Grossarth-Maticek, R.; Eysenck, H. J. (1991). Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II – Effects of treatment. Behaviour Research and Therapy, 29, 17-31.
NOTES
Reports on what they call creative novation behavior therapy or “autonomy training” to prevent cancer and coronary heart disease in prone individuals. This individually tailored cognitive-behavioral program includes the use of hypnosis and of imagery. When administered individually (20-30 hours) in a group (6-15 sessions of up to several hours) or via bibliotherapy with 4-6 hours of individual therapy, the outcome was better than that of control subjects. After 13 years, 45 of 50 cancer-prone subjects in individual treatment were still alive (and none of the 5 deaths were from cancer), while among 50 control subjects, 31 died, 16 from cancer. This study along with Spiegel et al. (1989) article in Lancet have important implications for health care.
McCue, Peter A. (1991). Key Paper Review: Prophylactic therapy for cancer and coronary heart disease. [Comment/Discussion]
NOTES
This is a commentary on two papers by Grossarth-Maticek and Eysenck, in which they report on ‘creative novation behaviour therapy’ to prevent cancer and heart disease in people with prsonalities associated with the development of those diseases. Therapy may involve hypnosis and/or relaxation, with suggestions that facilitate modification of unhealthy expectancies. The papers are:
Grossarth-Maticek, R. & Eysenck, H.J. (1991). Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part I – Description of treatment. Behaviour Research and Therapy 29, 1-16.
Eysenck, H.J. & Grossarth-Maticek, R. (1991). Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II – Effects of treatment. Behaviour Research and Thearpy 29, 1, 17-31.
Rapkin, David A.; Straubing, Marsha; Holroyd, Jean (1991). Guided imagery, hypnosis and recovery from head and neck cancer surgery. International Journal of Clinical and Experimental Hypnosis, 39, 215-226.
The value of a brief, preoperative hypnosis experience was explored with a sample of 36 head and neck cancer surgery patients. 15 patients volunteered for the experimental hypnosis intervention. 21 patients who received usual care (no hypnosis) were followed through their hospital charts and were used as a comparison group. Hypnotic intervention and usual care groups were comparable in terms of relevant demographic variables. Postoperative hospitalizations for the hypnotic intervention group were significantly shorter than for the usual care group. Within the hypnotic intervention group, hypnotizability was negatively correlated with surgical complications and there was a trend toward a negative correlation between hypnotizability and blood loss during surgery. Findings suggest that imagery-hypnosis may be prophylactic, benefitting patients by reducing the probability of postoperative complications and thereby keeping hospital stay within the expected range. Recommendations are presented for a controlled, randomized, clinical trial with a sufficiently large sample to provide the opportunity for statistical analysis with appropriate power.
NOTES
Actual stay in hospital, post-surgery, was 8.7 days (SD = 3.7) for the Hypnosis group and 13.9 days (SD = 9.7) for the Usual Care group; the range was 3-17 days for the Hypnosis group and 5-42 days for the usual care group.
The hypnosis script included an indirect, permissive induction; positive suggestions for relaxation and healing imagery; images of calm situations that would lead to expectation for healing (e.g. a ‘healing pool’); suggestions for patients to develop their own images of pleasurable, comforting situations. The only direct suggestions were for minimal blood loss during surgery, modeled after those given in the waking situation by Bennett, Benson, and Kuiken (1986).
As measured by the Stanford Hypnotic Clinical Scale, there were five highly hypnotizable patients (scores 4-5), six mediums (scores 2-3), and four lows (scores 0-1). “Hypnotizability correlated negatively with complications (r = -.54, p<.04, two-tailed test). There was a trend toward a negative correlation with length-of-stay (r = -.37, p<.18, two-tailed test) and estimated blood loss (r = -.40, p<.15, two-tailed test). Note that these correlations represent moderate to large effects, and the significance levels are due in part to low power associated with a small N (Cohen, 1988). The means for blood lost during surgery for the three hypnotizability groups were: highs = 904 cc, mediums = 1465 cc, and lows = 2056 cc" (p. 222).
Data on cost could not be published in this article but later was published in a letter to the Editor of the Newsletter of the Society of Clinical and Experimental Hypnosis (February 1994, Vol. 35, No. 1, p.8). "The average savings for the intervention group was $6,725. While this difference fell short of statistical significance on the Wilcoxon test (Z=- 1.5402, p < .10), it is rather striking on its face. The range actually was $7849 to $27,782 for Intervention Group patients and $9,390 to $53,627 for Usual Care group patients.
"In 1990 a semi-private room at UCLA Center for the Health Sciences cost $405 to $529 per day, depending on quality; standard ICU care (one nurse for two patients) was $1236 per day, and more intensive care (one nurse for one patient) was $2471/day. Head and neck surgery patients may remain in the ICU, driving up costs, solely because they have not learned to suction their own tracheostomies, usually a motivational factor that might be affected by hypnosis. UCLA is a tertiary care hospital in a high-cost area (and is therefore reimbursed at higher rates than many other hospitals), and costs may be driven up by the many additional procedures required for long-stay patients. Therefore the cost savings could not be expected to be as great where expected length of stay is brief, ICU use is limited, and community costs are lower" (p. 8).
Zeltzer, Lonnie K.; Dolgin, M. J.; LeBaron, Samuel; LeBaron, C. (1991). A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics, 88, 34-42.
