Spiegel Weiss

Spiegel Weiss

Spiegel Weiss

MethodParticipantsThe population studied consisted of 125 women diagnosed with stage IV metastatic breast cancer. Patients with another life-threatening comorbid medical illness or psychiatric or other mental disorder that had required hospitalization in the previous year were excluded. All assessments were conducted at baseline, prior to randomization in the psychotherapy trial. The average time from breast cancer recurrence to assessment was 22 months (SD = 29; range = 1–147). Out of 125 subjects initially included in the study, 1 subject refused to be hypnotized for the study; thus, 124 subjects were ultimately assessed.Patients completed questionnaires to assess depressive symptoms, demographic and disease status variables, and medical treatments. Demographic characteristics and disease status indicators of the women are illustrated in Table 1.Table 1Demographic, Medical, and Psychological Variables Among Women With Metastatic Breast Cancer (N = 124)Assessment of HypnotizabilityHypnotizability was assessed using the Hypnotic Induction Profile (HIP; H. Spiegel & Spiegel, 2004). The HIP provides a linear induction score from 0 (lowest) to 10 points (highest) that can be used for statistical analysis and possesses outcome validity and high test-retest reliability (H. Spiegel & Spiegel; Stern, Spiegel, & Nee, 1978). The 0-to-10 induction score is obtained by assessing responses to a standard hypnotic induction and a series of suggestions. The components of the induction score, each scored from 0 to 2, are the experience of dissociation in the hand instructed to feel light and float upwards, the postinduction levitation after the hand is pulled down, the sense of differential control between the two hands, the response to the cutoff of hypnotically instructed lightness in the hand, and the experience of sensory alteration. The HIP is moderately and positively correlated with the longer Stanford Hypnotic Susceptibility Scales, with a range of correlations between .45 and .6, similar to the correlation of any one item of the Stanford Scale to the total score (Frischholz, Spiegel, Trentalange, & Spiegel, 1987; Orne et al., 1979).Posttraumatic Stress SymptomsThe Impact of Events Scale (IES; Horowitz, Wilner, & Alvarez, 1979) is a self-report 15-item scale that assesses subjective distress, specifically intrusion and avoidance symptoms, after a stressful life event. Intrusion symptoms include experiencing unbidden thoughts and trauma-related feelings or images. Avoidance symptoms include trying to avoid reminders of the trauma or to dull one’s emotional reactions to it. Subjects rate the frequency of intrusive or avoidant experiences in the week prior to testing, using a 4-point scale with scores ranging from 0 to 5 (0 = not at all, 1 = rarely, 3 = sometimes, 5 = often). IES total score and intrusion and avoidance subscale scores were assessed. The IES has been used with a wide variety of populations, including metastatic breast cancer patients (Butler et al., 1999) and has been demonstrated to be a valid and reliable measure (Sundin & Horowitz, 2002). Participants were asked to estimate how often they experienced symptoms throughout the past week in response to having cancer. The IES was used instead of the revised IES (IES-R) because these data were collected prior to the development of the IES-R (Weiss & Marmar, 1997). In order to assess hyperarousal, the third symptom dimension of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (4th ed. ; American Psychiatric Association, 2000), we conducted a factor analysis of 15 items selected for their salience to hyperarousal/irritability from the Profile of Mood States (POMS; described below) and produced three hyperarousal factors (anxious, angry, and annoyed).Mood DisturbanceWe measured disturbances in mood using the Profile of Mood States (POMS; McNair, Lorr, & Droppleman, 1992). The POMS is a commonly used measure of affective states that has demonstrated validity in a variety of populations. Participants use a 5-point Likert scale, ranging from 0 = not at all to 4 = extremely, to rate 65 adjectival descriptors of their moods (e.g., angry, sad, tense, clear headed) during the week prior to testing. A Total Mood Disturbance (TMD) score is generated from the six POMS subscales (tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment). These six subscales have internal consistencies ranging from .87 to .95 (McNair et al.).Depressive SymptomsDepressive symptoms were measured with the Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, 1977). The measure consists of 20 items that assess mood, somatic symptoms, and interpersonal relationships during the past 7 days on a 4-point scale based on frequency of occurrence, ranging from 0 (rarely or none of the time ) to 3 (most or all of the time ). The summary score ranges from 0 to 60, with higher scores indicating more severe depressive symptoms. The CES-D has been used to study a variety of populations (Beekman et al., 1997; Caracciolo & Ciaquinto, 2002; Radloff, 1977) and has been demonstrated to be both valid and reliable with cancer patients (Hann, Winter, & Jacobsen, 1999; Schroevers, Sanderman, van Sonderen, & Ranchor, 2000).Statistical AnalysesWe dichotomized the HIP Induction Scores into “low” (0 to 5) and “high” (>5) hypnotizability categories. We conducted bivariate correlations to examine the relationship of high hypnotizability to depressive symptoms (CES-D), mood disturbance (POMS), subjective distress after a stressful life event (IES total, IES avoidance, IES intrusion), and the POMS-derived hyperarousal factors.We also conducted a logistic regression in which hypnotizability was the dependent variable, while CES-D, IES total, and the POMS-derived hyperarousal factor 1 (of the three hyperarousal factors, this “anxious” factor incorporated the largest number of POMS items) were the independent variables. Independent variables were centered to minimize collinearity (Kraemer & Blasey, 2004). In this regression model, we included interaction terms for CES-D with both IES total and POMS-derived hyperarousal factor 1 to assess interactions between depressive symptoms and trauma symptoms.
spiegel weiss 1

