Clinical Hypnosis for Procedural Pain and Distress in Children: A Scoping Review.

OBJECTIVE: Pain and distress are common in children undergoing medical procedures, exposing them to acute and chronic biopsychosocial impairments if inadequately treated. Clinical hypnosis has emerged as a potentially beneficial treatment for children's procedural pain and distress due to evidence of effectiveness and potential superiority to other psychological interventions. However, systematic reviews of clinical hypnosis for children's procedural pain and distress have been predominantly conducted in children undergoing oncology and needle procedures and are lacking in broader pediatric contexts. This scoping review maps the evidence of clinical hypnosis for children's procedural pain and distress across broad pediatric contexts while highlighting knowledge gaps and areas requiring further investigation. METHODS: Published databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus, and Web of Science) and grey literature were searched in addition to hand-searching reference lists and key journals (up to May 2022). Two independent reviewers screened the titles and abstracts of search results followed by a full-text review against eligibility criteria. Articles were included if they involved a clinical hypnosis intervention comprising an induction followed by therapeutic suggestions for pain and distress in children undergoing medical procedures. This review followed the Arksey and O'Malley (2005) methodology and incorporated additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: A total of 38 eligible studies involving 2,205 children were included after 4,775 articles were screened. Research on clinical hypnosis for children's procedural pain and distress was marked by a lack of fidelity measures and qualitative data as well as by inadequate intervention reporting and high attrition rates. Evidence regarding the safety of clinical hypnosis, pain unpleasantness outcomes, factors influencing outcomes, as well as barriers and facilitators to implementing hypnosis and study procedures was also lacking. Clinical hypnosis has potential benefits for children's procedural pain and distress based on evidence of superiority to control conditions and nonpharmacological interventions (e.g., distraction, acupressure) with moderate to large effect sizes as reported in 76% of studies. However, heterogeneous interventions, contexts, study designs, and populations were identified, and the certainty of the evidence was not evaluated. CONCLUSIONS: The review suggests potential benefits of clinical hypnosis for children's procedural pain and distress and thus provides a precursor for further systematic reviews and trials investigating the effectiveness of clinical hypnosis. The review also indicates the need to further explore the feasibility, acceptability, implementation, and safety of clinical hypnosis in children undergoing painful procedures. Based on the review, researchers implementing clinical hypnosis should adequately report interventions or use treatment manuals, follow recommended research guidelines, and assess the fidelity of intervention delivery to promote replicating and comparing interventions. The review also highlights common methodological shortcomings of published trials to avoid, such as the lack of implementation frameworks, small sample sizes, inadequate reporting of standard care or control conditions, and limited evidence on pain unpleasantness outcomes.

Meditation in the Workplace: Does Mindfulness Reduce Bias and Increase Organisational Citizenship Behaviours?

Mindfulness is becoming increasingly popular in the workplace. This likely relates to a growing body of research linking mindfulness to a range of psychological outcomes such as reduced anxiety, depression and increased subjective wellbeing. However, while mindfulness has received a great deal of attention in clinical research, the evidence for workplace relevant benefits is less established. Additionally, outside of clinical research, mindfulness studies have rarely been replicated. Recent evidence suggests that the cognitive skills cultivated during meditation may be instrumental in reducing biased thinking and increasing prosocial behaviour, but these findings have not been previously tested in a workplace setting. Specifically, mindfulness has been linked to reductions in implicit age bias, sunk-cost decision-making bias and increases in organisational citizenship behaviours (OCB). In two experiments using a workplace and laboratory sample, the present investigation aimed to test the reliability and generalisability of previous findings that a brief mindfulness meditation can reduce age and sunk-cost decision-making biases. To more directly test the potential positive benefits of mindfulness in a workplace setting, this study also investigated the impact of a mindfulness intervention on intention to perform OCB. While meditation significantly increased OCB intent, predictions relating to bias were not supported. Considerations for the degree to which empirical evidence aligns with claims in popular culture, along with implications for the practical uses of mindfulness in the workplace are explored.

Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol.

BACKGROUND: Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children's procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns. METHODS: An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children's hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes. DISCUSSION: Ethical approval was obtained from the Queensland Children's Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings. The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000988954.

Hypnotherapy for Procedural Pain and Distress in Children: A Scoping Review Protocol.

