The Effectiveness of Hypnoanalgesia Using Conventional and Placebo Hypnosis Induction

The effectiveness of hypnosis-based pain management is well-established. However, mechanisms of action and specific effective components are not well understood. The sociocognitive theory of hypnosis proposes that the effectiveness of hypnosis for pain management is determined by the nonspecific features of response expectancy and context. We tested this claim by contrasting the effectiveness of 2 hypnoanalgesia procedures in a within subjects design using the cold pressor task. The 2 procedures were identical, including analgesic suggestions, except for the hypnosis induction used. One condition involved a well-established hypnosis induction, including suggestions for focused attention, relaxation, and deepening. The other condition included a sham induction procedure using only white noise. In our confirmatory analysis (N = 46), we found that pain tolerance increased compared to baseline equivalently in the conventional and sham induction conditions (mean increase 13.7 and 12.4 seconds respectively, average within subject difference -1.27 seconds, 90% confidence interval [CI] = -8.46, 5.90). This finding supports the claim of the sociocognitive theory considering that response expectancy for pain reduction was also equivalent between the conditions (average difference 2.30, 90% CI = -2.23, 6.84). However, self-reported hypnosis depth was greater in the conventional induction condition (average difference -.78, 90% CI: -1.36, -.07), which contradicts sociocognitive predictions. Our findings indicate that conventional procedural elements of hypnosis inductions, such as suggestions for focused attention, relaxation, and deepening, may not be necessary to achieve acute pain reduction in an experimental setting when the hypnosis intervention includes analgesic suggestions. PERSPECTIVE: This study assessed the necessary effective components of hypnosis-based analgesia interventions. Our findings suggest that procedural features such as suggestions for focused attention, relaxation, and deepening may not be necessary for hypnoanalgesia as long as pain relief suggestions are present, and the hypnosis context and response expectancy are established. TRIAL REGISTRATION: This trial was registered on Open Science Framework with the registry number e96xk, available at https://osf.io/e96xk.

Correction to: 'Raising the value of research studies in psychological science by increasing the credibility of research reports: The Transparent Psi Project' (2023) by Kekecs et al

[This corrects the article DOI: 10.1098/rsos.191375.][This corrects the article DOI: 10.1098/rspb.2022.2500.].

Current Practices, Experiences, and Views in Clinical Hypnosis: Findings of an International Survey

An online survey of 691 clinicians who use hypnosis was conducted in 31 countries to gain a broad real-world picture of current practices, views, and experiences in clinical hypnosis. Among 36 common clinical uses, stress reduction, wellbeing and self-esteem-enhancement, surgery preparations, anxiety interventions, mindfulness facilitation, and labor and childbirth applications were the most frequently rated as highly effective (each by ≥70% of raters) in the clinicians' own experience. Adverse hypnosis-associated effects had been encountered by 55% of clinicians but were generally short-lived and very rarely judged as serious. The most common hypnosis approaches used were Ericksonian (71%), hypnotic relaxation therapy (55%), and traditional hypnosis (50%). Almost all respondents reported regularly using other therapeutic modalities alongside hypnosis. Among a range of client variables potentially affecting therapy, most clinicians rated hypnotist-client rapport (88%) and client motivation (75%) as very or extremely important factors for successful hypnotherapy. The majority of respondents had conducted hypnosis treatment via teletherapy, and 54% of those estimated it to be as effective as in-person treatment.

Raising the value of research studies in psychological science by increasing the credibility of research reports: the transparent Psi project

