Cancer Related Research

The Psychosocial Treatment Laboratory is engaged in numerous research projects designed to study the mind/body relationship. We examine the effects of stress on the one hand and interventions such as supportive/expressive group psychotherapy and hypnosis on emotional well-being and coping on the other. We then link possible effects of these psychological and social variables on mediating physiological systems, including the endocrine, immune, and autonomic nervous systems. Finally, we examine effects of these interventions and physiological systems on survival time. Studies in progress are described below.

  1. Effects of Psychosocial Treatment on Cancer Survival (A current attempt to replicate the original Metastatic Breast Cancer Survival Study)
  2. The Role that Brain Regulation of Stress Hormones has on Cancer Progresssion in Metastatic Breast Cancer
  3. Emotional Coding Lab – Stanford
  4. Do Community Cancer Groups Enhance Well-Being?
  5. Stress, Diunal Cortisol & Breast Cancer Survival
  6. Generativity and Meaning-Making as Resilience Factors in Breast and Prostate Cancer
  7. Supportive-Expressive Group Therapy for Men with Primary Prostate Cancer

For a list of completed studies, please refer to the Recent Studies page.

Effects of Psychosocial Treatment on Cancer Survival
(A current attempt to replicate the original Metastatic Breast Cancer Survival Study)

Principal Investigator: David Spiegel, M.D.
Co-Principal Investigator: Cheryl Koopman, Ph.D.
Co-Investigator and Project Director: Lisa Butler, Ph.D.
Co-Investigator: Janine Giese-Davis, Ph.D.
Administrative Coordinator: Xin-Hua Chen, B.A.
Clinical Coordinator: Karin Calde, B.A.

Funding: National Institute of Mental Health, National Cancer Institute, The MacArthur Foundation, Fetzer Institute

Our laboratory is currently conducting a replication trial of the effect of group treatment on survival time in a new sample of 125 women with metastatic breast cancer, with emphasis on the psycho-physiologic effects. The subjects are randomized with stratification for prognosis into intervention and non-intervention (control) samples. Psychosocial measures are similar, and include mood disturbance, adjustment to cancer, social support, and treatment compliance. Physiological measures used reflect the relationship between psychological stress and immune function: salivary cortisol, delayed hypersensitivity, total white blood cell count, natural killer cell number and cytotoxicity, and CD4/CD8 counts.

For further information, please see the abstract.

Do Community Cancer Support Groups Reduce Physiological Stress?

Collaborators: Co-Principal Investigator Carol Kronenwetter, Ph.D., Cancer Support Community; Co-Principal Investigator Mitch Golant, Ph.D., The Wellness Community; Consultant Mort Lieberman, Ph.D., U.C.S.F.; and Consultant Harold Benjamin, Ph.D., The Wellness Community.

Lab Personnel: Co-Principal Investigator David Spiegel, M.D.; Co-Investigator and Project Director Janine Giese-Davis, Ph.D.; Project Coordinator Jessica Donaghy

Funding: Breast Cancer Research Program of California, UCSF

Community support programs provide much needed psychosocial support rapidly and inexpensively to diverse populations of breast cancer patients. Through a randomized clinical trial, our study will assess the effectiveness of two major community-based support programs, the Cancer Support Community and The Wellness Community, which are designed to improve coping and quality of life for breast cancer patients. They will be compared with Dr. Spiegel's Supportive-Expressive therapy model.

We are currently recruiting women with breast cancer with no evidence of metastasis or recurrence. In San Francisco, participants will be randomly assigned to either the San Francisco Cancer Support Community or Supportive-Expressive group therapy. In Walnut Creek women will be assigned to either The Wellness Community-- SF East Bay or to Supportive-Expressive group therapy.

Participants will be assessed at baseline, 4, 8, and 12-month intervals by interviews and questionnaires designed to measure mood disturbance, coping, social support, demographics, and group envirnoment. Physiological response to stress will be measured using saliva samples for cortisol assessment.

The Role that Brain Regulation of Stress Hormones has on Cancer Progresssion in Metastatic Breast Cancer

Principal Investigator: Dr. David Spiegel
Project Director: Heather Abercromboie, Ph.D.

Funding: The Charles A. Dana Foundation

The study aims to get a better understanding of the role that hormones and the brain play in the course of breast cancer.

The objectives of this study are:
  1. To examine the relationship between brain regulation of endocrine function and cancer progression, by measuring the relationship between circadian rhythmicity of cortisol and other hormones and hippocampal damage in patients with metastatic breast cancer and healthy controls.
  2. To examine the relationship between cortisol dysregulation and severe stress.
  3. To asses neurophychological damage associated with reduced hippocampal volume, by measuring spatial memory.
  4. To better define the neural substrate of cortisol dysregulation by examining concomitant levels of adrenocorticotrophic hormone (ACTH), dehydoepiandrosterone (DHEA), prolactin (PRL), oxytocin (OXL) and melatonin.
We are currently seeking women with metastatic or recurrent breast cancer as well as women with no cancer to take part in this study. Participation would involve completing questionnaires designed to measure stressful life experiences, medical status, and demographics. Participants will also attend an interview to complete spatial memory tests at our laboratory. Stress hormone levels will be measured using saliva samples for cortisol assessment.
To participate in the study or for more detailed information, please contact Heather Abercrombie, Project Director at 650-724-7024 or send E-mail to

Emotional Coding Lab – Stanford

Principal Investigator: Dr. David Spiegel
Project Director: Janine Giese-Davis, Ph.D.
Co-Creators: Bita Nouriani, M.F.C.C., Jennifer Boyce, B.A., Sanjay Chakrapani, B.A., Diana Edwards, B.A., Barbara Symons, B.A., Julie Choe, B.A., Casey Alt, B.A., David Weibel, M.B.A., Jane Benson, M.S.W.

