, Breukink emphasized a calm mental state, both in hypnosis and in the waking state, thereby discouraging emotional expression, which he considered dangerous in psychotic patients. In the discussion, special attention is paid to the role and dangers of the expression of trauma-related emotions.

    View details for Web of Science ID A1993LG94300004

    View details for PubMedID 8335419



    The psychosocial outcomes of testicular cancer and Hodgkin's disease were compared to test our hypotheses that more specific dysfunction and less hiding of symptoms would be found in the former group, as cancer visibly affects a sexual organ. Since those with Hodgkin's disease could more easily deny the disease, poorer psychosocial adjustment was predicted.The sample consists of 85 men with Hodgkin's disease and 88 men with testicular cancer (seminomatous, n = 39; or nonseminomatous, n = 49). They were interviewed once, at least 1 year following the end of treatment. Measures of sociodemographic characteristics, physical functioning, psychologic distress, and social outcomes were collected. Treatment data were collected from medical records.Men with testicular cancer report more focused symptoms: less sexual enjoyment and poor health habits. Men with Hodgkin's disease report more generalized symptoms: fatigue, energy loss, and work impairment. Multivariate analysis indicates that most of these differences are site-related; independent effects of treatment on outcomes were found for more generalized symptoms. Contrary to expectations, both groups reported similar levels of infertility and erectile dysfunction.The response to testicular cancer is site-specific, while the response to Hodgkin's disease is related to both site and treatment (stage-related).

    View details for Web of Science ID A1993LA02600026

    View details for PubMedID 8487061


    View details for Web of Science ID A1993LA34000005

    View details for PubMedID 8509073

  • TRAUMA AND DISSOCIATION BULLETIN OF THE MENNINGER CLINIC Classen, C., Koopman, C., Spiegel, D. 1993; 57 (2): 178-194


    The stress associated with experiencing or witnessing physical trauma can cause abrupt and marked alterations in mental state, including anxiety and transient dissociative symptoms. Intense manifestations of this pattern of response to trauma are described in a new diagnostic category proposed for DSM-IV: acute stress disorder. Severe dissociative symptoms may predict subsequent posttraumatic stress disorder. Persons who experience a series of traumatic events may be especially vulnerable to a variety of dissociative states, including amnesia, fugue, depersonalization, and multiple personality disorder. Treatment for these symptoms emphasizes strengthening supportive interpersonal relationships and developing insight that reduces psychological pain by integrating the trauma into a meaningful, less self-blaming perspective.

    View details for Web of Science ID A1993LC53000004

    View details for PubMedID 8508155



    This study systematically evaluated the psychological reactions of a nonclinical population to the October 1989 earthquake in the San Francisco Bay Area.A representative group of about 100 graduate students from two different institutions in the Bay Area volunteered to participate in the study. Within 1 week of the earthquake, the authors administered a checklist of anxiety and dissociative symptoms to the subjects, and 4 months later they conducted a follow-up study with the same checklist.The participants reported significantly greater numbers and frequency of dissociative symptoms, including derealization and depersonalization, distortions of time, and alterations in cognition, memory and somatic sensations, during or shortly after the earthquake than after 4 months. To a lesser degree they also reported significantly more nonsomatic anxiety symptoms and Schneider's first-rank symptoms at the earlier testing time.These results suggest that among nonclinical populations, extreme distress may significantly increase the prevalence and severity of transient dissociative phenomena and anxiety. They provide further evidence of the role that dissociation plays in the response to trauma and are of considerable clinical and theoretical importance in view of the lifetime prevalence of traumatic experiences in the general population.

    View details for Web of Science ID A1993KN84500016

    View details for PubMedID 8434665

  • Letter; Multiple Personality British Journal of Psychiatry Spiegel D. 1993; 162: 126
  • Psychosocial outcomes of cancer; A comparative analysis of Hodgkin's Disease and testicular cancer Journal of Clinical Oncology Bloom J R, Fobair P, Gritz E, Wellisch D, Spiegel D, Varghese A, Hoppe R. 1993; 11 (5): 979-88

    View details for Web of Science ID A1993KF95000027

    View details for PubMedID 8425129

  • New directions in psycho-oncology Current Opinion in Psychiatry Stein S., Hermanson K, Spiegel D: 1993; 6: 838-846


    The case of a patient with symptoms suggestive of a dissociative disorder is presented. The consultant reviews the diagnosis of multiple personality disorder (MPD) as defined in DSM-III-R and DSM-IV in relation to the patient's dissociative states, hallucinations, memory loss, and other symptoms. He then highlights the distinctions among MPD, schizophrenia, borderline personality disorder, major depression, and complex partial seizures. After presenting the conceptualization of MPD as a chronic posttraumatic stress disorder, he concludes with a review of treatment approaches that address the traumatic history and that involve hypnosis to gain access to and control dissociative states.

