Occupational Health Psychology

bundet

578 Occupational Health Psychology the OHC serves an integrating function by bringing together the multiple support services in the organization to form a multidisciplinary team. Change management or stress man- agement teams have been shown to be effective tools for building organizational health (Murphy, 1988). By including management and labor representatives on the team, decisions made can be implemented into action more readily. Organizational Consulting OHC staff work with individuals, work teams or units, and the larger organization. The baseline provides overall organi- zational data for initial planning. However, much of the real work is conducted at a work unit level. OHC staff consult with individual work units, conducting evaluations and inter- ventions into the speci“c dynamics and issues arising in the work team. Organization development processes, both tech- nostructural and process consulting (Beer & Walton, 1990; Schein, 1988), are used in business units experiencing prob- lems, those at high risk for problems, as well as those desir- ing to enhance functioning. The Sacramento OHC used an organizational health assessment (OHA) process to diagnosis work unit problems and aid management and labor represen- tatives in developing a plan for intervention. Using that information, work unit impact teams were convened to im- plement the change process. Repeat OHAs at the end of six months and one year provided outcome information on which to base decisions on change program continuation or modi“cation. Team development and management-coaching strategies conducted for all business units complemented the more intensive organizational intervention strategies. At a broader, organizational level, the Sacramento OHC facilitated development of a labor-management partnership council as a proactive problem-solving body (Schwartz & Adkins, 1996). A partnership council brought together labor and management leaders prior to organizational changes so that consensus could be achieved in advance rather than con”icts resolved after the fact. The successful functioning of the council reduced grievances and unfair labor practice complaints. In many ways, the partnership council also served as a board of directors for the OHC, further integrat- ing organizational health programs into the business culture and providing a powerful champion for OHC-recommended policies and practices. Information Broker Information ”ow in organizations is notoriously inef“cient and ineffective, but essential for development of a sense of control for individual workers. OHC staff facilitate the ”ow of information and “nd ways to ensure that accurate informa- tion is conveyed and that systems and methods of communi- cation function effectively. Targeted Training and Prevention OHC program development is not intended to overstep the domains of other human resources and personnel support services. On the contrary, targeted areas include situations that fall across disciplinary lines or that may be neglected by current functions in the organization. Common examples include suicide prevention, workplace violence prevention, con”ict mediation, and training of the general workforce, as well as support personnel in occupational stress, organiza- tional change, and organizational health. Worksite Support Supervisory and social support, both peer and family, have demonstrated utility in reducing the negative impact of both occupational and personal stress. The OHC functions to bring enhanced support services to the workforce, increasing avail- ability and evaluating the effectiveness of available services in meeting the needs of a changing workforce. Support is provided through employee assistance programs, workplace health promotion, worksite stress management, peer counsel- ing, and occupational health and safety, including occupa- tional mental health services. Surveillance, Monitoring, and Evaluation OHC programs and policies are extracted from the literature available and targeted using epidemiological estimates, base- line information, and organizational assessment data. Process and outcome measures demonstrate the value of ongoing pro- grams and advocate an improved work environment. Bring- ing together metrics from across all levels of assessment, surveillance, and evaluation and across disciplinary lines in the organization enables a comprehensive look at organi- zational health and effective ongoing planning for improved organizational wellness. The Sacramento OHC incorporated assessment, forma- tive, and summative evaluation strategies at the work unit and overall organizational levels. Needs assessments focused on organizational risk factors and individual vulnerabilities, as well as protective factors or capacity at both levels. The state of strain or signs and symptoms of ill health were also evaluated and monitored. Outcome measures at a corporate level included health care utilization rates, workers• compen- sation costs, and productive years lost to behaviorally related Training in Occupational Health Psychology 579 illness and injury. The “rst year of operations found positive trends in all measures. Over the course of that year, the OHC staff made more than 10,000 individual employee contacts and conducted over 250 organizational consultations. Cus- tomer satisfaction in every case was rated as excellent. Outcome data indicated a 4% reduction in workers• com- pensation claims following a doubling of claims experience the previous “ve years and exceeding the organizationally set goal of a 3% savings, a 58% reduction in behaviorally related mortality, and a 12% reduction in lost productivity associated with health care utilization for job-related illness and injuries. TRAINING IN OCCUPATIONAL HEALTH PSYCHOLOGY The National Institute for Occupational Safety and Health de“nes OHP: •Occupational health psychology concerns the application of psychology to improving the quality of work- life and to protecting and promoting the safety, health and well-being of workersŽ (Sauter et al., 1999). This rather broad de“nition incorporates a large array of potential risk factors as well as numerous factors that could enhance safety and health in the workplace. Programs being developed in the United States and those that have been founded in The Netherlands, Sweden, and the United Kingdom have several common elements. The European programs typically focus on organizational risk factors for stress, illness, and injury and work redesign as the primary intervention. U.S. pro- grams may be more varied at present because of their early stage of development. In this section, we present a model for training in OHP that we believe re”ects the de“nition of OHP, the underlying philosophy of OHP, and incorporates many of the common elements of U.S. and European programs. The de“nition of OHP includes two dimensions: the pro- tection from harm and the promotion of health. This bifurca- tion mirrors the de“nition of health as the absence of illness versus health as something more than simply the absence of illness (Downie & Macnaughton, 1998; Raphael, 1998).Thus, it is important that training in OHP recognize the in”uence of organization of work factors in both the reduction of illness and injury and the enhancement of health and well-being. Underlying the philosophy and development of OHP is the multidisciplinary approach to understanding the work en- vironment, behavior of individuals in that environment, and the interaction between the work environment and their be- havior that results in physical and psychological well-being. Ilgen (1990) recognized that disciplines and specialties within disciplines view problems and generate solutions based on their own perspectives. Understanding a complex phenomenon such as health in today•s complex work envi- ronments requires not only knowledge of key content areas in psychology but also an awareness of other relevant content areas and disciplines. This awareness, coupled with leader- ship and communication skills, allows occupational health psychologists to bring together and lead a team with the nec- essary skills to address the complexity of the concerns with- out being blinded by their own disciplines. In this framework, a training model for OHP that ac- knowledges content areas to be covered and skills to be de- veloped can be visualized. The list of content areas is indeed long. If we consider the risk factors for occupational stress that have been compiled (e.g., the review by Kahn & Byosiere, 1992), there are multiple disciplines and specialties that can contribute to OHP. Industrial and organizational psychology, clinical psychology, life-span developmental psychology, and social psychology offer relevant knowledge as re”ected in Volumes 5, 6, 8, and 12 of this Handbook. Topics that might be incorporated in a graduate level OHP seminar would typically include occupational stress and burnout, job and work design, social support, organizational health, health psychology, occupational safety and health hazards, job security, work-nonwork balance, and individual differences. In addition, other disciplines can contribute to our under- standing of organizational risk factors and individual behav- ior as they relate to health and safety. These include the biological and health sciences, economics, engineering, in- dustrial relations, management, and law. Therefore, training in OHP should cut across academic departments. This may be accomplished by establishing collaborative arrangements with other departments or institutions so that students can take courses in safety engineering, occupational safety and health law, con”ict resolution, epidemiology, and human re- sources management and policies. Because the list of relevant topics is long, it is probably unrealistic to expect any individual to be an expert in all pos- sible areas. Rather, individuals need to have suf“cient aware- ness of other disciplines so that they can recognize the need to enlist team members with the appropriate knowledge. They also should develop leadership skills and team-building skills to manage the occupational safety and health function in organizations. These skills are probably best developed through internships and practica. Formal training in OHP is just getting underway. Some academic education in stress and occupational health has been offered at the undergraduate level (e.g., at the United States Air Force Academy). Courses at the master•s level have been offered at several schools (e.g., University of 580 Occupational Health Psychology California…SanFrancisco & Irvine, University of Hawaii, University of Houston, University of Nottingham, Oklahoma State University, The University of Texas at Arlington, and Xavier University). By 2001, universities that have incorpo- rated courses in OHP and/or minors at the doctoral level include Bowling Green State University, Kansas State University, University of Minnesota, University of Houston, Tulane University, Clemson University, Portland State Uni- versity, and University of California…LosAngeles. Schneider, Camara, Tetrick, and Stenberg (1999) discuss the role of postdoctoral educational, for example, funded for several years through the APA/NIOSH postdoctoral fellowships and the U.S. Air Force postdoctoral OHP fellowship at Harvard Medical School in 1998…1999.In addition, there now exists a European Academy of Occupational Health Psychology (www.ea-ohp.org). A CASE STUDY The preferred point of intervention from a public health standpoint is always primary prevention and, as applied in OHP, this generally translates to organizational intervention. The use of the term clinical is often associated with treatment and therapeutic settings, yet it has important applications for more diagnostic and intervention applications in organiza- tions (van de Loo, 2000). Thus, this case application of OHP by a clinical psychologist in an organizational context draws heavily on the public health notions of surveillance and pre- vention, exemplifying the inherently interdisciplinary nature of OHP. This section reviews the origins and role of an OHP pro- gram at a major military installation during the downsizing period preceding base realignment and closure, with the at- tendant risks and possible negative consequences associated with major industrial restructuring activities. With closure of a major facility, a multitude of anticipated coping problems may result from a signi“cant change in routine and expected way of living. These problems include the potential for in- creased substance abuse, increased family and/or interper- sonal violence, and increased potential for suicide (Adkins, 1998). History and Role of Organizational Health Psychology at Kelly Air Force Base An OHP program for Kelly Air Force Base (AFB) had been in a conceptual stage since 1994. At that time, the Base Realignment and Closure (BRAC) committee was evaluating military facilities for possible elimination as part of an ongoing military downsizing effort. This process had a nega- tive in”uence on the overall productivity and morale of the base. With the July 1995 announcement that the base would be closed in July 2001, senior leadership on the base became increasingly concerned about the potential impact of the stress of transition and closure. By placing a full time, active duty Air Force psychologist on his executive staff, the installation commander endorsed a proactive approach. The psychologist was to oversee relevant aspects and inte- gration of the necessary services required to manage the impending downsizing and closure, a major restructuring event that placed the well-being and mental health of the work population at risk. More precisely de“ned, the organizational clinical psy- chologist directed all phases of an Air Force industrial operational program, managing the program to increase pro- ductivity and teamwork and to reduce psychosocial work hazards. The psychologist also (a) led systems-focused, com- prehensive intervention programs, (b) coordinated base and community activities, © evaluated the workplace to identify pertinent negative stressors to be eliminated and positive fac- tors to be retained or added, and (d) promoted positive orga- nizational behavior as a key manager on the executive team. Workforce Composition The OHP position, initiated in March 1997, was “lled by an active duty Air Force clinical psychologist. At that time, the 12,000-member San Antonio Air Logistics Center workforce represented the largest industrial complex in the southwest- ern United States. This workforce re”ected the overall Hispanic demographic composition of the city of San Antonio. More than 60% of the Kelly employees were Hispanic. The Kelly population represented 48% of the total Air Force civilian Hispanic workforce and 14% of Depart- ment of Defense (DOD) Hispanic employees. It was the single largest group of civilian Hispanic personnel located at any one DOD facility or installation. The average Kelly employee was a 47-year-old Hispanic male blue-collar WG-9 (wage grade) worker with 19 years of service. He was earning approximately $29,829 per year, plus additional personnel bene“ts, with generous overtime avail- able. He was a high school graduate, a Vietnam combat vet- eran, whose father, and maybe even grandfather, had been a Kelly career employee. He was married and had a mid-sized family, which, based on local de“nitions, included four or “ve children. The Hispanic culture and heritage is a deeply integrated aspect of local life and is re”ected in most aspects of what in- dividuals do and how they react to situations. As determined A Case Study 581 by individual and small group discussions, these cultural as- pects played a signi“cant role in the existent problems of transition, downsizing, and closure. Cultural Issues and Dilemmas Certain positive facets associated with the Hispanic culture, including deep family, emotional, and cultural roots, pervade most aspects of Hispanic life. It is not unusual to see three gen- erations of a family, as well as their siblings, living in proxim- ity. Decision making is based on an executive corporate management style with signi“cant consideration given to the overall impact on the entire family structure. The close family cohesiveness provides for a very good support system, especially during times of turmoil and crisis. Members de- velop a great emotional dependency on the extended family network and respectfully take the advice of the family corporate council. However, this signi“cantly integrated family system can place great emotional strains on the individual who may en- tertain thoughts of change, especially geographic relocation. There is a tendency toward a generalized rigidity in this so- cial system resulting from a perceived inability to leave the family network. These barriers to relocation may affect the individual, the spouse, or both. Even if the worker was will- ing to leave the area for continued Civil Service employment and bene“ts, the spouse would often refuse to accompany him to avoid breaking overall family and community ties, leading to increased strain and domestic discord. Therefore, the worker found himself facing additional dilemmas. He would have to face added increased conditional stressors, such as marital and family separation or divorce unless a compromise could be reached. The degree of compromise might appear to be rather one-sided. As an example, one per- ception among groups of workers at Kelly was the idea that a relocation to Tinker AFB in Oklahoma was better than the perceived option of relocation to Robins AFB in Georgia. This was because Tinker was considered to be within week- end commuting distance even though it was 488 miles away. Course of Transition During the transition process, the workforce experienced several cycles of upheaval and recovery. Initially, a pervasive sense of overt optimism helped carry many workers over the low points. This optimism had been reinforced by infrequent, yet signi“cant, perceptions of potential salvation from job loss. The initial downsizing focus was on the 1,400 workers of the aircraft maintenance branch. During the “rst major reduction in force (RIF), focus groups and individual con- tacts indicated a popular and consistent belief that Kelly would be removed from the base closure list by the executive branch of the government. This perception was maintained by the belief that Kelly was currently the oldest functioning Air Force base, had the largest and most modern structures for the maintenance of a prevalently used aircraft, and, not in- cidentally, had the largest Hispanic population in the DOD. The results did not support these beliefs. Subsequently, Kelly workers turned their focus to a long- time Hispanic congressman who had proven his dedica- tion to the San Antonio community in the past. On his retirement, the workers• expectations were then focused on their union representatives, who apparently had their own shortcomings and agendas. After each setback, Kelly workers remained steadfast and optimistically convinced that some- thing good would happen. The •something goodŽ occurred just prior to the “rst known RIF. In February 1998, Boeing Corporation an- nounced a plan to move its aircraft ”eet maintenance and overhaul work to San Antonio. As part of the privatization initiative, Boeing representatives signed a 20-year lease for the aircraft facilities at Kelly. This agreement indicated that approximately 800 private industry jobs would become avail- able by the summer of 1999. In small group and individual discussions, workers verbalized their understanding that the workforce outnumbered the proposed positions and that Boeing would be offering transfers to their current employ- ees. However, in general, the majority of the Kelly workers individually believed that he or she would obtain one of the available openings. As that reinforcing •something goodŽ was happening, the initial RIF took place in the base•s aircraft maintenance branch of approximately 1,400 workers. After the departure of 233 temporary employees, 29 retirees, and the 390 work- ers who opted for one of the two offered buy-out programs, only three permanent employees were involuntarily sepa- rated. This extremely low number did not cause any great alarm to the Kelly community. The remaining employees were shifted to other open positions in their occupational cat- egories based on the employees• seniority. This bump and re- treat process contributed to the underlying currents of stress and potential disorganization. As a worker was identi“ed as having suf“cient seniority to be retained, for the time being, he or she would retreat to another job location and bump an- other worker with less seniority. Frequently, the newcomer•s presence would create signi“cant turmoil. The existing work unit, which may have been together for some time, was now altered and one of the original members was dismissed. The newcomer was seen as the cause of the disorganization. He or 582 Occupational Health Psychology she slowed production while learning the team•s unique pro- cedures taught by the group being disrupted and became a threatening symbol of what could happen to the others. The propulsion directorate, with approximately 3,500 em- ployees, was the next group to be scrutinized for reductions. Faced with a declining number of opportunities and open- ings, workers still maintained high levels of production. One stabilizing line of thought had been that the presence of Boeing would act as a catalyst for drawing a major engine company to the area. This was subsequently reinforced by an agreement with Lockheed Propulsion and Tinker AFB. This agreement kept some of the engine work in San Antonio; however, once again, the number of employees exceeded the number of possible jobs. The results of the RIFs and the various separations ap- peared to have a rather negligible initial impact. The workers remained optimistic, and production rates and job perfor- mance remained high. However, the •whisper network,Ž a term coined by the base chaplain, was beginning to indicate an increase in concerns, worries, and strains that resulted in an exacerbation of potential negative stress reactions. The existing network of base and community service providers was organized to address relevant issues and to attempt to buffer the impact of negative stressors. Service-Oriented Networks A number of service-oriented networks focused on the needs of Kelly personnel and assisted them in meeting their objec- tives for a successful transition. A nonexclusive number of key base and community agencies included the Kelly Action Information Board, the Integrated Delivery System team, the Chaplain Of“ce, the Civilian Employee Transition Of“ce, and the Kelly chapter of the United Way. The Kelly Action Information Board The Kelly Action Information Board (KAIB) was a cross- functional structure composed of a variety of necessary base and community organizations whose main purpose was to disseminate information and provide guidance to programs relevant to base closure. It was similar to the change manage- ment team as outlined by Adkins (1998). The KAIB was chaired by the installation vice commander, which re”ected the degree of importance associated with the welfare of the Kelly community. The Integrated Delivery System Team The Integrated Delivery System (IDS) team was the main working group of the KAIB. Its purpose was to coordinate all preventive, educational programs aimed at individual and family well-being and to ensure there were no redundancies or gaps in available programs and services. The OHP psy- chologist, as the designated representative of the installation commander, chaired the IDS. A major goal of the group was to facilitate the integration and implementation of all neces- sary services, resources, and support activities to meet the needs of the Kelly military and civilian population during the transition of base realignment and closure. It was highly preferred that IDS interventions be as proactive and preven- tive as possible. This required a sensor system that would provide an accurate assessment of workforce needs and per- ceptions. By assessing these perceptions, workforce concerns could be addressed at an earlier stage and healthier decision options could be offered and implemented. A major concern was in acquiring relevant, usable data from the workforce. Thus, IDS objectives were to determine the needs of individ- ual subgroups, increase the awareness of available services, and de“ne roles and responsibilities for those services. Chaplains The role of the chaplain•s of“ce in service delivery was in- dispensable. The chaplains were viewed by the workforce as individuals who could maintain con“dence of shared infor- mation. Talking with a chaplain was viewed as acceptable in terms of self-disclosure when events become increasingly dif“cult. A great deal of relevant information was obtained through the whisper network, by which unof“cial ”oor infor- mation was conveyed throughout the workforce. This net- work conveyed valid information as well as rumor. It revealed the perceptions of the workers and was essential in lending credibility to organizational offerings. The Civilian Transition Ofﬁce The Civilian Transition Of“ce (CTO), a department of the Civilian Personnel Of“ce, provided various developmental workshops and services designed to help employees enhance their marketability as they transitioned from Kelly to other employment. The CTO also acted as a networking link to nu- merous outside sources and systems to provide awareness of opportunities available to the workforce. The CTO covered four functional areas: transition assistance program, career counseling, permanent change of station, and supervisor feedback surveys. The Civilian Personnel Of“ce held a view to the future and deliberately focused on the importance of the overall base mission. They very quickly obtained training grants, outlined timetables of events and outcome expectations, and provided detailed monthly newsletters, which earned them a A Case Study 583 high degree of credibility. The Civilian Personnel Of“ce pro- vided education and training in many transition areas, includ- ing opportunities in self-employment. This training was successful in allowing individuals to begin their own busi- nesses but was also successful in dissuading those whose probability of success was low. The United Way The United Way representatives for Kelly provided signi“- cant contributions to the transition process. The referral agent (RA) system was a vital link between the workers and neces- sary services they required. They were the eyes and ears of the base organizations. The objective of the RA system was to maintain an informal network of employee volunteer lead- ers to help transitioning coworkers and positively impact mission accomplishment. The RAs provided limited referral information with more complicated cases being referred to appropriate agencies. The RAs were informational points of contact. These volunteers worked in the very same settings as their peers and were well-known to their coworkers, enabling them to carry a considerable degree of credibility, which was often hard to come by on the working ”oor. They also pro- vided quantitative data to management on workforce needs and stress levels. RAs provided assistance with a minimum disruption to production, conformed to federal and state con“dentiality policies, and encouraged coworkers to take advantage of available transition services. They were not meant to counsel, solve problems, or make decisions. They did not discuss coworkers• interviews with others, and they did not intervene in potentially violent situations. Under the contractual agreement between Kelly and United Way, three base program managers were provided to oversee and support the RAs, provide monthly in-service training, and compile monthly service reports. The 11-person profes- sional staff at the United Way conducted 20 hours of entry- level training to each RA, provided information and referral back-up during regular work hours, and provided a 24-hour counseling and crisis intervention helpline. United Way involvement provided a neutral, highly credible third party. This non-Air Force af“liation enabled them to reach employ- ees in denial or distrustful of being identi“ed to base services. This appealed to the employee•s strong need for con“dential- ity based on unsubstantiated concern that identi“cation might result in an early lay-off. Barriers and Goals Given the nature of the organizational transition, the OHP program relied on consistently produced, long-term results. Plans and projects were developed to provide appropriate services and interventions in a timely manner. However, timeliness is relative to the perceptions of the community served. Events were not always predictable, and projects evolved slowly in this particular environment. The overall population required increased awareness and encouragement to become involved in making use of available services. One signi“cant barrier in achieving program results was acceptance. As with most organizational entities, Kelly was composed of a multitude of different subgroups. The initial objective was to elicit information from work groups. In general, individuals who were not members of labor were perceived as management, automatically providing a signi“- cant barrier to communication. At the very least, a nongroup member would be seen as an outsider. Super“cial, polite con- versation might take place, but it took considerable time to establish meaningful dialogues. This communication barrier hindered service gap identi“cation, as the OHP was per- ceived as looking for problems. Persistence and a near- constant presence on the shop ”oor were means to overcome this resistance. A number of the IDS group members were frequently involved in providing workshops and presentations for all levels of the Kelly community. These presentations focused on topics such as violence in the workplace, suicide aware- ness, and stress management. They were offered both at the worksite and at other base facilities at a variety of convenient times. The attendees were assured that these presentations were informal, and attendance was not of“cially docu- mented. The informal setting and educational nature of the sessions encouraged involvement because workers did not have to acknowledge a problem but could participate just to obtain information. Transition Life Advisor Program One very important achievement of the OHP program was establishment of a Transition Life Advisor (TLA) Program. Based on the monthly report of service and information re- ferrals made by the RAs, a group of signi“cant problem areas„categorized as work related, mental health, medical, “nancial, protective services, substance abuse, and legal„ emerged. RAs reported that a relatively constant group of individuals consistently sought information for the same problem areas. This appeared to support the idea that ap- proximately 10% of any workforce needs some assistance at any given time. Of that group, approximately 25% to 30% (2.5% to 3% of the total workforce) are dealing with signif- icant problems and are chronic, heavy users of the service system. It became necessary to target service intervention to provide for the needs of this high-risk group. In the TLA 584 Occupational Health Psychology Figure 24.2 Fiscal years 1990 and 2000 “high risk” case management appointments. 