Marianne Wetendorff Nørgaard, lead author and a clinical nurse specialist at Copenhagen University Hospital, Rigshospitalet, Denmark, presented findings from two studies.

In her first clinical study of visualisation during ablation of atrial fibrulation (AF), the researchers compared outcomes between 76 patients who used visualisation and 71 patients who received conventional care.

Ablation of AF is a lengthy and invasive procedure that involves deliberately creating scars on areas of heart tissue. The scar tissue does not conduct electricity and, doctors believe, this can facilitate a return to a normal regular heart rhythm. There are two main ways in which ablation can be performed: surgically or by catheter (nonsurgically).

All patients were awake during the 2-4 hour treatment and received local anaesthesia plus painkillers when they signalled the nurse using a push button. During the procedure patients scored their pain and anxiety levels every 15 minutes and after specific painful experiences.

The researchers found that patients who used visualisation during the procedure were in pain less often and asked for fewer painkillers. When the patients perceived pain, there were no differences between groups in the perception of pain intensity and or anxiety levels.

Mrs Nørgaard said: “Patients who used visualisation expressed pain fewer numbers of times and asked for less painkillers. Their perceived pain intensity may have been the same because we interrupted their visualisation at regular intervals to record pain and anxiety levels. If they had been allowed to stay in their trance like state during the entire procedure, their perceived pain intensity may have also reduced.”

How it works

Said Nørgaard: “We ask patients to describe a comfortable safe place they want to be during the procedure. People have chosen a summer house, the beach, or the woods. During the procedure the nurse asks the patient to focus on their safe place and how it looks, smells and sounds.”

She added: “When the patient expresses pain, the nurse helps the patient visualise an alternative scenario to the invasive procedure. For example, if the patient says ‘my chest is burning’, the nurse may say ‘imagine that it’s a cold day and there is ice on your chest’. Patients tell us that being in this trance like state with safe images makes the procedure a pleasant experience and it feels shorter.”

Adding to the data

The current research presented at EuroHeartCare 2014, the official annual meeting of the Council on Cardiovascular Nursing and Allied Professions (CCNAP) of the European Society of Cardiology (ESC) in Stavanger, Norway, builds on these findings.

It explored in greater detail the experiences of 14 patients who had used visualisation during the first clinical study. Qualitative interviews were conducted and subjected to inductive content analysis.

Mrs Nørgaard said: “Patients told us that visualising their own safe place during the procedure made them feel involved and helped them cope with pain and anxiety. Before the intervention patients were anxious and afraid of being on the operating table for a long time but afterwards they said visualisation had made it seem short and that it was a positive and pleasant experience.”

She added: “We know that patients want to be in control when they come into hospital and into the operating room. But patients who used visualisation during their invasive procedure said they felt it allowed them to let go of the control because they felt secure and had something else to focus on.”

“Some countries, for example the US and in southern Europe, use general anaesthesia during ablation of AF which can be risky during such a long procedure and is expensive. Some of these patients could use local anaesthesia and visualisation instead, plus painkillers as needed. Extra nurses are not needed in the operating room, you just need to train the ones who are already there.”

Mrs Nørgaard concluded: “Patients go through painful procedures every day in different departments of the hospital. Visualisation has the potential to reduce the amount of pain patients experience during numerous invasive procedures. We offer visualisation to all our AF ablation patients and those who return for another procedure request it. We also use visualisation during other cardiac procedures because it works so well.”

Anxiety and depression are a common reaction to the diagnosis, treatment and possible outcomes when suffering from diseases such as cancer.

Palliative treatments are ones that focus on the relieving and preventing of suffering in patients, without having a curing effect on the underlying disease.

Hypnotherapy, the practice of treatment on a subject whilst under hypnosis, has long been used as a treatment to alleviate psychological and emotional distress.

A recent study published in the British Medical Journal aimed to assess the benefits of using hypnotherapy in the management of anxiety in palliative care patients. The effect it had on other symptoms such as depression and sleep disturbance were also measured.

Relieving of symptoms

The small study was originally conducted on 21 cancer patients, though only 11 were able to successfully complete the study.

Participants each received a total of 4 hypnotherapy sessions and were then assessed to measure emotional well being.

After the first two hypnotherapy sessions, there was a significant reduction in anxiety and physical symptoms reported by the patients, but depression and sleep disturbance remained somewhat the same.

However, after completion of the fourth hypnotherapy session, the researchers found an even greater reduction in patient-reported anxiety and physical symptoms. In addition, there was a significant drop in both depression and sleep disturbance.

The outcome showed that while some benefits of hypnotherapy are pretty much immediate, others may take time to develop. Persevering with more than a few sessions is, therefore, recommended.

Benefits for children and adults

Other studies have also shown benefit of using hypnotherapy in cancer. One review of children with cancer found that hypnotherapy can help with sickness caused by chemotherapy. In another review hypnotherapy was helpful in control distress and pain from medical procedures in children.

Studies with adults have also shown positive effects. In a 2007 study of breast cancer patients hypnotherapy  prior to surgery helped to control the pain, sickness, tiredness and upset post-surgery. In 2006 another study found the hypnotherapy helped lower anxiety and pain during a biopsy for suspected breast cancer.