    View details for Web of Science ID A1992HV73500008

    View details for PubMedID 1352164

  • Changes in marital and sexual functioning in long-term survivors and their spouses: Testicular cancer versus Hodgkin's Disease Psyho-Oncology Hannah M T, Gritz E R, Wellisch D K, Fobair P, Hoppe R T, Bloom J R, Sun G, Varghese A, Cosgrove M D, Spiegel D. 1992; 1: 89-103
  • None of Lazarus' problems makes the difficult into the impossible. Advances Spiegel D. 1992; 8 (3): 36-37
  • Effects of psychosocial support on patients with metastatic breast cancer Journal of Psychosocial Oncology Spiegel D. 1992; 10: 113-120
  • Book review of The Threatened Medical Identity of Psychiatry: The Winds of Change by T. Pearlman New England Journal of Medicine Spiegel D. 1992; 327 (24): 1763
  • Do psychosocial factors influence the course of breast cancer? A review of recent literature, methodological problems and future directions. Psycho-Oncology Mulder C L, Van der Pompe G, Spiegel D, Antoni M H, De Vries M J. 1992; 1: 155-167
  • A neural network model of dissociative disorders. Psychiatric Annals Li D, Spiegel D. 1992; 22: 144-147

    View details for Web of Science ID A1992KL03300001

    View details for PubMedID 1286652


    View details for Web of Science ID A1992GX47400008

    View details for PubMedID 1543801

  • The use of hypnosis in the treatment of PTSD. Psychiatric medicine Spiegel, D. 1992; 10 (4): 21-30

    View details for PubMedID 1289959

  • Hypnosis and related techniques in pain management. Hospice journal Spira, J. L., Spiegel, D. 1992; 8 (1-2): 89-119


    Hypnosis has been used successfully in treating cancer patients at all stages of disease and for degrees of pain. The experience of pain is influenced not only by physiological factors stemming from disease progression and oncological treatment, but also from psychosocial factors including social support and mood. Each of these influences must be considered in the successful treatment of pain. The successful use of hypnosis also depends upon the hypnotizability of patients, their particular cognitive style, their specific motivation, and level of cognitive functioning. While most patients can benefit from the use of hypnosis, less hypnotizable patients or patients with low cognitive functioning need to receive special consideration. The exercises described in this chapter can be successfully used in groups, individual sessions, and for hospice patients confined to bed. Both self-hypnosis and therapist guided hypnosis exercises are offered.

    View details for PubMedID 1286854

  • The use of hypnosis in the treatment of PTSD Psychiatric Medicine Spiegel D. 1992; 10 (4): 21-30

    View details for Web of Science ID A1991GM86600016

    View details for PubMedID 1821268



    We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

    View details for Web of Science ID A1991FY37600016

    View details for PubMedID 1918616


    View details for Web of Science ID A1991FN63900041

    View details for PubMedID 2035733

  • Second thoughts on personality, stress and disease Psychological Inquiry Spiegel D. 1991; 2 (3): 266-168
  • Physiologic and psychobehavioral research in oncology Cancer Redd W H, Silberfarb P M, Andersen P L, Andrykowski M A, Bovbjerg D H, Burish T G, Carpenter P J, Cleeland C, Dolgin M, Levy S L, Mitnick L, Morrow G R, Schover L R, Spiegel D, Stevens J. 1991; 67: 813-822
  • Psychosocial treatment and cancer survival Harvard Mental Health Letter Spiegel D. 1991; 7 (7): 4-6
  • A psychosocial intervention and survival time of patients with metastatic breast cancer Advances Spiegel D. 1991; 7: 10-19
  • Social supports and the social well-being of cancer survivors Advances in Medical Sociology Bloom J R, Fobair P, Spiegel D, Cox R S, Varghese A, Hoppe R. 1991; 2: 95-114
  • Invited Discussion of Bandaging a 'Broken Heart': Hypnoplay therapy in the treatment of multiple personality disorder American Journal of Clinical Hypnosis Spiegel D. 1991; 34: 19-20
  • Psychosocial aspects of cancer Current Opinion in Psychiatry Spiegel D. 1991; 4: 889-897
  • Letter: Comments on hynotizability and dissociation American Journal of Psychiatry Spiegel D, Cardena E. 1991; 148: 813-814
  • Uses of hypnosis in managing medical symptoms. Psychiatric medicine Spiegel, D. 1991; 9 (4): 521-533

    View details for PubMedID 1749836

  • Mind Matters: Effects of group support on cancer patients Journal of NIH Research Spiegel D. 1991; 3: 61-62
  • Dissociating consciousness from cognition Behavioral and Brain Sciences Spiegel D. 1991; 14: 695-696


    A recent call for a new speciality in biologically based brain diseases is questioned on historical, empirical, and theoretical grounds. Psychiatry has oscillated between biological and psychosocial explanations for mental illness since its inception. Training in the biological basis of mental illness is and should be incorporated into psychiatric training, along with a balanced appreciation of the utility of psychotherapeutic and social intervention. Emphasis on only one aspect resurrects Cartesian dualism. Any disease, however biological in origin, is best treated by a clinician adept at multiple levels of understanding and intervention.

    View details for Web of Science ID A1990EN17900015

    View details for PubMedID 2293180


    View details for Web of Science ID A1990EC66400001

    View details for PubMedID 2247563

  • Physical performance at work and at leisure: Validation of a measure of biological energy in survivors of Hodgkin's Disease Journal of Psychosocial Oncology Bloom J R, Gorsky R D, Fobair P, Hoppe R, Cox R S, Vwerghese A, Spiegel D. 1990; 8: 49-63
  • Dissociating Dissociation: A commentary on Dr Garcia's article Dissociation Spiegel D. 1990; 111: 214-215
  • Theoretical and empirical resistance to hypnotic compliance American Journal of Clinical Hypnosis Spiegel D. 1990; 32: 243-245
  • PSYCHOLOGICAL SUPPORT FOR CANCER-PATIENTS LANCET Spiegel, D., Bloom, J. R., Kraemer, H., Gottheil, E. 1989; 2 (8677): 1447-1447

    View details for Web of Science ID A1989CD88100014

    View details for PubMedID 2574371



    The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.