0 20 40 60 80 100 120 140 160 Oct-98 Dec-98 Feb-99 Apr-99 Jun-99 Aug-99 Oct-99 Dec-99 Feb-00 Apr-00 Jun-00 Aug-00 Blue Collar (143 Clients) White Collar (154 Clients) Program, designed by Klunder and Scheibler, clinical social workers were hired and deployed to base organizations with the goal of identifying these individuals and attempting to assist them in the transition process. These consultants acted as case managers working with identi“ed members, helping them set a path for transition, then ensuring their follow-up with the outlined recommendations. The consultants were available for crisis management as well as routine guidance and assistance. This also visibly demonstrated senior management concern for the employees and their families. Figure 24.2 shows utilization charts for services over the crit- ical period of the transition. However, a number of barriers had to be overcome. These seasoned professionals had to be age, gender, and ethnically similar to the populations they served. Given the cultural norms in the workforce, troubled individuals would have had considerable resistance in dealing with a young counselor. A more mature counselor would be seen as having a better un- derstanding of life circumstances. The caseworkers were strategically embedded throughout the industrial complex with a priority to locations that were high on the RIF list. Their of“ces were located in the work areas, and they made daily rounds with frequent contact with the entire workforce in their buildings. They built collaborative networks with supervisors, union stewards, on-base providers, and workers to facilitate referrals and working relationships. They con- ducted aggressive outreach marketing activities to identify and acquire high-risk employees for services. They consulted with senior and mid-level management on individual worker and workforce stabilization issues. Even though the clinical director was the OHP psychologist, the TLAs were not iden- ti“ed as being management, which greatly facilitated their acceptance. High-Risk Work Environment, Good Results In the context of this high-risk work environment with dra- matic change occurring daily, there was concern that serious problems, such as suicide and workplace violence, might be- come overtly manifest. This was a particular concern for the at-risk employee population. The at-risk employee popula- tion presented with very complicated personal and family problems, and with little or no identi“ed plan of action to re- solve them. Troubled employees with chronic performance problems were facing layoffs without a realistic transition plan. Individuals remained in denial despite RIFs, workforce movements, and building closures. Employees experienced job disidenti“cation when they were moved to a variety of locations with the intent of helping them. Many workers de- veloped or experienced exacerbation of existing physical problems. The base occupational medicine clinic indicated that more than 30% of the Kelly workforce did not have med- ical insurance. TLAs were able to “ll a needed gap in support services, especially for uninsured workers, and therefore played a signi“cant role in facilitating a smoother transition for the Kelly population. Suicides The three key results over the six-year closure process that have been examined were suicides, workplace violence, and labor grievance or complaint rates. The results are very af- “rming of the comprehensive OHP strategy for the health of this working population. While there was a degree of suicidal ideation and intent, as reported by TLAs, swift and direct in- tervention resulted in several saved lives. Only one suicide was completed within the base population during the six-year period, and that event occurred with a new employee who entered the workforce under psychiatric care. The event appeared to be totally unrelated to the work environment. During much of this period, the U.S. Air Force was very actively pursuing a suicide prevention program, which the Centers for Disease Control and Prevention credited with a “ve-year drop in suicide rates of 16 per 100,000 (1994) to 2.2 per 100,000 (1999), an over 80% decline. However, even in this high-risk environment, the Kelly results were well below the 1999 overall Air Force rates. Workplace Violence While there was some angry language, heated emotions, and minor pushing and shoving on occasion, there was never a se- rious physical altercation throughout the six-year period of the transition, re-alignment, and closure process. Future Directions in Occupational Health Psychology 585 Cost Savings The TLA program has been credited with signi“cant cost avoidance. The Kelly Equal Employment Opportunity (EEO) Of“ce indicated that overall approximately 40% of initial complaints move to formal status. The minimum administra- tive and investigative costs associated with a formal com- plaint is $80,000 regardless of whether it is validated. Based on the highest risk and highest/severe risk complaints dealt with by the TLAs, EEO projections attribute an administra- tive saving of between $23.9 million and $33.7 million. These are processing costs and do not include an undeter- mined amount of potential outcome costs that may have been awarded to complainants. The TLA team also presented a visible symbol of concern on management•s part, which assisted workers in overcom- ing a sense of isolation and fostered group cohesiveness. There was a minimized loss of production time associated with incident intervention, resolution, and disposition as workers took greater responsibility for their actions and out- comes. Aside from the humanitarian concerns, there were also practical results. The Air Force did not incur violence or suicide liability exposure. Financial liability resulting from litigation with a victim, traumatized coworker, family mem- ber, or class action coalition was eliminated. To Kelly employees, the TLA program provided compre- hensive, readily accessible services to needy families as well as a con“dential alternative to on-base services. To work su- pervisors, the program helped minimize worksite employee stress and lost production time. It allowed supervisors to focus on production priorities and provided an outlet for su- pervisor needs. To Kelly management, TLAs represented a visible sign of commitment to the workforce during height- ened periods of turmoil, provided a preventive approach to minimizing suicide as well as interpersonal and family vio- lence, and minimized administrative time and costs associ- ated with incident intervention, resolution, and disposition. FUTURE DIRECTIONS IN OCCUPATIONAL HEALTH PSYCHOLOGY As a relatively young specialty in psychology, a key question to be answered is how will OHP continue to grow and evolve? We see four directions for OHP. First, we see more bridge building with other disciplines, especially engineer- ing. However, we can see the need for bridges into disciplines such as “nance, economics, information systems, and pro- duction operations as well. Second, we see a greater empha- sis on an organizational balance between task mastery and interpersonal support in the workplace. Third, we see an inte- gration of the professions addressing the human side of the enterprise. Finally, we see the need for systems to address the toxins and emotional pain all too endemic to organiza- tional life. Luczek•s (1992) ideas of anthropocentric work design, which place the individual at the center of the design process, exemplify the bridge building between psychology and engi- neering. When it comes to the design of a wide variety of workplaces and tasks, those in OHP must make more exten- sive and concerted efforts to develop partnerships with the engineering disciplines. The design of bricks, mortar, work- stations, and a wide variety of machines and mechanisms for technological leverage in organizations require the combined input of experts in materials and products as well as people and behavior. Frederick Taylor was the “rst engineer to delve into psychology and human behavior. We must follow his ex- ample by linking psychology with engineering as well as with other disciplines. OHP needs to help managers and organizations better un- derstand the need for balance between task mastery and in- terpersonal support in the workplace (Joplin, Nelson, & Quick, 1999). Humans have two instinctual drives that are somewhat intractable. One is the drive to explore and master the world, and the other is to feel safe and secure. The inten- sity and degree to which these drives operate across individ- uals and across life stages varies. In the adulthood years, these drives are often manifest in the language of love and work. While task mastery leads to productive activity and achievement, secure interpersonal attachments and support provide the platform for emotional, psychological, and phys- ical health. Both needs must be addressed and balanced if or- ganizations and the individuals in them are to maintain their health in the midst of effortful striving (Frese, 1997). We brie”y discussed the concept of a chief psychological of“cer in an organization earlier in the chapter. A key role for a chief psychological of“cer, or even chief people of“cer, in an organization is to provide an integrating function for the specialties on the human side of the enterprise. These spe- cialties include human resource professionals, physicians and medical personnel, psychologists, safety professionals, secu- rity forces, and chaplains and spiritual advisors. Each expert offers a different type of expertise aimed at caring for people at work, as well as for the health of the organization. These experts need to be integrated and organized in functional role interrelatedness such that they are complimenting and supplementing each other as they provide the support and re- sponses individuals at work need. In a complex work setting, it may not be clear whether a worker should call the security forces, a psychologist, or a personnelist. 586 Occupational Health Psychology Finally, Edgar Schien (Quick & Gavin, 2000) and Peter Frost (Frost & Robinson, 1999) are among those concerned with addressing the toxins and emotional pain all too often endemic to organizational life. While healthy organizational systems may have natural homeopathic agents and immune systems that metabolize these psychological toxins and emo- tional pain, OHP can take the lead in crafting mechanisms and systems to help manage these unhealthy energies that inevitably, yet unintentionally, emerge in many work organi- zations. Schein uses the term organizational therapy, and we need to evolve language and mechanisms for making this process more concrete and complimentary to the other lead- ing edges of occupational health psychology. REFERENCES Adkins, J. A. (1998). Base closure: A case study in occupational stress and organizational decline. In M. K. Gowing, J. D. Kraft, & J. C. Quick (Eds.), The new organizational reality: Downsizing, restructuring, and revitalization (pp. 111…142).Washington, DC: American Psychological Association. Adkins, J. A. (1999). Promoting organizational health: The evolving practice of occupational health psychology. Professional Psy- chology: Research and Practice, 30, 129…137. Adkins, J. A., Quick, J. C., & Moe, K. O. (2000). Building world class performance in changing times. In L. R. Murphy & C. L. Cooper (Eds.), Healthy and productive work: An international perspective (pp. 107…132). Philadelphia: Taylor & Francis. Adkins, J. A., & Weiss, H. (in press). Evaluating organizational health programs. In J. C. Quick & L. Tetrick (Eds.), Handbook of occupational health psychology. Washington, DC: American Psychological Association. Barling, J., & Grif“ths, A. (in press). A history of occupational health psychology. In J. C. Quick & L. Tetrick (Eds.), Handbook of occupational health psychology. Washington, DC: American Psychological Association. Barone, D. (1995). Work stress conceived and researched transac- tionally. In R. Crandall & P. L. Perrewe (Eds.), Occupational stress: A handbook (pp. 29…37). Washington, DC: Taylor & Francis. Beer, M., & Walton, E. (1990). Developing the competitive organi- zation: Intervention and strategies. American Psychologist, 45, 154…161. Caplan, R. D., Cobb, S., French, J. R. P., Jr., Harrison, R. V., & Pinneau, S. R., Jr. (1975). Job demands and worker health: Main effects and occupational differences (DHEW NIOSH Publica- tion No. 75-160). Washington, DC: U.S. Government Printing Of“ce. Cartwright, S., Cooper, C. L., & Murphy, L. R. (1995). Diagnosing a healthy organization: A proactive approach to stress in the workplace. In L. R. Murphy, J. J. Hurrell, S. L. Sauter, & G. P. Keita (Eds.), Job stress interventions (pp. 217…234). Washington, DC: American Psychological Association. Casio, W. F. (1998). Learning from outcomes: Financial experiences of 300 “rms that have downsized. In M. Gowing, J. Kraft, & J. C. Quick (Eds.), The new organizational reality (pp. 55…70). Washington, DC: American Psychological Association. Cooper, C. L., & Cartwright, S. (1994). Healthy mind, healthy orga- nization: A proactive approach to occupational stress. Human Relations, 47, 455…471. Cooper, C. L., & Marshall, J. (1976). Occupational sources of stress: A review of the literature relating to coronary heart disease and mental ill health. Journal of Occupational Psychology, 49, 11…28. Cooper, C. L., Sloan, S. J., & Williams, S. (1988). Occupational stress indicator management guide. Oxford, England: NFER- Nelson. Cox, T. (1997). Workplace health promotion. Work and Stress, 11, 1…5. DeFrank, R. S., & Ivancevich, J. M. (1986). Job loss: An individual level review and model. Journal of Vocational Behavior, 28, 1…20. Donaldson, S. I. (1995). Worksite health promotion: Atheory-driven empirically based perspective. In L. R. Murphy, J. J. Hurrell, S. L. Sauter, & G. P. Keita (Eds.), Job stress interventions (pp. 73…90). Washington, DC: American Psychological Association. Downie, R. S., & Macnaughton, R. J. (1998). Images of health. Lancet, 351, 823…825. Edwards, J. R. (1996). An examination of competing versions of the person-environment “t approach to stress. Academy of Man- agement Journal, 39, 292…339. Elkin, A. J., & Rosch, P. J. (1990). Promoting mental health at the workplace: The prevention side of stress management. Occupa- tional Medicine: State of the Art Review, 5, 739…754. Elkind, H. B. (Ed.). (1931). Preventive management: Mental hy- giene in industry. New York: B. C. Forbes. Forward, G. E., Beach, D. E., Gray, D. A., & Quick, J. C. (1991). Mentofacturing: A vision for American industrial excellence. Academy of Management Executive, 5, 32…44. Frese, M. (1997). Dynamic self-reliance: An important concept for work in the twenty-“rst century. In C. L. Cooper & S. E. Jackson (Eds.), Creating tomorrow’s organizations: A handbook for future research in organizational behavior (pp. 399…416). Chichester, England: Wiley. Frone, M. R. (in press). Work-nonwork balance. In J. C. Quick & L. Tetrick (Eds.), Handbook of occupational health psychology. Washington, DC: American Psychological Association. Frone, M. R., Russell, M., & Barnes, G. M. (1996). Work-family con”ict, gender, and health-related outcomes: A study of em- ployed parents in two community samples. Journal of Occupa- tional Health Psychology, 1, 57…69. Frost, P., & Robinson, S. (1999). The toxic handler: Organizational hero„and casualty . Harvard Business Review, 77, 97…106. References 587 Gardell, B. (1987). Ef“ciency and health hazards in mechanized work. In J. C. Quick, R. S. Bhagat, J. E. Dalton, & J. D. Quick (Eds.), Work stress: Health care systems in the workplace (pp. 50…71). New York: Praeger Scienti“c. Gebhardt, D. L., & Crump, C. E. (1990). Employee “tness and well- ness programs in the workplace. American Psychologist, 45, 262…272. Gowing, M. K., Kraft, J. D., & Quick, J. C. (1998). The new organi- zational reality. Washington, DC: American Psychological Association. Grif“n, M. A., Hart, P. M., & Wilson-Evered, E. (2000). Using em- ployee opinion surveys to improve organizational health. In L. R. Murphy & C. L. Cooper (Eds.), Healthy and productive work (pp. 15…36). Philadelphia: Taylor & Francis. Hurrell, J. J., Jr., & McLaney, M. A. (1988). Exposure to job stress: A new psychometric instrument. Scandinavian Journal of Work, Environment, and Health, 14, 27…28. Hurrell, J. J., Jr., & Murphy, L. R. (1992). Psychological job stress. In W. N. Rom (Ed.), Environmental and occupational medicine (pp. 675…684). New York: Little, Brown. Ilgen, D. R. (1990). Health issues at work: Opportunities for industrial/organizational psychology. American Psychologist, 45, 273…283. Ivancevich, J. M., Matteson, M. T., Freedman, S. M., & Phillips, J. S. (1990). Worksite stress management interventions. Ameri- can Psychologist, 45, 223…239. James, L. A., & James, L. R. (1989). Integrating work perceptions: Explorations into the measurement of measuring. Journal of Applied Psychology, 74, 739…751. Johnson, J. V., & Hall, E. M. (1988). Job strain, workplace social support and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population. American Journal of Public Health, 78, 1336…1342. Joplin, J. R. W., Nelson, D. L., & Quick, J. C. (1999). Attachment behavior and health: Relationships at work and home. Journal of Organizational Behavior, 20, 783…796. Kahn, R. L., & Byosiere, P. (1992). Stress in organizations. In M. D. Dunnette & L. M. Houigh (Eds.), Handbook of industrial and or- ganizational psychology (2nd ed., Vol. 3, pp. 571…650). Palo Alto, CA: Consulting Psychologists Press, Inc. Karasek, R. A. (1979). Job demands job decision latitude, and men- tal strain: Implications for job redesign. Administrative Science Quarterly, 24, 285…308. Katz, D., & Kahn, R. L. (1966). The social psychology of organiz- ing. New York: Wiley. Kohler, S., & Kamp, J. (1992). American workers under pressure technical report. St. Paul, MN: St. Paul Fire and Marine Insurance. Kompier, M. A. J. (1996). Job design and well-being. In M. J. Schabracq, J. A. M. Winnubst, & C. L. Cooper (Eds.), Handbook of work and health psychology (pp. 349…368). Chichester , England: Wiley. Koop, C. E. (1992). Opening remarks of the APA/NIOSH confer- ence on Work and Well-Being. In G. P. Keita & S. L. Sauter (Eds.), Work and well-being: An agenda for the 1990s (pp. 3…4). Washington, DC: American Psychological Association. Kraut, A. I. (Ed.). (1996). Organizational surveys: Tools for assess- ment and change. San Francisco: Jossey-Bass. Laird, D. A. (1929). Psychology and proﬁts. New York: B. C. Forbes. Landy, F., Quick, J. C., & Kasl, S. (1994). Work, stress and well- being. International Journal of Stress Management, 1 (1), 33…73. Lazarus, R. S. (1995). Psychological stress in the workplace. In R. Crandall & P. L. Perrewe (Eds.), Occupational stress: A handbook (pp. 3…14). Washington, DC: Taylor & Francis. Levi, L., Brennar, S. O., Hall, E. M., Hjelm, R., Saolvaara, H., Arnetz, B., et al. (1984). The psychological, social, and biochemical impacts of unemployment in Sweden. International Journal of Mental Health, 13 (½), 18…34. Levinson, H. (2002). Organizational assessment: A manual. Washington, DC: American Psychological Association. Lobel, S. A. (1991). Allocation of investment in work and family roles: Alternative theories and implications for research. Academy of Management Review, 16 (3), 507…521. Lowman, R. L. (1993). Counseling and psychotherapy of work dysfunctions. Washington, DC: American Psychological Association. Luczek, H. (1992). •Good workŽ design: An ergonomic, industrial engineering perspective. In J. C. Quick, L. R. Murphy, & J. J. Hurrell, Jr. (Eds.), Stress and well-being at work (pp. 96…1 12). Washington, DC: American Psychological Association. McLean, A. (1979). Work stress. Reading, MA:Addison-Wesley. Millar, J. D. (1984). The NIOSH-suggested list of the ten leading work-related diseases and injuries. Journal of Occupational Medicine, 26, 340…341. Millar, J. D. (1992). Public enlightenment and mental health in the workplace. In G. P. Keita & S. L. Sauter (Eds.), Work and well- being: An agenda for the 1990s (pp. 5…8) . Washington, DC: American Psychological Association. Moos, R. H. (1981). Work Environment Scale manual. Palo Alto, CA: Consulting Psychologists Press. Moran, S. K., Wolff, S. C., & Green, J. E. (1995). Workers• compensation and occupational stress: Gaining control. In L. R. Murphy, J. J. Hurrell, S. L. Sauter, & G. P. Keita (Eds.), Job stress interventions (pp. 355…369). Washington, DC: American Psychological Association. Murphy, L. R. (1988). Workplace interventions for stress reduction and prevention. In C. L. Cooper & R. Payne (Eds.), Causes, cop- ing and consequences of stress at work (pp. 301…339) . New York: Wiley. Murphy, L. R., & Cooper, C. L. (Eds.). (2000). Healthy and produc- tive work: An international perspective. Philadelphia: Taylor & Francis. 588 Occupational Health Psychology Nelson, D. L., Quick, J. C., & Hitt, M. A. (1989). Men and women of the personnel profession: Some differences and similarities in their stress. Stress Medicine, 5, 145…152. Offermann, L. R., & Gowing, M. K. (1990). Organizations of the future: Changes and challenges. American Psychologist, 45, 95…108. Osipow, S. H., & Spokane, A. R. (1992). Occupational Stress Inventory: Manual, research version. Odessa, FL: Psychological Assessment Resources. Pellitier, K. R. (1991). A review and analysis of the health and cost- effective outcome studies of comprehensive health promotion and disease prevention programs. American Journal of Health Promotion, 5, 311…315. Piotrkowski, C. S. (1979). Work and the family system. New York: Free Press. Porter, G. (1996). The organizational impact of workaholism: Sug- gestion for researching the negative outcomes of excessive work. Journal of Occupational Health Psychology, 1, 70…84. Quick, J. C. (1992). Crafting an organizational culture: Herb•s hand at Southwest Airlines. Organizational Dynamics, 21, 45…56. Quick, J. C. (1999a). Occupational health psychology: Historical roots and future directions. Health Psychology, 18, 82…88. Quick, J. C. (1999b). Occupational health psychology: The conver- gence of health and clinical psychology with public health and preventive medicine in an organizational context. Professional Psychology: Research and Practice, 30, 123…128. Quick, J. C., Camara, W. J., Hurrell, J. J., Jr., Johnson, J. V., Piotrkowski, C. S., Sauter, S. L., et al. (1997). Introduction and historical overview. Journal of Occupational Health Psychol- ogy, 2, 3…6. Quick, J. C., & Gavin, J. H. (2000). The next frontier: Edgar Schein on organizational therapy. Academy of Management Executive, 14, 30…44. Quick, J. C., Murphy, L.R., & Hurrell, J. J., Jr. (1992). Stress and well-being at work: Assessments and interventions for occupa- tional mental health. Washington, DC: American Psychological Association. Quick, J. C., Quick, J. D., Nelson, D. L., & Hurrell, J. J., Jr. (1997). Preventive stress management in organizations. Washington, DC: American Psychological Association. Quick, J. C., & Tetrick, L. (in press). Handbook of occupational health psychology. Washington, DC: American Psychological Association. Quinn, R. P., & Staines, G. L. (1978). The 1977 Quality of Employ- ment Survey: Descriptive statistics, with comparison data from the 1969–70 and the 1972–73 survey. Ann Arbor: University of Michigan Survey Research Center. Raphael, D., Steinmetz, B., Renwick, R., Rootman, I., Brown, I., Sehdev, H., et al. (1999). The community quality of life project: A health promotion approach to understanding communities. Health Promotion International, 14 (3), 197…209. Raymond, J. S., Wood, D. W., & Patrick, W. D. (1990). Psychology training in work and health. American Psychologist, 45 (10), 1159…1161. Reason, N. (1997). Managing the risks of organizational accidents. Hampshire, UK: Ashgate. Rose, G. (1992). The strategy of preventive medicine. Oxford, England: Oxford University Press. Rosen, R. H. (1986). Healthy companies. New York: American Management Association. Rosenstock, L. (1997). Work organization research at the National Institute for Occupational Safety and Health. Journal of Occu- pational Health Psychology, 2, 7…10. Sauter, S. L., & Hurrell, J. J. (1999). Occupational health psychol- ogy: Origins, content, and direction. Professional Psychology: Research and Practice, 30, 117…122. Sauter, S. L., Hurrell, J. J., Jr., & Cooper, C. L. (1989). Job control and worker health. Chichester, England: Wiley. Sauter, S. L., Hurrell, J. J., Jr., Fox, H. R., Tetrick, L. E., & Barling, J. (1999). Occupational health psychology: An emerging disci- pline. Industrial Health, 37, 199…211. Sauter, S. L., Murphy, L. R., & Hurrell, J. J., Jr. (1990). Prevention of work-related psychological distress: A national strategy pro- posed by the National Institute for Occupational Safety and Health. American Psychologist, 45, 1146…1158. Schein, E. H. (1988). Process consultation (Rev. ed.), Reading, MA: Addison-Wesley. Schmidt, L. R. (1994). A psychological look at public health: Contents and methodology. International Review of Health Psychology, 3, 3…36. Schneider, D. L., Camara, W. J., Tetrick, L. E., & Stenberg, C. R. (1999). Training in occupational healthy psychology: Initial ef- forts and alternative models. Professional Psychology: Research and Practice, 30, 138…142. Schwartz, D. F., & Adkins, J. A. (1997). In pursuit of partnership. In M. A. Rahim, R. T. Golembiewski, & C. C. Lundberg (Eds.), Current topics in management (Vol. 2, pp. 243…252). Greenwich, CT: JAI Press. Shilling, S., & Brackbill, R. M. (1987). Occupational health and safety risks and potential health consequences perceived by U.S. workers. Public Health Reports, 102, 47…53. Spielberger, C. D. (1991). State-trait anger expression inventory: Revised research edition. Odessa, FL: Psychological Assessment Resources. Spielberger, C. D. (1994). Professional manual for the job stress survey (JSS). Odessa, FL: Psychological Assessment Resources. Spielberger, C. D., Krasner, S. S., & Solomon, E. P. (1988). The ex- perience, expression, and control of anger. In M. P. Janisse (Ed.), Health psychology: Individual differences and stress (pp. 89… 108). New York: Springer Verlag. Staw, B. M. (1986). Organizational psychology and the pursuit of the happy/productive worker. California Management Review, 28 (4), 40…53. References 589 Terborg, J. R. (1986). Health promotion at the worksite: A challenge for personnel and human resources management. Research in Personnel and Human Resources Management, 4, 225…267. Theorell, T., & Karasek, R. (1996). Psychosocial work environment and coronary heart disease: The role of the individual•s possibil- ity to control working conditions. Journal of Occupational Health Psychology, 1, 9…26. Wallace, R. B., Last, J. M., & Doebbeling, B. N. (Eds.). (1998). Maxcy-Rosenau-Last: Public health and preventive medicine. Stamford, CT: Appleton and Lange. Weiss, H. M. (2001). Experience sampling methods (ESM). Panel presentation at the Society for Industrial-Organizational Psy- chology Conference, San Diego, CA. Whittington, J. L., Paulus, P. B., & Quick, J. C. (in press). Manage- ment development, well-being and health in the twenty-“rst cen- tury. In M. J. Schabracq, J. Winnubst, & C. L. Cooper (Eds.), Handbook of work and health psychology (Rev ed.). Chichester, England: Wiley. Winters, E. E. (Ed.). (1952). The collected papers of Adolf Meyer: Mental hygiene (Vol. 4). Baltimore: Johns Hopkins University Press. Wright, L. (1988). The Type A behavior pattern and coronary artery disease. American Psychologist, 43, 2…14. Wright, T. A., & Cropanzano, R. (1997). Well-being, satisfaction and job performance: Another look at the happy/productive worker thesis. In L. N. Dosier & J. B. Keys (Eds.), Academy of management best paper proceedings (pp. 364…368). Statesboro, GA: Georgia Southern University. van de Loo, E. (2000). The clinical paradigm: Manfred Kets De Vries•s re”ection on organizational therapy. European Manage- ment Journal, 18, 2…22. Von Dusch, T. (1868). Lehrbuch der herzkrankheiten [Textbook of heart disease]. Leipzig, Germany: Verlag von Wilhelm Engelman. Yandrick, R. M. (1996). Behavioral risk management. San Francisco: Jossey-Bass. CHAPTER 25 Complementary and Alternative Therapies CHRISTINE MAGUTH NEZU, SOLAM TSANG, ELIZABETH R. LOMBARDO, AND KIM P. BARON 591 WESTERN SYSTEMS OF HEALING 592 Homeopathy 592 Osteopathy 593 Chiropractic 594 EASTERN SYSTEMS OF HEALING 595 Ayurveda 595 Traditional Chinese Medicine 596 OTHER COMMON HEALING APPROACHES 598 Herbal Remedies 598 Dietary, Nutrition, and Lifestyle Modiﬁcation 601 Tactile Therapies 602 Movement Therapies 604 Expressive Therapies 605 Mind/Body Therapies 606 COMMON THEMES 607 FUTURE DIRECTIONS 607 Integration of Psychological Interventions and Complementary and Alternative Therapies 607 A Decision-Making Problem 607 REFERENCES 607 Complementary and alternative therapeutic approaches to the treatment of medical disorders share many f

