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Hypnosis in the treatment of anxiety- and stress-related disorders



Self-hypnosis training represents a rapid, cost-effective, nonaddictive and safe alternative to medication for the treatment of anxiety-related conditions. Here we provide a review of the experimental literature on the use of self-hypnosis in the treatment of anxiety and stress-related disorders, including anxiety associated with cancer, surgery, burns and medical/dental procedures. An overview of research is also provided with regard to self-hypnotic treatment of anxiety-related disorders, such as tension headaches, migraines and irritable bowel syndrome. The tremendous volume of research provides compelling evidence that hypnosis is an efficacious treatment for state anxiety (e.g., prior to tests, surgery and medical procedures) and anxiety-related disorders, such as headaches and irritable bowel syndrome. Although six studies demonstrate changes in trait anxiety, this review recommends that further randomized controlled outcome studies are needed on the hypnotic treatment of generalized anxiety disorder and in documenting changes in trait anxiety. Recommendations are made for selecting clinical referral sources.
Review ISSN 1473-7175
© 2010 Expert Reviews Ltd
Most methods of facilitating hypnosis involve
suggestions for relaxation, but the most fun-
damental component in hypnosis appears to
involve facilitating a state of focused atten-
tion and concentration, although several other
factors are also believed to be involved [1].
Responsiveness to hypnosis has commonly
been experimentally defined by an individual’s
response to a series of suggestions for various
hypnosis phenomena (e.g., analgesia or amne-
sia) of varying difficulty. Responsiveness var-
ies, and a small percentage of individuals are
relatively unresponsive to hypnosis. Hypnotic
responsiveness is a very stable trait [2] , with
test–retest reliability after 25 years being
approximately 0.7, and responsiveness is not
easily modifiable [3]. While clinical experience
has shown that a majority of people are suffi-
ciently responsive to hypnosis to obtain anxiety
relief, a higher level of responsiveness is needed
to experience some hypnotic phenomena, such
as profound analgesia or amnesia. However,
despite variations in hypnotic response, most
patients have sufficient ability to benefit clini-
cally [4] . Nonetheless, most individuals have
been found to be more responsive to sugges-
tion after a hypnotic induction has been per-
formed [5]. Although occasionally hypnosis may
be used for unconscious exploration, in a large
proportion of clinical conditions patients are
taught self-hypnosis, which is commonly made
easier to learn through making individualized
self-hypnosis tapes or CDs for the patient [6].
There are many areas of application for self-
hypnosis training, for example in obstetrics
and gynecology, gastroenterology, dermatol-
ogy, asthma, management of chemotherapy
side effects, smoking and enuresis. Controlled
research, for instance, has established the effi-
cacy of hypnosis in controlling acute and chronic
pain [7,8]. This article will review the existing lit-
erature on the use of hypnosis and self-hypnosis
training in the treatment of anxiety, anxiety-
related disorders, stress management associated
with conditions that evoke state anxiety, such
as test and public speaking anxiety, and various
medical and dental procedures.
Anxiety & stress management
Kirsch performed a meta-ana lysis on 18 studies
in which cognitive–behavioral therapy (CBT)
with a variety of conditions (pain, insomnia,
anxiety, public speaking anxiety, obesity, hyper-
tension, phobia and duodenal ulcer) was com-
pared with the same therapy supplemented or
facilitated by hypnosis [9]. The results across
D Corydon Hammond
University of Utah School of
Medicine, PM &R, 30 No.
1900 East, Salt Lake City,
UT 84132-2119, USA
Tel.: +1 801 581 5741
Fax: +1 801 585 5757
Self-hypnosis training represents a rapid, cost-effective, nonaddictive and safe alternative to
medication for the treatment of anxiety-related conditions. Here we provide a review of the
experimental literature on the use of self-hypnosis in the treatment of anxiety and stress-related
disorders, including anxiety associated with cancer, surgery, burns and medical/dental procedures.
An overview of research is also provided with regard to self-hypnotic treatment of anxiety-related
disorders, such as tension headaches, migraines and irritable bowel syndrome. The tremendous
volume of research provides compelling evidence that hypnosis is an efficacious treatment for
state anxiety (e.g., prior to tests, surgery and medical procedures) and anxiety-related disorders,
such as headaches and irritable bowel syndrome. Although six studies demonstrate changes in
trait anxiety, this review recommends that further randomized controlled outcome studies are
needed on the hypnotic treatment of generalized anxiety disorder and in documenting changes
in trait anxiety. Recommendations are made for selecting clinical referral sources.
Keywor ds: anxiety • hypnosis • procedural anxiety • self-hypnosis • stress management
Hypnosis in the treatment
of anxiety- and
stress-related disorders
Expert Rev. Neurother. 10(2), 263–273 (2010)
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Expert Rev. Neur other. 10 (2), (2010)
Review Hammond
various conditions found that the addition of hypnosis sub-
stantially enhanced the therapy outcome. The average patient
receiving cognitive–behaviorally oriented hypnosis demonstrated
greater improvement than at least 70% of patients who received
nonhypnotic treatment. In the one study of anxiety cited in the
review, there was a high effect size of 1.4 standard deviations,
indicating that the addition of hypnosis significantly enhanced
the efficacy of CBT [10]. In addition, owing to popular concep-
tions of hypnosis, simply labeling an intervention as hypnosis
may increase its efficacy where the only difference between relax-
ation instructions in a nonhypnotic condition and the ‘hypnotic
induction’ is the use of the term ‘hypnosis’ [11] . A recent meta-
ana lysis of hypnosis for distress associated with medical proce-
dures found that when the intervention was labeled as hypnosis
instead of ‘suggestion’, they were significantly (p < 0.002) more
effective [12].
In a randomized controlled study of acute stress disorder in
civilian trauma survivors, CBT was compared with identical treat-
ment preceded by a hypnotic induction [13]. Positive outcomes
were comparable for the two treatments and hypnosis resulted in
a greater reduction in re-experiencing symptoms of post-traumatic
stress disorder at the completion of treatment than CBT alone.
A 3-year follow-up found that both hypnotically facilitated CBT
and CBT were effective [14].
Two other randomized controlled studies have found that
when hypnotic treatment was added to CBT, superior effects
were found. One study found that the hypnotic CBT treatment
produced significantly greater improvements in depressed patients
on the Beck Anxiety Inventory (as well as the Beck Depression
Inventory, and the Beck Hopelessness Scale) than CBT alone [15].
Another study by Schoenberger examined the effects of a multi-
dimensional CBT of anxiety for public speaking compared with
exactly the same treatment in which the relaxation training was
referred to as a hypnotic induction and automatic thoughts were
referred to as self-suggestions (although some explicit hypnotic
suggestions for improvement were also added) [16]. Other than
labeling the procedure as hypnotic and adding hypnotic sug-
gestions for improvement, the two procedures were the same.
Subjects (n = 62) in both conditions improved more than wait-
list control subjects. However, calling the treatment hypnosis
(and adding a few suggestions) appeared to mildly improve the
treatment effectiveness (effect size: 0.4). These studies suggest
that simply identifying a treatment as hypnosis may generate
greater expectancies for change than nonhypnotic treatments if
the individual has favorable attitudes toward hypnosis, and these
enhanced expectations can improve overall treatment outcome.
As will be discussed later in relation to medical procedures, the
findings of the Kirsch meta-ana lysis are also congruent with two
more recent studies involving the use of hypnosis in association
with acupuncture [17,18].
When the behavioral therapy technique of progressive mus-
cle relaxation was compared with self-hypnosis training it was
found that both treatments produced physiological improve-
ments associated with reduced anxiety, increasing skin tempera-
ture and reducing pulse rate [19]. In another study, however, the
authors found that behavioral progressive relaxation may produce
greater hypnoidal effects than hypnosis among individuals with
low hypnotic responsiveness, and the phenomenological effects
were roughly comparable to those produced with hypnosis among
highly hypnotizable individuals [20] .
O’Neill and colleagues compared self-hypnosis training (which
simply consisted of reading through written instructions several
times and then practicing for 15 min) with the behavioral therapy
technique of progressive muscle relaxation in a randomized study
with ‘stressed, anxious, worried’ patients attending a psychology
clinic [21]. At a 1-month follow-up, both groups showed simi-
lar significant improvement on the Beck Anxiety Inventory and
in both state and trait anxiety (State–Trait Anxiety Inventory).
