16 January 2018
A new study published this year (link below), covers the little discussed area of the use of hypnosis for sedation during surgery. Whilst the use of hypnosis is becoming more widely researched, in fields such as pain management and pre-surgery anxiety, there is less formal research of its use during surgery itself.
300 patients in a Breast Clinic, in Belgium, took part in this study, which had the intention to explore whether a hypnosis intervention could decrease the side effects of breast surgery. It was a comparative study; 150 patients had general anaesthesia for their surgery (group 1), and 150 patients had hypnotic sedation (group 2).
The hypno-sedation was performed by anaesthesiologists, who conducted a pre-operative consultation and pre-talk, that included hypnotic modalities and the procedure that would be undertaken. They also used this time to check for suitability for hypno-sedation.
In theatre, the anaesthesiologist used an eye fixation and muscle relaxation induction approach, to lead into focus on a positive memory, with the use of permissive and indirect suggestions to enhance dissociation.
The hypno-sedation patients’ surgery was not entirely without medication support. As a pre-medication, Lorazepam was given, an hour before surgery, and this can have sedating and anxiety-reducing effects. For some patients, during surgery, they were given Remifentanil, which can have sedative effects, for others, they were given Midazolam, as an anxiolytic (reduces anxiety).
A signalling system was established and if the patient indicated discomfort, the anaesthesiologist enhanced the strength of the hypnotic state and there were the options for local anaesthetic and medicated sedation. The aim being to maintain a consistent level of comfort throughout the surgery.
At the end of the surgery, hypnotic suggestions were given for ongoing maintenance of comfort during the post-operative period, for healing, and wound care.
The results are very positive in their support of hypnotherapy as an effective resource during and after surgery. The hypno-sedation group had a 25% shorter hospital stay and less anxiety. Furthermore, for those patients who went on to chemotherapy, there was less nausea and vomiting. For those on subsequent endocrine therapy, there was a reduction in symptoms including less hot flashes, joint and muscle pain.
Interestingly, the duration of the surgery had no significant differences between patients having general anaesthesia and hypno-sedation. However, for the hypno-sedation patients, the average (mean) duration of surgery was marginally less for each category of surgery (whether lumpectomy or mastectomy).
Anxiety levels were measured for all patients, pre, and post-surgery. Whilst anxiety levels were similar in both groups prior to surgery (8.86 in group 1 / 8.91 in group 2, scored out of 10), there was a very significant reduction in anxiety in the hypno-sedation group (4.12 in group 1), whilst there was barely any reduction in the general anaesthesia group (8.66 in group 2).
The authors of the journal article which published this research suggest that emotional distress that is related to medical procedures has both direct effects on suffering, and also ongoing (‘downstream’) consequences of distress. They recognise that reducing distress, will improve the patient experience.
Implications for hypnotherapists
This research is relevant to the hypnotherapist in several ways that can be incorporated into your practice:
Effectiveness of approaches for hypno-sedation
No difference in surgery duration
Reduced patient anxiety post-surgery
Reduced post-surgery hospitalisation
Reduced symptoms relating to surgery and subsequent treatment
Inducing and maintaining hypno-sedation
The approach taken to induce hypnosis was not a complex approach. The techniques are commonly taught in practitioner level training. The concept of external fixation, by, in this instance, looking at something to take the focus away from the individual’s inner experience, sets the patient up nicely for dissociation. The following progressive muscle relaxation (PMR) is a well-established method of reducing physical tension and this can generate a reduction also in mental tension, and enhance dissociation further. The subsequent dissociation to, and engagement in, a pleasant past experience can occupy the patient throughout the procedure. This approach could be taught to your suitable hypnotherapy clients (those with sufficient suggestibility and who have a good ability for attaining depth) for use in self-hypnosis, or during minor procedures, such as dental work. Here, your client could be taught how to enter hypnosis, using the eye fixation and PMR and then going to a favourite place or a positive past memory, such as a good holiday. It can be helpful to set up engagement with the experience in advance, so that your client can be fully immersed using all their senses. Furthermore, it can be even more beneficial, for some clients, to have them actively engaged in the experience, such as a home improvement (DIY) project, a visit to a fun-fair, or a long and scenic hike.
Where, as a hypnotherapist, you are able to attend the surgery or dental work, in person, during the procedure, this approach could also be undertaken, and would most likely conducted under the supervision of an anaesthetist.
If you were to ask a doctor, or dentist, whether they would use hypno-sedation, their answer would, most likely, support a common belief that the surgical procedure would take longer. This research dispels that misconception. Indeed, the duration was a little shorter for the patients undergoing hypno-sedation. This can be useful information to share with medics when you are discussing with them, the potential for your client, their patient, to benefit from hypno-sedation.
Post-surgery anxiety reduction
It is well established, and supported by research, that high levels of anxiety or stress reduce healing and recovery. Hypnotherapy is highly effective in reducing stress and anxiety. Furthermore, techniques, including self-hypnosis and cognitive approaches, can easily be taught to clients, to enable benefits to endure, and clients to develop skills for self-care.
Reduced post-surgical hospitalisation
The sooner a patient is able to leave the hospital, the less likelihood there is of them developing a hospital-acquired infection. Furthermore, people tend to recover better when they are in their own home environment. They are likely to be more active, more engaged and more focused on their recovery. So, post-hypnotic suggestions for a prompt and effective recovery, with good self-care (including exercise, wound management and medication compliance) can optimise your client’s recovery in many different ways.
For many patients, being able to avoid the potential risks of general anaesthesia, is both medically and psychologically helpful. Furthermore, these patients are likely to mobilise quicker after hypno-sedation than after general anaesthesia, and this can reduce post-surgical complications. By achieving a reduction in symptoms arising from surgery and any subsequent treatment, your client will be able to recover quicker and more effectively. The better they feel within themselves, the sooner they will return to a positive and healthy, normal mental and physical state.
Whether your client seeks help to prepare for surgery, use hypno-sedation within it, optimise their recovery, or even all three, you can help them. This may be remotely, such as the client using self-hypnosis, or listening to an MP3 you have custom-recorded for them, or it may be in-person, as part of the intervention team. You can also support them, with a broad range of behavioural, cognitive and analytical approaches through their recovery and transition into normal (or better!) health.
You can view the full article; “The advantages of hypnosis intervention on breast cancer surgery and adjuvant therapy” here:
References & Further Reading
Berlière, M., Roelants, F., Watremez, C., Docquier, M. A., Piette, N., Lamerant, S., … & Duhoux, F. P. (2018). The advantages of hypnosis intervention on breast cancer surgery and adjuvant therapy. The Breast, 37, 114-118.
Gouin, J. P., & Kiecolt-Glaser, J. K. (2011). The impact of psychological stress on wound healing: methods and mechanisms. Immunology and allergy clinics of North America, 31(1), 81-93.
Kiecolt-Glaser, J. K., Page, G. G., Marucha, P. T., MacCallum, R. C., & Glaser, R. (1998). Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. American Psychologist, 53(11), 1209.
Prins, M. H., & Hirsh, J. (1990). A comparison of general anesthesia and regional anesthesia as a risk factor for deep vein thrombosis following hip surgery: a critical review. Thrombosis and haemostasis, 64(4), 497-500.
We hope this blog on hypnosis research and breast surgery has been helpful, and if you have any questions relating to this blog, do please get in touch, because we’re always happy to help!
– written by Dr Kate Beaven-Marks