Subjects were randomly assigned to hypnosis, nonhypnotic distraction/relaxation, or attention placebo control. children in the hypnosis group reported the greatest reduction in both anticipatory and postchemotherapy symptoms. Distraction/relaxation kept symptoms from getting worse, but they did not get better, and the control children's symptoms became much worse.
Kaye, J. M.; Schindler, B. A. (1990). Hypnosis on a consultation-liaison service. General Hospital Psychiatry, 12, 379-383.
Studied the use of hypnosis on a consultation-liaison service with a broad spectrum of medically hospitalized patients. Autohypnosis tapes were used for reinforcement. Twenty-nine women and eight men from 24-75 years of age were hypnotized for relief of depression, pain, anxiety, or side effects of chemotherapy. Results were excellent (total to almost total relief of symptoms) in 68%, fair in 22%, and poor in 11%, with no differences among the results with the various conditions. This demonstrates that hypnotherapy is an extremely useful tool in medical management of patients in consultation-liaison psychiatry.
LaClave, Linda J.; Blix, Susanne (1989). Hypnosis in the management of symptoms in a young girl with malignant astrocytoma: A challenge to the therapist. International Journal of Clinical and Experimental Hypnosis, 37 (1), 6-14.
This paper presents the case of a 6.5-year-old girl with malignant astrocytoma of the left brain hemisphere. During the course of her chemotherapy treatment, severe vomiting developed to the degree that on several occasions she became dehydrated. Discontinuation of chemotherapy was being considered when she was referred for hypnotherapy. Despite severe neurological impairments which excluded many traditional techniques, hypnosis was successful in eliminating emesis. Hypnosis was also utilized to decrease pain and to improve sleep patterns. Drawings are presented to help show how this child resolved anxiety associated with treatment and fears surrounding the knowledge of her impending death.
Spiegel, David; Bloom, J. R.; Kraemer, H. C.; Gottheil, E. (1989, October 14). The beneficial effect of psychosocial treatment on survival of metastatic breast cancer patients: A randomized prospective outcome study. Lancet, 888-891.
The effect of psychosocial intervention on time of survival of 86 metastatic breast cancer patients was studied using randomized prospective design. The one-year treatment consisted of weekly supportive group therapy with training in self-hypnosis for pain management, and resulted in significant reductions in mood disturbance and pain. Both the treatment and control groups had routine oncologic care. At ten-year follow-up, only three of the original 86 patients were still alive, and death records were obtained for the other 83. Survival from the time of randomization and onset of intervention was 36.6 (sd = 37.6) months for the treatment group, compared with 18.9 (sd = 10.8) months for the control group, and this difference was highly significant (Z = 3.94, p <.0001) using the Cox life table regression model. Kaplan-Meier survival analysis indicated that the divergence in survival began at 20 months after entry into the study, or 8 months after the treatment intervention ended. These unexpected findings suggest that intensive psychosocial support affects the course of the illness, although the mechanism by which it does so is not clear.
Jay, Susan (1987, October). Hypnotic susceptibility and response to psychological intervention for distress related to painful procedures in leukemic children. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Los Angeles.
NOTES
Presented children with a cognitive behavioral intervention package that involved five elements 1. Filmed Modeling (child modeling and talking about it with good coping skills) 2. Positive Reinforcement - trophy 'for doing the best you can,' to change aversive situation to a positive situation 3. Breathing Exercises - 'puff yourself up like a tire' 4. Emotive Imagery/Distraction - super hero image (Superman), or being in a favorite place 5. Behavioral Rehearsal - dollplay, reviewing the procedure with medical equipment.
For Numbers 4 and 5 the therapist would actively guide the procedures; numbers 3, 4 & 5 are hypnotic elements.
Valium had lowered children's distress prior to procedures but not during the procedures. This study involved Valium plus cognitive behavior therapy.
25 Subjects ages 6-12, were measured for hypnotizability
2 groups: (1) Cognitive Behavior Therapy + Valium given just before intervention started, after film ended; (2) Cognitive Behavior Therapy alone.
Dependent Measures: 1. Observation Scale of Behavioral Distress coded every 15 seconds. 2. Faces Scale for Fear (self report) before procedure
Faces Scale for Pain (self report) after procedure 3. Blood pressure
RESULTS. No Significant Differences were found between the two groups (CBT vs CBT + Valium). Pre-Post Analyses: Post intervention scores were significant lower than Pretest on [missed notes]
Jay, Susan M.; Elliott, Charles H.; Katz, Ernest; Siegel, Stuart E. (1987). Cognitive-behavioral and pharmacologic interventions for children's' distress during painful medical procedures. Journal of Consulting and Clinical Psychology, 55, 860-865.
This study evaluated the efficacy of a cognitive-behavioral intervention package and a low-risk pharmacologic intervention (oral Valium), as compared with a minimal treatment-attention control condition, in reducing children's distress during bone marrow aspirations. The subjects were 56 leukemia patients who ranged in age from 3 years to 13 years. The three intervention conditions were delivered in a randomized sequence within a repeated-measures counterbalanced design. Dependent outcome measures included observed behavioral distress scores, self-reported pain scores, pulse rate, and blood pressure scores. Repeated-measures analyses of variance indicated that children in the cognitive-behavior therapy condition had significantly lower behavioral distress, lower pain ratings, and lower pulse rates than when they were in the attention- control condition. When children were in the Valium condition, they exhibited no significant differences from the attention control condition except that they had lower diastolic blood pressure scores.
