Integrated Pain Treatment Center:

Annotated - Partial Bibliography (for full bibliography, please contact our Clinic)

Cancer Groups:

Barbara Anderson: Ohio State University – APA address, Aug.21/99 – Stress and Immunity Breast Cancer Project, Ohio State U.

Women with Stage 2/Stage 3 breast cancer who participated in a psychological intervention program showed lower levels of cortisol 4 and 8 months after surgery, higher levels of mucin antibody, and tolerance to higher doses of chemotherapy. (115 women, 50% in control group). 

Burish GB - Vanderbilt University, Nashville, Tennessee – The Oncologist. June 2000; Vol 5 (3) 263-266. The Role of Behavioral and Psychosocial Science in Reducing Cancer Morbidity and Mortality. 

Overview article illustrating research that demonstrates that teaching and clinical programs in behavioral medicine are essential components of a complete oncology program.

Cunningham AJ, Edmonds CV, Phillips C, Soots KI, Hedley D, Lockwood GA – Department of Epidemiology and Statistics, Ontario Cancer Institute, Princess Margaret Hospital, Toronto – Psychooncolgy 2000 (4):323-39. A Prospective, Longitudinal Study of the Relationship of Psychological Work to Duration of Survival in Patients with Metastatic Cancer.

22 patients with medically incurable metastatic cancer received weekly group therapy for up to a year.

A strong association between longer survival time and psychological factors related to the involvement of patients in psychological self-help groups was found. Patients’ journals and clinicians’ notes were analyzed. Themes significantly related to survival were: ability to act and change; willingness to initiate change; application to self-help work; relationships with others; and quality of experience.

A.J. Cunningham, Philips C, Lockwood GA, Hedley DW, Edmonds CV, Ontario Cancer Institute, Princess Margaret Hospital, Toronto – Advances in Mind-Body Medicine, Aug 16, 2000 (4):276-287. Association of Involvement in Psychological self-Regulation with Longer Survival in Patients with Metastatic Cancer: An Exploratory Study.

Strong effects were observed supporting clinical observations that dedicated involvement in psychological self-regulation may prolong the life of some patients with metastatic cancer. A prospective, longitudinal correlative study was done with 22 patients testing dedication (high, moderate, low) to psychological behavioral medicine strategies, with influence on longevity.

A.J. Cunningham, C.V. Edmonds: Ontario Cancer Institute, PMH, Toronto – Int. Journal of Psychiatry Med 1996;26(1):51-82. Group Psychological Therapy for Cancer Patients: A Point of View, and Discussion of Hierarchy of Options. 

Group psychological therapy should be given to patients with cancer as an adjunctive in cancer management (just as chemotherapy is) if an expert assessor determines it would be beneficial.

C.V. Edmonds, G.A. Lockwood, A.J. Cunningham: Ont. Cancer Institute, PMH, Toronto – Psychooncology 1999; Jan-Feb;8(1): 74-91. Psychological Response to Long-Term Group Therapy: A Randomized Trial with Metastatic Breast Cancer Patients. 

Many of the psychological changes made by cancer patients in long-term interventions may elude conventional psychometric assessment.

A.J. Cunningham, C.V. Edmonds, D. Williams: Ontario Cancer Institute, Toronto – Psychooncology 1999; Mar-April;8(2): 177-82. Delivering a Very Brief Psychoeducational Program to Cancer Patients and Family Members in a Large Group Format.  

Benefits gained from a large group in a classroom are not substantially less than the improvements that have been documented in the usual small group format for cancer patients.

J. Blake-Mortimer, C. Gore-Felton, R. Kimerling, JM Turner-Cobb, D. Spiegel: Stanford U., Department of Psychiatry and Behavioral Sciences – Europ J of Cancer 1999; Oct;35(11):1581-6. Improving the Quality and Quantity of Life among Patients with Cancer: A Review of the Effectiveness of Group Psychotherapy.

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. 

Keith Block: U of Illinois College of Medicine, Evanston, Illinois – Advances in Mind-Body Medicine 1999; 15, 236-281; Psychooncology and Total Survivorship. 

There is good reason to believe that psychosocial stress caused by the diagnosis of medical illness, bereavement, social isolation, and suppression of emotional expression may adversely affect the immune and endocrine systems, with clinically relevant consequences for the body’s ability to resist disease progression. Conversely, enhanced psychosocial support via good coping, group therapy or other means may plausibly improve medical outcome by buffering the consequences of such stress and thereby ameliorating immune and endocrine function.

F.I. Fawzy, N.W. Fawzy, C.S. Hyunn, R. Elashoff., D. Guthrie, J.L. Fahey, and D.L. Morton: Department of Psychiatry and Biobehavioral Sciences. UCLA. – Archives of Gen Psychiatry 1993; 50;(9), 681-689. Malignant Melanoma: Effects of an Early Structured Psychiatric Intervention, Coping and Affective State on Recurrence of Survival 6 Years Later.

Lower death rates 5-6 years later for 68 patients in a support group for 6-weeks. Baseline affective stress and active coping were strong predictors of survival. Psychiatric interventions that enhance coping and reduce affective distress appear to have beneficial effects on survival, but are not proposed as an alternative or independent treatment. 

F.I. Fawzy, N. Cousin, N.W. Fawzy, N.W. Kemeny, R. Elashoff., and D.L. Morton: Department of Psychiatry, UCLA.- Archives of General Psychiatry 1990; 47(8), 720-725. A Structured Psychiatric Intervention for Cancer patients. I. Changes Over Time in Methods of Coping and Affective Disturbance. 

