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The purpose of this paper was to examine the longitudinal effects of psychological sense of control and control-related coping strategies on breast cancer outcomes. Utilizing the California Cancer Registry, follow-up data on cancer recurrence and all-cause mortality were obtained for 54 of 58 women originally diagnosed with breast cancer in 1992 to 1994. Relationships between cancer outcomes and psychological control and mood at 4 and 8 months post-diagnosis were examined. Results of the study showed that a greater sense of control at 8 months was associated with less cancer recurrence, while higher desire for control at both 4 and 8 months was associated with greater likelihood of recurrence. Utilization of an accepting mode of control appeared to mitigate the negative effects of desire for control on recurrence. No significant relationships were observed between mood and mortality or recurrence. These findings suggest the potential value of examining psychological control and control-related coping on cancer outcomes in future epidemiological and clinical studies.

Although the quest for active control and mastery can be seen as a central thread that ties together important aspects of human experience, we are frequently confronted with the reality that much of what is encountered in life lies outside our active instrumental control. Control must involve finding healthy and life-affirming ways to exercise personal mastery, and identifying constructive ways to respond to the lack of control that pervades the human condition. In this article we explore a number of professional areas in which physicians may experience significant feelings of loss or lack of personal control-difficult encounters with patients, dealing with patient nonadherence, end-of-life care, confronting the uncertainty and ambiguity that are frequently a part of illness, as well as institutional and systemic factors that can result in loss of various forms of autonomy and control over decision-making. We then consider maladaptive ways in which physicians sometimes attempt to address such losses of control and suggest that personal stress and burnout and difficulty developing effective therapeutic relationships with patients may be the consequence, in part, of these efforts. Finally, we discuss an empirically derived, multidimensional theoretical model for better understanding control dynamics, and identifying more optimal strategies physicians can employ in their efforts to gain and regain a sense of control in caring for patients.

Context: There is growing interest in the integration of meditation in higher education. Purpose: Here, we review evidence bearing on the utility of meditation to facilitate the achievement of traditional educational goals and to enhance education of the "whole person." Research Design: We examine how meditation practices may help foster important cognitive skills of attention and information processing, as well build stress resilience and adaptive interpersonal capacities through a review of the published research literature. Conclusions/Recommendations: We offer directions for future research, highlighting the importance of theory-based investigations, increased methodological rigor, expansion of the scope of education-related outcomes studied, and the study of best practices for teaching meditation in educational settings.

Recently, the psychological construct mindfulness has received a great deal of attention. The majority of research has focused on clinical studies to evaluate the efficacy ef mindfulness-based interventions. This line of research has led to promising data suggesting mindfulness-based interventions are effective for treatment of both psychological and physical symptoms. However, an equally important direction for future research is te investigate questions concerning mechanisms of action underlying mindfulness-based interventions. This theoretical paper proposes a model of mindfulness, in an effort to elucidate potential mechanisms to explain how mindfulness affects positive change. Potential implications and future directions for the empirical study of mechanisms involved in mindfulness are addressed. Keywords: mindfulness; meditation; mechanisms; reperceiving; intention; attention

Background. Large scale surveys in the United States and abroad suggest that 35-60% of adults have used some form of complementary/alternative medicine (CAM). However, no studies to date have focused on predictors and patterns of CAM use among elderly persons. Methods. The population surveyed were Californians enrolled in a Medicare risk product that offers coverage for acupuncture and chiropractic care. Surveys were mailed to 1597 members in 1997 and responses received by 728 (51% response rate). Health risk assessment data were also obtained at baseline and 12-15 months following enrollment in the plan. Multiple logistic regression analyses were carded out to examine predictors of CAM use. Results. Forty-one percent of seniors reported use of CAM. Herbs (24%), chiropractic (20%), massage (15%), and acupuncture (14%) were the most frequently cited therapies. CAM users tended to be younger, more educated, report either arthritis and/or depression/anxiety, not be hypertensive, engage in exercise, practice meditation, and make more frequent physician visits. Use of CAM was not associated with any observed changes in health status. Respondents also expressed considerable interest in receiving third-party coverage for CAM. Although 80% reported that they had received substantial benefit from their use of CAM, the majority (58%) did not discuss the use of these therapies with their medical doctor. Conclusions. Findings suggest that there is significant interest in and use of complementary/alternative medicine among elderly persons. These results suggest the importance of further research into the use and potential efficacy of these therapies within the senior population.

Many patients may use alternative medicine not necessarily because they are dissatisfied with conventional medicine but because alternative medicine is more consistent with their beliefs about health and illness. This was the conclusion of a survey of 1,035 randomly selected Americans. More education and poorer health was related to use of alternative medicine, as were personal problems with back pain, chronic pain and anxiety. Those committed to environmentalism, feminism and spiritual and personal growth were more likely to use alternative medicine. Only 4% relied exclusively on alternative treatments., Context.--Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine. However, the reasons for such use are, at present, poorly understood. Objective.--To investigate possible predictors of alternative health care use. Methods.--Three primary hypotheses were tested. People seek out these alternatives because (1) they are dissatisfied in some way with conventional treatment; (2) they see alternative treatments as offering more personal autonomy and control over health care decisions; and (3) the alternatives are seen as more compatible with the patients' values, worldview, or beliefs regarding the nature and meaning of health and illness. Additional predictor variables explored included demographics and health status. Design.--A written survey examining use of alternative health care, health status, values, and attitudes toward conventional medicine. Multiple logistic regression analyses were used in an effort to identify predictors of alternative health care use. Setting and Participants.--A total of 1035 individuals randomly selected from a panel who had agreed to participate in mail surveys and who live throughout the United States. Main Outcome Measure.--Use of alternative medicine within the previous year. Results.--The response rate was 69%. The following variables emerged as predictors of alternative health care use: more education (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI, 1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9), having had a transformational experience that changed the person's worldview (OR, 1.8; 95% CI, 1.3-2.5); any of the following health problems: anxiety (OR, 3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1.7-3.2); chronic pain (OR, 2.0; 95% CI, 1.1-3.5); urinary tract problems (OR, 2.2; 95% CI, 1.3-3.5); and classification in a cultural group identifiable by their commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies. Conclusion.--Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life. JAMA 1998;279:1518-1553

This article begins by examining psychology's contributions to understanding the positive consequences of control for individual mental and physical health. Person-environment control mismatches and the negative personal, interpersonal, and societal consequences of seeking and having control are then discussed. As corrections to mismatches and negative consequences, three methods of analyses are provided. First, definitional and conceptual precision is offered, including a more careful matching of control-related interventions to multidimensional, individual-specific control profiles. Second, therapeutic assessment and interventions are placed within a biopsychosocial model of control. Finally, philosophy of science and paradigmatic issues underlying control theories are highlighted, particularly as they affect psychology's role in examining values toward which control efforts should be directed. These topics are important for people's personal and collective well-being.