Hypnotherapy

Hypnotherapy

Hypnotherapy

Hypnosis has been suggested to be a useful adjunct for pain reduction in cancer patients and can significantly reduce cancer-related pain, antiemetic use, nausea and emesis (vomiting) during medical procedures, as well as anxiety related to all of the mentioned symptoms occurring in cancer patients.

Hypnotherapy

Source: CAM-CANCER

Abstract and key points

  • In hypnotherapy a patient attempts to enter into a trance-like state in order to cope better with complaints such as anxiety and stress by actively diverting their attention towards relaxing thoughts.
  • Existing evidence from sixteen randomised clinical trials and two controlled trials suggests that hypnotherapy may reduce cancer therapy related pain, anticipatory nausea and vomiting, and anxiety.
  • Only minor adverse effects have been reported, although patients who suffer from serious mental illnesses may be at greater risk.

Hypnotherapy uses hypnosis or self-hypnosis and can also include various relaxation techniques and imagery, in order to increase comfort or transform physical sensations such as pain, to cold or numbness.

Hypnosis has been suggested to be a useful adjunct for pain reduction in cancer patients, and is mainly used in the following areas: anxiety, insomnia, pain management and psychosomatic disorder, i.e. stress-related illness.

Sixteen randomized clinica trials (RCTs) and two controlled clinical trials (CCTs) report on results of hypnotherapy for cancer patients. This includes studies on hypnotherapy in anticipatory nausea and vomiting (ANV) during medical procedures, hypnotherapy for cancer therapy related pain, and studies of hypnotherapy in other cancer-related symptoms. Results show that hypnosis or self-hypnosis can significantly reduce cancer-related pain, antiemetic use, nausea and emesis during medical procedures, as well as anxiety related to all of the mentioned symptoms occurring in cancer patients.

Generally, hypnotherapy is considered a safe treatment modality. However, reported adverse effects include headache, dizziness, nausea, panic and the “creation” of false memories. It may involve particular risks for people who have certain types of mental illness such as schizophrenia or dementia .

What is it?
Hypnotherapy is a psychotherapeutic intervention using hypnosis, self-hypnosis or hypnosis therapy. A patient attempts to enter into a trance-like state in order to cope better with complaints such as anxiety and stress by actively diverting their attention towards relaxing thoughts.1 When using hypnosis, the subject is guided by the hypnotist to respond to suggestions.2 Hypnosis often takes the form of relaxation and imagery, incorporating suggestions for increasing comfort or transforming physical sensations such as pain, to cold or numbness.3 The hypnotized person is often relaxed, but at the same time mentally alert. Normally, there are three main stages of the depth of trance: light, medium and deep trance. Light trance is all that is needed for medical purposes. Nearly 90% of the population may enter such a trance-like state.4

Application and dosage
In classical hypnotherapy a state of reduced attention is achieved to make the patient amenable to suggestion. Muscle relaxation techniques are sometimes used to enhance the effect of hypnotherapy.5 Additionally, passive imagination or visualization can be used to divert the patient’s mind during the state of relaxation towards pleasant auditory, visual and kinesthetic imaginary circumstances.1,6 Generally, no hypnotherapist can successfully hypnotize a person who lacks motivation or does not co-operate. Willingness to co-operate and conquer the unpleasant symptoms are required in order for hypnotherapy to be effective.7

History/provider(s)
The term `hypnosis` is derived from the Greek word `hypnos`, meaning `sleep`. The history of hypnotherapy indicates that spiritual leaders, priests, healers and philosophers were the practitioners of early hypnosis. Scottish surgeon James Braid (1795-1860) noticed that many of his patients experienced a trance like state when they focused on one single spot for a longer period of time. He introduced the words `hypnosis` and `hypnotism` to the medical fraternity. Austrian physician Franz Anton Mesmer (1734-1815) is by some regarded as the father of hypnotherapy.

