Evidence-based hypnotherapy for asthma: a critical review

[HYPNOSTRESS study: Interest of medical hypnosis in the evaluation of perceived stress and the experience of hospitalization in an internal medicine department]

BACKGROUND

Patients with chronic illnesses, especially rare autoimmune and/or systemic diseases associated with significant diagnostic uncertainty, have a representation of their illness and a sometimes prolonged hospitalization experience that can be traumatic and anxiety-provoking.

OBJECTIVE

The aim of this study was to evaluate the impact of a non-medicinal medical hypnosis intervention in reducing the stress state and improving the experience of patients hospitalized in an internal medicine department.

METHODS

We conducted a prospective study of 24 patients hospitalized in the Internal Medicine Department of Lille University Hospital in 2023. Twelve patients received a non-drug medical hypnosis intervention known as the "place of safety" (case group) and were compared with 12 patients who did not (control group). Stress was assessed by the STAI questionnaire and hospitalization experience by a satisfaction questionnaire.

RESULTS

The 24 patients, 13 of whom were women, had a mean age of 55±17 years at inclusion. On admission to hospital, the median STAI-ETAT between the two groups was 43.5 (38.0; 56.6) in the case group versus 42.0 (37.0; 48.5) in the control group (P=0.45). In the case group, the median STAI-ETAT questionnaire taken immediately after the hypnosis session was significantly lower than at the start of hospitalization (30.0 [25.5; 36.5] vs. 43.5 [38.0; 56.5] P=0.003), indicating a significant reduction in stress. At the end of hospitalization, there was also a significant persistence of the median significant reduction between cases and controls (29.5 [26.5; 35.0] for cases vs. 41.5 [33.5; 45.5] for controls P=0.002). Experience of hospitalization was better in the case group (median 5.0 [4.5; 5.0] vs. 4.0 [4.0; 4.5], P=0.016).

CONCLUSION

This study suggests that medical hypnosis is a promising non-medicinal supportive intervention for reducing perceived stress and improving the experience of stress in patients hospitalized on an internal medicine ward.

A whole new world of healing: exploring medical hypnotherapy for pediatric patients : A review

This narrative review aims to unravel the potential of medical hypnotherapy for the treatment of children with a variety of diseases and symptoms. Going beyond its history and assumed neurophysiology, the chances of success for hypnotherapy will be outlined per pediatric speciality, accentuated by clinical research and experiences. Future implications and recommendations are given on extracting the positive effects of medical hypnotherapy for all pediatricians.    Conclusion: Medical hypnotherapy is an effective treatment for children with specified conditions such as abdominal pain or headache. Studies suggest effectiveness for other pediatric disciplines, from the first line up to third line of care. In a time in which health is defined as 'a state of complete physical, mental and social well-being', hypnotherapy stays an underrated treatment option for children. It is a unique mind-body treatment, which true potential still needs to be unraveled. What is Known: • Mind-body health techniques become a more relevant and accepted part of treatment in pediatric patients. • Medical hypnotherapy is an effective treatment for children with specified conditions such as functional abdominal pain. What is New: • Studies suggest the effectiveness of hypnotherapy in a high variety of pediatric symptoms and disease. • Hypnotherapy is a unique mind-body treatment which potential goes far beyond its current utilization.

Anxiety and Depression in Chronic Obstructive Pulmonary Disease: Perspectives on the Use of Hypnosis

Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent and debilitating respiratory condition, characterized by chronic airflow limitation, breathlessness, and other persistent respiratory symptoms. Critically, patients suffering from COPD often find themselves trapped in a vicious comorbidity cycle: while breathlessness and increased respiratory rate are known inducers of anxiety, the latter have been shown in turn to exacerbate breathlessness and chest discomfort. Hypnosis holds great potential for the simultaneous complementary management of anxiety and breathlessness in COPD. It is an inexpensive psychological intervention tailored to the patient's own experience, convenient in terms of logistics and implementation. In this short qualitative review, we present hypnosis' structural, cognitive, and neural fundamentals, and assess existing instances of hypnosis use in the treatment of anxiety, depression, and respiratory disease. We then discuss its potential as a tool for improving health-related quality of life and the self-management of COPD within (and beyond) pulmonary rehabilitation.