38 experimental vs 28 control patients with post-surgical multiple melanoma showed lower depression, fatigue, confusion, and total mood disturbance after a 6-week group intervention using education, relaxation techniques, and psychological support. Even greater differences were noted at 6 month follow-up.

F.I. Fawzy, N.W. Kemeny , M.E. Fawzy, N.W. Fawzy, R. Elashoff., J.L. Fahey, and D.L. Morton, N. Cousins: Department of Psychiatry, UCLA. – Archives of General Psychiatry 1990; 47(8), 729-735. A Structured Psychiatric Intervention for Cancer patients. II. Changes Over Time in Immunological Measures. 

Short term 6-week intervention for patients with malignant melanoma with a good prognosis was associated with longer-term changes in affective state, coping, and the NK lymphoid system. In the 35 intervention subjects vs the 26 controls increase in NK cytotoxic activity, increase in % of large granular lymphocytes and natural killer cells, and a small decrease in % of CD4 (helper-inducer) T-cells were seen at the 6-month follow-up, but not at the 6-week follow-up.

D. Shrock, R.F. Palmer, and B. Taylor: U. Of Pittsburgh. – Alternative Therapies in Health And Medicine 1999; 5m (3), 49-55. Effects of Psychosocial Intervention on Survival Among Patients with Stage I Breast and Prostate Cancer: A Matched Case-Control Study. 

21 breast and 29 prostate stage I cancer patients (treatment group) matched with 74 breast and 65 prostate stage I cancer patients from the same hospitals who did not receive the intervention (control group). Six 2-hour health psychology classes conducted by a licensed staff psychologist. Survival time was compared between the 2 groups and with national norms. The intervention group lived significantly longer than did matched controls. At 4- to 7-year follow-up (median = 4.2 years), none of the breast cancer patients in the intervention group died, whereas 12% of those in the control group died. Twice as many matched-control prostate cancer patients died compared with those in the intervention group (28% vs 14%). Control group survival was similar to national norms. These results are consistent with prior clinical trials and suggest that short-term psychosocial interventions that encourage the expression of emotions, provide social support, and teach coping skills can influence survival among cancer patients. 

D. Spiegal et al: Department of Psychiatry and Behavioral Sciences, Stanford University: The Lancet 1989; 2, 888-891. Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer. 

A 10-year follow-up to a previous study to determine effects of psychosocial interventions on time survival of 86 patients. 1 year intervention with weekly support group and self-hypnosis for pain. The intervention group lived on average twice as long as controls, with death coming significantly longer after first metastasis in the intervention group. At 10 years, 3 of the 86 survived. 

Anger and Hostility:

I.C. Siegler, B.L. Peterson, J.C. Barefoot, R.B. Williams: Duke University, Department of Psychiatry and Behavioral Sciences – Amer J of Epidemiology 1992; 136(2), 146-154. Hostility During Late Adolescence Predicts Coronary Risk Factors at Mid-Life. 

Prediction of coronary risk factors in 4710 men and women assessed 21-23 years later. Higher hostility  scores in teens predicted more caffeine, larger body mass index, higher lipid ratios, and more smoking in adulthood. Thus hostility may contribute to health problems in later life.

E.C. Suarez, C.M. Kuhn, S.M. Schanberg, R.B. Williams Jr., E.A. Zimmerman: Duke University, Department of Psychiatry and Behavioral Sciences- Psychosomatic Medicine 1998; 60 (1), 78-88. Neuroendocrine, Cardiovascular and Emotional Responses of Hostile Men: The Role of Interpersonal Challenge. 

53 healthy white men chosen for top and bottom scores of Cook and Medley Hostility Scale. Given an anagram task and 30 subjects harassed during the task. Harassed subjects with high hostility has increased blood pressure, heart rate, forearm blood flow, forearm vascular resistance, norepinephrine,  testosterone and cortisol scores, plus arousal of negative affect.

J. Moller, J. Hallqvist, F. Diderichsen, T. Theorell, C. Reuterwall, A. Ahlbom, Department of Occupational Medicine, Public Health Sciences, Stockholm: Psychosomatic Medicine, 1999-Nov/Dec; 61(6): 842-854. Do Episodes of Anger Trigger Myocardial Infarct? A Case Cross-Over Analysis in the Stockholm Heart Epidemiology Program (SHEEP).

699 patients in a coronary care unit studied, and authors found that anger was a risk for MI, with an increased risk lasting approximately 1 hour after an outburst of anger.

Attitude and Coping Skills:

J.A. Astin-Hoda, C.E. Anton-Culver, D.H. Schwartz, J. Shapiro, Hoag Hospital Cancer Center, Newport Beach, Calif.: Behavioral Medicine, 1999-Fall;25(3):101-109. Sense of Control and Adjustment to Breast Cancer: The Importance of Balancing Control Coping Styles.

58 women with stage 1 or 2 breast cancer surveyed at diagnosis and 4 and 8 months afterwards. Results showed that those women who had a positive yielding (accepting) mode and a high assertive mode showed the best psychosocial adjustment and quality of life. The poorest adjustment were in those women with a high desire for control and a low positive yielding mode.

M. Seligman, Harvard U. Dep’t of Psychology: Mayo Clinic Proceedings, 2000-February; 75(2):133-134. Optimism, Pessimism and Mortality. 

Patients followed over 34 years showed less morbidity in those with higher optimism scales.

J. Astin, S.L. Shapiro, R.A. Lee, D.H. Shapiro, Stanford U. Complementary and Alternative Medicine Program: Alt Therapies in Health and Medicine, 1999-March;5(2):42-47. The Construct of Control in Mind-Body Medicine: Implications for Health Care.

