Publications

Featured Publications

David Spiegel
Jack, Lulu and Sam Willson Professor of Medicine

Publications

  • Tranceformation: Digital dissemination of hypnosis. Neuron Spiegel, D. 2024

    Abstract

    Hypnosis is an underutilized tool despite evidence of efficacy from randomized clinical trials. In this NeuroView, I discuss potential mechanisms in the context of brain networks and propose the use of app-based instruction in self-hypnosis.

    View details for DOI 10.1016/j.neuron.2023.12.010

    View details for PubMedID 38262415

  • Emotion regulation and choice of bilateral mastectomy for the treatment of unilateral breast cancer. Cancer medicine Zhang, J. X., Kurian, A. W., Jo, B., Nouriani, B., Neri, E., Gross, J. J., Spiegel, D. 2023

    Abstract

    There has been steadily increasing use of bilateral mastectomy (BMX) in the treatment of primary breast cancer (BC). In this study, we utilized functional magnetic resonance imaging (fMRI) to examine the influence of emotion regulation on the decision of newly diagnosed BC patients to choose BMX rather than non-BMX treatments.We recruited 123 women with unilateral BC, 61 of whom received BMX and 62 of whom received non-BMX treatments, and 39 healthy controls. While participants were in the fMRI scanner, we showed them BC-related and non-BC-negative images. In one condition, they were instructed to watch the images naturally. In another, they were instructed to regulate their negative emotion. We compared the fMRI signal during these conditions throughout the brain.With non-BC-negative images as the baseline, BC patients showed greater self-reported reactivity and neural reactivity to BC-related images in brain regions associated with self-reflection than did controls. Among the BC patients, the BMX group showed weaker activation in prefrontal emotion regulation brain regions during emotion regulation than did the non-BMX group.BC patients are understandably emotionally hyper-reactive to BC-related stimuli and those who ultimately received BMX experience more difficulty in regulating BC-related negative emotion than non-BMX BC patients. These findings offer neuropsychological evidence that difficulty in managing anxiety related to the possibility of cancer recurrence is a factor in surgical treatment decision-making and may be an intervention target with the goal of strengthening the management of cancer-related anxiety by nonsurgical means.NCT03050463.

    View details for DOI 10.1002/cam4.5963

    View details for PubMedID 37083300

  • Point of care testing of enzyme polymorphisms for predicting hypnotizability and postoperative pain. The Journal of molecular diagnostics : JMD Cortade, D. L., Markovits, J., Spiegel, D., Wang, S. X. 2023

    Abstract

    Hypnotizability is a stable trait that moderates the benefit of hypnosis for treating pain, but limited availability of hypnotizability testing deters widespread use of hypnosis. Inexpensive genotyping of 4 single nucleotide polymorphisms in the catechol-o-methyltransferase (COMT) gene was performed using giant magnetoresistive biosensors to determine if hypnotizable individuals can be identified for targeted hypnosis referrals. For individuals with the proposed 'optimal' COMT diplotypes, 89.5% score highly on the Hypnotic Induction Profile (OR = 6.12, 95%CI = 1.26-28.75), which identified 40.5% of the treatable population. Mean hypnotizability scores of the optimal group were significantly higher than the total population (p = 0.015 effect size = 0.60), an effect that was present in females (p = 0.0015, effect size = 0.83), but not in males (p = 0.28). In an exploratory cohort, optimal individuals also reported significantly higher postoperative pain scores (p = 0.00030, effect size = 1.93), indicating a greater need for treatment.

    View details for DOI 10.1016/j.jmoldx.2023.01.002

    View details for PubMedID 36702396

  • Brief structured respiration practices enhance mood and reduce physiological arousal. Cell reports. Medicine Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., Huberman, A. D. 2023: 100895

    Abstract

    Controlled breathwork practices have emerged as potential tools for stress management and well-being. Here, we report a remote, randomized, controlled study (NCT05304000) of three different daily 5-min breathwork exercises compared with an equivalent period of mindfulness meditation over 1 month. The breathing conditions are (1) cyclic sighing, which emphasizes prolonged exhalations; (2) box breathing, which is equal duration of inhalations, breath retentions, and exhalations; and (3) cyclic hyperventilation with retention, with longer inhalations and shorter exhalations. The primary endpoints are improvement in mood and anxiety as well as reduced physiological arousal (respiratory rate, heart rate, and heart rate variability). Using a mixed-effects model, we show that breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation. Daily 5-min cyclic sighing has promise as an effective stress management exercise.

