Abstract
This pilot study examines the impact of guided imagery hypnotherapy (GIH) on symptoms of job-related burnout in medical professionals. Nine adults (eight female) involved in direct medical care in the region of San Diego, California participated in eight consecutive weekly GIH sessions. Subjective measures of burn-out, compassion, and self-compassion were recorded roughly one week before the start of the hypnotherapy series (baseline session zero) and after the first, fourth, and final GIH sessions. Resting state electroencephalographic data (EEG) was also recorded at each of these measurement times. Additionally, EEG was recorded for the duration of the hypnotherapy protocol during sessions one, four, and eight. Two sets of frontal alpha asymmetry (FAA) scores were computed for each participant. First, for each session, FAA was derived from the cleaned, preprocessed EEG recorded for the full duration of the GIH protocol. Additionally, FAA was computed from segments of EEG centered on eleven key events associated with hypnosis and visualization during the protocol. Linear mixed model analysis revealed a reliable increase in self-compassion and a decrease in emotional exhaustion across the four measurement times. Further, a reliable shift toward left over right hemispheric dominance, indicated by increases in FAA, was observed both across and within sessions, suggesting an evolution toward approach-related self-regulation at short and longer time scales. These outcomes indicate the promising potential of GIH for alleviating symptoms of job-related burnout and improving self-regulation in response to challenging work situations.
Plain Language Summary
Background
Burnout among healthcare workers is a growing crisis, contributing to emotional exhaustion, reduced empathy, and poorer patient outcomes. In response, we tested a novel approach—Guided Imagery Hypnotherapy (GIH)—to help medical professionals manage stress and reconnect with their inner resilience.
Methods
Nine medical professionals in the San Diego region participated in eight weekly sessions of GIH, a therapy that combines storytelling and light hypnosis to stimulate imagination and self-reflection. Participants completed questionnaires measuring burnout, self-compassion, and empathy before, during, and after the intervention. Brainwave activity (EEG) was also recorded during sessions to explore changes linked to emotional regulation.
Results
After eight weeks, participants reported feeling significantly less emotional exhaustion and more self-compassion. EEG activities reflected a progressive shift toward approach-related motivation. These results suggest that GIH may help shift brain dynamics toward a healthier state, both during sessions and over time.
Conclusion
Though this was a small pilot study, the results are promising. GIH offers a creative, non-invasive, and empowering way for medical professionals to care for their mental and emotional well-being. By fostering emotional regulation and self-compassion, this approach may help healthcare workers sustain their empathy and effectiveness in the face of ongoing stress.
Introduction
Work-related burnout has come to be understood as a psychological response to chronic on-the-job stressors. It is characterized by increased physical and mental exhaustion, decreased social connection and empathy, and a diminished sense of self-efficacy and accomplishment.1,2 Research suggests that burnout is particularly widespread in the healthcare profession, occurring at a rate of around 50%.3,4 Beyond the personal toll to individuals suffering from this syndrome, burnout has been linked to negative impacts for healthcare organizations in the form of diminished productivity5,6 and higher rates of attrition3,6–9 Burnout among medical professionals carries negative implications for patients as well, including lower quality of care, increased error, diminished satisfaction, and poorer treatment outcomes8,10 (though see Rathert et al 11 and Casalino et al 12 for a critique of methods employed by some burnout studies). Further, burnout symptoms have been shown to correlate negatively with medical residents’ capacity for empathy and patient perspective taking, suggesting that the more seriously a physician experiences burnout, the less empathy they will manifest for the patients under their care. 2
Existing methods to alleviate job-related burnout in the medical profession target remediation at either the organizational or individual levels. Organizational interventions, for instance, including wellness-centered leadership, workload reduction, job crafting, and peer support networks – are all aimed at addressing the root causes of burnout by improving the work environment and reducing stressors13–15 More peripherally, flexible work schedules, adequate staffing, and leveraging technology to automate administrative tasks and the delegation of responsibilities can alleviate the burden on healthcare workers16–18 At the individual level, mindfulness-based practices, such as meditation and yoga, have been widely adopted and shown to reduce burnout and enhance well-being, along with encouraging self-care practices and providing access to mental health resources19–21
