The effect of hypnosis therapy on the symptoms and disease activity in Rheumatoid Arthritis

Abstract

The present study aimed to assess the effectiveness of clinical hypnosis on the symptoms and disease activity of Rheumatoid Arthritis (RA). Sixty six RA patients participated in a controlled group design. Twenty six patients learnt the hypnosis intervention, 20 patients were in a relaxation control group and 20 patients were in a waiting-list control group. During hypnosis, patients developed individual visual imagery aimed at reducing the autoimmune activity underlying the RA and at reducing the symptoms of joint pain, swelling and stiffness. Subjective assessments of symptom severity and body and joint function, using standardised questionnaires and visual analogue scales, were obtained. Objective measures of disease activity via multiple blood samples during the therapy period and at the two follow-ups were also taken. These measurements were of erythrocyte sedimentation rate. C-reactive protein, haemoglobin and leukocyte total numbers. Results indicate that the hypnosis therapy produced more significant improvements in both the subjective and objective measurements. above relaxation and medication. Improvements were also found to be of clinical significance and became even more significant when patients practised the hypnosis regularly during the follow-up periods.     

The correlations of socioeconomic status,disease activity,quality of life,and depression/anxiety in Chinese patients with rheumatoid arthritis

This study aimed (i) to investigate the relationships among socioeconomic status, disease activity, quality of life, and the psychological status in Chinese rheumatoid arthritis (RA) patients; (ii) to explore the possible risk factors of anxiety and depression. A total of 160 RA patients underwent standardized laboratory examinations and completed several questionnaires. Independent samples t-tests, χ² analyses, and logistic regression modeling were used to analyze the data. We found 30.6% RA patients were anxiety, and 27.5% had depression, which were significantly higher than the control group (7.8 and 11.7%, respectively). And there were significant correlations among education, pain, disease activity, medication adherence, functional capacity, quality of life, and anxiety/depression. Meanwhile, logistic regression analysis revealed that poor quality of life and low education level were significantly associated with anxiety/depression in RA patients. In conclusion, there were significant relationships among education, quality of life, and anxiety/depression in Chinese RA patients.     

Short report: correlates of functional disability with disease activity in elderly patients with rheumatoid arthritis

Rheumatoid arthritis (RA) prevalence increases with age and old people are special patient population. The recognition of functional disability related to RA could be challenging in elderly patients because aging itself and potential co-morbid disease may also cause functional disability. In this study, we aimed to look at the correlation between disease activity and functional disability in elderly RA patients. Elderly RA patients, ≥65 years old at their routine visits were included in the study. The composite ‘disease activity score’ in 28 joints (DAS-28) was used to determine disease activity groups. Health assessment questionnaire (HAQ) scores were calculated to describe the functional disability and compared across the disease activity groups. Two hundred and fifty-eight RA patients with the mean age of 71 ± 5 (65–90) and a total disease duration of 8.4 ± 8.5 (.5–50) years were recruited. The proportion of patients with high and moderate disease activity was 70%. HAQ scores were significantly correlated with disease activity (p < .05). Functional disability estimated by HAQ was correlated with disease activity in elderly patients with RA     

Illness perceptions account for variation in positive outlook as well as psychological distress in rheumatoid arthritis

Psychological distress in rheumatoid arthritis (RA) is associated with adverse clinical outcomes, and appears highly related to patients' illness perceptions. This study aimed to investigate the association between illness perceptions, psychological distress, positive outlook and physical outcomes in RA. Two hundred and thirty patients aged >18 years and prescribed at least one disease-modifying anti-rheumatic drug (DMARD) were recruited from outpatient clinics across Hertfordshire (England). Patients completed a questionnaire that assessed psychological distress and positive outlook (depression, anxiety and positive outlook scale), illness perceptions (IPQ-R) and functional disability (health assessment questionnaire). Information regarding prescribed medication and disease activity [disease activity score (DAS28)] was collected from medical notes. Psychological distress, but not positive outlook, was associated with functional disability and DAS28. After controlling for sex, age and DAS28, perceptions of greater symptomatology (identity) and lesser understanding of RA (coherence) were significantly associated with increased psychological distress. Perceptions of greater treatment control were associated with greater positive outlook, but only for those with low DAS28. Coherence was also associated with positive outlook. These findings indicate that illness perceptions may influence psychological distress and positive outlook in RA patients, and may therefore be a useful basis for future psychological interventions.     

