Published Clinical Studies of Hypnosis
Here is a list of medical applications of hypnosis, followed by selected summaries of scientific studies supporting and validating use of hypnosis to promote health.
Some studies are included which use guided imagery, meditation, or autogenic training, which are all techniques addressing the subconscious mind.
These studies are not listed to serve as medical advice, only to provide some published clinical evidence for the value of using hypnosis for health issues. Some applications require a doctor referral. The only one who can make an informed decision about your medical care is your own physician.
ADD/ADHD
Allergy
Anxiety
Arthritis
Asthma
Back Pain
Bedwetting (Enuresis)
Cancer
Cardiovascular Disease
Cerebral Palsy
Chemotherapy
Childbirth
Compliance
Crohn's and Colitis
Cystic Fibrosis
Allergy
Anxiety
Arthritis
Asthma
Back Pain
Bedwetting (Enuresis)
Cancer
Cardiovascular Disease
Cerebral Palsy
Chemotherapy
Childbirth
Compliance
Crohn's and Colitis
Cystic Fibrosis
Cystits (interstitial)
Dental Procedures
Depression
Diabetes
Dry Mouth
Dyspepsia (Indigestion)
Eating Disorders
Fertility
Fibromyalgia
Hair-Pulling
Headache
Hot Flashes
Hypertension
Hypnosis Mechanisms
Immunity
Dental Procedures
Depression
Diabetes
Dry Mouth
Dyspepsia (Indigestion)
Eating Disorders
Fertility
Fibromyalgia
Hair-Pulling
Headache
Hot Flashes
Hypertension
Hypnosis Mechanisms
Immunity
Impotence
Insomnia
Irritable Bowel
Itch (Pruritis)
Learning
Medical Procedures
Meditation
Migraine
Morning Sickness
Multiple Sclerosis
Nausea and Vomiting
Nervous Habits
Pain
Palliative Care
Parkinson's Tremor
Insomnia
Irritable Bowel
Itch (Pruritis)
Learning
Medical Procedures
Meditation
Migraine
Morning Sickness
Multiple Sclerosis
Nausea and Vomiting
Nervous Habits
Pain
Palliative Care
Parkinson's Tremor
Phobias
Physical Rehabilitation
Post-Traumatic Stress
Self-Hypnosis
Skin Diseases
Smoking Cessation
Stress
Stroke
Surgery preparation
Test Anxiety
Tinnitus
Tourette Syndrome
Warts
Weight Loss
Wound Healing
ADD/ADHD
"Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study."
Zylowska, L., D. L. Ackerman, et al. (2008). J Atten Disord 11(6): 737-46.
OBJECTIVE: ADHD is a childhood-onset psychiatric condition that often continues into adulthood. Stimulant medications are the mainstay of treatment; however, additional approaches are frequently desired. In recent years, mindfulness meditation has been proposed to improve attention, reduce stress, and improve mood. This study tests the feasibility of an 8-week mindfulness training program for adults and adolescents with ADHD. METHOD: Twenty-four adults and eight adolescents with ADHD enrolled in a feasibility study of an 8-week mindfulness training program. RESULTS: The majority of participants completed the training and reported high satisfaction with the training. Pre-post improvements in self-reported ADHD symptoms and test performance on tasks measuring attention and cognitive inhibition were noted. Improvements in anxiety and depressive symptoms were also observed. CONCLUSION: Mindfulness training is a feasible intervention in a subset of ADHD adults and adolescents and may improve behavioral and neurocognitive impairments. A controlled clinical study is warranted.
"Alternative and controversial treatments for attention-deficit/hyperactivity disorder."
Baumgaertel, A. (1999). Pediatric Clinics of North America 46(5): 977-92.
ADHD is a syndrome that can be treated effectively, safely, and economically with stimulant medications. There is no equal alternative to these agents in short-term treatment of ADHD symptoms. However, many families seek alternatives to stimulants and other drug treatments for a variety of reasons. Alternative approaches reflect the complexity and heterogeneity of the disorder by being equally manifold, complex, and often obscure in their modus operandi. Scientific evidence suggests that individualized dietary management may be effective in some children. Trace element supplementation also may be beneficial when specific deficiencies are present. At this point, nootropics, herbs, and homeopathy are being seriously researched regarding their role in neurologic functioning, but evidence to support their role in the specific treatment of ADHD is inconsistent or lacking. Self-regulatory techniques such as hypnotherapy and biofeedback do not alter the core symptoms of ADHD but may be helpful in controlling secondary symptoms. These methods are unique in ADHD treatment because children can become active agents of their own coping strategies. There is no scientific evidence to support the validity of vision therapy, oculovestibular treatment, or sound training (Tomatis method) as treatment modalities for ADHD. However, auditory stimulation with individualized music may help to improve situational performance in cognitive tasks. Regardless of the treatment approach, the diagnosis of ADHD and other comorbidities first must be established through a standard medical evaluation. The standard treatment options always should be presented and discussed carefully. If alternative approaches are sought, the merits of available options should be reiterated. If the primary care provider is not comfortable or knowledgeable about an acceptable method, referral to capable and responsible practitioners in the community who are experienced in these areas should be considered. The primary care provider, the alternative "specialist," and the family all should be willing to engage in "collaborative research," applying the same standards for treatment evaluation that one would apply in mainstream methods. Communication among all parties involved in a treatment strategy is the key to demystifying alternative approaches, creating strong therapeutic relationships, and optimizing management.
Allergy
"Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study."
Langewitz, W., J. Izakovic, et al. (2005). Psychotherapy and Psychosomatics 74(3): 165-72.
BACKGROUND: Many people suffer from hay fever symptoms. Hypnosis has proved to be a useful adjunct in the treatment of conditions where allergic phenomena have an important role. METHODS: Randomised parallel group study over an observation period of two consecutive pollen seasons. Outcome data include nasal flow under hypnosis, pollinosis symptoms from diaries and retrospective assessments, restrictions in well-being and use of anti-allergic medication. We investigated 79 patients with a mean age of 34 years (range 19-54 years; 41 males), with moderate to severe allergic rhinitis to grass or birch pollen of at least 2 years duration and mild allergic asthma. The intervention consisted of teaching self-hypnosis during a mean of 2.4 sessions (SD 1.7; range 2-5 sessions) and continuation of standard anti-allergic pharmacological treatment. RESULTS: Of 79 randomised patients, 66 completed one, and 52 completed two seasons. Retrospective VAS scores yielded significant improvements in year 1 in patients who had learned self-hypnosis: pollinosis symptoms -29.2 (VAS score, range 0-100; SD 25.4; p < 0.001), restriction of well-being -26.2 (VAS score, range 0-100; SD 28.7; p < 0.001. In year 2, the control group improved significantly having learned self-hypnosis as well: pollinosis symptoms -24.8 (SD 29.1; p < 0.001), restriction of well-being -23.7 (SD 30.0; p < 0.001). Daily self-reports of subjects who learnt self-hypnosis do not show a significant improvement. The hazard ratio of reaching a critical flow of 70% in nasal provocation tests was 0.333 (95% CI 0.157-0.741) after having learnt and applied self-hypnosis.
"Reduction in skin reactions to histamine after a hypnotic procedure."
Laidlaw, T. M., R. J. Booth, et al. (1996). Psychosomatic Medicine 58(3): 242-8.
This study sought to test whether a cognitive-hypnotic intervention could be used to decrease skin reactivity to histamine and whether hypnotizability, physiological variables, attitudes, and mood would influence the size of the skin weals. Thirty eight subjects undertook three individual laboratory sessions; a pretest session to determine sensitivity to histamine, a control session, and an intervention session during which the subject experienced a cognitive-hypnotic procedure involving imagination and visualization. Compared with the control session, most subjects (32 of 38) decreased the size of their weals measured during the intervention session, and the differences between the weal sizes produced in the two sessions were highly significant (N = 38; t = 4.90; p < .0001). Mood and physiological variables but not hypnotizability scores proved to be effective in explaining the skin test variance and in predicting weal size change. Feelings of irritability and tension and higher blood pressure readings were associated with less change in weal size (i.e., a continuation of reactivity similar to that found in the control session without the cognitive-hypnotic intervention), and peacefulness and a lower blood pressure were associated with less skin reactivity during the intervention. This study has shown highly significant results in reducing skin sensitivity to histamine using a cognitive-hypnotic technique, which indicates some promise for extending this work into the clinical area.
"Subjective assessment of allergy relief following group hypnosis and self-hypnosis: a preliminary study."
Madrid, A., G. Rostel, et al. (1995). American Journal of Clinical Hypnosis 38(2): 80-6.
Self-hypnosis was taught to 34 self-identified allergy patients who attended two training classes. They practiced on their own and were questioned two months later. Seventy-six percent of the subjects reported they felt an improvement in their symptoms; 86% of those who were medicated decreased their medicines. Practice was clearly related to reported improvement. "Feeling hypnotized" was not related to improvement.
Anxiety
"The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders."
Apostolo, J. L. and K. Kolcaba (2009). Archives of Psychiatric Nursing 23(6): 403-11.
This article describes the efficacy of a guided imagery intervention for decreasing depression, anxiety, and stress and increasing comfort in psychiatric inpatients with depressive disorders. A quasi-experimental design sampled 60 short-term hospitalized depressive patients selected consecutively. The experimental group listened to a guided imagery compact disk once a day for 10 days. The Psychiatric Inpatients Comfort Scale and the Depression, Anxiety, and Stress Scales (DASS-21) were self-administered at two time points: prior to the intervention (T1) and 10 days later (T2). Comfort and DASS-21 were also assessed in the usual care group at T1 and T2. Repeated measures revealed that the treatment group had significantly improved comfort and decreased depression, anxiety, and stress over time.
"Mind-body interventions in oncology."
Carlson, L. E. and B. D. Bultz (2008). Curr Treat Options Oncol 9(2-3): 127-34.
OPINION STATEMENT: A number of mind-body interventions have been studied for use with cancer patients, primarily measuring outcomes relating to pain control, anxiety reduction, and enhancing quality of life. This chapter defines the scope and characteristics of mind-body interventions, followed by a selective review of research indicating their appropriate use or cautions in cancer care. Mind-body interventions included are hypnosis, imagery/relaxation, meditation, yoga, and creative therapies. Current evidence supports the efficacy of hypnosis and imagery/relaxation for control of pain and anxiety during cancer treatments. Meditation is supported for reductions in stress and improvements in mood, quality of life, and sleep problems. There is a growing body of support for yoga from randomized controlled trials for improving quality of life, sleep, and mood. Creative therapies such as visual arts, dance, and music may help cancer patients express their feelings and cope with the demands of a cancer experience. Research on biological marker effects of mind-body therapies remains inconclusive. Study of mind-body interventions generally requires additional, methodologically rigorous investigation of how various interventions best assist patients during various phases of cancer survivorship, although a major benefit of these therapies lies in the opportunity for patients to self-select them.
"Hypnosis in the treatment of anxiety."
Smith, W. H. (1990). Bulletin of the Menninger Clinic 54(2): 209-16.
Hypnotherapy and training in self-hypnosis can help persons achieve remarkable success in alleviating anxiety, not only in anxiety disorders, but also in any problem involving anxiety. The author describes the role of hypnosis in the treatment of several disorders and provides clinical examples illustrating treatment of generalized anxiety, phobias, and posttraumatic stress disorders. He concludes that because hypnosis exploits the intimate connection between mind and body, it provides relief through improved self-regulation and also beneficially affects cognition and the experience of self-mastery.
"Rational self-directed hypnotherapy: a treatment for panic attacks."
Der, D. F. and P. Lewington (1990). American Journal of Clinical Hypnosis 32(3): 160-7.
A single-subject research design was employed to assess the efficacy of rational self-directed hypnotherapy in the treatment of panic attacks. Presenting symptoms were acute fear, dizziness, constricted throat, upset stomach, loss of appetite, loss of weight, insomnia, fear of doctors, and fear of returning to work. Treatment lasted 13 weeks plus a 2-week baseline and posttherapy period and a 6-month follow-up. Objective measurements (MMPI, TSCS, POMS) and self-report assessments (physiological symptoms and a subjective stress inventory) were implemented. Using hypnosis and guided imagery, the subject reviewed critical incidents identifying self-defeating components within a cognitive paradigm, revising and rehearsing these incidents. Results showed an increased sense of control, improved self-concept, elimination of pathological symptoms, and cessation of panic attacks.
"Managing desperate emotional behaviour with hypnosis."
Swartz, C. (1981). Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 26(8): 555-7.
When no other psychotherapy or pharmacotherapy could prevent debilitation or institutionalization consequent to longstanding frequent repeated maladaptive behaviour, hypnosis has been observed to be effective in suitable patients. A documentation, three cases of such chronic severe behaviour which have been encountered by the author are described; each had been regarded as hopelessly unmanageable by the primary physician at the time of referral for hypnotherapy. Relevant to their suitability for hypnosis, all three patients were able to understand normal speech with difficulty, were able to concentrate well, and were agreeable to using hypnosis.
Arthritis
"Efficacy of guided imagery with relaxation for osteoarthritis symptoms and medication intake."
Baird, C. L., M. M. Murawski, et al (2010). Pain Manag Nurs 11(1): 56-65.
Supporting safe self-management interventions for symptoms of osteoarthritis (OA) may reduce the personal and societal burden of this increasing health concern. Self-management interventions might be even more beneficial if symptom control were accompanied by decreased medication use, reducing cost and potential side effects. Guided imagery with relaxation (GIR) created especially for OA may be a useful self-management intervention, reducing both symptoms and medication use. A longitudinal randomized assignment experimental design was used to study the efficacy of GIR in reducing pain, improving mobility, and reducing medication use. Thirty older adults were randomly assigned to participate in the 4-month trial by using either GIR or a sham intervention, planned relaxation. Repeated-measures analysis of variance revealed that, compared with those who used the sham intervention, participants who used GIR had a significant reduction in pain from baseline to month 4 and significant improvement in mobility from baseline to month 2. Poisson technique indicated that, compared with those who used the sham intervention, participants who used GIR had a significant reduction in over-the-counter (OTC) medication use from baseline to month 4, prescribed analgesic use from baseline to month 4, and total medication (OTC, prescribed analgesic, and prescribed arthritis medication) use from baseline to month 2 and month 4. Results of this study support the efficacy of GIR in reducing symptoms, as well as in reducing medication use. Guided imagery with relaxation may be useful in the regimen of pain management for clinicians.
"Effect of guided imagery with relaxation on health-related quality of life in older women with osteoarthritis."
Baird, C. L. and L. P. Sands (2006). Research in Nursing and Health 29(5): 442-51.
Osteoarthritis (OA) is the most common cause of disability in older adults, which, in turn, leads to poor quality of life (QOL). Disability is caused primarily by the joint degeneration and pain associated with OA. A randomized pilot study was conducted to test the effectiveness of guided imagery with relaxation (GIR) to improve health-related QOL (HRQOL) in women with OA. A two-group (intervention versus control) longitudinal design was used to determine whether GIR leads to better HRQOL in these individuals and whether improvement in HRQOL could be attributed to intervention-associated improvements in pain and mobility. Twenty-eight women were randomized to either the GIR intervention or the control intervention group. Using GIR for 12 weeks significantly increased women's HRQOL in comparison to the women who used the control intervention, even after statistically adjusting for changes in pain and mobility. These findings suggest that the effects of GIR on HRQOL are not limited to improvements in pain and mobility. GIR may be an easy-to-use self-management intervention to improve the QOL of older adults with OA.
"A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis."
Baird, C. L. and L. Sands (2004). Pain Manag Nurs 5(3): 97-104.
Osteoarthritis (OA) is a common, chronic condition that affects most older adults. Adults with OA must deal with pain that leads to limited mobility and may lead to disability and difficulty maintaining independence. A longitudinal, randomized clinical trial pilot study was conducted to determine whether Guided Imagery (GI) with Progressive Muscle Relaxation (PMR) would reduce pain and mobility difficulties of women with OA. Twenty-eight older women with OA were randomly assigned to either the treatment or the control group. The treatment consisted of listening twice a day to a 10-to-15-minute audiotaped script that guided the women in GI with PMR. Repeated-measures ANOVA revealed a significant difference between the two groups in the amount of change in pain and mobility difficulties they experienced over 12 weeks. The treatment group reported a significant reduction in pain and mobility difficulties at week 12 compared to the control group. Members of the control group reported no differences in pain and non-significant increases in mobility difficulties. The results of this pilot study justify further investigation of the effectiveness of GI with PMR as a self-management intervention to reduce pain and mobility difficulties associated with OA.
"Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson [correction of Erickson] hypnosis and Jacobson relaxation."
Gay, M. C., P. Philippot, et al. (2002). Eur J Pain 6(1): 1-16.
The present study investigates the effectiveness of Erikson hypnosis and Jacobson relaxation for the reduction of osteoarthritis pain. Participants reporting pain from hip or knee osteoarthritis were randomly assigned to one of the following conditions: (a) hypnosis (i.e. standardized eight-session hypnosis treatment); (b) relaxation (i.e. standardized eight sessions of Jacobson's relaxation treatment); (c) control (i.e. waiting list). Overall, results show that the two experimental groups had a lower level of subjective pain than the control group and that the level of subjective pain decreased with time. An interaction effect between group treatment and time measurement was also observed in which beneficial effects of treatment appeared more rapidly for the hypnosis group. Results also show that hypnosis and relaxation are effective in reducing the amount of analgesic medication taken by participants. Finally, the present results suggest that individual differences in imagery moderate the effect of the psychological treatment at the 6 month follow-up but not at previous times of measurement (i.e. after 4 weeks of treatment, after 8 weeks of treatment and at the 3 month follow-up). The results are interpreted in terms of psychological processes underlying hypnosis, and their implications for the psychological treatment of pain are discussed.
"Biochemical correlates of hypnoanalgesia in arthritic pain patients."
Domangue, B. B., C. G. Margolis, et al. (1985). Journal of Clinical Psychiatry 46(6): 235-8.
Self-reported levels of pain, anxiety, and depression, and plasma levels of beta-endorphin, epinephrine, norepinephrine, dopamine, and serotonin were measured in 19 arthritic pain patients before and after hypnosis designed to produce pain reduction. Correlations were found between levels of pain, anxiety, and depression. Anxiety and depression were negatively related to plasma norepinephrine levels. Dopamine levels were positively correlated with both depression and epinephrine levels and negatively correlated with levels of serotonin. Serotonin levels were positively correlated with levels of beta-endorphin and negatively correlated to epinephrine. Following hypnotherapy, there were clinically and statistically significant decreases in pain, anxiety, and depression and increases in beta-endorphin-like immunoreactive material.
Asthma
"Functional relaxation and guided imagery as complementary therapy in asthma: a randomized controlled clinical trial."
Lahmann, C., M. Nickel, et al. (2009). Psychotherapy and Psychosomatics 78(4): 233-9.
BACKGROUND: Asthma is a frequently disabling and almost invariably distressing disease that has a high overall prevalence. Although relaxation techniques and hypnotherapeutic interventions have proven their effectiveness in numerous trials, relaxation therapies are still not recommended in treatment guidelines due to a lack of methodological quality in many of the trials. Therefore, this study aims to investigate the efficacy of the brief relaxation technique of functional relaxation (FR) and guided imagery (GI) in adult asthmatics in a randomized controlled trial. METHODS: 64 patients with extrinsic bronchial asthma were treated over a 4-week period and assessed at baseline, after treatment and after 4 months, for follow-up. 16 patients completed FR, 14 GI, 15 both FR and GI (FR/GI) and 13 received a placebo relaxation technique as the control intervention (CI). The forced expiratory volume in the first second (FEV(1)) as well as the specific airway resistance (sR(aw)) were employed as primary outcome measures. RESULTS: Participation in FR, GI and FR/GI led to increases in FEV(1) (% predicted) of 7.6 +/- 13.2, 3.3 +/- 9.8, and 8.3 +/- 21.0, respectively, as compared to -1.8 +/- 11.1 in the CI group at the end of the therapy. After follow-up, the increases in FEV(1) were 6.9 +/- 10.3 in the FR group, 4.4 +/- 7.3 in the GI and 4.5 +/- 8.1 in the FR/GI, compared to -2.8 +/- 9.2 in the CI. Improvements in sR(aw) (% predicted) were in keeping with the changes in FEV(1) in all groups. CONCLUSIONS: Our study confirms a positive effect of FR on respiratory parameters and suggests a clinically relevant long-term benefit from FR as a nonpharmacological and complementary therapy treatment option.
"Evidence-based hypnotherapy for asthma: a critical review."
Brown, D. (2007). International Journal of Clinical and Experimental Hypnosis 55(2): 220-49.
Asthma is a chronic disease with intermittent acute exacerbations, characterized by obstructed airways, hyper-responsiveness, and sometimes by chronic airway inflammation. Critically reviewing evidence primarily from controlled outcome studies on hypnosis for asthma shows that hypnosis is possibly efficacious for treatment of symptom severity and illness-related behaviors and is efficacious for managing emotional states that exacerbate airway obstruction. Hypnosis is also possibly efficacious for decreasing airway obstruction and stabilizing airway hyper-responsiveness in some individuals, but there is insufficient evidence that hypnosis affects asthma's inflammatory process. Promising research needs to be replicated with larger samples and better designs with careful attention paid to the types of hypnotic suggestions given. The critical issue is not so much whether it is used but how it is used. Future outcome research must address the relative contribution of expectancies, hypnotizability, hypnotic induction, and specific suggestions.
"Psychological aspects of asthma."
Lehrer, P., J. Feldman, et al. (2002). Journal of Consulting and Clinical Psychology 70(3): 691-711.
Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures.
"Hypnosis and asthma: a critical review."
Hackman, R. M., J. S. Stern, et al. (2000). Journal of Asthma 37(1): 1-15.
Asthma is among the most common chronic diseases of the western world and has significant effects on patients' health and quality of life. Asthma is typically treated with pharmaceutical products, but there is interest in finding nonpharmaceutical therapies for this condition. Hypnosis has been used clinically to treat a variety of disorders that are refractive to pharmaceutical-based therapies, including asthma, but relatively little attention has been given recently to the use of clinical hypnosis as a standard treatment for asthma. Significant data suggest that hypnosis may be an effective treatment for asthma, but it is premature to conclude that hypnosis is unequivocally effective. Studies conducted to date have consistently demonstrated an effect of hypnosis with asthma. More and larger randomized, controlled studies are needed. Existing data suggest that hypnosis efficacy is enhanced in subjects who are susceptible to the treatment modality, with experienced investigators, when administered over several sessions, and when reinforced by patient autohypnosis. Children in particular appear to respond well to hypnosis as a tool for improving asthma symptoms.
"Hypnosis for exercise-induced asthma."
Ben-Zvi, Z., W. A. Spohn, et al. (1982). American Review of Respiratory Disease 125(4): 392-5.
Hypnosis has been used for many years in the treatment of asthma, but studies of its usefulness have been controversial. We assessed the efficacy of hypnosis in attenuating exercise-induced asthma (EIA) in 10 stable asthmatics. The subjects ran on a treadmill while mouth breathing for 6 min on 5 different days. Pulmonary mechanics were measured before and after each challenge. Two control exercise challenges resulted in a reproducible decrease in forced expiratory volume in one second (FEV1). On 2 other days, saline or cromolyn by nebulization was given in a double-blind manner with the suggestion that these agents would prevent EIA. Hypnosis prior to exercise resulted in a 15.9% decrease in FEV1 compared with a 31.8% decrease on the control days (p less than 0.001). Pretreatment with cromolyn resulted in a 7.6% decrease in FEV1. We conclude that hypnosis can alter the magnitude of a pathophysiologic process, namely, the bronchospasm after exercise in patients with asthma.
Back Pain
"Chronic low-back pain modulation is enhanced by hypnotic analgesic suggestion by recruiting an emotional network: a PET imaging study."
Nusbaum, F., J. Redoute, et al. International Journal of Clinical and Experimental Hypnosis 59(1): 27-44.
This study aimed to characterize the neural networks involved in patients with chronic low-back pain during hypnoanalgesia. PET was performed in 2 states of consciousness, normal alertness and hypnosis. Two groups of patients received direct or indirect analgesic suggestion. The normal alertness state showed activations in a cognitive-sensory pain modulation network, including frontotemporal cortex, insula, somatosensory cortex, and cerebellum. The hypnotic state activated an emotional pain modulation network, including frontotemporal cortex, insula, caudate, accumbens, lenticular nuclei, and anterior cingulate cortex (ACC). Direct suggestion activated cognitive processes via frontal, prefrontal, and orbitofrontal cortices, while indirect suggestion activated a widespread and more emotional network including frontal cortex, anterior insula, inferior parietal lobule, lenticular nucleus, and ACC. Confirmed by visual analog scale data, these results suggest that chronic pain modulation is greater with hypnosis, which enhances both activated networks.
"Complementary and alternative medicine approaches to pain management."
Tan, G., J. A. Alvarez, et al. (2006). Journal of Clinical Psychology 62(11): 1419-31.
This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and self-hypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment.
"Hypnosis compared to relaxation in the outpatient management of chronic low back pain."
McCauley, J. D., M. H. Thelen, et al. (1983). Archives of Physical Medicine and Rehabilitation 64(11): 548-52.
Chronic low back pain (CLBP) presents a problem of massive dimensions. While inpatient approaches have been evaluated, outpatient treatment programs have received relatively little examination. Hypnosis and relaxation are two powerful techniques amenable to outpatient use. Seventeen outpatient subjects suffering from CLBP were assigned to either Self-Hypnosis (n = 9) or Relaxation (n = 8) treatments. Following pretreatment assessment, all subjects attended a single placebo session in which they received minimal EMG feedback. One week later the subjects began eight individual weekly treatment sessions. Subjects were assessed on a number of dependent variables at pretreatment, following the placebo phase, one week after the completion of treatment, and three months after treatment ended. Subjects in both groups showed significant decrements in such measures as average pain rating, pain as measured by derivations from the McGill Pain Questionnaire, level of depression, and length of pain analog line. Self-Hypnosis subjects reported less time to sleep onset, and physicians rated their use of medication as less problematic after treatment. While both treatments were effective, neither proved superior to the other. The placebo treatment produced nonsignificant improvement.
Bedwetting (Enuresis)
"Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy."
Banerjee, S., A. Srivastav, et al. (1993). American Journal of Clinical Hypnosis 36(2): 113-9.
