Hypnotherapy for Cancer Care

The Benefits Of Hypnosis For Cancer Patients

There is a growing interest in the mind-body-spirit approach to health. According to the NIH, 38% of American adults used some form of complementary or alternative therapy in 2007, the most recent year for which statistics are available.

Hypnosis is an evidence-based form of complementary therapy that is growing in popularity. Researchers have documented the effectiveness of hypnosis for people with cancer across all phases of treatment, from detection/diagnosis, through various types of treatment, and into survivorship.

Hypnosis is a relatively low-cost and certainly low-risk intervention that has been shown to improve quality of life, decrease pain and other symptoms and treatment side-effects, decrease depression and anxiety, and improve well-being. Two studies have shown that hypnosis may even have an impact on longevity.

What is hypnosis?
Hypnosis is a relaxed state of mind. When we are hypnotized our brains are using alpha and theta brainwaves, just as we do in meditation and some stages of sleep. These relaxed brainwave patterns allow us to more open to suggestion, or “suggestible”: we are more likely to believe what we are told, and we are able to change how we think and feel about things. We can use this suggestibility to our great benefit in many areas of life, from emotional wellbeing to health. Indeed, there is a growing body of clinical data supporting the use of hypnosis for health in general, and for supporting cancer care in particular. Here are some highlights from the literature:

Cancer Detection/Diagnosis:
Hypnosis has been shown to decrease anxiety, distress, and pain for people undergoing biopsy. The studies published have focused on breast cancer screening.

  • Lange et al (2006) studied 236 women undergoing core image-guided breast biopsy. Women who had hypnosis experienced significantly less anxiety (p<0.001) and pain (p=0.024)
  • Montgomery et al (2002) studied 20 excisional breast biopsy patients and found that women who had hypnosis before the procedure had less pre- and post-biopsy distress and less post-biopsy pain (p’s<0.001).
  • Schnur et al (2008) compared the effect of hypnosis versus attention control for 90 women undergoing breast biopsy. They found less pre-biopsy upset (p<0.0001), depression (p0.02), and anxiety (p<0.0001), and the hypnosis group were more relaxed (p<0.001).

Cancer treatment:
Hypnosis can support every mainstream form of cancer treatment. It has been helpful for surgical patients, has reduced side-effects of chemotherapy, and has helped with the effects of radiation.

Surgery
Surgical patients who received hypnosis pre-operatively had less anxiety, pain, pain medication, emotional upset, and fatigue, and had shorter treatment time:

  • A meta-analysis conducted by Montgomery, David, Winkel and Silverstein (2002) investigated the use of hypnosis for surgical patients. Results revealed a large and significant effect size (d=1.20) for hypnosis. Patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups (effect size, D=1.20). Hypnosis affected a wide range of clinical outcomes including pain, pain medication, negative affect, blood pressure, nausea, fatigue, and treatment time.
  • Montgomery et al (2007) conducted a randomized, controlled trial of 200 breast cancer patients undergoing excisional biopsy or lumpectomy found that those who were given 15 minutes of hypnosis before the procedures required pain medication, reported less pain intensity, pain unpleasantness, nausea, fatigue, discomfort, and emotional upset.
  • Lang et al (2008) Studied 201 patients receiving tumor embolization or radiofrequency ablation were randomized to standard care, attention, or hypnosis groups. Patients in the hypnosis group had significantly less pain and anxiety and received significantly less medication (midazolam or fentanyl) than patients in the standard care (33% less medication) or empathic attention (43% less medication) groups.

Chemotherapy
Anti-nausea medications have improved quality of life for patients receiving chemotherapy. However, some patients still experience chemotherapy-related nausea and vomiting.  Hypnosis has been shown to help alleviate these treatment effects:

  • Richardson et alconducted a meta-analysis of randomized controlled trials (RCTs) (n=6) of hypnosis for controlling nausea and vomiting associated with cancer chemotherapy. All studies reported positive results including statistically significant reductions in nausea and vomiting with a moderate effect size for hypnosis compared to attention control and a large effect size of hypnotic treatment compared to treatment as usual.
  • A second review of the literature by Redd, Montgomery, and DuHamel (2001) also supports the use of hypnosis to treat chemotherapy-related nausea and vomiting. This review included both randomized and non-randomized studies.

Radiology
Patients undergoing radiation treatment are often affected by fatigue and emotional distress. Hypnosis helps:

  • Montgomery et al (2009) studied 42 breast cancer radiation patients to test whether CBT with hypnosis could affect fatigue. They found that hypnosis had a significant impact on fatigue: fatigue increased in the control group, whereas fatigue in the CBT-hypnosis group did not increase (p<0.05).
  • Schnur et al (2009) studied 40 women undergoing radiation for breast cancer to see if CBT with hypnosis could impact positive and negative affect. They found that CBTH significantly reduced negative affect and increased positive affect.

Survivorship:
According to the American Cancer Society, in January 2014 there were 14.5 million cancer survivors in the United States. Many experience impaired quality of life after treatment, including neuropathy and pain, cognitive problems, fatigue, fear of cancer recurrence, hot flashes and sexual dysfunction (American Cancer Society). Hypnosis may help with the after-effects of cancer treatment:

  • Elkins et al (2008) studied 60 women who had been treated for breast cancer to investigate the efficacy of hypnosis to treat hot flashes and other treatment after-effects. They found hypnosis significantly improved hot flashes, anxiety, sleep, and depression, compared to the non-treatment control group.

