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Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care. The hypnosis intervention reduced the anxiety associated with procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain. The authors explain this latter finding as indicating that the sensory component of a patient's pain experience may be of lesser importance than the affective component. The authors describe future studies to clarify their results and address the limitations of this study.

Hematopoietic stem cell transplant (HSCT; also commonly known as bone marrow transplant) is an aggressive treatment for hematological malignancies that causes numerous physical and psychological difficulties, including significant distress and poor quality of life [1, 2]. Although previously a treatment of last resort, HSCTs are now indicated early in the course of many diseases. This shift in treatment strategy has resulted in improved survival rates [3, 4], but has also led to a greater focus on lingering side effects found among survivors. Researchers have recently begun to examine the potential neurotoxic effects of HSCT as well as the deleterious neurological impact of the cancers it treats. There are two ways in which such cognitive impairments have been measured: neuropsychological assessment (objective) and self-report measures of cognitive functioning (subjective). HSCT patients have impaired cognitive function using both forms of measurement [5–7]. However, in general, objective neuropsychological test results are not correlated with subjective cognitive functioning [7, 8]. Thus, patients may demonstrate deficits on neuropsychological tests but perceive little impairment in daily functioning, or they may demonstrate relatively normal neuropsychological test results despite perceiving considerable daily impairment. Despite the fact that subjective cognitive functioning is often not correlated with objective neuropsychological impairment, it is associated with poorer psychological adjustment and quality of life. For instance, Booth-Jones and colleagues [7] investigated HSCT patients who were 6-months post-discharge and found that poorer subjective cognitive functioning was associated with greater depressive symptomatology as well as poorer physical and mental quality of life. Similar associations have also been found in women receiving adjuvant therapy for breast cancer for whom self-reports of memory and concentration difficulties were associated with psychological distress and poorer quality of life [9]. Mechanisms through which subjective cognitive impairment affects distress and quality of life are not currently well-defined, but they are worth clarifying because they may be good targets for psychosocial interventions. One possible mechanism is suggested by Bandura’s social cognitive theory and its emphasis on self-efficacy, or “belief in one’s capabilities to organize and execute the courses of action required to manage prospective situations” [10]. HSCT survivors’ self-efficacy for managing symptoms is particularly likely to have implications for their well-being because of their high physical and psychosocial symptom burden after treatment [1]. Indeed, low self-efficacy has been associated with elevated psychological distress and poorer quality of life in other cancer patients [e.g., 11–13]. Thus, experiencing difficulties such as memory problems and poor concentration may cause survivors to doubt their ability to manage symptoms, which in turn may adversely affect their psychological adjustment and quality of life. Evidence from other patient populations supports the plausibility of such a mechanism. For example, in chronic pain patients, self-efficacy has been shown to mediate the relationship between self-reported pain intensity and outcomes such as disability and depression [14]. Self-efficacy for managing cognitive symptoms has also been found to mediate the relationship between community integration and global life satisfaction in patients with traumatic brain injury [15]. If self-efficacy were similarly conceptualized as a mediator among HSCT survivors suffering from subjective cognitive impairment, it might explain the link between subjective cognitive impairment and distress and poor quality of life. Thus, the purpose of the present study was to examine whether self-efficacy for symptom management mediates relations between subjective cognitive functioning and the following outcomes: psychological adjustment (i.e., depressed mood and anxiety), and health-related quality of life. We hypothesized that among HSCT survivors, poorer subjective cognitive functioning would be associated with lower levels of self-efficacy for symptom management, which would in turn be associated with poorer adjustment and quality of life.

Objective:People who undergo hematopoietic stem cell transplantation are highly dependent on their caregiver during their lengthy treatment and recovery. The effectiveness of their caregiver's social support can profoundly affect their day-to-day treatment experiences and, in turn, how they recall those experiences and are affected by them long after the treatment ends.Method:Our participants were 182 men and women who had undergone a transplant within the previous 9 months to 3 years. They completed baseline measures (including a measure of caregiver social support effectiveness) and then completed three writing assignments describing their transplant experiences. Linguistic analyses were conducted to investigate their use of words indicating negative emotions, cognitive processing (insight and causation), and practical problems with money and insurance. Theory-based hypotheses predicted associations between specific functional types of caregiver support (emotional, informational, and instrumental) and these word categories.Results:As hypothesized, the effectiveness of different functional types of support from a caregiver were uniquely associated with theoretically relevant categories of word use. Structural equation models indicated that more effective caregiver emotional support predicted lower use of negative emotion words; more effective caregiver informational support predicted lower use of causation words; and more effective caregiver instrumental support predicted lower use of words related to money and insurance.Significance of results:Our findings provide insights to guide research on the mechanisms through which caregiver support influences patient outcomes after stem cell transplantation. For instance, research suggests that these kinds of effects could have implications for survivors' current self-concept, psychosocial functioning, and meaning-making.

This article will provide an examination of Erickson's model of hypnosis and the impact hypnosis has made on the psychosocial well being of the medically ill patient. The intrinsic three stage process of a hypnotic intervention, as well as its value, practice assumptions, and its relevance to alleviating pain, distress, and anxiety with oncology patients will be discussed. We have found this approach to be particularly effective with adult oncology patients at alleviating the side effects of the arduous treatment that is often endured. Case vignettes will demonstrate the benefits of utilizing this intervention with adult patients in the hospital setting as well as provide specific insight into the creative methods in which we have woven hypnosis into our clinical work. Finally, we will explore the use and rationale of hypnosis in medical settings and the impact of using this intervention on the role of the hospital social worker.