Spiegel Weiss

Hypnotizability was assessed using the Hypnotic Induction Profile (HIP; H. Spiegel & Spiegel, 2004). The HIP provides a linear induction score from 0 (lowest) to 10 points (highest) that can be used for statistical analysis and possesses outcome validity and high test-retest reliability (H. Spiegel & Spiegel; Stern, Spiegel, & Nee, 1978). The 0-to-10 induction score is obtained by assessing responses to a standard hypnotic induction and a series of suggestions. The components of the induction score, each scored from 0 to 2, are the experience of dissociation in the hand instructed to feel light and float upwards, the postinduction levitation after the hand is pulled down, the sense of differential control between the two hands, the response to the cutoff of hypnotically instructed lightness in the hand, and the experience of sensory alteration. The HIP is moderately and positively correlated with the longer Stanford Hypnotic Susceptibility Scales, with a range of correlations between .45 and .6, similar to the correlation of any one item of the Stanford Scale to the total score (Frischholz, Spiegel, Trentalange, & Spiegel, 1987; Orne et al., 1979).
spiegel weiss 2

Spiegel Weiss

Assessment of HypnotizabilityHypnotizability was assessed using the Hypnotic Induction Profile (HIP; H. Spiegel & Spiegel, 2004). The HIP provides a linear induction score from 0 (lowest) to 10 points (highest) that can be used for statistical analysis and possesses outcome validity and high test-retest reliability (H. Spiegel & Spiegel; Stern, Spiegel, & Nee, 1978). The 0-to-10 induction score is obtained by assessing responses to a standard hypnotic induction and a series of suggestions. The components of the induction score, each scored from 0 to 2, are the experience of dissociation in the hand instructed to feel light and float upwards, the postinduction levitation after the hand is pulled down, the sense of differential control between the two hands, the response to the cutoff of hypnotically instructed lightness in the hand, and the experience of sensory alteration. The HIP is moderately and positively correlated with the longer Stanford Hypnotic Susceptibility Scales, with a range of correlations between .45 and .6, similar to the correlation of any one item of the Stanford Scale to the total score (Frischholz, Spiegel, Trentalange, & Spiegel, 1987; Orne et al., 1979).
spiegel weiss 3

Spiegel Weiss

Alternatively, highly hypnotizable individuals may be at an increased risk of developing posttraumatic stress by virtue of their greater responsivity to external stimuli, suggestibility, and dissociative capacity (H. Spiegel & Greenleaf, 1992). In a diathesis-stress model of hypnotizability and posttraumatic stress, a person’s predisposition to enter a hypnotic state interacts with the experience of a traumatic event to produce pathological dissociation, which varies in severity as a function of both the individual’s innate dissociativity and the intensity of the traumatic event (Butler, Duran, Jasiukaitis, Koopman, & Spiegel, 1996). Entering a dissociated state in response to a traumatic event may serve as a coping mechanism (D. Spiegel, 1986; Van der Hart Nijenhuis, Steele, & Brown, 2004; Van der Kolk & Van der Hart, 1989) by providing psychological distance from a physically inescapable stressor, but research shows that this strategy also increases the risk of subsequently developing posttraumatic stress symptoms and other psychopathologies (Classen, Koopman, Hales, & Spiegel, 1998; Koopman, Classen, & Spiegel, 1994; McFarlane, 1986; Taal & Faber, 1997). A dissociative coping style in response to traumatic events is thought to impede an individual’s capacity for cognitive and emotional processing, particularly with regard to painful emotions resulting from the trauma (Dancu, Riggs, Hearst-Ikeda, Shoyer, & Foa, 1996; Foa & Kozak, 1986; Foa, McNally, & Murdock, 1989; D. Spiegel et al., 1988). Thus, dissociative strategies may hinder long-term recovery from trauma (Dancu et al.).
spiegel weiss 4

Spiegel Weiss

The relationships we observed of posttraumatic stress and depressive symptoms to high hypnotizability suggest that high hypnotizability potentially could be used to provide early preventive interventions for metastatic breast cancer patients who are at greater risk of developing these symptoms. Moreover, psychotherapy with hypnosis has been shown to be clinically beneficial in the treatment of posttraumatic stress (D. Spiegel & Cardeña, 1990; D. Spiegel et al., 1988; H. Spiegel & Spiegel, 2004; Yard et al., 2008), including reducing intrusive thoughts (Brom, Kleber, & Defares, 1989). More recently, investigators have begun using hypnosis as a component in the effective treatment of depression (Butler et al., 2008; Smith, 2004; Yapko, 2001a, 2001b; Yexley, 2007). Advancing our understanding of the relationship of PTSD and depression to hypnotizability in metastatic breast cancer patients may contribute to the development of interventions better designed to improve quality of life in this population.

Spiegel Weiss

Spiegel Weiss
Spiegel Weiss

Published on Feb 24, 2017 | Under News | By admin
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