bundet

undamental con- cepts and philosophies with health psychology. The term complementary and alternative therapy is used to describe a set of treatments that serve as an adjunct to, or complement, standard medicine practices, but also serve as an alternative form of medical therapy. Many of these approaches promote a holistic view of medicine, positing that psychological or emotional experiences have a reciprocal relationship with physical experiences, with a growing body of research sup- porting this link (see Cohen & Herbert, 1996; Pelletier, 1992). A common perspective of many complementary and alternative treatment approaches is that healing is viewed as a process of becoming whole on many different levels (phys- ical, emotional, social, spiritual) and often involves an in- crease in awareness and self-discovery. Complementary and alternative practitioners, similar to many health psycholo- gists, aim to help patients achieve an increased understanding of how their bodies, health, and well-being are linked. They also aim to empower their patients to take a more active ap- proach in health maintenance and decision making. In this chapter we (a) present a description of popular complemen- tary and alternative approaches to medicine, their clinical ap- plications, and a brief summary of supporting research; (b) present several common themes of these approaches from a health psychology perspective; and © provide suggestions for the future regarding the integration of such treatments with psychological intervention. One major criticism concerning complementary and alter- native therapies that frequently emerges throughout this chapter is the dif“culty in applying current scienti“c stan- dards to these therapy approaches. This challenge is due partially to the idiographic treatment and case history methodologies employed by many complementary and alter- native therapies, which contrast with the general diagnosis- based methodologies employed by the biomedical approach. Because health is often viewed as being related to multiple causes and in”uenced by multiple systems, conventional measurement and analyses are dif“cult to apply. Hence, re- sults from existing research data tend to be inconsistent and inconclusive. Until therapies are subjected to rigorous methodologies, many of these healing approaches will not be considered credible cures in their own right. Neverthe- less, complementary and alternative therapies have been increasingly accepted by the public. The various com- plementary and alternative approaches have originated from Western (e.g., homeopathy, osteopathy, chiropractic) and Eastern (e.g., Ayruveda, traditional Chinese medicine) cul- tures. Herbal remedies, lifestyle modi“cations, tactile thera- pies, movement therapies, and mind/body therapies are frequently used as treatment interventions for maintaining health across cultures. 592 Complementary and Alternative Therapies WESTERN SYSTEMS OF HEALING Homeopathy Homeopathy, founded by Samuel Hahnemann, M.D. (1755…1843), is based on the Law of Similars, or •Let likes be cured by likes.Ž It is a form of self-healing in which the substance (e.g., minerals, plant extracts, chemicals, or disease-producing germs) that creates illness symptoms in a healthy individual is used to cure those very symptoms when prescribed in microdoses. Symptoms are not thought to be part of the illness but part of a curative process (Spencer & Jacobs, 1999) because outward manifestations of illness rep- resent an attempt of an organism to heal itself, with the cor- responding remedy reinforcing that attempt in some way (Micozzi, 1996). The homeopathic practitioner views illness as a disturbance of the vital force of an individual, manifesting itself as a total- ity of physical, mental, and emotional symptoms that is unique to each patient (Micozzi, 1996). Homeopathic remedies exist for psychological conditions such as depression, anxiety, and the wide range of distressed mental states. For example, minerals such as argentum nitricum and aurum metallicum have been prescribed for anxiety and depression, respectively (Lockie, 1989; Stanton, 1981). Plant derivatives such as ignatia, arnica, and equisetum have been prescribed for grief, shock, and for curing bedwetting in both children and adults, respectively (Lockie, 1989; Stanton, 1981). Typical homeo- pathic practice includes a thorough idiographic assessment of a patient•s case history and presenting symptoms (e.g., physi- cal, cognitive, and emotional) to “nd a homeopathic remedy that matches the individual rather than a speci“c illness, with the correct remedy or combination of remedies aimed at cur- ing the patient•s whole spectrum of symptoms. One of the main advantages of homeopathic remedies is that they are relatively safe and have no side effects because of the in“nitesimal amounts of the homeopathic substances. However, because homeopathy is highly individualized, it is a dif“cult and exacting art. A skilled homeopathic practi- tioner might try several remedies before any bene“t is ob- tained. Furthermore, there remains a lack of understanding of dilute remedies• mechanism of action, as well as an inability to predict how a patient will respond to a certain remedy or which symptoms will be affected. These factors greatly hin- der the study of treatment ef“cacy of homeopathic remedies. Therapeutic Approaches To minimize the potentially toxic effects of a medicinal sub- stance, extremely minute doses are used. The preparation of the homeopathic remedy starts with an amount of the medic- inal substance (e.g., herbal tincture) and serially diluting it either 10- or 100-fold with water a number of times, followed by vigorous shaking between each dilution (potentizing; Ernst, Rand, & Stevinson, 1998; Micozzi, 1999). The dosage must be tailored to “t the patient very much like the choice of the remedy itself. The general rule is to stop the administra- tion of the remedy once the reaction is apparent, allowing the remedy to complete its course of action, and repeating only when the reaction has subsided. The therapeutic goal of homeopathy is to “nd a substance that matches as many of the individual•s symptoms as possi- ble, including not only physical symptoms, but also the living experience of the patient, such as the full range of thoughts and feelings. Hence, both cognitive and emotional symptoms sometimes weigh heavily in choosing the remedy. The homeopathic diagnostic interview is composed of a physical examination, laboratory work, and the opportunity for the patient to tell his or her life story. This provides an opportu- nity for assessment of symptoms and as a means of catharsis. It makes the homeopathic interview a possible healing expe- rience in its own right, leading critics to believe that effec- tiveness of homeopathic remedies may be a function of the placebo effect. Clinical Applications To date, there are signi“cantly more descriptive studies in the literature than there are clinical trials. A meta-analysis of homeopathic clinical trials uncovered 105 controlled trials, of which 81 indicated positive results and 24 indicated a lack of positive results compared to placebo (Kleijnen, Knipschild, & ter Riet, 1991). Another meta-analysis ex- tracted 89 of 185 homeopathic trials as having appropriate data for such an analysis (Linde et al., 1997). The results were also in support of homeopathy. A number of studies in peer-reviewed journals report the apparent effectiveness of homeopathy for certain asthmatic and allergic conditions. In a randomized, double-blind, placebo-controlled clinical trial involving 28 patients with allergic asthma, homeopathy was found to produce signi“- cantly more symptom improvement than placebo (Reilly et al., 1994). Another study with a similar design involving 144 patients with symptoms of hay fever found a signi“cant reduction in symptom intensity and use of histamines (50% less) in the homeopathy treatment group compared to the placebo group (Reilly, Taylor, McSharry, & Aitchison, 1986). The results from these studies suggest potential bene“ts of homeopathy as a complementary treatment for asthma, aller- gies, and other stress-related conditions. Western Systems of Healing 593 The value of homeopathy as a treatment for depression is presently unknown because of the lack of substantiation by systematic research. Davidson, Morrison, Shore, and Davidson (1997) reported a case study of a 47-year-old woman whose depressive and anxious symptoms improved on ”uoxetine (Prozac) and calcarea carbonica (a homeopathic remedy). The thorough review of homeopathy clinical trials by Kleijnen et al. (1991) and the meta-analysis by Linde et al. (1997) detected only one study related to depression. Although this study (Ernst et al., 1998) produced a result in favor of homeopathy, the study was of low methodological quality. Furthermore, two large reviews of the role of home- opathy in clinical medicine concluded that, except for the occasionally demonstrated bene“t, there was little scienti“c evidence to support the use of homeopathy in the majority of clinical settings (Watkins, 1994). Several problems exist in studying the ef“cacy of homeo- pathic treatments. To provide some scienti“c rigor, most con- ventional clinical research involves administering the same remedy to all patients, which contradicts the philosophy of the idiographic approach involved in homeopathic treat- ments. Furthermore, most homeopathic studies are case re- ports but do not include methodologies that include multiple baselines or a reversal to baseline methodology. Osteopathy Osteopathy, founded by Andrew Taylor Still, M.D. (1823…1917), is a complete system of prevention, diagnosis, and treatment based on a •whole personŽ approach. It posits that there is an interrelationship between the structure and function of the human body and that the body has the ability to self-regulate and self-heal. Speci“cally, when the body is in a normal structural relationship with adequate nutrition, it is capable of maintaining its own defenses against diseases and other pathologic conditions (Micozzi, 1996; C. M. Nezu, Nezu, Baron, & Roessler, 2000). However, when there are al- terations in the structural relationships of the body parts, the body has dif“culty resisting or recovering from illness. It has been proposed that structural dif“culties in the body can cause numerous problems such as arthritis, headaches, emo- tional problems, breathing problems, heart problems, and digestive problems depending on which area in the muscu- loskeletal system is restricted or under stress (The Burton Goldberg Group, 1995). Recovery from these conditions is said to occur through normalization of body mechanics and the neuromusculoskeletal system via osteopathic manipula- tive treatment (OMT). It is important to distinguish between the actual practices of osteopathic physicians from osteopathic manipulative treatments. Osteopathic training in the United States blends conventional medical practices and training in biomedical sciences with osteopathic manipulative treatment approaches as an integrated system of health care. Depending on the focus of the licensed osteopathic physicians, the actual prac- tice of osteopathy may vary according to the area of specialty (Sirica, 1995). Therapeutic Approaches The diagnostic process in osteopathy emphasizes a close and personal relationship between the physician and patient because it is based on the premise that familiarity with a patient•s personality and habits is essential to providing high- quality health care (Hruby, 1995). Because osteopathy evaluates the human body as an integral unit, treatment modalities are selected based on the patient•s report of signs and symptoms, along with a comprehensive patient history and examination in which the structure and function of the musculoskeletal system provides important clues to dysfunc- tion (Micozzi, 1996). OMT is a therapeutic means of correct- ing these dysfunctions and is often prescribed in conjunction with other clinical modalities, including education on nutri- tion, lifestyle, breathing techniques, relaxation techniques, and postural correction to reduce tension to the affected areas of the body (C. M. Nezu et al., 2000). Although osteopathy is considered a comprehensive system of healing, it is best known for its reliance on the diagnostic and therapeutic value of the musculoskeletal system and OMT, which is a distin- guishing hallmark of the osteopathic profession. Different manipulative approaches available to the osteopathic physi- cian include muscle energy, myofascial, counterstrain, and thrusting techniques (DiGiovanna & Schiowitz, 1991). Mus- cle energy techniques focus on directing muscles against a distinct counterforce such as increased tension or resistance. The goal is to mobilize joints by gently tensing and releasing speci“c muscles to produce relaxation. Myofascial tech- niques, also known as soft tissue techniques, focus on the continuous layer of connective tissue below the skin (i.e., fascia) that surrounds and bonds all of the body•s internal or- gans. They are used to relax and release restrictions in the soft tissues of body. In counterstrain techniques, somatic dys- function is believed to have a neuromuscular basis. These are functional and positional release methods used to relieve pain by placing the patient in a speci“c position to allow the body to relax and release muscular spasms that may have been caused by strain or injury. Thrusting techniques are small, high velocity forces applied by a practitioner in an effort to alleviate joint dysfunction (e.g., by altering the range of motion available at a joint). 594 Complementary and Alternative Therapies Clinical Applications Research to date focuses on the philosophy of osteopathic medicine and manipulation techniques and less on treatment outcome. Patients with HIV disease have been reported to use OMT for relaxation and pain management because of drug toxicity or disease progression (Micozzi, 1999). Treatment includes massage and myofascial release techniques to relax muscle tension, counterstrain techniques to relax and elon- gate muscle “ber for increased joint mobility and range of motion, muscle energy techniques to foster normalization of the musculoskeletal system, and visceral manipulation, which may potentiate normal physiologic function of indi- vidual organs. Chiropractic Chiropractic, derived from the Greek word meaning •done by hands,Ž was founded by Daniel David Palmer in 1895 based on the premise that vertebral subluxation (a spinal mis- alignment causing abnormal nerve transmission) is the cause of virtually all disease and that chiropractic adjustment (a manual manipulation of the subluxated vertebrae) is its cure (Palmer, 1910). Similar to the fundamental principles of os- teopathy and the foundation of the emerging holistic health or wellness paradigm, a chiropractic approach views human beings as possessing an innate healing potential. Like os- teopathy, structure and function are believed to exist in inti- mate relation with one another. Hence, structural distortions of the spine are proposed to cause functional abnormalities, which may impede the communication and balance between the different branches of the nervous system (central, auto- nomic, and peripheral) that are required for health mainte- nance. This is believed to result in injury or stress, causing pain. Restoration and maintenance of proper bodily function involves realigning the spine to remove the pressure of bone impingement on spinal nerves to restore spinal joint mobility and nerve function. Whereas osteopaths provide manual ther- apy to a variety of areas in the body, chiropractors focus speci“cally on spinal maladjustments. A balanced, natural diet and exercise is also considered an important part of treat- ment for maintaining proper bodily function and optimal health. Therapeutic Approaches Of the patients seeking chiropractors, 90% present with neu- romuscular problems such as back pain, neck pain, and headaches, conditions for which spinal manual therapy (SMT) is most effective (Plamondon, 1995). The central focus of chiropractic practice is to determine when and where SMT is appropriate, and what type of adjustment is most appropriate in a given situation. The most common form of chiropractic SMT is the high-velocity, low-amplitude thrust adjustment (HVLA), also known as osseous adjustment (Micozzi, 1996). It involves manual movement of a joint to the end point of its normal range of motion, followed by local pressure on bony prominences and then imparting a swift, speci“c, low-amplitude thrust for joint cavitation. Although patients often report signi“cant functional improvements and healing effects following chiropractic adjustment, positive health changes have never been convincingly correlated with vertebral alignment (Micozzi, 1996; Winkel, Aufdemkampe, Matthijs, Meijer, & Phelps, 1996). Clinical Applications Several comprehensive reviews exist on clinical outcome studies in spinal manipulation. Shekelle, Adams, Chassin, Hurwitz, and Brook (1992) analyzed nine randomized, con- trolled trials that tested the effects of spinal manipulation against various conservative treatments for patients with acute low back pain (e.g., back pain that does not result from fractures, tumors, infections, and vascular, abdominal, or uri- nary diseases). All nine studies found spinal manipulation to be ef“cacious, leading the authors to conclude that spinal manipulation hastens recovery from uncomplicated low back pain. Findings from two other meta-analyses (Abenhaim & Bergeron, 1992; Anderson et al., 1992) provide some evi- dence of the short-term effectiveness of spinal manipulation in relieving acute and chronic back pain, although long-term effects of this treatment have not been adequately evaluated. Chiropractic treatment has also been demonstrated to be more effective in treating the pain from muscle tension headaches than the tricyclic antidepressant amitriptyline for long-term relief of pain (Boline, 1991). Patients maintained their levels of improvement after treatment was discontinued, while those taking medication returned to pretreatment status in an average of four weeks following its discontinuation. Further research is needed to address the question of long-term ef“- cacy of spinal manipulation for different types of pain. Other studies have focused on applying chiropractic ma- nipulation to spinal cord injury patients (Fritz-Ritson, 1995; Woo, 1993), infantile colic (Klougart, Nilsson, & Jacobsen, 1989), and enuresis (Leboeuf et al., 1991; Reed, Beavers, Reddy, & Kern, 1994). The results generated from these studies are inconsistent and inconclusive because of limita- tions in research design. Further research is needed to Eastern Systems of Healing 595 determine the effectiveness of chiropractic manipulations in these populations. EASTERN SYSTEMS OF HEALING Ayurveda Ayurveda, a Sanskrit word meaning •the science of life and longevity,Žis a major health system developed in India more than 5,000 years ago that emphasizes a preventive approach to health by focusing on an inner state of harmony and spiritual realization for self-healing. It focuses on the whole organism and its relation to the external world because human beings are viewed as minute representations of the universe and contain within them everything that makes up the sur- rounding world. The cosmos is believed to be composed of “ve basic elements (earth, air, “re, water, and space), which occur as the three doshas ( vata, pitta, and kapha), or the basic bodily and mental human energy forces (Micozzi, 1996). Most people possess a combination of doshas, in which one dosha predominates. When the three doshas are in equilib- rium, health is said to be maintained. When an imbalance occurs among them, body dysfunctions that lead to the mani- festation of disease exist. The cause of the imbalance may originate in the body, outside the body, or from spiritual sources. In addition to the doshas, Ayurveda principles indicate that an individual is in”uenced by three mental states based on the qualities of balance, energy, and inertia (Micozzi, 1996). The mind is said to be in equilibrium when it is in the state of bal- ance. The mind is excessively active when it is in a state of energy and is inactive when it is in a state of inertia, with both states causing weakness in equilibrium. Hence, the body and the mind can interact to create a healthy and functional, or unhealthy and nonfunctional, condition. During the assess- ment phase, the Ayurvedic physician determines both the mental and physical conditions of the patient before proceed- ing with any form of diagnosis and treatment. Treatment aims to restore the balance of the doshas or to maintain the proper balance of energy ”ow ( prana; C. M. Nezu et al., 2000). This can be achieved through a variety of methods such as medi- tation, exercise, diet, herbs, aromatherapy, oil massages, yoga, and medicated enemas (Spencer & Jacobs, 1999), with a main focus on lifestyle changes. Although a centuries-old healing phenomena, Ayurveda was revived in recent decades by Maharishi Mahesh Yogi. This speci“c reformulation of Ayurveda is known as Maharishi Ayurveda (MAV). •MAV promotes the idea of consciousness as a primary importance in maintaining opti- mal health, and emphasizes meditation techniques as a way to develop integrated holistic functioning,Ž according to Micozzi (1996, p. 243). The fundamental principles of MAV are similar to those of traditional Ayurveda. However, the ultimate basis of disease in MAV is associated with losing a person•s sense of spiritual being. Prevention and cure is focused primarily on restoring the conscious connection to the person•s spiritual core, enabling the full expression of the body•s •inner intelligence.Ž Therapeutic Approaches The two general courses of treatment in Ayurveda are pro- phylaxis and therapy (Micozzi, 1996). Prophylaxis is used to help a healthy person maintain health and prevent disease. Therapy is used to help an ill person restore health. When a person is diagnosed with an imbalance of the doshas, puri“- cation therapy, alleviation therapy, or a combination of these is prescribed. In puri“cation therapy, a patient might be given a purgative, such as an enema, to eliminate the dosha that is thought to be causing the disease. Alleviation therapy uses the condiments honey, butter or ghee, and sesame or caster oil for the same purpose. Once the individual returns to health, continuous prophylaxis is recommended based on a variety of methods such as diet, meditation, herbal regimens, and regular therapeutic puri“cation procedures. In MAV, the most important technique in achieving over- all well-being is transcendental meditation ™, where •the mind transcends even the subtlest impulses of thought and settles down to the simplest state of awarenessŽ (Micozzi, 1996, p. 246), a state known as transcendental consciousness. Although MAV views unfolding consciousness as the single most important strategy of both disease prevention and cure, lifestyle, behavioral, and emotional factors can also have a great impact. For example, traditional virtues such as re- specting others, familial harmony, practicing nonviolence, pardoning others, and maintaining a positive emotional tone are understood to promote health for the individual•s mind and body, as well as for the community and society. Clinical Applications Herbal remedy is an important component of Ayurvedic med- icine. Laboratory and animal studies have found cytotoxicity in some traditional and MAV remedies (Sharma et al., 1991; Smit et al., 1995), suggesting potential effectiveness in can- cer treatments. However, no randomized studies in humans have been conducted (Spencer & Jacobs, 1999). Some 596 Complementary and Alternative Therapies Ayurvedic herbal mixtures have been found to have bene“- cial health effects. The herbal mixture MA-631 may be used to prevent and treat atherosclerotic vascular disease (Hanna, Sharma, Kauffman, & Newman, 1994). Herbal mixtures MAK-4 and MAK-5 have been found to be effective in angina patients in signi“cantly reducing angina frequency and sys- tolic blood pressure, and in improving exercise tolerance (Dogra, Grover, Kumar, & Aneja, 1994). The extant research surrounding TM appears to support its proposed bene“cial effects on health, suggesting that TM may be an effective complementary intervention for patients suffering from a variety of psychological and physical prob- lems. A Harvard study of elderly nursing home residents compared the practice of TM with two other types of med- itation and relaxation techniques over a three-year period (Alexander, Langer, Newman, Chandler, & Davies, 1989). The study found that the TM group had the greatest reduc- tions in stress and blood pressure, and the lowest mortality rate. Ameta-analysis on the effect of meditation and trait anx- iety conducted at the Stanford Research Institute found that TM is approximately twice as effective as other meditation techniques at reducing trait anxiety (Eppley, Abrams, & Shear, 1989). TM has also been found in several studies to re- tard biological aging (Glaser et al., 1992), to signi“cantly reduce high blood pressure and cholesterol (Cooper & Aygen, 1978), and to help in giving up harmful habits such as cigarette smoking, heavy drinking, and illegal drug use by incorporating more healthy dietary and lifestyle changes (Alexander, Robinson, & Rainforth, 1994; Gelderloos, Walton, Orme-Johnson, & Alexander, 1991). These studies collectively suggest that practicing TM has bene“cial effects on health. Traditional Chinese Medicine Similar to Ayurveda, traditional Chinese medicine (TCM) diagnostic and treatment strategies involve a search for im- balance and disharmony in each individual patient. The phi- losophy of TCM begins with yin (shady side) and yang (sunny side), which are opposing but complementary forces that exist in a dynamic equilibrium (The Burton Goldberg Group, 1995). Like Ayruveda, TCM focuses on interrelation and interdependence of the whole organism with the external world. In addition to being viewed in relation to their sur- roundings, yin and yang are also used to correlate the body and other phenomenon to the human experience of health and disease, and all health treatments are aimed at keeping yin and yang in balance. Another concept that is crucial to understanding TCM is qi, often translated with the term energy or life force. While the Western de“nition of energy is the capacity to do work, qi implies that •the body is pervaded by subtle material and mo- bile in”uences that cause most physiological functions and maintain the health and vitality of the individualŽ (Micozzi, 1996, p. 195). According to TCM, this vital energy system exists in the body along pathways called meridians or chan- nels. When energy is ”owing at normal levels, the body is balanced and healthy, resistant to disease, and can activate its own healing efforts. When imbalances or blockages occur, physiological and pathological changes ensue. Practitioners of TCM believe that all illnesses result from a disturbance of qi within the body. In TCM, there is no distinction between mind and body. TCM believes that an individual•s emotional and physiologi- cal experiences are reciprocal. Hence, aspects of the human emotional experience are linked to speci“c physiological or- gans (e.g., anger is related to the liver, joy to the heart), and, thus, are causal factors in disease. There are three cate- gories for the causes of disease: external causes (i.e., wind, cold, “re, dampness, summer heat, and dryness, collectively referred to as •the six environmental evilsŽ), internal causes (i.e., joy, anger, anxiety, thought, sorrow, fear, and fright, col- lectively referred to as •the seven affectsŽ), and causes that are neither external nor internal (e.g., dietary irregularities, excessive sexual activity, overexertion, or complete inactiv- ity; Micozzi, 1996). Each of the causes of disease disrupts the balance of yin and yang in the body and disrupts the free movement of qi. Successful diagnosis and treatment are based on identifying the precise pattern of such imbalances. This is accomplished by taking a comprehensive medical his- tory, which includes asking about the nature of the patient•s complaints, the presence of any excessive activities such as sleeping or waking, diet, and sensations of •hotŽ and •cold.