Beliefs and opinions about hypnosis held by the general public: a systematic evaluation

Redefining hypnosis: A narrative review of theories to move towards an integrative model

Hypnosis is an ancient mind-body intervention that has regained interest with the surge of research in the last decade documenting its clinical validity. Yet, theoretical controversies and misconceptions prevail among theorists, clinicians, and the general public, impeding the understanding, acceptance, replication, and use of hypnosis. Providing adequate information, which dispels misconceptions and promotes more balanced views, is warranted to facilitate the implementation and adoption of hypnosis in clinical and research settings. This review re-examines the conceptualisation of hypnosis throughout history and the theoretical controversies surrounding it while highlighting their meeting points and clinical implications. Despite dichotomies, a broad agreement appears across theoretical approaches regarding hypnotic analgesia effects, key components, and vocabulary. Further, theories highlight key factors of hypnotic responding. For instance, social theories highlight social and contextual variables, whereas state theories highlight biopsychosocial mechanisms and individual factors. Based on theories, the terms hypnotherapy or clinical hypnosis are recommended to refer to the therapeutic use of hypnosis in psychotherapeutic and medical contexts, respectively. This review concludes with a model that integrates various theories and evidence and presents hypnosis as a complex multifaceted intervention encompassing multiple procedures, phenomena, and influencing factors. This review intends to deepen our understanding of hypnosis, and promote its more rapid adoption and adequate implementation in research and clinical contexts, in addition to steering research towards evidence-based hypnotic practice. The review can have important research and clinical implications by contributing to advancing knowledge regarding hypnotic procedures, phenomena, and influencing factors.

Demystifying hypnosis: Unravelling facts, exploring the historical roots of myths, and discerning what is hypnosis

BACKGROUND AND PURPOSE

Hypnosis, a mind-body treatment dating back to early human history, has regained attention in the last decade, with research suggesting its effectiveness for varied physiological and psychological ailments such as distress, pain, and psychosomatic disorders. However, myths and misconceptions have prevailed among the general public and clinicians, hindering the adoption and acceptance of hypnosis. It is important to distinguish myths from facts and discern what is hypnosis and what is not to enhance the understanding, acceptance, and adoption of hypnotic interventions.

METHODS

This narrative review traces the history of myths surrounding hypnosis in contrast to the evolution of hypnosis as a treatment modality. In addition to comparing hypnosis to other interventions with similar procedures and features, the review unravels misconceptions that have impeded the adoption and acceptance of hypnosis in clinical and research settings and presents evidence to demystify this intervention.

RESULTS

This review examines the roots of myths while presenting historical facts and evidence that support hypnosis as a treatment modality and alleviate misconceptions depicting it as mystical. Further, the review distinguishes hypnotic and non-hypnotic interventions with overlapping procedures and phenomenological features to enhance our understanding of hypnotic techniques and phenomena.

CONCLUSION

This review enhances the understanding of hypnosis in historical, clinical, and research contexts by disproving related myths and misconceptions to promote the adoption of hypnosis in clinical and research contexts. Further, this review highlights knowledge gaps requiring further investigations to steer research toward an evidence-based practice of hypnosis and optimise multimodal therapies embedding hypnosis.

Effectiveness of Hypnosis for the Prevention of Anxiety During Coronary Angiography (HYPCOR study): a prospective randomized study

BACKGROUND

Coronary angiography is the gold standard for the diagnosis of coronary artery disease. This intervention is nevertheless a source of anxiety for the patient both by its discomfort and by the consequences linked to the discovery of potential diseases.

OBJECTIVES

The aim of this study was to determine the effectiveness of hypnosis in reducing anxiety in patients undergoing coronary angiography.

METHODS

One hundred sixty-nine patients with planned coronary angiography and no history of coronary angiography were randomized to a hypnosis or control group. Patients in the hypnosis group underwent a hypnosis session with self-hypnosis posthypnotic suggestions, while those in the control group had a conversational interview with the hypnotherapist. The primary endpoint was pre-exam anxiety level assessed by the Spielberger State-Trait Anxiety Inventory (STAI-Y A).

RESULTS

Performing a hypnosis session did not result in a significant decrease in anxiety before the intervention. Age, high trait anxiety, high state anxiety the day before, and belief that hypnosis works in general were associated with increased anxiety before the procedure. No adverse events were reported after hypnosis. There was no statistically significant difference between the 2 groups for the occurrence of complications of the intervention.

