Evidence-Based Practice and Clinical Hypnosis

ABSTRACT

The lead article of this issue of the International Journal of Clinical and Experimental Hypnosis (IJCEH) is a landmark report from an international task force that provides contemporary guidelines for evaluating the efficacy of clinical hypnosis interventions. This is a very important article that can inform clinical practice as well as future research. Further, this issue of the IJCEH includes a study of the role of hypnotizability in well-being and health which has implications for positive psychology interventions integrating clinical hypnosis. Also, another study in this issue of the IJCEH reports the impressive results from the one year follow-up from a randomized clinical trial of self-hypnosis and self-care among cancer patients. The findings from these studies point to the role of clinical hypnosis in well-being and self-care. Additional articles provide insights from virtual reality hypnosis in pain research and the relationship between beliefs and hypnotizability. The final article presents new research on the feasibility of an on-line hypnosis intervention for women with persistent pelvic pain.

Evidence-based practice is generally understood as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (American Psychological Association [APA], 2005). There are multiple components to evidence-based practice. Clinicians must consider individual patient or client characteristics, therapeutic relationship, and cultural factors in providing state-of-the-art therapeutic interventions. However, evidence-based practice also rests on a foundation of critical knowledge of the best available research. This leads to the important question: What constitutes best research evidence in clinical hypnosis? The lead article in this issue of the IJCEH addresses this critically important issue by presenting the guidelines identified by the international Task Force for Establishing Efficacy Standards for Clinical Hypnosis (Kekecs et al., 2022). The Task Force surveyed contemporary research guidelines (Atkins et al., 2004) as well as challenges to bridging clinical research to practice (Kazdin, 2008). It recognized the importance of clearly defining hypnosis, hynotizability, and hypnotherapy (Elkins et al., 2015) and the need for guidelines for evaluating existing evidence and planning future research. The result includes 10 specific recommendations and discussion of methodological issues in the use of these guidelines. Given the importance of this article, it has been made open access and readers are encouraged to share this manuscript freely with colleagues, clinicians, and researchers.

There has been increasing interest in hypnosis interventions for stress and enhancing well-being (Slonena & Elkins, 2021). Both hypnotizability and well-being are relevant to health care. The second article in this issue (Biscuola et al., 2022) investigates the relationship between high hypnotizability and well-being and whether the latter was related to the activity of the Behavioral Inhibition/Approach System (BIS/BAS). The findings provide potential insights into relevant functional brain characteristics, equivalence between imagery and perception, and whether well-being could be a prognostic factor for positive mental well-being and health.

Well-being can be defined in a number of ways, including effectively managing stress and having positive coping skills. Importantly, patients diagnosed with cancer experience particular barriers to well-being, including fatigue, sleep disturbances, and emotional distress. Understanding the short- and long-term effects of a hypnosis intervention (combining self-care and self-hypnosis) is important in posttreatment cancer patients. Ninety-five female cancer survivors were randomized to either a hypnosis/group intervention or wait-list control. Results showed significant decreases in fatigue, sleep difficulties, and emotional distress postintervention for the hypnosis/group intervention in comparison to the wait-list control (Grégoire et al., 2022). The results are encouraging, as most of the positive effects were maintained at one year follow-up.

Virtual reality hypnosis is an emerging area of research (Patterson et al., 2010), and more research is needed to determine the efficacy for pain reduction and well-being. In this issue, a randomized controlled trial examined the impact of virtual reality hypnosis technology on pain, anxiety, and opioid use in patients with a history of trauma (Wiechman et al., 2022). This study used an early version of virtual reality technology to induce hypnosis and provides important lessons about the challenges of implementation of this technology and the importance of improving the approach of virtual reality technology for hypnosis interventions in clinical practice.

Understanding individual differences and beliefs as related to hypnotizability is another area of research that can have implications for evaluating the efficacy of hypnosis interventions. An exploratory study is reported (Green & Hina, 2022) that investigated the relationship among God as locus of health control, paranormal beliefs, and hypnotizability. Results suggested that God as locus of health control beliefs accounted for 26% to 30% of the variance in behavioral and subjective scores on a measure of hypnotizabilty. Further research is needed to determine the implications of these findings for clinical practice.

Telehealth and online hypnotherapy have become increasingly used during the COVID-19 pandemic, as restrictions have been placed on face-to-face therapy sessions. Research reported in this issue of the IJCEH provides relevant data on the feasibility of an online hypnotic intervention for women with persistent pelvic pain (Brooks et al., 2022). The intervention group received an online hypnotic intervention over seven weeks. Results found modest compliance with the practice of audio recordings delivered online. Comments from a limited number of participants indicated the online delivery of the hypnosis intervention was acceptable. The results are limited but suggest this method of delivery of a hypnosis intervention is potentially feasible; however, further refinement and optimization are needed, as well as a large study to establish efficacy. The guidelines from the Task Force for Establishing Efficacy Standards for Clinical Hypnosis (Kekecs, et al., 2022) reported in this issue will be helpful in evaluating the future clinical studies of these encouraging hypnosis interventions and applications.