Suggestive techniques connected to medical interventions

Power of a Few Vagrant Words: Effects of Direct and Indirect Suggestions for Self-Representation in Art-Based Online Interventions

This study compares two groups of university students with differing instructions participating in an object drawing task as a part of an art therapy-based self-help online intervention. The intervention aimed to help participants enhance positive mood and subjective feeling of self-control and reduce negative mood. The object task contained suggestive elements in the instructions similar to self-hypnosis with an indirect and a direct way of formulation. Quantitative (positive affect and negative affect scale and Self-Assessment Manikin scale) and qualitative methods (text and picture rating) were used to investigate the difference between the outcome effects on the two groups. The results found a significant decrease in negative mood for indirect suggestion, while a significant increase of positive mood for the direct suggestion condition. Based on qualitative analyses, findings indicated that hidden implications in the art-making instructions modified the chosen imaginary and emotional changes related to art-making. Suggestions in the instructions can make a difference in one's mood and this should also be considered while designing guidelines for self-hypnosis.

Motivational Enhancement: What Ancient Technologies of the Self and Recent Biotechnologies Have in Common

Motivational enhancement of any kind can be conceived of either as a way to reduce the need for effort, or as a change in the subjective perception of effort. However, in both cases, effort is not all that matters. In the evaluation of praiseworthy conduct, the practical goals pursued by the subject, their dedication, and the discernment they exercise are equally important. I further argue that not only in terms of the general purpose, but also in terms of the means employed for human enhancement, we cannot, in fact, establish significant differences between the traditional technology of the self and biomedical technologies for enhancing motivation. There are two key features they all share. The traditional techniques of the self also aim at the gradual reduction of effort through their steady practice, and they are all mental conditioning and self-conditioning techniques based on repetition and training.

Meta-analytic evidence on the efficacy of hypnosis for mental and somatic health issues: a 20-year perspective

Introduction

Documented use and investigation of hypnosis spans centuries and its therapeutic use has received endorsement by multiple medical associations. We conducted a comprehensive overview of meta-analyses examining the efficacy of hypnosis to provide a foundational understanding of hypnosis in evidence-based healthcare, insight into the safety of hypnosis interventions, and identification of gaps in the current research literature.

Methods

In our systematic review, meta-analyses of randomized controlled trials on the efficacy of hypnosis in patients with mental or somatic health problems compared to any control condition published after the year 2000 were included. A comprehensive literature search using Medline, Scopus, PsycINFO, The Cochrane Library, HTA Database, Web of Science and a manual search was conducted to identify eligible reviews. Methodological quality of the included meta-analyses was rated using the AMSTAR 2 tool. Effect estimates on various outcomes including at least three comparisons (k ≥ 3) were extracted and transformed into a common effect size metric (Cohen's d). If available, information on the certainty of evidence for these outcomes (GRADE assessment) was obtained.

Results

We included 49 meta-analyses with 261 distinct primary studies. Most robust evidence was reported for hypnosis in patients undergoing medical procedures (12 reviews, 79 distinct primary studies) and in patients with pain (4 reviews, 65 primary studies). There was a considerable overlap of the primary studies across the meta-analyses. Only nine meta-analyses were rated to have high methodological quality. Reported effect sizes comparing hypnosis against control conditions ranged from d = -0.04 to d = 2.72. Of the reported effects, 25.4% were medium (d ≥ 0.5), and 28.8% were large (d ≥ 0.8).

Discussion

Our findings underline the potential of hypnosis to positively impact various mental and somatic treatment outcomes, with the largest effects found in patients experiencing pain, patients undergoing medical procedures, and in populations of children/adolescents. Future research should focus on the investigation of moderators of efficacy, on comparing hypnosis to established interventions, on the efficacy of hypnosis for children and adolescents, and on identifying patients who do not benefit from hypnosis.

Clinical Trial Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023395514, identifier CRD42023395514.

Hypnotherapy and therapeutic suggestion: bridging the gap between evidence and utility

The use of hypnotherapy in psychiatry has been controversial. However, evidence presented by Chan and colleagues shows that it is beneficial to the promotion of good mental health and well-being, specifically being applicable in the management of mental disorders. But what does this mean for practice? This commentary looks at what we agree and disagree with, what we opine is missing from the article and what now needs to happen. Patients should be able to access hypnotherapy or hypnosis routinely on the National Health Service. Since it works, who may it work for and how may we make this available to those who could benefit from it?