Advanced/Metastatic disease:
Metastatic and recurrent diagnoses can be very distressing for cancer patients. Metastatic patients often experience pain and suffering, as well as emotional distress. Hypnosis has had a measurable impact on quality and even quantity of life for these patients:

  • Two studies ― one by Spiegel and Bloom in 1983, and a more recent replication by Butler et al in 2009 ― found that women with metastatic breast cancer who had been randomly assigned to weekly group therapy with hypnosis experienced significantly less pain and suffering and improved mood than no-treatment controls.
  • In 1989, Spiegel et al studied 86 metastatic breast-cancer patients and found hat survival time was significantly longer in the women who were randomly assigned to supportive group therapy with hypnosis (mean of 36.6 months) compared to no-treatment controls (mean of 18.9 months).
  • A replication by Spiegel et al in 2007 found that survival time for metastatic breast cancer patients with ER-positive cancers was not significantly affected by the hypnosis intervention (mean of 32.8 months). However, for ER negative patients, the hypnosis group had a significant longer survival time (mean of 29.8 months) than the non-treatment controls (mean of 9.3 months).

Hypnosis by any other name….
Many people hear the word “hypnosis” and think of people at comedy shows walking like a chicken. There is also often a general unease, as many believe that hypnosis will somehow make them do things they otherwise would not do. Because of this, many practitioners are inclined to use words like “guided imagery” or “relaxation”. However, there is some benefit to using the word “hypnosis”.

  • Gandhi and Oakley compared the hypnotic suggestibility of patients in two groups receiving the same intervention, but with one group calling it “hypnosis” and the other “relaxation”. They found that those in the “hypnosis” group were significantly more suggestible than those in the “relaxation” group. In their meta-analysis of hypnosis to treat distress related to medical procedures, Schnur et al similarly found greater effect sizes for interventions labeled “hypnosis” compared to “relaxation”.

Hypnosis delivery: live or recorded?
There is a plethora of guided meditations, guided imagery, and hypnosis on the market, for free or offered at a low cost. While these recordings can be helpful, live hypnosis is better:

  • According to results of a meta-analysis by Montgomery et al (2002), live hypnosis had a large effect size (d=1.40) whereas recorded hypnosis had a moderate effect size (d=.55).
  • In their meta-analysis of hypnosis for distress related to medical procedures, Schnur et al (2008) found that live hypnosis had a large effect size (g=1.22), while recorded hypnosis had a moderate effect size (g=0.19).

Conclusions:
For those who are living with cancer and undergoing cancer treatment, hypnosis can be tremendously helpful to address a wide range of symptoms, from emotional distress to physical pain. Relaxing and opening ourselves up to the mind-body-spirit connection improves quality of life and overall wellbeing.


 

References

Butler LD, Koopman C, Neri E, Giese-Davis J, Palesh O, Thorne-Yocam KA, Dimiceli S, Chen XH, Fobair P, Kraemer HC, Spiegel D (2009). Effects of supportive-expressive group therapy on pain in women with metastatic breast cancer. Health Psychologl.28(5):579-87.

Elkins G, Marcus J, Stearns V, Perfect M, Rajab MH, Ruud C, Palamara L, Keith T (2008). Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. Journal of Clinical Oncoogyl. 26(31):5022-6.

Gandhi B, Oakley DA (2005). Does ‘hypnosis’ by any other name smell as sweet? The efficacy of ‘hypnotic’ inductions depends on the label ‘hypnosis’. Consciousness and Cognition. 14(2):304-15.

Lang EV, Berbaum KS, Faintuch S, Hatsiopoulou O, Halsey N, Li X, Berbaum ML, Laser E, Baum J (2006). Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy. Pain. 126(1-3):155-64.

Lang EV, Berbaum KS, Pauker SG, Faintuch S, Salazar GM, Lutgendorf S, Laser E, Logan H, Spiegel D. (2008) Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice. Journal of Vascular Interventional Radiology. 19(6):897-905.

Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH (2002). The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesthesia and Analgesia. 94(6):1639-45

Montgomery GH, Weltz CR, Seltz M, Bovbjerg DH, (2002). Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. International Journal of Clinical Exp Hypnosis. 50(1):17-32.

 Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, Weltz CR, Schechter C, Graff-Zivin J, Tatrow K, Price DD, Silverstein JH (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute. 99(17):1304-12.

Montgomery GH, Kangas M, David D, Hallquist MN, Green S, Bovbjerg DH, Schnur JB (2009) Fatigue during breast cancer radiotherapy: an initial randomized study of cognitive-behavioral therapy plus hypnosis.Health Psychology. 28(3):317-22.

Reid WH, Montgomery GH, DuHamel KN (2001) Behavioral intervention for cancer treatment side effects. Journal of the National Cancer Institute. 93(11):810-23.

Richardson J, Smith JE, McCall G, Richardson A, Pilkington K, Kirsch I. (2007). Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. European Journal of Cancer Care (Engl). 16(5):402-12.

Schnur JB, Bovbjerg DH, David D, Tatrow K, Goldfarb AB, Silverstein JH, Weltz CR, Montgomery GH, (2008). Hypnosis decreases presurgical distress in excisional breast biopsy patients. Anesthsia and Analgesoa; 106(2):440-4

Schnur JB, Kafer I, Marcus C, Montgomery GH (2008). Hypnosis to manage distress related to medical procedures: a meta-analysis. Contemporary Hypnotherapy. 25(3-4):114-128.

Schnur JB, David D, Kangas M, Green S, Bovbjerg DH, Montgomery GH (2009) A randomized trial of a cognitive-behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy. Journal of Clinical Psychology. 65(4):443-55.

Spiegel D, Bloom JR (1983) Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine. 45(4):333-9.

Spiegel D, Bloom JR, Kraemer HC, Gottheil E (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 2(8668):888-91.

 

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