A longitudinal study of the development of anticipatory nausea and vomiting in cancer chemotherapy patients: the role of absorption and autonomic perception.

We interviewed 70 cancer patients receiving chemotherapy at home before their second treatment session to obtain baseline measures of absorption, autonomic perception, depression, state-trait anxiety, and basic demographic information. Patients were then interviewed before each of their next six treatment sessions, at which time measures of depression, state anxiety, severity and duration of postchemotherapy nausea and/or vomiting (PCNV), and experience of anticipatory nausea and/or vomiting (ANV) were obtained. Previous findings suggesting that motion sickness, trait anxiety, depression, sex of subject, and age are predictors of the development of ANV were not replicated. Patients with ANV did score significantly higher on measures of absorption and autonomic perception than patients who did not develop ANV. Those variables hypothesized to mediate conditioning (i.e., toxicity of treatment drugs, severity of PCNV, levels of state anxiety) accurately predicted which patients developed ANV. Absorption and autonomic perception added significantly to the prediction.     

Personality factors associated with anticipatory nausea/vomiting in patients receiving cancer chemotherapy

One hundred cancer chemotherapy patients rated the severity of pre- and posttreatment nausea and emesis and completed the State-Trait Anxiety Inventory. In addition, scores on the Millon Behavioral Health Inventory were obtained for 59 of those patients. Thirty-three percent of the patients reported having experienced anticipatory nausea and 11% reported having experienced anticipatory vomiting. Patients who experienced anticipatory nausea had more posttreatment nausea and vomiting, were more depressed, and were characteristically more anxious than other patients. A personality profile including the future despair, social alienation, and inhibited style (from the Millon Behavioral Health Inventory) identified patients with anticipatory nausea.     

Do infusion-related tastes and odors facilitate the development of anticipatory nausea? A failure to support hypothesis

Distinctive tastes and odors have been identified as potent nausea-eliciting stimuli in cancer chemotherapy patients who develop anticipatory nausea or vomiting (ANV). Based on the experimental research on illness-aversion learning and based on previous clinical research with chemotherapy patients, it was hypothesized that the presence of tastes and odors during infusions should increase the likelihood that a patient will subsequently develop ANV. Seventy-eight new chemotherapy outpatients were interviewed immediately following each of their infusions with regard to the experience of infusion-related tastes, odors, and body sensations. Results failed to support the hypothesis. The subsequent development of ANV was unrelated to reports of tastes and odors both during patients' initial two chemotherapy infusions and during the two infusions preceding their initial report of ANV. Furthermore, reports of tastes and odors were surprisingly infrequent relative to previous research. Methodological and environmental explanations for this difference in taste and odor prevalence are considered. It is concluded that, when present, infusion-related tastes and odors may indeed increase the likelihood of subsequent development of ANV. However, future research should examine the extent to which the physical characteristics of chemotherapy clinics might affect the prevalence of infusion-related tastes and odors.     

Anticipatory nausea in cancer patients receiving chemotherapy: Classical conditioning etiology and therapeutical implications

The delivery of cytotoxic drugs in cancer treatment is often accompanied by posttreatment side effects (e.g., nausea). Moreover, there is evidence that cancer patients are at risk to develop these side effects in anticipation of chemotherapy (i.e., anticipatory nausea [AN]). AN can be explained as the result of a classical conditioning process with the cytotoxic drug as the unconditioned stimulus (US). Stimuli paired with the US (e.g., smells, tastes) can become conditioned stimuli (CSs) eliciting AN as the conditioned response (CR). The present study was conducted to test whether AN shows characteristics of a CR. Fifty-five ambulatory cancer patients were asked to record nine kinds of physical symptoms (e.g., nausea, vomiting, sweating) on time-scheduled symptom lists: after an infusion (indicating posttreatment symptoms) and prior to their next infusion (indicating anticipatory symptoms). Each measurement period covered a maximum of 48 hours. AN was reported by ten patients (18.08%). Data revealed (a) a statistically significant association between posttreatment nausea and vomiting, respectively, and AN; (b) the occurrence of AN increased with drug emetogenity (i.e., US-intensity); and (c) the duration of AN increased with temporal proximity to the infusion. The results support the conditioning model. Thus, it is proposed to prevent AN by classical conditioning techniques (e.g., overshadowing).     