    View details for DOI 10.1016/j.xcrm.2022.100895

    View details for PubMedID 36630953

  • Marital status and survival in cancer patients: A systematic review and meta-analysis. Cancer medicine Krajc, K., Mirosevic, S., Sajovic, J., Klemenc Ketis, Z., Spiegel, D., Drevensek, G., Drevensek, M. 2022

    Abstract

    BACKGROUND: In recent years, authors have repeatedly reported on the significance of social support in cancer survival. Although overall the studies appear to be convincing, little is known about which types of social support promote better survival rates, and which subgroups of cancer patients are more susceptible to the benefits of it. The aim of this study was to identify, organize, and examine studies reporting on the significance of social support in cancer survival.METHODS: The PubMed, CINAHL and EBSCO databases were searched using the keywords social support/marital status, cancer, and survival/mortality. Where possible we used a meta-analytical approach, specifically a random effect model, in order to combine the results of the hazard ratios in studies from which this information could be obtained. When interpreting clinical relevance, we used the number needed to treat (NNT).RESULTS: Better survival was observed in married patients when compared to unmarried (single, never-married, divorced/separated, and widowed) in overall and cancer-specific survival. Gender group differences showed that the association was statistically significant only in cancer-specific survival when comparing divorced/separated male and female cancer patients (p<0.001), thus confirming results from the previous meta-analysis.CONCLUSIONS: Being unmarried is associated with significantly worse overall and cancer-specific survival. The most vulnerable group found in our study were divorced/separated men. The results of this review can motivate physicians, oncologists, and other healthcare professionals to be aware of the importance of patients' social support, especially in the identified sub-group.

    View details for DOI 10.1002/cam4.5003

    View details for PubMedID 35789072

  • Effects of hypnosis versus enhanced standard of care on postoperative opioid use after total knee arthroplasty: the HYPNO-TKA randomized clinical trial. Regional anesthesia and pain medicine Markovits, J., Blaha, O., Zhao, E., Spiegel, D. 2022

    Abstract

    BACKGROUND: Hypnosis decreases perioperative pain and has opioid-sparing potential but has not been rigorously studied in knee arthroplasty. This trial investigates the impact of perioperative hypnosis on inpatient opioid use following total knee arthroplasty.METHODS: This prospective randomized controlled trial was conducted at a single academic medical center. The hypnosis arm underwent a scripted 10min hypnosis session prior to surgery and had access to the recorded script. The control arm received hypnosis education only. The primary outcome was opioid use in milligram oral morphine equivalents per 24 hours during hospital admission. A secondary analysis was performed for patients taking opioids preoperatively.RESULTS: 64 primary knee arthroplasty patients were randomized 1:1 to hypnosis (n=31) versus control (n=33) and included in the intent-to-treat analysis. The mean (SD) postoperative opioid use in oral morphine equivalents per 24 hours was 70.5 (48.4) in the hypnosis versus 90.7 (74.4) in the control arm, a difference that was not statistically significant (difference -20.1; 95% CI -51.8 to 11.4; p=0.20). In the subgroup analysis of the opioid-experienced patients, there was a 54% daily reduction in opioid use in the hypnosis group (82.4 (56.2) vs 179.1 (74.5) difference of -96.7; 95% CI -164.4 to -29.0; p=<0.01), equivalent to sparing 65mg of oxycodone per day.CONCLUSION: Perioperative hypnosis significantly reduced inpatient opioid use among opioid-experienced patients only. A larger study examining these findings is warranted.TRIAL REGISTRATION NUMBER: NCT03308071.