However, cognitive changes and perceptions of treatment efficacy
were greater for self-hypnosis than for relaxation. The subjects
using self-hypnosis reported higher expectations of success than
those using progressive rela xation exercises, demonstrating a
greater belief that they could now do something to manage their
anxiety. Similarly, comparable success of self-hypnosis in com-
parison to ‘relaxation response’-style medication was also reported
by Benson’s group in a randomized study with ‘anxiety neurosis’
patients on 8-week follow-ups [22].
Autogenic training (which is a structured German form of
self-hypnosis) was facilitated in a group by Houghton for stress
management with teachers for achieving reduced pulse rates [23].
Over a 14-week period these self-hypnotic exercises allowed
all of the teachers to reduce their pulse rates with significant
(p < 0.0001) consistency. Their success was found to be unre-
lated to gender or behavioral characteristics, such as Type-A
behaviors, speed, impatience, job involvement or being hard
driving. Two studies demonstrated improved heart rate vari-
ability profiles showing improved autonomic function, reduced
sympathetic activity and enhanced parasympathetic activity
following hypnosis [2 4, 25].
Kanji and coworkers compared eight sessions of autogenic
training with attentional control and no treatment groups in a
randomized study [26]. Significant reductions (p < 0.001) in both
state and trait anxiety resulted from autogenic training compared
with both other groups. Significant reductions were also seen in
systolic (p < 0.01) and diastolic (p < 0.05) blood pressure and
pulse rate (p < 0.002). Autogenic training has also been success-
fully used to reduce anxiety with patients undergoing coronary
angioplasty in a study where 59 patients were randomly assigned
to receive either standard care or autogenic training added to
standard care, during which small groups learned autogenic train-
ing for 60 min [27]. Compared with the standard care control
group, the hypnosis group demonstrated lower (p < 0.001) state
anxiety at 2 and 5 months following this brief group treatment
and lower trait anxiety at 2 months (p < 0.001) and after 5 months
(p < 0.04). Four sessions of hypnotic relaxation was also shown to
reduce anxiety (as well as anger and to produce increases in self-
esteem) when used in a study using a repeated measures design
with patients with traumatic brain injuries, stroke or multiple
sclerosis [28]. Importantly, a significantly reduced trait, as well as
state, anxiety was demonstrated in this study. 265
Hypnosis in the treatment of anxiety- & stress-related disorders
Stress associated with test anxiety & immune function
A number of investigations have examined the effects of hypno-
sis on immune function and have included measures of anxiety
in their studies. Undoubtedly, every reader has experienced test
anxiety and the stress of midterm and final examinations. Sapp
compared hypnosis with a Hawthorne control group and demon-
strated a decrease in test anxiety and improvements in achievement
for the hypnosis group, which were maintained on 6-week follow-
up [29]. Stanton randomly assigned 40 high school students who
were matched on sex and anxiety scores to either a self-hypnosis
training group that met for two 50-min sessions, or to a control
group who had two 50-min sessions in discussing ways to reduce
test anxiety [30]. Students were retested after two sessions and
6 months later. Anxiety scores were significantly reduced only
for the self-hypnosis group at both evaluation times. Schreiber
similarly examined the effects of group self-hypnosis training on
midterm and final examination grades in comparison with two
control conditions [31]. Students trained in self-hypnosis had sig-
nificantly higher scores on final examinations than controls, but
not on midterm exams.
Several sophisticated research studies have examined not only the
influence of self-hypnosis training in reducing stress, but also its
impact on enhancing immune function. Whitehouse and colleagues
evaluated the effects of self-hypnosis in relieving stress and moderat-
ing immune system reactivity to medical school examination stress
in a 19-week prospective study [32]. In total, 21 first-year medical stu-
dents who were identified as moderate-to-high in responsiveness to
hypnosis were trained in self-hypnosis, encouraged to practice regu-
larly and to keep daily records of mood, sleep, physical symptoms
and frequency of practice. A total of 14 control subjects received
no training, but kept daily ratings. Self-report measures and blood
samples were obtained at the time of orientation, late in the semester,
at an examination period, and post-semester. As one would expect,
significant increases in fatigue and stress were discovered during
the examination period paralleled by increases in B lymphocytes
and activated T lymphocytes, phyto hemagglutinin-induced and
pokeweed mitogen-induced blastogenesis and natural killer (NK)
cell cytotoxity. There were no decreases in immune measures. The
self-hypnosis subjects reported significantly less anxiety and distress
than control subjects, but there was no difference between groups in
immune function. However, in students using self-hypnosis it was
found that their relaxation ratings predicted both the number of
NK cells and NK activity. It is believed that stress connected with
academic demands influences immune function, but that immune
suppression is not inevitable. The authors concluded that the use
of self-hypnosis reduces stress without differential immune effects
overall, but individual responses to self-hypnosis do seem to predict
immune effects. Other studies have concluded that self-hypnosis
training for stress reduction before college examinations can have
sizeable influences on cell-mediated immunity, which has impli-
cations for illness prevention and for patients with compromised
immunity [33,34] .
It is well known that anxiety and stress can evoke herpes
outbreaks. A follow-up study examined the effects of self-hyp-
nosis training using dynamic imagery (rather than just passive
relaxation imagery) with chronic and severe herpes simplex virus
genital herpes [35]. Immune measures were performed prior to and
following 6 weeks of self-hypnosis practice. Self-hypnosis reduced
anxiety and depression, and it almost cut in half the recurrence
rate or herpes, benefiting 65% of patients.
Anxiety-related conditions & anxiety associated with
medical or dental procedures
Tension headaches & migraines
Melis et al., in a single-blind study of chronic tension headaches,
compared hypnosis with a wait-list control condition on 4-week
follow-up, nding not only significantly fewer headaches, but
also significantly lower anxiety [36] . Van Dyck et al. investigated
the relative efficacy of autogenic training and of self-hypnosis
training with tension headaches, finding both equally effective in
reducing anxiety and headaches [37]. A review has documented a
large volume of controlled research on self-hypnosis training for
migraine and tension headaches, which was shown to be statis-
tically superior to or equivalent to commonly used medication
treatments [38] . Furthermore, this literature review found that
simply teaching the use of self-hypnotic relaxation and imagery
techniques for daily self-hypnosis practice is as effective as more
complex hypnotic techniques in the relief of headaches.
Obstetrics & gynecology
Obstetrics and gynecology are specialties where hypnosis and self-
hypnosis training have been used extensively, not only for the relief
of pain with childbirth, but also for anxiety and relief of hyper emesis
gravidarum [39]. Mairs, for instance, used four 1-h self-hypnosis
training sessions with pregnant women (28 primigravida women
compared with 27 primigravida women not receiving hypnosis
training, where there were no significant demographic differences
between groups) [40]. Prebirth questionnaires asked for ratings of
anticipated levels of pain and anxiety, and post-birth questionnaires
were completed. Postbirth, those who received self-hypnosis train-
ing reported statistically significant ratings that were lower for both
pain and anxiety than untrained women, and when Caesarean sec-
tion patients were excluded the differences were even more signifi-
cant. Self-hypnosis also helped alleviate even the unexpected and
unprepared anxieties of Caesarean sections.
Irritable bowel syndrome & ulcers
A prominent anxiety-mediated medical condition is irritable bowel
syndrome (IBS). A variety of research studies have demonstrated
that teaching patients self-hypnosis skills proves of considerable
value for patients with IBS [41–45]. These studies by Whorwell’s
group have found long-term follow-up success rates of 95% with
classical, refractory IBS cases (who had previously failed with an
average of six types of treatment), 43% with atypical cases and 60%
with cases exhibiting significant psychopathology. Patients over
50 years of age responded more poorly (25% success), but patients
below 50 years of age with classical IBS had a 100% success rate.
Galovski and Blanchard obtained Whorwell’s cooperation so that
they were able to apply his exact treatment protocol to systematically
replicate his work [46]. Although worried about how hypnosis would
Expert Rev. Neur other. 10 (2), (2010)
Review Hammond
be accepted by a US population, they found that hypnosis was
highly acceptable, with no applicant declining treatment, and “in
fact, patients were seen to be readily amenable to hypnotherapy” [45].