CONCLUSION

In this study, performing a hypnosis session before coronary angiography did not reduce the state of anxiety measured just before the intervention. In all cases, the hypnotic experience appears to be positive for the patient, encouraging further research efforts.

TRIAL REGISTRATION

The research protocol has been registered on the ClinicalTrials.gov registry (NCT02818101; 29/06/2016) and with the ANSM (IDRCB 2016-A00205-46; 02/02/2016).

Positions of French Nurses Regarding the use of Hypnotherapy to Relieve Pain in Postoperative Settings

The objective of this study was to carry out a detailed mapping of the different personal positions of French nurses concerning the practice of hypnotherapy. Factorial design was used to assess the impact of 4 situational factors: type of postoperative care and degree of pain associated with it (chemotherapy, wound cleansing and bandaging, or body grooming that leads to pain on mobilization); whether paracetamol (also known as acetaminophen) was administrated along with hypnosis or not; professional credentials of the hypnotherapist; and patient's identity (adult, young person, elderly person, or young person with learning difficulties). A combination of scenario technique and cluster analysis was implemented. Participants were 91 registered nurses and, for comparison, 19 nurse's aides, 9 physicians, 5 psychologists, and 77 laypersons. Seven qualitatively different positions were found. Only a minority of French nurses were convinced that hypnotherapy is an indisputably acceptable practice in postoperative care. Most of them were indifferent to the issue as long as pain medication was used. Nurses' views appeared to be similar to physicians' views.

Myths of Clinical Psychology and Psychotherapy: Development and Testing of a Questionnaire for Standardized Assessment

<b><i>Background:</i></b> Myths in the sense of scientifically untenable statements are widespread in the field of clinical psychology and psychotherapy and can have considerable consequences (e.g., stigmatization, ineffective/potentially harmful treatments). In German-speaking countries, myths have so far been little investigated, and there is no validated questionnaire specifically for the assessment of myths in clinical psychology/psychotherapy. The aim of the study was to develop a questionnaire on myths in clinical psychology/psychotherapy (FMKPP) and to conduct a first psychometric test on two samples (general population, students). In addition, correlations with personality traits, absorption, and intolerance of uncertainty were examined. <b><i>Methods:</i></b> In a sample of the German general population (<i>n</i>= 286) as well as in college students (<i>n</i>= 368), the factor structure and item characteristics were examined, and correlations with dispositional characteristics were calculated. <b><i>Results:</i></b> The FMKPP consists of three factors: “myths about the effectiveness of psychotherapy,” “myths about mental disorders/processes in psychotherapy,” and “myths concerning the functioning of memory.” Reliabilities (McDonald’s ω) were between 0.50 and 0.75. As expected, the FMKPP showed significant positive correlations with absorption and uncertainty intolerance. <b><i>Conclusion:</i></b> The reliability and validity of individual items should be investigated in future studies. The association with intolerance of uncertainty could indicate a function of myths in terms of increasing safety and predictability.

Clinical Hypnosis in Pediatric Crohn's Disease: A Randomized Controlled Pilot Study

OBJECTIVE

The aim of this study was to implement clinical hypnosis (CH) as an adjunctive therapy for adolescents with Crohn's disease (CD) and to assess the impact of CH on quality of life (QoL), abdominal pain, psychosocial measures, and disease activity compared with standard care.

METHODS

Forty adolescents with CD were randomized to a hypnosis intervention (HI) or waitlist control (WC) group. The intervention consisted of 1 in-person CH session, self-hypnosis education, and recordings for home practice. Data was collected at baseline, after the 8-week intervention, and at week 16. The primary outcome was patient- and parent-reported QoL; secondary outcomes were patient-reported abdominal pain, depression, anxiety, and sleep; school absences; and disease activity by Pediatric Crohn's Disease Activity Index. Paired and independent t-tests were used to compare differences from baseline to postintervention within and between groups.

RESULTS

Forty patients (50% girls, mean 15.8 years) were enrolled from February to May 2019. Seventy-eight percent had inactive disease, and 55% had abdominal pain. Post intervention, significant improvements were noted in HI parent-reported QoL compared with WC in total score (P = 0.05), social functioning (P = 0.01), and school functioning (P = 0.04) but patient-reported QoL was unchanged. Abdominal pain severity significantly improved in HI compared with WC (P = 0.03). School absences decreased in significantly more intervention than control patients (P = 0.01). Patients who practiced self-hypnosis consistently showed a trend toward greater QoL improvement than those who did not (P = 0.1).