Treatment-related anxieties in children and adolescents with cancer

Abstract

Side-effects of anti-cancer treatment like nausea and vomiting and frightening medical procedures are relevant sources of anxiety in children and adolescents with cancer. Anticipatory nausea and vomiting can be described in terms of respondent conditioning. Hypnosis, systematic desensitization, relaxation training and employment of video-games are effective in mitigating these unpleasant concomitants of chemotherapy. Venipunctures, bone marrow aspirations, and lumbar punctures are repetitive painful procedures. Responses of pain and anxiety are ubiquitous, but still difficult to differentiate by psychological assessment. Rating scales and checklists have been developed to evaluate various intervention programs. Hypnotherapeutic approaches and comprehensive cognitive-behavioral treatment packages have been employed successfully to reduce anxiety reactions. In the future, it might be promising to match specific intervention programs with the coping behaviors spontaneously shown by the child; for instance, patients avoiding anxiety-provoking stimuli should be supported by additional distraction techniques, whereas vigilant patients that spontaneously focus their attention on these stimuli should be shown how to transform them in a positive context.     

Persistent symptoms among survivors of Hodgkin's disease: an explanatory model based on classical conditioning.

Persistent symptoms of nausea, distress, and vomiting triggered by reminders of cancer treatment were examined among 273 Hodgkin's disease survivors, 1 to 20 years posttreatment. Prevalence rates were high for distress and nausea but low for vomiting. Retrospective report of anticipatory symptoms during treatment was the strongest predictor of persistent symptoms, suggesting that treatment-induced symptoms are less likely to persist if conditioning does not occur initially. Time since treatment was also a significant predictor, with patients more recently treated more likely to experience persistent symptoms. Thus, an explanatory model based on classical conditioning theory successfully predicted presence of persistent symptoms. Symptoms also were associated with ongoing psychological distress, suggesting that quality of life is diminished among survivors with persistent symptoms. Recommendations for prevention and treatment of symptoms are discussed.     

Test-retest reliability and concurrent validity of the Morrow Assessment of Nausea and Emesis (MANE) for the assessment of cancer chemotherapy-related nausea and vomiting

The present study evaluated the concurrent validity of two assessment approaches for the measurement of cancer chemotherapy-related nausea and vomiting. The results indicated that the concurrent validity between the Morrow Assessment of Nausea and Emesis (MANE; Morrow, 1984b) and continuous self-monitoring and the reliability on the MANE were moderate. The heterotrait-monomethod and heterotrait-heteromethod matrices demonstrated moderate correlations among the frequency, severity, and duration of anticipatory nausea and vomiting as well as high correlations among the frequency, severity, and duration of posttreatment nausea and vomiting. Additionally, the heterotrait-monomethod matrices show a number of correlations above chance between anticipatory and posttreatment symptoms. The results are discussed in light of future research endeavors.This research was supported in part by Research Grant IN-150 from the American Cancer Society.     

Anticipatory nausea and vomiting among cancer patients: A Review

Abstract

Anticipatory nausea and vomiting (ANV), as a side-effect of cancer chemotherapy, is a well recognized phenomenon. The literature is reviewed for data on: prevalence rates, factors contributing to onset and psychological treatments used to attempt a remission in the symptoms. From the available evidence it appears that ANV is a substantial problem with one major review indicating an average combined prevalence of 32%. Although explicable using a conditioning model it has a complex aetiology with emotional and cognitive elements, as well as specific pharmacological factors, playing a role in onset. ANV appears to be responsive to psychologically-based treatment methods, with a good outcome overall. However, more process evaluation is needed in order to understand aetiologic and treatment mechanisms and to determine how best to treat cases of ANV with different aetiologies. It is considered that procedures for identifying and referring patients with ANV should be routinely incorporated into the care of cancer patients receiving repeated cycles of chemotherapy.     

