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.

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.

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.

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.

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.

Integrating mindful self-hypnosis with resistance training to reduce stress: a case study.

This case study explores the effects of a combined intervention involving Mindful Self-Hypnosis (MSH) and Resistance Training (RT) on perceived stress levels and well-being in a university student. The participant, Ms. P, engaged in a 12-week program comprised of two weekly RT sessions accompanied by MSH inductions. Perceived stress levels were evaluated using the Perceived Stress Scale (PSS), and well-being was assessed using the WHO-5 Well-Being Index. Intervention sessions were designed to enhance focus and calmness, along with imagery of performing the workout. Results from the case study reveal a notable reduction in Ms. P's perceived stress levels over the intervention period as indicated by a 30.8% decrease in PSS scores. Additionally, Ms. P demonstrated an improved strength in leg press 1-repetition maximum by an increased weight of 153.9%. This case study suggests that integrating MSH and RT may offer a beneficial strategy for stress reduction and enhancing well-being in university students. The findings underscore the potential applicability of this intervention to address stress-related challenges in this population. Future research with a larger sample size is needed to determine general efficacy of an MSH + RT intervention for stress reduction.

Feasibility of a Self-Administered Hypnosis Intervention for Improving Sleep in College Students.

Approximately two out of three college students report experiencing suboptimal sleep quality. The aim of this study was to examine the feasibility of a self-administered hypnosis intervention to improve sleep in college students. Twenty-two college students who self-reported poor sleep quality were enrolled in a 4-week study comprising 1 baseline week and a 3-week self-administered hypnosis intervention. Sleep onset latency and sleep efficiency as measured by wrist actigraphy were significantly improved. The mean average nightly sleep duration during the baseline week was 398.88 minutes (SD = 56.44), which increased to a mean of 413.88 minutes (SD = 57.80) during the 3rd week of intervention. However, the results show that there was no statistically significant difference between weeks on objective nightly sleep duration, 95% CI [-11.13, 41.13], t(15) = 1.224, p = .240. Also, results showed that there was no significant difference between weeks on self-reported nightly sleep duration, F(3, 57) = 2.155, p = .103. Twenty participants (91%) completed the study intervention and adherence to daily self-hypnosis practice with an audio recording was high. Zero study-related adverse events were reported, and participants perceived the intervention as easy to use and helpful for improving sleep. These results provide evidence for the feasibility and safety of a self-administered hypnosis intervention to improve sleep in college students. A larger randomized clinical trial is warranted to determine efficacy.

Magnitude of placebo response in clinical trials of paroxetine for vasomotor symptoms: a meta-analysis.

Introduction: Vasomotor symptoms, or hot flashes, are among the most common complaints for menopausal and postmenopausal women. As an alternative to hormone replacement therapy, paroxetine mesylate became the only non-hormonal treatment approved by the U.S. Food and Drug Administration (FDA), despite limited evidence for its efficacy. More specifically, there is uncertainty around paroxetine's unique benefit and the magnitude of the placebo response in clinical trials of paroxetine. Methods: Relevant databases were searched to identify randomized clinical trials examining the efficacy of paroxetine to treat hot flashes. The primary outcomes of interest were hot flash frequency and hot flash severity scores. Data was extracted from the published results, and risk of bias assessments were conducted. Results: Six randomized clinical trials that included a total of 1,486 women were coded and analyzed. The results demonstrated that 79% of the mean treatment response for hot flash frequency is accounted for by a placebo response, resulting in a mean true drug effect of 21% at most. Additionally, 68% of the mean treatment response for hot flash severity is accounted for by a placebo response, resulting in a maximum true drug effect of 32%. Discussion: The results herein call into question the actual efficacy of the only FDA approved, non-hormonal treatment for hot flashes by demonstrating that a placebo response accounts for the majority of treatment responses for reductions in both hot flash frequency and severity. The findings provide evidence to reevaluate the use of paroxetine to treat postmenopausal hot flashes and emphasize the importance of considering effective, alternative treatments for vasomotor symptoms.

