Indonesian Journal of Medicine (2021), 06(02): 152-158 Research

Masters Program in Public Health, Universitas Sebelas Maret

The Effectiveness of Hypnotherapy in Reducing Pain

in Patients with Cervical Cancer
Hanung Prasetya1), Heni Nur Kusumawati1), Wardiyatmi2)
1)Study Program in Acupuncture, Health Polytechnics, Ministry of Health Surakarta
2)Dr. Moewardi Hospital, Surakarta

ABSTRACT

Background: Complaints of pain in cervical independent variable is hypnotherapy. The

cancer patients make the patient suffer more. level of pain is measured by a numerical pain
Pain is a subjective matter so that hypnothe- scale of 0 to 10. Hypnotherapy is performed
rapy can reduce the pain suffered by patients. using hypnosis recording/ audio. Data analysis
The use of hypnotherapy in cancer patients was performed using an independent t test.
focuses on the emotional aspects and dynamics Results: The mean pain level after hypno-
that occur in the client's subconscious mind. therapy (Mean= 0.8; SD= 1.96) was lower than
Hypnotherapy can change sensations, percep- the control group (Mean= 3.2; SD= 1.7), effect
tions, thoughts, feelings or behavior after being size= -1.31, and it was statistically significant (p
suggested. Positive suggestions given are able <0.001).
to influence the perception of someone who is Conclusion: Hypnotherapy complementary
in a hypnotic state so that they behave or per- therapy can help reduce pain levels in cervical
ceive according to the suggestions given. The cancer patients.
purpose of this study was to analyze the effect
of hypnotherapy as a complementary therapy in
Keywords: hypnotherapy, pain, cervical
reducing pain in cervical cancer patients.
cancer
Subjects and Method: The experimental
study used a random control trial which was
Correspondence:
conducted at the Dr. Moewardi Hospital from
Hanung Prasetya. Study Program in Acu-
January to September 2019. A sample of 90
puncture, Health Polytechnics, Ministry of
patients was selected by purposive sampling. 45
Health. Jl. Letjend Sutoyo, Mojosongo, Sura-
subjects from the treatment group received the
karta 57127, Central Java. Email: Hanung-
hypnotherapy intervention and 45 subjects
[email protected]. Mobile: +62812263-
from the control group received standard care. 8908.
The dependent variable is the level of pain. The

Cite this as:

Prasetya H, Kusumawati HN, Wardiyatmi (2021). The Effectiveness of Hypnotherapy in Reducing Pain in
Patients with Cervical Cancer. Indones J Med. 06(02): 152-158. https://doi.org/10.26911/theijmed.2021.-
06.02.04.
Indonesian Journal of Medicine is licensed under a Creative Commons
Attribution-NonCommercial-ShareAlike 4.0 International License.

BACKGROUND cancer patients longer, and this means that

According to the World Health Organiza- they will experience longer cancer pain,
tion (WHO), Indonesia is a country with the either due to the disease itself or from treat-
largest number of cervical cancer sufferers ment (Wargo and Burton, 2005). According
in the world (Ministry of Health, 2015). The to Lukman and Harjanto (2007) the mana-
prevalence of cervical cancer was 0.8 ‰ gement of cancer pain is still below
and the prevalence of breast cancer was 0.5 standard, it is said that 50% of patients
‰. The discovery of various new treatment with cancer and 90% of patients with
methods has increased the average age of advanced stages suffer from pain. 70% of

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Prasetya et al./ The Effectiveness of Hypnotherapy in Reducing Pain