    View details for Web of Science ID A1989AU63500004

    View details for PubMedID 2571815



    The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 +/- 0.48 to a mean of 6.80 +/- 0.02 mmol H+/h with hypnosis, an increase of 89% (p = 0.0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output (4.29 +/- 0.93 vs. 2.60 +/- 0.44 mmol H+/h, p less than 0.05) and an 11% reduction in pentagastrin-stimulated peak acid output (28.69 +/- 2.34 vs. 25.43 +/- 2.98 mmol H+/h, p less than 0.05). We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control.

    View details for Web of Science ID A1989U655900001

    View details for PubMedID 2714570



    The relevance of hypnosis to the treatment of sexual assault derives from two sources: the fact that hypnotic phenomena are mobilized spontaneously as defenses during assault, becoming part of the syndrome of posttraumatic stress disorder (PTSD) and the usefulness of formal hypnosis in treating PTSD. The role of dissociative defenses during and after traumatic experiences is reviewed; an analogy between the major elements of formally-induced hypnosis--absorption, dissociation, and suggestibility, and the major elements of PTSD--is drawn. Special problems relevant to sexual assault in childhood are discussed, including extreme self-blame and a profound sense of personality fragmentation. Uses of hypnosis in the treatment of sexual assault victims are reviewed, with an emphasis on helping such patients restructure their memories of the experience, both by reviewing them with greater control over their physical sense of comfort and safety and by balancing painful memories with recognition of their efforts to protect themselves or someone else who was endangered. The use of a split-screen technique in hypnosis is described with a clinical example. Special considerations in such treatment, including the traumatic transference and forensic complications of such psychotherapeutic work, are enumerated.

    View details for Web of Science ID A1989AA82000005

    View details for PubMedID 2664731



    Effects of hypnotic alterations of perception on amplitude of somatosensory event-related potentials were studied in 10 highly hypnotizable subjects and 10 subjects with low hypnotizability. The highly hypnotizable individuals showed significant decreases in amplitude of the P100 and P300 waveform components during a hypnotic hallucination that blocked perception of the stimulus. When hypnosis was used to intensify attention to the stimulus, there was an increase in P100 amplitude. These findings are consistent with observations that highly hypnotizable individuals can reduce or eliminate pain by using purely cognitive methods such as hypnosis. Together with data from the visual system, these results suggest a neurophysiological basis for hypnotic sensory alteration.

    View details for Web of Science ID A1989U760600009

    View details for PubMedID 2729425

  • Hypnotizability and weight loss in obese subjects International Journal of Eating Disorders Barbarsz M, Spiegel D. 1989; 8: 335-341
  • Uses and abuses of hypnosis Integrative Psychiatry Spiegel D. 1989; 6: 211-222
  • Editorial: Hypnosis and the relaxation response Gastroenterology Spiegel D. 1989; 96: 1609-11
  • Commentary. The treatment accorded those who treat patients with multiple personality disorder. journal of nervous and mental disease Spiegel, D. 1988; 176 (9): 535-536

    View details for PubMedID 3418325


    View details for Web of Science ID A1988P472400002

    View details for PubMedID 3064577



    The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.

    View details for Web of Science ID A1988M329100004

    View details for PubMedID 3344845

  • Dissociation and hypnosis in post-traumatic stress disorders Journal of Traumatic Stress Spiegel D. 1988; 1: 17-33
  • Pain management in the cancer patient Journal of Psychosocial Oncology Spiegel D, Sands S. 1988; 6: 205-216
  • Hypnosis embodying the mind: I think therefore I am Contemporary Psychiatry Spiegel D. 1988; 7: 117-121


    The families of 14 schizophrenic patients who were recently discharged from a Veterans Administration hospital received periodic consultation in their homes from members of a clinical team. The visiting clinicians educated the families and the patients about community resources, consulted with them about interpersonal problems, and were available for crisis intervention following the last scheduled visit. Three months and one year after their discharge, the patients were compared on various measures of outcome with a control group of 22 similar patients whose families did not receive periodic consultation. At the three-month follow-up, patients whose families received consultation had spent significantly fewer days in the hospital than had the control patients, but the difference was not significant at one-year follow-up. They also rated themselves significantly higher on the Vets Adjustment Scale at both the three-month and one-year follow-ups. The authors interpret the results in light of other studies of after-care interventions.

    View details for Web of Science ID A1987K244700013

    View details for PubMedID 2822566


    View details for Web of Science ID A1987K588400002

    View details for PubMedID 3687817


    View details for Web of Science ID A1987J790500003

    View details for PubMedID 3679099

  • Seeing through social influence: Hypnotic hallucinations are opaque Behavioral and Brain Sciences Spiegel D. 1987; 10: 775-776
  • Chronic pain masks depression, multiple personality disorder Hospital and Community Psychiatry Spiegel D. 1987: 933-935
  • The healing trance The Sciences Spiegel D. 1987: 35-41
  • CEPHALIC PHASE OF ACID-SECRETION GASTROENTEROLOGY Klein, K. B., Spiegel, D. 1986; 91 (6): 1581-1581

    View details for Web of Science ID A1986E808100038

    View details for PubMedID 3770382


    View details for Web of Science ID A1986E383200008

    View details for PubMedID 3535482

  • PSYCHOSOCIAL PROBLEMS AMONG SURVIVORS OF HODGKINS-DISEASE JOURNAL OF CLINICAL ONCOLOGY Fobair, P., Hoppe, R. T., Bloom, J., Cox, R., Varghese, A., Spiegel, D. 1986; 4 (5): 805-814