The low reproducibility rate in social sciences has produced hesitation among researchers in accepting published findings at their face value. Despite the advent of initiatives to increase transparency in research reporting, the field is still lacking tools to verify the credibility of research reports. In the present paper, we describe methodologies that let researchers craft highly credible research and allow their peers to verify this credibility. We demonstrate the application of these methods in a multi-laboratory replication of Bem's Experiment 1 (Bem 2011 J. Pers. Soc. Psychol. 100, 407-425. (doi:10.1037/a0021524)) on extrasensory perception (ESP), which was co-designed by a consensus panel including both proponents and opponents of Bem's original hypothesis. In the study we applied direct data deposition in combination with born-open data and real-time research reports to extend transparency to protocol delivery and data collection. We also used piloting, checklists, laboratory logs and video-documented trial sessions to ascertain as-intended protocol delivery, and external research auditors to monitor research integrity. We found 49.89% successful guesses, while Bem reported 53.07% success rate, with the chance level being 50%. Thus, Bem's findings were not replicated in our study. In the paper, we discuss the implementation, feasibility and perceived usefulness of the credibility-enhancing methodologies used throughout the project.

Electrodermal Orienting Response During Active-Alert Hypnosis: Do Verbal Suggestions Influence Automatic Attentional Processes?

This study explored the influence of suggestions on differences in electrodermal laterality of the skin conductance orienting response (SCR). Thirty-two participants were randomly assigned to either permitting or excluding suggestions. During the dream task in the permitting condition the suggestion was: "You are aware of your surroundings and any distractions that might disturb your dream," while in the excluding condition the wording was: "No outside stimulus will disturb your sleep." Participants were presented with 12 standards and 2 deviant computer-generated tones during active-alert hypnosis and musical control conditions in a mixed within-between design. High hypnotizables produced higher SCRs after permissive compared to excluding suggestions during hypnosis, while low hypnotizables did the same in the control condition. Study limitations include some loss of data due to equipment failure and relative homogeneity of sample, therefore results cannot be considered definitive.

Guidelines for the Assessment of Efficacy of Clinical Hypnosis Applications

Research on the efficacy of hypnosis applications continues to grow, but there remain major gaps between the science and clinical practice. One challenge has been a lack of consensus on which applications of hypnosis are efficacious based on research evidence. In 2018, 6 major hypnosis organizations collaborated to form the Task Force for Establishing Efficacy Standards for Clinical Hypnosis. This paper describes a Guideline for the Assessment of Efficacy of Clinical Hypnosis Applications developed by the Task Force, which makes 10 specific recommendations. The guideline is intended to be a tool for those who want to assess the quality of existing evidence on the efficacy of clinical hypnosis for any particular indication. The paper also discusses methodological issues in the interpretation and implementation of these guidelines. Future papers will report on the other products of the Hypnosis Efficacy Task Force, such as best practice recommendations for outcomes research in hypnosis and an international survey of researchers and clinicians on current practice and attitudes about hypnosis.

Patient Safety Education 20 Years After the Institute of Medicine Report: Results From a Cross-sectional National Survey

OBJECTIVES

Educating healthcare professionals in patient safety is essential to achieving sustainable improvements in care. This study aimed to identify the key constituents of patient safety education alongside its facilitators and barriers from a frontline perspective.

METHODS

An electronic survey was sent to 592 healthcare professionals and educators in patient safety education in the United Kingdom. Two independent reviewers conducted a thematic analysis of the free-text data. Themes focused on effective content, learning practices and facilitators and barriers to patient safety education.

RESULTS

Of 592 individuals completing the survey, 545 (92%) submitted analyzable responses. Interrater reliability of coding was high with Cohen k value of 0.86. Participants endorsed experiential and interactive learning as ideal modalities for delivery and expressed a need for content to be based on real clinical cases and tailored to the needs of the learners. The most commonly mentioned facilitators were standardization of methods and assessment (49%), dedicated funding (21%), and culture of openness (20%). Staffing problems and high workload (41%) and lack of accessibility of training (23%) were identified as primary barriers of efficacy and uptake.

CONCLUSIONS

This study identified key factors to the success of patient safety education in terms of content and delivery alongside facilitators and barriers. Future curricula developers and interventions should improve standardization, funding, culture, and access so as to optimize education programs to enhance patient safety.