cancer pain results from involvement of the The use of hypnotherapy in cancer
tumor in the soft, visceral, nerve, or bone patients focuses on the emotional aspects
tissue. Cancer pain can also come from and dynamics that occur in the client's sub-
changes in the body's structure due to the conscious mind. Pain is a subjective matter
tumor, while 25% of cancer pain comes so that hypnotherapy can reduce the pain
from the impact of giving cancer therapy suffered by patients. One of the causes of
such as radiotherapy, chemotherapy, cancer is the decreased performance of the
immunotherapy and/ or surgery (Wargo immune system due to chronic stress expe-
and Burton, 2005). The suffering of cancer rienced by a person, this is where hypno-
patients can be doubled if you do not get therapy can play a role in helping cancer
adequate pain management therapy. As a sufferers. According to Prasetya (2018), in
spiritual biopsychosocial being, the patient Indonesia, there are still many people who
also suffers from common symptoms of consider hypnosis a mystical thing and are
cancer such as fatigue, weakness, nausea, often associated with crime. In fact, hyp-
constipation and decreased cognitive nosis is scientific knowledge and has been
function. recognized by WHO as a safe method of
The use of complementary therapies therapy. In developed countries such as
is increasingly being used, including hypno- America and England, many doctors, psy-
therapy. As a mind-body therapy, hypno- chiatrists, psychologists, and hypnothera-
therapy is able to bring patients into a very pists have used hypnosis to treat physical
deep hypnotic state, experience mental and psychological problems. Since 1955 the
imagery and can receive therapeutic sug- British Medical Association, 1958 American
gestions. Various ways can be done to Medical Association and 1960 American
manage pain including hypnotherapy. Psychological Association officially lega-
Hypnotherapy is a hypnosis applica- lized hypnosis as a legal therapeutic tool
tion in curing mental disorders and relie- even now hypnosis is widely taught in many
ving physical disorders (Arter, 2014). Hyp- medical schools, especially in America.
nosis can change sensations, perceptions,
thoughts, feelings or behavior after sugges- SUBJECTS AND METHOD
tion. A brain that has been influenced by 1. Study design
suggestion will instruct the central nervous This was an experimental study which was
system to directly stimulate the Reticular conducted using the Random Control Trial.
Activating System to reduce its perform- The research was conducted at the Dr
ance so that it has an impact on the release Moewardi Hospital Surakarta in 2019.
of serotonin from specific cells in the pons 2. Population and samples
and brainstem, namely Bulbar Synchro- The population of this study includes all
nizing Regional (BSR) (Tarwoto and Warto- cervical cancer patients at Dr Moewardi
nah, 2010). When the client's condition is Hospital Surakarta who experienced pain
relaxed, the next RAS activation decreases throughout January to September 2019.
and the BSR will take over, causing the The sample was 90 patients who were
client to fall asleep (Potter & Perry, 2005). randomly divided into 2 groups into control
Positive suggestions given are able to and treatment groups. Inclusion criteria
influence the perception of someone who is Cervical cancer patients who are treated at
in a hypnotic state so that they behave or the Dr Moewardi Hospital Surakarta, the
perceive according to the suggestions given. patient experiences complaints of pain

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Prasetya et al./ The Effectiveness of Hypnotherapy in Reducing Pain

related to his illness, can communicate in control group. The data used in the group
Indonesian, has good hearing, is willing to were nominal dichotomous including
do hypnotherapy intervention every day at categorical data.
least once for seven consecutive days. Pain 5. Data Analysis
exclusion criteria are not related to cervical The difference in pain levels in cervical
cancer, have sensory impairments, are not cancer patients was measured before and
willing to participate in hypnotherapy after treatment and then analyzed by t test
intervention every day at least once for in the SPSS program.
seven consecutive days. 6. Research Ethic
3. Study variables Subjects who fit the inclusion criteria were
The dependent variable was pain. The inde- given an explanation of the objectives,
pendent variable was hypnotherapy benefits, assurance of confidentiality and
4. Operational definition of variables what to do in providing answers to the
Hypnotherapy was the provision of thera- questions on the questionnaire. All subjects
peutic intervention using hypnotherapy to in this study had signed a letter of approval
cervical cancer patients who experience to become respondents. This research has
pain, at least once per day for 7 consecutive passed the research ethics committee of
days. Hypnotherapy is carried out by giving Poltekkes Kemenkes Surakarta with
suggestions in the form of an invitation to number: LB.02.02 / 1.3 / 1683/2019
accept and live the problem while remain-
ing grateful even though it is difficult. RESULTS
Hypnotherapy is administered using audio 1. Univariate analysis
recordings recorded on the patient's cell- The description of the univariate analysis
phone. The level of pain is a feeling or describes the general characteristics of the
uncomfortable condition due to pain due to sample data for each variable including
cervical cancer or cervical cancer treatment data on age, education and occupation.
activities. The coding in this study was ―yes‖ Univariate analysis can be seen in tables 1
for the treatment group and ―no‖ for the and 2.

Table 1. Sample characteristics of continous data

Group n Mean SD Min. Max.
Age (Years) 90 44.21 11.96 20 68

2. Bivariate analysis therapy group before the intervention, and

The bivariate analysis in this study used an it was not statistically significant (p=
independent t test to test the mean diffe- 0.885).
rence between the independent and depen- These results indicate that randomi-
dent variables. The results of the different zation carried out in allocating into the
pain levels in the hypnotherapy interven- hypnotherapy group and not hypnotherapy
tion group and the standard care group are was successful in making the two groups
presented in table 2. comparable at the initial pain level before
Table 3 shows that there was no diffe- the intervention.
rence in mean pain between the hypno-

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Prasetya et al./ The Effectiveness of Hypnotherapy in Reducing Pain

Table 2. Sample characteristics of categorical data

Variables n %
Education
ES 14 15.5
JHS 16 17.7
SHS 19 21.1
College 41 45.5
Employment
House Wife 38 42.2
Laborer 10 11
Entrepreneur 18 2
Civil Servant 8 0.88
Student 9 10
Farmer 7 0.77

