Hypnotherapeutic Ego Strengthening with Male South African Coronary Artery Bypass Patients

American Journal of Clinical Hypnosis,  Oct 2004  by de Klerk, Jacoba E,  Plessis, Wynand F du,  Steyn, Hendrik S,  Botha, Mike

• E-mail
• Print
• Link

Hypnotherapy offers abundant ego strengthening techniques for patients' preparation and follow-through during CABS. Hypnotherapeutic ego strengthening (HES) techniques are potentially powerful because they increase conscious, unconscious, and superconscious complementarity and endeavour to activate deep internal healing powers. Thus the patient's ability to access inner resources and activate internal survival mechanisms is enhanced, although little is known about the nature and effectiveness of these techniques (Phillips, 2000). However, no research concerning the effectiveness of HES in pre- and postoperative management of CABS patients could be traced. The use of inner-strength techniques and other interventions associated with HES has only been partially realized and deserves further exploration (Frederick & McNeal, 1999).

Since the treatment of anxiety and depression is crucial to patient recovery, we hypothesized that hypnotherapeutic techniques would be useful to complement conventional medical treatment. Our study was designed to evaluate the use of an HES intervention in facilitating patients' ability to cope with the psychological stresses of hospitalization and surgery associated with CABS.

Method

Research Data

A two-group three-time point design was used.

Participants

Fifty White, married, Afrikaans-speaking males, scheduled for their first CABS, were randomly allocated to an experimental (n = 25) and a control group (n = 25) respectively. All 50 participants completed the study until follow-up. Differences in morbidity amounted to a single patient who returned to theatre because of insufficient attachment of the bypass graft. In view of this complication the patient was excluded from the study and replaced by another. Their mean age was 56 years, on average they attended 12 years of education, and were admitted to Unitas Hospital (Pretoria, Gauteng Province) one day prior to surgery.

Research instruments

Biographical Questionnaire. The principal researcher developed a biographical questionnaire as a framework for the initial interview with couples which tapped the following variables: age, education, marital status, cardiac history, family health, life Stressors, and social support.

Beck Depression Inventory (BDI-II; Beck, Steer, & Brown, 1996). This 21item multiple choice questionnaire was developed to detect overt manifestations of depression. Scores range from 0 to 13 (minimal), 14 to 19 (mild) and 29 to 63 (severe), with higher scores indicating progressively severe levels of depression.

Profile of Mood States (POMS; McNair, Lorr, & Droppleman, 1992). This 65-item self-rating adjective checklist was designed to measure negative mood states like anxiety and depression. Though not scaled from mild to severe, the higher the score, the greater the degree of psychological distress.

Statistical analysis.

To determine pre-intervention group comparability, categorical biographical variables were compared by means of a chi-square analysis and the significance of differences between groups was determined by means of t tests. P values were noted in terms of which the degree of statistical significance between groups was established. A two-way ANOVA with a group factor and a repeated measure factor over time was performed, from which the group by time interaction was assessed. The software system Statistica (StatSoft, Incorporated, 2003; data analysis software system, version 6, www.statsoft.com), was used for the statistical analysis of the data. To compare the means within and between groups in a multiple way, a Bonferroni-adjusted 0.0083 comparison-wise level of significance was used, which led to a family-wise level of at most 0.05. For statistically significant findings, effect sizes were calculated according to Cohen's d (Cohen, 1988) to determine the practical significance of the HES intervention. Using Cohen's guidelines, large practical differences were indicated by d = 0.8, minor possible differences by d = 0.2, while an effect size of d = 0.5, was regarded as indicative of a tendency towards practical difference. A 95% confidence interval was reported as interval estimate for each of the baseline, posttest, and follow-up means (Easton & McColl, 2002).