As this study does not involve the direct involvement of human participants, an institutional ethical review will not be warranted. However, to adhere to a strict methodology, the protocol of this systematic review and meta-analysis has been registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42024497817, registered on January 23, 2024). The record details can be seen at [26]. PROSPERO provides a unique permanent registration number to the protocol that prevents duplication, thereby reducing reporting bias.

This review aims to address the following questions. The primary question is what the effect of hypnosis or hypnotherapy is on burnout symptoms among adults. The secondary questions are as follows: (2) What is the effect of hypnosis or hypnotherapy on associated psychological outcomes, specifically depression, anxiety, and PTSD? (3) How do study characteristics (eg, population, intervention format, session frequency and duration, delivery modality) influence the effectiveness of hypnotherapy for burnout and related psychological outcomes? (4) What methodological factors contribute to variations in findings across the included studies?

The PECOS (Population, Exposure, Comparison, Outcome, Study Design) framework (Textbox 1) was used to develop the eligibility criteria for this systematic review. Eligible studies included adult participants (18 years or older), regardless of occupation or geographic location. Although health care workers and students represent key populations of interest due to the high prevalence of burnout, the review is not restricted to these groups. Only peer-reviewed studies published in English were included due to resource constraints, and no geographical restrictions were applied.

A systematic search of bibliographical electronic databases was conducted on all English-language human studies. Articles were not excluded based on the date of publication. A comprehensive search and article retrieval strategy was planned by the study’s investigators, guided by a library subject matter expert, to find potentially relevant articles in the following databases: PubMed, Scopus, and PsycINFO. In accordance with the search development and optimization method proposed by Bramer et al [27], the search strategy was developed in PubMed and then translated into the syntax of Scopus and PsycINFO [1]. The search strategy was optimized for each database using a thesaurus, free-text search terms, as well as MeSH terms. Informed by the PECOS or PICOS (Population, Intervention, Comparison, Outcome, Study Design) framework, search strings for each database were developed iteratively and revised as new search terms were discovered. In consultation with a subject matter expert, the search strategy was finalized based on the PRESS (Peer Review of Electronic Search Strategies) 2015 Evidence-Based Checklist [2]. The following search terms were used: “‘stress,” “depression,” “anxiety,” “Hamilton Anxiety Scale,” “HAM-A”, “Hamilton Depression Rating Scale,” “HAM-D,” “Beck Depression Inventory,” “Patient Health Questionnaire,” “PHQ-9,” “self-hypnosis,” “hypnosis,” “hypnotherapy,” “anxiety disorders,” “anxiety management,” “anxiety screening,” “anxiety sensitivity,” “Depression Screening,” “Major Depression,” “stress,” “stress and coping measures,” and “stress management.” A combination of appropriate Boolean operators (AND, OR), truncation, and the MeSH terms was used. Table 2 includes the full search strategy in detail.

All references were imported into the systematic review tool Rayyan for screening [28]. After deduplication, all references were assessed by 2 independent reviewers to check for inclusion and exclusion criteria. Titles, abstracts, and full texts of articles were screened in a systematic and sequential manner.

Two reviewers independently extracted the relevant data elements from the eligible full texts of the articles and recorded these variables in a standardized code book. A double extraction method was used to ensure accuracy and completeness. After data extraction, disparities were resolved by consensus and discussion with a third reviewer or a “tie-breaker.” Attempts to contact the corresponding authors of the included articles will be made if more information about the individual study data is needed. However, since this is a time-bound project, such an attempt will only be made within a window of 4 weeks. If author contact attempts are unsuccessful within this timeframe, analyses will proceed using available data, and sensitivity analyses will be conducted to assess potential bias. Because the review team does not have resources for professional translation, the selection of studies is limited to English-language publications.

The following data elements were extracted: author name, publication year, study country, study design, time point of data collection, recruitment method, type of survey tool used and scoring criteria, sample size, participants’ characteristics (eg, age, gender, sexual orientation, gender identity), intervention type, and effect on psychological morbidities. For studies reporting multiple measures for the same psychological construct, a predefined hierarchy of instruments was applied to maintain consistency in the meta-analysis. For burnout, the Maslach Burnout Inventory (MBI) was prioritized; for depression, the Hamilton Depression Rating Scale (HAM-D); for anxiety, the Hamilton Anxiety Rating Scale (HAM-A); and for PTSD, the Clinician-Administered PTSD Scale (CAPS), where available. When several validated tools are reported within a study, the primary outcome specified by the authors or the measure with the most complete data and largest sample size was selected for quantitative synthesis.

