PLEASE SCROLL DOWN FOR ARTICLE

This article was downloaded by: [Cardena, Etzel]On: 1 November 2010Access details: Access Details: [subscription number 928675592]Publisher RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

International Journal of Clinical and Experimental HypnosisPublication details, including instructions for authors and subscription information:http://www.informaworld.com/smpp/title~content=t713657963

Hypnosis as an Adjunct Therapy in the Management of DiabetesYuan Xua; Etzel Cardeñaa

a Lund University, Lund, Sweden

Online publication date: 27 October 2010

To cite this Article Xu, Yuan and Cardeña, Etzel(2008) 'Hypnosis as an Adjunct Therapy in the Management of Diabetes',International Journal of Clinical and Experimental Hypnosis, 56: 1, 63 — 72To link to this Article: DOI: 10.1080/00207140701673050URL: http://dx.doi.org/10.1080/00207140701673050

Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf

This article may be used for research, teaching and private study purposes. Any substantial orsystematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply ordistribution in any form to anyone is expressly forbidden.

The publisher does not give any warranty express or implied or make any representation that the contentswill be complete or accurate or up to date. The accuracy of any instructions, formulae and drug dosesshould be independently verified with primary sources. The publisher shall not be liable for any loss,actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directlyor indirectly in connection with or arising out of the use of this material.

Intl. Journal of Clinical and Experimental Hypnosis, 56(1): 63–72, 2008Copyright © International Journal of Clinical and Experimental HypnosisISSN: 0020-7144 print / 1744-5183 onlineDOI: 10.1080/00207140701673050

63

NHYP0020-71441744-5183Intl. Journal of Clinical and Experimental Hypnosis, Vol. 56, No. 1, Oct 2007: pp. 0–0Intl. Journal of Clinical and Experimental HypnosisHYPNOSIS AS AN ADJUNCT THERAPY IN THE MANAGEMENT OF DIABETES

Hypnosis in Diabetes Management Yuan Xu and Etzel CardeñaYUAN XU AND ETZEL CARDEÑA

Lund University, Lund, Sweden

Abstract: Although diabetes is one of the most serious global healthproblems, there is no real cure yet for it. The conventional insulintreatment programs aimed at life quality improvement do not takeinto account the psychological aspects of the disease. Because diabe-tes has important psychological components, it seems reasonable toconsider hypnosis as an adjunct therapy for diabetes. This paperexamines the empirical literature on the effectiveness of hypnosis inthe management of diabetes, including regulation of blood sugar,increased compliance, and improvement of peripheral blood circula-tion. Despite some methodological limitations, the literature showspromising results that merit further exploration. Multimodal treat-ments seem especially promising, with hypnosis as an adjunct toinsulin treatments in the management of both Type 1 and Type 2 dia-betes for stabilization of blood glucose and decreased peripheral vas-cular complications.

Diabetes is rapidly becoming one of the most serious global healthproblems. It was estimated in 2003 that about 5.1% of the global popu-lation of 20- to 79-year-olds had diabetes and that this number willincrease to 6.3% by 2025 (International Diabetes Federation, 2003).Type 2 diabetes constitutes about 85%–95% of all diabetes in devel-oped countries (World Health Organization, 1994) and accounts for aneven higher percentage in developing countries and among some eth-nic minorities in industrialized nations (e.g., Hertz, Unger, & Ferrario,2006).

Diabetes mellitus is an endocrine disorder of carbohydrate metabo-lism characterized by hyperglycemia and glucose intolerance causedby insulin deficiency, insulin resistance, or both. The predominantcause of Type 1 diabetes (T1D, insulin-dependent diabetes mellitus) ispolygenically inherited autoimmune destruction of pancreatic betacells (Atkinson & Maclaren, 1994), although the specific etiology ofType 2 diabetes (T2D, noninsulin-dependent diabetes mellitus) is notquite understood.