Patients who were taught self-hypnosis (in 12 sessions utilizing an
eye fixation and progressive relaxation hypnotic induction followed
by imagery) improved significantly more than a symptom-monitor-
ing wait-list control group. In total, 82% of self-hypnosis patients
improved (and 27% were symptom free) compared with 0% of con-
trol patients, and when the wait-list patients crossed over to hypnotic
treatment, 67% of them significantly improved. Furthermore, on
2-month follow-up, the effects of treatment were relatively endur-
ing. Significant decreases were also found in not only state, but
also trait anxiety from pre- to post-treatment. The improved physi-
ological symptoms included abdominal pain, constipation, bloating
and flatulence. Although on the Stanford Hypnotic Susceptibility
Scale, Form A, the scores ranged from 2 (very low overall hypnotic
responsiveness) to 12 (high responsiveness), there was not a signifi-
cant relationship between formally measured hypnotizability and
treatment outcome. The authors concluded that the results “bode
well for this form of therapy in general. Many of the subjects in
the current study reported many positive side effects to this form
of therapy. Hypnotherapy thus appears to be beneficial over and above
the effect seen on the gastrointestinal symptoms.(emphasis added) [45].
They conclude that the high outcomes and lack of drop-outs make
self-hypnosis training a viable treatment option.
An audit was taken of the first 250 IBS patients treated on a unit
in England specifically established to provide 12 sessions of self-
hypnosis training over a 3-month period [47]. Marked improve-
ment was seen in all of the symptom measures, quality of life,
anxiety and depression (all probabilities p < 0.001), in keeping
with previous studies. This study clearly demonstrated that self-
hypnosis training is an extremely effective treatment for IBS and
should prove more cost effective as new, more expensive drugs
come on the market.
The mechanism of improvement in the self-hypnotic treat-
ment of IBS had not been ascertained in previous studies.
Therefore, two studies evaluated possible physiological and
psycho logical mechanisms [48]. Patients with severe IBS received
seven biweekly self-hypnosis training sessions and used self-
hypnosis audiotapes at home. Rectal pain thresholds and
smooth-muscle tone were measured with a barostat before and
after treatment in 18 patients in the first study, and treatment
changes in heart rate, blood pressure, skin conductance, finger
temperature and forehead electromyographic (EMG) activity
were assessed in 24 patients in the second study. Somatization,
anxiety and depression were also measured. All central IBS
symptoms improved substantially from treatment in both stud-
ies. Rectal pain thresholds, autonomic functioning (except for
electro dermal response) and rectal smooth-muscle tone were
unaffected by the hypnotic treatment, but somatization and
psychological distress showed large decreases. It was con-
cluded that the practice of self-hypnosis improves IBS symp-
toms through reductions in anxiety, psychological distress and
somatization, since improvements were unrelated to changes in
the physiological parameters measured.
Controlling anxiety associated with medical procedures
Two recent studies examined the use of hypnosis in association
with acupuncture. An intervention involving 20 min of hypnosis
while acupuncture needles were in place was evaluated for the
treatment of chronic pain in children [17]. After six sessions, pain
was not only improved as rated by both parents and children,
but anticipatory anxiety also declined significantly. A somewhat
similar study compared the effects of acupuncture after receiv-
ing an hypnotic induction versus pure acupuncture treatment of
angina pectoris (AP) [18]. A total of 40 patients with AP received
hypnosis with acupuncture, and 31 received pure acupuncture
therapy for 4 weeks (six sessions per week) in a Tibet hospital.
When hypnosis was involved, the result was superior to pure acu-
puncture treatment in reducing both anxiety and depression in
the treatment of AP.
As early as 1982, Zeltzer and LeBaron found that anxiety was
significantly reduced by hypnosis, but not by distraction, in a ran-
domized study of children undergoing bone marrow aspiration
or lumbar puncture [49]. The use of self-hypnosis for relaxation to
reduce the need for intravenous sedation during radiological pro-
cedures was evaluated by Lang’s group [50]. A total of 14 patients
were randomly assigned to a control group, while 16 were randomly
assigned to the experimental group. In total, 30 out of 33 patients
invited to participate were willing to do so, suggesting a great public
openness to this alternative medicine, nonpharmacologic interven-
tion. All patients had the capacity to administer patient-controlled
analgesia. Self-hypnosis training included teaching the patients to
use relaxation and imagery of a pleasant place for hypnotic induc-
tion and deepening. If something unpleasant was experienced,
patients were taught to allow an image to form representing the
feeling, and then to transform the image to neutralize the emotion.
When a possibly painful experience was anticipated (e.g., contrast
medium injection) patients were told to imagine a competing feel-
ing (e.g., numbness, coolness). Often only 5–10 min were spent
with a patient during sterile preparation and administration of
local anesthesia, followed by a few minutes at a later time to deepen
self-hypnotic relaxation, prepare the patient for potentially pain-
ful stimuli or to obtain reports (e.g., pain or anxiety scores). In
comparison to controls, the self-hypnosis patients required less
drugs (0.28 vs 2.01 drug units; p < 0.01) and experienced less pain
(median rating 2 vs 5 on a 0–10 scale; p < 0.01). Control patients
exhibited oxygen desaturation and/or required interventions for
hemodynamic instability significantly more often. Anxiety ratings
were approximately half those of control patients. As noted in other
studies already reviewed, benefits were unrelated to hypnotiz ability,
indicating that a high level of hypnotic talent is not necessary for
this level of intervention focused on relaxation.
In order to determine how patients’ underlying anxiety affects
their experience of distress, use of resources and responsiveness
toward nonpharmacologic analgesia adjunct therapies during inva-
sive procedures, Schupp et al. worked with 236 patients undergo-
ing vascular and renal interventions [51]. Patients were randomly
assigned to receive structured empathic attention or self-hypnotic
relaxation during standard care treatment, and were divided into
two groups: those with low state anxiety scores on the State–Trait 267
Hypnosis in the treatment of anxiety- & stress-related disorders
Anxiety Inventory and those with high state anxiety scores. All
patients had access to patient-controlled analgesia with fentanyl
and midazolam. Every 15 min during the procedure, patients
were asked to rate their anxiety and pain on a scale of 0–10 (0:
no pain/anxiety at all; 10: worst possible pain/anxiety). Effects
were assessed by ana lysis of variance and repeated-measures ana-
lysis, and it was found that patients with high state anxiety lev-
els required significantly greater procedure time and medication.
Empathic attention, as well as self-hypnosis, reduced procedure
time and medication use for all patients. These nonpharmacologic
treatments also provided significantly better pain control than
standard care for patients who had low anxiety levels. Anxiety was
found to decrease over the time of the procedure and patients with
high state anxiety levels experienced the most significant decreases
in anxiety with both interventions, whereas patients with low state
anxiety levels coped relatively well under all conditions. Thus,
patients’ state anxiety level was a predictor of trends in procedural
pain and anxiety, need for medication, and procedure duration, but
both low and high state anxiety groups profited from self-hypnosis,
although those with high state anxiety levels benefitted the most.
A randomized controlled comparison evaluated hypnosis versus
CBT or standard care in 30 pediatric cancer patients undergo-
ing bone aspirations [52]. Hypnosis and CBT were equally effec-
tive in reducing pain in comparison with standard care. However,
hypnosis was significantly more effective than CBT in reducing
anxiety (p < 0.0002) and observed distress (p = 0.0025). The same
authors subsequently found training in self-hypnosis was effective in
reducing anxiety and pain associated with pediatric cancer patients
under going regular lumbar punctures in comparison to attentional
controls or standard medical care groups [53]. A further randomized,
blinded study with the same population evaluated the efficacy of an
analgesic cream, versus hypnosis and analgesic cream, versus analge-
sic cream and attention [54]. The addition of hypnosis significantly
reduced both anticipatory anxiety and procedural anxiety (as well as
pain) in comparison with the cream alone (p < 0.001) and attentional
controls (p < 0.001). Furthermore, benefits from self-hypnosis train-
ing were maintained at 6-month follow-up. A parallel blinded study
by this group found that the addition of brief, 15-min self-hypnosis
training to the use of a local anesthetic was significantly superior to
local anesthetics alone or local anesthetic with attentional control,
in reducing anticipatory anxiety and procedure-related anxiety (and
pain) with pediatric cancer patients undergoing venopuncture for
blood sampling [55]. Results were maintained during two follow-up
venopunctures. As an added bonus, the parents of the children who
had been briefly trained in self-hypnosis also experienced less anxiety
during their childrens’ procedures.
A meta-ana lysis of 26 randomized controlled trials (with
2342 patients) of hypnosis associated with medical procedures
found that 82% of patients receiving hypnosis experienced lower
levels of emotional distress [56] . The effect size for hypnosis was
0.88 and it was found that children (who as a group have higher
hypnotic responsiveness [57]) benefited more, but adults still had
a medium effect size. Hypnosis was found to be most effective
when at least part of the hypnotic procedure was performed in
person (versus audio recording) and when at least part of the
hypnosis occurred prior to the beginning of the medical proce-
dure. Hypnosis appeared equally effective when compared with
standard care or an attentional control group, demonstrating that
benefits from hypnosis are not simply due to receiving attention.