    View details for DOI 10.1136/rapm-2022-103493

    View details for PubMedID 35715013

  • Shared cognitive mechanisms of hypnotizability with executive functioning and information salience. Scientific reports Faerman, A., Spiegel, D. 2021; 11 (1): 5704

    Abstract

    In recent years, evidence linked hypnotizability to the executive control and information salience networks, brain structures that play a role in cognitive conflict resolution and perseveration (insisting on applying a previously learned logical rule on a new set). Despite the growing body of neuroimaging evidence, the cognitive phenotype of hypnotizability is not well understood. We hypothesized that higher hypnotizability would correspond to lower perseveration and set-shifting. Seventy-two healthy adults were tested for hypnotizability and executive functions (perseveration and set-shifting). Multiple regression analyses were performed to test the relationship between hypnotizability and perseveration and set-shifting. Higher hypnotizability was associated with lower perseveration after accounting for age and education. Hypnotizability significantly predicted perseveration but not set-shifting. Our results indicate an inverse relationship between trait hypnotizability and perseveration, an executive function that utilizes regions of both the executive control and the salience systems. This suggests that hypnotizability may share a common cognitive mechanism with error evaluation and implementation of logical rules.

    View details for DOI 10.1038/s41598-021-84954-8

    View details for PubMedID 33707531

  • Testing Hypnotizability by Phone: Development and Validation of the Remote Hypnotic Induction Profile (rHIP). The International journal of clinical and experimental hypnosis Kittle, J., Zhao, E., Stimpson, K., Weng, Y., Spiegel, D. 2021; 69 (1): 94–111

    Abstract

    Standard hypnotizability scales require physical contact or direct observation by tester and participant. The authors addressed this limitation by developing and testing the remote Hypnotic Induction Profile (rHIP), a hypnotizability test derived from the Hypnotic Induction Profile that is completed by telephone. To assess the validity of the rHIP, 56 volunteers naive to hypnotizability testing completed both the HIP and the rHIP, with order of testing randomized. Results indicate a strong correlation between HIP and rHIP scores, r s=.71(0.53-0.84), p <.0001, and good concordance, difference=.03(-0.53, 0.59), p =.91, independent of testing order. The rHIP had few complications. Possible advantages of using the rHIP include improving patient expectancy prior to scheduling a hypnosis session, increasing access to hypnotizability testing for remote interventions, and obviating resource-intensive in-person hypnotizability screening for trials that exclude subjects with certain scores.

    View details for DOI 10.1080/00207144.2021.1827937

    View details for PubMedID 33513064

  • When Physicians Engage in Practices That Threaten the Nation's Health. JAMA Pizzo, P. A., Spiegel, D. n., Mello, M. M. 2021

    View details for DOI 10.1001/jama.2021.0122

    View details for PubMedID 33538765

  • International Prevalence and Correlates of Psychological Stress during the Global COVID-19 Pandemic. International journal of environmental research and public health Adamson, M. M., Phillips, A. n., Seenivasan, S. n., Martinez, J. n., Grewal, H. n., Kang, X. n., Coetzee, J. n., Luttenbacher, I. n., Jester, A. n., Harris, O. A., Spiegel, D. n. 2020; 17 (24)

    Abstract

    This study reports perceived stress and associated sociodemographic factors from an international sample of adults, during the COVID-19 pandemic. The Perceived Stress Scale (PSS-10) along with socio-demographic questions were conducted between 8 April 2020 and 11 May 2020. The survey was translated from English into five languages. Recruitment was conducted worldwide using social media. A total of 1685 survey responses were collected across 57 countries with eleven countries (≥30 responses/country) included in the sub-analyses. Overall, the mean PSS-10 score was 19.08 (SD = 7.17), reflecting moderate stress compared to previously reported norms. Female gender was associated with a higher PSS score (3.03, p < 0.05) as well as four-year degree holders (3.29, p < 0.05), while adults over 75 years (-7.46, p < 0.05) had lower PSS scores. Personal care composite score (including hours of sleep, exercise, and meditation) was associated with lower PSS scores (-0.39, p < 0.01). Increases in personal care and changes in work expectations were associated with lower PSS scores (-1.30 (p < 0.05) and -0.38 (p < 0.01), respectively). Lower total PSS scores were reported in Germany (-4.82, p < 0.01) compared to the global response sample mean. This information, collected during the initial period of global mitigation orders, provides insight into potential mental health risks and protective factors during crises.