Claims of efficacy/Alleged indication(s)
Hypnotherapy has been used in cancer care, together with other relaxation therapies, to ameliorate adverse effects resulting from conventional cancer treatment, to help patients adjust to their disease, to reduce pain and anxiety, and also to alter the mechanism of immunity in order to hopefully improve the prognosis of the patient.8 Hypnotherapy is mainly used for anxiety, insomnia, pain management and psychosomatic disorder, i.e. stress-related illness.8 Hypnosis has been suggested to be a useful adjunct for pain reduction in cancer patients.12 Specifically, hypnosis is claimed to reduce the need for medication and post-surgical symptoms in some populations such as head and neck cancer patients and to be effective in cancer patients undergoing surgery.9 Hypnotically suggested hypothermia has been used to control cancer metastases.34

Mechanism(s) of action
Numerous theories and hypotheses exist to try to explain the mechanism of hypnosis: the “conditioned response” theory, the “dissociation theory”, the “suggestion” theory, the “role play” theory, the “modified sleep” theory, the “psychoanalytic theory”, the “atavistic regression” theory, and the “neurophysiological” theory. Several scientific models of the action of hypnosis have been developed in order to explain the psychobiological effect of hypnosis and bring hypnosis into the field of “evidence based medicine”.7

Research investigating the effect of stress on the physiology and psychoimmunology of the human organism in health and disease, shows a downregulation in the transcription of the interleukin-2 receptor gene and interleukin-2mRNA. Downregulation of psychosocial stress is an important indicator that the normal functioning of the immune system can be impaired at the cellular-genetic level by prolonged stress and as a result it gives a meaningful biological explanation to some of the mind-body interactions.10,11

If hypnosis changes the negative state of mind of the cancer patient, and gives the patient a realistic but positive outlook and provides him/her with a tool to feel in control of his emotional symptoms, then this patient will be better equipped to fight the psychological and physical consequence of the disease process or, even better, some of them may never be expressed due to the greater control of the mind-body interaction.

Prevalence of use
A systematic review on prevalence data of cancer patients’ use of complementary and alternative medicine including n=152 surveys suggests a global use between 0.5 and 11% by cancer patients.13

Legal issues
Both, the British and American Medical Associations officially recognizes hypnosis as a legitimate medical procedure. Hypnotherapy has not yet been regulated in the UK. Most hypnotherapists are licensed medical doctors, registered nurses, social workers, or family counselors who have received additional training in hypnotherapy. The practice of hypnotherapy, however, entails virtually no standards or requirements for minimum training, practical experience, or demonstrated competence. In most countries, hypnotherapy is administered by both medically-trained and statutorily regulated professionals and by non-medically-trained and often unregulated hypnotherapists.

Cost(s) and expenditures
Cost of a single hypnotherapy session will vary between countries and states and largely depend on a number of factors including the location and region where the patient lives in. In some locations a hypnotherapist will charge $50 (€ 37) whilst others will charge as much as $500 (€ 368).

Does it work?
Due to the challenges of applying blinding it is difficult to test the efficacy of hypnotherapy. The studies included in this summary therefore test the effectiveness of hypnotherapy.

Systematic reviews
One clinical review of medical research on hypnotherapy and relaxation therapies specifically for cancer patients was published in 1999.14 The review concludes that “There is strong evidence from randomised trials of the effectiveness of hypnosis and relaxation for cancer related anxiety, pain, nausea, and vomiting, (side effects of chemotherapy) particularly in children.” This review however, only included three reviews, two randomised clinical trials and one NIH Technology Assessment, all published before 1999.

Clinical trials
In total 16 randomised clinical trials and two controlled clinical trials report on results of hypnotherapy used by cancer patients.3,9,15-30 This includes studies of hypnotherapy for anticipatory nausea and vomiting during medical procedures, studies of hypnotherapy for cancer- or cancer therapy related pain and studies of hypnotherapy for other cancer-related symptoms. The main results of the studies are described in Tables 1, 2 and 3.

The results of hypnotherapy interventions for anticipatory nausea and vomiting (ANV, n=6)) during medical procedures suggest that a significant reduction of nausea was achieved in six studies, a reduction of emesis in five and a reduction of antiemetic use in one of the included trials (see Table 1).

Of the nine studies included in cancer-related pain, eight showed a significant reduction of pain whereas another seven also showed a reduction of anxiety or pain-related anxiety when comparing the hypnotherapy group with the control groups (see Table 2).

With regards to studies on other cancer-related symptoms (n=3), one study showed an increase of self-competence in the hypnotherapy group (see Table 3).

Is it safe?
Hypnosis that is conducted under the care of a trained therapist or health care professional is considered safe.

Adverse events
Hypnotherapy has generally shown to have no specific adverse effects.31,32 However, in adolescents, observed adverse reactions included dissociated state, depersonalization, anxiety and fears.33 Other adverse effects of hypnotherapy might be: headache, dizziness, nausea and panic or the creation of false memories.