NOTES
Lonnie Zelzer, M.D., in a UCLA Hypnosis Seminar lecture in 1992, stated that in pre-treatment with Valium the patients did worse during the procedure, vs no pretreatment with Valium, because the medicated patients didn't have clarity of attention during the cognitive behavioral learning.
Katz, Ernest R.; Kellerman, Jonathan; Ellenberg, Leah (1987). Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology, 12, 379-394.
Hypnosis has been used as a behavioral approach to help children tolerate aversive medical procedures more effectively, but empirical longitudinal research evaluating the outcome of such interventions has been limited. In the present study, 36 children with acute lymphoblastic leukemia between the ages of 6 and 12 years of age undergoing repeated bone marrow aspirations (BMAs) were randomized to hypnosis or play comparison groups. Subjects were selected on their behavioral performance on baseline procedures and received interventions prior to their next three BMA procedures. Major results indicated an improvement in self-reported distress over baseline with both interventions, with no differences between them. Girls exhibited more distress behavior than boys on three of four dependent measures used. Suggestions of an interaction effect between sex and treatment group were noted. The role of rapport between patient and therapist in therapeutic outcome was also evaluated. Results are discussed in terms of potential individual differences in responding to stress and intervention that warrant further research.
Hendler, Cobie S.; Redd, William H. (1986). Fear of hypnosis: The role of labeling in patients' acceptance of behavioral interventions. Behavior Therapy, 17, 2-13.
One hundred and five outpatient cancer chemotherapy patients were interviewed to assess their attitudes toward hypnosis and relaxation as well as to determine their beliefs in and willingness to try a behavioral procedure. Patients were randomly assigned to groups receiving identical descriptions labeled "hypnosis," "relaxation," or "passive relaxation with guided imagery." The description stressed the behavioral components of hypnosis and relaxation rather than the nonbehavioral techniques often associated with hypnosis such as age regression and posthypnotic suggestion. Patients believed hypnosis to be a powerful process that involved loss of control and altered states of consciousness. When compared with a group of college students, patients held significantly more fearful, conservative views about hypnosis. Patients who received a description of an intervention labeled "hypnosis" were significantly less likely to believe the procedure would effectively control their nausea and vomiting and were significantly less likely to state they would try the procedure than patients in the other two label conditions. This reaction to the label occurred independently of patients' degree of nausea, vomiting, and pain due to their chemotherapy treatments.
Achterberg, J. (1984, October). Cancer, immunology, psychological factors, and imagery. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Antonio, TX.
NOTES
Author developed a way of scoring imagery (which will be published in Imagery and Disease.). In terms of predicting who will die and who will survive, the content of the images doesn't seem to be as important as the quality (strength, vividness, etc.), which supports Bernauer Newton's (1984) findings. "The image seems to be a basic pre-verbal component of our species that has survival value."
Margolis, Clorinda G. (1984). Hypnosis and cancer: An overview of the field. [Unpublished manuscript]
NOTES
This paper apparently was presented either at American Psychological Association or the Society for Clinical and Experimental Hypnosis. The author has two tables summarizing types of cancer associated with pain, and pain syndromes in patients with cancer.
Table 3 is a list of Erickson's procedures for Controlling Pain: --Direct hypnotic suggestion for total abolition of pain --Permissive indirect hypnotic abolition of pain --Amnesia --Hypnotic analgesia --Hypnotic anesthesia --Hypnotic replacement or substitution of sensations --Hypnotic displacement of pain --Hypnotic dissociation
Time and body disorientation --Hypnotic reinterpretation of pain experience --Hypnotic time distortion --Hypnotic suggestions effecting a diminution of pain
(from Rossi, Ed., _Innovative Hypnotherapy_, Vol. IV of the Collected Papers of Milton H. Erickson on Hypnosis, 1980
Table 4 is a list of Sacerdote's Procedures for Controlling Pain: --Teleological approach --Reinterpretation of signals --Associating and conditioning --Dissociation --Simile of electric wiring --Development of amnesia --Positive and negative hallucinations --Induction of dreams --Time and space distortion, and elicitation of mystical states --Relaxation techniques --Glove anesthesia and analgesia --Pain management through control of autonomic functions
(from Barber & Adrian, Eds., _Psychological Approaches to the Management of Pain_, 1982)
The author describes cases treated by Erickson (one in which he used 12 hours of training, in one session, reported in Rossi's 1980 edited writings of Milton Erickson, Vol. IV) and by Sacerdote.
Author notes that the Hilgards, in _Hypnosis in the Relief of Pain_ (1975), describe the use of hypnosis in treating patients with cancer pain. In all three--Butler (1954), Lea, Ware, and Monroe (1960), and a larger study by Cangello (1961), both success and failure are reported. As the Hilgards point out, about 50% of the patients studied were able to reduce their pain--a percentage the Hilgards remark is rather close to what successful clinicians tend to report.
Morrow, Gary R. (1984). Appropriateness of taped versus live relaxation in the systematic desensitization of anticipatory nausea and vomiting in cancer patients. Journal of Consulting and Clinical Psychology, 52 (6), 1098-1099.