Additional data will be extracted to characterize how the hypnotherapy intervention was delivered, including the number and length of sessions, total treatment duration, provider type (eg, licensed clinician, certified hypnotherapist, or psychologist), delivery modality (in-person, virtual, individual, or group format), and intervention setting (eg, clinical, occupational, or academic). These elements will allow for comparison across differing implementation approaches. Primary and secondary outcomes will be extracted using standardized tools, with burnout prioritized using the MBI, and depression, anxiety, and PTSD assessed using validated measures such as the HAM-D, HAM-A, and CAPS, respectively.

For the quality assessments of the included studies, the NHLBI quality assessment tool will be used [29]. Two reviewers will assess the quality of the full texts and will perform scoring independently. The Kappa statistics will be calculated to measure the interrater agreement. The NHLBI tool has 14 items in the checklist to evaluate all essential components of original research studies. Quality will be rated as poor (0‐4 out of 14 questions), fair (5‐10 out of 14 questions), or good (11‐14 out of 14 questions) as guided by the tool (Figure 1). The NHLBI quality assessment tool will be applied using the design-specific checklists corresponding to each study type (eg, separate tools for RCTs, cohort, case-control, and cross-sectional studies). Each study will be evaluated within its methodological context, and bias domains including selection, performance, detection, and reporting biases will be assessed accordingly. Interrater agreement will be calculated using Cohen κ to ensure scoring consistency. Scores will not be combined across study types; instead, quality will be interpreted qualitatively to guide inclusion in the meta-analysis or narrative synthesis. Because cross-sectional studies cannot establish treatment effectiveness, studies using this design will be included only for descriptive or contextual purposes and will not contribute to the quantitative meta-analysis. Quality assessments will guide analytic decisions: only studies rated as “fair” or “good” and using designs appropriate for evaluating intervention effects (eg, RCTs, quasi-experiments, longitudinal pre-post studies) will be included in the pooled analysis. Studies rated as “poor” quality or those whose design precludes causal inference will be synthesized narratively. Studies will be eligible for inclusion in the quantitative meta-analysis only if they use designs capable of evaluating intervention effects, including RCTs, quasi-experimental studies, and longitudinal pre-post studies, and are rated as fair or good quality based on the NHLBI assessment tools. Studies with designs that do not support causal inference, such as cross-sectional studies, case series, or studies rated as poor quality, will not be included in the meta-analysis and will instead be synthesized narratively. In addition, meta-analysis will be conducted only when at least 3 studies are sufficiently comparable in terms of population, intervention, and outcome measures.

First, the results of all finally included studies will be described succinctly in the form of a summary table. The pooled estimates with a 95% CI will be generated using the Comprehensive Meta-Analysis Package (version 4.0). Effect sizes will be calculated based on study design and outcome type. For continuous outcomes (eg, burnout, depression, anxiety, and PTSD scores), standardized mean differences (Hedges g) with 95% CIs will be computed. For studies with pre-post designs without a control group, within-group effect sizes will be calculated using standardized mean change. For randomized and controlled studies, between-group effect sizes will be derived by comparing intervention and comparator groups at postintervention. If dichotomous outcomes are reported, pooled estimates will be calculated using odds ratios. When multiple outcome measures are reported for the same construct, a predefined hierarchy of validated instruments will be applied, and the primary outcome identified by the study authors or the measure with the most complete data will be selected. If multiple time points are available, postintervention outcomes will be prioritized for the primary analysis. Statistical heterogeneity will be assessed using the Cochran Q test and quantified using the I² statistic, with thresholds of low (25%), moderate (50%), and high (75%) heterogeneity. In the presence of substantial heterogeneity, subgroup and sensitivity analyses will be conducted to explore potential sources, including study design, population characteristics, intervention format, and study quality. A random-effects model will be used to calculate pooled estimates, as this is a more robust estimate regardless of heterogeneity. Cochran Q and I² statistics will be used as indicators of heterogeneity. If enough studies are available in subgroups, further analyses based on moderator variables, such as sociodemographic variables, country, and study quality, will also be conducted. Sensitivity analysis will be conducted to identify studies that may severely affect the pooled prevalence. A funnel plot and Egger linear regression test will be used to assess publication bias. The significance level will be set as 2-sided, with P<.05. Forest plots will be used to present the data. In the meta-analysis of factors, variables common to all participants will be pooled quantitatively to examine the effect of the intervention on various psychopathologies. If the data do not allow for quantitative pooling, for example, due to substantial clinical or methodological heterogeneity, incompatible outcome measures, or an insufficient number of comparable studies, a narrative synthesis will be conducted. This synthesis will summarize the direction and magnitude of effects, study-level characteristics, intervention parameters, and quality ratings. Patterns across studies will be explored using structured comparisons by population, intervention format, and outcome type. This approach ensures that meaningful conclusions can still be drawn even when a meta-analysis is not possible.

