ArticleLiterature Review

Effectiveness of Hypnotherapy with Cancer Patients' Trajectory: Emesis, Acute Pain, and Analgesia and Anxiolysis in Procedures

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Abstract

Clinical hypnosis in cancer settings provides symptom reduction (pain and anxiety) and empowers patients to take an active role in their treatments and procedures. The goal of this paper is to systematically and critically review evidence on the effectiveness of hypnotherapy for emesis, analgesia, and anxiolysis in acute pain, specifically in procedures with an emphasis on the period from 1999 to 2006. Further, it aims to provide a theoretical rationale for the use of hypnosis with cancer populations in the whole spectrum of illness/treatment trajectory in several clinical contexts. Finally, a treatment protocol for management of overt anxiety and phobic reactions in the radiotherapy suite is presented, with the intent of having such a protocol empirically validated in the future.

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... Complementary and alternative medicine (CAM) interventions that are both cost effective and that affirm the patients' ability to influence their own health care can provide additional relief from these symptoms and are coming to the forefront. Evidence suggests that hypnosis, a CAM intervention, is effective in managing the symptoms associated with breast cancer surgery, is cost effective and, when employed as self-hypnosis, enhances patients' perceptions of self-efficacy (Neron & Stephenson, 2007). The purpose of this pilot project was to test the feasibility of hypnosis as a preoperative intervention. ...
... Multiple meta-analyses have been conducted of the clinical trials using hypnosis for the management of symptoms associated with invasive procedures, surgery, and cancer treatment (Mendoza & Capafons, 2009;Montgomery, David, Winkel, Silverstein, & Bovbjerg, 2002;Neron & Stephenson, 2007;Richardson, Smith, McCall, & Pilkington, 2006;Schnur, Kafer, Marcus, & Montgomery, 2008). The results of these analyzes support the use of hypnosis for symptom management specifically for pain, nausea/vomiting, anxiety, and distress. ...
... The benefits of preoperative hypnosis are well established. Psychological and physical symptoms (i.e., pain, nausea/vomiting, anxiety, and distress) are reduced by preoperative hypnosis (Aapro, Molassiotis, & Oliver, 2005;Montgomery et al., 2007;Neron & Stephenson, 2007;Wobst, 2007). As a noninvasive intervention with virtually no side effects, hypnosis may be successfully employed with most people (Schnur et al., 2008). ...
Article
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The purpose of this pilot project was to test the feasibility of hypnosis as a preoperative intervention. The unique features of this study were: (a) use of a standardized nurse-delivered hypnosis protocol, (b) intervention administration immediately prior to surgery in the preoperative holding area, and (c) provision of hypnosis to breast cancer surgery patients receiving general anesthesia. A mixed-method design was used. Data collected from the intervention group and historical control group included demographics, symptom assessments, medication administration, and surgical, anesthesia, and recovery minutes. A semi-structured interview was conducted with the intervention group. A reduction in anxiety, worry, nervousness, sadness, irritability, and distress was found from baseline to postintervention while pain and nausea increased. The results support further exploration of the use of nurse-led preoperative hypnosis.
... Complementary and alternative medicine (CAM) interventions that are both cost effective and that affirm the patients' ability to influence their own health care can provide additional relief from these symptoms and are coming to the forefront. Evidence suggests that hypnosis, a CAM intervention, is effective in managing the symptoms associated with breast cancer surgery, is cost effective and, when employed as self-hypnosis, enhances patients' perceptions of self-efficacy (Neron & Stephenson, 2007). ...
... Multiple meta-analyses have been conducted of the clinical trials using hypnosis for the management of symptoms associated with invasive procedures, surgery, and cancer treatment (Mendoza & Capafons, 2009;Montgomery, David, Winkel, Silverstein, & Bovbjerg, 2002;Neron & Stephenson, 2007;Richardson, Smith, McCall, & Pilkington, 2006;Schnur, Kafer, Marcus, & Montgomery, 2008). The results of these analyzes support the use of hypnosis for symptom management specifically for pain, nausea/vomiting, anxiety, and distress. ...
... The benefits of preoperative hypnosis are well established. Psychological and physical symptoms (i.e., pain, nausea/vomiting, anxiety, and distress) are reduced by preoperative hypnosis (Aapro, Molassiotis, & Oliver, 2005;Montgomery et al., 2007;Neron & Stephenson, 2007;Wobst, 2007). As a noninvasive intervention with virtually no side effects, hypnosis may be successfully employed with most people (Schnur et al., 2008). ...
Article
The purpose of this project is to develop and evaluate a psycho-educational program that assists nurses to develop stress management plans. Discussion of nursing-specific risk factors, practice with relaxation techniques, and exploration via art are used as interventions. Quantitative and qualitative measures of stress and burnout are conducted pre- and postcourse using the Maslach Burnout Inventory, Draw-a-Person-in-the-Rain Art Assessment, and wellness plans. Descriptive statistics are used, and preliminary analysis indicates that the course is useful in impacting levels of emotional exhaustion. There are opportunities for evolving the program so that more enduring change in self-care is generated.
... Várias revisões literárias já concluíram que a hipnose promove significativa redução de dor para 75% da população estudada, assim como a analgesia hipnótica é superior a atenção ou condição controlada de cuidados básicos [16] . ...
... O significado físico, sua localização, intensidade, duração e a valorização afetiva da dor, são influenciados por uma série de variáveis ambientais, sociais, emocionais, situacionais, sintetizadas por meio da ativação de circuitos cerebrais corticais associados a memória da dor e que podem influenciar a experiência de dor [1,7,16,20] . ...
Article
Full-text available
Os procedimentos cirúrgicos odontológicos normalmente são cercados por temor e ansiedade por parte dos pacientes. O objetivo desse estudo foi apresentar um relato de caso com tratamento por hipnose, demonstrando assim o efeito da hipnose no controle da dor durante exodontia de terceiro molar, com mínimo de anestesia. Realizou-se a técnica de hipnose rápida com analgesia da região e dissociação da dor. O relato de caso sugere que a técnica é viável em pacientes sugestionáveis, possibilitando, nestes casos, a ausência de dor e o incomodo durante a cirurgia, e melhora o controle do pós-operatório. A técnica é viável para pacientes sugestionáveis minimizando os efeitos adversos da anestesia.
... The 1996 report by the National Institute of Health Technology Assessment Panel considered an effective and viable solution for the treatment of pain associated with cancer and many other chronic pain conditions [37]. Hypnotherapy has also been reported effective for anxiolysis in acute pain, analgesia, and emesis [38]. Brugnoli et al. [39] also reported the effectives of hypnosis for anxiety management as an adjunct therapy for patients receiving palliative care in chronic diseases conditions. ...
... These findings were taken to a new level of sophistication by some neurophysiological studies [56]. As an adjunct therapy, clinical hypnosis was considered effective for pain reduction in cancer patients as well as severe chronic diseases for patients receiving palliative care [38]. In the management of chronic pain or cancer procedure-related pain in children, hypnosis is considered as an effective technique [56]. ...
Chapter
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Hypnosis is a state of mind that is characterized by focused attention and heightened receptivity for suggestions. It is either established by compliance with instructions or achieved naturally; the critical nature of the mind is bypassed during hypnosis and acceptable suggestions are delivered. Misperceptions about hypnosis by clinical practitioners and their clients have been shaped through years of inaccurate but interesting portrayals of hypnosis in books, plays, and movies. Part of the misperceptions is that individuals with seemingly magical powers to manipulate the unsuspecting innocent with their authoritative voice commands and penetrating eyes are depicted as hypnotists. This chapter will review the traditional and conventional approaches used in hypnosis, their advantages and disadvantages as well as where hypnosis is used as a complementary or alternative therapy to the modern day orthodox medicine. Despite the pejorative image display of hypnosis and misconceptions surrounding it, hypnosis still has numerous applications in contemporary medicine. Hypnotherapy conducted by a trained therapist is considered as a complementary or safe alternative to present day orthodox medication for numerous ailments.
... Annak ellenére, hogy a gondos ápolás melle számos nem-gyógyszeres módszer (relaxáció, meditáció, progresszív izomrelaxációs tréning, hipnózis, zeneterápia, jóga, bio-feedback, irányíto képzelet, terápiás érintés, masszázs, akupresszúra és akupunktúra) alkalmazásáról ismertek adatok a daganatkezelés okozta hányinger és hányás csillapításában, részben terjedelmi okokból, részben a fentiek nem általános elfogado sága mia a továbbiakban a gyógyszeres kezeléssel foglalkozunk (3,12,14,43,47,55). ...
... Hasznosnak bizonyultak viszont más szerekkel való kombinálásban. Jelentőségüket elsősorban a -később tárgyalt -szerotonin-és neurokininreceptor-antagonista készítményekkel való kombinálásban őrizték meg, ahol ma is az alapvető protokollok elemei közé tartoznak (3,12,16,19,20,22,25,27,30,31,34,36,43). ...
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I S S N 0 0 2 5-0 24 4 © A kadé miai K i adó, B U DA PES T • M ag yar O nkoló gi a 5 3: 3 9 – 4 5, 2 0 0 9 • D O I: 10.15 5 6 / M O n ko l. 5 3. 2 0 0 9.1.6 39 Eredeti közlemény A daganatos betegek kezelésében a hányinger és hányás – a megítélés némi javulása ellenére – még mindig a betegek által re ege mellékhatások közé tartozik. A szerzők a hányinger és hányás szabályozásának bemutatása után kitérnek az ezeket befolyásoló legfontosabb tényezőkre (az alkalmazo készítmények emetogenitási szintek szerinti táblázatos bemutatásával), a betegek jellegzetessége ire és a hányáscsillapí-tó gyógyszerekre. A korai próbálkozások rövid felsorolása után a metoclopramid és a kortikoszteroidok bemutatását követően részletesebben foglalkoznak – az elsősorban az akut hányinger és hányás kezelésére kiváló, s elterjedten alkalmazo – szerotoninreceptor-antagonistákkal. A hányáscsillapításban a követ-kező jelentős előrelépés a neurokininreceptorok antagonistáinak kifejlesztése volt; jelenleg hazánkban az aprepitant férhető hozzá, mely (kortikoszteroiddal és ondanszetronnal kombinálva) az erősen és mérsé-kelten emetogén kemoterápiás szerek és ezek kombinációi esetén indikált. Vizsgálatok igazolták, hogy ez az első vegyület, mely az akut hányinger-és hányáscsillapítás melle az elhúzódó hányinger és hányás kezelésére is alkalmas. Jelenleg az aprepitant az 50 mg/m 2 ciszplatin-tartalmú protokollokban kiemelt támogatással rendelhető a szerotoninantagonisták sikertelensége után. A szerzők a legújabb ajánlások adaptálásával adnak javaslatot a különböző mértékben hányást keltő gyógyszerek antiemetikus profi laxi-sára. A sugárkezeléssel kapcsolatban kialakuló hányinger és hányás mechanizmusa kissé eltérő, kockázati tényezői is mások; kezelésükben a metoclopramid és (fi nanszírozási szabályok mia) az ondanszetron alkalmazhatók, míg a radiokemoterápia citosztatikus elemeit a megfelelő protokollok szerint szükséges ellátni. Magyar Onkológia 53: 39–45, 2009 Even today, nausea and vomiting are two of the most distressing adverse eff ects associated with tumor therapy. The authors give an overview of the mechanism and the trigger factors (emetogenic potential of the chemotherapies, the patient risk factors, and the used antiemetic drugs) of nausea and vomiting. A short summary will describe the antiemetic drugs focusing on metoclopramid, steroid and the currently widely used setron therapy which is eff ective only during the acute phase of chemotherapy-induced nausea and vomiting (CINV). In the treatment of CINV the latest improvement was the introduction of the neurokinin (NK1) receptor antagonist class. Currently the only available agent is aprepitant which is indicated to treat CINV in case of highly and moderately emetogenic chemotherapies. The pivotal phase III trials defi ned that aprepitant is the fi rst drug that is able to protect against the delayed phase of CINV plus can improve the antiemetic therapy during the acute phase. Currently aprepitant is reimbursed in Hungary only a er the failure of setron therapy in case of high dose (>50 mg/m 2) cisplatin protocols. The authors give a recommendation how to treat CINV based on the latest international antiemetic guidelines.The mechanism and the trigger factors of radiotherapy-induced nausea and vomiting (RINV) are diff erent from CINV. For treatment of RINV metoclopramid (due to reimbursement regulation) and ondansetron can be used. In case of radio-chemotherapy the antiemetic treatment should follow the CINV guidelines. Pikó B, Bassam A. Treatment of tumor therapy-induced nausea and vomiting. Hungarian Oncology 53: 39–45, 2009 Keywords: antiemetic treatment, chemotherapy-induced nausea and vomiting, radiotherapy-induced nausea and vomiting, neurokinin (NK1) receptor antagonist, guidelines * A közleményben leírtak a Sugárterápiás és Onkológiai Szakmai Kollégium által az aprepitant (Emend ®) társadalombiztosítási befogadásához benyújto elemzés egyik forrásául szolgáltak.
