David Spiegel

Pain and depression in patients with cancer

Background. 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.

The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications.

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.

Dissociative Disorders in DSM-5

Background: 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. Methods: 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. Results: 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.

Classification of trauma and stressor-related disorders in DSM-5

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 individuals 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. Depression and Anxiety, 2011.

Health caring. Psychosocial support for patients with cancer

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.

Effects of medical and psychotherapeutic treatment on the survival of women with metastatic breast carcinoma

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.

Vietnam grief work using hypnosis.

Abstract Problems unique to the veteran of the Vietnam War are discussed, and a new strategy using hypnosis for assisting some of these veterans in coming to terms with their psychological and physical losses is presented. Many Vietnam veterans suffer from losses common to any war: of friends, of body parts, of a sense of self as hero. Putting these losses into perspective has been made more difficult by the absence of a sense of national purpose for the war. This deprives the suffering of a sense of meaning, giving rise to a delayed stress response syndrome. Treatment should take into account the lack of social support for these veterans. Previous uses of hypnosis in treating traumatic neurosis have focused on abreaction. The limitations of this technique are discussed in relation to Freuds conception of psychotherapy as “remembering, repeating, and working through.” The working through can be conceptualized as a kind of grief work in which the patient puts losses into perspective, and it is this elemen...

Effects of Hypnotic Instructions on P300 Event-Related-Potential Amplitudes: Research and Clinical Implications

Abstract Apparently conflicting findings in two recent studies of the effects of hypnotic hallucination on the P300 component of cortical event-related potentials are examined. In one study, Barabasz and Lonsdale (1983) found an increase in P300 amplitude in response to hypnotic anosmia instructions. However, Spiegel, Cutcomb, Ren, and Pribram (1985) obtained a decrease in P300 amplitude after instructing high hypnotizables that an imaginary cardboard box blocked their view of the stimulus generator. These differences are reconciled on the basis of differences in the hypnotic instructions given. The former study employed language which emphasized negation (“You will not smell anything at all”), while the latter had subjects focus on a competing obstructive hallucination. The anosmia subjects were surprised when they smelled anything at all, leading to an enhanced P300 response, while the subjects in the visual study were so absorbed in the hallucinated obstruction that perception of the stimulus was reduc...

Hypnotic Responsivity and the Treatment of Flying Phobia

Systematic follow-up data are reported for 178 consecutive flying phobia patients treated with a single 45-minute session involving hypnosis and a problem restructuring strategy. One hundred fifty-eight (89%) of the patients completed follow-up questionnaires between six months and ten and one half years after treatment. Results showed that hypnotizable patients were over two and one half times more likely to report some positive treatment impact than those who were found to be nonhypnotizable on the Hypnotic Induction Profile. In addition, the patients’ previous experiences with psychotherapy were found to be significantly associated with treatment outcome. The clinical implications of these findings are discussed.

Tranceformations: hypnosis in brain and body.

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.