Hypnosis Intervention for Sleep Disturbance: Determination of Optimal Dose and Method of Delivery for Postmenopausal Women

Sleep disturbances are a pervasive problem among postmenopausal women, with an estimated 40 to 64% reporting poor sleep. Hypnosis is a promising intervention for sleep disturbances. This study examined optimal dose and delivery for a manualized hypnosis intervention to improve sleep. Ninety postmenopausal women with poor sleep were randomized to 1 of 4 interventions: 5 in-person, 3 in-person, 5 phone, or 3 phone contacts. All received hypnosis audio recordings, with instructions for daily practice for 5 weeks. Feasibility measures included treatment satisfaction ratings and practice adherence. Sleep outcomes were sleep quality, objective and subjective duration, and bothersomeness of poor sleep. Results showed high treatment satisfaction, adherence, and clinically meaningful (≥ 0.5 SD) sleep improvement for all groups. Sleep quality significantly improved, p < .05, η2 = .70, with no significant differences between groups, with similar results for the other sleep outcomes across all treatment arms. Comparable results between phone and in-person groups suggest that a unique "dose" and delivery strategy is highly feasible and can have clinically meaningful impact. This study provides pilot evidence that an innovative hypnosis intervention for sleep (5 phone contacts with home practice) reduces the burden on participants while achieving maximum treatment benefit.

Towards a multi-brain framework for hypnosis: a review of quantitative methods

Most real-world applications of hypnosis involve a pair of actors: a hypnotist and a subject. Accordingly, most current models of hypnosis acknowledge the relevance of social factors in the development of the hypnotic response. Yet, psychophysiological research on hypnosis has been mostly restricted to techniques that are studying one individual, neglecting the complexity of hypnosis as a social phenomenon. In this paper, we review evidence suggesting that a multi-brain approach to studying the psychophysiology of hypnosis could lead to a breakthrough in our understanding of the neural correlates of hypnosis. In particular, we aim to highlight how this approach which relies on the information conveyed by complex verbal stimuli can be utilized to deal with the multifaceted nature of hypnosis. Furthermore, we present analytical approaches to assessing brain-to-brain coupling developed in the field of social cognitive neuroscience in the past decade, to aid the design of similar multi-brain studies in hypnosis research.

Test-Retest Reliability of the Stanford Hypnotic Susceptibility Scale, Form C and the Elkins Hypnotizability Scale

This project aimed to assess the consistency of hypnotizability over repeated assessments when measured by the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C), and the Elkins Hypnotizability Scale (EHS) and to contrast score distribution and pleasantness of these scales. University students were administered either the SHSS:C or the EHS twice with a one-week delay by separate experimenters. Test-retest reliability of the EHS and the SHSS:C was r _s =.82 (.71-.92) and r _s =.66, 95% (.47-.86), respectively (Spearman's correlation). Hypnotizability was comparable at test and retest in the EHS group, SHSS:C scores decreased by the retest. We found that the SHSS:C produced higher scores than the EHS, and the pleasantness of the 2 scales was comparable. Overall, our results supported the reliability of the EHS, while SHSS:C scores were more inconsistent between the 2 assessments. More research is warranted.

Can unconscious intentions be more effective than conscious intentions? Test of the role of metacognition in hypnotic response

While several theories assume that responses to hypnotic suggestions can be implemented without executive intentions, the metacognitive class of theories postulate that the behaviors produced by hypnotic suggestions are intended and the accompanying feeling of involuntariness is only a consequence of strategically not being aware of the intention. Cold control theory asserts that the only difference between a hypnotic and non-hypnotic response is this metacognitive one, that is, whether or not one is aware of one's intention to perform the relevant act. To test the theory, we compared the performance of highly suggestible participants in reducing the Stroop interference effect in a post-hypnotic suggestion condition (word blindness: that words will appear as a meaningless foreign script) and in a volitional condition (asking the participants to imagine the words as a meaningless foreign script). We found that participants had equivalent expectations that the posthypnotic suggestion and the volitional request would help control the conflicting information. Further, participants felt they had more control over experiencing the words as meaningless with the request rather than the suggestion; and they experienced the request largely as imagination and the suggestion largely as perception. That is, we set up the interventions we required for the experiment to constitute a test of cold control theory. Both the suggestion and the request reduced Stroop interference. Crucially, there was Bayesian evidence that the reduction in Stroop interference was the same between the suggestion and the volitional request. That is, the results support the claim that responding hypnotically does not grant a person greater first order abilities than they have non-hypnotically, consistent with cold control theory.