Breaking the cycle: cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome

The present article presents a case of cognitive behavioral therapy (CBT) along with heart rate variability (HRV) biofeedback training for the treatment of a medication unresponsive 13-year-old boy with cyclic vomiting syndrome (CVS). CVS is characterized by recurring stereotypic episodes of vomiting, interspersed with asymptomatic periods. Triggers for vomiting include anticipatory anxiety related to school examinations, family conflicts, and birthday parties as well as infectious diseases, and certain foods. Current treatment design addressed two pivotal etiological factors: autonomic dysregulation and anticipatory anxiety. Treatment outcome suggests that vomiting episodes may be successfully prevented by aiding the patient to identify and manage precipitant psychological stressors, to regulate HRV patterns, and gain a renewed sense of bodily control and self-efficacy. Further research is suggested using a controlled study with pre- and post-behavioral and stress measures to evaluate the effectiveness of CBT and biofeedback training compared to pharmacotherapy and placebo.     

心理干预在化疗患者中的应用

本研究针对化疗患者常见的恶心呕吐、烦躁不安等副作用．运用心理行为技术．采用病例对照研究方法,对129名化疗患者进行了比较研究。结果为：各项情绪指标和总的情绪状况以及恶心呕吐反应。干预组患者比对照组改善明显;生活质量各指标在组问和组内比较中,有不同程度的改善,角色、社会、认知功能和疼痛症状在两组比较中改善不明显。由此认为,对化疗患者实施恰当的心理行为技术．干预效果是明显的     

Issues in treatment efficacy research with alcoholics.

A variety of therapeutic strategies have been used in the treatment of alcoholic patients. Within this context, behavioral techniques have been widely employed with varying degree of effectiveness. This paper attempts to explore theoretically 2 widely used behavioral therapeutic methods, systematic desensitization and covert sensitization, along with traditional insight-oriented therapy. Possible merits and limitations of applying these treatment approaches to alcoholic patients are explored.     

心理干预在放疗患者中的应用

探讨通过实施恰当的心理行为治疗,尤其是教育性干预措施,达到改善放疗患者情绪、提高其生活质量以及降低治疗负反应的效果.采用病例对照的临床研究方法,选用生活质量和心境问卷对160名正在进行放射治疗的住院癌症病人进行了心理干预的比较研究.结果表明,干预组患者的总体情绪和总体生活质量状况,比对照组患者有明显的改善,但愤怒、认知功能以及恶心呕吐症状在两组间的差异不显著;干预组组内比较中,角色功能没有显著性差别.其原因有待于进一步研究.     

不同5-HT3受体拮抗剂预防腹腔镜术后恶心呕吐的临床观察

观察使用不同5-HT3受体拮抗剂预防全麻下腹腔镜手术术后恶心呕吐的临床效果。选择160例气管内插管全身麻醉下腹腔镜手术,随机分四组,每组40例,手术结束前30min分别静脉注射昂丹司琼4mg（A组）;托烷司琼2mg（B组）;格拉司琼3mg（C组）;D组为对照组。记录术后2h、6h、12h、24h患者恶心、呕吐出现的例数。结果四组患者术后恶心呕吐的发生率是一个逐渐下降的趋势,A、B、C三组与D组相比较有显著性差异（P〈0．05）;术后2h、6h、12hB组与A组、C组相比较有显著性差异（P〈0．05）;而术后24hA、B、C三组差异无统计学意义,A、B、C三组抑制恶心呕吐的有效率分别为67．5％、87．5％和70．0％,与对照组比较差异有统计学意义（P〈0．05）,随访患者24h内无与药物相关的不良反应。结论：三种药物都能有效地预防术后恶心呕吐,但12h内托烷司琼的有效性更为明显。     