Review article: the effectiveness of group and self-help hypnotherapy for irritable bowel syndrome and the implications for improving patients' choice and access to treatment

BACKGROUND

Individual hypnotherapy (IH) is a recognised treatment for irritable bowel syndrome (IBS). However, it is not widely available to patients due to its resource-intensive nature, lack of adequately trained therapists, and scepticism about hypnosis. Non-individualised hypnotherapy approaches, such as group and self-help hypnotherapy, could maximise existing therapist resources by treating more patients at the same time, thus widening patient access to treatment without incurring additional expenditure.

AIMS

To investigate the research literature for non-individualised approaches to hypnotherapy for IBS and to determine their effectiveness for reducing symptom severity and/or providing adequate relief.

METHODS

A literature review of published peer-reviewed studies was conducted. Quantitative research was selected to determine the effectiveness of the interventions.

RESULTS

Ten studies were eligible for inclusion. Three delivered group hypnotherapy, three integrated hypnosis within a group concept, and four utilised a self-help home hypnotherapy treatment using audio recordings. Both group hypnotherapy for adults and the self-help home hypnotherapy treatment for children were effective interventions that may be non-inferior to IH for patients with mild-to-moderate symptoms. Treatment benefits were long-lasting. The evidence for the integrative group concept and home treatment for adults was less compelling.

CONCLUSIONS

Group hypnotherapy for adults, and self-help hypnotherapy for children, may be cost-effective treatments that can widen access for patients with milder IBS in primary care settings. Further research is needed to determine the effectiveness of group hypnotherapy for patients with severe, refractory IBS.

Hypnotherapy as an Adjunct to Medical Treatment: Highlighting Effectiveness and Identifying Barriers to Further Integrative Treatment

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.

Hypnosis for the Management of Anxiety and Dyspnea in COPD: A Randomized, Sham-Controlled Crossover Trial

Background

Patients with chronic obstructive pulmonary disease (COPD) are prone to dyspnea, increased respiratory rate and other anxiety-inducing symptoms. Hypnosis constitutes a complementary procedure capable of improving subjective feelings of anxiety.

Objective

Assessing the efficacy of a 15-minute hypnosis intervention for immediate improvement of anxiety in severe COPD patients.

Methods

Twenty-one participants, COPD patients (mean FEV1 < 32.3%), were randomly assigned to two individual sessions in crossover (sham and hypnosis, 24-h washout period, arms: hypnosis-sham [n=11]/sham-hypnosis [n=10]). We tracked pre- and post-intervention anxiety (STAI-6 score) as primary endpoint.

Results

Nineteen (90.5%) participants completed the study. Anxiety diminished significantly after hypnosis (STAI-6 scores −23.8% [SD = 18.4%] hypnosis vs −3.1% [32.8%] sham; χ²=8, P<0.01, Bayes Factor 5.5). Respiratory rate also decreased after hypnosis. Improvements in SpO2 and Borg exertion scores were registered after both conditions.

Conclusion

A 15-minute hypnosis session improved participants’ anxiety and lowered respiratory rate (as opposed to sham). Improvements in anxiety were correlated with an alleviation in respiratory strain. Results imply that hypnosis can contribute to the improvement of anxiety levels and breathing mechanics in severe COPD patients.

Registration Id

ISRCTN10029862.

A Pragmatic Guide to the Setting up of Integrated Hypnotherapy Services in Primary Care and Clinical Settings

Despite the continued debate and lack of a clear consensus about the true nature of the hypnotic phenomenon, hypnosis is increasingly being utilized successfully in many medical, health, and psychological spheres as a research method, motivational tool, and therapeutic modality. Significantly, however, although hypnotherapy is widely advertised, advocated, and employed in the private medical arena for the management and treatment of many physical and emotional disorders, too little appears to be being done to integrate hypnosis into primary care and national health medical services. This article discusses some of the reasons for the apparent reluctance of medical and scientific health professionals to consider incorporating hypnosis into their medical practice, including the practical problems inherent in using hypnosis in a medical context and some possible solutions.