Development and refinement of Rel@x:A training in hypnosis-derived communication for pediatric nurses to prevent procedural pain

Introduction

Studies in pediatric oncology have shown that hypnosis effectively reduces patients' pain and distress during painful procedures. This remains underutilized in the healthcare system due to the staff cost and availability of hypnotherapists. To develop the use of hypnosis-derived communication, we aimed to train nurses to use hypnosis-derived communication while they perform painful procedures.

Objectives

This study aimed to (1) develop a brief training in hypnosis-derived communication for pediatric nurses named Rel@x, (2) pretest the training with experienced pediatric oncology nurses, and (3) refine the training based on nurses' suggestions.

Methods

The Rel@x training consists of two 4-h sessions: one related to relational aspects and another one presenting one of two selected hypnotic communication techniques ("pleasant place" or "magic glove"). Rel@x makes use of manuals, cue card reminders, visual aids, videos, and an e-learning platform. To refine Rel@x, a complete training cycle was conducted with seven female pediatric oncology nurses. A mixed method study with an evaluation questionnaire and a post-training focus group interview was conducted.

Results

Quantitative data showed that nurses overall positively rated the training program: relevance and acceptability (median average of 5.4/6); use of hypnotic communication (median average of 5.2/6); expected effects (median average of 5.4/6); program implementation (5.6/6). Two general themes emerged from the qualitative data: perceptions of hypnotic communication and the evaluation of the Rel@x training program. Based on nurses' suggestions, Rel@x was refined by adding more practical components, more time for practice, more time between the two sessions and additional tools (cue card reminders, keywords, virtual e-learning recap module).

Conclusion and clinical implications

The use of hypnosis-derived communication during painful procedures and the Rel@x training were viewed favorably amongst pediatric nurses. Rel@x offers a complete training in hypnosis-derived communication for pediatric nurses. This training fosters the optimal use of hypnosis-derived communication during care and may significantly reduce children's procedural pain and distress.

Therapeutic Suggestions During General Anesthesia Reduce Postoperative Nausea and Vomiting in High-Risk Patients – A Post hoc Analysis of a Randomized Controlled Trial

Postoperative nausea and vomiting (PONV) are one of the most adverse events after general anesthesia, a distressing experience, and pose a risk to the patient. Despite advances in drug prophylaxis and PONV treatment, the incidence remains high and additional non-pharmacological treatments are needed. In this post hoc analysis of a recently published double-blind multicenter randomized controlled trial on the efficacy of intraoperative therapeutic suggestions on postoperative opioid dosage, we analyzed the effects of intraoperative therapeutic suggestions on PONV. We focus on patients with a high risk of PONV (Apfel risk score of 3–4) and distinguished early (first two postoperative hours) and delayed PONV (2–24 h). A total of 385 patients with a moderate or high risk for PONV were included. The incidence of early and delayed PONV was reduced (22.7–18.3 and 29.9–24.1%, respectively), without statistical significance, whereas in high-risk patients (n = 180) their incidence was nearly halved, 17.2 vs. 31.2% (p = 0.030) and 20.7 vs. 34.4% (p = 0.040), corresponding to a number needed to treat of 7 to avoid PONV. In addition, there was a significant reduction in PONV severity. In a multivariate logistic regression model, assignment to the control group (OR 2.2; 95% CI: 1.1–4.8) was identified as an independent predictor of the occurrence of early PONV. Our results indicate that intraoperative therapeutic suggestions can significantly reduce the incidence of PONV in high-risk patients. This encourages the expansion of therapeutic suggestions under general anesthesia, which are inexpensive and virtually free of side effects.

Clinical Trial Registration: German Clinical Trials Register, https://drks.de, registration number: DRKS00013800.

Do professionals change their communication behaviours following a training in hypnosis-derived communication? A feasibility study in pediatric oncology

OBJECTIVES

The purpose of this study was to test the feasibility of a training in hypnotic communication techniques (HCTech) for pediatric nurses to prevent procedural pain and distress in children during venipunctures. Specifically, this study aimed to (1) assess nurses' mastery of HCTech and (2) nurses' experience regarding the training program.