Various therapeutic modalities have been used for treating enuresis due to the lack of a single identifiable cause. We carried out a comparative study of imipramine and direct hypnotic suggestions with imagery used for the management of functional nocturnal enuresis. Enuretic children, ranging in age from 5 to 16 years, underwent 3 months of therapy with imipramine (N = 25) or hypnosis (N = 25). After termination of the active treatment, the hypnosis group continued practicing self-hypnosis daily during the follow-up period of another 6 months. Of the patients treated with imipramine, 76% had a positive response (all dry beds); for patients treated with hypnotic strategies, 72% responded positively. At the 9-month follow-up, 68% of patients in the hypnosis group maintained a positive response, whereas only 24% of the imipramine group did. Hypnosis and self-hypnosis strategies were found to be less effective in younger children (5-7 years old) compared to imipramine treatment. The treatment response was not related to the hypnotic responsivity of the patient in either group.
"Hypnotherapy as a treatment for enuresis."
Edwards, S. D. and H. I. van der Spuy (1985). Journal of Child Psychology and Psychiatry and Allied Disciplines 26(1): 161-70.
The main objective of this study was to provide an adequately controlled experimental and clinical study to assess the efficacy of hypnotherapy in the treatment of nocturnal enuresis. Subjects were 48 nocturnal enuretic boys, aged 8-13 yr. Treatment consisted of six standardized sessions, one hourly session per subject per week. Results indicated that hypnotherapy was significantly effective over 6 months in decreasing nocturnal enuresis, compared with both pretreatment baseline enuresis frequency and no-treatment controls. It also suggested that trance induction was not a necessary prerequisite for success. Comparison with other methods of treatment provided evidence that hypnotherapy was an effective alternative or adjunctive form of treatment for enuresis.
"The use of relaxation-mental imagery (self-hypnosis) in the management of 505 pediatric behavioral encounters."
Kohen, D. P., K. N. Olness, et al. (1984). Journal of Developmental and Behavioral Pediatrics 5(1): 21-5.
This report assessed outcomes of hypnotherapeutic interventions for 505 children and adolescents seen by four pediatricians over a period of one year and followed from four months to two years. Presenting problems included enuresis, acute pain, chronic pain, asthma, habit disorders, obesity, encopresis, and anxiety. Using strict criteria for determination of problem resolution (e.g., all beds dry) and recognizing that some conditions were intrinsically chronic, the authors found that 51% of these children and adolescents achieved complete resolution of the presenting problem; an additional 32% achieved significant improvement, 9% showed initial or some improvement; and 7% demonstrated no apparent change or improvement. Children as young as three years of age effectively applied self-hypnosis techniques. In general, facility in self-hypnosis increased with age. There was an inverse correlation (p less than 0.001) between clinical success and number of visits, suggesting that prediction of responsivity is possible after four visits or less.
Cancer
"The effectiveness of hypnosis in reducing pain and suffering among women with metastatic breast cancer and among women with temporomandibular disorder."
Nash, M. R. and A. Tasso. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 497-504.
The authors describe two studies of special interest to clinicians and clinical researchers. Both are randomized controlled studies, exclusively focused on female patients. The first study tests whether a year-long weekly group intervention including hypnosis can reduce cancer pain among women with metastatic breast cancer. Findings suggest the intervention slowed the increase in reported pain over a 12-month period relative to controls. The second study examines the effect of hypnosis in women suffering from temporomandibular disorder (TMD), with a special focus on function as well as pain. Hypnosis reduced TMD pain as measured by a numerical-rating scale.
"Immuno-modulatory effects of relaxation training and guided imagery in women with locally advanced breast cancer undergoing multimodality therapy: a randomised controlled trial."
Eremin, O., M. B. Walker, et al. (2009). Breast 18(1): 17-25.
Eighty women undergoing multimodality treatment for large (>4cm) or locally advanced (T3, T4, Tx, N2), breast cancers participated in a randomised controlled trial (RCT) to evaluate the immuno-modulatory effects of relaxation training and guided imagery. Patients underwent chemotherapy followed by surgery, radiotherapy, and hormone therapy. Those in the intervention group were taught relaxation and guided imagery. Patients kept diaries of the frequency of relaxation practice and imagery vividness. On 10 occasions during the 37 weeks following the diagnosis, blood was taken for immunological assays CD phenotyping: T cell subsets (helper, cytotoxic), natural killer (NK) and lymphokine activated killer (LAK) cells, B lymphocytes and monocytes; cytotoxicity: NK and LAK cell activities; cytokines interleukin 1 beta (1beta), 2, 4 and 6 and tumour necrosis factor alpha. Significant between-group differences were found in the number of CD25+ (activated T cells) and CD56+ (LAK cell) subsets. The number of CD3+ (mature) T cells was significantly higher following chemotherapy and radiotherapy, in patients randomised to relaxation and guided imagery. Using a median split, women who rated their imagery ratings highly had elevated levels of NK cell activity at the end of chemotherapy and at follow-up. Significant correlations were obtained between imagery ratings and baseline corrected values for NK and LAK cell activity, and IL1beta. Relaxation frequency correlated with the number of CD4+ (T helper) cells, the CD4+:8+ (helper:cytotoxic) ratio, and IL1beta levels. Relaxation training and guided imagery beneficially altered putative anti-cancer host defences during and after multimodality therapy. Such changes, to the best of our knowledge, have not been previously documented in a RCT.
"Hypnosis for Postradiation Xerostomia in Head and Neck Cancer Patients: A Pilot Study."
Schiff, E., J. G. Mogilner, et al. (2009). Journal of Pain and Symptom Management 37(6):1086-1092.
Xerostomia, the sensation of dry mouth, affects almost all patients who undergo radiotherapy for cancer in the head and neck area. Current therapies for xerostomia are inadequate, and the condition negatively impacts the quality of life. This prospective observational pilot aimed to evaluate whether hypnosis could improve salivation and decrease xerostomia. Twelve patients with xerostomia after radiotherapy for head and neck cancer were assessed for severity of xerostomia symptoms and sialometry. They then received a single hypnosis session with specific suggestions to increase salivation. The session was recorded on a compact disk (CD), and the participants were instructed to listen to it twice a day for one month. Sialometry was repeated immediately after hypnosis. Validated xerostomia questionnaires were completed at one, four, and 12 weeks after hypnosis. A substantial overall improvement was reported by eight patients at 12 weeks (66%). The saliva flow rate increased on sialometry in nine patients following hypnosis (75%). There was no correlation between the magnitude of changes in the measured saliva flow rate and changes in subjective measures (Spearman's correlation coefficient r=0.134). Symptomatic improvement significantly correlated with the number of times the patients listened to the hypnosis CD (r=0.714, P=0.009). No adverse events were reported. The data from this small observational trial suggest that hypnosis may be an effective treatment for xerostomia. Confirmation in a larger randomized and controlled investigation is warranted.
"Cancer, cognitive impairment, and meditation."
Biegler, K. A., M. A. Chaoul, et al. (2009). Acta Oncologica 48(1): 18-26.
BACKGROUND AND OBJECTIVES: Cancer-related cognitive impairment has been acknowledged as a substantial limiting factor in quality of life among cancer patients and survivors. In addition to deficits on behavioral measures, abnormalities in neurologic structure and function have been reported. In this paper, we review findings from the literature on cognitive impairment and cancer, potential interventions, meditation and cognitive function, and meditation and cancer. In addition, we offer our hypotheses on how meditation practice may help to alleviate objective and subjective cognitive function, as well as the advantages of incorporating a meditation program into the treatment of cancer patients and survivors for cancer-related cognitive deficits. FINDINGS: Various factors have been hypothesized to play a role in cancer-related cognitive impairment including chemotherapy, reduced hormone levels, proinflammatory immune response, fatigue, and distress. Pharmacotherapies such as methylphenidate or modafinil have been suggested to alleviate cognitive deficits. While initial reports suggest they are effective, some pharmacotherapies have side effects and may not relieve other symptoms associated with multimodal cancer treatment including sleep disturbance, nausea and pain. Several recent studies investigating the effects of meditation programs have reported behavioral and corresponding neurophysiological modulations that may be particularly effective in alleviating cancer-related cognitive impairment. Such programs also have been shown to reduce stress, fatigue, nausea and pain, and improve mood and sleep quality. CONCLUSIONS: With the increasing success of cancer treatment and the ability to return to previous family, social, and work activities, symptom management and quality of life are an essential part of survivorship. We propose that meditation may help to improve cancer-related cognitive dysfunction, alleviate other cancer-related sequelae, and should be fully investigated as an adjuvant to cancer treatment.
"Mind-body interventions in oncology."
Carlson, L. E. and B. D. Bultz (2008). Curr Treat Options Oncol 9(2-3): 127-34.
OPINION STATEMENT: A number of mind-body interventions have been studied for use with cancer patients, primarily measuring outcomes relating to pain control, anxiety reduction, and enhancing quality of life. This chapter defines the scope and characteristics of mind-body interventions, followed by a selective review of research indicating their appropriate use or cautions in cancer care. Mind-body interventions included are hypnosis, imagery/relaxation, meditation, yoga, and creative therapies. Current evidence supports the efficacy of hypnosis and imagery/relaxation for control of pain and anxiety during cancer treatments. Meditation is supported for reductions in stress and improvements in mood, quality of life, and sleep problems. There is a growing body of support for yoga from randomized controlled trials for improving quality of life, sleep, and mood. Creative therapies such as visual arts, dance, and music may help cancer patients express their feelings and cope with the demands of a cancer experience. Research on biological marker effects of mind-body therapies remains inconclusive. Study of mind-body interventions generally requires additional, methodologically rigorous investigation of how various interventions best assist patients during various phases of cancer survivorship, although a major benefit of these therapies lies in the opportunity for patients to self-select them.
"Immune responses to guided imagery during breast cancer treatment."
Lengacher, C. A., M. P. Bennett, et al. (2008). Biol Res Nurs 9(3): 205-14.
BACKGROUND: The use of relaxation and guided imagery to reduce stress and improve immune function has great potential benefits for patients with breast cancer. METHODS: This pilot study used a pretest-posttest experimental design with 28 breast cancer patients, aged 25 to 75 years, with the diagnosis of stage 0, 1, or 2 breast cancer. The experimental group received a relaxation and guided imagery intervention and the control group received standard care. The effects of the intervention on immune function were measured by natural killer (NK) cell cytotoxicity and IL-2-activated NK cell activity prior to surgery and 4 weeks postsurgery. NK cell activity was measured using a 15-hr incubation chromium release assay. Cytotoxicity of NK cells was measured against chromium-labeled K-562 target cells. IL-2 was used to enhance reactivity of NK cells against tumor cells. After incubation for 15 hr, cytotoxicity was measured through the release of radioactive chromium. RESULTS: Significant differences between groups were found at 4 weeks postsurgery. T-tests showed increased NK cell cytotoxicity for the intervention group at 100:1, 50:1, and 25:1 effector cell: target cell ratios (E:T) (p < .01 to p < .05) and increased activation for IL-2 at 100:1, 50:1, 25:1, and 12.5:1 (E:T) (p < .01 to p < .05) for the intervention group as compared to the control group. DISCUSSION: These findings suggest that a relaxation intervention such as guided imagery could have an effect on NK cell cytotoxicity and NK cell cytotoxicity after activation with IL-2 in patients undergoing surgery for breast cancer.
"Potential role of mind-body therapies in cancer survivorship."
Monti, D. A., M. Sufian, et al. (2008). Cancer 112(11 Suppl): 2607-16.
The use of complementary and alternative medicine (CAM) by cancer survivors is high, particularly among those with psychosocial distress, poor quality of life, culturally based health beliefs, and those who experience health disparities in the mainstream healthcare system. As the number of cancer survivors continues to increase, so does the diversity of the survivorship population, making it increasingly important to understand and address the CAM culture in different survivor groups. Given the known communication barriers between cancer patients and their physicians regarding CAM, it would be useful for oncology providers to have a platform from which to discuss CAM-related issues. It is proposed that mind-body therapies with some basis in evidence could provide such a platform and also serve as a possible means of connecting cancer survivors to psychosocial supportive services. This article reviews a few mind-body therapies that may have particular relevance to cancer survivors, such as hypnosis and meditation practices. A theoretical foundation by which such therapies provide benefit is presented, with particular emphasis on self-regulation.
"Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors."
Elkins, G., J. Marcus, et al. (2008). Journal of Clinical Oncology 26(31): 5022-6.
PURPOSE: Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. PATIENTS AND METHODS: Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities. RESULTS: Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group. CONCLUSION: Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.
"Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice."
Lang, E. V., K. S. Berbaum, et al. (2008). Journal of Vascular and Interventional Radiology 19(6): 897-905.
PURPOSE: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events. MATERIALS AND METHODS: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (> or =50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment. RESULTS: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118). CONCLUSIONS: Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.
"Complementary and alternative medicine."
Filshie, J. and C. N. Rubens (2006). Anesthesiol Clin 24(1): 81-111, viii.
Thirty years ago, the integration of complementary medicine into cancer care almost was dismissed as quackery. Today, a whole range of complementary and alternative medicine (CAM) techniques have been integrated into the management of cancer, which are often of benefit to patients, when conventional treatment is deemed to have failed or caused intolerable side effects. Health care workers need to inquire about the use of CAM in their patients routinely in a sensitive and nonjudgmental way, and may need to advise patients to stop certain therapies. Yet in advanced cancer, a sensible balance needs to be struck between fear about adverse effects and interactions and the importance of making the remaining weeks/days/months as comfortable and enjoyable as possible.
"Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy."
Marchioro, G., G. Azzarello, et al. (2000). Oncology 59(2): 100-4.
AIMS AND BACKGROUND: In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies. PATIENTS AND METHODS: The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis. RESULTS: In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients. CONCLUSIONS: The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.
"Critical review of 5 nonpharmacologic strategies for managing cancer pain."
Sellick, S. M. and C. Zaza (1998). Cancer Prevention and Control 2(1): 7-14.
PURPOSE: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. METHODS: The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. RESULTS: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. CONCLUSION: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed.
"Imagery and hypnosis in the treatment of cancer patients."
Spiegel, D. and R. Moore (1997). Oncology (Williston Park) 11(8): 1179-89; discussion 1189-95.
Many patients with cancer often seek some means of connecting their mental activity with the unwelcome events occurring in their bodies, via techniques such as imagery and hypnosis. Hypnosis has been shown to be an effective method for controlling cancer pain. The techniques most often employed involve physical relaxation coupled with imagery that provides a substitute focus of attention for the painful sensation. Other related imagery techniques, such as guided imagery, involve attention to internally generated mental images without the formal use of hypnosis. The most well-known of these techniques involves the use of "positive mental images" of a strong army of white blood cells killing cancer cells. Despite claims to the contrary, no reliable evidence has shown that this technique affects disease progression or survival. Studies evaluating more broadly defined forms psychosocial support have come to conflicting conclusions about whether or not these interventions affect survival of cancer patients. However, 10-year follow-up of a randomized trial involving 86 women with cancer showed that a year of weekly "supportive/expressive" group therapy significantly increased survival duration and time from recurrence to death. This intervention encourages patients to express and deal with strong emotions and also focuses on clarifying doctor-patient communication. Numerous other studies suggest that suppression of negative affect, excessive conformity, severe stress, and lack of social support predict a poorer medical outcome from cancer. Thus, further investigation into the interaction between body and mind in coping with cancer is warranted.
"Hypnosis for children and adolescents with cancer: an annotated bibliography, 1985-1995."
Steggles, S., S. Damore-Petingola, et al. (1997). Journal of Pediatric Oncology Nursing 14(1): 27-32.
This annotated bibliography reviews the professional literature published in English, from 1985 to 1995 inclusive, on the subject of the use of hypnosis with pediatric cancer patients. Books, chapters, and journal articles are included; dissertation, theses, and unpublished material are not. This bibliography contains 37 items organized into three categories: (1) General Discussions; (2) Case Reports or Case Studies: and (3) Experimental and Nonexperimental Group Designs. The brief annotations provided are not intended to be reviews or to be evaluative, but, rather, to inform the reader about the content and focus of the publication. This is an update of a previously published annotated bibliography, also presented in this Journal, which explored the relationship between hypnosis and pediatric cancer in journal articles published from 1960 to 1985.
"Hypnotherapy: complementary support in cancer care."
Pattison, J. (1997). Nursing Standard 11(52): 44-6.
The psychological and physical consequences of cancer threaten patients' wellbeing and quality of life (Fallowfield 1991). Patients' needs are wide ranging and can include both personal and physical demands as well as support, relaxation and distraction. This article describes how many of these needs can be cared for by the skillful use of hypnotherapy.
"The use of hypnosis with cancer patients."
Levitan, A. A. (1992). Psychiatric Medicine 10(1): 119-31.
Hypnosis has proven to be extremely valuable in the treatment of cancer patients. Specific applications include: establishing rapport between the patient and members of the medical health team; control of pain with self-regulation of pain perception through the use of glove anesthesia, time distortion, amnesia, transference of pain to a different body part, or dissociation of the painful part from the rest of the body; controlling symptoms, such as, nausea, anticipatory emesis, learned food aversions, etc.; psychotherapy for anxiety, depression, guilt, anger, hostility, frustration, isolation, and a diminished sense of self-esteem; visualization for health improvement; and, dealing with death anxiety and other related issues. Hypnosis has unique advantages for patients including improvement of self-esteem, involvement in self-care, return of locus of control, lack of unpleasant side effects, and continued efficacy despite continued use.
Cardiovascular Disease
"Feasibility and effectiveness of a brief meditation-based stress management intervention for patients diagnosed with or at risk for coronary heart disease: a pilot study."
Olivo, E. L., B. Dodson-Lavelle, et al. (2009). Psychol Health Med 14(5): 513-23.
Extensive research has led to the development of a psychobiological model of cardiovascular disease. This model suggests that psychological factors such as depression, anxiety, hostility, and stress may affect the development and progression of coronary heart disease (CHD). Recent studies have also demonstrated that meditation-based stress reduction programs are useful interventions for patients with various medical and psychological symptoms. The objective of this pilot study was to gather preliminary information regarding the feasibility of implementing a brief meditation-based stress management (MBSM) program for patients with CHD, and those at high risk for CHD, at a major metropolitan hospital that serves a predominately non-local patient population. The secondary aim of this study was to investigate the possibility that such an intervention might reduce depression, as well as perceived stress, anxiety, and hostility, while improving general health scores. The overall feasibility results indicate that this MBSM intervention was highly feasible with regard to both recruitment and retention of participants. In fact, 40% of patients requested further training. In addition, after completion of the 4-week intervention, participants reported significant reductions in depression and perceived stress. In conclusion, the present study demonstrated that the brief meditation-based stress management program was well-received by patients and can successfully be used as a supportive program for patients at risk or diagnosed with CHD.
"Mind-body medicine: state of the science, implications for practice."
Astin, J. A., S. L. Shapiro, et al. (2003). Journal of the American Board of Family Practice 16(2): 131-47.
BACKGROUND: Although emerging evidence during the past several decades suggests that psychosocial factors can directly influence both physiologic function and health outcomes, medicine had failed to move beyond the biomedical model, in part because of lack of exposure to the evidence base supporting the biopsychosocial model. The literature was reviewed to examine the efficacy of representative psychosocial-mind-body interventions, including relaxation, (cognitive) behavioral therapies, meditation, imagery, biofeedback, and hypnosis for several common clinical conditions. METHODS: An electronic search was undertaken of the MEDLINE, PsycLIT, and the Cochrane Library databases and a manual search of the reference sections of relevant articles for related clinical trials and reviews of the literature. Studies examining mind-body interventions for psychological disorders were excluded. Owing to space limitations, studies examining more body-based therapies, such as yoga and tai chi chuan, were also not included. Data were extracted from relevant systematic reviews, meta-analyses, and randomized controlled trials. RESULTS: Drawing principally from systematic reviews and meta-analyses, there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. We found moderate evidence of efficacy for mind-body therapies in the areas of hypertension and arthritis. Additional research is required to clarify the relative efficacy of different mind-body therapies, factors (such as specific patient characteristics) that might predict more or less successful outcomes, and mechanisms of action. Research is also necessary to examine the cost offsets associated with mind-body therapies. CONCLUSIONS: There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions.
"Healing the heart: integrating complementary therapies and healing practices into the care of cardiovascular patients."
Kreitzer, M. J. and M. Snyder (2002). Progress in Cardiovascular Nursing 17(2): 73-80.
Complementary therapies and healing practices have been found to reduce stress, anxiety, and lifestyle patterns known to contribute to cardiovascular disease. Promising therapies include imagery and hypnosis, meditation, yoga, tai chi, prayer, music, exercise, diet, and use of dietary supplements. Many of these complementary approaches to healing have been within the domain of nursing for centuries and can readily be integrated into the care of patients with cardiovascular disease. While individual complimentary modalities hold considerable merit, it is critical that the philosophy underlying these therapies--caring, holism, and harmony--also be understood and honored.
Cerebral Palsy
"Can children with spastic cerebral palsy use self-hypnosis to reduce muscle tone? a preliminary study."
Mauersberger, K., K. Artz, et al. (2000). Integr Med 2(2): 93-96.
A few scattered reports suggest self-hypnosis may be helpful in reducing muscle tone in children with spastic cerebral palsy (CP). These reports are largely anecdotal and offer little objective evidence. This study used the Biocomp 2000 biofeedback electomyogram device to measure the degree of muscle tension in two muscle groups before, during, and after hypnosis in four children with spastic quadriplegic CP. Three of the four children were able to show a very significant decrease in muscle tension while under "trance" and were able to use self-relaxation techniques when confronted with stressful situations. Two of the children also had athetoid or involuntary movements and each was able to better control those movements with the aid of hypnosis. All four children demonstrated improved functional abilities.
Chemotherapy
"Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence."
Richardson, J., J. E. Smith, et al. (2007). European Journal of Cancer Care (English Language Edition) 16(5): 402-12.
To systematically review the research evidence on the effectiveness of hypnosis for cancer chemotherapy-induced nausea and vomiting (CINV). A comprehensive search of major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine databases were searched and efforts were made to identify unpublished and ongoing research. Citations were included from the databases' inception to March 2005. Randomized controlled trials (RCTs) were appraised and meta-analysis undertaken. Clinical commentaries were obtained. Six RCTs evaluating the effectiveness of hypnosis in CINV were found. In five of these studies the participants were children. Studies report positive results including statistically significant reductions in anticipatory and CINV. Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioural therapy. Meta-analysis has demonstrated that hypnosis could be a clinically valuable intervention for anticipatory and CINV in children with cancer. Further research into the effectiveness, acceptance and feasibility of hypnosis in CINV, particularly in adults, is suggested. Future studies should assess suggestibility and provide full details of the hypnotic intervention.
"Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy."
Marchioro, G., G. Azzarello, et al. (2000). Oncology 59(2): 100-4.
AIMS AND BACKGROUND: In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies. PATIENTS AND METHODS: The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis. RESULTS: In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients. CONCLUSIONS: The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.
Childbirth
"Hypnosis for childbirth: a retrospective comparative analysis of outcomes in one obstetrician's practice."
VandeVusse, L., J. Irland, et al. (2007). American Journal of Clinical Hypnosis 50(2): 109-19.
This exploratory, descriptive study, done retrospectively from perinatal medical records, compared childbirth outcomes in one obstetrician's caseload between 50 women who elected antepartal hypnosis preparation (usually a 5-class series) and 51 who did not. The groups were demographically similar. To achieve similar numbers to the hypnosis group, the control group was randomly selected from the women in the caseload who opted not to take hypnosis preparation, based on characteristics of parity and delivery mode. Prenatal hypnosis preparation resulted in significantly less use of sedatives, analgesia, and regional anesthesia during labor and in higher 1-minute neonatal Apgar scores. Other physiologic and outcome measures did not reveal statistical significance, although some trends were of clinical interest. Well-controlled studies are warranted for clinicians to offer hypnosis more frequently as a pain relief option for childbirth. Additional information provided includes pragmatic, clinical, and cost information about incorporating hypnosis into a physician's practice.
"Evidence-based clinical hypnosis for obstetrics, labor and delivery, and preterm labor."
Brown, D. C. and D. C. Hammond (2007). International Journal of Clinical and Experimental Hypnosis 55(3): 355-71.
This paper reviews the benefits and effectiveness of hypnosis in obstetrics and labor and delivery, demonstrating significant reductions in the use of analgesics and anesthesia and in shorter Stages 1 and 2 labors. It presents empirical and theoretical rationales for use of hypnosis in preterm labor (PTL) and labor and delivery at term. The benefits of hypnosis in relation to labor length, pain levels, and the enjoyment of labor, as well as its effectiveness in preterm labor are noted in randomized controlled trials and in a meta-analysis. Risk factors are reported for preterm delivery; hypnosis significantly prolongs pregnancy. Six cases are presented of hypnosis stopping PTL a number of times and when indicated at term. A case report of successful use of hypnosis in quadruplets is presented with some scripts. Suggestions are made for further research.
"Hypnosis: removing the labour from birth."
Mottershead, N. (2006). Practicing Midwife 9(3): 26-7, 29.
Hypnosis has been used in obstetrics for more than a century. However, with increasing numbers of women looking for alternative coping strategies for use during labour, the birth of a new discipline, HypnoBirthing, is gaining in popularity. HypnoBirthing is a hypnotherapy programme specifically designed for birth, employing the principles and techniques of hypnosis and self-relaxation. This article explains the philosophy and principles of HypnoBirthing, the evidence base and its physiological impact on labouring women, brought to life by real accounts.
"Self-hypnosis: alternative anesthesia for childbirth."
Ketterhagen, D., L. VandeVusse, et al. (2002). MCN; American Journal of Maternal Child Nursing 27(6): 335-40; quiz 341.
The purpose of this article is to inform nurses about the use of self-hypnosis in childbirth. Hypnosis is a focused form of concentration. Self-hypnosis is one form of hypnosis in which a certified practitioner or therapist teaches an individual to induce his or her own state of altered consciousness. When used for childbirth pain, the primary aim of self-hypnosis is to help the woman maintain control by managing anxiety and discomfort though inducing a focused state of relaxation. Before the widespread use of pharmaceuticals for pain, hypnosis was one of the few pain relief methods available for labor. However, as new technologies for pain relief emerged, hypnosis received less attention. Most nurses have little experience with hypnosis, and there is limited information available in the literature. However, because nurses are at laboring women's bedsides, it is important that nurses learn about self-hypnosis to be able to inform pregnant women fully about all pain control options and to maximize the benefits for the woman choosing hypnosis.