Manuscript submitted August 2, 2006; final revision accepted September 2, 2006.Address correspondence to Etzel Cardeña, Ph.D., Thorsen Professor, Department of

Psychology, Lund University, P.O. Box 213 SE-221 00, Lund, Sweden. E-mail:Etzel.Cardena@psychology.lu.se

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

64 YUAN XU AND ETZEL CARDEÑA

Epidemiological evidence indicates that Type 2 diabetes resultsfrom the interaction between genetic and environmental factors suchas the excess of fat and sugar as well as calories. Likewise, a sedentarylifestyle leads to obesity and insulin resistance. The identification ofgenes that predispose to Type 2 diabetes has suggested that polymor-phism in a certain number of genes are important. These include thegenes for the peroxisome-proliferator-activated receptor gamma(PPAR γ), a nuclear receptor important for insulin function; the geneKir6.2, which is a potassium channel that is needed for insulin secre-tion; as well as the promoter region of hepatocyte nuclear factor 4,which regulates pancreatic beta cell function. However, it is commonlyagreed that T2D is caused by a complex interaction between polygenicinheritance and environmental factors. Risk factors for the onsetand severity of T2D include central/abdominal obesity, age over 45,low activity level, hypertension, dyslipidemia, a history of low glucosetolerance, race/ethnicity, and a history of gestational diabetes forwomen.

No real cure exists yet for diabetes. Both T1D and T2D are chronicdiseases requiring constant close monitoring of blood glucose levelsand lifelong daily management aimed at symptom reduction and life-quality maintenance. Though having different causes, the rationale fortheir management is the same, namely the stabilization of blood glu-cose to relieve symptoms and to prevent secondary diseases and long-term complications from chronic hyperglycemia such as retinopathy,nephropathy, neuropathy, peripheral vascular disease, atherosclerosis,hypertension, and coronary heart disease. Conventional treatmentprograms usually consist of daily insulin injections and rigorous nutri-tion-intake control. Regular exercise and weight-loss programs are alsohighly recommended for obese T2D patients.

With the exception of a single master’s thesis (Warner, 2004), theconventional insulin-treatment programs have usually not taken intoaccount the psychological aspects of the condition. With the autonomicnervous and endocrine systems being the main regulators of bloodglucose, it is not a high stretch to think of diabetes as a psychosomaticdisorder—namely, a condition with primarily physiological causesthat can be greatly exacerbated by psychological stresses through thedysfunctional activation of the autonomic nervous and endocrine sys-tems. A variety of psychological variables have been found to beimportant in the metabolic control of diabetic patients (Rose, Schirop,Fliege, Klapp, & Hildebrandt, 2002). For instance, Dutour et al. (1996)found that the acute psychological stress produced by a video-recorded public speech played a role in the glycemic instability of brit-tle T1D patients (unstable diabetes). Other research showed that ratssubjected to chronic psychological stress (exposed to chronic stressorstwice daily for 1 hour) showed higher glucose intolerance and lower

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

HYPNOSIS IN DIABETES MANAGEMENT 65

plasma insulin levels than nonstressed rats (Zardouz, 2005). A psycho-neuroendocrine model has also been proposed with the hyperactivityof the hypothalamic-pituitary-adrenal (HPA) axis as a predictor of theinsulin resistance found in T2D (Björntorp, Holm, & Rosmond, 1999;Rosmond & Björntorp, 2000). Further, an early report investigated howemotions and stress related to blood-glucose levels in 2 diabetics(Meyer, Bollmeier, & Alexander, 1945). Both patients developed diabetesunder the strain of emotional conflicts, and the presence of emotionalstress caused by unsatisfied demands of attention and love was shownto be responsible for the increases in their urine sugar output, whereasemotional stability related to the temporary renouncement of theirdemanding attitudes resulted in decreased urine sugar. The impor-tance of psychological factors in diabetic management is now begin-ning to receive more and more attention. Petrak and collaborators(2005) provided evidence-based support for psychosocial factors inboth T1D and T2D, which were integrated into treatment guidelines bythe German Diabetes Association.

