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This chapter discusses the development of anticipatory and nonpharmacological side effects associated with cancer chemotherapy. Research on anticipatory side effects of chemotherapy has generally focused on describing the parameters of the phenomenon and on methods of controlling or ameliorating it. Patients with anticipatory nausea/emesis reported higher levels of anxiety than patients who did not experience such side effects. Patients who had anticipatory symptoms also experienced greater emotional distress associated with treatment. Of course reported anxiety and distress may have resulted from, rather than have caused, anticipatory side effects. The conceptualization of the development of anticipatory side effects as the result of respondent conditioning has received the widest acceptance among researchers in the area. The acquisition of taste aversions in laboratory rats was originally demonstrated by Garcia and his colleagues. A similar phenomenon has been reported by researchers investigating the use of marijuana as an antiemetic with chemotherapy patients.

Cancer and its treatments can deleteriously affect memory. Cardiac function and insomnia can exacerbate memory problems.To examine the relationships among cardiovascular disease, insomnia, and self-reported memory problems (SRMP) in adult-onset cancer survivors.We included data from participants (41-64 year-old) of the 2007-2008 National Health and Nutrition Examination Survey, a nationally representative probability sample of the civilian, non-institutionalized population of the US. We excluded participants with brain cancer/stroke history since these conditions are expected to cause cognitive problems. Using binary logistic regression, we determined the prevalence of SRMP relative to cardiac problems and insomnia by weighting our results proportionally. We adjusted for predictors of memory problems: age, sex, race, education and general health.The sample included 2289 adults (49% females), 9% with a cancer history. The results pertain only to cancer survivors. Those with insomnia were 16 times as likely to have SRMP. Only insomnia symptoms (OR, 15.74; 95% CI, 1.73-143.30; p 0.01) significantly predicted SRMP, uniquely explaining 12% of the variance. Insomnia accounted for 18.8% of the association between cardiac issues and SRMP, demonstrating mediation (Sobel p 0.05). The large CI is a consequence of analyzing a sub-group of a subpopulation. Among participants without a cancer history, cardiovascular disease and insomnia were not associated with SRMP (p 0.05).We could not determine severity and time-related changes in SRMP.Likelihood of SRMP was higher in cancer survivors with a history of cardiovascular disease and insomnia symptoms. Future studies are needed to delineate the cardiac-insomnia-memory interrelationships.

Behavioral and psychosocial science has the potential to contribute much to the overall effort to reduce cancer morbidity and mortality and to improve the quality of life for cancer patients and their families. However, for a variety of reasons, including a lack of sustained funding for research and training and a lack of confidence by some in the potential payoff for investments in the area, this potential has not only not been realized but also not been adequately explored. A special subcommittee of “The March” Research Task Force studied research in this area and issued a report making several recommendations for future funding for psychosocial and behavioral research in cancer. This article reports those recommendations and the reasons the committee supported them.

Chemotherapy-related nausea and vomiting (NV) in 300 consecutive patients treated in community practices prior to the availability of 5-HT3 antiemetics (9/87 to 1/91) were compared with NV in a second sample of 300 patients treated after their commercial introduction (9/93 to 2/95). Eighty-six percent of the later patients received 5-HT3 antiemetics, and significantly fewer (43.3%) reported one or more episodes of posttreatment vomiting during their first four cycles of chemotherapy compared with those in the previous sample (55.0%: P.01). Identical numbers of both groups (79.3%) reported at least one episode of posttreatment nausea. A significant increase in the average duration of both posttreatment nausea (from 28.1 h to 37.2 h; P = 0.001) and posttreatment vomiting (from 10.9 h-16.5 h, P = .02) was found; no significant differences were seen in the reported severity of either symptom. The proportion of patients experiencing at least one episode of anticipatory nausea (31.0% vs 32.0%) or anticipatory vomiting (7.7% vs 6.3%) did not differ significantly (P0.5) between groups, nor were there significant differences in the duration or severity of anticipatory symptoms (P0.4 for all comparisons). The reduction in the frequency of posttreatment vomiting supports research findings of efficacy. Findings of an increase in duration of posttreatment nausea and emesis and no change in the frequency of posttreatment nausea or in anticipatory symptoms show a continuing need for progress in control of posttreatment emesis and emphasize the need for further research on the control of chemotherapy-induced nausea.

