The Research

ANXIETY: A META-ANALYSIS

Keara E. Valentine, Leonard S. Milling, Lauren J. Clark & Caitlin L. Moriarty

Pages 336-363 | Received 09 Oct 2018, Accepted 07 Dec 2018, Published online: 28 Jun 2019

This meta-analysis quantifies the effectiveness of hypnosis in treating anxiety. Included studies were required to utilize a between-subjects or mixed-model design in which a hypnosis intervention was compared with a control condition in alleviating the symptoms of anxiety. Of 399 records screened, 15 studies incorporating 17 trials of hypnosis met the inclusion criteria. At the end of active treatment, 17 trials produced a mean weighted effect size of 0.79 (p ≤ .001), indicating the average participant receiving hypnosis reduced anxiety more than about 79% of control participants. At the longest follow-up, seven trials yielded a mean weighted effect size of 0.99 (p ≤ .001), demonstrating the average participant treated with hypnosis improved more than about 84% of control participants. Hypnosis was more effective in reducing anxiety when combined with other psychological interventions than when used as a stand-alone treatment.

Anxiety problems and anxiety disorders are some of the most impairing and costly mental health conditions in the United States. As a group, the anxiety disorders are also the most common of the mental disorders (American Psychiatric Association, 2013American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VAAuthor.[Crossref] , [Google Scholar]), with the lifetime prevalence in the US estimated to be approximately 29% of the population (Kessler, Chiu, Demler, & Walters, 2005Kessler, R. C.Chiu, W. T.Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the national comorbidity survey replication (NCS-R)Archives of General Psychiatry, 62(6), 617627. doi: 10.1001/archpsyc.62.6.617[Crossref][PubMed][Web of Science ®] [Google Scholar]). No doubt, there are many other individuals who suffer from significant anxiety symptoms but who do not qualify for a diagnosis of an anxiety disorder according to the criteria listed in the Diagnostic and Statistical Manual (American Psychiatric Association). According to the National Comorbidity Survey Replication (Kessler et al., 2005Kessler, R. C.Berglund, P.Demler, O.Jin, R.Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replicationArchives of General Psychiatry, 62(6), 593602. doi: 10.1001/archpsyc.62.6.593[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), among individuals with an anxiety disorder, an estimated 23% had serious impairment and 34% had moderate impairment. The economic costs associated with the anxiety disorders are staggering. One study estimated the total costs associated with the anxiety disorders in the US to be $46.6 billion, with about three-quarters of those costs attributable to reduced productivity (DuPont et al., 1996DuPont, R. L.Rice, D. P.Miller, L. S.Shiraki, S. S.Rowland, C. R., & Harwood, H. J. (1996). Economic costs of anxiety disordersAnxiety, 2(4), 167172. doi: 10.1002/(ISSN)1522-7154[Crossref], [PubMed] , [Google Scholar]). Fortunately, there are many effective psychological interventions for anxiety.

Clinical Implications

The findings of our meta-analysis suggest that clinicians who work with patients and clients suffering from anxiety should consider utilizing hypnosis as part of treatment. Indeed, our findings indicate that hypnosis is more effective in relieving anxiety when it is combined with other interventions such as CBT than when used as a stand-alone treatment. Therefore, we recommend that therapists integrate hypnosis and other interventions such as CBT in treating anxiety. There are at least two ways this could be done. First, hypnosis and CBT could be employed as side-by-side interventions. Second, CBT techniques could be delivered in a hypnotic context (Kirsch et al., 1995Kirsch, I.Montgomery, G., & Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysisJournal of Consulting and Clinical Psychology, 63, 214220.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]) by performing a hypnotic induction first and then relabeling the CBT techniques as hypnotic in nature. For example, the effect of imaginal exposure could be amplified by relabeling it as hypnotic exposure and presenting the anxiety-provoking images after an induction. Similarly, cognitive restructuring could be relabeled as cognitive self-suggestions and provided after an induction.

Conclusion

“The findings of this meta-analysis show that hypnosis is a highly effective intervention for anxiety. Our results indicate the average participant treated with hypnosis achieved more anxiety reduction than about 79% of control participants at the end of active treatment and about 84% of controls at the longest follow-up. The hypnosis interventions evaluated in this meta-analysis appear to be about as effective in alleviating anxiety as CBT, PMR, and psychodynamic psychotherapy and were possibly more effective than mindfulness. Hypnosis produced more anxiety reduction when used in combination with other treatments such as CBT or biofeedback than when employed as a stand-alone intervention. Clinicians may wish to consider hypnosis for clients and patients suffering from anxiety whether as a stand-alone intervention or in conjunction with other treatment modalities.”

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