Gary Elkins, PhD., ABPP

Transcription

1 Gary Elkins, PhD., ABPP

2 *What are Hot Flashes? *Hormone Replacement Therapy *Alternate Treatment Options *Clinical Hypnosis? *Methods *Preliminary Results *Conclusions & Future Directions

3 *Over 66% of post-menopausal women experience hot flashes, and nearly 20% find them to be nearly intolerable. 1 *It is estimated that over 25 million women in the U.S. have hot flashes and 4 million women have severe hot flashes. 2 *Transient episode of flushing, sweating, and a sensation of heat, often accompanied by palpitations and a feeling of anxiety, and sometimes followed by chills. ronenberg, F. (1990). Hot flashes: Epidemiology and physiology. Annuals of the New York Academy of Science, 592, tearns et al.(2002). Hot flushes. Lancet, 360,

4 *Hormone Replacement Therapy, (HRT) is the medical standard for the alleviation of hot flashes, however there are demonstrable risks.

5 *Sample of 16,000 post-menopausal women. *Evaluated placebo vs. estrogen plus progestin. *The study was halted on May 31, 2002 due to health risks associated with HRT. *The incidence of breast cancer increased by 26% for women in the estrogenprogestin group.

6 WHI Estrogen+ Progesterone Findings, 5.2 yrs Risks 29*% Increase Coronary Heart 41*% Disease Increase Stroke 41*% Increase Pulmonary Emboli 26*% Increase Breast Cancer Benefits 33*% Decrease Hip Fractures 37*% Decrease Colorectal Cancer Threshold Level STOPPED Early, Clear Harm Also: DVTs Stopped 3.3 yrs early *Adapted from: Writing Group for the Women s Health Initiative. JAMA. 2004; 291:

7 *Black Cohosh *Soy *Vitamin E *Venlafaxine *Gabapentin *SSRIs (fluoxetine, paroxetine, sertraline) *MPA

8 *Clinical Hypnosis for the relief of hot flashes in breast cancer survivors 1. *Five sessions of hypnosis intervention vs. wait list *Breast cancer survivors reduced their hot flashes by 68% using clinical hypnosis. Mean hot flash score for breast cancer survivors baseline and endpoint (week 5). 1 Elkins et al., (2008). Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes Among Breast Cancer Survivors. Journal of Clinical Oncology, 26,

9 Hypnosis for Hot Flashes: A Randomized Clinical Trial for Postmenopausal Women. The first, large-sample, randomized, actively controlled clinical trial of clinical hypnosis for the treatment of hot flashes in post-menopausal women.

10 *Hypnotic induction with relaxation and direct and indirect suggestions/mental imagery/dissociation. *Five sessions approximately weekly *Individualize mental imagery. *Teach self-hypnosis. *Goal is empowerment of the patient. *CONTROL GROUP received monitoring, supportive relationship, and structured attention for 5 weekly sessions.

11 Demographics N 184 Post-Menopausal Women Age m=54.6 sd= 6.8 Ethnicity No. % White African-American Hispanic American Indian/Alaska Native Asian Relationship Status Married Unmarried Educational Level Non-Diplomate High School Diplomate Some College Technical College Diplomate College Diplomate Post-Graduate

12 HFRDIS = Hot Flash Related Interference Scale CES-D = Center for Epidemiologic Studies Depression Scale SHSS = Stanford Hypnotic Susceptibility Scale

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14 Typical output from 24-hour skin conductance recording of a subject employing the gold-standard hot flash monitor, (Biolog Hot Flash Recorder, UFI, Inc).

15 Baseline Endpoint Hypnosis Control Hypnosis Control Mean SD Mean SD Mean SD Mean SD Hot Flash Frequency Hot Flash Score HFRDIS Pittsburgh Sleep HADS CES-D * All mean differences in treatment group vs control were significant at the P<.001 level at endpoint.

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17 Borrowed from Charles Loprinzi, MD.

18 *Hypnosis when properly applied can be a safe and effective treatment for hot flashes. *Side benefits appear to be likely. *Mediators and moderators are yet to be determined. *Dissemination is the next critical step in the research program. *Multicultural issues have also yet to be addressed.

19 *This research was supported by the National Center for Complementary and Alternative Medicine, National Institutes of Health Grant U01AT and National Cancer Institute grant R21CA *Address correspondence to Gary Elkins, Ph.D., ABPP., Department of Psychology and Neuroscience, One Bear Place #97334, Baylor University, Waco, Texas, phone: (254) *