Can Hypnosis Reduce Hot Flashes in Breast Cancer Survivors? A Literature Review

American Journal of Clinical Hypnosis,  Jul 2004  by Elkins, Gary,  Marcus, Joel,  Palamara, Lynne,  Stearns, Vered

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The Potential Use of Hypnosis to Reduce Hot Flashes

Clinical hypnosis may be identified as a mind-body therapy that often involves a deeply relaxed state and mental imagery (Elkins & Handel, 2001; Hammond & Elkins, 1994; Woody, Bowers, & Oakman, 1992). The hypnotic state has been described variously as being an altered state of consciousness, focused attention, imaginative involvement, and role assumption. However, it is generally agreed that hypnosis is a "state or condition, which occurs when appropriate suggestions elicit distortions of perception, memory or mood" (Orne & Dinges, 1989). There have been a few studies that suggest that stress management methods (Stevenson & Delprato, 1983) or group hypnosis (Younus, Simpon, Collins, & Wang, 2003) may be helpful in managing menopausal symptoms. However there have not been any randomized clinical trials of hypnosis for hot flashes. Our clinical experience has suggested that hypnosis may be of significant benefit in reducing the frequency and severity of hot flashes by: (1) suggestions for coolness and comfort; (2) reducing the anxiety; (3) decreasing psychological stress; and (4) improving sleep in breast cancer survivors with hot flashes.

Suggestions for Coolness

Hypnosis usually involves the use of mental imagery. A hypnotic induction may include suggestions for imagining one is in a pleasant place such as walking through a garden, feeling a cool breeze, or drinking cool water. It has been demonstrated that highly hypnotized persons are able to experience an alteration in perception and report feeling and experiencing the mental imagery that is suggested (Weitzenhoffer & Hilgard, 1962). For example, hypnosis has been used with migraine patients with suggestions for peripheral (hand and foot) warming and central (head) cooling (Diamond & Friedman, 1983). Suggestions for cooling have also been used with patients suffering from sympathetic reflex dystrophy and other types of pain (Chaves, 1993). Further, hypnotic suggestions for "coolness" have been associated with a decrease in peripheral skin temperature (Peters, Lundy, & Stern, 1973). Because hot flashes are episodes of thermoregulatory dysregulation, women report that standing in front of an open refrigerator or air conditioner helps to ameliorate the discomfort (Kronenberg, 1990). Also, an increase in body temperature precedes most hot flashes (Freedman, 1998). Our clinical experience has indicated that breast cancer survivors with hot flashes are also able to utilize and benefit from mental imagery for coolness and learning self-hypnosis methods.

Suggestions to Manage Anxiety

Additionally, hypnosis involves suggestions for deep relaxation and has been found to be of significant benefit in reducing anxiety (Elkins, 1987; Wadden & Anderton, 1982). In this regard, hypnosis has been successfully used with cancer patients to induce relaxation and to reduce anxiety and distress (Gruberet al., 1993; Decker, Cline-Elsen, & Gallagher, 1992; Araoz, 1983; Burish, Snyder, & Jenkins, 1991). Several studies have suggested that hypnotic relaxation is of benefit to cancer patients for managing anxiety. For example, Gruber et al. (1993) randomly assigned breast cancer patients to receive either relaxation, guided imagery, and biofeedback training, or delayed treatment. Results showed a significant reduction in anxiety that was apparent shortly after each group began the intervention. Kraft (1990) completed a study of the possible value of hypnotic relaxation in the management of anxiety in 12 terminally ill patients with cancer. This is important because previous research has also suggested that many patients with hot flashes experience anxiety that may contribute to symptoms (Kronenberg, 1990). Therefore it is reasonable to speculate that hypnosis may be of benefit in reducing anxiety and the onset and severity of hot flashes.