Cyna, McAuliffe, Andrew, 2004, in their study titled “Hypnosis for pain relief in labor and childbirth: a systematic review,” examined the evidence regarding the effects of hypnosis for pain relief during childbirth.
The method used in the study was an electronic search (gathered from Embase, Cochrane library, Pubmed, and Medline). The search was made for “clinical trials that used hypnosis during pregnancy and childbirth in comparison with no treatment, placebo or a non-hypnosis intervention” (Cyna, McAuliffe, Andrew, 2004). Further, reference lists and bibliographies from obtained papers and hypnotherapy articles were also examined. The study used the following outcome measures: pain scores in labor and labor analgesia needs (opiate drug use, epidural drug use or without any analgesia). Ideal comparative studies were included so that a further assessment could be made by predefined criteria. Meta-analyses of the included randomized controlled trials (RCTs) were made.
“The study used the following exclusion criteria: case series with no comparison group or case reports, those studies that did not state that they were investigating the use of hypnosis for pain relief in labor and childbirth, and studies without pain relief as an outcome” (Cyna, McAuliffe, Andrew, 2004.)
“The inclusion criteria included: all comparative trials having at least one treatment as hypnosis, and studies where at least one outcome was a pain measure or analgesia requirements” (Cyna, McAuliffe, Andrew, 2004.)
Validity assessment included internal validity and external validity. A data collection form was used to include independent data abstraction. Two assessors then cross checked this. Those data, which was ideal for meta-analyses, were transcribed to the Review Manager Computer program.
The results of the study indicated that only a few patients who had hypnosis needed analgesia when compared with controls, and these patients rated their labor pain as being less painful. In addition, opioid requirements was less.
The study concluded that there is an advantage in using hypnosis, alone or in combination with other anesthetic techniques, compared to the use of conventional analgesia only. However, according to the authors there is great need for well-designed trials so that the effects of hypnosis in childbirth can be more accurately confirmed.
The study article has a clear and appropriate title with a specific abstract. The introduction has made a clear mention of the purpose of the study and has given a good background about the subject. The methods used in the study have been described adequately and are appropriate for this study. The exclusion and inclusion criteria used in the study are clearly mentioned. The discussion is relevant and has cited pertinent literature.
This study is among the most comprehensive literature reviews on the subject. However, an element of bias could be present in this study due to the lack of power analyses and the small numbers of patients used in the study. A small sample size will not have enough power (sensitivity) (Eng, 2003.) In order to clearly analyze the advantages of using hypnosis for pain relief in labor and childbirth, larger studies are required.
Anbar, 2002, in their study titled “Hypnosis in pediatrics: applications at a pediatric pulmonary center” describes the usefulness of hypnosis in patients who attended a Pediatric Pulmonary Center over a period of 30 months.
About 303 patients were enrolled for assessment in this study. Patients who received hypnotherapy included; those felt to have symptoms due to psychological issues and those patients whose symptoms persisted in spite of adequate medical treatment. A pediatric pulmonologist trained in hypnotherapy taught the patients about self-hypnosis for managing their pulmonary condition.
The method used in the study was an observation by the pulmonologist for improvement in patient symptoms following hypnosis. An assessment was also made of improvement of any other conditions based on the patients’ subjective evaluations. Open-ended questions (about subjective evaluation of hypnosis efficacy), asked by the pulmonologist, helped to determine the outcome of hypnotherapy in this study.
The initial hypnosis session lasted for approximately 45 minutes, which consisted of: a pre-hypnotic interview, hypnosis induction and deepening, teaching the patients to relax with the help of hypnosis, instructions to give themselves suggestions for improvement on important issues, and a discussion with both the patients and parents after the hypnosis sessions. The patients were advised and encouraged to use self-hypnosis at home, daily, for at least a few minutes until there was a resolution or improvement of their symptoms.
After the initial hypnosis session, about twenty-one patients did not return for follow-up, and therefore, the remaining 254 patients formed the cohort for the reported results.
The results indicated that 81% of patients had an improvement in symptoms (either immediately or after a few weeks) with hypnotherapy. With the use of hypnosis, both the intensity as well as the frequency of the patients’ respiratory distress episodes had improved. Vocal cord dysfunction of 29 patients had resolved. There was no worsening of symptoms in any patient or the occurrence of new symptoms after hypnotherapy. In 50 patients, no improvement in symptoms was observed.
The study concluded that hypnotherapy helped to relieve the symptoms of patients’, and thus, in a pediatric practice, it could prove to be an important alternate therapy. The pediatricians could interact better with their patients, and they would be more aware of the importance of using a positive approach for the management of this condition.
The study article has a clear and appropriate title with a specific abstract. The introduction has made a clear mention of the purpose of the study. The methods used in the study have been described adequately and are appropriate for this study. The discussion is relevant and has cited pertinent literature.
However, the pediatric patients involved in the study could have tried to please the physician by reporting fewer symptoms, and this could have created an apparent success of the study and a reporting bias. In addition, a consistently organized analysis of the application of hypnosis in this study is not possible due to its retrospective nature.
Cox, Lusignan, Chan, 2004, in their study titled “General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care” explores general practitioners’ beliefs about irritable bowel syndrome (IBS), and whether they see hypnotherapy as an appropriate complementary therapy for its management; and if so, who should deliver it.
