Clinical hypnosis: the mind’s suggestion box
When I first bring up the topic of clinical hypnosis with a patient and family at St. Jude Children’s Research Hospital, I start by dispelling popular misconceptions. Clinical hypnosis is nothing like the “stage hypnosis” performed at comedy clubs and county fairs. Although patients who are engaged in hypnosis are more open to suggestion, they maintain control over their behavior
Hypnosis is simply one of many tools or techniques that psychologists may offer to St. Jude patients—from early childhood to young adulthood—throughout the cycle of treatment and survivorship.
This method brings patients into a mental state of increased concentration and suggestibility in which they can learn to manage sensations of discomfort and anxiety. Children have a natural ability to move into a hypnotic state.
They already do this on their own every day, when they engage with a favorite program, game, or toy and mentally banish the outside world until they are finished.
Hypnosis: A search for new therapeutic tools
My interest in hypnosis was sparked while I was a postdoctoral fellow at St. Jude. I was searching for additional nonpharmacological interventions to offer patients who were experiencing physical and psychological symptoms during cancer treatment. Several of my mentors had also been interested in hypnosis, including Sean Phipps, PhD, and Nicole Alberts, PhD, who is the senior author for our review paper, published this year in the journal PAIN. After completing training in pediatric clinical hypnosis, I began to explore how it has been applied in pediatric oncology.
That's how this review paper evolved. We analyzed findings of 14 randomized control trials and three non-randomized control trials with sample sizes ranging from 12 to 80 children or adolescents. Most of the participants were being treated for leukemia. Our findings suggest that hypnosis can help with the pain, anxiety and distress associated with procedures such as bone marrow aspirations, lumbar punctures and venipuncture. Evidence also supports hypnosis as a treatment for chemotherapy-related nausea and vomiting
Hypnosis in pediatric oncology: understudied and likely underused
We started our review with past research focusing on pain management and broadened our search to include other physical and psychological symptoms that are often intertwined with pain. We found that hypnosis in pediatric oncology has remained understudied, and potentially underused, in recent years. The lack of current clinical research is unfortunate, given the long-term effects associated with poorly managed pain that often persist into survivorship and adulthood.
The lack of recent research may be attributed to the introduction of effective pharmacological interventions that target procedure-related pain and distress as well as chemotherapy-related nausea and vomiting. In addition, clinical hypnosis can be a challenging fit for rigidly controlled clinical trials, where all participating clinicians would be required to follow a standard methodology while meeting the needs and preferences of individual patients. However, there remains a number of physical and psychological symptoms in pediatric oncology that have the potential to be alleviated with behavioral interventions, such as clinical hypnosis.
Methods of clinical hypnosis
The 17 clinical studies we examined included a range of hypnotic approaches, including both provider-led hypnosis and self-hypnosis. Relaxation exercises, such as breathing exercises, muscle relaxation and imagery/visualization, were included in many studies, in addition to direct and indirect suggestions. Direct suggestions included analgesic suggestions and suggestions of physical and psychological well-being. A few studies included indirect suggestions, which were typically presented as comforting metaphors, such as a setting sun and Mexican food.
Understanding how hypnosis works
In addition to a need for more clinical studies, the field of clinical hypnosis would also benefit from deeper neurological investigations to better understand how hypnosis works in the brain and why some people demonstrate a stronger response to hypnotic techniques.
The potential long-term risks associated with undertreated pain and distress in childhood demand that future lines of research and clinical application focus on behavioral interventions. Hypnosis is one such intervention that has the potential to safely and effectively address these problems.