Investigated the suggestion that the relaxation part of systematic desensitization--an effective treatment for the nausea and vomiting experienced by approximately 25% of cancer patients in anticipation of chemotherapeutic treatments-- could be learned from a prerecorded audiotape prior to meeting a psychologist for treatment. 10 cancer patients who had developed anticipatory nausea or vomiting were assigned to either a live-relaxation or a tape-relaxation group. Results show that 4 of 5 Ss assigned to the tape-relaxation group experienced nausea while listening to the prerecorded audiotape, while none of the patients in the live-relaxation group reported nausea when subsequently listening to an audiotape made during the live presentation of relaxation.
Newton, Bernauer (1984, October). The use of imagery in the treatment of cancer patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Antonio, TX.
Several hundred cancer patients were treated with the Simonton visualization method, with the additional factor that they were hypnotized for the visualization. In a long term follow-up study, those patients who were treated for at least 6 months and are still alive had imagery that was vivid, persistent, positive, and passive ("passive" here meaning an underlying sense of calm). Those who died had the opposite kind of images, and retrospective review of clinical notes indicates their aggressive images reflected desperation. Of the patients who were treated less than six months, a few lived. Their images also were vivid, persistent, and positive.
Petrucci, Ralph J.; Harwick, Robert D. (1984). Role of the psychologist on a radical head and neck surgical service team. Professional Psychology: Research and Practice, 15, 538-543.
Surgery for head and neck cancers often produces disfiguration and a sense of hopelessness in patients, and it may also results in a lack of self-acceptance, depression, and covert hostility. Psychologists are often called on to help such patients deal with drug abuse, suicidal behaviors, strong characterological disorders, noncompliance, and overall adjustment. Behavioral management and anxiety-reduction strategies, such as relaxation exercises and visual imagery, are often helpful. (17 ref).
Gardner, G. Gail; Lubner, Alison (1982-83). Hypnotherapy for children with cancer: Some current issues. American Journal of Clinical Hypnosis, 25 (2-3), 135-142.
The authors review some of the problems that now face clinicians and researchers working in the field of hypnotherapy for pediatric cancer patients. These include (1) understanding and dealing with resistance and refusal, (2) developing preventive hypnotherapeutic strategies for children who will survive cancer, and (3) carrying out research that clarifies the value of hypnotherapy with childhood cancer patients and elucidates when and how specific approaches can best be utilized.
Hall, Marian D. (1982-83). Using relaxation imagery with children with malignancies: A developmental perspective. American Journal of Clinical Hypnosis, 25 (2-3), 143-149.
Developmental theory has been the foundation for this program of relaxation-imagery therapy with its goal of increasing the efficacy of immune mechanisms, thus increasing the survival rate of children with malignancies and/or improving the comfort and quality of their lives. Three basis constructs--the impact of social stress, the positive development of attachment and the negative effects of separation and loss, and the stages of concept formation relating to the functioning of the human body, the processes of disease and death--are basic approaches to the use of imagery-relaxation as an integral part of a comprehensive care plan.
Hilgard, Josephine R.; LeBaron, Samuel (1982). Relief of anxiety and pain in children and adolescents with cancer: Quantitative measures and clinical observations. International Journal of Clinical and Experimental Hypnosis, 30, 417-442.
Children and adolescents with cancer, chiefly forms of leukemia, aged 6 to 19 years, underwent medical treatments which required repeated bone marrow aspirations, normally a painful and anxiety-provoking experience. Data were obtained in baseline bone marrow observations on 63 patients, who were then offered the opportunity to volunteer for hypnotic help in pain control. Of the 24 patients who accepted hypnosis, 9 were highly hypnotizable. 10 of the 19 reduced self-reported pain substantially by the first hypnotic treatment (the prompt pain reducers) and 5 more reduced self-reported pain by the second treatment (the delayed pain reducers) while none of the 5 less hypnotizable patients accomplished this. The latter benefitted by reducing anxiety. Short case reports illustrate the variety of experiences.
Analysis of baseline observations before any therapeutic intervention revealed age and sex differences. The difference between self-reported and observed pain was not statistically significant for patients under age 10 but was significant for the patients age 10 and older (p<.001). There were minor but significant sex differences both in observed pain (p<.01) and in self-reported pain (p<.05), with the females reporting more pain.
Hoffman, Mark L. (1982/83). Hypnotic desensitization for the management of anticipatory emesis in chemotherapy. American Journal of Clinical Hypnosis, 25 (2-3), 173-176
A hypnotic treatment employing systematic desensitization was used to alleviate anticipatory nausea and vomiting in a middle-aged man undergoing chemotherapy for Hodgkin's Disease. After four treatment sessions, all nausea associated with chemotherapy was eliminated. Results of this treatment are compared with those of another hypnotic treatment recently reported by Redd et al (1982), and reasons for differences are discussed. [Redd, W. H., Andersen, G. V. & Minagawa, R. Y. (1982). Hypnotic control of anticipatory emesis in patients receiving cancer chemotherapy. Journal of Consulting and Clinical Psychology, 50, 14-19.]
LeBaron, Samuel; Zeltzer, Lonnie (1982, October). The effectiveness of behavioral intervention for reducing chemotherapy related nausea and vomiting in children with cancer. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Indianapolis, IN.
