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the international journal of clinical and experimental Hypnosis


Evidence-Based Practice in Hypno-Psychotherapy

Clinical Research Review

The April and July editions of the International Journal for Clinical & Experimental Hypnosis (IJCEH) are both Special Issues on ‘Evidence-Based Practice in Clinical Hypnosis.’ In his opening article, guest editor Assen Alladin and colleagues, review the status of hypnotherapy as an evidence-based practice. He reviews a previous Special Issue of IJCEH (2000), edited by Michael R. Nash which had reviewed the empirical support for clinical hypnosis from a different perspective. In this issue, Lynn et al. had concluded that hypnosis was an empirically “well-established” treatment for pain. Schoenberger carried out an analysis of the additive value of hypnosis when combined with CBT and replicated the earlier finding of Kirsch et al. (1995) that cognitive-behaviour al hypnotherapy had a larger average effect size than CBT alone. Green & Lynne reviewed the research on hypnotherapy for smoking cessation and concluded that the status of hypnotherapy in this area was difficult to establish because it seemed to depend primarily upon the integration of cognitive and behavioural interventions. Cardena found that hypnosis for PTSD was an area where little research existed, despite the fact that many clinicians and researchers see this as a credible application.

The following abstracts summarise the articles published in the two Special Issues on Evidence-Based Practice in Clinical Hypnosis published in 2007.

What we Ought to Mean by Empirical Validation in Hypnotherapy: Evidence-Based Practice in Clinical Hypnosis
Assen Alladin, Linda Sabatini, and Jon K. Amundson
(IJCEH, Vol. 55, No. 2, April 2007)

Abstract: This paper briefly surveys the trend of and controversy surrounding empirical validation in psychotherapy. Empirical validation of hypnotherapy has paralleled the practice of validation in psychotherapy and the professionalization of clinical psychology, in general. This evolution in determining what counts as evidence for bona fide clinical practice has gone from theory-driven clinical approaches in the 1960s and ‘70s through critical attempts at categorization of empirically supported therapies in the ‘90s on to the concept of evidence-based practice in 2006. Implications of this progression in professional psychology are discussed in the light of hypnosis’ current quest for validation and empirical accreditation.

Cognitive Hypnotherapy for Depression: An Empirical Investigation
Assen Alladin and Alisha Alibhai
(IJCEH, Vol. 55, No. 2, April 2007)

Abstract: To investigate the effectiveness of cognitive hypnotherapy (CH), hypnosis combined with cognitive behavior therapy (CBT), on depression, 84 depressives were randomly assigned to 16 weeks of treatment of either CH or CBT alone. At the end of treatment, patients from both groups significantly improved compared to baseline scores. However, the CH group produced significantly larger changes in Beck Depression Inventory, Beck Anxiety Inventory, and Beck Hopelessness Scale. Effect size calculations showed that the CH group produced 6%, 5%, and 8% greater reduction in depression, anxiety, and hopelessness, respectively, over and above the CBT group. The effect size was maintained at 6-month and 12-month follow-ups. This study represents the first controlled comparison of hypnotherapy with a well-established psychotherapy for depression, meeting the APA criteria for a “probably efficacious” treatment for depression.

Review of the Efficacy of Clinical Hypnosis with Headaches and Migraines
D. Corydon Hammond
(IJCEH, Vol. 55, No. 2, April 2007)

Abstract: The 12-member National Institute of Health Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996) reviewed outcome studies on hypnosis with cancer pain and concluded that research evidence was strong and that other evidence suggested hypnosis may be effective with some chronic pain, including tension headaches. This paper provides an updated review of the literature on the effectiveness of hypnosis in the treatment of headaches and migraines, concluding that it meets the clinical psychology research criteria for being a well-established and efficacious treatment and is virtually free of the side effects, risks of adverse reactions, and ongoing expense associated with medication treatments.