The methods used in the study involved sending a questionnaire (which was pre-tested with a pilot group for reliability, validity, readability, time taken to complete, and layout acceptability) to 406 general practioners (GP’s) in the area in order to know their opinion on this subject and if they regarded hypnotherapy as an appropriate complementary therapy in the management of irritable bowel syndrome. The questionnaire themes included the general practitioners perception of irritable bowel syndrome, the management of irritable bowel syndrome, and the use of hypnotherapy as a treatment in this condition. In addition, the questionnaire also included queries regarding funding of therapy and whether hypnotherapy would be embraced as part of irritable bowel syndrome management in a primary care set up.
The responses, which were received, were in the form of a Likert scale, which allows the measurement of degrees of opinion. This increases the sensitivity of the analysis. The questions were worded in such a way that the expected responses had an unpredictable variation according to the scale direction. This prevented any acquiescence bias.
“In order to assess sample bias, a comparison was made of the characteristics of GP’s in the achieved sample with of the target sample” (Cox, Lusignan, Chan, 2004). To allow the assessment of possible biased responses from factors such as age, sex, or practice size, the demographic data was also included. The data was analyzed with SPSS (Statistical Package for Social Sciences). The Chi-square test of proportion was also used. The results obtained from the main question form were not reported not as a score but as proportions.
The results revealed that about 38% of the general practitioners who received the questionnaire had responded. About half of the doctors believed that irritable bowel syndrome was due to a nervous problem and had used a combination of dietary advice to the patient, medicinal treatment and personal care (causing a placebo effect).
There was a considerable variation in the approach to treatment for this condition. About 68% felt that hypnotherapy should not be offered by general practitioners; 70% felt that hypnotherapy may have a role in the management of IBS; 84% thought that only a qualified hypnotherapist should offer hypnotherapy for IBS; 40% of general practioners had the opinion that hypnotherapy for IBS should be provided outside the health service. A large percentage of doctors (44.5%) thought that funds could be better utilized on other things than hypnotherapy for IBS. About 76.3% of the doctors were of the view that in primary care, they were willing to refer patients into a hypnotherapy study for IBS treatment.
The study concluded that even though general practitioners varied on their opinion as to what constituted an effective treatment for IBS, they were willing to consider a referral of their patient to a qualified hypnotherapist for the management of irritable bowel syndrome.
This study is important considering the fact that this is among the few studies on this subject. However, the title of the study seems too long, and it could have been more concise and shorter. The introduction methods used and discussion are adequate. Only 38% of the doctors had responded to the questionnaire, which is a low response rate. Additionally, more information may be provided by a qualitative study, and an additional quantitative study would show if there are age-sex differences in the general practitioners attitudes.
Morrson, 1988 in their study titled “Chronic asthma and improvement with relaxation induced by hypnotherapy” aimed to investigate the role of hypnosis-induced relaxation in chronic asthma, which is not responding adequately to drug therapy.
The methods involved 16 patients who were suffering from asthma. After the patients were explained the usefulness of hypnotherapy and a suggestibility test, the study was initiated. In order to induce relaxation daily for 5-15 minutes, instructions were given in autohypnosis. If for any reason the patient found this to be difficult, they were given a tape recording to listen to. They were instructed to follow this whenever they got a mild to moderate wheezing either alone or after a B2 stimulant inhaler. However, they were instructed never to use when they get a severe asthmatic attack.
The peak flow of each patient was recorded 4 times daily using the best of 3 readings before and after salbutamol inhalation and also once daily before and after hypnotherapy, induced 2 hours after a salbutamol dose. In order to record daily cough, sputum and wheezing, the patients were provided with asthma diary cards. This also recorded all the drugs that were used.
Clinic visits were made regularly (weekly for 2-3 weeks, followed by visits at 2, 3 and 4 weeks according to progress). During this time, records of the peak flow, FEV1 and FVC were made. About 3699 recordings were obtained for analysis. The effect of therapy was assessed by means of a visual analogue scale. A record was made of the frequency of admissions and duration of stay, a year before, and a year after hypnotherapy, and this was observed over several years.
The results indicated that 62% of the patients noticed an improvement on the visual analogue scale, although this was not showing a correlation with lung function tests. The authors concluded that hospital admissions and drug therapy could be reduced by the use of hypnotherapy even in intractable asthma.
The abstract, which is provided in the article, is too small. It should have been more comprehensive. The discussion section is adequate. However, the sample size (10 patients) used in this study is too less. “Sample size is closely tied to statistical power, which is the ability of a study to enable detection of a statistically significant difference when there truly is one” (Eng, 2003.)
If the sample size is good, then the statistical test will have enough power (sensitivity), and conversely, a small sample size will not have enough power, and is thus inappropriate (Eng, 2003.)
Anbar, RD (2002). Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatrics. 2:11.
Cyna, AM, McAuliffe, GL, Andrew, MI (2004). Hypnosis for pain relief in labour and childbirth: a systematic review. British Journal of Anaesthesia. 93(4):505-511.
Cox, S, Lusignan, S, Chan, T (2004). General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care. BMC Family Practice. 5:22.
Eng, J (2003). Sample Size Estimation: How Many Individuals Should Be Studied? Radiology. 227:309-313.
Morrson, JB (1988). Chronic asthma and improvement with relaxation induced by hypnotherapy. Journal of the Royal Society of Medicine. (81).