... The target disorders were identified in recent reviews or meta analyses articles published in the International Journal of Clinical &Experimental Hypnosis in 2000, 48(2) and2007, 55(2) and (3). Eighteen meta analyses were searched for articles which seemed to be representative of their general finding and usefulness for clinical practice (Alladin & Alibhai, 2007;Barabasz, 2007;Brown & Hammond, 2007;Brown, 2007;Cardeña, 2000;Elkins, Jensen, & Patterson, 2007;Flammer & Alladin, 2007;Flory, Martinez Salazar, & Lang, 2007;Golden, 2007;Graci & Hardie, 2007;Green & Lynn, 2000;Hammond, 2007;Lynn & Cardeña, 2007;Milling & Costantino, 2000;Crum & Langer, 2007;Néron & Stephenson, 2007;Pinnell & Covino, 2000;and Schoenberger, 2000). For example, several analyses covered reports of hypnosis to treat various types of pain (Flammer & Alladin, 2007;Milling & Costantino, 2000;Montgomery, DuHamel, & Redd, 2000;Néron & Stephenson, 2007;and, Pinnell & Covino, 2000). ...
... Eighteen meta analyses were searched for articles which seemed to be representative of their general finding and usefulness for clinical practice (Alladin & Alibhai, 2007;Barabasz, 2007;Brown & Hammond, 2007;Brown, 2007;Cardeña, 2000;Elkins, Jensen, & Patterson, 2007;Flammer & Alladin, 2007;Flory, Martinez Salazar, & Lang, 2007;Golden, 2007;Graci & Hardie, 2007;Green & Lynn, 2000;Hammond, 2007;Lynn & Cardeña, 2007;Milling & Costantino, 2000;Crum & Langer, 2007;Néron & Stephenson, 2007;Pinnell & Covino, 2000;and Schoenberger, 2000). For example, several analyses covered reports of hypnosis to treat various types of pain (Flammer & Alladin, 2007;Milling & Costantino, 2000;Montgomery, DuHamel, & Redd, 2000;Néron & Stephenson, 2007;and, Pinnell & Covino, 2000). For acute pain, the most representative and useful reference was Patterson and Jensen (2003). ...
... Oncología La hipnosis se ha utilizado con pacientes de cáncer para ayudarles a manejar el dolor, reducir la ansiedad relacionada con los procedimientos médicos y reducir la emesis e hiperémesis posterior a la quimioterapia (Pinnel y Covino, 2000; Néron y Stephenson, 2007). ...
... También cabe destacar el estudio aleatorizado llevado a cabo por Spiegel y Moore (1997) cuyos resultados en un seguimiento a 10 años indicaron que las mujeres con cáncer que habían recibido un año de terapia grupal semanal expresiva y de apoyo, con hipnosis, mostraron un aumento significativo de la duración de la supervivencia, así como del tiempo de la recurrencia a la muerte. Néron y Stephenson (2007) han propuesto un protocolo de tratamiento para el manejo de la ansiedad manifiesta y las reacciones fóbicas en la radioterapia, si bien este protocolo aun requiere ser validado empíricamente. Por otro lado, en un estudio de Montgomery et al. (2007), se asignó aleatoriamente a las pacientes que iban a someterse cirugía de mama a dos grupos, uno de ellos recibió una sesión de hipnosis de 15 minutos antes de la operación y el otro una sesión en la que se les escuchaba de manera empática y no directiva. ...
Article
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La hipnosis es una intervención clínica valiosa en el tratamiento de una amplia variedad de problemas psicológicos y médicos, ayudando a la mejora de la calidad de vida de muchos pacientes. Este artículo revisa el estado de la evidencia empírica de la eficacia de la hipnosis, teniendo en cuenta los resultados de la investigación más rigurosa al respecto, así como los de otros estudios que, a pesar de no cumplir unos criterios metodológicos rigurosos, poseen relevancia clínica. En general, y según la investigación revisada, cuando se utiliza la hipnosis como un coadyuvante a otras intervenciones médico psicológicas, incrementa la eficacia y/o eficiencia de tales intervenciones. Asimismo, la eficacia de la hipnosis está bien establecida en diversas aplicaciones clínicas, especialmente el manejo del dolor y otras condiciones médicas, existiendo evidencia aceptable de su eficacia en el tratamiento de la depresión, los trastornos del sueño, dejar de fumar, la obesidad, el asma y la enuresis infantil. De acuerdo con la investigación publicada hasta la fecha, está justificada la realización de investigaciones que utilicen estudios controlados con muestras de tamaño adecuado. Así mismo, es esencial establecer la eficacia de la hipnosis en otras áreas aún por investigar.
... Annak ellenére, hogy a gondos ápolás melle számos nem-gyógyszeres módszer (relaxáció, meditáció, progresszív izomrelaxációs tréning, hipnózis, zeneterápia, jóga, bio-feedback, irányíto képzelet, terápiás érintés, masszázs, akupresszúra és akupunktúra) alkalmazásáról ismertek adatok a daganatkezelés okozta hányinger és hányás csillapításában, részben terjedelmi okokból, részben a fentiek nem általános elfogado sága mia a továbbiakban a gyógyszeres kezeléssel foglalkozunk (3,12,14,43,47,55). ...
... Hasznosnak bizonyultak viszont más szerekkel való kombinálásban. Jelentőségüket elsősorban a -később tárgyalt -szerotonin-és neurokininreceptor-antagonista készítményekkel való kombinálásban őrizték meg, ahol ma is az alapvető protokollok elemei közé tartoznak (3,12,16,19,20,22,25,27,30,31,34,36,43). ...
Article
Even today, nausea and vomiting are two of the most distressing adverse effects associated with tumor therapy. The authors give an overview of the mechanism and the trigger factors (emetogenic potential of the chemotherapies, the patient risk factors, and the used antiemetic drugs) of nausea and vomiting. A short summary will describe the antiemetic drugs focusing on metoclopramide, steroid and the currently widely used setron therapy which is effective only during the acute phase of chemotherapy-induced nausea and vomiting (CINV). In the treatment of CINV the latest improvement was the introduction of the neurokinin (NK1) receptor antagonist class. Currently the only available agent is aprepitant which is indicated to treat CINV in case of highly and moderately emetogenic chemotherapies. The pivotal phase III trials defined that aprepitant is the first drug that is able to protect against the delayed phase of CINV plus can improve the antiemetic therapy during the acute phase. Currently aprepitant is reimbursed in Hungary only after the failure of setron therapy in case of high dose (\>50 mg/m2) cisplatin protocols. The authors give a recommendation how to treat CINV based on the latest international antiemetic guidelines.The mechanism and the trigger factors of radiotherapy-induced nausea and vomiting (RINV) are different from CINV. For treatment of RINV metoclopramide (due to reimbursement regulation) and ondansetron can be used. In case of radio-chemotherapy the antiemetic treatment should follow the CINV guidelines.
... The target disorders were identified in recent reviews or meta analyses articles published in the International Journal of Clinical & Experimental Hypnosis in 2000, 48(2) and 2007, 55(2) and (3). Eighteen meta analyses were searched for articles which seemed to be representative of their general finding and usefulness for clinical practice (Alladin & Alibhai, 2007; Barabasz, 2007; Brown & Hammond, 2007; Brown, 2007; Cardeña, 2000; Elkins, Jensen, & Patterson, 2007; Flammer & Alladin, 2007; Flory, Martinez Salazar, & Lang, 2007; Golden, 2007; Graci & Hardie, 2007; Green & Lynn, 2000; Hammond, 2007; Lynn & Cardeña, 2007; Milling & Costantino, 2000; Crum & Langer, 2007; Néron & Stephenson, 2007; Pinnell & Covino, 2000; and Schoenberger, 2000). For example, several analyses covered reports of hypnosis to treat various types of pain (Flammer & Alladin, 2007; Milling & Costantino, 2000; Montgomery, DuHamel, & Redd, 2000; Néron & Stephenson, 2007; and, Pinnell & Covino, 2000). ...
... Eighteen meta analyses were searched for articles which seemed to be representative of their general finding and usefulness for clinical practice (Alladin & Alibhai, 2007; Barabasz, 2007; Brown & Hammond, 2007; Brown, 2007; Cardeña, 2000; Elkins, Jensen, & Patterson, 2007; Flammer & Alladin, 2007; Flory, Martinez Salazar, & Lang, 2007; Golden, 2007; Graci & Hardie, 2007; Green & Lynn, 2000; Hammond, 2007; Lynn & Cardeña, 2007; Milling & Costantino, 2000; Crum & Langer, 2007; Néron & Stephenson, 2007; Pinnell & Covino, 2000; and Schoenberger, 2000). For example, several analyses covered reports of hypnosis to treat various types of pain (Flammer & Alladin, 2007; Milling & Costantino, 2000; Montgomery, DuHamel, & Redd, 2000; Néron & Stephenson, 2007; and, Pinnell & Covino, 2000). For acute pain, the most representative and useful reference was Patterson and Jensen (2003). ...
Article
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This article summarizes the search for efficacious hypnotic treatments. Eighteen major meta analyses were reviewed and the results evaluated using the criteria of Chambless & Hollon, (1998). The analysis identified 32 disorders for which hypnosis can be considered a possible treatment, 5 for which it seems effective, and 2 for which it appears specific. If clinicians use hypnosis in the situations where it seems to be efficacious, and systematically expand the list of conditions where it will be helpful, the results will be even more impressive for the 100th anniversary of this Journal.
... In oncology, there is evidence for the benefits of hypnosis for reducing pain, anxiety, and the nausea and vomiting associated with chemotherapy. Increased positive mood, decreased negative mood, less fatigue, and better sleep (Brown & Hammond, 2007;Montgomery et al., 2014Montgomery et al., , 2009Néron & Stephenson, 2007), as well as the reduced economic costs of the intervention have also been reported . ...
Article
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.
... -In reduction of pain for gastrointestinal disorders such as ulcers, irritable colon, colitis, crohn's disease (9); -In reduction for pain for dermatological disorders like eczema, herpes, neurodermatitis, itchiness, psoriasis, warts (10); -In reduction of acute and chronic pain back aches, oncological pain, head aches and migraines, arthritis, rheumatism (11)(12)(13)(14)(15); -In reduction of nausea and vomiting as symptoms caused by chemotherapy (16)(17)(18)(19)(20); -In stabilizing hematic flow (21,22); -In handling anxiety in cases of acute respiratory events connected to allergies, in particular asthma (23); -In reduction of hypertension and in invasive vascular procedures (24,25); -In reduction of pain connected to the replacement of medication on second degree burns and above (26,28); -In surgery as an analgesic, especially in cases of allergic or hypersensitive patients or in cases of awake surgery (5,18,29,30); -During childbirth as to reduce nausea caused by pregnancy (gestational hypermisis) (31); -As an alternative to pharmaceutical anesthesia in dental contexts (32)(33)(34); -In reduction of anxiety and pain connected to invasive procedures in ambulatory regimes (29)(30)(31)(32)(33)(34)(35)(36)(37)(38); -In reduction of anxiety, through the blocking of the sympathetic reactions caused by stress (16; 39-41); ...
Article
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Background Much evidence shows that hypnotic communication can have a pain-relieving effect and reduce complications such as anxiety, insomnia and depression. Whenever this technique was applied, the use of pharmaceuticals was reduced, there were less side effects, shorter hospitalization timesframes and lower treatment costs. Aim of the study Evaluate the knowledge and perceptions of nurses about hypnotic communication and the causes for which this technique is not frequently used. A secondary objective pointed to measuring the effectiveness of an educational event on hypnosis. Method The evaluation was done by administering an anonymous and voluntary survey, in a pre-test and post-test modality to nurses subscribed to a formative event on hypnotic communication organized by the Nursing Order, Province of Ravenna. Results 78 nurses participated in the study. The analysis of the pre-test results show a gap of knowledge regarding hypnotic communication. The main causes were found regarding the lack of use for hypnotic communication: stereotypes and prejudices related to this technique and insufficient university education. Conclusions The implementation of this technique, effective and efficient under various aspects, requires a preliminary creation of culture regarding this theme, capable of surpassing the stereotypes and resistances brought by a lack of theoretical elements.