A randomized study of the impact of a combination of hypno-
sis and CBT versus standard care in breast cancer radiotherapy
patients found significantly lower levels (p = 0.0007) of negative
affect and significant levels (p = 0.0035) of positive affect in the
hypnosis and CBT group [58]. Trait anxiety significantly decreased
following the treatment, which consisted of brief hypnosis and pro-
vision of a hypnosis CD to listen to at home, as well as 30 min of
CBT instruction and provision of a CBT workbook for home study.
Another study compared hypnosis with distraction in severely
ill children undergoing painful medical procedures [59]. A sample
of high and low hypnotizable children (n = 27) of diverse eth-
nic backgrounds and suffering from blood or cancer disorders
were trained, along with their parents, to use both self-hypnosis
and distraction for pain and anxiety reduction. Pain and anxiety
measures were obtained from parents and children, and inde-
pendent raters estimated the distress from videotapes. Data were
then collected during painful medical procedures for baseline,
self-hypnosis and distraction conditions. Children who were
hypnotizable demonstrated significantly lower pain, anxiety and
distress scores when hypnotized compared with low hypnotizable
children. Distraction produced significant positive effects only
for observer ratings of distress in the low hypnotizable condition.
One randomized prospective study with out-patient EMG
procedures compared a 20-min hypnosis audio program with a
20-min education about the EMG audio program. Lower anxi-
ety was reported in the hypnosis condition, but it did not reach
statistical significance [60].
A total of 20 min of hypnosis prior to the start of a first-trimes-
ter abortion was found, in a randomized study, to significantly
reduce anxiety (p < 0.0001) at the time of suction evacuation and
to reduce needs for subsequent intravenous sedation [61].
Hypnosis for surgical anxiety
Anxiety is a problem for patients anticipating surgery, with more
than half of them fearing anesthesia or not waking up after sur-
gery [62]. A randomized controlled study with children found that
preoperative hypnotic guided imagery resulted in significantly
less pain and state anxiety, and shorter hospital stays [63]. In a
randomized, placebo controlled study on the effects of ‘relaxation
and guided imagery’ on knee strength, reinjury anxiety and pain
in anterior cruciate ligament knee surgery patients it was shown
that the hypnotic imagery/relaxation patients had significantly
greater knee strength and significantly less reinjury anxiety and
pain at 24 weeks post-surgery than either attentional placebo or
control group participants [64] .
Hypnosis was evaluated as an adjunct to conscious sedation for
plastic surgery by Faymonville et al. [65]. In a study of 337 patients
undergoing minor and major plastic surgery under local anesthesia
and conscious intravenous sedation, they divided patients into
three groups: intravenous sedation (n = 137) using only midazolam
and alfentanil; hypnosis (n = 172), during which relaxation age
Expert Rev. Neur other. 10 (2), (2010)
Review Hammond
regression was used; and relaxation (n = 28), consisting of patients
where a rapid hypnotic induction was performed, but without
much depth. In all three groups, midazolam and alfentanil were
titrated to achieve patient immobility, in response to patient com-
plaints and to maintain hemodynamic stability. Intraoperative
anxiety in the hypnosis group and in the brief hypnotic relaxation
group were significantly (p < 0.001) less than in the intravenous
sedation group. Pain scores during surgery were also significantly
greater in the intravenous sedation group than in the hypnosis
group (p < 0.001) and the rapid self-hypnotic relaxation group
(p < 0.01). In addition, midazolam requirements were signifi-
cantly less in the hypnosis group (p < 0.001) and in the relaxation
group (p < 0.01) compared with the sedation group. Alfentanil
requirements were significantly decreased in the hypnosis group
and postoperative nausea and vomiting were reported by 1.2% of
the patients in the hypnosis group, 12.8% in the relaxation group
and in 26.7% in the intravenous sedation group. Greater patient
satisfaction with the anesthetic procedure and greater surgical
comfort were also found in the hypnosis group. Thus, even a very
brief hypnotic induction was found to be helpful, but a deeper level
of hypnosis was even more beneficial.
In a later randomized controlled study with 60 plastic surgery
patients, this same group found that hypnosis was associated with
less peri- and post-operative anxiety and pain, even though there
was a significant reduction in intraoperative needs for midazolam
and alfentanil in the hypnosis group [66] . The patients in the
hypnosis group also felt a greater sense of intraoperative control
than the control group, and experienced significantly less nau-
sea and vomiting than the other patients. Hypnotized patients
demonstrated fewer signs of discomfort and pain.
In yet another study, 130 patients undergoing elective colorectal
surgical procedures were randomly assigned to routine procedure
or guided imagery tape groups [67]. The latter patients listened to
hypnotic type imagery tapes for 3 days before surgery, during the
induction of anesthesia, intraoperatively, in the recovery room and
for 6 days following surgery. Anxiety levels, pain perceptions and
narcotic medication were assessed. Patients in the experimental
group experienced considerably less pre- and post-operative anxi-
ety and pain, and required almost 50% less narcotic medications
than the control group.
Schnur et al. randomly compared excisional biopsy patients
(n = 90) receiving a 15-min presurgical hypnosis session versus
a 15-min presurgical attentional control session (empathic lis-
tening) [68] . The hypnosis group had significantly (p < 0.0001)
less anxiety, depressed mood (p < 0.02) and emotional upset
(p < 0.001) and greater relaxation (p < 0.001) than controls at
post-intervention and presurgical evaluations. Similarly, a ran-
domized comparison of hypnosis (n = 26) and attentive listen-
ing and support without hypnotic suggestions (n = 26) versus
standard care found significantly less (p = 0.0008) preoperative
anxiety with hypnosis compared with the other groups in ambu-
latory surgery patients [69]. On entering the operating room, the
hypnosis group patients had a 56% decrease in anxiety, while
the attentional control group experienced a 10% increase and
the standard care group a 47% increase in anxiety (p = 0.001).
Lang’s group conducted a prospective randomized controlled
study of simple self-hypnotic relaxation, standard care or struc-
tured empathic attention in 236 women undergoing large core-
needle breast biopsy [70]. The women receiving only standard care
experienced a significant increase in anxiety (p > 0.001), while
anxiety did not change in the empathy group, and decreased sig-
nificantly in the self-hypnosis group (p < 0.001). Pain increased
significantly (p < 0.001) in all three groups, although less steeply
with hypnosis and empathy than standard care. It was concluded
that self-hypnosis more powerfully relieved anxiety without
undue cost. Another randomized study by the same group of
201 patients receiving pericutaneous tumor surgeries found that
patients receiving hypnosis experience significantly less state anxi-
ety (pain and medication) than those receiving standard care or
empathic communication [71].
In a randomized study of coronary artery bypass patients, de
Klerk et al. found that 2 h of preoperative hypnotic ‘ego-strength-
ening’ (n = 50) significantly reduced anxiety (and depression)
compared with a standard-care control group (n = 25), and
changes were maintained on 6-week follow-up [72]. Hypnosis has
also been found to significantly (p < 0.01) reduce cardiac sym-
pathetic activity and myocardial ischemia during pericutaneous
transluminal angioplasty [73].
One placebo-controlled study compared midazolam and hyp-
nosis for reducing preoperative anxiety in children and found that
hypnosis was just as effective as midazolam in its effects preop-
eratively (but, of course, without the risks associated with medi-
cation), and hypnosis was more effective (p < 0.05) in reducing
anxiety during the induction of chemical anesthesia [74].
All of these results can still be reasonably summarized by the
findings of a 2002 meta-ana lysis of 20 studies (1624 patients) that
found that an average of 89% of surgical patients benefited from
the inclusion of hypnosis relative to patients in control conditions,
with a high effect size (1.07) for the reduction of negative affect
(anxiety and depression) [56].
Dental anxiety & oral surgery
Dental anxiety is relatively common, but has been shown to be
significantly improved with self-hypnosis training [75]. Hypnosis
has also been used effectively in oral surgery. Dyas found that
hypnosis prior to sedation (midazolam and fentanyl) resulted
in a significantly (p < 0.001) lower heart rate, and much less
(p < 0.001) intravenous sedation than was required compared
with a standard sedation procedure [76]. Outcomes in control
patients were not as positive and they required more intravenous
medication, and one patient required conversion to a full general
anesthetic. Enqvist and Fischer compared a control group with
patients who used a presurgical self-hypnosis tape prior to surgical
removal of molars [77]. Hypnosis patients experienced significantly
less anxiety and required significantly less analgesic medication.
