Home Hypnotherapy for Refractory Functional Chest Pain: A Pilot Study

NCT ID: NCT01284179

Last Updated: 2016-12-20

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: NA
• Total Enrollment: 8 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-02-28
• Study Completion Date: 2015-12-31

Brief Summary

The primary aim is to develop and test the feasibility of a standardized digital audio home-hypnotherapy (HHT) program for patients with refractory functional chest pain (FCP).

The secondary aims of this study are:

1. To obtain pilot data to assess the magnitude of the treatment effect of self-hypnosis in refractory FCP for an anticipated future, larger treatment trial;

2. To determine the stability of the treatment effect of HHT in refractory FCP;

3. To assess the relationship between response to HHT and psychological factors; and

4. To assess the relationship between response to HHT and symptomatic dimensions of chest pain (severity, frequency, and duration).

5. To assess the difference

Detailed Description

Eligible patients with refractory FCP will be randomized to one of 2 arms: the active treatment group, who will receive the HHT program; or a control group. Patients in the active treatment group will receive the 12-week digital audio HHT program. This protocol consists of 7 sessions, each approximately 30-40 minutes, administered every 2 weeks, for a cumulative 12 weeks of treatment, along with a shorter (approximately 12 minute) session administered daily. Patients in the control group will receive a digital audio educational program. Subjects in both groups will be assessed at baseline, 4-6 weeks into treatment, at the end of the treatment, and 3 months after conclusion of the program. Global change in symptoms will be assessed with a 7-point Likert scale. Patients will be considered to respond if they have significant improvement on the Likert scale at the post-treatment visit. Patients will complete a chest pain symptom diary, the SCL-90 and the Coping Strategies Questionnaire-Catastrophizing subscale to assess psychological features, and the SF-36 as a measure of Health Related Quality of Life (HRQOL).

Conditions

Functional Chest Pain

Keywords

Functional Chest Pain; Functional GI Disorders; Home Hypnotherapy

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Hypnotherapy

Participants will be randomized to either the home hypnotherapy or educational group. The HHT protocol will consist of sequences of two different types of sessions, longer biweekly sessions (LS), each approximately 30-40 minutes in length, and shorter daily sessions (SS), approximately 12 minutes in length. On the first day of each sequence, the patient will listen to the appropriate LS. The patients will listen to the SS on a daily basis in between each LS. Every 2 weeks a new sequence will begin, for a total of 12 weeks of treatment.

Group Type: EXPERIMENTAL

Home Hypnotherapy

Intervention Type: BEHAVIORAL

Each session contains the following elements: (1) trance induction consisting of narrowing the focus of attention and eye-closure, (2) trance deepening through imagery, guided dissociation from the here-and-now and graded suggestions of change in mental state, (3) vivid guided imagery that engages all the senses and implies improved health, well-being and a sense of strength and personal power, (4) therapeutic suggestions and imagery, both direct and indirect, for enhanced chest comfort, overall physical comfort and mental well-being and immunity to discomfort, that is suggested will last beyond termination of the session and become more noticeable and permanent over time, and (5) trance termination through direct suggestions and counting.

Educational

Participants will be randomized to receive either home hypnotherapy or an educational program. The control group will receive an educational digital audio program on MP3 players. These digital audio files will contain general information about FCP and FGIDs. These audio files will be similar to the intervention audio files in length. Patients will be instructed to begin listening on the day of randomization. Patients will be instructed to continue their other medical treatment for chest pain during the study. The control group will be assessed at the same times as the HHT group.

Group Type: OTHER

Educational

Intervention Type: BEHAVIORAL

Educational recordings regarding FCP and FGIDs.

Interventions

Home Hypnotherapy

Each session contains the following elements: (1) trance induction consisting of narrowing the focus of attention and eye-closure, (2) trance deepening through imagery, guided dissociation from the here-and-now and graded suggestions of change in mental state, (3) vivid guided imagery that engages all the senses and implies improved health, well-being and a sense of strength and personal power, (4) therapeutic suggestions and imagery, both direct and indirect, for enhanced chest comfort, overall physical comfort and mental well-being and immunity to discomfort, that is suggested will last beyond termination of the session and become more noticeable and permanent over time, and (5) trance termination through direct suggestions and counting.

Intervention Type: BEHAVIORAL

Educational

Educational recordings regarding FCP and FGIDs.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Age 18 to 80, male or female.
• Patients must fulfill the Rome III criteria for Functional Chest Pain of Presumed Esophageal Origin for the previous 3 months (with symptom onset at least 6 months before diagnosis), including all of the following:

• Midline chest pain or discomfort that is not of burning quality
• Absence of evidence that gastroesophageal reflux is the cause of the symptom
• Absence of histopathology-based esophageal motility disorders
• Persistent symptoms despite a trial of antidepressant therapy, as defined by either:

• chest pain despite at least a continuous 4-week trial of at least one antidepressant within the last 6 months; or
• intolerance of at least one antidepressant within the last 6 months.
• Negative cardiac evaluation (negative cardiac stress test or negative coronary angiogram)
• Negative gastrointestinal evaluation for cause of the pain, defined by absence of Los Angeles grade C or D erosive esophagitis on endoscopy, persistent chest pain on PPI therapy, and no association of chest pain with reflux episodes on an ambulatory pH or pH-impedance study, defined as a symptom index <50% or symptom association probability <95% for chest pain .

Exclusion Criteria

• Severe co-morbid illness (cardiac, pulmonary, renal, hematologic, hepatic)
• Prior treatment with hypnosis/hypnotherapy for a medical condition
• Prior major thoracic surgery
• Prior diagnosis of or treatment for dissociative disorders, post-traumatic stress disorder, borderline personality disorder, or other psychiatric disorders that include psychotic features
• Pregnancy or planned pregnancy within the upcoming 3 months
• Inability or unwillingness to give informed consent

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role: collaborator

University of North Carolina, Chapel Hill

OTHER

Sponsor Role: lead

Responsible Party

Ryan Madanick, MD

Assistant Professor of Medicine Director, UNC Gastroenterology & Hepatology Fellowship Program

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Ryan Madanick, MD

Role: PRINCIPAL_INVESTIGATOR

UNC-Chapel Hill

Locations

University of North Carolina Chapel Hill

Chapel Hill, North Carolina, United States

Countries

United States

Other Identifiers

R24DK067674

Identifier Type: NIH

Identifier Source: secondary_id

View Link

09-0772

Identifier Type: -

Identifier Source: org_study_id