    View details for DOI 10.3390/ijerph17249248

    View details for PubMedID 33321950

Journal Articles

David Spiegel
Jack, Lulu and Sam Willson Professor of Medicine

Publications

  • The associations of spirituality and Hispanic ethnicity with neuroendocrine biomarkers among patients with colorectal cancer. Journal of psychosomatic research Cruz, E., Mendez, A., Ting, A., Spiegel, D., Tsai, T. C., Carver, C. S., Kim, Y. 2024; 185: 111865

    Abstract

    Dealing with cancer evokes not only physical and emotional distress, but may also promote resilience through spirituality. Patients with cancer are vulnerable to neuroendocrine dysregulation. This longitudinal observational study examined the degree to which spirituality was associated with neuroendocrine biomarkers and the moderating role of Hispanic ethnicity.Participants were adults who were recently diagnosed with colorectal cancer (n = 81, 55 years old, 66% male, 63% Hispanic, 72% advanced cancer, 7 months post-diagnosis). The domains of spirituality (faith, meaning, and peace) and ethnicity (Hispanic vs. non-Hispanic) were self-reported. Cortisol and alpha amylase (sAA) were assayed from saliva samples collected at waking and bedtime on seven consecutive days. Mean levels at waking and bedtime, and diurnal slopes over seven days were calculated. Age and cancer stage were covariates.Overall, patients reported moderate to high levels of spirituality. General linear modeling revealed that greater faith was associated with higher levels of sAA at waking and bedtime as well as more blunted diurnal pattern of sAA only among Hispanic patients (p ≤ .045). Greater peace was associated with steeper diurnal pattern of sAA, regardless of ethnicity (B = 0.021, p = .005). Meaning and cortisol were not significantly associated with study variables.Findings indicate that presence of peace facing a cancer diagnosis associated with neuroendocrine regulation, whereas drawing on one's faith, particularly among Hispanic patients, associated with neuroendocrine dysregulation during the first months after the diagnosis. Further investigations of psychobiobehavioral moderators and mediators for healthy neuroendocrine functioning among patients with cancer are warranted.

    View details for DOI 10.1016/j.jpsychores.2024.111865

    View details for PubMedID 39116686

  • Hypnosis facilitates psychosomatic improvement in a patient with treatment-resistant idiopathic tinnitus. The American journal of clinical hypnosis Tran, N., Zewde, N., Spiegel, D. 2024: 1-6

    Abstract

    Chronic tinnitus, also known as phantom sound perception, is a pervasive and often debilitating condition, affecting 15 to 20% of the population. Due to its idiopathic and persistent nature, chronic tinnitus is frequently associated with co-occurring psychiatric disorders as well as decreased sleep and quality of life. Additionally, heterogeneous presentations of tinnitus create challenges for treatment. In this paper, we present a case study of a 70-year-old female patient who presented with severe bilateral tinnitus over a period of 5years. After failing multiple treatment trials such as transtympanic electric stimulation, acupuncture, Eye Movement Desensitization and Reprocessing, and medication, the patient found relief only through hypnotherapy. Results may be explained by alterations in interoceptive processing, increased cognitive flexibility, or somatosensory changes, with corresponding changes in functional neural structures. Given the results of this case study, we recommend hypnosis as an alternative or adjunct to current treatment modalities for tinnitus and further investigation in this area.