"Hypnosis and conversion of the breech to the vertex presentation."
Mehl, L. E. (1994). Archives of Family Medicine 3(10): 881-7.
OBJECTIVE: To evaluate the effectiveness of hypnosis to convert a breech presentation to a vertex presentation. DESIGN: Prospective case series compared with historical, matched comparison group. SUBJECTS: One hundred pregnant women whose fetuses were in breech position at 37 to 40 weeks' gestation and a matched comparison group of women with similar obstetrical and sociodemographic parameters derived from databases for other studies from the same time period and geographical areas. INTERVENTION: The intervention group received hypnosis with suggestions for general relaxation with release of fear and anxiety. While in the hypnotic state women were asked for the reasons why their baby was in the breech presentation. As much hypnosis was provided as was convenient and possible for the women until they were delivered of the baby or the baby converted to the vertex position. MAIN OUTCOME VARIABLES: A successful conversion for the intervention group was scored when the baby spontaneously converted to the vertex position before delivery or successful external cephalic version. The conversion rate of the intervention group was compared with the comparison group who received standard obstetrical care without the opportunity for hypnosis. DATA ANALYSIS: Parametric testing of statistically significant differences in the rate of conversion between the two groups. RESULTS: Eighty-one percent of the fetuses in the intervention group converted to vertex presentation compared with 48% of those in the comparison group. This difference was statistically significant. CONCLUSIONS: Motivated subjects can be influenced by a skilled hypnotherapist in such a manner that their fetuses have a higher incidence of conversion from breech to vertex presentation. Psychophysiological factors may influence the breech presentation and may explain this increased frequency of conversion to vertex presentation.
Compliance with Medical Advice
"Conscious hypnosis as a method for patient motivation in cervical headgear wear--a pilot study."
Trakyali, G., K. Sayinsu, et al. (2008). European Journal of Orthodontics 30(2): 147-52.
The aim of the present study was to assess the efficiency of conscious hypnosis on patient cooperation. The subjects were 30 patients (14 females and 16 males) with a skeletal Class II division 1 malocclusion, divided into two equal groups, a control and a study group. The mean age was 10.78 +/- 1.06 years for the hypnosis, and 10.07 +/- 1.09 years for the control group. Both groups were treated with cervical headgear containing a timer module. The patients were also asked to record their actual wear time on timetables. The hypnosis group patients were motivated with conscious hypnosis while the control group were given verbal motivation by their orthodontist. The timer modules were read at every visit and compared with the timetables. Analysis of variance was used to determine the differences in measurements at each time point. For comparison of the groups, an independent t-test was used. A statistically significant decrease (P < 0.05) in headgear wear was observed in the control group from the first to the sixth month; however, the difference in the hypnosis group was not significant. This result indicates that conscious hypnosis is an effective method for improving orthodontic patient cooperation. There was a low correlation between actual headgear wear indicated by the patient and that recorded by the timing modules, which showed that, timetables are not consistent tools for measuring patient cooperation.
"Psychological management of postsurgical pain and patient adherence."
Moskowitz, L. (1996). Hand Clinics 12(1): 129-37.
The advantages of proper management of postsurgical pain include fewer postoperative complications; increased early ambulation and mobilization; decreased opportunity for chronic pain syndromes to occur; shorter, less complicated rehabilitation; greater patient satisfaction; and increased patient adherence to prescribed regimens. In turn, greater adherence positively affects pain management and, therefore, patients, satisfaction with their surgeon. A variety of approaches may be used for the management of acute pain, and the "psychological preparation" of the patient prior to surgery plays a significant role. Specific approaches include (1) cognitive-behavioral (such as diaphragmatic breathing, positive visualization rehearsal, and autogenic training); (2) hypnosis; (3) biofeedback; and (4) microelectrostimulation. Some of these approaches to pain management apply during surgery and the recovery and rehabilitation periods. Many of the approaches can be carried out relatively easily by the physician and his or her staff; in some cases, specialists, such as psychologists trained in behavioral medicine, are needed. Variables that affect patient adherence, both positively and negatively, include patient motivations, the nature and chronicity of the disorder, treatment variables, and the quality of the patient-doctor relationship. Physician behaviors may encourage or discourage patient adherence.
"Use of hypnosis for improving medication compliance in psychiatric patients."
Forman, B. D. (1985). Southern Medical Journal 78(3): 242-4.
Factors involved in failure to comply with medication regimens may be divided into four categories: patient characteristics, physician-patient relationship, psychosocial environment, and treatment regimen features. Although several methods aimed at improving medication compliance have been described in the literature, hypnosis was not among them. Three cases in which hypnosis was effective for improving compliance are presented, suggesting that hypnotherapy for compliance problems has potential clinical applications.
Crohn's and Colitis
"Hypnosis and upper digestive function and disease."
Chiarioni, G., O. S. Palsson, et al. (2008). World J Gastroenterol 14(41): 6276-84.
Hypnosis is a therapeutic technique that primarily involves attentive receptive concentration. Even though a small number of health professionals are trained in hypnosis and lingering myths and misconceptions associated with this method have hampered its widespread use to treat medical conditions, hypnotherapy has gained relevance as an effective treatment for irritable bowel syndrome not responsive to standard care. More recently, a few studies have addressed the potential influence of hypnosis on upper digestive function and disease. This paper reviews the efficacy of hypnosis in the modulation of upper digestive motor and secretory function. The present evidence of the effectiveness of hypnotherapy as a treatment for functional and organic diseases of the upper bowel is also summarized, coupled with a discussion of potential mechanisms of its therapeutic action.
"Treatment of inflammatory bowel disease: a role for hypnotherapy?"
Miller, V. and P. J. Whorwell (2008). International Journal of Clinical and Experimental Hypnosis 56(3): 306-17.
Fifteen patients with severe or very severe inflammatory bowel disease on corticosteroids but not responding to medication received 12 sessions of "gut-focused hypnotherapy" and were followed up for a mean duration of 5.4 years with disease severity being graded as remission, mild, moderate, severe, or very severe. Two patients (13.4%) failed to respond and required surgery. At follow-up for the remaining 13 patients, 4 (26.6%) were in complete remission, 8 (53.3%) had mild severity, and 1 (6.7%) was moderately severe. Quality of life became good or excellent in 12 (79.9%). Corticosteroid requirements dramatically declined with 60% of patients stopping them completely and not requiring any during follow-up. Hypnotherapy appears to be a promising adjunctive treatment for inflammatory bowel disease and has steroid sparing effects. Controlled trials to clearly define its role in this disease area are justified.
"The effect of hypnosis on systemic and rectal mucosal measures of inflammation in ulcerative colitis."
Mawdsley, J. E., D. G. Jenkins, et al. (2008). American Journal of Gastroenterology 103(6): 1460-9.
OBJECTIVES: Hypnotherapy is effective in several diseases with a psychosomatic component. Our aim was to study the effects of one session of hypnosis on the systemic and rectal mucosal inflammatory responses in patients with active ulcerative colitis (UC). METHODS: In total, 17 patients with active UC underwent a 50-min session of gut-focused hypnotherapy. Before and after each procedure, the systemic inflammatory response was assessed by serum interleukin (IL)-6 and IL-13 concentrations, tumor necrosis factor-alpha (TNF-alpha) and IL-6 production by lipopolysaccharide (LPS)-stimulated whole blood, leukocyte count, natural killer (NK) cell number, platelet activation, and platelet-leukocyte aggregate formation. Rectal inflammation was assessed by mucosal release of substance P (SP), histamine, IL-13 and TNF-alpha, reactive oxygen metabolite production, and mucosal blood flow. Eight patients with active UC underwent a control procedure. RESULTS: Hypnosis decreased pulse by a median 7 beats per minute (bpm) (P= 0.0008); it also reduced the median serum IL-6 concentration by 53% (P= 0.001), but had no effect on the other systemic variables assessed. Hypnosis reduced rectal mucosal release of SP by a median 81% (P= 0.001), histamine by 35% (P= 0.002) and IL-13 by 53% (P= 0.003), and also, blood flow by 18% (P= 0.0004). The control protocol had no effect on any of the variables assessed. CONCLUSIONS: Hypnosis reduced several components of the systemic and mucosal inflammatory response in active ulcerative colitis toward levels found previously in the inactive disease. Some of these effects may contribute to the anecdotally reported benefits of hypnotherapy and provide a rationale for controlled trials of hypnotherapy in UC.
"Hypnotherapy for crohn's disease. A promising complementary/alternative therapy."
Abela, M. B. (2000). Integr Med 2(2): 127-131.
Crohn's disease is a nonspecific chronic syndrome of unknown origin for which, to date, no conventional (i.e., medical or surgical) cure exists. However, recent clinical case studies and anecdotal reports have shown that the use of different forms of hypnotherapy for the treatment of Crohn's have actually resulted in cures. This report reviews and compares the effectiveness of hypnotherapy in the treatment of Crohn's disease vis-a-vis current medical and surgical therapies, in addition to reviewing evidence of the modulation of immune function parameters by hypnosis, while providing support for current etiological hypotheses of Crohn's disease as an autoimmune disorder."
"Stress and mind-body impact on the course of inflammatory bowel diseases."
Anton, P. A. (1999). Seminars in Gastrointestinal Disease 10(1): 14-9.
At present, the medical management of inflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis, are focused on topical, locally active antiinflammatories and systemic immunosuppressives, which are thought to exert their targeted effects in the gastrointestinal mucosa. There is a paucity of controlled trials assessing the impact of mind, central nervous system (CNS), and neuromodulation on the overly active immune response in the intestinal mucosa. Patients and their physicians have long been aware of a strong association between attitude, stress, and flares of their IBD. Although reports to date remain mostly anecdotal, the degree to which mind-body influences and stress impact levels of local inflammation deserves closer attention with the aim of identifying contributing mechanisms, which may highlight new therapeutic interventions, as well as assist in identifying particular subsets of patients that may respond to novel forms of adjunctive treatments for IBD, including hypnosis, meditation, neuropeptide receptor modulation, and cortisol-releasing factor (CRF) modulation.
"Hypnosis and the treatment of ulcerative colitis and Crohn's disease."
Schafer, D. W. (1997). American Journal of Clinical Hypnosis 40(2): 111-7.
Ulcerative colitis and Crohn's Disease can be cured if they are treated as autoimmune diseases with a special understanding of the personality conflicts in the patient. The author hypothesizes that all autoimmune diseases are characterized by a high normal amount of the aggressive instinctual drives and ambivalence about their realization. Each patient's personality causes the ambivalence to be somaticized into specific autoimmune bodies that aggressively are overproduced and then attack specific tissues. Hypnosis helps in gaining insight, reinforcing interpretations, handling stress, visualizing normal intestinal areas, and controlling of the autoimmune antibodies to the normal level. This paper deals specifically with these 2 diseases.
Cystic Fibrosis
"Self-hypnosis for patients with cystic fibrosis."
Anbar, R. D. (2000). Pediatric Pulmonology 30(6): 461-5.
This report documents the utility of self-hypnosis in patients with cystic fibrosis (CF). Sixty-three patients 7 years of age or older were offered the opportunity to be taught self-hypnosis by their pulmonologist. Forty-nine agreed to learn it. Patients generally were taught hypnosis in one or two sessions. The outcome of hypnotherapy was determined by patients' answers to open-ended questions regarding their subjective evaluation of the efficacy of hypnosis. The average age of the 49 patients who were taught and used self-hypnosis was 18.1 years (range, 7-49 years). Many of the patients used hypnosis for more than one purpose, including relaxation (61% of patients), relief of pain associated with medical procedures (31%), headache relief (16%), changing the taste of medications to make the flavor more palatable (10%), and control of other symptoms associated with CF (18%). The patients successfully utilized self-hypnosis 86% of the time. No symptoms worsened following hypnotherapy. Sixteen patients chose to practice hypnosis on their own for a half year or longer. In conclusion, with the use of self-hypnosis, patients with CF can quickly learn to enhance their control over discomforts associated with therapy and their disease. Consideration should be given to making instruction in self-hypnosis available to patients with CF.
"The effects of self-hypnosis for children with cystic fibrosis: a pilot study."
Belsky, J. and P. Khanna (1994). American Journal of Clinical Hypnosis 36(4): 282-92.
This pilot study assessed the effects of self-hypnosis on psychological and physiological functioning of children ages 7 to 18 with Cystic Fibrosis (N = 12). The study used a pre- and posttest design, repeated measures, and control group. Control and experimental groups were matched for age and clinical severity. The experimental group demonstrated significant changes in locus of control, health locus of control, and self-concept. State anxiety scores did not differ significantly, but changes in trait anxiety distinguished the experimental group from the control group. The experimental group also demonstrated significant increase in peak expiratory flow rates using an air flow meter immediately after self-hypnosis when compared to the control group. Generalizability of the results is discussed in terms of the small sample size. Recommendations are offered for future studies with larger samples and variations in procedure.
Cystitis (Interstitial)
"Guided imagery for women with interstitial cystitis: results of a prospective, randomized controlled pilot study."
Carrico, D. J., K. M. Peters, et al. (2008). Journal of Alternative and Complementary Medicine 14(1): 53-60.
INTRODUCTION: In the United States, more than 1 million women and men are affected with interstitial cystititis (IC), which is a clinical syndrome involving urinary urgency, frequency, and pelvic pain. A review of the literature revealed that there are no studies showing the effect of guided imagery in women with IC. The purpose of this clinical investigation was to explore the effect of guided imagery on pelvic pain and urinary symptoms in women with IC symptoms. METHODOLOGY: Thirty (30) women with diagnosed IC were randomized into 2 equal groups. One group (treatment) listened to a 25-minute guided imagery compact disc (CD), that was created specifically for women with pelvic pain and IC, twice a day for 8 weeks. The control group rested for 25 minutes twice daily for 8 weeks. Because no guided imagery CDs specifically for women with IC were found on the commercial market, the authors created a script and recorded the CD specifically for women with IC and pelvic pain. The focus of this guided imagery CD was on healing the bladder, relaxing the pelvic-floor muscles, and quieting the nerves specifically involved in IC. Baseline and end-of-study assessment questionnaires (Interstitial Cystitis Symptom Index & Problem Index [IC-SIPI], IC Self-Efficacy Scale, a visual analogue [VAS] scale for pain, and a global response assessment [GRA]), 2-day voiding diaries, and 24-hour pain diaries were completed by the subjects and were evaluated using SPSS (Chicago, IL). RESULTS: More than 45% of the treatment group were responders to guided imagery therapy noting a moderate or marked improvement on the GRA. Pain scores and episodes of urgency significantly decreased in the treatment group. Responders had significant reductions in IC-SIPI scores (problem index, p = 0.006; symptom index, p = 0.004). In addition, responders on the GRA had significant (p = 0.039) improvements in mean pain scores from 5.50 to 2.57 at the end of the study in contrast to the nonresponders, whose pain levels remained the same (4.89 to 4.39). CONCLUSIONS: This is the first study providing preliminary data supporting the use of guided imagery as a potential therapy for IC. Guided imagery may be a useful tool to offer women with IC for pain and IC symptom management. It is an intervention without negative side-effects, is readily available, and shows a trend toward improvement of IC symptoms.
Dental Procedures
"Comparison of conventional therapies for dentin hypersensitivity versus medical hypnosis."
Eitner, S., C. Bittner, et al. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 457-75.
This study compared the efficacy of conventional treatments for dentin hypersensitivity (DHS) and hypnotherapy. During a 1-month period at an urban practice in a service area of approximately 22,000 inhabitants, all patients were examined. A total of 102 individuals were included in the evaluation. Values of 186 teeth were analyzed. The comparison of the different treatment methods (desensitizer, fluoridation, and hypnotherapy) did not show significant differences in success rates. However, a noticeable difference was observed in terms of onset and duration of effect. For both desensitizer and hypnotherapy treatments, onset of effect was very rapid. Compared to the other methods studied, hypnotherapy effects had the longest duration. In conclusion, hypnotherapy was as effective as other methods in the treatment of DHS.
"Psychological treatment of fearful and phobic special needs patients."
Peltier, B. (2009). Special Care in Dentistry 29(1): 51-7.
Dental fears and phobias trouble patients with and without special needs, and they are a problem for dentists, as well. This article reviews current research and literature related to methods used to alleviate dental fear and concludes that while some important psychological methods are available, much work is left to be done in this area. It is clear that there is an important role for psychological and behavioral input to the dentist-patient interaction. While dental phobia represents a class of special needs itself, patients with other important disabilities (e.g., physical or cognitive impairments) are sometimes comorbidly phobic, a condition often missed or misdiagnosed by treating practitioners. Office-based techniques that focus on relaxation, breathing, imagery, hypnosis, and effective use of operatory language are described. The methods advocated here can be used with patients having mild or moderate cognitive impairments. Readings are recommended for the dentist or auxiliary practitioner interested in learning these techniques.
"Conscious hypnosis as a method for patient motivation in cervical headgear wear--a pilot study."
Trakyali, G., K. Sayinsu, et al. (2008). European Journal of Orthodontics 30(2): 147-52.
The aim of the present study was to assess the efficiency of conscious hypnosis on patient cooperation. The subjects were 30 patients (14 females and 16 males) with a skeletal Class II division 1 malocclusion, divided into two equal groups, a control and a study group. The mean age was 10.78 +/- 1.06 years for the hypnosis, and 10.07 +/- 1.09 years for the control group. Both groups were treated with cervical headgear containing a timer module. The patients were also asked to record their actual wear time on timetables. The hypnosis group patients were motivated with conscious hypnosis while the control group were given verbal motivation by their orthodontist. The timer modules were read at every visit and compared with the timetables. Analysis of variance was used to determine the differences in measurements at each time point. For comparison of the groups, an independent t-test was used. A statistically significant decrease (P < 0.05) in headgear wear was observed in the control group from the first to the sixth month; however, the difference in the hypnosis group was not significant. This result indicates that conscious hypnosis is an effective method for improving orthodontic patient cooperation. There was a low correlation between actual headgear wear indicated by the patient and that recorded by the timing modules, which showed that, timetables are not consistent tools for measuring patient cooperation.
"Management of the anxious patient: what treatments are available?"
Mellor, A. (2007). Dental Update 34(2): 108-10, 113-4.
Fear of the dentist is a common phenomenon. There are many ways of dealing with anxious patients and this review aims to present the most common methods available to general dental practitioners. Clinical Relevance: An ability to deal with anxious patients successfully is undoubtedly a practice builder. Anxious patients can be stressful to manage but they often become the most vocal advocates of dentists that they trust.
"Hypnosis in dentistry."
Roberts, K. (2006). Dental Update 33(5): 312-4.
In this article, the nature of hypnosis will be discussed, together with its therapeutic/facilitator role in the control of the potential problems that occur in everyday dental practice. It is the vital relationship between a patient and therapist which produces the desired results of hypnotherapy. CLINICAL RELEVANCE: A holistic approach, in patient care, emphasizes the treatment of an individual who has a dental problem.
"Potential adjunctive applications of hypnosis in the management of periodontal diseases."
Wood, G. J. and H. H. Zadeh (1999). American Journal of Clinical Hypnosis 41(3): 212-25.
Many uses of hypnosis in dentistry have been described in the literature including anesthesia, analgesia, anxiety management, treatment for bruxism, to control gagging, and the alteration of salivary flow and bleeding control during treatment. However, very few references have been made specifically regarding the use of hypnosis with patients who have periodontal disease, a wide spread chronic inflammatory disease affecting the oral cavity of about 80% of the population. The purpose of this paper is to describe potential adjunctive applications of hypnosis in the treatment of patients with periodontal diseases. The supporting literature from two broad areas for potential application, health behaviors and psychoneuroimmunology is discussed, followed by proposed hypnotic strategies and suggestions for use with patients with periodontal diseases.
"Etiology and treatment of dental anxiety and phobia."
Rodolfa, E. R., W. Kraft, et al. (1990). American Journal of Clinical Hypnosis 33(1): 22-8.
Dental anxiety and phobia afflict millions of people. Dental patients who are anxious anticipate pain and feel vulnerable and out of control. Hypnotherapy to alleviate dental anxiety and phobias has received clinical and empirical support. Our purpose in this paper is to provide a body of objective data from American Society of Clinical Hypnosis members regarding incidence rates and the relative importance of various etiological and conceptual issues in the development and maintenance of dental anxiety and treatment interventions. From these data, we constructed a model of etiology, maintenance, and treatment of dental anxiety.
"Hypnosis in the treatment of dental fear and phobia."
Forgione, A. G. (1988). Dental Clinics of North America 32(4): 745-61.
The term hypnosis is currently used to define an area of research and treatment that employs suggestion. Within this area, suggestion refers to the induction of expectancies by implicit or explicit means, usually involving concentration and the expectancy that the suggested results are possible. This use of suggestion differs from the common use of the term suggestion, which is a logical offering for a change in behavior or thought. The long history of hypnosis is testimony to its effectiveness, although there has been controversy as to why it works. Patient selection is important. Further, fear must be distinguished from phobia. Combined with other treatment techniques, such as systematic desensitization, it is a powerful behavior modification method. To prevent accidental delivery of suggestions that may be counterproductive to treatment, the study of hypnosis is important even to those health care professionals who have no intention of employing it in their practice.
Depression
"A meta-analysis of hypnosis in the treatment of depressive symptoms: a brief communication."
Shih, M., Y. H. Yang, et al. (2009). International Journal of Clinical and Experimental Hypnosis 57(4): 431-42.
The efficacy of hypnosis in the treatment of depressive symptoms was subjected to a meta-analysis. Studies were identified using Google Scholar and 6 electronic databases: PubMed, Cochrane Library, PsiTri, PsychLit, Embase, and the Cochrane Depression, Anxiety and Neurosis Review Group (CCDAN). The keywords used were (a) hypnosis, (b) hypnotherapy, (c) mood disorder, (d) depression, and (e) dysthymia. Six studies qualified and were analyzed using the Comprehensive Meta-Analysis software package. The combined effect size of hypnosis for depressive symptoms was 0.57. Hypnosis appeared to significantly improve symptoms of depression (p < .001). Hypnosis appears to be a viable nonpharmacologic intervention for depression. Suggestions for future research are discussed.
"The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders."
Apostolo, J. L. and K. Kolcaba (2009). Archives of Psychiatric Nursing 23(6): 403-11.
This article describes the efficacy of a guided imagery intervention for decreasing depression, anxiety, and stress and increasing comfort in psychiatric inpatients with depressive disorders. A quasi-experimental design sampled 60 short-term hospitalized depressive patients selected consecutively. The experimental group listened to a guided imagery compact disk once a day for 10 days. The Psychiatric Inpatients Comfort Scale and the Depression, Anxiety, and Stress Scales (DASS-21) were self-administered at two time points: prior to the intervention (T1) and 10 days later (T2). Comfort and DASS-21 were also assessed in the usual care group at T1 and T2. Repeated measures revealed that the treatment group had significantly improved comfort and decreased depression, anxiety, and stress over time.
"A benchmarked feasibility study of a self-hypnosis treatment for depression in primary care."
Dobbin, A., M. Maxwell, et al. (2009). International Journal of Clinical and Experimental Hypnosis 57(3): 293-318.
This investigation assessed the effectiveness of a self-help, self-hypnosis treatment in a primary-care setting in Edinburgh, UK. A partially randomized preference (PRP) study design was used, with benchmarking results to trials of CBT and counseling. Patients seeing their general practitioner for depression were offered randomization to, or their treatment preference of, either self-help (self-hypnosis) or antidepressant medication. Evaluation measures were Becks Depression Inventory, Brief Symptom Inventory, and SF-36. Of the 58 patients recruited, 50 chose self-hypnosis, 4 chose antidepressants, and 4 were randomized. The preference groups demonstrated similar demography, baseline measurements, and outcome effects to benchmarked trials. This feasibility study of a self-help, self-hypnosis program for depression showed promise for its future use in primary care. Benchmarking improved validity and reliability. A PRP study design appeared useful in a primary-care setting, where past studies have experienced problems of recruitment, concordance, and compliance.
"Hypnosis in treating symptoms and risk factors of major depression."
Yapko, M. (2001). American Journal of Clinical Hypnosis 44(2): 97-108.
This article summarizes aspects of effective psychotherapy for major depression and describes how hypnosis can further enhance therapeutic effectiveness. Hypnosis is helpful in reducing common symptoms of major depression such as agitation and rumination and thereby may decrease a client' sense of helplessness and hopelessness. Hypnosis is also effective in facilitating the learning of new skills, a core component of all empirically supported treatments for major depression. The acquisition of such skills has also been shown to not only reduce depression, but also the likelihood of relapses, thus simultaneously addressing issues of risk factors and prevention.
Diabetes
"Hypnosis as an adjunct therapy in the management of diabetes."
Xu, Y. and E. Cardena (2008). International Journal of Clinical and Experimental Hypnosis 56(1): 63-72.
Although diabetes is one of the most serious global health problems, there is no real cure yet for it. The conventional insulin treatment programs aimed at life quality improvement do not take into account the psychological aspects of the disease. Because diabetes has important psychological components, it seems reasonable to consider hypnosis as an adjunct therapy for diabetes. This paper examines the empirical literature on the effectiveness of hypnosis in the management of diabetes, including regulation of blood sugar, increased compliance, and improvement of peripheral blood circulation. Despite some methodological limitations, the literature shows promising results that merit further exploration. Multimodal treatments seem especially promising, with hypnosis as an adjunct to insulin treatments in the management of both Type 1 and Type 2 diabetes for stabilization of blood glucose and decreased peripheral vascular complications.
"A hypnotherapeutic approach to the improvement of compliance in adolescent diabetics."
Ratner, H., L. Gross, et al. (1990). American Journal of Clinical Hypnosis 32(3): 154-9.
Adolescents with insulin-dependent diabetes mellitus (IDDM) have a rate of noncompliance in our clinic of approximately 20% despite all of the usual measures aimed at securing compliance. Seven IDDM patients ranging in age from 11 to 19 years were managed in our clinic with all of our usual modalities, but all remained in long-term poor control during the 6 months immediately prior to the study. To ensure that each patient would serve as his/her own control, no changes were made in his/her management other than the addition of hypnosis. Six of the seven patients were followed for more than 6 months. No changes were made in insulin, diet, or exercise as prescribed. Posttreatment, the average HgbA1C dropped from 13.2% to 9.7%, and the average fasting blood sugar from 426 mg/dl to 149 mg/dl, values which are consistent with good compliance.