HYPNOSIS AND DIABETES

There is considerable evidence that the disregard of extraneous con-cerns and increased focus of hypnotic suggestions can affect variousphysiological functions often considered completely autonomous(Barber, 1983) and that these changes can have important clinicalimplications (Lynn, Kirsch, Barabasz, Cardeña, & Patterson, 2000).Therefore, it is reasonable to consider whether hypnosis can help regu-late autonomic processes such as blood glucose and peripheral bloodflow in the treatment of diabetes. Diment (1991) also suggested thatdiabetes itself can be a stressor that will in turn exacerbate the condi-tion and provided arguments for a pragmatic use of hypnosis as anadjunct in diabetes counseling to reduce stress for both diabetes-related anxiety and general life stress to improve metabolic control.Despite the anecdotal reports and the theoretical rationales for usinghypnosis, no large-scale study has been conducted to assess the effec-tiveness of hypnosis in diabetic management. This is an area thatshould be explored further. The increased suggestibility shown duringthe hypnotic state would also be helpful in increasing compliance forexercise, diet, and other lifestyle changes.

Hypnosis and Regulation of Blood GlucoseSome studies have evaluated the effect of hypnosis on blood-glu-

cose levels. In an experiment designed to assess the effect of hypnoti-cally induced acute emotional stress on carbohydrate and lipidmetabolism in diabetics, Vandenbergh, Sussman, and Titus (1966)were surprised to find a decreased level of blood glucose instead of an

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

66 YUAN XU AND ETZEL CARDEÑA

increased one as they had hypothesized. They speculated that the hyp-notic induction itself might have been responsible for the decrease.McCord (1968) reported a case where a 58-year-old man, who was pri-marily treated with hypnosis for incontinence and for diabetes, wasgiven suggestions about following his recommended diet moreclosely. He reported a changed attitude toward food and a surprisingspontaneous reduction in his daily insulin intake despite the fact thatinsulin was never mentioned in his session.

Hypnosis to Increase ComplianceOne of the most widely quoted articles to support the claim that

hypnosis is effective in the metabolic control of diabetes is an experi-ment conducted by Ratner, Gross, Casas, and Castells (1990). Sevenadolescents with T1D and poor metabolic control were admitted withno changes in their old management program except the addition ofhypnosis (both hetero- and self-hypnosis). After 6 months, their gly-cated hemoglobin (HgbA1C) and fasting blood-glucose valuesdropped significantly. The study did not use hypnosis to target the dis-ease itself but to redirect the goals of the patients to secure compliancewith the insulin injections, glucose testing, and diet-control programs.

Hypnosis for Weight LossResearch suggests that not only T1D patients but T2D patients also

have a low level of compliance: they only follow dietary recommenda-tions about 60% of the time, exercise recommendations 34% of thetime, and foot-care recommendations 47% of the time (Toobert, Hampson,& Glasgow, 2000). The healthy lifestyle required for diabetic manage-ment is essentially the same as the one for weight loss, with regularexercise and a healthy diet. Obesity is a well-established risk factor forT2D (Willett, Dietz, & Colditz, 1999). T2D patients are very often,though not always, overweight. The drastic increase in the prevalenceof diabetes in recent decades has been strongly associated to theincrease in obesity. Therefore, one of the key factors in the manage-ment of diabetes, especially T2D, is weight control. Evolutionary selec-tion might be partly responsible for our innate preference for energy-rich food and an inactive lifestyle, making weight loss excessively dif-ficult for some. Therefore, reprogramming of the “reward” and “plea-sure” centers in the brain is required for our adaptation to the modernlifestyle.

Hypnosis has long been suggested as a treatment for weight loss,and it has been examined in various studies. For instance, Cochraneand Friesen (1986) showed at a 6-month follow-up that both audio-taped and nonaudiotaped suggestions induced significantly greaterweight loss than control in women at least 20% overweight and not inother treatment programs. Hypnotizability was not a predictor of how