    View details for DOI 10.1080/00029157.2024.2379284

    View details for PubMedID 39051968

  • Differential effects of desvenlafaxine on hot flashes in women with breast cancer taking tamoxifen: a randomized controlled trial. NPJ breast cancer Kim, Y., Yeom, C. W., Lee, H. J., Kim, J. H., Lee, K. M., Kim, T. Y., Lee, H. B., Kim, H., Im, S. A., Lee, K. H., Kim, M., Han, W., Moon, H. G., Spiegel, D., Hahm, B. J., Son, K. L. 2024; 10 (1): 59

    Abstract

    Hot flashes (HF) are a common adverse event of prolonged tamoxifen use in women with estrogen receptor-positive breast cancer, impacting psychiatric health and quality of life. While desvenlafaxine does not interact with tamoxifen, its efficacy and safety in breast cancer patients remain unstudied. This phase 3, four-week, multi-center, three-arm, parallel-group, randomized, double-blind, placebo-controlled trial investigated the efficacy and safety of desvenlafaxine for treating HF in women with breast cancer taking tamoxifen, assessing potential differential effects in patients with psychiatric and inflammatory conditions. Between December 2017 and February 2019, 57 women aged 19 or older, regularly taking tamoxifen as adjuvant therapy, experiencing moderate-to-severe HFs for more than a month, were randomized to receive desvenlafaxine 50 mg/day (D-50), desvenlafaxine 100 mg/day (D-100), or placebo for four weeks. The primary endpoint was the change rate in HF scores over four weeks, with adverse events as a secondary endpoint. Both desvenlafaxine arms demonstrated greater HF score reductions compared to placebo: D-50 (2.20 points/week, 95% CI: 0.71, 3.68) and D-100 (2.34 points/week, 95% CI: 0.92, 3.76). Notably, D-50 arm showed significantly greater efficacy in patients with depression or elevated inflammation. Desvenlafaxine offers an effective and safe treatment regimen for HF in women with breast cancer taking tamoxifen. The presence of depression and inflammation may guide optimal desvenlafaxine dosing. (Trial Registration: ClinicalTrials.gov Identifier: NCT02819921).

    View details for DOI 10.1038/s41523-024-00668-w

    View details for PubMedID 39019875

    View details for PubMedCentralID 4603551

  • Treatment of Refractory Bipolar Depression With Stereotactic Radiosurgery Targeting the Subgenual Cingulate Cortex CUREUS JOURNAL OF MEDICAL SCIENCE Solvason, H. B., Marianayagam, N. J., Soltys, S. G., Schatzberg, A. F., Debattista, C., Ketter, T., Wang, P., Chang, S. D., Spiegel, D., Adler, J. R. 2024; 16 (4)

    View details for DOI 10.7759/cureus.57904

    View details for Web of Science ID 001209664200022

  • Preliminary testing of "roadmap to parenthood" decision aid and planning tool for family building after cancer: Results of a single-arm pilot study. Psycho-oncology Benedict, C., Ford, J. S., Schapira, L., Davis, A., Simon, P., Spiegel, D., Diefenbach, M. 2024; 33 (4): e6323

    Abstract

    Many young adult female cancer survivors need to use reproductive medicine, surrogacy, or adoption to have a child. This study pilot tested Roadmap to Parenthood, a web-based, self-guided decision aid and planning tool for family building after cancer (disease agnostic).A single-arm pilot study tested feasibility, acceptability, and obtained effect size estimates of the Roadmap tool. Participants, recruited via hospital-based and social media strategies, completed a baseline survey (T1), accessed the Roadmap tool (website), then completed surveys at one- and 3-months (T2 and T3, respectively). Feasibility and acceptability were evaluated with rates of eligibility, enrollment, and survey completion, and feedback. Pairwise t-tests and repeated measures ANOVA evaluated usage effects. Effect size estimates were calculated.Participants (N = 98) averaged 31 years old (SD = 5.61); 71% were nulliparous. Enrollment rate was 73%, T1-T2 completion rate was 80%, and 93% accessed the website. From T1-T2, participants reported improvements in decisional conflict (p < 0.001; Cohen's d = 0.85), unmet information needs (p < 0.001; Cohen's d = 0.70), self-efficacy (p = 0.003; Cohen's d = 0.40), and self-efficacy for managing negative emotions (p = 0.03; Cohen's d = 0.29); effects were sustained at T3. There was no change in reproductive distress (p = 0.22). By T3, 94% reported increased consideration of preparatory actions and 20%-61% completed such actions.The Roadmap intervention was feasible to conduct, acceptable to users, and led to improvements in key psychosocial outcomes. Future directions will test intervention efficacy in a randomized controlled trial with a larger sample and over a longer period. A web-based tool may help women make decisions about family building after cancer and prepare for potential challenges.

