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Efficacy of Hypnosis for the Treatment of Comorbid

Chronic Pain and Insomnia in Older Adults

Dissertation

Author:

Judy AKelly

Efficacy of Hypnosis for the Treatment of Comorbid Chronic Pain and Insomnia in Older Adults

Dissertation Submitted to Northcentral University Graduate Faculty of the School of Behavioral

and Health Sciences in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF

PHILOSOPHY by JUDY A. KELLY Prescott Valley, Arizona March 2011

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APPROVAL PAGE Efficacy of Hypnosis for the Treatment of Comorbid Chronic Pain and

Insomnia in Older Adults by Judy A. Kelly Approved by: Certified by: '^ — JflVtf Chair: Robert

E. Haussmann, Ph.D. Date Member: Sandra Pace, Ph.D. Member: Amy Hecht, Ph.D. Vfa///

School Dean: Helthel Frederick, Ph.D. Date

Abstract Within the coming decades, the projected increase in the number of older adults will be

accompanied by an increase in age-related health care issues. Chronic pain and insomnia are two

common health conditions that compromise quality of life and successful aging. Although

pharmacotherapy is commonly prescribed for these conditions, myriad problems associated with

pharmacotherapy suggest the need for more benevolent treatments. This quantitative, quasi-

experimental study evaluated the efficacy of a 21-day hypnotic protocol for the treatment of

comorbid chronic pain and insomnia in 26 community-dwelling adults aged 60 years and older.

A within-subjects repeated measures, treatment-only design was used. One-way repeated

measures ANOVAs were conducted to assess pre- and posttreatment differences for pain

intensity, pain severity, severity of insomnia, sleep onset latency, frequency of awakenings,

quality of sleep, and quality of life. Significant treatment effects (p < .05), with large effect sizes

(ranging from .22 to .41), were found for all variables except sleep onset latency.

Hypnotizability, as measured by the Long Stanford Scale, did not affect treatment outcome. The

majority of the participants (81%) perceived some improvement; however, the mean overall

impression of change was not equal to clinically important improvement. The findings also

supported the existence of a bidirectional relationship between pain and sleep. A significant

negative correlation was found between pain intensity and quality of sleep (r = .30, p < .001).

The results of Wilcoxon signed ranks tests suggested that (a) hypnotic suggestions for

hypnoanalgesia significantly improved quality of sleep (p = .036) and (b) hypnotic suggestions

for improved sleep significantly decreased pain intensity (p = .026); effect sizes were r = .25 and

r = .26, respectively. Based on one-month follow-up data (n iv

= 22), 86% of the respondents continued to listen to the hypnotic CDs postintervention.

Improvements were maintained for each of the variables assessed at one-month follow- up: pain