A Mind-body Intervention to Improve Body and/or Self Image

This will be a phase II randomized controlled trial involving two arms: hypnotic relaxation
and progressive muscle relaxation (PMR), using a 2:1 randomization schedule.

1. Evaluate the impact of a hypnotic relaxation intervention compared to progressive muscle
relaxation on body image distress.

Hypothesis 1: Women randomized to the hypnotic relaxation will have significantly more
improvement in body image distress as measured by the Impact of Treatment Scale than
women randomized to receive progressive muscle relaxation at 6 weeks.

2. Evaluate the impact of a hypnotic relaxation intervention compared to progressive
relaxation on sexual self-image, sexual health, and mood.

Hypothesis 2: Women randomized to hypnotic relaxation will show significantly more
improvement on the Sexual Self-Schema Scale, the Patient Reported Outcomes Measurement
Information System (PROMIS) sexual health scale and the Positive-Negative Affect Scale
(PANAS) than women receiving progressive relaxation at 6 weeks.

3. Evaluate the side effects of hypnotic and progressive muscle relaxation. Hypothesis 3a:
Hypnotic relaxation will not be associated with significantly more negative side effects
than progressive muscle relaxation.

Hypothesis 3b: Neither hypnotic nor progressive muscle relaxation will be associated
with negative side effects.

4. Explore the physiologic effects of hypnotic relaxation compared to progressive muscle
relaxation by evaluating cortisol slopes and comparing am/pm cortisol values.

Hypothesis 4a: Women receiving hypnotic relaxation will have a steeper cortisol slope, higher
am and lower pm cortisol concentrations at the end of 6 weeks compared with women receiving
progressive muscle relaxation.

Women will be referred from providers in the Breast and Gynecology Clinics of the University
of Michigan Cancer Center as well as the Symptom Management, Sexual Health and
Psycho-Oncology clinics. The study coordinator will provide education about the trial and a
consent form will be provided for review. If a woman decides to participate, she will sign
the consent form. Sessions will be held at Dr. Barton's behavioral research office located on
Washtenaw Avenue in Ann Arbor, where there is privacy, a recliner, a relaxing environment,
and convenient parking.

Both intervention arms will involve three sessions that will occur at 2 week intervals. Each
visit will last about 40 minutes to an hour.

Inclusion Criteria:

- a history of any stage of breast or gynecologic cancer

- reported a change in body/self-image since diagnosis and wish to improve it. Two
screening questions will be used: Has body image or self-image changed in an unwanted
way since the cancer diagnosis? (Answer must be yes.) Would the potential participant
like to be able to do something to improve body image or self-image? (Answer must be
yes.)

- Concurrent cancer treatment of any kind is allowed, but the participant can also have
completed all treatment

- Performance status of 2 or better

Exclusion Criteria:

- Diagnosis of a major depressive episode, an acute anxiety disorder, psychosis, or
schizophrenia as listed in the patient's medical history per Diagnostic and
Statistical Manual for Mental Health-IV criteria in the chart and/or by self-report

- Past history of sexual abuse.

- Currently on 2 or more antidepressant therapies for mood disturbance of any kind. Past
use is allowed, just not current use.

- Currently on 2 or more anti-anxiety therapies. Past use is allowed, just not current
use.