A shortcoming of many of these established interventions, however, is the adoption of blanket, one-size-fits-all solutions to a complex problem. Burnout stems from multifaceted causes22,23 and is mediated by multiple physiological systems. 24 It is characterized by diverse psychological, behavioral, and biological consequences24,25 that can vary as a function of gender, 26 race, 27 work experience, 28 relationship status, 28 and other factors. Hypnotherapy is a promising alternative form of treatment because of its individualized focus, which builds from a patient's personal goals and pathways towards vitality. Generally speaking, hypnotherapy is the therapeutic application of hypnosis to induce the patient into a deep state of relaxation, focused attention, and heightened concentration, allowing them to be more receptive to suggestions given verbally or through imagery29–31 These suggestions may be direct or indirect and include positive affirmations or inclinations towards beneficial behaviors. Although hypnotherapy may best be known for its role in pain management and mitigation of anxiety and stress during medical treatment, 32 it is increasingly being adopted in response to diverse disorders of mental health,33–35 including job-related burnout. 36
The Light-Induced Guided Healing Therapy (LIGHT) protocol is a form of guided imagery hypnotherapy (GIH) that integrates storytelling with deep visualization techniques to encourage personal growth and well-being. This method allows individuals to explore and modify their subconscious narratives in order to foster changes that resonate through their lives. Differing from traditional hypnotherapy, which often focuses on direct suggestion for behavior modification or stress relief,32,35,37 LIGHT and other forms of GIH tap into the eudaemonic aspects of well-being—emphasizing the pursuit of meaning and self-realization. Through the guided imagery protocol, participants engage in a deeply immersive process that addresses their immediate concerns and encourages them to harness their creativity and inner resources. This engagement is structured around powerful storytelling, where the participants visualize and reconstruct the narratives that shape their perceptions and behaviors.
The LIGHT intervention, by design, represents a highly cost-efficient model for burnout prevention in healthcare settings. Delivered via guided imagery and light hypnosis, this protocol can be implemented on-site by a facilitator or scaled via digital delivery systems, such as video conferencing. This form of therapy does not require prolonged clinical engagement, extensive in-person infrastructure, or high-cost specialized personnel, thereby minimizing overhead while retaining therapeutic fidelity. From a cost-benefit standpoint, addressing burnout in medical professionals is of urgent economic importance. A recent analysis found that the financial burden of burnout—including reduced productivity, increased turnover, and diminished care quality—can exceed $5 million annually for a mid-sized healthcare organization.38,39 Furthermore, studies have shown that interventions that reduce burnout symptoms not only improve psychological well-being, but also yield positive returns on investment by reducing absenteeism, enhancing patient satisfaction, and improving team cohesion40–42 In this context, GIH protocols emerge as a low-cost, scalable, and replicable approach capable of delivering measurable occupational health benefits with considerable downstream economic value.
In this study, we investigate the effects of the Light-Induced Guided Healing Therapy (LIGHT) protocol on symptoms of work-related burnout among medical professionals. Prior research using this protocol and other forms of guided imagery for multiple sclerosis patients reported improved quality of life, diminished walking dysfunction, and diminished fatigue and symptoms of depression.43,44 In the case of the LIGHT protocol, these benefits were attributed in part to the personalized component of the LIGHT framework, as well as to its integrated mind-body approach. Here, we explore the possibility that the individualized self-regulation tools offered by LIGHT may also benefit individuals suffering from symptoms of job-related burnout. We recruited medical professionals to participate in eight weekly LIGHT sessions and recorded their responses on the Maslach Burnout Inventory (MBI),45,46 the Compassionate Love for Humanity Scale,47,48 and the Self-compassion Scale 49 at four time points – roughly one week before the LIGHT regimen commenced (baseline session 0), then after the first, fourth, and final treatments.