Bilateral comparison of traditional and alternate electrodermal measurement sites

Advances in mobile and wireless technology have expanded the scope of electrodermal research. Since traditional electrodermal measurement sites are not always suitable for laboratory research and are rarely appropriate for ambulatory measurements, there is a need to explore and contrast alternate measurement locations. We evaluated bilateral electrodermal activity (EDA) from five measurement sites (fingers, feet, wrists, shoulders, and calves). In a counterbalanced, randomized, within-subjects design study, participants (N = 115) engaged in a 4-min-long breathing exercise and were exposed to emotionally laden and neutral stimuli. High within-subject correlations were found between the EDA measured from fingers bilaterally (r = .89), between the left fingers and both feet (r = .72). Moderate correlations were found between EDA measured from the left fingers and wrists (r = .30 and r = .33), low correlations between the left fingers and the shoulders (r = -.03 and r = -.06) or calves (r = .05 and r = .14). Response latency was the shortest on the fingers while it was the longest on the lower body. Short response windows would miss some of the responses from the palmar surfaces and a substantial number from other evaluated locations. The fingers and the feet are the most reliable locations to measure from, followed by the wrists. We suggest setting site-specific response windows for different measurement locations. An investigation of repeatability showed that within-subject correlations, response frequencies, response amplitudes show a similar pattern from the first measurement time to a later one.

A consensus-based transparency checklist

We present a consensus-based checklist to improve and document the transparency of research reports in social and behavioural research. An accompanying online application allows users to complete the form and generate a report that they can submit with their manuscript or post to a public repository.

The Psychological Science Accelerator: Advancing Psychology through a Distributed Collaborative Network

Concerns have been growing about the veracity of psychological research. Many findings in psychological science are based on studies with insufficient statistical power and nonrepresentative samples, or may otherwise be limited to specific, ungeneralizable settings or populations. Crowdsourced research, a type of large-scale collaboration in which one or more research projects are conducted across multiple lab sites, offers a pragmatic solution to these and other current methodological challenges. The Psychological Science Accelerator (PSA) is a distributed network of laboratories designed to enable and support crowdsourced research projects. These projects can focus on novel research questions, or attempt to replicate prior research, in large, diverse samples. The PSA's mission is to accelerate the accumulation of reliable and generalizable evidence in psychological science. Here, we describe the background, structure, principles, procedures, benefits, and challenges of the PSA. In contrast to other crowdsourced research networks, the PSA is ongoing (as opposed to time-limited), efficient (in terms of re-using structures and principles for different projects), decentralized, diverse (in terms of participants and researchers), and inclusive (of proposals, contributions, and other relevant input from anyone inside or outside of the network). The PSA and other approaches to crowdsourced psychological science will advance our understanding of mental processes and behaviors by enabling rigorous research and systematically examining its generalizability.

Brief Report: Knowledge of, Interest in, and Willingness to Try Behavioral Interventions in Individuals With Parkinson's Disease

Purpose/Objective • Behavioral interventions hold enormous promise for managing a variety of motor and nonmotor symptoms in Parkinson's disease (PD). Despite this, prior studies have suggested that the utilization of these interventions is relatively low. The current study seeks to understand factors that could relate to the utilization of PD behavioral strategies. Specifically, the study evaluates the self-described knowledge of, interest in, and willingness to participate in behavioral interventions in a community-dwelling sample of individuals with PD. Research Method/Design • Forty-five individuals with PD completed a survey that assessed knowledge, interest, and willingness to participate in 5 behavioral interventions: hypnosis, relaxation training, mindfulness/meditation, computerized "brain games," and counseling. In addition, participants self-reported their quality of life across several domains; these domain scores were correlated with overall ratings of interest and willingness to participate in behavioral interventions. Results • Self-reported knowledge of behavioral interventions was low, but interest and willingness to participate was moderate to high across modalities. Statistically significant correlations were noted between perceived knowledge of the techniques and interest (r = 0.29, P = .05) as well as willingness to participate (r = 0.32, P = .03) in these techniques. Interest and willingness were also correlated with self-reported bodily discomfort (r = 0.36, P = .02). Conclusions/Implications • The participants of the current sample were interested and willing to participate in behavioral interventions but had limited knowledge of the potential for these techniques to manage their symptoms. The reported high level of willingness to participate in behavioral interventions suggests that it is feasible to provide behavioral interventions in this population.