Authors show that gaining a psychological sense of control may influence physiological function and health outcomes, and that it is important to match control strategies to patient control styles and preferences.

L. Grassi, G. Rosti, Dep’t of Psychiatry, U of Ferrara, Ferrara, Italy: Psychosomatics, 1996- Nov/Dec;37(6):523-31. Psychosocial Morbidity and Adjustment to Illness Among Long-Term Cancer Survivors.

DSM and Adjustment to illness (psychiatric stress, illness behaviour, and coping) studied in 52 cancer patients evaluated at time of diagnosis 6 years earlier. The prevalence of psychiatric disorders and improvement in psychological adjustment was noted between these 2 points in time, but external locus of control, low social support, abnormal illness behaviour, emotional stress and poor coping mechanisms were associated with psychological symptoms and maladjustment to cancer at follow-up.

C. Cheng, M.D. Wai-Mo, S. Lam, Hong Kong U. of Science and Technology, Division of Social Science: Psychosomatic Medicine, 1999-Nov./Dec.;61(6):789-798. Coping Styles of Individuals with Functional Dyspepsia.

Matched case control study of 3 groups of 30 patients (30 with functional dyspepsia, 30 with rheumatism, and 30 healthy) given a new Coping Flexibility Interview Questionnaire. Functional Dyspeptic patients were characterized by a nondiscriminative, action-oriented coping style.

Autogenic Training and Biofeedback:

G.D. Fuller. Skin Temperature Feedback. Exerts from - Biofeedback: Methods and Procedures in Clinical Practice. San Francisco, Ca. Biofeedback press, 46-52. 

Info on the history and physiology of skin temperature biofeedback. How skin Temp. is measured and a brief description of the procedure.

P.A. Norris and S.L. Fahrion.: Berkeley,Calif., Wheat Ridge, Colorado – in Principles and Practices of Stress Management. by P.M. Lehrer and R.L. Woolfolk. New York: The Guilford Press.1993, 231-262. Autogenic Biofeedback in Psychophysiological Therapy and Stress Management. 

A history of th emethod and review of the literature concerning the scope of its applications for a variety of illnesses and disorders. Clinical indications, contraindications and mechanisms and methods are given, along with case example.

Breathing:

R. Fried. The Breath Connection. New York: Plenum Press. 1990; 58-71, 91-93, 171-179, 182-184.

Discussion of respiration, lung and airway passage physiology, composition of air in the atmosphere and in the lungs. Process of breathing, volume, mode and rhythm, as well as issues pertaining to the hyperventillation syndrome also described.

S. DeGuire, R. Gervitz, D. Hawkinson, and K. Dixon: Biofeedback and Self-Regulation, 1996-21(2):191-198. Breathing Re-Training: A Three Year Follow-Up Study for Hyperventillation Syndrome and Associated Functional Cardiac Symptoms.

10 of the original 41 subjects in this study were followed 3 years later and showed lasting effects on both respiratory parameters measured (respiratory rate and end-tidal carbon dioxide) and subjects continued to report a decrease in frequency of functional cardiac symptoms.

Biologic Underpinnings of Mind-Body Therapies:

J.S. Gordon. Georgetown U.: What is Stress? Chapter I in Stress Management. New York: Chelsea House Publishers, 13-24. 

The concept of stress, pioneering research, and psychosocial aspects.

J.S. Gordon. Georgetown U.: The Biology of Stress. Chapter 2 in Stress Management. New York: Chelsea House Publishers,25-40. 

Effects of stress on the CNS, the endocrine and immune system.

R. Ader and N. Cohen: University of Rochester: Psychosomatic Medicine 1975; 37(4), 279-286. Behaviorally conditioned immunosupression. 

The landmark study of behavioral conditioning of the immune system. The pairing of a neutral stimulus (saccharin) with cyclophosphamide, am immunosupressive agent, would result in the conditioning of immunosuppression in rats. Lithium chloride, a non- immunosuppressive agent, showed the results were definitely behaviorally conditioned.

H.O. Besedovsky , R.B. Herberman, L.R. Temoshok, F. Sendo: Cancer Research, 1996-56(18), 4278-4281. Psychoneuroimmunology and Cancer: Fifteenth Saporo Cancer Seminar. 

Reports of links between cancer and emotion, especially anger. One group reported a lack of expression of anger and increased risk of malignant melanoma, and another group a link between anger expression and longer disease-free intervals for colon and breast cancer. 

J.E. Blalock: Immunology Today-15(11)504-511. The Syntax of Neuroendocrine Communication.

Summary of the evidence that the immune and neuroendocrine systems represent a totally integrated information circuit that results from a sharing of ligands and their receptors.

N. Cohen, J.A. Moynihan, R. Ader: Int’l Archives of Allergy and Immunology, 1994-105(2), 101-106. Pavlovian Conditioning of the Immune System.

Highlights research in conditioning and immunity, and it’s potential use for reducing amounts of drugs given to autoimmune disordered patients.

W. Savino: Immunology Today, 1995-16(7):318-322. Immune-Endocrine Interactions.

The molecular basis for immuno-endocrine crosstalk and immune-neuroendocrine interactions in pathology discussed.

D.A. Weigent, J.E. Blalock: J of Leukocyte Biology, 1995-58(2):137-150. Associations between the Neuroendocrine and Immune Systems.

Review and details of production of neuroendocrine hormones by the immune system, and cytokines by the neuroendocrine system.

M.E. Kemeney, G.F. Solomon, J.E. Morley, T.L. Herbert, U.C.L.A. Department of Medicine: Neuroendocrinology, Boca Raton, Fla.,CRC Press: 563-592. Neuroendocrinology.

