Zoltan Kekecs

The effectiveness of suggestive techniques in reducing postoperative side effects: a meta-analysis of randomized controlled trials.

BACKGROUND:Suggestive interventions such as hypnosis and therapeutic suggestions are frequently used to alleviate surgical side effects; however, the effectiveness of therapeutic suggestion intervention has not yet been systematically evaluated. In the present study, we tested the hypotheses that (1) suggestive interventions are useful for reducing postoperative side effects; (2) therapeutic suggestions are comparable in effectiveness to hypnosis; (3) live presentation is more effective than recordings; and (4) suggestive interventions would be equally effective used in minor and major surgeries. METHODS:We performed random effect meta-analysis with meta-regression and sensitivity analysis by moderating factors on a pool of 26 studies meeting the inclusion criteria (N = 1890). Outcome variables were postoperative anxiety, pain intensity, pain medication requirement, and nausea. RESULTS:Suggestive interventions reduced postoperative anxiety (g = 0.40; 99% confidence interval [CI] = 0.13–0.66; P < 0.001) and pain intensity (g = 0.25; 99% CI = 0.00–0.50; P = 0.010), but did not significantly affect postoperative analgesic drug consumption (g = 0.16; 99% CI = −0.16 to 0.47; P = 0.202) and nausea (g = 0.38; 99% CI = −0.06 to 0.81; P = 0.026). No significant differences were found for intervention type, presentation method, and severity of surgery; however, sensitivity analysis only supported the effectiveness of hypnosis (g = 0.62; 99% CI = 0.31–0.92; P < 0.001) and live presentation (g = 0.55; 99% CI = 0.23–0.88; P < 0.001) for decreasing postoperative anxiety, and that of live presentation for alleviating postoperative pain (g = 0.44; 99% CI = 0.07–0.82; P = 0.002). Sensitivity analyses also suggested that suggestive interventions are only effective for decreasing pain intensity during minor surgical procedures (g = 0.39; 99% CI = 0.00–0.78; P = 0.009). CONCLUSIONS:Suggestive techniques might be useful tools to alleviate postoperative anxiety and pain; however, strength of the evidence is weak because of possible bias in the reviewed articles. The lack of access to within-subjects data and the overlap between moderator conditions also limit the scope of the analysis. More methodologically correct studies are required with sensitivity to moderating factors and to within-subjects changes. For clinical purposes, we advise the use of hypnosis with live presentation to reduce postoperative anxiety and pain, until convincing evidence is uncovered for the effectiveness of therapeutic suggestions and recorded presentation. Pain management with adjunct suggestive interventions is mostly encouraged in minor rather than major surgeries.

Effects of patient education and therapeutic suggestions on cataract surgery patients: A randomized controlled clinical trial

OBJECTIVE This paper describes a randomized controlled single blind study testing the effects of a patient education intervention combined with positive therapeutic suggestions on anxiety for cataract surgery patients. METHODS 84 patients participated in the study. Physiological and behavioral indicators of anxiety were compared between a regularly treated control and an intervention group receiving an audio CD containing information, relaxation, and positive imagery. RESULTS We found that the intervention group was calmer throughout the four measurement points of the study (p=.004; d=0.71) and they were more cooperative (p=.01; d=0.60) during the operation. The groups did not differ in sleep quality before the day of the operation, heart rate during the procedure, and subjective Well-being. CONCLUSION Findings indicate that preoperative information combined with positive suggestions and anxiety management techniques might reduce patient anxiety in the perioperative period of cataract surgery, but further research is needed to investigate the benefits of such interventions and to uncover the underlying mechanisms. PRACTICE IMPLICATIONS Patient education interventions providing additional anxiety management techniques are recommended for use prior to cataract surgery.

Oxytocin and cortisol in the hypnotic interaction.

Abstract Changes in oxytocin and cortisol levels were tested in healthy volunteers during hypnotic interactions in standardized laboratory sessions. Pre- to posthypnosis changes of oxytocin and cortisol were related to the hypnotic susceptibility of subjects and the relational experiences reposted by subjects and hypnotists on several paper-and-pencil tests. Results show that the changes in oxytocin are not related to hypnotic susceptibility but to relational experiences. After the hypnotic interaction, the subjects oxytocin level increased if perceived harmony with the hypnotist was high, whereas it increased in the hypnotist if the subject had memories of less warm emotional relationships with his or her parents. The results are interpreted within the social-psychobiological model of hypnosis.

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.