Ž Treatment involves helping the person regain health by reestablishing a normal balance and ”ow in the energy sys- tem, so that the body may heal itself. All of the treatment modalities in TCM are designed to achieve this harmony. Healthy individuals also practice these treatment modalities prophylactically to maintain health and prevent disease. Therapeutic Approaches There are a number of therapeutic approaches in TCM, of which Qigong is the most powerful (Micozzi, 1996). Qigong is a form of exercise-stimulation therapy that proposes to improve health by redirecting mental focus, breathing, coor- dination, and relaxation to mobilize and regulate the move- ment of qi in the body to facilitate the body•s own healing capacities (Spencer & Jacob, 1999). Tai Chi Ch’uan (also called tai chi) is a type of martial art that uses slow, Eastern Systems of Healing 597 purposeful motor-physical movements to achieve control and a more balanced physiological and psychological state. This technique is particularly popular among senior adults, and has been endorsed by the National Institute of Aging. Other TCM approaches include acupuncture, acupressure, massage ( Tui Na ), herbal medicine, and diet. Acupuncture is employed to remove the obstruction caus- ing the interruption of the ”ow of qi, or to redirect the ”ow of qi to where it is insuf“cient. Thin needles are inserted super- “cially on the skin throughout the body where meridian points are located (Spencer & Jacobs, 1999). To further en- hance the movement of qi, acupuncture is often used in conjunction with heat ( moxibustion) or electric current (elec- troacupuncture ). Healing is proposed by restoration of a balance of qi ”ow within the body. Acupressure uses the deep pressure of the “ngers or hands to stimulate meridian points and qi ”ow. It is an effective self-care and preventative health care treatment for tension- related ailments (The Burton Goldberg Group, 1995). Acu- pressure is also prescribed to help decrease psychological distress by assisting persons to increase their body awareness and ability to cope with stress through release of built-up ten- sion (Jacobs, 1996). Tui Na is a form of acupressure massage that uses techniques such as pushing, rolling, kneading, rub- bing, grasping, percussion, and vibration to improve circula- tion and to stimulate stale blood and lymph from tissues (The Burton Goldberg Group, 1995). It is often used as an adjunct to acupuncture treatment, to increase the range of motion of a joint, or in populations where acupuncture is contraindicated (e.g., pediatric). A type of popular acupressure called Shiatsu (“nger pressure) originated in Japan and uses applied pres- sure for 3 to 10 seconds in a rhythmic fashion. Shiatsu uses the same points as acupressure, but a practitioner of shiatsu refers to such points as tsubo, rather than meridian points. Shiatsu combines meridian point therapy with gentle stretch- ing and both soft tissue and joint manipulation and relies on gravity, rather than muscular force, to operate. Although magnetic therapy is not a TCM approach, it has recently gained popularity in the Chinese culture because of its self-help properties via the production of accessible de- vices such as magnetic bracelets and small magnets that can be easily adhered to the skin. The belief is that magnets can heal and enhance health by placing them either along a particular meridian or directly over the area of dysfunction to remove the obstruction of qi ”ow. Despite the increasing use of magnetic therapy as a form of self-help, empirical studies to support its proposed bene“ts are lacking (Dexter, 1997). Chinese herbal medicine is an integral part of Chinese culture and medical practice. It includes not only plants, but also mineral and animal parts as listed in the traditional Chinese material medica (also Liu, 1988; Spencer & Jacobs, 1999). Prescribing rules exist for consideration of the com- patibilities and incompatibilities of substances, the traditional pairing of substances, and their combination for speci“c symptoms (Liu, 1988). All of the formulas are organized in such a way as to support the qi that is desired for returning the body to a balanced and harmonious state. Maintaining a balanced diet in TCM is extremely impor- tant in maintaining health and in preventing, or recovering from, diseases and other pathological conditions. Many of the foods that are used for therapy in TCM are also routinely prepared by families and are part of cultural practices. Spe- cial foods, as characterized by their yin and yang properties, may be prepared when seasons change or when a person is ill. These food preparations are aimed at keeping yin and yang in balance in the individual and preventing disturbance in qi ”ow. Clinical Applications Most of the research studies in the literature on TCM focus on meridian point therapies such as acupuncture, elec- troacupuncture, and acupressure. Thus far, the evidence on the ef“cacy of acupuncture in the management of chronic pain is controvertible. One well-controlled study by Vincent (1989) demonstrated the long-term effectiveness of acupunc- ture in the treatment of migraine headaches. There was a 43% reduction in past treatment pain scores and a 38% reduction in medication usage for the acupuncture group compared to the placebo group, and these results were maintained at four- month and one-year follow-up. Patel, Gutzwiller, Paccand, and Marazzi (1989) examined the effectiveness of acupunc- ture for chronic pain in a meta-analysis of 14 randomized, controlled trials comparing acupuncture with placebo or standard care. The pooled results suggest that acupuncture was effective in treating low back and chronic headache pain. However, a second meta-analysis of 51 trials (ter Riet, Kleijnen, & Knipschild, 1990) found that most of the studies were of mediocre or poor quality with the best studies yield- ing contradictory results, raising signi“cant debate over effectiveness. The bene“ts of acupuncture have also been explored in a variety of other conditions. For example, acupuncture was found to be effective in the management of symptoms associ- ated with withdrawal from a variety of addictive substances such as cocaine (Culliton & Kiresuk, 1996). Jobst (1995) concluded that acupuncture produced favorable effects in the management of patients with bronchial asthma, chronic bron- chitis, and chronic disabling breathlessness. Although there is no evidence that acupuncture is an effective treatment for 598 Complementary and Alternative Therapies cancer itself, there are claims that it may be effective in pro- viding some relief from the side effects of cancer or the symptoms associated with conventional cancer treatments, such as pain control, and nausea and vomiting associated with chemotherapy (Vickers, 1996). Some bene“ts of acupressure are supported in the scien- ti“c literature. For example, compared to sham acupressure, true acupressure was more effective in improving the quality of sleep in institutionalized residents (Chen, Lin, Wu, & Lin, 1999). In randomized controlled studies, acupressure treat- ment resulted in signi“cantly less nausea and vomiting than placebo in persons undergoing laparoscopy (Harmon, Gardiner, Harrison, & Kelly, 1999) and caesarean sections (Harmon, Ryan, Kelly, & Bowen, 2000). Acupressure also re- sulted in less nausea than treatment as usual in a sample of women with breast cancer undergoing chemotherapy treat- ment (Dibble, Chapman, Mack, & Shih, 2000). However, not all published studies support the ef“cacy of acupressure. For example, acupressure was not effective at decreasing motion sickness in a double-blinded controlled study with a sam- ple of male college students (Warwick-Evans, Masters, & Redstone, 1991). There is some support for the use of electroacupuncture in the treatment of depression. Two randomized, controlled clinical trials compared the effects of electroacupuncture and amitriptyline hydrochloride in depressed patients (Luo, Jia, Wu, & Dai, 1990; Luo, Jia, & Zhan, 1985). Both studies found a signi“cant reduction in clinician•s ratings of depres- sion scores after treatment for both groups; however, there were no signi“cant differences between groups. Furthermore, a two- to four-year follow-up also found no signi“cant differ- ences between groups in the rate of depression recurrence, with electroacupuncture having fewer side effects than anti- depressant medication. Additional well-designed studies are needed to further delineate the ef“cacy of meridian point therapies in the treatment of depression. Clinical data for the ef“cacy of other TCM therapeutic ap- proaches also exist. Ryu et al. (1996) studied the effects of Qigong and meditation on stress hormone levels in 20 sub- jects who were engaged in at least four months of Qigong training. The results supported the stress-relieving bene“ts of such training. However, the study lacked both a control group and random selection of treatment group participants. As such, well-controlled studies are warranted to reach more conclusive results. Although most studies on tai chi have lim- ited generalizability because randomized trials with control groups were rarely used, positive cardiovascular changes (i.e., reductions in heart rate, blood pressure, and urinary cat- echolamines) have been demonstrated when comparing a participant•s own pretest and posttest scores in performance (Jin, 1992). Tai chi may also help in promoting cardiorespira- tory functioning in elderly subjects (Lai & Lan, 1995), as well as enhancing positive mood (Jin, 1989, 1992). These re- sults suggest that the practice of Qigong and tai chi may have stress-moderating functions. OTHER COMMON HEALING APPROACHES Herbal Remedies Although frequently employed as part of the overall healing systems previously discussed, herbs have also been used as a sole treatment to promote healing and balance. In the past two decades, herbal remedies for psychiatric and medical care have been increasingly used and investigated scienti“- cally. One survey suggests that in 1990, •Americans made an estimated 425 million visits to providers of unconventional therapyŽ (Eisenberg et al., 1993, p. 247). Another survey found that between 30% and 70% of patients in developed countries use complementary and alternative medicine (Linde et al., 1996). Overall, early studies suggest that phy- totherapy, the use of active substances found in plants, can enhance psychotherapeutic and medical treatment. The phy- totherapeutic substances, described next, have undergone some degree of scienti“c study. Echinacea Echinacea, also known as purple corn”ower, is derived from the Greek word echinos, meaning •hedgehogŽ or •sea urchin,Ža name given to the plant because of its spiky seed heads (Gunning, 1999). The herb is popular among Native Americans and in Germany, and is represented by nine species found in the United States. Echinacea is classi“ed by the plant species used, the part of the plant processed, the mode of pro- cessing, and the mode of application (Grimm & Muller, 1999). Amajority of studies have investigated echinacea for the treat- ment of colds and upper respiratory infections (URIs), chronic arthritis, cancer, chronic fatigue syndrome, wounds and ul- cers, and chronic pelvic infections (e.g., see Grimm & Muller, 1999). A review of 13 published and unpublished, random- ized, placebo-controlled trials of echinacea in the treatment of URIs found echinacea to be more effective than placebo in eight out of nine treatment trials by decreasing the severity and duration of URI symptoms (Barrett, Vohmann, & Calabrese, 1999). Other studies (Grimm & Muller, 1999; Melchart, Walther, Linde, Brandmaier, & Lersch, 1998) have not found such positive effects. The active ingredient of echinacea is unclear. Studies suggest that echinacea produces its effects via the immune Other Common Healing Approaches 599 system (Gunning, 1999), such as inducing cytokine produc- tion (Bruger, Torres, Warren, Caldwell, & Hughes, 1997) or enhancing cellular immune function of peripheral blood mononuclear cells (See, Broumand, Sahl, & Tilles, 1997). In their review, Barrett et al. (1999) highlight the dif“culty in comparing the research studies because different species are studied and there are no universally accepted standardization procedures. Garlic Although commonly considered a food substance, garlic ( Allium sativum ) is a commonly prescribed supplemental herb for the treatment of high cholesterol. Allicin is consid- ered the active compound found in the garlic bulb. Many of the studies investigate Kwai garlic powder tablets because it is standardized for alliin content (1.3% by weight). While Kleijnen, Knipschild, and ter Riet (1989) suggest that early studies on the ef“cacy of garlic were methodologically ”awed, more recent studies suggest garlic is effective in treat- ing hypercholesterolaemia. Two meta-analyses (Silagy & Neil, 1994; Warshafsky, Kamer, & Sivak, 1993) suggest that garlic reduces the high serum cholesterol levels considered to be a risk factor for coronary artery disease. Warshafsky et al. (1993) found 13 studies to meet their methodological criteria, and meta-analytic results suggested that garlic signi“cantly lowered cholesterol levels by about 9% in the experimental groups as compared to placebo. The results of Silagy and Neil•s (1994) meta-analysis of the 16 trials meeting their standards for methodological quality found that garlic low- ered serum cholesterol over one to three months and did not produce signi“cantly more adverse effects. While several au- thors (Isaacsohn et al., 1998; Jain, Vargas, Gotzkowsky, & McMahon, 1993) criticized these early meta-analytic “nd- ings, more recent, randomized, controlled trials have found garlic to reduce ratios of serum total cholesterol (Adler & Holub, 1997) and decrease low-density lipoprotein cho- lesterol in healthy men (Jain et al., 1993; Steiner, Khan, Holbert, & Lin, 1996). Ginger Zingiber ofﬁcinale, commonly known as ginger, has been pri- marily investigated for its antiemetic effects. This research has been particularly important for individuals who suffer from motion sickness and from postoperative nausea, or who experience nausea and vomiting due to chemotherapy but are unable to take synthetic drugs because of side effects such as sedation and visual disturbances. Several early studies found ginger to be more effective than placebo in alleviat- ing gastrointestinal symptoms of motion sickness (Mowrey & Clayson, 1982), reducing symptoms of seasickness (Grontved, Brask, Kambskard, & Hentzer, 1988), reducing nausea (Bone, Wilkinson, Young, McNeil, & Charlton, 1990) and reducing the request for antiemetics (Phillips, Ruggier, & Hutchinson, 1993) in postoperative patients. In addition, gin- ger has been studied for its antitumor effects (Koshimizu, Ohigashi, Tokudo, Kondo, & Yamaguchi, 1988). Vimala, Norhanom, and Yadav (1999) demonstrated that some, but not all, types of ginger inhibit Epstein Barr virus (EBV) acti- vation without the cytotoxicity effects. The authors suggest that populations with a high risk of cancer are •encouragedŽ to take plants with ginger, yet they also acknowledge that such use will not completely eliminate the disease. Ginkgo Biloba Ginkgo biloba extract is derived from the maidenhair tree and has been studied primarily for its effect on the brain, demen- tia, and Alzheimer•s disease. Active ingredients include Egb 761 (tapenoids), which have platelet-activating factor antagonistic properties, and gingkolides and ”avanoids (Oken, Storzbach, & Kaye, 1998). Three of the most popular preparations used in controlled trials include Tebonin, Tanakan, and Rokan, all of which are different names for the extract Egb 761. Various products available to the public contain different amounts of ginkgo biloba extract. In their review of the literature, Itil and Martorano (1995) suggest ginkgo has been •proven effectiveŽin the treatment of tinni- tus, sudden hearing loss, retinal damage, arthritic symptoms, vertigo, water retention, circulatory dysfunction, and age- related dementia. Early studies demonstrated the ef“cacy of Egb 761 on reducing the negative effects of experimentally induced stress on rats (Hasenohrl et al., 1996; Porsolt, Martin, Lenegre, Fromage, & Drieu, 1990; Rapin, Lamproglou, Drieu, & Defeudis, 1994) over other depressive medications (Porsolt et al., 1990) and over placebo (Porsolt et al., 1990; Rapin et al., 1994; Rodriguez de Turco, Droy-Lefaix, & Bazan, 1993). For instance, Rapin et al. (1994) found Egb 761 to decrease plasma hormone levels such as epinephrine, norepinephrine, and corticosterone. Alternatively, in their critical review of 40 controlled trials on Ginkgo and cerebral insuf“ciency in humans, Kleijnen and Knipschild (1992) found that only eight trials met criteria of good methodology, with only one showing positive effects compared with placebo on symptoms such as dif“culty concentrating, memory problems, confusion, lack of energy, tiredness, de- pressive mood, anxiety, dizziness, tinnitus, and headaches. Similarly, a more recent meta-analysis of more than 50 arti- cles (Oken et al., 1998) found only four studies (Hofferberth, 600 Complementary and Alternative Therapies 1994; Kanowski, Hermann, Stephan, Wierich, & Horr, 1996; Le Bars et al., 1997; Wesnes et al., 1997) that met the authors• standards for strong research methodology. These authors concluded there to be a •small but signi“cant effectŽ of ginkgo biloba extract on cognitive function, such as memory and attention, in patients with Alzheimer•s disease (Oken et al., 1998). Likewise, studies have found ginkgo biloba to improve mild to moderate memory impairment in elderly patients (Rai, Shovlin, & Wesnes, 1991), memory and psy- chopathology (Hofferberth, 1994), as well as daily living and social behavior (Le Bars et al., 1997). Moreover, consistent with previous reviews, ginkgo biloba was found to have no signi“cant adverse effects. Ginseng Ginseng, a popular herb in traditional Chinese medicine, is primarily used for its effects on anxiety, concentration, and physical stress. Yun (1996) found Panax ginseng C. A. Meyer (Korean ginseng) to prevent the development of cancer in mice by inhibiting the proliferation of tumors. He has also demonstrated a decrease in the risk of certain types of cancer in 1,987 pairs of humans when ginseng was ingested as a fresh extract or powder, as well as a decrease in the relative risk of cancer in a prospective population-based study of 4,634 adults. Ginseng has also demonstrated to improve quality of life among healthy volunteers (Wiklund, Karlberg, & Lund, 1994), as well as improve mood, vigor, well-being, and psychomotor performance in patients with noninsulin- dependent diabetes mellitus (Sotaniemi, Haapakoski, & Rautio, 1995). Several studies investigating the mechanism of action through which ginseng works demonstrate antinociceptive effects of ginseng on stress-induced mice (H.-S. Kim, Oh, Rheu, & Kim, 1992; Takahashi, Tokuyama, & Kaneto, 1992). Other studies suggest ginseng may enhance nitric oxide synthesis (Gillis, 1997), promote cytokine induction (Sonoda et al., 1998), or enhance natural killer cell activity in healthy subjects and in patients with chronic fatigue and acquired im- munologic syndromes (Gillis, 1997). Kava Kava, which means •bitterŽ in Polynesian, is derived from a black pepper plant in the South Paci“c called Piper methys- ticum, or •intoxicating pepper.Ž Kava has been traditionally ingested as a drink, but recently sold in capsule form in health food stores in the United States. Explorers• journals have documented the effects of kava for centuries: Kava has a numbing effect on the tongue when drunk, is tranquilizing and relaxing, and has genitourinary antiseptic qualities (Anonymous, 1988). However, too much kava can cause ad- verse effects such as dermopathy (Norton & Ruze, 1994), a skin condition characterized by scaly skin, gastrointestinal distress, and sleepiness (Cerrato, 1998), or a semicomatose state when it interacts with alprozam (Almeida & Grimsley, 1996). There are few randomized trials investigating the ef“cacy of kava on anxiety. The majority of trials that do exist are published in German. These studies have found kava extract to be superior to placebo and comparable to oxazepam and bromazepam (Volz & Keiser, 1997). A randomized, placebo- controlled study of 101 outpatients with various anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised ( DSM-III-R; American Psychiatric Association, 1987) criteria also found kava to be superior to placebo by reducing anxiety and caus- ing fewer side effects (Volz & Keiser, 1997). The psychopharmacology of kava remains unclear. Initial hypotheses suggested by investigators include: (a) Kava in- creases the number of binding sites of GABA A receptors (Jusso“e, Schmitz, & Hiemke, 1994); (b) it modulates the serotonin-1A receptor activity (Walden, Von Wegerer, Winter, & Berger, 1997; Walden, Von Wegerer, Winter, Berger, & Grunze, 1997); © it serves as reversible MAO-B inhibitors (Uebelhack, Franke, & Schewe, 1998); or (d) it in- hibits NA  channels (Magura, Kopanitsa, Gleitz, Peters, & Krishtal, 1997). St. Johns’ Wort St. Johns• wort (SJW) is an herbal product resulting from the ”owering of the plant Hypericum perforatum L. The plant•s oil has been used for centuries as a medicine to heal burns and improve mood. Over the past two decades, the pharma- ceutical industries have attempted to develop extracts of SJW for more popular and standardized use. In Germany, SJW is the most widely prescribed treatment for depression, totaling more than 25% of prescribed antidepressants (Muller & Kasper, 1997). Overall, the research suggests SJW to be ef“cacious in re- ducing depressive symptoms and to produce signi“cantly fewer side effects as compared to popular antidepressants. Studies comparing SJW to placebo have found antidepres- sive ef“cacy as well as high tolerability for SJW among pa- tients with mild depression (Hansgen, Vesper, & Plouch, 1994; Hubner, Lande, & Podzuweit, 1994; Sommer & Harrer, 1994). SJW has also demonstrated to be as effective as imipramine (Vorbach, Hubner, & Arnold, 1994), maproti- line (Harrer, Hubner, & Podzuweit, 1994), and amitryptiline Other Common Healing Approaches 601 (Wheatley, 1997), yielding a slightly better side effect pro“le. Meta-analyses evaluating theses studies have found SJW to be between 1.5 to 3 times more likely to produce an antide- pressant response as compared to placebo, and to be equiva- lent in ef“cacy to tricyclic antidepressants, (see H. L. Kim, Streltzer, & Goebert, 1999; Linde et al., 1996). Research on the biological mechanisms through which SJW may exert its antidepressant effects suggests that similar to popular pharmaceutical antidepressants, SJW in”uences amine levels. The main dif“culty in studying the biological mechanism of SJW pertains to the fact that several active constituents have been identi“ed from H. perforatum (Nahrstedt & Butterweck, 1997) including hypericin (Muller, Rolli, Schafer, & Hafner, 1997), and hyperforin (Chatterjee, Bhattacharya, Wonnemann, Singer, & Muller, 1998; Laakmann, Schule, Baghai, & Kieser, 1998; Muller et al., 1997, 1998; Schellenberg, Sauer, & Dimpfel, 1998). Overall, research indicates that SJW may inhibit the synaptosomal re- uptake of serotonin, dopamine, and norepinephrine (Muller et al., 1997, 1998; Muller & Rossol, 1994; Neary & Bu, 1999); upregulate postsynaptic serotonin receptors (Teufel- Mayer & Gleitz, 1997); and interfere with the central dopaminergic system (Butterweck, Wall, Lie”ander-Wulf, Winterhoff, & Nahrstedt, 1997; Franklin et al., 1999). Studies demonstrate that the main advantage to SJW is its more preferable side effect pro“le and tolerability to syn- thetic antidepressants. The most common adverse side effects included gastrointestinal symptoms (0.6%), allergic reactions (0.5%), tiredness (0.4%), and restlessness (0.3%) (Woelk, Burkard, & Grunwald, 1994). In addition, hypericum has been found to be safer with regard to cardiac function than tricyclic antidepressants (Czekalla, Gastpar, Hubner, & Jager, 1997). While SJW appears to be a safe herbal remedy for de- pression when taken alone, the major danger with SJW seems to lie in its potential for drug interactions. Current limitations in the research include lack of •well characterized populationsŽ (Cott, 1997); translation bias (Gaster & Holroyd, 2000); limited research on long-term ef- “cacy, safety, and tolerance at various doses (Volz & Kieser, 1997); ef“cacy for severe depression (Gaster & Holroyd, 2000); and ef“cacy as compared to serotonin reuptake inhibitors. Summary of Herbal Treatment Research In addition to the herbal remedies highlighted, more than 20,000 herbs are available to the public over the counter. For a good review of herbal remedies frequently used in psychi- atric practice, refer to Wong, Smith, and Boon (1998). Cur- rently, the Dietary Supplement Health and Education Act (DSHEA) does not require manufacturers to provide data on the safety, purity, and ef“cacy of their products (Wagner, Wagner, & Hening, 1998). Moreover, the Food and Drug Ad- ministration (FDA) does not regulate their use or standardize their purity or content (Lantz, Buchalter, & Giambanco, 1999). Therefore, individuals are able to self-prescribe herbs without the guidance of a physician, which may lead to ad- verse side effects and drug interactions. For instance, Lantz et al. (1999) discussed several case studies of elderly patients who developed serotonin syndrome (e.g., central and periph- eral serotonergic hyperstimulation) from taking SJW in con- junction with their prescribed antidepressant. It is important that clinicians appreciate the strength of these herbs and ask their patients about herbal use and educate them on the dan- gers of herbal and drug interactions. Lantz et al. also recom- mends that herbal remedies provide warning labels and that ef“cacy studies be subjected to •the same vigorous stan- dardsŽ as prescription medications as related to ef“cacy and safety. While the research suggests ef“cacy of a variety of herbal remedies, further research in required. There is a need for studies with (a) larger sample sizes, (b) data assessing partic- ipants• ability to distinguish placebo from the herb, © better characterization of the active constituents and mechanisms of action, and (d) results on the effects of chronic dosing, side effects, and standardization of preparation. Dietary, Nutrition, and Lifestyle Modiﬁcation Dietary modi“cation has recently become a way for individ- uals to take an active role in their well-being and a way to prevent the onset of illness or reduce the negative conse- quences of disease. Medical practitioners commonly recom- mend dietary modi“cation and lifestyle changes as a complement to traditional treatment, rather than as a sole al- ternative cure. Very Low Fat Diets In 1988, the National Cholesterol Education Program (NCEP) published guidelines for the treatment of high cho- lesterol in adults. The guidelines recommend dietary therapy for the lowering of LDL cholesterol (LDL-C). Speci“cally, they recommend an initial diet that includes an intake of total fat less than 30% of calories (National Cholesterol Education Program Expert Panel, 1998). Lichtenstein and Van Horn (1998) conducted a review of the literature on the ef“cacy of a very low fat diet, and reported that while there is •over- whelming evidenceŽ that reductions in saturated fat, dietary cholesterol, and weight are effective in reducing total 602 Complementary and Alternative Therapies cholesterol, LDL-C levels, and cardiovascular risk, the long- term effects remain unclear. Macrobiotic Diets Macrobiotics stems from the Greek words macro, meaning large, and bios, meaning life. A macrobiotic diet is composed of whole grains and cereals, vegetables (including sea veg- etables), fruits, beans, nuts, and seeds. A macrobiotic ap- proach underscores social interactions, climate, geographic location, and diet as all-important lifestyle habits to promote well-being and longevity. George Ohsawa is considered to be the founder of the macrobiotic diet, and it was popularized in the United States by Michio Kushi. Two early studies sup- port the theory that a vegetarian diet results in a signi“cant re- duction in blood pressure among patients with hypertension (Margetts, Beilin, Vandongen, & Armstrong, 1986; Rouse, Beilin, Armstrong, & Vandongen, 1983). The use of macrobi- otic in treatment of other medical conditions (e.g., cancer) remains controversial and has not been scienti“cally tested. Atkins’ Diet In 1972, Robert Atkins published the book Dr. Atkins’ Diet Revolution. He proposed metabolic imbalance to be the cause of obesity and stated that many of today•s diseases, including diabetes, hypoglycemia, and cardiac disease, are a result of •carbohydrate intoleranceŽ (Atkins, 1972). Atkins proposed that carbohydrates prevent our bodies from ketogenesis, a process by which the body burns fat and turns it into fuel. There are no scienti“c studies investigating ketogenic diets for the previously mentioned diseases, and therefore, these diets may be based more on theory than on scienti“c evidence. However, ketogenic diets have been investigated for their ef- “cacy in managing epilepsy and seizure disorder. One study found that 54% of a group of children with intractable seizures who remained on a ketogenic diet reported a decrease in the frequency of their seizures by more than 50% three months after initiating the diet (Vining et al., 1998). Despite such “nd- ings, there is continued controversy regarding its use. Roach (1998) argues that while there is •a clear biochemical rationale and a well-de“ned therapeutic objectiveŽ(p. 1404), he urges for more rigorous investigations on safety and ef“cacy. Gerson Method Nutrition has become increasingly used, though not necessarily empirically supported, by individuals diagnosed with cancer. Max Gerson was a German-born physician who believed that •degenerativeŽ diseases such as cancer, arthritis, and multiple sclerosis are the result of extreme body toxicity. Therefore, he advocated a special diet in the treatment of cancer, which included •detoxi“cationŽ of the body, a no-sodium, no-fat, high-potassium, and high-carbohydrate diet, as well as coffee enemas. There are few studies investigating the ef“cacy of the Gerson Method; however, those that exist are methodologi- cally ”awed. One study (Hildenbrand, Hildenbrand, Bradford, & Calvin, 1995) investigated the ef“cacy of Gerson•s diet ther- apy with 153 patients diagnosed with melanoma and found the “ve-year survival rate to be 100% for individuals at Stage I and II, 72% for individuals at Stage IIIA, and 41% for individuals at Stage IVA. While there was no placebo control group in this study, “ve-year survival rates were signi“cantly higher than the survival rates published in other studies. It should be noted that the Gerson Method is highly con- troversial. The American Cancer Society (ACS) reported a lack of evidence of the ef“cacy of the Gerson Method and urged people with cancer not to seek treatment with the Gerson Method (ACS, 1990). The ACS publicly acknowl- edges that while the dietary measures may have preventive utility, there is no scienti“c evidence than any nutritionally related regimen is appropriate as a primary treatment for cancer (ACS, 1993). Ornish Lifestyle Heart Trial Dean Ornish is well-known for his work with patients with coronary artery disease through vegetarian diet, exer- cise, and stress management on coronary atherosclerosis. The Lifestyle Heart Trial (Ornish et al., 1990), a prospective, ran- domized, controlled trial of patients with coronary artery dis- ease, demonstrated that this prescribed lifestyle modi“cation resulted in regression on coronary atherosclerosis as evi- denced by a decrease in diameter stenosis. The study, how- ever, did not investigate the individual contributions of the various interventions (e.g., low-fat vegetarian diet, sto