Dry Mouth-Xerostomia
"Hypnosis for Postradiation Xerostomia in Head and Neck Cancer Patients: A Pilot Study."
Schiff, E., J. G. Mogilner, et al. (2009). Journal of Pain and Symptom Management.
Xerostomia, the sensation of dry mouth, affects almost all patients who undergo radiotherapy for cancer in the head and neck area. Current therapies for xerostomia are inadequate, and the condition negatively impacts the quality of life. This prospective observational pilot aimed to evaluate whether hypnosis could improve salivation and decrease xerostomia. Twelve patients with xerostomia after radiotherapy for head and neck cancer were assessed for severity of xerostomia symptoms and sialometry. They then received a single hypnosis session with specific suggestions to increase salivation. The session was recorded on a compact disk (CD), and the participants were instructed to listen to it twice a day for one month. Sialometry was repeated immediately after hypnosis. Validated xerostomia questionnaires were completed at one, four, and 12 weeks after hypnosis. A substantial overall improvement was reported by eight patients at 12 weeks (66%). The saliva flow rate increased on sialometry in nine patients following hypnosis (75%). There was no correlation between the magnitude of changes in the measured saliva flow rate and changes in subjective measures (Spearman's correlation coefficient r=0.134). Symptomatic improvement significantly correlated with the number of times the patients listened to the hypnosis CD (r=0.714, P=0.009). No adverse events were reported. The data from this small observational trial suggest that hypnosis may be an effective treatment for xerostomia. Confirmation in a larger randomized and controlled investigation is warranted.
Dyspepsia (Indigestion)
"Functional dyspepsia: At least recommend hypnotherapy."
Sharma, R. L. (2008). British Medical Journal 337: a1972.
"Dyspepsia in childhood and adolescence: insights and treatment considerations."
Perez, M. E. and N. N. Youssef (2007). Curr Gastroenterol Rep 9(6): 447-55.
Functional dyspepsia (FD) is common in children, with as many as 80% of those being evaluated for chronic abdominal pain reporting symptoms of epigastric discomfort, nausea, or fullness. It is known that patients with persistent complaints have increased comorbidities such as depression and anxiety. The interaction with psychopathologic variables has been found to mediate the association between upper abdominal pain and gastric hypersensitivity. These observations suggest that abnormal central nervous system processing of gastric stimuli may be a relevant pathophysiologic mechanism in FD. Despite increased understanding, no specific therapy has emerged; however, recent nonpharmacological-based options such as hypnosis may be effective. Novel approaches, including dietary manipulation and use of nutraceuticals such as ginger and Iberogast (Medical Futures Inc., Ontario, Canada), may also be considered.
"Long-term improvement in functional dyspepsia using hypnotherapy."
Calvert, E. L., L. A. Houghton, et al. (2002). Gastroenterology 123(6): 1778-85.
BACKGROUND & AIMS: We have shown hypnotherapy (HT) to be effective in irritable bowel syndrome, with long-term improvements in symptomatology and quality of life (QOL). This study aimed to assess the efficacy of HT in functional dyspepsia (FD). METHODS: A total of 126 FD patients were randomized to HT, supportive therapy plus placebo medication, or medical treatment for 16 weeks. Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase (short-term) and after 56 weeks (long-term) with 26 HT, 24 supportive therapy, and 29 medical treatment patients completing all phases of the study. QOL was measured as a secondary outcome. RESULTS: Short-term symptom scores improved more in the HT group (median, 59%) than in the supportive (41%; P = 0.01) or medical treatment (33%; P = 0.057) groups. HT also benefited QOL (42%) compared with either supportive therapy (10% [P < 0.001]) or medical treatment (11% [P < 0.001]). Long-term, HT significantly improved symptoms (73%) compared with supportive therapy (34% [P < 0.02]) or medical treatment (43% [P < 0.01]). QOL improved significantly more with HT (44%) than with medical treatment (20% [P < 0.001]). QOL did improve in the supportive therapy (43%) group, but 5 of these patients commenced taking antidepressants during follow-up. A total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the HT group did so (P < 0.001). Those in the HT group visited their general practitioner or gastroenterologist significantly less (median, 1) than did those in the supportive therapy (median, 4) and medical treatment (median, 4) groups during follow-up (P < 0.001). CONCLUSIONS: HT is highly effective in the long-term management of FD. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.
Eating Disorders
"Rapid remission of anorexia nervosa and unconscious communication."
Walsh, B. J. (2010) American Journal of Clinical Hypnosis 52(4): 319-33.
An alternate framework for thinking about anorexia treatment is presented with a treatment approach that results in prompt remission of anorexia symptoms. Prior treatment of eating disorders using hypnosis is reviewed. A case example illustrating the method is followed by a discussion. The process is described for teaching clients how to nullify the anorexia symptom complex when it is reactivated.
"Exploratory study to decrease postprandial anxiety: Just relax!"
Shapiro, J. R., E. M. Pisetsky, et al. (2008). International Journal of Eating Disorders 41(8): 728-33.
OBJECTIVE: Critical first steps in the treatment of anorexia nervosa (AN) include re-nutrition and weight restoration, both highly anxiety provoking for patients. We explored the impact of progressive muscle relaxation (PMR), guided imagery (GI), self-directed relaxation (SR), and control (C) on reducing postprandial anxiety in 64 females with AN. METHOD: Participants began the study upon hospital admission. They received relaxation training after lunch for 15 days. Pre- and post-session anxiety and treatment acceptability ratings were made daily. RESULTS: Although all conditions improved relaxation and decreased anxiety, feelings of fullness, and thoughts about weight, the three active conditions significantly reduced anxiety and increased relaxation more than C (p < .0001). Participants significantly enjoyed the three active treatments, were more likely to recommend them to a friend, and were more likely to use either PMR or GI again versus C (p < .0001). CONCLUSION: Relaxation may be a valuable component for reducing postprandial anxiety in AN.
"Efficacy of hypnotherapy in the treatment of eating disorders."
Barabasz, M. (2007). International Journal of Clinical and Experimental Hypnosis 55(3): 318-35.
Research on the efficacy of hypnosis in the treatment of eating disorders has produced mixed findings. This is due in part to the interplay between the characteristics of people with eating disorders and the phenomena of hypnosis. In addition, several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of the hypnotic intervention(s) to facilitate replication and clinical implementation. Therefore, this paper only reviews literature with replicable methodological descriptions. It focuses on the three primary disorders of interest to clinicians: bulimia nervosa, anorexia nervosa, and obesity. The implications for evaluating treatment efficacy are discussed.
"Hypnotizability, eating behaviors, attitudes, and concerns: a literature survey."
Hutchinson-Phillips, S., K. Gow, et al. (2007). International Journal of Clinical and Experimental Hypnosis 55(1): 84-113.
The literature suggests that aspects of hypnotizability may be involved in the etiology and maintenance of self-defeating eating. However, interpretation of the published research findings has been complicated by the use of instruments that appear to have measured different or, at best, only related facets of the underlying constructs. This article reports relationships between weight, shape, dietary concerns, hypnotizability, dissociative capacity, and fantasy proneness. Implications for a key role for hypnosis in the treatment of eating behaviors, attitudes, and concerns are discussed.
"The use of hypnosis with eating disorders."
Torem, M. S. (1992). Psychiatric Medicine 10(4): 105-18.
This paper reviews the literature on the use of hypnosis in the assessment and treatment of eating disorders. It proposes that patients with eating disorders ought to be investigated as to the underlying dynamics behind the eating disorders symptoms. Following a thorough assessment, a number of hypnotherapeutic techniques are explained and discussed, such as: general relaxation and calmness, guided imagery, teaching self-hypnosis, ego-strengthening, direct and indirect suggestions for healing and recovery, cognitive restructuring and reframing, symbolic guided imagery, age progression ("back from the future" technique), metaphorical prescriptions, age regression and abreactions, and ego state therapy. Verbatim examples of these techniques are given as illustrations of how to use them.
"Hypnotic alteration of body image in the eating disordered."
Walsh, B. J. (2008). American Journal of Clinical Hypnosis 50(4): 301-10.
A driving force in an eating disorder like anorexia nervosa has been a distorted body image. The psychobiological dynamics of eating disorders have demonstrated significant hypnotic phenomena such as forms of dissociation, hallucination, time distortion and catalepsy, and therefore, pose hypnosis as a good fit for particular parts of treatment. Presented here are four hypnotic approaches designed to inspire the establishment of a reality based body image in the eating disordered individual. Conditional prerequisites for application of these interventions are described and case examples illustrate each approach. A discussion on some of the rationale for formulating these strategies is offered.
Fertility
"Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization-embryo transfer: a case-control study."
Levitas, E., A. Parmet, et al. (2006). Fertility and Sterility 85(5): 1404-8.
OBJECTIVE: To investigate whether hypnosis during ET contributes to successful IVF/ET outcome. DESIGN: Case-control clinical study. SETTING: Academic Fertility and IVF Unit, Soroka Medical Center, Beer-Sheva, Israel. PATIENT(S): Infertile couples undergoing IVF. INTERVENTION(S): Ninety-eight IVF/ET cycles with hypnosis during the ET procedure were matched with 96 regular IVF/ET cycles. MAIN OUTCOME MEASURES: Comparison of clinical pregnancy and implantation rates between the two groups. RESULT(S): We obtained 52 clinical pregnancies out of 98 cycles (53.1%) with an implantation rate of 28% among hypnosis IVF/ET cycles, and 29 out of 96 (30.2%) clinical pregnancies and an implantation rate of 14.4% in the control cycles. Our overall IVF program pregnancy rate for the same period was 32.1%. Logistic regression analysis was performed emphasizing the positive contribution of hypnosis to the IVF/ET conception rates. CONCLUSION(S): This study suggests that the use of hypnosis during ET may significantly improve the IVF/ET cycle outcome in terms of increased implantation and clinical pregnancy rates. Furthermore, it seems that the patients' attitude to the treatment was more favorable.
"Hypnosis in the treatment of functional infertility."
Gravitz, M. A. (1995). American Journal of Clinical Hypnosis 38(1): 22-6.
The literature was reviewed and found to contain sparse information regarding the applicability of clinical hypnosis in the treatment of functional infertility. Two cases were then described in which hypnosis based on imagery and a relaxation strategy was successful in facilitating pregnancy in both instances. The treatment was considered to have resulted in beneficial modification of attitude, optimism, and mind-body interaction.
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Fibromyalgia
"Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: An fMRI analysis."
Derbyshire, S. W., M. G. Whalley, et al. (2008). Eur J Pain.
The neuropsychological status of pain conditions such as fibromyalgia, commonly categorized as 'psychosomatic' or 'functional' disorders, remains controversial. Activation of brain structures dependent upon subjective alterations of fibromyalgia pain experience could provide an insight into the underlying neuropsychological processes. Suggestion following a hypnotic induction can readily modulate the subjective experience of pain. It is unclear whether suggestion without hypnosis is equally effective. To explore these and related questions, suggestions following a hypnotic induction and the same suggestions without a hypnotic induction were used during functional magnetic resonance imaging to increase and decrease the subjective experience of fibromyalgia pain. Suggestion in both conditions resulted in significant changes in reported pain experience, although patients claimed significantly more control over their pain and reported greater pain reduction when hypnotised. Activation of the midbrain, cerebellum, thalamus, and midcingulate, primary and secondary sensory, inferior parietal, insula and prefrontal cortices correlated with reported changes in pain with hypnotic and non-hypnotic suggestion. These activations were of greater magnitude, however, when suggestions followed a hypnotic induction in the cerebellum, anterior midcingulate cortex, anterior and posterior insula and the inferior parietal cortex. Our results thus provide evidence for the greater efficacy of suggestion following a hypnotic induction. They also indicate direct involvement of a network of areas widely associated with the pain 'neuromatrix' in fibromyalgia pain experience. These findings extend beyond the general proposal of a neural network for pain by providing direct evidence that regions involved in pain experience are actively involved in the generation of fibromyalgia pain.
"Integrative therapy for fibromyalgia: possible strategies for an individualized treatment program."
Morris, C. R., L. Bowen, et al. (2005). Southern Medical Journal 98(2): 177-84.
One of the most complex patient treatment situations encountered by the clinician is the patient who presents with the cluster of signs and symptoms that lead to the diagnosis of fibromyalgia syndrome. While physicians focus primarily on pharmacologic treatment, a number of nonpharmacologic modalities have been shown to benefit patients as well. No one therapy is uniformly effective in every patient; treatment programs consisting of a combination of pharmacologic and nonpharmacologic therapies must be individualized to the patient, and the clinician may have to try several different modalities before reaching an optimal improvement in the patient's symptoms.
"Complementary medicine treatments for fibromyalgia syndrome."
Berman, B. M. and J. P. Swyers (1999). Baillieres Best Pract Res Clin Rheumatol 13(3): 487-92.
Fibromyalgia is a chronic-pain-related syndrome associated with high rates of complementary and alternative medicine (CAM) use. Among the many CAM therapies frequently used by fibromyalgia patients, empirical research data exist to support the use of only three: (1) mind-body, (2) acupuncture, and (3) manipulative therapies for treating fibromyalgia. The strongest data exist for the use of mind-body techniques (e.g. biofeedback, hypnosis, cognitive behavioural therapy), particularly when utilized as part of a multidisciplinary approach to treatment. The weakest data exist for manipulative techniques (e.g. chiropractic and massage). The data supporting the use of acupuncture for fibromyalgia are only moderately strong. Also, for some fibromyalgia patients, acupuncture can exacerbate symptoms, further complicating its application for this condition. Further research is needed not only in these three areas, but also for other treatments being frequently utilized by fibromyalgia patients.
"Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia."
Haanen, H. C., H. T. Hoenderdos, et al. (1991). Journal of Rheumatology 18(1): 72-5.
In a controlled study, 40 patients with refractory fibromyalgia were randomly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks. Compared with the patients in the physical therapy group, the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience, fatigue on awakening, sleep pattern and global assessment at 12 and 24 weeks, but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter. At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist. These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy, but they remained abnormally strong in many cases. We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.
Hair-Pulling
"Hypnosis as a vehicle for choice and self-agency in the treatment of children with Trichotillomania."
Iglesias, A. (2003). American Journal of Clinical Hypnosis 46(2): 129-37.
Three pediatric cases of Trichotillomania were treated with direct hypnotic suggestion with exclusive emphasis on sensitizing and alerting the patients to impending scalp hair pulling behaviors. These children had presented with total lack of awareness of their scalp hair pulling behaviors until they had actually twisted and pulled off clumps of hair. It was also suggested, under hypnosis, that upon learning to recognize impending scalp hair pulling behaviors, the patients would become free to choose to willfully pull their hair or to resist the impulse and not pull. At no point was the explicit suggestion given that they stop pulling their hair. A preliminary condition was agreed to by the parents that redefined the patients' hair as their own property and affirmed their sole responsibility for its care and maintenance. An element of secondary gain was identified in each of these cases. Scalp hair pulling was hypothesized to provide these particular patients with a vehicle with which to oppose their overbearing and over-involved parents. The technique of direct suggestion under hypnosis, aimed at alerting the patients to impending scalp hair pulling behaviors was combined with forming contracts with the parents to relinquish their authority over matters regarding the patients' hair. This combination provided an effective treatment that extinguished the scalp hair pulling in 7 visits or less. These cases received follow-up at intervals up to 6 months and no evidence of relapse was found.
"Acceptability of treatments for trichotillomania. Effects of age and severity."
Elliott, A. J. and W. R. Fuqua (2002). Behavior Modification 26(3): 378-99.
Based on the literature, trichotillomania (TTM, chronic hair pulling) in children and adults appears to be responsive to behavioral interventions such as habit reversal. However, some have questioned the generality and acceptability of such procedures. This study compared the acceptability ratings of four interventions targeting TTM (habit reversal, hypnosis, medication, and punishment). In the study, 233 college students read case vignettes in which the age of the analogue client and the severity of the hair pulling were manipulated. Results showed significant differences between the four treatment conditions, with hypnosis and habit reversal being rated most acceptable. Age of the analogue client and severity of TTM did not significantly influence acceptability ratings.
"The characterization and treatment of trichotillomania."
Christenson, G. A. and S. J. Crow (1996). Journal of Clinical Psychiatry 57 Suppl 8: 42-7; discussion 48-9.
Trichotillomania is an impulse control disorder characterized by chronic self-directed hair pulling. Trichotillomania has additionally been viewed as one of the obsessive-compulsive spectrum disorders. Any body hair may be targeted, and most patients pull from more than one site. In clinical settings the disorder predominantly affects females. Onset is generally in childhood or adolescence, and a chronic course is typical. Depression and anxiety frequently accompany the disorder. An increased incidence of comorbid obsessive-compulsive disorder (OCD) has been noted. Neurobiological investigations have paralleled etiologic studies of OCD and have demonstrated both similarities and differences between these two disorders. Current treatment options include a variety of medications, particularly the serotonin selective reuptake inhibitors, the behavioral technique of habit reversal, and hypnosis.
Headache
"Long-term follow-up of self-hypnosis training for recurrent headaches: what the children say."
Kohen, D. P. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 417-32.
The author sent surveys to 178 consecutive youths previously referred for hypnosis for headaches. The survey sought current status of headaches: treatment, application of self-hypnosis, headache intensity, frequency, duration after self-hypnosis, generalization of self-hypnosis to other problems, and attitudes regarding self-hypnosis and life stresses. Of 134 delivered surveys, 52 were returned complete. Years after treatment, 85% (44/52) reported continued relief with self-hypnosis, 44% (23/52) reported decreased headache frequency, 31% (16/52) noted decreased severity, and 56% (29/52) reported that self-hypnosis reduced headache intensity. Many (26/52) emphasized the value of self-hypnosis to life stresses. In children and adolescents, self-hypnosis is associated with significant improvement of headaches and with an enduring positive effect for many years following training. Results suggest common and spontaneous generalizability of self-hypnosis by young people to modulation of other problems in their lives.
"Relationship of headache-associated stressors and hypnosis therapy outcome in children: a retrospective chart review."
Anbar, R. D. and G. G. Zoughbi (2008). American Journal of Clinical Hypnosis 50(4): 335-41.
This study examined potential psychosocial stressors of 30 children with headaches (mean age, 15 years), and the role of insight generation in the outcome of hypnosis therapy. The mean duration of headache occurrence was 3 years. All of the patients were instructed in how to use hypnosis-induced relaxation and headache-related imagery to improve their symptoms. Thirty-seven percent reported their headaches were associated with fixed stressors, defined as caused by events over which patients had no control, while 63% reported variable stressors, defined as modifiable by the patients' actions. Four patients were lost to follow-up. Overall, 96% (25/26) reported a decrease in headache frequency and/or intensity following use of hypnosis. However, prior to insight generation patients reporting fixed stressors were significantly less likely to improve than those reporting variable stressors (p = 0.018). Thus, insight generation may be more important for achievement of improvement in children whose headaches are associated with fixed stressors.
"Review of the efficacy of clinical hypnosis with headaches and migraines."
Hammond, D. C. (2007). International Journal of Clinical and Experimental Hypnosis 55(2): 207-19.
The 12-member National Institute of Health Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996) reviewed outcome studies on hypnosis with cancer pain and concluded that research evidence was strong and that other evidence suggested hypnosis may be effective with some chronic pain, including tension headaches. This paper provides an updated review of the literature on the effectiveness of hypnosis in the treatment of headaches and migraines, concluding that it meets the clinical psychology research criteria for being a well-established and efficacious treatment and is virtually free of the side effects, risks of adverse reactions, and ongoing expense associated with medication treatments.
"Mind-body therapies for headache."
Sierpina, V., J. Astin, et al. (2007). American Family Physician 76(10): 1518-22.
Headache is one of the most common and enigmatic problems encountered by family physicians. Headache is not a singular entity, and different pathologic mechanisms are involved in distinct types of headache. Most types of headache involve dysfunction of peripheral or central nociceptive mechanisms. Mind-body therapies such as biofeedback, cognitive behavior therapy, hypnosis, meditation, and relaxation training can affect neural substrates and have been shown to be effective treatments for various types of headache. Meta-analyses of randomized controlled trials show that the use of mind-body therapies, alone or in combination, significantly reduces symptoms of migraine, tension, and mixed-type headaches. Side effects generally are minimal and transient.
"Effect of guided imagery on quality of life for patients with chronic tension-type headache."
Mannix, L. K., R. S. Chandurkar, et al. (1999). Headache 39(5): 326-34.
OBJECTIVE: To determine the effect of adjuvant guided imagery on patients with chronic tension-type headache. BACKGROUND: Management of chronic tension-type headache often requires a combination of pharmacological and nonpharmacological therapies. Guided imagery is a relaxation technique based on visualizing pleasant images and body awareness. METHODS: One hundred twenty-nine patients with chronic tension-type headache completed the Headache Disability Inventory and the Medical Outcomes Study Short Form (SF-36) at their initial visit to a specialty headache center and again 1 month after the visit. In addition to individualized headache therapy, patients listened to a guided imagery audiocassette tape daily for the month. One hundred thirty-one control subjects received individualized therapy without guided imagery. RESULTS: Controls and the patients who listened to the guided imagery tape improved in headache frequency, headache severity, patient global assessment, quality of life, and disability caused by headache. More guided imagery patients (21.7%) than controls (7.6%) reported that their headaches were much better (P = .004). The guided imagery patients had significantly more improvement than the controls in three of the SF-36 domains: bodily pain (95% CI; guided imagery patients 11.0, controls 0.2), vitality (95% CI; guided imagery patients 10.9, controls 1.7), and mental health (95% CI; guided imagery patients 7.8, controls 0.4). CONCLUSIONS: Guided imagery is an effective adjunct therapy for the management of chronic tension-type headache.
Hot Flashes
"Hypnosis helps reduce hot flashes in breast cancer survivors."
(2009). Harvard Womens Health Watch 16(6): 3.
"Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors."
Elkins, G., J. Marcus, et al. (2008). Journal of Clinical Oncology 26(31): 5022-6.
PURPOSE: Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. PATIENTS AND METHODS: Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities. RESULTS: Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group. CONCLUSION: Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.
"Mind control of menopause."
Younus, J., I. Simpson, et al. (2003). Womens Health Issues 13(2): 74-8.
The primary objective of this study was to observe the effect of hypnosis on hot flashes (HF) and overall quality of life in symptomatic patients. A secondary objective was to observe the effect of hypnosis on fatigue. Ten healthy volunteers and four breast cancer patients (total 14 patients) with symptoms of HF were treated with four, 1 h/wk sessions of hypnosis. The same physician, with the help of a nurse, conducted every session. All subjects recorded frequency, duration, and severity of HF in a HF diary. The QLQ-C30 and Brief Fatigue Inventory forms were used to assess the impact on quality of life and fatigue, respectively. The statistical evaluations were performed, including analysis of variance and nonparametric procedures. The frequency (p < 0.0001), duration (p < 0.0001), and severity (p < 0.0001) of HF were significantly reduced. The overall quality of life was also improved (p = 0.05). The subjects enjoyed better sleep and had less insomnia (p = 0.012). There was a significant improvement on current fatigue level (p = 0.017), but we did not find a statistically significant reduction in the total fatigue level. We conclude that hypnosis appears to be a feasible and promising intervention for HF, with a potential to improve quality of life and insomnia. Although improvement in current level of fatigue was observed in this pilot study, total fatigue improvement did not reach statistical significance.
Hypertension
"Effectiveness of hypnosis in reducing mild essential hypertension: a one-year follow-up."
Gay, M. C. (2007). International Journal of Clinical and Experimental Hypnosis 55(1): 67-83.
The present study investigates the effectiveness of hypnosis in reducing mild essential hypertension. Thirty participants were randomly assigned to hypnosis (standardized, individual 8-session hypnosis treatment) or to a control group (no treatment). Results show that hypnosis is effective in reducing blood pressure in the short term but also in the middle and long terms. We did not find any relationship between the practice of self-hypnosis and the evolution of blood pressure or between anxiety, personality factors, and therapeutic results. The implications of the results of the psychological treatment of hypertension are discussed.
Hypnosis Mechanisms
"The mysterious persistence of hypnotic analgesia."
Barber, J. (1998). International Journal of Clinical and Experimental Hypnosis 46(1): 28-43.
Hypnotic treatment of pain has a long history and, among hypnotic phenomena, pain relief is a relatively commonplace focus for intervention, yet we lack a conceptual explanation for this treatment. Hilgard's neodissociation theory accounts for the phenomenon of acute hypnotic analgesia, but not of persistent pain relief. Perhaps the enduring effect of hypnotic treatment can be explained at either of two levels: a neurophysiological model or a learning model. This explanation leads to the further question: How does hypnotic treatment of recurring pain achieve enduring relief? Clinical experience suggests a two-component model. First, the clinician communicates specific ideas that strengthen the patient's ability to derive therapeutic support and to develop a sense of openness to the unexplored possibilities for pain relief within the security of nurturing therapeutic relationship. Second, the clinician employs posthypnotic suggestions that capitalize on the patient's particular pain experiences, which simultaneously ameliorate the pain experience, and which, in small, repetitive increments, tend to maintain persistent pain relief over increasing periods of time.
"Evaluation of the efficacy and neural mechanism of a hypnotic analgesia procedure in experimental and clinical dental pain."
Barber, J. and D. Mayer (1977). Pain 4(1): 41-8.
Previous research implicates an endogenous central pain inhibitory mechanism in opiate analgesia, analgesia produced by focal electrical stimulation of the brain, and acupuncture analgesia. This investigation evaluates the possibility that analgesia produced by hypnosis is also mediated by such a mechanism. Results suggest that hypnotic analgesia is unlikely to involve this central pain inhibitory mechanism since hypnotic analgesia is not altered by naloxone hydrochloride, a specific narcotic antagonist. Results further demonstrate that the hypnotic procedure used produces an unusually effective and reliable increase in pain threshold. This finding generalizes to the control of clinical dental pain, and suggests that hypnotic pain control is a more widespread phenomenon in the population than has been thought.
"The neuroscience of observing consciousness & mirror neurons in therapeutic hypnosis."
Rossi, E. L. and K. L. Rossi (2006). American Journal of Clinical Hypnosis 48(4): 263-78.