CONCLUSIONS

CH is an acceptable and feasible adjunct in CD and may improve psychosocial QoL and abdominal pain. Further research is warranted.

Mythen der Klinischen Psychologie und Psychotherapie: Entwicklung und Erprobung eines Fragebogens zur standardisierten Erfassung

<b><i>Hintergrund:</i></b> Mythen im Sinne von wissenschaftlich nicht haltbaren Aussagen sind im Bereich der Klinischen Psychologie und Psychotherapie weitverbreitet und können erhebliche Auswirkungen haben (z.B. Stigmatisierung, unwirksame/potenziell schädliche Behandlungen). Im deutschsprachigen Raum sind Mythen bislang wenig erforscht, und es existiert kein validierter Fragebogen spezifisch zur Erfassung von Mythen der Klinischen Psychologie/Psychothe­rapie. Die Studie verfolgte das Ziel, einen Fragebogen zu ­Mythen der Klinischen Psychologie und Psychotherapie (FMKPP) zu entwickeln und an zwei Stichproben (Allgemeinbevölkerung, Studierende) einer ersten psychometrischen Prüfung zu unterziehen. Zudem wurden Zusammenhänge mit Persönlichkeitsmerkmalen, Absorption und Unsicherheitsintoleranz geprüft. <b><i>Methode:</i></b> An einer Stichprobe der Allgemeinbevölkerung (<i>n</i> = 286) sowie Studierenden (<i>n</i> = 368) wurden mittels einer Hauptkomponentenanalyse die Faktorstruktur untersucht, eine Itemanalyse durchgeführt sowie Korrelationen mit Fragebögen zu dispositionellen Merkmalen berechnet. <b><i>Ergebnisse:</i></b> Der FMKPP zeigte die drei Faktoren: “Mythen zur Wirksamkeit von Psychotherapie”, “Mythen zu psychischen Störungen/Prozessen in der Psychotherapie” und “Mythen bezüglich der Funktionsweise des Gedächtnisses”. Die Reliabilitäten (McDonalds ω) lagen zwischen 0,50 und 0,75. Erwartungskonform zeigte der FMKPP signifikant positive Zusammenhänge mit Absorption und Unsicherheitsintoleranz. <b><i>Schlussfolgerung:</i></b> Vor dem Hintergrund einer ersten psychometrischen Prüfung sollten die Reliabilität sowie die Validität einzelner Items in zukünftigen Studien untersucht werden. Die Assoziation mit Unsicherheitsintoleranz könnte eine Funktion von Mythen im Sinne der Erhöhung von Sicherheit und Vorhersagbarkeit indizieren.

Clinical Hypnosis for Chronic Pain in Outpatient Integrative Medicine: An Implementation and Training Model

Introduction: Clinical hypnosis for pain management cultivates specific skills to enhance general self-regulation and address pain. Hypnosis is well suited to integrative medicine settings; however, questions persist about its feasibility. This article describes a financially viable hypnosis practice model implemented in an integrative medicine clinic, providing initial feasibility data about rates of referral, participation, reimbursement, and provider retention. The specific processes required to establish and implement hypnosis services were detailed, including instruction in billing, reimbursement data, and a training model to enhance reach of services. Materials and methods: Insurer reimbursement data and operational costs were examined from three hypnosis groups conducted between September 2017 and March 2018. Furthermore, information on referral patterns and enrollment in treatment was collected from program initiation in September 2017 to January 2019. Provider retention in training with the expansion of supervision in the program's second year was also examined. Results: Of 258 individuals referred to hypnosis, 124 (48%) enrolled in group treatment. Analysis of insurer reimbursement over a subset of enrollees from three completed groups (N = 26) indicated an average collection of $95.85 per patient per session, equating to $706.86 per patient for the eight-session treatment. This extrapolates to $4,926.82 in total per seven-person group for the entirety of the eight-session treatment. After an annual training workshop, provider retention significantly increased (to 81% of eligible trained providers) with the initiation of twice-monthly clinical supervision focusing on transitioning from training to practice. Conclusion: This analysis indicates that a training- and practice-based research model of clinical hypnosis is feasible and financially sustainable in an integrative medicine setting.