While problems with sleep and energy level (ie fatigue) are commonly reported during recovery from bone marrow transplantation (BMT), little in-depth information regarding these two problem areas in BMT patients is available. Using both questionnaire and telephone interview methods, information regarding current sleep and energy level problems was obtained from 172 adult BMT survivors drawn from five different BMT treatment centers. Respondents were a mean of 43.5 months post-BMT at the time of the initial assessment. Similar questionnaire data was obtained from 137 respondents (80%) at a follow-up assessment 18 months after the initial assessment. Results suggested that half to two-thirds of disease-free BMT recipients experience problems with regard to current energy level or sleep quality. While for the majority of patients these problems were rated as mild, 15-20% of BMT recipients showed moderate to severe problems in these areas with corresponding decrements in quality of life. Furthermore, both cross-sectional and longitudinal analyses suggested that problems in these areas did not simply abate with time. Only low to moderate correlations were obtained between indices of sleep and energy problems and measures of anxious and depressed mood. Finally, the presence of current sleep problems was associated with older age at BMT, receipt of TBI during pre-BMT conditioning, and female gender. Further research needs to address the specific etiology of chronic problems with sleep and energy level in BMT recipients as well as evaluate biobehavioral strategies for managing these problems.

Malignant tumors and their various treatments such as chemotherapy, radiotherapy and hormonal therapy can deleteriously affect a large number of cancer patients and survivors on multiple dimensions of psychosocial and neurocognitive functioning. Oncology researchers and clinicians are increasingly cognizant of the negative effects of cancer and its treatments on the brain and its mental processes and cognitive outcomes. Nevertheless, effective interventions to treat cancer and treatment-related neurocognitive dysfunction (CRND), also known as chemobrain, are still lacking. The paucity of data on effective treatments for CRND is due, at least partly, to difficulties understanding its etiology, and a lack of reliable methods for assessing its presence and severity. This paper provides an overview of the incidence, etiology, and magnitude of CRND, and discusses the plausible contributions of psychological, motor function, and linguistic and behavioral complications to CRND. Strategies for reliable neuropsychological screening and assessment, and development and testing of effective ways to mitigate CRND are also discussed.

Studies of the adverse effects of cancer chemotherapy often do not distinguish between delayed and persistent nausea and emesis. Although persistent nausea is simply acute nausea that continues beyond the treatment day, postchemotherapy delayed nausea and delayed vomiting first develop after an initial 24 h free of these symptoms. To access its occurrence in clinical practice, we conducted a structured examination of chemotherapy-induced delayed nausea and emesis in consecutive chemotherapy patients unselected for diagnosis, chemotherapy, or antiemetic usage. Three hundred twenty-seven consecutive with histologically confirmed cancer were followed through three consecutive chemotherapy treatments at three geographically separate institutions. Patient-reported assessments of nausea and emesis were made for each 6-h period over 3 days after chemotherapy. One in three patients developed delayed nausea and one in four incurred delayed emesis. Of >950 chemotherapy treatments assessed, approximately 1 in 6 were characterized by delayed nausea and 1 in 9 by delayed vomiting. We conclude that nausea and emesis that first begin >24 h after chemotherapy are a significant clinical concern. Patients receiving cancer chemotherapy without being admitted to the hospital should be informed of the possible occurrence of delayed nausea and vomiting and be given adequate and appropriate antiemetic medication for use at home for the prevention of these delayed side effects.

Research on health locus of control (HLC; Wallston, Wallston and DeVellis, 1978; Wallston, Wallston, Kaplan and Maides, 1976) suggests that beliefs concerning health outcomes are associated with various health-related variables such as mood, physical symptoms, adherence to medical regimens, use of preventive health behaviors and utilization of health care services (see Wallston and Wallston, 1981 and Wallston, Wallston, Smith and Dobbins, 1987 for reviews). HLC refers to the degree to which people view health outcomes as contingent on various forces in their lives and is derived from Rotter's (1954, 1966) social learning theory.