Additionally, participants’ electroencephalographic (EEG) data were recorded throughout the duration of the first, fourth, and final hypnotherapy sessions. This approach was motivated by the hypothesis that LIGHT can modulate patterns of brain activity implicated in emotion regulation. For instance, during different forms of guided meditation, which is also a brain-body modality with some parallels to hypnotherapy, a shift toward greater relative engagement of the left versus right frontal cortex was reported, as reflected by analysis of frontal alpha asymmetry (FAA).50,51 Similar outcomes were also observed over time after longitudinal mindfulness meditation training interventions of varying lengths52–55
FAA is derived by subtracting the mean of estimated spectral power in the alpha range (8-12 Hz) obtained over frontal left hemisphere (LH) electrodes from the mean of power estimates obtained over the right hemisphere (RH) counterparts. Elevated alpha activities over the right relative to left hemisphere are thought to reflect greater engagement of left frontal cerebral cortex, whereas the inverse reflects more dominance from right frontal cortex. Extensive research on these two patterns of hemispheric engagement suggests that LH dominance reflects approach motivation, whereas RH dominance is linked to avoidance or withdrawal.55–58 This link between hemispheric engagement and motivation has been explained by the theory that FAA reflects asymmetric modulation of amygdalar structures by right and left lateral prefrontal cortex.55,59
In the context of the Keune et al study and others,50,55 it was proposed that this shift toward LH dominance may be related to the emergence of a more non-judgmental attitude toward negative emotions that participants were prompted to explore during the meditation session. By analogy, EEG data recorded during live LIGHT sessions will be analyzed here to examine whether a consistent shift toward LH or RH dominance in FAA accompanies the visualization or other phases of the process. Outcomes from this analysis will begin to shed light on possible mechanisms whereby hypnotherapy can impact motivational components of professional burnout.
Methods and Materials
Participants
A total of 9 adults (female = 8, male = 1) participated in this study. Ages ranged from 25 to 66 years (µ = 50.3, σ = 14.26 years). Five individuals identified as White, one as Asian, two as Hispanic, and one as Black. All participants were active health care providers who provide direct care to patients. Participants were in generally good health, and had no history of traumatic brain injury, no history of alcohol or substance abuse, and no history of neurological or neuropsychiatric illness. Additional exclusion criteria included language or communication barriers that would prevent the LIGHT professional from effectively administering the LIGHT session, or if participants reported zero feelings of burnout or job dissatisfaction. All participants provided written informed consent prior to participation and no participants were withdrawn from the study. The study was approved by the UC San Diego IRB and began in June 2022.
LIGHT Paradigm
The LIGHT paradigm is a guided relaxation and imagery protocol. Before every session, participants were asked to decide on an intention or goal for the session, which the LIGHT professional would then refer to throughout the LIGHT session. The first phase of each session was guided relaxation – or induction – followed by prompts to visualize a “perfect place” of comfort and safety in one's creative imagination. Participants were asked to describe this place through follow up questions about details that the participant might notice, such as smell, sound, or feel. Next, they were prompted to visualize a path or a set of stairs, and asked to walk down that path or stairway for ten steps, counting down from ten to one out loud – and upon reaching the last step, they were guided to visualize and describe a chair or seat, followed by a crown – again, with an emphasis on creative imagination. After taking a seat in their imagined chair and putting on the crown, they were encouraged to pause and observe the world they had conjured. Following this brief period of reflection, awareness was drawn to a light or color that emerged from their creative mind. They identified the color of the light and were instructed to imagine that light entering and traveling through their body, filling up each cell as it passed through. The participant was instructed to leave a mental bookmark in this place so that they could come back to it at any time, before removing and storing their crown. At the end of the LIGHT sessions, the participant was asked to rise from their imagined chair or throne and count their way up from one to ten, with the session ending as the participant returned to an awake and alert state at the end of the ten count.
Experimental Procedure
Participants attended an initial lab visit, during which they provided written informed consent. This visit served as the baseline Session 0. Participants were seated in a comfortable chair and responses were recorded to the following assessments: Maslach's Burnout Inventory (MBI) for medical personnel, 60 the Self-Compassion Scale (SCS), 49 and the Compassionate Love for Humanity Scale (CLS-H). 47 Participants were then outfitted with a 64-channel EEG cap and 2 ECG electrodes placed below the collarbone. (ECG data were analyzed separately as part of a different study.) Five minutes of resting EEG and ECG measurements were recorded.
After completing the baseline session, participants were assigned to a certified LIGHT professional who administered a total of eight LIGHT sessions on a weekly basis. All sessions were conducted remotely via video call between the participant and the LIGHT professional. Sessions 1, 4, and 8 were performed in the lab, while the remaining sessions were completed by the participants at their homes. The first LIGHT session (Session 1) occurred two weeks after Session 0. The remaining seven sessions occurred once per week following Session 1, with some flexibility to accommodate participant availability (see Figure 1). Participants were asked to schedule their weekly sessions around the same day and time each week for consistency.