... Patients with all stages of cancer have reported benefits with regard to pain management, including metastatic and late-stage cancer patients. Similarly, hypnosis interventions have been delivered to patients at all points of diagnosis and treatment, including procedural pain before and after medical/surgical interventions, and pain related to diagnostic procedures such as bone marrow aspiration [34], and major surgery [35,36]. The only point of care at which hypnosis interventions for pain management have not been studied extensively is during chemotherapy treatments [22•], possibly because pain may not be the most salient symptom during this phase, or due to logistical problems in intervention delivery such as time availability and provider travel for sessions. ...
Article
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Purpose of Review This paper reviews the current evidence-base for the use of hypnosis as an adjunct treatment for common cancer-related symptoms and side effects, including those experienced during treatment, as well as long-term and late effects. First, a general description and history of medical hypnosis in cancer care is provided, followed by a review of the latest evidence across a range of common symptoms. Recent Findings The evidence suggests that hypnosis may help treat symptoms of nausea and vomiting in breast cancer patients, manage pain in a variety of contexts, and also reduce levels of anxiety and overall distress around surgical and medical procedures, both in children and adults. Emerging research shows promise for treating hot flashes in women with breast cancer. Summary The research in this area would benefit from assessing populations beyond women with breast cancer, including late-stage disease, using more rigorous study designs, following published reporting guidelines and better describing and standardizing interventions.
... Hypnosis, self-introspective hypnosis and meditative states, represents an increasingly popular area of research in cognitive science, including notable ventures in the domains of perception, attention, concentration, consciousness, memory, motor control, pain and suffering control (36,(51)(52)(53)(54)(55)(56)(57)(58)(59)(60). The use of introspective hypnosis, as meditation, often includes an induction phase to increase mental absorption followed by a suggestion phase providing directions to elicit particular changes in thoughts and behaviors. ...
Article
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Human body is a biological, open system and maintains itself in the changing environment. Disease state is cured by many medicinal systems for healing. Esoteric healing (through introspective hypnosis, meditation and spiritual intercession) is the system where its believers regard Supreme Being as Omnipotent, Omnipresent and Omniscient. Such persons take ill health as a boon and pray through meditation that He may by His Mercy grant health or if God wishes otherwise, they happily accept it so that they keep moving ahead on their spiritual path. This study is a review of literature, where results clearly point towards better psychological and spiritual healing in patients who believe in esoteric cures. Modern science in terms of cognitive psychology or neurophysiology has begun to emphasize the role of consciousness but, that is confined only to the physical world. It is only with the advent of Param Purush Puran Dhani Soami Ji Maharaj (200 years ago) that in the religion of Saints, the ultimate consciousness or the Super Consciousness of the highest order has been revealed.
... The mask is not in the field of view of the patient, which makes it much more comfortable. Hypnosis can also be useful in radiotherapy [128] and is an effective method to ease the simulation computed tomography scan and the first sessions of radiation therapy. Patients who benefit from hypnosis in the first and second sessions can then usually continue the treatment without hypnosis. ...
Article
Lung cancer represents a major public health issue worldwide. Unfortunately, more than half of them are diagnosed at an advanced stage. Moreover, even if diagnosed early, diagnosis procedures and treatment can be difficult due to the frequent comorbidities observed in these patients. Some of these comorbidities have a common major risk factor, i.e. smoking, whereas others are unrelated to smoking but frequently observed in the general population. These comorbidities must be carefully assessed before any diagnostic and/or therapeutic decisions are made regarding the lung cancer. For example, in a patient with severe emphysema or with diffuse lung fibrosis, transthoracic needle biopsy can be contraindicated, meaning that in some instances a precise diagnosis cannot be obtained; in a patient with chronic obstructive pulmonary disease, surgery may be impossible or should be preceded by intensive rehabilitation; patients with interstitial lung disease are at risk of radiation pneumonitis and should not receive drugs which can worsen the respiratory insufficiency. Patients who belong to what are called “special populations”, e.g. elderly or HIV infected, should be treated specifically, especially regarding systemic treatment. Last but not least, psychosocial factors are of great importance and can vary from one country to another according to health insurance coverage.
... 17 Hypnosis therapy relieves pain during and after surgical procedures [18][19][20] and reduces discomfort associated with various chronic pain conditions. [21][22][23] Relaxation therapy shares common elements with hypnosis and involves self-regulation techniques intended to reduce muscle tension around the jaw. 24 Therapy includes the adoption of a relaxed, passive mode of thinking, brought about by focusing of attention on some neutral target or set of targets, such as parts of the body or breathing, while ignoring distracting thoughts. ...
Article
To conduct a systematic review and meta-analysis to evaluate the effectiveness of hypnosis/relaxation therapy compared to no/minimal treatment in patients with temporomandibular disorders (TMD). Studies reviewed included randomized controlled trials (RCTs) where investigators randomized patients with TMD or an equivalent condition to an intervention arm receiving hypnosis, relaxation training, or hyporelaxation therapy, and a control group receiving no/minimal treatment. The systematic search was conducted without language restrictions, in Medline, EMBASE, CENTRAL, and PsycINFO, from inception to June 30, 2014. Studies were pooled using weighted mean differences and pooled risk ratios (RRs) for continuous outcomes and dichotomous outcomes, respectively, and their associated 95% confidence intervals (CI). Of 3,098 identified citations, 3 studies including 159 patients proved eligible, although none of these described their method of randomization. The results suggested limited or no benefit of hypnosis/relaxation therapy on pain (risk difference in important pain -0.06; 95% CI: -0.18 to 0.05; P = .28), or on pressure pain thresholds on the skin surface over the temporomandibular joint (TMJ) and masticatory muscles. Low-quality evidence suggested some benefit of hypnosis/relaxation therapy on maximal pain (mean difference on 100-mm scale = -28.33; 95% CI: -44.67 to -11.99; P =.007) and active maximal mouth opening (mean difference on 100-mm scale = -2.63 mm; 95% CI: -3.30 mm to -1.96 mm; P < .001) compared to no/minimal treatment. Three RCTs were eligible for the systematic review, but they were with high risk of bias and provided low-quality evidence, suggesting that hypnosis/relaxation therapy may have a beneficial effect on maximal pain and active maximal mouth opening but not on pain and pressure pain threshold. Larger RCTs with low risk of bias are required to confirm or refute these findings and to inform other important patient outcomes.
... Although the lineage of hypnosis is not measured in millennia, its range of application is equally impressive. Reviews and meta-analytic studies consistently document the effectiveness or promise of hypnosis in treating an array of psychological and medical conditions ranging from acute and chronic pain to obesity (see Brown, 2007;Brown & Hammond, 2007;Flammer & Alladin, 2007;Flammer & Bongartz, 2003;Elkins, Jensen, & Patterson, 2007;Flory, Salazar, & Lang, 2007;Lynn et al., 2000;Neron & Stephenson, 2007). Furthermore, meta-analyses have shown that hypnosis enhances the effectiveness of both psychodynamic and cognitive behavioral psychotherapies (Kirsch, 1990;Kirsch, Montgomery, & Sapirstein, 1995). ...
Article
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Hypnosis and mindfulness practices provide clinicians with two viable yet distinct methods, or more accurately families of methods, for increasing well-being and ameliorating problems in liv-ing. In this article, we compare and contrast hypnotic and mindfulness interventions, address the question of whether they inhabit a common domain, describe how they may be combined to advantage, and discuss clinical and research implications. We contend that hypnosis and mindful-ness inhabit a common, albeit broad, domain of suggestive approaches. However, we also argue that meaningful differences exist that are particularly salient and consequential in the forensic arena.
... Hypnosis has been used with cancer patients to help them manage pain, reduce medical procedure related anxiety, and reduce postchemotherapy emesis and hyperemesis (Pinnel & Covino, 2000;Néron & Stephenson, 2007). ...
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Hypnosis is a valuable clinical intervention for the treatment of a wide variety of psychological and medical problems which helps improve the quality of life in patients. This paper reviews the state of the evidence regarding the efficacy of hypnosis taking into account the most rigorous research results in this respect, together with other studies of clinical relevance although they do not fulfill stringent methodological criteria. Overall, the findings of research indicate that hypnosis used as an adjunctive to other medical or psychological interventions increases the efficacy and/or efficiency of these interventions. Moreover, hypnosis efficacy is well established in certain clinical applications, especially pain management and other medical conditions, and there is acceptable evidence of its efficacy in treating depression, sleep disorders, smoking cessation, obesity, asthma, and enuresis in children. According to the literature to date, continued research using randomized, controlled methodologies as well as adequate sample sizes is well justified, and it is essential in order to establish the efficacy of hypnosis in other areas.
... These findings are supported by the results of Montgomery, DuHamel, and Redd's[44]meta-analytic review, which found that 75% of the people experienced pain reduction due to hypnosis, and these reductions were found in both a clinical and a healthy population. In their review of the literature, Neron and Stephenson[45]also present evidence on the effectiveness of hypnotherapy for emesis, analgesia, and anxiolysis in acute pain. Montgomery et al.[46]found that when com‐ pared to empathic listening, presurgery hypnosis was more effective in reducing pain in‐ tensity and pain unpleasantness for breast cancer patients. ...
... Children with pain levels above this threshold are considered to require the maintenance of or an increase in analgesia. Such effects on pain have already been described in adults for various medical procedures (Elkins, Jensen, & Patterson, 2007;Hammond, 2007;Montgomery, Duhamel, & Redd, 2000;Néron & Stephenson, 2007), for oral surgery (Enqvist et al., 1995;Enqvist & Fischer, 1997;Hermes et al., 2005), and for interventions outside the oral cavity in children (Butler, Symons, Henderson, Shortliffe, & Spiegel, 2005;Richardson, Smith, McCall, & Pilkington, 2006;Rogovik & Goldman, 2007), especially in procedures with children involving needles (Dufresne et al., 2010;Liossi & Hatira, 2003;Uman et al., 2006). In most cases, a decrease in both anxiety and pain in the populations studied was reported. ...
Article
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The authors of this prospective study initially hypothesized that hypnosis would lower the anxiety and pain associated with dental anesthesia. Thirty children aged 5 to 12 were randomly assigned to 2 groups receiving hypnosis (H) or not (NH) at the time of anesthesia. Anxiety was assessed at inclusion in the study, initial consultation, installation in the dentist's chair, and at the time of anesthesia using the modified Yale preoperative anxiety scale (mYPAS). Following anesthesia, a visual analogue scale (VAS) and a modified objective pain score (mOPS) were used to assess the pain experienced. The median mYPAS and mOPS scores were significantly lower in the H group than in the NH group. Significantly more children in the H group had no or mild pain. This study suggests that hypnosis may be effective in reducing anxiety and pain in children receiving dental anesthesia.
... Indeed, hypnosis has been shown to relieve pain during and after surgical procedures [1][2][3] and to alleviate various chronic pain conditions. [4][5][6] A few studies have also shown pain relief from hypnosis in different orofacial pain conditions. [7][8][9][10] Data from recent positron emission tomography and functional magnetic resonance imaging studies has created a growing understanding of the cortical mechanisms of hypnotic analgesia. ...
Article
This study contrasted the effect of hypnosis on self-reported pain and changes in a nociceptive brainstem reflex, the blink reflex (BR), in 39 women with temporomandibular disorder. The patients were randomized to hypnosis or control (nonhypnotic relaxation). Pain intensity was assessed 3 times daily on a 0 to 10 numerical rating scale. BRs were elicited by electrical stimulation with a nociceptive-specific electrode and recorded before and after treatment at pain threshold (Ip) and supra threshold (2×Ip). Significant reduction of pain intensity was observed in the hypnosis group from 4.5±2.1 at baseline to 2.9±2.4 after treatment (P<0.001). The pain reduction was generally unrelated to changes in the BR, with the exception being a lowered ipsilateral R2 BR component at the right side supra threshold (P=0.034). Hypnosis thus seems to reduce complex temporomandibular disorder pain, most likely because of cortical changes with little, if any, involvement of brainstem reflex pathways.
... For example, hypnotic hypoalgesia has been shown to reduce the unpleasantness and intensity of experimental pain in healthy individuals and is associated with different brain activation patterns in response to painful stimulation [23,41,42]. Hypnosis may also relieve clinical pain, e.g., during and after surgical procedures [17,35,36,53] and in some chronic pain conditions [1,2,21,26,27]. In experimental pain studies with healthy participants, hypnotic hypoalgesia is associated with changes in pain thresholds and phys-iological pain correlates including brain activity [15,16,24,44], somatosensory event-related potentials (SERPs) [10], and spinal reflexes [28,43,54]. ...
