William Fisher

Mind–Body Therapies in Integrative Oncology

Opinion statementThere is growing interest in mind–body therapies as adjuncts to mainstream cancer treatment, and an increasing number of patients turn to these interventions for the control of emotional stress associated with cancer. Increased research funding has enabled many such interventions to be evaluated for their efficacy, including studies of mind–body interventions to reduce pain, anxiety, insomnia, anticipatory, and treatment-related nauseas, hot flashes, and improved mood. Mind–body treatments evaluated for their utility in oncology include relaxation therapies, biofeedback, meditation and hypnosis, yoga, art and music therapy, tai chi, and qigong. Although studies are not always methodologically sound and results mixed, a growing number of well-designed studies provide convincing evidence that mind–body techniques are beneficial adjuncts to cancer treatment. The evidence is sufficient to recommend further investigation and adoption of these techniques in mainstream oncology care.

Cognitive Hypnotherapy for Pain Management

Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for cognitive hypnotherapy in the treatment in chronic pain, cancer, osteoarthritis, sickle cell disease, temporomandibular disorder, fibromyalgia, non-cardiac chest pain, and disability related chronic pains are identified. Implications for clinical practice and research are discussed in light of the accumulating evidence in support of the efficacy and effectiveness of cognitive hypnotherapy for pain management.

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

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Hypnosis for Acute Procedural Pain: A Critical Review

Abstract Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.

P02.30. Assessment of hypnotizability in clincal research: development, reliability, and validation of the Elkins Hynotizability Scale

Purpose Hypnotherapy has been shown to be an effective treatment for some conditions such as pain, anxiety, chemotherapy side effects, and hot flashes. Measurement of hypnotizability is essential for research. There are a number of scales that have been developed to measure hypnotizbility in clincal research. However, the currently available scales suffer from a number of important shortcomings such as time for administration, validity concerns, and item difficulty. As a result, hypnotizability is rarely measured in clinical work and research has been limited. The purpose of this study was to develop a new scale to measure hypnotizability that met the following criteria: (1) administration in 30 minutes or less; (2) correlation of .80 or better with the Stanford Hypnotic Susceptibility Scale; and (3) improved item selection.

Hypnosis for hot flashes among postmenopausal women study: A study protocol of an ongoing randomized clinical trial

BackgroundHot flashes are a highly prevalent problem associated with menopause and breast cancer treatments. The recent findings from the Womens Health Initiative have important implications for the significance of a non-hormonal, mind-body intervention for hot flashes in breast cancer survivors. Women who take hormone therapy long-term may have a 1.2 to 2.0 fold increased risk of developing breast cancer. In addition, it is now known that hormone therapy with estrogen and progestin is associated with increased risk of cardiovascular disease and stroke. Currently there are limited options to hormone replacement therapy as non-hormonal pharmacological agents are associated with only modest activity and many adverse side effects. Because of this there is a need for more alternative, non-hormonal therapies. Hypnosis is a mind-body intervention that has been shown to reduce self-reported hot flashes by up to 68% among breast cancer survivors, however, the use of hypnosis for hot flashes among post-menopausal women has not been adequately explored and the efficacy of hypnosis in reducing physiologically measured hot flashes has not yet been determined.Methods/designA sample of 180 post-menopausal women will be randomly assigned to either a 5-session Hypnosis Intervention or 5-session structured-attention control with 12 week follow-up. The present study will compare hypnosis to a structured-attention control in reducing hot flashes (perceived and physiologically monitored) in post-menopausal women in a randomized clinical trial. Outcomes will be hot flashes (self-report daily diaries; physiological monitoring; Hot Flash Related Daily Interference Scale), anxiety (State-Trait Anxiety Inventory; Hospital Anxiety and Depression Scale (HADS); anxiety visual analog scale (VAS rating); depression (Center for Epidemiologic Studies Depression Scale), sexual functioning (Sexual Activity Questionnaire), sleep quality (Pittsburgh Sleep Quality Index) and cortisol.DiscussionThis study will be the first full scale test of hypnosis for hot flashes; one of the first studies to examine both perceived impact and physiologically measured impact of a mind-body intervention for hot flashes using state-of-the-art 24 hour ambulatory physiological monitoring; the first study to examine the effect of hypnosis for hot flashes on cortisol; and the first investigation of the role of cognitive expectancies in treatment of hot flashes in comparison to a Structured-Attention Control.Trial RegistrationThis clinical trial has been registered with ClinicalTrials.gov, a service of the U.S. National Institutes of Health, ClinicalTrials.gov Identifier: NCT01293695.