Eight children (nine to seventeen years, Mean age 12.1) with cancer received behavioral intervention for chemotherapy related nausea and vomiting. Within three to five days after the administration of each course of chemotherapy, patients rated (1-10 scale; 1 = none, 10 = all the time or maximal amount) their nausea and vomiting and the extent to which chemotherapy bothered them and disrupted their daily routine. After a pre-intervention assessment of 2.5 courses of chemotherapy, patients received intervention (Mean = 2.6 courses). Significant reductions following intervention (Wilcoxon matched- pairs signed ranks test) were found in nausea (Z = 2.37, p<.02), vomiting (Z = 2.52, p<.01), bother (Z = 2.24, p<.02), and disruption of activities (Z = 2.38, p<.02). This preliminary study indicates that chemotherapy side effects can be reduced through behavioral intervention.
Lyles, Jeanne Naramore; Burish, Thomas G.; Krozely, Mary G.; Oldham, Robert K. (1982). Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy. Journal of Consulting and Clinical Psychology, 50, 509-524.
Fifty cancer patients receiving chemotherapy, 25 by push injection and 25 by drip infusion, were assigned to one of three conditions for their chemotherapy treatments: (a) progressive muscle-relaxation training plus guided-relaxation imagery; (b) therapist control, in which a therapist was present to provide support and encouragement but did not provide systematic relaxation training; and (c) no-treatment control. Patients participated in one pretraining, three training, and one follow-up session. Results indicated that during the training sessions, patients who received relaxation training, relative to patients in either of the other two conditions, (a) reported feeling significantly less anxious and nauseated during chemotherapy, (b) showed significantly less physiological arousal (as measured by pulse rate and systolic blood pressure) and reported less anxiety and depression immediately after chemotherapy, and (c) reported significantly less severe and less protracted nausea at home following chemotherapy. The attending nurses' observations during chemotherapy confirmed patient reports. In general, patients in the therapist control condition and the no-treatment control condition did not differ significantly from each other. The differences among conditions generally remained significant during the follow-up session. The data suggest that relaxation training may be an effective procedure for helping cancer patients cope with the adverse effects of their chemotherapy.
Margolis, Clorinda G. (1982-83). Hypnotic imagery with cancer patients. American Journal of Clinical Hypnosis, 25 (2-3), 128-134.
This is a clinical report on the use of hypnotic imagery to reduce pain and discomfort in cancer patients. Deep relaxation, ego strengthening, imagery, and suggestions for changes in perception and awareness are the principal techniques used to reduce suffering and to produce a sense of well-being among cancer patients treated at different stages of disease. Hypnotic intervention involving six patients is described, with emphasis on the ease with which positive transference is established and the effectiveness with which it may be used to enhance therapeutic effects.
Meares, Ainslie (1982-83). A form of intensive meditation associated with the regression of cancer. American Journal of Clinical Hypnosis, 25 (2-3), 114-121.
Elsewhere I have reported a number of cases of regression of cancer following intensive meditation. This type of meditation is characterized by extreme simplicity and stillness of the mind, and so differs from other forms using a mantra, awareness of breathing or visualization of the healing process. Any logical verbal communication by the therapist stimulates intellectual activity in the patient. So communication is by unverbalized phonation, reassuring words and phrases, and most important, by touch. There follows a profound reduction in the patient's level of anxiety which flows on into his daily life. The non-verbal nature of the meditative experience initiates a non-verbal philosophical understanding of other areas of life.
Oliver, George W. (1982-83). A cancer patient and her family: A case study. American Journal of Clinical Hypnosis, 25 (2-3), 156-160.
In recent years, increasing numbers of mental health workers have been attempting to use techniques of psychotherapy to influence the course of malignant disease. This paper reviews in detail the course of treatment of one female patient with an inoperable malignancy and conveys a sense of the clinical experience of working intensively with a cancer patient and her family. It shows the complex levels of interaction within the patient herself, between the patient and her family, and between the therapist and her family and within the therapist himself during different phases of the therapeutic journey.
Redd, William H.; Andrykowski, Michael A. (1982). Behavioral intervention in cancer treatment: Controlling aversion reactions to chemotherapy. Journal of Consulting and Clinical Psychology, 50 (6), 1018-1029.
During the protracted course of cancer chemotherapy, approximately 25% of patients develop aversion reactions to treatment by becoming nauseated and/or vomiting before their chemotherapy treatments. This phenomenon has been conceptualized as a result of respondent conditioning. Since commonly used antiemetic drugs do not reliably control anticipatory nausea/emesis, behavioral techniques of control have been studied. They include hypnosis used in conjunction with guided-relaxation imagery, progressive muscle relaxation with guided imagery, and systematic desensitization. (67 ref)
Redd, William H.; Andresen, Graciela V.; Minagawa, Rahn Y. (1982). Hypnotic control of anticipatory emesis in patients receiving cancer chemotherapy. Journal of Consulting and Clinical Psychology, 50 (1), 14-19.
NOTES
Deep muscle relaxation hypnosis controlled nausea, gagging, retching in all cases. Anticipatory emesis recurred when hypnosis was not used. During subsequent sessions in which hypnosis was reinstated, anticipatory emesis was again controlled.
Redd, William H.; Rosenberger, Patricia H.; Hendler, Cobie S. (1982-83). Controlling chemotherapy side effects. American Journal of Clinical Hypnosis, 25 (2-3), 161-172.
Severe nausea and vomiting are commonly experienced by cancer patients after receiving chemotherapy treatments. Moreover, approximately 25% of these patients develop conditioned aversions to treatment and become nauseated before they receive their chemotherapy injections. The use of deep muscle relaxation hypnosis in conjunction with guided imagery to control pre- and post-chemotherapy nausea and emesis is discussed. Theoretical and clinical issues raised by this application of hypnosis in cancer treatment arc also addressed.