Reliability and Validity of the Elkins Hypnotizability Scale within a Clinical Sample.

Hypnotherapy is used in clinical settings to treat mental and physical health-related conditions. Hypnotic response can be measured through hypnotizability scales to help interventionists personalize treatment plans to suit the patients' individualized hypnotic abilities. Examples of these scales are the Elkins Hypnotizability Scale (EHS) and the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C). According to the previous literature, these scales have good discriminating ability and internal consistency (α = 0.85) in collegiate samples, but the psychometric properties of the EHS for a targeted clinical population have not been determined yet. This study assessed said properties, and results showed adequate reliability of the EHS in a targeted clinical sample and strong convergent validity of the EHS to the SHSS:C. The authors conclude that the EHS is a strong and useful measure of hypnotizability that is pleasant, safe, brief, and sensible to individualities in hypnotic ability found in diverse clinical samples.

Systematic Review of Hypnotherapy for Sleep and Sleep Disturbance.

Sleep disturbance can negatively affect physical and psychological health. Hypnotherapy may be effective for improving sleep with fewer side effects than other treatments. The purpose of this systematic review is to comprehensively identify studies and evidence regarding hypnotherapy for sleep disturbances. Four databases were searched to identify studies examining the use of hypnotherapy for sleep in adult populations. The search yielded 416 articles, of which 44 were included. Qualitative data analysis revealed that 47.7% of the studies showed positive results regarding the impact of hypnotherapy for sleep, 22.7% showed mixed results, and 29.5% showed no impact. A subset of 11 studies that set sleep disturbance as an inclusion criterion and included suggestions for sleep were examined separately and had more favorable results, such that 54.5% showed positive results, 36.4% showed mixed results, and 9.1% showed no impact results. Hypnotherapy appears to be a promising treatment for sleep disturbance. Future studies should report effect sizes, adverse events, and hypnotizability and include sleep-specific suggestions, standardized measures, and descriptions of hypnotherapy intervention procedures.

Adaptive Experiential Theory of Hypnosis.

State and nonstate theories of hypnosis have dominated the field for decades and helped advance hypnosis clinically and scientifically. However, they fall short in various ways including insufficient consideration of unconscious/experiential processes. The authors' new theory is predicated on Epstein's cognitive-experiential self-theory, a dual-process model that provides a comprehensive understanding of the rational system and the experiential system and highlights that, although they interact synergistically, their features and modes of operation differ greatly. The rational system, influenced by logic and reason, is demanding of cognitive resources and operates effortfully with minimal affect. In contrast, the experiential system is emotionally driven, associative, and encodes reality in images and feelings without conscious effort. Our theory, the adaptive experiential theory, posits that complex hypnotic responding is attributable to an individual's ability to adapt and deliberately shift from processing primarily within the rational system to the experiential system. Greater association with the experiential system yields alterations in processing reality, which allows hypnotic suggestions to be internalized and enacted without excessive interference from the rational system.

Current Practices, Experiences, and Views in Clinical Hypnosis: Findings of an International Survey.

An online survey of 691 clinicians who use hypnosis was conducted in 31 countries to gain a broad real-world picture of current practices, views, and experiences in clinical hypnosis. Among 36 common clinical uses, stress reduction, wellbeing and self-esteem-enhancement, surgery preparations, anxiety interventions, mindfulness facilitation, and labor and childbirth applications were the most frequently rated as highly effective (each by ≥70% of raters) in the clinicians' own experience. Adverse hypnosis-associated effects had been encountered by 55% of clinicians but were generally short-lived and very rarely judged as serious. The most common hypnosis approaches used were Ericksonian (71%), hypnotic relaxation therapy (55%), and traditional hypnosis (50%). Almost all respondents reported regularly using other therapeutic modalities alongside hypnosis. Among a range of client variables potentially affecting therapy, most clinicians rated hypnotist-client rapport (88%) and client motivation (75%) as very or extremely important factors for successful hypnotherapy. The majority of respondents had conducted hypnosis treatment via teletherapy, and 54% of those estimated it to be as effective as in-person treatment.