Hot Flashes: Phenomenology and Measurement

Hot flashes are a highly prevalent symptom experienced by women transitioning through menopause, as well as by men and women undergoing certain cancer-related treatments. Though many individuals do not find these symptoms troublesome, others suffer from severe and frequent symptoms and related decrements in sleep, psychological well-being, sexual health and overall quality of life. In order to develop a better understanding of the etiology and treatment options for hot flashes, accurate measurement is vital. This chapter provides an overview of hot flash measurement both physiologic, and via self-report measures. It critically evaluates the four categories of hot flash measurement tools: symptom scales based on retrospective reporting over weeks and months, daily diaries completed by end of day, daily diaries completed at the time of the hot flash, and physiologic measures of hot flashes. Further, the impact of psychological/emotional influences, ethnic differences, and body mass on hot flash reporting is discussed. Finally, this chapter provides recommendations for the future development and refinement of hot flash reporting tools and suggestions for best-practice hot flash measurement methodology.

Measuring hot flash phenomenonology using ambulatory prospective digital diaries.

Objective:This study provides the description, protocol, and results from a novel prospective ambulatory digital hot flash phenomenon diary. Methods:This study included 152 midlife women with daily hot flashes who completed an ambulatory electronic hot flash diary continuously for the waking hours of three consecutive days. In this diary, women recorded their hot flashes and accompanying characteristics and associations as the hot flashes occurred. Results:Self-reported hot flash severity on the digital diaries indicated that the majority of hot flashes were rated as mild (41.3%) or moderate (43.7%). Severe (13.1%) and very severe (1.8%) hot flashes were less common. Hot flash bother ratings were rated as mild (43%), or moderate (33.5%), with fewer hot flashes reported bothersome (17.5%) or very bothersome (6%). The majority of hot flashes were reported as occurring on the face (78.9%), neck (74.7%), and chest (61.3%). Of all reported hot flashes, 32% occurred concurrently with prickly skin, 7% with anxiety, and 5% with nausea. A novel finding from the study was that 38% of hot flashes were accompanied by a premonitory aura. Conclusions:A prospective electronic digital hot flash diary allows for a more precise quantitation of hot flashes while overcoming many of the limitations of commonly used retrospective questionnaires and paper diaries. Unique insights into the phenomenology, loci, and associated characteristics of hot flashes were obtained using this device. The digital hot flash phenomenology diary is recommended for future ambulatory studies of hot flashes as a prospective measure of the hot flash experience.

Medical hypnosis for pain and psychological distress during burn wound debridement: a critical review

Introduction Burn injuries are often considered to be one of the most physically and psychologically damaging experiences an individual may endure. Because of this, more treatment options for managing pain and distress during burn wound debridement are needed. When used in combination with traditional treatment, medical hypnosis may offer health-care professionals an option for meeting the needs of patients with burn wounds. This article offers a critical review of the literature currently available on the efficacy of medical hypnosis for managing pain and distress during wound debridement and offers suggestions for an improved methodology for future trials. Materials and Methods MEDLINE, PsycINFO, Psyc ARTICLES, HealthSource: Nursing Edition, PubMed and Google Scholar were searched using the keywords ‘hypnosis’, ‘burn wounds’, ‘pain’ and ‘debridement’. Additional articles were selected from the bibliographies of representative literature. All experimental and quasi- experimental studies investigating the efficacy of hypnosis for managing pain and psychological distress during wound debridement were included in our results. Results Six studies involving a total of 217 participants met our inclusion criteria. The results of these studies suggest that hypnosis may be more effective than structured attention for reducing patients’ pain and anxiety levels during wound debridement. However, results are inconclusive due to oversights in study design, and additional studies that correct these design flaws are needed. Conclusion The existing evidence suggests that medical hypnosis may be effective in managing pain and distress for burn victims who have difficulty coping during wound debridement. Further investigation is warranted.

OA14.05. Hypnosis for hot flashes: results from a randomized clinical trial and future directions

Purpose Hot flashes are a significant clinical problem for many women. Currently there are limited options to hormone replacement therapy as non-hormonal pharmacological agents are associated with only modest activity and many adverse side effects. Hypnosis is one mind-body therapy that seems particularly promising for treating hot flashes and was investigated in the present study. This study examined the efficacy of hypnosis in reducing both self-reported and physiologically determined hot flash frequency and severity among post-menopausal women.