METHODS

Participants were 6 female pediatric nurses and 33 of their cancer patients. Nurses took part in a 4-day theoretical and practical training in HCTech. Venipuncture procedures were video-recorded and assessed to evaluate nurses' mastery of HCTech using a standardized scale. Pre-training use of HCTech was compared with post-training and follow-up for the entire nurse sample and across nurses with the same patients (109 nurse-patient interactions). After the follow-up, nurses were questioned about their experience in regards to the training and activities (themes and practice).

RESULTS

Results showed medium pre-post changes in hypnotic communication behaviours (pre-post d = 0.74), with changes maintaining at follow-up (pre-follow-up d = 0.97). Interviews transcripts' analyses revealed moderate levels of motivation and satisfaction regarding the training content and format. Nurses suggested to emphasize on the practice of HCTech in a noisy outpatient clinic as well as offer more practical exercises.

CONCLUSION

A 4-day training in hypnotic communication techniques translated into the use of HCTech by nurses practicing in pediatric oncology when comparing the same dyads at baseline, post-training and follow-up. Results support further refinement and suggest nurses could be trained to prevent pain and distress with hypnosis-derived communication strategies.

The Potential to Source a Patient's Imaginative Powers in Treating Cancer: Illustrated in Three Cases

BACKGROUND

The imaginative power of a human patient has the big advantage of sourcing his/her own depth leading to first-hand experiencing. Such experiences have a potential to make a deep impact that can be instrumental to the process of healing. Successful healing is almost inevitably linked to new recognitions and perceptions, changes in attitudes or changes in lifestyle. Therapists in charge may find that they cannot exert direct control over this process but nevertheless, there is a big inherent potential to such processes as a truly complementary approach to clinical oncology.

CASE REPORTS

Going by the characteristic of the matter, it seems impossible to conduct randomized trials; rather, we have to learn from the very individual experiences and try to find common traits. Hence, in this contribution, it is "just" three cases that are presented: patients with a pancreatic tumor, lung metastasis, and a colon carcinoma. Still, the same objectives of evaluation criteria as in any conventional clinical trial, namely overall survival and quality of life, are followed here. The presented cases are set against expected outcomes of the guideline-oriented therapy options.

CONCLUSION

Quality of life has improved in all three cases, expected overall survival extended in one case, the second is still to be verified. Certainly beneficially, however, is the ratio of effect to - in these cases - no negative side effects.

Future-Focused Therapeutic Strategies for Integrative Health

For many years, the therapy field was dominated by a focus on the past. In this context, many clinicians were trained to use hypnosis as a tool to explore the past, and there is a rich literature documenting the use of hypnosis as a tool to induce age regression and the uncovering of traumatic memories. This article presents a therapeutic paradigm that focuses on the future. Hypnosis is used to induce creativity, flexibility, and openness to the future. In the context of health care, hypnosis is used to explore the best possible treatment outcome, which may be pharmacological, surgical, or a combination of both as well as other nonsurgical interventions. This article elaborates on the effective use of a therapeutic hypnosis strategy and technique focused on the future.

Impact of a Hypnotically-Based Intervention on Pain and Fear in Women Undergoing Labor

The purpose of this study was to evaluate the effects of a hypnotically-based intervention for pain and fear in women undergoing labor who are about to receive an epidural catheter. A group of 155 women received interventions that included either (a) patient rocking, gentle touching, and hypnotic communication or (b) patient rocking, gentle touching, and standard communication. The authors found that the hypnotic communication intervention was more effective than the standard communication intervention for reducing both pain intensity and fear. The results support the use of hypnotic communication just before and during epidural placement for women who are in labor and also indicate that additional research to evaluate the benefits and mechanism of this treatment is warranted.

Efficacy of therapeutic suggestions under general anesthesia: a systematic review and meta-analysis of randomized controlled trials

Background

General anesthesia does not block central nervous processing of auditive information. Therefore, positive suggestions even given during surgery might have the potential to encourage well-being and recovery of patients.

Aim of this review was to summarize the evidence on the efficacy of therapeutic suggestions under general anesthesia in adults undergoing surgery compared to an attention control (i.e. white noise).

Methods

We included randomized controlled trials that investigated therapeutic suggestions presented during general anesthesia to adult patients undergoing surgery or medical procedures. Outcomes on pain intensity, mental distress, recovery, use of medication, measured postoperatively within hospitalization were considered. Electronic searches were carried out in the following databases (last search February 23, 2015): MEDLINE, CENTRAL, Web of Science, PsycINFO, ProQuest Dissertations and Theses.