Link between psychological factors and immune system reviewed in both animals and humans, plus  direct links found between the nervous and immune sytems.

S. Reichlin: New England J of Medicine, 1993-329(17):1246-1253. Neuro-endocrine Immune Interactions.

Review of implications for neuroendocrinimmunology for clinical medicine.

Exercise:

S.J. Farrel, A.D. Ross, K.V. Sehgal, Dep’t of Physical Medicine and Rehabilitation, Medical College of Ohio, Toledo: Phys Med Rehabil Clin N Am, 1999-Aug;10(3):617-29. Eastern Movement Therapies. 

Review of promising research into Tai Chi, Qi Gong and Yoga therapies for ambulatory and non-ambulatory patients.

P.Austin: Internal Medicine News, 1990-Aug;23(15)15; Walking and Immune Function. 

Study of inactive women on a 15-week walking program demonstrated showed half the length of flu illness than control group of non-walkers.

C. Wood: J of the Royal Society of Medicine, 1993-86:254-258. Mood Change and Perception of Vitality: A Comparison of the Effects of Relaxation, Visualization and Yoga.

3 groups of  normal patients each participated with each technique for 6 sessions over 2 weeks. Pranayama (yoga) produced a marked increase in energy in mood, significantly better than either relaxation or imagery.

T.P. LaFontaine, T.P. DiLorenzo, P.A. Frensch, R.C. Stucky-Ropp, E.P. Bargman, and D.G. McDonald: Sports Medicine, 1992-13(3):160-170. Aerobic Exercise and Mood. A Brief Review, 1985-1990. 

Review article, with consistent conclusions that: aerobic exercise and depression and anxiety are related in an inversely proportional manner; aerobic exercise is effective in the treatment of mild to moderate mood disorders; increased benefits were greatest for those who were more depressed and more anxious; an increase in cardiovascular fitness was not necessary for mood enhancement.

T. Plante: Advances in Mind-Body Medicine, 1999-Fall;15(4), 235-306. Could the Perception of Fitness Account for Many of the Mental and Physical Health Benefits of Exercise?

In this review article the authors point to some evidence that perception of fitness may in fact be a key factor in triggering the benefits of physical exercise itself.

Heart Disease:

Hillel W. Cohen, DrPH, Shantha Madhavan, DrPH, and Michael H. Alderman, MD. 2001, March-April. Psychosomatic Medicine. Pp. 203-209.

History of Treatment for Depression: Risk Factor for Myocardial Infarction in Hypertensive Patients.

Participants (5564) in a union-sponsored, hypertension control program in New York City, who entered the program during 1981-1994 without a history of cardiovascular disease and who were asked whether they had been treated for depression, were followed in a prospective cohort study. The primary outcome of interest was hospitalization or death due to myocardial infarction. A self-reported history of treatment for depression is independently associated with subsequent myocardial infarction in treated hypertensive patients without prior cardiovascular disease. Whether additional or different treatment for depression will be cardioprotective is unknown and merits further study. 

Redford B. Williams, MD, Douglas A. Marchuk, PhD, Kishore M. Gadde, MD, John C. Barefoot, PhD, Katherine Grichnik, MD, Michael J. Helms, BS, Cynthia M. Kuhn, PhD, James G. Lewis, PhD, Saul M. Schanberg, MD, PhD, Mark Stafford-Smith, MD, Edward C. Suarez, PhD, Greg L. Clary, MD, Ingrid K. Svenson, BSc, and Ilene C. Siegler, PhD. . 2001, March-April. Psychosomatic Medicine. Pp. 300-305. Central Nervous System Serotonin Function and Cardiovascular Responses to Stress 

The objective of this study was to evaluate the impact of indices of central nervous system (CNS) serotonin function on cardiovascular reactivity to mental stress. 

Methods: Lumbar puncture was performed on 54 healthy volunteers to obtain cerebrospinal fluid (CSF) for determination of 5-hydroxyindoleacetic acid (5HIAA) levels. Genotypes were determined with respect to a functional polymorphism of the serotonin transporter gene promoter region (5HTTLPR). Subjects then underwent mental stress testing. 

5HTTLPR polymorphism affects CNS serotonin function, and they are consistent with the general hypothesis that CNS serotonin function is involved in the regulation of potentially health-damaging biobehavioral characteristics. In particular, the l allele could contribute, through its association with increased cardiovascular reactivity to stress, to increased risk of cardiovascular disease. 

Sylvie Cossette, RN, PhD, Nancy Frasure-Smith, PhD, and Françfcois Lespéferance, MD.- 2001, March-April. Psychosomatic Medicine. Pp. 257-266. 

Clinical Implications of a Reduction in Psychological Distress on Cardiac Prognosis in Patients Participating in a Psychosocial Intervention Program
The objective of this secondary analysis was to examine the relationships between a reduction in psychological distress and long-term cardiac and psychological outcomes in post-myocardial infarction patients who participated in a randomized trial of home-based psychosocial nursing interventions (the Montreal Heart Attack Readjustment Trial [M-HART]). Gender differences were considered. 433 patients (36.0% women) from the M-HART treatment group who received two home visits after achieving a high psychological distress score (ie, G5) on the General Health Questionnaire (GHQ). Short-term GHQ success was determined by a return to a normal GHQ score (|Ld5) or a reduction of G50% after the two visits. Patients with short-term successful and unsuccessful GHQ outcomes were compared for mid-term maintenance of success, 1-year death and readmission rates, and 1-year depression and anxiety symptoms. Post-myocardial infarction interventions that reduce psychological distress have the potential to improve long-term prognosis and psychological status for both men and women. 