Questionnaires assessing a range of quality of life (QOL) outcomes were completed by 200 adult bone marrow transplant (BMT) recipients from five BMT treatment centres. Respondents had undergone allogeneic (46%) or autologous BMT (54%) for a haematological malignancy and were disease free and at least 12 months post BMT (mean 43 months). Variability in post-BMT QOL was reported with deficits in physical, sexual and occupational functioning particularly likely. Allogeneic recipients reported poorer QOL than autologous recipients. Greater age at BMT, lower level of education and more advanced disease at BMT were consistent risk factors for poorer QOL. Contrary to previous research, evidence for improved functional status with the passage of time post BMT was obtained. Factors generally not associated with post-BMT QOL included disease diagnosis, dose of total body irradiation, presence of chronic graft-versus-host disease (GVHD), type of GVHD prophylaxis and extent of marrow graft match. In conclusion, while many BMT recipients reported normal QOL, the majority indicated that their QOL was compromised relative to premorbid status. Prospective, longitudinal research will be necessary to further identify risk factors for poor post-BMT QOL and identify the temporal trajectory of post-BMT QOL.

A major thrust in psychosocial oncology has been to use psychosocial and behavioral techniques to prevent and manage the adverse symptoms associated with cancer and its treatment. This article defines the field of symptom management in psychosocial oncology and reviews its early and recent history. Recent progress in the field is reviewed, with a focus on several thematic advances in theory and practice. Finally, an agenda is suggested for the next decade of research, with attention given to research needs, research policy, and training issues.

Sixty cancer chemotherapy patients were randomly assigned to one of six conditions formed by a 3(cognitive distraction, relaxation training, no intervention) x 2(high anxiety, low anxiety) factorial design. All patients were followed for five consecutive chemotherapy sessions. Outcome measures included patient reports, nurse observations, and physiological indices. Results indicated that distraction patients reported less nausea prior to chemotherapy and lower systolic blood pressures after chemotherapy than controls. Relaxation training patients reported less nausea prior to chemotherapy and exhibited lower systolic and diastolic blood pressures after chemotherapy than control patients. There were no significant differences between distraction and relaxation training patients on any measure. Patients with high initial levels of anxiety exhibited continually elevated levels of distress throughout the chemotherapy experience; however, anxiety level did not interact with the effectiveness of the treatment interventions. Overall, the data support the use of both cognitive distraction and relaxation training for reducing the distress of chemotherapy with both high and low-anxiety patients and suggest that at least some of the effects of relaxation training can be achieved with distraction alone.

A major thrust in research in psychosocial oncology is the study of the interaction of psychologic and physiologic variables. This discussion reviews the current status and future directions of such research. Areas addressed include pain, nausea and vomiting with chemotherapy, sexuality, effects of cancer on psychologic and neuropsychologic function, impact of psychologic factors on cancer and its treatment, and psychoneuroimmunology. In addition, specific recommendations for strategies to facilitate research in these areas of psychosocial oncology are proposed.

A major component of the Second Workshop on Methodology in Behavioral and Psychosocial Cancer Research was a discussion of enabling strategies, that is, strategies by which future goals and needs in the area of psychosocial and behavioral oncology might be accomplished. This report describes and comments on the discussion that took place at a special plenary session at which representatives from four funding agencies, the American Cancer Society, National Cancer Institute, National Institute of Mental Health, and National Science Foundation, presented their views and their agencies' programs for promoting research in psychosocial and behavioral oncology. It is concluded that much progress has been made in the field and that strategies are in place for ensuring continued progress. However, suggestions are also made for new strategies that might accelerate and broaden that progress.

e17613 Background: Accurate evaluation of patient satisfaction is an important dimension of quality of cancer screening and treatment. We applied ordinal logistic regression to assess uniform, non-uniform and total Differential Item Functioning (DIF) for the Patient Satisfaction with Cancer-related Care (PSCC) measure items in English vs. Spanish speaking cancer patients. Methods: The sample included 18 to 86 years old patients who completed the PSCC in English (N = 1067; 82.5% female) and Spanish (N = 229; 100% female 100%). We used total scale score and latent satisfaction estimate separately as matching variable to assess uniform, non-uniform, and total DIF for the PSCC items using ordinal logistic regression analysis. We used language as the grouping variable, i.e., the English speaking group is the reference group and the Spanish speaking group the focal group. Results: Using the total scale score (TSS), we found uniform DIF for 10 out of 29 PSCC items. For example, item 1 showed uniform DIF (χ2 = 5....