In another study, listening to an 18-min self-hypnosis tape prior
to maxillofacial surgery was found to result in significantly less
postsurgical edema (p < 0.000), pyrexia (p < 0.006) and use
of anxiolytics (p < 0.003) postoperatively in comparison with
matched controls [78]. 269
Hypnosis in the treatment of anxiety- & stress-related disorders
Eitner examined anxious and nonanxious patients during
oral/maxillofacial (dental implant) surgery, finding that hypno-
sis significantly reduced anxiety and physiologically monitored
parameters on the day of surgery [79]. Findings were even more
significant in highly anxious patients.
Patients who have a history of drug dependence often experience
considerable anxiety regarding surgical sedation. Lu and cowork-
ers found hypnotic augmentation of standard sedation to be very
beneficial in 18 such patients where previous attempts at oral sur-
gery had proven unsuccessful because of their fears [80]. Hypnotic
induction preceded use of intravenous sedation (midazolam or
diazepam plus methohexital), but followed intra muscular sedation
(meperidine plus promethazine). Treatment outcomes were good
or excellent in 11 out of 18 of these refractory patients. When the
treatment outcome was poor or fair it was found that five out of
seven patients had the possibility of tolerance or crosstolerance
between their drug of abuse and the sedative agent, while this
possibility was only found in one out of 11 patients having good or
excellent outcomes. It was concluded that hypnosis can be used to
augment sedation in drug-dependent patients, but it is important
to use sedatives where tolerance is unlikely.
Burn patients
Burn patients not only experience pain, but also a great deal of
anxiety, especially in anticipation of dressing changes. A prospective
randomized study compared hypnosis against another stress-reduc-
ing strategy (SRS) for controlling peri-dressing-change pain and
anxiety in severely burned patients [81]. A total of 30 patients with a
total burned surface area of 10–25%, requiring a hospital stay of at
least 14 days, were randomly selected to receive either self-hypnosis
training or SRSs adjunctively to routine intramuscular pre-dressing-
change analgesia and anxiolytic drugs. Visual analogue scale (VAS)
scores for anxiety, pain, pain control and patient satisfaction were
recorded at 2-day intervals throughout the 14-day study period,
before, during and after dressing changes. The psychological inter-
ventions were provided on days 8 and 10 after hospital admission.
The comparison of the two treatment groups indicated that VAS
anxiety scores significantly decreased before and during dressing
changes when the hypnotic technique was used instead of SRS. No
differences were observed for pain, pain control and satisfaction,
although VAS scores were always better in the hypnosis group.
Anxiety in cancer patients
When someone receives a diagnosis of cancer, anxiety naturally
increases. Laidlaw and Willett studied the outcome from using self-
hypnosis tapes in 27 cancer patients versus breathing techniques
in a randomized study [82]. Outcome measures included incidence
of acute anxiety episodes and ratings of both positive and negative
emotions, which were collected prior to and post-intervention.
Patients showed significant improvement in both incidence of acute
anxiety attacks and in experiencing more positive and less negative
mood states.
Another study explored the use of autogenic training to increase
coping ability in patients diagnosed with cancer [83]. It was believed
that reduction in arousal and anxiety could help cancer patients to
perceive their environment as less hostile and threatening, improve
coping ability, relieve symptoms and increase the overall sense of
wellbeing. Each of the 18 subjects completed a Hospital Anxiety
and Depression Scale and the Profile of Mood States questionnaire
before and after a 10-week training course. Patients experienced
a statistically significant reduction in anxiety and an increase in
fighting spirit compared with before training, with an improved
sense of coping and improved sleep being other apparent benefits.
One study randomly assigned 50 advanced cancer patients to
receive either standard palliative medical care with supportive
cognitive existential counseling or to receiving four group self-
hypnosis training sessions along with standard medical care [84] .
The self-hypnosis group was found to result in significantly better
overall quality of life measures (p < 0.01), less psychological dis-
tress (p < 0.01), less physical distress (p < 0.01) and lower levels of
anxiety (p < 0.01) and depression (p < 0.01) compared with stand-
ard care. Thus, even in terminally ill cancer patients, self-hypnosis
training appears effective in reducing anxiety and distress.
This review has demonstrated that the inclusion of hypnosis with
other treatment modalities (e.g., CBT or acupuncture) commonly
improves the outcomes obtained by the other therapeutic modali-
ties alone. It has been further shown that self-hypnosis training and
practice results in improvements in physiological measures (e.g.,
heart rate) and has the potential to enhance immune function as it
reduces stress. Hypnosis has also been shown to have comparable
effects in comparison with well-established treatments, such as
progressive relaxation.
Considerable evidence exists that training in self-hypnosis not
only reduces generalized stress, but is also effective in reducing anx-
iety associated with public speaking, test taking and coping after
being diagnosed with cancer, as well as in reducing anxiety expe-
rienced by burn patients and those going through childbirth. The
evidence is especially compelling regarding the ability of hypnosis
to significantly reduce anxiety associated with a variety of surgical,
medical and dental procedures (e.g., incisional biopsy, venepunc-
ture, having radiological and imaging procedures, dentistry or oral
surgery). Self-hypnosis training has been documented to produce
improvements in stress related medical conditions, such as ten-
sion headaches, migraines and IBS, and in reducing the frequency
of anxiety-provoked herpes outbreaks. Results also demonstrate
that the process of learning self-hypnosis commonly increases self-
esteem and perceptions of self-efficacy from having developed a self-
mastery skill. However, despite the fact that this review has identi-
fied extensive evidence from randomized controlled studies for the
value of hypnosis in reducing state anxiety associated with a large
variety of stressful conditions, and that significant improvements
occur in anxiety-related disorders after self-hypnosis training, only
six studies of self-hypnosis or autogenic training have adequately
documented outcomes of reduced trait anxiety [20,23–25,41,56]. It was
surprising not to have uncovered more studies focused on general-
ized anxiety disorder. Thus, while the available scientific evidence is
very supportive of the value of hypnosis and self-hypnosis training
with problems of anxiety associated with many things, this review
Expert Rev. Neur other. 10 (2), (2010)
Review Hammond
has also documented that a need exists for further controlled stud-
ies focused on generalized anxiety disorder and that also include
measures of trait anxiety. When the State–Trait Anxiety Inventory
is used in research it is recommended that outcomes on both the
state and trait measures be reported, rather than overall State–Trait
Anxiety Inventory improvements.
Chambless et al. established the following criteria to obtain
the status of a well-established treatment in clinical psychol-
ogy [85]. First, there must be at least two experiments that show
efficacy through demonstrating that it is superior statistically to
another treatment or to a pill or psychological placebo, or that it
is “equivalent to an already established treatment in experiments
with adequate sample sizes.” Alternatively, a treatment may be
considered to be well established through “a large series of single
case design experiments (n > 9) demonstrating efficacy” that must
have used good experimental designs and compared the treat-
ment to another intervention. Furthermore, a well-established
treatment must have been conducted with a treatment manual,
must clearly specify the characteristics of the client samples and
the positive outcomes must have been demonstrated by at least
two different investigators or research teams.
According to these standards for judging efficacy of psycho-
logical treatments, hypnosis with anxiety that is associated with
medical procedures and of hypnosis utilized presurgically has
been demonstrated to be statistically superior or equivalent in
comparison to commonly used medication treatments and CBT,
and in comparison to attentional control conditions that could
be considered as an equivalent of a placebo-control condition.
Thus, it can be said that hypnosis meets the criteria for being a
well-established treatment that is both efficacious and specific.
Six studies of hypnosis in association with trait anxiety, which we
might judge to be fairly synonymous with a diagnosis of generalized
anxiety disorder, have also demonstrated its effectiveness.
Expert commentary
Perspective is provided by comparing self-hypnosis training with
other treatment options. CBT has proven effective in reducing
anxiety, but may often require a larger number of sessions to
accomplish the objective. Medication treatment is widely used,
but clearly has limitations. A review of the research on 13 anxi-
ety medications found that psychopharmacologic treatment was
superior to a placebo less than half of the time (48%) [86] , while,
as noted previously, hypnosis has been documented as superior
to placebo and at least equivalent to medication in numerous
studies of procedural or surgical anxiety. Similarly, an independ-
ent ana lysis of drug company research obtained from the US
FDA through the Freedom of Information Act found that anti-
depressants on average only have an 18% effect over and above
placebo effects [87], while another review found an average drug
versus placebo difference of only 16.8% in randomized controlled
trials [88]. Such findings have been referred to as the ‘dirty little
secret’ in the pharmaceutical literature and with the FDA [89].