The Effectiveness of Group Metacognitive Therapy for Generalised Anxiety Disorder: A Pilot Study

Generalised anxiety disorder (GAD) responds well to individually delivered metacognitive therapy (MCT). The current study investigated the effectiveness of MCT administered to groups of patients with GAD in a general outpatient treatment centre. Thirty-three consecutively referred adult patients with GAD were assessed before treatment (pretreatment), after the last treatment session (posttreatment), and six months after treatment had ended (follow-up). Analyses of treatment effects were conducted for all patients entering the study (i.e., intent-to-treat analysis, using the last-observation-carried-forward procedure), and repeated for the patients who completed treatment (completers analysis), using paired samples t-tests. Further, effect sizes (ESs) and indices of clinical significance were calculated, and compared with those reported in studies into the efficacy and effectiveness of individually delivered MCT for GAD. Among both the intent-to-treat and the completers sample, large pre- to posttreatment reductions in symptoms of worry, trait-anxiety, and general psychopathology. The magnitude of change and the degree of clinical significance were smaller than those reported in studies into the effectiveness of individually delivered MCT for GAD, whereas the attrition rate (27 %) was higher. It is tentatively concluded that MCT for GAD can be effectively delivered in a group format in a heterogenous clinical practice setting. Further evaluation is clearly indicated.     

Alleviation of Side Effects and Distress in Breast Cancer Patients by Cognitive-Behavioral Interventions: A Systematic Review and Meta-analysis

Cognitive and behavioral interventions (CBI) have been used for breast cancer patients with various stages of the disease or undergoing different treatments. However, no quantitative review has summarized their efficacy on the side effects of treatment, distress, and quality of life in the acute treatment setting after diagnosis. This meta-analysis synthesizes data from 19 randomized clinical trials in order to: (a) provide an estimation of overall effect of CBI in breast cancer patients during treatment for breast cancer, i.e., neo-adjuvant and adjuvant treatment; (b) provide average effect sizes on side effects of treatment, distress, and quality of life; and (c) test possible moderators of effect size. The results show that CBI yielded a small effect size overall, specifically on general side effects of treatment, nausea, vomiting, distress, and quality of life. Individual and behavioral interventions seem to elicit better results on distress and on general side effects of treatment, respectively. While more studies are needed with regard to specific side effects (i.e., fatigue, pain, and sleep disturbance), the overall results clearly support the use of CBI in breast cancer patients during treatment.     

Helping the child with cancer: what school personnel want to know

As more children with cancer survive, the importance of facilitating school reintegration as a part of maximizing the quality of life has become evident. Workshops have been presented to school personnel to acquaint them with the issues facing cancer patients and their families, but there are gaps in our knowledge of what school personnel really need or want to know. In this study, 18 teachers of children with cancer and 15 teachers with no prior contact with students with cancer completed a questionnaire designed to assess needs, beliefs, and priorities with regard to working with cancer patients in the classroom. Significant findings included: (a) a consensus that a certain core of information about medical/psychological issues would be useful, and presentation of such information by psychologists and medical personnel working with such families would be optimal; (b) teachers having cancer patients as students were less likely to see the adaptation of siblings as an important issue; (c) teachers associated working with a student with cancer with less stress and demands on their time than predictable from previous studies; and (d) cancer patients as a whole were rated as having fewer behavioral, emotional, and learning problems than randomly selected students without a major illness, suggesting a "halo effect" or contradiction of some literature. Preliminary findings are detailed and implications are discussed for those attempting to help teachers facilitate students' adjustment to school following diagnosis and treatment of cancer.     

