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Fear of Hypnosis : the Role of Labeling in Patients' Acceptance of Behavioral Interventions

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Fear of Hypnosis : the Role of Labeling in Patients' Acceptance of Behavioral Interventions 1 / ... FEAR OF HYPNOSIS : THE ROLE OF LABELING IN PATIENTS' ACCEPTANCE OF BEHAVIORAL INTERVENTIONS BY COB IE SUSAN HENDLER B.A., University of Virginia, 1980 THESIS Submitted in partial fulfillment of the requirements for the degree of Master of Arts in Psychology in the Graduate College of the University of Illinois at Urbana-Champaign, 1985 Urbana, Illinois 8_, G\5". ~5"1~ H'3~'3t UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN THE GRADUATE COLLEGE MAY 1985 WE HEREBY RECOMMEND THAT THE THESIS BY COBIE SUSAN HENDLER ENTITLED FEAR OF HYPNOSIS: THE ROLE OF LABELING IN PATIENTS' ACCEPTANCE OF BEHAVIORAL INTERVENTIONS BE ACCEPTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF__ __+-- M_A_S_T_E_R_ O_ F_A_ R_T_S__________ _ t Required for doctor's degree but not for master's. 0-5 17 - iii ACKNOWLEDGMENTS I would like to express my sincere appreciation to all of those individ­ uals who contributed to the completion of this thesis. Without the generous cooperation and support of the oncology staff at Carle Clinic in Urbana, Illinois, this research would not have been possible. Special thanks go to Dr. Alan Hatfield for his support throughout the study; to Marie des Champs, Mary Gould, and Teresa Jannasch of the nursing staff for their kindness and assistance; and to Sharon Zech, Linda Foster, Lynnell Lacy, and Rita Plew of the reception staff for introducing me to patients and encourag­ ing their participation in the study. Dr. William Chaplin and Dr. Harold Hake provided invaluable assistance with the data analyses. Their patience and support are greatly appreciated. A special thanks goes to Dr. Douglas Bernstein, who listened to my concerns with empathy, offered constructive comments, and renewed my interest in the study when I felt most frustrated. Dr. William H. Redd, my thesis advisor, sparked my interest in the area of cancer-related research. His faith in my ability and belief in this project were indispensible, as was his excellent editorial insight. My most heartfelt thanks go to my husband, Seth, for his support, patience, and assistance in preparing the manuscript; and to my mother, Teri Silverman, for her confidence and understanding. Finally, deep appreciation is extended to all of the cancer patients who participated in this research project. Their contribution literally made this research possible. They shared their fears, concerns, and hopes for the future with me. Their optimism and strength renewed my own. iv TABLE OF CONTENTS Page INTRODUCTION AND LITERATURE REVIEW........................ 1 Side Effects of Cancer Chemotherapy . • . • . 1 Research on Attitudes Toward Hypnosis . • . 3 Response to Treatment Labels . • . • . • . • . 5 EXPERIMENT I: CANCER PATIENTS' BELIEFS IN AND STATED INTENTIONS TO TRY THE BEHAVIORAL INTERVENTION ••..•..•..•.••.•.....••.•.....•.....•.••..........• 12 Method . • . 1 2 Subjects . 12 Assessment Instruments . 13 Procedure . • . 15 Results . • . 16 Label Effect . • . • . • . 16 Distress and Other Variables . • . 21 EXPERIMENT II: A COMPARISON OF PATIENT AND STUDENT SUBJECTS' ATTITUDES TOWARD HYPNOSIS . • . • . 24 Method . • . • . 24 Subjects . • . 24 Measures . • . 24 Procedure . • . • . • . • . 24 Results . • . • . • . 25 DISCUSSION 31 APPENDIX A HYPNOSIS TREATMENT DESCRIPTION •••...••..••• 37 APPENDIX B PASSIVE RELAXATION WITH GUIDED IMAGERY TREATMENT DES CR I PT ION •.•...••..............•. 38 APPENDIX C RELAXATION TREATMENT DESCRIPTION ....•...... 39 APPENDIX D PR ET REA TM ENT NAUSEA VAS .....••........•.•... 40 V Page APPENDIX E DURING TREATMENT NAUSEA VAS . • . • . • . • . 41 APPENDIX F POSTTREATMENT NAUSEA VAS . • . • • • • . • . • . 42 APPENDIX G PAIN VAS • . • . • . • . • . • . • • . • . • • • . • 43 APPENDIX H LONDON'S (1961) SURVEY ON ATTITUDES TOWARD HYPNOSIS . • • • . • . • . • • 44 APPENDIX DEMOGRAPHIC INFORMATION AND PREVIOUS EXPERIENCE WITH HYPNOSIS QUESTIONNAIRE..... 46 APPENDIX J DRUG PROTOCOLS' EMETIC POTENTIAL QUESTIONNAIRE • • . • . • . • . • • . • . • • • . • . • • • . • • • 49 APPENDIX K INFORMED CONSENT FORM . • • . • . • . • • • • • • . • . • 55 REFERENCES...................................................... 56 vi LIST OF TABLES Table Page 1 Mean Rank Scores on Dependent Variables for Patients in Different Label Conditions ................... ... ....... ~ 17 2 Results of the Kruskal-Wallis One-Way Analysis of Variance for Ordered Contingency Tables .. ....... ......... 18 3 Probabilities Between Patient's Belief In and Stated Intention to Try the Treatment Procedure in All Label Conditions......................... .. ................ 20 4 Patients' Reasons for Noncompliance with the Procedure in Each Label Condition......... ........ .............. .. 22 5 Comparison of Adjective Endorsement for Patient and Student Samples....................... ..................... 25 6 Comparison of Items Endorsed "True" on the London Questionnaire for Patient, Student, and London's Student Samples.. ................. .............. .. ...... 27 INTRODUCTION AND LITERATURE REVIEW Although increasing numbers of physicians, dentists, and health-care professionals employ hypnosis and relaxation techniques to control pain and reduce anxiety, clinicians have reported that many lay people are reluctant to engage in such procedures (Redd, Rosenberger, & Hendler, 1982). This reluctance may be, in part, due to negative attitudes shaped by the popular press. The media have often associated hypnosis with magic or the super­ natural, overdramatized its effects, and characterized the hypnotized indi­ vidual as dependent and vulnerable. It is unclear whether these negative attitudes are in response to the actual procedure or to the label used to identify it. The aims of the research reported here were: (a) to assess cancer patients' attitudes toward hypnosis and relaxation procedures used to control chemotherapy side effects, (b) to determine the role of procedural labels on patients' beliefs in and their willingness to use the behavioral procedure; and (c) to compare cancer patients' attitudes toward hypnosis with those of undergraduate students. Side Effects of Cancer Chemotherapy The aversive side effects of cytotoxic chemotherapy can compound the cancer patients' distress. Some patients report that the side effects of treatment are worse than the disease itself. Many patients feel the most aversive consequences are the nausea and vomiting which usually start 1 to 2 hours after the injection and can continue for 2 to 24 hours (Frytak & 2 . Moertel, 1981; Golden, 1975; Golden, Horwich, & Lokich, 1980). In addi- tion to post-treatment side effects, between 25% and 65% of chemotherapy patients develop anticipatory nausea/vomiting (Redd & Andrykowski, 1982). The sight of the oncology nurse, the smell of the alcohol, or just the thought of the chemotherapy process may become stimuli that trigger the aversion reaction. The nausea may be so pervasive and distressing that patients terminate treatment and face the consequences of untreated cancer. Unfortunately, commonly used antiemetic drugs (e.g., the phenothia­ zines and butyrophenes) typically have little or no effect on nausea ex­ perienced before treatment (Chang, 1981). Because the process of developing anticipatory nausea /vomiting is believed to be the result of inadvertant respondent conditioning (Redd, Andresen, & Minagawa, 1982), interest has focused on the use of behavioral methods of control. A major focus of initial research on anticipatory nausea control has been the use of hypnosis in conjunction with pleasant, relaxing imagery . Early clinical reports (Dash, 1980; Dempster, Balson, & Whalen, 1976; LeBaw, Holton, Tewell, & Eccles, 1975) consistently reported that this technique effectively reduced both pre- and postchemotherapy nausea and vomiting as well as distress. However, no quantifiable data were collected. Redd, Andresen, and Minagawa ( 1982) employed deep muscle relaxation hypnosis to effectively control anticipatory vomiting in cancer patients. Unfortunately, Redd and his colleagues encountered fears and misconceptions about hypnosis ( Redd, personal communication, March 1982). Although patients expressed distress from nausea and vomiting associated with chemo­ therapy and had their oncologist's endorsement that the hypnosis procedure was effective, many refused to participate. They referred to popular litera­ ture and the entertainment industry which have characterized the procedure 3 as a method of mind control. The few patients who actually observed some type of hypnosis procedure reported the participants behaving in an embarrassing manner (e.g., acting like a chicken). Research on Attitudes Toward Hypnosis Our understanding of patients' attitudes regarding hypnosis is based solely on anecdotal reports (e.g., Shevrin, 1972). As early as 1892, Van Eiden expressed regret that the words hypnotism and hypnosis were ever used in conjunction with suggestive therapeutics because of the preju­ dice, confusion, and misunderstanding involved (Tinterow, 1970). In an attempt to understand why individuals are so fearful of hypnosis, Ludwig ( 1963) noted that fictional works depict the hypnotist and subject in stereo­ typic roles; the hypnotist is a demonic, older man while the subject is a helpless, naive female victim. Mo re recently, when Schafer ( 1976) offered hypnosis as a method of pain control to patients on a burn unit, patients' reactions ranged from absolute refusal to skepticism and acceptance, to an almost fervent desire to be hypnotized. He noted that refusals were often associated with "religious
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