Relaxation‐induced cortisol changes within lunch breaks – an experimental longitudinal worksite field study

The aim of the worksite study presented here is to elucidate the cortisol reducing impact of different ways of spending lunch breaks. With the help of the so‐called silent room cabin concept it was possible to induce a relaxation opportunity that provides visual and territorial privacy. In order to evaluate its proposed effects, 14 call centre agents were distributed to either 20 min progressive muscle relaxation (PMR) or small talk break group. Participants were analysed in a controlled trial for a period of 6 months (1 day each month with five daily measurements at awakening, awakening +30 min, start of lunch break, end of lunch break, and bedtime) using saliva cortisol measurements as a stress indicator. Results indicated that only the PMR break reduced awakening, lunchtime, and bedtime cortisol response. Although further intervention research is required, our results suggest that post‐lunch PMR may sustainably reduce participants' cortisol states in real worksite settings.     

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up

The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.     

Hypnosis versus relaxation: accuracy and confidence in dating international news events

This study compared participants who were administered either a hypnosis (n=50) or a relaxation (n=44) recall priming procedure in terms of the ability to estimate the dates of 20 relatively memorable (‘easy’) vs. less memorable (‘difficult’) international news events. The hypnosis and relaxation groups performed comparably in terms of the accuracy of estimates of when the events occurred, self‐reported confidence in estimates, and the memorability and emotionality of the events that were reported during hypnosis and relaxation. After these initial ratings, participants were informed that ‘at least one’ of their estimates was incorrect, and they were given the opportunity to change their estimates of the date of when one or more of the events occurred. Participants who generated their initial estimates during hypnosis were less likely to change their previous estimates of both easy and difficult events, than were participants in the relaxation condition. The measure of self‐reported confidence and a behavioural measure of willingness to change initial reports were largely dissociated from one another. Copyright © 2005 John Wiley & Sons, Ltd.     

Mental relaxation improves long-term incidental visual memory

Experimental evidence has linked increased arousal to enhanced memory retention. There is also evidence that procedures reducing arousal, i.e., mental relaxation, might improve memory, but conflicting results have been reported. To clarify this issue, we studied the effects of a single session of relaxation training on incidental visual long-term memory. Thirty-two relaxation-naive subjects viewed 280 slides without being told that there would be subsequent memory testing. Afterwards, subjects listened to a 12 min relaxation tape; 16 subjects relaxed by following the instructions (relaxation group), and the other 16 subjects pressed a button whenever a body part was mentioned (control group). While listening to the relaxation tape, high frequency heart rate variability (HRV) was greater and low frequency HRV was lower in the relaxation group, implying effective relaxation and increasing parasympathetic activation. The relaxation group had superior memory retention 4 weeks later (p = .004), indicating enhancement of long-term memory performance. This effect could not be explained by retroactive interference experienced in the control group because short-term memory performance immediately after the tape was slightly better in the control group. Retention of materials acquired after the relaxation session remained unaffected, suggesting relaxation has retrograde effects on memory consolidation. Our data demonstrate a favorable influence of relaxation on at least this aspect of learning. Our data also extend previous knowledge on the beneficial effects of ascending parasympathetic stimulation on memory retention in that enhanced long-term memory consolidation may also occur in the presence of central and descending parasympathetic activation triggered by willful psychomotor activity.     

Autonomous motivation,cardiorespiratory fitness,and exercise in rheumatoid arthritis: Randomised controlled trial

ObjectiveRheumatoid arthritis (RA) is an autoimmune disease, characterised by high-grade systemic inflammation, pain, and swollen joints. RA patients have an increased risk for cardiovascular disease (CVD). This study examined if a 3-month individualised RA-tailored exercise programme with one-on-one Self-Determination Theory (SDT)-based support for physical activity (PA) facilitated autonomous motivation, increased PA behaviour, and induced greater improvements in cardiovascular and RA-related disease characteristics, and wellbeing in RA, compared to a standard provision tailored exercise programme.Methods115 RA patients were randomised into either the SDT-based psychological intervention + exercise programme (experimental group) or an exercise programme only (control group). Cardiorespiratory fitness (primary outcome), self-reported PA, disease characteristics, CVD risk, wellbeing, and SDT constructs were assessed at baseline (pre-intervention), 3 months (post-intervention), 6 months, and 12 months follow-up. Mixed linear modeling was used to examine within- and between participant changes in these outcome measures.ResultsIn 88 patients with complete baseline data, cardiorespiratory fitness did not change from baseline to 3-, 6- or 12 months in either group. CVD risk, disease characteristics, wellbeing, and need satisfaction did not change, with the exception of diastolic blood pressure. Significant group by time interaction effects were found for functional ability (6- & 12-months), CVD risk (6-months) and PA (3-months). Autonomous motivation increased and controlled motivation decreased more in the experimental group compared to the control group at 3 months.ConclusionsDespite improving quality of motivation for exercise, no changes in cardiorespiratory fitness or other psychological and physiological health outcomes were found. This suggests more intensive support is needed when initiating an exercise programme to achieve health benefits in RA.     