    View details for DOI 10.1002/pon.6323

    View details for PubMedID 38629761

  • Treatment of Refractory Bipolar Depression With Stereotactic Radiosurgery Targeting the Subgenual Cingulate Cortex. Cureus Solvason, H. B., Marianayagam, N. J., Soltys, S. G., Schatzberg, A. F., DeBattista, C., Ketter, T., Wang, P., Chang, S. D., Spiegel, D., Adler, J. R. 2024; 16 (4): e57904

    Abstract

    Background The subgenual cingulate cortex (SGC) has been identified as a key structure within multiple neural circuits whose dysfunction is implicated in the neurobiology of depression. Deep brain stimulation in the SGC is thought to reduce and normalize local metabolism, causing normalization of circuit behavior and an improvement in depressive symptoms. We hypothesized that nonablative stereotactic radiosurgery (SRS) to the SGC would reduce local metabolism and reduce the severity of depression in patients with treatment-resistant bipolar depression. Methods Under the FDA's Humanitarian Device Exemption program, patients were screened for inclusion and exclusion criteria. Three volunteers meeting the criteria provided informed consent. Bilateral SGC targets were irradiated to a maximum dose of 75 Gy in one fraction. Subjects were followed for one year following the procedure with mood assessments (Hamilton Depression Rating Scale (HDRS), Clinical Global Impression-Improvement, Clinical Global Impression-Severity, and Young Mania Rating Scale), neurocognitive testing (Delis-Kaplan Executive Function System, Wechsler Adult Intelligence Scale III digit span, and California Verbal Learning Test II), and imaging. Further imaging was completed approximately two years after the procedure. Clinical improvement was defined as a ≥50% reduction in HDRS. Results Two of the three subjects showed clinical improvement in depressive symptoms during the follow-up period, while one subject showed no change in symptom severity. One of three subjects was hospitalized for the emergence of an episode of psychotic mania after discontinuing antipsychotic medications against medical advice but promptly recovered with the reinstitution of an antipsychotic. Sequential assessments did not reveal impairment in any cognitive domain assessed. For one of the three subjects, MRI imaging showed evidence of edema at 12 months post-SRS, which resolved at 22 months post-procedure. In a second of three patients, there was evidence of local edema at the target site at long-term follow-up. All imaging changes were asymptomatic. Conclusion Radiosurgical targeting of the SGC may be a noninvasive strategy for the reduction of severe depression in treatment-resistant bipolar disorder. Two out of three patients showed clinical improvement. While these results are promising, further study, including improvements in target selection and dosing considerations, is needed.

    View details for DOI 10.7759/cureus.57904

    View details for PubMedID 38725772

    View details for PubMedCentralID PMC11079710

  • Dyadic Investigation of Posttraumatic Stress Symptoms and Daily Sleep Health in Patients with Cancer and their Caregivers. Psychosomatic medicine Tsai, T. C., Mitchell, H. R., Zeitzer, J., Ting, A., Laurenceau, J. P., Spiegel, D., Kim, Y. 2024