bundet

pping smoking, stress management training, exercise) to the out- come measure. Later studies (Gould et al., 1995; Ornish et al., 1998) investigated a similar lifestyle change program in patients with coronary artery disease over “ve years and found that the size and severity of perfusion abnormalities on dipyridamole positron emission tomography images de- creased (improved) after risk factor modi“cation in the experimental group, compared with an increase (worsening) of size and severity in the control group. Tactile Therapies Tactile therapies are de“ned as interventions that center on soft tissue or energy mobilization techniques performed by a Other Common Healing Approaches 603 health care provider. Such methods can be divided into soft tissue therapies, energy mobilization, and meridian point therapy. Soft Tissue Therapies Encompassing a variety of treatment approaches, soft tissue therapies are geared toward decreasing dysfunction in mus- cles and fascia (i.e., the continuous subcutaneous layer of soft tissue throughout the body). Soft tissue therapies are pur- ported to alleviate somatic organizational dysfunction, thus enhancing both psychological and physical health. The goal of massage is to decrease muscular tension using strokes, kneading, and friction techniques. Proposed bene“ts of massage include both psychological and physiological re- laxation, facilitated ease with breathing, enhanced immune function, reduced anxiety, increased vigor, lessened pain, and improved sleep (Wanning, 1993). Positive effects from mas- sage have been demonstrated in both adult and child popula- tions (Field, Ironson, et al., 1996; Field, Morrow, et al., 1992). In one study, participants with depression and adjust- ment disorders were randomly assigned to receive a back massage or watch relaxing videos for 30 minutes over a “ve- day period (Field, Morrow, et al., 1992). Results demon- strated decreased depressive symptoms, anxiety, and salivary cortisol, as well as enhanced sleeping, for the massage group only. Aromatherapy, the use of fragrances to augment mood and activity, is often used in conjunction with massage. Aromatherapy uses speci“c essential oils from plants for therapeutic use. For example, lavender is believed to have calming and analgesic effects, while ginger is deemed to in- cite stimulating, warming sensations (Jacobs, 1996). In one study, 122 patients in an intensive care unit were randomly assigned to massage, massage with lavender oil, or rest (Dunn, Sleep, & Collett, 1995). Only patients receiving mas- sage with lavender oil demonstrated signi“cantly enhanced mood following intervention. Aromatherapy can also be used via bathing, candles, and culinary manners. Assessing the effects of aromatherapy ventilated throughout a room, one nonrandomized study demonstrated that depressed patients used less antidepressant medication after being exposed to citrus oils (Komori, Fujiwara, Tanida, Nomura, & Yokoyama, 1995). There are few empirical studies on aromatherapy, and the majority of those conducted use poor control and lack statistical analyses (Martin, 1996). In a review article, Evans (1995) suggests that the paucity of psychometrically sound studies makes it dif“cult to differentiate the bene“cial effects of aromatherapy from attention, social interaction, or the use of massage. Reﬂexology is a soft tissue mobilization centered on the foot. This technique is based on the belief that distinct areas of the foot represent different parts of the body. By applying pressure to speci“c regions of the foot, the corresponding body structure can be stimulated, promoting a health re- sponse. For example, the head and sinus regions are mapped in the toes, and massage of the toes is believed to help allevi- ate headaches and sinus pressure. A quasi-experimental study of persons with lung or breast cancer demonstrated positive effects on anxiety and pain following re”exology (Stephenson, Weinrich, & Tavakoli, 2000). Myofascial release and Rolﬁng are two additional types of soft tissue therapies, both of which are purported to decrease pain and enhance health. The purpose of myofascial release is to free restrictions in the myofascial caused by physical or psychological stress using gentle pushing techniques against the client•s skin. This technique is used to treat muscu- loskeletal dysfunction, headaches, chronic pain, and tem- poromandibular pain (Ramsey, 1997). Rol“ng also attempts to manipulate myofascial constraints, but, unlike myofascial release, it uses the forces of gravity and more vigorous pres- sure from the practitioner. It has been suggested that Rol“ng permits increased muscular ef“ciency, decreases physiologi- cal stress on the body, and promotes neurological functioning (Jacobs, 1996); however, scienti“c studies to support these claims are not present in the literature. Energy mobilization attempts to alleviate poor physical and psychological health that is said to result from distur- bances in a person•s forces of energy. For example, therapeu- tic touch (TT) involves techniques that are aimed at centering awareness and energy in the client. Despite its name, this pro- cedure does not necessarily involve direct contact with the client and may consist of the clinician•s hands being held over the areas of needed energy mobilization. Some literature supports the ef“cacy of TT. For example, the effects of TT in reducing anxiety were assessed in a sam- ple of psychiatric in-patients (Gagne & Toye, 1994). Patients were randomly assigned to TT, mimic TT, or relaxation ther- apy. Results demonstrated signi“cant decreases in anxiety for the TT and relaxation groups, with the former exhibiting greater bene“ts than the latter. The group receiving mimic TT demonstrated no signi“cant changes. An additional random- ized study supports TT as being more effective than •calm touchŽ at decreasing the time necessary to soothe medically hospitalized children between the ages of two weeks to two years (Kramer, 1990). In a randomized study of elderly indi- viduals with arthritis, both TT and progressive muscle relax- ation interventions resulted in comparable and signi“cant improvements in pain, tension, and mood (Peck, 1998). However, not all studies support the bene“cial effects of 604 Complementary and Alternative Therapies TT (e.g., Olson, et al., 1997). A literature review and meta- analysis highlights the poor methodology implemented in TT studies but calculated an average effect size of .39 for TT (Winstead-Fry & Kijek, 1999). Reiki, another type of energy mobilization, means •uni- versal life force energy.Ž Whereas TT involves the mobiliza- tion of energy in the client•s body, Reiki entails transferring or mobilizing energy from the clinician to the client. It is based on the concept that all living creatures possess energy and that the human body is programmed to heal itself. Practi- tioners of Reiki report positive effects of this technique on mood, psychological distress, pain, and functional abilities, but these results are based on patient case history reports. A similar energy-based approach, polarity therapy, is based on the concept that the body holds an electromagnetic force, with a positive charge located cephalically and a nega- tive charge situated toward the toes. The clinician•s hands are believed to be conductors of energy. When they are placed in certain areas of the client•s human energy “eld, the clinician attempts to facilitate energy movement in the client•s body. This facilitation is believed to enhance energy ”ow and relaxation throughout the mind and body. Scienti“c studies regarding its ef“cacy are absent. Movement Therapies Movement therapies are complementary approaches to health that emphasize changes in the client•s bodily positions. Leisure activity (e.g., casual walking) has been demonstrated to buffer anxiety in the face of stressors (Carmack, Boudreaux, Amaral-Melendez, Brantley, & de Moor, 1999). Active perimenopausal women reported less psychosomatic symptoms (e.g., irritability, headaches) and fewer sexual problems than those who were more sedentary (Li, Gulanick, Lanuza, & Penckofer, 1999). Some literature exists supporting the psychological bene- “ts of aerobic exercise. Correlational studies predominantly endorse positive psychological health in people who partici- pate in aerobic exercise. One study assessing more than 3,400 participants found that those who engaged in exercise two or more times each week reported less depressive symptoms, anger, cynical distrust, and stress compared to those exercis- ing less or not at all (Hassmen, Koivula, & Uutela, 2000). This former group also reported a greater sense of social integration and perceived health. Similarly, meta-analytic reviews revealed that those who exercise are signi“cantly less likely to be depressed (Craft & Landers, 1998) and to report distress (Crews & Landers, 1987). However, other meta-analyses demonstrate little (i.e., only one-half standard deviation; North, McCullagh, & Tran, 1990) or no (e.g., Schlicht, 1994) difference in psychological distress between exercisers and nonexercisers. Intervention studies provide stronger evidence for the psy- chological bene“ts of aerobic exercise regarding psychologi- cal distress. One study randomly assigned participants with dysphoric mood to cognitive therapy, aerobic exercise, or a combination of these two interventions over a 10-week period (Fremont & Craighead, 1987). Although no signi“cant differences were noted between the groups, all three demon- strated signi“cant decreases in depressive symptoms. Simi- larly, older patients with major depressive disorder were randomly assigned to aerobic exercise (3 times per week), antidepressant medication (sertraline hydrochloride), or both for 16 weeks (Blumenthal et al., 1999). Results demonstrated all three groups signi“cantly improved on measures of depression, anxiety, self-esteem, life satisfaction, and dys- functional attitudes from pre- to posttreatment, but no differ- ences were noted between the groups following intervention. Those receiving antidepressant medications did, however, demonstrate quicker enhancement of mood compared to those participating in aerobic exercise only. Ameta-analytic study demonstrated the effects of rehabili- tative exercise programs on anxiety and depression in patients with coronary disease (Kugler, Seelbach, & Kruskemper, 1994). Speci“cally, exercise resulted in moderate decreases in both anxiety and depressive symptoms and did not differ signi“cantly from psychotherapy. Similarly, breast cancer survivors randomly assigned to exercise or exercise plus behavior modi“cation demonstrated comparably signi“cant decreases in depressive symptoms and anxiety (Segar et al., 1998). The waitlist control (WLC) group in this study did not initially exhibit such declines in distress. However, following the waiting period, those participants in the WLC who partook in the exercise program also exhibited signi“cantly dimin- ished anxiety and depressive symptoms. In addition to aerobic exercise, resistance exercise (e.g., weight lifting) has also demonstrated bene“cial effects on health (Tsutumi et al., 1998). Fox•s (1999) review of the literature on exercise and men- tal health supports the following conclusions: Exercise (a) is an effective treatment for clinical depression; (b) decreases state and trait anxiety; © enhances self-perceptions and, perhaps, self-ef“cacy; (d) improves mood; and (e) may improve cognitive functioning, especially in older adults. Possible mechanisms of action may be in the physiological (e.g., release of endorphins), psychological (e.g., diversion, improved self-image), and/or social (e.g., social interactions, receiving attention) domains. Other Common Healing Approaches 605 Yoga incorporates exercise, static poses, breathing, relax- ation, and meditation (Jacobs, 1996). The purpose of yoga is to •centerŽ the person•s mind, body, and spirit. Speci“c hy- pothesized bene“ts include improving muscular and cardio- vascular endurance, boosting the immune system, enhancing circulation, increasing muscular and cognitive ”exibility, and relaxation. Yoga is often used as complementary therapy for medical disorders such as asthma, arthritis, HIV/AIDS, cancer, and coronary artery disease. While there are several different types of yoga, Hatha yoga is most frequently prac- ticed in the West. Hatha yoga combines stretching, breathing, relaxation, and meditation (Wanning, 1993). Research supports positive bene“ts of practicing yoga. Pa- tients with epilepsy were randomly assigned to true yoga, sham yoga (i.e., similar but distinct postures), and a nontreat- ment control group (Panjwani, Gupta, Singh, Selvamurthy, & Rai, 1995). Decreases in galvanic skin response, as an indi- cator of sympathetic nervous system activity, were noted in the true yoga group only. Another study compared yoga, relaxation (i.e., progressive muscle relaxation), and visual- ization in a group of healthy adults (Wood, 1993). Partici- pants practiced for six, 25- to 30-minute sessions over a two-week period. Following intervention, the yoga group re- ported increased mental and physical energy, alertness, and positive mood. These bene“ts were signi“cantly greater than the other two groups. The relaxation group was more tired and sluggish compared with yoga, and the visualization group reported more sluggishness and less contentment com- pared to those performing yoga. Additionally, yoga has been integrated into cardiac rehabilitation programs (Ornish et al., 1998). Additional movement therapies conjectured to enhance mind and body health include the Alexander technique and Feldenkrais. The Alexander technique is based on the con- cept that poor posture produces functional problems in the mind and body. Those practicing this technique strive to work with unconscious thoughts and to correct poor postures, especially centered on the head, neck, and back. One uncon- trolled study investigated the effects of the Alexander tech- nique on patients with Parkinson•s disease (Stallibrass, 1997). Following a series of lessons (mean number  12), participants demonstrated decreased depressive symptoms and increased functional abilities. Similarly, Feldenkrais’ functional integration is based on the premise that pain and decreased movement are caused by poor usage patterns. The goal of this movement therapy is to develop •freedom through awarenessŽ via •re-educatingŽ motor components by using slow, purposeful movements. As a result, the body and mind are hypothesized to relax, permitting ease with movement, thinking, and feeling. One randomized controlled study investigating Feldenkrais movement was identi“ed (Johnson, Frederick, Kaufman, & Mountjoy, 1999). In this study, patients with multiple sclero- sis participated in true or sham Feldenkrais sessions. Only those participants in the true Feldenkrais intervention reported less perceived stress and anxiety. Expressive Therapies Expressive therapies include techniques designed to in- crease the person•s awareness and expression of emotions. Written emotional disclosure refers to writing about thoughts and feelings regarding a stressful or traumatic event. This type of expressive therapy has consistently demonstrated positive effects on psychological well-being, mood, and physiological and general functioning (Smyth, 1998). Specif- ically, written emotional disclosure has resulted in greater positive mood, less negative mood, decreased anxiety, fewer somatic complaints, and less frequent physician visits for both students and unemployed adults (Greenberg & Stone, 1992; Pennebaker, 1993; Pennebaker, Colder, & Sharp, 1990). With regard to medical populations, patients with rheuma- toid arthritis (RA) and asthma were randomly assigned to write about either stressful experiences or a neutral topic (Smyth, Stone, Hurewitz, & Kaell, 1999). Four months fol- lowing intervention, those in the former group demonstrated signi“cant health bene“ts not gleaned from the group writing about neutral events. Speci“cally, patients with RA demon- strated improvements in overall disease activity, while those with asthma demonstrated improved lung function. Further- more, 47% of those writing about stressful events, compared to 9% in the other group, demonstrated clinically signi“cant improvements. Positive mood and enhanced physical func- tion were also noted in another study in a group of patients with RA (Kelley, Lumley, & Leisen, 1997). Similar to the previous study, only participants randomly assigned to dis- close stressful events (this time via verbal means) gained psychological and physical bene“ts, while those randomly assigned to discuss a neutral topic showed no psychological or physical health bene“ts. Dance movement therapy (DMT) attempts to promote expression and reduce tension through movement. It has been prescribed in the clinical literature to help treat children and adults with behavior problems or expressive dif“culties. DMT is believed to help decrease negative effects of stress (e.g., tension, fatigue) by gaining a sense of control through (a) the spiritual aspect of dance, (b) moving (e.g., increased 606 Complementary and Alternative Therapies circulation), © distraction from stress, and (d) confronting stressors by projecting them in dance (Hana, 1995). While there are intervention studies investigating the ben- e“ts of DMT for patients with a range of psychological symptoms (Brooks & Stark, 1989; Stewart, McMullen, & Rubin, 1994), most were conducted with poor methodologi- cal control. Music therapy (MT) involves the active or passive use of music to enhance health and express emotions (Achterberg et al., 1994). It has been used with adults and children who exhibit cognitive and affective de“cits. In addition, patients with physical disabilities and chronic mental illness were reported to bene“t from MT (Achterberg et al., 1994). A review of the literature provides support for the use of MT to decrease anxiety associated with speci“c events (i.e., surgery and medical procedures) in some populations (i.e., cardiac patients and premature neonates; Snyder & Chlan, 1999; and patients with asthma; Lehrer et al., 1994). With regard to depression, one study observed the impact of elderly pa- tients who were randomly assigned to either home-based MT, self-administered MT, or waitlist control (WLC) over an eight-week period (Hanser & Thompson, 1994). Results demonstrated both MT groups achieved a greater decrease in depression than those on the waitlist, and these bene“ts were maintained at a nine-month follow-up assessment. Art therapy entails using drawing, painting, or sculpting to express oneself and increase self-awareness (Achterberg et al., 1994). Art therapy has been connected with mental health since the 1800s. Few empirical studies have been conducted investigating the ef“cacy of art therapy as a treatment for speci“c medical or psychological disorders. However, Anand and Anand (1997) discussed the bene“ts gleaned from art therapy in patients following laryngec- tomy. Speci“cally, art therapy reportedly served as an ad- junct assessment and treatment tool for patients who experience depression, anxiety, grief, and concern regarding physical appearance. Mind/Body Therapies Complementary and alternative therapies categorized as mind/body interventions have often been derived from decades of psychological and behavioral science. They are discussed in other chapters of this volume with regard to their ef“cacy in treatment of psychological and physical syn- dromes, such as pain, that are associated with various medical disorders. These include many cognitive and behav- ioral interventions such as relaxation training, guided visual- ization, cognitive restructuring, behavior modi“cation, self-instructional training, stress inoculation training, prob- lem solving, anger management, and psychoeducation, as well as other psychological interventions such as hypnosis and supportive group counseling. When employed to reduce psychological distress (e.g., anx- iety and depression), to manage stress, or to treat a range of other behavioral disorders, many of these therapies are well-tested and thus considered standard approaches to treatment. For ex- ample, many clinical interventions falling under the rubric of cognitive-behavioral treatment have been documented through numerous studies, reviews, and texts as effective for a wide range of psychological and behavioral problems (Beutler, Harwood, & Caldwell, 2001). Many are listed as empirically validated techniques. Cognitive-behavioral therapies are markedly present among the list of empirically supported psy- chotherapies (Chambless & Hollon, 1998). When the focus of such therapies is on the reduction of medical symptoms and disease, their use may be viewed as alternative or complementary, because they have not been traditionally prescribed or employed in a medical context. However, as many of the chapters in this volume indicate, mind/body strategies have shown promise as potentially effective strategies that can alter the occurrence, course, or management of medical syndromes. Additionally, their po- tential effectiveness regarding many medically unexplained symptoms has been suggested (A. M. Nezu, Nezu, & Lombardo, 2001). This is particularly relevant with regard to the large percentage of individuals who seek medical care each year from their primary care physicians, in which there exists no identi“able underlying medical disease that can ex- plain the persistent experience of certain physical symptoms (A. M. Nezu et al., 2001). Recent reviews concerning other interventions such as hypnosis have also shown promise as both alternative and complementary interventions for medical disorders such as obesity, insomnia, hypertension, asthma, irritable bowel syndrome, and dermatological disor- ders (Nash, 2001). Are all complementary and alternative therapies mind/ body? As traditional psychological interventions are more frequently applied to both medical and psychological para- meters of disease, and as other complementary and alterna- tive treatments described earlier in this chapter gain wider public attention and acceptance, the dichotomous line be- tween medical and nonmedical symptoms, disorders and treatments can be rapidly blurred. As such, the concept of mind/body therapies to maintain health and heal disease can be expanded to include almost all interventions based on the understanding that such conditions represent an interac- tion of physical, psychological, emotional, and spiritual factors. Most of the interventions described in this chapter are •mind/bodyŽ therapies. References 607 COMMON THEMES From a health psychology perspective, several important themes emerge that concern the shared characteristics of al- ternative and complementary treatments in the context of an expanded mind/body rubric. These include: 1. A biopsychosocial model, which incorporates biological, immunological, psychological, spiritual, interpersonal, and environmental variables, characterizes an underlying mind/ body philosophy of most complementary and alternative approaches. Psychological wellness is viewed as a critical component of health regarding most of these therapeutic systems. Many psychological interventions, such as cogni- tive-behavioral therapy, group therapy, and hypnosis, may provide strategies that increase psychological well-being and decrease distress. 2. A holistic, individualized case assessment approach is a common method of diagnosis and treatment. Although each healing approach may vary in the methodology, such as use of the interview, physical exam techniques, or tests that are administered, there is a marked tendency to design treatment speci“c to the individual case formulation rather than rely on a standard prescription or dosage strategy. 3. The underlying philosophy on which many complemen- tary and alternative interventions are based view health as a state of harmony and energy balance, wherein the phys- ical, emotional, mental, and spiritual aspects of energy are all given signi“cant weight and seen as interrelated. 4. Treatment ef“cacy is most often associated with stress- related disorders and those diseases that have been etio- logically linked to cognition, behavior, and lifestyle. This covers a wide range of what have been historically con- sidered medical disorders, such as cardiac problems, diabetes, immune functioning disorders, asthma, pain syn- dromes, and gastrointestinal disorders. FUTURE DIRECTIONS Integration of Psychological Interventions and Complementary and Alternative Therapies Because psychological health is considered such an integral part of most complementary and alternative approaches, there is wide applicability for psychological interventions to be delivered in conjunction with these approaches as part of an overall health maintenance strategy. Particularly helpful in this regard would be the widespread provision of psychoedu- cation and promotion of a biopsychosocial model, so that patients can learn to view psychological interventions as part of a comprehensive treatment, rather than an indication that health providers have labeled them as •crazyŽ or diagnosed their problem as •all in their head.Ž Additionally, psycholog- ical interventions speci“cally shown to be ef“cacious with comorbid symptoms of anxiety and depression, which occur with high prevalence in patients with diagnosed dif“culties such as cancer or heart disease, can be integrated with ongo- ing treatment aimed at the cancer itself. A Decision-Making Problem Because of the wide choice of treatments available, individ- uals who are interested in pursuing a more holistic approach to their health and incorporating complementary and alter- native approaches are faced with the daunting task of sort- ing through myriad information. Media and technology have made available to the general public both the access and marketing of information concerning a wide range of health choices possible. Thus, when faced with a disease diagnosis, people are in the position of choosing from competing philosophies, therapies, and providers. Such de- cisions are dif“cult enough„when compounded by the emotional impact of an illness, a person•s decision making can be further impaired (A. M. Nezu, Nezu, Friedman, Faddis, & Houts, 1998). Training patients in decision- making strategies, such as social problem-solving skills, as a way of coping with the many decisions they must confront may serve as a particularly useful intervention in this re- gard. Problem solving, de“ned by D•Zurilla and Nezu (2001), is a •self-directed cognitive-behavioral process by which a person attempts to identify and discover effective and adaptive solutions for speci“c problems encountered in everyday livingŽ(p. 212). Findings from a variety of studies have provided support for problem-solving therapy as a po- tent intervention to reduce stress, increase quality of life, and perhaps most germane to this discussion, increase sense of self-ef“cacy and con“dence in making decisions (A. M. Nezu et al., 1998). Training patients in such skills can in- crease the likelihood that patients will become active part- ners with their various health care providers, deriving maximum bene“t from the range and combination of treat- ment alternatives available. REFERENCES Abenhaim, L., & Bergeron, A. M. (1992). Twenty years of random- ized clinical trials of manipulative therapy for back pain: A review. Clinical and Investigative Medicine, 15 (6), 527…535. 608 Complementary and Alternative Therapies Achterberg, J., Dossey, L., Gordon, J. S., Hegedus, C., Herrmann, M. W., & Nelson, R. (1994). Mind-body interventions. In B. M. Berman & D. B. Larson (Co-Chairs), Alternative medicine: Expanding medical horizons. A report to the National Institutes of Health on alternative medical systems and practices in the United States prepared under the auspices of the Workshop on Alternative Medicine (1992, Chantilly, VA) (pp. 3…43). Washing- ton, DC: U.S. Government Printing Of“ce. Adler, A. J., & Holub, B. J. (1997). Effect of garlic and “sh-oil supplementation on serum lipid and lipoprotein concentrations in hypercholesterolemic men. American Journal of Clinical Nutrition, 65, 445…450. Alexander, C. N., Langer, E. J., Newman, R. I., Chandler, H. M., & Davies, J. L. (1989). Transcendental meditation, mindfulness and longevity: An experimental study with the elderly. Journal of Personality and Social Psychology, 57, 950…964. Alexander, C. N., Robinson, P., & Rainforth, M. (1994). Treating alcohol, nicotine, and drug abuse through transcendental medita- tion: A review and statistical meta-analysis. Alcoholism Treat- ment Quarterly, 11, 13…87. Almeida, J. C., & Grimsley, E. W. (1996). Coma from the health food store: Interaction between kava and alprazolam. Annals of Internal Medicine, 125 (11), 940…941. American Cancer Society. (1990). Unproven methods of cancer management: Gerson method. CA—A Cancer Journal for Clini- cians, 40 (4), 252…256. American Cancer Society. (1993). Questionable methods of cancer management: •NutritionalŽ therapies. CA—A Cancer Journal for Clinicians, 43 (5), 309…319. American Psychiatric Association. (1987). Diagnostic and statisti- cal manual of mental disorders (3rd ed., rev.). Washington, DC: Author. Anand, S. A., & Anand, V. K. (1997). Art therapy with laryngectomy patients. Art Therapy, 14, 109…117. Anderson, R., Meeker, W., Wirick, B. E., Mootz, R. D., Kirk, D. H., & Adams, A. (1992). A meta-analysis of clinical trials of spinal manipulation. Journal of Manipulative and Physiological Therapeutics, 15 (3), 181…194. Anonymous. (1988). Kava. Lancet, 2, 258…259. Atkins, R. C. (1972). Dr. Atkins’diet revolution. New York: Bantam Books. Barrett, B., Vohmann, M., & Calabrese, C. (1999). Echinacea for upper respiratory infection. Journal of Family Practice, 48 (8), 628…635. Beutler, L. E., Harwood, M. T., & Caldwell, R. (2001). Cognitive- behavioral therapy and psychotherapy integration. In K. S. Dobson (Ed.), Handbook of cognitive and behavioral therapies (2nd ed., pp. 138…172). New York: Guilford Press. Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., et al. (1999). Effects of exercise training on older patients with major depression. Archives of Internal Medicine, 159, 2349…2356. Boline, P. D. (1991). Chiropractic treatment and pharmaceutical treatment for muscle contraction headaches: A randomized com- parative clinical trial. Proceedings from the 1991 Conference on Spinal Manipulation, Arlington, VA; Foundation for Chiroprac- tic Education and Research. Bone, M. E., Wilkinson, D. J., Young, J. R., McNeil, J., & Charlton, S. (1990). Ginger root„A new antiemetic: The effect of ginger root on postoperative nausea and vomiting after major gynaeco- logical surgery. Anaesthesia, 45, 669…671. Brooks, D., & Stark, A. (1989). The effect of dance/movement therapy on affect: A pilot study. American Journal of Dance Therapy, 11, 101…112. Bruger, R. A., Torres, A. R., Warren, R. P., Caldwell, V. D., & Hughes, B. G. (1997). Echinacea-induced cytokine production by human macrophages. International Journal of Immunophar- macology, 19 (7), 371…379. The Burton Goldberg Group. (1995). Alternative medicine. Fife, WA: Future Medicine. Butterweck, V., Wall, A., Lie”ander-Wulf, U., Winterhoff, H., & Nahrstedt, A. (1997). Effects of the total extract and fractions of hypericum perforatum in animal assays for antidepressant activ- ity. Pharmacopsychiatry, 30 (Suppl. 2), 117…124. Carmack, C. L., Boudreaux, E., Amaral-Melendez, M., Brantley, P. J., & de Moor, C. (1999). Aerobic “tness and leisure activity as moderators of the stress-illness relation. Annals of Behavioral Medicine, 21, 251…257. Cerrato, P. L. (1988). Natural tranquilizers. RN, 61 (12), 61…62. Chambless, D., & Hollon, S. D. (1998). De“ning empirically sup- ported therapies. Journal of Consulting and Clinical Psychology, 66, 7…18. Chatterjee, S. S., Bhattacharya, S. K., Wonnemann, M., Singer, A., & Muller, W. E. (1998). Hyperforin as a possible antidepressant component of hypericum extracts. Life Sciences, 63 (6), 499…510. Chen, M. L., Lin, L. C., Wu, S. C., & Lin, J. G. (1999). The effec- tiveness of acupressure in improving the quality of sleep of institutionalized residents. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 54, M389…M394. Cohen, S., & Herbert, T. B. (1996). Health psychology: Psycholog- ical factors and physical disease from the perspective of human psychoneuroimmunology. Annual Review in Psychology, 47, 113…142. Cooper, M. J., & Aygen, M. M. (1978). Effect of transcendental meditation on serum cholesterol and blood pressure. Harefuah, 95 (1), 1…2. Cott, J. M. (1997). In vitro receptor binding and enzyme inhibition by hypericum perforatum extract. Pharmacopsychiatry, 30 (Suppl. 2), 108…1 12. Craft, L. L., & Landers, D. M. (1998). The effect of exercise on clin- ical depression and depression resulting from mental illness: A meta-analysis. Journal of Sport and Exercise Psychology, 20, 339…357. References 609 Crews, D. J., & Landers, D. M. (1987). A meta-analytic review of aerobic “tness and reactivity to psychosocial stressors. Medicine and Science in Sports and Exercise, 19, S114…S120. Culliton, P. D., & Kiresuk, T. J. (1996). Overview of substance abuse acupuncture treatment research. Journal of Alternative and Complementary Medicine, 2 (1), 149…159. Czekalla, J., Gastpar, M., Hubner, W. D., & Jager, D. (1997). The ef- fect of hypericum extract on cardiac conduction as seen in the electrocardiogram compared to that of imipramine. Pharma- copsychiatry, 30 (Suppl. 2), 86…88. Davidson, J. R. T., Morrison, R. M., Shore, J., & Davidson, R. T. (1997). Homeopathic treatment of depression and anxiety. Alter- native Therapies in Health and Medicine, 3 (1), 46…49. Dexter, D. (1997). Magnetic therapy is ineffective for the treatment of snoring and obstructive sleep apnea syndrome. Wisconsin Medical Journal, 96, 35…37. Dibble, S. L., Chapman, J., Mack, K. A., & Shih, A. S. (2000). Acu- pressure for nausea: Results of a pilot study. Oncology Nursing Forum, 27, 41…47. DiGiovanna, E. L., & Schiowitz, S. (Eds.). (1991). An osteo- pathic approach to diagnosis and treatment. Philadelphia: Lippincott. Dogra, J., Grover, N., Kumar, P., & Aneja, N. (1994). Indigenous free radical scavenger MAK 4 and 5 in angina pectoris: Is it only a placebo? Journal of the Association of Physicians of India, 42 (6), 466…467. Dunn, C., Sleep, J., & Collett, D. (1995). Sensing an improvement: An experimental study to evaluate the use of aromatherapy, massage, and periods of rest in an intensive care unit. Journal of Advanced Nursing, 21, 34…40. D•Zurilla, T. J., & Nezu, A. M. (2001). Problem-solving therapies. In K. S. Dobson (Ed.), Handbook of cognitive and behavioral therapies (2nd ed., pp. 211…246). New York: Guilford Press. Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, C., Calkins, D. R., & Delbanco, T. L. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal of Medicine, 328 (4), 246…252. Eppley, K. R., Abrams, A., & Shear, J. (1989). Differential effects of relaxation techniques on trait anxiety: A meta-analysis. Journal of Clinical Psychology, 45, 957…974. Ernst, E., Rand, J. I., & Stevinson, C. (1998). Complementary ther- apies for depression. Archives of General Psychiatry, 55, 1026…1032. Evans, B. (1995). An audit into the effects of aromatherapy massage and the cancer patient in palliative and terminal care. Comple- mentary Therapies in Medicine, 3, 239…241. Field, T., Ironson, G., Sca“di, F., Nawrocki, T., Goncalves, A., Burman, I., et al. (1996). Massage therapy reduces anxiety and enhances EED pattern of alertness and math computations. International Journal of Neuroscience¸ 86, 197…205. Field, T., Morrow, C., Valdeon, C., Larson, S., Kuhn, C., & Schanberg, S. (1992). Massage reduces anxiety in child and adolescent psychiatric patients. Journal of the American Acad- emy of Child and Adolescent Psychiatry, 31, 125…131. Fox, K. R. (1999). The in”uence of physical activity on mental well- being. Public Health Nutrition, 2, 411…418. Franklin, M., Chi, J., McGavin, C., Hockney, R., Reed, A., Campling, G., et al. (1999). Neuroendocrine evidence for dopaminergic actions of hypericum extract (LI 160) in healthy volunteers. Biological Psychiatry, 46, 581…584. Fremont, J., & Craighead, L. W. (1987). Aerobic exercise and cog- nitive therapy in the treatment of dysphoric moods. Cognitive Therapy and Research, 11, 241…251. Fritz-Ritson, D. (1995). Phasic exercises for cervical rehabilitation after •whiplashŽ trauma. Journal of Manipulative and Physio- logical Therapeutics, 18 (1), 21…24. Gagne, D., & Toye, R. C. (1994). The effects of therapeutic touch and relaxation therapy in reducing anxiety. Archives of Psychi- atric Nursing, 8, 184…189. Gaster, B., & Holroyd, J. (2000). St. John•s wort for depression: A systematic review. Archives of Internal Medicine, 160, 152…156. Gelderloos, P., Walton, K. G., Orme-Johnson, D. W., & Alexander, C. N. (1991). Effectiveness of the transcendental meditation program in preventing and treating substance misuse: A review. International Journal of Addictions, 26, 293…325. Gillis, C. N. (1997). Panax ginseng pharmacology: A nitric oxide link? Biochemical Pharmacology, 54, 1…8. Glaser, J. L., Brind, J. L., Vogelman, J. H., Eisner, M. J., Dillbeck, M. C., Wallace, R. K., et al. (1992). Elevated serum dehy- droepiandrosterone sulfate levels in practitioners of the tran- scendental meditation ™ and TM-Sidhi programs. Journal of Behavioral Medicine, 15 (4), 327…341. Gould, K. L., Ornish, D., Scherwitz, L., Brown, S., Edens, R. P., Hess, M. J., et al. (1995). Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modi“cation. Journal of the American Med- ical Association, 274 (11), 894…901. Greenberg, M. A., & Stone, A. A. (1992). Writing about disclosed versus undisclosed traumas: Immediate and long-term effects on mood and health. Journal of Personality and Social Psychology, 63, 75…84. Grimm, W., & Muller, H. H. (1999). A randomized controlled trial of the effect of ”uid extract of echinacea purpurea on the inci- dence and severity of colds and respiratory infections. American Journal of Medicine, 106, 138…143. Grontved, A., Brask, T., Kambskard, J., & Hentzer, E. (1988). Ginger root against seasickness. Acta Otolaryngolica, 105, 45…49. Gunning, K. (1999). Echinacea in the treatment and prevention of upper respiratory tract infections. Western Journal of Medicine, 171, 198…200. Hana, J. L. (1995). The power of dance: Health and healing. Journal of Alternative and Complementary Medicine, 4, 323…331. 610 Complementary and Alternative Therapies Hanna, A. N., Sharma, H. M., Kauffman, E. M., & Newman, H. A. (1994). In vitro and in vivo inhibition of microsomal lipid peroxidation by MA-631. Pharmacology, Biochemistry, and Behavior, 48, 505…510. Hanser, S. B., & Thompson, L. W. (1994). Effect of music therapy strategy on depressed older adults. Journal of Gerontology, 49, 265…269. Hansgen, K. D., Vesper, J., & Plouch, M. (1994). Multicenter dou- ble blind study examining the antidepressant effectiveness of the hypericum extract LI 160. Journal of Geriatric Psychiatry and Neurology, 7, 15…18. Harmon, D., Gardiner, R., Harrison, R., & Kelly, A. (1999). Acu- pressure and the prevention of nausea and vomiting after la- paroscopy. British Journal of Anaesthesia, 82, 387…390. Harmon, D., Ryan, M., Kelly, A., & Bowen, M. (2000). Acupressure and the prevention of nausea and vomiting during and after spinal anaesthesia for cesarean section. British Journal of Anaes- thesia, 84, 463…467. Harrer, G., Hubner, W. D., & Podzuweit, H. (1994). Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: A multicenter double-blind study. Journal of Geri- atric Psychiatry and Neurology, 7, S24…S28. Hasenohrl, R. U., Nichau, C. H., Frisch, C. H., De Souza Silva, M. A., Huston, J. P., Mattern, C. M., et al. (1996). Anxiolytic-like effect of combined extracts of zingiber of“cinale and ginkgo biloba in the elevated plus-maze. Pharmacology, Biochemistry, and Behavior, 53 (2), 271…275. Hassmen, P., Koivula, N., & Uutela, A. (2000). Physical exercise and psychological well-being: A population study in Finland. Preventative Medicine, 30, 17…25. Hildenbrand, G. L., Hildenbrand, L. C., Bradford, K., & Calvin, S. W. (1995). Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: A retrospec- tive review [Abstract]. Alternative Therapies in Health and Medicine, 1 (4), 29…37. Hofferberth, B. (1994). The ef“cacy of EGb 761 in patients with senile dementia of the Alzheimer type, a double-blind, placebo- controlled study on different levels of investigation. Human Psychopharmacology, 9, 215…222. Hruby, R. J. (1995). Session II: Contemporary philosophy and prac- tice of osteopathic medicine. In C. M. Sirica (Ed.), Osteopathic medicine: Past, present, and future (pp. 49…80). New York: Josiah Macy Jr. Foundation. Hubner, W. D., Lande, S., & Podzuweit, H. (1994). Hypericum treatment of mild depressions with somatic symptoms. Journal of Geriatric Psychiatry and Neurology, 7, 12…14. Isaacsohn, J. L., Moser, M., Stein, E. A., Dudley, K., Davey, J. A., Liskov, E., et al. (1998). Garlic powder and plasma lipids and lipoproteins. Archives of Internal Medicine, 158, 1189…1194. Itil, T., & Martorano, D. (1995). Natural substances in psychiatry (ginkgo biloba in dementia). Psychopharmacology Bulletin, 31 (1), 147…158. Jacobs, J. (1996). The encyclopedia of alternative medicine: A com- plete guide to complementary therapies. Boston: Carlton Books Limited. Jain, A. K., Vargas, R., Gotzkowsky, S., & McMahon, F. G. (1993). Can garlic reduce levels of serum lipids? A controlled clinical study. American Journal of Medicine, 94, 632…635. Jin, P. (1989). Changes in heart rate, noradrenaline, cortisol, and mood during tai chi. Journal of Psychosomatic Research, 33 (2), 197…206. Jin, P. (1992). Ef“cacy of tai chi, brisk walking, meditation, and reading in reducing mental and emotional stress. Journal of Psy- chosomatic Research, 36 (4), 361…370. Jobst, K. A. (1995). A critical analysis of acupuncture in pul- monary disease: Ef“cacy and safety of the acupuncture needle. Journal of Alternative and Complementary Medicine, 1 (1), 57…85. Johnson, S. K., Frederick, J., Kaufman, M., & Mountjoy, B. (1999). A controlled investigation of bodywork in multiple sclerosis. Journal of Alternative and Complementary Medicine, 5, 237… 243. Jusso“e, A., Schmitz, A., & Hiemke, C. (1994). Kavapyrone enriched extract from piper methysticum as modulator of the GABA binding site in different regions of rat brain. Psychophar- macology, 116, 469…474. Kanowski, S., Hermann, W. M., Stephan, K., Wierich, W., & Horr, R. (1996). Proof of ef“cacy of ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi-infarct dementia. Pharmacopsychiatry, 29, 47…56. Kelley, J. E., Lumley, M. A., & Leisen, J. C. C. (1997). Health effects of emotional disclosure in rheumatoid arthritis patients. Health Psychology, 16, 331…340. Kim, H.-S., Oh, K.-W., Rheu, H.-M., & Kim, S.-H. (1992). Antago- nism of U-50, 448H-induced antinociception by ginseng total saponins is dependent on serotonergic mechanisms. Pharmacol- ogy, Biochemistry, and Behavior, 42, 587…593. Kim, H. L., Streltzer, J., & Goebert, D. (1999). St. John•s wort for depression: A meta-analysis of well-de“ned clinical trials. Jour- nal of Nervous and Mental Diseases, 187 (9), 532…538. Kleijnen, J., & Knipschild, P. (1992). Ginkgo biloba for cerebral insuf“ciency. British Journal of Clinical Pharmacology, 34, 352…358. Kleijnen, J., Knipschild, P., & ter Riet, G. (1989). Garlic, onions and cardiovascular risk factors: A review of the evidence from human experiments with emphasis on commercially available preparations. British Journal of Clinical Pharmacology, 28, 535…544. Kleijnen, J., Knipschild, P., & ter Riet, G. (1991). Clinical trials of homeopathy. British Medical Journal, 302, 316…323. Klougart, N., Nilsson, N., & Jacobsen, J. (1989). Infantile colic treated by chiropractor. Journal of Manipulative and Physiolog- ical Therapeutics, 12 (4), 281…288. References 611 Komori, T., Fujiwara, R., Tanida, M., Nomura, J., & Yokoyama, M. M. (1995). Effects of citrus fragrance on immune function and depressive states. Neuroimmunomodulation, 2, 174…180. Koshimizu, K., Ohigashi, H., Tokudo, H., Kondo, A., & Yamaguchi, K. (1988). Screening of edible plants against anti-tumor promot- ing activity. Cancer Letters, 39, 247…257. Kramer, N. A. (1990). Comparison of therapeutic touch and causal touch in stress reduction of hospitalized children. Pediatric Nursing, 16, 483…485. Kugler, J., Seelbach, H., & Kruskemper, G. M. (1994). Effects of rehabilitation exercise programmes in anxiety and depression in coronary patients: A meta-analysis. British Journal of Clinical Psychology, 33, 401…410. Laakmann, G., Schule, C., Baghai, T., & Kieser, M. (1998). St. John•s wort in mild to moderate depression: The relevance of hyperforin for the clinical ef“cacy. Pharmacopsychiatry, 31 (Suppl. 1), 54…59. Lai, J. S., & Lan, C. (1995). Two-year trends in cardiorespiratory function among older tai chi chuan practitioners and sedentary subjects. Journal of American Geriatrics Society, 43, 1222… 1227. Lantz, M. S., Buchalter, E., & Giambanco, V. (1999). St. John•s work and antidepressant drug interactions in the elderly. Journal of Geriatric Psychiatry and Neurology, 12, 7…10. Le Bars, P., Katz, M. M., Berman, N., Itil, T. M., Freedman, A. M., & Schatzberg, A. F. (1997). A placebo-controlled, double-blind, randomized trial of an extract of ginkgo biloba for dementia. Journal of the American Medical Association, 278 (16), 1327…1332. Leboeuf, C., Brown, P., Herman,A., Leembruggen, K., Walton, D., & Crisp, T. C. (1991). Chiropractic care of children with nocturnal enuresis: A prospective outcome study. Journal of Manipulative and Physiological Therapeutics, 14 (2), 110…115. Lehrer, P. M., Hochron, S. M., Mayne, T., Isenberg, S., Carlson, V., Lasoski, M., et al. (1994). Relaxation and music therapies for asthma among patients prestabilized on asthma medications. Journal of Behavioral Medicine, 17, 1…21. Li, H. K., Gulanick, M., Lanuza, D., & Penckofer, S. (1999). The re- lationship between physical activity and perimenopause. Health Care for Women International, 20, 163…178. Lichtenstein, A. H., & Van Horn, L. (1998). Very low fat diets. Circulation, 98 (9), 935…939. Linde, K., Claudius, N., Ramirez, G., Melchart, D., Eitel, F., Hedges, L. V., et al. (1997). Are the clinical effects of homeopa- thy placebo effects? A meta-analysis of placebo-controlled trials. Lancet, 350, 834…843. Linde, K., Ramirez, G., Mulrow, C., Pauls, A., Weidenhammer, W., & Melchart, D. (1996). St. John•s wort for depression: An overview and meta-analysis of randomized clinical trials. British Medical Journal, 313, 253…258. Liu, Y. (1988). The essential book of traditional Chinese medicine: Clinical practice (Vol. 2). New York: Columbia University Press. Lockie, A. (1989). The family guide to homeopathy. New York: Simon & Schuster. Luo, H., Jia, Y., Wu, X., & Dai, W. (1990). Electro-acupuncture in the treatment of depressive psychosis. International Journal of Clinical Acupuncture, 1, 7…13. Luo, H., Jia, Y., & Zhan, L. (1985). Electro-acupuncture in the treat- ment of depressive states. Journal of Traditional Chinese Medi- cine, 5, 3…8. Magura, E. I., Kopanitsa, M. V., Gleitz, J., Peters, T., & Krishtal, O. A. (1997). Kava extract ingredients, ( )-methysticin and (  )- kavain inhibit voltage-operated Na -channels in rat CA1 hip- pocampal neurons. Neuroscience, 81 (2), 345…351. Margetts, B. M., Beilin, L. J., Vandongen, R., & Armstrong, B. K. (1986). Vegetarian diet in mild hypertension: A randomised con- trolled trial. British Medical Journal, 293, 1468…1471. Martin, G. N. (1996). Olfactory remediation: Current evidence and possible applications. Social Science and Medicine, 43, 63…70. Melchart, D., Walther, E., Linde, K., Brandmaier, R., & Lersch, C. (1998). Echinacea root extracts for the prevention of upper res- piratory tract infections: A double-blind, placebo-controlled trial. Archives of Family Medicine, 7, 541…545. Micozzi, M. S. (1996). Fundamentals of complementary and alter- native medicine. New York: Churchill-Livingstone. Micozzi, M. S. (1999). Current review of complementary medicine. Philadelphia: Current Medicine. Mowrey, D. B., & Clayson, D. E. (1982). Motion sickness, ginger, and psychophysics. Lancet, 1, 655…657. Muller W. E., & Kasper, S. (1997). Clinically used antidepressant drugs. Pharmacopsychiatry, 30 (Suppl. 2), 71. Muller, W. E., Rolli, M., Schafer, C., & Hafner, U. (1997). Effects of hypericum extract (LI 160) in biochemical models of antidepres- sant activity. Pharmacopsychiatry, 30 (Suppl. 2), 102…107. Muller, W. E., & Rossol, R. (1994). Effects of hypericum extract on the expression of serotonin receptors. Journal of Geriatric Psy- chiatry and Neurology, 7 (Suppl. 1), S63…S64. Muller, W. E., Singer, A., Wonnemann, M., Hafner, U., Rolli, M., & Schafer, C. (1998). Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract. Pharma- copsychiatry, 31 (Suppl. 1), 16…21. Nahrstedt, A., & Butterweck, V. (1997). Biologically active and other chemical constituents of the herb of hypericum perforatum L. Pharmacopsychiatry, 30 (Suppl. 2), 129…134. Nash, M. R. (2001). The truth and the hype of hypnosis, Scientiﬁc American, 285, 46…55. National Cholesterol Education Program Expert Panel. (1988). Re- port of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cho- lesterol in adults. Archives of Internal Medicine, 148, 36…69. Neary, J. T., & Bu, Y. (1999). Hypericum LI 160 inhibits uptake of serotonin and norepinephrine in astrocytes. Brain Research, 816, 358…363. 612 Complementary and Alternative Therapies Nezu,A. M., Nezu, C. M., Friedman, S. H., Faddis, S., & Houts, P. S. (1998). Helping cancer patients cope: A problem-solving ap- proach. Washington, DC: American Psychological Association. Nezu, A. M., Nezu, C. M., & Lombardo, E. R. (2001). Cognitive- behavior therapy for medically unexplained symptoms: A criti- cal review of the treatment literature, Behavior Therapist, 32, 537…583. Nezu, C. M., Nezu, A. M., Baron, K. P., & Roessler, E. (2000). Alternative therapies. In G. Fink (Ed.), Encyclopedia of stress (Vol. 1, pp. 150…158). San Diego, CA: Academic Press. North, T. C., McCullagh, P., & Tran, Z. V. (1990). Effect of exercise on depression. Exercise and Sports Science Review, 18, 379…415. Norton, S. A., & Ruze, P. (1994). Kava dermopathy. Journal of the American Academy of Dermatology, 31, 89…97. Oken, B. S., Storzbach, D. M., & Kaye, J. A. (1998). The ef“cacy of ginkgo biloba on cognitive function in Alzheimer disease. Archives of Neurology, 55, 1409…1415. Olson, M., Sneed, N., LaVia, M., Virella, G., Bonadonna, R., & Michel, V. (1997). Stress-induced immunosuppression and ther- apeutic touch. Alternative Therapies, 3, 68…74. Ornish, D., Brown, S., Scherwitz, L. W., Billings, J. H., Armstrong, W. T., Portis, T., et al. (1990). Can lifestyle changes reverse coro- nary hear disease: The lifestyle heart trial. Lancet, 336, 129…133. Ornish, D., Scherwitz, L. W., Billings, J. H., Gould, K. L., Merritt, T. A., Sparler, S., et al. (1998). Intensive lifestyle changes for reversal of coronary heart disease. Journal of the American Medical Association, 280 (23), 2001…2007. Palmer, D. D. (1910). Textbook of the science, art and philosophy of chiropractic. Portland, OR: Portland Printing House. Panjwani, U., Gupta, H. L., Singh, S. H., Selvamurthy, W., & Rai, U. C. (1995). Effect of Sahaja yoga practice on stress manage- ment in patients with epilepsy. Indian Journal of Physiology and Pharmacology, 39, 111…1 16. Patel, M., Gutzwiller, F., Paccand, F., & Marazzi, A. (1989). A meta- analysis of acupuncture for chronic pain. International Journal of Epidemiology, 18 (4), 900…906. Peck, S. D. (1998). The ef“cacy of therapeutic touch from improv- ing functional abilities in elders with degenerative arthritis. Nursing Science Quarterly, 11, 123…132. Pelletier, K. R. (1992). Mind-body health: Research, clinical, and policy applications. American Journal of Health Promotion, 6, 345…358. Pennebaker, J. W. (1993). Putting stress into words: Health, linguis- tic, and therapeutic implications. Behavioral Research and Therapy, 31, 539…548. Pennebaker, J. W., Colder, M., & Sharp, L. K. (1990). Accelerating the coping process. Journal of Personality and Social Psychol- ogy, 58, 528…537. Phillips, S., Ruggier, R., & Hutchinson, S. E. (1993). Zingiber of“c- inale (Ginger)„An antiemetic for day case sur gery. Anaesthe- sia, 48, 715…717. Plamondon, R. L. (1995). Summary of 1994 ACA annual statistical study. Journal of American Chiropractic Association, 32 (1), 57…63. Porsolt, R. D., Martin, P., Lenegre, A., Fromage, S., & Drieu, K. (1990). Effects of an extract of ginkgo biloba (EGB 761) on •learned helplessnessŽ and other models of stress in rodents. Pharmacology, Biochemistry, and Behavior, 36, 963…971. Rai, G. S., Shovlin, C., & Wesnes, K. A. (1991). A double-blind, placebo controlled study of ginkgo biloba extracts (Tanakan) in elderly outpatients with mild to moderate memory impairment. Current Medical Research and Opinion, 12 (6), 350…355. Ramsey, S. M. (1997). Holistic manual therapy techniques. Primary Care: Clinics in Ofﬁce Practice, 24, 759…786. Rapin, J. R., Lamproglou, I., Drieu, K., & Defeudis, F. V. (1994). Demonstration of the •anti-stressŽ activity of an extract of ginkgo biloba (EGb 761) using a discrimination learning task. General Pharmacology, 25 (5), 1009…1016. Reed, W. R., Beavers, S., Reddy, S. K., & Kern, G. (1994). Chiropractic management of primary nocturnal enuresis. Jour- nal of Manipulative and Physiological Therapeutics, 17 (9), 596…600. Reilly, D. T., Taylor, M. A., Beattie, N. G., Campbell, J. H., McSharry, C., Aitchison, T. C., et al. (1994). Is evidence for homeopathy reproducible? Lancet, 344, 1601…1606. Reilly, D. T., Taylor, M. A., McSharry, C., & Aitchison, T. (1986). Is homeopathy a placebo response? Controlled trial of homeo- pathic potency, with pollen in hay fever as model. Lancet, 2, 881…886. Roach, E. S. (1998). Alternative neurology: The ketogenic diet. Archives of Neurology, 55 (1), 1403…1404. Rodriguez de Turco, E. B., Droy-Lefaix, M. T., & Bazan, N. G. (1993). EGb 761 inhibits stress-induced polydipsia in rats. Phys- iology and Behavior, 53, 1001…1002. Rouse, I. L., Beilin, L. J., Armstrong, B. K., & Vandongen, R. (1983). Blood-pressure-lowering effect of a vegetarian diet: Controlled trial in normotensive subjects. Lancet, 1, 5…10. Ryu, H., Lee, H. S., Shin, Y. S., Chung, S. M., Lee, M. S., Kim, H. M., et al. (1996). Acute effect of qigong training on stress hormonal levels in man. American Journal of Chinese Medicine, 24 (2), 193…198. Schellenberg, R., Sauer, S., & Dimpfel, W. (1998). Pharmacody- namic effects of two different hypericum extracts in healthy volunteers measured by quantitative EEG. Pharmacopsychiatry, 31 (Suppl. 1), 44…53. Schlicht, W. (1994). Does physical exercise reduce anxious emo- tions? A meta-analysis. Anxiety, Stress, and Coping: an Interna- tional Journal, 6, 275…288. See, D. M., Broumand, N., Sahl, L., & Tilles, J. G. (1997). In vitro effects of echinacea and ginseng on natural killer and antibody- dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunode“ciency syndrome pa- tients. Immunopharmacology, 35, 229…235. References 613 Segar, M. L., Katch, V. L., Roth, R. S., Garcia, A. W., Portner, T. I., Glickman, S. G., et al. (1998). The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncology Nursing Forum, 25, 101…113. Sharma, H. M., Dwivedi, C., Satter, B. C., Gudehithlu, C. P., Abou-Issa, H., Malarkey,W., et al. (1991).Antineoplastic proper- ties of Maharishi-4 against DMBA-induced mammary tumors in rats. Pharmacology, Biochemistry, and Behavior, 35, 767…773. Shekelle, P. G., Adams, A. H., Chassin, M. R., Hurwitz, E. L., & Brook, R. H. (1992). Spinal manipulation of low-back pain. Annals of Internal Medicine, 117 (7), 590…598. Silagy, C., & Neil, A. (1994). Garlic as a lipid lowering agent: A meta-analysis. Journal of the Royal College of Physicians of London, 28 (1), 39…45. Sirica, C. M. (Ed.). (1995). Osteopathic medicine: Past, present, and future. New York: Josiah Macy Jr. Foundation. Smit, H. F., Woerdenbag, H. J., Singh, R. H., Meulenbeld, G. J., Labadie, R. P., & Zwaving, J. H. (1995). Ayurvedic herbal drugs with possible cytostatic activity. Journal of Ethnopharmacology, 47 (2), 75…84. Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66, 174…184. Smyth, J. M., Stone, A. A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. Journal of the American Medical Association, 281, 1304…1309. Snyder, M., & Chlan, L. (1999). Music therapy. Annual Review of Nursing Research, 17, 3…25. Sommer, H., & Harrer, G. (1994). Placebo-controlled double blind study examining the effectiveness of a hypericum preparation in 105 mildly depressed patients. Journal of Geriatric Psychiatry and Neurology, 7 (Suppl. 1), 9…1 1. Sonoda, Y., Kasahara, T., Mukaida, N., Shimizu, N., Tomoda, M., & Takeda, T. (1998). Stimulation of interleukin-8 production by acidic polysaccharides from the root of Panax ginseng. Im- munopharmacology, 38, 287…294. Sotaniemi, E. A., Haapakoski, E., & Rautio, A. (1995). Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care, 18 (10), 1373…1375. Spencer, J. W., & Jacobs, J. J. (1999). Complementary/alternative medicine: An evidence-based approach. St. Louis, MO: Mosby. Stallibrass, C. (1997). An evaluation of the Alexander Technique for the management of disability in Parkinson•s disease: A prelimi- nary study. Clinical Rehabilitation, 11, 8…12. Stanton, H. E. (1981). Enuresis, homeopathy, and enhancement of the placebo effect. American Journal of Clinical Hypnosis, 24 (1), 59…61. Steiner, M., Khan, A. H., Holbert, D., & Lin, I.-S. (1996). A double- blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipids. American Journal of Clinical Nutrition, 64, 866…870. Stephenson, N. L., Weinrich, S. P., & Tavakoli, A. S. (2000). The effects of foot re”exology on anxiety and pain in patients with breast and lung cancer. Oncology Nursing Forum, 27, 67…72. Stewart, N. J., McMullen, L. M., & Rubin, L. D. (1994). Movement therapy with depressed inpatients: A randomized multiple single- case design. Archives of Psychiatric Nursing, 8, 22…29. Takahashi, M., Tokuyama, S., & Kaneto, H. (1992). Anti-stress ef- fect of ginseng on the inhibition of the development of morphine tolerance in stressed mice. Japanese Journal of Pharmacology, 59, 399…404. ter Riet, G., Kleijnen, J., & Knipschild, P. (1990). Acupuncture and chronic pain: A criteria-based meta-analysis. Journal of Clinical Epidemiology, 43, 1191…1199. Teufel-Mayer, R., & Gleitz, J. (1997). Effects of long-term adminis- tration of hypericum extracts on the af“nity and density of the central serotonergic 5-HT1 A and 5-HT2 A receptors. Pharma- copsychiatry, 30 (Suppl. 2), 113…1 16. Tsutumi, T., Don, B. M., Zaichkowsky, L. D., Takenaka, K., Oka, K., & Ohno, T. (1998). Comparison of high and moderate inten- sity of strength training on mood and anxiety in older adults. Perceptual and Motor Skills, 87, 1003…1011. Uebelhack, R., Franke, L., & Schewe, H. J. (1998). Inhibition of platelet MAO-B by kava pyrone-enriched extract from piper methysticum forster (Kava-kava). Pharmacopsychiatry, 31, 187…192. Vickers, A. J. (1996). Can acupuncture have speci“c effects on health? A systematic review of acupuncture antiemesis trials. Journal of the Royal Society of Medicine, 89, 303…311. Vimala, S., Norhanom, A. W., & Yadav, M. (1999). Anti-tumor pro- moter activity in Malaysian ginger rhizobia used in traditional medicine. British Journal of Cancer, 80 (½), 110…1 16. Vincent, C. A

bundet