Cognitive-behavioural treatment of pathological gambling in individuals with chronic schizophrenia: a pilot study

The current study aimed to test the clinical effectiveness of a cognitive-behavioural program (CBT) specifically adapted for pathological gamblers with chronic schizophrenia, carried out in a naturalistic setting of community Mental Health Centres. Forty-four pathological gamblers with chronic schizophrenia were assigned either to a standard drug therapy for schizophrenia (control group) or to cognitive-behavioural therapy for pathological gambling plus a standard drug therapy for schizophrenia (experimental group). Psychological treatment comprised a 20-session program including psychoeducation, stimulus control, gradual exposure and relapse prevention. Therapeutic success was defined as abstinence or the occurrence of only 1 or 2 episodes of gambling during the follow-up period. While the patients treated in the experimental group showed a rate of success of 73.9%, only 19% of the participants belonging to the control group gave up gambling at the 3-month follow-up. The CBT group also did better than the control group in the number of gambling episodes and in the amount of money spent on gambling. However, the improvement of the experimental group was weaker at the 6- and 12-month follow-up. These findings support the beneficial effects of CBT as adjunctive therapy for patients with dual diagnoses (schizophrenia and pathological gambling).     

Perceptual organization based upon spatial relationships in Alzheimer's disease

Alzheimer's disease (AD) is often accompanied by impaired object recognition, thereby reducing the ability to recognize common objects and familiar faces. Impaired recognition may stem from decreased efficacy in integrating visual information. Studies of perceptual abnormalities in AD indicate an impairment in organizing elements of the visual scene, thereby confusing components of individual forms. This type of impairment is consistent with the characteristics of neural loss, which impact cortical integration. To examine the extent to which perceptual organization is impaired in AD, psychophysical measurements were made of visual perceptual grouping based upon spatial relationships in a group of AD patients and demographically matched elderly control subjects. A comparison was also made between young and elderly control subjects to evaluate the effects of aging on these capacities. Deficits in perceptual organization were found for a subgroup of AD patients, which corresponded to impairment on facial recognition. A less profound functional decline was found for the elderly control group. The degree of impairment for AD subjects did not correlate to level of dementia, but instead appears to be idiosyncratic to individual patients. These results are consistent with impaired integrative function in AD, the degree of which reflects individual differences in the regional distribution of neuropathological changes.     

RELAXATION AS THERAPY FOR HYPERACTIVE CHILDREN

The purpose of this study was to determine the effectiveness of a relaxation therapy program with a sample of hyperactive, learning disabled, male children. The sample of 16 boys aged 8 to 12 years-old, from a private school providing special education, was divided randomly into an experimental and a control group. Relaxation procedures based on the theories of Jacobson and Bruno were done twice weekly for 11 weeks, during 20 minute sessions. All children in the experimental and control groups were pretested and posttested on six outcome measures. The Developmental Test of Visual-Motor Integration, Motor Accuracy subtest of the Southern California Sensory Integration Tests, Abbreviated Parent and Teacher Questionnaires, House-Tree Person test, and Sophistication-of-Body Concept Scale were administered. Significannt levels of differences were reported by most of the outcome measures. It was concluded that relaxation therapy has a direct effect upon the hyperactivity syndrome. Implications for use of relaxation therapy as a component of the occupational behavior frame of reference for the occupational therapist are discussed.     