    The psychosocial problems that develop in long-term survivors of Hodgkin's disease were examined in a cross-sectional survey of 403 patients. The average age at treatment was 27 years and at interview was 36 years. The median time since treatment was 9 years. Sixty percent of the patients were treated for stage I or II disease and 40% for stage III or IV. Eighty-two percent of the patients had never relapsed, and 98% were free of disease at the time of interview. The study investigated the type and frequency of problems by means of a self-administered questionnaire using standard survey items to assess disruption in three areas of life: sense of well-being, family relationships, and employment. Results indicate that energy had not returned to patients' satisfaction in 37% of the cases. This was influenced by age, time since therapy, stage of disease, and type of treatment. Patients with self-reported energy loss were more likely to be depressed. Moderately high divorce rates (32%), problems with infertility (18%), and less interest in sexual activity (20%) were reported. Employment patterns favored men returning to work, and number of hours worked was highly correlated with less depression, younger age, and return of energy. Difficulties at work were reported by 42% of the cases. The interaction of treatment, biologic, psychosocial, and functional variables is described.

    View details for Web of Science ID A1986C177800026

    View details for PubMedID 3486256

  • Nonpharmacological Management of Pain Mediguide to Inflammatory Diseases Spiegel D. 1986; 5: 1-5


    The Family Environment Scale scores and demographic characteristics of 108 discharged psychiatric patients were used to predict outcome at 3 months and 1 year. Higher ratings of family expressiveness predicted fewer days of rehospitalization, especially among schizophrenic patients. Higher family cohesion scores predicted better family-rated patient adjustment. The patients were more likely to rate themselves as better adjusted if they had higher incomes, lived with parents rather than a spouse, and came from families with less emphasis on independence. Family environment was a better predictor of rehospitalization than baseline ratings of clinical status, indicating the importance of family support in the community adjustment of chronic psychiatric patients.

    View details for Web of Science ID A1986AXS5800010

    View details for PubMedID 3942288

  • Adjunctive uses of hypnosis in the treatment of smoking Psychiatric Annals Frischholz E J, Spiegel D. 1986; 16: 87-90
  • Painstaking reminders of forgotten trance logic Behavioral and Brain Sciences Spiegel D. 1986; 9: 484-485

    View details for Web of Science ID A1985ANY5600002

    View details for PubMedID 4031221


    View details for Web of Science ID A1985ANC6500004

    View details for PubMedID 3926258

  • Scientific status of refreshing recollection by the use of hypnosis. Journal of the American Medical Association Orne M T, Axelrad D, Diamond B L, Gravitz M A, Heller A, Mutter C B, Spiegel D, Spiegel H. 1985; 253: 1918-1923
  • Psychosocial interventions with cancer patients Journal of Psychosocial Oncology Spiegel D. 1985; 3: 83-95
  • Trance, Trauma & Testimony The Stanford Magazine Spiegel D 1985; 13: 40-44


    Age regression--reliving the past as though it were occurring in the present, with age appropriate vocabulary, mental content, and affect--can occur with instruction in highly hypnotizable individuals, but has rarely been reported to occur spontaneously, especially as a primary symptom. The psychiatric presentation and treatment of a 16-year-old girl with spontaneous age regressions accessible and controllable with hypnosis and psychotherapy are described. Areas of overlap and divergence between this patient's symptoms and those found in patients with hysterical fugue and multiple personality syndrome are also discussed.

    View details for Web of Science ID A1984TX68700009

    View details for PubMedID 6501240



    This article examines multiple or dissociative personality syndrome as a multiple post-traumatic stress disorder, discussing these patient's developmental histories, their high hypnotizability, and their profound capacity to dissociate spontaneously to protect themselves from emotional and physical pain.

    View details for Web of Science ID A1984SM12200009

    View details for PubMedID 6718261



    Of interest to the field is the mechanism through which social support acts as a resistance resource for individuals undergoing stressful life circumstances. Women with advanced breast cancer (N = 86) were interviewed to determine how their outlook on life and social functioning were affected by the social support they received. Emotional support provided by the family was predicted to affect the woman's sense of well-being whereas the opportunities for social exchange provided by one's social activities were expected to effect the woman's social functioning. Consistent with the predictions, the data indicate that social support is multidimensional. Emotional support was strongly related to one's outlook. However, one's opportunities for social exchange affect not only one's social functioning, but also one's outlook on life, suggesting an interactive process whereby family support improves outlook, both outlook and opportunities for social exchange are related to one's sense of social functioning. These data explain the erosion of social support during life-threatening illness such as cancer as a result of the limitations imposed by the illness on one's opportunities for social exchange.

    View details for Web of Science ID A1984TS31700009

    View details for PubMedID 6505749



    The role of hypnosis as a tool in the treatment of problems commonly encountered among medical and surgical patients is examined. Hypnosis is defined as a change in state of mind far more akin to intense concentration than sleep. Diagnostic implications of differences in hypnotic responsivity are explored, and scales suitable for use in the clinic are examined. Uses of hypnosis in treating anxiety, pain, childbirth, psychosomatic symptoms, seizure disorders, neuromuscular dysfunction, and habits are described and evaluated. The phenomenon of hypnosis is presented as a means of exploring the mind-body relationship in a controlled fashion, providing information of diagnostic importance while at the same time allowing hypnotizable patients to intensify their concentration and interpersonal receptivity in the service of a therapeutic goal.