Experimental schedule over eight LIGHT sessions following the initial baseline session.
For the LIGHT sessions conducted in the lab (Session 1, Session 4, and Session 8), participants were seated in a comfortable chair and outfitted with a 64-channel EEG cap and 2 ECG electrodes placed below the collarbone. Before engaging with the hypnotherapist, participants completed the MBI, the SCS, and the CLS-H, and five minutes of pre-session resting measurements were recorded. In-lab hypnotherapy sessions were also conducted via video call with the LIGHT professional, and EEG and ECG measurements were recorded for the duration of the LIGHT session. During each recorded session, the experimenter manually logged the onset of key phases of the LIGHT session (relaxation, visualizing a safe haven, descending deeper, settling in and sitting down, self-empowerment, visualizing light, directing light into the body, encouraging new pathways, setting bookmarks to reactivate these pathways, returning to wakefulness, and closure). Once the LIGHT session had concluded, another five minutes of post-session resting data measurements were recorded, after which all electrodes were removed.
Self-Report Measures
All participants completed the MBI, the SCS, and the CLS-H. The MBI is comprised of 22 items relating to occupational burnout and measures three separate dimensions of burnout – namely, emotional exhaustion (9 items), depersonalization (5 items), and personal accomplishment (8 items) on a 7-point Likert-type frequency response scale.46,60 Average scores of these subscale items are reported. The SCS is composed of 26 items that belong to one of six subscales on a 5-point Likert-type response scale: self-kindness (5 items), self-judgment (5 items), common humanity (4 items), isolation (4 items), mindfulness (4 items), and over-identification (4 items).49,61 The CLS-H has no subscales and is composed of 21 items relating to altruism on a 7-point Likert-type scale.48,62
EEG Acquisition and Preprocessing
EEG was obtained using a 64-electrode EEG cap placed according to the international 10–20 layout and a BioSemi ActiveTwo acquisition system at a sampling rate of 512 Hz. EEG data were streamed and recorded using Lab Streaming Layer.63,64 Each dataset was recorded in extensible data format (XDF). Custom EEGLAB 65 scripts (version 2023.0) written with MATLAB R2023a were used to preprocess the EEG post hoc. Prior to downsampling the EEG recordings to 256 Hz, a 1 Hz high pass and 128 Hz low pass Hamming windowed-sinc finite impulse response (FIR) filter was applied. Line noise at 60 Hz was removed from the downsampled EEG using the CleanLine EEGLAB plugin.65,66 The clean_rawdata EEGLAB function was used to remove flatline channels and channels poorly correlated with others (r < 0.85; μ = 2.4, σ = 2.0 channels removed). Additionally, artifact subspace reconstruction (ASR; burst threshold set to 20) was used to remove and reconstruct non-brain artifacts (eg, eye blinks or muscle activity).67,68 Removed channels were interpolated using spherical spline interpolation, and the EEG was re-referenced to the common average reference. The adaptive mixture independent component analysis (AMICA) algorithm was applied to decompose the data, and ICLabel was used to classify components as eye, muscle, heart, line, and channel noise. Finally, flagged artifactual components with at least 80% confidence in their respective classification were removed. On average, 23% (SD = 10%) each participant's total ICs were classified as artifactual (muscle: 17% (SD = 10%); eye: 4% (SD = 2%); channel noise: 2% (SD = 3%); line noise, heart activity: <1%). Preprocessed data can be accessed from the Open Neuro repository (https://doi.org/10.18112/openneuro.ds006437.v1.0.0).
Behavioral Data Analysis
To assess whether self-reported burnout, compassion, and self-compassion changed systematically over the course of the LIGHT regimen, we performed separate linear mixed model (LMM) analyses using data collected during the four assessment times on each of the subscales of the MBI, as well as on the SCS and CLS-H, as outcome variables. Each model included fixed effects for the sessions and random effects to account for individual differences among participants. Additionally, for outcome measures that changed reliably, we used separate simple correlation tests to evaluate the relationship between behavioral outcome scores and FAA scores derived from preprocessed continuous EEG data recorded over the course of each full session. We opted for this approach instead of including FAA scores as predictor variables in the LMM model in order to avoid the risk of overfitting due to the relatively small sample size.
