The relevance of outcome expectations in group hypnosis for stress reduction: a secondary analysis of a multicenter randomized controlled trial

Background

There is evidence that patients' positive outcome expectations prior to study interventions are associated with better treatment outcomes. Nevertheless, to date, only few studies have investigated whether individual outcome expectations affect treatment outcomes in hypnosis.

Objective

To examine whether outcome expectations to hypnosis prior to starting treatment were able to predict perceived stress, as measured on a visual analog scale (VAS), after 5 weeks.

Methods

We performed a secondary data analysis of a multicenter randomized controlled trial of intervention group participants only. Study participants with stress symptoms were randomized to 5 weekly sessions of a group hypnosis program for stress reduction and improved stress coping, plus 5 hypnosis audio recordings for further individual practice at home, as well as an educational booklet on coping with stress. Perceived stress for the following week was measured at baseline and after 5 weeks using a visual analog scale (0-100 mm; VAS). Hypnosis outcome expectations were assessed at baseline only with the Expectations for Treatment Scale (ETS). Unadjusted and adjusted linear regressions were performed to examine the association between baseline expectations and perceived stress at 5 weeks.

Results

Data from 47 participants (M = 45.02, SD = 13.40 years; 85.1% female) were analyzed. Unadjusted (B = 0.326, t = 0.239, p = 0.812, R2 = 0.001) and adjusted (B = 0.639, t = 0.470, p = 0.641, R2 = 0.168) linear regressions found that outcome expectations to hypnosis were not associated with a change in perceived stress between baseline and after 5 weeks in the intervention group.

Conclusion

Our findings suggest that the beneficial effect of group hypnosis in distressed participants were not associated with outcome expectations. Other mechanisms of action may be more important for the effect of hypnosis, which should be explored in future research.Clinical trial registration: ClinicalTrials.gov, identifier NCT03525093.

Group Hypnosis for Stress Reduction - A Feasibility Study

The aim of this study was to develop a standardized hypnotherapeutic group program for stress reduction, test its feasibility, and measure its preliminary pre- to postintervention effects. In this prospective, single-arm feasibility study, healthy adult participants with self-assessed increased stress levels received 5 weekly group hypnosis sessions plus audio recordings. Twelve persons (10 females, mean (SD) age 48.9 (11.8) years participated. The mean (SD) intensity of perceived stress on a 0-to-100 mm VAS was reduced from 75.5 (11.5) mm at baseline to 33.9 (18.8) mm after 5 weeks. Cohen's perceived stress scale was reduced from 20.8 (5.7) to 13.8 (5.4). Focus group interviews showed that the study intervention was feasible and well accepted. Confirmatory testing of the intervention in a randomized controlled trial is necessary.

How effective is the early support program Babylotse-Plus for psychosocially burdened mothers and their infants? A comparative intervention study

Objectives

Our aim was to examine the effects of an early perinatal prevention program offered to mothers and families suffering from significant psychosocial burden.

Methods

All mothers giving birth in a Berlin university hospital during Jan-Aug 2013 were screened with a standardized 27-item questionnaire by trained staff. Mothers with a screening-score ≥ 3, who were not enrolled in other public support programs, were defined as psychosocially burdened. They received a detailed needs assessment and were followed up with counseling. When necessary, affected mothers were voluntarily guided through to specialized ‘early support’ institutions during the 12-month-intervention period. The historical control group (care-as-usual) consisted of children born at the same hospital the year before.

At 12 months postnatally, we interviewed mothers in both groups to assess their stress burden and coping skills by Parenting Stress Index and assessed the current childcare condition. Differences between the groups were compared by multivariable logistic regression analyses adjusting for potential confounders.

Results

The intervention group and the control group included 225 and 157 families, respectively. After 12-months, mothers in the ‘early support’ intervention group had significantly less often depression (adjusted odds ratio 0.25, 95%-confidence interval 0.07–0.94), less often a disturbed relationship with the parenting partner (0.34, 0.10–1.14) and reported reduced stress due to the child’s demands (0.40, 0.15–1.10) compared to the control group. Childcare indicators did not differ between the 2 groups.

Conclusions

In mothers at high psychosocial risk, the ‘early support’ intervention program Babylotse-Plus seemed to reduce the occurrence of depression and several stress indicators in the first postnatal year.

[Evaluation of the Babylotse-Plus screening form : Evaluation of a simple instrument to systematically identify parents of newborns with severe psychosocial stress at Charité Berlin]

BACKGROUND

The well-being and healthy development of children are at risk in families with severe psychosocial stress. In Germany, simple and valid screening instruments are lacking to identify families in need of early support.