In comparison to medication treatment, self-hypnosis train-
ing offers patients a method for rapidly self-administering what
we may think of as a naturalistic tranquilizer. Advantages of
self-hypnotic treatment of anxiety include freedom from adverse
side effects and drug interactions, lack of addictive risks and
problems with drug withdrawal, and the fact that it increases the
patient’s sense of mastery and self-efficacy, knowing that he or she
possesses a self-management skill. Once learned, this skill may be
used to cope with general stress, anxiety associated with specific
situations (e.g., public speaking, fear of flying, medical and dental
procedures) and to assist in managing insomnia, irritable bowel
symptoms and headaches or migraines. Hypnosis has proven
cost effective in healthcare, commonly requiring only three to
five office visits or less for self-hypnosis training for generalized
anxiety, and as little as 10–20 min in association with medical/
dental procedures [90–92]. However, clinicians do not have to think
in either/or terms. The choice does not have to be to either use
self-hypnosis training or other treatments, such as medication,
biofeedback or CBT. Particularly in patients with more severe
problems, self-hypnosis training may be very easily combined
with other forms of treatment.
Caution must be exercised, however, in identifying competent
referral sources for hypnosis services because of the large number
of unlicensed lay hypnotists. Therefore, it is recommended that
referral only be made to licensed healthcare professionals who
are also trained in hypnosis. Such individuals may be identified
through contacting the American Society of Clinical Hypnosis [101]
or the Society for Clinical and Experimental Hypnosis [102], both
of which also provide hypnosis training to licensed professionals.
Five-year view
Although hypnosis has been a treatment modality for more than
200 years it has been underutilized owing to misconceptions
among professionals about the nature of hypnosis. However, inter-
est in and openness to alternative and complementary medicine
techniques has rapidly increased at the same time that the public
has become increasingly dissatisfied with and wary of reliance
on only medication treatment. Studies cited have shown that the
vast majority of the public have an openness to the use of hypno-
sis as part of treatment. These factors combined with increasing
healthcare costs and unfavorable economic conditions create a
climate in which a rapid and cost-effective treatment modality,
such as self-hypnosis training, will become increasingly appealing.
Economic factors reinforce the importance of the principle of par-
simony in guiding treatment selection – utilizing the least complex
and most rapid methods of treatment first, and only turning to
invasive or more time-consuming treatments in the more chronic
or complex cases where less complicated methods have not proven
sufficient. When offered by licensed healthcare professionals as a
psychotherapy procedure, services are also usually reimbursable.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any
organization or entity with a financial interest in or financial conflict with
the subject matter or materials discussed in the manuscript. This includes
employment, consultancies, honoraria, stock ownership or options, expert
testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript. 271
Hypnosis in the treatment of anxiety- & stress-related disorders
Key issues
• Hypnosis has been shown to be effective in reducing state anxiety associated with cancer, surgery, burns and a variety of
medical/dental procedures.
• Self-hypnosis training has also been demonstrated to effectively treat anxiety-related disorders, such as tension headaches, migraines
and irritable bowel syndrome.
• Six studies have demonstrated changes in trait anxiety from self-hypnosis training, but further randomized controlled outcome studies
would be desirable on the hypnotic treatment of generalized anxiety disorder and in further documenting changes in trait anxiety.
• Self-hypnosis training has been demonstrated to be a rapid, cost-effective, nonaddictive, side-effect free and safe alternative to
medication for the treatment of anxiety-related conditions, and the public has been shown to be open to hypnosis treatment.
• Economic factors reinforce the importance of the principle of parsimony in guiding treatment selection – utilizing the least complex and
most rapid methods of treatment first and only turning to invasive or more time-consuming treatments in the more chronic or complex
cases where less complicated methods have not proven sufficient.
• In patients with more severe problems, self-hypnosis training may very easily be combined with other forms of treatment.
• Caution must be exercised in identifying competent referral sources for hypnosis services because of the large number of unlicensed
lay hypnotists.
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73 Baglini R, Sesana M, Capuano C,
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74 Calipel S, Lucas-Polomeni M-M, Wodey E,
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75 Moore R, Brodsgaard I, Abrahamsen R.
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76 Dyas R. Augmenting intravenous sedation
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78 Enqvist B, von Konow L, Bystedt H.
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80 Lu DP, Lu GP, Hersh EV. Augmenting
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91 Lang EV, Rosen MP. Cost analysis of
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101 The American Society of Clinical Hypnosis
102 The Societ y for Clinical and Experimental
Hypnosis (SCEH)
D Corydon Hammond, PhD, ABPH
University of Uta h School of Medicine,
PM&R, 30 No. 1900 East, Salt Lake City,
UT 84132-2119, USA
Tel.: +1 801 581 5741
Fax: +1 801 585 5757

Supplementary resource (1)

... Hypnosis merupakan salah satu terapi non farmakologis belakangan sering di gunakan untuk mengatasi kecemasan pada ibu hamil. Hipnosis merupakan alternatif pengobatan yang cepat dan aman untuk pengobatan kondisi terkait kecemasan (Hammond, 2010). ...
... Hasil metaanalisis Kisch et al, terhadap 18 studi yang menerapkan terapi hypnosis pada berbagai kasus menunjukkan peningkatan hasil terapi 70% lebih besar dibandingkan dengan pasien yang tidak menerima terapi hypnosis (Hammond, 2010). Studi RCT pada 30 ibu hamil menjelang hari persalinan, sebagian dialokasikan kedalam kelompok hypnobirthing dan Sebagian dialokasikan ke kelompok non-hypnobirthing. ...
... Pengalaman klinis menggunakan terapi hipnosis menunjukkan bahwa mayoritas orang cukup responsif untuk menghilangkan kecemasan. Meskipun terdapat variasi respon, sebagian besar klien memiliki kemampuan yang cukup untuk memperoleh manfaat secara klinis (Hammond, 2010). ...
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Background: In general, third-trimester pregnant women experience increased anxiety. Anxiety in pregnant women can have an impact the labor process to be more difficult. Various non-pharmacological therapies can overcome anxiety in pregnant women, including hypnosis therapy. Hypnosis therapy with various methods is given to pregnant women to reduce anxiety. Hypnosis is the art of communication by lowering brain waves to explore the subconscious.Objectives: The study aims to determine the effectiveness of hypnosis in reducing anxiety in pregnant women.Methods: This literature review study uses the original research article search method from the 2015-2022 timeframe using the Google Scholar, Pubmed, and Proquest databases. Twenty-eight articles were obtained and then identified and screened so that ten articles were obtained that met the inclusion criteria.Results: The average results of the articles reviewed showed a difference in anxiety levels compared between before and after hypnosis in pregnant women.Conclusion: Hypnosis is effectively used in pregnant women to reduce anxiety levels.
... Hypnosis is interesting as it has already shown its efficiency on both physical and psychological symptoms in several clinical domains (e.g., [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]). Moreover, it works on dysfunctional thoughts or negative beliefs with more unconscious material, which does not mobilize language capacities and in which implicit learning is allowed, even in the event of memory deficits [59]. ...
... However, positive expectations, professional endorsement, and the feasibility of using hypnosis for medical purposes are three factors that perhaps counterbalance the negative representations of hypnosis. In recent years, studies showing the use and effectiveness of clinical hypnosis in different fields of health have given a more reassuring image of the practice [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. Most of the couples in our study were reassured and took the study seriously, as it was proposed by a professional they trusted. ...
Background: Dementia has a negative impact on the quality of life of the person with dementia and their spouse caregivers, as well as on the couple's relationship, which can lead to high levels of distress for both partners. Hypnosis has been shown to be effective in managing distress and increasing the quality of the relationship. Objective: The aim was to develop a standardized hypnosis intervention for couples confronted with Alzheimer's disease and evaluate its feasibility, acceptability, and helpfulness in managing the distress of both partners and increasing the quality of the relationship. Methods: In a single-arm study, sixteen couples received the 8-week intervention. Qualitative and quantitative assessments were conducted pre- and post-intervention as well as three months after. Results: 88.9% of couples (n = 16) of the final sample (n = 18) completed the intervention. Despite the negative representations of hypnosis, several factors led couples to accept to participate in this study: positive expectations, professional endorsement, medical application, non-drug approach, home-based, free, flexible, and couple-based intervention. The results showed a significant decrease in distress for both partners. These effects were maintained three months after the intervention. Couples felt more relaxed, had fewer negative emotions, accepted difficulties more easily, were more patient, and reported better communication and more affection in the relationship. Conclusion: Overall, this pilot study shows the feasibility and acceptability of hypnosis with couples confronted with Alzheimer's disease. Although measures of the preliminary pre- and post-intervention effects are encouraging, confirmatory testing with a randomized controlled trial is needed.