D. Ornish et al., UCSF: Lancet 1990; 336, 129-133. Can Lifestyle Changes Reverse Coronary Artery Disease?

28 patients with severe coronary atherosclerosis studied in a prospective, randomized, controlled trial for 1 year (28 patients in the experimental group). Low fat vegetarian diet, stopping smoking, stress management training, and moderate exercise used with angiographic assessments. Overall, 82% of experimental group had an average change towards regression of ASHD, as opposed to the control group.

L.S. Savage, C. Canody, Medical Colleges of Virginia Hospitals, Richmond: Am J Crit Care, 1999-Sept.;8(5) 340-343. Life with a Left Ventricular Assist Device: The Patient’s Perspective.

Spirituality, humor and strong family relationships seemed to be most effective coping mechanisms for 6 such patients.

Klaus L, Benaminovitz A, Choi L, Greenfield F, Whitworth GC, Oz MC, Mancini DM.

Columbia University – Am J of Cardiology 2000; July 1 86(1): 101-104. Pilot Study of Guided Imagery Use in Patients with Severe Heart Failure.  Improvement shown in symptoms and longevity in a group of patients with congestive heart failure, all other variables being equal. 

Moore NG. Altern Ther Health Medicine - 1997 Jan 3(1):30-32 – The Columbia-Presbyterian Complementary Care Center: A Comprehensive Care of the Mind, Body and Spirit. Review of the innovative self-regulation behavioral medicine techniques used in this program.

T. Rutledge, W. Linden, R. Davies, UBC: Psychosomatic Medicine, 1999-Nov./Dec.; 61(6):834-846. Psychological Risk Factors May Moderate Pharmacological Treatment Effects Among Ischemic Heart Disease Patients.

12 week pharmacological treatment study of 80 coronary disease patients, who underwent a treadmill exercise testing, 48 hour Holter monitoring, and psychological testing for hostility, depression and daily stress scales. Combination treatment protocols were given in the last 3 weeks (anti-ischemic meds or placebos). Results indicate that psychological risk factors may have globally negative effects on the course of treatment and suggest particular factors that may warrant attention in trial targeting cardiac symptom reduction.

Whitworth J, Burkhardt A, Oz M. Department of Complementary Medicine Services, Columbia-Presbyterian Medical Center, New York, N.Y. – J of Cardiovascular Nursing – 1999 July 13 (4): vi and 2000 Apr 14(3): vii. Complementary Therapy and Cardiac Surgery. A review of the benefits of complementary medicine techniques used in the cardiac surgery program of this hospital. 

Imagery:

M.S. Rider, J. Achterberg, G.F. Lawlis, A. Goven. R. Toledo, J.R. Butler, Southern Methodist U.: Biofeedback and Self-Regulation, 1990; Dec; 15(4):317-333. Effects of Immune System Imagery on Secretory IgA.

College students taught physiologically oriented imagery with music entrainment showed significant increase in IgA levels, and decreased heart rate, breathing difficulties and jaw clenching – compared to a control group.

J. Kiecolt-Glaser, R. Glaser, Ohio State U. Institute for Behavioral Medicine Research; 2000 – ongoing. 

Cortisol, saliva, wound healing and leukocyte measurements from happily married couples given contentious issues to debate.

L.G. Walker, S.D. Heys, M.B. Walker, K. Ogston, I.D. Miller, A.W. Hutcheon, T.K. Sarkar, A.K. Ah-See, O. Eremin, Inst. Of Rehabilitation, U of Hull, U.K.: Eur J of Cancer, 1999-Dec.;35(13):1783-8. Psychological Factors Can Predict the Response to Primary Chemotherapy in Patients with Locally Advanced Breast Cancer.

96 women with advanced or large breast cancers in prospective, randomized trial evaluating guided imagery, relaxation techniques and L-arginine effects. Supported the importance of psychological factors as independent predictors in response to primary chemotherapy in patients with breast cancer.

J.F. Giedt: J of Holistic Nursing, 1997-15(2):112-127. A Psychoneuroimmunological Intervention in Holistic Nursing Practice.

Concepts and basic steps of guided imagery are presented, with a link to psychoneuroimmunolgy and directions for future research.

R. Stephens: Clinical Nurse Specialist, 1993-7(4) and 7(5)-170-174, 235-240 (parts 1 and 2). Imagery: A Strategic Intervention to Empower Clients. 

History and types of imagery, with guidelines to help use imagery in clinical practice.

Infertility:

A.D. Domar, R. Friedman, P.C. Zuttermeister, Mind?Body Medical Institute,Beth Israel Deaconess Hospital, Harvard U.: J Am Med Womens Assoc, 1999-Fall;54(4):196-198. Distress and Conception in Infertile Women: A Complementary Approach. 

132 infertile women attending support group and cognitive behavioral sessions for 10 weeks and were monitored by symptom checklists, Beck Depression scale and fertility rates post program. Preprogram psychological distress and younger age were associated with significantly higher viable pregnancy rates.

Nutrition:

K. Glantz: University of Hawaii, Cancer Research Center- 2000; American Journal of health Promotion. Nov/Dec 2000. Americans Still Face Dietary Challenges. 

Study shows 5 of 10 leading causes of death for Americans relate to dietary practices; heart disease, some cancers, stroke, diabetes, and atherosclerosis. Programs that encourage dietary behaviour change are most effective with individuals who are motivated by having or being at high-risk for dietary illness.