Funding: Breast Cancer Research Program of California

We have created a way to code emotion for speakers, response by listeners, and topics discussed in group therapy. In particular, our system was customized for the coding of metastatic breast cancer patients participating in supportive-expressive groups; however, the system we have created could be used in any group situation. We code in multiple passes through videotapes of group sessions:

  1. Speaker Coding - we code who is speaking,
  2. Emotion Coding - we code emotion for speaker using a modification of John Gottman's Specific Affect Coding System we call Breast Cancer-SPAFF,
  3. "Listener" Coding - we code who is backchanneling (yah, uh-huh, wow),
  4. Listener Emotion Coding - we code the emotion for the backchannelers, and
  5. Topics Coding - we code topics discussed.

Each of these 5 layers can be brought into a time-linked data-set using the vitc time-code laid down on the videotape. We utilize The James Long System to enable us to code, edit our coding, and transform the data for statistical analysis.

For further information, please see the Emotional Coding Project Description.


Stress, Diurnal Cortisol & Breast Cancer Survival

Principal Investigator: David Spiegel, M.D.
Co-Investigator: Janine Giese-Davis, Ph.D.

Funding: National Institute on Aging

Breast cancer can be understood as a series of stressors, including physical symptoms, treatment side effects, fears about disease progression, and disruption of social and vocational roles. Stress can be further exacerbated by social isolation and maladaptive coping, which may in turn adversely affect the endocrine system, and potentially the rate of disease progression. Conversely, enhanced psychosocial support via group therapy or other means may improve medical outcome by buffering the consequences of such stress and thereby ameliorating endocrine function. Previous research in this laboratory with metastatic breast cancer patients has demonstrated an association between diurnal cortisol rhythm and survival, revealing flatter slopes (i.e, loss of normal diurnal variation to be associated with shorter survival. This is of particular importance because glucocorticoids have been shown to facilitate tumor growth.

This program of research is designed to examine the relationships among stress, dysfunction of the hypothalamic-pituitary-adrenal axis (HPA), and breast cancer progression. A sample of 100 women with metastatic breast cancer will be recruited for intensive evaluation of their stress response. Salivary cortisol samples will be taken to determine the pattern of diurnal variation in cortisol and to examine its relationship to stress and survival time. Regulation of the stress response system will be studied utilizing low-dose dexamethasone suppression and corticotropin releasing factor (CRF) challenge. Stress-induced phasic artivation of cortisol will be evaluated using the Trier Social Stress Task. This systematic assessment of stimulation and suppression of the cortisol stress response and its relationship to breast cancer progression will thoroughly examine the hypothesis that endocrine dysfunction may mediate the relationship between stress and breast cancer progression.

We are currently recruiting subjects for this project. If you are interested in participating please contact Bita Nouriani at 650/723-8479 or Please see the project flyer (download MS Word file, 77.4 KB) for additional information.

Generativity and Meaning-Making as Resilience Factors in Breast and Prostate Cancer

Principal Investigator: David Spiegel, M.D.
Fellow: Jay Azarow, Ph.D.

Funding: American Cancer Society

The goal of this study is to see if recently-diagnosed breast cancer patients benefit psychologically from finding some positive meaning in their illness, particularly through reevaluating their life goals and priorities and by parenting and helping others. This premise flows from an apparent paradox: many patients with more advanced cancer seem medically quite ill, but psychologically quite healthy and resilient. Distress is common when breast cancer is first diagnosed, but good adjustment to advancing cancer often seems to involve real psychological growth.

A major component of such growth—according to many patients, their loved ones, and their physician—is finding positive meaning in the illness, in part through redefining personal values and life goals. An important contributor to life meaning for many adults is "generativity"—Erik Erikson's term for the adult's concern for the well-being of the next generation and for one's psychologicallegacy. Generativity often takes the form of parenting, teaching, mentoring, and community service.

Recent research outside of oncology has found that: (1) finding genuine positive meaning after loss or trauma seems to contribute to health and well-being; and (2) persons concerned with generativity, who involve themselves in generative pursuits like parenting and helping others, are less depressed and anxious and more satisfied with themselves and with their lives. These results are consistent with previous research at Stanford by Dr. Spiegel (the mentor for this project) which found that a form of group therapy—emphasizing discussion of the personal meaning of illness and the reassessment of life goals, and featuring participants mentoring each other—led to less distress, better quality of life, and longer life. However, not enough is understood about the process of meaning-making in breast cancer, and there is no published research on generativity with cancer or other medical patients.

The study is currently recruiting participants; for more information, please contact Jay at 650.725.5424;

Supportive-Expressive Group Therapy for Men with Primary Prostate Cancer

Principal Investigator: David Spiegel, M.D.
Project Director: Jay Azarow, Ph.D.

Funding: The National Cancer Institute, The Nathan Cummings Foundation

Research Base: University of Rochester Cancer Center / Community Clinical Oncology Program

Prostate cancer is the second most prevalent cause of cancer-related mortality in men. Treatment may involve surgery, radiation, hormonal therapy or “watchful waiting”. A pilot study of supportive-expressive group therapy in men with stage A or B prostate cancer revealed the efficacy of this model in alleviating psychosocial distress. This multi-center collaborative study will be modeled on the similar trial with primary breast cancer patients.

The prostate cancer intervention study is an effort to determine if this form of group therapy - which emphasizes emotional expression and group support as therapeutic factors in coping with cancer, and has proven so successful for women with breast cancer - is similarly helpful for men with prostate cancer.

This study is currently recruiting a final cohort of participants; for additional information please contact Jay (650.725.5424;

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