A Randomised Controlled Clinical Trial on the Additional Effect of Hypnosis in a Comprehensive Treatment Programme for In-Patients with Conversion Disorder of the Motor Type

Abstract

Background: The primary aim of this study was threefold: (1) to examine the additional effects of hypnosis aimed at symptom reduction, using symptom-oriented and expression- and insight-oriented techniques in a comprehensive clinical treatment programme for in-patients with a persistent conversion disorder of the motor type; (2) to assess whether the level of hypnotisability was predictive of treatment outcome, and (3) to explore the efficacy of the total clinical treatment programme. Methods: The study population consisted of 45 in-patients between 18 and 65 years of age meeting the DSM-III-R criteria for conversion disorder of the motor type or somatisation disorder with motor conversion symptoms. A randomised controlled clinical trial was undertaken. The primary outcome measures were the Video Rating Scale for Motor Conversion Symptoms, the D(isabilities) code items from the International Classification of Impairments, Disabilities and Handicaps and the Symptom Checklist-90. Measures of the credibility of treatment and patient expectations of treatment outcome were used as manipulation checks. Hypnotisability was measured using the Stanford Hypnotic Clinical Scale. Results: Significant treatment results for all outcome measures were found for the total sample. These effects proved to be clinically significant. The use of hypnosis had no additional effect on treatment outcome. Hypnotisability was not predictive of treatment outcome. Conclusion: A comprehensive treatment programme, either with or without hypnosis, can be worthwhile for patients with long-standing conversion symptoms.

Neurophysiology of hypnosis

“…An additional study has shown that symptom reduction was observed independently of the treatment condition (i.e. comprehensive program vs hypnosis added to a comprehensive program) [41]. Later, significant treatment results were reported for hypnosis-based therapy in patients with conversion disorders as compared to a no-treatment group [42].…”

Treatment of Functional (Psychogenic) Movement Disorders

“…Moene et al [41] conducted a RCT in a group of 45 patients with conversion disorder (motor type) or somatization disorder (with motor conversion symptoms) evaluating the efficacy of adding hypnosis to a standard inpatient treatment. Patients in both treatment (standard inpatient program+hypnosis) and control (only inpatient program) groups followed a group therapy program with the aim of increasing problem-solving skills (including group psychotherapy, social skills training, formulation and evaluation of treatment goals, creative therapy, and sports, physiotherapy, and individual exercise sessions).…”

“…Moene et al [41] reported on the usefulness of the addition of hypnosis to an inpatient program (see above). Although the hypnosis treatment did not provide additional benefit to the inpatient program, the treatment program itself did lead to improvement in symptoms in the majority of patients.…”

Conversion disorder: advances in our understanding

“…Results from two trials of hypnosis have been contradictory. 26,27 Preliminary findings from studies with small sample sizes suggest that antidepressant medication, 28 behavioural therapy, 29 paradoxical intention 30 and transcranial magnetic stimulation 31 may be effective, but these results need to be replicated. From a theoretical standpoint, the data on transcranial magnetic stimulation are intriguing.…”