Authored by Francesca Vescovelli*
Abstract
Objectives: Hypnosis showed beneficial effects in terms of symptom relief in patients suffering from neurodegenerative conditions. Little is known about the effects of hypnosis on well-being, quality of life and personal resources of these patient populations. This narrative review aimed to summarize and discuss existing studies, which investigated improvements in well-being in patients with neurodegenerative disorders following hypnosis treatment.
Methods: A narrative review was performed in English databases with specific keywords “neurological disease or illness and hypnosis”, “hypnosis and positive psychology” and “hypnosis and well-being”. Eleven studies (with a total of 178 patients) were found which applied hypnosis for neurodegenerative disorders (Parkinson’s disease, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, etc.).
Results: Hypnosis demonstrated beneficial effects, improving patients’ physical well-being and quality of life. Hypnosis was also found to promote existential well-being and resilience.
Conclusions: The majority of studies produced improvement in patients’ well-being. This points to the possibility of applying hypnosis aimed at increasing well-being as a complementary therapy for patients with neurodegenerative disorders. More controlled investigations are needed.
Keywords:Neurodegenerative disorders; Hypnosis; well-being; Embodiment; Relaxation; Complementary therapy
Introduction
Neurological and neurodegenerative disorders are medical conditions that primarily affect the neurons in the human brain, producing a variety of physical and psychological symptoms and complications. They often tend to be progressive, chronic and incurable, seriously hampering patients’ physical and psychological health [1]. Some of the most frequent types of neurodegenerative diseases include Alzheimer’s disease (AD), Parkinson’s disease (PD), Multiple Sclerosis (MS), Amyotrophic lateral sclerosis (ALS), and Huntington’s disease (HD). These disorders comprise of a progressive deterioration of motor neurons and functions and are associated with a variety of unpredictable symptoms, which affect sensory-tactile, motor, visual, bladder, sexual and bowel functioning. These disorders could be disabling and impair patients’ daily functioning. It is therefore important to consider psychological interventions, such as hypnosis, that could represent a complementary promising therapy to address these symptoms and which could also add to patients’ quality of life and well-being [2].
Historically, studies on individuals suffering from neurodegenerative diseases and other chronic conditions were based on a psychiatric and neurological perspective and mainly focused on their possible negative psychological consequences [3-5]. However, the World Health Organization defined health not merely as the absence of disease or symptoms, but as “a state of
complete physical, mental and social well-being” [6]. Consequently, the focus of research on chronic medical conditions started shifting towards also investigating well-being and other related concepts of positive psychological functioning. These themes are the focus of investigation of positive psychology. This relatively new field focuses on the scientific study of those factors that enable individuals to flourish and function optimally [7]. Accordingly, it explores conditions, processes and mechanisms that contribute to well-being and positive psychological functioning. It is important to state that positive psychology does not intend to ignore negative aspects of being human, such as emotional or physical suffering and psychological disorders. Rather, it aims to provide a complementary focus on the positive to allow for a broader understanding of the human experience [8].
Positive psychology theories have been applied both with normal and clinical populations, including individuals with psychological and medical illness in order to gain a more extensive understanding of their psychological experiences [9,10].
FFrom this perspective, it became evident that positive characteristics and resources such as the experience of well-being, positive emotions, gratitude, posttraumatic growth, and meaning may be linked to each other and associated with better psychological adaptation to illness, including neurodegenerative conditions [9-12]. Furthermore, the experience of well-being and positive emotions seemed to positively influence biological parameters involved in the aging process, thereby protecting psychological and physical health both in healthy and clinical populations [9-18].
These dimensions also seem to play a crucial role in the psychological adaptation of patients suffering from neurodegenerative disorders [9,10]. Such disorders may have many disabling consequences, but at the same time, given their lifethreatening nature they may implicate a process of personal growth and the achievement of new existential changes. They could lead patients to experience a personal journey of psychological growth, search for meaning and process of embodiment that may promote their adaptation to the illness [19,20].