Article
Hypnosis modulates pain perception but the associated brain mechanisms in chronic pain conditions are poorly understood. Brain activity evoked by painful repetitive pin-prick stimulation of the left mental nerve region was investigated with use of fMRI in 19 patients with painful temporomandibular disorders (TMD) during hypnotic hypoalgesia and hyperalgesia and a control condition. Pain intensity and unpleasantness of the painful stimulation was scored on a 0-10 Numerical Rating Scale (NRS). NRS pain and unpleasantness scores during hypnotic hypoalgesia were significantly lower than in the control condition and significantly higher in the hypnotic hyperalgesia condition. In the control condition, painful stimulation caused significant activation of right posterior insula, primary somatosensory cortex (SI), BA21, and BA6, and left BA40 and BA4. Painful stimulation during hypnotic hyperalgesia was associated with increased activity in right posterior insula and BA6 and left BA40 whereas hypnotic hypoalgesia only was associated with activity in right posterior insula. Unexpectedly, direct contrasts between control and hypnotic hyperalgesia conditions revealed significant decreases in S1 during hyperalgesia. Direct contrasts between control and hypnotic hypoalgesia conditions demonstrated significant decreases in right posterior insula and BA21, as well as left BA40 during hypoalgesia. These findings are the first to describe hypnotic modulation of brain activity associated with nociceptive processing in chronic TMD pain patients and demonstrate that hypnotic hypoalgesia is associated with a pronounced suppression of cortical activity and a disconnection between patient-based scores and cortical activity in S1 during hypnotic hyperalgesia.
... About three-fourths of breast cancer survivors experience hot flashes, which can significantly impact mood, sleep, and anxiety. Hypnosis is noted for its impact on soma (Gay, 2007;Neron & Stephenson, 2007;Santarcangelo, Carli, et al., 2008;Shakibaei, Harandi, Gholamrezaei, Samoei, & Salehi, 2008). Clinical case reports (e.g., Elkins, Marcus, Stearns, & Rajab, 2007) have suggested that by using hypnosis women have been able to reduce the frequency and intensity of hot flashes by 41% to 91%. ...
Article
The authors summarize 4 articles of special interest to the hypnosis community in the general scientific and medical literatures. All are empirical studies testing the clinical utility of hypnosis, and together address the role of hypnosis in prevention, diagnosis, and treatment of medical and psychiatric disorders/conditions. The first is a randomized controlled study of smoking cessation treatments comparing a hypnosis-based protocol to an established behavioral counseling protocol. Hypnosis quit rates are superior to those of the accepted behavioral counseling protocol. A second study with pediatric patients finds hypnosis critically helpful in differentiating nonepileptic seizure-like behaviors (pseudoseizures) from epilepsy. The remaining 2 papers are randomized controlled trials testing whether hypnosis is effective in helping patients manage the emotional distress of medical procedures associated with cancer treatment. Among female survivors of breast cancer, hypnosis reduces perceived hot flashes and associated emotional and sleep disruptions. Among pediatric cancer patients, a brief hypnotic intervention helps control venepuncture-related pain.
... Hypnosis is another intervention which could be effective for chronic pain (25). While hypnosis has been shown to relieve pain in various chronic pain conditions, including cancer, headaches and migraines (26)(27)(28)(29), there are only few studies of hypnotic treatment in orofacial pain conditions. In TMD patients, Winocur et al. (30) found an effect of hypnosis in 15 patients, and Simon and Lewis (31) an effect in 23 patients, but these studies are case-series trials lacking randomization and control. ...
Article
This study investigated the effect of hypnosis in patients with temporomandibular disorders (TMD) with focus on oral function and psychological outcomes. Forty women (mean age +/- s.d.: 38.6 +/- 10.8 years) suffering from TMD (mean duration 11.9 +/- 9.9 years) were randomized to four individual 1-hour sessions of either hypnotic intervention or a control condition of simple relaxation. Pain intensity was assessed three times daily on a 0-10 Numerical Rating Scale. Additional outcomes were TMD-associated symptoms assessed by the Research Diagnostic Criteria examination form and questionnaire, psychological symptoms (Symptom Check List 60), pain coping strategies (Coping Strategies Questionnaire), sleep difficulties (Pittsburgh Sleep Quality Index) and use of analgesics. Data were analyzed with between-groups within-subjects anovas. The hypnosis group significantly reduced the daily NRS pain scores from 4.5 +/- 2.1 at baseline to 2.9 +/- 2.4 after treatment (P < 0.001) compared to the control group where no significant changes were found (4.2 +/- 1.4 to 3.9 +/- 1.5) (P = 0.733). Number needed to treat for a 50% pain reduction was 4.0. The hypnosis group also increased use of the coping strategy 'reinterpreting pain sensations' from 5.2 +/- 6.9 to 10.3 +/- 6.8 (P < 0.001). Both groups exhibited significant reductions in the number of painful muscle palpation sites and pain on palpation (P < 0.004), in number of awakenings due to pain (P < 0.006), and in somatization, obsessive compulsive symptoms and anxiety (P < 0.004). Hypnosis thus appears to effectively reduce some aspects of complex TMD pain.
... Hypnosis works through physical relaxation plus attention control. • In cancer care, hypnosis appears to be effective primarily for pain relief, analgesia, and anxiety reduction and for the control of nausea and vomiting [10][11][12]. Surgical and procedural pain also can be effectively controlled with hypnosis. In a randomized controlled trial, hypnosis was more effective in relieving pain and anxiety, and in improving hemodynamic stability, than standard care or structured attention [13]. ...
Article
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Opinion statement: A number of mind-body interventions have been studied for use with cancer patients, primarily measuring outcomes relating to pain control, anxiety reduction, and enhancing quality of life. This chapter defines the scope and characteristics of mind-body interventions, followed by a selective review of research indicating their appropriate use or cautions in cancer care. Mind-body interventions included are hypnosis, imagery/relaxation, meditation, yoga, and creative therapies. Current evidence supports the efficacy of hypnosis and imagery/relaxation for control of pain and anxiety during cancer treatments. Meditation is supported for reductions in stress and improvements in mood, quality of life, and sleep problems. There is a growing body of support for yoga from randomized controlled trials for improving quality of life, sleep, and mood. Creative therapies such as visual arts, dance, and music may help cancer patients express their feelings and cope with the demands of a cancer experience. Research on biological marker effects of mind-body therapies remains inconclusive. Study of mind-body interventions generally requires additional, methodologically rigorous investigation of how various interventions best assist patients during various phases of cancer survivorship, although a major benefit of these therapies lies in the opportunity for patients to self-select them.
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Vsak človek je enkraten. Zato moramo psihoterapijo prikrojiti enkratnosti posameznikovih potreb, ne pa ga skušati stlačiti v Prokrustovo posteljo hipotetičnih teorij o človeškem vedenju.« Milton H. Erickson (v Zeig in Gilligan, 1990, str. xix) 1 UVOD: OD HIPNOZE PREKO HIPNOTERAPIJE DO HIPNOPSIHOTERAPIJE 1.1. »Nočem. da bi me bolelo«: primer hipnopsihoterapije Miltona H. Ericksona Ker je bil psihiater in psihoterapevt Milton Hyland Erickson (1901-1980) najpomembnejši inovator na področju uporabe hipnoze v terapevtske namene v njeni celotni zgodovini (Haley, 2022; Možina, 2022), začenjam s kratkim prikazom primera iz njegove prakse. Ericksona so prosili, naj pomaga ženski, ki je zbolela za rakom in trpela skrajno hude bolečine. Metastaze so se razširile v pljuča ter po kolkih in medenici. Tudi morfij in drugi narkotiki niso zalegli, da bi ji ublažili neznosne bolečine. Ko je Erickson skupaj z lečečim zdravnikom vstopil v Cathyjino sobo, je začela s trpečim glasom ponavljati dva stavka: »Nočem, da bi me bolelo. Nočem, da me preplašite. Nočem, da bi me bolelo. Nočem, da me preplašite…« Stara je bila samo šestintrideset let in je imela tri otroke, najstarejši je dopolnil sedem let. Vedela je, da ji ostaja samo še par mesecev življenja. Erickson je takoj pritegnil njeno pozornost: »Ampak moralo vas bo boleti. Moral vas bom preplašiti. Moralo vas bo boleti. Moral vas bom preplašiti. Vendar samo malo.« Nato je Erickson Cathy sugeriral, naj ostane budna od vratu navzgor, medtem ko naj njeno telo zaspi. S prizvokom nujnosti v glasu ji je rekel: »Ne vem, zakaj. Ne vem, kaj to pomeni. Vendar vas mora začeti srbeti na podplatu.« Cathy, ki si je obupno želela olajšanje bolečine, se je sugestiji uprla: »Mi je žal, ampak ne morem razviti srbenja. Vse, kar lahko čutim, je odrevenelost pete.« Erickson je na vljuden način izrazil svoje obžalovanje, da ji ni uspelo razviti srbenja in ji nato sugeriral, naj se odrevenelost postopno razširi po celem stopalu, nogah, medenici in po možnosti do vratu. Ko se je občutek odrevenelosti povzpel do prsnega koša, je Erickson opazil: »Na mestu, kjer so vas operirali, je še vedno sveža rana. Mi je žal, ampak te bolečine ne morem odstraniti.« Cathy je sprejela njegovo obžalovanje in mu oprostila njegov »neuspeh«. Oba sta se strinjala, da je preostala bolečina dovolj majhna, da jo bo lahko prenašala. To srečanje je bilo konec februarja in do konca avgusta istega leta, ko je padla v komo in kmalu nato umrla, je bila večinoma brez bolečin. (Short, Erickson in Erickson, 2006, str. 63) 1 Tekst je bil objavljen kot poglavje v knjigi Možina, M. (2022). Hipnopsihoterapija. V N. Podgornik Pulec (ur.), Sodobne metode v psihoterapiji in energijski psihologiji (str. 127-191). Faculty of Social Sciences, University of Ss. Cyril and Methodus in Trnava. 2 Mag. Miran Možina, dr. med., spec. psihiater in psihoterapevt, supervizor in učni terapevt, je direktor ter vodja izobraževanja iz sistemske psihoterapije in hipnopsihoterapije na ljubljanski podružnici Univerze Sigmunda Freuda z Dunaja (SFU Ljubljana). Je tudi strokovni vodja ambulante za otroke in mladostnike v okviru Psihoterapevtske ambulante SFU Ljubljana. Pri svojem kliničnem delu že 35 let uporablja hipnozo.
Chapter
This textbook is written as a comprehensive overview of acute pain management. It is designed to guide clinicians through an impressive array of different options available to them and to patients. There has been a flurry of interest in the extent to which acute pain can become chronic pain, and how we might reduce the incidence of such chronicity. This overview covers a wide range of treatments for pain management, including the anatomy of pain pathways, the pathophysiology of severe pain, pain assessment, therapeutic guidelines, analgesic options, organization of pain services, and the role of anesthesiologists, surgeons, pharmacists, and nurses in providing optimal care. It also discusses the use of patient-controlled analgesia and how this may or may not be effective and useful.
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Integrative models of health care have garnered increasing attention over the years and are currently being employed within acute and secondary health care services to support medical treatments in a range of specialities. Clinical hypnosis has a history of working in partnership with medical treatments quite apart from its psychiatric associations. It aims to mobilise the mind–body connection in order to identify and overcome obstacles to managing symptoms of ill health, resulting in overall improved emotional and physical well-being. This article aims to encourage the use of hypnotherapy in physical health care by highlighting the effectiveness of hypnosis as an adjunct to medical treatment and identifying barriers preventing further integrative treatments.
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Social workers are key interdisciplinary team members who support oncology patients and their families across the continuum of cancer care, from the time of initial diagnosis through end-of-life and in multiple care settings. The roles of the emergency department (ED) and palliative care social worker are both complex and complementary in providing support to oncology patients/families in the ED. To ensure continuity of care and avoid duplication of services, social workers in the fields of ED, oncology, and palliative care work together to employ strategies and initiatives that improve cancer care across all settings. Among other positive outcomes, such interdisciplinary care serves to minimize unnecessary ED visits and hospitalizations. This chapter examines social work’s involvement with oncology patients in the ED, as well as the oncology social work’s role in the outpatient setting, and suggests psychosocial interventions that may be utilized with this population. Current and future initiatives are proposed among ED, oncology, and palliative social workers for patients/families with oncologic emergencies.
