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SELF-HYPNOSIS FOR DEPRESSION IN PRIMARY CARE
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increasing our confidence in the validity and reliability of this study
design. Although our randomized group was too small for compari-
son, previous PRP studies have demonstrated no significant difference
in outcomes between those exercising preference and those agreeing
randomization to a particular treatment (Bedi et al.; Dwight-Johnston
et al.; Ward et al.). This increases the validity of the results from the
preference arms of this feasibility study suggesting a greater improve-
ment in those choosing self-hypnosis compared with those choosing
medication. The self-hypnosis group, while self-selected, responded
with similar treatment effects to the benchmarked randomized
psychological-therapy groups. This cost-effective study design also
provided useful recruitment, compliance, and safety information for
future trials of hypnosis interventions. Treatment effects in our study
were substantial, but the absence of a nontreatment control group
(excluded on ethical grounds) meant that we cannot eliminate the con-
tribution of natural remission in a primary-care setting; although
regression to the mean should have produced a greater effect in the
antidepressant group with the higher baseline, which would
strengthen the suggestion of the greater effect of the self-hypnosis
intervention. Interestingly, almost all studies in this field do not have a
control group, for ethical reasons, and rely on a limited number of
previous randomized studies that have included such a group, which
is a form of benchmarking. Using this feasibility study with bench-
marking established that the intervention was useful in clinical practice
(i.e., it was a popular choice with benefit to those who chose it). This
completes the exploratory stages of a complex intervention study as
recommended by the Medical Research Council (MRC, 2000), inform-
ing the next stage of a strictly randomized trial, currently under
development.
C
ONCLUSION
With 93% of participants exercising a preference, this study indi-
cates the benefit of adopting the PRP design in a naturalistic primary-
care setting. Benchmarking these results with other similar studies of
psychological treatment in depression adds validity and reliability to
this study. Results indicate that a self-help, self-hypnosis program may
be a useful addition to depression treatment available in primary care
and the next stage of evaluation is being explored.
R
EFERENCES
Amat, J., Paul, E., Watkins, L., & Maier, S. (2008). Activation of the ventral medial pre-
frontal cortex during an uncontrollable stressor reproduces both the immediate and
long-term effects of behavioral control.
Neuroscience
,
154
, 1178–1186.
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