Subjective experience of hypnosis/music interventions of cancer

Relatively few studies explore the nature of experiences of cancer patients undergoing adjunctive therapies involving altered states of consciousness. In these studies, it has become clear that the quality of patients’ experience affects the perceived or measured benefits of the interventions. Walker et al. (1999) asked cancer patients in a relaxation combined with guided imagery study to keep a journal of their experiences, keeping track of their exercises, any difficulties experienced in the performance, as well as rating how

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vivid the imagery was (with ratings of 0–10 on a Likert scale). In line with their findings, while the control and treatment groups showed no difference in primary response to the chemotherapy, there proved to be a marked difference in clinical response, showing correlation with the vividness ratings for the visualisation exercises. Eremin et al. (2009) used a similar methodology to investigate the immuno-modulatory effects of relaxation training and guided imagery exercises for patients suffering from breast cancer. Their results showed significant correlation between the vividness of imagery, as rated by the patient, and NK (Natural Killer) and LAK cell (lymphokine-activated killer cell) activity change from base line to end of chemotherapy/pre-surgery. Furthermore, significant correlation between imagery ratings and change from baseline NK cell activity, as well as IL1b (interleukin 1 beta) levels were detected eight weeks after radiotherapy.

In a pilot study of 62 hospitalized cancer patients currently experiencing pain, Kwekkeboom, Kneip & Pearson (2003) found that as imaging ability scores increased, mean pain intensity decreased, and patients reported more positive affect and perceived control over pain. However, imaging ability could not predict pain-related distress as a more emotional component of pain. In this study, the preferred way of coping with pain as a predictor of outcome expectancy was included, but no significant association was found.

In a study by Kwekkeboom, Wanta & Bumpus (2008) on the reduction in pain level among 40 cancer patients using guided imagery, they discovered that a meaningful improvement in pain reduction was associated with greater imaging ability, more positive outcome expectancy, and fewer concurrent symptoms.

Kwekkeboom, Hau, Wanta & Bumpus (2008) performed a retrospective study on how the efficacy of relaxation and visualisation treatment techniques could be affected by the perceptions and expectations of patients. According to their findings, among other factors, patients’ active, motivated involvement in the treatment and individual abilities showed correlation with its ultimate effectiveness.

Regarding musical interventions with oncology patients, in line with the findings of Potvin, Bradt, Kesslick (2015) symptom management is not a linear process (i.e.

receiving an intervention that helps to relieve symptoms), but rather requires intrapsychic involvement on the part of the patients to achieve a more holistic wellbeing. The authors

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also recommend for future research the incorporation of intrapsychic content when examining interventions for symptom management.

These findings demonstrate that there is an important relationship between the subjective experience of patients, their active involvement, the vividness of imagery, and the efficiency of the method used. However clinical trials to describe the effects of a supportive techniques (like hypnosis, music) in oncology settings, and to determine statistical significance, usually report group data (e. g. means) only. These studies tend to overlook how individuals respond to the psychological intervention technique in question. Patients’ subjective experience and level of involvement in the given technique and, as a result, their perception on how well the intervention worked for them, are often not reflected in the conclusion drawn from the group data. So, it is important to identify patient-related factors that influence the effectiveness of a supportive intervention in cancer care. Therefore, patients’ subjective experience should be better understood and analysed.

In summary, in order to help patients to adjust to breast cancer it is extremely important to understand the personality resources which help patients to become stress-tolerant and to cope effectively. Since psychological immune competence involves coping strategies, protective personality resources and dimensions of resilience, it seems to provide a comprehensive insight into coping processes. It is important to gain more knowledge on the psychological immune competence that characterises breast cancer patients, and on how it changes over time, during cancer treatment and the survivor period, and how it can be affected by well-proven methods in oncological settings, by psychological interventions such as hypnosis or music medicine. Patients’ subjective experience of guided imagery interventions such as imagery ratings, involvement and vividness seems to have an impact on the clinical outcomes of cancer patients, therefore it seems essential to explore in depth what patients experience when undergoing adjuvant hypnosis or music medicine as psychosocial interventions during their cancer treatment, and how these experiences are related to coping, personal resources, how they reflected in adaptational outcomes such as patients’ quality of life and personal growth.

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3 Aims and hypothesis

The main aim of our study is to discover the patterns of psychological immune competence of breast cancer patients: changes during treatment and in early years of survivorship, changes that occur due to psychological interventions. Furthermore, our aim is to analyse the subjective experience of psychological interventions (hypnosis/music/special attention only without further intervetion), and compare patients’

psychological immune competence, quality of life and posttraumatic growth according to it.

To study the above aims, we compared our breast cancer patient sample to a group of healthy women in order to determine how the patients' psychological immune competence develops during the study compared to a healthy sample. We found it important to determine the most dominant elements of psychological immune competence that are used by patients receiving different interventions.

Based on theoretical considerations and previous empirical findings, the following research hypotheses (H) and questions (Q) were formulated

1. H1: Breast cancer patients have a different psychological immune competence to healthy control women. Due to the activation of the psychological immune response to distress, it can be assumed that breast cancer patients show higher immune competence than healthy control women.

2. H2: The most prominent and the lowest elements of immune competence in certain phases of cancer treatment can be identified, and since psychotherapy affects coping, it is assumed that this may vary across intervention groups.

3. H3: Psychological interventions (hypnosis/music/special attention only, without further intervention) are assumed to have different effects on Psychological Immune Competence. It is hypothesized that hypnosis may be a more effective tool for increasing Psychological Immune Competence than music or special attention.

4. H4: As coping changes in time and under the influence of therapy, it can be assumed that psychological immune competence as an integrated system changes over time in the course of treatment and early survival period. Psychological intervention also influences this change in time.

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5. Q1: It can be assumed that subjective experiences of the received intervention differ among patients. How can these experiences be described and to what extent do they reflect personal involvement in the received psychological intervention?

6. Q2: Is the degree of involvement connected to the psychological immune competence, quality of life and post-traumatic growth of patients? Can it be assumed that greater involvement is related to higher immune competence, better quality of life and higher post-traumatic growth?

4 Method