Neuroscience documents the activity of "mirror neurons" in the human brain as a mechanism whereby we experience empathy and recognize the intentions of others by observing their behavior and automatically matching their brain activity. This neural basis of empathy finds support in research on dysfunctions in the mirror systems of humans with autism and fMRI research on normal subjects designed to assess intentionality, emotions, and complex cognition. Such empathy research now appears to be consistent with the historical and research literature on hypnotic induction, rapport, and many of the classical phenomena of suggestion. A preliminary outline of how mirror neurons may function as a rapport zone mediating between observing consciousness, the gene expression/protein synthesis cycle, and brain plasticity in therapeutic hypnosis and psychosomatic medicine is proposed. Brain plasticity is generalized in the theory, research, and practice of utilizing mirror neurons as an explanatory framework in developing and training new skill sets for facilitating an activity-dependent approach to creative problem solving, mind-body healing, and rehabilitation with therapeutic hypnosis.
"Clinical hypnosis modulates functional magnetic resonance imaging signal intensities and pain perception in a thermal stimulation paradigm."
Schulz-Stubner, S., T. Krings, et al. (2004). Regional Anesthesia and Pain Medicine 29(6): 549-56.
OBJECTIVE: This study was designed to describe regional changes in blood oxygenation level dependent signals in functional magnetic resonance images (fMRI) elicited by thermal pain in hypnotized subjects. These signals approximately identify the neural correlates of the applied stimulation to identify neuroanatomic structures involved in the putative effects of clinical hypnosis on pain perception. METHODS: After determination of the heat pain threshold of 12 healthy volunteers, fMRI scans were performed at 1.5 Tesla by using echoplanar imaging technique during repeated painful heat stimuli. Activation of brain regions in response to thermal pain during hypnosis (using a fixation and command technique of hypnosis) was compared with responses without hypnosis. RESULTS: With hypnosis, less activation in the primary sensory cortex, the middle cingulate gyrus, precuneus, and the visual cortex was found. An increased activation was seen in the anterior basal ganglia and the left anterior cingulate cortex. There was no difference in activation within the right anterior cingulate gyrus in our fMRI studies. No activation was seen within the brainstem and thalamus under either condition. CONCLUSION: Our observations indicate that clinical hypnosis may prevent nociceptive inputs from reaching the higher cortical structures responsible for pain perception. Whether the effects of hypnosis can be explained by increased activation of the left anterior cingulate cortex and the basal ganglia as part of a possible inhibitory pathway on pain perception remains speculative given the limitations of our study design.
"Naloxone fails to reverse hypnotic alleviation of chronic pain."
Spiegel, D. and L. H. Albert (1983). Psychopharmacology 81(2): 140-3.
The hypothesis that the alleviation of chronic pain with hypnosis is mediated by endorphins was tested. Six patients with chronic pain secondary to peripheral nerve irritation were taught to control the pain utilizing self-hypnosis. Each subject was tested at 5-min intervals during four 1-h sessions for the amount of reduction of pain sensation and suffering associated with hypnosis while being given, in a random double-blind crossover fashion, an IV injection of either 10 mg naloxone or a saline placebo through an indwelling catheter. The patients demonstrated significant alleviation of the pain with hypnosis, but this effect was not significantly diminished in the naloxone condition. These findings contradict the hypothesis that endorphins are involved in hypnotic analgesia.
Immunity
"Efficacy of hypnosis in the treatment of human papillomavirus (HPV) in women: rural and urban samples."
Barabasz, A., L. Higley, et al. (2010) International Journal of Clinical and Experimental Hypnosis 58(1): 102-21.
This article investigates the effect of hypnosis on immunity and whether this is the key mechanism in the hypnotic treatment of the genital infection caused by human papillomavirus (HPV). HPV is the most common sexually transmitted disease and can lead to cervical and other cancers. Current medical treatments are aimed at tissue assault (acids, freezing, surgery). Medical wart clearance rates are only 30% to 70% and recurrence is common. Our research contrasted hypnosis-only with medical-only therapies, using both urban hospital and rural community samples. Both hypnosis and medical therapy resulted in a statistically significant (p < .04) reduction in areas and numbers of lesions. Yet, at the 12-week follow-up, complete clearance rates were 5 to 1 in favor of hypnosis.
"A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health."
Gruzelier, J. H. (2002). Stress 5(2): 147-63.
This review considers psychological interventions involving relaxation and guided imagery targeting immune functions. The review provides evidence of immune control accompanied by reports of enhanced mood and well-being. Three recent investigations of the author and his colleagues with self-hypnosis training incorporating imagery of the immune system are outlined. In two studies, hypnosis buffered the effects of stress on immune functions in medical students at exam time, and the comparison of self-hypnosis with and without immune imagery confirmed advantages to targeted imagery for both immune function and mood, and importantly, fewer winter viral infections. The implications for health were investigated in a third study in patients with virulent and chronic herpes simplex virus-2 HSV-2). Six weeks of training almost halved recurrence, improved mood and reduced levels of clinical depression and anxiety. Immune functions were up-regulated, notably functional natural killer cell activity to HSV-1. Individual differences in hypnotic susceptibility and absorption have typically been found to predict efficacy. New replicable evidence is reviewed of the importance of cognitive activation, a personality difference whose neurophysiological underpinning is consistent with left hemispheric preferential influences over the immune system. Now that the validation of psychological interventions includes advantages for health, this field of enquiry, which has been characterised by modest, small scale, largely preliminary studies, warrants a greater investment in research.
"Psychological treatment for recurrent symptoms of colds and flu in children."
Hewson-Bower, B. and P. D. Drummond (2001). Journal of Psychosomatic Research 51(1): 369-77.
The effect of stress management and relaxation with guided imagery on upper respiratory tract infections (URTIs) was investigated in 45 children with a history of 10 or more infections in the past year. To investigate the influence of psychological treatment on mucosal immunity, secretory immunoglobulin A (sIgA) was measured before and during treatment. The number of symptomatic episodes during 13 weeks of monitoring was similar in treatment and waitlist conditions; however, episodes were shorter in stress management and guided imagery conditions than in the waitlist condition. Levels of sIgA increased toward the end of treatment. These findings were confirmed in a replication study. In addition, symptom reduction and improvements in psychological state persisted at 1-year follow-up. The findings suggest that psychological treatment interrupts a chronic illness cycle in children with symptoms of recurrent URTI.
"Hypnosis as a modulator of cellular immune dysregulation during acute stress."
Kiecolt-Glaser, J. K., P. T. Marucha, et al. (2001). Journal of Consulting and Clinical Psychology 69(4): 674-82.
To assess the influence of a hypnotic intervention on cellular immune function during a commonplace stressful event, the authors selected 33 medical and dental students on the basis of hypnotic susceptibility. Initial blood samples were obtained during a lower stress period, and a second sample was drawn 3 days before the first major exam of the term. Half of the participants were randomly assigned to hypnotic-relaxation training in the interval between samples. Participants in the hypnotic group were, on average, protected from the stress-related decrements that were observed in control participants' proliferative responses to 2 mitogens, percentages of CD3+ and CD4+ T-lymphocytes, and interleukin 1 production by peripheral blood leukocytes. More frequent hypnotic-relaxation practice was associated with higher percentages of CD3+ and CD4+ T-lymphocytes. These data provide encouraging evidence that interventions may reduce the immunological dysregulation associated with acute stressors.
"Cellular and humoral immunity, mood and exam stress: the influences of self-hypnosis and personality predictors."
Gruzelier, J., F. Smith, et al. (2001). International Journal of Psychophysiology 42(1): 55-71.
The effects of self-hypnosis training on immune function and mood were examined in medical students at exam time. Hypnosis involved relaxation and imagery directed at improved immune function and increased energy, alertness and concentration. Hypotheses were made about activated and withdrawn personality differences. Eight high and eight low hypnotically susceptible participants were given 10 sessions of hypnosis, one live and nine tape-recorded, and were compared with control subjects (N=12). CD3, CD4, CD8, CD19 and CD56 NK cells and blood cortisol were assayed. Life-style, activated vs. withdrawn temperament, arousal and anxiety questionnaires were administered. Self-hypnosis buffered the decline found in controls in NK (P<0.002) and CD8 cells (P<0.0.07) and CD8/CD4% (P<0.06) (45-35% order of magnitude differences) while there was an increase in cortisol (P<0.05). The change in NK cell counts correlated positively with changes in both CD8 cells and cortisol. Results were independent of changes in life-style. Energy ratings were higher after hypnosis (P<0.01), and increased calmness with hypnosis correlated with an increase in CD4 counts (P<0.01). The activated temperament, notably the cognitive subscale (speaking and thinking quickly), was predictive of exam levels of T and B lymphocytes (P&z.Lt;0.08-P<0.02), and reaching r=0.72 (P<0.001) in the non-intervention control group. The sizeable influences on cell-mediated immunity achieved by a relatively brief, low cost psychological intervention in the face of a compelling, but routine, stress in young, healthy adults have implications for illness prevention and for patients with compromised immunity.
"Psychoneuroimmunology: can psychological interventions modulate immunity?"
Kiecolt-Glaser, J. K. and R. Glaser (1992). Journal of Consulting and Clinical Psychology 60(4): 569-75.
There is ample evidence from human and animal studies demonstrating the downward modulation of immune function concomitant with a variety of stressors. As a consequence, the possible enhancement of immune function by behavioral strategies has generated considerable interest. Researchers have used a number of diverse strategies to modulate immune function, including relaxation, hypnosis, exercise, classical conditioning, self-disclosure, exposure to a phobic stressor to enhance perceived coping self-efficacy, and cognitive-behavioral interventions, and these interventions have generally produced positive changes. Although it is not yet clear to what extent these positive immunological changes translate into any concrete improvements in relevant aspects of health, that is, alterations in the incidence, severity, or duration of infectious or malignant disease, the preliminary evidence is promising.
Impotence
"Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction."
Aydin, S., M. Ercan, et al. (1997). Scandinavian Journal of Urology and Nephrology 31(3): 271-4.
We have examined the effects of acupuncture and hypnotic suggestions, and compared them with placebo in the treatment of male sexual dysfunction with no detectable organic cause. The study comprised 15 men (mean age 36.7 +/- 10.43 years) who received acupuncture treatment, 16 men (mean age 38.4 +/- 10.75 years) who underwent hypnosis (mean age 35.3 +/- 11.52 years) and 29 men (mean age 36.2 +/- 11.38 years) who served as controls. They were interviewed periodically; the patients' reports were verified by interviewing their partners. Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be used as an adjuvant therapy in non-organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.
"The use of hypnosis in the treatment of impotence."
Crasilneck, H. B. (1992). Psychiatric Medicine 10(1): 67-75.
This chapter describes the use of hypnotherapy in the treatment of psychogenic impotency. A listing of etiological factors common to this problem are described. Appropriate case histories are presented.
Insomnia
"Hypnotherapy in the treatment of chronic combat-related PTSD patients suffering from insomnia: a randomized, zolpidem-controlled clinical trial."
Abramowitz, E. G., Y. Barak, et al. (2008). International Journal of Clinical and Experimental Hypnosis 56(3): 270-80.
This study evaluated the benefits of add-on hypnotherapy in patients with chronic PTSD. Thirty-two PTSD patients treated by SSRI antidepressants and supportive psychotherapy were randomized to 2 groups: 15 patients in the first group received Zolpidem 10 mg nightly for 14 nights, and 17 patients in the hypnotherapy group were treated by symptom-oriented hypnotherapy, twice-a-week 1.5-hour sessions for 2 weeks. All patients completed the Stanford Hypnotic Susceptibility Scale, Form C, Beck Depression Inventory, Impact of Event Scale, and Visual Subjective Sleep Quality Questionnaire before and after treatment. There was a significant main effect of the hypnotherapy treatment with PTSD symptoms as measured by the Posttraumatic Disorder Scale. This effect was preserved at follow-up 1 month later. Additional benefits for the hypnotherapy group were decreases in intrusion and avoidance reactions and improvement in all sleep variables assessed.
"Hypnosis for treatment of insomnia in school-age children: a retrospective chart review."
Anbar, R. D. and M. P. Slothower (2006). BMC Pediatr 6: 23.
BACKGROUND: The purposes of this study are to document psychosocial stressors and medical conditions associated with development of insomnia in school-age children and to report use of hypnosis for this condition. METHODS: A retrospective chart review was performed for 84 children and adolescents with insomnia, excluding those with central or obstructive sleep apnea. All patients were offered and accepted instruction in self-hypnosis for treatment of insomnia, and for other symptoms if it was felt that these were amenable to therapy with hypnosis. Seventy-five patients returned for follow-up after the first hypnosis session. Their mean age was 12 years (range, 7-17). When insomnia did not resolve after the first instruction session, patients were offered the opportunity to use hypnosis to gain insight into the cause. RESULTS: Younger children were more likely to report that the insomnia was related to fears. Two or fewer hypnosis sessions were provided to 68% of the patients. Of the 70 patients reporting a delay in sleep onset of more than 30 minutes, 90% reported a reduction in sleep onset time following hypnosis. Of the 21 patients reporting nighttime awakenings more than once a week, 52% reported resolution of the awakenings and 38% reported improvement. Somatic complaints amenable to hypnosis were reported by 41%, including chest pain, dyspnea, functional abdominal pain, habit cough, headaches, and vocal cord dysfunction. Among these patients, 87% reported improvement or resolution of the somatic complaints following hypnosis. CONCLUSION: Use of hypnosis appears to facilitate efficient therapy for insomnia in school-age children.
"Hypnotic relaxation and the reduction of sleep onset insomnia."
Stanton, H. E. (1989). International Journal of Psychosomatics 36(1-4): 64-8.
In the present study, a hypnotic relaxation technique was compared to stimulus control and placebo conditions as a means of reducing sleep onset latency (SOL). Forty-five subjects (Ss) were matched on their baseline SOL as measured through sleep diaries. They were randomly assigned to one of three groups: hypnotic relaxation; stimulus control; and placebo. These groups experienced four weekly sessions of 30-minutes duration with demand effects being controlled through the use of counter-demand instructions. Data generated by the study suggested that the particular hypnotic relaxation treatment used was effective in helping Ss go to sleep more quickly. Neither stimulus control nor placebo groups recorded similar improvement.
Irritable Bowel Syndrome
"Hypnotherapy for irritable bowel syndrome: the response of colonic and noncolonic symptoms."
Whorwell, P. J. (2008). Journal of Psychosomatic Research 64(6): 621-3.
There is now good evidence that hypnotherapy benefits a substantial proportion of patients with irritable bowel syndrome and that improvement is maintained for many years. Most patients seen in secondary care with this condition also suffer from a wide range of noncolonic symptoms such as backache and lethargy, as well as a number of musculoskeletal, urological, and gynaecological problems. These features do not typically respond well to conventional medical treatment approaches, but fortunately, their intensity is often reduced by hypnosis. The mechanisms by which hypnosis mediates its benefit are not entirely clear, but there is evidence that, in addition to its psychological effects, it can modulate gastrointestinal physiology, alter the central processing of noxious stimuli, and even influence immune function.
"Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial."
Vlieger, A. M., C. Menko-Frankenhuis, et al. (2007). Gastroenterology 133(5): 1430-6.
BACKGROUND & AIMS: Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and compared clinical effectiveness of HT with standard medical therapy (SMT) in children with FAP or IBS. METHODS: Fifty-three pediatric patients, age 8-18 years, with FAP (n = 31) or IBS (n = 22), were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions over a 3-month period. Patients in the SMT group received standard medical care and 6 sessions of supportive therapy. Pain intensity, pain frequency, and associated symptoms were scored in weekly standardized abdominal pain diaries at baseline, during therapy, and 6 and 12 months after therapy. RESULTS: Pain scores decreased significantly in both groups: from baseline to 1 year follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0. Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group. Hypnotherapy was highly superior, with a significantly greater reduction in pain scores compared with SMT (P < .001). At 1 year follow-up, successful treatment was accomplished in 85% of the HT group and 25% of the SMT group (P < .001). CONCLUSIONS: Gut-directed HT is highly effective in the treatment of children with longstanding FAP or IBS.
"Standardized hypnosis treatment for irritable bowel syndrome: the North Carolina protocol."
Palsson, O. S. (2006). International Journal of Clinical and Experimental Hypnosis 54(1): 51-64.
The North Carolina protocol is a seven-session hypnosis-treatment approach for irritable bowel syndrome that is unique in that the entire course of treatment is designed for verbatim delivery. The protocol has been tested in two published research studies and found to benefit more than 80% of patients. This article describes the development, content, and testing of the protocol, and how it is used in clinical practice.
"Long term benefits of hypnotherapy for irritable bowel syndrome."
Gonsalkorale, W. M., V. Miller, et al. (2003). Gut 52(11): 1623-9.
BACKGROUND AND AIMS: There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question. PATIENTS AND METHODS: 204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status". RESULTS: 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy. CONCLUSION: This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.
"Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms."
Palsson, O. S., M. J. Turner, et al. (2002). Digestive Diseases and Sciences 47(11): 2605-14.
Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.
Itch (Pruritis)
"A practical review and update on the management of pruritus sine materia."
Tuerk, M. J. and J. Koo (2008). Cutis 82(3): 187-94.
Pruritus can be divided into several categories: pruritoceptive, neurogenic, neuropathic, and psychogenic. Neuropathic itch is caused by lesions of afferent neural pathways. Psychogenic itch is secondary to primary psychiatric disorders. Both of these types of pruritus present with no evidence of primary cutaneous lesions. The presentation of both conditions can be confusing and patients with no primary cutaneous lesions can be prematurely diagnosed as having a psychiatric disorder. Treatment of neuropathic and psychogenic pruritus can be divided into pharmacologic and nonpharmacologic therapies. Medications used include topical capsaicin and anesthetic agents, antiepileptic agents, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and atypical antipsychotic agents. Nonpharmacologic therapies such as psychotherapy and hypnosis have been beneficial. Further studies are needed, as most reports of efficacy are not evidence based.
"The efficacy of hypnosis in the treatment of pruritus in people with HIV/AIDS: a time-series analysis."
Rucklidge, J. J. and D. Saunders (2002). International Journal of Clinical and Experimental Hypnosis 50(2): 149-69.
Pruritus, or generalized itch, is a source of serious discomfort and distress in a significant minority of people living with AIDS. Anecdotal reports suggest hypnosis might be a useful treatment, leading to reductions in distress and improvements in the condition. But empirical examination of the question is notably lacking. This time-series study reports results of a 6-session self-hypnosis treatment (relaxation, deepening, imagery, and home practice) for 3 HIV-positive men suffering from pruritus, related to disease progression and/or HIV medications. Posttreatment, all 3 patients reported significant reductions in daily itch severity and extent of sleep disturbance due to itch. One patient also evidenced significantly less itch distress. Another also experienced significantly less time bothered by itch. For the 2 patients on which 4-month follow-up data were available, treatment benefit across variables was stable or further improved.
"Hypnosis in a case of long-standing idiopathic itch."
Rucklidge, J. J. and D. Saunders (1999). Psychosomatic Medicine 61(3): 355-8.
OBJECTIVE: This article presents the results of a brief hypnosis treatment of a woman with chronic, idiopathic vaginal and anal itch. METHODS: The patient was referred after 3 years of unsuccessful outcomes with standard topical and oral treatments prescribed by her family physician and three dermatologists. Treatment consisted of five sessions of self-hypnosis training in techniques of relaxation, deepening, and imagery, and home practice with an individualized instructional tape. RESULTS: After treatment, the patient reported substantial tissue healing, confirmed by her treating physician, that coincided with significant reductions in her scores of itch intensity, itch-related sleep disruption, and distress from pre- to posttreatment. These improvements continued at 4 months of follow-up, and the patient reported complete resolution of physical symptoms. CONCLUSIONS: The fact that these changes coincided with only minor improvements in general anxiety scores suggests that the resolution of the patient's itch condition was treatment-specific rather than the result of methodological artifact, participant reporting bias, or a general sense of feeling better. These findings suggest that hypnosis is a cost-effective treatment for idiopathic itch conditions, especially those that are unresponsive to standard medical treatments.
Learning
"Teaching college students better learning skills using self-hypnosis."
Wark, D. M. (1996). American Journal of Clinical Hypnosis 38(4): 277-87.
This paper reports the effects of self-hypnosis used by 51 college students enrolled in a 10-week course on efficient learning skills. All students were administered the Creative Imagination Scale. Subsequently, they learned to enter and deepen alert self-hypnosis. They gave themselves personal suggestions and then studied in hypnosis. They reported their depth of hypnosis and satisfaction with each session. Grades were collected the quarter before, during and after the course. Satisfaction and depth data indicated the students were involved all through the course. Statistical testing showed that students who scored highest on the CIS had the lowest initial GPA, improved most during the course, and significantly increased their GPA in the quarter after.
Medical Procedures
"Practical hypnotic interventions during invasive cancer diagnosis and treatment."
Flory, N. and E. Lang (2008). Hematology/Oncology Clinics of North America 22(4): 709-25, ix.
Novel advances in biotechnology and medical imaging techniques have enabled an evolution toward earlier diagnosis and treatment by way of "minimally invasive" surgical techniques performed on the conscious patient without the use of general anesthesia. Although the risks of diagnostic and therapeutic interventions have been reduced with these approaches, patients still face many physical and psychologic challenges. Several randomized controlled trials have shown that hypnotic techniques are effective in reducing pain, anxiety, and other symptoms; in reducing procedure time; and in stabilizing vital signs. The benefits of adjunctive hypnotic treatments come at no additional cost. Patients, health care providers, hospitals, and insurance companies are advised to take advantage of hypnotic techniques.
"Methods of reducing discomfort during colonoscopy."
Leung, F. W. (2008). Digestive Diseases and Sciences 53(6): 1462-7.
In the United States sedation for colonoscopy is usual practice. Unsedated colonoscopy is limited to a small proportion of unescorted patients and those with a personal preference for no sedation. Over 80% of patients who accept the option of as-needed sedation can complete colonoscopy without sedation. Colonoscopy in these unsedated patients is performed with techniques similar to those used in the sedated patients. Uncontrolled observations indicate willingness to repeat colonoscopy amongst these patients was correlated significantly with low discomfort score during the examination. Methods reported to minimize patient discomfort or enhance cecal intubation during sedated or unsedated colonoscopy included use of pediatric colonoscope, variable stiffness colonoscope, gastroscope, and inhalation of nitrous oxide or insufflation of carbon dioxide, hypnosis, music, audio distraction, or simply allowing the patients to participate in administration of the medication. Research focusing on confirming the efficacy of a simple inexpensive nonmedication dependent method for minimizing discomfort will likely improve the outcome of care and more importantly will ensure compliance with future surveillance in patients accepting the unsedated option.
"Hypnosis for acute distress management during medical procedures."
Flory, N., G. M. Salazar, et al. (2007). International Journal of Clinical and Experimental Hypnosis 55(3): 303-17.
The use of hypnosis during medical procedures has a long-standing tradition but has been struggling for acceptance into the mainstream. In recent years, several randomized-controlled trials with sufficient participant numbers have demonstrated the efficacy of hypnosis in the perioperative domain. With the advancements of minimally invasive high-tech procedures during which the patient remains conscious, hypnotic adjuncts have found many applications. This article describes the procedural environment as well as pharmacologic and nonpharmacologic interventions to reduce distress. Current research findings, controversies in the literature, and safety considerations are reviewed. Implications for clinical practice and training as well as directions for future research are discussed. Obstacles and possible reasons for the slow acceptance of nonpharmacologic interventions, mind-body therapies, and patient-centered approaches are addressed.
"Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy."
Lang, E. V., K. S. Berbaum, et al. (2006). Pain 126(1-3): 155-64.
Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical center were prospectively randomized to receive standard care (n=76), structured empathic attention (n=82), or self-hypnotic relaxation (n=78) during their procedures. Patients' self-ratings at 1 min-intervals of pain and anxiety on 0-10 verbal analog scales with 0=no pain/anxiety at all, 10=worst pain/anxiety possible, were compared in an ordinal logistic regression model. Women's anxiety increased significantly in the standard group (logit slope=0.18, p<0.001), did not change in the empathy group (slope=-0.04, p=0.45), and decreased significantly in the hypnosis group (slope=-0.27, p<0.001). Pain increased significantly in all three groups (logit slopes: standard care=0.53, empathy=0.37, hypnosis=0.34; all p<0.001) though less steeply with hypnosis and empathy than standard care (p=0.024 and p=0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46 min/161 dollars for standard care, 43 min/163 dollars for empathy, and 39 min/152 dollars for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.
"Effect of hypnotic sedation during percutaneous transluminal coronary angioplasty on myocardial ischemia and cardiac sympathetic drive."
Baglini, R., M. Sesana, et al. (2004). American Journal of Cardiology 93(8): 1035-8.
Forty-six patients were randomized to receive drug (group 1) or hypnotic sedation (group 2) during percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery. Intracoronary and standard electrocardiograms were continuously registered, and heart rate spectral variability was studied. Normalized units of low- and high-frequency components and the ratio of low to high frequency were measured during balloon inflations. The ST segment shifted at the first balloon inflation from 0.02 +/- 0.01 to 0.09 +/- 0.6 mm in group 1 and from 0.02 +/- 0.08 to 0.1 +/- 0.6 in group 2 mm (p <0.05). In group 1, the low-frequency band and the ratio of low to high frequency increased significantly during the first balloon inflation (from 59 +/- 10 to 75 +/- 10 normalized units and from 2.4 +/- 1.4 to 7.3 +/- 4.7, respectively; p <0.001). The increase of the ratio of low to high frequency was significantly related to ST shift (r = 0.706; p <0.01). In contrast, no significant variation of spectral parameters was found in group 2. The increase in cardiac sympathetic activity associated with balloon inflation and myocardial ischemia during percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery was selectively eliminated by hypnosis but not by drug sedation.
"Clinical management of stressors perceived by patients on mechanical ventilation."
Thomas, L. A. (2003). AACN Clinical Issues 14(1): 73-81.
Psychological and psychosocial stressors perceived by the mechanically ventilated patient include intensive care unit environmental factors, communication factors, stressful symptoms, and the effectiveness of interventions. The studies reviewed in this article showed four stressors commonly identified by mechanically ventilated patients including dyspnea, anxiety, fear, and pain. Few interventional studies to reduce these stressors are available in the literature. Four interventions including hypnosis and relaxation, patient education and information sharing, music therapy, and supportive touch have been investigated in the literature and may be helpful in reducing patient stress. The advanced practice nurse is instrumental in the assessment of patient-perceived stressors while on the ventilator, and in the planning and implementation of appropriate interventions to reduce stressors and facilitate optimal ventilation, weaning, or both.
