Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: response expectancies and emotional distress
Open accessAbstract
OBJECTIVE: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). METHOD: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years; 63% White, 15% Hispanic, 13% African American, and 9% other) were randomized to a hypnosis or to an attention control group. Prior to surgery, patients completed assessments of hypothesized mediators (response expectancies and emotional distress), and following surgery, patients completed assessments of outcome variables (pain, nausea, and fatigue). RESULTS: Structural equation modeling revealed the following: (a) Hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p < .0001) but not by distress (p = .12); (b) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p = .02) but not by nausea expectancy (p = .10); and (c) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p = .0001) and presurgical distress (p = .02). CONCLUSIONS: The results demonstrate the mediational roles of response expectancies and emotional distress in clinical benefits associated with a hypnotic intervention for breast cancer surgical patients. More broadly, the results improve understanding of the underlying mechanisms responsible for hypnotic phenomena and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery.
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There are several shared risk factors between pain and fatigue after surgery, including depression and outcome expectancies.
“Interestingly, there are several shared risk factors between pain and fatigue after surgery, including depression and outcome expectancies [22], implying that the very same processes might influence both post-surgical pain and fatigue.”
From Pre- and post-operative psychological interventions to prevent pain and fatigue after breast cancer surgery (PREVENT): Protocol for a randomized controlled trial (2022) · cites this paper as [22]
The Results sections on postsurgical pain and fatigue report that expectancies mediated the hypnosis intervention’s effects on both outcomes; presurgical distress mediated the fatigue effect but not the pain effect. The paper also discusses prior evidence linking distress to postsurgical pain. It does not establish depression specifically as a shared risk factor, so the claim is broader than the evidence on that point. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe protocol was prospectively registered on PROSPERO and is reported according to PRISMA guidelines.
“The protocol was prospectively registered on PROSPERO (CRD42018108791) and is reported according to PRISMA guidelines (Supplementary Material, http://links.lww.com/PR9/A243).99”
From Adjunctive use of hypnosis for clinical pain: a systematic review and meta-analysis (2024) · cites this paper as [99]
The Method sections describe a hypnosis intervention in breast surgery patients, not the registration or reporting of a review protocol. Searches for PROSPERO, CRD42018108791, and PRISMA found no passage addressing the claim in our copy. (LLM, conf=0.76)
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- Authors
- Montgomery, G. H., Hallquist, M. N., Schnur, J. B., David, D., Silverstein, J. H., & Bovbjerg, D. H.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Binghamton University (US)
- Babeș-Bolyai University (RO)
- University of Pittsburgh (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2010
- Volume
- 78
- Issue
- 1
- Pages
- 80-88
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC2819459
- OpenAlex
- W2114089452
- Cited by
- 110
- References
- 69
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 10 · 2021: 7 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 11 · 2016: 7 · 2015: 3 · 2014: 10 · 2013: 5 · 2012: 10
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (CA129094-01; CA131473)
- American Cancer Society (CRTG 04-213-01-CPPB)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Music Therapy and Health
- Keywords
- breast-conserving surgery, breast cancer surgery, postoperative pain, response expectancy, emotional distress, mediation, hypnotherapy, surgical side effects
- MeSH terms
- Adult, Attention, Breast, Fatigue, Female, Humans, Hypnosis, Middle Aged, Pain Measurement, Pain, Postoperative, Postoperative Pain, Surveys and Questionnaires, Stress, Psychological, Suggestion, Mastectomy, Segmental, Chi-Square Distribution, Postoperative Nausea and Vomiting
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