Morgan Snyder’s research while affiliated with Baylor University and other places

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Publications (12)


Hypnosis Apps: A Systematic Review
  • Literature Review
  • Full-text available

December 2024

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37 Reads

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2 Citations

Katherine Scheffrahn

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Morgan Snyder

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Gary R Elkins

For over a decade, the growing use of smartphone apps provided a way to make hypnotherapy more widely accessible. However, available apps vary widely in the quality of hypnosis provided to users. This study systematically reviewed apps delivering some form of hypnotherapy intervention and summarized their characteristics. Using hypnosis-related search terms, a list of apps was generated, yielding 679 unique hypnosis apps across both Android and iOS stores, and 168 apps met inclusion criteria for this review. The most common app targets were sleep (k = 94, 56.0%), relaxation/meditation (k = 92, 54.8%), and stress (k = 62, 36.9%). Only 34 (20.2%) of the apps indicated that the developer or person providing hypnosis was trained in hypnosis. Thirteen (7.7%) apps included some claim of evidence-based treatment. Only four apps reported inclusion in a clinical efficacy trial. Relationships between key app characteristics were explored using chi-square analysis. Though hypnotherapy apps have much potential in health care, apps based upon evidence-based protocols and empirical research are limited at this time.

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Differences in categorical demographic, clinical, and symptom variables between BCS who did (n = 34) and did not (n = 18) report their palpitations to a healthcare provider (n = 52).
Differences in continuous demographic, clinical, symptom, and attitudinal variables between BCS who did (n = 34) and did not (n = 18) report their palpitations to a healthcare provider.
Differences in palpitations sensations between BCS who did (n = 34) and did not (n = 18) report their palpitations to a healthcare provider.
Number and descriptions of tests and results following report of palpitations to a healthcare provider.
A pilot survey of breast cancer survivors’ reporting of palpitations to healthcare providers

December 2024

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10 Reads

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Morgan Snyder

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[...]

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Background Breast cancer survivors (BCS) may experience cardiotoxicities from chemotherapy and oral endocrine therapy. Although a few studies have documented that palpitations are prevalent and associated with poorer outcomes, there is limited to no information on BCS’ reporting of palpitations to healthcare providers. Objectives To compare BCS who did and did not report their palpitations to a healthcare provider and describe how those who did report palpitations recalled their provider responding. Design This was a cross-sectional, national, electronic, pilot survey of BCS enrolled in the Love Army of Women registry. Methods Participants (n = 52 with palpitations) completed standardized and investigator-designed questionnaires. Data were analyzed using frequency and descriptive statistics, chi-square tests, and Mann–Whitney tests. Responses to one open-ended question were analyzed using frequency counts and standard content analysis. Results Compared to BCS who reported palpitations to a provider (n = 34), BCS who did not report their palpitations (n = 18) were significantly more anxious (p = 0.002) and more likely to feel palpitations as an irregular heartbeat (70.6% versus 38.9%, p = 0.027). Among the 34 BCS who reported palpitations to a provider, 32 completed the open-ended question. Of these 32 BCS, a majority (n = 27, 84%) indicated their provider recommended cardiac testing and/or referral to a cardiologist. Most (n = 24) reported completing testing. Test results included diagnosis of a new arrhythmia or other cardiac abnormality (n = 11, 46%), receipt of a new prescription (n = 5, 21%), or normal results (n = 5, 21%). Five (16%) of the 32 BCS did not receive recommendations for testing or referral and felt their provider normalized or dismissed their symptoms. Conclusion Palpitations are a salient topic for further research and clinical practice recommendations to address cardiac health in BCS.


A General Factor of Hypnotizability Revealed by Confirmatory Factor Analysis

September 2024

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19 Reads

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1 Citation

The objective of this study was to determine the model fit of a standardized hypnotizability measure in a targeted clinical sample. The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) was administered to 168 post-menopausal women aged 39 to 75 years. Confirmatory factor analysis was conducted, and comparative fit index (CFI) and root mean square error of approximation (RMSEA) were used to determine goodness of fit. Results indicated that the single-factor structure modeled with twelve indicators based on the individual items on the SHSS:C provided the best description of fit. Results of the present study demonstrate that the SHSS:C has a single-factor structure. These findings suggest that new scales of hypnotizability can be optimized by focusing on the use of items that correlate highly with the overall score representing the unidimensional construct of hypnotizability. The findings should be interpreted with caution due to the small sample size, and further research is needed with other populations to clarify generalizability.


Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study

March 2024

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18 Reads

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1 Citation

JMIR Formative Research

Background Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking. Objective This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app. Methods This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users. Results Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=–0.09). Conclusions This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app.


Confirmatory Factor Analysis of the Elkins Hypnotizability Scale in a Clinical Population

December 2023

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11 Reads

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3 Citations

The objective of this study was to determine the best-fit factor structure of a standardized hypnotizability measure in a clinical population. The Elkins Hypnotizability Scale (EHS) was administered to 173 post-menopausal women, age from 39 to 75 years, with a mean age of 54.61 years. Confirmatory factor analysis was conducted, and comparative fit index (CFI) and root mean square error of approximation (RMSEA) were used to determine goodness of fit. Results indicated that the single-factor structure modeled with six indicators based on the individual items on the EHS provides the best description of fit. Results of the present study demonstrate that the EHS has a single-factor structure. Further research is required with other populations and measures.


Exploring Variables Associated with the Effects of a Self-Administered Hypnosis Intervention for Improving Sleep Quality

December 2023

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177 Reads

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1 Citation

About two-thirds of college students rate their sleep as suboptimal which is associated with a variety of additional issues. Poor sleep is shown to follow certain pre-sleep cognitive activity that inhibits sleep onset and reduces sleep quality. Preliminary evidence suggests that a self-administered hypnosis intervention is feasible in improving sleep within a college student population, and the current study explores potential correlating variables to inform future mechanistic research. Twenty-two college students who self-reported poor sleep quality utilized a three-week self-administered hypnosis intervention while completing baseline and endpoint measures of sleep quality, insomnia symptoms, and psychological factors. Results indicated that participants experienced significant improvement with large effects in sleep quality (d = -1.21) and significant decreases in insomnia symptoms (d = 1.05) from pre- to post-intervention. Significant improvements were also observed on measures of pre-sleep arousal and worry. The results suggest that a self-administered hypnosis intervention may modulate pre-sleep cognitive activity associated with poor sleep quality.


Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study (Preprint)

October 2023

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4 Reads

BACKGROUND Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking. OBJECTIVE This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app. METHODS This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users. RESULTS Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression ( r =–0.09). CONCLUSIONS This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app.


Descriptive Characteristics of Study Participants, N = 22
Hypnosis Practice Log Data, N = 20
Impression of Change and Treatment Satisfaction Ratings, N = 20
Feasibility of a Self-Administered Hypnosis Intervention for Improving Sleep in College Students

September 2023

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61 Reads

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3 Citations

Approximately two out of three college students report experiencing suboptimal sleep quality. The aim of this study was to examine the feasibility of a self-administered hypnosis intervention to improve sleep in college students. Twenty-two college students who self-reported poor sleep quality were enrolled in a 4-week study comprising 1 baseline week and a 3-week self-administered hypnosis intervention. Sleep onset latency and sleep efficiency as measured by wrist actigraphy were significantly improved. The mean average nightly sleep duration during the baseline week was 398.88 minutes (SD = 56.44), which increased to a mean of 413.88 minutes (SD = 57.80) during the 3rd week of intervention. However, the results show that there was no statistically significant difference between weeks on objective nightly sleep duration, 95% CI [-11.13, 41.13], t(15) = 1.224, p = .240. Also, results showed that there was no significant difference between weeks on self-reported nightly sleep duration, F(3, 57) = 2.155, p = .103. Twenty participants (91%) completed the study intervention and adherence to daily self-hypnosis practice with an audio recording was high. Zero study-related adverse events were reported, and participants perceived the intervention as easy to use and helpful for improving sleep. These results provide evidence for the feasibility and safety of a self-administered hypnosis intervention to improve sleep in college students. A larger randomized clinical trial is warranted to determine efficacy.