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

HYPNOSIS IN DIABETES MANAGEMENT 67

much weight was lost, but there was a trend toward greater weightloss with higher suggestibility scores. Two reviews (Pittler & Ernst,2005; Vanderlinden & Vandereycken, 1994) that analyzed results fromseveral different studies both arrived at the conclusion that hypnosis iseffective in weight loss although considered the effect to be small. Incontrast, specific meta-analyses on the use of hypnosis for obesityfound a 0.98 standard deviation effect size when hypnosis was anadjunct to treatment and that the benefits of hypnosis increased sub-stantially over time (Kirsch, Capafons, Cardeña, & Amigó, 1999). Pittlerand Ernst also concluded that hypnosis with cognitive-behavioral ther-apy was more effective than cognitive-behavioral therapy alone, andthat hypnotherapy directed at stress reduction was more effective thandietary advice. Vanderlinden and Vandereycken proposed a multifac-eted hypnotherapy program for obesity, consisting of a beginningphase with suggestions for relaxation, self-control, and physical exer-cise, a middle phase for altering self-esteem and body image, strength-ening motivation, exploring ambivalence towards change, and a finalphase for consolidation of improvement and prevention of relapse.This is one of the most comprehensive programs found. Many of theproposed ideas could be easily adapted to diabetes management aswell. In one of the most recent analysis from the Cochrane Collabora-tion, known for its rigorous standards for evidence-based medicine,Shaw, O’Rourke, Del Mar, and Kenardy (2005) concluded that notenough research is available to reach a conclusion for the effectivenessof hypnosis for obesity, although the meta-analyses mentioned abovemake this an arguable point. Nonetheless, more empirical studies,especially well-controlled large-scale randomized control studies, arerequired in this area, especially on the effect of hypnotic suggestionsfor weight loss on diabetes management and metabolic control.

Hypnosis for Increasing Peripheral CirculationAnother important aspect of diabetic management is diabetic foot

care. Chronically high blood-glucose values damage blood vessels andimpair peripheral circulation. Being one of the furthermost extremitiesof the body, the foot is especially affected. The poor peripheral bloodcirculation caused by diabetes makes the foot prone to infection andwound healing very difficult. On top of that, diabetic peripheral neur-opathy makes the foot numb so it is difficult to feel anything whendamage is done to it. If not managed properly, even a small injurycould result in potential amputation. Because the vascular system israther sensitive to psychological stimuli (Barber, 1983), hypnosis couldbe effective in increasing blood flow to the extremities and in reducingthe diabetic foot problem.

An early study conducted by Grabowska (1971) showed that sug-gestions of warmth increased the mean skin temperature by 2.7% and

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

68 YUAN XU AND ETZEL CARDEÑA

the velocity of capillary blood flow by a surprising 163%. Significantclinical improvements occurred among the diabetics in this study; theyreported intermittent claudication and coldness in the toes after 4weeks of treatment with hypnosis and autogenic training. Piedmont(1981) investigated the effect of hypnosis with biofeedback on skintemperature regulation. Biofeedback for lowering skin temperaturewas given both with and without hypnosis and participants showed agreater decrease in skin temperature when both treatments wereapplied. Though not a study aimed at improving blood circulation indiabetics, it provides interesting possibilities on the significance ofhypnosis for vascular regulation. Finally, Galper, Taylor, and Cox(2003) reviewed the application of mind-body interventions for vascu-lar complications of diabetes and found thermal biofeedback usedtogether with hypnosis to be effective in relieving diabetic angiopathy.In general, the efficacy of hypnosis looks promising in diabetic footcare.

DISCUSSION

The studies reviewed in this paper argue for the effectiveness ofhypnosis for diabetes management. However, despite the promisingand interesting results, most of the reports consist of a small number ofclinical cases or poorly controlled studies. Clearly, large-scale maskedstudies with placebo controls are needed to fully evaluate the potentialof hypnotic interventions. Finding a placebo treatment to replace hyp-nosis is a somewhat difficult but not insurmountable problem (Lynn etal., 2000). The placebo effect has long been recognized in the medicaltradition, and there is evidence that placebo-induced expectancies cantruly alter physiology in clinically significant ways (Cardeña & Kirsch,2000). Kirsch (1994) even refers to hypnosis as a “nondeceptive pla-cebo.” However, there is strong evidence that hypnosis interventionscan have a clinically significant effect over placebo in irritable bowelsyndrome (e.g., Whorwell, Prior, & Faragher, 1984).

