Treating Hot Flashes with Hypnosis: Does Hypnotizability Modulate Reductions?

Hypnosis is an effective treatment option for a variety of concerns. Past research has suggested that those who score in the high range of hypnotizability initially show greater improvement than those in the low range. A post hoc analysis was conducted to examine the extent to which hypnotizability modulates the reduction of hot flash frequency. Average number of hot flashes reported during hypnosis treatment and a 12-week follow-up were grouped according to participants' level of hypnotizability. Using baseline data, the reduction percentage of hot flash frequency was plotted and visually examined to determine when a clinically significant reduction (50%) in hot flashes was reached. Our results suggested that, regardless of hypnotizability, participants ultimately obtained a 50% reduction in hot flash frequency. Interestingly, participants who were rated as either moderately or highly hypnotizable achieved a 50% reduction by Week 3 while those of low hypnotizability did not cross the 50% reduction threshold until the 12-week follow-up. Implications from these findings include the importance of assessing hypnotizability in clinical settings to better tailor treatment dose and expectations.

A brief nap during an acute stressor improves negative affect.

Overnight sleep can reduce perceived stress, and improve associated cognitive disruptions and negative affect after an acute stressor. Whether a brief nap can also bestow these benefits in a non-sleep-restricted population is currently unknown. In this study that used a between-subjects design, stress was triggered by administering a modified Trier Social Stress Test to two groups of participants (nap [n = 29], wake [n = 41]). All participants were instructed they would give a speech during the study but the topic would be withheld until later, and then completed a math task. After a 40-min break in which participants watched a neutral video or took a nap monitored with electroencephalography, stress was reinforced by presenting the speech topics and giving participants a 10-min preparation period. Next, instead of giving a speech, the study ended and participants were debriefed. Negative affect, perceived stress and working memory were measured at multiple time points before and after the break. Both groups showed lower perceived stress and improved working memory after the break than before, but a nap did not confer additional benefits for perceived stress or working memory beyond taking a break. However, the nap group exhibited lower negative affect after the break than the wake group, and only the nap group showed a reduction in negative affect compared with initial negative affect levels. These results indicate a nap can improve negative emotions accompanying a stressor to a greater extent than taking a break, and suggest that brief naps may be a useful way to improve mood while experiencing an acute stressor.

Effect of Hypnosis on Anxiety: Results from a Randomized Controlled Trial with Women in Postmenopause.

Anxiety is common, yet often under-treated, among women in postmenopause. This study examined the effect of a hypnotic intervention designed to reduce hot flashes, on anxiety levels of postmenopausal women. Anxiety was assessed using the State-Trait Anxiety Inventory, the Hospital Anxiety and Depression Scale-Anxiety subscale, and a visual analog scale. Additionally, hypnotizability was tested as a moderator of anxiety reductions. Significant reductions in anxiety were found from baseline to endpoint and follow-up and hypnosis was superior to the control condition. Additionally, ratings of Current Anxiety decreased from pre-session to post-session at each weekly visit and the pre-session scores reduced continuously. Hypnotizability was found to moderate anxiety reductions, but regardless of hypnotizability level participants, on average, experienced significant symptom improvement from baseline scores. These data provide initial support for the use of hypnosis to reduce symptoms of anxiety among postmenopausal women.Trial registration: This study was registered at ClinicalTrials.gov on February 11, 2011 under Identifier number NCT01293695 ( https://clinicaltrials.gov/ct2/show/NCT01293695?term=Elkins&cond=hot+flashes&draw=2&rank=2 ).

Risk factors, pathophysiology, and treatment of hot flashes in cancer.