"Use of hypnosis in controlling lumbar puncture distress in an adult needle-phobic dementia patient."
Simon, E. P. and M. M. Canonico (2001). International Journal of Clinical and Experimental Hypnosis 49(1): 56-67.
Lumbar punctures are often vital to the medical management of patients with suspected organic pathology, yet they are commonly met with such distress that medical risk is significantly increased, and patient rapport is significantly decreased, further compromising medical treatment. Although the use of hypnosis for lumbar punctures is well established in pediatric patients, no literature exists for adult patients. Similarly, there is no extant research regarding hypnosis for dementia patients, likely due to the limiting factors of impaired attention and concentration. With these factors in mind, a method for incorporating hypnosis into a lumbar puncture procedure is described for a needle-phobic adult patient suffering from dementia.
"Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial."
Lang, E. V., E. G. Benotsch, et al. (2000). Lancet 355(9214): 1486-90.
BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. METHODS: 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. FINDINGS: Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
"Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use."
Lang, E. V., J. S. Joyce, et al. (1996). International Journal of Clinical and Experimental Hypnosis 44(2): 106-19.
The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.
"Liver biopsy under hypnosis."
Adams, P. C. and P. G. Stenn (1992). Journal of Clinical Gastroenterology 15(2): 122-4.
Two patients underwent outpatient percutaneous liver biopsy under hypnosis without complications. One patient had severe anxiety about the procedure because of a previous adverse experience with liver biopsy and the other had a history of severe allergy to local anesthesia. Both patients had undergone a session of hypnosis at least once prior to the biopsy. One received no local anesthetic and the other received 1% lidocaine as a local anesthetic. Both patients were completely cooperative during the procedure with the required respiratory maneuvers. Both patients stated that they were aware of the procedure under hypnosis but described no pain and would be most willing to have the procedure done under hypnosis in the future. Hypnosis can be a useful method of preparing carefully selected patients for percutaneous liver biopsy.
Meditation
"Effect of meditation on stress-induced changes in cognitive functions."
Mohan, A., R. Sharma, et al. Journal of Alternative and Complementary Medicine 17(3): 207-12.
OBJECTIVES: The objective of this study was to study the effects of meditation on stress-induced changes in cognitive functions. METHODS: The study was conducted on 32 healthy adult male student volunteers who had never practiced meditation before the study. The study consisted of practicing 20 minutes of guided meditation and administration of psychologic stress to the subjects. The psychologic stress was administered to the subjects by asking them to play a (preselected) stressful computer game. The subjects were asked to meditate either before or after the administration of psychologic stress. For the control group measurements, the subjects were asked to wait quietly for an equivalent period of meditation time. OUTCOME MEASURES: The outcome measures were galvanic skin response (GSR), heart rate (HR), electromyography (EMG), sympathetic reactivity (QTc/QS2 ratio), cortisol, and acute psychologic stress scores. The central nervous system functions were assessed using Wechsler memory scale and visual-choice reaction time (VCRT). These parameters were measured both at the beginning and at the end of the intervention, using a pre-post experimental test design. RESULTS: Computer game stress was associated with a significant increase in physiologic (GSR, EMG, HR, QTc/QS2) and psychologic (acute stress questionnaire scores) markers of stress. Meditation was associated with relaxation (significant decrease in GSR, EMG, QTc/QS2, and acute stress questionnaire scores). Meditation, if practiced before the stressful event, reduced the adverse effects of stress. Memory quotient significantly increased, whereas cortisol level decreased after both stress and meditation. VCRT showed no significant change. CONCLUSIONS: Practice of meditation produced a relaxation response even in the young adult subjects who had never practiced meditation before. The practice of meditation reduced the physiologic stress responses without taking away the beneficial effect of stress, namely, improved memory scores.
"Feasibility and effectiveness of a brief meditation-based stress management intervention for patients diagnosed with or at risk for coronary heart disease: a pilot study."
Olivo, E. L., B. Dodson-Lavelle, et al. (2009). Psychol Health Med 14(5): 513-23.
Extensive research has led to the development of a psychobiological model of cardiovascular disease. This model suggests that psychological factors such as depression, anxiety, hostility, and stress may affect the development and progression of coronary heart disease (CHD). Recent studies have also demonstrated that meditation-based stress reduction programs are useful interventions for patients with various medical and psychological symptoms. The objective of this pilot study was to gather preliminary information regarding the feasibility of implementing a brief meditation-based stress management (MBSM) program for patients with CHD, and those at high risk for CHD, at a major metropolitan hospital that serves a predominately non-local patient population. The secondary aim of this study was to investigate the possibility that such an intervention might reduce depression, as well as perceived stress, anxiety, and hostility, while improving general health scores. The overall feasibility results indicate that this MBSM intervention was highly feasible with regard to both recruitment and retention of participants. In fact, 40% of patients requested further training. In addition, after completion of the 4-week intervention, participants reported significant reductions in depression and perceived stress. In conclusion, the present study demonstrated that the brief meditation-based stress management program was well-received by patients and can successfully be used as a supportive program for patients at risk or diagnosed with CHD.
"Cancer, cognitive impairment, and meditation."
Biegler, K. A., M. A. Chaoul, et al. (2009). Acta Oncologica 48(1): 18-26.
BACKGROUND AND OBJECTIVES: Cancer-related cognitive impairment has been acknowledged as a substantial limiting factor in quality of life among cancer patients and survivors. In addition to deficits on behavioral measures, abnormalities in neurologic structure and function have been reported. In this paper, we review findings from the literature on cognitive impairment and cancer, potential interventions, meditation and cognitive function, and meditation and cancer. In addition, we offer our hypotheses on how meditation practice may help to alleviate objective and subjective cognitive function, as well as the advantages of incorporating a meditation program into the treatment of cancer patients and survivors for cancer-related cognitive deficits. FINDINGS: Various factors have been hypothesized to play a role in cancer-related cognitive impairment including chemotherapy, reduced hormone levels, proinflammatory immune response, fatigue, and distress. Pharmacotherapies such as methylphenidate or modafinil have been suggested to alleviate cognitive deficits. While initial reports suggest they are effective, some pharmacotherapies have side effects and may not relieve other symptoms associated with multimodal cancer treatment including sleep disturbance, nausea and pain. Several recent studies investigating the effects of meditation programs have reported behavioral and corresponding neurophysiological modulations that may be particularly effective in alleviating cancer-related cognitive impairment. Such programs also have been shown to reduce stress, fatigue, nausea and pain, and improve mood and sleep quality. CONCLUSIONS: With the increasing success of cancer treatment and the ability to return to previous family, social, and work activities, symptom management and quality of life are an essential part of survivorship. We propose that meditation may help to improve cancer-related cognitive dysfunction, alleviate other cancer-related sequelae, and should be fully investigated as an adjuvant to cancer treatment.
"Potential role of mind-body therapies in cancer survivorship."
Monti, D. A., M. Sufian, et al. (2008). Cancer 112(11 Suppl): 2607-16.
The use of complementary and alternative medicine (CAM) by cancer survivors is high, particularly among those with psychosocial distress, poor quality of life, culturally based health beliefs, and those who experience health disparities in the mainstream healthcare system. As the number of cancer survivors continues to increase, so does the diversity of the survivorship population, making it increasingly important to understand and address the CAM culture in different survivor groups. Given the known communication barriers between cancer patients and their physicians regarding CAM, it would be useful for oncology providers to have a platform from which to discuss CAM-related issues. It is proposed that mind-body therapies with some basis in evidence could provide such a platform and also serve as a possible means of connecting cancer survivors to psychosocial supportive services. This article reviews a few mind-body therapies that may have particular relevance to cancer survivors, such as hypnosis and meditation practices. A theoretical foundation by which such therapies provide benefit is presented, with particular emphasis on self-regulation.
"Migraines and meditation: does spirituality matter?"
Wachholtz, A. B. and K. I. Pargament (2008). Journal of Behavioral Medicine 31(4): 351-66.
Migraine headaches are associated with symptoms of depression and anxiety (Waldie and Poulton Journal of Neurology, Neurosurgery, and Psychiatry 72: 86-92, 2002) and feelings of low self-efficacy (French et al. Headache, 40: 647-656, 2000). Previous research suggests that spiritual meditation may ameliorate some of the negative traits associated with migraine headaches (Wachholtz and Pargament Journal of behavioral Medicine, 30: 311-318, 2005). This study examined two primary questions: (1) Is spiritual meditation more effective in enhancing pain tolerance and reducing migraine headache related symptoms than secular meditation and relaxation? and, (2) Does spiritual meditation create better mental, physical, and spiritual health outcomes than secular meditation and relaxation techniques? Eighty-three meditation naive, frequent migraineurs were taught Spiritual Meditation, Internally Focused Secular Meditation, Externally Focused Secular Meditation, or Muscle Relaxation which participants practiced for 20 min a day for one month. Pre-post tests measured pain tolerance (with a cold pressor task), headache frequency, and mental and spiritual health variables. Compared to the other three groups, those who practiced spiritual meditation had greater decreases in the frequency of migraine headaches, anxiety, and negative affect, as well as greater increases in pain tolerance, headache-related self-efficacy, daily spiritual experiences, and existential well being.
"Hypnosis and meditation: similar experiential changes and shared brain mechanisms."
Grant, J. A. and P. Rainville (2005). Medical Hypotheses 65(3): 625-6.
"Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes."
Wachholtz, A. B. and K. I. Pargament (2005). Journal of Behavioral Medicine 28(4): 369-84.
This study compared secular and spiritual forms of meditation to assess the benefits of a spiritual intervention. Participants were taught a meditation or relaxation technique to practice for 20 min a day for two weeks. After two weeks, participants returned to the lab, practiced their technique for 20 min, and placed their hand in a cold-water bath of 2 degrees C for as long as they could endure it. The length of time that individuals kept their hand in the water bath was measured. Pain, anxiety, mood, and the spiritual health were assessed following the two-week intervention. Significant interactions occurred (time x group); the Spiritual Meditation group had greater decreases in anxiety and more positive mood, spiritual health, and spiritual experiences than the other two groups. They also tolerated pain almost twice as long as the other two groups.
"Alterations in brain and immune function produced by mindfulness meditation."
Davidson, R. J., J. Kabat-Zinn, et al. (2003). Psychosomatic Medicine 65(4): 564-70.
OBJECTIVE: The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees. METHODS: We measured brain electrical activity before and immediately after, and then 4 months after an 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group. A wait-list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8-week period, subjects in both groups were vaccinated with influenza vaccine. RESULTS: We report for the first time significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Finally, the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine. CONCLUSIONS: These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.
"The science of meditation and the state of hypnosis."
Holroyd, J. (2003). American Journal of Clinical Hypnosis 46(2): 109-28.
Two aspects of Buddhist meditation--concentration and mindfulness--are discussed in relationship to hypnosis. Mindfulness training facilitates the investigation of subjective responses to hypnosis. Concentration practice leads to altered states similar to those in hypnosis, both phenomenologically and neurologically. The similarities and differences between hypnosis and meditation are used to shed light on perennial questions: (1) Does hypnosis involve an altered state of consciousness? (2) Does a hypnotic induction increase suggestibility? I conclude that a model for hypnosis should include altered states as well as capacity for imaginative involvement and expectations.
"Eastern meditative techniques and hypnosis: a new synthesis."
Otani, A. (2003). American Journal of Clinical Hypnosis 46(2): 97-108.
In this article major ancient Buddhist meditation techniques, samatha, vipassana, Zen, and ton-len, will be described in reference to contemporary clinical hypnosis. In so doing, the Eastern healing framework out of which these techniques emerged is examined in comparison with and in contrast to its Western counterpart. A growing body of empirical literature shows that meditation and hypnosis have many resemblances despite the distinct differences in underlying philosophy and technical methodologies. Although not all meditation techniques "fit" the Western culture, each has much to offer to clinicians who are familiar with hypnosis.
"Effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in HIV positive men."
Taylor, D. N. (1995). Psychological Reports 76(2): 451-7.
This study evaluated the effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in a group of HIV-positive men who were asymptomatic except for T-cell counts below 400. The program consisted of 20 biweekly sessions of progressive muscle relaxation and electromyograph biofeedback-assisted relaxation training, meditation, and hypnosis. Ten subjects were randomly assigned to either a treatment group of a no-treatment control group, and the 2 groups were compared on pre- to posttreatment changes in the dependent measures. Analysis showed that, compared with the no-treatment group, the treatment group showed significant improvement on all the dependent measures, which was maintained at a 1-mo. follow-up. Since stress is known to compromise the immune system, these results suggest that stress management to reduce arousal of the nervous system and anxiety would be an appropriate component of a treatment regimen for HIV infection.
Migraine
"Mind-body therapies for headache."
Sierpina, V., J. Astin, et al. (2007). American Family Physician 76(10): 1518-22.
Headache is one of the most common and enigmatic problems encountered by family physicians. Headache is not a singular entity, and different pathologic mechanisms are involved in distinct types of headache. Most types of headache involve dysfunction of peripheral or central nociceptive mechanisms. Mind-body therapies such as biofeedback, cognitive behavior therapy, hypnosis, meditation, and relaxation training can affect neural substrates and have been shown to be effective treatments for various types of headache. Meta-analyses of randomized controlled trials show that the use of mind-body therapies, alone or in combination, significantly reduces symptoms of migraine, tension, and mixed-type headaches. Side effects generally are minimal and transient.
"Review of the efficacy of clinical hypnosis with headaches and migraines."
Hammond, D. C. (2007). International Journal of Clinical and Experimental Hypnosis 55(2): 207-19.
The 12-member National Institute of Health Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996) reviewed outcome studies on hypnosis with cancer pain and concluded that research evidence was strong and that other evidence suggested hypnosis may be effective with some chronic pain, including tension headaches. This paper provides an updated review of the literature on the effectiveness of hypnosis in the treatment of headaches and migraines, concluding that it meets the clinical psychology research criteria for being a well-established and efficacious treatment and is virtually free of the side effects, risks of adverse reactions, and ongoing expense associated with medication treatments.
"The efficacy of hypnotherapy in the treatment of migraine."
Matthews, M. and S. Flatt (1999). Nursing Standard 14(7): 33-6.
The pain of migraine is notoriously difficult to manage. This article describes hypnotherapy as an effective intervention in a group of self-diagnosed migraine sufferers.
Morning Sickness
"Medical hypnosis for hyperemesis gravidarum."
Simon, E. P. and J. Schwartz (1999). Birth 26(4): 248-54.
Hyperemesis gravidarum in pregnancy is a serious condition that is often resistant to conservative treatments. Medical hypnosis is a well-documented alternative treatment. This article reviews the empirical studies of medical hypnosis for treating hyperemesis gravidarum, explains basic concepts, and details the treatment mechanisms. The importance of a thorough differential diagnosis and appropriate referrals is stressed. The article presents three case studies to illustrate the efficacy of this treatment approach. It is suggested that medical hypnosis should be considered as an adjunctive treatment option for those women with hyperemesis gravidarum. It is also stressed that medical hypnosis can be used to treat common morning sickness that is experienced by up to 80 percent of pregnant women. Its use could allow a more comfortable pregnancy and healthier fetal development, and could prevent cases that might otherwise proceed to full-blown hyperemesis gravidarum.
Multiple Sclerosis
"Effects of self-hypnosis training and cognitive restructuring on daily pain intensity and catastrophizing in individuals with multiple sclerosis and chronic pain."
Jensen, M. P., D. M. Ehde, et al. International Journal of Clinical and Experimental Hypnosis 59(1): 45-63.
Fifteen adults with multiple sclerosis were given 16 sessions of treatment for chronic pain that included 4 sessions each of 4 different treatment modules: (a) an education control intervention; (b) self-hypnosis training (HYP); (c) cognitive restructuring (CR); and (d) a combined hypnosis-cognitive restructuring intervention (CR-HYP). The findings supported the greater beneficial effects of HYP, relative to CR, on average pain intensity. The CR-HYP treatment appeared to have beneficial effects greater than the effects of CR and HYP alone. Future research examining the efficacy of an intervention that combines CR and HYP is warranted.
"A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain."
Jensen, M. P., J. Barber, et al. (2009). International Journal of Clinical and Experimental Hypnosis 57(2): 198-221.
Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS.
"Hypnosis as adjunctive therapy for multiple sclerosis: a progress report."
Sutcher, H. (1997). American Journal of Clinical Hypnosis 39(4): 283-90.
Several reports suggest that hypnosis can facilitate healing in various physical pathologies. This is a preliminary report, supported by three cases. They demonstrate that suggestion by a hypnotist of symptom improvement can be used beneficially in the treatment of the physical impairment caused by Multiple Sclerosis. The first patient, severely affected, had Multiple Sclerosis for over 35 years. He had been wheelchair bound for many years. The second, recently diagnosed and minimally affected, had difficulty with balance and walked with the aid of a cane. The third, also minimally affected, reported pain in her right leg. All three showed improvement either immediately or within several weeks when the hypnotist suggested improvement or displacement of symptoms with the patients in hypnosis. No attempt was made to deal with psychodynamics or to suggest alternative symptoms to the patients. Symptom substitution did not occur. When symptoms improved, even slightly, these patients exhibited increased hopefulness.
"Hypnosis for pain and neuromuscular rehabilitation with multiple sclerosis: case summary, literature review, and analysis of outcomes."
Dane, J. R. (1996). International Journal of Clinical and Experimental Hypnosis 44(3): 208-31.
Videotaped treatment sessions in conjunction with 1-month, 1-year, and 8-year follow-up allow a unique level of analysis in a case study of hypnotic treatment for pain and neuromuscular rehabilitation with multiple sclerosis (MS). Preparatory psychotherapy was necessary to reduce the patient's massive denial before she could actively participate in hypnosis. Subsequent hypnotic imagery and posthypnotic suggestion were accompanied by significantly improved control of pain, sitting balance, and diplopia (double vision), and a return to ambulatory capacity within 2 weeks of beginning treatment with hypnosis. Evidence regarding efficacy of hypnotic strategies included (a) direct temporal correlations between varying levels of pain relief and ambulatory capacity and the use versus nonuse of hypnotic strategies, (b) the absence of pharmacological explanations, and (c) the ongoing presence of other MS-related symptoms that remained unaltered. In conjunction with existing literature on hypnosis and neuromuscular conditions, results of this case study strongly suggest the need for more detailed and more physiologically based studies of the phenomena involved.
"The effects of imagery on attitudes and moods in multiple sclerosis patients."
Maguire, B. L. (1996). Alternative Therapies in Health and Medicine 2(5): 75-9.
OBJECTIVE: To determine the efficacy of imagery for influencing attitudes and moods in multiple sclerosis patients. DESIGN: Experimental pretest-posttest, control-group. SETTING: Outpatient group in Central Pennsylvania. PATIENTS: 33 patients with mean ages of 43.93 years in the imagery group and 46.33 years in the control group. All subjects previously were identified with multiple sclerosis. INTERVENTION: Control group subjects followed their typical medical protocol and completed pretest and posttest measures. Imagery group subjects completed pretest and posttest measures and participated in a six-session group process that included brief exposure to relaxation training and ongoing work with biologically oriented imagery. Relaxation training and imagery were practiced on a daily basis. Imagery group subjects also produced imagery drawings, which were assessed after the third and sixth sessions. MAIN OUTCOME MEASURES: Profile of Mood States, State-Trait Anxiety Inventory, Health Attribution Test, Imagery Assessment Tool, and Multiple Sclerosis Symptom Checklist. MAIN RESULTS: Imagery group subjects demonstrated significant reductions in state anxiety and significant alteration in their illness imagery because of feedback obtained during the study. CONCLUSION: Use of the relaxation/imagery protocol led to clinically significant reductions in state anxiety. Imagery may be assessed through drawings that allow for positive modification of the imagery material to increase its utility and power.
Nausea and Vomiting
"Preoperative hypnotherapy in the management of a child with anticipatory nausea and vomiting."
Mackenzie, A. and G. P. Frawley (2007). Anaesthesia and Intensive Care 35(5): 784-7.
A six-year-old boy with oesophageal strictures secondary to neonatal repair of oesophageal atresia and requiring six to eight weekly oesophageal dilatations by bouginage developed anticipatory nausea and vomiting. This was effectively managed by a course of preoperative hypnotherapy over four sessions. Resolution of anticipatory nausea and vomiting occurred along with cessation of postoperative nausea and vomiting. This case supports early intervention with preoperative hypnotherapy in children with anticipatory nausea and vomiting that has not responded to other measures.
"Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence."
Richardson, J., J. E. Smith, et al. (2007). European Journal of Cancer Care (English Language Edition) 16(5): 402-12.
To systematically review the research evidence on the effectiveness of hypnosis for cancer chemotherapy-induced nausea and vomiting (CINV). A comprehensive search of major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine databases were searched and efforts were made to identify unpublished and ongoing research. Citations were included from the databases' inception to March 2005. Randomized controlled trials (RCTs) were appraised and meta-analysis undertaken. Clinical commentaries were obtained. Six RCTs evaluating the effectiveness of hypnosis in CINV were found. In five of these studies the participants were children. Studies report positive results including statistically significant reductions in anticipatory and CINV. Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioural therapy. Meta-analysis has demonstrated that hypnosis could be a clinically valuable intervention for anticipatory and CINV in children with cancer. Further research into the effectiveness, acceptance and feasibility of hypnosis in CINV, particularly in adults, is suggested. Future studies should assess suggestibility and provide full details of the hypnotic intervention.
"Behavioral interventions in treating anticipatory nausea and vomiting."
Figueroa-Moseley, C., P. Jean-Pierre, et al. (2007). J Natl Compr Canc Netw 5(1): 44-50.
Anticipatory nausea and vomiting (ANV) is associated with a significant reduction in the quality of life for many chemotherapy patients. The use of 5-hydroxytryptamine type 3 receptor antagonists provides some relief for chemotherapy-induced nausea and vomiting, but does not seem to control ANV. Nonpharmacologic approaches, which include behavioral interventions, may provide the greatest promise in relieving symptoms. Little evidence supports the use of complementary and alternative methods, such as acupuncture and acupressure, in relieving ANV. Behavioral interventions, especially progressive muscle relaxation training and systematic desensitization, should be considered important methods for preventing and treating ANV.
"Psychological factors in the etiology and treatment of severe nausea and vomiting in pregnancy."
Buckwalter, J. G. and S. W. Simpson (2002). American Journal of Obstetrics and Gynecology 186(5 Suppl Understanding): S210-4.
The assumption is frequently made that women with severe nausea and vomiting during pregnancy are transforming psychological distress into physical symptoms. Psychoanalytic theory supporting this assumption is reviewed, along with the few methodologically flawed empirical studies that have been conducted. Little support can be found for the hypothesis that nausea and vomiting during pregnancy is such a conversion disorder, but there are suggestions that psychological responses to the physiologic condition(s) underlying this problem may become entrenched, or conditioned. This possibility is supported by findings that psychological treatments, such as hypnosis, can be effective. This implies that psychological responses can interact with the physiology of nausea and vomiting during pregnancy to exacerbate the condition. As such, psychological treatments for the symptoms of this disorder need to be further explored.
"Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy."
Marchioro, G., G. Azzarello, et al. (2000). Oncology 59(2): 100-4.
AIMS AND BACKGROUND: In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies. PATIENTS AND METHODS: The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis. RESULTS: In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients. CONCLUSIONS: The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.
Nervous Habits
"Elucidating Tourette's syndrome: perspectives from hypnosis, attention and self-regulation."
Raz, A., S. Keller, et al. (2007). American Journal of Clinical Hypnosis 49(4): 289-309.
Biological psychiatry favors drug treatment over non-pharmacological intervention and shapes the way clinicians both treat and understand Tourette's Syndrome (TS). However, drug treatments for TS involve side effects and are potentially toxic to the central nervous system. Moreover, current pharmacological treatments are largely ineffective and at best only provide a modest symptom reduction. In this paper, we describe how non-pharmacological treatments such as focused attention can modulate, reduce, or indeed entirely eliminate the symptoms of TS as well as elucidate the underlying neural mechanisms. Showing that the symptoms of TS are susceptible to self-regulatory interventions such as hypnosis, we propose that attentional training could be used to both treat the disorder and better understand it.
"User friendly hypnosis as an adjunct for treatment of habit cough: a case report."
Anbar, R. D. (2007). American Journal of Clinical Hypnosis 50(2): 171-5.
The more user friendly medical hypnosis can be, the more readily it will be accepted by patients and the medical community. Hypnosis is user friendly when it is simple to employ, and yields rapid, effective, and clinically significant results. Thus, we should define reasons for the effectiveness of such successful hypnosis methods, and provide this information to students of hypnosis. Some of the elements that may permit hypnosis to be user friendly are establishment of rapport, a belief that a symptom often has a functional role, and a flexible approach to the hypnosis encounter. This case report of a child with habit cough, illustrates the importance of these elements.
"Using hypnosis to facilitate resolution of psychogenic excoriations in acne excoriee."
Shenefelt, P. D. (2004). American Journal of Clinical Hypnosis 46(3): 239-45.
Hypnotic suggestion successfully alleviated the behavioral picking aspect of acne excoriee des juenes filles in a pregnant woman who had been picking at the acne lesions on her face for 15 years. Acne excoriee is a subset of psychogenic or neurotic excoriation. Conventional topical antibiotic treatment was used to treat the acne. Compared with other treatments for uncomplicated acne excoriee, hypnosis is relatively brief and cost-effective and is non-toxic in pregnancy.
"Childhood habit cough treated with self-hypnosis."
Anbar, R. D. and H. R. Hall (2004). Journal of Pediatrics 144(2): 213-7.
OBJECTIVES: To better understand factors associated with the development and persistence of habit cough and to report use of self-hypnosis for this condition. STUDY DESIGN: A retrospective chart review was performed for 56 children and adolescents with habit cough. Interested patients were instructed in self-hypnosis for relaxation and to help ignore the cough-triggering sensation. RESULTS: The patients' mean age was 10.7 years. The cough was triggered by upper respiratory infections in 59%, asthma in 13%, exercise in 5%, and eating in 4%. Onset of the cough occurred as early as 2 years, and its average duration was 13 months (range, 2 weeks to 7 years). There was a high incidence of abdominal pain and irritable bowel syndrome in the 50% of the patients who missed more than 1 week of school because of their cough. Among the 51 patients who used hypnosis, the cough resolved during or immediately after the initial hypnosis instruction session in 78% and within 1 month in an additional 12%. CONCLUSIONS: Habit cough is triggered by various physiologic conditions, related frequently to other diagnoses, and it is associated with significant school absence. Self-hypnosis offers a safe efficient treatment.
