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Clinical Applications of Hypnotherapy - what is the evidence?

 

Clinical Applications of Hypnotherapy– what is the evidence?

A review by D M Wark in 2008 entitled “What we can do with Hypnosis: A brief note” identifies many studies of hypnotherapy which he rates using the Chambless and Hollon (1998) standardised criteria for “possible”, “probable”, or “specific” empirically-supported treatment depending on the evidence available. The following table summarises his findings at the time. These are not the only applications of hypnotherapy and more studies are published every year that potentially meet these criteria. Thus the evidence base is constantly expanding.

Hypnotherapy has evidence for benefit in the treatment of anxiety, insomnia, pain and several stress related medical conditions e.g. IBS. There is evidence to support it's use in pregnancy and childbirth and as an aid to weight management.

Using this review we can go beyond anecdote and clinical observations and provide a summary of the therapeutic applications of hypnotherapy based on good quality medical research.

 

“Specific” empirically supported treatments

1. Anxiety about asthma

attack

 

 Brown, 2007

2. Headaches and migraine

Relaxation + image modification > wait list control

Hammond, 2007

 

“Effective” empirically-supported treatments

3. Cancer pain

 

 Syrjala et al 1992

4. Distress during surgery

 Hypnosis reduces distress and pain > controls

Lang et al., 2006

5. Surgery pain (adult)

Self-hypnosis reduces drug use > attention control

Lang et al., 1996

6. Surgery pain (child)

Hypnosis reduces pain + hospital time > control

Lambert, 1996

7. Weight reduction

Hypnosis + CBT > CBT, differences increase over time

 Kirsch, 1996

 

“Possible” empirically-supported treatments

8. Acute pain (adult)

 

Patterson & Jensen, 2003

9. Acute pain (children)

Hypnosis > distraction for bone marrow aspiration

Zeltzer & LaBaron, 1982

10. Anorexia

 Staged treatment with hypnosis > same without hypnosis

Baker & Nash, 1987

11. Anxiety about public

speaking

Hypnosis > CBT

Schoenberger et al., 1997

12. Anxiety about taking a

test

Self-hypnosis>discussion control

 Stanton, 1994

13. Asthma

 Hypnosis>attention control

 Ewer & Stewart, 1986

14. Bed wetting

Suggestion with or without hypnosis > wait list control

Edwards & Van der Spuy, 1986

15. Bulimia

Hypnosis = CBT > wait list

 Griffiths et al., 1996

16. Chemotherapy distress

Hypnosis>conversation + antiemetic medication

 Jacknow et al., 1994

17. Cystic fibrosis

Self-hypnosis>wait list control

Belsky & Khanna, 1994

18. Depression

Hypnosis enhances CBT

Alladin & Alibhai, 2007

19. Duodenal ulcer relapse

Hypnosis + medication > medication only

Colgan et al., 1988

20. Fibromyalgia

Hypnosis > physical therapy for subjective symptoms

Haanen et al., 1991

21. Haemorrhage

 Preoperative suggestion reduces blood flow

Enqvist et al., 1995

22. High blood-pressure

Hypnosis > wait list in reducing BP long-term

Gay, 2007

23. Hip/knee osteoarthritis pain

Hypnosis = relaxation > wait list control

Gay et al., 2002

24. Insomnia (primary)

Hypnosis + CBT > medication long-term

Graci & Hardie, 2007

25. Irritable bowel syndrome (IBS)

Hypnosis > psychotherapy

Whorwell et al., 1984

26. Nausea & hyperemesis

Hypnotic-like relaxation > control

Lyles et al., 1982

 27. Obstetrics Apgar score

Hypnosis associated with higher Apgar score

Harmon et al., 1990

28. Obstetrics pain

Hypnosis shortens labour and reduces analgesic use

Jenkins & Prichard, 1983

29. Smoking cessation

Hypnosis or relaxation > wait list controls for good subjects

Schubert, 1983

30. Trauma recovery

 Desensitisation = hypnosis = psychodynamic therapy > control

Brom et al., 1989

31. Wart removal

Suggestion with or without hypnosis > control or medication

Spanos et al., 1990

 

Definitions

Possible

A treatment is “possibly” empirically-supported if peer-reviewed studies meet the following minimum criteria. Studies should normally contain samples of at least 25 subjects who are randomly assigned to treatment and control groups, i.e., the study is a randomised control trial (RCT). There is a treatment manual or equivalent (such as a hypnosis script) so that the treatment can be replicated in other studies. Treatment must be conducted upon a specific condition which has been adequately assessed, and adequate outcome measures must be used which are subject to suitable statistical analysis. The outcome must essentially show the treatment to be significantly more effective than a placebo or no-treatment control group, or equivalent to another empirically-supported treatment.

 

Effective

A treatment is termed empirically-supported as being “effective” if statistically significant

superiority to control group measures have been replicated with completely independent samples or by independent research teams, and data supporting the treatment in question must be shown to predominate if there are conflicting data from other studies.

Specific

A treatment can be considered empirically-supported as “specific” (i.e., better than “non-specific” treatment) if it has shown statistically significant superiority to a placebo (“sham”) therapy or another psychological therapy in at least two independent studies.