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The authors summarize research findings, their clinical implications, and directions for future research derived from 40 years of study of hypnosis, hypnotic phenomena, and hypnotic responsiveness at Steven Jay Lynn’s Laboratory of Consciousness, Cognition, and Psychopathology and Joseph P. Green’s Laboratory of Hypnosis. We discuss (a) the accumulating body of evidence that hypnosis can be used to advantage in psychotherapy; (b) the fact that hypnosis can facilitate a broad array of subjective experiences and suggestions; (c) the failure to find a reliable marker of a trance or radically altered state of consciousness and reservations about conceptualizing hypnosis in such terms; (d) determinants of hypnotic responsiveness, including attitudes and beliefs, personality traits, expectancies, motivation, and rapport; (e) efforts to modify hypnotic suggestibility; and (f) the need to further examine attentional abilities and the role of adopting a readiness response set that the authors argue is key in maximizing hypnotic responsiveness.
Distress is highly prevalent in cancer survivors, from the point of diagnosis through treatment and recovery, with rates higher than 45% reported worldwide. One approach for helping people cope with the inherent stress of cancer is through the use of mind-body therapies (MBTs) such as mediation, yoga, hypnosis, relaxation, and imagery, which harness the power of the mind to affect physical and psychological symptoms. One group of MBTs with a growing body of research evidence to support their efficacy focus on training in mindfulness meditation; these are collectively known as mindfulness-based interventions (MBIs). Research supports the role of MBIs for dealing with common experiences that cause distress around cancer diagnosis, treatment, and survivorship including loss of control, uncertainty about the future, fears of recurrence, and a range of physical and psychological symptoms including depression, anxiety, insomnia, and fatigue. Growing research also supports their cost-effectiveness, and online and mobile adaptations currently being developed and evaluated increase promise for use in a global context.
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Pain has been identified as one of the most significant factors in patients' experience of cancer and its treatment. Pain experienced during cancer treatment procedures such as radiotherapy can be unpleasant and distressing for the patient, as well as for their family and carers. Nurses have an important role in assessing and managing any pain associated with such procedures. This article explores the procedural pain that may be experienced by patients in general, and by those with cancer specifically, and details the pharmacological and non-pharmacological strategies that nurses can use to manage this challenging complication.
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In the history of the development of medical and psychological procedures, hypnosis has played a prominent role, being a valuable clinical intervention in the treatment of a wide variety of problems. However, it has not been spared controversy and myths about its nature. In the present work we review the historical development of hypnosis and the most relevant explanatory models from those who consider it an altered state of consciousness to those who argue that hypnotic phenomena can be explained by the same variables as behavior and experience Not hypnotic. We also review some of the definitions that have emerged from the different paradigms, as well as the empirical evidence of their effectiveness, proving that when used as an adjunct to medical and psychological treatments increases their effectiveness, being of special relevance the relationship Of communication between clinician and patient. It ends with a review of its application in the field of sport and the presentation of a case study (3 athletes and 1 player) in which hypnosis is used adjuvant with other techniques. In all cases optimal results are achieved.
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A New Classification of the Modified States of Consciousness. A basic understanding of the different states and stages of the consciousness and its psychological and neural correlates, is of major importance for all scientists, clinicians, psychologists and philosophers. Today clinical hypnosis and traditional oriental philosophy attract the growing interest of occidental scientists. Consciousness poses the most enigmatic problems in the science of the mind. This work presents a new classification of the neurophysiological states of consciousness. It is not only a review of the neurosciences and neuropsychological foundations of consciousness, sleep phenomena, awareness, hypnosis stages and meditative stages; it provides a new model of the current scientific studies and definitions. This new theory is based on a new perspective to consider the modified states of consciousness as different states of attention and concentration. The purpose of the present new classification, is to focus on the relationship between concentration, hypnosis, meditative stages and awareness.
Chapter
Social workers are key interdisciplinary team members who support oncology patients and their families across the continuum of cancer care, from the time of initial diagnosis through end-of-life and in various care settings. The roles of the emergency department (ED) and palliative care social worker are both complex and complementary in providing support to oncology patients/families in the ED. To ensure continuity of care and avoid duplication of services, social workers in the fields of ED, oncology, and palliative care work together to employ strategies and initiatives that improve cancer care across all settings. Among other positive outcomes, such interdisciplinary care serves to minimize unnecessary ED visits and hospitalizations. This chapter examines social work’s involvement with oncology patients in the ED, as well as the oncology social work role in the outpatient setting, and suggests psychosocial interventions that may be utilized with this population. Current and future initiatives are proposed among ED, oncology and palliative social workers for patients/families with oncologic emergencies.
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Epidural analgesia is a widely accepted analgesic technique for the treatment of postoperative pain. Compared to parenteral opioids, epidural analgesia in general will provide superior analgesia and may confer certain physiologic benefits, including attenuation of perioperative pathophysiologies, which may ultimately contribute to a decrease in perioperative morbidity or even mortality. High-risk surgical patients, such as those who are elderly, have decreased physiologic reserve or, undergoing certain procedures, may especially benefit from postoperative epidural analgesia. However, postoperative epidural management must be optimized to achieve any improvement in postoperative outcomes. Despite the potential benefits of postoperative epidural analgesia, the superiority of epidural analgesia compared to parenteral opioids is somewhat uncertain, which may be related to conflicting results of relatively small randomized controlled trials (RCTs) and other methodological issues. However, we limit our focus to larger RCTs, meta-analyses of RCTs, and large databases in an attempt to elucidate the benefits of postoperative epidural analgesia on conventional outcomes (eg, mortality, major morbidity) and patient-reported outcomes (eg, satisfaction, quality of recovery, and analgesia). Mortality: The overall advances in anesthesia care have significantly decreased the incidence of mortality since the late 1960s, as reflected in the Institute of Medicine report on medical errors (ie, “anesthesiology has successfully reduced anesthesia mortality rates from two deaths per 10,000 anesthetics administered, to one death per 200,000–300,000 anesthetics administered”). © Cambridge University Press, 2009 and Raymond S. Sinatra, Oscar A. de Leon-Casasola, Brian Ginsberg, Eugene R. Viscusi 2009.
Article
Introduction: There is an ever reoccurring question in medical practice: Does the positive attitude and communication of the medical staff make any diff erence? Aim: Our aim is to present a comprehensive overview of the medically relevant eff ects of positive suggestions by reviewing the recent literature. Methods: We will review the studies measuring the eff ects of suggestive communication of the past 20 years. In cases of studies presented in more details we quote from the suggestion scripts used in the study, too. Results: Some of the reviewed papers report that positive suggestions lead to decreased pain and use of pain medication and positively aff ect physiological factors like bowel motility, blood pressure and bleeding during surgery as well. However, the literature also contains studies in which only partial or no positive eff ects were found. Conclusions: We emphasize further, more detailed investigation of positive suggestion techniques and its integration into the education of medical professionals.
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Pain is a symptom associated with prolonged recovery from illness and procedures, decreased quality of life, and increased health-care costs. While there have been advances in the management of cancer pain, there is a need for therapeutic strategies that complement pharmaceutical management without significantly contributing to the side-effect profile of these agents. Hypnosis provides a safe and efficacious supplement to pharmaceutical management of cancer pain. One barrier to the regular use of hypnosis is health-care providers' lack of current knowledge of the efficacy and safety of hypnosis. Advanced practitioners who are well-informed about hypnosis have an opportunity to increase the treatment options for patients who are suffering with cancer pain by suggesting to the health-care team that hypnosis be incorporated into the plan of care. Integration of hypnosis into the standard of care will benefit patients, caregivers, and survivors by reducing pain and the suffering associated with it.
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Humans are a part of the complex system including both natural and cultural-technological environment. Evolution of this system included self-amplifying feedbacks that lead to the appearance of human conscious mind. We describe the current state of the understanding of human brain evolution that stresses neurohormonal and biochemical changes rather than simple increase of anatomical substrate for the mind. It follows that human brain is strongly influenced by the state of the body and may operate at various levels of consciousness depending on its biochemical environment created by ingestion of various substances and by specific physical activities. Through the study of the widespread phenomenon of shamanism that uses mind-altering practices we argue that altered states of consciousness and non-local minds are not only real phenomena, but that they are products of natural evolution, valuable for human survival and development. Consideration of altered states of consciousness and broadening of the framework for understanding brain function beyond mechanistic interpretations is necessary to further develop human adaptations and provide a better way of fitting humans as parts of the interconnected system into the global and universal patterns.
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A hipnose clínica é uma técnica terapêutica segura e eficaz. É mais eficaz do que qualquer outra técnica psicológica no controlo da dor (Patterson & Jensen, 2003), e quando usada como coadjuvante das intervenções psicoterapeuticas aumenta a eficácia destes tratamentos. (Kirsch, Montgomery, & Sapirstein, 1995). Contudo esta técnica não é largamente usada pelos profissionais. A que se deve este paradoxo? A resposta encontra-se na história e na cultura popular que originaram um preconceito em relação à hipnose onde esta tem sido vista no contexto da magia e da superstição. Os indivíduos hipnotizados são frequentemente retratados como zombies que perderam a capacidade de controlar as suas acções. Não espanta pois que a hipnose seja receada e evitada. É neste contexto que O ESSENCIAL SOBRE A HIPNOSE: TEORIAS, MITOS, APLICAÇÕES CLÍNICAS E INVESTIGAÇÃO é particularmente bem-vindo. A Drª Cláudia Carvalho, a maior especialista em Portugal na ciência da hipnose, sumaria o que o que se sabe actualmente a partir da investigação científica acerca da natureza e prática da hipnose. A Drª Cláudia Carvalho dissipa os mitos que envolvem esta área de estudos e que a impedem de obter uma maior aceitação, e examina cuidadosamente as provas da sua eficácia clínica. O resultado é um livro que deve ser lido por todos os profissionais e estudantes da área da saúde, dado que oferece uma introdução a uma técnica empiricamente testada que é fácil de aprender e que pode resultar em grande benefício dos pacientes. Irving Kirsch, PhD
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This article details a self-hypnosis technique designed to teach patients how to manage acute or chronic pain through directed focus. The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis. The case examples demonstrate how the focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective.
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Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care. The hypnosis intervention reduced the anxiety associated with procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain. The authors explain this latter finding as indicating that the sensory component of a patient's pain experience may be of lesser importance than the affective component. The authors describe future studies to clarify their results and address the limitations of this study.
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In the cancer setting, e-counseling interventions may be uniquely beneficial as they spare patients the cost and burden of traveling to a hospital or clinic for psychosocial care. However, the prevalence of e-counseling among psychosocial cancer care providers is unknown, as are the training needs with regard to e-counseling among this group of professionals. Thus, our group conducted an online professional training needs assessment with psychosocial cancer care providers. Participants (n=120) were recruited from the listservs of the Health Psychology Division of the American Psychological Association, the Society of Behavioral Medicine-Cancer Special Interest Group, the American Psychosocial Oncology Society, and the Association of Oncology Social Work. All completed a 14-item online survey. Although 84% of participants stated that e-counseling could be important to their clinical work with cancer patients and survivors, 88% reported that they did not have the skills to effectively conduct e-counseling, and 81% reported that there were no adequate e-counseling educational opportunities. When asked about future training opportunities, participants reported a preference for online training versus live training (p<0.001). Overall, the results highlight the need for online training programs in e-counseling for psychosocial cancer care providers. The training of psychosocial cancer care providers in e-counseling is a critical first step towards increasing implementation of e-counseling interventions and using the Internet to deliver effective interventions to cancer patients in need.
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Novel advances in biotechnology and medical imaging techniques have enabled an evolution toward earlier diagnosis and treatment by way of "minimally invasive" surgical techniques performed on the conscious patient without the use of general anesthesia. Although the risks of diagnostic and therapeutic interventions have been reduced with these approaches, patients still face many physical and psychologic challenges. Several randomized controlled trials have shown that hypnotic techniques are effective in reducing pain, anxiety, and other symptoms; in reducing procedure time; and in stabilizing vital signs. The benefits of adjunctive hypnotic treatments come at no additional cost. Patients, health care providers, hospitals, and insurance companies are advised to take advantage of hypnotic techniques.
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Fear of death, pain, or the recurrence of the illness of tumor patients can narrow their attention to a point where a spontaneous altered state of consciousness occurs. In these cases hypnosis either in formal psychotherapy or embedded into the everyday communication with the physician can effectively complement other already known medical and psychological techniques. Although numerous studies have reported the beneficial physical and mental changes induced by hypnosis, for a long time there were not enough research to affect evidence-based medicine. New studies meeting the most rigorous methodological standards, new reviews and the characteristics of hypnosis shown by neuroimaging techniques support the acceptance of this method. Hypnosis is used and studied with adult and child tumor patients alike mostly in the areas of anxiety, pain, nausea, vomiting, quality of life, mood amelioration, immune system and hot flushes. Most of the assays describe hypnosis as an empirically validated treatment technique that in most cases surpass attention diversion, coping trainings, cognitive behavior and relaxation techniques and other regular treatments. In this paper we review these observations.