"Hypnosis as a vehicle for choice and self-agency in the treatment of children with Trichotillomania."
Iglesias, A. (2003). American Journal of Clinical Hypnosis 46(2): 129-37.
Three pediatric cases of Trichotillomania were treated with direct hypnotic suggestion with exclusive emphasis on sensitizing and alerting the patients to impending scalp hair pulling behaviors. These children had presented with total lack of awareness of their scalp hair pulling behaviors until they had actually twisted and pulled off clumps of hair. It was also suggested, under hypnosis, that upon learning to recognize impending scalp hair pulling behaviors, the patients would become free to choose to willfully pull their hair or to resist the impulse and not pull. At no point was the explicit suggestion given that they stop pulling their hair. A preliminary condition was agreed to by the parents that redefined the patients' hair as their own property and affirmed their sole responsibility for its care and maintenance. An element of secondary gain was identified in each of these cases. Scalp hair pulling was hypothesized to provide these particular patients with a vehicle with which to oppose their overbearing and over-involved parents. The technique of direct suggestion under hypnosis, aimed at alerting the patients to impending scalp hair pulling behaviors was combined with forming contracts with the parents to relinquish their authority over matters regarding the patients' hair. This combination provided an effective treatment that extinguished the scalp hair pulling in 7 visits or less. These cases received follow-up at intervals up to 6 months and no evidence of relapse was found.
"Acceptability of treatments for trichotillomania. Effects of age and severity."
Elliott, A. J. and W. R. Fuqua (2002). Behavior Modification 26(3): 378-99.
Based on the literature, trichotillomania (TTM, chronic hair pulling) in children and adults appears to be responsive to behavioral interventions such as habit reversal. However, some have questioned the generality and acceptability of such procedures. This study compared the acceptability ratings of four interventions targeting TTM (habit reversal, hypnosis, medication, and punishment). In the study, 233 college students read case vignettes in which the age of the analogue client and the severity of the hair pulling were manipulated. Results showed significant differences between the four treatment conditions, with hypnosis and habit reversal being rated most acceptable. Age of the analogue client and severity of TTM did not significantly influence acceptability ratings.
"Hypnosis for habit disorders. Helping children help themselves."
Thomson, L. (2002). Advance for Nurse Practitioners 10(7): 59-62.
"The characterization and treatment of trichotillomania."
Christenson, G. A. and S. J. Crow (1996). Journal of Clinical Psychiatry 57 Suppl 8: 42-7; discussion 48-9.
Trichotillomania is an impulse control disorder characterized by chronic self-directed hair pulling. Trichotillomania has additionally been viewed as one of the obsessive-compulsive spectrum disorders. Any body hair may be targeted, and most patients pull from more than one site. In clinical settings the disorder predominantly affects females. Onset is generally in childhood or adolescence, and a chronic course is typical. Depression and anxiety frequently accompany the disorder. An increased incidence of comorbid obsessive-compulsive disorder (OCD) has been noted. Neurobiological investigations have paralleled etiologic studies of OCD and have demonstrated both similarities and differences between these two disorders. Current treatment options include a variety of medications, particularly the serotonin selective reuptake inhibitors, the behavioral technique of habit reversal, and hypnosis.
"Outcome of habit cough in children treated with a brief session of suggestion therapy."
Lokshin, B., S. Lindgren, et al. (1991). Annals of Allergy 67(6): 579-82.
Nine patients with habit cough, initially misdiagnosed as asthma, were treated during a period of sustained repetitive symptoms with a brief session of suggestion therapy. Symptoms had previously been present for up to 2 years (median = 2 months). Five had been hospitalized for the cough. Evaluation revealed no physiologic or radiologic abnormality. All patients became symptom free during a 15-minute session of suggestion therapy. During the subsequent week, one remained completely asymptomatic and 8 had transient minor relapses that were readily self-controlled. Seven of the 9 could be contacted for determination of long-term outcome at periods up to 9 years (median 2.2 years) after the session. Six were totally asymptomatic; one had occasional minor self-controlled symptoms. A standardized questionnaire assessing psychologic symptoms at the time of follow-up revealed no somatization nor emotional distress. In contrast to this apparent cure, others have reported extended periods of continued symptoms in the absence of a uniform treatment plan for suggestion therapy even though the correct diagnosis was made. We conclude that the classical habit cough syndrome is amenable to immediate relief and long-term cure in most cases with a single session of appropriate suggestion therapy.
"Hypnobehavioral treatment of chronic nailbiting: a multiple baseline analysis."
Bornstein, P. H., R. G. Rychtarik, et al. (1980). International Journal of Clinical and Experimental Hypnosis 28(3): 208-17.
Pain
"Psychosocial Issues in Cancer Pain."
Porter, L. S. and F. J. Keefe (2011) Curr Pain Headache Rep.
Cancer pain is a complex and multidimensional experience that affects and is affected by psychological and social factors. This article reviews recent research that points to a number of key psychosocial factors associated with pain, including psychological distress, coping, and social support, as well as the impact of socioeconomic factors on barriers to pain management. We also review recent research suggesting that psychosocial interventions, including education, coping-skills training, and hypnosis, may be useful adjuncts to medical management of pain. Clinical implications and recommendations for future research are discussed.
"The effectiveness of hypnosis in reducing pain and suffering among women with metastatic breast cancer and among women with temporomandibular disorder."
Nash, M. R. and A. Tasso. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 497-504.
The authors describe two studies of special interest to clinicians and clinical researchers. Both are randomized controlled studies, exclusively focused on female patients. The first study tests whether a year-long weekly group intervention including hypnosis can reduce cancer pain among women with metastatic breast cancer. Findings suggest the intervention slowed the increase in reported pain over a 12-month period relative to controls. The second study examines the effect of hypnosis in women suffering from temporomandibular disorder (TMD), with a special focus on function as well as pain. Hypnosis reduced TMD pain as measured by a numerical-rating scale.
"Treatment of chronic recurrent abdominal pain: laparoscopy or hypnosis?"
Galili, O., R. Shaoul, et al. (2009). Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A 19(1): 93-6.
OBJECTIVE: Functional chronic recurrent abdominal pain (FCRAP) is long lasting, intermittent, or constant pain affecting 15-30% of children ages 4-18 and presents a diagnostic and treatment challenge to the physician. The predictive value of diagnostic tests is questionable, and studies of the treatment of chronic abdominal pain show inconclusive evidence regarding diet regimens as well as medical and surgical treatments. However, there is evidence that cognitive-behavioral therapy may be useful in improving pain and disability outcome. Increasing the understanding of the neural-pain pathways and research in cognitive modulation of pain led to the application of behavioral strategies in children with FCRAP with variable success. However, the use of hypnotherapy in children with recurrent abdominal pain is not common. During the last 3 years, we have implemented hypnosis as the preferred treatment for patients with FCRAP. In the current study, we aimed to summarize our experience with hypnosis for the treatment of FCRAP in children. PATIENTS AND METHODS: Twenty patients who met the criteria for FCRAP were candidates for hypnosis. Hypnosis or imagery was offered to the families, of whom 3 refused. Seventeen patients underwent just one single session of hypnosis. RESULTS: A possible nonorganic etiology for the abdominal pain was revealed in all cases. In 14 adolescents, all clinical symptoms resolved. Hypnosis was not effective in 3 cases, in whom secondary gain was probably responsible for their symptoms. No side effects have been noted during and after the study. Follow-up was available for a period of 4-24 months. CONCLUSIONS: Although effective in the management of acute pain and distress in pediatric cancer patients, the use of hypnotherapy in children with FCRAP is not a common practice. The current study highly supports the use of hypnosis as a part of the biobehavioral approach for this dilemma.
"Hypnotherapy in management of pain and reexperiencing of trauma in burn patients."
Shakibaei, F., A. A. Harandi, et al. (2008). International Journal of Clinical and Experimental Hypnosis 56(2): 185-97.
This study examined the effects of hypnosis on both pain and reexperiencing of trauma in burn patients. Forty-four patients hospitalized for burn care were randomly assigned to either hypnotherapy or a control group. Direct and indirect hypnotic suggestions were used to reduce pain and reexperiencing of trauma. All patients received routine burn care. Pain reports were quantified by using a self-report numeric rating scale ranging from 0 to 5. The number of recalled vivid, troubling events of the trauma in 24-hour intervals was used for rating the reexperiencing of trauma. The hypnotherapy group showed significantly lower pain ratings than the control group and reported a significant reduction in pain from baseline. There was a significant reduction in trauma reexperience scores in the hypnotherapy group but not the control group. The findings support the efficacy of hypnotherapy in the management of both pain and reexperiencing of trauma in burn patients.
"Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice."
Lang, E. V., K. S. Berbaum, et al. (2008). Journal of Vascular and Interventional Radiology 19(6): 897-905.
PURPOSE: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events. MATERIALS AND METHODS: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (> or =50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment. RESULTS: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118). CONCLUSIONS: Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.
"Long-term outcome of hypnotic-analgesia treatment for chronic pain in persons with disabilities."
Jensen, M. P., J. Barber, et al. (2008). International Journal of Clinical and Experimental Hypnosis 56(2): 156-69.
Data from 26 participants in a case series of hypnotic analgesia for chronic pain were examined to determine the long-term effects of hypnosis treatment. Statistically significant decreases in average daily pain intensity, relative to pretreatment values, were observed at posttreatment and at 3- and 9-month follow-up but not at 6- or 12-month follow-up. The percent of participants who reported clinically meaningful decreases in pain were 27%, 19%, 19%, and 23%, at the 3-, 6-, 9-, and 12-month follow-up points, respectively. Moreover, at 12-months posttreatment, 81% of the sample reported that they still used the self-hypnosis skills learned in treatment. Overall, the results indicate that about 20% of the sample obtained substantial and lasting long-term reductions in average daily pain following hypnosis treatment and that many more continue to use self-hypnosis up to 12 months following treatment.
"Relationship of headache-associated stressors and hypnosis therapy outcome in children: a retrospective chart review."
Anbar, R. D. and G. G. Zoughbi (2008). American Journal of Clinical Hypnosis 50(4): 335-41.
This study examined potential psychosocial stressors of 30 children with headaches (mean age, 15 years), and the role of insight generation in the outcome of hypnosis therapy. The mean duration of headache occurrence was 3 years. All of the patients were instructed in how to use hypnosis-induced relaxation and headache-related imagery to improve their symptoms. Thirty-seven percent reported their headaches were associated with fixed stressors, defined as caused by events over which patients had no control, while 63% reported variable stressors, defined as modifiable by the patients' actions. Four patients were lost to follow-up. Overall, 96% (25/26) reported a decrease in headache frequency and/or intensity following use of hypnosis. However, prior to insight generation patients reporting fixed stressors were significantly less likely to improve than those reporting variable stressors (p = 0.018). Thus, insight generation may be more important for achievement of improvement in children whose headaches are associated with fixed stressors.
"Hypnosis for treatment of pain in children."
Rogovik, A. L. and R. D. Goldman (2007). Canadian Family Physician 53(5): 823-5.
QUESTION: Many children suffer from chronic and painful illnesses. Hypnosis was found to be effective for analgesia in adults. Is it effective for managing pain in children? ANSWER: Children can be easier to hypnotize than adults. Studies have shown clinical hypnosis and self-hypnosis to be effective as adjunct treatments for children in pain. Examples include painful medical procedures, such as bone marrow aspiration and lumbar puncture in pediatric cancer patients, postoperative pain and anxiety in children undergoing surgery, and chronic headache.
"Self-hypnosis training for headaches in children and adolescents."
Kohen, D. P. and R. Zajac (2007). Journal of Pediatrics 150(6): 635-9.
OBJECTIVE: To describe the effect of treatment with self-hypnosis for youth with recurrent headaches. STUDY DESIGN: A retrospective review was conducted of outpatient clinical records of 178 consecutive youths referred to the Behavioral Pediatrics Program (University of Minnesota) from 1988 to 2001 for recurrent headaches. All patients were taught self-hypnosis for self-regulation. Intensity, frequency, and duration of headaches before, during, and after treatment were measured. Outcomes included number and frequency of visits, types of medication, and nature of self-hypnosis practice. RESULTS: Data were available for 144 patients in this patient self-selected and uncontrolled observation. Compared with self-reports before learning self-hypnosis, children and youths who learned self-hypnosis for recurrent headaches reported reduction in frequency of headache from an average of 4.5 per week to 1.4 per week (P < .01), reduction in intensity (on a self-rating scale of 0 to 12) from an average of 10.3 to 4.7, P < .01, and reduction in average duration from 23.6 hours to 3.0 hours, (P < .01). There were no adverse side effects of self-hypnosis. CONCLUSIONS: Training in self-hypnosis is associated with significant improvement of chronic recurrent headaches in children and adolescents.
"Hypnotherapy for the management of chronic pain."
Elkins, G., M. P. Jensen, et al. (2007). International Journal of Clinical and Experimental Hypnosis 55(3): 275-87.
This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than nonhypnotic interventions such as attention, physical therapy, and education. Most of the hypnosis interventions for chronic pain include instructions in self-hypnosis. However, there is a lack of standardization of the hypnotic interventions examined in clinical trials, and the number of patients enrolled in the studies has tended to be low and lacking long-term follow-up. Implications of the findings for future clinical research and applications are discussed.
"Painful menstruation."
Tzafettas, J. (2006). Pediatr Endocrinol Rev 3 Suppl 1: 160-3.
Painful menstruation is a cyclic painful condition that adversely affects the woman's wellbeing for a large part of her life. Its pathogenesis is not always understood. Prostaglandins seem to be intimately involved in primary dysmenorrhoea although it is difficult to understand the underlying cause for their excessive secretion. Abnormalities in plasma steroid levels could account for the disturbance, especially significantly elevated plasma levels of estradiol in the luteal phase. Plasma levels of vasopressin appear to be higher in women with dysmenorrhea suggesting a possible aetiological role in the uterine prostaglandin synthesis. The main aim of diagnosis is to distinguish those cases with secondary dysmenorrhoea due to endometriosis and chronic pelvic inflammatory disease and treat them accordingly although the exact role of endometriosis remains unclear. The development of sonographic and magnetic resonance imaging techniques (MRI) allow pre-operative diagnosis of adenomyosis, a difficult to diagnose cause of dysmenorrhea and pelvic pain. Medication is usually required for all cases of moderate to severe painful menstruation. Apart from pharmacological agents, several techniques have been used including relaxation therapy, hypnosis, manipulation, psychotherapy, acupuncture, biofeedback techniques, surgery e.g. Despite the high prevalence of painful menstruation, its frequency and severity is very often underestimated.
"Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy."
Jones, H., P. Cooper, et al. (2006). Gut 55(10): 1403-8.
BACKGROUND: Non-cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting. AIMS: This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina-like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory. PATIENTS AND METHODS: Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication. RESULTS: Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores. CONCLUSION: Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.
"Satisfaction with, and the beneficial side effects of, hypnotic analgesia."
Jensen, M. P., K. D. McArthur, et al. (2006). International Journal of Clinical and Experimental Hypnosis 54(4): 432-47.
Case study research suggests that hypnosis treatment may provide benefits that are not necessarily the target of specific suggestions. To better understand satisfaction with and the beneficial "side effects" of hypnosis treatment, questions inquiring about treatment satisfaction and treatment benefits were administered to a group of 30 patients with chronic pain who had participated in a case series of hypnotic analgesia treatment. The results confirmed the authors' clinical experience and showed that most participants reported satisfaction with hypnosis treatment even when the targeted symptom (in this case, pain intensity) did not decrease substantially. Study participants also reported a variety of both symptom-related and nonsymptom-related benefits from hypnosis treatment, including decreased pain, increased perceived control over pain, increased sense of relaxation and well-being, and decreased perceived stress, although no single benefit was noted by a majority of participants.
"Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial."
Weydert, J. A., D. E. Shapiro, et al. (2006). BMC Pediatr 6: 29.
BACKGROUND: Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. METHODS: 22 children, aged 5-18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with < or = 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. RESULTS: At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P < 0.01) months and significantly greater decrease in days with missed activities at one (85% vs. 15%, P = 0.02) and two (95% vs. 77%. P = 0.05) months. During the two months of follow-up, more children who had learned guided imagery met the threshold of < or = 4 day of pain each month and no missed activities (RR = 7.3, 95%CI [1.1,48.6]) than children who learned only the breathing exercises. CONCLUSION: The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.
"Changes in the meaning of pain with the use of guided imagery."
Lewandowski, W., M. Good, et al. (2005). Pain Manag Nurs 6(2): 58-67.
The purpose of this study is to determine how verbal descriptions of pain change with the use of a guided imagery technique. A mixed method, concurrent nested design was used. Participants in the treatment group used the guided imagery technique over a consecutive 4-day period, and those in the control group were monitored. Verbal descriptions of pain were obtained before randomization and at four daily intervals. A total of 210 pain descriptions were obtained across the five time points. Data were analyzed using content analysis. Six categories emerged from the data: pain is never-ending, pain is relative, pain is explainable, pain is torment, pain is restrictive, and pain is changeable. For participants in the treatment group, pain became changeable. The meaning of pain as never-ending was a prominent theme for participants before randomization to treatment and control groups. It remained a strong theme for participants in the control group throughout the 4-day study period; however, pain as never-ending did not resurface for participants in the treatment group.
"Hypnosis and clinical pain."
Patterson, D. R. and M. P. Jensen (2003). Psychological Bulletin 129(4): 495-521.
Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.
"Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison."
Lu, D. P., G. P. Lu, et al. (2001). American Journal of Clinical Hypnosis 44(2): 141-8.
Despite their long histories, acupuncture and hypnosis have only recently been acknowledged as valuable by the medical establishment in the U.S. Few studies have used rigorous prospective measurement to evaluate the individual or relative merits of hypnosis and acupuncture in specific clinical settings. In this study, 25 patients with various head and neck pain were studied. Each had an initial assessment of their pain, as well as of their attitudes and expectations. All patients received acupuncture, followed by a reassessment of their pain. After a washout period they received another assessment of pain before and after hypnosis therapy. Preferences for therapy were sought following the hypnotic intervention. Both acupuncture and hypnosis were effective at relieving pain under these conditions. The average relief in pain reported was 4.2 units on a ten point scale, with hypnosis reducing pain by a mean of 4.8 units, compared to 3.7 for acupuncture (p = 0.26). Patient characteristics appeared to impact the effectiveness of treatment: patients with acute pain benefited most from acupuncture treatment, whereas patients with psychogenic pain were more likely to benefit from hypnosis. Patients with chronic pain had more variation in their results. Patients who received healing suggestions from a tape during a hypnotic trance benefited more than those who received no such suggestion, and acupuncture patients who were needle phobic benefited less than those who were not fearful of needles. This study demonstrates the benefits of well designed studies of the effectiveness of these alternative modalities. More work is needed to help practitioners identify which patients are most likely to benefit from these complementary therapies.
"Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial."
Lang, E. V., E. G. Benotsch, et al. (2000). Lancet 355(9214): 1486-90.
BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. METHODS: 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. FINDINGS: Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
"Critical review of 5 nonpharmacologic strategies for managing cancer pain."
Sellick, S. M. and C. Zaza (1998). Cancer Prevention and Control 2(1): 7-14.
PURPOSE: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. METHODS: The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. RESULTS: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. CONCLUSION: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed.
"Evaluation of the efficacy and neural mechanism of a hypnotic analgesia procedure in experimental and clinical dental pain."
Barber, J. and D. Mayer (1977). Pain 4(1): 41-8.
Previous research implicates an endogenous central pain inhibitory mechanism in opiate analgesia, analgesia produced by focal electrical stimulation of the brain, and acupuncture analgesia. This investigation evaluates the possibility that analgesia produced by hypnosis is also mediated by such a mechanism. Results suggest that hypnotic analgesia is unlikely to involve this central pain inhibitory mechanism since hypnotic analgesia is not altered by naloxone hydrochloride, a specific narcotic antagonist. Results further demonstrate that the hypnotic procedure used produces an unusually effective and reliable increase in pain threshold. This finding generalizes to the control of clinical dental pain, and suggests that hypnotic pain control is a more widespread phenomenon in the population than has been thought.
Palliative Care
"Efficacy of guided imagery with theta music for advanced cancer patients with dyspnea: a pilot study."
Lai, W. S., C. S. Chao, et al. (2010) Biological Research for Nursing 12(2): 188-97.
BACKGROUND: Dyspnea is a frequent and devastating symptom among advanced cancer patients for which improved and low-cost palliative techniques are needed. METHODS: A one-group repeated measures research design investigated the efficacy of guided imagery (GI) with theta music (M) on dyspnea in advanced cancer patients. The intervention consisted of four periods: (a) pretest; (b) intervention with peaceful non-M; (c) intervention with 10 min of GI with M (GI/M), with the first and last 3 min being M only (i.e., the middle 4 min was GI/M); and (d) posttest. Dyspnea outcome was measured with the Modified Borg Scale (MBS) for self-reported evaluation of dyspneic symptoms. Physiological parameters measured were pulse oxygen saturation (SpO(2)), end-tidal CO( 2) (EtCO(2)), heart rate (HR), and respiratory rate (RR). Posttest qualitative data were obtained via interview for subjective patient experience. RESULTS: Participants included 53 patients, 33% with lung cancer. GI/M produced a significant decrease in MBS scores; 90% of the subjects gave positive qualitative reviews of GI/M. SpO(2) did not change significantly over time. GI/M significantly increased EtCO(2), decreased RR, and decreased HR. DISCUSSION: This study demonstrates that GI/M is a useful intervention for palliative care of patients with dyspnea. M alone was demonstrated to be effective, while soothing non-M was not effective. GI/M was more effective than M alone. GI/M should be considered low-cost end-of-life palliative care for dyspnea.
"Complementary medicine in palliative care and cancer symptom management."
Mansky, P. J. and D. B. Wallerstedt (2006). Cancer J 12(5): 425-31.
Complementary and alternative medicine (CAM) use among cancer patients varies according to geographical area, gender, and disease diagnosis. The prevalence of CAM use among cancer patients in the United States has been estimated to be between 7% and 54%. Most cancer patients use CAM with the hope of boosting the immune system, relieving pain, and controlling side effects related to disease or treatment. Only a minority of patients include CAM in the treatment plan with curative intent. This review article focuses on practices belonging to the CAM domains of mind-body medicine, CAM botanicals, manipulative practices, and energy medicine, because they are widely used as complementary approaches to palliative cancer care and cancer symptom management. In the area of cancer symptom management, auricular acupuncture, therapeutic touch, and hypnosis may help to manage cancer pain. Music therapy, massage, and hypnosis may have an effect on anxiety, and both acupuncture and massage may have a therapeutic role in cancer fatigue. Acupuncture and selected botanicals may reduce chemotherapy-induced nausea and emesis, and hypnosis and guided imagery may be beneficial in anticipatory nausea and vomiting. Transcendental meditation and the mindfulness-based stress reduction can play a role in the management of depressed mood and anxiety. Black cohosh and phytoestrogen-rich foods may reduce vasomotor symptoms in postmenopausal women. Most CAM approaches to the treatment of cancer are safe when used by a CAM practitioner experienced in the treatment of cancer patients. The potential for many commonly used botanical to interact with prescription drugs continues to be a concern. Botanicals should be used with caution by cancer patients and only under the guidance of an oncologist knowledgeable in their use.
"The integration of hypnosis into a model of palliative care."
Marcus, J., G. Elkins, et al. (2003). Integr Cancer Ther 2(4): 365-70.
There exists a need for a broad and inclusive model of integration of mind-body interventions for palliative care. Symptoms relating to psychological distress and existential concerns are even more prevalent than pain and other physical symptoms among those with life-limiting conditions. The hypnotic model's purpose is to improve the patient's total psychological, social, and spiritual well-being. A 4-stage model of interventions is offered to assist the clinician in developing and implementing appropriate hypnotherapeutic treatment for noncurative patients. The focus of the hypnotherapy is to ameliorate the effects of pain and dyspnea to restore a level of psychological and physical wellbeing. Within this model of therapy for patients with active, progressive, far-advanced disease and a short life expectancy, the goals of the hypnotic intervention are to provide relief from pain and shortness of breath. Other focuses include assisting the patient with the psychological adjustment to their noncurative and ultimately final state.
"Hypnosis: useful, neglected, available."
Douglas, D. B. (1999). American Journal of Hospice and Palliative Care 16(5): 665-70.
Hypnosis is presented as a valuable and frequently neglected resource for many patients with chronic and terminal illness. Particular attention is given herein to the use of hypnosis in attaining relaxation, overcoming insomnia, helping the patient achieve pain relief, and, most particularly, teaching the patient to work with relatives and other persons close to them, as caregivers in a special relationship that can be a very important source of relief to the patient. A brief overview of indications, contraindications, errors, and safeguards is given. Sources of education and training are briefly reviewed and a bibliography is included to identify the nature of professional societies, three in the United States and one international, together with some standard publications. The purpose of this article is to affirm the value of hypnosis as a complementary or alternative therapy for hospice patients, to summarize its clinical applications, and to list the most standard and best known professional societies and publications.
Parkinson's Tremor
"Parkinson's disease tremor is diminished with relaxation guided imagery."
Schlesinger, I., O. Benyakov, et al. (2009). Movement Disorders.
Patients with Parkinson's disease (PD) may have pronounced tremor that exacerbates during stress. To determine whether PD tremor improves with relaxation guided imagery (RGI) and relaxing music. Twenty patients with PD with moderate to severe tremor participated in sessions where relaxation techniques were implemented. Tremor was objectively monitored using an accelerometer. RGI dramatically decreased tremor in all 20 patients (baseline 270.38 +/- 85.82 vs. RGI 35.57 +/- 43.90 movements per minute P < 0.0001). In 15 patients, RGI completely abolished tremor for 1-13 min. Average tremor activity remained significantly bellow baseline both 15 min and 30 min after RGI was discontinued (P < 0.001). Patients reported improvement lasting 2-14 hours (mean 6.8 +/- 3.8). Relaxing music significantly reduced tremor but to a lesser degree than RGI (220.04 +/- 106.53 movements per minute P = 0.01). Self-relaxation had no significant effect on tremor. RGI can supplement conventional medical treatments for tremor in patients with PD on best medical treatment. (c) 2009 Movement Disorder Society.
"The effects of hypnosis on a parkinsonian tremor: case report with polygraph/EEG recordings."