Rosenberg, Simon W. (1982-83). Hypnosis in cancer care: Imagery to enhance the control of the physiological and psychological 'side-effects' of cancer therapy. American Journal of Clinical Hypnosis, 25 (2-3), 122-127.
The use of surgery, radiation, and chemotherapy has resulted in increased control of malignancy and prolonged survival for cancer patients. These modalities also carry significant morbidity. Normal physiological homeostasis is often altered by both the neoplasm and its treatment. The diagnosis, treatment, and social stigma of cancer exact profound psychological impact. Hypnosis effectively can control the range of both physiological and psychological 'side-effects' of cancer and its therapy. This paper will delineate those effects of hypnosis of proven value to the cancer patient. Incorporation of images into each phase of a hypnosis session will be demonstrated with an actual case history and annotated transcript. Imagery as a therapeutic modality will be discussed in general, and specific suggestions and images will be given.
Shapiro, Arnold (1982-83). Psychotherapy as adjunct treatment for cancer patients. American Journal of Clinical Hypnosis, 25 (2-3), 150-155
During the past ten years psychotherapy as adjunct treatment for cancer patients has become increasingly common. The use of hypnosis as an integral part of that treatment has also burgeoned. This report will follow the progress of two cancer patients in psychotherapy. While each is highly individual, the commonalities which allow treatment to be systematic will be quite apparent. The ability to minimize pain and discomfort, the ability to keep the white cell count high despite ongoing chemotherapy, and augmenting the ability of the body's immune system to fight the disease are utilized by both of the patients. All of the above are accomplished through the use of visual imagery in the trance state. Visual imagery is also used to reach feelings which patients are often unable to verbalize, and of which they often claim to be unaware. Other aspects of therapy such as the gradual shift from despair to hope and even confidence, and the development of more assertive behavior are discussed.
Reviews research on psychophysiology of cancer, effect of stress on host resistance, cancer prediction from personality traits, psychological theories of cancer aetiology, and psychological characteristics of patients with different types of neoplasms. The hypnotherapy of cancer patients is outlined in terms of its effect upon the malignancy, relief of discomfort, and psyche of the cancer patient. Recommends direction of hypnotherapeutic treatment of cancer patients.
NOTES
"In summary, the radical treatment of malignancies presents a number of hypnotherapeutic opportunities. Not only can hypnotherapy help alleviate disease-related symptoms, but it can also limit some of the distressing side-effects of the treatments. The patient can gain needed hope by having the impact of his disease lessened. The hypnotherapeutic relationship also provides a useful base fom which to deal with the issues of terminal illness, of death, and of dying.
"Implications for the future basically revolve around the issue of supportive hypnotehrapy during radical treatment. As the use of chemotherapy of malignancies increases, there will be many opportunities for successful hypnotherapeutic interventions" (pp. 7-8).
Gardner, Gail G. (1976). Hypnosis and mastery: Clinical contributions and directions for research. International Journal of Clinical and Experimental Hypnosis, 24 (3), 202-214.
This paper explores the concept of mastery in relation to hypnotherapy by pulling together clinical observations and suggesting directions for research. It is suggested that a sense of mastery may enhance the effectiveness of hypnosis, either by facilitating induction, or by strengthening hypnotherapeutic suggestions, or by maintaining hypnotherapeutic gains. Moreover, the qustion is raised as to whether hypnotherapy, as compared with other psychotherapeutic approaches, better facilitates the development of a sense of mastery.
Clawson, T. A.; Swade, R. H. (1975). The hypnotic control of blood flow and pain: The cure of warts and the potential for the use of hypnosis in the treatment of cancer. American Journal of Clinical Hypnosis, 17 (3), 160-169.
Case histories show that hypnosis can control massive bleeding and pain, and it can remove warts, probably by stopping blood flow to them. We propose that blood flow to cancerous tumors can likewise be controlled, which could destroy them outright, or which control could be a useful adjunct to chemo- or radio-therapy
Sacerdote, Paul (1970). Theory and practice of pain control in malignancy and other protracted or recurring painful illnesses. International Journal of Clinical and Experimental Hypnosis, 18 (3), 160-180.
Recent neuroanatomical and neurophysiological experimental data suggest absence or presence of pain and changes in pain intensity as expressions of the balance between sensory (peripheral) and central (centrifugal) inputs at synaptic stations. Psychological activities by contributing to the centrifugal input influence conduction, transduction, and perception of pain stimuli. Hypnotically induced analgesia and anesthesia are therefore acceptable as neurophysiological realities. Methods for hypnotic alterations of pain based upon these premises are described utilizing neurophysiological mechanisms, psychodynamic changes, establishment of new behavioral patterns, or changes in time-space concepts and percepts. Case presentations illustrate some of these multiple psychological and physiological approaches to pain control. (Spanish & German summaries) (28 ref.) (PsycINFO Database Record (c) 2003 APA, all rights reserved)
Slater, Roger C.; Flores, Louis S. (1963). Hypnosis in organic symptom removal: A temporary removal of an organic paralysis by hypnosis. American Journal of Clinical Hypnosis, 5 (4), 248-255.
NOTES
"Summary and Conclusions. A detailed case study is reported on the use of hypnosis with beneficial results in an instance of eventually proved organic brain disease. Three other confirmatory case reports of organic disease definitely benefitted by the use of hypnosis are briefly cited.
