Clinical Hypnosis in the Treatment of Postmenopausal Hot Flashes: A Randomized Controlled Trial

Gary R. Elkins, PhD; William I. Fisher, MA; Aimee K. Johnson, MA; Janet S. Carpenter, PhD, RN, FAAN; Timothy Z. Keith, PhD

Disclosures

Menopause. 2013;20(3):291-298. 

In This Article

Discussion

Improvements of at least a 50% reduction in hot flashes and daily interference are considered clinically significant.[27,28] As hypothesized, clinical hypnosis significantly reduced hot flashes in postmenopausal women relative to structured-attention controls. At 12-week follow up, reductions in hot flash frequency (74.16% vs 17.13%; P < 0.001) and hot flash score (80.32% vs 15.38%; P < 0.001) were observed. Also, as hypothesized, significant reductions were found between clinical hypnosis participants and structured-attention controls in indices of hot flash daily interference scores (82.11% vs 22.96%; P < 0.001) and sleep quality, as indicated by PSQI global scores (53.63% vs 10.34%; P < 0.001).

Physiologically recorded hot flashes also showed significant reductions in the clinical hypnosis participants compared with controls. To our knowledge, this is the first published study to demonstrate a significant reduction in physiologically measured hot flashes in response to a mind-body intervention. At 12-week follow-up, the hypnosis intervention resulted in a 56.86% reduction in physiologically monitored hot flashes from baseline, compared with a 9.94% decrease from baseline in the control condition, further adding to evidence on the intervention's effectiveness.

It has been reported that there is a substantial placebo effect on hot flash treatment.[47] Why the placebo effect on hot flash treatment is so substantial is unknown; however, supportive care or the act of maintaining a diary may be empowering to participants and thus provide some relief.[48] Although the results of the clinical hypnosis intervention in this trial exceeded the effect of supportive care and diary monitoring provided in the structured-attention control condition, the study has several limitations.

In clinical hypnosis, the mechanism of action to reduce hot flashes is unknown. Because hot flashes involve increases in heart rate, flashing, and sweating, hot flashes have been posited to be a result of autonomic dysfunction.[49] A theory suggesting that hot flashes may be a result of a decrease in parasympathetic tone has been proposed.[50] Notably, a link between hot flashes and cardiovascular risk has been reported, and this theory suggests that the cause may be a decrease in relative parasympathetic influence, as indicated by reductions in the high frequencies of heart rate variability.[51,52,53,54] A possible mechanism of action for clinical hypnosis could be that regular practice of clinical hypnosis improves parasympathetic tone, resulting in reduced hot flash symptoms. This is an empirical question that should be investigated through comparative heart rate variability analyses in subsequent studies.

A limitation of this study is that the results may not be generalized to all participants with hot flashes because some hot flashes occur at times other than during climacteric (eg, pregnancy, perimenopause). Owing to the nature of mind-body clinical trials, self-selection bias may confound the results of this study. Participants who are negatively predisposed to mind-body therapy, unable to make the substantial time commitments required of a clinical trial of this nature, or unwilling to provide initial hot flash diaries to determine eligibility may have influenced the results. This may suggest that these results might be best interpreted as being particularly relevant to women who are more open to mind-body therapy. It should also be noted that the sample in this study was largely white, and there is evidence to suggest that ethnic and cultural differences may contribute to perceived interference in the reporting of hot flash frequency and severity among postmenopausal women.[55]

Treatment satisfaction in this study was assessed via a single question rated on a rating scale of 0 to 10. The mean score of 9.33 for the hypnosis intervention reflects a high level of satisfaction and suggests that the intention is likely to be well received in a clinical setting. The mean satisfaction score of 7.09 in the control group was expected to be lower because of disappointment after a minimal decrease in hot flashes.

The strengths of this study include its sample size, the active control condition, the absence of negative adverse effects, and the inclusion of physiological measures in diary reports of hot flashes.

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