It is fitting that, in this year when our campus is focused through the Notre Dame Forum on issues of sustainability and responsible stewardship of the earth’s resources, we celebrate the centennial of the University’s oldest scholarly journal, The American Midland Naturalist. For 100 y, since it was started in 1909 by the Rev. Julius Nieuwland C.S.C., this journal has been a unique Notre Dame contribution to scientific understanding of the earth, its creatures and its natural systems. As president and provost of the University, we are pleased to pay tribute to The American Midland Naturalist, to Dr. William E. Evans, the current editor, and to all who over the years have had a hand in creating it, sustaining it and maintaining its reputation. When Father Nieuwland created The American Midland Naturalist, he did so with the intent of providing an outlet for studies about the natural history of the American Midwest. But both the subject matter and the geographic reach of the journal’s articles soon grew beyond the bounds suggested by the title. Before it was even 15 y old, the journal was publishing material about subjects far from the Midwest, and the broad field of ‘‘natural history’’ was giving way to specialized fields of study and investigation. Most notable among those was the budding field of ecology. Already in those early days there was a recognition that activities in one sector of the environment were fundamentally inseparable from those in others. To page chronologically through the 160 volumes of The American Midland Naturalist is to observe the growth and development of biological science over the last 100 y. From an abundance of articles in the early years describing and classifying plants, animals, other organisms and fossils in their natural states and habitats, the journal’s contents have, like science itself, grown more numeric in their approach and more experimental. Occasionally the experimentation has been of unusual and daring nature. A former editor, Robert P. McIntosh, in a history of the journal’s first 80 y, observed that the ‘‘devotion of natural historians to their cause was evident in [a 1971 article] when a panel of human tasters was assembled to determine the relative palatibility (sic) to predators of tadpoles from Costa Rica.’’ Both in its early years and more recently, The American Midland Naturalist has published some of the most eminent biological scientists of their times. Besides Nieuwland, who achieved his greatest fame in chemistry, but had a lifelong passion for botany, the early eminences who graced the journal’s pages included E.L. Greene, the legendary plant taxonomist and historian of botany with whom Nieuwland had studied at Catholic University of America and later was a colleague at Notre Dame, and Lucy Braun, a plant ecologist who was to become the first woman president of the Ecological Society of America. The farsightedness of The American Midland Naturalist and its then editor Theodore Just was demonstrated in Volume 21, No. 1, published in 1939. Virtually the entire number was given over to contributions from a landmark conference, ‘‘Plant and Animal Communities,’’ held in August and September 1938 at Cold Spring Harbor, N.Y. Described later as an ‘‘ecological audit,’’ the conference was, in McIntosh’s words, ‘‘an attempt to bridge the gaps between American and European ecologists, plant and animal ecologists and aquatic and terrestrial ecologists.’’ Ultimately, he said, the conference ‘‘failed Am. Midl. Nat. 161:5–6

This report identifies five general conclusions that emerged from the Second Workshop on Methodology in Behavioral and Psychosocial Cancer Research. These conclusions address diverse topics, including a focus on areas other than methodology; an emphasis on the transfer of technology and knowledge to applied settings; a recognition of the role of basic behavioral research in answering clinical questions; the need to recognize and strengthen ties between the field of behavioral and psychosocial oncology and the basic behavioral and social science fields from which it emerged; and the importance of additional research on minorities and other special populations. It is suggested that meeting the challenges posed in each of these five areas is critical to continued progress in the field.

Cancer is, in many ways, a behavioral problem. Since researchers estimate that we could prevent, or at least successfully treat, more than half of all cancers if people changed their behaviors so as to reduce risk of developing the disease and increase likelihood of early detection and treatment if it does develop (Tubiana, 1991). In addition to prevention and early detection, psychosocial and behavioral factors play a role in determining quality of life once individuals develop cancer, degree to which individuals can successfully manage some treatment-related symptoms and perhaps even outcome of treatment.

A less-than-optimal proportion of patients with cancer are entered into National Cancer Institute-sponsored clinical trials. This article reviews the literature on accrual in oncology clinical trials to characterize the extent of the problem, identify reasons for low accrual, and suggest ways to promote accrual. Four well known theories of health behavior (the Health Belief Model, Subjective Expected Utility Theory, Protection Motivation Theory, and the Theory of Reasoned Action) point to central concepts involved in understanding patient health-related behavior: (1) the probability that an unwelcomed health event will happen to a patient, (2) the severity of that event if it does occur, (3) the effectiveness of a particular behavior (such as taking part in a clinical trial) to modify the severity, and (4) the cost of adopting that behavior. These concepts form a framework for integrating the available information about accrual to clinical oncology trials. Patient and physician factors previously related to clinical trials suggest specific recommendations for increasing accrual to clinical oncology trials.

