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Research focus
Hypnosis There is much debate about the definition and efficacy of hypnosis. However, in therapy, hypnosis usually involves deep relaxation combined with appropriate suggestions made by the therapist to enable the patient to make positive changes. It is increasingly being used as a treatment for health problems including anxiety, insomnia and pain control. This review summarises two studies relating to the use of hypnosis for chronic pain and radiotherapy treatment.

A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain
This trial compared the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on 22 patients with multiple sclerosis (MS) and chronic pain. The inclusion criteria were a diagnosis of MS, aged 18 or over, and a reported chronic daily pain score of at least 4/10. The first eight eligible participants piloted the HYP training programme; the next 14 participants were randomised to the HYP or PMR interventions. As there were no significant differences in the characteristics of the pilot and randomised group for HYP they were combined , for subsequent analysis. Following one week of pre-treatment assessments of average daily pain, participants received ten sessions of either HYP or PMR. The primary outcome variable was pain intensity, which was assessed before and after each treatment session. Telephone interviews were conducted by a researcher who was blind to the treatment to assess average daily pain before and after the treatment, and at three months follow up. Secondary outcomes included pain interference and frequency, effects of self-hypnosis and relaxation practice. There was no significant difference in treatment-outcome expectancy between the two treatment groups either before or after the first treatment session. Participants in the HYP group reported significantly greater pre- to post-session and pre- to 14 October 2010 | Volume 20 | Number 8

post-treatment decreases in pain and pain interference than the PMR-condition participants. The majority of participants in both groups continued to use the treatment skills learnt with subsequent pain relief. The authors concluded that the results support the efficacy of self-hypnosis for chronic pain relief in people with MS. However, PMR was limited as a comparison condition as it is an active treatment which may result in an underestimate of the actual effects of HYP in comparison. The inclusion of a wait-list control would have enabled an estimation of treatment effects. The study was also limited by its small sample size and quasi-experimental design. Jensen MP, Barber J, Romano JM et al (2009) International Journal of Clinical and Experimental Hypnosis. 57, 2, 198-221.

Deep relaxation can help in the relief of chronic pain

A randomized trial of a cognitive-behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy
Women receiving radiotherapy for breast cancer experience anxiety about the treatment and its potential side effects. This trial investigated the effectiveness of a cognitive behaviour therapy plus hypnosis intervention (CBTH) to reduce negative affect for 40 women receiving radiotherapy. Participants were aged over 18, able to understand English, scheduled to receive radiotherapy, for Stage 0, I, II or III breast cancer and willing to be randomised to the intervention. Twenty participants were randomised to the CBTH or standard care control (SCC) group. CBTH training was carried out by a clinical psychologist before the start of radiation, followed by a hypnosis recording to listen to at home and a CBT workbook to complete weekly. Participants assigned to the SCC group completed questionnaires only, but were eligible to receive an intervention session following the study. Diener and Emmons (1984) nine-item mood report form was administered weekly to assess participants positive and negative affect during their radiotherapy course over five weeks. The scale is reliable and has previously been used with women who have breast cancer. Participants rated their positive and negative affect on a scale of 0 to 6.

Items measuring positive affect included happy and pleased, negative affect included unhappy and anxious. Personality traits were also measured as they may determine affect. Demographics and medical history were also collected from all participants. Repeated and univariate analysis of variance indicated that the CBTH approach reduced levels of negative affect as well as increasing positive affect over the period of radiotherapy treatment. The frequency of days with a greater positive than negative affect was also significantly higher for the CBTH group. The findings indicated that the CBTH intervention had the potential to improve the affect of women receiving radiotherapy for breast cancer. The study was limited by the absence of an attention control for non-specific effects such as professional time and attention. It was recommended that future research should examine the generalisability of this intervention. Schnur JB, David D, Kangas M et al (2009) Journal of Clinical Psychology. 65, 4, 443-455. Reference
Diener E, Emmons RA (1984) The independence of positive and negative affect. Journal of Personality and Social Psychology. 47, 5, 1105-1117.

Research focus was compiled by Sue Davies, research fellow, University of Hertfordshire

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