E.M. Haas: Chapter 12 in Staying Healthy with Nutrition. 1992. Berkeley Calif., Celestial Arts, 505-526. The Components of a Healthy Diet. Author changes the categories of food groups with more emphasis on vegetables, whole grains, and legumes. 10 key components of a healthy diet are described as natural foods, fresh foods, nutritional foods, clean foods, tasty and appealing foods, variety and rotation, and moderation. Seasonal foods and balancing of a diet are emphasized.

D. Ornish, et al: JAMA, 1983-249(1):54-59. Effects of stress Management Training and Dietary Changes in Treating Ischemic Heart Disease. 

Earlier study of 48 patients over 24 days. Stretching/relaxing, meditation, visualization, a staying together in a rural environment included in program. Essentially a low-fat vegan diet, with little cholesterol or salt was used. Reduction in plasma cholesterol and triglycerides and improvements in several physiological parameters noted.

Meditation:

J.S. Gordon. Georgetown U.: The Atlantic Monthly 1991;115. The Inner Life. 

The history, types, benefits and advantages of meditation.

I. Kutz, J. Borysenko, H. Benson. Harvard U.: The American J of Psychiatry 1985; 142(1);1-8. Meditation and Psychotherapy: A rationale for the integration of dynamic psychotherapy, the relaxation response, and mindfulness meditation.  

The psychobiological nature of meditation (relaxation response) and the use of traditional meditation practice (mindfulness meditation) as an effective technique for the development of self-awareness.

J.A. Astin: Psychotherapy and Psychosomatics, 1997-66:97-106. Stress Reduction Through Mindfulness Meditation.

Effects of an 8-week stress reduction program using mindfulness meditation. Used 28 randomized contolled subjects. Experimental subjects had a reduction in the overall psychological symptomatology, an increase in overall domain-specific sense of control and utilization of an accepting or yielding control in their lives, and higher scores on measures of experiential experiences. Author concludes that this technique may help to transform our perception of life events, and may prevent relapse of affective disorders.

Music:

M.S. Rider and J. Achterberg. Southern Methodist University: Biofeedback and Self-Regulation 1989; 14(3), 247-257. Effect of Music-Assisted Imagery on Neutrophils and Lymphocytes. 

30 subjects randomly assigned to 2 experimental groups in 6-week training program, focusing on images of morphology, location and movement of either neutrophils or lymphocytes. Music was used to enhance the imagery of the subjects. Neutrophils decreased significantly in the neutrophil group alone, and lymphocytes in the lynphocyte group alone. Mental images may have specific effects on sub-populations of the immune system.

H. Goodcare, Horsham, West Sussex,U.K.: Advances in Mind-Body Medicine, 1999-15:154-155.(Letter) Breast Cancer, Tamoxifen, and Music Therapy. Advantages of music therapy to create a sense of wholeness, and the detrimental effects of the anti-estrogen drug Tamoxifen on the voice.

C. Marwick, Florida State U., Talahassee, Florida: JAMA, 2000-January;283(4)468-69. (Letter). Music Hath Charms for Care of Premies. 

Cites study at Center for Music Research at U. of Florida by J. Standley (Pediatric Nursing, 1998:24:532-38). In a controlled matched study of 40 premature babies, 20 babies were sung lullabies and massaged. The “sung to” babies left hospital earlier, females by 11 days and males by 1.5 days. Sucking may be the first rhythm pattern that babies engage in, and music in a neonatal unit that is soothing, constant, stable, and at a volume of 60-70-dB range is both quieting and developmental enhancing to newborns.

L.L. Chlan, U. of Minnesota School of Nursing, Minneapolis, Minn.: Amer J of Critical Care, 1995-May;4(3):223-8. Psychophysiologic Responses to Mechanically Ventilated Patients to Music: A Pilot Study.

20 randomized mechaically ventillated patients were measured for physiologically dependent measures while listening of not-listening to relaxing music. Data indicated that music listening significantly decreased heart rate, respiratory rate, and Profile of Mood States scores, indicating relaxation and mood improvement.

Y.M. Lai, Chang Gung U., Taiwan, School of Nursing: Issues Ment Health Nursing, 1999- May/June; 20(3):229-46. Effects of Music Listening on Depressed Women in Taiwan.

30 depressed women in a controlled study showed that the experimental group who had listened to music had significant differences post-test in heart rates, respiratory rates, blood pressure, and tranquil mood states. 

P.A. Updike, D.M. Charles: Amer Plastic Surg, 1987-July;19(1):29-33. Music Therapy: Physiologic and Emotional responses to Taped Music Programs of Preoperative Patients Awaiting Plastic Surgery. 

Controlled non-randomized study measured blood pressure, pulse rate, mean arterial pressure, and double product index before and after a 30-minute music tape, and emotional responses were measured by questionnaire. Every physiological level decreased in value at .001 significance value, and the most significant emotional shift was awareness of a more relaxed, calm state.

R. McCraty, B. Barrios-Choplin, M. Atkinson, D. Tomasino, Institute of Heart Math, Boulder Creek, Colorado:Alt Ther Health Medicine, 1998-January;4(1):5-94.The Effects of Different Types of music on Mood, Tension, And Mental Clarity.

144 subjects completed a physiological profile before and after listening to different types of music. Designer music for relaxation was most effective in increasing positive feelings and decreasing negative feelings, whereas grunge rock music significantly increased hostility, tension, sadness and fatigue scores.

L. Heitz, T. Symreng, F.L. Scamman: J Post Anaesth Nurs, 1992-February;7(1):22-31. Effects of Music Therapy in the Postanesthesia Care Unit: A Nursing Intervention.

60 patients scheduled for thyroid, parathyroid or breast surgery under general anaesthesia randomly assigned to groups with headphones with or without music. The music group was able to wait significantly longer before requiring analgesia on the nursing unit, and perceived their stay as being significantly more pleasant than the other groups.