Hot flashes are prevalent and severe symptoms that can interfere with mood, sleep, and quality of life for women and men with cancer. The purpose of this article is to review existing literature on the risk factors, pathophysiology, and treatment of hot flashes in individuals with cancer. Electronic searches were conducted to identify relevant English-language literature published through June 15, 2012. Results indicated that risk factors for hot flashes in cancer include patient-related factors (eg, age, race/ethnicity, educational level, smoking history, cardiovascular risk including body mass index, and genetics) and disease-related factors (eg, cancer diagnosis and dose/type of treatment). In addition, although the pathophysiology of hot flashes has remained elusive, these symptoms are likely attributable to disruptions in thermoregulation and neurochemicals. Therapies that have been offered or tested fall into 4 broad categories: pharmacological, nutraceutical, surgical, and complementary/behavioral strategies. The evidence base for this broad range of therapies varies, with some treatments not yet having been fully tested or showing equivocal results. The evidence base surrounding all therapies is evaluated to enhance hot flash treatment decision-making by clinicians and patients.

Phase II randomized controlled trial of hypnosis versus progressive muscle relaxation for body image after breast or gynecologic cancer.

BACKGROUND: Sexual dysfunction, fueled by body image stress, is prevalent in women with a history of breast or gynecologic cancer. Preliminary data support that mind-body connections may improve sexual health outcomes through improving body image. OBJECTIVE: This randomized controlled trial compared hypnosis to progressive muscle relaxation (PMR). The primary outcome was body image at week 6 as measured by the Impact of Treatment Scale for women who have or have had breast or gynecologic cancer. INTERVENTIONS/METHODS: Consented participants were randomized 2:1 to hypnosis or PMR. Both arms consisted of three face-to-face sessions delivered by a trained therapist. Sessions were every 2 weeks for 6 weeks; participants practiced at home between sessions using an audio recording. RESULTS: Eighty-seven women were randomized, 59 to hypnosis and 28 to PMR. Both groups reported significant improvements on body image over time (within group effect size Cohen's d = 0.49-0.75) with no significant difference between groups (p = 0.15). Secondary outcomes were not significantly different between groups. The hypnosis group improved more in sexual satisfaction and sexual interest while the PMR group improved more in positive affect. CONCLUSIONS: Interventions facilitating mind-body connections such as hypnosis and PMR may help to improve body image. This study suggests that stress relieving strategies of hypnosis and PMR may contribute to providing a re-connection to one's body, improved positive affect, and overall better sexual health.

Advancing Research and Practice: The Revised APA Division 30 Definition of Hypnosis.

This article describes the history, rationale, and guidelines for developing a new definition of hypnosis by the Society of Psychological Hypnosis, Division 30 of the American Psychological Association. The definition was developed with the aim of being concise, being heuristic, and allowing for alternative theories of the mechanisms (to be determined in empirical scientific study). The definition of hypnosis is presented as well as definitions of the following related terms: hypnotic induction, hypnotizability, and hypnotherapy. The implications for advancing research and practice are discussed. The definitions are presented within the article.

Does a General "G Factor" Best Account for Hypnotizability?

The lead article in this issue of the International Journal of Clinical and Experimental Hypnosis (IJCEH), entitled, "Confirmatory Factor Analysis of the Elkins Hypnotizability Scale in a Clinical Population", reports on a factor analysis of hypnotizability scores in a clinical population of postmenopausal women. The results found evidence for a general hypnotizability latent variable. This finding suggests a general "G factor" may best account for hypnotizability. More research is needed, however, if confirmed in future research would lead to a new understanding of hypnotizability as having a single-factor structure. Existing research proposes greater recognition of the natural capacity of humans to intentionally alter their own experiences. Another study reports that perceptions of clinical hypnosis are positive among the public and healthcare providers, but more education of healthcare providers about hypnotherapy is needed. Additional articles are presented that examine the feasibility and potential benefit of clinical hypnosis in treatment of pain and distress among patients with fibromyalgia syndrome and in improving sleep disturbances in individuals with mild cognitive impairment.

Clinical Hypnosis Intervention for Improving Sleep Quality: Emerging Research and Future Directions.