Hypnosis, hypnotizability, and placebo

Dr. Raz's speculations about the relation between placebo responsivity and hypnotizability are critically examined. While there is no generally accepted theoretical definition of hypnosis, there is a general consensus that hypnotizability can be reliably measured. In contrast, there seems to be a general consensus about a theoretical definition of placebo (including placebo effect, placebo response, and nocebo). There is no widely accepted measure of individual differences in placebo responsivity. Various methodological considerations about how to examine the relation between placebo responsivity and hypnotizability are identified. Studies are identified which indicate that response to treatments which utilize adjunctive hypnosis are superior to placebo treatments. The only study which examined whether placebo responsivity was correlated with hypnotizability seems to indicate that they are only slightly related at best. The possibility that there may be such thing as a "good placebo responder (GPR)" is questioned, while the known clinical value of hypnotizability assessment is reaffirmed. Future directions for empirical research on the relation between placebo responsivity and hypnotizability are identified.

Complementary Therapies for Symptom Management in Cancer Patients

Cancer patients are often poly-symptomatic which distressingly affects their quality of lives (QOLs). Alhough, conventional management provides adequate symptom control, yet is coupled with some limitations. Complementary therapies (CTs) have shown beneficial effects in cancer patients for symptomatic relief. The aim of this article is to provide evidence-based review of commonly used CTs for symptom management in cancer care. Hypnosis has promising evidence to be used for managing symptoms such as pain, chemotherapy-induced nausea/vomiting, distress, fatigue, and hot flashes. Guided imagery increases comfort and can be used as a psycho-supportive therapy. Meditation substantially improves psychological function, mental health, and QOL. Cognitive behavioral therapies effectively reduce pain, distress, fatigue, anxiety, and depression; and improve subjective sleep outcomes along with mood and QOL. Yoga has short term beneficial effects for anxiety, depression, fatigue, perceived stress, QOL, and well-being. T'ai Chi and qigong are beneficial adjunctive therapies for supportive cancer care, but their role in reducing cancer pain is not well proven. Acupuncture is effective for reducing treatment related side-effects, pain and fatigue. Other therapies such as massage techniques, energy therapies, and spiritual interventions have also demonstrated positive role in managing cancer-related symptoms and improve overall well-being. However, the clinical effectiveness of these therapies for symptom management in cancer patients cannot be concluded due to poor strength of evidence. Nonetheless, these are relatively free from risks and hence can be given along with conventional treatments. Only by tailoring these therapies as per patient's beliefs and preferences, optimal patient-centered holistic care can be provided.

Complementary and alternative medicine in pulmonology

PURPOSE OF REVIEW

To provide a comprehensive review of complementary and alternative medicine (CAM) therapies for the treatment of pulmonary disorders in children.

RECENT FINDINGS

The use of complementary medicine (CAM) is commonly used by both children and adults with breathing problems, and especially in chronic pulmonary disorders such as asthma and cystic fibrosis. Many clinics and hospitals now offer CAM, even though most of the conventionally trained health practitioners have little knowledge or education regarding CAM therapies. Research in CAM that demonstrates overall benefit is lacking, especially in children. Often parents do not report CAM use to their child's healthcare provider and this could compromise their overall quality of care. Although many research studies evaluating CAM therapies have methodological flaws, data exist to support CAM therapies in treating children with pulmonary disorders.

SUMMARY

This review examines the latest evidence of CAM use and effectiveness in children with pulmonary disorders. Physicians should be aware of the many CAM therapy options and the research surrounding them in order to provide their patients with the most current and accurate information available.

Hypnosis in paediatric respiratory medicine

Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis.

