Integrating Self-Hypnosis Training as an adjuvant therapy during Cancer Treatment
An increasing number of my patients amaze and delight me, by defying the doom-laden list of side effects I have to go through on the consent form covering the ‘predictable’ side effects of their Head and Neck irradiation. Some of their experiences include remarkably rapid transformations from being ‘nervous wrecks’ with long-standing severe claustrophobia and anxiety, to ‘chilled out’, optimistic people who manage their discomfort with barely more than Paracetamol, although the norm is moderate or high dose opiates. They maintain swallowing better, maintain their calorie intake so they lose less weight, and generally prove to be emotionally more resilient. Their secret weapon? Self-hypnosis.
There is no doubt that “Intensity modulated radiotherapy” having become the standard of care has helped reduce radiotherapy side effects. This method of beam delivery definitely reduces the volume of tissue receiving high dose regions, and markedly moderates the severity and longevity of the worst of the immediate and late side effects. However, if the regions treated includes both sides of the throat and neck, then the anticipated ‘meltdown’ dictates putting in a feeding tube or gastrostomy beforehand, to allow supplementary nourishment when the poor patient becomes too sore and unable to swallow sufficient calories. Invariably, this is a daunting prospect. Normally patients depend on gastrostomy supplements for several weeks from the latter part of a six-week course of radiotherapy, until a month or two afterwards, when they can again begin to swallow more comfortably. Taste recovery can take much longer.
If there was a treatment that significantly reduced side-effects across the board, safely, without interactions, and made patients happier into the bargain, we would definitely want that integrated to treatment! And if it reduced treatment costs by foreshortening supplementary feeding time or medication usage, shortened time in hospital, and improved the patient experience over-all, then, in this health service of ours, under-resourced and under-staffed, it would be perverse NOT to make this widely available, would it not? But of course there would need to be evidence this was so. Actually there is.
Research into Hypnosis has been accruing over the past 200 years. This includes some large, randomised studies, but in the main most are smaller trials. However, meta-analyses of hypnosis trials show consistent findings in favour of clinical hypnosis. Most studies have involved individualised hypnosis, but self-hypnosis also has been shown to be highly effective as well, especially when used repeatedly. Clinical hypnosis is used within a variety of healthcare pathways in some parts of Europe, but is a relatively rare asset within UK, and more routinely only accessed from within the private sector. So why is that?
There is some controversy about whether the term “Hypnosis” is a factor in promoting suspicion and scepticism, or whether this terminology actually helps to improve its effect. I am sure there are people who fall into both camps, both within the medical profession and beyond, but it all comes down to whether we trust the process involved. If the individual’s only exposure to ‘hypnosis’ has been from within the entertainment industry, then its therapeutic potential is not demonstrated. Nowadays this is often the case within the medical profession, which tends to undermine its role within Medicine, as it is not routinely integrated into the mainstream medical school curriculum.
When I was at medical school, a stage hypnotist was commissioned to deliver an hour long ‘show’, but there was not much educational background given, and certainly no discussion of its integration into medical care, even within psychiatry, in the late 80’s. Fast forward ten years, and it was my chance introduction to a Neurolinguistic Programming open-evening that demonstrated a ‘quick phobia cure’ integrating hypnotic techniques, which eventually culminated in my undertaking a diploma course in clinical hypnosis. Of the 11 medics enrolled, there were about 4 psychiatrists and a couple of anaesthetists, but otherwise we comprised a wide spectrum of medical domains, of which I was the only oncologist.
I suspect we don’t realise we are all in and out of trance states throughout each day. For example, this occurs when waking, deeply focussed on any activity to the exclusion of all else, or the transition to sleep. The potential to assimilate positive suggestions within a trance state is an opportunity that is more frequently missed than utilised, and sadly within the medical school curriculum, education regarding Hypnosis is the exception rather than the norm, and thus many medics are no more informed than their patients.
There are many people who are good ‘hypnotists’ but don’t even know it. They may be good salesmen, effective clinicians, good friends, and they may achieve the desired goals through intuition, taught techniques, or empathic care without any analytical insight as to the processes that determine their success. Yet the power of using the right words, empathy, and empowering people to achieve a desired vision of the future are common factors.
As a young teenager, I seemed to be the only one of our household that could coax my mother out of her episodic bouts of deep melancholia. Her depressions would hit with unpredictable regularity, and might be accompanied by back pain, or at other times provoked by visits back to see her elderly mother, evoking painful childhood memories. The therapeutic impact of ‘talking therapies’ is well established, and of great value, but more often quite time consuming both for therapist and patient alike. It is rarely a ‘quick fix’.
Ever since I appreciated that words themselves could have transformative powers, my interest in psychology has grown. In fact, I was fascinated by the the mismatch between the physiological spectrum of responses to stress and pain within a ‘standard population’, and those reported within ritualistic settings, where feats of endurance were demonstrated, physiological ‘impossibilities’ achieved, and sporting records attained. Looking deeper at the processes invoked in all these settings, some form of meditation or trance states are invariably involved.
However, although medical knowledge has seen fantastic developments in technology, scientific insights into cellular immunology and neuroscience, there has been a comparatively small investment in research into communication, and cognitive behavioural techniques. This however, is beginning to change. There is a greater acceptance of mindfulness techniques and cognitive behavioural therapy, and there are many studies (more often smaller, and less frequently randomised) using hypnosis. This is perhaps not so surprising since major trials are usually funded by big Pharma, with a longer term view to profit margins and drug sales. Funding sources for larger studies into clinical hypnosis has proven far harder to come by.
So how can we bring these opportunities to a greater number of people who might benefit?
Well, the internet era and smart-phone technology may enable more of us to seek out information, but the source of that information is as important as the content. The breadth of healthcare information on the internet makes it daunting to find relevant material appropriate for your precise diagnosis and staging, and getting a sense that one can influence treatment decisions becomes ever less achievable with a sense of overwhelm. Thus any means to get a sense of perspective and calm, amidst the turbulent sea of emotions can be invaluable, particularly if it helps you navigate the information you need to ask appropriate questions, get personal support, and stay in control. Using web-based technology provides ever greater opportunities for self-care.
We have designed a spectrum of hypnotic audio files to address the most commonly experienced challenges our patients experience whilst receiving their cancer treatment. A key component of this is ‘Self -Hypnosis training’, and learning to use your imagination for therapeutic ends.
It is generally true that one size doesn’t fit all, and no single psychological approach will have the desired outcome for everyone. Just as there are off-the-rail fashions that have wide appeal and look almost as good as a personalised, tailored outfits, there are simple techniques utilising hypnosis, that CAN have profound, transformative benefits for those that use them in the right circumstances. Hypnosis could be an ‘adjuvant’ therapy used alongside all manor of medical, surgical or psychological treatment.
Every one of us needs to make time for self-care, and making space for that in this frantic world can be remarkably difficult. However, we have tried to design our audiofiles to fit into timeframes that will suit the waiting room, or treatment environment, so that what seems ‘wasted time’- waiting for someone else to make the next step to recovery happen – can be repossessed. By harnessing the means to be a motivated, calm, and involved partner in the healing process, you can relax and prime your immune system using these tools, so that you get the optimal benefit from treatment, even before it has started.