Sunday, 7 May 2017

EXAMPLE ANSWER: Q28

Q28. Locate a piece of hypnotherapy research on pain control. Include statistical evidence and explanation. Explain the scientific methodology used in this research and its advantages. Properly cite your reference sources.
Learning outcomes: 5.5
Student answer
Article:
Montgomery, G.H., Bovbjerg, D.H.; Schnur, J.B.; David, D.; Goldfarb, A.; Weltz, C.R.; Schechter, C.; Graff-Zivin, J.; Tatrow, K.; Price, D.D.; Silverstein, J.H. (2007) A Randomized Clinical Trial of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients. Journal Of The National Cancer Institute Vol 99: pp1304–1312

Montgomery et al (2007) conducted a randomized clinical trial of 200 women who were undergoing a breast biopsy (excisional) or having a lumpectomy. These are considered minor surgical procedures which are associated with clinically significant side effects which include postsurgical pain, nausea, and fatigue. The side effects often result in longer recovery room stay, delay in discharge and increased mediation.
Their hypothesis was that a brief hypnosis session before surgery would means that less anesthesia would be used during surgery and there would be a reduction in post operative analgesic use and in the side effects associated with breast cancer surgery would also reduce. The reduction in analgesia can be linked with experience of pain.
Patients from the sample were randomly assigned to one of two groups. One received a 15-minute hypnosis session before surgery and the other received nondirective empathic listening as a control group. Both interventions were undertaken by 4 psychologists and took place in private – away from the surgical team. There was no statistical differences between therapists. No blinding or matching within the sample allocation took place and there were no statistical variances on demographics between groups. The hypnosis intervention consisted of a relaxation-based induction which included muscle relaxation imagery and specific symptom-focused suggestions of reduced pain, nausea, and fatigue. It also included suggestion as to how the client could use self -hypnosis after the intervention. The nondirective empathic listening involved the patients directing the flow of the conversation with attentive listening.


The anesthesia/sedatives (lidocaine; fentanyl; propofol and midazolam) used were recorded. Patients were asked to report pain and side effects on a scale (0–100) at the point of discharge. Costs of medication used and time spent in surgery were also analysed.
Statistical analysis of the results revealed the following statistically significant results:
Patients in the hypnosis group
  • required less propofol and lidocaine
  • reported less
    • pain intensity (mean difference = 25.40 lower),
    • pain unpleasantness (mean difference 17.86 lower)
    • nausea (mean difference 18.92 lower)
    • fatigue (mean difference 24.73 lower,
    • discomfort (mean difference 20.19 lower) and
    • emotional upset (mean difference 24.79 lower)
There were no statistically significant differences within the use of fentanyl, midazolam, or in the use of analgesics within the recovery room.
A cost saving of $772.71 per patient was reported for those who received hypnotherapy.
This research was conducted because whilst other areas of surgery had reported demonstrable effects from using hypnotherapy; this had not been extended to breast surgery which represents the largest number of female cancer surgeries in the United States. Therefore this ???


Montgomery et al concluded that the results support the use of pre-operative hypnosis with breast cancer surgery patients. This research was conducted as there was a lack of research in the area and the authors felt that there was a benefit to using hypnosis. The findings supported their hypothesis in a way that can justify the use of hypnosis both in terms of benefit and in cost savings. By conducting and publishing the research Montgomery et al have increased the likelihood of hypnotherapy being increasingly used before breast surgery.
(LO 5.5 A demonstrable ability to locate hypnotherapy research)

Tutor feedback (DO NOT delete/edit feedback. Write amendments, additional information & thoughts underneath this table)
Correct. Thank you for this example of a furthering of the profession of Hypnotherapy and its collaboration with the medical community. It is a piece of research well worth sharing with others and citing at every opportunity. Long may your ability to locate hypnotherapy research such as this serve you well.




Further Student Example Answer:  
Hypnotherapy for the Management of Chronic Pain

Fibromyalgia

In a controlled study, Haanen et al. (1991) randomly assigned 40 patients with fibromyalgia to groups that received either eight 1-hour sessions of hypnotherapy with a self-hypnosis home-practice tape over a 3-month period, or physical therapy (that included 12 to 24 hours of massage and muscle relaxation training) for 3 months. Outcome was assessed pre- and post treatment and at 3-month follow-up. The hypnosis intervention included an arm-levitation induction and suggestions for ego strengthening, relaxation, improved sleep, and “control of muscle pain.” Compared with patients in the physical therapy group, the patients who received hypnosis showed significantly better outcomes on measures of muscle pain, fatigue, sleep disturbance, distress, and patient overall assessment of outcome. These differences were maintained at the 3-month follow-up assessment and the average percent decrease in pain among patients who received hypnosis (35%) was clinically significant, whereas the percent decrease in the patients who received physical therapy was marginal (2%).

Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia.
Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, Hekster GB J Rheumatol. 1991 Jan; 18(1):72-5.
Int J Clin Exp Hypn. Author manuscript; available in PMC 2009 Sep 25.


Published in final edited form as:



The above abstract includes the statistical data of how many patients were selected for the trial, the period of the experiment and follow-up assessments as well as a basic report on the findings, the two basic methods of treatment are also reported.

A random number of subjects from a selected pool of previously diagnosed Fibromyalgia sufferers were given hypnosis and hypnotic recordings to listen to over a 3-month period whilst another group of subjects were given massage and muscle relaxation training.

At the end of the initial experiment all the subjects were again measured for any changes/improvements in their symptoms and measured again after a 3-month period to monitor how these changes/improvements had lasted.
The results showed that hypnosis and hypnotic recordings were significantly more effective in pain management and managing the other symptoms of Fibromyalgia than simple massage and muscle relaxation.

The advantages of these experiments is that the subjects all have a known medical condition which has measurable symptoms and as such can provide a repeatable set of results. This experiment has been repeated by several different research facilities utilising other forms of treatment from pharmaceuticals to massage etc. verses hypnosis as well as hypnosis in conjunction with these traditional treatments and they have all found hypnosis improves the subject’s condition.



Q28. Correct. You have demonstrated your ability to locate hypnotherapy research and to comment and evaluate on this particular subject of fibromyalgia treatment with good citations throughout.


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