Interactions
None known.

Contraindications
Individuals with psychiatric conditions.

Warnings
People who have certain types of mental illness are at greater risk of adverse reactions if hypnotized.

Studies of hypnotherapy for anticipatory nausea and vomiting during medical proceudres
Table 1:
Studies of hypnotherapy for anticipatory nausea and vomiting (ANV) during medical procedures

Hypnotherapy-table 1 120830.pdf 193.04 kB

Studies of hypnotherapy for cancer- or cancer therapy related pain
Table 2:
Studies of hypnotherapy for cancer- or cancer therapy related pain

Hypnotherapy-table 2 120830.pdf 210.56 kB

Studies of hypnotherapy for other cancer-related symptoms
Table 3:
Studies of hypnotherapy for other cancer-related symptoms

Hypnotherapy-table 3 120830.pdf 181.96 kB

Citation
Katja Boehm, CAM-Cancer Consortium. Hypnotherapy [online document]. http://www.cam-cancer.org. September 6, 2012.

Document history
Fully updated and revised in August 2012 by Katja Boehm.

Summary first published in September 2009, authored by Katja Boehm.

References

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  2. Kihlstrom JF. Hypnosis. Annu Rev Psychol 1985;36:385-416.
  3. Syrjala KL, Cummings C, Donaldson GW. Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial. Pain 1992;48:137-46.
  4. Hartland J. “Medical and Dental Hypnosis” third edition. 1998, Harcourt Brace and Company Ltd.
  5. Jacobson E. Progressive relaxation. Chicago: University of Chicago; 1938.
  6. Lankton S, Lankton A. The answer within: a clinical framework of Ericksonian hypnotherapy. New York: Brunner-Manzel; 1983.
  7. Peynovska R, Fisher J, Oliver D, Mathew VM. Efficacy of hypnotherapy as a supplement therapy in cancer intervention. European Journal of Clinical Hypnosis 2005;6(1):2-7.
  8. Taylor EE, Ingleton CC. Hypnotherapy and cognitive-behaviour therapy in cancer care: the patients’ view. European Journal of Cancer Care 2003;12:137-42.
  9. Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, Weltz CR, Schechter C, Graff-Zivin J, Tatrow K, Price DD, Silverstein JH. A Randomized Clinical Trial of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients. J Natl Cancer Inst 2007;99: 1304–12.
  10. Glaser R, Lafuse W. Stress-associated modulation of proto-oncogene expression in human peripheral blood leucocytes. Behavioral Neuroscience 1993;7:707-l2.
  11. Rosenberg, S. & Barry, J, (1992). The Transformed Cell: Unlocking the Mysteries of Cancer. New York: Putnam/Chapmans.
  12. Elkins G, Cheung A, Marcus J, Palamara L, Rajab H. Hypnosis to reduce pain in cancer survivors with advanced disease: a prospective study. Journal of Cancer Integrative Medicine 2004;2(4):167-72.
  13. Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How Many Cancer Patients Use Complementary and Alternative Medicine: A Systematic Review and Metaanalysis. Integr Cancer Ther 2011 doi: 10.1177/1534735411423920.
  14. Vickers A, Zollman C. Clinical Review: Hypnosis & Relaxation Therapies. British Medical Journal 1999;319 (7221): 1346–49.
  15. Zeltzer LK, Dolgin MJ, et al. A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics 1999;1: 34-42.
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  17. Enqvist B, Bjorklund C, Engman M, Jakobsson J. Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts: a prospective, randomized and blinded study. Acta Anaesthesiol Scand 1997;41:1028 –32.
  18. Montgomery GH, Schnur JB, Silverstein JH, Hallquist MN, David D, Bovbjerg DH. Mediators of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients: Response Expectancies and Emotional Distress. Journal of Consulting and Clinical Psychology 2010;78(1):80-88.
  19. Cotanch P, Hockenberry M, Herman S. Self-hypnosis as antiemetic therapy in children receiving chemotherapy. Oncol Nurs Forum 1985;12(4):41-46.
  20. Zeltzer L, LeBaron S et al. The effectiveness of behavioral intervention for reduction of nausea and vomiting in children and adolescents receiving chemotherapy. Journal of Clinical Oncology : official journal of the American Society of Clinical Oncology 1984;6:683-90.
  21. Lang EV, Berbaum KS, Pauker SG, Faintuch S, Salazar GM, Lutgendorf S, Laser E, Logan H, Spiegel D. Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice. J Vasc Interv Radiol 2008;19(6):897-905.
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  23. Liossi C, Hatira P. Clinical hypnosis in the alleviation of procedure-related pain in pediatric oncology patients. The International journal of clinical and experimental hypnosis 2003;1: 4-28.
  24. Liossi C, White P, Hatira P. Randomized Clinical Trial of Local Anesthetic Versus a Combination of Local Anesthetic With Self-Hypnosis in the Management of Pediatric Procedure-Related Pain. Health Psychology 2006;25(3):307-15.
  25. Liossi C, White P, Hatira P. A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients. Pain 2009;142:255-63.
  26. Zeltzer L, LeBaron S. Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. The Journal of Pediatrics 1982;101(6):1032-5.
  27. Bukhtoiarov OV, Kozhevnikov VS et al. [Hypnosis for rehabilitation of immunological status in neoplasia]. Voprosy Onkologii 2007;53(6): 699-703.
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  29. Liossi C, White P. Efficacy of clinical hypnosis in the enhancement of quality of life of terminally ill cancer patients. Contemporary Hypnosis 2001;3:145-160.
  30. Jacknow DS, Tschann JM, Link MP, Boyce WT. Hypnosis in the prevention of chemotherapy-related nausea and vomiting in children: a prospective study. Developmental and Behavioral Pediatrics 1994;15(4):258-64.
  31. Rhue JW , Lynn SJ , Kirsch I . Handbook of clinical hypnosis . Washington (DC) : American Psychological Association ; 1993.
  32. Lynn SJ , Martin DJ , Frauman DC . Does hypnosis pose special risks for negative effects? Int J Clin Exp Hypn 1996;44:7 – 19.
  33. Haber CH, Nitkin R, Shenker IR. Adverse reactions to hypnotherapy in obese adolescents: A developmental viewpoint. Psychiatric Quarterly 1979;51; 55-63.
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Legal notice
The present documentation has been compiled by the CAM-CANCER Project with all due care and expert knowledge. However, the CAM-CANCER Project provides no assurance, guarantee or promise with regard to the correctness, accuracy, up-to-date status or completeness of the information it contains. This information is designed for health professionals. Readers are strongly advised to discuss the information with their physician. Accordingly, the CAM-CANCER Project shall not be liable for damage or loss caused because anyone relies on the information.