" The first patient had been adequately studied repeatedly for organic brain disease. Because the studies led to an uncertain indefinite unconfirmed suspicion of psychogenic epilepsy, the patient was returned with a recommendation for continued treatment and observation by the author, a general practitioner. Hence, she was, after still further study for organic disease, treated symptomatically by hypnosis with beneficial results. This led to the erroneous conclusion that the patient's disability was probably functional. A sudden fatal outcome of the actual but unrecognized brain disease led to a correct but post- mortem diagnosis of astrocytoma of the brain, Grade IV.
"This report and those given to supplement it raise significant questions about the importance and value of hypnosis in organic disease. These include the challenging question of the extent to which the use of hypnosis can potentiate the natural corrective forces of the body; the need to recognize the value of hypnosis in effecting beneficial results in organic disease; the need to qualify the reliability of hypnosis as a differential diagnostic procedure in relation to psychogenic and organic disability; and the possibility and extent of the amelioration or actual correction of known organic illness" (p. 254).
Cangello, V. W. (1961). The use of hypnotic suggestion for pain relief in malignant disease. International Journal of Clinical and Experimental Hypnosis, 9, 17-22.
Using hypnotic suggestion, pain relief was attempted in 22 cases. 13 of these patients showed a decrease in narcotic requirements. Duration of effectiveness was from 1 week to 41/2 months. It is concluded that this method should be tried before resorting to either chemical or surgical procedures since it is relatively simple to perform, has no harmful complications, and is not unduly time consuming. From Psyc Abstracts 36:02:2II17C. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
NOTES
"At the present time it appears that there are several problems in which hpnosis is an acceptable and perhaps preferable method of anesthesia. Some of these problems include cases in which chemical analgesics and depressants are contraindicated or dangerous because of respiratory or cardiac disease. It may be indicated with patients who have demonstrated sensitivity to certain local anesthetics. Hypno-anesthesia may be used in cases in which repeated chemical anesthesia tends to have a debilitating effect on the patient with an already disturbed physiology, such as patients with thermal injuries who require multiple repeated debridements and dressings. Hypnosis may also obviate the debilitating effects of prolonged chemical anesthesia" (p. 156).
Stokvis, B. (1956). The appliction of hypnosis in organic diseases. Journal of Clinical and Experimental Hypnosis, 4 (2), 79-82.
SUMMARY
Hypnotherapy, applied as a symptomatic treatment, is especially indicted in those cases of organic diseases in which the patient has neurotically elaborated his physical suffering. In cases presenting neither etiological nor secondary psychic factors one may try to improve the patient's condition by hypnotic treatment. Description of a case (hypnotherapy in a woman with carcinoma mammae)[sic]. The writer's lack of appreciation of hypnotherapy in organic diseases does not include the treatment of diseases which are definitely psychosomatically determined" (pp. 81-82).
CANCER
Hendler CS, Redd WH Fear of hypnosis: The role of labeling in patients' acceptance of behavioral interventions Behav Ther. 1986;17(1):2-13 One hundred and five outpatient cancer chemotherapy patients were interviewed to assess their attitudes toward hypnosis and relaxation as well as to determine their beliefs in and willingness to try a behavioral procedure. Patients were randomly assigned to groups receiving identical descriptions labeled 'hypnosis', 'relaxation', or 'passive relaxation with guided imagery'. The description stressed the behavioral components of hypnosis and relaxation rather than the nonbehavioral techniques often associated with hypnosis such as age regression and posthypnotic suggestion. Patients believed hypnosis to be a powerful process that involved loss of control and altered states of consciousness. When compared with a group of college students, patients held significantly more fearful, conservative views about hypnosis. Patients who received a description of an intervention labeled 'hypnosis' were significantly less likely to believe the procedure would effectively control their nausea and vomiting and were significantly less likely to state they would try the procedure than patients in the other two label conditions. This reaction to the label occurred independently of patients' degree of nausea, vomiting, and pain due to their chemotherapy treatments.
Hockenberry-Eaton MJ. Cotanch PH. Evaluation of a child's perceived self-competence during treatment for cancer. Journal of Pediatric Oncology Nursing 1989;6(3):55-62 The purpose of this study was to evaluate the effect of self-hypnosis on the perceived self-competence of children undergoing treatment for cancer and to determine longitudinal differences in perception of self-competence over time. Twenty-two children were randomized into an experimental group (taught self-hypnosis) and a control group (given standard care). Data were collected using the Harter Perceived Self-Competence Profile (HPSCP) during four courses of chemotherapy. A decrease in mean scores for the control group was found compared with the hypnosis group, which showed an increase in mean scores in five of six domains. Both groups showed a statistically significant increase in the scholastic cognitive domain and social acceptance domain from the time of diagnosis compared with the second test period. Ten children had a visible physical disability. These children were found to have significant decreases in the domains of athletic competence, social acceptance, and global self-worth. Decreases remained significant throughout all test periods in the athletic competence domain for the children with a visible physical disability. This study is unique in that the researchers evaluated children's perception of self-competence over time. These findings support previous studies and identify the need for nurses to become actively involved in helping children develop effective coping skills during chemotherapy for cancer.