Reliability and Validity of the Elkins Hypnotizability Scale within a Clinical Sample

July 2023

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10 Reads

Hypnotherapy is used in clinical settings to treat mental and physical health-related conditions. Hypnotic response can be measured through hypnotizability scales to help interventionists personalize treatment plans to suit the patients' individualized hypnotic abilities. Examples of these scales are the Elkins Hypnotizability Scale (EHS) and the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C). According to the previous literature, these scales have good discriminating ability and internal consistency (α = 0.85) in collegiate samples, but the psychometric properties of the EHS for a targeted clinical population have not been determined yet. This study assessed said properties, and results showed adequate reliability of the EHS in a targeted clinical sample and strong convergent validity of the EHS to the SHSS:C. The authors conclude that the EHS is a strong and useful measure of hypnotizability that is pleasant, safe, brief, and sensible to individualities in hypnotic ability found in diverse clinical samples.


Systematic Review of Hypnotherapy for Sleep and Sleep Disturbance

July 2023

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80 Reads

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8 Citations

Sleep disturbance can negatively affect physical and psychological health. Hypnotherapy may be effective for improving sleep with fewer side effects than other treatments. The purpose of this systematic review is to comprehensively identify studies and evidence regarding hypnotherapy for sleep disturbances. Four databases were searched to identify studies examining the use of hypnotherapy for sleep in adult populations. The search yielded 416 articles, of which 44 were included. Qualitative data analysis revealed that 47.7% of the studies showed positive results regarding the impact of hypnotherapy for sleep, 22.7% showed mixed results, and 29.5% showed no impact. A subset of 11 studies that set sleep disturbance as an inclusion criterion and included suggestions for sleep were examined separately and had more favorable results, such that 54.5% showed positive results, 36.4% showed mixed results, and 9.1% showed no impact results. Hypnotherapy appears to be a promising treatment for sleep disturbance. Future studies should report effect sizes, adverse events, and hypnotizability and include sleep-specific suggestions, standardized measures, and descriptions of hypnotherapy intervention procedures.


Citations (3)


... Exploratory factor analysis (EFA) [27] and confirmatory factor analysis (CFA) [28] were used to assess the structural validity of the scale. EFA is typically used to extract a comprehensive factor structure from a set of related data, while CFA is used to evaluate the fit of this factor structure. ...

Reference:

Patients' sense of medical gain on family doctor contracting services in China: scale development and preliminary validation
Confirmatory Factor Analysis of the Elkins Hypnotizability Scale in a Clinical Population
  • Citing Article
  • December 2023

... Current barriers to hypnotherapy access could potentially be addressed through smartphone app delivery, including financial concerns, lack of geographic proximity to hypnotherapy providers, debilitating chronic symptoms, or the time commitment needed for appointments Hussain, 2021). Additionally, for conditions where individuals already might be inclined to turn to mHealth apps, hypnotherapy has been shown to be beneficial, such as sleep Wofford et al., 2023), pain (Wallen et al., 2021), food cravings (Delestre et al., 2022), anxiety , smoking cessation (Batra et al., 2024), stress (Olendzki et al., 2020), and hot flashes in menopausal women and breast cancer survivors (Sliwinski & Elkins, 2017). Despite these advantages to smartphone delivered hypnotherapy, the current hypnosis app landscape contains a wide variety of quality and characteristics of the apps, creating the need for evaluation and review. ...

Systematic Review of Hypnotherapy for Sleep and Sleep Disturbance
  • Citing Article
  • July 2023

... Their findings demonstrate that 71% of participants achieved high levels of well-being or flourishing. In addition to this innovative study, several articles are included that increase access to scales that measure hypnotizability in French (Apelian, 2022), Russian (Kvitchasty 2022), and Spanish (Muñiz et al., 2022). Kasos et al. 2022 explore the role of hypnotizability in regard to skin conductance orienting response (SCR) in response to differing types of suggestions. ...

Feasibility of the Elkins Hypnotizability Scale–Spanish Translation
  • Citing Article
  • October 2022