In a Flash

It's a condition that more than 80 percent of women will experience in their lifetime, and the symptoms can last for years and be extremely debilitating. Yet hot flashes are more often the subject of jokes or embarrassment than true medical research. But Dr. Gary Elkins, Baylor professor of clinical psychology and neuroscience, takes the subject seriously, and he’s using unorthodox methods to conduct clinical trials.

Thanks to a $2.6-million grant from the National Institutes of Health (NIH), Elkins and his small team of researchers are beginning a five-year study into how hypnotic relaxation therapy can decrease hot flashes in postmenopausal women. Elkins, who has been at Baylor since 2006, says he never intended to study menopausal symptoms when he stumbled across unusual findings while doing pain management trials. (Elkins is pictured with post-doctoral fellows Jen Bunn and Jackie Dove, left to right.)

"There was one particular patient who was having pain but also having hot flashes," says Elkins, who conducted early research at Scott and White Clinic in Temple, where he was a clinical psychologist. "She noticed that her hot flashes began to decrease as she was using hypnotic relaxation therapy."

Intrigued, Elkins pursued funding for a larger study, using breast cancer survivors as his subjects. Part of the follow-up treatment for women with breast cancer, Elkins explains, is a regimen of anti-estrogen therapy, which can prevent the recurrence of cancer but also can cause severe hot flashes. "Up to a fourth of women discontinue that therapy because of the side effects, and the primary one is hot flashes," he says. "So if we can provide a non-hormonal, alternative, safe treatment to reduce hot flashes, it not only increases the quality of life, but it could ultimately increase survival of these women."

In his initial study—funded by the NIH, the National Cancer Institute, and the National Center for Complementary and Alternative Medicine—Elkins studied sixty breast cancer survivors, some who received no therapy and some who received five weekly sessions of hypnosis intervention. At the end of five weeks, the women receiving therapy had a 68 percent decrease in hot flashes—a finding that was recently published in the Journal of Clinical Oncology. The study's significant results led to the second NIH grant and Elkins’ current study, which will involve 180 postmenopausal women with moderate to severe hot flashes.

Elkins says that part of the interest in alternate menopausal therapies stems from a study by the Women's Health Initiative, which found an increase in cancer, heart disease, and stroke for women on long-term hormone replacement therapy. Women are now understandably reluctant to take hormone therapy, yet they also need relief from menopausal symptoms.

So how does hypnotic therapy work? "The underlying theme of our research is to empower women," Elkins says, "and that means teaching self-hypnosis and increasing the sense of self-control." Elkins and his team--which includes two post-doctoral fellows, a clinical research coordinator, a data coordinator, and graduate and undergraduate students--teach their patients relaxation and self-hypnosis techniques by using mental images that are of particular significance to each individual.

"We make recordings of the hypnosis sessions and ask the women to practice on a daily basis," Elkins says. "In traditional medicine, the patient is fairly passive. But in mind-body medicine, the patient is more of a partner."

Because the primary predictor of hot flashes is anxiety, Elkins says, hypnotic therapy is particularly effective because it helps subjects relax and eliminate stress and anxiety. An added benefit, he says, is that women experienced an improvement in their quality of life—improved sleep and reductions in depression and stress levels.

During the next five years, Elkins and his team will be working with the Scott and White Clinic in Temple to recruit subjects for their study. Those patients will be followed for three months, during which time they'll participate in regular hypnosis sessions while wearing a halter monitor, which records the mind-body techniques' physiological effects on the body.

Women interested in participating in the study may contact Vicki Patterson at mbmr@baylor.edu.