A letter arrives asking you to come back after a mammogram. An ultrasound finds something that needs a closer look. You are told you need a biopsy.
For most women the result will be benign. But the days of waiting, and the procedure itself, are among the most anxious experiences in routine healthcare. A study from Boston tested whether a simple hypnotic technique could make the biopsy easier.
What a core biopsy involves
In a large core needle biopsy, a radiologist uses ultrasound or X-ray guidance to pass a hollow needle into the area of concern and take small samples of tissue. It is done under local anaesthetic, with the woman awake, as an outpatient procedure.
It is usually not very painful. What makes it hard is everything around it: fear of cancer, an unfamiliar room, lying still in an awkward position, and the click of the device. Sedative drugs are generally avoided, because women need to go home afterwards.
The trial
Published in 2006, the study was led by the radiologist Elvira Lang, who had earlier shown the benefits of self-hypnosis during other kinds of procedure.
A total of 236 women referred for large core needle breast biopsy at a university medical centre were randomly assigned to one of three groups.
- Standard care (76 women)
- Structured empathic attention (82): a team member stayed attentive and responsive, used encouraging language and avoided negative suggestions
- Self-hypnotic relaxation (78): the same empathic attention, plus a team member reading a script guiding the woman into self-hypnosis
During the procedure, women were asked every ten minutes to rate their anxiety and pain.
What it found
Anxiety was the clearest result.
- With standard care, anxiety rose significantly as the procedure went on.
- With empathic attention, it stayed level.
- With self-hypnosis, it fell significantly.
Pain increased over time in all three groups, as would be expected, but it rose less steeply with hypnosis and with empathy than with standard care.
Time. Procedures took an average of 46 minutes with standard care, 43 with empathic attention and 39 with self-hypnosis.
Adverse events were recorded in seven women in the standard group, eleven in the empathy group and three in the hypnosis group.
Cost. The hypnosis procedures did not take longer or cost more, despite the extra person involved.
What to take from it
Three things stand out.
Doing nothing lets anxiety climb. Left alone, women became more frightened as the procedure continued.
Kindness helps. Attentive, encouraging staff were enough to stop that climb.
Hypnosis did more. It was the only approach under which anxiety actually fell.
It was a single-centre study, and the women knew which kind of care they were getting. But it was large for its type, and it fits with the same team’s earlier trial in other procedures.
What the script contained
The method was deliberately simple so that ordinary staff could deliver it after brief training. In outline:
- Roll your eyes up, close them, and take a deep breath.
- Breathe out and let your body float.
- Imagine yourself somewhere pleasant and safe. Notice what you see, hear, smell and feel.
- If you have any discomfort, imagine a sensation of coolness or warmth, or tingling, in that area instead.
- If a worry comes, place it somewhere outside you: in a box, on a cloud, to be dealt with later.
- Stay there for as long as you like. You can come back whenever you need to.
A woman can do this entirely by herself.
How to prepare for a biopsy
In the days before
- Ask what will happen: which type of biopsy, how long, what you will feel and hear.
- Ask about the click. Some devices make a loud snapping sound. Knowing in advance stops it startling you.
- Practise the routine above for ten minutes a day. Choose your place now.
- Limit the internet searching. Most biopsies are benign, and reading worst cases does not help.
- Arrange for someone to come with you and take you home.
- Plan something pleasant for afterwards.
On the day
- Tell the staff you are anxious. They would much prefer to know.
- Ask them to say what they are doing as they go, or to stay quiet, whichever you prefer.
- Ask for neutral language. “Tell me when you are starting” works better than a warning about a sharp scratch.
- Close your eyes once you are positioned.
- Breathe out slowly and go to your place.
- Translate sensations: pressure, not pain. The click is a camera shutter.
- Give your hands a job: press thumb and finger together as your cue for calm.
Afterwards
- Follow the advice on the dressing and on pain relief.
- Expect some bruising.
- Waiting for the result is often the hardest part. Use the same routine at bedtime, keep busy, and talk to someone.
- Ask when and how you will get the result, so you are not left guessing.
For partners and friends
Go along if you are asked. Drive. Be calm. Do not say “I’m sure it’s nothing,” which closes the conversation. “I’m here whatever happens” is better.
If your hospital offers nothing
Few units have staff trained in hypnosis, but any unit can provide attentive, kind care, which the study showed is valuable in itself. You can bring the technique with you.
The bottom line
In a trial of 236 women, self-hypnosis during breast biopsy was the only approach under which anxiety fell instead of rising, and procedures were a little shorter. The method is simple enough to learn at home in a few days, and it will serve for any procedure you have to stay awake through.
Next in the series: Hypnosis for Children Having Cancer Procedures
This article is for general information and is not medical advice.