Granulocyte activation in humans is modulated by psychological stress and relaxation

Our aim was to study the possible relationship between psychological stress and granulocyte activation primarily in healthy students during an examination period (n = 11) and also in chronically anxious patients (n = 15). We employed cell surface markers: lactoferrin, L-selectin, alphaMbeta2-integrin and CD15s and flow cytometry to detect changes in the activation state of granulocytes, with the start of the stressed state in students at the beginning of an examination period, which was associated with elevated blood plasma cortisol level, and following relaxation hypnosis in both students, during their examination term, and patients. The ratios of all four types of marker-carrier granulocytes increased at the start of the examination period in students; an especially dramatic (ca. 5-fold) enhancement was observed in the proportion of lactoferrin-bearing cells relatively to the pre-examination term value. After hypnosis, the percentage of lactoferrin-exposing granulocytes decreased considerably both in students and in patients, by about half; a similar decrease was observed in the ratio of CD15s-carrier cells in patients. No significant alteration was observed during the study in state or trait anxiety levels, and in total or differential leukocyte counts. Thus, granulocyte activation could be associated with stress, while relaxation may facilitate reducing activation of these cells. In both groups of subjects, granulocyte surface lactoferrin appeared to be a sensitive "stress indicator". This needs further evaluation.     

Personal Control in Chronic Pain Sufferers During Acute Interpersonal Stress

Among individuals with Rheumatoid Arthritis (RA), pain-associated stress can severely impact wellbeing. Psychological attributes, such as a sense of personal mastery, may attenuate the effects of chronic pain on life quality. We tested the hypothesis that a high sense of mastery would predict lower pain, perceived stress, fatigue, and mean arterial pressure (MAP) than would a low sense of mastery during an acute, interpersonal stressor.Seventy-four individuals with RA completed a psychophysiological laboratory session involving MAP measurements, as well as self-ratings of stress, joint pain, and fatigue. Measurements were collected before, during, and after an interpersonal stressor. To assess personal mastery, exploratory and confirmatory factor analyses were conducted on the Pearlin Mastery Scale based on recommendations by Reich and Zautra (1991)The Pearlin Mastery Scale yielded two distinct factors: fatalism and control. Both fatalism and control were significant predictors of the wellbeing variables. Individuals with a highly fatalistic style demonstrated higher general levels of mean arterial pressure (F(1) = 3.41, p<.1) and reported greater joint pain (F(1) = 4.72, p<.05) across all periods. Individuals with a high sense of control also evidenced lower MAP (F(1) = 3.73, p<.1) and reported less stress (F(1) = 7.44, p<.01) and fatigue (F(1) = 5.16, p<.05). Neither fatalism nor control were related to objective measures of disease severity (r's = -.10, p=NS and -.02, p=NS, respectively).RA patients with a high level of personal mastery, as evidenced by scores on two distinct indices, experience lower MAP, and report less pain, stress and fatigue. Although fatalism and control were not related to objective disease state, they seem to play an important role in the experience of wellbeing for people with RA.     

Effects of hypnosis and level of processing on repeated recall of line drawings

Moderately susceptible subjects (N = 30) initially judged 30 line drawings of objects for pleasantness (deep processing) and 30 line drawings for visual complexity (shallow processing), after which they were given two immediate recall tests. Following a 48-hr delay, subjects were allocated randomly to hypnosis, simulation, or neutral control conditions and were tested four more times. Subjects produced more correct and incorrect responses over the six trials and gave a higher number of correct responses for deep items than for shallow items. Over the last four trials, hypnosis had no general facilitative effect relative to the other two treatments, but the effect of depth was strongest for hypnotized subjects, who recalled more deep items than did the controls. Finally, both hypnotized and simulating subjects rated their recall as more involuntary and their experimental treatment as more helpful than did the controls. Caution is urged in the forensic use of hypnosis as a retrieval device.     

Positive Thought Induction for Arresting Disease Progression: A Hypnotherapeutic Application in HIV/AIDS

The present research aimed to investigate the effect of positive thought induction through hypnotherapeutic strategies, e.g., package of relaxation, guided imagery, positive suggestions, etc., on the coping strategies, clinical and immune parameters of disease progression in people living with HIV/AIDS(PLWHA). Data were collected from 20 adults HIV+ patients having CD4 count above 250 and plasma viral load less than 5000, screened from a large group of HIV+ patients who had volunteered for the study. A repeated measure design of research was used. Results of post and follow-up tests indicated that positive thought induction through hypnotherapy had yielded significant positive changes in several dimension of coping strategies (e.g., active coping, alcohol/drug abuse, denial, planning, reinterpretation and growth). Similarly, it led to significant increase in different Immunological parameters (e.g.,% of CD4 count, absolute CD4 count, absolute CD8 count, proportion of CD4 to CD8 count, and absolute CD3 count). These results suggest the effective use of hypnotherapy as an adjunct therapy to arrest disease progression and improve quality of life of PLWHA. In addition, the result highlights the effect of positive thoughts in strengthening positive coping strategies and improving immune competence in PLWHA.     