Physical illness may be experienced as traumatic events that could produce not only psychological disabilities and symptoms, but often physical and body changes and transformation. The modification of the relationship with one’s body, the physiological processes of the body and the perception of the representation of the body are thus central to adjusting to living with these critical events, and in particular, neurocognitive disease.
Embodiment can be defined as an “awareness of and responsiveness to bodily sensations”, and also as “thoughts, feelings and behaviours that are grounded in sensory experiences and bodily states” [21,22]. The experience of psychological embodiment may allow individuals who suffer from medical illness and neurological disorders to develop greater body awareness. It reflects a process in which individuals could both correctly identify and recognize body sensations and link these body sensations to emotions [23,24]. Body awareness has been linked to subjective well-being within healthy individuals, any may therefore be equally, if not more important, to individuals suffering from neurological conditions [24]. Therefore, interventions, which could support body awareness using the mind-body connection, such as hypnosis, may be useful to these patients.
Research on interventions, conceptualized and implemented from a positive psychology stance, has burgeoned in the past decade. Positive interventions are strategies aimed at promoting positive emotions, thoughts and behaviors, which, in turn, are associated with increased well-being [25]. These empirically validated activities are based on theories of positive psychology. There is increasing evidence that positive interventions could increase wellbeing but also contribute to recovery and relief from pain, distress and psychological symptoms [25,26]. Further, there has been an increased focus on implementing positive interventions in clinical settings and in combination with existing psychotherapeutic strategies, such as cognitive behavioural therapy [27,28]. Hypnosis as therapeutic strategy could also be implemented in the context of positive interventions, through its focus on building positive psychological resources [29,30]. Specifically, hypnosis could potentially be applied to increase positive psychological functioning in the context of medical illnesses, as evident from the large body of research on its application as psychotherapeutic intervention for improving mental and physical health of patients with medical problems [31,32].
In this context, hypnosis could be useful to address patients’ physical symptoms and build personal resources for example through promoting both pain relief [33,34], and well-being [35,36]. Additionally, implementing hypnosis aligned with the goals of positive psychology, that is, to identify and promote individuals’ well-being and psychological resources, may be particularly important in the aftermath of medical illness in general and presence of neurocognitive disorders in particular. However, to our knowledge, there are only a few examples of research that applied hypnosis explicitly to promote well-being from the perspective of positive psychology. These include hypnosis for the treatment of childhood sexual trauma [37], for improving well-being during pregnancy and the post-partum period [35,36], promoting wellbeing of coronary artery bypass patients [38], and patients with pain disorders [34,39].
At the same time, there are some studies which allude to the implementation of hypnosis to improve well-being in medical conditions in general [40,41], and neurodegenerative disorders specifically [2], without explicitly implementing a positive psychology framework. Moreover, Jensen and colleagues state that hypnosis may lead to additional beneficial outcomes [34,42], such as increased well-being, for patients with chronic health conditions. Yet, well-being was not conceptualized as a comprehensive construct, unlike other studies using positive psychology theory [25,35-37].
The aim of this narrative review is to summarize and discuss existing studies, which implemented hypnosis and investigated possible positive experiences, changes and psychological resources reported by patients who suffer from neurodegenerative disorders. This can inform further development of hypnotherapeutic interventions to promote well-being in these patients and to complement their usual medical treatment.
Methods
We performed a narrative review to extract published scientific papers on the use of hypnosis for patients suffering from neurological illness with the aim of improving well-being. Terms such as “neurological disease or illness and hypnosis”, “hypnosis and positive psychology” and “hypnosis and well-being” were introduced in the databases. An electronic literature search on the following databases was undertaken: PubMed, Scopus, Ebsco, and Web of Science. We identified and reviewed the entire crossreferences of articles and book chapters, which described the use of hypnosis for neurological illnesses. Each of these selected articles of interest was entered one by one in the databases. If the database contained the article, a list of all cross-citing articles was created. The list of cross-citing articles was thereafter limited to the English language. No other search method was applied and the full search was conducted including articles from inception to December 2019. The Risk of Bias was calculated for each included study, and the results are presented in Table 1 [43].
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