A six-week at-home hypnosis program not only eased hot flashes more than an active placebo but also improved women’s daily functioning and sense of control, offering a powerful new option for those who can’t or don’t want to use hormone therapy.
Study: Self-Administered Hypnosis vs Sham Hypnosis for Hot Flashes. Image credit: fizkes/Shutterstock.com
A recent study published in the open-access journal JAMA Network Open compares self-hypnosis with sham hypnosis in the management of hot flashes in menopause.
Understanding menopausal hot flashes
Many postmenopausal women report that hot flashes significantly reduce their quality of life. These occurrences consist of a sudden feeling of widespread heat and flushing, often accompanied by sweating, discomfort, thirst, anxiety, and sleep disruption. They affect up to 80% of menopausal women, persisting for up to six or seven years from onset.
Hormone replacement therapy for hot flashes is effective at controlling the symptoms. Still, many women cannot use hormone therapy, including those above the age of 60 years, or with a history of gynecologic cancer (uterus or breast), thromboembolism, or heart disease. Clinical hypnosis is considered safe and effective as a non-hormonal method of managing this symptom, but women find it difficult to access. Its mechanism of action is also unclear.
The current study aimed to directly compare self-administered hypnosis with sham hypnosis in menopausal women with hot flashes for the benefit of reducing hot flash severity, making allowance for differences in treatment adherence when calculating the effect of treatment.
The women behind the data
The study was conducted at two American universities as a single-blind randomized trial. It included 250 postmenopausal women experiencing at least four daily, or 28 weekly, hot flashes. The mean age was 56 years.
About a quarter had a history of breast cancer, thus making them unsuitable for hormonal therapy. Moreover, hot flashes often set in more abruptly in these women due to the sudden onset of menopause with cancer treatment.
The participants were randomized to receive sham hypnosis vs self-administered clinical hypnosis. The frequency and severity of hot flashes were evaluated as their product to obtain a hot flash score.
Hypnosis was induced through a 20-minute daily audio session that suggested various relaxation methods, accompanied by cooling imagery. The sham hypnosis consisted of white noise labeled as “hypnosis” to match expectancy, for the same period. This compensates for placebo effects as well as the mental expectancy induced by the intervention, without actually involving hypnosis.
The women were assessed for hot flashes and perceived benefits at six weeks from baseline, with a follow-up assessment at 12 weeks.
How symptoms improved
The study showed that hot flash scores fell more significantly with self-administered hypnosis compared to sham hypnosis at six weeks. That is, hot flash scores in the hypnosis group improved by 53% vs 41% in the sham hypnosis group. Thus, the improvement with hypnosis exceeds the 50% threshold required for clinical significance.
Women in the hypnosis group were more likely to report less disruption of daily life from hot flashes after the intervention, with a mean Hot Flash Related Daily Interference Scale (HFRDIS; score range, 0 to 100) score decrease of 49% compared to 37% in the sham group, rather than 49% vs 37% of women reporting improvement.
Over 90% of the women in the hypnosis group reported it to be beneficial vs 64% in the sham hypnosis group, using the Subject Global Impression of Change.
These findings confirm that compared to cognitive behavioral therapy (CBT), the only other commonly used behavioral method in the management of hot flashes, clinical hypnosis “continues to consistently demonstrate clinically significant reductions in hot flash symptoms” in contrast to the less concrete findings with CBT.
The white noise used in the sham hypnosis group served as an active control, demonstrating the beneficial effect of the placebo, although it fell below the significance threshold. Intervention adherence significantly influenced treatment benefits, with greater practice associated with greater symptom reductions.
At 12 weeks, reductions in hot flash scores were maintained in both groups, with the hypnosis group continuing to show larger improvements.
Implications for treatment
The study indicates that hypnosis self-administered via audio files is more effective than sham hypnosis in managing hot flashes, reducing their frequency and severity by more than half. While the difference in symptom trajectory over time did not reach statistical significance at the prespecified threshold, the between-group difference at six weeks was significant.
Further research is required to determine the duration and long-term effects of this treatment on the symptom.
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