S.L. Beck, U of Utah Health Sciences Center, Salt Lake City: Oncol Nursing Forum, 1991-Nov/Dec;18(8):1327-37. The Therapeutic Use of Music for Cancer-Related Pain.

15 patients receiving scheduled analgesics in randomized controlled cross-over study listened to different types of music, a control 60-cycle hum, or nothing. McGill Pain Questionnaire found that those listening to either music or sound gave significantly significant decrease in pain, but no significant shift in mood.

J.A. Schorr, Department of Nursing, Northern Michigan University, Marquette: ANS Adv Nurs Sci, 1993-June;15(4):27-36. Music and Pattern Change in Chronic Pain.

30 women with rheumatoid arthritis given McGill Pain Questionnaire before, during and after listening to music of their choice. Results supported use of music as a unitary-transformative intervention.

J.M. White, School of Nursing, University of Wisconsin-Milwaukee: Am J Crit Care, 1999-July;8(4):220-230. Effects of Relaxing Music on Cardiac Autonomic Balance and Anxiety After Acute Myocardial Infarction. 

Randomly assigned 3-group measure of 45 patients to a music-quieted environment, quieted environment, and normal environment. Anxiety levels and physiological indicators were measured, and found that reductions in heart rate, respiratory rates, and myocardial oxygen demand were significantly greater in the experimental group. State anxiety was decreased in the experimental group only.

C.H. McKinney, M.H. Antoni, M. Kumar, F.C. Tims, P.M. McCabe, Department of Music Education/Music Therapy, University of Miami: Health Psychology, 1997-July;16(4):390-400. Effects of Guided Imagery and Music Therapy on Mood and Cortisol in Healthy Adults. 

28 healthy adults in randomized trial looking at Profile of Mood States and serum cortisol. After 6 bi-weekly sessions experimental participants reported significant decreases between pre-and post-session depression, fatigue, and total mood disturbance and had significant decreases in cortisol level by follow-up.

Genograms:

P.J. Guerin and E.G. Pendergast. from Family Therapy: Theory and Practice, P. Guerin.Gardner Publishing,1976. Chapter 26. Evaluation of Family Systems and Genogram. 

Definition, description and examples of family genograms.

Journaling:

J.M. Smyth, A.A. Stone, A. Hurewitz, A. Kaell: JAMA, 1999-281(14):1304-1309. Effects of Writing About Stressful Experiences of Symptom Reduction in Patients with Asthma or Rheumatoid Arthritis.

107 patients and control group (wrote about the most stressful events or neutral events). Wrote x3 20 minute sessions for 3 consecutive days at 2 weeks, 2 months and 4 months.47% of experimental group showed symptom improvement (v.s. 24% of controls).

Pain:

B. McCarberg, J. Wolf, Kaiser-Permanente, San Diego, California: Clin J Pain, 1999-March:15(1):50-57. Chronic Pain Management in Health Maintenance Organizations.

Gains were achieved in pain severity, pain affect and pain interference with the patient’s life after an 8-week 16-hour class for chronic pain patients on a 6-month follow-up (v.s. control group). 78% of the patients in the large HMO were satisfied with the care provided.

Placebo:

H. Benson and M. Epstein. Harvard U.: 1975 - Chapter 12 in Health for the Whole Person. Boulder, Colorado: West View Press, 179-185. The Placebo Effect: A neglected asset in the care of patients.

The important role of the doctor-patient relationship as it relates to the placebo effect. The placebo effect often enhances patient well-being, and requires more study and be allowed to survive for optimal treatment.

C.E. Margo, Department of Opthamology, Watson Clinic, Lakeland, Fla: Surv Opthamology, 1999-July-Aug;44(1):31-44. The Placebo Effect. 

Review demonstrating that the placebo effect may be the most versatile and underused therapeutic tools at the disposal of physicians.

Rheumatology:

J.E. Broderick, Dep’t of Psychiatry and Behavioral Sciences, State U of New York at Stony Brook: Rheum Dis Clin North America, 2000-Feb.;26(1):161-176. Mind-Body Medicine in Rheumatologic Disease.

This article finds that Mind-Body treatment results in significant, incremental symptom relief and improvement in disability status and well-being beyond that achieved through routine medical care. There is also evidence that these interventions reduce utilization of health care services, despite continuing progression of disease, a finding that has major economic implications for health care policy.

Herrmann M, Scholmerich J, Straub RH. Department of Internal Medicine, University Medical Center, Regensburg, Bavaria, Germany. 2000 Nov.: Rheum Dis Clin North Am ;26(4):737-63, viii
Stress and rheumatic diseases.
This study was done to review the literature concerning the influence of minor and major stress factors on onset and course of rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), systemic lupus
erythematosus (SLE), and fibromyalgia syndrome (FS).
Major life events and chronic minor stress seem to be very important factors in JCA and are significantly associated with the onset of the disease. With respect to RA and FS, stress may be a provoking factor but
the data in the literature are equivocal. However, during the course of the disease, minor stress aggravates SLE, FS, JCA, and RA. Patients with FS and RA may profit from psychological therapies. Optimistic and confronting coping strategies were found most frequently and perceived to be most effective. Very important for psychological function is the social background, especially the functioning of the family is of outstanding importance for clinical and psychological outcome.

Sleep:

Eve Van Cauter, Deprtment of Medicine, U of Chicago: The Lancet, 1999-October 23. Sleep Debt Affects Metabolic Functions. 