Evidence-Based Hypnotherapy for Asthma: A Critical Review
Daniel Brown
(IJCEH, Vol. 55, No. 2, April 2007)

Abstract: Asthma is a chronic disease with intermittent acute exacerbations, characterized by obstructed airways, hyperresponsiveness , and sometimes by chronic airway inflammation. Critically reviewing evidence primarily from controlled outcome studies on hypnosis for asthma shows that hypnosis is possibly efficacious for treatment of symptom severity and illness-related behaviors and is efficacious for managing emotional states that exacerbate airway obstruction. Hypnosis is also possibly efficacious for decreasing airway obstruction and stabilizing airway hyperresponsiveness in some individuals, but there is insufficient evidence that hypnosis affects asthma’s inflammatory process. Promising research needs to be replicated with larger samples and better designs with careful attention paid to the types of hypnotic suggestions given. The critical issue is not so much whether it is used but how it is used. Future outcome research must address the relative contribution of expectancies, hypnotizability, hypnotic induction, and specific suggestions.

The Efficacy of Hypnotherapy in the Treatment of Psychosomatic Disorders: Meta-Analytical Evidence
Erich Flammer and Assen Alladin
(IJCEH, Vol. 55, No. 3, July 2007)

Abstract: Hypnotherapy is claimed to be effective in treatment of psychosomatic
disorders. A meta-analysis was conducted with 21 randomized controlled clinical studies to evaluate efficacy of hypnosis in psychosomatic disorders. Studies compared patients exclusively treated with hypnotherapy to untreated controls. Studies providing adjunctive standard medical care in either treatment condition were also admitted. Hypnotherapy was categorized into classic (n = 9), mixed form (n = 5), and modern (n = 3). Results showed the weighted mean effect size for 21 studies was d+ = .61 (p = .0000). ANOVA revealed significant differences between classic, mixed, and modern hypnosis. Regression of outcome on treatment dose failed to show a significant relationship. Numerical values for correlation between suggestibility and outcome were only reported in 3 studies (mean r = .31). The meta-analysis clearly indicates hypnotherapy is highly effective in treatment of psychosomatic disorders.

Hypnotherapy in the Management of Chronic Pain
Gary Elkins, Mark Jensen, and David Patterson
(IJCEH, Vol. 55, No. 3, July 2007)

Abstract: This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic pain problems. Also, hypnosis was generally found to be more effective than nonhypnotic interventions such as attention, physical therapy, and education. Most of the hypnosis interventions for chronic pain include instructions in self-hypnosis. However, there is a lack of standardization of the hypnotic interventions examined in clinical trials, and the number of patients enrolled in the studies has tended to be low and lacking long-term follow-up. Implications of the findings for future clinical research and applications are discussed.

Hypnosis for Acute Distress Management During Medical Procedures
Nicole Flory, Gloria M. Martinez Salazar, and Elvira V. Lang
(IJCEH, Vol. 55, No. 3, July 2007)

Abstract: The use of hypnosis during medical procedures has a long-standing tradition but has been struggling for acceptance into the mainstream. In recent years, several randomized-controll ed trials with sufficient participant numbers have demonstrated the efficacy of hypnosis in the peri-operative domain. With the advancements of minimally invasive high-tech procedures during which the patient remains conscious, hypnotic adjuncts have found many applications. This article describes the procedural environment as well as pharmacologic and nonpharmacologic interventions to reduce distress. Current research findings, controversies in the literature, and safety considerations are reviewed. Implications for clinical practice and training as well as directions for future research are discussed. Obstacles and possible reasons for the slow acceptance of nonpharmacologic interventions, mind-body therapies, and patient-centered approaches are addressed.

Hypnosis Efficacy in the Treatment of Eating Disorders
Marianne Barabasz
(IJCEH, Vol. 55, No. 3, July 2007)

Abstract: Research on the efficacy of hypnosis in the treatment of eating disorders has produced mixed findings. This is due in part to the interplay between the characteristics of people with eating disorders and the phenomena of hypnosis. In addition, several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of the hypnotic intervention( s) to facilitate replication and clinical implementation. Therefore, this paper only reviews literature with replicable methodological descriptions. It focuses on the 3 primary disorders of interest to clinicians: bulimia nervosa, anorexia nervosa, and obesity. The implications for evaluating treatment efficacy are discussed.

