The purpose of this study is to see if treatments that include components of self-hypnosis training and cognitive behavioral therapy (CBT) can help decrease pain in people with MS.
This study examined the benefits of two treatments, individually and together, for helping individuals with MS manage their pain. We conducted a time series design in which MS subjects received all four treatment conditions in two orders (randomly assigned): (1) Control (education intervention-CONT),Self-Hypnosis Training (HYP), Cognitive Behavioral Therapy (CBT), HYP-CBT(a combination of HYP and CBT) and (2) CONT, CBT, HYP, HYP-CBT. Subjects attended 16 60-minute treatment sessions conducted by one of the study's psychologists either at the UW,HMC or in the subject's home. Each subject received four treatment sessions of each treatment module listed above. Primary outcome measures were collected via the telephone and mail by research personnel blind to the treatment condition before treatment, immediately after treatment ends and one month after treatment ends. Secondary outcome measures were collected at the same assessment points via pencil and paper interviews completed by subjects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
22
There is also the possibility that the two treatments together may be even more helpful than either one alone. Because some of the patients in this study will get both CBT and self-hypnosis, we will be able to determine if each one facilitates the efficacy of the other. If the patients treated in this study report benefits, as we expect they will, then this will encourage us to design and complete a larger study to better understand how patients with MS would benefit from these treatments.
One treatment module is we will study is called "cognitive restructuring" or "cognitive-behavior therapy" (CBT). In this treatment, people learn to identify negative thoughts that make them feel bad or anxious. Such negative thoughts lead to feelings of frustration and anxiety, and can even increase the experience of pain, because they cause a person to focus more on pain. With CBT, people learn to identify and stop these thoughts, and then replace them with more reassuring ones. When they do this, they feel more relaxed and focus less on their pain. As a result, they often say that they feel much better and are less aware of pain.
University of Washington
Seattle, Washington, United States
A composite of average daily pain intensity measured using a 0-10 NRS via four phone interviews performed on different days by research staff.
Time frame: Before treatment, after each treatment module, and 1-month after the final treatment module.
Sleep quality- Medical Outcomes Sleep Study Measure (Hays et al., 2005)
Time frame: before treatment, after each treatment module, one month after 4th treatment modules
Depression- (CMDI; Nyenhuis et al., 1998)
Time frame: before treatment, after each treatment module, one month after 4th treatment modules
Catastrophizing cognitions- (PCS; Sullivan et al. 1995)
Time frame: before treatment, after each treatment module, one month after 4th treatment modules
Adaptive cognitions (CPAQ; McCracken et al., 2004)
Time frame: before treatment, after each treatment module, one month after 4th treatment modules
Distinguishing neuropathic vs. non-neuropathic pain (S-LANSS; Bennett et al., 2005)
Time frame: before treatment, after each treatment module, one month after 4th treatment modules
Pain Interference-(Brief Pain Inventory, Cleeland et al., 1994)
Time frame: before treatment, after each treatment module, one month after 4th treatment modules
Impact of Fatigue (FIS; Fisk et al. 1993)
Time frame: before treatment, after each treatment module, one month after 4th treatment modules
Fatigue Severity (FSS; Krupp et al., 1989)
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Self-hypnosis (HYP) is another strategy that people can learn to manage pain. With this treatment, people learn to enter a state of focused attention, and then change how they experience pain. Although we do not yet know how hypnosis works, research has repeatedly shown that the effects are real; when people report decreases in pain with hypnosis, scans and images of the brain's activity show decreases in the parts of the brain that process pain information. With hypnosis, people are not just pretending to feel less pain, they actually do feel less pain.
The CONT condition for this study will include lectures that are interactive and are compelling and informative enough to be both (1) credible as an attentional control condition and (2) perceived as helpful to subjects. The CONT condition will not, however, include instructions in making specific cognitive or behavioral changes related to pain management. Thus, it could control for non-specific factors related to behavioral treatment, but will not impact the primary outcome measure (pain).
Time frame: before treatment, after each treatment module, one month after 4th treatment modules
Health Status (SF-36; Ware et al., 1992)
Time frame: before treatment, after each treatment module, one month after 4th treatment modules