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Adults age 55 and older with hematological malignancies who require hematopoietic cell transplantation (HCT) for survival are at risk for a number of nonmalignancy-related, potentially life-threatening outcomes, often due to suboptimal immune function. Evidence is emerging regarding how abnormal glycemic levels-newly termed malglycemia-impair cells of the immune system. Further, older adult HCT recipients appear highly susceptible to malglycemic states, particularly hyperglycemia, due to treatment regimens, nutritional imbalances, states of immobility, and stress, all coupled with the natural aging process. Patients with preexisting diabetes may be at further risk for malglycemic states. The growing number of older adults receiving HCT will substantially increase the likelihood nurses will have to provide care to HCT survivors. Therefore, it is important nurses in all practice settings have an understanding of the short-and long-term effects of glycemic status on immune function.
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The effects of four empirically supported therapeutic relationship factors (therapeutic alliance, empathy, goal consensus/collaboration, and group cohesion) on the outcome of psychotherapeutic interventions conducted with individuals living with cancer were systematically reviewed. PubMed, PsycINFO, and CINAHL were searched from their inception through November 13, 2008. Studies of psychotherapeutic interventions targeted to individuals living with cancer, which also empirically assessed the association between any of these therapeutic relationship factors and psychotherapy outcome were included in the review (8 of 742 papers initially reviewed). Information on study methodology and results were abstracted independently by the authors using a standardized form. Results indicated that therapist-rated rapport and group cohesion were significantly related to positive psychotherapeutic outcomes. No studies examined empathy. The literature on collaboration was mixed, but showed some support for increased collaboration being related to positive therapeutic outcomes. Overall the current literature on the role of therapeutic relationship factors in the context of individuals living with cancer is scant, and much more research is needed to determine the overall contribution of these four relationship elements to the outcomes of psychotherapeutic interventions for individuals living with cancer. Results of such studies could have important clinical and research implications.
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Three articles of special interest to the hypnosis community recently appeared in the general scientific and medical literatures. The first paper is a thoughtful review of the clinical applications of hypnosis in pediatric settings. The second article reports the findings of a randomized, controlled trial of hypnosis for burn-wound care, carried out at the University of Washington Medical School. The third article describes an innovative EEG laboratory case study tracking the cortex functional connectivity of a highly hypnotizable subject across various baseline and experimental conditions. These three articles are sturdy examples of how hypnosis illuminates (and is illuminated by) medical and psychological science.
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The clinical utility of hypnosis for controlling pain during burn wound debridement was investigated. Thirty hospitalized burn patients and their nurses submitted visual analog scales (VAS) for pain during 2 consecutive daily wound debridements. On the 1st day, patients and nurses submitted baseline VAS ratings. Before the next day's would debridement, Ss received hypnosis, attention and information, or no treatment. Only hypnotized Ss reported significant pain reductions relative to pretreatment baseline. This result was corroborated by nurse VAS ratings. Findings indicate that hypnosis is a viable adjunct treatment for burn pain. Theoretical and practical implications and future research directions are discussed.
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To determine the effect of adjuvant psychological therapy on the quality of life of patients with cancer. Prospective randomised controlled trial comparing the quality of life of patients receiving psychological therapy with that of patients receiving no therapy, measured before therapy, at eight weeks, and at four months of follow up. CRC Psychological Medicine Group of Royal Marsden Hospital. 174 patients aged 18-74 attending hospital with a confirmed diagnosis of malignant disease, a life expectancy of at least 12 months, or scores on various measures of psychological morbidity above previously defined cut off points. Adjuvant psychological therapy, a brief, problem focused, cognitive-behavioural treatment programme specifically designed for the needs of individual cancer patients. Hospital anxiety and depression scale, mental adjustment to cancer scale, Rotterdam symptom checklist, psychosocial adjustment to illness scale. 156 (90%) patients completed the eight week trial; follow up data at four months were obtained for 137 patients (79%). At eight weeks, patients receiving therapy had significantly higher scores than control patients on fighting spirit and significantly lower scores on helplessness, anxious preoccupation, and fatalism; anxiety; psychological symptoms; and on orientation towards health care. These differences indicated improvement in each case. At four months, patients receiving therapy had significantly lower scores than controls on anxiety; psychological symptoms; and psychological distress. Clinically, the proportion of severely anxious patients dropped from 46% at baseline to 20% at eight weeks and 20% at four months in the therapy group and from 48% to 41% and to 43% respectively among controls. The proportion of patients with depression was 40% at baseline, 13% at eight weeks, and 18% at four months in the therapy group and 30%, 29%, and 23% respectively in controls. Adjuvant psychological therapy produces significant improvement in various measures of psychological distress among cancer patients. The effect of therapy observed at eight weeks persists in some but not all measures at four month follow up.
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Drawing on the literature reviews of this special issue of the International Journal of Clinical and Experimental Hypnosis (2000), this article summarizes the evidence for the effectiveness of hypnosis as an empirically supported clinical intervention. As a whole, the clinical research to date generally substantiates the claim that hypnotic procedures can ameliorate some psychological and medical conditions, as judged against the Chambless and Hollon methodological guidelines. In many cases, these clinical procedures can also be quite cost-effective. It is probable that with some key empirical refinement a number of other hypnosis treatment protocols will have sufficient empirical documentation to be considered "well-established." However, it is noted that the Chambless and Hollon guidelines are not particularly well-suited for assessing hypnosis' impact when used adjunctly with other interventions. The article concludes with recommendations regarding the efficacy questions that need to be more fully addressed empirically and offers methodological guidelines for researchers and practitioners.
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Over the past two decades, hypnoanalgesia has been widely studied; however, no systematic attempts have been made to determine the average size of hypnoanalgesic effects or establish the generalizability of these effects from the laboratory to the clinic. This study examines the effectiveness of hypnosis in pain management, compares studies that evaluated hypnotic pain reduction in healthy volunteers vs. those using patient samples, compares hypnoanalgesic effects and participants' hypnotic suggestibility, and determines the effectiveness of hypnotic suggestion for pain relief relative to other nonhypnotic psychological interventions. Meta-analysis of 18 studies revealed a moderate to large hypnoanalgesic effect, supporting the efficacy of hypnotic techniques for pain management. The results also indicated that hypnotic suggestion was equally effective in reducing both clinical and experimental pain. The overall results suggest broader application of hypnoanalgesic techniques with pain patients.
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In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies. The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis. In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients. The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.
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Efforts to increase the practice of evidence-based psychotherapy in the United States have led to the formation of task forces to define, identify, and disseminate information about empirically supported psychological interventions. The work of several such task forces and other groups reviewing empirically supported treatments (ESTs) in the United States, United Kingdom, and elsewhere is summarized here, along with the lists of treatments that have been identified as ESTs. Also reviewed is the controversy surrounding EST identification and dissemination, including concerns abou research methodology, external validity, and utility of EST research, as well as the reliability and transparency of the EST review process.
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Metastatic breast cancer carries with it considerable psychosocial morbidity. Studies have shown that some patients with metastatic breast cancer experience clinically significant anxiety and depression and traumatic stress symptoms. Supportive-expressive group psychotherapy was developed to help patients with cancer face and adjust to their existential concerns, express and manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control. Of 125 women with metastatic breast cancer recruited into the study, 64 were randomized to the intervention and 61 to the control condition. Intervention women were offered 1 year of weekly supportive-expressive group therapy and educational materials. Control women received educational materials only. Participants were assessed at baseline and every 4 months during the first year. Data at baseline and from at least 1 assessment were collected from 102 participants during this 12-month period, and these participants compose the study population. Primary analyses based on all available data indicated that participants in the treatment condition showed a significantly greater decline in traumatic stress symptoms on the Impact of Event Scale (effect size, 0.25) compared with the control condition, but there was no difference in Profile of Mood States total mood disturbance. However, when the final assessment occurring within a year of death was removed, a secondary analysis showed a significantly greater decline in total mood disturbance (effect size, 0.25) and traumatic stress symptoms (effect size, 0.33) for the treatment condition compared with the control condition. Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.
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Many patients experience some degree of anxiety and/or discomfort during dermatologic procedures. For most patients this anxiety or discomfort is tolerable, but a few find it intolerable to the point of interference with the accomplishment of the procedure. A case is presented in which a 51 -year-old female experienced so much anxiety that it jeopardized the continuation of a necessary procedure. When (with her consent) a trance state was induced through hypnosis, she relaxed and remained in a pleasant mental condition for the remainder of the procedure. This case illustrates the usefulness of hypnosis in selected situations where it can alleviate anxiety and discomfort associated with dermatologic procedures. Suggested trance induction, maintenance, and termination scripts are included to assist those with adequate training and experience in providing this comfort to selected patients through hypnosis.
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Empirically supported therapy (EST) has become a major focus and trend for mental health practice. When hypnosis is involved, this may mean satisfying a standard that is entirely too narrow in its emphasis. In this article "efficacy"-based research in clinical practice is contrasted with "effectiveness" -focused research, and they are discussed from the perspective of hypnosis. When clinicians can consider trans-theoretical factors as well as those that are treatment-enhancing, possibilities for improved treatment outcome increase. The "effectiveness" perspective also serves as a counter point for hypnosis in contrast with the dubious efficacy-based gold standard currently proposed for therapy in general, and hypnosis in particular.
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Objective: Voiding cystourethrography (VCUG) is a commonly performed radiologic procedure in children that can be both painful and frightening. Given the distress that some children experience during the VCUG and the need for children to be alert and cooperative during the procedure, finding a psychological intervention that helps children to manage anxiety, distress, and pain is clearly desirable. This study was designed to examine whether relaxation and analgesia facilitated with hypnosis could reduce distress and procedure time for children who undergo this procedure. Methods: Forty-four children who were scheduled for an upcoming VCUG were randomized to receive hypnosis (n = 21) or routine care (n = 23) while undergoing the procedure. The sample consisted of 29 (66%) girls and 15 (34%) boys with a mean age of 7.6 years (SD: 2.5; range: 4-15 years). Ethnic/racial backgrounds were 72.7% white, 18.2% Asian, 4.5% Latino, 2.3% black, and 2.3% Filipino. The mean number of previous VCUGs was 2.95 (SD: 2.51; mode: 2; range: 1-15). Potential participants were identified through computerized hospital records of upcoming VCUGs. Parents were contacted by telephone and invited to participate if their child was eligible. To be eligible for the study, the child must have undergone at least 1 previous VCUG, been at least 4 years of age at that time, and experienced distress during that procedure, and both the child and the participating parent had to be English speaking. Each eligible child and parent met with the research assistant (RA) before the day of the scheduled procedure for an initial assessment. Children were queried regarding the degree of crying, fear, and pain that they had experienced during their most recent VCUG. Parents completed a series of parallel questions. Immediately after this assessment, those who were randomized to the hypnosis condition were given a 1-hour training session in self-hypnotic visual imagery by a trained therapist. Parents and children were instructed to practice using the imaginative self-hypnosis procedure several times a day in preparation for the upcoming procedure. The therapist was also present during the procedure to conduct similar exercises with the child. The majority (83%) of those who were randomized to the routine care control group chose to participate in a hospital-provided recreation therapy program (offered as part of routine care). The program includes demonstration of the procedure with dolls, relaxation and breath work training, and assistance during the procedure. On the day of the VCUG, the RA met the family at the clinic before the procedure, and both the child and the parent rated the child's present level of fearfulness. During the procedure, the RA recorded observational ratings of the child's emotional tone and behavior and timed the overall procedure and its phases. Immediately after the VCUG, the child was asked how much crying, fear, and pain he or she had experienced during the procedure; the parent rated the child's experience on the same dimensions and also how traumatic the procedure had been (both generally and compared with their previous one), and the medical staff rated the degree of procedural difficulty. Outcomes included child reports of distress during the procedure, parent reports of how traumatic the present VCUG was compared with the previous one, observer ratings of distress during the procedure, medical staff reports of the difficulty of the procedure overall, and total procedural time. Results: Results indicate significant benefits for the hypnosis group compared with the routine care group in the following 4 areas: (1) parents of children in the hypnosis group compared with those in the routine care group reported that the procedure was significantly less traumatic for their children compared with their previous VCUG procedure; (2) observational ratings of typical distress levels during the procedure were significantly lower for children in the hypnosis condition compared with those in the routine care condition; (3) medical staff reported a significant difference between groups in the overall difficulty of conducting the procedure, with less difficulty reported for the hypnosis group; and (4) total procedural time was significantly shorter-by almost 14 minutes-for the hypnosis group compared with the routine care group. Moderate to large effect sizes were obtained on each of these 4 outcomes. Conclusions: Hypnotic relaxation may provide a systematic method for improving the overall medical care of children with urinary tract abnormalities and may be beneficial for children who undergo other invasive medical procedures. Because the VCUG is an essential part of the evaluation of urinary tract infections and vesicoureteral reflux in children, lower distress during the procedure may improve patient and family compliance with initial as well as follow-up evaluations. These findings augment the accumulating literature demonstrating the benefits of using hypnosis to reduce distress in the pediatric setting. The present findings are noteworthy in that this study was a controlled, randomized trial conducted in a naturalistic medical setting. In this context, we achieved a convergence of subjective and objective outcomes with moderate to large effect sizes, including those that may have an impact on patient care and procedure cost, that were consistently supportive of the beneficial effects of hypnosis-a noninvasive intervention with minimal risk. The findings, therefore, have immediate implications for pediatric care. Limitations of this study include the lack of participant and staff blindness to the child's condition assignment, which could have introduced bias into reports. However, the objective procedural time differences between groups were consistent with the other, more subjective outcome findings. The sample was also small and primarily white in ethnic/racial makeup, which may have restricted our ability to detect some differences and may limit the generalizability of findings to more representative samples. In addition, the sample comprised children who had already undergone at least 1 VCUG during which they had had difficulty. Consequently, additional research is needed to determine whether hypnosis would be helpful to those who are undergoing their first VCUG. Additional limitations, clinical observations, and directions for future research are also discussed.