Table 3. Results of mean t-test differences in pain levels in the hypnotherapy and
non-hypnotherapy groups before the intervention
Group n Mean SD p
Hypnotherapy 45 3.91 1.98 0.885
Non Hypnotherapy 45 3.66 1.96

Table 4 shows that the mean pain in These findings indicate that hypno-
the hypnotherapy group (Mean= 0.8; SD= therapy is effective in reducing pain in
1.96) was lower than that in the non- cervical cancer patients. These results come
hypnotherapy group (Mean= 3.2; SD= 1.7). from an RCT.
The difference was statistically significant
(p <0.001).
Table 4. Average results of differences in pain levels in the hypnotherapy and
non-hypnotherapy groups after the intervention
Group n Mean SD p
Hypnotherapy 45 0.8 1.96 <0.001
Non Hypnotherapy 45 3.2 1.7

3. Size Effect that patients who received hypnotherapy

The effect of the use of hypnotherapy on had lower mean pain rates than the control
reducing the pain level of cancer patients is group who only received standard care.
known based on the calculation is equal to - This study strengthens the opinion
1.31. Based on the standard Cohen size that a thought program that has been
effect having a value of 0.8 - 2.0 has a implanted through affirmations and
strong effect. Thus, the use of hypnotherapy suggestions in a hypnotic state, can be a
has a strong influence in reducing pain in trigger for permanent change (Beneditis,
cervical cancer patients. 2015). The hypnotic state begins with
focusing one's attention, creating a relaxa-
DISCUSSION tion response through induction and deep-
The results of the study used an indepen- ening techniques (Daitch, 2018). The place-
dent t test to determine the effect of hypno- bo effect occurs when a person responds to
therapy in the control group and the medication or other action because of the
treatment group. The data in Table 4 shows hope that the treatment will actually work.

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Prasetya et al./ The Effectiveness of Hypnotherapy in Reducing Pain

Accepting treatment or action alone is a According to Prasetya et al. (2018)

positive effect. and Iserson (2014) under the influence of
Patients' positive expectations about hypnosis, the cerebral cortex experiences
treatment can increase the effectiveness of strong inhibition, so that the power of
giving hypnotherapy interventions. Often identification, analysis, decision making of
the more clues a patient receives about the new stimuli decreases, past experiences
effectiveness of an intervention, the more cannot be utilized, as a result suggestive
effective the intervention will be. Indivi- words become strength irresistible domi-
duals who were told that a medication was nant. In the hypnosis condition, through
thought to provide pain relief was almost active direction, the patient's condition and
certainly more likely to experience pain behavior, both psychological and physio-
relief than patients who were told that their logical, can be controlled, so that it can eli-
medication had no effect. Positive patient- minate or heal the psychological or physio-
health worker relationships can also be a logical obstacles experienced by the patient.
very important role in enhancing the However, the patient's response is also
placebo effect (Smeltzer & Bare, 2002). strengthened by the ability of the hypnotist
Hypnosis therapy is effective at / therapist's approach.
modulating pain perception by affecting a
person's cognitive processes compared to AUTHOR CONTRIBUTION
individuals who do not receive hypnosis Hanung Prasetya is the main writer who
therapy. The subconscious mind is a place writes manuscripts, processes data and
where humans store all beliefs, values, and compiles hypnotherapy audio instruments.
control the functions of the human body. Heni Nur Kusumawati and Wardiyatmi
The use of hypnosis in analgesia according formulated study methods and collected
to Kihlstorm (1984) is more mediated by research and discussion materials.
cognitive processes and not directly influ-
enced by physiological processes. The CONFLICT OF INTEREST
success of hypnosis in analgesia or often There is no conflict of interest in this study.
referred to as hypnoanalgesia is not asso-
ciated with an increase in serum beta FUNDING AND SPONSORSHIP
endorphins (Spiegel and Albert, 1983 in This research was funded by the Research
Kihlstorm, 1984). Hypnoanalgesia is for Health Personnel Development of the
thought to block the entry of consciousness Ministry of Health of the Republic of
by activating the frontal limbic system to Indonesia.
inhibit the transmission of pain impulses
from the thalamus to the cortical struc- ACKNOWLEDGEMENT
tures. Another theory suggests that hypno- Acknowledgments were conveyed by the
analgesia can relieve pain by decreasing authors to the director of the Dr. Moewardi
activity in the anterior cingulated cortex Hospital for allowing this study to be
rather than affecting the activity of the carried out. Thank you to all the health
cortex. Implanted suggestions are able to personnel for helping in data collection.
make the patient experience deep relaxa- Thank you to all patient with cancer cervics
tion, change the character of pain and who have been willing and cooperative to
change a person's attitude towards pain become the study subjects.
shows positive results.

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Prasetya et al./ The Effectiveness of Hypnotherapy in Reducing Pain

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