Cancer patients receiving chemotherapeutic treatments often experience unpleasant side effects that compromise the quality of their life and may be so severe that they lead to suboptimal drug dosages, missed treatments, or even discontinuation of treatment. In recent years it has been discovered that some of these side effects result from maladaptive learning. This article reviews over 10 years of research conducted at Vanderbilt University on the prevention and treatment of these psychological side effects. This research includes the assessment of the efficacy of a behavioral relaxation technique, the exploration of procedures that make this intervention clinically practical for widespread application, research aimed at predicting which patients will and will not benefit from the intervention, and the comparison of this intervention to alternative treatment approaches. The review of this research generates four major conclusions and points to several important areas for future inquiry.

The fear of cancer is largely the fear of pain. The reason is clear: Most cancer patients will experience pain either as a result of the disease process itself or as a result of the diagnostic and treatment procedures to which they are subjected. Given that approximately 30% of Americans will develop cancer [1], it is therefore not surprising that cancer pain has been described as one of the most pressing problems facing society today [2].

Chemotherapie ist die Behandlungsmethode der Wahl fur Hunderttausende Krebspatienten, die jedes Jahr in den USA diagnostiziert werden (Silverberg u. Lubera 1986). Ihre haufige Anwendung bei Krebspatienten erklart sich aus der Tatsache, das in jungster Zeit auf dem Gebiet der antineoplastischen Medikation Fortschritte gemacht wurden; neue und effektivere Medikamente haben zu einer erhohten Lebenserwartung der Patienten gefuhrt und — in einigen Fallen — zu Remission und Heilung. Leider ist dieser langfristige Gewinn fur den Krebspatienten mit betrachtlichen kurzfristigen Kosten in Form von aversiven und beeintrachtigenden Nebenwirkungen verbunden. Die haufigsten dieser medikationsbedingten Nebenwirkungen sind Haarausfall, Stomatitis, Immunsuppression, Appetitlosigkeit, Ubelkeit und Erbrechen. Auser diesen pharmakologischen Nebenwirkungen erfahren Chemotherapiepatienten auch psychologische Nebenwirkungen.

Pain is one of the most feared consequences of cancer, often causing significant psychological distress to the patient. The purposes of this paper are (a) to discuss the psychological implications of cancer-related pain, (b) to offer conceptual explanations of the roles behavioural interventions mayplay in reducing cancer-related pain, and (c) to review studies examining the effectiveness of behavioural interventions in reducing cancer-related pain. Clinical issues raised by recent research are addressed, and suggestions for future research are offered. It is concluded that behavioural techniques may serve as a useful adjunct to traditional medical interventions for cancer pain, although considerably more methodologically rigorous research is needed to determine the nature and extent of treatment efficacy.

After receiving a sample shock, subjects in a Threat Condition were told that they would receive additional painful shocks while subjects in a Nonthreat Condition were not threatened with additional shocks. Subjects in an Attentional Diversion Condition were then instructed to read and think about an amusing story, subjects in a Situation Redefinition Condition were instructed to write down reasons why they should not be afraid in this situation, and subjects in a Control Condition were not given any instructions for coping with stress. (Coping Conditions were factorially crossed with Threat Conditions and 192 subjects were employed.) Physiological measures (pulse rate, finger pulse volume, skin resistance) indicated that unlike the results of previous research, attentional diversion was effective in reducing stress but situation redefinition was not. Discussion was focused on the parameters which determine whether or not a coping strategy will be effective.

Progressive muscle relaxation training was used to reduce the conditioned negative responses developed by a 30-yr-old cancer patient undergoing chemotherapy treatment. In a design that included Baseline, Phase 1 therapist-directed relaxation. Phase 1 patient-directed relaxation, Phase 2 therapist-directed relaxation, and Phase 2 patient-directed relaxation sessions, the patient underwent therapist-directed or self-directed relaxation training immediately before and during 10 consecutive chemotherapy treatments. Results indicated tha during the therapist-directed phases and one or both of the patient-directed phases the patient showed reductions in negative affect, frequency of vomiting, and post-session physiological arousal. It was concluded that progressive muscle relaxation training may be an effective procedure for reducing the adverse side effects of cancer chemotherapy.