OBJECTIVES

We aimed to examine the diagnostic accuracy of a simple perinatal screening form to identify families at high psychosocial risk.

METHODS

For every mother giving birth at Charité Berlin between January and August 2013 the short Babylotse-Plus screening form with 27 items was filled out by medical staff. Completing the form took about 5 min. After calculating a sum score, values of ≥3 were defined as "likely at risk". A one-hour comprehensive standardized interview with the parents after birth served as the reference standard for assessing family resources and stress factors.

RESULTS

Among the 279 participants included in the analyses, 215 were "likely at risk" and 64 had a low or no risk, the latter were randomly selected among all families with scores <3. The screening form had an excellent sensitivity (98.9 %; 95 % confidence interval 93.4-99.9 %) to detect families likely at risk, whereas its specificity was only low (33.0 %; 95 % confidence interval 30.5-33.5 %). This resulted in a rather poor positive likelihood ratio of 1.5 but a very good negative likelihood ratio of 0.03.

CONCLUSIONS

The screening form identified families with psychosocial risks well, but many families with low or no risk were falsely defined as being at risk. Before recommending the screening instrument for clinical practice, further studies are needed in different settings to improve the specificity without reducing its high sensitivity.

Hypnosis in patients with perceived stress - a systematic review

BACKGROUND

Although hypnosis and hypnotherapy have become more popular in recent years, the evidence for hypnosis to influence perceived stress is unclear. In this systematic review we searched and evaluated randomized clinical studies investigating the effect of hypnosis on perceived stress reduction and coping.

METHODS

The Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Review of Effects, EMBASE, Medline, PsycINFO, PSYNDEX and PubMed were systematically screened from their inception until December 2015 for randomized controlled trials (RCTs) reporting about hypnosis or hypnotherapy for stress reduction in healthy participants. Risk of Bias was assessed according the Cochrane Collaboration recommendations.

RESULTS

Nine RCTs with a total of 365 participants met the inclusion criteria and were included in this review. Most included participants were medical students, predominantly female (n = 211). Mean age of participants ranged in most studies between 20 and 25 years, in three studies the mean ages were between 30 and 42 years. Perceived stress was measured by a wide range of psychological questionnaires including Face Valid Stress Test, Stress Thermometer, and immunological data was collected. All nine included studies used explorative designs and showed a high risk of bias. Six out of nine studies reported significant positive effects of hypnosis for stress reduction in the main outcome parameter compared to control groups (3 active controls, 3 no therapy controls). Immunological outcomes were assessed in six studies, the results were inconclusive.

CONCLUSIONS

Due to exploratory designs and high risk of bias, the effectiveness of hypnosis or hypnotherapy in stress reduction remains still unclear. More high quality clinical research is urgently needed.

Messinstrumente zur Erfassung von Trauer - Ein kritischer Überblick

Scientific investigations show that the course of a grieving process may have a substantial impact on the mental and physical wellbeing of those concerned. An international survey of measuring instruments designed to register grief shows little conformity with respect to the key symptoms of grieving. Only few instruments are derived from scientific theory, the majority have been developed on the basis of clinical observations and only some of the instruments are psychometrically designed. Some instruments display correlations with other constructs such as depression and anxiety, with the question of whether the symptoms are grief-specific or autonomous remaining unanswered. Only few instruments serve to differentiate between normal and pathologic grief. The fact that only two German-language instruments for registering grief are available to date also indicates that this subject matter has attracted only scant attention despite its clinical significance. In conclusion, the demands to be made on an instrument to be developed in the future are outlined.

Outpatient psychotherapy for mothers--a new treatment

The perinatal period and new motherhood entail a multitude of physiologic and psychosocial changes and are also associated with an increased risk of mental illness. Nevertheless, many mothers with an acute postpartum mental illness reject hospitalization to avoid being separated from their children even when treatment is urgently needed. A new psychotherapeutic outpatient treatment program adapted to the special needs of mothers and offering a substitute to inpatient treatment is presented. Empirical results indicate that this treatment is an effective alternative to hospitalization.

Double-blind comparison of triamterene plus hydrochlorothiazide and spironolactone plus hydrochlorothiazide in the treatment of hypertension

The results from this double-blind, multi-investigator study showed that a combination of 50 mg triamterene plus 25 mg hydrochlorothiazide and a combination of 25 mg spironolactone plus 25 mg hydrochlorothiazide were equally efficacious in lowering blood pressure in hypertensive outpatients, and that they produced the same type and incidence of adverse effects. Likewise, the two drug combinations produced similar effects on blood chemistry and hematology. There were no significant differences between the two combination drugs in efficacy laboratory studies, or adverse effects.