The public's perception of psychotherapy and counseling: Differential views on the effectiveness of psychologists,psychiatrists, and other providers

This study examined the public's perceptions relative to the effectiveness of psychotherapy and counseling, expectations of treatment efficacy for different psychotherapy and counseling providers (i.e., clinical psychologists, counseling psychologists, counselors, general medical practitioners, marital and family therapists, psychiatrists, self-help groups, and social workers), professional characteristics, and factors that may influence treatment utilization in an adult population. The sample viewed psychotherapy or counseling as moderately effective and perceived psychotherapy/counseling to be effective for 26 to 50 percent of all cases. The perceived amount of time necessary for noticeable improvement in psychotherapy or counseling was approximately four months, and the expected necessary length of treatment was approximately eight months. Participants stated they were moderately willing to seek psychotherapy or counseling if they were to experience a mental problem, and reported discernible differences among the eight psychotherapy/counseling providers in terms of treatment efficacy. Differences were also found in the relative perception of providers' personal/professional qualities and characteristics.     

Vicarious desensitization of test anxiety

students fail in the university environment due to an inability to perform in testing situations because of anxiety associated with tests (Suinn, 1968). Systematic desensitization has been found to be effective in the treatment of test anxiety, and attempts are being made to improve both the efficiency and effectiveness of this procedure (Mann and Rosenthal, 1969; Suinn and Hall, 1970). This study evaluates the relative effectiveness of four methods of systematic desensitization in the treatment of test anxiety. Specifically, two changes were investigated which may lead to: (a) more rapid forms of treatment (massed treatment versus distributed treatment); (b) more easily administered forms of treatment (vicarious desensitization versus active desensitization).     

Cognitive Behavioral Therapy for Bariatric Surgery Patients: Preliminary Evidence for Feasibility,Acceptability, and Effectiveness

Bariatric surgery is the most effective treatment for extreme obesity; however, 20% to 50% of patients begin to regain their weight within the first 1.5 to 2 years following surgery. Despite some psychosocial factors predicting postoperative weight loss and weight regain, psychosocial interventions are not routinely offered in bariatric surgery programs. In this paper, we describe a 6-session cognitive behavioral therapy (CBT) intervention for preoperative and postoperative bariatric surgery patients with maladaptive eating behaviors or thought patterns, which can be delivered either in person or by telephone. In addition, we describe a small pilot study (n = 8) designed to examine the feasibility and acceptability of the CBT intervention, as well as its effectiveness in improving eating pathology and psychosocial functioning. Most pilot study participants reported improvements in binge eating severity, emotional eating, and depression from pre- to posttreatment, and all participants provided positive qualitative feedback regarding the intervention.     

An integrated approach to delivering exposure-based treatment for symptoms of PTSD and depression in OIF/OEF veterans: preliminary findings

Combat-exposed military personnel from the wars in Iraq and Afghanistan report high rates of PTSD and associated psychiatric problems. A formidable body of research supports exposure therapy as a front-line intervention for PTSD; however, relative to studies of civilians, fewer investigations have evaluated the effectiveness of exposure therapy using military samples. Specifically, barriers to care (e.g., stigma associated with receiving mental health services ) may compromise utilization of evidence-based psychotherapy. As such, researchers have argued that veterans with PTSD may require an integrated and innovative approach to the delivery of exposure techniques. This paper presents the rationale for and preliminary data from an ongoing clinical trial that compares the home-based telehealth (HBT) application of a brief, behavioral treatment (Behavioral Activation and Therapeutic Exposure; BA-TE) for veterans with PTSD to the standard, in-person application of the same treatment. Forty OIF/OEF veterans with PTSD and MDD were consented, enrolled, and randomized to condition (BA-TE in-person, or BA-TE HBT) and symptoms of anxiety and depression were assessed at pre- and posttreatment. Participants in both conditions experienced reductions in depression, anxiety, and PTSD symptoms between pre- and posttreatment, suggesting that HBT application of an integrated PTSD treatment may be feasible and effective.