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.

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

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.

• 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

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

PHASE OF CARE: Multiple phases of care

Prospective, non-random, three-group trial

• 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

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).

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.

• 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.

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.