Managing hot flushes with hypnotherapy and CBT

This post is one for the ladies! Monday was the hottest day of the year here in the UK. And then yesterday. And I reckon today will break that record again too. I sat on an overcrowded train with no air conditioning and only one window open for 45 minutes on my way in to Bristol today to see clients. It was a very uncomfortable journey and I was hot and flustered to say the least. It made me think about all the women going through the menopause who have to manage the unusually hot temperatures and at the same time experiencing hot flushes.

So I thought I’d focus on hot flushes in the menopause, namely the research that’s out there for both hypnotherapy and CBT in helping to manage them better.

On average, women enter the menopause around the age of 50. However, around 1 in 100 women experience premature menopause in their 40s, 30s, and even as early as their 20s.

After my mum gave birth to me at the age of 30, she went through the menopause. Whilst there is still a stigma attached to the menopause, generally women are able to talk about it with their friends, colleagues and family, especially when they experience it at the age which is typical for women. However, this is not the case for those who experience it prematurely. They can often feel isolated. None of their friends are going through it or have any experience with it so they find it difficult to talk about what they are experiencing. And so they often end up experiencing the menopausal symptoms in silence.

There are many common symptoms that women experience during the menopause but for the purpose of this blog post, I’m going to talk about the most common symptoms, hot flushes and night sweats, which affect 60-70% of women during the menopause.

The research
This is my favourite part. I’m going to talk about the research that’s been done on managing hot flushes using placebo, CBT and hypnotherapy. Hot flushes and night sweats can be managed successfully using evidence-based techniques that are backed by science.

Research has shown that the placebo effect can be quite remarkable at reducing hot flushes. For those who don’t know, a placebo is a substance or treatment with no active therapeutic effect. Sugar pills are often used in research trials to compare their efficacy with that of actual active medicines. It is one of the ways the pharmaceutical industry tests to see whether a drug is effective or not. Placebo is a very powerful thing. In such trials relating to hot flushes, placebo pills were found to reduce hot flushes in women by 30-40%. I think the placebo effect is fascinating and really illustrates how powerful our mind can be.

Let’s look at the CBT research first.

In the last 5 years in particular, there have been many research studies carried out looking at ways to reduce hot flushes in both menopausal women and women who have breast cancer, as they also can suffer with them as a result of their treatments. It’s quite an exciting time really as we are beginning to understand much more about why they occur, what causes them and how we control them.

A randomised control group study, called MENOS2, looked at group CBT and guided self help CBT for women with problematic hot flushes during the menopause transition. Participants experienced a significant reduction in the problem rating of hot flushes, improved mood and quality of life including memory, and emotional and physical functioning. Improvements were maintained at 6 months. (Ayers et al, 2012)

An evaluation was carried out comparing CBT with HRT and no treatment and found that CBT and HRT significantly reduced hot flush frequency, but CBT also significantly reduced anxiety and hot flush problem ratings. Changes were maintained at 3 months follow-up. (Hunter & Liao, 1996)

And the most recent randomized controlled trial which looked at self-help CBT for working women with problematic hot flushes and night sweats. Participants experienced significantly reduced hot flush problem ratings and frequency, improved work and social adjustment, sleep, menopause, as well as hot flush beliefs and behaviours which were still maintained at the 6 weeks and 20 weeks, with additional improvements in wellbeing, somatic symptoms and reduced work impairment due to menopause-related presenteeism at 20 weeks. (Hardy et al, 2018)

So already with just these three studies, there is very good news for those who suffer with hot flushes. We have a reduction in problem rating for hot flushes, improved mood and quality of life. And these improvements can be maintained long term too. These studies showed that the techniques were effective regardless of age, BMI, menopausal status, and psychological distress at the beginning of the trials.

Research has shown that when hypnosis is used in conjunction with CBT, it enhances its effectiveness (Schoenberger et al, 1997). I use a wide range of cognitive behavioural techniques with my clients in conjunction with hypnotherapy.

Which brings us on nicely to, the hypnosis research.

A randomized trial was used to study hypnosis for the treatment of hot flushes among breast cancer survivors. Participants experienced a 68% decrease in hot flush scores (frequency x average severity) as well as significant improvements in self-reported anxiety, depression, interference of hot flushes on daily activities, and sleep. (Elkins et al, 2008)

A randomized controlled trial was conducted on clinical hypnosis in the treatment of postmenopausal hot flushes. Participants experienced a 74% reduction in hot flushes, an 80% reduction in hot flush problem rating, as well as improved sleep quality and less daily interference from hot flushes. (Elkins et al, 2013)

Now with these two studies added in to the mix we have a reduction in the frequency of hot flushes, less interference of hot flashes on daily activities, and improved sleep.

Oh, and by the way, the image at the beginning of the post is there to create a cooling effect! In research, the most widely used imagery by the women to help manage their hot flushes involved water associated with coolness. Other people imagined cool mountains, air/wind, snow, trees/leaves/forest, cool waterfall or rain. (Elkins et al, 2010)

I have studied the research that I’ve listed here and pulled out much of the structure and techniques that have been used to create change in these women. Many therapists do not read the research out there for their discipline which is a real shame. I am fascinated by it! I have learnt so much from reading through the journals relating to my subject and my clients get to benefit from it too.

References:

• Ayers, B., Smith, M., Hellier, J., Mann, E. & Hunter, M.S. (2012) Effectiveness of group and self-help cognitive behaviour therapy to reduce problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause 19,7:749-759
• Elkins, G., Marcus, J., Stearns, V., Perfect, M., Rajab, M.Ruud, C. (2008) Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. Journal of Clinical Oncology, 26: 5022–5026.
• Elkins, G, Marcus, J, Bunn, J, Perfect, M, Palamara, L, Stearns, V & Dove, J. (2010) Preferences for Hypnotic Imagery for Hot-Flash Reduction: A Brief Communication. International Journal of Clinical and Experimental Hypnosis, Volume 58, Issue 3
• Elkins GR, Fisher WI, Johnson AK, Carpenter JS, Keith TZ.Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. (2013) Menopause. Mar;20(3):291-8.
• Hardy C, Griffiths A, Norton S, Hunter MS. (2018) Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial. Menopause. Jan 8.
• Hunter, M. S. & Liao, K.L. (1996) Evaluation of a four-session cognitive–behavioural intervention for menopausal hot flushes. British Journal of Health Psychology. Volume 1, Issue 2 Pages 113–125
• Schoenberger, N. E., Kirsch, I., Gearan, P., Montgomery, G., & Pastyrnak, S. L. (1997). Hypnotic Enhancement of a Cognitive Behavioral Treatment for Public Speaking Anxiety. Behavior Therapy (28), 127-140.