... Hypnotherapy is a therapy that uses hypnosis. Hypnotic interventions are carried out to suppress stimuli that trigger nausea and vomiting and provide relaxation to eliminate nausea and vomiting without side effects [35]. ...
... In obstetrics, medication and analgesics are also reduced by applying hypnosis (Brown & Hammond, 2007), and for patients with chronic pain, hypnosis has positive effects on their anxiety, sleep, and quality of life, in addition to reducing their pain (Jensen et al., 2006). Although few studies have been carried out with adequate methodological rigor (McCann & Landes, 2010), the results for the reduction of depression and anxiety are improved when hypnosis is applied as an adjuvant to a cognitive-behavioral treatment, and it also enhances the development of coping and problem-solving strategies (Alladin & Alibhai, 2007;Hammond, 2010;Yapko, 2013). ...
Previous research has shown promising results in using hypnosis to treat various symptoms and side effects of medical treatments. The objective was to identify studies that use hypnosis as an adjuvant to evidence-based treatments to evaluate its benefits in patients with cancer. The search identified 873 articles published between 2000 and February 2021, of which 22 were selected using the principles of the PRISMA. Apart from 1 study, all studies showed that interventions improved the measured variables compared to a control group. Most studies showed that hypnosis has positive effects on reducing anxi-ety, pain, nausea, fatigue, drug use, and length of hospital stays. Hypnosis also improves depressive symptoms, insomnia, hot flashes, well-being, and quality of life, and helps increase adherence to treatment. When used by qualified professionals as an adjuvant to well-established treatments, hypnosis improves symptoms caused by oncological interventions and the disease itself. In addition, hypnosis has no side effects.
... Controlled outcome studies are needed on the hypnotic treatment of generalized anxiety -stress disorder and in documenting changes in trait anxiety. Recommendations are made for selecting clinical referral sources [10]. ...
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Stress is the priceless poison for human life in the universe. It can disturb any one's physical, mental, emotional and behavioral balance. Stress can damage different parts of human body from tissues, muscles to organs and blood vessels. It can speed up pulse rate and respiration. It can raise blood pressure and body temperature. It can also interfere with the body metabolism, digestion, appetite, sleep, sexuality and even fertility. The study conducted on a sample of 120 (Hypnosis=60 and Meditation=60) Railway employees of Mysore Division of South Western Railway. In order to realize the objective of the study, two hypotheses were formulated. (1). There would be significant impact of Hypnosis on Stress among Railway employees with regard Pre-test and Post-test. (2). There would be significant impact of Meditation on Stress among Railway employees with regard Pre-test and Post-test. Occupational stress index developed by Srivatsava AK and Singh AP was administered to the sample. Their age is range from 25 to 55 years. Data was analyzed using Mean, SD and t values. Results showed that Yoga and Mediation training reduce the stress among Railway employees and implications were drawn.
... As a therapeutic technique, it has many aims, including activating and strengthening positive emotional resources through reinforcement and re-experiencing these positive emotions in trance. The latter is achieved through suggestive messages repeated to stimulate positive effects, such as reducing anxiety and chronic perceived stress (e. g., Fisch et al., 2017;Hammond, 2010). For example, in a Randomized Controlled Trial (RCT), Fisch et al. (2020) observed a reduction in perceived stress (measured with a visual analog scale) after 5 weeks of group hypnotherapeutic intervention (five weekly sessions) and a 12-week follow-up, indicating an enduring stress-alleviating effect from a multiple session hypnosis intervention. ...
Full-text available
Background: Chronically stressed people often suffer from anxiety and depressive mood. Hypnosis is a technique that can induce a relaxation response and reduce negative stress symptoms. Objective: This explorative study investigated the impact of a single relaxation hypnosis session on stress-related psychological symptoms. Method: 47 suggestible, stressed individuals (87 % female) were randomized to a hypnosis group (n = 23, 20-minute hypnosis) or a control group (n = 24, 20-minute scientific documentary). Before and after the intervention , we assessed perceived stress, negative affect, anxiety, and depressive mood. Results: After the hypnosis intervention, depressive mood (d = 0.36) and state anxiety (d = 1.00) decreased, while negative affect remained stable (d = 0.04). Perceived stress was reduced in both groups. Conclusion: A single relaxation hypnosis session decreased stress-related symptoms in chronically stressed individuals. Our results substantiated the stress-alleviating effects of hypnosis.
... Hypnosis has been applied to the treatment of musculoskeletal (Tan et al., 2015), neuropathic (Dorfman et al., 2013), and centralized pain (Zech et al., 2017). Along with its secondary benefits to overall well-being (Jensen et al., 2006), hypnosis has been shown to be efficacious in treating state anxiety (e.g., prior to an event like a medical procedure) and anxiety-related conditions, such as tension-type headache (Hammond, 2010;Johnson et al., 2016;Schupp et al., 2005). Thus, hypnosis may be well suited to individuals with diverse pain presentations as well as those for whom stress can trigger acute symptom exacerbations. ...
Although strong evidence exists for using individual hypnosis to treat pain, evidence regarding group applications is limited. This project evaluated changes in multiple outcome measures in persons with chronic pain treated with 8 weeks of group hypnosis. Eighty-five adults with diverse chronic pain etiologies completed an 8-session, structured group hypnosis treatment. Pain intensity, pain interference, and global health were evaluated at baseline, posttreatment, and 3- and 6-months posttreatment. Linear mixed effects models assessed changes in outcomes over time. In a model testing, all three outcome measures simultaneously, participants improved substantially from pre- to posttreatment and maintained improvement across follow-up. Analyses of individual outcomes showed significant pre- to posttreatment reductions in pain intensity and interference, which were maintained for pain intensity and continued to improve for pain interference across follow-up. The findings provide compelling preliminary evidence that a group format is an effective delivery system for teaching individual skills in using hypnosis for chronic pain management. Larger randomized controlled trials are warranted to demonstrate equivalence of outcomes between treatment modes.
... Hypnosis was found to be more effective than other psychological interventions [52] and, through a systematic review and meta-analysis of randomised controlled trials on the effect of hypnosis on anxiety, statistically significant results were found for its efficacy. It is considered that there is a 'tremendous volume' of research proving that hypnosis is very effective in the treatment of, and reduction in, anxiety [53]. ...
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Anxiety is one of the most common mental health conditions experienced by people in Australia during their working years according to the Australian Bureau of Statistics (ABS) and employers recognising that mental health impacts their organisation’s bottom line are increasingly interested in programs to promote better mental health, well-being, and productivity. Beyond management concern for productivity, statutory protection is necessary to safeguard mental health, under the Australian Occupational Health and Safety (OHS) Act, organisations have a duty to eliminate or minimise risks to psychological (mental) health by designing effective workplace systems and Occupational Health and Safety (OHS) practitioners are central to the design and responsibility in managing these systems. Despite literature indicating the benefits of OHS workplace mental health initiatives, such as improved overall health, reduced absenteeism, increased job satisfaction and morale, there remains a lack of empirical research around program measurement, and their effectiveness in this area has been brought into question. The OHS function is interested in improving research around the relationship and connection between work performance and mental health but: there are few studies regarding performance outcomes of mental health OHS services within management journals and insufficient information around the prevalence of psychological morbidity in the workplace and its impact. The purpose of this study was to assess OHS perception regarding anxiety and reveal perceptions and receptivity towards alternative therapies and solutions being used in clinical practice to deal with anxiety such as cognitive behavioural therapy (CBT) with a focus on Hypnotherapy.
Hypnosis is a clinically accepted relaxation technique known for stress reduction. Results from hematological research provide evidence of changes in blood components through hypnosis. However, these hematological effects have been rarely examined. Hence, we exploratively investigated the effect of a single relaxation hypnosis on the hemogram in stressed individuals, assuming a reduction of leukocytes, thrombocytes, and erythrocytes (primary outcomes). Additionally, a reduction in the erythrocyte-related parameters (hemoglobin, hematocrit), and an increase in plasma volume was hypothesized (secondary outcomes). Forty-four individuals (89% women) with chronic stress and moderate to high hypnotic suggestibility were randomized to a hypnosis condition (20min relaxation hypnosis; n = 20) or a control condition (20min documentary; n = 24). Venous blood was drawn before and after the intervention and used to generate a differential hemogram and determine the plasma volume. A relaxation hypnosis led to a significant reduction in erythrocytes (Cohen´s d = 0.23) and consequently to a decrease in erythrocyte-related parameters (hemoglobin, d = 0.27; hematocrit, d = 0.37) as well as to a reduction in thrombocytes (d = 0.15) in the hypnosis compared to the control condition. Putatively, this could be the consequence of an increased plasma volume (d = 0.10), estimated by the hematocrit concentration and body weight. A hypnosis-induced change in leukocyte count could not be confirmed. Thus, a single session of relaxation hypnosis already alters specific blood count parameters. While relaxation-induced vasodilatation might explain these changes, it is still not completely clear how these changes affect our stress response system.
