The effect of hypnotic suggestion on labor market attachment, functioning, and cognition after brain injury – a randomized controlled trial
DOI:
https://doi.org/10.15584/ejcem.2025.2.10Keywords:
cognition, functioning, hypnosis, mindfulness, workAbstract
AbstractIntroduction and aim. Cognitive impairments after acquired brain injury (ABI) or concussion significantly affect work capacity. While hypnotic suggestion has shown promise in improving working memory and work ability, studies on its long-term effects on labor market attachment and cognition are lacking. The aim of this study was to estimate the long-term effect of hypnotic suggestion on labor market attachment, cognition, and functioning following acquired brain injury or concussion.
Material and methods. A randomized controlled trial (RCT) was conducted at a municipal vocational rehabilitation center in Denmark, among 87 patients aged 18 to 62 years who experienced ABI or concussion at least 6 months prior to the first therapy session. The study group were randomized according to the applied intervention: usual care (n=28), hypnosis (n=30) or mindfulness (n=29). Participants underwent baseline and 6-month follow-up assessments involving The Danish Register for Evaluation of Marginalization (DREAM), The Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV), Impact on Participation and Autonomy questionnaire (IPA), The Working Memory Questionnaire and Trial Making Test related to working memory and functioning, assessing three dimensions: short-term storage, attention, and executive control.
Results. The primary outcome was the average number of weeks employed during the 12–24-month period post-inclusion. The mean number of weeks employed was 32.71 (SD: 22.31) in the usual care group, 35.97 (SD: 21.58) in the hypnosis group, and 32.90 (SD: 22.44) in the mindfulness group. All intervention groups had exhibited a working memory score of around 90, which improved to a range of 91 to 95 at the 6-month follow-up. No significant differences were found between the groups.
Conclusion. Brief hypnotic treatment at a municipal vocational rehabilitation center for people with ABI and concussion showed no significant advantage over mindfulness or usual care in labor market attachment, cognition, or family functioning. However, participants in the hypnosis group demonstrated improved social functioning at the 6-month follow-up compared to usual care.
Supporting Agencies
This work was supported by TrygFonden (Grant ID 118428).Downloads
References
Turner-Stokes L, Pick A, Nair A, Disler PB, Wade DT. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev. 2015;2015(12):CD004170. Doi: 10.1002/14651858. CD004170.pub3
Whyte E, Skidmore E, Aizenstein H, Ricker J, Butters M. Cognitive impairment in acquired brain injury: a predictor of rehabilitation outcomes and an opportunity for novel interventions. PM R. 2011;3(6 Suppl 1):45-51. doi: 10.1016/j.pmrj.2011.05.007
Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil. 2014;95(5):986-995.e1. doi: 10.1016/j.apmr.2013.10.0324.
Westerlind E, Persson HC, Sunnerhagen KS. Return to Work after a Stroke in Working Age Persons; A Six-Year Follow Up. PLoS One. 2017;12(1):e0169759. doi: 10.1371/journal.pone.0169759
Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY). 2019;11(9):2542-2544. doi: 10.18632/aging.101931
Hommel M, Miguel ST, Naegele B, Gonnet N, Jaillard A. Cognitive determinants of social functioning after a first ever mild to moderate stroke at vocational age. J Neurol Neurosurg Psychiatry. 2009;80(8):876-880. doi: 10.1136/jnnp.2008.169672
Ashley KD, Lee LT, Heaton K. Return to Work Among Stroke Survivors. Workplace Health Saf. 2019;67(2):87-94. doi: 10.1177/2165079918812483
Palstam A, Westerlind E, Persson HC, Sunnerhagen KS. Work-related predictors for return to work after stroke. Acta Neurol Scand. 2019;139(4):382-388. doi: 10.1111/ane.13067
Hannerz H, Holbæk Pedersen B, Poulsen OM, Humle F, Andersen LL. A nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996-2006. BMJ Open. 2011;1(2):e000180. doi: 10.1136/bmjopen-2011-000180
Fadyl JK, McPherson KM. Approaches to vocational rehabilitation after traumatic brain injury: a review of the evidence. J Head Trauma Rehabil. 2009;24(3):195-212. doi: 10.1097/HTR.0b013e3181a0d458
Fure SCR, Howe EI, Andelic N, et al. Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial. Ann Phys Rehabil Med. 2021;64(5):101538. doi: 10.1016/j.rehab.2021.101538
Jamieson GA. A unified theory of hypnosis and meditation states: The interoceptive predictive coding approach. Hypnosis and meditation: Towards an integrative science of conscious planes. New York, NY, US: Oxford University Press; 2016. p. 313-42.
Kirsch I. Response expectancy as a determinant of experience and behavior. American Psychologist. 1985;40(11): 1189.