Other control comparisons are possible in hypnosis studies. Relax-ation without hypnosis and/or suggestions given without a hypnoticinduction could be evaluated. These and other strategies might be con-sidered in future hypnotic research for better evaluation of the activetherapeutic ingredients. However, the more controlled and standard-ized the trials get, the more of the uniqueness of each patient and theimportance of the doctor-patient relationship may be jeopardized.Thus, both the efficacy and efficiency of hypnosis as an adjunct for thetraditional management of diabetes need to be evaluated.

Although some clinicians may assume that hypnotic interventionsmay consume time and add a cost to the patient, the analysis by Langand Rosen (2002) suggests that hypnosis may actually save considerable

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

HYPNOSIS IN DIABETES MANAGEMENT 69

time and money in the management of medical conditions. Even in achronic condition like this, after a few sessions of hetero-hypnosis, thepatients could be taught self-hypnosis for home practice.

We have proposed various rationales to develop a multifaceted pro-gram with hypnotic techniques for both Type 1 and Type 2 diabetesmanagement. The interventions should include suggestions forincreasing compliance to existing medical, exercise, and diet programs,stress reduction and relaxation for better metabolic control, and ther-mal vascular regulation of distal limbs. This development might notonly add diabetes to the list for which hypnosis may be an effectivetherapeutic adjunct (besides preoperative preparation, asthma, derma-tological disorders, irritable bowel syndrome, hemophilia, postchemo-therapy nausea and emesis, and various obstetric conditions; MaréPinell & Covino, 2000) but it would address an urgent and globalhealth problem.

REFERENCES

Atkinson, M., & Maclaren, N. (1994). The pathogenesis of insulin-dependent diabetesmellitus. New England Journal of Medicine, 331, 1428–1426.

Barber, T. X. (1983). Changing “unchangeable” bodily processes by (hypnotic) sugges-tions: A new look at hypnosis, cognitions, imaginings, and the mind-body problem. InA. A. Sheikh (Ed.), Imagination and healing (pp. 69–127). Farmingdale, NY: Baywood.

Björntorp, P., Holm, G., & Rosmond, R. (1999). Hypothalamic arousal, insulin resistanceand Type 2 diabetes mellitus. Diabetic Medicine, 16, 373–383.

Cardeña, E., & Kirsch, I. (2000). What is so special about the placebo effect? Mind-BodyMedicine, 16, 16–18.

Cochrane, G., & Friesen, J. (1986). Hypnotherapy in weight loss treatment. Journal of Con-sulting and Clinical Psychology, 54, 489–492.

Diment, A. D. (1991). Uses of hypnosis in diabetes-related stress management counsel-ing. Australian Journal of Clinical & Experimental Hypnosis, 19, 97–101.

Dutour, A., Boiteau, V., Dadoun, F., Feissel, A., Atlan, C., & Oliver, C. (1996). Hormonalresponse to stress in brittle diabetes. Psychoneuroendocrinology, 21, 525–543.

Galper, D. I., Taylor, A. G., & Cox, D. J. (2003). Current status of mind-body interven-tions for vascular complications of diabetes. Family & Community Health, 26, 34–40.

Grabowska, M. J. (1971). The effect of hypnosis and hypnotic suggestion on the bloodflow in the extremities. Polish Medical Journal, 10, 1044–1051.

Hertz, R. P., Unger, A. N., & Ferrario, C. M. (2006). Diabetes, hypertension, and dyslipi-demia in Mexican Americans and Non-Hispanic Whites. American Journal of Preven-tive Medicine, 30, 103–110.

International Diabetes Federation (IDF). (2003). Executive summary of the diabetes atlas(2nd ed.). Brussels, Belgium.

Kirsch, I. (1994). Clinical hypnosis as a nondeceptive placebo: Empirically derived tech-niques. American Journal of Clinical Hypnosis, 37, 95–106.

Kirsch, I., Capafons, A., Cardeña, E., & Amigó, S. (1999). Clinical hypnosis and self-regu-lation: An introduction. In I. Kirsch, A. Capafons, E. Cardeña-Buelna, & S. Amigó(Eds.), Clinical hypnosis and self-regulation therapy: A cognitive-behavioral perspective (pp.3–18). Washington, DC: American Psychological Association.