EEG Data Analysis
Natural log power of preprocessed EEG within the alpha range (8–12 Hz) was computed using the spectopo function in EEGLAB, which implements a windowed fast Fourier transform (FFT) with a Hamming window with a length of 1 s and 50% overlap. To derive FAA scores, mean spectral power estimates obtained from data recorded at the LH F3 electrode were subtracted from the RH homologue F4 electrode (log(F4) − log(F3)). To assess the impact of the treatment regimen over time, FAA scores were computed from data recorded during each of the four baseline rest periods. To assess changes in FAA within sessions, eleven key events during the LIGHT protocol were identified on the basis of interviews with hypnotherapists (relaxation, safe haven, going deeper, settling in, self-empowerment symbolism, light and color visualization, directing light into the body, encouraging new neural pathways, setting bookmarks for crucial breakthroughs, returning to wakefulness, and closure). These events always occurred in successive order, but at slightly different times for each of the sessions, which varied in duration (µ = 29.4 min, σ = 5.1 min). For this reason, the key event times were computed in the following way. First, for all events within each dataset, the ratio of the time when the event occurred to the total length of the recording was derived. Next, these ratios were averaged across recordings to obtain a mean time percentage value for each key event to be used in subsequent analysis. EEG data was extracted from time windows encompassing 5% of the full data recording (µ = 88.2 s; σ = 15.0 s). Windows were centered on time points established from each of the eleven mean key event percentage values.
Multiple linear mixed models (LMMs) were created using the R programming language (version 4.2.3) and the lme4 package (version 1.1.35.1). An LMM was constructed that modeled FAA scores across the eleven successive key events as a fixed effect (time), while variance due to both participants and sessions were modeled as random effects with random intercepts. A quadratic term (the square of key event time estimates) was also added to these models to assess any non-linear effects of session events on FAA values. This additional term was warranted by the finding that both marginal and conditional R2 estimates increased with the addition of the quadratic term (Table 1). Additionally, to assess modulations of FAA across sessions, a second LMM modeled each participants’ FAA estimate from resting-state EEG obtained at each session using session as a fixed effect and participants as a random effect.
Marginal and Conditional R2 Values with and Without an Additional Quadratic Term.
Results
Behavioral Measures
The linear mixed model analysis of self-compassion scores across the LIGHT sessions revealed a significant effect of sessions on self-compassion (β = 0.04, t(26) = 4.44, p < 0.0001, 95% CI [0.02, 0.06]), confirming the observable trajectory in Figure 2 of consistent increases in self-compassion across successive LIGHT sessions. This outcome reveals a steady improvement in self-compassion over time, with the model accounting for 94% of variance in scores (R2 = 0.94) Additionally, we found a significant effect of sessions on emotional exhaustion (β = −0.10, t(26) = 3.30, p < 0.01, 95% CI [−0.15, −0.04]). This negative trend is driven by a decrease in emotional exhaustion over the course of the LIGHT sessions (Figure 2), with R2 indicating that the model explained 86% of the variance over sessions and subjects. Simple correlation tests within each session did not reveal a reliable relationship between self-compassion or emotional exhaustion scores and FAA values (all |r| < 0.6, n.s.).
Self-compassion and emotional exhaustion scores across LIGHT sessions.
Analysis of scores on the Compassion Scale (for humanity) did not reveal any reliable changes over the course of treatment (|t| < 0.5, n.s.). Similarly, no reliable relationship between session and scores on the depersonalization or personal achievement subscales of the Maslach Inventory was obtained (|t| < 1.6, n.s.).
Frontal Alpha Asymmetry (FAA)
As shown in Figure 3, measures of FAA suggest progressive increasing left hemispheric dominance over the visualization phase (red color family) of each session, followed by pronounced shifts back toward equilibrium during the subsequent phases. These visual impressions were confirmed by the LMM that modeled changes in FAA across the eleven key session events. A likelihood-ratio test comparing the full LMM with linear and quadratic terms with a null version revealed that including the session events as a predictor variable led to a better fit of the data than a null model (Χ2(2) = 14, p < 0.001). The reliable linear and quadratic terms indicate consistent modulations of FAA scores within each session (Table 2). Further, a second LMM designed to capture the variance in FAA values across sessions was also found to surpass a null model (Χ2(2) = 7, p < 0.01). Inspection of the output (Table 3) indicates reliably negative (RH dominant) FAA scores obtained from session 0. Over the course of the intervention, FAA increased in a modest, but consistently in a positive direction.
