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.

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.

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.

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.

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.

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.

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.

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.

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 in Clinical Hypnosis: Research and Commentary.

This issue of the International Journal of Clinical and Experimental Hypnosis provides a landmark international survey of clinicians across 31 countries regarding current practices and views of clinical hypnosis. Thirty-six common uses of hypnosis were identified including stress reduction, wellbeing, and other applications. The most common approaches to hypnotherapy were Ericksonian, Hypnotic Relaxation Therapy, and Traditional Hypnosis. Commentaries are provided by leading experts in the field of clinical and experimental hypnosis.

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.

Can Hypnotherapy Increase Well-Being?

Emotional well-being is a broad term that refers to happiness, positive social relationships, life balance, and the pursuit of positive goals. Further, emotional well-being has been shown to reduce risk of death by nearly 20% (Cohen, et al., 2016). The lead article (Na et al., 2022) explores this issue and reports on a pilot study of hypnotic relaxation therapy for well-being (HRT-WB). Their findings demonstrate that 71% of participants achieved high levels of well-being or flourishing. In addition to this innovative study, several articles are included that increase access to scales that measure hypnotizability in French (Apelian, 2022), Russian (Kvitchasty 2022), and Spanish (Muñiz et al., 2022). Kasos et al. 2022 explore the role of hypnotizability in regard to skin conductance orienting response (SCR) in response to differing types of suggestions. Finally, Cordi and Rasch (2022) explore the role of hypnotizability in accurate perception of sleep, with findings suggesting sleep depth may be associated with slow wave sleep and interoceptive ability of accurately perceive sleep depth depending on hypnotizability. Together, these studies identify new applications of clinical hypnosis, increase the availability of scales to measure hypnotizability across cultures, and further understanding of hypnotizability.