Mind-body CAM interventions: current status and considerations for integration into clinical health psychology

OBJECTIVE

Complementary and alternative medicine (CAM) is increasingly used for treating myriad health conditions and for maintaining general health. The present article provides an overview of current CAM use with a specific focus on mind-body CAM and its efficacy in treating health conditions.

METHOD

Characteristics of CAM users are presented, and then evidence regarding the efficacy of mind-body treatments (biofeedback, meditation, guided imagery, progressive muscle relaxation, deep breathing, hypnosis, yoga, tai chi, and qi gong) is reviewed.

RESULTS

Demographics associated with CAM use are fairly well-established, but less is known about their psychological characteristics. Although the efficacy of mind-body CAM modalities for health conditions is receiving a great deal of research attention, studies have thus far produced a weak base of evidence. Methodological limitations of current research are reviewed. Suggestions are made for future research that will provide more conclusive knowledge regarding efficacy and, ultimately, effectiveness of mind-body CAM. Considerations for clinical applications, including training and competence, ethics, treatment tailoring, prevention efforts, and diversity, conclude the article.

CONCLUSIONS

Integration of CAM modalities into clinical health psychology can be useful for researchers taking a broader perspective on stress and coping processes, illness behaviors, and culture; for practitioners seeking to incorporate CAM perspectives into their work; and for policy makers in directing healthcare resources wisely.

Treatment of psychological factors in a child with difficult asthma: a case report

Difficult asthma is defined as the persistence of asthma symptoms, abnormal pulmonary function showing airway obstruction, and continued requirement for short-acting bronchodilator therapy, despite adequate treatment with inhaled corticosteroids. It calls for a thorough evaluation of the patient to look into alternate and complicating diagnoses. The authors report a case of a 9-year-old patient with difficult asthma who failed to respond to conventional therapy. Although it was recognized that he had a number of potential medical complicating factors including allergies, chronic sinusitis, and gastroesophageal reflux, a psychological intervention using hypnosis ultimately appeared to help alleviate his symptoms completely. Thus, psychological evaluation and intervention should be considered early in the course of management of a patient with difficult asthma, because it may help avoid time-consuming and expensive investigations of potential complicating factors, and it may yield rapid improvement in the patient's clinical condition.

Complementary and alternative therapies: use in pediatric pulmonary medicine

With increased awareness of complementary/alternative medicine (CAM) and concern of potential adverse effects or limited effectiveness of conventional medications, patients and parents are looking to CAM approaches as either an alternative or as adjunct therapy, especially for chronic diseases such as asthma or cystic fibrosis. It is important that practitioners have adequate information so that patients and parents receive balanced and accurate information, especially regarding safety and potential efficacy. This review provides an overview of some of the more frequently used CAM therapies for children with chronic pulmonary disorders and summarizes the basic principles of each modality, along with efficacy and safety data.

Neurophysiological attributes of the hypnotic state and the utility of hypnosis in pediatric medicine and burn care

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.

What we can do with hypnosis: a brief note

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.

Hypnosis, hynotizability, and placebo

Dr. Raz' speculations about the relation between placebo responsivity and hypnotizability are critically examined. While there is no generally accepted theoretical definition of hypnosis, there is a general consensus that hypnotizability can be reliably measured. In contrast, there seems to be a general consensus about a theoretical definition of placebo (including placebo effect, placebo response and nocebo). There is no widely accepted measure of individual differences in placebo responsivity. Various methodological considerations about how to examine the relation between placebo responsivity and hypnotizability are identified. Studies are identified which indicate that response to treatments which utilize adjunctive hypnosis are superior to placebo treatments. The only study which examined whether placebo responsivity was correlated with hypnotizability seems to indicate that they are only slightly related at best. The possibility that there may be such thing as a "good placebo responder (GPR)" is questioned, while the known clinical value of hypnotizability assessment is reaffirmed. Future directions for empirical research on the relation between placebo responsivity and hypnotizability are identified.