Commentary: Oxytocin-gaze positive loop and the coevolution of human–dog bonds

It has been proposed that evolution of dogs have led to a set of changes, which made them functionally similar to humans in some cognitive, behavioral, and social aspects (Topal et al., 2005; MacLean and Hare, 2015). Searching for these similarities, Nagasawa et al. (2015) hypothesize an oxytocin-mediated positive loop, which developed through the coevolution of human–dog bonding. To test this hypothesis, they conducted a highly original experiment, examining the effects of a 30-min human–dog interaction on oxytocin-secretion in both owners and dogs, and investigating which characteristics of the interaction modulated the oxytocin change (experiment 1). A unique feature of the study is that the same experiment was repeated with hand-reared wolves and their owners to evaluate whether the proposed oxytocin loop was specific to the human–dog interaction. In a following experiment (experiment 2), they administered oxytocin to dogs, and recoded changes in social behavior, and effects of the behavioral change on the owners urinary oxytocin levels.

Positive suggestion techniques in somatic medicine: A review of the empirical studies

INTRODUCTION THERE IS AN EVER REOCCURRING QUESTION IN MEDICAL PRACTICE: Does the positive attitude and communication of the medical staff make any difference? AIM Our aim is to present a comprehensive overview of the medically relevant effects of positive suggestions by reviewing the recent literature. METHODS We will review the studies measuring the effects of suggestive communication of the past 20 years. In cases of studies presented in more details we quote from the suggestion scripts used in the study, too. RESULTS Some of the reviewed papers report that positive suggestions lead to decreased pain and use of pain medication and positively affect physiological factors like bowel motility, blood pressure and bleeding during surgery as well. However, the literature also contains studies in which only partial or no positive effects were found. CONCLUSIONS We emphasize further, more detailed investigation of positive suggestion techniques and its integration into the education of medical professionals.

Alterations in electrodermal activity and cardiac parasympathetic tone during hypnosis

Exploring autonomic nervous system (ANS) changes during hypnosis is critical for understanding the nature and extent of the hypnotic phenomenon and for identifying the mechanisms underlying the effects of hypnosis in different medical conditions. To assess ANS changes during hypnosis, electrodermal activity and pulse rate variability (PRV) were measured in 121 young adults. Participants either received hypnotic induction (hypnosis condition) or listened to music (control condition), and both groups were exposed to test suggestions. Blocks of silence and experimental sound stimuli were presented at baseline, after induction, and after de-induction. Skin conductance level (SCL) and high frequency (HF) power of PRV measured at each phase were compared between groups. Hypnosis decreased SCL compared to the control condition; however, there were no group differences in HF power. Furthermore, hypnotic suggestibility did not moderate ANS changes in the hypnosis group. These findings indicate that hypnosis reduces tonic sympathetic nervous system activity, which might explain why hypnosis is effective in the treatment of disorders with strong sympathetic nervous system involvement, such as rheumatoid arthritis, hot flashes, hypertension, and chronic pain. Further studies with different control conditions are required to examine the specificity of the sympathetic effects of hypnosis.

Positive suggestion techniques in somatic medicine

UNLABELLED There is a re-occurring question in medical practice: do positive attitude and communication of the medical staff make any difference? AIM Our aim is to present a comprehensive image of the medically relevant effects of positive suggestions by reviewing the recent literature. METHODS We review the studies measuring the effects of suggestive communication of the past 20 years. In cases of studies presented in more details we quote from the suggestion scripts used in the study, too. RESULTS Most of the reviewed papers affirm that positive suggestions lead to decreased pain and use of pain medication. But physiological factors like bowel motility, blood pressure and bleeding during surgery can be positively affected, too. CONCLUSIONS Suggestive communication - a yet poorly utilized tool - used appropriately can significantly affect healing and recovery of a patient. Thus we emphasize further, more detailed study of this technique and its integration into the education of medical professionals.

Feature-based coding system : A new way of characterizing hypnosis styles

Abstract In this pilot study, the authors introduce a new system to assess hypnosis style. The Feature-Based Coding System (FBCS) comprises 24 standard individual hypnosis sessions, which were videotaped and coded according to both a previous and the new coding system. In addition, both subjects and hypnotists filled the Archaic Involvement Measure (AIM), the Phenomenology of Consciousness Inventory (PCI), and the Dyadic Interactional Harmony Questionnaire (DIH). The interrater agreement of FBCS was good and the construct Maternal-Paternal Axis had a good internal consistency (α = .95). Construct validity was also supported by the findings. Based on these results, a larger scale study is warranted to further establish the reliability and usefulness of this tool.

The Elkins Hypnotizability Scale: Assessment of Reliability and Validity

Abstract Measuring hypnotizability is an integral part of hypnosis research and is also relevant for predicting effectiveness of hypnosis-based therapies. The Elkins Hypnotizability Scale (EHS) was designed to meet the needs of modern hypnosis research and clinical practice. Reliability, validity, and normative data were explored by subjecting 230 participants to the EHS and Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C). The EHS demonstrated adequate internal consistency (α = .78), its items showed good discriminating ability, and scores of the two scales were highly correlated (ρ = .86). Results indicate that the EHS is a reliable and valid tool to assess hypnotizability. Further research is needed to establish its role as a surrogate for the SHSS:C.