Two studies were conducted to investigate the use of cognitive/attentional distraction (via commercially available video games) to control conditioned nausea in pediatric cancer patients receiving chemotherapy. The first study compared the nausea severity in children who played video games during chemotherapy-related procedures with that of control-group children who did not play video games. The second study used a combined ABAB withdrawal and repeated measures analysis of variance design that incorporated baseline and intervention assessments within a single session. In both studies, video game-playing resulted in significantly less nausea. The introduction and withdrawal of the opportunity to play video games produced significant changes (reduction and exacerbation, respectively) in nausea. Although video games also reduced self-reported anxiety, the effects were weaker than those for nausea. Pulse rate and systolic/diastolic blood pressure were not consistently affected.Hypnosis and related relaxation induction procedures have been shown to relieve the distress associated with painful medical treatment (cf. Turk, Meichenbaum, & Genest, 1983). Although the mechanisms underlying the effectiveness of these techniques are not clearly understood, it has been suggested that cognitive/attentional distraction may be involved (McCaul & Malott, 1984). The hypothesis is that cognitive-behavioral techniques block pain by consuming some degree of the attentional capacity that would otherwise be devoted to pain perception.Our understanding of the use of distraction in behavioral symptom control comes largely from laboratory research in which healthy volunteers were required to engage in repetitive cognitive tasks (e.g., repeating a word list) while immersing an arm in ice water (Farthing, Venturino, & Brown, 1984;Spanos, McNeil, Gwynn, & Stam, 1984). Subjects in these studies generally reported less pain when they were involved in the distracting task.Clinical research on distraction has been more limited. Pickett and Clum (1982) found that cognitive distraction (therapist-guided imagery of pleasant scenes) resulted in reductions in patients' ratings of their worst pain since surgery. In two separate studies, ulig (1979a, 1979b) found that distraction via video game-playing relieved discomfort in adult dental patients during amalgam restoration. A recent individual-analysis case study involving 3 pediatric cancer patients (Kolko & Rickard-This research was funded by a grant to William H. Redd from the American Cancer Society and by gifts from the Society of Memorial Sloan-Kettering Cancer Center and the Rudin Foundation. The authors wish to thank Matthew Seegull for his consultation in designing the video game intervention and the patients for their cooperation.

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The increased awareness of the cancer patient's psychosocial needs in the past few years has led to the development of training programs for health professionals working in oncology. Given the diversity of training goals, professionals involved in the care of patients, institutional resources and local needs, there is a lack of uniform criteria to train specialists in the field of psycho-oncology. This paper describes a model for a one-year cumculum the objective of which is to establish minimal standards of training to become a professional who is subspecialized in adult or child and adolescent psycho-oncology. The cumculum primarily consists of a didactic and a skills development components. Selection of trainees and faculty as well as teaching tools and evaluation of the curriculum are described. The second part of the model cumculum contains specific recommendations that address the particular educational needs of specific oncological disciplines (oncologists, nurses, social workers) and volunteers. In addition, the need for multidisciplinary teams in oncology settings is emphasized. Defining minimum standards for training across institutions and even nations will not only improve patient care but will also contribute to define psycho-oncology as a discipline.

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