The purpose of this study was to investigate the feasibility, acceptability, and potential effect of a novel hypnotherapeutic intervention, informed by positive psychology, to enhance well-being in college students. The present study investigated adapting hypnotic relaxation therapy for enhancing well-being (denoted as HRT-WB). Twenty-seven college students were enrolled in a 5-week intervention of HRT-WB and instructed in daily home practice of HRT-WB self-hypnosis using audio recordings. Participants completed baseline and endpoint measures of well-being and symptoms of psychological distress. Results showed participants who received the HRT-WB intervention experienced improvements in subjective well-being as well as reductions in psychological distress. At endpoint, 71% of the participants who completed the HRT-WB intervention were categorized as experiencing high levels of well-being, or flourishing. In addition, HRT-WB is a feasible intervention, with high rates of retention, compliance with home practice, and satisfaction. Based on these promising results, further research into HRT-WB is warranted. HRT-WB could be a well-accepted, easily administered, and effective means of addressing well-being and enhancing flourishing.
Posted July 15, 2002. In a review of efficacy data submitted to the U. S. Food and Drug Administration (FDA), I. Kirsch, T. J. Moore, A. Scoboria, & S. S. Nicholls (2002) found that mean posttreatment differences in symptom levels between drug and placebo were modest at best. This led the authors to suggest that either medication effects are trivial or that new designs are needed that do not assume additive effects. We suggest that not all patients necessarily respond to a given medication and that effect sizes based on the "average" patient may underestimate drug-placebo differences for those who do. Data submitted to the FDA can also underestimate how a drug will perform in clinic practice, as studies sometimes are designed as much for marketing purposes as they are to estimate the magnitude of a medication's effects. Finally, even when drug-placebo differences are small, antidepressant medication remains a potent treatment that typically matches or exceeds the efficacy of alternative interventions.
A number of issues relating to patient education in anesthesia have been addressed in this review and, based upon the available data, some questions can be answered clearly. It is apparent both that a large minority of the American, British, and Australian public is under the misconception that anesthesiologists are not physicians and that the role of the anesthesiologist, both in and out of the operating room, is not fully understood. Many surgical patients, particularly younger ones, have fears about the anesthetic that are distinct from their fears about the surgery, the most common of them relating to waking up prematurely or not at all. Traditional attire for anesthesiologists is preferred by patients but does not appear to significantly influence patient satisfaction. While there are numerous putative advantages to improving patient rapport, good communication as judged by the patient is associated with a lower incidence of malpractice litigation. Preoperative instruction has been demonstrated to have benefit with regard to patient anxiety, postoperative pain, and length of hospitalization. It is also clear that patients' coping behavior varies considerably and strongly influences the usefulness of providing detailed preoperative information. Preoperative teaching should therefore be tailored accordingly. An issue that is less clear concerns the optimal methods for educating patients and the general public. Preliminary evaluation of videotape instruction has yielded somewhat encouraging results, but whether the preoperative visit, supplemented by videotape or in-hospital, on-demand television programming, or computer networks, such as the World Wide Web or home television, are the most effective and practical means for this education remains to be seen. How best to identify in a cost-effective way patients who would most likely benefit from more information is an important question that remains relatively unaddressed. Advances in surgical diagnosis and treatment and critical care have depended upon the development of anesthesia as a specialty. Our ability to continue to develop may depend upon our success in educating the public, politicians, and other health care professionals about what we do. The evaluation of educational methods for disseminating information about anesthesia thus may be important in determining the very future of our specialty and the quality of surgical and pain therapy that patients will receive.
Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, focused on specific outcome domains (e.g., patients’ selfreported pain), and rarely address the impact of different modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assessing the beneficial impact of adjunctive hypnosis for surgical patients, as well as to examine whether the beneficial impact of hypnosis goes beyond patients’ pain and method of the administration. We conducted metaanalyses of published controlled studies (n 20) that used hypnosis with surgical patients to determine: 1) overall, whether hypnosis has a significant beneficial impact, 2) whether there are outcomes for which hypnosis is relatively more effective, and 3) whether the method of hypnotic induction (live versus audiotape) affects hypnosis efficacy. Our results revealed a significant effect size (D 1.20), indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups. No significant differences were found between clinical outcome categories or between methods of the induction of hypnosis. These results support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients. (Anesth Analg 2002;94:1639 –45)
Morbidity (i.e., elevated anxiety and depression) is a common feature of coronary artery bypass surgery (CABS) patients, pre- and postoperatively. Since hypnotherapy can possibly reduce morbidity in CABS patients, the aim of this study was to determine the feasibility of hypnotherapeutic ego strengthening (HES) to facilitate patient coping with concomitant anxiety and depression. Fifty patients were randomly assigned to a non-intervention control group (n = 25) and an experimental group (n = 25) and exposed to a pre- and postoperative HES intervention. Anxiety and depression were assessed with the Beck Depression Inventory and Profile of Mood States, administered preoperatively, at discharge, and at 6-week follow-up. Findings confirmed large practical reductions of anxiety and depression in the experimental group and were maintained at follow-up, while a trend towards increased depression levels occurred in the control group. Although not generalizable, results suggest broadened applications of hypnotherapy with patients in cardiac centers.
The present study evaluates the effects of employing hypnosis in conjunction with a standard sedation regimen in 20 patients. All the patients had mandibular third molars surgically removed by a single surgeon. The results from these patients were compared with a further 20 control subjects who were treated by the same team using the same sedation regimen but without hypnosis. The hypnotic induction took place before intravenous drug administration (of midazolam and fentanyl). Heart rate (taken to be an indicator of stress and anxiety), ECG and pulse oximeter recordings were taken throughout the procedures. Any heart rate increase was significantly lower in patients treated with the hypno-sedative approach, much less intravenous sedation was required and recovery time was significantly shorter in this group. In contrast, treatment outcomes in the control subjects were not as good, most required much more intravenous medication and one subject had to be converted to a full general anaesthetic. Analysis of these results suggests that hypnosis may augment the effects of sedation in this patient population.
The fact that terminal cancer patients experience considerable psychological distress is now undisputed, but the effectiveness of psychological treatments in relieving this suffering is less clear. The aim of the present research was to evaluate the efficacy of clinical hypnosis in the enhancement of quality of life of patients with far-advanced cancer. Fifty terminally ill cancer patients were randomly assigned to two groups: standard care and hypnosis. Patients in the standard care group received routine medical and psychological care. Their medical treatment included pharmacological management of pain and other symptoms following the World Health Organization's model of palliative care (WHO, 1990). The psychological support consisted of supportive counselling based on the cognitive existential therapeutic tradition. In addition to the standard care, patients in the hypnosis group received weekly sessions of hypnosis with a therapist for four weeks. Outcome measures included quality of life, as measured by The Rotterdam Symptom Checklist (DeHaes, Olschewski, Fayers, Visser, Cull, Hopwood and Sanderman, 1996), and depression and anxiety, as measured by The Hospital Anxiety and Depression Scale (Zigmond and Snaith, 1983). Results demonstrated that at the end of intervention patients in the hypnosis group had significantly better overall quality of life and lower levels of anxiety and depression when compared to the standard care group. It is concluded that hypnosis is effective in the enhancement of quality of life in terminally ill cancer patients.
Conducted a longitudinal study of hypnotizability, as measured by the Stanford Hypnotic Susceptibility Scale, Form A, that yielded a relatively high degree of stability in hypnotic responsiveness over repeated testings spanning a 25-year period. The 50 Ss were retested in 1985, after tests when they were students, between 1958–1962 and again in 1970. The statistically significant stability coefficients were .64 (10-year retest), .82 (15-year retest), and .71 (25-year retest). The means did not change significantly, and the median change in the scores of individuals was only 1 point on the 12-item scale. A set of score measures and their intercorrelations are insufficient to resolve the issue of why stability occurs. The stability of hypnotizability over time compares favorably with that of other measures of individual differences.