Progress checkpoints were conducted at key stages following title and abstract screening, after the completion of full-text screening, and prior to data analysis to ensure adherence to the planned protocol and timely progress. Any significant methodological changes or deviations from the initial protocol were documented and submitted as amendments to the PROSPERO registration, and these updates will be transparently reported in the final study.

This systematic review and meta-analysis is anticipated to demonstrate that hypnotherapy may have beneficial effects in reducing symptoms of burnout and related psychopathologies, including depression, anxiety, and PTSD. While the strength and consistency of the evidence will depend on study quality and design, we expect to observe trends suggesting positive therapeutic outcomes, particularly in health care populations and students experiencing occupational stress. Building upon prior work that has primarily focused on stress, depression, or anxiety individually, this review aims to provide an integrated synthesis addressing the intersection between burnout and these related conditions. The study is designed to fill the evidence gap regarding the role of hypnosis as a distinct therapeutic modality for burnout, distinguishing it from mindfulness and other relaxation-based interventions.

Although hypnosis has been a therapeutic tool for centuries, to date, there have been very few systematic reviews regarding its use in the treatment of psychiatric pathologies. While the use of hypnotherapy in clinical settings has recently gained resurgence, the practice has been subject to controversy surrounding its efficacy and impacts on patients with psychiatric conditions [30]. Hypnosis differs from interventions such as cognitive behavioral therapy and mindfulness due to its focus on inducing a state of increased suggestibility, which allows the patient to experience an altered state of agency. As a result, subsequent changes to thoughts, actions, and symptoms feel involuntary and outside the patient’s control [31]. Our study aims to conduct a comprehensive systematic review of the currently available literature investigating the efficacy of hypnotherapy for burnout, stress, depression, anxiety, and other psychiatric symptoms. Although there have been studies and systematic reviews regarding hypnosis as a treatment, their focus is on its impacts on pain, physical health, and mood disturbances secondary to illness or hospitalization [32]. Limited reviews have been conducted regarding the use of hypnosis to treat psychopathology symptoms, and none have focused on the treatment of burnout [23,33]. Our study focuses on the efficacy of hypnosis in treating primary psychiatric illness and symptoms in relation to burnout, an area of research that still requires further investigation.

Burnout in physicians, including trainees, is a prevalent issue, with studies finding 45% to 55% of physicians and medical students reporting at least one symptom of burnout [7,34]. Furthermore, burnout can be considered an occupational hazard and is shown to diminish health outcomes for both health care providers and patients [35-38]. Burnout’s comorbidity with psychopathologies such as depression, anxiety, and PTSD increases strain on the health care system, as the experience of burnout can perpetuate symptoms of other disorders [39,40]. Thus, addressing this growing crisis is imperative to maintaining the integrity of the health care workforce and improving care for patients. Current research in burnout prevention and treatment primarily focuses on interventions such as cognitive behavioral therapy and mindfulness [24,41]. Although prior systematic reviews have explored the effects of hypnosis on stress, depression, and anxiety, none have systematically synthesized evidence on burnout as a primary construct. As outlined in our gap analysis (Table 1), previous reviews largely excluded burnout or its occupational correlates. Therefore, this review represents the first comprehensive effort to evaluate hypnotherapy’s impact on burnout and its associated psychopathologies, integrating these interconnected outcomes to inform future clinical and research directions. Examining the impact of hypnosis and hypnotherapy on burnout symptoms can provide a valuable avenue for the identification, prevention, and treatment of burnout in health care professionals.