. (1989). A controlled trial of the treatment of migraine acupuncture. Clinical Journal of Pain, 5, 305…312. Vining, E. P. G., Freeman, J. M., Ballaban-Gil, K., Cam“eld, C. S., Cam“eld, P. R., Holmes, G. L., et al. (1998). A multicenter study of the ef“cacy of the ketogenic diet. Archives of Neurology, 55 (11), 1433…1437. Volz, H. P., & Keiser, M. (1997). Kava-kava extract WS 1490 versus placebo in anxiety disorders: A randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry, 30, 1…5. Vorbach, E. U., Hubner, W. D., & Arnold, K. H. (1994). Effective- ness and tolerance of the hypericum extract LI 160 in compari- son with imipramine. Journal of Geriatric Psychiatry and Neurology, 7 (Suppl. 1), S19…S23. Wagner, J., Wagner, M. M., & Hening, W. A. (1998). Beyond ben- zodiazepines: Alternative pharmacologic agents for the treat- ment of insomnia. Neuropsychiatry, 32, 680…691. Walden, J., Von Wegerer, J., Winter, U., & Berger, M. (1997). Ac- tions of kavain and dihydromethysticin on ipsapirone-induced 614 Complementary and Alternative Therapies “eld potential changes in the hippocampus. Human Psychophar- macology, 12, 265…270. Walden, J., Von Wegerer, J., Winter, U., Berger, M., & Grunze, H. (1997). Effects of kawain and dihydromethysticin on “eldpotential changes in the hippocampus. Progress in Neuro- Psychopharmacology and Biological Psychiatry, 21, 697…706. Wanning, T. (1993). Healing and the mind/body arts. American As- sociation of Occupational Health Nurses Journal, 41, 349…351. Warshafsky, S., Kamer, R. S., & Sivak, S. L. (1993). Effect of garlic on total serum cholesterol. Annals of Internal Medicine, 119, 599…605. Warwick-Evans, L. A., Masters, I. J., & Redstone, S. B. (1991). A double-blind placebo controlled evaluation of acupressure in the treatment of motion sickness. Aviation Space and Environmental Medicine, 62, 776…778. Watkins, A. D. (1994). The role of alternative therapies in the treat- ment of allergic diseases. Clinical and Experimental Allergy, 24 (9), 813…825. Wesnes, K. A., Feleni, R. A., Hefting, N. R., Hoogsteen, G., Houben, J. J. G., Jenkins, E., et al. (1997). The cognitive, sub- jective, and physical effects of a ginkgo biloba/Panax ginseng combination in healthy volunteers with neurasthenic complaints. Psychopharmacology Bulletin, 33 (4), 677…683. Wheatley, D. (1997). LI 160, an extract of St. Johns• wort, versus amitriptyline in mildly to moderately depressed outpatients: A controlled 6-week clinical trial. Pharmacopsychiatry, 30 (Suppl. 2), 77…80. Wiklund, I., Karlberg, J., & Lund, B. (1994). A double-blind com- parison of the effect on quality of life of a combination of vital substances including standardized ginseng G115 and placebo. Current Therapeutic Research, 55 (1), 32…42. Winkel, D., Aufdemkampe, G., Matthijs, O., Meijer, O. G., & Phelps, V. (1996). Diagnosis and treatment of the spine. Gaithersburg, MD: Aspen. Winstead-Fry, P., & Kijek, J. (1999). An integrative review and meta-analysis of therapeutic touch research. Alternative Thera- pies in Health and Medicine, 5, 58…67. Woelk, H., Burkard, G., & Grunwald, J. (1994). Bene“ts and risks of the hypericum extract LI 160: Drug monitoring study with 3250 patients. Journal of Geriatric Psychiatry and Neurology, 7 (Suppl. 1), S34…S38. Wong, A. H. C., Smith, M., & Boon, H. S. (1998). Herbal remedies in psychiatric practice. Archives of General Psychiatry, 55, 1033…1044. Woo, C. C. (1993). Post-traumatic myelopathy following flop- ping high jump: A pilot case of spinal manipulation. Journal of Manipulative and Physiological Therapeutics, 16 (5), 336… 341. Wood, C. (1993). Mood change and perceptions of vitality: A com- parison of the effects of relaxation, visualization, and yoga. Journal of the Royal Society of Medicine, 86, 254…258. Yun, T.-K. (1996). Experimental and epidemiological evidence of the cancer-preventive effects of Panax ginseng C. A. Meyer. Nutrition Reviews, 54 (11), S71…S81. Author Index 615 Aaron, L. A., 174, 185, 188 Aarons, S. J., 480, 482 Aaronson, N. K., 291 Abbott, P. J., 551, 559 Abbott, R. D., 565 Abbuhl, S., 541 Abdel-Moty, E., 313 Abel, G. G., 250, 263 Abel, J. L., 60, 69 Abeles, N., 500, 507, 508 Abenhaim, L., 594, 607 Ablashi, D., 372, 384, 386 Abou-Issa, H., 613 Abraham, M., 346, 359, 570 Abrahams, R., 532, 541 Abrams, A., 596, 609 Abrams, M., 57, 70 Abreu, J., 112, 116 Abrous, N., 163 Achenbach, T. M., 402, 408 Achterberg, J., 606, 608 Ackenheil, M., 189 Ackerman, K. D., 76, 90 Ackerson, L., 104, 115 Acquas, E., 151, 162 Adams, A., 594, 608, 613 Adams, D. C., 56, 73 Adams, G., 37, 45 Adams, J. H., 547, 560 Adams, P., 37, 45 Adams, S., 109, 114 Adams, T. A., 344, 359 Adams-Campbell, L. L., 546, 552, 559, 560 Adamson, K. L., 151, 163 Aday, L. A., 549, 561 Adelson, J., 468, 483, 484 Ader, R., 34, 39, 45, 85, 87, 93, 188, 372, 385 Adesso, V. J., 552, 565 Adkins, J. A., 425, 435, 569, 573, 574, 575, 576, 577, 578, 580, 582, 586, 588 Adkins, R., 425, 431 Adler, A. I., 550, 559, 561 Adler, A. J., 599, 608 Adler, C. S., 249, 263, 265 Adler, G. K., 172, 178, 185 Adler, L. E., 154, 162 Adler, N. E., 479, 482, 521, 528, 529, 536 Adler, S. M., 265 Adler, W. H., 78, 88 Adlis, S., 109, 117, 128, 141 Aebi, M., 313 Afari, N., 105, 106, 107, 108, 109, 110, 115, 119 Af”eck, G., 52, 57, 58, 59, 66, 68, 73, 105, 109, 115, 173, 174, 176, 182, 185, 187, 188 Agatisa, P. K., 537 Agnew, H. W., 318, 337 Agurs-Collins, T. D., 546, 559 Ahern, D., 299, 313, 347, 357, 359 Ahima, R. S., 126, 138 Ahlbom, A., 342, 360 Ahles, T. A., 175, 185, 252, 262, 263 Ahluwalia, J. S., 552, 559 Ahmed, M., 388 Ahmed, S. H., 152, 162 Ahn, D. K., 546, 557, 561, 567 Aho, K., 171, 185, 188 Aiken, L. S., 385, 454, 459 Aikens, J. E., 196, 210 Aisquith, B. F., 155, 163 Aitchison, T., 592, 612 Aiuti, F., 73 Akerstedt, T., 369, 384 Akil, H., 181, 185 Akman, D., 408 Aksit, B., 42, 47 Alarcon, G. S., 185, 188 Albain, K. S., 501, 506 Albert, A., 204, 217 Albert, S. G., 196, 211 Alboukrek, D., 189 Albrecht, R. J., 130, 138 Albu, J., 206, 210 Alcaraz, J. E., 144 Aldag, J. C., 178, 190 Aldenkamp, A. P., 476, 482 Aldwin, C., 44, 45, 496, 507, 508 Alexander, B. K., 152, 162 Alexander, C. J., 419, 430, 435 Alexander, C. N., 596, 605, 608, 609 Alexander, F., 102, 115, 354, 357, 557, 559 Alexander, R. W., 185, 188 Alexander, S. D., 332, 334 Alferi, S. M., 65, 68 Al“ci, S., 174, 185 Al“eri, T., 56, 71 Ali, A., 413 Ali, N., 279, 286 Alkan, N., 42, 47 Allan, R., 339, 349, 357 Allard, M., 500, 507 Allemand, H., 399, 409 Allen, G. M., 107, 115, 539 Allen, J., 451, 461 Allen, K. A., 61, 71 Allen, K. D., 260, 262, 471, 482 Allen, S. M., 281, 286 Allender, P. S., 355, 357 Allerton, M., 225, 241 Alleyne, E., 244 Allgood-Merten, B., 470, 482 Allison, D. B., 124, 125, 126, 138, 139, 161, 163, 560 Allison, M., 409 Allshouse, J. E., 127, 143 Almeida, J. C., 600, 608 Almqvist, M., 323, 335 Alpérovitch, A., 492, 509 Alpers, J. H., 107, 120 Alpert, E. J., 518, 536 Alstead, M., 228, 239 Alter, C., 272, 286, 502, 503 Altice, F. L., 234, 243 Altman, A., 464 Altman, D. G., 6, 23, 155, 162 Alvarez, W., 32, 47 Alverez, J. H., 400, 411 Amaateau, L. M., 60, 70 Amaral-Melendez, M., 604, 608 Amble, P., 153, 164 Amick, T. L., 346, 357 Amico, E., 154, 164, 264 Aminian, S., 140 Amiri, M. M., 85, 90 Amit, Z., 152, 167 Amorosa, L., 207, 215 Amsterdam, J., 197, 217 An, Z., 215 Anagnostopoulos, F., 54, 68 Anand, S. A., 606, 608 Anand, V. K., 606, 608 Anbar, R. D., 447, 462 Ancoli-Israel, S., 326, 334 Anda, R., 346, 347, 357 Andersen, B., 83, 87, 267, 278, 287, 290, 502, 503 Andersen, R., 144, 231, 239 Andersen, T., 144 Anderson, B., 502, 503 Anderson, B. J., 200, 210, 211, 212, 213, 214, 217, 288 Anderson, B. L., 274, 278, 287, 515, 529, 537 Anderson, C., 450, 458 Anderson, D. A., 125, 144 Anderson, D. M., 155, 164 Anderson, E. A., 195, 216 Anderson, H. V., 363 Anderson, J., 361 Anderson, J. J., 171, 185 Anderson, J. L., 357 Anderson, J. R., 155, 165 Anderson, J. S., 380, 381, 384 Anderson, J. W., 141 Anderson, K. E., 140 616 Author Index Anderson, K. O., 184, 185 Anderson, N., 357, 545, 555, 556, 557, 559, 560, 563, 567 Anderson, R., 194, 197, 200, 201, 203, 211, 212, 214, 594, 608 Anderson, S., 95 Anderson, T. J., 559 Anderson, V. E., 77, 91 Andersson, G., 261, 266 Anding, R., 207, 211 Andrasik, F., 245, 246, 249, 250, 252, 253, 254, 255, 256, 257, 258, 260, 261, 262, 263, 264, 265, 266, 406, 408 Andreoli, A., 81, 87 Andres, R., 78, 88 Andreski, P., 154, 162, 322, 334 Andrews, W. S., 259, 271, 339, 457, 459 Andruzzi, E., 409 Andrykowski, M. A., 275, 287, 504 Aneja, N., 596, 609 Aneshengel, C. S., 470, 485 Angeletti, K., 287 Angst, J., 322, 337 Annas, G. J., 161, 162 Annunziato, B., 60, 70 Anson, C. A., 421, 430 Anthony, K. K., 460 Anton, P. A., 77, 89 Antoni, M., 53, 54, 55, 65, 68, 70, 72, 80, 81, 86, 87, 89, 91, 92, 93, 233, 239, 243, 373, 384 Antonucci, T. C., 547, 562 Apfelbaum, M., 129, 139 Apley, J., 400, 402, 408 Appelbaum, K. A., 248, 249, 253, 258, 263, 265, 408 Appels, A., 346, 357, 361 Apple, D., 429, 430, 553 Appleby, L., 388 Applegate, W. B., 355, 364, 489, 503 Apter, A., 102, 105, 109, 115 Araneo, B. A., 75, 89 Arata, C. M., 38, 45 Arbel, Y., 361 Arboix, A., 516, 537 Arena, J. G., 2, 7, 258, 261, 262, 263 Arendt-Nielsen, L., 85, 95 Argyle, M., 60, 68 Arheart, K. L., 104, 119 Arky, R. A., 139 Armeli, S., 57, 73 Armenian, H. K., 362 Armstead, C. A., 545, 555, 556, 557, 559, 563 Armstrong, B. K., 602, 611 Armstrong, F. D., 452, 459 Armstrong, W. T., 362, 612 Arndt, L. A., 278, 288 Arnett, D. K., 140 Arnett, F. C., 187 Arnetz, B., 62, 68, 587 Arnold, K. H., 600, 613 Arnold, M. S., 211 Arnold, R., 410 Arntz, A., 524, 538 Arooma, A., 347, 357 Arpanahi, A., 159, 163 Arroyo, W., 48 Arruda, J. L., 181, 185 Artin, K. H., 91 Ary, D., 217, 223, 243, 479, 484 Asch, A., 424, 432 Aschercraft, T., 284, 289 Ascherio, A., 360 Ashkanazi, G., 432 Ashton, S., 368, 389 Askenasy, J. J. M., 322, 334 Aspinwall, L. G., 52, 68 Astrup, A., 129, 140 Atchison, M., 37, 47 Atkins, R. C., 602, 608 Atkinson, C., 90 Atkinson, J. H., 185, 300, 314 Atkinson, R. L., 137, 139 Atrash, H. K., 543 Attanasio, V., 250, 258, 262 Audrian, J., 166, 167, 291 Aufdemkampe, G., 594, 614 August, B. A., 87 August, S., 87, 239 Augustiny, K. F., 176, 189 Ault, K. A., 89 Auslander, W., 199, 210 Aversa, S. L., 235, 239 Avery, B., 555, 563 Avins, A. L., 223, 239 Axelrod, A., 272, 286, 503 Ayalon, O., 38, 46 Ayanian, J. Z., 515, 537 Aygen, M. M., 596, 608 Aymann, D., 354, 357 Azzouz, F., 556, 564 Baar, H., 213 Babyak, M., 357, 359, 608 Bacchetti, P., 220, 243 Bacha, G., 212 Bachanas, P. J., 450, 462 Bachen, E. A., 77, 87, 91 Bachman, J. G., 148, 155, 165 Bachman, L., 493, 508 Bachman, R., 518, 537 Backhouse, S., 398, 409 Bacon, N. M., 175, 185 Bacon, S. F., 185 Badcock, C. A., 408 Baer, K., 564 Baer, P. E., 362 Baer, R., 216 Baerwald, C., 178, 185 Baez, S., 188 Baggett, H. I., 87 Baggett, L., 87, 239 Baghai, T., 601, 611 Bahr, G. R., 242 Baider, L., 280, 287, 533, 537 Bailey, W. C., 164, 196 Baillie, R., 289 Bairey Merz, C. N., 361 Baker, D., 193, 217, 342, 360, 528, 540, 565 Baker, E., 420, 431, 553, 561 Baker, L., 103, 118 Baker, R. A., 76, 94 Baker, S., 70, 120, 243 Baker, T. B., 157, 164 Baker-Thomas, T. A., 558, 566 Balanda, K., 163 Baldwin, J. A., 561 Baldwin, K., 459 Baldwin, L. M., 104, 116 Bales, C. B., 277, 290 Balfour, D. J., 154, 162 Balfour, J. L., 271, 287 Ball, K., 127, 139 Ballaban-Gil, K., 613 Ballenger, J. C., 111, 118, 397, 411 Ballew, C., 550, 559 Balsiger, B. M., 130, 131, 139 Balta, E., 42, 47 Balter, M. B., 321, 336 Baltes, P. B., 45, 46, 47, 48, 49, 488, 503 Baltzan, R., 360 Bandura, A., 223, 224, 239 Bangsberg, D. R., 234, 239 Banks, S. M., 169, 174, 176, 186, 300, 313, 507 Bansal, S., 204, 217 Banspach, S., 240 Bantle, J. P., 215 Bar, F. W., 42, 45, 202, 227, 346, 361 Bar-Tal, Y., 42, 45 Barabasz, A., 85, 94 Barabasz, M., 85, 94 Barakat, L. P., 439, 441, 442, 449, 456, 458, 459, 460, 461, 463 Barbero, G., 401, 402, 410 Barbier, R. L., 525, 539 Barboriak, P. N., 125, 141 Barbul, A., 77, 87 Barefoot, J. C., 343, 346, 347, 357, 364, 496, 503, 508, 509, 510, 547, 553, 557, 559, 560 Barg, F. K., 283, 284, 287, 289 Barkan, S., 538 Barker, D. J. P., 547, 556, 560 Barker, I., 359 Barker, J. C., 551, 560 Barkley, R. A., 153, 162 Barlett, S. J., 144 Barling, J., 570, 572, 586, 588 Barlow, D. H., 116, 262, 397, 409 Barnard, J. A., 413 Barnard, M., 361 Barnes, G. M., 572, 586 Barnett, A., 214 Barnett, P. A., 60, 68 Barnett, R. C., 529, 530, 531, 532, 537, 541 Barnhart, S., 105, 107, 110, 115, 119 Baron, K. P., 591, 593, 612 Baron, R. S., 61, 68, 82, 87 Barone, D., 574, 586 Barone, M., 145 Barr, R. G., 77, 89, 90, 401, 408, 410, 599 Barraclough, J., 276, 287 Barre-Sinoussi, F., 230, 239 Barreiro, M. A., 399, 409 Barrett, B., 598, 599, 608 Barrett, D. C., 88, 240, 343, 364, 528, 544 Barrett, E. J., 245, 262 Author Index 617 Barrett, R. J., 275, 289 Barrett-Connor, E., 552, 553, 560 Barron, C. R., 54, 68 Barron, K. D., 263, 408 Barrows, E., 109, 115 Barry, R. E., 404, 410 Barry, T., 329, 336 Barsky, A. J., 374, 384 Barth, R., 463 Bartke, A., 152, 166 Bartlett, J. A., 80, 94 Bartrop, R., 39, 45, 80, 88 Baruch, A., 240 Baruch, J. D. R., 288, 290 Barza, L., 201, 214 Basbaum, A. I., 181, 186, 188 Basen-Engquist, K., 155, 164, 240 Baskin, S., 246, 262 Bassett, D. R., 339, 360, 364 Bassett, R. L., 240 Bastani, R., 547, 564 Bastian, L. A., 497, 500, 508 Bastien, C., 322, 327, 334, 336 Basun, H., 493, 504, 508 Bata, I., 349, 359 Bates, D. W., 389 Batsford, W. P., 341, 361 Battaglia, M., 88 Battistutta, D., 289 Battle, E. K., 127, 138, 139 Battle, R. S., 547, 560 Bauer, M. E., 78, 88 Bauer, N. K., 459 Baum, A., 37, 45, 46, 61, 69, 74, 78, 85, 88, 89, 93, 240, 267, 283, 287, 288, 290, 339, 357, 361, 499, 503, 504, 506, 507, 508, 509, 537, 542, 554, 559, 563 Baum, J. G., 133, 139 Baum, M. K., 90 Bauman, W., 433 Bawden, H. N., 455, 464 Bayer, T., 295, 313 Bayless, M. L., 195, 213 Bazan, N. G., 599, 612 Bazelmans, E., 380, 384, 389 Beach, D. E., 571, 586 Beahrs, J. O., 85, 88 Beall, A. E., 533, 537 Beattie, N. G., 612 Beaty, T. H., 158, 165 Beavers, S., 594, 612 Beck, A. T., 197, 198, 211, 257, 259, 262, 273, 287, 328, 334, 347, 396, 408 Beck, N., 72, 432 Becker, D. M., 546, 567 Becker, K., 241 Becker, M. H., 454, 461 Beckett, L. A., 496, 510 Beckham, J. C., 182, 186 Bedwani, C. N., 256, 263 Beekman, A. T. F., 94 Beeney, L., 193, 194, 211, 212 Beer, M., 577, 578, 586 Begg, C., 503 Behan, P. O., 373, 385, 386 Behan, W. M. H., 386 Beilin, L. J., 602, 611, 612 Beiser, M., 42, 47 Beitchman, J. H., 399, 408 Belanger, A. M., 364 Belar, C. D., 1, 2, 22 Belcher, L., 227, 239 Beliard, D., 136, 139 Belilos, E., 518, 519, 537 Belknap, J. K., 163 Bell, D. S., 196, 210, 372, 390 Bell, J., 107, 119 Bell, R. A., 551, 565 Bell, R. M., 155, 162, 163 Bellinger, D. L., 76, 93, 181, 186 Bellodi, L., 88 Belsky, J., 447, 459 Belzer, M. E., 479, 482 Bem, S. L., 533, 537 Bendel, R., 557, 562 Bender, B., 78, 88, 104, 109, 115 Bendtsen, L., 251, 265 Bendtsen, P., 59, 68 Benefante, R., 495, 503 Bengtsson, C., 563 Benjamin, C., 188, 413 Bennett, B., 374, 386 Bennett, D. A., 496, 510 Bennett, E. J., 399, 408 Bennett, P., 6, 15, 21, 127, 143, 405, 408, 518, 538, 550, 565 Bennett, R. M., 172, 181, 183, 186, 190 Benotsch, E. G., 234, 240 Benowitz, N. L., 147, 162 Benschop, R. J., 94 Ben-Shlomo, Y., 503, 506 Bensing, J., 373, 389 Benson, H., 254, 262, 332, 335, 353, 359, 406, 408 Benson, L. J., 559 Benson, P., 280, 287 Bentall, R. P., 379, 389 Bentley, G., 295, 314 Benyamini, Y., 498, 506 Benz, R. L., 323, 336 Ben-Zur, H., 38, 42, 44, 45 Beresford, T., 159, 167 Berg, C. J., 543 Berg, P. A., 182, 187 Berg, S., 500, 507 Berga, S. L., 93 Berge, K., 364 Berger, M., 600, 613, 614 Bergeron, A. M., 594, 607 Bergman, L. H., 457, 460 Bergman, R., 217 Bergman, W., 73 Bergmann, B. M., 319, 336 Bergner, M., 306, 313 Berkbigler, D., 109, 118 Berkey, S. C., 358 Berkman, A. H., 419, 431 Berkman, L., 59, 61, 63, 68, 73, 82, 88, 323, 337, 342, 357, 498, 503 Berkowitz, J., 314 Berkowitz, R. I., 128, 130, 144 Berlant, N., 457, 463 Berlin, J. A., 263, 363, 507, 543 Berman, M. B., 185, 189 Berman, N., 611 Berman, S., 73 Berman, S. M., 478, 480, 482 Berman, S. R., 327, 334 Bernard, T. M., 53, 71 Bernardini, R., II., 190 Bernbaum, M., 196, 211 Bernotas, T. D., 471, 482 Bernstein, D., 190 Bernstein, D. A., 254, 262 Bernstein, D. I., 111, 117, 119 Bernstein, E. D., 489, 507 Bernstein, I. L., 111, 117, 119 Bernstein, L., 516, 541, 544, 556, 562 Berntorp, E., 73, 95 Berntson, G. G., 88 Berreman, C. F., 412 Berridge, K. C., 151, 167 Berry, C., 148, 153, 163, 164 Berry, H., 69 Berry, J. W., 41, 45 Berson, J., 166 Bertakis, K. D., 534, 537 Bertini, M., 55 Bertolet, B. D., 527, 537 Besselman, L., 291 Bessler, H., 81, 95 Besson, C., 107, 115 Betschart, J., 194, 211 Beutel, M., 524, 537 Beutler, L., 295, 300, 313, 606, 608 Bevington, D. J., 272, 290 Beyrer, C., 240, 243 Bhalerao, U., 360 Bhapkar, M. V., 483 Bhatnagar, D., 531, 537 Bhatnagar, S. O. D., 116 Bhattacharya, S. K., 601, 608 Bickham, N. L., 222, 244 Biegel, D., 284, 291 Bieliauskas, L. A., 94 Biernat, M., 125, 139, 533, 542 Bierut, L. J., 159, 162 Bigby, J. A., 540 Bigelow, C., 539 Biglan, A., 217, 223, 243, 402, 412, 479, 484 Bijkerk, C., 172, 186 Bijlsma, J. W., 66, 69, 177, 178, 187, 190 Biller, B. M. K., 470, 483 Billings, A. G., 276, 287 Billings, J. H., 362, 612 Binkley, J. K., 127, 139 Binks, M., 434 Birchler, G., 300, 314 Bird, K., 386 Biron, C. A., 93 Birstein, S., 433 Bisbal, C., 385 Bishop, A. L., 116 Bishop, D. B., 144 Bishop, D. S., 104, 116 618 Author Index Bishop, M., 57, 73 Bisping, R., 213 Bittner, V., 514, 537 Biundo, J., 433 Bixler, E., 322, 334, 335 Bjelle, A., 184, 186 Bjerring, P., 85, 95 Bjornsson, E., 107, 116 Black, B. S., 547, 560 Black, P. H., 92 Black, S., 85, 88, 197, 211 Blackall, G., 461 Blackburn, G. L., 139 Blackburn, H., 361 Blacklay, A., 505 Blair, E., 217 Blair, S. N., 137, 142, 362, 363 Blais, F., 331, 336 Blake, D. D., 258, 262 Blake, G. H., 207, 211 Blake, G. M., 499, 508 Blake, S., 276, 292 Blalock, S. J., 190 Blalock, T. H., 261, 266 Blanc, P. D., 107, 115 Blanchard, C. G., 291 Blanchard, E. B., 248, 255, 257, 260, 262, 265, 285, 393, 400, 404, 413, 453, 460 Blanchet, J., 323, 337 Blane, D., 556, 562 Blaney, N., 66, 68, 83, 90 Blankenstein, M. A., 177, 190 Blass, J. P., 503, 505, 506, 507, 509 Blazer, D., 61, 73, 322, 335, 342, 357, 520, 540, 567 Bleijenberg, G., 380, 384, 389, 390, 413 Bleil, M. E., 442, 459 Blewett, A., 397, 409 Bliss, J. M., 501, 509 Bliwise, D. L., 322, 334 Block, G., 143, 156, 271, 313, 492 Blomkvist, V., 73, 95, 375, 390 Blondal, T., 156, 162 Bloom, B. R., 77, 88 Bloom, E., 80, 91 Bloom, F. R., 232, 242 Bloom, J., 65, 68, 277, 281, 282, 287, 288, 291 Bloom, P. B., 459 Bloomgarden, Z. T., 204, 211 Blount, R. L., 448, 450, 462, 463 Bluethmann, H., 77, 89 Blum, D., 164, 168, 281, 287 Blume, A. W., 109, 119 Blumenthal, J. A., 60, 73, 339, 349, 351, 352, 353, 357, 359, 363, 493, 496, 506, 507, 509, 510, 553, 565, 604, 608 Blumenthal, R. S., 567 Blumenthal, S., 382 Blum“eld, D., 562 Blustein, J., 344, 357 Bluthe, R. M., 89 Bluthenthal, R. N., 235, 239 Blyth, D. A., 469, 485 Bobbitt, R., 306, 313 Boden-Albala, B., 565 Bodnar, J. C., 62, 69, 78, 88, 89 Boehm, S., 199, 200, 211 Boeke, T., 72 Boekeloo, B. O., 225, 237, 239 Boeren, R. B., 295, 315 Boersma, J. W., 178, 187, 190 Bogaards, M. C., 252, 263 Bogart, L. M., 232, 234, 239, 240 Bogduk, N., 180, 188, 295, 315 Bohlander, J., 70 Boivin, J. F., 330, 335 Bolam, B., 19, 21 Bolan, G., 242 Boland, L. L., 506 Bolden, S., 268, 288 Boldrin, M., 144 Bolger, N., 65, 68, 77, 88, 173, 186 Boline, P. D., 594, 608 Boll, T. J., 22 Bolund, C., 272, 287 Boman, G., 107, 116 Bombardier, C., 187, 190, 375, 376, 377, 380, 381, 384, 426, 428, 431, 434 Bonadonna, R., 612 Bond, C. M., 167 Bond, G. G., 454, 459 Bond, J. T., 529, 530, 537 Bond, K. C., 240 Bond, R. N., 80, 94, 346, 363 Bondy, B., 189 Bone, M. E., 599, 608 Bonica, J. J., 313 Bonneau, R. H., 77, 80, 83, 90 Bononi, P., 217 Bonte, L., 69 Booher, P., 172, 190 Book, S. W., 46 Bookbinder, M., 70 Bookless, C. L., 37, 47 Bookwala, J., 40, 47, 277, 291, 532, 543 Boomsma, D. I., 158, 166 Boon, H. S., 601, 614 Boos, N., 294, 313 Booth, M. L., 552, 565 Booth, R., 86, 94, 561 Boothby, J. L., 302, 313 Bootzin, R. R., 331, 334 Bor, W., 411 Bordie, A. K., 395, 409 Bordley, W. C., 446, 460 Borecki, I., 140 Borg, S., 524, 537 Borgeat, F., 256, 263 Borgens, R., 430, 431 Borgo, S., 31, 46 Borkman, M., 204, 211 Borkovec, T. D., 254, 262, 321, 334 Borrelli, B., 157, 168 Borretzen, M., 179, 188 Bors, K. P., 519, 540 Bortner, R. W., 345, 361 Borum, M. L., 518, 538 Borus, J. F., 374, 384 Borysenko, M., 89 Boscarino, J. A., 81, 88, 239 Bosley, C. M., 109, 115 Bosma, H., 342, 357 Bosmajian, L., 394, 397, 413 Bosmans, E., 81, 93 Bostrum, A. G., 340, 361 Bosworth, H. B., 487, 488, 496, 497, 498, 499, 500, 503, 508, 545 Bouchard, C., 126, 139, 143, 362 Boudreaux, E., 604, 608 Boughal, T., 553, 566 Boughton, C., 368, 388, 391 Bou-Holaigah, I., 372, 385 Boulet, L. P., 110, 118 Boulet, M. J., 499, 507 Bourassa, M. G., 359 Bourdony, C. J., 483 Bourestrom, N., 426, 431 Bousquet, J., 107, 115 Bousser, M. G., 249, 265, 266 Boustead, C., 159, 162, 163 Boutelle, K. N., 127, 140 Boutsen, M., 166 Bovasso, G. B., 35, 47 Bovbjerg, D. H., 71, 79, 85, 88, 95, 282, 287 Bowden, C. A., 189 Bowden, J. J., 107, 120 Bowen, M., 598, 610 Bower, A., 360 Bower, J. E., 80, 82, 88 Bowler, R., 38, 46 Bowles, C. A., 78, 93 Bowman, B., 142, 214 Bowman, E. D., 166, 167 Bowser, D. M., 235, 243 Boyce, T., 528, 536 Boyce, W. T., 551, 567 Boyd, J. H., 389 Boyd, N. R., 166, 167 Boyd, S. C., 273, 288 Boyer, B., 461 Boyko, E. J., 550, 559 Bozzette, S., 239 Braaten, L. S., 240 Brackbill, R. M., 575, 588 Bradford, K., 602, 610 Bradley, C., 196, 198, 211, 212, 215 Bradley, L. A., 184, 185, 188, 314, 399, 412 Bradshaw, B. S., 548, 562 Bradshaw, S. L., Jr., 381, 390 Bradshaw-Robinson, S., 163 Brady, M. J., 290 Brambilla, F., 81, 88 Brancati, F. L., 198, 212 Brancoti, F. L., 361 Brand, R. J., 362 Brand-Driehorst, S., 91, 360 Brandenberg, Y., 272, 287 Brandmaier, R., 598, 611 Brandt, K. D., 183, 186 Branholm, I. B., 203, 212 Brannon, L., 1, 2, 34, 45 Brantley, P. J., 54, 69, 398, 409, 604, 608 Brant-Zawadzki, M., 294, 314 Bras“eld, T. L., 226, 242, 244 Brask, T., 599, 609 Author Index 619 Brassloff, I., 372, 388 Brattberg, G., 294, 313 Brauchle, M., 91 Bravo, M., 37, 46 Bray, G. A., 129, 139, 208, 211 Breedveld, F., 73, 186 Breen, N., 502, 505, 556, 560 Brehm, S. S., 540 Breitbart, W., 272, 273, 280, 287, 291 Brekke, M. L., 557, 565 Brener, N. D., 472, 482 Brenner, S. O., 68, 364, 587 Brent, D., 483 Breslau, N., 154, 162, 322, 323, 324, 334 Breslow, L., 5, 21 Brester, M., 243 Bret-Dibat, J. L., 89 Brett, K., 499, 503 Breur, G., 431 Brewer, G., 135, 140 Brewer, K. K., 240 Brey, R. L., 517, 537 Brezinka, V., 529, 537 Brickman, A., 384 Bridge, L. R., 280, 287 Bridges, M. W., 34, 48, 94 Briefel, R. R., 127, 140 Briere, J., 30, 37, 45 Briggs, S., 31, 46 Brigham, J., 160, 165 Brind, J. L., 609 Brindis, C. D., 484 Brink, D., 177, 190, 333, 336 Broadhead, W. E., 520, 540 Brockington, I. F., 527, 537 Broderick, C. P., 434 Broderick, G. A., 203, 214 Broderick, M., 291 Brodsky, I., 378, 390 Brody, C. L., 167, 540 Broege, P., 53, 68 Bromberg, J., 459 Bromet, E., 37, 45, 520, 540 Bronfenbrenner, U., 439, 459 Bronstone, A., 225, 241 Brook, A., 471, 485 Brook, R. H., 594, 613 Brookes, C. A., 421, 431, 433, 560 Brooks, A., 189 Brooks, D., 606, 608 Broome, A. K., 5, 21 Brophy, C. J., 454, 460 Brophy, P., 445, 461 Brosstad, F., 173, 190 Broumand, N., 599, 612 Brouwer, B., 373, 385 Brown, B. M., 142 Brown, C., 149, 163, 357, 520, 527, 537 Brown, D., 422, 433, 478, 482, 561 Brown, G., 55, 66, 68 Brown, G. K., 57, 66, 71, 72, 174, 186 Brown, G. W., 33, 46, 49 Brown, H. K., 559 Brown, I., 588 Brown, J., 55, 68, 199, 212, 214, 426, 432, 502, 503 Brown, L., 426, 434 Brown, L. A., 561 Brown, L. J., 155, 163 Brown, L. R., 219, 240 Brown, P., 428, 434, 611 Brown, R., 451, 452, 459, 460, 472, 476, 478, 479, 480, 482 Brown, S., 91, 609, 612 Brown, S. A., 207, 211 Brown, S. E., 362 Brown, T., 522, 537 Browne, S., 105, 115 Brownell, K. D., 125, 127, 136, 138, 139, 140, 141, 142, 143, 144, 215, 413, 537, 538, 539, 541, 542, 543, 544 Browning, S. R., 557, 562 Brownson, R. C., 561 Brozek, J., 361 Bruce, B., 412 Brucker, B., 429, 431 Bruger, R. A., 599, 608 Brugman, S. M., 103, 120 Brummett, B. H., 503, 508 Bruneau, J., 229, 240 Bruno, G. M., 258, 262 Brunson, K. W., 93 Brunton, R., 195, 214 Brutsaert, D. L., 358 Bryant, G. D., 107, 120 Bu, Y., 601, 611 Bua, G., 426, 434 Bubb, J., 214, 459, 483 Buceta, J. M., 112, 120 Buchalter, E., 601, 611 Buchanan, I., 459 Buchanan, J., 12, 23 Buchbinder, S., 243 Bucher, J. A., 281, 283, 285, 287, 289 Buchowski, M. S., 546, 551, 560 Buchwald, D., 105, 115, 368, 369, 370, 375, 376, 377, 380, 381, 384, 385, 389 Buchwald, D. B., 110, 115, 389 Buchwald, D. S., 101, 119 Buckelew, S. A., 424, 432 Buckelew, S. P., 174, 186, 189, 428, 432 Buckley, C. E., 503 Buckloh, L. M., 451, 462 Buczek, Y., 152, 162 Buddenberg, C., 55, 68 Budin, W., 65, 68, 70 Budzynski, T. H., 249, 256, 263 Buer, N., 294, 303, 314 Buescher, K., 72 Buist, A. S., 120 Buist, D. S., 514, 542 Bukberg, J. B., 272, 287 Bulaeva, N. V., 429, 431 Bulcroft, R. A., 119 Bulloch, K., 93 Bulto, M., 226, 242 Bultz, B. D., 289 Bunker, C., 363, 538 Buono, L. A., 456, 459 Burack, J., 81, 88, 232, 240 Burbridge, J., 81, 95 Burchette, R., 156, 163, 164 Burch“el, C. M., 548, 560, 562, 565 Burch“eld, S. R., 557, 560 Burckhardt, C. S., 184, 186 Burdon, J. G. W., 102, 115 Burg, M. M., 57, 73, 341, 361 Burgdoff, K., 475, 482 Burger, A. L., 409 Burger, P. C., 503 Burgess, A. P., 73 Burgess, C., 276, 287 Burgess, R. L., 475, 482 Buring, J. E., 489, 505 Burish, T. G., 272, 275, 279, 287 Burish, T. J., 279, 289 Burkard, G., 601, 614 Burke, E. J., 250, 258, 262 Burke, H. M., 169, 175, 190, 518 Burke, J. D., Jr., 389, 543 Burke, L., 499, 500, 503 Burke, R. J., 530, 537 Burleson, M. H., 77, 88, 173, 175, 190 Burman, I., 609 Burn, P., 126, 136, 139, 433, 476, 485 Burnett, C., 398, 413, 566 Burns, A. S., 421, 424, 431 Burns, B. J., 483 Burns, J. W., 566 Burns, R., 382, 385, 563 Burns, S. P., 421, 431 Burrell, G., 357 Burroughs, V., 387 Burrows, L., 190 Burt, V. L., 352, 357 Burton, H. J., 64, 68 Burton, L. C., 532, 537 Burton, L. R., 133, 134, 141, 145 Bury, R. G., 400, 409 Bush, D., 361 Bush, T. M., 73 Buske-Kirschbaum, A., 85, 88 Buskila, D., 179, 186 Busse, E. W., 490, 491, 503 Butler, B., 206, 210 Butler, G., 140 Butler, L. D., 66, 68 Butler, P. M., 211, 401, 411 Butler, R., 449, 451, 459, 462 Butow, P. N., 53, 55, 68 Butter“eld, J., 202, 212 Butterweck, V., 601, 608, 611 Button, J., 73 Buysse, D. J., 322, 325, 327, 334, 336 Buzaglo, J., 461 Byosiere, P., 579, 587 Byrd, B. L., 274, 287 Byrd, G., 291 Byrne, D., 53, 68 Cacioppo, J., 60, 73, 77, 83, 88, 92, 95, 244, 553, 557, 560, 566 Cadieux, R. J., 335 Cadman, E. C., 229, 241 Cado, S., 399, 410 Caetano, R., 547, 549, 560, 562 620 Author Index Caggiula, A. R., 93, 149, 163 Cagle, H. H., 561 Cahn, T., 250, 263 Cain, K. C., 398, 411 Cairns, D. M., 425, 431 Calabrese, C., 598, 608 Calabresi, P., 149, 162 Calcagnetti, D. J., 151, 152, 162, 167 Calcraft, B., 409 Caldwell, A. B., 322, 335 Caldwell, C., 80, 91 Caldwell, D. S., 57, 71, 174, 182, 186, 187, 188 Caldwell, R., 599, 608 Caldwell, V. D., 606, 608 Califf, R. M., 364, 509 Calkins, D. R., 609 Calkins, H., 372, 385 Callahan, L., 174, 189, 259, 271, 339 Callegari, S., 119 Calogero, A. E., 190 Caloro, G., 66, 70 Calvin, S. W., 602, 610 Camacho, J., 377, 385, 387 Camacho, T., 498, 506 Camara, W. J., 569, 570, 572, 580, 588 Camargo, C. A., 100, 115 Cambell, S. M., 548, 563 Camerino, M., 80, 94 Cameron, C. L., 57, 73 Cameron, H. R., 360 Cameron, L., 53, 68 Cam“eld, C. S., 613 Cam“eld, P. R., 613 Camilleri, M., 394, 395, 409 Campbell, D., 217, 411 Campbell, E. J., 102, 115, 543 Campbell, I. W., 203, 214 Campbell, J. H., 612 Campbell, J. K., 253, 263 Campbell, K. H. S., 20, 23 Campbell, L. V., 204, 211 Campbell, R. T., 163 Campbell, S. M., 142 Campbell, S. S., 319, 337 Camp“eld, L. A., 126, 136, 139 Campine, I., 385 Campling, G., 609 Campos, S., 471, 485 Campsmith, M., 239 Canada, A. L., 280, 288 Canelones, P., 115 Canino, G., 37, 46 Canning, R. D., 457, 463, 474, 485 Cannon, W. B., 176, 178, 186, 195, 211, 570 Cantillon, D., 12, 21, 387 Cantwell, D. P., 367, 385 Cantwell, M. F., 556, 560 Canupp, K. C., 430, 431 Cao, G., 555, 563 Capitman, J. A., 532, 541 Caplan, B., 428, 434 Caplan, R. D., 575, 586 Caporaso, N. E., 166 Capponi, R., 195, 211 Cappucio, F. P., 357 Caralis, P., 92 Carboni, E., 151, 162 Cardenas, C. C., 420, 431 Cardenas, D. D., 421, 422, 431 Cardon, L. R., 160, 164, 168 Carey, K. B., 225, 240, 244 Carey, M., 203, 216, 219, 222, 225, 226, 229, 238, 240, 242, 244, 272, 275, 279, 287, 456, 459, 517 Carey, V., 543, 556, 563 Cargill, V. A., 244 Carlin, M. M., 459 Carlisle, D. M., 344, 358 Carlson, B. W., 264 Carlson, L., 450, 459 Carlson, S. L., 76, 90 Carlson, V., 117, 611 Carmack, C. L., 604, 608 Carmelli, D., 157, 158, 159, 160, 162, 168, 490, 509 Carmichael, S., 143 Carnes, M., 534, 536, 537 Carney, M., 57, 73 Carney, R., 198, 214, 346, 347, 358, 360 Carota-Orne, E., 459 Carpenter, J. K., 90, 289 Carpenter, K. M., 125, 139 Carr, A., 447, 460 Carr, J. E., 280, 291 Carr, R. E., 101, 103, 107, 110, 113, 115, 116, 117 Carr, V. J., 44, 49 Carretero, O. A., 352, 354, 355, 358 Carrico, A. W., 366, 368, 373, 387 Carrier, S., 256, 264 Carroll, D., 19, 21 Carroll, M. D., 121, 123, 140, 142 Carrougher, G., 430, 433 Carruthers, M., 362 Carskadon, M. A., 336 Carson, J. W., 460 Carsons, S., 518, 519, 537 Carstensen, L. L., 84, 88, 507, 509 Carter, W., 306, 313 Carter, A., 441, 461, 474, 483 Carter, R., 193, 213, 474, 483 Carter, W., 306, 313 Carter, W. A., 378, 390 Carter, W. R., 195, 205, 211, 213 Carter-Nolan, P. L., 552, 560 Cartledge, J. J., 204, 211 Cartwright, S., 573, 576, 586 Carty, J., 131, 141 Carver, C. S., 34, 46, 57, 65, 68, 89, 276, 287 Case, N., 63, 67 Case, R., 63, 67 Casey, R., 458, 461 Cash, J. M., 186 Cash, T. F., 125, 143 Casio, W. F., 576, 586 Casper, M. L., 562 Caspersen, C. J., 546, 565 Cassavia, E., 408 Cassel, J., 59, 69, 82, 88, 353, 360 Castellanos, L. G., 561 Castelli, W. P., 124, 141, 344, 358 Castés, M., 112, 115 Castilla, A., 81, 88 Castilla-Cortazar, I., 81, 88 Castillo, J., 249, 264 Castle, S., 78, 88 Cataldo, M. F., 402, 410, 454, 460, 483 Cates, W., Jr., 478, 479, 480, 482 Catley, D., 172, 178, 186 Catz, S., 