    View details for Web of Science ID A1983RU95100006

    View details for PubMedID 6662357


    View details for Web of Science ID A1983RR17600002

    View details for PubMedID 6642804



    The hypothesis that the alleviation of chronic pain with hypnosis is mediated by endorphins was tested. Six patients with chronic pain secondary to peripheral nerve irritation were taught to control the pain utilizing self-hypnosis. Each subject was tested at 5-min intervals during four 1-h sessions for the amount of reduction of pain sensation and suffering associated with hypnosis while being given, in a random double-blind crossover fashion, an IV injection of either 10 mg naloxone or a saline placebo through an indwelling catheter. The patients demonstrated significant alleviation of the pain with hypnosis, but this effect was not significantly diminished in the naloxone condition. These findings contradict the hypothesis that endorphins are involved in hypnotic analgesia.

    View details for Web of Science ID A1983RK80300010

    View details for PubMedID 6415744

  • Family environment of patients with metastatic carcinoma. Journal of Psychosocial Oncology Spiegel D, Bloom J R, Gottheil E. 1983; 1: 33-44


    The pain and mood disturbance of 54 women with metastatic carcinoma of the breast were studied over the course of one year. A random sample was offered weekly group therapy during the year, with or without self-hypnosis training directed toward enhancing their competence at mastering pain and stress related to cancer. Both treatment groups demonstrated significantly less self-rated pain sensation (t = 2.5 p less than 0.02) and suffering (t = 2.17, p less than 0.03) than the control sample. Those who were offered the self-hypnosis training as well as group therapy fared best in controlling the pain sensation (F = 3.1, p less than 0.05). Pain frequency and duration were not affected. Changes in pain measures were significantly correlated with changes in self-rated total mood disturbance on the Profile of Mood States and with its anxiety, depression, and fatigue subscales. Possible mechanisms for the effectiveness of these interventions are discussed.

    View details for Web of Science ID A1983RD87400005

    View details for PubMedID 6622622



    This study compared the perceived family environments of former psychiatric inpatients with thought, affective, and substance abuse disorders to those of normative comparison couples using the Family Environment Scale. Family environment was assessed among patients and wives separately at hospital discharge and at three- and twelve-month follow-ups. Patients and their wives were consistently more incongruent in their perceptions of their shared environment than normative couples. In addition, low-functioning patient couples reported less family cohesion, expressiveness, and recreational emphasis than their higher functioning counterparts; the high-functioning patient couples more closely resembled the norm. The paper discusses possible relationships between positive family contact and better patient functioning.

    View details for Web of Science ID A1983RX98300011

    View details for PubMedID 6677524

  • Hypnosis is not therapy Bulletin of the British Society of Experimental and Clinical Hypnosis Frischholz E J, Spiegel D. 1983; 6: 3-8
  • Hypnosis: How you can use it to help patients stop smoking Your Patient and Cancer Spiegel D. 1983; 3: 72-84
  • PAIN IN METASTATIC BREAST-CANCER CANCER Spiegel, D., Bloom, J. R. 1983; 52 (2): 341-345


    The pain experiences of 86 women with metastatic carcinoma of the breast were systematically evaluated over a period of one year. Fifty-six percent of the sample reported experiencing pain, and the intensity of pain was not significantly related to site of metastasis. Multiple regression analysis revealed that 50% of the variance in the pain experience was accounted for by: (1) the amount of mood disturbance as measured by the Profile of Mood States (POMS); (2) the patients' belief that the pain indicated worsening of the illness; and (3) the use of analgesic medication. The nature of family support, social functioning, and coping responses were not significantly associated with pain intensity, nor was mortality during the one-year follow-up period. These data document the significance of psychological factors in accounting for differences in pain experience and document the interaction between pain and mood disturbance. These findings suggest that treatment of metastatic pain should include attention to the patient's mood and adjustment to the illness.

    View details for Web of Science ID A1983QW70300026

    View details for PubMedID 6861077


    View details for Web of Science ID A1983SE31300014

    View details for PubMedID 6673591


    View details for Web of Science ID A1982PJ48600018

    View details for PubMedID 7142550


    View details for Web of Science ID A1982PR75100012

    View details for PubMedID 6762966

  • HILGARD ILLUSION ARCHIVES OF GENERAL PSYCHIATRY Spiegel, D., Tryon, W. W., FRISCHHOLZ, E. J., Spiegel, H. 1982; 39 (8): 972-974

    View details for Web of Science ID A1982PE49500011

    View details for PubMedID 7103686



    The authors compared the hypnotic responsivity of 115 chronically ill psychiatric patients with that of 83 nonpatient volunteers. The Hypnotic Induction Profile was administered to all subjects, and diagnoses were established for the patients according to Research Diagnostic Criteria. All of the diagnosed patients (those with thought disorder, affective disorder, generalized anxiety, and miscellaneous disorders) were significantly less hypnotizable than the nonpatient comparison group. This effect was unrelated to age or medication differences. The authors discuss the implication of these findings in relation to a new model of hypnotic responsivity that takes into account the moderating effects of severe psychopathology.

    View details for Web of Science ID A1982NH46300004

    View details for PubMedID 7065288


    View details for Web of Science ID A1982PA70500006

    View details for PubMedID 7130522

  • Hypnosis in the treatment of psychosomatic symptoms and pain. Psychiatric Annals Spiegel D. 1981; 11: 343-349

    View details for Web of Science ID A1981ME54800003

    View details for PubMedID 7282575

  • Hypnosis and the unhypnotizable: A reply to Barber. American Journal of Clinical Hypnosis Frischolz E J, Spiegel H, Spiegel D. 1981; 24: 55-58

    View details for Web of Science ID A1981MR40200009

    View details for PubMedID 7315760



    The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this invention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mood-disturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.