Overstepping the boundaries of free choice: Folk beliefs on free will and determinism in real world contexts

We know little about the commonality of folk beliefs around applications of psychological research on the unconscious control of behaviours. To address this, in Experiment 1 (N = 399) participants volunteered examples of where research on the unconscious has been applied to influence their behaviours. A subset of these were presented in Experiment 2 (N = 198) and Experiment 3 (N = 100). Participants rated the extent to which the behaviour being influenced in these contexts was: (1) via the unconscious, (2) free, (3) the result of prior conscious intentions, (4) under conscious control. Relative to judgements about the extent to which behaviour was influenced via the unconscious, the remaining judgements regarding conscious control of behaviours were either higher (e.g., political contexts) or lower (e.g., therapy). This study is the first to show, using ecologically valid examples, the folk beliefs people share on psychological constructs concerning free will and determinism.

A NATIONAL SURVEY OF CLINICAL HYPNOSIS VIEWS AND EXPERIENCES OF THE ADULT POPULATION IN THE UNITED STATES

A nationwide, demographically balanced Internet survey of 1000 adults (500 females, 500 males, mean age 49.5, range 18-88 years) was conducted to assess views and experiences of clinical hypnosis in the United States population. Participants were unaware when enrolling in the survey that hypnosis was the subject matter. Key findings included that most reported a positive (38.6%) or neutral (48.4%) view of clinical hypnosis, with only 12.8% expressing a negative view; 7.6% of respondents had undergone hypnosis treatment, and 63.1% reported some resulting benefit; 54.9% of individuals who had never undergone hypnosis treatment indicated that they would consider seeking such treatment; 45.6% of all respondents thought there was moderate or strong scientific evidence supporting hypnosis as a real phenomenon; 77.8% identified one or more areas where they thought clinical hypnosis had substantial practical utility, and 44.8% estimated themselves to be at least moderately hypnotizable.

THE NEUROPHENOMENOLOGY OF OUT-OF-BODY EXPERIENCES INDUCED BY HYPNOTIC SUGGESTIONS

Inducing out-of-body experiences in hypnosis (H-OBEs) offers an almost unique opportunity to investigate them under controlled conditions. OBEs were induced as an imaginative task in a resting condition (I-OBE) or in hypnosis (H-OBE) in a group of 15 high hypnotizable subjects. A 32-channel EEG was recorded, and the spectral power and imaginary coherence of each frequency band and each couple of electrodes were calculated. At the end of each session, the Phenomenology of Consciousness Inventory (PCI) was administered to assess the phenomenological aspects of the subjects' experience. Significantly higher scores in the altered state, positive affect altered experience, and attention subdimensions of the PCI were reported in H-OBE than in I-OBE, which were associated with a significant decrease of power in beta and gamma band activity in right parieto-temporal derivations. These results suggest that the H-OBE may offer a useful experimental model of spontaneous OBEs.

Interest and Attitudes about Hypnosis in a Large Community Sample

Despite the available empirical evidence supporting the efficacy of hypnosis for alleviating symptoms and side effects across a variety of clinical contexts, hypnosis has failed to disseminate widely. One way to try to better understand the lack of hypnosis dissemination is to apply a marketing theory approach, focusing on attitudes and beliefs about a product (hypnosis) held by consumers. Better understanding of such factors can lead to strategies to promote the product among consumers, and in this case, encourage dissemination. The goal of the study was to investigate relationships between interest in hypnosis use and: 1) attitudes about hypnosis; 2) beliefs about the effectiveness of hypnosis (i.e., hypnosis credibility, and hypnosis effectiveness expectancies); 3) past experience with hypnosis; and 4) the perceived hedonic value and utility of hypnosis. The study also explored participants' preferences for hypnosis delivery method (i.e., live or recorded), as well as preferences for hypnosis labeling (i.e., how hypnosis is defined). Participants (N = 509) were recruited through Amazon Mechanical Turk and completed an anonymous online survey. The results revealed that participants' attitudes about hypnosis, their expectancies for the effectiveness of hypnosis, and the perceived hedonic value of hypnosis accounted for unique variance in participants' interest in hypnosis, ps < .05. Together, these variables accounted for 73% of the variance in participants' interest in hypnosis use. Based on these findings, we recommend that these key variables should be considered when planning for greater dissemination and uptake of empirically supported hypnosis interventions.

Hypnotic Induction: Enhancing Trance or Mostly Myth?