Effectiveness of Hypnotherapy with Cancer Patients’ Treatment Trajectory: Emesis, Acute Pain, Analgesia, and Anxiolysis in Procedures
Sylvain Neron and Randolph Stephenson
(IJCEH, Vol. 55, No. 3, July 2007)

Abstract: Clinical hypnosis in cancer settings provides symptom reduction (pain and anxiety) and empowers patients to take an active role in their treatments and procedures. The goal of this paper is to systematically and critically review evidence on the effectiveness of hypnotherapy for emesis, analgesia, and anxiolysis in acute pain, specifically in procedures with an emphasis on the period from 1999 to 2006. Further, it aims to provide a theoretical rationale for the use of hypnosis with cancer populations in the whole spectrum of illness/treatment trajectory in several clinical contexts. Finally, a treatment protocol for management of overt anxiety and phobic reactions in the radiotherapy suite is presented, with the intent of having such a protocol empirically validated in the future.

Evidence-Based Clinical Hypnosis in Obstetrics, Labor and Deliver, and Preterm Labor
Donald Brown and D. Corydon Hammond
(IJCEH, Vol. 55, No. 3, July 2007)

Abstract: This paper reviews the benefits and effectiveness of hypnosis in obstetrics and labor and delivery, demonstrating significant reductions in the use of analgesics and anesthesia and in shorter Stages 1 and 2 labors. It presents empirical and theoretical rationales for use of hypnosis in preterm labor (PTL) and labor and delivery at term. The benefits of hypnosis in relation to labor length, pain levels, and the enjoyment of labor, as well as its effectiveness in preterm labor are noted in randomized controlled trials and in a meta-analysis. Risk factors are reported for preterm delivery; hypnosis significantly prolongs pregnancy. Six cases are presented of hypnosis stopping PTL a number of times and when indicated at term. A case report of successful use of hypnosis in quadruplets is presented with some scripts. Suggestions are made for further research.

Cognitive Behavioral Hypnotherapy in the Treatment of Irritable Bowel Syndrome–Induced Agoraphobia
William L. Golden
(IJCEH, Vol. 55, No. 2, April 2007)

Abstract: There are a number of clinical reports and a body of research on the effectiveness of hypnotherapy in the treatment of irritable bowel syndrome (IBS). Likewise, there exists research demonstrating the efficacy of cognitive-behaviora l therapy (CBT) in the treatment of IBS. However, there is little written about the integration of CBT and hypnotherapy in the treatment of IBS and a lack of clinical information about IBS-induced agoraphobia. This paper describes the etiology and treatment of IBS-induced agoraphobia. Cognitive, behavioral, and hypnotherapeutic techniques are integrated to provide an effective cognitive-behaviora l hypnotherapy (CBH) treatment for IBS-induced agoraphobia. This CBH approach for treating IBS-induced agoraphobia is described and clinical data are reported.

Hypnosis and the Treatment of Posttraumatic Conditions: An Evidence-Based Approach
Steven Jay Lynn and Etzel Cardeña
(IJCEH, Vol. 55, No. 2, April 2007)

Abstract: This article reviews the evidence for the use of hypnosis in the treatment of posttraumatic conditions including posttraumatic stress disorder and acute stress disorder. The review focuses on empirically supported principles and practices and suggests that hypnosis can be a useful adjunctive procedure in the treatment of posttraumatic conditions. Cognitive-behaviora l and exposure-based interventions, which have the greatest empirical support, are highlighted, and an illustrative case study is presented.

Evidence-Based Hypnotherapy for the Management of Sleep Disorders
Gina Graci and John C. Hardie
(IJCEH, Vol. 55, No. 3, July 2007)

Abstract: There is a plethora of research suggesting that combining cognitive-behaviora l therapy with hypnosis is effective for a variety of psychological, behavioral, and medical disorders. Yet, very little empirical research exists pertaining to the use of hypnotherapy as either a single or multi-treatment modality for the management of sleep disorders. The existing literature is limited to a small subset of nonbiologic sleep disorders. The objectives of this paper are: to provide a review of the most common sleep disorders, with emphasis on insomnia disorders; discuss the cognitive-behaviora l approaches to insomnia; and review the existing empirical literature on applications of hypnotherapy in the treatment of sleep disturbance. The overreaching goal is to educate clinicians on how to incorporate sleep therapy with hypnotherapy. There is an immediate need for research evaluating the efficacy of hypnotherapy in the management of sleep disturbance.

Donald Robertson © 2008