Jacknow DS. Tschann JM. Link MP. Boyce WT. Hypnosis in the prevention of chemotherapy-related nausea and vomiting in children: a prospective study. Journal of Developmental & Behavioral Pediatrics 1994;15(4):258-64 To study the effectiveness of hypnosis for decreasing antiemetic medication usage and treatment of chemotherapy-related nausea and vomiting in children with cancer, we conducted a prospective, randomized, and controlled single-blind trial in 20 patients receiving chemotherapy for treatment of cancer. Patients were randomized to either hypnosis or standard treatment. The hypnosis group used hypnosis as primary treatment for nausea and vomiting, using antiemetic medication on a supplemental (p.r.n.) basis only, whereas the control group received a standardized antiemetic medication regimen. Nausea, vomiting, and p.r.n. antiemetic medication usage were measured during the first two courses of chemotherapy. Anticipatory nausea and vomiting were assessed at 1 to 2 and 4 to 6 months postdiagnosis. Patients in the hypnosis group used less p.r.n antiemetic medication than control subjects during both the first (p < .04) and second course of chemotherapy (p < .02). The two groups did not differ in severity of nausea and vomiting. The hypnosis group experienced less anticipatory nausea than the control group at 1 to 2 months postdiagnosis (p < .02). Results suggest self-hypnosis is effective for decreasing antiemetic medication usage and for reducing anticipatory nausea during chemotherapy.
Kuttner L. Bowman M. Teasdale M. Psychological treatment of distress, pain, and anxiety for young children with cancer. Journal of Developmental & Behavioral Pediatrics 1988;9(6):374-81 The study compared the efficacy of hypnotic "imaginative involvement," behavioral distraction and standard medical practice for the reduction of pain, distress and anxiety in children with leukemia, during bone marrow aspirations. Two age groups of children, 3 to 6, and 7 to 10 years, were randomized to the three treatment groups. Two intervention sessions were given. At first intervention, observational ratings of distress indicated significant reductions for the younger group in the hypnotic treatment, whereas the older group achieved significant reductions in both treatment conditions for observer-rated pain and anxiety. At second intervention, all groups showed reductions and the control group appeared to be contaminated. The hypnotic method with its internal focus had an all-or-none effect, whereas distraction appeared to require that coping skills be learned over one session or more.
Rapkin DA. Straubing M. Holroyd JC. Guided imagery, hypnosis and recovery from head and neck cancer surgery: an exploratory study. International Journal of Clinical & Experimental Hypnosis 1991;39(4):215-26 The value of a brief, preoperative hypnosis experience was explored with a sample of 36 head and neck cancer surgery patients. 15 patients volunteered for the experimental hypnosis intervention. 21 patients who received usual care (no hypnosis) were followed through their hospital charts and were used as a comparison group. Hypnotic intervention and usual care groups were comparable in terms of relevant demographic variables. Postoperative hospitalizations for the hypnotic intervention group were significantly shorter than for the usual care group. Within the hypnotic intervention group, hypnotizability was negatively correlated with surgical complications and there was a trend toward a negative correlation between hypnotizability and blood loss during surgery. Findings suggest that imagery-hypnosis may be prophylactic, benefitting patients by reducing the probability of postoperative complications and thereby keeping hospital stay within the expected range. Recommendations are presented for a controlled, randomized, clinical trial with a sufficiently large sample to provide the opportunity for statistical analysis with appropriate power.
Richardson MA, Post-White J, Grimm EA, Moye LA, Singletary SE, Justice B. Coping, life attitudes, and immune responses to imagery and group support after breast cancer treatment. Alternative Therapies in Health and Medicine 1997;3(5):62-70 BACKGROUND: The pilot study used clinical trial methodology to differentiate the effects of imagery and support on coping, life attitudes, immune function, quality of life, and emotional well-being after breast cancer. METHODS: Women (N = 47) who completed treatment for primary breast cancer, excluding stage IV, were randomly assigned to standard care (n = 15) or six weekly support (n = 16) or imagery (n = 16) sessions. Self-report measures included Ways of Coping-Cancer, Life Attitude Profile, Quality of Life (FACT-B), Profile of Mood States, and Functional Support. Immune measures included natural killer cell activity, plasma neopterin, interferon-gamma, interleukins 1 alpha, 1 beta, and 2, and beta-endorphin levels. Differences between groups over time were tested using general linear models, adjusted for pretest score and covariates (age, stage, and months posttreatment). RESULTS: For all women, interferon-gamma increased, neopterin decreased, quality of life improved, and natural killer activity remained unchanged. Compared with standard care, both interventions improved coping skills (seeking support) and perceived social support, and tended to enhance meaning in life. Support boosted overall coping and death acceptance. When comparing imagery with support, imagery participants tended to have less stress, increased vigor, and improved functional and social quality of life. CONCLUSION: Although imagery reduced stress and improved quality of life, both imagery and support improved coping, attitudes, and perception of support. The clinical implications of these changes warrant further testing.
Sellick SM, Zaza C Critical review of 5 nonpharmacologic strategies for managing cancer pain Cancer Prev Control 1998 Feb;2(1):7-14 Purpose: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacological strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. Methods: The databases MEDLINE (1966 to June 1997) CINAHL (1982 to June 1997) and PsycholINFO Lit (1980 to June 1979) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. Results: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. Conclusion: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed.
Sellick SM. Zaza C. Critical review of 5 nonpharmacologic strategies for managing cancer pain. Cancer Prevention & Control 1998;2(1):7-14 PURPOSE: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. METHODS: The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. RESULTS: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. CONCLUSION: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed. [References: 35]
CANCER/ONCOLOGY