Hypnosis has often, and primarily, been portrayed as a mystical means that controls and exploits vulnerable and defenseless people. Sources accused of perpetuating hypnosis myths and misconceptions have included numerous media productions and stage demonstrations at state fairs and festivals. Ironically, one largely unexamined potential culprit disseminating misinformation about hypnosis is the field of clinical hypnosis itself. This article not only questions the legitimacy of the term "hypnotic induction" and its derivatives but also explores the potential impact these terms have on the perpetuation of hypnosis myths and misconceptions. Through an examination of a selective history of hypnotic induction, the customary language of hypnosis, and information promoted by professional hypnosis societies, some of the contributing terminology is identified. Alternative terms that more appropriately embody the manifestation of trance are offered and discussed.

Role of Beliefs About Hypnotic States as a Moderator Variable: A Reexamination of the Relationship Between Reactance and Hypnotizability

The hypothesis that beliefs about hypnosis determine the amount of psychological reactance aroused was tested. Participants were administered a measure of trait reactance to therapist directives (Therapeutic Reactance Scale; TRS), the Beliefs about Hypnotic State Questionnaire (BHSQ-R), and behavioral and subjective scales concerning hypnotic response. Hierarchical multiple regressions revealed significant interactions between BHSQ-R subscales and TRS. The findings suggest that the arousal of psychological reactance to hypnosis is determined by individuals' trait reactance levels acting together with their interpretations of the hypnotic situation. The role of beliefs about hypnotic states as a moderator of the relationship between personality and hypnotizability was discussed.

A causal model explaining the relationships governing beliefs, attitudes, and hypnotic responsiveness

The author developed a new scale aimed at measuring beliefs about "hypnotic states" and investigated the influence of such beliefs and attitudes on hypnotic responses in a large sample of Japanese undergraduate students. Exploratory factor analysis of this new questionnaire examining beliefs about hypnotic states yielded four factors: Dissociative or Depersonalized Experience, Loss of Self-Control, Therapeutic Expectation, and Arousing Extraordinary Ability. The results of structural equation modeling showed that Therapeutic Expectation and Arousing Extraordinary Ability influenced hypnotizability through attitudes toward hypnosis, while also directly affecting subjective experiences without mediating attitudes. Present findings suggest that it is more effective to enhance therapeutic expectations than to correct misconceptions about hypnotic states in modification of patients' beliefs before initiating treatment.

The myth of hypnosis: the need for remythification

Myths or misconceptions concerning hypnosis are regarded among the major barriers to effective implementation of hypnosis. Contemporary hypnotherapists are expected to elicit patients' misconceptions and to provide explanations that distinguish between mystical and scientific perceptions of hypnosis and that offer a picture of the state of the art of hypnosis. Dealing with misconceptions on a rational and cognitive level seems to have the ability to change a patient's conscious knowledge and understanding of hypnosis. Nevertheless, deeply rooted and emotionally saturated misbeliefs with historical-cultural origins still prevail. This article focuses on the prehypnotic phase of therapy and proposes remythification to deal with the myth of hypnosis. This approach aims to promote the hypnotherapeutic process by utilizing myth-related misconceptions.

Disseminating hypnosis to health care settings: Applying the RE-AIM framework

Hypnosis is a brief intervention ready for wider dissemination in medical contexts. Overall, hypnosis remains underused despite evidence supporting its beneficial clinical impact. This review will evaluate the evidence supporting hypnosis for dissemination using guidelines formulated by Glasgow and colleagues (1999). Five dissemination dimensions will be considered: Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM).

REACH

In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems.

EFFICACY

There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrome.

ADOPTION

Although hypnosis is currently not a part of mainstream clinical practices, evidence suggests that patients and healthcare providers are open to trying hypnosis, and may become more so when educated about what hypnosis can do.

IMPLEMENTATION

Hypnosis is a brief intervention capable of being administered effectively by healthcare providers.

MAINTENANCE

Given the low resource needs of hypnosis, opportunities for reimbursement, and the ability of the intervention to potentially help medical settings reduce costs, the intervention has the qualities necessary to be integrated into routine care in a self-sustaining way in medical settings. In sum, hypnosis is a promising candidate for further dissemination.