Lang, E. V., & Rosen, M. P. (2002). Cost analysis of adjunct hypnosis with sedation dur-ing outpatient interventional radiologic procedures. Radiology, 222, 375–382.

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

70 YUAN XU AND ETZEL CARDEÑA

Lynn, S. J., Kirsch, I., Barabasz, A., Cardeña, E., & Patterson, D. (2000). Hypnosis as anempirically supported clinical intervention: The state of the evidence and a look tothe future. International Journal of Clinical and Experimental Hypnosis, 48, 235–255.

Maré Pinell, C., & Covino, N. A. (2000). Empirical findings on the use of hypnosis inmedicine: A critical review. International Journal of Clinical and Experimental Hypnosis,48, 170–194.

McCord, H. (1968). Hypnotherapy in diabetes: A brief note. American Journal of ClinicalHypnosis, 10, 309–310.

Meyer, A., Bollmeier, L. N., & Alexander, F. (1945). Correlation between emotions andcarbohydrate metabolism in two cases of diabetes mellitus. Psychosomatic Medicine, 7,335–341.

Petrak, F., Herpertz, S., Albus, C., Hirsch, A., Kulzer, B., & Kruse, J. (2005). Current Diabe-tes Reviews, 1, 255–270.

Piedmont, R. L. (1981). Effects of hypnosis and biofeedback upon the regulation ofperipheral skin temperature. Perceptual and Motor Skills, 53, 855–862.

Pittler M. H., & Ernst, E. (2005). Complementary therapies for reducing body weight: Asystematic review. International Journal of Obesity, 29, 1030–1038.

Ratner, H., Gross, L., Casas, J., & Castells, S. (1990). A hypnotherapeutic approach to theimprovement of compliance in adolescent diabetics. American Journal of Clinical Hyp-nosis, 32, 154–159.

Rose, M., Schirop, T., Fliege, H., Klapp B. F., & Hildebrandt, M. (2002). The network ofpsychological variables in patients with diabetes and their importance for quality oflife and metabolic control. Diabetes Care, 25, 35–42.

Rosmond, R., & Björntorp, P. (2000). The hypnothalamic-pituitary-adrenal axis activityas a predictor of cardiovascular disease, Type 2 diabetes and stroke. Journal of InternalMedicine, 247, 188–197.

Shaw, K., O’Rourke, P., Del Mar, C., & Kenardy, J. (2005). Psychological interventions foroverweight or obesity. Cochrane Database of Systematic Reviews, Issue 2. Art. No.:CD003818. DOI: 10.1002/14651858.CD003818.pub2.

Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The summary of diabetes self-careactivities measure: Results from 7 studies and a revised scale. Diabetes Care, 23, 943–950.

Vandenbergh, R. L., Sussman, K. E., & Titus, C. C. (1966). Effects of hypnotically inducedacute emotional stress on carbohydrate and lipid metabolism in patients with diabe-tes mellitus. Psychosomatic Medicine, 28, 382–390.

Vanderlinden, J., & Vandereycken, W. (1994). The (limited) possibilities of hypnotherapyin the treatment of obesity. American Journal of Clinical Hypnosis, 36, 248–257.

Warner, L. (2004). Effects of hypnosis for appetite modification as an adjunct in the treat-ment of chronic hyperglycemia in adult with Type II diabetes. Unpublished Master’sThesis, Washington State University.

Whorwell, P. J., Prior, A., & Faragher, E. B. (1984). Controlled trial of hypnotherapy inthe treatment of severe refractory irritable-bowel syndrome. Lancet, 2, 1232–1234.

Willett, W. C., Dietz, W. H., & Colditz, G. A. (1999). Primary care: Guidelines for healthyweight. New England Journal of Medicine, 341, 427–434.

World Health Organization (WHO). (1994). Prevention of diabetes mellitus. TechnicalReport Series, no. 844. Geneva, Switzerland.

Zardouz, H. (2005). The effects of chronic psychological stress on carbohydrate metabo-lism in rat. European Neuropsychopharmacology, 15(S3), S643.