11 young men studied for sleep debt, carbohydrate metabolism and hormonal functions. Compared 4-hrs. per night v.v. 12-hrs. per night sleep effects, and found that with sleep debt blood glucose, cortisol concentrations and sympathetic nervous activity were higher, and thyrotropin activity was lower.

Spirituality:

L. Dossey. New Mexico: 1999. Do religion and spirituality matter in health? A response to the recent article in the Lancet. Alternative Thearpies in Health and Medicine, 5(3), 6-8. 

Rebuttal to a review article cited in Lancet by authors below.

R.P. Sloan, E.Bagiella, T. Powell. Columbia-Presbyterian Hospital, Department of Psychiatry – 1999; Lancet, 353 (9153), 664-667. Religion, Spirituality and Medicine. 

The authors state that the poor methodology of most research linking spirituality and health means that there is weak and inconsistent evidence of a link.

B. Cairns.: Maine Medical Centre. Portland –1999, Home Helathc Nurse; July ;17(7):450-5. Spirituality and Religiosity in Palliative Care. 

Understanding of principals for the home health care nurse in treating the dying.

R. Marrone.: California State U., Sacramento – 1999, Death Studies. Sept. 23(6); 495-519. Dying, Mourning and Spirituality: a psychological perspective. 

Examination of the cognitive basis of the spiritual experience and the use of cognitive assimilation, accommodation strategies during the process of mourning the death of a loved one, as well as the process of living our own dying. The ability to re-ascribe meaning to a changed world through spiritual transformation, religious conversion, or existing change may be more significant than the specific content by which that need is fulfilled.

Matthews DA, Marlowe SM, MacNutt FS. Arthritis/Pain Treatment Center, Clearwater, Fla.-Dec, 2000; South Med J; 93(12), 1177-86.

Effects of intercessory prayer on patients with rheumatoid arthritis.

Patients receiving in-person intercessory prayer showed significant overall improvement during 1-year follow-up. No additional effects from supplemental, distant intercessory prayer were found. In-person intercessory prayer may be a useful adjunct to standard medical care for certain patients with rheumatoid arthritis. Supplemental, distant intercessory prayer offers no additional benefits.

Byrd RC. - Medical Service, San Francisco General Medical Center, CA. – July, 1988; South Med;81(7):826-9. Positive therapeutic effects of intercessory prayer in a coronary care unit population.
The therapeutic effects of intercessory prayer (IP) to the Judeo-Christian God, one of the oldest forms of therapy, has had little attention in the medical literature. To evaluate the effects of IP in a coronary care unit (CCU) population, a prospective randomized double-blind protocol was followed. Over ten months, 393 patients admitted to the CCU were randomized, after signing informed consent, to an intercessory prayer group (192 patients) or to a control group (201 patients). While hospitalized, the first group received IP by participating Christians praying outside the hospital; the control group did not. The control patients required ventilatory assistance, antibiotics, and diuretics more frequently than patients in the IP group. These data suggest that intercessory prayer to the Judeo-Christian God has a beneficial therapeutic effect in patients admitted to a CCU.

J.W. Ehman, B.B. Ott, T.H. Short, R.C. Ciampa, J. Hansen-Flaschen.: U of Pennsylvania Hospital, Department of Pastoral Care- 1999. Arch Internal Medicine; Aug 9-23;159)15);1803-6. Do patients want physicians to enquire about their spiritual or religious beliefs if they become gravely ill? 

177 ambulatory patients in a pulmonary care ambulatory faculty office practice questioned. Many (2/3) but not all patients surveyed welcome a carefully worded inquiry about their spiritual or religious beliefs in the event they become gravely ill. 90% believed prayer may influence illness outcome.

P.B Fryback and B.R. Reinert.: University of Southern Mississippi, College of Nursing- 1999 Nurs Forum Jan-Mar;34(1):13-22. Spirituality and people with potentially fatal diagnosis. 

Interviewed 10 women with cancer and 5 men with HIV/AIDS. Those that found spiritual meaning in their disease had a better quality of life now than before the diagnosis, and found it a bridge between hopelessness and meaningfulness in life. 

Harris WS, Gowda M, Kolb JW, Strychacz CP, Vacek JL, Jones PG, Forker A, O'Keefe JH, McCallister BD. Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO. – October 25, 1999; Arch Intern Med.;159(19):2273-8.

A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit.
Intercessory prayer (praying for others) has been a common response to sickness for millennia, but it has received little scientific attention. To determine whether remote, intercessory prayer for hospitalized, cardiac patients will reduce overall adverse events and length of stay a randomized, controlled, double-blind, prospective, parallel-group trial was completed on nine hundred ninety consecutive patients who were newly admitted to a coronary care unit  At the time of admission, patients were randomized to receive remote, intercessory prayer (prayer group) or not (usual care group). The first names of patients in the prayer group were given to a team of outside intercessors who prayed for them daily for 4 weeks. Patients were unaware that they were being prayed for, and the intercessors did not know and never met the patients. Remote, intercessory prayer was associated with lower CCU course scores. This result suggests that prayer may be an effective adjunct to standard medical care.

J. Walton: St.Luke’s Hospital of Kansas City –1999, J Holist Nurs Mar;17(1):34-53. Spirituality of Patients Recovering from an Acute Myocardial Infaction. 

A grounded theory study. Definition of spirituality, and supporting categories (faith, purpose, gift of self). Five phases to discover purpose are given as: facing mortality, releasing fear and turmoil, identifying and making lifestyle changes, seeking divine purpose, and making meaning in daily life. How spirituality influenced recovery addressed.

A.M. Somlai, J.A. Kelly, S.C. Kalichman, G. Mulry, K.J. Sikkema, T. McAuliffe, K. Multhauf, B. Davantes: M