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Hypnosis quells postmenopausal hot flashes.


NEW ORLEANS--A five-session hypnosis program reduced the frequency and severity of postmenopausal hot flashes by 80%, according to the results of a randomized, controlled trial.

"When properly applied, [hypnosis] can be a safe and effective treatment for hot flashes. And side benefits appear likely. We had a lot of women comment that they were generally feeling better; improvement in sleep was a big deal," Gary Elkins, Ph.D., said in presenting the results at the meeting.

Dr. Elkins and his colleagues randomized 184 postmenopausal women with moderate to severe hot flashes to either five weekly hypnosis sessions or a structured attention control condition of equal duration.

Hot flash frequency and severity scores as recorded in patients' daily hot flash diaries decreased by about 70% at 5 weeks and even further to 80% at 12 weeks of follow-up, 7 weeks after the intervention ended, reported Dr. Elkins, professor of psychology and neuroscience at Baylor University in Waco, Tex.

Another key study end point was change in physiologically measured hot flashes obtained via a 24-hour skin conductance monitor sensitive to sweating; this tool was particularly helpful in getting objective data on nighttime hot flashes. Hot flashes as documented by the monitor, the Biologic HF Recorder with computer linkage, declined by about 50% at 5 weeks and 60% at 12 weeks. In contrast, the control group showed a 10% decrease in hot flashes at 5 weeks and a 15% reduction at 12 weeks.

Secondary end points assessing sleep, depression, and hot flash--related interference with daily life also showed marked improvement in the hypnosis group. (See chart.)

The intervention entailed hypnotic induction with relaxation and direct and indirect suggestions, dissociation, and mental imagery evoking coolness, such as walking down a mountain path on a cool day. The imagery was individualized to incorporate places a patient had been and things she'd experienced. The emphasis was on teaching patients self-hypnosis with the goal of patient empowerment, the psychologist explained.

Results with the hypnosis intervention compare favorably with studies of other proposed treatments for hot flashes. For instance, the nonpharmacologic therapies black cohosh, soy, and vitamin E have been shown "virtually indistinguishable" from placebo, according to Dr. Elkins.

Venlafaxine and selective serotonin reuptake inhibitors have achieved roughly a 50% reduction in hot flashes in clinical trials. Although that's a clinically meaningful improvement, it's a weaker effect than seen in the hypnosis trial. Moreover, Dr. Elkins noted, some women don't want to take drugs or they experience limiting side effects. Hormone replacement therapy, formerly the standard treatment for hot flashes, has fallen into disfavor since the 16,000-subject Women's Health Initiative was halted early because of a 26% increase in breast cancer, a 29% increase in coronary heart disease, and a 41% greater risk of stroke than in the placebo arm (JAMA 2004; 29:1701-12).

The critical next step in this hypnosis research project is to disseminate the required therapeutic skills as widely as possible. After all, it's estimated that more than 25 million American women experience hot flashes, and 4 million of them are severely affected.

Dr. Elkins and his coinvestigators are pursuing a twofold dissemination strategy. They are developing a treatment manual for interested health care professionals, although "that's still not going to create an army of practitioners," Dr. Elkins noted. So in addition, the investigators plan to put a guided hypnotic intervention on a CD for self-treatment. "That could be very widely distributed. Even if it's not quite as effective, I think that's going to be the long-term way to go," he said.

The trial was funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine. Dr. Elkins and his colleagues reported having no financial conflicts.
Hypnosis for Postmenopausal Hot Flashes: Secondary End Points

 Hypnosis group Control group

Hot Flash-Related Interference Scale -68% -20%

Center for Epidemiologic -60% -16%

Studies-Depression Scale

Pittsburgh Sleep Quality Index -50% -11%

Hospital Anxiety and Depression Scale -43% -48%

% Reduction in Score From Baseline to End Point

Note: Based on data for 184 women with moderate to severe hot flashes.

Source: Dr. Elkins

Note: Table made from bar graph.
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Author:Jancin, Bruce
Publication:Clinical Psychiatry News
Date:Jul 1, 2012
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