Research into clinical hypnosis for sleep disturbances is an expanding area with important implications for clinical practice and future research. This issue of the International Journal of Clinical and Experimental Hypnosis includes emerging research on clinical hypnosis to improve sleep quality and disturbances. While clinical hypnosis for sleep is very promising, the underlying mechanisms are largely unknown. To address this is an article that examines pre-sleep arousal and worry reduction as potential variables associated with the effects of clinical hypnosis in improving sleep quality. Related to this topic is an article entitled, "Aging adults' willingness, preferences, and access to self-hypnosis for sleep: A cross-sectional study," which identifies aging adults' preferences and access to self-hypnosis for sleep. This issue of the IJCEH also includes an important article on health care professionals' perceptions, knowledge and attitudes toward clinical hypnosis which considers the need for more training and education in clinical hypnosis among health care providers. Further, a scoping review of hypnotherapy for treatment of depression is presented, followed by an exploration of implicit rapport in hypnotherapy, and a case report on hypnotherapy in oral surgery with a highly hypnotizable patient.

The Everyday Wellbeing Appraisal Scale: Assessing a type of subjective well-being uniquely associated with health behavior in people with hypertension.

Everyday well-being appraisals are judgments about the goodness of recent daily life events. These appraisals are expected to be distinct from other types of well-being involving traits, affect, and psychological distress and expected to be uniquely important for understanding health behavior such as exercise, diet, and treatment adherence for people with medical conditions. To develop and test a new Everyday Wellbeing Appraisal Scale, two studies were conducted in which a total of 718 people with hypertension completed online questionnaires. In Study 1, to achieve maximum validity with the fewest number of items, an empirical analysis was used to select a set of six items with high discrimination that incorporated multiple types of response-option formats. In Study 2, the scale's unidimensional factor structure and high discrimination were confirmed, and the new scale outperformed several existing types of well-being scales in its ability to explain unique variance in health behavior criterion variables. Specifically, it explained unique variance in health behavior after controlling for a widely used measure assessing trait-level reflections of well-being, as well as measures of positive affect and two types of psychological distress. Also, when compared to the trait-level measure of well-being, the new scale demonstrated less overlap with affect and psychological distress. These results suggest that this brief, new scale is valuable for assessing a distinct construct that is especially salient for understanding health behavior. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study.

BACKGROUND: Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking. OBJECTIVE: This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app. METHODS: This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users. RESULTS: Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=-0.09). CONCLUSIONS: This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app.

Confirmatory Factor Analysis of the Elkins Hypnotizability Scale in a Clinical Population.

The objective of this study was to determine the best-fit factor structure of a standardized hypnotizability measure in a clinical population. The Elkins Hypnotizability Scale (EHS) was administered to 173 post-menopausal women, age from 39 to 75 years, with a mean age of 54.61 years. Confirmatory factor analysis was conducted, and comparative fit index (CFI) and root mean square error of approximation (RMSEA) were used to determine goodness of fit. Results indicated that the single-factor structure modeled with six indicators based on the individual items on the EHS provides the best description of fit. Results of the present study demonstrate that the EHS has a single-factor structure. Further research is required with other populations and measures.

Aging Adults' Willingness, Preferences, and Access to Self-Hypnosis for Sleep: A Cross-Sectional Survey.

Sleep disturbance is a public health problem among aging adults (age 45 and older). While aging adults are at an elevated risk for sleep disturbance, many also have high rates of mistrust toward psychological interventions, such as self-hypnosis, which may be beneficial for sleep. The purpose of the study was to assess factors that may impact utilization of self-hypnosis for sleep, including willingness, preferences, and access among informed aging adults. 244 aging adults were recruited. After reading an information sheet on self-hypnosis for sleep, participants completed questionnaires assessing sleep related worry, stress, and perceptions of self-hypnosis for sleep, including willingness, benefits, barriers, preferences, and access. The findings indicated that informed aging adults were willing to engage in self-hypnosis for sleep, regardless of their race or gender. Furthermore, they preferred technological delivery methods (i.e. telehealth or smartphone apps) with flexible scheduling options. However, very few participants endorsed having access to self-hypnosis.