BILATERAL ELECTRODERMAL ACTIVITY IN THE ACTIVE-ALERT HYPNOTIC INDUCTION

Shifts in hemispheric dominance were previously proposed to play a role in hypnosis. Participants (N = 32) were exposed to an active-alert hypnosis induction and a music-control condition while electrodermal activity was registered bilaterally, providing information on alterations in hemispheric dominance. The results suggest that highly hypnotizable participants show a shift to right-sided and low hypnotizable participants demonstrated a shift to left-sided electrodermal dominance in response to the induction, whereas no change in laterality is present in the control condition. Additionally, the authors found that self-reported hypnosis experiences were also associated with a shift in laterality. These results underline the importance of the shift to right hemispheric activity in hypnosis and underscore the importance of hemispheric changes in shaping subjective experience.

Feasibility of Music and Hypnotic Suggestion to Manage Chronic Pain

The authors investigated the feasibility and possible effects of hypnotic suggestion and music for chronic pain. Ten people completed the 2-week intervention that consisted of daily listening to hypnotic suggestions combined with music. Averaged subjective pain intensity, pain bothersomeness, overall distress, anxiety, and depression decreased from baseline to endpoint. Participants rated pre- and postlistening pain intensity and pain bothersomeness decreased for each session. Information provided during end-of-study interviews indicated all participants were satisfied with treatment and felt they benefited from being in the study. Means and standard deviations are reported for outcome measures and a case study is provided. This preliminary study supports the use of a combined hypnotic suggestion and music intervention for chronic pain.

Hypnosis for burn-related pain: Case studies and a review of the literature

Burn injuries create severe pain and psychological distress that are highly variable between patients. Distinct types of pain during various stages of injury and recovery make treatment complex. Standard pharmacological treatment of pain can have adverse effects and is not effective in treating anxiety and other psychological issues. Researchers have proposed that integrating clinical hypnosis as a complementary therapy can be highly beneficial to burn patients and their healthcare providers. The existing literature is reviewed and specific hypnosis techniques are discussed. Evidence exists indicating that adjunctive hypnosis is effective at reducing pain and procedural anxiety. Implementing a multidisciplinary burn care team that includes clinical hypnosis and focuses on the patients’ psychological health as well as pain reduction is likely to result in faster healing and reduced distress for patients and caregivers alike.

Presence of Meaning in Life and Search for Meaning in Life and Relationship to Health Anxiety

The present study explored presence of meaning in life, search for meaning in life, and their correlation with health anxiety. The Meaning in Life Questionnaire and the Short Health Anxiety Inventory were completed by 753 individuals. Results indicated higher presence of meaning in life was associated with lower health anxiety, while the opposite was observed for search for meaning in life. Results also revealed an interaction between presence of meaning in life and search for meaning in life, where individuals with high search for meaning in life and high presence of meaning in life had lower health anxiety than those with high search for meaning in life and low presence of meaning in life. These findings suggest that presence of meaning in life and search for meaning in life are correlates of health anxiety.

Re-Evaluation of the Psychometric Properties of the Maternal-Fetal Attachment Scale in a Hungarian Sample

OBJECTIVE

To explore the factor structure of the Maternal-Fetal Attachment Scale (MFAS) and investigate its psychosocial and demographic correlates in a Hungarian sample.

DESIGN

Cross-sectional survey.