Factors that contribute to the willingness to try "street hypnosis"

This study takes a context-specific approach to examine people's willingness to try hypnosis under various conditions and the factors that contribute to their willingness. It examined 378 participants, who completed a web-based hypnosis survey. The results showed that people's willingness to try hypnosis varies by context. Specifically, people are more willing to try hypnosis when it is framed as "peak focus" rather than "hypnosis" and when they perceive the environment as being safer. Moreover, factors including participants' demographics, hypnotists' demographics (relative to the subjects'), participants' control bias, and knowledge of hypnosis affect people's degrees of willingness to try hypnosis, depending on the specific context. The results suggest further analysis of hypnosis occurring in public contexts and the effects it may have on attitudes and therapeutic outcomes.

Attitudes about hypnosis: factor analyzing the VSABTH-C with an American sample

In the present study, the authors factor-analyzed responses from 1,141 American undergraduate students to the Valencia Scale of Attitudes and Beliefs Toward Hypnosis-Client Version. They obtained an 8-factor solution accounting for 66% of the total variance in responses. A confirmatory factor analysis indicated acceptable fit of their model and those reported earlier by Carvalho et al. (2007) and Capafons, Mendoza, et al. (2008) using Portuguese and international samples, respectively. Unlike previous factor analyses of the scale, the authors obtained an independent clusters solution. Distinctions between the authors' model and those reported previously are discussed.

Examining hypnosis legislation: a survey of the practice in Israel

Hypnosis as a therapeutic technique bears potential risks when carried out inexpertly. Because of this, Israel was the first to legislate hypnosis. This study examines the current state of clinical hypnosis practice in Israel. A questionnaire was sent to 470 licensed hypnotists and 1250 unlicensed professionals; 478 (25.7%) of the 1720 potential respondents returned the questionnaires. Of these, 249 (51.8%) were licensed hypnotists, and 232 (48.2%) were unlicensed. Of the unlicensed professionals, 45% reported practicing hypnosis; 50% of them practice hypnosis with adolescents and 41.2% with children. Many of them practice hypnosis in public clinics (71.6%). Of the licensed professionals, 94.4% reported practicing hypnosis in the course of their clinical work. The authors conclude that great number of unlicensed hypnotists carry on clinical practice of hypnosis and suggest steps to increase the efficiency of the law as part of a regulatory system.

A project to change the attitudes, beliefs and practices of health professionals concerning hypnosis

This study describes an educational project designed to change the beliefs, attitudes and practices of health care professionals concerning hypnosis and hypnotherapy. The purpose of the study was to investigate whether an educational offering that dispelled myths and misconceptions of hypnosis, offered a historical perspective, discussed how hypnosis works therapeutically, and elucidated the many medical uses of hypnosis, could change the attitudes, practices and beliefs of health care providers. Workshops were given to health care professionals at a variety of venues. Three questionnaires were used to collect data from study subjects before, immediately after and three months following the educational intervention. The results indicated that it is possible with a 90 to 180 minute lecture on hypnosis to create changes in beliefs, attitudes and practices. When health professionals have accurate information on hypnosis that is substantiated by scientific research, they are more likely to believe that hypnosis has a place in traditional mainstream medicine and to suggest self-regulatory strategies and hypnosis to their patients. An educational presentation on hypnosis can encourage health care professionals to learn more about this modality and to seek training in hypnosis.

Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial

Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing. The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants' group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants' subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36). Analysis of variance showed the hypnosis group's objectively observed wound healing to be significantly greater than the other two groups', p < .001, through 7 postoperative weeks; standard care controls showed the smallest degree of healing. In addition, at both the 1 and 7 week post-surgical observation intervals, one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls, p < 0.02. The mean scores of the subjective assessments of postoperative pain, incision healing and functional recovery trended similarly. Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.

Developing evidence-based clinicians

Evidence-based care has heralded an advancement for health with extensive rhetoric and incentives encouraging clinicians to become active participants in practice change. This paper explores two mechanisms-research utilization and systematic reviews--as processes to develop empowerment in clinicians, and develop an ethos of basing practice on research. The intent of these approaches is to create an environment that enables clinicians to seek solutions to practice problems, inform practice decisions and develop practice policy using evidence from research. The goal is to develop evidence-based clinicians who remain active and interested in their practice and who are committed to promoting the application of research to practice. The strengths and weaknesses of these methods are explored within two case studies where they are applied to the management of hypothermia and the efficacy of postoperative observations. Key points of application for each of the methods are outlined in the conclusions.