    View details for Web of Science ID A1981LR49100004

    View details for PubMedID 7235853

  • Vietnam grief work using hypnosis. American Journal of Clinical Hypnosis Spiegel D. 1981; 24: 33-40

    View details for Web of Science ID A1981MF34800001

    View details for PubMedID 7282976


    View details for Web of Science ID A1981MR40200006

    View details for PubMedID 7315757



    The successful treatment of a man with severe posttraumatic contractures of the hand using a combined psychological and physical rehabilitation approach is reported. The contractures had functional and organic components, as did the treatment, which involved teaching the patient self-hypnosis exercises and the use of a splint. The patient obtained virtually complete return of movement after 3 1/2 years of total disability. The importance of identifying and mobilizing rather than challenging the patient's motivation for recovery using a rehabilitation approach is discussed. Hypnosis can facilitate recovery in such psychosomatic disorders in patients with the requisite hypnotic capacity and motivation.

    View details for Web of Science ID A1980KH98900003

    View details for PubMedID 7430579

  • The recent literature: Sel-help and mutual support groups. Community Health Review Spiegel D. 1980; 5: 15-25

    View details for Web of Science ID A1980KN01100005

    View details for PubMedID 7424799


    View details for Web of Science ID A1980JB89900005

    View details for PubMedID 7360854


    View details for Web of Science ID A1979HD38700003

    View details for PubMedID 541133


    View details for Web of Science ID A1979HU36600007

    View details for PubMedID 523596



    The very existence of hysterical psychosis as a diagnostic entity has been questioned as part of the general difficulty in defining both hysteria and psychosis. However, several recent investigations have documented a syndrome that usually involves brief and intense periods of psychotic behavior, generally with graphic decompensation, severe environmental stress, and rapid recompensation, in individuals with other hysterical features. The authors assert that such a syndrome does exist as a clinical entity and that the differential diagnosis can be facilitated by using a standardized measure of hypnotic trance capacity. They hypothesize that patients with hysterical psychosis are highly hypnotizable, while those who are schizophrenic and psychotic have low hypnotizability. The authors review the literature and present two case examples.

    View details for Web of Science ID A1979GY06700005

    View details for PubMedID 443460


    View details for Web of Science ID A1978EV67100007

    View details for PubMedID 631956


    View details for Web of Science ID A1977DW03100011

    View details for PubMedID 903086



    The importance of the distinction between supervision and psychotherapy is examined, utilizing experience in several residency training programs and theoretical literature. The tendency to confound personal and professional issues in supervision is examined in the light of institutional pressures for control of psychotherapists in training.

    View details for Web of Science ID A1977EC46500012

    View details for PubMedID 596493

  • The psychiatrist as a consultant to self-help groups. Hospital and Community Psychiatry Spiegel D. 1977; 28: 711-712
  • Psychiatric consultation to a legal services agency. Psychiatric Opinion Spiegel D, Naparstek B. 1974; 11: 25-30

Conference Proceedings

  • Psychosocial correlates of sleep architecture in women with advanced breast cancer. Gerry, A. A., Jo, B., Palesh, O., Zeitzer, J., Neri, E., Spiegel, D. AMER SOC CLINICAL ONCOLOGY. 2012
  • Pride following an acute stressor is associated with healthier physiology Giese-Davis, J., Maya, Y., Nouriani, B., Spiegel, D. SPRINGER. 2008: S125-S125
  • Talking about empowerment with a peer counselor predicts increased marital satisfaction in women with breast cancer Wittenberg, L., Yutsis, M., Giese-Davis, J., Bliss-Isberg, C., Star, P., Houston, D., Conger, J., Spiegel, D. SPRINGER. 2008: S151-S151
  • Process of discussions with peer counselors predicts reduction in trauma symptoms in matched newly diagnosed women with breast cancer Yutsis, M., Wittenberg, L., Giese-Davis, J., Bliss-Isberg, C., Cordova, M., Star, P., Houston, D., Conger, J. T., Spiegel, D. SPRINGER. 2008: S150-S150
  • Peer counseling improves quality of life for women with breast cancer: A randomized trial Giese-Davis, J., Bliss-Isberg, C., Lynne, W., Yutsis, M., Star, P., Cordova, M., Houston, D., Conger, J. T., Spiegel, D. SPRINGER. 2008: S74-S74
  • Circadian rhythms and physical functioning in cancer patients Spiegel, D., Giese-Davis, J., Barr, T. C., Kraemer, H. WILEY-BLACKWELL. 2006: S59-S60
  • Supportive-expressive group therapy and survival in patients with metastatic breast cancer: A randomized clinical intervention trial. Spiegel, D., Butler, L. D., Giese-Davis, J., Koopman, C., Miller, E., DiMiceli, S., Classen, C. C., Fobair, P., Carlson, R. W., Kraemer, H. C. SPRINGER. 2006: S240-S240
  • Change in emotion regulation mediates change in trauma symptoms and mood disturbance in women with metastatic breast cancer following supportive-expressive group therapy Giese-Davis, J., Butler, L. D., Koopman, C., Cordova, M., Classen, C., Kraemer, H. C., Spiegel, D. WILEY-BLACKWELL. 2003: S192-S192
  • Novel parameters of autonomic and cardiovascular function obtained with a mobile mental stress testing laboratory in a general clinical research center Wilhelm, F. H., Giese-Davis, J., Taylor, C. B., Spiegel, D. BLACKWELL PUBLISHING. 2003: S91-S91
  • Endocrine pathways in cancer: Effects of stress and support Spiegel, D., Sephton, S., LEVINE, S. ELSEVIER SCIENCE INC. 2002: 18S-18S
  • Steeper diurnal cortisol rhythm associated with greater primary negative affect and greater positive affect within spoken narratives in cancer support groups Giese-Davis, J., Perry, C. J., Abercrombie, H., Spiegel, D. BLACKWELL PUBLISHING. 2002: S38-S38
  • Improving the quality of life for patients with cancer through the Cancer Supportive Care Program and Web site Rosenbaum, E. H., Spiegel, D., Gautier, H., Hawn, M., Fobair, P., Festa, B., Dzubur, K., Manuel, F., Tayam, A., Peart, J. V., FOURNIER, J., Kramer, P., Nouriami, B., Andrews, A., Chan, J., Ignoffo, R. ELSEVIER. 2002: 11-12
  • Suppression, repressive-defensiveness, restraint, and distress in metastatic breast cancer: Separable or inseparable constructs? Giese-Davis, J., Spiegel, D. BLACKWELL PUBLISHING. 2001: 417-449


