Bernard H. Fox

The role of religious and spiritual beliefs in coping with malignant melanoma

This study investigated the role of spiritual and religious beliefs in ambulatory patients coping with malignant melanoma. One‐hundred and seventeen patients with melanoma being seen in an outpatient clinic completed a battery of measurements including the newly validated Systems of Belief Inventory (SBI‐54). No correlation was found between SBI‐54 scores and levels of distress. However, there was a correlation between greater reliance on spiritual and religious beliefs and use of an active–cognitive coping style (r=0.46, p<0.0001). Data suggest that use of religious and spiritual beliefs is associated with an active rather than passive form of coping. We suggest that such beliefs provide a helpful active–cognitive framework for many individuals from which to face the existential crises of life‐threatening illness. Copyright

Short-term immunological effects of induced emotion

&NA; Twenty healthy volunteers (half male) recalled and relived maximally disturbing (NEG) and maximally pleasurable (POS) emotional experiences. Forty minutes of silence, then neutral conversation, preceded and followed 40 minutes of emotion elicitation (NEG and POS randomly rotated). They were under video, cardiovascular, and immunological monitoring. Subjects reported appropriate emotions and showed significant cardiovascular activation during the NEG condition. Speech alone had an independent cardiovascular activating effect. Emotion, particularly NEG, led to further activation. NEG emotion promoted significant declines in mitogenic lymphocyte reactivity, followed by return to pre‐emotion levels. A similar though less extreme decline was seen in the POS condition. There was a weak trend for elevated natural killer cell activity under the NEG condition, possibly due in part to changed trafficking patterns. Correlational findings confirmed these group effects. The decline in mitogenic reactivity during POS emotion appeared to be due to subtle degrees of tension and excitement triggered by the experimental experience regardless of the exact emotions recalled. Results suggest that immunologic processes are sensitive to influence by arousal of emotion.

The role of religious and spiritual beliefs in coping with malignant melanoma: an Israeli sample

This preliminary study examined the possible relationship between a newly developed instrument, the Spiritual Beliefs Inventory (SBI‐54), and the coping style of a group of cancer patients in Israel. The sample consisted of 100 malignant melanoma patients diagnosed at stages I and II, A and B. Patients were individually interviewed at home and completed seven self‐reports. The present report focuses on the relationship of the SBI‐54 with other measures of coping, psychological distress and social support. Findings showed that there was a significantly positive correlation between the SBI‐54 and the active‐cognitive coping style (r=0.48, p<0.0l). Copyright

A hypothesis about Spiegel et al.'s 1989 paper on Psychosocial intervention and breast cancer survival.

In a randomized prospective study of 86 metastatic breast cancer patients by Spiegel et al. in 1989, the 50 who took part in a group psychosocial intervention survived on average 18 months longer than the 36 controls who did not. Because the control survival curve looked unusually steep, lacking an expected right‐skewed tail, both curves were compared with that of a population from the same region having metastatic breast cancer. When transformed to life‐table format, the curves of the control sample and the regional population, neither group having had an intervention, were almost identical for a year, and differed strikingly after 20 months. This led to the hypothesis that the 12 control patients surviving for more than 20 months were an extremely aberrant sample, being subject to the strong biasing influence of possible confounders, of which a considerable number are known, but not including those accounted for in the study. Corollaries to the hypothesis are that the intervention had no effect; that the intervention curve was in fact equivalent to a control curve with mild sampling departure from that of the regional population; and that, therefore, the repetition of the study now under way would not yield confirmation of the 1989 study, but rather, would support the hypothesis and the first two corollaries.

Epidemiologic Aspects of Stress, Aging, Cancer and the Immune System

The relationship among cancer, the immune system, stress, and aging can be addressed in a number of ways. Here the choice will be how stress and the immune system may interact with or even, in part, be responsible for the incidence of cancer associated with aging. It will first be necessary to set forth some data relating aging and cancer, to establish the epidemiologic baseline of events in general. Then, several relevant facts and some hypotheses regarding phenotypic biologic events will be presented. Next, the behavioral and biologic aspects of stress (and some associated reactions and personal characteristics) will be discussed. Finally, but also throughout the discussion, the possible interrelations among the four topics will be given, and tentative conclusions drawn.

CERTAIN VALIDITY PROBLEMS IN COMPUTER ANALYSIS OF CLINICAL EEGS

Using computer analysis for strictly clinical purposes is not a widespread practice. Certain technical problems have delayed such use at a developmental level’ and, even when good techniques are developed,ll other problems tend to hinder it at a practical level. This discussion will deal with two validity problems in drawing inferences from computer analysis. Because clinical application is so limited, it was deemed better to address these problems by example as they are encountered in a research question with few criterion outcomes, but with aspects of a quasiclinical situation, and then to extrapolate to clinical determinations. That research question is sleep stage identification. The first validity problem is the variation of instrumental and analytic approaches to the predictor measures, these measures being the several patterns of wave characteristics amplitudes, frequencies, forms, etc. defining the sleep stages. A corollary to this, of course, is the reliability of these measures themselves in any single approach. The second validity problem is the fallibility of criteria. Not only does variation or uncertainty in the definition of criterion measures contribute to this fallibility, but also variation in the measure of the “true” state of the criterion once it has been defined by a given investigator. In a sense this question concerns the more fundamental issue of defining an acceptable ultimate criterion and its operational description, to say nothing of the ultimacy problem itself if an intermediate criterion is chosen. It is not even certain that the “true” state is defined rigorously enough to apply to descriptive measure unequivocally, except in the computer instructions. But these latter are separate validity problems and will be discussed here only as they contribute to the problem of fallibility of the criterion. Variation among predictors need not yield different validities but is often associated with them, as shown by the following sampling of some recent efforts to measure sleep stages automatically. Reason tells us that such variation probably did contribute to the differing validities. Four studies with some common and some different sleep stage criteria, but with different procedures for quantifying the predictor, were chosen for comparison. Martin and colleagues12 distinguished the standard six stages recommended by Rechtschaffen and Kales13 waking, REM, and stages 1-4. Using 30-sec increments, they defined delta at < or = 2 c/sec., valley to peak > 75 pv, the valleypeak cross-correlation of observed points and straight line > or = 0.75. Stages 3 and 4 were defined by percent of delta. If an epoch was not labeled 3 or 4, then stage 2 and “stage 1 or REM” were identified by 34 spectral indicators from 1-34 c/sec. Other decision processes were outlined. Smith and Karacanl4 used special limited bandpass detectors for specific waves spindle, artifact, alpha, delta. An epoch with delta lasting 12-30 sec was called stage 3. If the epoch contained more than 30 sec of delta it was called stage 4. If delta < 12 sec and alpha > 30 sec, this was stage 0. If delta > 12 sec but alpha < or = 30 sec, a record with more than one spindle was called stage 2, and with one or none was called stage 1.