Effect of Self- Hypnosis in Patients Undergoing CABG
May 1998; Volume 1: 59-60
Source: Ashton C, Whitworth GC, Seldomridge JA, et al. Self-hypnosis reduces anxiety following coronary artery bypass surgery-a prospective, randomized trial. J Cardiovasc Surg 1997;38:69-75.
Ashton and coworkers designed a prospective, randomized, controlled, surgeon-blinded trial to evaluate the effects of self-hypnosis and its role in coronary artery bypass surgery (CABG).
A total of 32 patients undergoing first-time elective CABG were randomized into two groups. The study group was taught self-hypnosis relaxation techniques preoperatively; the control group received no therapy. Patients who were taught the techniques were significantly more relaxed postoperatively than the control group (P = 0.032). Pain medication requirements were significantly lower in patients practicing the techniques than those who were noncompliant (P = 0.046). No differences were noted in intraoperative parameters, morbidity, or mortality. Patients were followed until time of discharge.
COMMENT
Surgeons and a psychiatrist from Columbia University in New York teamed up to assess preliminarily the utility of self-hypnosis relaxation techniques, a form of behavior modification. The night before surgery, patients were instructed to focus on and practice breathing deeply, relaxing their jaw and throat muscles, keeping the incision free from infection, minimizing bleeding, reducing pain and discomfort, and maintaining normal blood pressure. After surgery, they were asked to practice relaxing, reducing pain and discomfort and infection, normalizing blood pressure and appetite, healing quickly, and returning to "normal or customary lifestyle."
The 32 patients were randomized into a group of 20 (hypnosis) and 12 (control) using age, sex, and the Hypnotic Induction Profile (HIP), which assesses "the degree to which an individual can control dissociation, become absorbed, and accept suggestion." All hypnosis patients reported practicing the techniques pre-operatively; 65% practiced post-operatively.
Intraoperative pain management, bypass time, and length of stay were not different between the two groups. Three complications, including a sternal dehiscence, occurred in the hypnosis group; one occurred in the control group.
The authors did not use objective measures to measure pain, noted the "positive experience" had by all who participated, and the effect of crossover contamination of the control group by the screening HIP.
Recommendation
This incomplete study does not demonstrate the beneficial effects of self-hypnosis, or even that self-hypnosis occurred. The investigators' time constraints and the limits of their protocol do not permit them to generalize about the effectiveness of self-hypnosis or relaxation techniques. This is a shame, as the hypothesis that teaching patients self-hypnosis relaxation techniques could improve outcomes is eminently testable. Hypnosis, which has been effectively used as a means of anesthesia for valve surgery, awaits focused peri-operative attention.
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