Description of experiences that characterised breast cancer patients’

involvement in hypnosis/music/special attention 6.4.2.1 Somatic complaints

Chemotherapy treatment usually comes with a range of physical, psychological, and psychosocial side effects. Side effects can be clinical syndromes (e.g., depression, anxiety, cognitive impairment), observable physical problems (e.g., nausea, vomiting, hair loss), subjective physical problems (e.g., pain, fatigue), as well as psychosocial difficulties (e.g., job and financial problems) (Wagland et al., 2015). Patients in our sample talked about their experience right after an actual chemotherapy treatment or one week after when they came for their blood test result checks. When they were asked to tell about their experience of the intervention, some in our sample spoke of physical problems. These physical problems were represented in the category of somatic complaints. This category covers any disturbing somatic experience that was present at the same time when the patient was receiving the intervention. (i.e. listening to hypnosis, or music, or receiving extra attention from the research team). This included the treatment

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itself, the medical environment, conditioned physical responses such as anticipatory nausea, but somatic complaints could also include the symptoms themselves if the patient was not sufficiently diverted from them. These Somatic complaints, however, appeared in the three groups with highly different frequencies. The highest occurrence was in the special attention group, as somatic complains appeared twice as frequently as in the hypnosis groups and 1.5 times more than in the music group. The least occurrence of somatic complains was in the hypnosis group. It seems that hypnosis was the most capable of reducing disturbing somatic symptoms. This is consistent with the large number of studies which have proved that hypnosis can modulate conscious bodily experience like chronic or procedural pain, nausea, and vomiting (Carlson et al., 2018; Cramer et al., 2015; Montgomery et al., 2013; Wortzel & Spiegel, 2017).

6.4.2.2 Internal/external disturbances

Internal/external disturbances describe the attempt to become involved in the intervention; however, inner thoughts or outside events distracted the patients from becoming involved. Its highest occurrence was in the music group. This could be owing to the fact that special attention did not require a focused immersion on the part of the patients, and it seems that the verbal nature of hypnosis was more successful in orienting attention.

6.4.2.3 Pleasant somatic experiences

Despite the generally frequent somatic side effects and negative psychological consequences of chemotherapy, a pleasant somatic experience was the most dominant response in all three types of interventions. Pleasant somatic experience refers to a state when patients feel relaxed, calm, and free of stress in a mental or physical sense. Above all it seems to be one of the most important merits of this study that all three types of interventions could outweigh the side effects of chemotherapy, and treatment time could be referred to as a pleasant somatic experience. The beneficial effect of achieving a relaxed state during chemotherapy has a long history in easing emotional adjustment, anxiety, depression, improving treatment related symptoms, and immune functions, to mention but a few (Gruzelier, 2002; Luebbert, Dahme & Hasenbring, 2001) It seems that hypnosis providing direct suggestions to achieve a state of relaxation, and music working in a non-verbal fashion are both highly conductive to such a state. In the special attention group, pleasant somatic experiences occurred most frequently out all types of

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involvement. This result has an important clinical significance, showing that simple intervention, such as the social support provided by special attention, can generate such beneficial state. At the same time, with hypnosis and music, patients talk about a wider range of other experiences of deeper involvement (sensory experiences, personal memories, visualisation or elaboration of symbols), while in the special attention group these categories representing positive, altered states of consciousness are almost entirely absent.

6.4.2.4 Nonverbal sensory experiences and positive personal memories

There were no direct instructions for non-verbal sensory experiences such as visualization of colours, smelling a certain aroma like a pine tree, or of feeling as though floating on waves, or positive personal memories such as childhood experiences or recent affirmative, sometimes symbolic positive events. It is important to highlight that the appearance of these experiences was spontaneous, and therefore their occurrence might denote a greater degree of intrapsychic work. When they talk about their experience, patients usually realise the personal significance of these sensory experiences and positive memories. These types of involvement happened only in the case of music and the hypnosis group. Literature examining experiences of hypnosis as well as music, denotes the occurrence of both positive personal memories and sensory delusions (Dileo, 2006;

Pekala, 1991). Both categories appeared most frequently in the hypnosis group, while nonverbal sensory experience did not occur in the special attention group and a positive memory was reported only once.

6.4.2.5 Visualization of symbols

Visualization of symbols was mentioned in 331 sessions in the hypnosis group, 120 sessions in music and 18 in the special attention group. In the case of hypnosis, suggestions were overt messages given for therapeutic reasons, and contained images to help relieve stress-induced anxiety, as well as metaphors for ego-strengthening, helping to increase motivation for recovery, dealing with the side-effects of chemotherapy, activating inner healing resources, and facilitating immune functions. Music was designed to match the themes, moods, and dynamics of the hypnotic text. It seems that symbols and images similar to the ones given overtly in hypnosis could be evoked by the non-verbal channels of music, but less frequently than in hypnosis. Visualization of symbols in the case of special attention was rare, though still detectable. Symbols in this

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group were in connection with symbols of physical healing, auto suggestions such as visualising the chemo as it helps to cure, but these images were vaguely described by the patients.

6.4.2.6 Elaboration of symbols

Elaboration of symbols represents compound images that become personal, original, and unique, they contain meaningful extra details more than the original suggestions gave.

This extra meaning is generated by the patient. The occurrence of elaboration of symbols was again highest in the hypnosis group (in case of 75 sessions) but it also appeared in music group (in 23 sessions), where these symbols were activated nonverbally. None of the patients in the special attention group reported symbols in such manner. Both the visualization of symbols and the elaboration of symbols have clinical importance, since previous studies have proved that vividness of imagery is correlated with clinical response to cancer treatment (Eremin et al., 2009; Walker et al., 1999).

6.4.2.7 Relative precedence of categories in the different involvement groups

In the hypnosis group, somatic complaints and internal/external disturbances were mentioned in 30.2 % of all sessions. Pleasant somatic experience was almost as high as the previous two, with 27.4% reporting nonverbal sensory experience, while memories and the visualization and elaboration of symbols were mentioned in 42.5% of cases. In the music group the figures were 42.5% – 38.6% – 18.9 % respectively, and in the special attention group 48.5% – 46.6% – 4.8 % So, in case of hypnosis, in almost half the sessions some kind of intrapsychic involvement more than a simple relaxed feeling was registered.

This type of involvement was lower in case of music group, and almost absent in special attention. It is important to note that both music and special attention had the same relative pattern, with equally high occurrences of somatic complaints, internal/external disturbances and pleasant somatic feelings.