SETTING

Sonography clinic in a metropolitan area.

PARTICIPANTS

One hundred fourteen women over the age of 18 years in the second or third trimesters of pregnancy.

METHODS

Participants completed the Hungarian version of the MFAS and provided information on demographic, socioeconomic, and pregnancy-related factors.

RESULTS

The internal consistency of the MFAS total scale was acceptable (Cronbach's alpha = .87). However, the reliability of the five subscales was low (alpha coefficients between .57 and .74), and the original five-factor model was not supported by the factor analyses. Married mothers had higher scores on the MFAS than participants who were unmarried, and uncertainty about the sex of the fetus was associated with lower attachment scores. Furthermore, gestational age showed a positive correlation with MFAS scores. No significant association was found between the total score on the MFAS and such factors as age, income, or education of the parents; whether the pregnancy was planned; method of conception; number of children born previously; prior perinatal losses; and circumstances of the mother's own birth.

CONCLUSION

Our study showed that marital status, uncertainty about the sex of the fetus, and gestational age were associated with maternal-fetal attachment; however, more detailed analysis was not possible because of the instability of the subscales of the instrument. Further research is warranted on the underlying factors related to maternal-fetal attachment.

The Effectiveness of Psychosocial Interventions as Adjuncts to Orthopaedic Surgery: A Systematic Review Protocol

AIMS

Pain and anxiety are commonly reported among those undergoing orthopaedic surgery. Improvement in anxiety and pain control might be achieved by supplementing standard care with psychological interventions. However, the effectiveness of adjunctive psychosocial interventions in anxiety and pain control have not been addressed sufficiently by previous systematic reviews in orthopaedic surgeries. The present study aimed to assess the effectiveness of adjunctive psychosocial techniques to improve perioperative clinical care in orthopaedic surgery, to identify the most effective intervention types and to evaluate potential moderators.

METHODS

We will perform a systematic review and meta-analysis to address the study aims. PubMed, PsycINFO, CINAHL and ProQuest Dissertations & Theses will be searched between 1980 and 2015. Prospective controlled clinical trials completed in adults, contrasting standard care and standard care supplemented with psychosocial methods, will be eligible for inclusion. Effectiveness will be assessed through the outcomes of postoperative pain intensity, analgesic requirement, perioperative anxiety, quality of life and postoperative recovery. The results of a random-effect meta-analysis will be reported. To aid implementation of best practice, moderating effects of the type and timing of psychosocial intervention, type of surgical intervention and type of anaesthesia will be evaluated through meta-regression. Sensitivity analyses and subgroup contrasts will follow as necessary.

DISCUSSION

Recommendations will be made to improve medical care in orthopaedic procedures. The quality of evidence will be rated using GRADE criteria. Copyright © 2016 John Wiley & Sons, Ltd.

An empirical analysis of the methodology of automatic imitation research in a strategic context

Since the discovery of the mirror neuron system, it has been proposed that the automatic tendency to copy observed actions exists in humans and that this mechanism might be responsible for a range of social behavior. A strong argument for automatic behavior can be made when actions are executed against motivation to do otherwise. Strategic games in which imitation is disadvantageous serve as ideal designs for studying the automatic nature of participants' behavior. Most recently, Belot, Crawford, and Heyes (2013) conducted an explorative study using a modified version of the Rock-Paper-Scissors game, and suggested that in the case of asynchrony in the execution of the gestures, automatic imitation can be observed early on after the opponent's presentation. In our study, we video recorded the games, which allowed us to examine the effect of delay on imitative behavior as well as the sensitivity of the previously employed analyses. The examination of the recorded images revealed that more than 80% of the data were irrelevant to the study of automatic behavior. Additional bias in the paradigm became apparent, as previously presented gestures were found to affect the behavior of the players. After noise filtering, we found no evidence of automatic imitation in either the whole filtered data set or in selected time windows based on delay length. Besides questioning the strength of the results of previous analyses, we propose several experimental and statistical modifications for further research on automatic imitation.