Hypnosis for cancer care: Over 200 years young

Source: Wiley Online Library

Hypnosis in Cancer Care
One of the earliest documented uses of hypnosis with a cancer patient was as anesthesia for breast cancer surgery. In 1829, M. le Docteur Chapelain used hypnosis (then referred to as mesmerism) over a period of several months to relieve the suffering of Madame Plantin, who had an ulcerated cancer of the right breast with massive enlargement of the right axillary lymph nodes. On April 1, 1829, in Paris, Chapelain used hypnosis as an anesthetic during mastectomy and axillary lymph node dissection. This was prior to the introduction of modern anesthesia techniques. During the operation, the patient was calm and evidenced good pain control.16 In the past 2 centuries, research on hypnosis has continued to support the efficacy of hypnosis in the cancer setting as an adjunct to modern care (eg, analgesics): that is, hypnosis is typically used in conjunction with modern medical approaches, as it is the rare cancer patient who can achieve complete symptom and side effect control during major medical and surgical procedures with hypnosis alone.

Cancer Prevention
There is strong evidence that an individual’s cancer risk can be significantly reduced by avoiding tobacco, exercising, practicing healthy dietary habits, and participating in cancer screening. The American Cancer Society estimates that this year alone, 173,200 cancer deaths in the United States will be caused by tobacco use, and that one-third of the 577,190 cancer deaths expected to occur in 2012 will be attributed to poor nutrition, physical inactivity, overweight, and obesity.19 Hypnosis has shown some promise in promoting these healthy behaviors. Evidence is reviewed below…continue reading this article at Wiley Online Library


 

Where can I get this treatment and more information?
Hypnotherapy is widely available.

Warning
1. Some cancer therapies can conflict with others. Do not start ANY therapy without consulting your doctor to ensure it’s safe and beneficial to do so.
2. Just because any given therapy worked for someone else does not necessarily mean it will work for you.
3. Although there are many viable alternative cancer treatments, there isn’t a “best” treatment for a certain type or stage of cancer.

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