    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.

    View details for Web of Science ID 000169839100003

    View details for PubMedID 11478732

  • Supportive-expressive group therapy and distress in patients with metastatic breast cancer - A randomized clinical intervention trial Classen, C., Butler, L. D., Koopman, C., Miller, E., DiMiceli, S., Giese-Davis, J., Fobair, P., Carlson, R. W., Kraemer, H. C., Spiegel, D. AMER MEDICAL ASSOC. 2001: 494-501


    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.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.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.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.

    View details for Web of Science ID 000168479100010

    View details for PubMedID 11343530

  • Predictors of breast cancer-related posttraumatic growth Cordova, M. J., Chang, V., Giese-Davis, J., Kronenwetter, C., Golant, M., Benjamin, H., Spiegel, D. LIPPINCOTT WILLIAMS & WILKINS. 2001: 127-127
  • Less expression of primary negative affect associated with flattened diurnal slope of cortisol Giese-Davis, J., Sephton, S., Spiegel, D. BLACKWELL PUBLISHING. 2001: S44-S44
  • Workbook-journal significantly reduces posttraumatic stress disorder symptoms among rural women with primary breast cancer Koopman, C., Angell, K., Kreshka, M. A., Turner-Cobb, J., Donnelly, P., McCoy, R., Graddy, K., Spiegel, D. TAYLOR & FRANCIS LTD. 2001: 160-161
  • Repression associated with a physiological risk factor for early death in metastatic breast cancer Giese-Davis, J., Sephton, S., Duran, R. E., Spiegel, D. WILEY-BLACKWELL. 2000: S42-S42
  • Quality of couples' relationship and adjustment to metastatic breast cancer Giese-Davis, J., Hermanson, K., Koopman, C., Weibel, D., Spiegel, D. AMER PSYCHOLOGICAL ASSOC. 2000: 251-266


    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.

    View details for DOI 10.1037//0893-3200.14.2.251

    View details for Web of Science ID 000087676300006

    View details for PubMedID 10870293

  • Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies Cacioppo, J. T., Ernst, J. M., Burleson, M. H., McClintock, M. K., Malarkey, W. B., Hawkley, L. C., Kowalewski, R. B., Paulsen, A., Hobson, J. A., Hugdahl, K., Spiegel, D., Berntson, G. G. ELSEVIER SCIENCE BV. 2000: 143-154


    Loneliness is a complex set of feelings encompassing reactions to unfulfilled intimate and social needs. Although transient for some individuals, loneliness can be a chronic state for others. Prior research has shown that loneliness is a major risk factor for psychological disturbances and for broad-based morbidity and mortality. We examined differences between lonely and socially embedded individuals that might explain differences in health outcomes. 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. Individuals who were chronically lonely were characterized by elevated mean salivary cortisol levels across the course of a day, suggesting more discharges of corticotropin-releasing hormone and elevated activation of the hypothalamic-pituitary-adrenocorticol axis. An experimental manipulation of loneliness further suggested that the way in which people construe their self in relation to others around them has powerful effects on their self concept and, possibly, on their physiology.

    View details for Web of Science ID 000085630700004

    View details for PubMedID 10677643

  • Impact and timing of group support for cancer patients experiencing trauma symptoms Caldwell, R., Golant, M., Giese-Davis, J., Butler, L. D., Kronenwetter, C., Benjamin, H., Spiegel, D. JOHN WILEY & SONS LTD. 1999: 38-38
  • Workbook-journal significantly reduces postraumatic stress disorder symptoms among rural women with primary brest cancer Koopman, C., Angell, K., Kreshka, M. A., Turner-Cobb, J., Donnelly, P., McCoy, R., Spiegel, D. JOHN WILEY & SONS LTD. 1999: 13-13
  • Relateralizing hypnosis: Or, have we been barking up the wrong hemisphere? Jasiukaitis, P., Nouriani, B., Hugdahl, K., Spiegel, D. SAGE PUBLICATIONS INC. 1997: 158-177


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

    View details for Web of Science ID A1997WM47700005

    View details for PubMedID 9077052

  • Dissociative responses in the immediate aftermath of the Oakland/Berkeley firestorm Koopman, C., Classen, C., Spiegel, D. PLENUM PUBL CORP. 1996: 521-540


    This study examined relationships between dissociative symptoms experienced in the immediate aftermath of the Oakland/Berkeley firestorm and contact with the fire, life events, demographic variables, and actions taken after learning about the fire. One hundred eighty-seven participants completed self-report measures about their experiences during and immediately following the fire. Dissociative symptoms were significantly related to contact with the fire, sex, and stressful life events. Also, dissociative symptoms were significantly related to engaging in certain activities, such as trying to get closer to the fire and going into blocked-off areas and crossing police barricades. These results suggest that dissociative symptoms may merit special attention in intervention focusing on the immediate aftermath of disaster.