Movies as a Therapeutic Technique in School‐Based Counseling Groups to Reduce Parent–Adolescent Conflict

The authors evaluated a school‐based group counseling program aimed at reducing parent–adolescent conflict and assessing the unique contribution of movie therapy. Participants were 173 Arab adolescents who scored high on conflict with parents. Students were divided among 3 conditions: a treatment intervention with movies, a treatment intervention without movies, and a no‐treatment control group. Results indicated more favorable outcomes in both interventions compared with the control group, with no effect of movies.     

The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial

Randomised controlled studies in research environments have demonstrated dialectical behaviour therapy (DBT) to be more efficacious than treatment as usual in reducing suicidal behaviour in patients with borderline personality disorder (BPD). Limited evidence exists for the effectiveness of DBT in the treatment of BPD within routine clinical settings. This study examines the clinical and cost effectiveness of providing DBT over treatment as usual in a routine Australian public mental health service. Forty-three adult patients with BPD were provided with outpatient DBT for six months with patient outcomes compared to those obtained from patients in a wait list group receiving treatment as usual (TAU) from the same service. After six months of treatment the DBT group showed significantly greater reductions in suicidal/non-suicidal self-injury, emergency department visits, psychiatric admissions and bed days. Self-report measures were administered to a reduced sample of patients. With this group, DBT patients demonstrated significantly improved depression, anxiety and general symptom severity scores compared to TAU at six months. Average treatment costs were significantly lower for those patients in DBT than those receiving TAU. Therapists who received intensive DBT training were shown to produce significantly greater improvements in patients’ suicidal and non-suicidal self-injury than therapists who received only 4 day basic training. Further clinical improvements were achieved in patients offered an additional six months of DBT. This study demonstrates that providing DBT to patients within routine public mental health settings can be both clinically effective and cost effective.     

Delsartean hypnosis for girls' bodies and minds: Annie Payson Call and the Lasell Seminary nerve training controversy

In the summer of 1890, news that two students at Lasell Seminary for Young Women in Auburndale, MA had suffered a complete nervous collapse as a result of being hypnotized by an instructor in a nerve training class caused a brief but sharp national sensation regarding hypnotism and nerve training in girls' education. The instructor, Annie Payson Call, denied practicing hypnotism, and the seminary's principal defended both Call and the "mind concentration" course she taught at Lasell. Call's approach to nerve training blended Delsartean relaxation exercises, New Thought psychology, and self-hypnotic techniques into a therapeutic regimen which can be termed "Delsartean hypnosis." Developed further in her 1891 popular self-help handbook, Power Through Repose, Call's variety of Delsartean hypnosis was incorporated into the procedures of proponents of suggestive therapeutics, and it served as a model for subsequent relaxation training programs in the early- and mid-20th century.     

Die Effektivität der Hypnose

From 193 studies published until 1998 that investigated the efficacy of hypnosis 43 randomized clinical studies were selected that compared a patient group treated exclusively by hypnosis with an untreated control group (or with a group of patients treated by conventional medical procedures). The 43 studies were integrated into a meta-analysis that yielded a weighted average post-treatment effect size of d=.60 (medium effect size) for hypnotic treatment of ICD-10 coded disorders (24 studies; average treatment period: 5.1 weeks) and d=.38 (small effect) for hypnosis as an adjunct for supporting medical procedures (19 studies). These estimates are conservative since all variables of a given study were used. Most of the studies employed methods of the classical approach to hypnosis. In order to obtain an estimate to which extent non-clinical factors (design-quality, way of comparison of dependent variables) have an influence on the effect sizes, effect sizes were computed for all studies of the original 193 studies that reported the necessary statistical information (N=89). For those studies with an average effect size of d=.80 a massive influence of non-clinical factors was demonstrated with a range from d=.51 for randomized studies with group comparisons to d=2.0 for non-randomized studies using pre-post-comparisons.