Nerva, a mobile application of gut-directed hypnotherapy for irritable bowel syndrome: User characteristics, patterns of use, and predictors of persistence.

Background: Hypnotic intervention for irritable bowel syndrome (IBS), or gut-directed hypnotherapy (GDH), is an effective treatment for improving IBS symptoms with minimal burden and risk in delivery to patients. The Nerva app, developed by Mindset Health, shows promise for dissemination and implementation of evidence-based GDH intervention for IBS. Objectives: This study aimed to describe the demographic and clinical characteristics of Nerva app users, examine usage patterns, and explore potential factors associated with Nerva app usage. Methods: A retrospective analysis of data was conducted of 14,898 individuals who downloaded and used the Nerva app between January 2022 and September 2022. Descriptive statistics and Chi-square tests of independence were calculated to examine demographic/clinical characteristics, usage patterns, and their associations to program persistence. Simple linear regression models were used for correlations of GI symptoms severity scores to user persistence. Results: Users predominantly identified as female (77.2%; n = 11,503) and had a mean age of 38.59 years old (SD = 13.38). Thirty-one percent of users persisted with the program, and a small statistically significant association was found between Nerva app program persistence and age, χ2 (6, N = 6745) = 164.82, p < 0.001, V = .16. Conclusions: The present study found promising adherence rates for the Nerva app program within the first six weeks of use. Statistics in prevalence estimates of IBS agree with previous literature and significant associations were found between user/clinical characteristics and Nerva app program persistence.

Exploring Variables Associated with the Effects of a Self-Administered Hypnosis Intervention for Improving Sleep Quality.

About two-thirds of college students rate their sleep as suboptimal which is associated with a variety of additional issues. Poor sleep is shown to follow certain pre-sleep cognitive activity that inhibits sleep onset and reduces sleep quality. Preliminary evidence suggests that a self-administered hypnosis intervention is feasible in improving sleep within a college student population, and the current study explores potential correlating variables to inform future mechanistic research. Twenty-two college students who self-reported poor sleep quality utilized a three-week self-administered hypnosis intervention while completing baseline and endpoint measures of sleep quality, insomnia symptoms, and psychological factors. Results indicated that participants experienced significant improvement with large effects in sleep quality (d = -1.21) and significant decreases in insomnia symptoms (d = 1.05) from pre- to post-intervention. Significant improvements were also observed on measures of pre-sleep arousal and worry. The results suggest that a self-administered hypnosis intervention may modulate pre-sleep cognitive activity associated with poor sleep quality.

A General Factor of Hypnotizability Revealed by Confirmatory Factor Analysis.

The objective of this study was to determine the model fit of a standardized hypnotizability measure in a targeted clinical sample. The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) was administered to 168 post-menopausal women aged 39 to 75 years. Confirmatory factor analysis was conducted, and comparative fit index (CFI) and root mean square error of approximation (RMSEA) were used to determine goodness of fit. Results indicated that the single-factor structure modeled with twelve indicators based on the individual items on the SHSS:C provided the best description of fit. Results of the present study demonstrate that the SHSS:C has a single-factor structure. These findings suggest that new scales of hypnotizability can be optimized by focusing on the use of items that correlate highly with the overall score representing the unidimensional construct of hypnotizability. The findings should be interpreted with caution due to the small sample size, and further research is needed with other populations to clarify generalizability.

Mindful Self-Hypnosis Combined with Resistance Training to Reduce Perceived Stress and Improve Other Psychological Factors in Female College Students.