    View details for Web of Science ID A1996UW92100008

    View details for PubMedID 8827653

  • Self-hypnotic relaxation during interventional radiological procedures: Effects on pain perception and intravenous drug use Lang, E. V., Joyce, J. S., Spiegel, D., Hamilton, D., Lee, K. K. SAGE SCIENCE PRESS. 1996: 106-119


    The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.

    View details for Web of Science ID A1996UD72800002

    View details for PubMedID 8871338

  • Effects of group therapy on women with primary breast cancer Spiegel, D., Morrow, G. R., Classen, C., Riggs, G., STOTT, P. B., MUDALIAR, N., Pierce, H. I., Flynn, P. J., Heard, L. BLACKWELL SCIENCE INC. 1996: 104-106


    Psychosocial treatments, including group, individual and family psychotherapies, are of proven efficacy, and deserve inclusion as standard components of biomedical treatment for cancer patients. Anxiety and depression are very common (and treatable) problems among cancer patients, most of whom can benefit from intervention. Psychotherapy, both group and individual, employs three fundamental approaches: emotional expression, social support, and cognitive symptom-management skills. Psychotherapy has been shown to be effective in improving quality of life. Results of studies of various psychotherapies include reduction in depression, anxiety, and pain, and improved coping skills, and, in some cases, there is evidence of extended survival time.

    View details for Web of Science ID A1995RG08100009

    View details for PubMedID 7551629



    Psychosocial treatments, including group, individual, and family therapies, are of proven efficacy and deserve inclusion as standard components of biomedical treatment for patients with cancer. Four issues regarding such treatment are reviewed. The first is need. Significant anxiety and depression are common (and treatable) problems among the medically ill and represent a major aspect of the burden of illness. Even those with less severe emotional reactions need help coping with the stress of serious illness. The second is methods. Psychotherapy, both group and individual, provides valuable emotional and social support and teaches important symptom management skills. The third is outcome. Psychotherapy has been shown to be effective in improving quality of life and enhancing the ability of the medically ill to cope with their illness. Results of various psychotherapies include reducing depression and anxiety, improving coping skills, and in some cases, extending survival time. The fourth is cost offset. Appropriate psychotherapeutic intervention saves money by reducing unnecessary office visits, diagnostic tests, medical procedures, and hospital admittance.

    View details for Web of Science ID A1994PC39300008

    View details for PubMedID 8062175



    Hypnosis is associated with the treatment of posttraumatic stress disorder (PTSD) for two reasons: (1) the similarity between hypnotic phenomena and the symptoms of PTSD, and (2) the utility of hypnosis as a tool in treatment. Physical trauma produces a sudden discontinuity in cognitive and emotional experience that often persists after the trauma is over. This results in symptoms such as psychogenic amnesia, intrusive reliving of the event as if it were recurring, numbing of responsiveness, and hypersensitivity to stimuli. Two studies have shown that Vietnam veterans with PTSD have higher than normal hypnotizability scores on standardized tests. Likewise, a history of physical abuse in childhood has been shown to be strongly associated with dissociative symptoms later in life. Furthermore, dissociative symptoms during and soon after traumatic experience predict later PTSD. Formal hypnotic procedures are especially helpful because this population is highly hypnotizable. Hypnosis provides controlled access to memories that may otherwise be kept out of consciousness. New uses of hypnosis in the psychotherapy of PTSD victims involve coupling access to the dissociated traumatic memories with positive restructuring of those memories. Hypnosis can be used to help patients face and bear a traumatic experience by embedding it in a new context, acknowledging helplessness during the event, and yet linking that experience with remoralizing memories such as efforts at self-protection, shared affection with friends who were killed, or the ability to control the environment at other times. In this way, hypnosis can be used to provide controlled access to memories that are then placed into a broader perspective. Patients can be taught self-hypnosis techniques that allow them to work through traumatic memories and thereby reduce spontaneous unbidden intrusive recollections.

    View details for Web of Science ID A1990EF22100008

    View details for PubMedID 2211565



    Patient resources for coping with breast cancer can be enhanced by attention to cognitive, affective, psychosomatic, and social components of the illness. The diagnosis and treatment of breast cancer constitutes an immediate confrontation with mortality, and sympathetic but direct examination of the patient's vulnerability and means of coping with it will reduce rather than amplify death anxiety. The development and pursuit of realistic goals influenced by the prognosis can help patients adjust constructively. Extremes of emotion are to be expected at times, but persistent depression and/or anxiety should be vigorously treated, including the use of appropriate psychoactive medication when the symptoms are primarily somatic (e.g., sleep disturbance and reductions in energy). Physical symptoms such as pain, nausea, and vomiting can be controlled by teaching patients such techniques as self-hypnosis, biofeedback, and systemic desensitization. Finally, a feeling of social isolation is the rule, not the exception, with cancer patients. Group and family treatment can effectively counter this. Systematic studies of such treatment interventions have shown favorable results, including significant reductions in mood disturbance and pain.

    View details for Web of Science ID A1990EC77600018

    View details for PubMedID 2205373


Stanford Medicine Resources: