May Research Snippet: Multiple Sclerosis

Apologies for the delay, but here we are again… Research snippets… but first some news…

Stephanie Kirke’s research on hypnotic pain management, sponsored by NCH, is nearing publication and that will probably be summarised in the NCH Journal.

Incidentally, the NCH page on Facebook now has over 300 members and we’re posting research snippets there on a regular basis. There are now ways to subscribe to various RSS news feeds online whereby you can receive updates on research news and journal articles as they’re published, updated in real time. Scientific American even have a news feed that links to 60 second audio podcasts summarising news snippets about psychology, much of which would be of interest to hypnotherapists. You can beam psychology factoids directly into your brain via your ipod while you’re playing sardines on the underground. Technology races ahead of us!

I should also give a plug for my own research into cognitive-behavioural hypnotherapy for noise-related stress, and my historical article in this month’s IJCEH, which presents a backward translated version of James Braid’s last article On Hypnotism (1860), also published in the new NCH book The Discovery of Hypnosis: The Complete Writings of James Braid, the Father of Hypnotherapy. You can now order the book online at Amazon UK. In the same edition of IJCEH as Braid’s “lost manuscript” we find an intersting outcome study by a team of ten (!) researchers, let’s call them Jensen, Barber, Romano, et al., entitled ‘A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain’ (IJCEH, 57(2): 198-221).

Twenty-two participants were recruited for this study (which is just short of the 25 required for an empirically-supported treatment). Self-hypnosis was compared head-to-head against progressive muscle relaxation (PMR) for its ability to help management of pain in multiple sclerosis and, basically, those receiving self-hypnosis reported significantly greater pain reduction during sessions, and following treatment, than those using PMR., this was maintained at 3-month follow-up. (The use of an established relaxation technique as an active treatment control group serves here as a valid alternative to a placebo control group.)

Two predictor variables were measured: hypnotic susceptibility and the Treatment Expectancy Scale (TES). The TES is a common measure of expectancy which I think might have some useful applications in clinical practice. It basically asks the client to rate their response to four questions (0-10),

1. How logical does this type of treatment seem to you?
2. How confident are you that this treatment will be succesful in eliminating your symptoms?
3. How succesful do you feel that this treatment will be in reducing your symptoms?
4. How confident would you be in recommending this treatment to a friend who is suffering badly from the same symptoms?

Despite having similar outcome expectations, however, in both relaxation and self-hypnosis groups, the hypnotic subjects experienced more improvement. In other words, their improvement probably exceeded the effect of expectation alone. However, overall there was a moderate correlation between expectation and outcome across both groups (r=.40). In other words, expectation probably contributed substantially but does not account for all of the effects of self-hypnosis. Hypnotic susceptibility, by contrast, was not found to correlate with outcome. (Both findings which have been reported in other studies.)

Analysis of the levels of clinically significant reduction in pain showed that at 3-month follow-up, 47% of self-hypnosis subjects reported clinically meaningful pain reduction compared to only 29% of the relaxation group. (Although below 50%, this is a reasonably good outcome for a clinical trial of this kind.)

This study provides some support for the view that relatively simple self-hypnosis techniques can be effective in managing pain associated with multiple sclerosis, and is substantially superior to relaxation training, and probably therefore superior to placebo. It adds further to the body of evidence showing that treatment outcome expectations are an important factor in determining the outcome of therapy, but far from being the only factor. And it also adds to those studies which question the value of hypnotic susceptibility scales in predicting treatment outcome. Either these scales are flawed, perhaps because they measure the wrong type of responses, or being highly hypnotisable isn’t more helpful than being moderately hypnotisable when it comes to the kind of suggestions used in therapy.