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To determine whether hypnotherapy reduces anxiety and improves the quality of life in cancer patients undergoing curative radiotherapy (RT). After providing written informed consent, 69 patients were randomized between standard curative RT alone (36 controls) and RT plus hypnotherapy (33 patients). Patients in the hypnotherapy group received hypnotherapy at the intake, before RT simulation, before the first RT session, and halfway between the RT course. Anxiety was evaluated by the State-Trait Anxiety Inventory DY-1 form at six points. Quality of life was measured by the Rand Medical Outcomes Study 36-item Health Survey (SF-36) at five points. Additionally, patients answered a questionnaire to evaluate their experience and the possible benefits of this research project. No statistically significant difference was found in anxiety or quality of life between the hypnotherapy and control groups. However, significantly more patients in the hypnotherapy group indicated an improvement in mental (p <0.05) and overall (p <0.05) well-being. Hypnotherapy did not reduce anxiety or improve the quality of life in cancer patients undergoing curative RT. The absence of statistically significant differences between the two groups contrasts with the hypnotherapy patients' own sense of mental and overall well-being, which was significantly greater after hypnotherapy. It cannot be excluded that the extra attention by the hypnotherapist was responsible for this beneficial effect in the hypnotherapy group. An attention-only control group would be necessary to control for this effect.
Article
Objective. - To provide physicians with a responsible assessment of the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. Participants. - A nonfederal, nonadvocate, 12- member panel representing the fields of family medicine, social medicine, psychiatry, psychology, public health, nursing, and epidemiology. In addition, 23 experts in behavioral medicine, pain medicine, sleep medicine, psychiatry, nursing, psychology, neurology, and behavioral and neurosciences presented data to the panel and a conference audience of 528 during a 1 1/4 - day public session. Questions and statements from conference attendees were considered during the open session. Closed deliberations by the panel occurred during the remainder of the second day and the morning of the third day. Evidence. - The literature was searched through MEDLINE, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. Assessment Process. - The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. Conclusions. - A number of well-defined behavioral and relaxation interventions now exist and are effective in the treatment of chronic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions as well as strong evidence for the use of hypnosis in alleviating pain associated with cancer. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. Regarding insomnia, behavioral techniques, particularly relaxation and biofeedback, produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant.
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Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post-chemotherapy nausea and emesis. In this study, 67 bone marrow transplant patients with hematological malignancies were randomly assigned to one of four groups prior to beginning transplantation conditioning: 1.(1) hypnosis training (HYP);2.(2) cognitive behavioral coping skills training (CB);3.(3) therapist contact control (TC); or4.(4) treatment as usual (TAU; no treatment control). Patients completed measures of physical functioning (Sickness Impact Profile; SIP) and psychological functioning (Brief Symptom Inventory; BSI), which were used as covariates in the analyses. Biodemographic variables included gender, age and a risk variable based on diagnosis and number of remissions or relapses. Patients in the HYP, CB and TC groups met with a clinical psychologist for two pre-transplant training sessions and ten in-hospital “booster” sessions during the course of transplantation. Forty-five patients completed the study and provided all covariate data, and 80% of the time series outcome data. Analyses of the principal study variables indicated that hypnosis was effective in reducing reported oral pain for patients undergoing marrow transplantation. Risk, SIP, and BSI pre-transplant were found to be effective predictors of inpatient physical symptoms. Nausea, emesis and opioid use did not differ significantly between the treatment groups. The cognitive behavioral intervention, as applied in this study, was not effective in reducing the symptoms measured.
Article
Goals of work: Prevention of chemotherapy-induced nausea and vomiting (CINV) with standard antiemetics has been more difficult to achieve in female patients. Data from two phase III trials of the NK1 antagonist aprepitant were assessed for potential effect of gender on treatment response. Patients and methods: 1,044 patients receiving cisplatin (> or = 70 mg/m2) were randomly assigned to control regimen [ondansetron (O) 32 mg i.v. and dexamethasone (D) 20 mg p.o. on day 1; D 8 mg twice daily on days 2-4] or aprepitant (A) regimen (A 125 mg p.o. plus O 32 mg and D 12 mg on day 1; A 80 mg and D 8 mg once daily on days 2-3; and D 8 mg on day 4). The primary endpoint was overall complete response (no emesis and no rescue therapy over days 1-5). Data were analyzed by a modified intent-to-treat approach. Between-treatment comparisons for each gender were made using logistic regression. Main results: Women comprised 42 and 43% of the aprepitant and control groups, respectively. In the control group, 41% of women had overall complete response compared with 53% of men. In the aprepitant group, 66% of women had overall complete response compared with 69% of men. Conclusion: The addition of aprepitant may negate the adverse prognostic effect of female gender on the prevention of CINV in patients receiving highly emetogenic chemotherapy.
Article
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. Copyright © 2001 British Society of Experimental and Clinical Hypnosis
Article
This article discusses the likelihood of the empirically supported treatment (EST) movement impacting the practice of psychosocial oncology, with the goal of raising awareness of these issues and encouraging debate within the psychosocial oncology research and practice community. In 1993, the American Psychological Association struck a task force to develop criteria for empirically evaluating psychological interventions. The Clinical Psychology (Division 12) Task Force now evaluates psychological interventions and publishes an updated list of ESTs on a yearly basis. Concerns raised about the EST movement in psychology have included difficulties with the terminology and process of the Task Force, problems with the methodology used in psychotherapy research, and with the possible practical implications of the Task Force list of EST. A review of the literature suggests that psychosocial interventions in oncology are currently beginning to be evaluated by the EST criteria and that the reviewed interventions have yet to attain EST status. Following from this review, it is argued that researchers and practitioners in psychosocial oncology should become aware of the standards established by the Division 12 Task Force and that future psycho-oncology intervention research may need to be designed to meet those standards. The discipline of psychosocial oncology is encouraged to consider the possible implications of accepting or not accepting the EST criteria. Copyright © 2001 John Wiley & Sons, Ltd.
Article
Rapid assessment of patient anxiety is necessary to insure quality care. A number of self-report measures provide valid and reliable measures of anxiety. These measures can be timeconsuming to complete, however, and may be burdensome to medical patients who are in pain or acute anxiety states. Many medical procedures are performed in conditions in which written measures are cumbersome (e.g. patient in supine position), and scoring and interpretation of written measures in a busy clinical setting may be difficult for medical personnel. The present study provides validity data for a verbally administered (0–10) anxiety rating. One hundred and ninety-eight adult interventional radiology patients completed standard measures assessing state anxiety, trait Negative and Positive Affect, and the dimensions of the five-factor model of personality. Verbal anxiety rating was highly correlated with Spielberger’s State Anxiety Inventory, showed moderate correlations to the related constructs of neuroticism and trait Negative Affect, and was largely unrelated to theoretically distinct constructs. Verbal anxiety ratings made prior to the invasive procedure also predicted pain and anxiety during the procedure. The verbal anxiety rating also demonstrated sensitivity to changes in anxiety that occurred as a result of changes in situation. Findings support the convergent and discriminant validity of verbal anxiety ratings.
Article
Rationale and Objectives.Imagery as a hypnotic technique can produce analgesia and anxiolysis, but effective use may be restricted to select, highly hypnotizable individuals. This study assessed (a) whether patients not selected for hypnotizability can produce imagery during interventional radiologic procedures and (b) the type of imagery produced. A secondary goal of the study was to familiarize health care providers with a simple, time-efficient technique for imagery.Materials and Methods.Fifty-six nonselected patients referred for interventional procedures were guided to a state of self-hypnotic relaxation by a health care provider according to a standardized protocol and script. Patient hypnotizability was assessed according to the Hypnotic Induction Profile test.Results.Patients as a group had average distribution of hypnotizabilty. The induction script was started in all patients and completed in 53. All patients developed an imagery scenario. Chosen imagery was highly individual, but common trends were nature and travel, family and home, and personal skills. Being with loved ones was an important element of imagery for 14 patients. Thirty-two patients chose passive contemplation, and 24 were action oriented.Conclusion.Average patients who present for interventional radiologic procedures and are not preselected for hypnotizabilty can engage in imagery. Topics chosen are highly individual, thus making prerecorded tapes or provider-directed imagery unlikely to be equally successful.
Article
Twenty-two studies on the effects of psychological treatment on cancer patients are reviewed. Only studies that compared one or more experimental conditions with at least one control group have been considered. The studies were evaluated with respect to a) research methods, b) psychological interventions, and c) results. Tailored counseling has been shown to be effective with respect to distress, self-concept, (health) locus of control, fatigue, and sexual problems. Structured counseling showed positive effects with respect to depression and distress. Behavioral interventions and hypnosis were effective with respect to specific symptoms such as anxiety, pain, nausea, and vomiting. The research methods, interventions and results of the studies are reviewed critically. Several recommendations for future research are made.
Article
Fifty-four pediatric cancer patients were studied to determine the relative efficacy of two forms of behavioral intervention for reducing chemotherapy-related distress. Following baseline assessment, subjects were randomly assigned to receive either hypnosis, non-hypnotic distraction/relaxation, or attention placebo (control) during the subsequent identical chemotherapy course. Observational and interview measures of anticipatory and postchemotherapy nausea, vomiting, distress, and functional disruption served as outcome data. Results indicated that treatment condition was the single best predictor of change from baseline to intervention, with children in the hypnosis group reporting the greatest reduction of both anticipatory and postchemotherapy symptoms. The cognitive distraction/relaxation intervention appeared to have a maintenance effect in which symptoms did not get much worse or much better, while children in the control group had symptoms that consistently became worse over time. Emetic potential of the chemotherapy and the prophylactic use of antiemetics each appeared to contribute to the overall severity of symptoms. While the efficacy of hypnosis in the management of chemotherapy distress is supported, the complexities of interacting biologic and psychologic factors are highlighted.
Article
Hypnotherapy has increasingly been included in the management of burn patients, particularly in the area of acute pain. To better understand such issues as (1) overall efficacy of hypnotherapy to alleviate acute burn pain, (2) instances in which hypnotherapy is contraindicated, (3) interaction of hypnotherapy with medication, (4) standard induction techniques to use with various age groups, (5) role of nursing and other staff in facilitating hypnotic effects, and (6) future methodological directions, we examined the clinical and methodological merits of recent studies of hypnoanalgesia. Through a computer search of the medical literature and cross-referencing recent bibliographies, we were able to find 17 studies in which hypnotherapy was applied to the management of burns. The literature generally supports the efficacy of this approach to reduce burn pain; however, little else can be concluded from these studies. Several recent studies have applied hypnotherapy to aspects of burn care other than pain using excellent experimental designs. It is suggested that future studies of acute pain management follow suit.
Article
The pain and mood disturbance of 54 women with metastatic carcinoma of the breast were studied over the course of one year. A random sample was offered weekly group therapy during the year, with or without self-hypnosis training directed toward enhancing their competence at mastering pain and stress related to cancer. Both treatment groups demonstrated significantly less self-rated pain sensation (t = 2.5 p less than 0.02) and suffering (t = 2.17, p less than 0.03) than the control sample. Those who were offered the self-hypnosis training as well as group therapy fared best in controlling the pain sensation (F = 3.1, p less than 0.05). Pain frequency and duration were not affected. Changes in pain measures were significantly correlated with changes in self-rated total mood disturbance on the Profile of Mood States and with its anxiety, depression, and fatigue subscales. Possible mechanisms for the effectiveness of these interventions are discussed.
