Montgomery, G. H., Bovbjerg, D. H., Schnur, J. B., David, D., Goldfarb, A., Weltz, C. R., ... & Silverstein, J. H. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute, 99, 1304–1312.

Both the hypnosis and attention control sessions were standardized and provided for patients individually by clinical psychologists. All four interventionists were PhD-level clinical psychologists trained in the use of hypnosis in medical settings. The hypnosis intervention was provided in a 15-minute session on the morning of surgery one hour before surgery. Sessions included a relaxation-based induction (including imagery for muscle relaxation), suggestions for relaxation and peace, specific symptom-focused suggestions, a deepening procedure, and instructions for how patients could use hypnosis on their own following the intervention session. Patients in the attention control condition spent identical amounts of time with the same interventionists that led the hypnosis intervention. Patients were allowed to direct the flow of the conversation, and therapists provided supportive/empathic comments according to standardized procedures. Patient outcome measures were evaluated before discharge on the same day of surgery. Interventions were based on previously published work.

• The sample included 200 patients with breast cancer (mean age = 48.5 years) scheduled to undergo excisional breast biopsy or lumpectomy. 
• The majority of patients were white (intervention group = 71%, control group = 55%), and about half were married (intervention group = 50%, control group = 45%).
• Patients in the hypnosis group received less intraoperative medications than patients in the control group. 
• Patients were not eligible if they were scheduled for mastectomy or lumpectomy with full axillary dissection or if they had any uncontrolled major comorbid mental or physical illness.

Patients were recruited from two Mount Sinai Medical Center surgical practices.

Patients were undergoing the active treatment phase of care.

The study was a randomized, controlled trial:

1. Hypnosis (n = 105)
2. Attention control (n = 95).

Visual analog scales (VASs)

A MANOVA showed an overall effect of the intervention on the six outcomes (as assessed by VASs), including patient-reported pain intensity, pain unpleasantness, nausea, fatigue, discomfort, and emotional upset (p < 0.0001). One-way ANOVAs of the effects of the intervention on VAS outcomes revealed that each outcome was statistically significantly lower in patients in the intervention group compared to those in the control group. In all cases, mean differences were clinically meaningful.

A cost-effectiveness analysis revealed that the intervention group had reduced costs compared to the patients in the attention control condition. These cost savings were primarily a result of reduced time in surgery in the hypnosis group.

• Patients were not blinded to group assignment because patients in the hypnosis group had to be aware and actively participate in the intervention.
• Formal assessment of the effectiveness of blinding research and clinical staff was not conducted.
• The study did not analyze the long-term effects of the intervention.