Posttraumatic growth-oriented peer-based training among U.S. veterans: evaluation of post-intervention and long-term follow-up outcomes.

Introduction: Exposure to trauma among U.S. military veterans occurs at a high rate, often resulting in continued difficulty with emotional adjustment and a diagnosis of posttraumatic stress disorder (PTSD). The present study provides data from 184 U.S. military veterans who completed a manualized posttraumatic-growth oriented training program during an integrative seven-day retreat. Methods: Data was collected at baseline, after program completion, and at 18-month follow-up. Results: Results on primary outcomes indicated significant increases, with medium to large effect sizes, in growth related outcomes. Specifically, there was a significant increase in scores by 54% on the posttraumatic growth outcome measure (PTGI-X) from baseline (M = 50.2, SD = 31.1) to endpoint (M = 77.4, SD = 29.6), t(183) = -8.78, p < 0.001. Also, results indicate that immediately following training (Day 7), participants reported a significant decrease of 49% on the PCL-5 from baseline (M = 39.7, SD = 17.6) to endpoint (M = 20.1, SD = 13.2), t(183) = 11.75, p < 0.001. Depression subscale scores decreased by 60% from baseline (M = 8.0, SD = 5.2) to endpoint (M = 3.2, SD = 3.0), t(183) = 10.68, p < 0.001; Anxiety scores decreased by 28% from baseline (M = 5.8, SD = 4.3) to endpoint (M = 4.2, SD = 3.5), t(183) = 4.08, p < 0.001; and Stress scores decreased by 50% from baseline (M = 10.0, SD = 4.4) to endpoint (M = 5.0, SD = 3.3), t(183) = 12.21, p < 0.001. Eighteen-month follow-up data was available for 74 participants and indicated that all significant changes in growth-related outcomes were maintained. Further, all significant changes in symptomatology-related outcomes were also maintained at follow-up. Discussion: These findings demonstrate both the immediate and the long-lasting impact of an integrative posttraumatic growth-oriented training program on psychological growth and PTSD symptom reduction among U.S. military veterans.

Feasibility of the Elkins Hypnotizability Scale-Spanish Translation.

The absence of a Spanish translation of the Elkins Hypnotizability Scale (EHS) suggests access to clinical research and hypnotic interventions may be limited for those in predominantly Spanish-speaking populations. The present study aims to mitigate this disparity by providing a translation of the EHS to facilitate participation in experimental research and clinical care in Spanish-speaking communities. The EHS was translated and administered to 9 participants. No major modifications were done to the characteristics or structure of the EHS after translation. To assess feasibility, mean hypnotizability levels and self-reported levels of pleasantness and comprehension were observed and compared to the English EHS. The results provide a Spanish translation of the EHS. This study demonstrates the Spanish translation of the EHS is feasible for further research.

Adaptation of the Russian Version of the Elkins Hypnotizability Scale.

Until now, there has been an acute shortage of valid and reliable tools in Russia for making an accurate and highly differentiable assessment of hypnotizability. However, numerous studies confirm the high efficiency, reliability, and accuracy of the Elkins Hypnotizability Scale (EHS), allowing it to claim the title of the new gold standard for assessing hypnotizability. In the present study, the original English-language version of the EHS was translated into Russian. One hundred and five volunteers from Moscow (42% male; 58% female), aged 19 to 44, underwent a hypnotizability assessment procedure according to the EHS protocol. The Russian version of the EHS, like the original, requires an average of 28 minutes to administer and score by a trained assessor. The results showed that the Russian version of the EHS has good internal consistency and does not contain unnecessary elements. Alpha Cronbach values (0.76), and the item-total correlations (rs = 0.44-0.64) are satisfactory.