Article
50 cancer patients receiving chemotherapy (25 by push injection and 25 by drip infusion) were assigned to 1 of 3 conditions for their chemotherapy treatments: (a) progressive muscle-relaxation training plus guided-relaxation imagery; (b) therapist control, in which a therapist was present to provide support and encouragement but did not provide systematic relaxation training; and (c) no-treatment control. Ss participated in 1 pretraining, 3 training, and 1 follow-up session. Results indicate that during the training sessions, Ss who received relaxation training (a) reported feeling significantly less anxious and nauseated during chemotherapy, (b) showed significantly less physiological arousal and reported less anxiety and depression immediately after chemotherapy, and (c) reported significantly less severe and less protracted nausea at home following chemotherapy. Data suggest that relaxation training may be an effective procedure for helping cancer patients cope with the adverse effects of their chemotherapy. (28 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Children and adolescents with cancer, chiefly forms of leukemia, aged 6 to 19 years, underwent medical treatments which required repeated bone marrow aspirations, normally a painful and anxiety-provoking experience. Data were obtained in baseline bone marrow observations on 63 patients, who were then offered the opportunity to volunteer for hypnotic help in pain control. Of the 24 patients who accepted hypnosis, 19 were highly hypnotizable. 10 of the 19 reduced self-reported pain substantially by the first hypnotic treatment (the prompt pain reducers) and 5 more reduced self-reported pain by the second treatment (the delayed pain reducers) while none of the 5 less hypnotizable patients accomplished this. The latter benefitted by reducing anxiety. Short case reports illustrate the variety of experiences.Analysis of baseline observations before any therapeutic intervention revealed age and sex differences. The difference between self-reported and observed pain was not statistically significant for patients under age 10 but was significant for the patients age 10 and older (p < .001). There were minor but significant sex differences both in observed pain (p < .01) and in self-reported pain (p < .05), with the females reporting more pain.
Article
This is a review of the systematic studies conducted since 1980 in the area of hypnotic interventions for anxiety, pain, and emesis control in child and adolescent cancer patients. The focus of the present paper is on how the problems encountered in studying the use of hypnosis with this population influence the results. The review is divided between studies focused on controlling anxiety and pain and those focused on controlling nausea and vomiting. Consistent findings are identified, and suggestions for future research are made.
Article
To study the effectiveness of hypnosis for decreasing antiemetic medication usage and treatment of chemotherapy-related nausea and vomiting in children with cancer, we conducted a prospective, randomized, and controlled single-blind trial in 20 patients receiving chemotherapy for treatment of cancer. Patients were randomized to either hypnosis or standard treatment. The hypnosis group used hypnosis as primary treatment for nausea and vomiting, using antiemetic medication on a supplemental (p.r.n.) basis only, whereas the control group received a standardized antiemetic medication regimen. Nausea, vomiting, and p.r.n. antiemetic medication usage were measured during the first two courses of chemotherapy. Anticipatory nausea and vomiting were assessed at 1 to 2 and 4 to 6 months postdiagnosis. Patients in the hypnosis group used less p.r.n antiemetic medication than control subjects during both the first (p < .04) and second course of chemotherapy (p < .02). The two groups did not differ in severity of nausea and vomiting. The hypnosis group experienced less anticipatory nausea than the control group at 1 to 2 months postdiagnosis (p < .02). Results suggest self-hypnosis is effective for decreasing antiemetic medication usage and for reducing anticipatory nausea during chemotherapy.
Article
Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment. This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants (BMT): (1) treatment as usual control, (2) therapist support, (3) relaxation and imagery training, and (4) training in a package of cognitive-behavioral coping skills which included relaxation and imagery. A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week 'booster' sessions during the first 5 weeks of treatment. Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive-behavioral coping skills would report less pain than patients in the other 2 groups. The hypothesis that the cognitive-behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed. Average visual analogue scale (VAS) report of pain within the therapist support group was not significantly lower than the control group (P = 0.103) nor significantly higher than the training groups. Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports. From these results, we conclude that relaxation and imagery training reduces cancer treatment-related pain; adding cognitive-behavioral skills to the relaxation with imagery does not, on average, further improve pain relief.
Article
The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.
Article
Adjuvant psychological therapy (APT), a brief, problem-focused, cognitive-behavioural treatment for patients with cancer, is described. A previously published randomized trial demonstrated a significant reduction in cancer-related emotional distress. APT is recommended for cancer patients suffering from such distress.
Article
Stress reducing strategies are useful in patients undergoing surgery. Hypnosis is also known to alleviate acute and chronic pain. We therefore compared the effectiveness of these two psychological approaches for reducing perioperative discomfort during conscious sedation for plastic surgery. Sixty patients scheduled for elective plastic surgery under local anesthesia and intravenous sedation (midazolam and alfentanil upon request) were included in the study after providing informed consent. They were randomly allocated to either stress reducing strategies (control: CONT) or hypnosis (HYP) during the entire surgical procedure. Both techniques were performed by the same anesthesiologist (MEF). Patient behavior was noted during surgery by a psychologist, the patient noted anxiety, pain, perceived control before, during and after surgery, and postoperative nausea and vomiting (PONV). Patient satisfaction and surgical conditions were also recorded. Peri- and postoperative anxiety and pain were significantly lower in the HYP group. This reduction in anxiety and pain were achieved despite a significant reduction in intraoperative requirements for midazolam and alfentanil in the HYP group (alfentanil: 8.7 +/- 0.9 microg kg(-1)/h(-1) vs. 19.4 +/- 2 microg kg(-1)/h(-1), P < 0.001; midazolam: 0.04 +/- 0.003 mg kg(-1)/h(-1) vs. 0.09 +/- 0.01 mg kg(-1)/h(-1), P < 0.001). Patients in the HYP group reported an impression of more intraoperative control than those in the CONT group (P < 0.01). PONV were significantly reduced in the HYP group (6.5% vs. 30.8%, P < 0.001). Surgical conditions were better in the HYP group. Less signs of patient discomfort and pain were observed by the psychologist in the HYP group (P < 0.001). Vital signs were significantly more stable in the HYP group. Patient satisfaction score was significantly higher in the HYP group (P < 0.004). This study suggests that hypnosis provides better perioperative pain and anxiety relief, allows for significant reductions in alfentanil and midazolam requirements, and improves patient satisfaction and surgical conditions as compared with conventional stress reducing strategies support in patients receiving conscious sedation for plastic surgery.
Article
Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed.
Article
A randomized controlled trial was conducted to compare the efficacy of clinical hypnosis versus cognitive behavioral (CB) coping skills training in alleviating the pain and distress of 30 pediatric cancer patients (age 5 to 15 years) undergoing bone marrow aspirations. Patients were randomized to one of three groups: hypnosis, a package of CB coping skills, and no intervention. Patients who received either hypnosis or CB reported less pain and pain-related anxiety than did control patients and less pain and anxiety than at their own baseline. Hypnosis and CB were similarly effective in the relief of pain. Results also indicated that children reported more anxiety and exhibited more behavioral distress in the CB group than in the hypnosis group. It is concluded that hypnosis and CB coping skills are effective in preparing pediatric oncology patients for bone marrow aspiration.
Article
Imagery as a hypnotic technique can produce analgesia and anxiolysis, but effective use may be restricted to select, highly hypnotizable individuals. This study assessed (a) whether patients not selected for hypnotizability can produce imagery during interventional radiologic procedures and (b) the type of imagery produced. A secondary goal of the study was to familiarize health care providers with a simple, time-efficient technique for imagery. Fifty-six nonselected patients referred for interventional procedures were guided to a state of self-hypnotic relaxation by a health care provider according to a standardized protocol and script. Patient hypnotizability was assessed according to the Hypnotic Induction Profile test. Patients as a group had average distribution of hypnotizability. The induction script was started in all patients and completed in 53. All patients developed an imagery scenario. Chosen imagery was highly individual, but common trends were nature and travel, family and home, and personal skills. Being with loved ones was an important element of imagery for 14 patients. Thirty-two patients chose passive contemplation, and 24 were action oriented. Average patients who present for interventional radiologic procedures and are not preselected for hypnotizability can engage in imagery. Topics chosen are highly individual, thus making prerecorded tapes or provider-directed imagery unlikely to be equally successful.
Article
Two case studies are reported to illustrate the use of a comprehensive cognitive-behavioral approach to treat claustrophobia in cancer patients undergoing external beam radiation therapy. Hypnosis was an essential component of the cognitive-behavioral approach. Both patients responded favorably to the psychological intervention and completed the required external beam radiation therapy.
Article
This report proposes hypnosis as a valid alternative to general anaesthesia for immobilisation and set-up in certain cases in paediatric radiotherapy. We report three cases of children who underwent radiotherapy in 1994 and were treated using hypnosis for set-up during irradiation. The first and the second were two cases of macroscopic resection of cerebellar medulloblastoma in which craniospinal irradiation was necessary, while the third patient suffered of an endorbitary relapse of retinoblastoma previously treated with bilateral enucleation, radiotherapy and chemotherapy; in this last situation the child needed radiation as palliative therapy. Hypnosis was used during treatment to obtain the indispensable immobility. Hypnotic conditioning was obtained by our expert psychotherapist while the induction during every single treatment was made by the clinician, whose voice was presented to the children during the conditioning. Every single fraction of the radiation therapy was delivered in hypnosis and without the need for narcosis. Hypnosis may be useful in particular situations to prepare paediatric cancer patients during irradiation, when lack of child collaboration might necessitate the use of general anaesthesia and when anaesthesia itself is not possible.
Article
In the past decade, the increasing acceptance of hypnosis as a therapeutic adjunct by physicians and health care professionals both within and outside of the mental health community has resulted in broader use of the technique with patients in both hospital and outpatient settings. In our recent experiences with urologic patients, our staff has found that many bring a surprisingly sophisticated knowledge of clinical hypnosis to the office and often have had experience with some form of therapeutic hypnosis prior to consulting us. Consequently, we find we often encounter a surprising openness to the use of hypnosis as a part of the treatment programs we employ. As a result we have been able to utilize clinical hypnosis successfully in several treatment areas to the benefit of our patients. This paper will describe several programs in place at our practice which utilize clinical hypnosis as an adjunct to treatment.
Article
Recent changes in health care have been characterized by an increased demand for empirically supported treatments in medicine. Presently, there is moderate support for the integration of hypnotic techniques in the treatment of a number of medical problems. This critical review of the research literature focuses on the empirical research on the effectiveness of hypnotic treatments as adjuncts to medical care for anxiety related to medical and dental procedures, asthma, dermatological diseases, gastrointestinal diseases, hemorrhagic disorders, nausea and emesis in oncology, and obstetrics/gynecology. Wider acceptance of hypnosis as an intervention to assist with medical care will require further research.
Article
In his introductory remarks to this Journal's special issue on the status of hypnosis as an empirically supported clinical intervention, the editor briefly describes the dawn of clinical hypnosis research, the logic of the natural science model, the importance of an inspired but tough-minded clinical science, and the auspicious confluence of practice and research purpose in this enterprise. The progenitor of this effort was indeed the Report of the Royal Commission coauthored by Benjamin Franklin and Antoine Lavoisier, among others, more than 215 years ago--a report noted as one of the most important documents in the history of human reason. The ethos and logic of this special issue is grounded on the legacy of that document. Eschewing the conflicting mental health agendas of managed-care, government, patient rights, and professional guild interests, this special issue seeks to present a frank, evenhanded, informed, and dispassionate assessment of what science knows and does not know about clinical hypnosis.
Article
Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
Article
This article discusses the likelihood of the empirically supported treatment (EST) movement impacting the practice of psychosocial oncology, with the goal of raising awareness of these issues and encouraging debate within the psychosocial oncology research and practice community. In 1993, the American Psychological Association struck a task force to develop criteria for empirically evaluating psychological interventions. The Clinical Psychology (Division 12) Task Force now evaluates psychological interventions and publishes an updated list of ESTs on a yearly basis. Concerns raised about the EST movement in psychology have included difficulties with the terminology and process of the Task Force, problems with the methodology used in psychotherapy research, and with the possible practical implications of the Task Force list of EST. A review of the literature suggests that psychosocial interventions in oncology are currently beginning to be evaluated by the EST criteria and that the reviewed interventions have yet to attain EST status. Following from this review, it is argued that researchers and practitioners in psychosocial oncology should become aware of the standards established by the Division 12 Task Force and that future psycho-oncology intervention research may need to be designed to meet those standards. The discipline of psychosocial oncology is encouraged to consider the possible implications of accepting or not accepting the EST criteria.