Mean FAA values derived from EEG extracted from windows centered on the eleven key events. More positive values indicate more left hemisphere engagement. Error bars represent standard error of the mean.
Fixed Effect of Progression of key Events Within LIGHT Sessions on FAA Scores.
Fixed Effect of Progressive LIGHT Sessions on FAA Scores.
Discussion
A cohort of medical professionals each completed an intervention consisting of eight LIGHT guided imagery hypnotherapy sessions. Burnout, compassion, self-compassion, HRV, and FAA were assessed before the start of the intervention, then after the first session, fourth, and final sessions. Symptoms of burnout-related emotional exhaustion were found to progressively decline over the course of the intervention, while self-compassion scores progressively increased. Analysis of physiological data recorded during the same three sessions revealed that the visualization process was characterized by autonomic and brain dynamic changes. Most strikingly, relative engagement of the LH around frontal electrodes increased during guided visualizations and then decreased afterwards toward equilibrium. Further, over the course of the intervention, a linear shift toward increasing LH dominance was observed.
Alleviating Burnout through Self-Efficacy
The outcomes of this study demonstrate the promising therapeutic potential of GIH as a treatment for professional caregiver burnout. While many studies have shown the effectiveness of hypnotherapy in improving well-being33–35 and improving resilience to anxiety and pain,69–71 the value of this treatment modality for job-related burnout is only beginning to be apprised36,72–74 Indeed, research has shown that burnout and emotional exhaustion in particular are a common workplace phenomenon characterized by feelings of fatigue, cynicism or depersonalization, and depleted coping potential that exert unfavorable impacts on productivity and self-efficacy. 23
In the current study, it is possible that LIGHT alleviated emotional exhaustion by cultivating pathways for self-healing. A defining feature of the LIGHT routine is guiding patients to access their own mental abilities to reconnect with their bodies through visualization. Toward the culmination of a session, patients are directed to visualize luminous colors passing through their head and to direct this luminance throughout their bodies at the cellular or systems levels. Next, they are encouraged to “bookmark” or commit their visualizations and interoceptive sensations to memory for recall in periods of need during everyday life. The progressive increases in self-compassion over the course of the eight-week intervention may reflect the gradual emergence of skilled bookmarking and recall.
This proposal is in alignment with a recent study in which neurologists were trained in self-hypnosis techniques that, like LIGHT, involved relaxation and mental imagery. In a follow-up assessment conducted six months after training, roughly half of the cohort reported reduced fatigue and anxiety and improved quality of life, with the most sizeable benefits observed in those individuals who practiced self-hypnosis on a regular daily or weekly basis. 74 In other words, the benefits of hypnotherapy are closely tied to an individual's own proactive engagement and self-efficacy in incorporating hypnosis techniques in response to day to day stressors.
Benefits to Self-Regulation
In addition to improvement on qualitative measures, the hypnotherapy intervention led to increasingly more positive FAA scores, indicating a trajectory towards greater relative LH versus RH activity at frontal electrodes. Although there is little prior work examining FAA in the context of hypnotherapy, numerous studies have utilized this metric to shed light on mental health and well-being, with a smattering of papers focused on medical professionals. For instance, in medical students who participated in weekly wellness sessions centered on gratitude, satisfaction, and future-oriented thinking, more positive FAA scores were reported relative to a control group. 75 Further, even participating in a short, altruistically motivated craft activity led to higher FAA scores in occupational therapy students relative to a comparable non-altruistic task. 76 On the other hand, in a separate study, medical students with more negative self-appraisals and depressogenic psychological factors tended to exhibit lower FAA, indicating higher relative RH engagement. 77
This positive relationship between FAA scores and well-being in medical students is consistent with numerous more general studies linking asymmetric hemispheric engagement to emotional and motivational regulation,55,58 with higher FAA scores indicating a shift towards more positive emotional states and approach-related behaviors,56,78 as well as improved psychological and emotional well-being.75,79 Indeed, even subtle, short-term changes related to immediate well-being are positively associated with FAA scores.55,79 In the present study, relative left frontal activities increased both within and across sessions, in keeping with the view that FAA can reflect ongoing self-regulatory processes across different time scales. 55 Indeed, it is remarkable that enhancement in relative frontal LH activity coincided with the visualization phase of each hypnotherapy session, with a progressive increase in asymmetry scores that continued through the culmination, when patients imagined luminance directed throughout the body. This consistent outcome within each session offers a striking demonstration of the promising potential of guided imagery, which appears to drive a shift from FAA dynamics reflecting near hemispheric equilibrium to a pattern of robust LH dominance. Further, the fact that the overall magnitude of relative left frontal engagement intensified across sessions suggests that the benefits of guided visualization are cumulative with repetition and build over time.