Perceived stress is a significant problem among female college students that can impact psychological distress, sleep, and overall well-being. Mindful self-hypnosis (MSH) and resistance training (RT) have both been shown to reduce perceived stress. The rationale for the present study was to investigate whether MSH combined with RT could be more effective at reducing perceived stress as measured by the Perceived Stress Scale than RT alone due to synergistic effects achieved by combining the interventions. Forty-four female college students were randomized to one of the three groups: MSH+RT, RT only, or a wait-list control (WLC). Results indicated that, compared to RT only, the addition of MSH led to pronounced improvements in perceived stress which was significantly greater than WLC. Also, MSH+RT resulted in significant increases in mindfulness, sleep, strength, and well-being in comparison to WLC. MSH+RT was shown to be feasible with highly satisfactory participant ratings. Future research should examine the MSH+RT intervention with a larger population and with older women who are more at risk for stress and declining strength.

Hypnosis Intervention for Sleep Disturbances in Individuals with Mild Cognitive Impairment: A Randomized Pilot Study.

Poor sleep quality is highly prevalent among individuals with mild cognitive impairment (MCI). Further, poor sleep quality is associated with reduced quality of life, increased stress response, memory impairments, and progression to dementia among individuals with MCI. Pharmacological treatments for sleep have mixed efficacy and can lead to dependency. Therefore, alternatives to pharmacological treatments for improving sleep among individuals with MCI are needed. The present study reports on the feasibility of a non-pharmacological self-administered hypnosis intervention focused on sleep quality in adults with MCI. It was hypothesized that the hypnosis intervention program would be feasible and have acceptable levels of adherence to daily hypnosis practice. A two-armed randomized controlled pilot trial was conducted using a sample of 21 adults with MCI. Eligible participants were randomly assigned to listen to either hypnosis audio recordings or sham hypnosis recordings for five weeks. Program feasibility, program adherence, pain intensity, stress, and sleep quality were measured using a daily home practice log, questionnaires, and wrist actigraphy. The results found mid or higher levels of treatment satisfaction, ease of use, and perceived effectiveness at one-week follow-up, with participants in the hypnosis arm reporting greater perceived benefit. Adherence to assigned audio recordings and meetings were likewise within acceptable margins in both groups. No intervention-related adverse events were reported in either treatment condition. Significant improvements in sleep quality, sleep duration, and daytime sleepiness were found for the hypnosis intervention. The results of this study can be used to inform future research on the effects of hypnosis on sleep quality in adults with MCI.

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.

Enhancing placebo effects: insights from social psychology.

Placebo effects are widely recognized as having a potent impact upon treatment outcomes in both medical and psychological interventions, including hypnosis. In research utilizing randomized clinical trials, there is usually an effort to minimize or control placebo effects. However, in clinical practice there may be significant benefits in enhancing placebo effects. Prior research from the field of social psychology has identified three factors that may enhance placebo effects, namely: priming, client perceptions, and the theory of planned behavior. These factors are reviewed and illustrated via a case example. The consideration of social-psychological factors to enhance positive expectancies and beliefs has implications for clinical practice as well as future research into hypnotic interventions.

Efficacy of Hypnosis Interventions: Fibromyalgia, Sleep, Oncology, Test Anxiety, and Beliefs.

This issue of the International Journal of Clinical and Experimental Hypnosis addresses the efficacy and feasibility of hypnosis interventions for several medical problems and issues. The lead article provides a narrative review of the efficacy of hypnosis interventions for Fibromyalgia. This is followed by a feasibility study of self-administered hypnosis for sleep disturbances in college students and an article on self-hypnosis for self-care in oncology patients. The effect of self-hypnosis on test anxiety is added in a study of secondary school students in Malaysia. These articles are complemented by a survey about hypnosis among students, therapists, and the general public in Poland. These are impactful topics that are addressed from an international perspective. The feasibility and potential efficacy of hypnosis interventions for a range of medical concerns are addressed as well as the impact of beliefs and attitudes about clinical hypnosis.