54, 63, 69, 232, 234, 235, 239, 240, 242 Cauce, A. M., 558, 560 Caulet, M., 322, 329, 336 Cauley, J. A., 489, 506 Cavalieri, F., 186 Cave, B., 15, 21 Celentano, D. D., 228, 229, 240, 243 Celentano, E., 49 Celia, M., 542 Cella, D., 272, 287, 290, 291 Celum, C., 243 Cerise, F., 211 Cerney-Seeler, B., 41, 49 Cerrato, P. L., 600, 608 Cesari, H., 223, 243 Chadwick, O., 141, 455, 459 Chagnon, Y. C., 126, 139 Chaisson, C. E., 186 Chaitchik, S., 53, 71 Chalder, T., 369, 370, 378, 379, 385, 389, 390, 391 Chalmers, J. C., 526, 540 Chaloupka, F., 154, 155, 163, 167 Chamaret, S., 239 Chamberlain, K., 109, 117 Chamberlain, R. M., 164, 167 Chamberlin, K., 335 Chambers, D., 233, 240 Chambers, M. J., 332, 334 Chambers, W. H., 93 Chambless, D., 442, 459, 606, 608 Chambless, L., 562 Champion, V., 529, 538, 540, 541, 578 Chan, C. Y., 91 Chan, J. M., 124, 139 Chan, K., 243 Chan, L., 421, 431 Chandler, H. M., 596, 608 Chandra, A., 525, 543 Chandra, V., 83, 88 Chaney, J., 432 Chang, B. H., 558, 566 Chang, C. H., 187 Chang, C. J., 364 Chang, E., 423, 433 Chang, H. K., 196, 213, 561 Chang, J., 81, 88 Chang, L., 175, 186 Chang, M. H., 561 Chang, P. F., 359 Chape, C., 360 Chapman, H. A., 543 Chapman, J., 598, 609 Chapman, K. R., 517, 538 Chapman, T., 241 Charlebois, E. D., 239 Charlifue, S., 419, 420, 426, 431, 433 Author Index 621 Charlton, S., 599, 608 Chassin, L., 148, 153, 163 Chassin, M. R., 594, 613 Chatterjee, M. B., 359 Chatterjee, S. S., 601, 608 Chatterton, M. L., 201, 215 Chattington, P., 388 Chaudhary, B. S., 343, 363 Chaudhary, J. D., 63, 73 Chaudhuri, A., 373, 385, 386 Chauhardy, G., 37, 48 Chauncey, S., 66, 70 Chawla, S. J., 61, 70 Cheang, M. C., 282, 289 Chee, M., 92 Chen, C. C., 54, 69 Chen, E., 449, 451, 459 Chen, J., 563 Chen, M. H., 244 Chen, M. L., 598, 608 Chen, W., 241 Chen, X., 565 Chen, Y., 426, 432 Cheney, P., 390 Cheng, C., 330, 335 Cheng, T. L., 239 Chermann, J. C., 239 Cherner, M., 72 Chernigovskaya, N. V., 113, 115 Chesney, M., 83, 88, 90, 233, 234, 235, 240, 241, 243, 356, 360, 496, 508, 510, 528, 536, 553, 554, 564, 566 Chetboun, I., 361 Cheu, J., 388 Cheung, L. P., 499, 503 Cheung, P., 41, 46 Cheung, Y. W., 548, 560 Chi, J., 596, 598, 609, 610, 611 Chiamulera, C., 149, 166, 167 Chicoye, A., 115 Chilcott, L. A., 324, 334 Childress, A. R., 151, 163 Chinchilli, V. M., 483 Chisholm, D. J., 204, 211 Chisolm, A. W., 207, 214 Chiu, B., 182, 189 Chiu, C., 163 Chlan, L., 606, 613 Chng, C. L., 548, 566 Cho, J. K., 167, 599 Chochinov, H. M., 273, 287 Choen, D., 360 Choi, K. H., 548, 560 Choi, M. G., 394, 395, 409 Choi, S. T., 548, 566 Choi, W. S., 148, 153, 154, 163, 164 Cholerton, S., 159, 162, 163 Chon, K. K., 28, 47 Chong, G. C., 258, 262 Chou, S. P., 522, 539 Chow, D., 358 Christakis, D., 461 Christenfeld, N., 61, 69 Christens, P., 524, 542 Christensen, M. F., 401, 402, 409 Christensen, S., 85, 95 Christiaanse, M. E., 453, 459 Christian-Herman, J., 117 Christiani, D. C., 529, 541 Christoffel, K. K., 475, 482 Christophersen, E. R., 460 Chrousos, G. P., 80, 88, 90, 172, 173, 177, 181, 186, 190, 373, 385, 484 Chu, J., 501, 503 Chung, R. C., 41, 46, 612 Chung, S. M., 612 Chung, T. H., 499, 503 Chwalisz, K., 425, 431 Chwalow, J., 71 Chyou, P. H., 562 Ciambrone, D., 286 Cinciripini, P. M., 270, 287 Citrin, C. M., 294, 315 Claghorn, J. L., 196, 214 Clancy, C. M., 523, 538 Clancy, M. C., 523, 538 Clapp-Channing, N., 360, 503 Clare, A., 409 Clark, C. L., 547, 549, 560 Clark, D., 546, 552 Clark, H. B., 127, 133, 139, 140 Clark, J., 208, 215 Clark, K., 358, 498, 509 Clark, M., 389 Clark, M. B., 127, 140 Clark, M. C., 37, 48 Clark, M. R., 358, 375, 377, 385 Clark, R., 545, 556, 557 Clark, V., 547, 556 Clark, W. S., 552, 559 Clarke, B. F., 203, 214 Clarke, D., 323, 336 Clarke, P. B., 151, 163 Clarke, W. L., 195, 205, 206, 211, 213 Classen, C., 66, 68, 282, 288, 291 Claudius, N., 611 Clauw, D. J., 172, 173, 181, 186 Clay, D., 432, 442, 459 Clayer, J. R., 37, 47 Clayson, D. E., 599, 611 Clayton, G., 506 Cleare, A., 378, 385, 389 Clearman, R., 427, 434 Cleary, G. L., 510 Cleary, P. D., 236, 240, 532, 538 Cleghorn, G., 403, 412 Clement, C., 194, 211 Clement, K., 144 Clementi, F., 148, 149, 163 Clements, C. M., 40, 46 Clemmer, D., 433 Clemow, L., 207, 215 Cleveland, S. E., 362 Cleven, K., 92 Cline, C. L., 299, 313 Cline-Elsen, J., 280, 288 Clipp, E., 501, 502, 504, 506 Cloitre, M., 33, 48 Cloninger, C. R., 162, 504 Clouse, R., 197, 198, 214 Clum, G. A., 36, 47 Coakley, E., 127, 139, 157, 168 Coambs, R. B., 152, 162 Coate, D., 154, 166 Coates, A. S., 55, 68, 70 Coates, T. J., 66, 87, 88, 227, 232, 236, 239, 240, 241, 242, 321, 326, 334, 551, 566 Cobb, J., 354, 358, 361, 490, 505 Cobb, S., 36, 46, 59, 69, 82, 89, 354, 358, 575, 586 Cochrane, G. M., 109, 115, 165, 166, 167 Coda, R., 73 Coderre, T. J., 188, 294, 313 Coe, C. C., 79, 89 Coe, C. L., 82, 91 Coen, K. M., 149, 151, 163 Coglianese, M. E., 543 Cohen, B. H., 158, 165 Cohen, C. J., 234, 240 Cohen, D., 78, 87, 464 Cohen, F., 79, 87 Cohen, H. J., 488, 505 Cohen, J., 80, 94, 129, 139, 346, 363, 372, 388 Cohen, K. R., 273, 281 Cohen, L., 85, 87, 88, 283, 288, 527, 538 Cohen, M., 256, 263, 273, 291, 314, 517, 538 Cohen, N., 85, 93, 188, 372, 385 Cohen, R. D., 359, 498, 505, 506, 509, 562 Cohen, S., 34, 35, 46, 47, 59, 69, 70, 78, 79, 80, 83, 87, 88, 90, 91, 93, 99, 108, 115, 120, 164, 199, 211, 216, 277, 281, 282, 289, 342, 358, 380, 388, 547, 553, 560, 590, 608 Coker, J., 433 Colburn, R. W., 181, 185 Colder, C. R., 153, 163 Colder, M., 605, 612 Colditz, G. A., 124, 125, 126, 139, 143, 144, 145, 355, 360, 564, 567 Cole, J. A., 196, 210 Cole, K., 200, 215 Cole, S. W., 63, 72, 77, 81, 89, 232, 240, 431 Colecchi, C. A., 333, 336 Colegrove, R., 456, 463 Coleman, R. E., 357 Coley, B., 226, 242 Colgan, S. M., 404, 413 Colin, P. R., 355, 358 Colket, J. T., 46 Colla, M., 178, 186 Collett, D., 603, 609 Collie, J., 296, 313 Collier, A. C., 231, 240 Collier, G. R., 126, 139 Collins, A., 152, 163, 167 Collins, C., 57, 73, 555, 556, 567 Collins, F. L., 250, 263 Collins, J. L., 472, 482, 557, 563 Collins, L. M., 495, 496, 503, 504, 506, 509 Collins, P. Y., 517, 538 Collins, R. L., 554, 566 Collins, V. R., 124, 141 Colon, E., 521, 541 Coltman, C. A., 501, 506 Comarr, A. E., 420, 431 622 Author Index Comerci, G. D., 465, 472, 482, 484 Comings, D. E., 159, 163, 581 Compas, B. E., 69, 401, 409 Comuzzie, A. G., 126, 139, 161, 163, 560 Conger, J. J., 469, 482 Conigliaro, J., 344, 364 Conneally, P. M., 161, 167 Connell, D. B., 116, 369, 386 Conners, C. K., 166 Connett, J., 110, 118 Connolly, B., 433 Connolly, H. M., 129, 139 Connor, S. L., 553, 566 Connor, W. E., 553, 566 Connors, G. J., 154, 166 Conran, P., 93 Considine, R. V., 126, 139 Conte, P., 443, 452, 464 Contrada, R., 84, 93 Contrada, R. J., 348, 358 Contrada, R. L., 496, 503, 504 Conway, B., 243 Cook, E. F., 339, 359 Cook, E. W., 394, 398, 412, 413 Cook, N. R., 129, 139 Cook, W. W., 345, 346, 358 Coombs, R. W., 240 Coonrod, B. A., 194, 211 Cooper, C. L., 69, 569, 570, 571, 573, 574, 576, 586, 587, 588, 589 Cooper, D., 243 Cooper, M. J., 596, 608 Cooper, P. J., 521, 538, 541 Cooper, R. S., 555, 563 Cooper, W., 359 Cooper, Z., 136, 139 Cooper-Hilbert, B., 525, 526, 538 Cooper-Patrick, L., 197, 212, 359 Copeland, L. J., 274, 287 Corao, A., 115 Corbishley, M., 300, 313 Corcoran, J., 422, 425, 432 Corder, E. H., 499, 504 Cordingley, G. E., 251, 264 Cordova, M. J., 501, 502, 504 Coresh, J., 344, 348, 358 Corey, L. A., 165 Coriell, M., 521, 528, 529, 536 Corn, B., 54, 72 Cornelisse, P. G., 244 Corney, R. H., 398, 405, 409 Cornoni-Huntley, J. C., 488, 505 Coronado, N., 558, 560 Corrazziari, E., 393, 409 Corrigall, W. A., 149, 151, 163 Corsica, J. A., 121, 128, 132, 133, 143 Costa, J. P. T., 398, 409 Costa, M., 73, 104, 119 Costa, P. T., Jr., 81, 95, 345, 358, 397, 413, 487, 489, 497, 498, 504, 508 Costello, A. J., 474, 483 Costello, E. J., 474, 483 Costlow, C., 91 Cott, J. M., 601, 608 Cotter, M. W., 450, 462 Cottington, E. M., 341, 358 Cottler, L., 160, 167, 366, 389 Cotton, S., 174, 186, 228 Coulter, P., 369, 385 Council, J., 12, 299, 302, 313, 317, 357, 445, 513, 538, 571, 578, 581 Couper, J., 306, 314 Cournos, F., 235, 244 Couropmitree, N. N., 186 Cousins, M. J., 421, 435 Cousins, N., 90, 280, 281, 288 Coutinho, R. A., 229, 244 Cover, H., 324, 334 Covey, L. S., 154, 163 Covi, L., 398, 409 Covino, N. A., 92 Cowles, M. K., 110, 118 Cox, C., 450, 459 Cox, D., 95, 195, 196, 202, 204, 206, 211, 212, 213, 254, 263 Cox, N. K., 95 Cox, R., 288 Cox, T., 572, 586 Coyle, C., 427, 429, 431, 433 Coyle, D. A., 346, 363 Coyle, K., 224, 240 Coyle, S., 223, 228, 240, 243 Coyne, J., 58, 59, 69, 398, 410 Coyne, L., 259, 266, 381, 390 Cozzi, L., 452, 459 Crabbe, J. C., 163 Craft, L. L., 604, 608 Craig, A., 281, 288, 295, 423, 425, 431 Craig, K. D., 264, 297, 313 Craig, S. E., 475, 483 Craighead, L. W., 604, 609 Craighead, W. E., 608 Cram, J. R., 250, 263 Cramer, P., 58, 69 Cramond, W. A., 274, 288 Crandall, C., 125, 139, 536, 538, 586, 587 Crane, L. A., 290 Crary, B., 76, 89 Crary, J. L., 139 Craske, M. G., 81, 94, 451, 459 Craven, T., 174, 189 Crawford, D., 127, 139 Crawley, J. N., 152, 163 Creamer, P., 185, 189 Creed, F., 174, 186, 394, 403, 409, 410, 412 Creer, T., 106, 108, 111, 114, 117, 118, 119, 453, 459 Cremer, P., 342, 363 Crespo, C. J., 549, 560 Crewe, N., 423, 427, 431 Crews, D. J., 604, 609 Crilley, P., 273, 290 Crimmins, E., 488, 504 Crippens, D. L., 564 Criqui, M. A., 361 Criqui, M. H., 506 Criquim, M. H., 363 Crisco, J. J., 456, 462 Crisp, R., 428, 431 Crisp, T. C., 611 Crisson, J. E., 174, 186, 187 Crittenden, P. M., 475, 483 Crocker, M. F., 296, 314 Crockett, L. J., 469, 483 Crofford, L. J., 178, 186 Croft, P. R., 188 Croghan, T. W., 499, 504 Cromer, B. A., 473, 481, 483 Cromer, L., 561 Crommelin, R. M., 207, 212 Cropanzano, R., 569, 589 Cross, C. K., 529, 539 Crouter, A. C., 530, 542 Crow, F., 426, 433 Crowell, M., 394, 398, 412, 413 Crowley, J. J., 501, 506 Crowther, R., 330, 335 Croyle, R. T., 54, 69 Cruess, D. G., 239 Cruess, S., 239 Crum, R. M., 197, 212, 362 Crump, C., 528, 542, 572, 587 Crutch“eld, A. B., 561 Cruz, P. T., 195, 214 Cryer, P., 205, 212 Crystal, S., 239 Cuevas, J. L., 394, 412 Cuisinier, M. C., 524, 540 Culbert, J. P., 332, 336 Culjak, G., 55, 68 Cullhed, I., 357 Culliton, P. D., 597, 609 Cummings, C., 280, 291 Cummings, G. L., 547, 560 Cummings, S. R., 551, 566 Cunningham, S. J., 462 Cunningham, W., 193, 213, 474, 483 Cunradi, C. B., 547, 560 Curb, J. D., 560, 561, 562, 565 Curie, C. J., 377, 390 Currie, S. L., 244 Currie, S. R., 332, 334 Currier, J. S., 241 Curtis, S., 15, 21 Cutler, G. B., Jr., 484, 485 Cutler, J. A., 352, 357, 358 Cutler, R. B., 312, 313 Cutrona, C. E., 59, 61, 68, 69, 82, 87 Cutter, G., 344, 362 Cwikel, J., 44, 46 Czajkowski, S. M., 339, 357, 363, 553, 565 Czeisler, C. A., 336 Czekalla, J., 601, 609 Da Costa, I. G., 454, 459 daCosta, G. A., 408 Dadds, M., 66, 72, 411 Daeschner, C. W., 460 D•Agostino, R. B., 354, 361, 364, 490, 491, 504, 505 Dahlberg, L., 173, 190 Dahlem, N. W., 110, 115, 117 Dahlgren, L. A., 154, 165 Dahlquist, L. M., 450, 451, 459 Dahlstrom, W. G., 346, 357, 508, 557, 559, 560 Author Index 623 Dahme, B., 113, 118, 119 Dai, W., 598, 611 Dailey, C., 369, 386 Dailey, J. W., 178, 190 Dakof, G. A., 64, 69 Daldrup, R., 295, 313 Dale, J., 388 Dale, L. C., 165 Daley, J., 317, 344, 359, 362 Damato, N., 324, 337 D•Amico, D., 264 Dan, A., 537 Dancey, C. P., 395, 398, 399, 409 D•Angelo, L. J., 239 Daniel, E. E., 411, 594 Daniels, J., 214 Daniels, M., 80, 91 Danner, D. D., 497, 504 Danneskiold-Samsoe, B., 174, 187 Danoff-Burg, S., 57, 73 Dantzer, R., 76, 89 D•Arcangelo, R., 483 Darrow, W. W., 220, 243 Das, L., 461 Dash, J., 355, 358, 452, 464 Dashevsky, B., 332, 334 Daum, R. S., 447, 460 Daumit, G. L., 344, 358 Davenport, T. A., 386 Davey, J. A., 610 Davey Smith, G., 19, 21 David, A. S., 69, 366, 381, 385 David, D., 46 David, H. P., 482 David, J. R., 77, 89 Davidoff, G., 425, 431 Davidoff, R., 358 Davidson, H., 531, 537, 593, 609 Davidson, J., 32, 46, 501, 509, 593, 609 Davidson, K., 349, 359 Davidson, L., 37, 46, 78, 89 Davidson, M., 129, 130, 140, 401, 409 Davidson, P., 116, 393, 410 Davidson, R. J., 79, 89 Davidson, R. T., 593, 609 Davies, H., 505 Davies, J. B., 306, 314 Davies, J. L., 596, 608 Davies, R., 32, 47, 125, 140 Daviglus, M. L., 497, 504 Davis, B. D., 562 Davis, B. R., 347, 358, 364 Davis, C., 52, 69, 428, 431 Davis, D., 214, 242 Davis, H., 547, 562 Davis, K. L., 94 Davis, M. C., 169, 175, 186, 518 Davis, M. W., 280, 291 Davis, R. M., 521, 538 Davis, S., 459, 483, 557, 561 Davis, W. K., 193, 213 Davison, B. J., 289 Davison, K. P., 86, 94 Dawber, T. R., 494, 506 Dawson, D., 403, 410 Dawson, D. A., 522, 539 Dawson, D. V., 508 Dawson, E. C., 187 Dawson, J. L., 69 Dayan, K. I., 361 Daynes, R. A., 75, 89 D•Costa, A., 112, 119 Deale, A., 369, 379, 385 Deamant, C., 538 De Araujo, G., 110, 115 Deardorff, W. W., 2 Deasy-Spinetta, P., 456, 459 De Becker, P., 385 DeBolt, A. J., 457, 459 de Boo, T. M., 389 de Bruin-Kofman, A. T., 261, 263 Dechene, L., 367, 376, 385, 386 Deci, E., 200, 217 Deckardt, R., 524, 537 Decker, S., 428, 435 Decker, T., 280, 288 De Clerck, L., 188 DeCuir-Whalley, S., 474, 484 Deeds, S. G., 71 Deeg, D., 72, 94, 487, 504 Defeudis, F. V., 599, 612 DeFlorio, M., 272, 288 DeFrank, R. S., 574, 586 Defriese, G. H., 446, 460 Degner, L. F., 289 DeGood, D. E., 196, 212, 302, 314 de Graauw, K. P., 524, 540 DeGroen, J. H. M., 46 de Groot, L. C., 550, 561 De Groot, M., 214, 550, 561 DeGuire, M. J., 199, 213 deGuman, M., 562 de Haes, J., 65, 69 deHueck, A., 184, 187 Deichmann, M. M., 253, 264, 452, 453, 460 Deitrich, R. A., 551, 561 de Jonge, S., 189 De Jongh, R., 93 Dekel, R., 38, 48 Dekker, E., 100, 115 Dekker, F. W., 109, 115 deKloet, E. R., 178, 187 de la Bije, Y., 216 Del Puente, A., 195, 216, 518, 538 Delamater, A., 201, 214, 454, 459, 471, 483 Delaney, B. R., 80, 94 Delaney, K. M., 243 DeLawyer, D. D., 459 Delbanco, T. L., 358, 609 DeLeo, J. A., 181, 185 DeLisa, J., 418, 432, 435 DelliCarpini, L., 273, 277, 290 Deloria, M., 388 DeLuca, J., 372, 375, 376, 385, 387, 388 Delvaux, M., 399, 409 Demakis, J. G., 527, 538 DeMarco, J., 109, 117 Demark-Wahnefried, W., 501, 502, 504, 506 Dembroski, T. M., 345, 358 Demedts, P., 93 De Meirleir, K., 372, 385 Dement, W., 328, 335, 336 Demeter, L. M., 241 Demettre, E., 385 Deminiere, J. M., 152, 163 Demitrack, M., 371, 385, 388 de Moor, C., 155, 163, 604, 608 Demyttenaere, K., 54, 69, 203, 212 Denis, P., 399, 409 Denmark, F. L., 13, 21, 23, 515, 543 Dennis, M., 293, 455, 459 Denoillet, J., 347, 358 De-Nour, A. K., 280, 287, 537 Dentinger, M. P., 248, 253, 258, 263, 265 de Paredes, E. S., 69 Depner, M., 178, 186 deProsse, C., 502, 503 DePue, J., 164 Derdiarian, A. K., 284, 288 de Rivera, J. L. G., 112, 116 Derogatis, L. R., 271, 272, 273, 288, 328, 334, 398, 409 De Rosa, C. J., 236, 240 DeRubeis, R. J., 80, 95 de Ruiter, J., 65, 69 Desch, C. F., 501, 507 de Silva, A., 139 Desivilya, H. S., 38, 46 Des Jarlais, D. C., 223, 229, 241 Desmond, K., 273, 288 De Souza Silva, M. A., 610 Despres, J. P., 143 de Swart, H. B., 346, 361 Desy, M., 240 Deuschle, M., 178, 186 de Valk, H., 216 Devellis, R. F., 190 DeVeno, T., 258, 263 Devereux, R. B., 362 Devesa, S., 502, 505 DeVet, K. A., 447, 461 DeVevey, S., 149, 166 DeVivo, M., 418, 419, 425, 430, 431, 432, 433, 434 Devos, R., 126, 136, 139 de Vroome, E. M., 55, 72 Dew, M. A., 93, 336 Dewar, H. A., 341, 362 DeWilde, S., 104, 119 Dewsnap, P., 396, 410 Dexter, D., 597, 609 Deyo, R. A., 187, 294, 314 Dhabhar, F. S., 76, 77, 89, 93 Dhivert, H., 115 D•Hoore, W., 515, 538 Diaferia, G., 88 Diamant, N. E., 409 Diamond, S., 253, 254, 258, 263, 264, 282, 288 Diamond-Falk, J., 258, 263 Diaz, T., 549, 561, 563 Diaz, Y. E., 242 Dibble, S. L., 598, 609 Di Blasio, P., 103, 115 Di Chiara, G., 149, 151, 162, 163, 165 Dickey, D., 93 624 Author Index Dickson, H., 423, 431, 433 DiClemente, C. C., 164, 226, 243 DiClemente, R. J., 224, 239, 241, 242, 477, 479, 483, 484 Diefenbach, M. A., 277, 290 Diehr, P., 503 Dieleman, F. E., 109, 115 Diener, E., 425, 431 Diener, H. C., 248, 263 Dietrich, M., 103, 116 Die-Trill, M., 456, 459 Dietz, W. H., 125, 140, 142 DiFranza, J. R., 155, 163 DiGasbarro, I., 413 DiGiovanna, E. L., 593, 609 DiGiovine, F. S., 180, 190 DiGirolamo, A. M., 476, 485 DiGirolamo, M., 140 Dignan, M. B., 551, 565 Dijkers, M., 424, 425, 428, 431, 434, 435 DiLillo, V., 515, 537 Dillbeck, M. C., 609 Dillon, B., 241 DiMatteo, M., 201, 213, 215, 499, 504 Dimmock, J. A., 538 Dimpfel, W., 601, 612 Dinan, T., 371, 373, 380, 385, 389 Ding, Y., 356, 360 Dinges, D. F., 323, 334, 336 Dinges, D. P., 449, 452, 459 Dinwiddie, H., 161, 167 DiPietro, L., 127, 140 Dirks, D. I., 102, 110, 116, 119 Dirks, J. F., 102, 110, 115, 116, 119 Dixey, J., 177, 188 Dixhoorn, J. V., 353, 358 Dixon, R. M., 141 Dobbins, J. G., 386, 389, 390 Doctor, J., 430, 433 Dodge, J., 400, 401, 411 Doebbeling, B. N., 572, 589 Doeglas, D., 66, 69 Doepke, K., 459 Doghramji, K., 326, 337 Dogra, J., 596, 609 Doherty, G. W., 44, 46 Dohm, G. L., 142 Dohrenwend, B. P., 28, 33, 46, 48, 176, 188, 520, 529, 540, 541 Dohrenwend, B. S., 28, 46, 520, 541, 547, 561 Dolce, J. J., 296, 302, 314 Doleys, D. M., 296, 314 Dolgin, M., 456, 463 Dolski, I., 79, 89 Domagalski, L. R., 484 Don, B. M., 440, 613 Donaldson, G., 280, 291 Donaldson, S. I., 574, 586 Donatelle, R. J., 561 Donati, F., 372, 385 Donatoni, E., 204, 214 Donker, F. J. S., 5, 12, 13, 21, 22 Donnan, P. T., 167 Donnelly, J., 212, 281, 288 Donner, T. W., 211 Donny, E. C., 149, 163 Donoghue, G. D., 536, 539 Donohoe, M., 385 Donohue, J. F., 116 Donohue, R., 426, 433 Donovan, W., 418, 435 Donzella, B., 79, 89 Doolittle, T. H., 388, 389 Dopp, J. M., 84, 89, 93 Dorfman, S. F., 164 Dorn, L. D., 485 Dornadula, G., 234, 241 Dorr, H. G., 471, 485 Dorr, N., 189 Dos-Santos, J. E., 547, 561 Dossey, L., 608 Doswell, W. M., 69 Dotevall, G., 403, 412 Dougherty, J., 56, 65, 66, 71 Douglas, J. M., 242, 243, 323, 334 Douglas, J. S., 359 Douglas, P., 343, 358 Douglas, S. D., 323, 334, 337 Douvan, E. A., 468, 483 Dow, K. H., 272, 288 Dowler, R., 424, 425, 429, 431, 434 Downey, J., 525, 538 Downey, K. K., 153, 167 Downie, R. S., 579, 586 Downs, W. R., 528, 541 Dowse, G. K., 124, 141 Dowsett, E. G., 368, 369, 385 Doyle, W. J., 83, 89 Dramaix, M., 156, 166 Draper, G. J., 502, 505 Drazen, J. M., 543 Dreher, H., 278, 288 Dressler, W. W., 547, 561 Drewnowski, A., 141, 213 Drieu, K., 599, 612 Drossman, D. A., 393, 394, 395, 396, 397, 398, 399, 400, 407, 409, 411, 412 Drotar, D., 458, 460, 463 Drougas, H., 137, 141 Droy-Lefaix, M. T., 599, 612 Drucker-Colín, R., 154, 166 Druley, J. A., 67, 69 Dubbert, B. K., 521, 544 Dubbert, P. M., 214, 339, 355, 356, 358 Dubitsky, A. A., 37, 48 Dubois-Arber, F., 229, 230, 241 Ducimetière, P., 492, 509 Duckro, P. N., 196, 211, 249, 263 Dudley, D. L., 110, 115 Dudley, K., 610 Duey, W. J., 552, 561 Duff, G. W., 180, 190 Duffy, F. H., 372, 385 Dufouil, C., 492, 509 Dugoni, B. L., 125, 143 Dugowson, C. E., 518, 538 Duivenvoorden, H. J., 276, 291, 358, 500, 509 Duke, M., 413 Duke, P. M., 466, 483 Dulcan, M. K., 483 Dulloo, A. G., 131, 140 Dumesic, D. A., 125, 140 Dunaif, A., 125, 140 Dunbar, R., 354, 358 Dunbar, V., 212 Dunbar-Jacobs, J., 54, 69, 356, 358, 499, 503 Duncan, G. J., 556, 564 Duncan, S. C., 153, 163 Duncan, T. E., 153, 163 Dundore, D. E., 296, 314 Dungan, S., 458, 463 Dunkel-Schetter, C., 56, 64, 65, 69, 74, 277, 278, 288, 292, 534, 538 Dunn, A. L., 137, 142, 214, 603, 609 Dunn, C., 603, 609 Dunn, D. S., 423, 428, 431 Dunn, L., 37, 45 Dunn, M., 423, 428, 429 Dunn, S., 55, 68, 193, 194, 211, 212 Dunning, E. J., 356, 358 Dunsmore, G., 397, 412 Dunstan, R. H., 372, 385 Dura, J. R., 61, 71, 78, 89, 91, 112 Duran, R., 65, 68, 91, 242 Durand, E., 56, 74, 144 Durant, L. E., 240 Durel, L. A., 348, 361 Dusek, D. E., 373, 386 Dutton, D. B., 385, 528, 538 Dutton, M., 44, 48, 518 Duvall, K., 120 Dvorak, H. F., 92 Dwivedi, C., 613 Dworkin, H. S., 372, 388 Dworkin, R. H., 295, 314 Dworkin, S. F., 175, 190 Dwyer, J., 391, 492, 504 Dwyer, K., 176, 188, 358 Dyck, S., 284, 292 Dye, C., 489, 504 Dyer, A. R., 124, 140, 504 Dyer, C. S., 92 Dyer, P. H., 214 Dzau, V. J., 340, 358 Dziuba-Leatherman, J., 475, 483 D•Zurilla, T. J., 285, 288, 607, 609 Eagle Elk, M., 551, 561 Eagle, K. A., 348, 358 Eaker, E., 344, 357, 358, 364, 500, 504 Eales, J., 127, 139 Eardley, I., 204, 211 Earl, N. L., 508 Earles, J. E., 261, 264 Eastman, H. B., 384 Eastwood, J., 397, 410 Eastwood, M. A., 397, 410 Eaton, C., 164 Eaton, S. B., 128, 140 Eaton, W. W., 362 Eaves, L., 159, 165, 167, 540 Ebbesson, L., 550, 561 Ebbesson, S. O., 550, 561 Eberhardt, K., 171, 186 Eberl, G., 189 Author Index 625 Eberly, R. E., 38, 46 Eccleston, C., 308, 314 Eckel, R. H., 207, 212 Eckholdt, H. M., 80, 94 Eckman, J., 452, 459 Eddy, J. M., 119 Eddy, L., 532, 544 Eddy, V. A., 448, 460 Edelberg, R., 117 Edelbrock, C., 402, 408, 483 Edelman, S., 281, 288 Edelmann, R., 13, 21 Edenberg, H. J., 162 Edens, J., 57, 60, 69, 70 Edens, R. P., 609 Edgeworth, J., 447, 460 Edinger, J. D., 322, 325, 326, 334, 335, 336 Edison, M., 483 Edlin, B. R., 236, 239 Edwards, B. K., 379, 510 Edwards, B. S., 139 Edwards, C., 165 Edwards, D. A., 148, 163 Edwards, J. R., 54, 69, 572, 586 Edwards, M. E., 500, 507 Edwards, P., 289 Edwards, R., 379, 388, 389 Edwards, W. D., 139 Egolf, B., 343, 358 Ehlert, U., 372, 386 Ehrenpreis, A. B., 326, 335 Ehrlich, C. M., 523, 539 Ehrlich, E., 447, 462 Ehrman, R. N., 151, 163 Eichel, J., 204, 215 Eidelmen, B. H., 265 Eigenbrodt, M. L., 364 Eisdorfer, C., 71, 78, 89, 487, 491, 492, 504, 509 Eisen, S. A., 214 Eisenberg, D. M., 355, 356, 358, 598, 609 Eisenberg, H. M., 455, 462 Eiser, C., 505 Eisner, M. J., 609 Eitel, F., 611 Eiumtrakol, S., 243 Eiumtrakul, S., 240 Ekstrand, M. L., 88, 240 Ekstrum, J., 541 El Amrani, M., 266 Elashoff, R., 89, 90, 288 El-Bayoumi, G., 518, 538 Elbert, K., 199, 216 Elder, J. P., 163, 165, 491 Elder, P., 564 Elenkov, I. J., 373, 385 El-Guebaly, N., 522, 538 Elias, J. W., 487, 504 Elias, M. F., 487, 490, 491, 492, 493, 494, 495, 496, 498, 500, 504, 505, 507, 508, 509, 545 Elias, P. K., 487, 490, 491, 492, 493, 494, 495, 496, 498, 504, 505 El-Kebbi, I., 202, 212 Elkin, A. J., 574, 586 Elkind, H. B., 570, 586 El-Khorazaty, M. N., 482 Ell, K., 562 Ellegaard, J., 95 Eller, L. S., 86, 89 Eller, M., 243 Ellers, B., 454, 460 Ellickson, P. L., 155, 162, 163 Elliot, D., 30, 37, 45 Elliott, C., 451, 461 Elliott, P., 124, 140, 357 Elliott, T., 415, 422, 423, 424, 425, 426, 427, 428, 429, 430, 431, 432, 433, 434, 435 Ellis, S. P., 257, 375, 385, 388 Elman, C., 557, 561 Elman, M. R., 532, 538 Elmer, G. I., 149, 168 Elmer, P. J., 362 Elston, M. A., 555, 564 Elving, L. D., 389 Ely, D. L., 61, 69 Embury, S. H., 452, 460 Emery, G., 257, 262 Emery, S., 155, 163 Emmelkamp, P. M., 93 Emmott, S., 413 Emshoff, J., 239 Endicott, J., 367, 385 Endicott, N. A., 374, 385 Endler, N. S., 47, 48, 53, 69 Eneroth, P., 68, 82, 95 Engdahl, B. E., 38, 46 Engebretson, T. O., 346, 363 Engel, G. L., 87, 89, 169, 186 Engel, R., 443, 452, 464 Engelgau, M., 214 Engelhard, I. M., 324, 524, 538 Engelhardt, C. L., 337 England, R., 172, 188 Engle, D., 295, 300, 313 Engleberg, N. C., 187 English, A., 473, 477, 483 Enns, M., 273, 287 Enstrom, J. E., 5, 21, 323, 335 Enzlin, P., 203, 204, 212 Epping-Jordan, J. E., 55, 56, 69 Eppley, K. R., 596, 609 Epstein, A. M., 344, 364, 515, 537 Epstein, D., 331, 334 Epstein, L., 141, 206, 208, 213, 217, 250, 263 Epstein, N. B., 104, 116 Erb, S., 152, 163 Erbaugh, J., 328, 334, 396, 408 Erfurt, J. D., 360 Erhardt, D., 166 Ericson, D., 38, 49 Ericsson, K., 505 Eriksson, J. G., 343, 359 Erkelens, D., 216 Erlen, J. A., 69 Ernst, A. R., 402, 411 Ernst, D., 498, 509 Ernst, E., 592, 593, 609 Ernst, J. A., 244 Ernst, N. D., 127, 140 Eron, J. J., 241 Erringer, E. A., 236, 239 Erwin, C. W., 334 Escarce, J. J., 344, 363 Escobar, J. I., 37, 46 Escobedo, L. G., 546, 561 Eshleman, S., 117, 540 Esler, M., 354, 359 Esparza, J., 127, 143, 550, 565 Espie, C. A., 330, 335 Espino, D. V., 550, 564 Esposito-Del Puente, A., 195, 216 Esterling, B. A., 62, 69, 78, 80, 81, 82, 83, 86, 89, 90 Eth, S., 48, 462 Ettinger, K. M., 120 Ettinger, W. H., 174, 184, 189, 355, 364, 503, 505, 506, 507, 509 Euba, R., 369, 370, 385 Evans, B., 5, 22, 603, 609 Evans, D. A., 496, 510 Evans, D. D., 263, 408 Evans, G. W., 61, 71 Evans, J. G., 489, 505, 507 Evans, M., 195, 212 Evans, N., 110, 115, 116, 148, 164 Evans, R., 117, 245, 263, 412 Evengard, B., 371, 385, 390 Everaerd, W., 101, 104, 106, 108, 118, 119 Ever-Hadani, P., 537 Everly, G. S., Jr., 373, 386 Evers, A. W. M., 66, 69 Everson, C. A., 324, 335 Everson, S., 359, 496, 505, 557, 561 Ewart, C., 357, 359 Ewbank, D., 499, 505 Ewing-Cobbs, L., 455, 460, 462 Ewy, G. A., 358 Eyler, A. A., 549, 552, 561 Eysenck, H. J., 396, 409 Eysenck, S. B. G., 396, 409 Fabian, R. L., 275, 289 Fabsitz, R., 124, 141, 159, 162 Faddis, S., 267, 276, 277, 290, 607, 612 Fagerström, K. O., 156, 158, 159, 160, 163, 164, 165, 166 Fagioli, L., 372, 385, 388 Fahey, J., 78, 79, 80, 81, 84, 88, 89, 90, 91, 93, 94, 242, 288 Fahrion, S., 256, 264 Fairbank, J. C., 306, 314 Fairburn, C. G., 136, 139, 141, 142, 143, 144, 538, 539, 541, 542, 543 Fairclough, D., 456, 462 Fairclough, P., 409 Faith, M. S., 125, 139, 277, 513 Falger, P. R., 38, 46 Falke, R., 56, 69, 534, 538 Falus, A., 189 Fang, C. Y., 277, 290 Fanurik, D., 448, 450, 451, 458, 460, 463 Faragher, E. B., 404, 413 Faraone, S. V., 538 Farber, J., 282, 289 Farberow, N. L., 274, 288 626 Author Index Farinaro, E., 49 Farkas, A. J., 148, 163 Farmer, I. P., 549, 561 Farmer, M. E., 542 Farooqi, I. S., 126, 140, 142 Farquhar, J. W., 557, 561 Farris, E., 93 Farthing, M., 396, 410 Fass, R. J., 66, 70 Fassler, R., 91 Fatkenheuer, G., 231, 233, 241 Faucette, N., 144 Faulkner, D. L., 499, 505 Faull, C., 400, 410 Fava, M., 346, 359 Favagehi, M., 77, 93 Fawzy, F. I., 86, 87, 89, 90, 277, 278, 280, 281, 282, 288 Fawzy, N. W., 86, 87, 89, 90, 277, 278, 280, 281, 282, 288 Feaganes, J. R., 508 Feaster, D., 68, 82, 90 Federico, J., 312, 314 Federlin, K., 177, 188 Fee, F., 431, 444, 523, 539 Feeney, A., 555, 564 Feeney, T. J., 455, 464 Feeny, N. C., 40, 46 Fefer, P., 186 Feffer, H. L., 294, 315 Fehrenbach, A. M. B., 453, 460 Feigelman, S., 244 Feighery, E. C., 154, 164 Feighner, J. P., 367, 385 Feight, P., 503 Feil, E. G., 199, 214 Feinglos, M., 195, 196, 212, 214, 216 Feinleib, M., 124, 141, 345, 360, 492, 504 Feinstein, L. G., 56, 69, 534, 538 Feist, J., 1, 2, 34, 45 Feitosa, M. F., 126, 140 Feldman, H. A., 203, 212 Feldman, J. M., 99, 103, 112, 116 Feldman, M., 204, 214 Feldman, W., 402, 410 Feleni, R. A., 614 Felgoise, S. H., 267, 281, 290 Felson, D. T., 171, 172, 173, 185, 186, 187 Felten, D. L., 76, 85, 87, 90, 93, 181, 186 Felten, S. Y., 76, 84, 90, 93, 181, 186 Felton, B., 55, 58, 69, 73 Fenaughty, A. M., 550, 561 Fennell, E. B., 445, 463 Fennell, P. A., 376, 385, 386, 387 Fennis, J. F., 390, 413 Fenwick, J. W., 148, 165 Ferguson, D. C. E., 174, 355, 363 Ferguson, J. A., 344, 359 Ferguson, J. M., 139 Ferguson, S. J., 174, 186 Fernandez, E., 300, 313, 314 Fernandez-Repollet, E., 540 Fernbach, D., 450, 459 Ferraccioli, G., 177, 186 Ferrandez, A., 471, 485 Ferrando, S. J., 232, 233, 243 Ferrans, C. E., 381, 384 Ferrari, J., 382, 387, 390 Ferrario, C. M., 359, 499, 505 Ferreri, M., 266 Ferry, L., 156, 157, 163, 164 Festa, J., 434 Feste, C., 211, 212 Fett, S. L., 400, 412 Fetting, J., 271, 288 Fex, E., 171, 186 Fibiger, H. C., 151, 163 Fidanza, F., 122, 141 Field, B. J., 199, 213 Field, T., 603, 609 Fielder, K., 431 Fields, H. L., 5, 6, 8, 13, 161, 181, 186, 357, 367, 465, 503, 524, 530, 536 Fi“eld, J., 66, 68, 176, 185 Figley, C., 31, 46 Figueroa, J. B., 556, 560 Fihn, S. D., 359 Filipp, S. H., 49, 61, 71, 554, 563 Fillenbaum, G. G., 488, 505, 508 Finch, A. B., 447, 463 Finch, A. J., 32, 48 Findley, T., 388, 419, 430 Fine, M., 424, 432 Fine, P. R., 419, 428, 431, 434 Fine, R. N., 453, 461 Fingerhut, M., 566 Finkelhor, D., 475, 482, 483 Finkelstein, J. S., 470, 483 Finkelstein, J. W., 466, 483 Finlay, J., 71 Finney, J., 402, 410, 443, 447, 448, 454, 460, 461 Finucane, M. L., 499, 507 Fiore, M. C., 156, 157, 164 Fireman, P., 89 Firestone, P., 402, 411 Firor, W., 360 First, M. B., 328, 337, 366, 390 Fischl, M. A., 230, 241, 244 Fish, L., 120, 608 Fishbach, R. L., 554, 565 Fishbain, D. A., 313 Fishbein, M., 224, 241, 242 Fisher, C., 167 Fisher, D. G., 561 Fisher, E. B., 194, 196, 210, 212 Fisher, G., 555, 564 Fisher, J. D., 223, 224, 226, 241, 360 Fisher, L., 83, 91, 92 Fisher, P. W., 48 Fisher, W. A., 223, 226, 241 Fishman, B., 62, 72, 83, 94 Fiske, S. T., 382, 386 Fisler, R., 81, 95 Fitch, M., 65, 72 Fitch, P., 402, 410 Fitch, R. J., 166 Fitzgerald, J. T., 211 Fitzgerald, L. Z., 175, 186 Fitzgibbon, M., 125, 128, 136, 139, 140, 546, 561 Fitzpatrick, K. M., 534, 538 Flack, J., 359, 499, 505, 557, 567 Flaherty, J., 199, 215, 370, 389, 484 Flanery, R., 401, 402, 410 Flannery, J. T., 273, 288 Flavin, K., 200, 215 Flay, B. R., 148, 155, 158, 164, 167 Flegal, K. M., 121, 123, 124, 130, 140, 142, 548, 563 Fleishman, J. A., 244 Fleishman, S., 288 Fleissner, K., 532, 543 Fleming, I., 37, 38, 45, 46, 549, 552, 563, 564, 565 Fleming, P. L., 549, 563, 564 Fleming, R., 61, 69, 552, 565 Fleshner, M., 372, 388 Fletcher, A. P., 499, 506 Fletcher, B., 423, 435 Fletcher, E. M., 189 Fletcher, G. F., 363 Fletcher, J. M., 455, 460 Fletcher, L., 153, 164 Fletcher, M. A., 86, 89, 90, 371, 388, 389 Fletcher, P. J., 166 Fletcher, R. D., 344, 362 Fletcher, R. H., 489, 505 Fletcher, S., 489, 505 Flier, J. S., 126, 138 Flietcher, M. A., 70 Flor, H., 258, 264, 294, 299, 301, 302, 312, 314, 315 Florin, I., 103, 112, 116, 410 Flory, J. D., 93, 490, 507 Flynn, K. J., 546, 561 Flynn, R., 73 Foa, E. B., 40, 46, 49 Fobair, P., 273, 288 Foege, W. H., 121, 142, 553 Fogelman, I., 499, 508 Folen, R. A., 261, 264 Foley, B., 456, 460, 461 Foley, D., 322, 335, 490, 506 Folgering, H., 380, 384 Folkman, S., 33, 51, 53, 58, 71, 174, 176, 188, 233, 240, 241, 276, 289, 528, 536 Folks, D. G., 396, 397, 410 Follick, M., 299, 313, 342, 359 Follman, D., 357 Folsom, A. R., 124, 140, 361, 563 Fonagy, P., 524, 539 Fong, G. T., 227, 241 Fong, K. O., 560 Fong, W., 548, 566 Fonger, J., 358 Fonner, E., Jr., 548, 562 Fontaine, K. R., 125, 138 Fontana, S., 186 Fontanetta, R., 367, 376, 385, 386 Forastiere, F., 231, 244 Ford, D., 198, 212, 321, 322, 323, 324, 335, 347, 359, 362 Ford, E