Results

Thirty-two eligible randomized controlled trials were included, comprising a total of 2102 patients. All studies used taped suggestions. Random effects meta-analyses revealed no effects on pain intensity (Hedges’ g = 0.04, CI 95% [−0.04; 0.12], number needed to treat [NNT] = 44.3) and mental distress (g = 0.03, CI 95% [−0.11; 0.16], NNT = 68.2). In contrast, we found small but significant positive effects on use of medication (g = 0.19, CI 95% [0.09; 0.29], NNT = 9.2) and on recovery (g = 0.14, CI 95% [0.03; 0.25], NNT = 13.0). All effects were homogeneous and robust.

Conclusions

Even though effects were small, our results provide indications that intraoperative suggestions can have the potential to reduce the need for medication and enhance recovery. Further high quality trials are needed to strengthen the promising evidence on the efficacy of therapeutic suggestions under general anesthesia for patients undergoing surgery.

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-016-0292-0) contains supplementary material, which is available to authorized users.

Effects of Positive Suggestions on the Need for Red Blood Cell Transfusion in Orthopedic Surgery

This study examined whether positive suggestions applied without a hypnotic induction in the perioperative period reduces the need for red blood cell transfusions in patients who underwent total hip or knee arthroplasties with spinal anesthesia. No hypnotic assessment was performed. Ninety-five patients were randomly assigned to the suggestion group (n = 45) and to the control group (n = 50). Patients in the suggestion group received verbal suggestions before and audiotaped suggestions during the surgery for reducing blood loss, anxiety, postoperative pain, and fast recovery. Our study showed that using positive suggestions in the perioperative period significantly decreases the necessity for transfusion.

The Effectiveness of Psychosocial Interventions as Adjuncts to Orthopaedic Surgery: A Systematic Review Protocol

AIMS

Pain and anxiety are commonly reported among those undergoing orthopaedic surgery. Improvement in anxiety and pain control might be achieved by supplementing standard care with psychological interventions. However, the effectiveness of adjunctive psychosocial interventions in anxiety and pain control have not been addressed sufficiently by previous systematic reviews in orthopaedic surgeries. The present study aimed to assess the effectiveness of adjunctive psychosocial techniques to improve perioperative clinical care in orthopaedic surgery, to identify the most effective intervention types and to evaluate potential moderators.

METHODS

We will perform a systematic review and meta-analysis to address the study aims. PubMed, PsycINFO, CINAHL and ProQuest Dissertations & Theses will be searched between 1980 and 2015. Prospective controlled clinical trials completed in adults, contrasting standard care and standard care supplemented with psychosocial methods, will be eligible for inclusion. Effectiveness will be assessed through the outcomes of postoperative pain intensity, analgesic requirement, perioperative anxiety, quality of life and postoperative recovery. The results of a random-effect meta-analysis will be reported. To aid implementation of best practice, moderating effects of the type and timing of psychosocial intervention, type of surgical intervention and type of anaesthesia will be evaluated through meta-regression. Sensitivity analyses and subgroup contrasts will follow as necessary.

DISCUSSION

Recommendations will be made to improve medical care in orthopaedic procedures. The quality of evidence will be rated using GRADE criteria. Copyright © 2016 John Wiley & Sons, Ltd.

Psychological support based on positive suggestions in the treatment of a critically ill ICU patient - A case report

This case report describes the way psychological support based on positive suggestions (PSBPS) was added to the traditional somatic treatment of an acute pancreatitis 36-year-old male patient. Psychological support based on positive suggestions (PSBPS) is a new adjunct therapeutic tool focused on applying suggestive techniques in medical settings. The suggestive techniques usually applied with critically ill patients are based on a number of pre-prepared scripts like future orientation, reframing, positivity, supporting autonomy, etc., and other, very unique and personalized interventions, which are exemplified with verbatim quotations. We describe the way several problems during treatment of intensive care unit (ICU) patients were solved using suggestive methods: uncooperativeness, difficulties of weaning, building up enteral nutrition, supporting recovery motivation, and so on, which permanently facilitated the patient's medical state: the elimination of gastrointestinal bleeding, recovery of the skin on the abdomen, etc. Medical effects follow-up data at 10 months show that the patient recovered and soon returned to his original work following discharge.