Pilot Study of Hypnotic Relaxation Therapy for Well-Being (HRT-WB): A New Intervention to Enhance Well-Being and Positive Affect.

The purpose of this study was to investigate the feasibility, acceptability, and potential effect of a novel hypnotherapeutic intervention, informed by positive psychology, to enhance well-being in college students. The present study investigated adapting hypnotic relaxation therapy for enhancing well-being (denoted as HRT-WB). Twenty-seven college students were enrolled in a 5-week intervention of HRT-WB and instructed in daily home practice of HRT-WB self-hypnosis using audio recordings. Participants completed baseline and endpoint measures of well-being and symptoms of psychological distress. Results showed participants who received the HRT-WB intervention experienced improvements in subjective well-being as well as reductions in psychological distress. At endpoint, 71% of the participants who completed the HRT-WB intervention were categorized as experiencing high levels of well-being, or flourishing. In addition, HRT-WB is a feasible intervention, with high rates of retention, compliance with home practice, and satisfaction. Based on these promising results, further research into HRT-WB is warranted. HRT-WB could be a well-accepted, easily administered, and effective means of addressing well-being and enhancing flourishing.

Willingness and Accessibility of a Hypnosis Intervention for Anxiety Among a Low Socioeconomic Status Population.

Objective: This survey study aimed to investigate the willingness and accessibility of a hypnosis intervention for anxiety among low socioeconomic status patients in a primary care setting. Methods: Participants were asked to complete a one-page survey during a scheduled office visit with their primary care provider. Survey questions included participants' interest in hypnosis as a treatment for anxiety, how many sessions they would be willing/able to attend, how they would prefer access to a recorded hypnosis intervention, and items relating to anxiety, including the Generalized Anxiety Disorder-7 measure. Results: Two hundred participants (71.5% female) completed the survey with a mean age of 43.16 (standard deviation = 15.78). Over half (54.6%) of the survey participants reported that they experience anxiety, and 74% of the participants indicated that they would be interested in hypnosis if it were recommended by their provider for anxiety. Discussion: Given the high prevalence of anxiety among survey participants, there exists a clear need for effective and accessible treatment options. These results demonstrate the willingness of individuals to use hypnosis for anxiety and to engage in remote hypnosis interventions.

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 ).

Effects of a Brief Mindful Hypnosis Intervention on Stress Reactivity: A Randomized Active Control Study.

A novel, audio-based brief mindful hypnosis (BMH) intervention for reducing stress-reactivity during the Trier Social Stress Test (TSST) was investigated. Fifty-five college-aged participants with elevated stress were randomized to BMH or a cognitive training (CT) active-control condition. Participants received a BMH or CT session and downloaded the audio-recorded intervention for daily home practice. Approximately 1 week later, participants received their second BMH or CT session and then completed the TSST. Results indicated BMH produced significant and medium effects in reducing stress reactivity and weekly stress and increasing mindfulness, with large increases in immediate relaxation compared to the CT active control. BMH demonstrated excellent adherence and was rated highly regarding satisfaction, ease of practice, perceived benefit, and likelihood of future use. This study provides the first empirical support that BMH is superior to an active-control intervention for reducing stress reactivity while significantly increasing mindfulness and relaxation.

Feasibility of Attention Restoration Theory-Driven Hypnotherapy for Fatigue in Cancer Survivors.

This study aimed to assess the feasibility of Attention Restoration Theory (ART)-driven hypnotherapy to address cancer-related fatigue (CRF). Six participants with CRF completed the study. Participants completed measures of fatigue and pain pre- and posttreatment of 5 sessions of ART-driven hypnotherapy, each of which followed a treatment manual. Results indicate that participants experienced reductions in fatigue, fatigue bothersomeness, and pain following the intervention. Additionally, participants reported high levels of treatment satisfaction. This innovative intervention of ART-driven hypnotherapy appears to be feasible and warrants further study in a controlled trial with a larger sample.