Effect of dyspnoea-oriented hypnosis as an adjunct to pulmonary rehabilitation on the affective dimension of dyspnoea and physical activity level: a randomized controlled trial

Background Pulmonary rehabilitation (PR) has limited long-term effects on physical activity (PA) levels in patients with COPD. Dyspnoea-related anxiety, part of the affective dimension of dyspnoea, is a major barrier to PA. This study assessed whether hypnosis as an adjunct to standard PR could improve the affective dimension of dyspnoea, as well as PA levels, six months after rehabilitation. Methods In a randomized, open label trial ( NCT04010825 ), 106 COPD patients were enrolled to receive either conventional 4-week inpatient PR (CONT) or PR plus five 1-hour hypnosis sessions (HYPNO) primarily targeting emotional dyspnoea management. The primary outcome was the evolution of the affective dimension of dyspnoea at six months, assessed by the multidimensional dyspnoea profile questionnaire. Secondary outcomes included changes in PA levels via the SIMPAQ questionnaire. Results Affective dyspnoea scores decreased after PR in both groups (p<0.01). At six months, improvement persisted only in HYPNO (p<0.001 versus baseline), whereas CONT returned to baseline (p=0.98). PA levels increased only in HYPNO (p<0.05 versus baseline) and was higher than in CONT at follow-up (p<0.001). Changes in PA levels correlated with changes in affective dyspnoea (r=-0.26, p<0.05). Conclusions The results suggest that a brief intervention of five hypnosis sessions, as an adjunct to PR, maintained the benefits of PR on the affective dimension of dyspnoea six months after PR. The improvement in the affective dimension of dyspnoea was associated with an increase in PA levels, a key goal of PR that is poorly achieved in usual PR programmes.