Hypnotherapy for insomnia: A randomized controlled trial comparing generic and disease-specific suggestions

• Published in: Complementary therapies in medicine 2018-12, Vol.41, p.231-239
• Main Authors: Lam, Tak-Ho, Chung, Ka-Fai, Lee, Chit-Tat, Yeung, Wing-Fai, Yu, Branda Yee-man
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anxiety; Bias; Blindness; China; Clinical trials; Disease control; Disease-specific suggestions; Evidence-based medicine; Expectancy; Female; Generic suggestions; Humans; Hypnosis; Hypnotherapy; Insomnia; Male; Medical research; Mental depression; Mental disorders; Middle Aged; Patient Satisfaction; Randomization; Randomized controlled trial; Sleep; Sleep disorders; Sleep Initiation and Maintenance Disorders - therapy; Systematic review; Young Adult
• ISSN: 0965-2299; 1873-6963
• DOI: 10.1016/j.ctim.2018.10.008

•We conducted the first controlled trial comparing generic and disease-specific suggestions in hypnotherapy for insomnia.•4-week once-weekly course of hypnotherapy produced significant time effect but no between-group difference.•Early treatment termination was 10% but none due to adverse events, while a report of unpleasantness varied from 5.5% – 7.4%.•Our data cast doubts about the value of disease-specific suggestions in hypnotherapy for insomnia. Hypnotherapy is commonly used for treating insomnia, but a definite conclusion regarding its safety and effectiveness is unavailable due to a lack of adverse event monitoring and comparison between generic and disease-specific hypnotic suggestions in previous studies. Randomized controlled, participant-blind, parallel-group with subject recruitment after trial registry. Sixty participants were randomized to receive 4-week once-weekly 1-hour hypnotherapy with disease-specific suggestions (using counter-hyperarousal hypnotic exercise and screen visualization technique targeted at insomnia-related anxieties) or generic suggestions (using thought distraction technique and suggestions for self-confidence and self-care enhancement). Primary outcome was sleep efficiency (SE) derived from 1-week sleep diary at weeks 4, 6 and 9. Secondary outcomes included other sleep-diary parameters, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Sheehan Disability Index. Treatment expectancy, adverse events (AEs), and subjective experiences were obtained after hypnotherapy sessions 2 and 4. Mixed linear modeling showed that time effect was significant for most variables. Within-group effect size of sleep-diary-derived SE from baseline to follow-up ranged from 0.70 to 0.90 for disease-specific suggestions (mean difference: 8.5–10.4%); for generic suggestions, it was 0.65–0.69 (mean difference: 6.8–8.3%); however, no significant between-group difference was found. Discontinuation rate was 10%, report of unpleasantness varied from 5.5 to 7.4%, while the incidence of AEs ranged from 37.0 to 51.8%, depending on session content. Hypnotherapy using disease-specific and generic suggestions produced similar improvements in sleep and daytime functioning. AEs were common but mostly mild. The finding raises doubts about the value of disease-specific suggestions in hypnotherapy for insomnia. This clinical trial was registered on 23 May 2014 at the University of Hong Kong Clinical Trials Registry as “Hypnotherapy for insomnia