Hypnose als Zusatztherapie bei der Diabetesbehandlung

Yuan Xu und Etzel CardeñaZusammenfassung: Obwohl Diabetes eines der dringlichsten weltweitenGesundheitsprobleme darstellt, existiert bislang keine kurative Therapie.

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

HYPNOSIS IN DIABETES MANAGEMENT 71

Konventionelle Insulinbehandlungen zielen darauf ab, die Lebensqualitätzu verbessern, vernachlässigen jedoch die psychologischen Aspekte erErkrankung. Zumal da bei Diabetes wesentliche psychologischeKomponenten bedeutsam sind, erscheint es folgerichtig, über Hypnose alsZusatzbehandlung bei Diabetes nachzudenken. Dieser Artikel bespricht dieempirische Literatur zur Effektivität von Hypnose bei der Behandlung vonDiabetes, sowohl in Bezug auf die Blutzuckerregulation als auch imZusammenhang mit Kompleanz und peripherer Blutzirkulation. Trotzmancher methodischer Schwächen wird aus der Literatur deutlich, dassvielversprechende Ergebnisse vorliegen, welche weiter untersucht werdensollten. Multimodale Beahandlungsansätze scheinen besonderserfolgversprechend, wobei Hypnose als Zusatz zur Insulinbehandlung beider Behandlung von Typ 1 und 2 Diabetes zur Stabilisation des Blutzuckersund Verbesserung periphervaskulärer Komplikationen eingesetzt werdenkann.

RALF SCHMAELZLE

University of Konstanz, Konstanz, Germany

L’hypnose en tant que traitement adjuvant dans la gestion du diabète

Yuan Xu et Etzel CardeñaRésumé: Malgré le fait que le diabète représente l'un des problèmes de santéles plus graves sur la planète, il ne fait encore l’objet d’aucun traitementréellement efficace. Les programmes de traitement traditionnels à l’insulinevisant à améliorer la qualité de la vie des patients ne tiennent pas comptedes aspects psychologiques de cette maladie. Étant donné que le diabètecomporte un important volet psychologique, il semble raisonnable deconsidérer l’hypnose comme une thérapie complémentaire au traitement decette maladie. Cet article examine la documentation empirique portant surl’efficacité de l’hypnose dans la gestion du diabète, y compris lastabilisation de la glycémie, l’adhésion accrue du patient au traitement etl’amélioration de la circulation sanguine périphérique. Malgré certaineslimitations méthodologiques, cette documentation montre des résultatsprometteurs méritant une recherche plus approfondie. Des traitementsmultimodaux semblent particulièrement encourageants, avec l’hypnoseutilisée comme complément aux traitements à l’insuline dans la gestion desdiabètes de types 1 et 2, pour stabiliser la glycémie et réduire lescomplications vasculaires périphériques.

JOHANNE REYNAULT

C. Tr. (STIBC)

La hipnosis como una terapia suplementaria en el cuidado de la diabetes

Yuan Xu y Etzel CardeñaResumen: Aunque la diabetes es uno de los problemas globales de saludmás serios, no hay cura para ella. Los programas convencionales detratamiento con insulina para mejorar la calidad de vida no toman en cuenta

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010

72 YUAN XU AND ETZEL CARDEÑA

los aspectos psicológicos de la enfermedad. Ya que la diabetes tienecomponentes psicológicos importantes, es razonable considerar a la hipnosiscomo una terapia adjunta para la diabetes. Este trabajo examina la literaturaempírica sobre la eficacia de la hipnosis en el cuidado de la diabetes,incluyendo la regulación del azúcar en la sangre, aumento en elcumplimiento del tratamiento, y mejoría en la circulación periférica desangre. A pesar de algunas limitaciones metodológicas, la literatura revelaresultados prometedores que ameritan exploración. Los tratamientosmultimodales son particularmente prometedores, con la hipnosis como unadjunto en los tratamientos de insulina para diabetes Tipo 1 y Tipo 2, paraestabilizar la glucosa en la sangre y disminuir complicaciones vascularesperiféricas.

ETZEL CARDEÑA

Lund University, Lund, Sweden

Downloaded By: [Cardena, Etzel] At: 08:10 1 November 2010