One strength of our review is the breadth of psychiatric pathology included in our investigation. While current studies primarily focus on the efficacy of hypnotherapy on specific psychiatric illnesses, our comprehensive study will allow us to aggregate the data and directly compare the effects of hypnotherapy on different symptoms and pathologies. This will better allow clinicians to understand which conditions may be more responsive to hypnotherapy. Additionally, many of the current studies regarding the use of hypnosis and hypnotherapy consolidate it with similar techniques, such as mindfulness meditation or guided imagery. We created an operational definition of hypnosis and hypnotherapy, and thus our review will be able to better distinguish and isolate the use and impacts of hypnosis as a treatment. Furthermore, we did not impose a time limit on the studies we included, thereby ensuring that historical data on the use of hypnosis were also considered. This approach allowed for a robust and thorough understanding of hypnosis as a stand-alone therapeutic intervention across a wide range of psychiatric conditions.

Our review’s focus on the larger-scale impacts of hypnosis on psychiatric pathology presents certain limitations. Primarily, the lack of a comparison treatment or placebo group makes it difficult to quantify the effects of hypnotherapy, especially in contrast to current gold-standard treatments. Additionally, due to the breadth of psychiatric illnesses we plan to include in our review, our study will not investigate the specific effects of hypnosis on individual pathologies, such as its impact on mania versus depression in bipolar disorder or its efficacy in different types of depressive disorders. Excluding related therapeutic modalities like guided meditation, visualization, and autogenic training based on our operational definition of hypnosis, may exclude beneficial techniques that share similarities with hypnosis [42]. Furthermore, our focus on individuals with primary psychiatric disorders, while excluding those with significant comorbidities or psychiatric symptoms secondary to other conditions (eg, surgical anxiety or depressed mood due to chronic pain or illness), limits the generalizability of our findings. This exclusion may prevent us from understanding the full potential of hypnosis across a broader range of psychological and psychosomatic conditions, indicating areas where further research is necessary. Additionally, this review is limited to English-language publications due to resource constraints, which may exclude relevant evidence published in other languages. These weaknesses present opportunities for further research. The inclusion of multiple psychological outcomes and diverse study designs may introduce statistical heterogeneity, which could limit the comparability of the findings across studies. To address this, subgroup and sensitivity analyses will be conducted to identify and explore sources of heterogeneity. Nevertheless, variations in study populations, intervention formats, and measurement tools may complicate the interpretation of pooled results and should be considered when evaluating the overall conclusions.

Our systematic review will provide a comprehensive understanding of the efficacy of hypnotherapy techniques in treating psychiatric illnesses. As a nonpharmaceutical treatment approach, hypnotherapy may be a cost-effective tool with a low physical side effect profile, which can easily be performed as an adjunctive treatment without the risk of negative pharmacological interactions [43]. Furthermore, hypnotherapy has a broad clinical application, and there have been many studies conducted on the efficacy of hypnotherapy in treating many different disorders and symptoms, including insomnia and sleep disorders, acute and chronic pain disorders, and functional neurological disorders [25,44,45]. By appreciating the current evidence surrounding this treatment modality, clinicians in all specialties will be well-informed in using hypnotherapy. Additionally, as this comprehensive review will investigate the impact of hypnotherapy on many different psychiatric symptoms, clinicians will also better understand the efficacy of hypnotherapy in treating various disorders and symptoms, thereby informing their clinical practice.

This systematic review and meta-analysis protocol outlines a rigorous plan to synthesize the available evidence on the effects of hypnotherapy in addressing burnout and related psychopathologies, including depression, anxiety, and PTSD. By establishing burnout as the primary outcome and related mental health conditions as secondary outcomes, this review aims to clarify the current state of evidence and identify knowledge gaps to inform future research and clinical practice. The findings are expected to guide the design of future trials and help determine whether hypnotherapy represents a promising adjunctive strategy for managing burnout and its associated psychological sequelae.