Two experiments were conducted to investigate the sensitivity of frontal EMG to increased arousal. In Experiment 1 subjects who were aroused by a physical threat (electric shock) showed changes in skin temperature and self-report of arousal, but did not show changes in frontal EMG. In Experiment 2 subjects who were aroused by an evaluative threat (poor performance on an important intelligence test) showed changes in skin temperature, pulse rate, finger pulse volume, and self-report of arousal, but again failed to show changes in frontal EMG. The finding that frontal EMG was not sensitive to increases in arousal is inconsistent with what has generally been assumed and suggests that frontal EMG biofeedback training may not be effective for teaching persons to reduce high levels of arousal.

In Phase One, 44 subjects participated in a 2 (instructions to increase alpha, no instructions to increase alpha) × 2 (alpha biofeedback, no alpha biofeedback) factorial experiment. Results indicated that increases in alpha production were due to instructions to increase alpha and that biofeedback had no effect on alpha production. In Phase Two, the 44 subjects from Phase One were exposed to a threat of shock whereas 11 additional subjects in a control condition were not. The design employed in Phase Two was a 2 (previous instructions and stress, no previous instructions and stress) × 2 (previous biofeedback and stress, no previous biofeedback and stress) plus 1 (no previous instructions/no previous biofeedback, no stress). Results indicated that the threat of shock was effective in increasing arousal (as measured by heart rate and skin resistance) but previous EEG-alpha biofeedback training was not effective in helping subjects decrease arousal while in the stressful situation. The results indicate that it is the instructions (and related information concerning alpha) rather than the biofeedback that is critical in alpha biofeedback training and that this training does not appear to have utility for controlling arousal under stress.

Forty-eight male normal drinkers were given a beverage to drink containing either tonic plus alcohol or tonic alone, and then were asked to perform arithmetic problems under either stressful or nonstressful conditions. Self-report measures of positive and negative affect and actual measures of physiological arousal (pulse rate and finger pulse volume) were collected at four times: baseline, ascending limb of the blood concentration BAC curve. Results indicated that (a) the stress manipulation was effective in increasing negative and actual physiological arousal, (b) subjects were more accurate in estimating the amount of alcohol they consumed under stressful than under nonstressful conditions, (c) alcohol was not effective in reducing the negative affect or physiological arousal produced by the stress, and (d) alcohol was effective in reducing negative affect and increasing positive affect under nonstressful conditions. These results support the growing body of research that suggests that alcohol produces a complex pattern of responses, one of which may be the enhancement of mood under nonstressful conditions.

Cancer patients receiving chemotherapeutic treatments routinely experience a wide range of distressing side effects, including nausea, vomiting, and dysphoria. Such symptoms often compromise patients1 quality of life and may lead to the decision to postpone or even reject future, potentially life-saving, treatments. In this article, we discuss the hypotheses that have been offered to explain the development of such symptoms. We also review, in greater detail, the research evidence for the efficacy of five treatments for such symptoms: hypnosis, progressive muscle relaxation training with guided imagery, systematic desensitization, attentional diversion or redirection, and biofeedback. We discuss the implications of this treatment research, paying particular attention to factors associated with treatment outcome, mechanisms of treatment effectiveness, and issues associated with clinical application.

The effectiveness of causal projection and similarity projection in controlling stress associated with threat to self-esteem was investigated. To induce threat to self-esteem, half of the subjects were told that they had done poorly on an important achievement test while the remaining subjects were not told that they had done poorly. The projection strategies were manipulated by encouraging subjects to attribute the cause of their poor performance to the examiner instead of to themselves (causal projection) or to estimate how poorly their friends would have scored on the test had they taken it and not performed well on it (similarity projection). Measures of subjective anxiety, depression, and anger indicated that (a) the testing situation and negative feedback were effective in increasing stress, (b) causal projection was effective in controlling stress, and (c) similarity projection was partially effective in controlling stress. The results provide evidence that causal projection can be effective in controlling stress and also have implications concerning the conditions under which the use of projection will and will not be effective for coping with stress. The importance that situational factors may have on the effectiveness of cognitive coping strategies was emphasized.