Lifshitz M, Howells C, Raz A. Can expectation enhance response to suggestion? De-automatization illuminates a conundrum. Conscious Cogn. 2012;21(2):1001-1008. doi: 10.1016/j.concog.2012.02.002
Raz A. Hypnobo: perspectives on hypnosis and placebo. Am J Clin Hypn. 2007;50(1):29-36. doi: 10.1080/00029157.2007.10401595
Fontanelli L, Spina V, Chisari C, Siciliano G, Santarcangelo EL. Is hypnotic assessment relevant to neurology?. Neurol Sci. 2022;43(8):4655-4661. doi: 10.1007/s10072-022-06122-8
Lindeløv JK, Overgaard R, Overgaard M. Improving working memory performance in brain-injured patients using hypnotic suggestion. Brain. 2017;140(4):1100-1106. doi: 10.1093/brain/awx001
Cui-Ping L. Influence of hypnosis therapy on recovery of hemorrhagic stroke. Journal of Taishan Medical College. 2011;25(1):63-65.
Johansson B, Bjuhr H, Karlsson M, Karlsson J-O, Rönnbäck L. Mindfulness-Based Stress Reduction (MBSR) Delivered Live on the Internet to Individuals Suffering from Mental Fatigue After an Acquired Brain Injury. Mindfulness. 2015;6(6):1356-1365. doi: 10.1007/s12671-015-0406-7
Johansson B, Bjuhr H, Rönnbäck L. Mindfulness-based stress reduction (MBSR) improves long-term mental fatigue after stroke or traumatic brain injury. Brain Inj. 2012;26(13-14):1621-1628. doi: 10.3109/02699052.2012.700082
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737-1744. doi: 10.1001/jama.282.18.1737
Bebbington P, Nayani T. The psychosis screening questionnaire. Int J Methods Psychiatr Res. 1995;5(1):11-19.
Lindeløv JK, Kvamme TL, Thomsen KR, Overgaard R, Overgaard M. Hypnosis for acquired brain injury: Four patient cases and five testable predictions. New Ideas in Psychology. 2023;71:101046.
Hjollund NH, Larsen FB, Andersen JH. Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health. 2007;35(5):497-502. doi: 10.1080/14034940701271882
Stapelfeldt CM, Jensen C, Andersen NT, Fleten N, Nielsen CV. Validation of sick leave measures: self-reported sick leave and sickness benefit data from a Danish national register compared to multiple workplace-registered sick leave spells in a Danish municipality. BMC Public Health. 2012;12:661. doi: 10.1186/1471-2458-12-661
Wechsler D. Wechsler Adult Intelligence Scale–Fourth Edition (WAIS–IV): San Antonio, TX: The Psychological Corporation; 2008.
Iverson GL. Interpreting change on the WAIS-III/WMS-III in clinical samples. Arch Clin Neuropsychol. 2001;16(2):183-191.
Sánchez-Cubillo I, Periáñez JA, Adrover-Roig D, et al. Construct validity of the Trail Making Test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. J Int Neuropsychol Soc. 2009;15(3):438-450. doi: 10.1017/S1355617709090626
Vallat-Azouvi C, Pradat-Diehl P, Azouvi P. The Working Memory Questionnaire: a scale to assess everyday life problems related to deficits of working memory in brain injured patients. Neuropsychol Rehabil. 2012;22(4):634-649. doi: 10.1080/09602011.2012.681110
Cardol M, de Haan RJ, van den Bos GA, de Jong BA, de Groot IJ. The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA). Clin Rehabil. 1999;13(5):411-419. doi: 10.1191/026921599668601325
Bonkhoff AK, Hope T, Bzdok D, et al. Bringing proportional recovery into proportion: Bayesian modelling of post-stroke motor impairment. Brain. 2020;143(7):2189-2206. doi: 10.1093/brain/awaa146 Stata Statistical Software Release 17. College Station, TX: StataCorp LLC: StataCorp; 2021.
La Torre G, Lia L, Francavilla F, Chiappetta M, De Sio S. Factors that facilitate and hinder the return to work after stroke: an overview of systematic reviews. Med Lav. 2022;113(3):e2022029. doi: 10.23749/mdl.v113i3.13238
Cedercreutz C, Lähteenmäki R, Tulikoura J. Hypnotic treatment of headache and vertigo in skull injured patients. Int J Clin Exp Hypn. 1976;24(3):195-201. doi: 10.1080/00207147608416201
Kirsch I. Response expectancy as a determinant of experience and behavior. American Psychologist. 1985;40(11): 1189-1202.
Polich G, Iaccarino MA, Kaptchuk TJ, Morales-Quezada L, Zafonte R. Placebo Effects in Traumatic Brain Injury. J Neurotrauma. 2018;35(11):1205-1212. doi: 10.1089/neu.2017.5506
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