OBJECTIVE: Inadequately treated pain and distress elicited by medical procedures can put children at higher risk of acute and chronic biopsychosocial sequelae. Children can benefit from hypnotherapy, a psychologically tailored intervention, as an adjunct to pharmacological agents to address the multiple components of pain and distress. Despite providing evidence on the effectiveness and potential superiority of hypnotherapy to other psychological interventions, research on hypnotherapy for pediatric procedural pain and distress has been predominantly limited to oncology and needle procedures. Plus, there is a lack of reporting of intervention manuals, factors influencing hypnotic responding, pain unpleasantness outcomes, theoretical frameworks, adverse events, as well as barriers and facilitators to the feasibility of delivering the intervention and study procedures. The proposed review aims to map the range and nature of the evidence on hypnotherapy for procedural pain and distress in children to identify gaps in literature and areas requiring further investigation. METHODS: This review will follow the Arksey and O'Malley (2005) methodology and incorporate additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses. Relevant studies will be identified through searching published literature databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus and Web of Science) and grey literature in addition to hand-searching of reference lists and key journals. Two authors will independently screen titles and abstracts of search results followed by full-texts review against eligibility criteria. CONCLUSION: Findings are anticipated to guide future research and inform the development of tailored hypnotic interventions in children.

Hypnotic clever hands: Agency and automatic responding.

The Clever Hands task (Wegner, Fuller, & Sparrow, 2003) is a behavioral illusion in which participants make responses to a trivia quiz for which they have no sense of agency. Sixty high hypnotizable participants completed two versions of the Clever Hands task. Quiz One was a replication of the original study. Quiz Two was a hypnotic adaptation using three suggestions that were based on clinical disruptions to the sense of agency. The suggestions were for: random responding, thought insertion, and alien control. These suggestions led to differences in accuracy (action production) and estimates of accuracy (action projection). Specifically, whereas the random responding suggestion had little effect, the two clinically based suggestions had opposite impacts on action production: the thought insertion suggestion led to an increase in the rate of correct responses (although participants still believed they were responding randomly); while the alien control suggestion led to a reduction in the rate of correct answers and a pattern of results that more closely approximated randomness. Contrary to theoretical accounts that claim that hypnosis affects executive monitoring rather than executive control, this result indicates that specific hypnotic suggestions can also influence the implicit processes involved in action production. (PsycINFO Database Record

Belief, delusion, hypnosis, and the right dorsolateral prefrontal cortex: A transcranial magnetic stimulation study.

According to the Two-Factor theory of delusional belief (see e.g. Coltheart at al., 2011), there exists a cognitive system dedicated to the generation, evaluation, and acceptance or rejection of beliefs. Studies of the neuropsychology of delusion provide evidence that this system is neurally realized in right dorsolateral prefrontal cortex (rDLPFC). Furthermore, we have shown that convincing analogues of many specific delusional beliefs can be created in nonclinical subjects by hypnotic suggestion and we think of hypnosis as having the effect of temporarily interfering with the operation of the belief system, which allows acceptance of the delusional suggestions. If the belief system does depend on rDLPFC, then disrupting the activity of that region of the brain by the application of repetitive transcranial magnetic stimulation (rTMS) will increase hypnotizability. Dienes and Hutton (2013) have reported such an experiment except that it was left DLPFC to which rTMS was applied. An effect on a subjective measure of hypnotizability was observed, but whether there was an effect on an objective measure could not be determined. We report two experiments. The first was an exact replication of the Dienes and Hutton experiment; here we found no effect of rTMS to lDLPFC on any hypnotic measure. Our second experiment used rTMS applied to right rather then left DLPFC. This right-sided stimulation enhanced hypnotizability (when hypnotic response was measured objectively), as predicted by our hypothesis. These results imply a role for rDLPFC in the cognitive process of belief evaluation, as is proposed in our two-factor theory of delusion. They are also consistent with a conception of the acceptance of a hypnotic suggestion as involving suspension of disbelief.

Changes in the sense of agency during hypnosis: The Hungarian version of the Sense of Agency Rating Scale (SOARS-HU) and its relationship with phenomenological aspects of consciousness.