Threatened Ss in five stress groups with electric shock, while Ss in a sixth group were not threatened. In one of the stress groups Ss were encouraged to project causality for their feelings that resulted from the threat of shock to the E instead of to the shock, while Ss in the remaining stress groups were not encouraged to project causality for the threat-produced affects to the E. Physiological and self-report measures indicated that Ss who projected their anxiety and nervousness to the E were just as distressed by the veridical source of arousal as were Ss who did not project. Implications of these results for the hypothesized stress-reducing effectiveness of complementary projection were discussed.

A total of 62 cancer chemotherapy patients completed the Multidimensional Health Locus of Control (MHLC) scale prior to receiving training in progressive muscle relaxation and/or biofeedback for the reduction of the side effects of their treatment. Physiological measures of arousal and patient-reported indices of negative affect and nausea were collected during baseline, training, and follow-up chemotherapy sessions. Results indicated that following relaxation training and/or biofeedback, chemotherapy patients with a high external health locus of control orientation, as compared to patients without such an orientation, had lower levels of physiological arousal and reported less negative affect. These findings suggest that in medical situations in which little personal control is possible, an external health locus of control may be advantageous.

In a study of the antiemetic effectiveness of high-dose oral metoclopramide, 66 previously untreated patients receiving 60 mg/m2 cisplatin were entered into a double-blind randomized trial. Patients were stratified according to age and tumor type, then randomized to receive either oral or intravenous (IV) high-dose metoclopramide. Patients were evaluated for antiemetic protection, toxicity, affect (anxiety, hostility, and depression), and autonomic arousal (pulse rate and blood pressure) at three-hour intervals on the day of their chemotherapy. Metoclopramide serum levels were measured by high-performance liquid chromatography. Results indicated no significant differences between the oral and IV groups on any measurement of antiemetic protection, affect, or autonomic arousal. There were also no significant differences in side effects except for frequency of stools; patients who received oral metoclopramide had significantly more stools than patients who received IV metoclopramide. The mean (+/- SD) serum metoclopramide level at four hours achieved orally was 1,171 +/- 660 ng/mL; the mean (+/- SD) level achieved IV was 1,030 +/- 392 ng/mL (P = .498). We conclude that high-dose oral and IV regimens of metoclopramide as administered in this study have equivalent antiemetic efficacy in previously untreated patients receiving 60 mg/m2 cisplatin.

During the training phase, 36 subjects received (a) EMG biofeedback from multiple muscle sites, (b) EMG biofeedback from the frontal site, or (c) no biofeedback. Results indicated that neither biofeedback procedure reduced self-reports of anxiety, but that multiple-site biofeedback was effective in reducing several indices of autonomic arousal (pulse rate, finger pulse volume, and skin temperature) while frontal biofeedback was not. During the generalization/stress phase, all subjects were threatened with and received electric shocks and were told to apply the relaxation techniques they learned during the training phase even though no additional biofeedback would be provided. Results indicated that multiple-site biofeedback was effective in reducing self-reports of anxiety and autonomic arousal but that frontal biofeedback was not. These results confirm previous data indicating that frontal biofeedback is not an effective procedure for controlling stress, but suggest that EMG biofeedback can be effective in reducing self-reported anxiety and autonomic arousal if a multiple muscle-site feedback procedure is employed.

In this paper, we suggest that health psychology has provided a productive forum for the integration of social and clinical psychology. The very nature of the field has prompted researchers to break out of traditional roles and has stimulated the cross-fertilization of ideas. We provide examples from two research areas—health-specific denial and health locus of control—in order to illustrate the potential benefits and pitfalls of integrative research within health psychology.

Cancer patients who had developed negative conditioned responses to their chemotherapy either did (relaxation training) or did not (no relaxation training) receive progressive muscle relaxation training and guided relaxation imagery instructions immediately before and during their chemotherapy treatments. Physiological (blood pressure and pulse rate) measures of arousal, frequency of vomiting, and patient-reported and nurse-reported indices of negative affect and nausea were collected during pretraining, training and posttraining chemotherapy sessions. Results indicated that during both the training and the posttraining sessions, patients in the relaxation training condition reported feeling less emotionally distressed and nauseated, and showed less physiological arousal following the chemotherapy infusion, than patients in the no relaxation training condition. The attending nurses' observations confirmed the patients' self-reports. No differences were found in frequency of vomiting between conditions. These data clearly suggest that the use of relaxation procedures may be an effective means of reducing several of the adverse side effects of cancer chemotherapy.