    Abstract

    Cancer can be a traumatic experience affecting multidimensional aspects of sleep among patients and caregivers. This study examined the differential associations of cancer-related post-traumatic stress symptoms (PTSS) with various sleep markers in this population.Patients newly diagnosed with colorectal cancer (n = 138, mean age = 56.93 years, 31.88% female, 60.14% Hispanic, 6.53 months post-diagnosis) and their sleep-partner caregivers (n = 138, mean age = 55.32 years, 68.12% female, 57.97% Hispanic) completed questionnaires assessing the four PTSS clusters (intrusion, avoidance, alterations in arousal and reactivity, negative alterations in cognitions and mood). Participants also completed daily sleep diaries for 14 consecutive days, from which sleep onset latency (SOL), wake after sleep onset (WASO), and sleep duration were derived.Actor-partner interdependence model revealed that caregivers' greater alterations in arousal and reactivity were associated with their own longer SOL (b = 14.54, p < .001) and their patients' longer sleep duration (b = 0.47, p = .040), whereas patients' arousal and reactivity were associated with their caregivers' shorter SOL (b = -8.34, p = .047) and WASO (b = -8.12, p = .019). Patients' and caregivers' greater negative alterations in cognitions and mood were associated with patients' longer SOL (b = 8.89, p = .016) and shorter sleep duration (b = -0.40, p = .038), respectively. Caregivers' greater intrusion was related to their own shorter SOL (b = -10.92, p = .002).The four PTSS clusters, particularly arousal and reactivity and negative cognitions and mood, have distinct associations with sleep markers individually and dyadically in patients and caregivers affected by cancer. Investigations of psychosocial and biobehavioral pathways underlying these relations are warranted. Tailored trauma treatments and sleep interventions may improve the well-being of this population.

    View details for DOI 10.1097/PSY.0000000000001283

    View details for PubMedID 38345316

  • The Neural Separability of Emotion Reactivity and Regulation. Affective science Zhang, J. X., Dixon, M. L., Goldin, P. R., Spiegel, D., Gross, J. J. 2023; 4 (4): 617-629

    Abstract

    One foundational distinction in affective science is between emotion reactivity and regulation. This conceptual distinction has long been assumed to be instantiated in spatially separable brain systems (a typical example: amygdala/insula for reactivity and frontoparietal areas for regulation). In this research, we begin by reviewing previous findings that support and contradict the neural separability hypothesis concerning emotional reactivity and regulation. Further, we conduct a direct test of this hypothesis with empirical data. In five studies involving healthy and clinical samples (total n = 336), we assessed neural responses using fMRI while participants were asked to either react naturally or regulate their emotions (using reappraisal) while viewing emotionally evocative stimuli. Across five studies, we failed to find support for the neural separability hypothesis. In univariate analyses, both presumptive "reactivity" and "regulation" brain regions demonstrated equal or greater activation for the reactivity contrast than for the regulation contrast. In multivariate pattern analyses (MVPA), classifiers decoded reactivity (vs. neutral) trials more accurately than regulation (vs. reactivity) trials using multivoxel data in both presumptive "reactivity" and "regulation" regions. These findings suggest that emotion reactivity and regulation-as measured via fMRI-may not be as spatially separable in the brain as previously assumed. Our secondary whole-brain analyses revealed largely consistent results. We discuss the two theoretical possibilities regarding the neural separability hypothesis and offer thoughts for future research.The online version contains supplementary material available at 10.1007/s42761-023-00227-9.

    View details for DOI 10.1007/s42761-023-00227-9

    View details for PubMedID 38156247

    View details for PubMedCentralID PMC10751283

  • Circadian, hormonal, and sleep rhythms: effects on cancer progression implications for treatment. Frontiers in oncology Jagielo, A. D., Benedict, C., Spiegel, D. 2023; 13: 1269378

    Abstract

    Circadian, hormonal, and sleep rhythm disruptions are commonly experienced concerns among cancer patients throughout the cancer care continuum. This review aims to summarize the existing literature on circadian, hormonal, and sleep rhythms in the oncological population, focusing on circadian disruption and physiological and psychological abnormalities, disease progression, and chronomodulated treatment approaches. The findings demonstrate that subjectively and objectively measured circadian rhythm disruption is associated with adverse mental health and disease outcomes in patients with cancer. Chronomodulated chemotherapy, light therapy, cognitive behavioral therapy for insomnia, and physical activity have shown evidence of effectiveness in improving sleep, and occasionally, disease outcomes.