Changes in the sense of agency are defining feature of hypnosis. The Sense of Agency Rating Scale (SOARS) is a 10-item questionnaire, administered after a hypnosis session to assess alteration in the sense of agency. In the present study, a Hungarian version of the measure (SOARS-HU) is presented. The SOARS-HU and the Phenomenology of Consciousness Inventory (PCI) were administered to 197 subjects following hypnotizability screening with the Harvard Group Scale of Hypnotic Susceptibility Scale, Form A (HGSHS:A). Confirmatory factor analysis and correlations with hypnotizability demonstrate the reliability and validity of the SOARS-HU. Changes in the Involuntariness and Effortlessness subscales of the SOARS-HU were associated with alterations in subjective conscious experience, as measured by the PCI. These changes in subjective experience remained significant after controlling for HGSHS:A scores. These results indicate that changes in the sense of agency during hypnosis are associated with alterations of consciousness that are independent of hypnotizability.

Meditation and auditory attention: An ERP study of meditators and non-meditators.

The findings of a study by Cahn and Polich (2009) suggests that there is an effect of a meditative state on three event-related potential (ERP) brain markers of "low-level" auditory attention (i.e., acoustic representations in sensory memory) in expert meditators: the N1, the P2, and the P3a. The current study built on these findings by examining trait and state effects of meditation on the passive auditory mismatch negativity (MMN), N1, and P2 ERPs. We found that the MMN was significantly larger in meditators than non-meditators regardless of whether they were meditating or not (a trait effect), and that N1 amplitude was significantly attenuated during meditation in non-meditators but not expert meditators (an interaction between trait and state). These outcomes suggest that low-level attention is superior in long-term meditators in general. In contrast, low-level attention is reduced in non-meditators when they are asked to meditate for the first time, possibly due to auditory fatigue or cognitive overload.

A laboratory analogue of mirrored-self misidentification delusion: the role of hypnosis, suggestion, and demand characteristics.

Mirrored-self misidentification is the delusional belief that one's own reflection in the mirror is a stranger. In two experiments, we tested the ability of hypnotic suggestion to model this condition. In Experiment 1, we compared two suggestions based on either the delusion's surface features (seeing a stranger in the mirror) or underlying processes (impaired face processing). Fifty-two high hypnotisable participants received one of these suggestions either with hypnosis or without in a wake control. In Experiment 2, we examined the extent to which social cues and role-playing could account for participants' behaviour by comparing the responses of 14 hypnotised participants to the suggestion for impaired face processing (reals) with those of 14 nonhypnotised participants instructed to fake their responses (simulators). Overall, results from both experiments confirm that we can use hypnotic suggestion to produce a compelling analogue of mirrored-self misidentification that cannot simply be attributed to social cues or role-playing.

Developing the Sense of Agency Rating Scale (SOARS): an empirical measure of agency disruption in hypnosis.

Two experiments report on the construction of the Sense of Agency Rating Scale (SOARS), a new measure for quantifying alterations to agency. In Experiment 1, 370 participants completed a preliminary version of the scale following hypnosis. Factor analysis revealed two underlying factors: Involuntariness and Effortlessness. In Experiment 2, this two factor structure was confirmed in a sample of 113 low, medium and high hypnotisable participants. The two factors, Involuntariness and Effortlessness, correlated significantly with hypnotisability and pass rates for ideomotor, challenge and cognitive items. Twelve week test-retest correlations showed that Involuntariness was highly stable, but Effortlessness only moderately stable. Analysis of the combined datasets from Experiments 1 and 2 showed both SOARS scores were significantly related to the derived factors of Woody, Barnier, and McConkey's (2005) 4-factor model of hypnotisability. This scale clarifies conceptual confusion around agentive action and provides empirical support for a multifactorial account of sense of agency.

The experience of altered states of consciousness in shamanic ritual: the role of pre-existing beliefs and affective factors.

Much attention has been paid recently to the role of anomalous experiences in the aetiology of certain types of psychopathology, e.g. in the formation of delusions. We examine, instead, the top-down influence of pre-existing beliefs and affective factors in shaping an individual's characterisation of anomalous sensory experiences. Specifically we investigated the effects of paranormal beliefs and alexithymia in determining the intensity and quality of an altered state of consciousness (ASC). Fifty five participants took part in a sweat lodge ceremony, a traditional shamanic ritual which was unfamiliar to them. Participants reported significant alterations in their state of consciousness, quantified using the 'APZ' questionnaire, a standardized measure of ASC experience. Participants endorsing paranormal beliefs compatible with shamanic mythology, and those showing difficulty identifying feelings scored higher on positive dimensions of ASC experience. Our findings demonstrate that variation in an individual's characterisation of anomalous experiences is nuanced by pre-existing beliefs and affective factors.