Limitations and Future Directions
A limitation of current findings is the small sample size that they are derived from. However, even to support the study of nine participants, professional hypnotherapists led seventy-two individual LIGHT sessions, while research staff conducted thirty-six EEG/ECG acquisition sessions. An important step toward future scaling with a larger, randomized sample and control will be determining optimal dosage and spacing of treatments. On the one hand, it is possible that reliable impacts could be obtained with fewer than eight sessions – especially if hypnotherapy treatments were combined with other therapies. Indeed, a recent study reported that a single hypnotherapy session was sufficient to reduce skin conductance response in dentists who reported moderate perceived stress at the outset, in keeping with the idea that even limited exposure to hypnotherapy can diminish sympathetically-mediated arousal. 73 On the other hand, however, it is also possible that with continued treatment beyond eight sessions of the protocol utilized here, even further reduction in burnout symptoms might be obtained. For instance, whereas the impacts of LIGHT in the present study were focused around feelings of emotional exhaustion, a twelve-session intervention that combined hypno- and psychotherapy led to improvement on all three subscales of the MBI (depersonalization, professional accomplishment, and emotional exhaustion) in a sample population that included physicians, reporters, and schoolteachers. 36
In future work, it will also be important to understand more about the longitudinal impact of GIH. It should be noted that many LIGHT practitioners encourage clients to engage in self-guided visualization practices on their own after the conclusion of a treatment series. Assessing whether personal visualization practices relate to the magnitude and duration of relief from burnout symptoms would offer a clearer picture of strategies for optimizing treatment designs. Additionally, more data are needed to elucidate the relationship between FAA and burnout mitigation. While it is proposed here that the increased left-hemispheric dominance observed over the course of LIGHT treatment may reflect more effective emotional regulation, in the present analysis, no reliable correlations between the magnitude of relative left hemisphere engagement and either emotional exhaustion or self-compassion ratings were found. However, it is possible that a reliable relationship might be obtained with a larger sample size. Finally, because the sample was skewed toward female health care professionals, more work is needed to demonstrate that research results can generalize to males as well.
Conclusion
Eight sessions of LIGHT guided imagery hypnotherapy led to reductions in emotional exhaustion and increased self-compassion in medical health care professionals. Additionally, a shift in FAA scores indicated progressively increasing relative left frontal engagement was observed both within each session, and across sessions. This pattern of outcomes was interpreted within the framework of improved emotional self-regulation at both short and longer timescales. Overall, the findings of this study demonstrate the efficacy of guided-imagery hypnotherapy as an intervention to treat job-related burnout.
Footnotes
Ethical Considerations
This study was approved by the Institutional Review Board of UC San Diego (#804309).
Consent for Publication
Not applicable.
Consent to Participate
All research volunteers gave written informed consent.
Author Contributions
Ying Choon Wu contributed to conceptualization, formal analysis, funding acquisition, investigation, project administration, methodology, supervision, visualization, and all phases of writing.
Enrique Carrillosulub contributed to data curation, formal analysis, investigation, software, supervision, visualization, and writing the original draft.
Leon Lange contributed to formal analysis, investigation, visualization, and writing the original draft.
Nicole Wells contributed to the methodology, data curation, project administration, resources, investigation, and writing the original draft.
Paula Jackson and Thomas Thudiyanplackal contributed to conceputalization, methodology, funding acquisition, project administration, supervision, and review and editing.
Paul J Mills oversaw the study as principal investigator, contributing to conceptualization, supervision, project administration, methodology, funding acquisition, and review and editing.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a grant from the Sanford Institute for Empathy and Compassion.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.