    View details for DOI 10.3389/fonc.2023.1269378

    View details for PubMedID 37746277

    View details for PubMedCentralID PMC10514358

  • Changing cancer mindsets: A randomized controlled feasibility and efficacy trial. Psycho-oncology Zion, S. R., Schapira, L., Berek, J. S., Spiegel, D., Dweck, C. S., Crum, A. J. 2023

    Abstract

    OBJECTIVE: A cancer diagnosis and subsequent treatment can disrupt the full spectrum of physical, social, emotional, and functional quality of life. But existing psychological treatments are focused primarily on specific psychological symptoms as opposed to improving the overall patient experience. We studied the feasibility and efficacy of a novel digital intervention targeting patient mindsets-core assumptions about the nature and meaning of illness-designed to improve overall health-related quality of life (HRQoL) in newly diagnosed cancer patients undergoing treatment with curative intent.METHODS: Recently diagnosed (≤150days) adult patients with non-metastatic cancers undergoing systemic treatment (N=361) were recruited from across the United States to participate in this decentralized clinical trial. Patients were randomized 1:1 to receive the Cancer Mindset Intervention (CMI) or Treatment as Usual (TAU). Participants in the CMI group completed seven online modules over 10weeks (2.5h total) targeting mindsets about cancer and the body. The primary outcome was overall HRQoL, and secondary outcomes were coping behaviors and symptom distress.RESULTS: Patients in the CMI group reported significant (p<0.001) improvements in adaptive mindsets about cancer and the body over time. Compared with the TAU condition, the CMI group reported significant improvements in overall HRQoL (B=0.60; 95% CI 0.34-0.85; p<0.001), increased engagement in adaptive coping behaviors (B=0.03; 95% CI 0.02-0.04; p<0.001), and reduced distress from physical symptoms (B=-0.29; 95% CI -0.44 to -0.14; p<0.01). Effect sizes of these changes ranged from d=0.42-d=0.54.CONCLUSION: A brief mindset-focused digital intervention was effective at improving physical, social, emotional, and functional HRQoL. increasing adaptive coping behaviors, and reducing physical symptom distress in newly diagnosed cancer patients.

    View details for DOI 10.1002/pon.6194

    View details for PubMedID 37529924

Conference Proceedings

David Spiegel
Jack, Lulu and Sam Willson Professor of Medicine

Publications

  • POSTER SESSION D: PILOT STUDY OF 'ROADMAP TO PARENTHOOD' DECISION AID AND PLANNING TOOL FOR FAMILY BUILDING AFTER CANCER Benedict, C., Simon, P., Spiegel, D., Kurian, A. W., Alvero, R., Berek, J. S., Philip, E. J., Schapira, L. OXFORD UNIV PRESS INC. 2023: S533

    View details for Web of Science ID 001042977901464

  • Changing Cancer Mindsets: A Randomized Controlled Feasibility and Efficacy Trial Zion, S., Schapira, L., Berek, J., Spiegel, D., Dweck, C., Crum, A. WILEY. 2023: 17

    View details for Web of Science ID 000947888900033

  • CARDIOVASCULAR COREGULATION TO A SERIES OF ACUTE INTERPERSONAL STRESSORS: INNOVATIVE METHODOLOGICAL APPROACH TO STUDYING REGULATION TO A CHRONIC ILLNESS IN THE FAMILY Moulder, R., Tsai, T. C., Hurwitz, B., Spiegel, D., Kim, Y. LIPPINCOTT WILLIAMS & WILKINS. 2022: A38

    View details for Web of Science ID 000804854700122

  • Altered Neurochemical Ratio in the Prefrontal Cortex is Associated With Pain in Fibromyalgia Syndrome Bishop, J., Faerman, A., Geoly, A., Maron-Katz, A., Sacchet, M., Spiegel, D., Williams, N. SPRINGERNATURE. 2021: 163

    View details for Web of Science ID 000725511400314

  • FEASIBILITY OF HYPNOSIS AS ADJUNCTIVE TREATMENT FOR SUBJECTIVE SLEEP DISTURBANCE: A PILOT STUDY AND PROOF OF CONCEPT Zhao, E., Faerman, A., Spiegel, D. OXFORD UNIV PRESS INC. 2021: A140-A141

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