Effectiveness Not Established

Hypnosis/Hypnotherapy

for Depression

hypnotic state is a state between wakefulness and sleep, a state of heightened concentration and receptivity that results in suspension of peripheral cues. The effect of a hypnotic state results in alteration of perception and attention. Hypnosis has been tested for its effect on pain, anxiety, depression, chemotherapy-induced nausea and vomiting (CINV), hot flashes, and fatigue in patients with cancer. Hypnosis has been delivered in various formats, including individual in-person sessions, CD program, and self-hypnosis.

Systematic Review/Meta-Analysis

Rajasekaran, M., Edmonds, P.M., & Higginson, I.L. (2005). Systematic review of hypnotherapy for treating symptoms in terminally ill adult cancer patients. Palliative Medicine, 19, 418–426.

Search Strategy

Databases searched were MEDLINE and Index Medicus, EMBASE, CINAHL, CancerLIT, Allied and Complementary Medicine Database (AHMED), PsycINFO, CISCOM, Cochrane Database, and Database of Abstracts and Reviews of Effects (DARE).

Literature Evaluated

The search yielded 27 studies from 1974–2003, only one of which was a randomized controlled trial (RCT). Authors analyzed only the RCT.

 

Results

Results of one RCT documented effectiveness of hypnotherapy in treating symptoms in terminally ill adult cancer patients.

Limitations

The lack of well-designed studies to be analyzed calls for further research, involving effectively designed studies, to establish the effectiveness of hypnotherapy.

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Research Evidence Summaries

Bragard, I., Etienne, A.M., Faymonville, M.E., Coucke, P., Lifrange, E., Schroeder, H., . . . Jerusalem, G. (2017). A nonrandomized comparison study of self-hypnosis, yoga, and cognitive-behavioral therapy to reduce emotional distress in breast cancer patients. International Journal of Clinical and Experimental Hypnosis, 65, 189–209.

Study Purpose

To compare the effects of self hypnosis, yoga, and cognitive-based therapy (CBT) on psychological and sleep patient outcomes

Intervention Characteristics/Basic Study Process

Women with non-metastatic breast cancer selected whether they wanted to participate in groups receiving CBT, self hypnosis, or yoga interventions. CBT included six weekly 90 minute group sessions led by trained psychologists. The yoga intervention included six weekly 90 minute group sessions of Hatha yoga and a DVD for use in home practice. Self-hypnosis sessions were 2 hours every two weeks for 12 weeks in small groups. The intervention included tasks and discussions inspired by CBT, with a 15 minute hypnosis exercise at the end of the session. They also received a CD with hypnosis exercises and homework assignments between sessions.

Sample Characteristics

  • N = 99   
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: All had breast cancer, about 33% participated during treatment with chemotherapy
  • OTHER KEY SAMPLE CHARACTERISTICS: On average, all had at least a high school education

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: Belgium

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Study Design

Prospective, non-random, three-group trial

Measurement Instruments/Methods

  • Hospital Anxiety and Depression Scale
  • EORTC-QLQ-C30
  • Mental adjustment to cancer scale
  • Insomnia Severity Index
  • Self-report of frequency of practice of interventions provided

Results

The majority of patient selected the hypnosis intervention. Anxiety and depression declined significantly in the yoga and hypnosis groups (p < 0.05). Fatigue and insomnia declined in the hypnosis group (p < 0.05). Most attended at least five sessions and practiced at least weekly at home. All three interventions showed medium effect sizes for change in anxiety (Cohen’s d range = 0.57-0.77).

Conclusions

Yoga and self-hypnosis group sessions were associated with decline in anxiety and depression. Self-hypnosis was also associated with improvement in sleep and fatigue scores.

Limitations

  • Small sample (< 100)
  • Baseline sample/group differences of import         
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Risk of bias (no appropriate attentional control condition)
  • Key sample group differences that could influence results
  • Intervention expensive, impractical, or training needs
  • Other limitations/explanation:  Only the CBT group did not have any material for home practice.  Sizes of the sample groups were vastly different, with only 10 people in the CBT group.  Though not statistically significant, the effect size for CBT was moderate, suggesting lack of significance was due to the small sample.  There was no differentiation between women currently in treatment and those not in treatment which could influence results -The hypnosis intervention included elements of CBT, so it is difficult to determine to what extent this versus the self hypnosis approach had effectiveness.  Provision of self hypnosis requires availability of appropriately trained providers.

Nursing Implications

Findings suggest that self hypnosis can be helpful to reduce anxiety, depression and insomnia in women with breast cancer.  If relevant resources are available to clinicians this could be a low risk and beneficial activity for symptom management.

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Gregoire, C., Bragard, I., Jerusalem, G., Etienne, A.M., Coucke, P., Dupuis, G., . . . Faymonville, M.E. (2017). Group interventions to reduce emotional distress and fatigue in breast cancer patients: A 9-month follow-up pragmatic trial. British Journal of Cancer, 117, 1442–1449.

Study Purpose

To determine the long-term (nine months) effectiveness of three different group interventions compared to usual care for patients with breast cancer 

Intervention Characteristics/Basic Study Process

Participants were allowed to select one of three groups to receive either cognitive behavioral therapy, yoga, and self-hypnosis. People who declined to participate were in a control group. Measurements were taken T0 through T3 to include before and after the short-term interventions, at month 3, and at month 9 follow-up.

Sample Characteristics

  • N =123 total; 21 yoga, 67 self-hypnosis (after dropouts and one who died), 10 CBT, 24 control group 
  • AGE: 27-73 across all groups 
  • FEMALES: 100%
  • CURRENT TREATMENT: Not applicable; mixed numbers of patients who had surgery, chemotherapy, radiation therapy, and hormonal therapy
  • KEY DISEASE CHARACTERISTICS: Non-metastatic breast cancer; 18 months postdiagnosis 
  • OTHER KEY SAMPLE CHARACTERISTICS: Inclusion criteria were at least 18 years old and can read, speak, and write French

Setting

  • SITE: Not stated/unknown   
  • SETTING TYPE: Not specified    
  • LOCATION: Belgium

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Study Design

Three group intervention self-selection; testing at T0, T1, T2 (month 3), T3 (month 9)

Measurement Instruments/Methods

Demographics; medical history; Hospital Anxiety Depression Scale (anxiety and depression emotional distress); Quality of Life 30-item questionnaire (fatigue); Insomnia Severity Index (sleep quality)

Results

Only results from baseline (T0) and the month 9 follow-up (T3) were reported using MANOVA with repeated analysis and post-hoc analysis. 

Post-hoc comparisons of time T0-T1: hypnosis group showed significant decreases in anxiety (p = 0.000), depression (p = 0.004), and fatigue (p = 0.045). Yoga group showed significant decrease in anxiety (p = 0.01). 

Post-hoc comparisons of time at T3: hypnosis group showed decreases in anxiety (p = 0.000), depression (p = 0.000), and fatigue (p = 0.002); yoga group showed decrease in anxiety (p = 0.024).

Conclusions

Self-hypnosis led to improvements in anxiety, depression, and fatigue. Anxiety improved in the yoga group. There were no improvements in the CBT or control groups.

Limitations

  • Small sample (< 100)
  • Risk of bias (no random assignment)
  • Other limitations/explanation: Control group included some of the non-consenters

Nursing Implications

Two of the three interventions may be helpful in reducing anxiety, depression, or fatigue when measured at nine months. Self-hypnosis may help patients improve emotional distress such as depression and anxiety, and may also reduce fatigue; yoga may also help improve anxiety. Larger samples and longer follow-up studies are needed.

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