Wain, H. J., D. Amen, et al. (1990). American Journal of Clinical Hypnosis 33(2): 94-8.
Although Parkinsonian tremors typically disappear during sleep and are reduced during relaxation periods, the effects of hypnosis on this type of movement disorder have been generally ignored. We observed a patient's severe Parkinsonian tremor under hypnosis and monitored it with EEG and EMG studies. The patient was taught self-hypnosis and performed it three to four times daily in conjunction with taking medication. The results suggest that daily sessions of self-hypnosis can be a useful therapeutic adjunct in the treatment of Parkinsonian tremors.
Phobias
"Brief hypnosis for severe needle phobia using switch-wire imagery in a 5-year old."
Cyna, A. M., D. Tomkins, et al. (2007). Paediatric Anaesthesia 17(8): 800-4.
We present a case of severe needle phobia in a 5-year-old boy who learned to utilize a self-hypnosis technique to facilitate intravenous (i.v.) cannula placement. He was diagnosed with Bruton's disease at 5 months of age and required monthly intravenous infusions. The boy had received inhalational general anesthesia for i.v. cannulation on 58 occasions. Initially, this was because of difficult venous access but more recently because of severe distress and agitation when approached with a cannula. Oral premedication with midazolam or ketamine proved unsatisfactory and hypnotherapy was therefore considered. Following a 10-min conversational hypnotic induction, he was able to use switch--wire imagery to dissociate sensation and movement in all four limbs in turn. Two days later the boy experienced painless venepuncture without the use of topical local anesthetic cream. There was no movement in the 'switched-off' arm during i.v. cannula placement. This report adds to the increasing body of evidence that hypnosis represents a useful, additional tool that anesthetists may find valuable in everyday practice.
"Accessing state-bound memories in the treatment of phobias: two case studies."
Bodden, J. L. (1991). American Journal of Clinical Hypnosis 34(1): 24-8.
Two cases of simple phobia demonstrate the inadequacies of both behavioral and psychodynamic theories. These cases and their treatment outcomes provide support for the state-dependent memory and learning theory. Hypnosis and ideomotor signaling proved to be not only effective treatments but also useful means of illuminating the role and nature of symptom function. Issues of symptom removal and substitution are also discussed in relation to these cases.
"Hypnotic regression and reframing in the treatment of insect phobias."
Domangue, B. B. (1985). American Journal of Psychotherapy 39(2): 206-14.
Two cases of insect phobia are presented in which constructs and strategies from psychodynamic, cognitive, and behavioral approaches were combined with hypnotic interventions. Flexibility and integration of approaches may be advantageous and hypnosis, including regression and reframing, may be especially powerful in the treatment of phobics.
Physical Rehabilitation
"Effect of motor imagery in the rehabilitation of burn patients."
Guillot, A., F. Lebon, et al. (2009). J Burn Care Res 30(4): 686-93.
Although there is ample evidence that motor imagery (MI) improves motor performance after CNS injury, it is still unknown whether MI may enhance motor recovery after peripheral injury and most especially in the rehabilitation of burn patients. This study aimed to investigate the effects of a 2-week MI training program combined with conventional rehabilitation on the recovery of motor functions in handed burn patients. Fourteen patients admitted to the Medical Burn Center were requested to take part in the study and were randomly assigned to the imagery or the control group. Behavioral data related to the ability to perform each successive step of three manual motor sequences were collected at five intervals during the medical procedure. The results provided evidence that MI may facilitate motor recovery, and the belief in the effectiveness of MI was strong in all patients. MI may substantially contribute to improve the efficacy of conventional rehabilitation programs. Hence, this technique should be considered as a reliable alternative method to help burn patients to recover motor functions.
"Clinical applications of hypnosis in the physical medicine and rehabilitation setting: three case reports."
Appel, P. R. (1990). American Journal of Clinical Hypnosis 33(2): 85-93.
Hypnosis is useful in the rehabilitation setting to help patients master skills, to increase their sense of self-efficacy and self-esteem and, in general, to facilitate and accelerate their rehabilitation program. I used hypnosis with three patients where patient behaviors and beliefs were interfering with the rehabilitation treatment goals set by the patient and the health care team. Collectively, these cases demonstrate the use of hypnotic techniques in diagnosing and treating problems with patient compliance and assisting patients to gain greater benefit from their rehabilitation regimen.
"The use of hypnosis in physical medicine and rehabilitation."
Appel, P. R. (1992). Psychiatric Medicine 10(1): 133-48.
Hypnosis and hypnotic strategies has been used for over 30 years in the field of Physical Medicine and Rehabilitation by psychiatrists and psychologists to effectively intervene in and influence: the enhancement of the patient's attainment of rehabilitation goals; adjustment and grief reactions to disability and handicap; and pre-existing psychiatric conditions exacerbated by the disability or handicap. In this article I will focus on how hypnosis has been effectively utilized to enhance performance of functional ability, increase self-esteem, and potentiate brief psychotherapy for adjustment difficulties to injuries and disabilities through the use of case examples.
"Performance enhancement in physical medicine and rehabilitation."
Appel, P. R. (1992). American Journal of Clinical Hypnosis 35(1): 11-9.
Performance enhancement or mental practice is the "symbolic rehearsal of a physical activity without any gross muscular movements" to facilitate skill acquisition and to increase performance in the production of that physical activity. Performance-enhancement interventions have been well known in the area of sports psychology and medicine. However, clinical applications in physical medicine and rehabilitation have not flourished to the same extent, though the demand for improved physical performance and the acquisition of various motor skills are as important. In this paper I will describe how hypnosis can potentiate mental practice, present a model of mental practice to enhance performance, and describe how to help patients access an ideal performance state of consciousness.
"Hypnosis also useful in rehabilitation therapy."
Martin, J. (1983). JAMA 249(12): 1536.
"Attempts to influence movement disorders in hemiparetics."
Radil, T., I. Snydrova, et al. (1988). Scandinavian Journal of Rehabilitation Medicine. Supplement 17: 157-61.
Step duration, measured in hemiparetic patients walking on a circular path, showed that step duration of the affected foot is usually longer. Functional electrical stimulation of the peroneal nerve in the swing phase of the step (eliminating foot drop) shortened step duration in the majority of cases. Hypnosis induced by the verbal fixation technique was used in hemiparetic patients (a) to ascertain whether the patient's mobility would increase during hypnosis and to determine (in positive cases) whether this approach might be used to predicting the effect of rehabilitation performed by classical methods; (b) to use hypnosis as a method of auxiliary treatment. The general finding was that the extent of movements of the hemiparetic upper extremity considerably improved during and immediately after hypnosis. This effect could be observed both at the level of severe impairment (at the beginning of treatment) and during the later stages when mobility greatly improved due to rehabilitation and recovery.
Post-Traumatic Stress Disorder
"Hypnotherapy in the treatment of chronic combat-related PTSD patients suffering from insomnia: a randomized, zolpidem-controlled clinical trial."
Abramowitz, E. G., Y. Barak, et al. (2008). International Journal of Clinical and Experimental Hypnosis 56(3): 270-80.
This study evaluated the benefits of add-on hypnotherapy in patients with chronic PTSD. Thirty-two PTSD patients treated by SSRI antidepressants and supportive psychotherapy were randomized to 2 groups: 15 patients in the first group received Zolpidem 10 mg nightly for 14 nights, and 17 patients in the hypnotherapy group were treated by symptom-oriented hypnotherapy, twice-a-week 1.5-hour sessions for 2 weeks. All patients completed the Stanford Hypnotic Susceptibility Scale, Form C, Beck Depression Inventory, Impact of Event Scale, and Visual Subjective Sleep Quality Questionnaire before and after treatment. There was a significant main effect of the hypnotherapy treatment with PTSD symptoms as measured by the Posttraumatic Disorder Scale. This effect was preserved at follow-up 1 month later. Additional benefits for the hypnotherapy group were decreases in intrusion and avoidance reactions and improvement in all sleep variables assessed.
"Hypnosis in the treatment of trauma: a promising, but not fully supported, efficacious intervention."
Cardena, E. (2000). International Journal of Clinical and Experimental Hypnosis 48(2): 225-38.
Hypnotic techniques for the treatment of posttraumatic conditions were often used by the clinical pioneers of the end of the 19th century and by military therapists treating soldiers during the 20th century's conflagrations. More recently, hypnosis has also been used with survivors of sexual assault, accidents, and other traumas, and with various groups, including children and ethnic minorities. Nonetheless, there have been almost no systematic studies on the efficacy of hypnosis for posttraumatic disorders. This state of affairs is especially disappointing considering that: hypnosis can be easily integrated into therapies that are commonly used with traumatized clients; a number of PTSD individuals have shown high hypnotizability in various studies; hypnosis can be used for symptoms associated with PTSD; and hypnosis may help modulate and integrate memories of trauma. Hypnotic techniques may indeed be efficacious for posttraumatic conditions, but systematic group or single-case studies need to be conducted before reaching that conclusion.
"New uses of hypnosis in the treatment of posttraumatic stress disorder."
Spiegel, D. and E. Cardena (1990). Journal of Clinical Psychiatry 51 Suppl: 39-43; discussion 44-6.
Hypnosis is associated with the treatment of posttraumatic stress disorder (PTSD) for two reasons: (1) the similarity between hypnotic phenomena and the symptoms of PTSD, and (2) the utility of hypnosis as a tool in treatment. Physical trauma produces a sudden discontinuity in cognitive and emotional experience that often persists after the trauma is over. This results in symptoms such as psychogenic amnesia, intrusive reliving of the event as if it were recurring, numbing of responsiveness, and hypersensitivity to stimuli. Two studies have shown that Vietnam veterans with PTSD have higher than normal hypnotizability scores on standardized tests. Likewise, a history of physical abuse in childhood has been shown to be strongly associated with dissociative symptoms later in life. Furthermore, dissociative symptoms during and soon after traumatic experience predict later PTSD. Formal hypnotic procedures are especially helpful because this population is highly hypnotizable. Hypnosis provides controlled access to memories that may otherwise be kept out of consciousness. New uses of hypnosis in the psychotherapy of PTSD victims involve coupling access to the dissociated traumatic memories with positive restructuring of those memories. Hypnosis can be used to help patients face and bear a traumatic experience by embedding it in a new context, acknowledging helplessness during the event, and yet linking that experience with remoralizing memories such as efforts at self-protection, shared affection with friends who were killed, or the ability to control the environment at other times. In this way, hypnosis can be used to provide controlled access to memories that are then placed into a broader perspective. Patients can be taught self-hypnosis techniques that allow them to work through traumatic memories and thereby reduce spontaneous unbidden intrusive recollections.
Self-Hypnosis
"Hypnosis in the treatment of anxiety- and stress-related disorders."
Hammond, D. C. (2010) Expert Review of Neurotherapeutics 10(2): 263-73.
Self-hypnosis training represents a rapid, cost-effective, nonaddictive and safe alternative to medication for the treatment of anxiety-related conditions. Here we provide a review of the experimental literature on the use of self-hypnosis in the treatment of anxiety and stress-related disorders, including anxiety associated with cancer, surgery, burns and medical/dental procedures. An overview of research is also provided with regard to self-hypnotic treatment of anxiety-related disorders, such as tension headaches, migraines and irritable bowel syndrome. The tremendous volume of research provides compelling evidence that hypnosis is an efficacious treatment for state anxiety (e.g., prior to tests, surgery and medical procedures) and anxiety-related disorders, such as headaches and irritable bowel syndrome. Although six studies demonstrate changes in trait anxiety, this review recommends that further randomized controlled outcome studies are needed on the hypnotic treatment of generalized anxiety disorder and in documenting changes in trait anxiety. Recommendations are made for selecting clinical referral sources.
"Long-term follow-up of self-hypnosis training for recurrent headaches: what the children say."
Kohen, D. P. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 417-32.
The author sent surveys to 178 consecutive youths previously referred for hypnosis for headaches. The survey sought current status of headaches: treatment, application of self-hypnosis, headache intensity, frequency, duration after self-hypnosis, generalization of self-hypnosis to other problems, and attitudes regarding self-hypnosis and life stresses. Of 134 delivered surveys, 52 were returned complete. Years after treatment, 85% (44/52) reported continued relief with self-hypnosis, 44% (23/52) reported decreased headache frequency, 31% (16/52) noted decreased severity, and 56% (29/52) reported that self-hypnosis reduced headache intensity. Many (26/52) emphasized the value of self-hypnosis to life stresses. In children and adolescents, self-hypnosis is associated with significant improvement of headaches and with an enduring positive effect for many years following training. Results suggest common and spontaneous generalizability of self-hypnosis by young people to modulation of other problems in their lives.
"Identification of children who may benefit from self-hypnosis at a pediatric pulmonary center."
Anbar, R. D. and S. C. Geisler (2005). BMC Pediatr 5(1): 6.
BACKGROUND: Emotional difficulties can trigger respiratory symptoms. Thus, children presenting with respiratory complaints may benefit from a psychological intervention. The purpose of this study was to define the proportion of patients referred to a Pediatric Pulmonary Center who may benefit from instruction in self-hypnosis, as a psychological intervention. METHODS: A retrospective chart review was conducted for all newly referred patients to the SUNY Upstate Medical University Pediatric Pulmonary Center during an 18 month period beginning January 1, 2000. Patients were offered hypnosis if they presented with symptoms or signs suggestive of psychological difficulties. Hypnosis was taught in one or two 15-45 minute sessions by a pediatric pulmonologist. RESULTS: Of 725 new referrals, 424 were 0-5 years old, 193 were 6-11 years old, and 108 were 12-18 years old. Diagnoses of anxiety, habit cough, or vocal cord dysfunction accounted for 1% of the 0-5 year olds, 20% of the 6-11 year olds, and 31% of the 12-18 year olds. Hypnotherapy was offered to 1% of 0-5 year olds, 36% of 6-11 year olds, and 55% of 12-18 year olds. Of 81 patients who received instruction in self-hypnosis for anxiety, cough, chest pain, dyspnea, or inspiratory difficulties, 75% returned for follow-up, and among the returning patients 95% reported improvement or resolution of their symptoms. CONCLUSION: A large number of patients referred to a Pediatric Pulmonary Center appeared to benefit from instruction in self-hypnosis, which can be taught easily as a psychological intervention.
"Self-hypnosis training as an adjunctive treatment in the management of pain associated with sickle cell disease."
Dinges, D. F., W. G. Whitehouse, et al. (1997). International Journal of Clinical and Experimental Hypnosis 45(4): 417-32.
A cohort of patients with sickle cell disease, consisting of children, adolescents, and adults, who reported experiencing three or more episodes of vaso-occlusive pain the preceding year, were enrolled in a prospective two-period treatment protocol. Following a 4-month conventional treatment baseline phase, a supplemental cognitive-behavioral pain management program that centered on self-hypnosis was implemented over the next 18 months. Frequency of self-hypnosis group straining sessions began at once per week for the first 6 months, became biweekly for the next 6 months, and finally occurred once every third week for the remaining 6 months. Results indicate that the self-hypnosis intervention was associated with a significant reduction in pain days. Both the proportion of "bad sleep" nights and the use of pain medications also decreased significantly during the self-hypnosis treatment phase. However, participants continued to report disturbed sleep and to require medications on those days during which they did experience pain. Findings further suggest that the overall reduction in pain frequency was due to the elimination of less severe episodes of pain. Non-specific factors may have contributed to the efficacy of treatment. Nevertheless, the program clearly demonstrates that an adjunctive behavioral treatment for sickle cell pain, involving patient self-management and regular contact with a medical self-hypnosis team, can be beneficial in reducing recurrent, unpredictable episodes of pain in a patient population for whom few safe, cost-effective medical alternatives exist.
"The effects of self-hypnosis on quality of life following coronary artery bypass surgery: preliminary results of a prospective, randomized trial."
Ashton, R. C., Jr., G. C. Whitworth, et al. (1995). Journal of Alternative and Complementary Medicine 1(3): 285-90.
The effects of complementary techniques and alternative medicine on allopathic therapies is generating much interest and research. To properly evaluate these techniques, well controlled studies are needed to corroborate the findings espoused by individuals practicing complementary medicine therapies. To this end, we evaluated the role of one of these therapies, self-hypnosis relaxation techniques, in a prospective, randomized trial to study its effects on quality of life after coronary artery bypass surgery. Subjects were randomized to a control group or a study group. Study group patients were taught self-hypnosis relaxation techniques the night prior to surgery. The control group received no such treatment. Patients then underwent routine cardiac management and care. The main endpoint of our study was quality of life, assessed by the Profile of Moods Scale. Results demonstrated that patients undergoing self-hypnosis the night prior to coronary artery bypass surgery were significantly more relaxed than the control group (p = 0.0317). Trends toward improvement were also noted in depression, anger, and fatigue. This study demonstrates the beneficial effects of self-hypnosis relaxation techniques on coronary surgery. This study also identifies endpoints and a study design that can be used to assess complementary medicine therapies. Results of this preliminary investigation are encouraging and demonstrate a need for further well-controlled studies.
"Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study."
Langewitz, W., J. Izakovic, et al. (2005). Psychotherapy and Psychosomatics 74(3): 165-72.
BACKGROUND: Many people suffer from hay fever symptoms. Hypnosis has proved to be a useful adjunct in the treatment of conditions where allergic phenomena have an important role. METHODS: Randomised parallel group study over an observation period of two consecutive pollen seasons. Outcome data include nasal flow under hypnosis, pollinosis symptoms from diaries and retrospective assessments, restrictions in well-being and use of anti-allergic medication. We investigated 79 patients with a mean age of 34 years (range 19-54 years; 41 males), with moderate to severe allergic rhinitis to grass or birch pollen of at least 2 years duration and mild allergic asthma. The intervention consisted of teaching self-hypnosis during a mean of 2.4 sessions (SD 1.7; range 2-5 sessions) and continuation of standard anti-allergic pharmacological treatment. RESULTS: Of 79 randomised patients, 66 completed one, and 52 completed two seasons. Retrospective VAS scores yielded significant improvements in year 1 in patients who had learned self-hypnosis: pollinosis symptoms -29.2 (VAS score, range 0-100; SD 25.4; p < 0.001), restriction of well-being -26.2 (VAS score, range 0-100; SD 28.7; p < 0.001. In year 2, the control group improved significantly having learned self-hypnosis as well: pollinosis symptoms -24.8 (SD 29.1; p < 0.001), restriction of well-being -23.7 (SD 30.0; p < 0.001). Daily self-reports of subjects who learnt self-hypnosis do not show a significant improvement. The hazard ratio of reaching a critical flow of 70% in nasal provocation tests was 0.333 (95% CI 0.157-0.741) after having learnt and applied self-hypnosis.
"Complementary and alternative medicine approaches to pain management."
Tan, G., J. A. Alvarez, et al. (2006). Journal of Clinical Psychology 62(11): 1419-31.
This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and self-hypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment.
"Psychosocial and immune effects of self-hypnosis training for stress management throughout the first semester of medical school."
Whitehouse, W. G., D. F. Dinges, et al. (1996). Psychosomatic Medicine 58(3): 249-63.
This study was a 19-week prospective conducted to determine the effectiveness of a self-hypnosis/relaxation intervention to relieve symptoms of psychological distress and moderate immune system reactivity to examination stress in 35 first-year medical students. Twenty-one subjects were randomly selected for training in the use of self-hypnosis as a coping skill and were encouraged to practice regularly and to maintain daily diary records related to mood, sleep, physical symptoms, and frequency of relaxation practice. An additional 14 subjects received no explicit training in stress-reduction strategies, but completed similar daily diaries. Self-report psychosocial and symptom measures, as well as blood draws, were obtained at four time points: orientation, late semester, examination period, and postsemester recovery. It was found that significant increases in stress and fatigue occurred during the examination period, paralleled by increases in counts of B lymphocytes and activated T lymphocytes, PHA-induced and PWM-induced blastogenesis, and natural killer cell (NK) cytotoxicity. No immune decreases were observed. Subjects in the self-hypnosis condition reported significantly less distress and anxiety than their nonintervention counterparts, but the two groups did not differ with respect to immune function. Nevertheless, within the self-hypnosis group, the quality of the exercises (ie, relaxation ratings) predicted both the number of NK cells and NK activity. It was concluded that stress associated with academic demands affects immune function, but immune suppression is not inevitable. Practice of self-hypnosis reduces distress, without differential immune effects. However, individual responses to the self-hypnosis intervention appear to predict immune outcomes.
Skin Diseases
"Therapeutic management of psychodermatological disorders."
Shenefelt, P. D. (2008). Expert Opin Pharmacother 9(6): 973-85.
BACKGROUND: The skin and the brain interact through psychoneuroimmunoendocrine mechanisms and through behaviors that can strongly influence the initiation or flaring of skin disorders. OBJECTIVE: To obtain knowledge of these factors to assist in designing treatment plans for specific skin disorders. METHODS: Psychocutaneous disease literature for the past 80 years was reviewed. RESULTS/CONCLUSION: Therapeutic options include standard psychotropic drugs and alternative herbs and supplements, the placebo effect, suggestion, cognitive-behavioral methods, biofeedback, and hypnosis. When simple measures fail to produce the desired results, combinations of drugs or addition of nonpharmacological therapies may produce better results. Psychophysiological skin disorders may respond well to nonpharmacological therapies that counteract stress, supplemented when indicated by anxiolytic or antidepressant drugs. Treatment of primary psychiatric disorders that affect the skin often results in improvement of the associated skin disorders. Psychiatric disorders secondary to skin disorders may also require treatment.
"Nonpharmacologic management of common skin and psychocutaneous disorders."
Fried, R. G. and S. H. Hussain (2008). Dermatol Ther 21(1): 60-8.
Data supporting the effectiveness of nonpharmacologic psychocutaneous techniques continues to accumulate. These interventions are used for the treatment of common and psychocutaneous skin conditions. They are most commonly used as adjuncts to traditional therapies. This article will review the data on the effectiveness of hypnosis, biofeedback, psychotherapy, meditation, support groups, guided imagery and progressive muscle relaxation, and psychotherapy.
"Biofeedback, cognitive-behavioral methods, and hypnosis in dermatology: is it all in your mind?"
Shenefelt, P. D. (2003). Dermatol Ther 16(2): 114-22.
Biofeedback can improve cutaneous problems that have an autonomic nervous system component. Examples include biofeedback of galvanic skin resistance (GSR) for hyperhidrosis and biofeedback of skin temperature for Raynaud's disease. Hypnosis may enhance the effects obtained by biofeedback. Cognitive-behavioral methods may resolve dysfunctional thought patterns (cognitive) or actions (behavioral) that damage the skin or interfere with dermatologic therapy. Responsive diseases include acne excoriee, atopic dermatitis, factitious cheilitis, hyperhidrosis, lichen simplex chronicus, needle phobia, neurodermatitis, onychotillomania, prurigo nodularis, trichotillomania, and urticaria. Hypnosis can facilitate aversive therapy and enhance desensitization and other cognitive-behavioral methods. Hypnosis may improve or resolve numerous dermatoses. Examples include acne excoriee, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Hypnosis can also reduce the anxiety and pain associated with dermatologic procedures.
"Hypnosis in dermatology."
Shenefelt, P. D. (2000). Archives of Dermatology 136(3): 393-9.
BACKGROUND: Hypnosis is an alternative or complementary therapy that has been used since ancient times to treat medical and dermatologic problems. OBJECTIVE: To describe the various uses for hypnosis as an alternative or complementary therapy in dermatologic practice. METHODS: A MEDLINE search was conducted from January 1966 through December 1998 on key words related to hypnosis and skin disorders. RESULTS: A wide spectrum of dermatologic disorders may be improved or cured using hypnosis as an alternative or complementary therapy, including acne excoriee, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. CONCLUSION: Appropriately trained clinicians may successfully use hypnosis in selected patients as alternative or complementary therapy for many dermatologic disorders.
"Hypnotherapy as a treatment for atopic dermatitis in adults and children."
Stewart, A. C. and S. E. Thomas (1995). British Journal of Dermatology 132(5): 778-83.
Eighteen adults with extensive atopic dermatitis, resistant to conventional treatment, were treated by hypnotherapy, with statistically significant benefit (P < 0.01) measured both subjectively and objectively, which was maintained at up to 2 years where results were available. Twenty children with severe, resistant atopic dermatitis were treated by hypnosis. All but one showed immediate improvement, which was maintained at the following two clinic appointments. In 12 children, replies to a questionnaire at up to 18 months after treatment, showed that 10 had maintained improvement in itching and scratching, nine in sleep disturbance, and seven maintained improvement in mood.
Smoking Cessation
"Hypnosis for smoking cessation: a randomized trial."
Carmody, T. P., C. Duncan, et al. (2008). Nicotine Tob Res 10(5): 811-8.
The purpose of this study was to determine whether hypnosis would be more effective in helping smokers quit than standard behavioral counseling when both interventions are combined with nicotine patches (NP). A total of 286 current smokers were enrolled in a randomized controlled smoking cessation trial at the San Francisco Veterans Affairs Medical Center. Participants in both treatment conditions were seen for two 60-min sessions, and received three follow-up phone calls and 2 months of NP. At 6 months, 29% of the hypnosis group reported 7-day point-prevalence abstinence compared with 23% of the behavioral counseling group (relative risk [RR] = 1.27; 95% confidence interval, CI 0.84-1.92). Based on biochemical or proxy confirmation, 26% of the participants in the hypnosis group were abstinent at 6 months compared with 18% of the behavioral group (RR = 1.44; 95% CI 0.91-2.30). At 12 months, the self-reported 7-day point-prevalence quit rate was 24% for the hypnosis group and 16% for the behavioral group (RR = 1.47; 95% CI 0.90-2.40). Based on biochemical or proxy confirmation, 20% of the participants in the hypnosis group were abstinent at 12 months compared with 14% of the behavioral group (RR = 1.40; 95% CI 0.81-2.42). Among participants with a history of depression, hypnosis yielded significantly higher validated point-prevalence quit rates at 6 and 12 months than standard treatment. It was concluded that hypnosis combined with NP compares favorably with standard behavioral counseling in generating long-term quit rates.
"Gender-related differences in hypnosis-based treatments for smoking: a follow-up meta-analysis."
Green, J. P., S. J. Lynn, et al. (2008). American Journal of Clinical Hypnosis 50(3): 259-71.
In an earlier meta-analysis of 12 studies using hypnosis-based treatments for smoking cessation, we provided preliminary evidence that males fare better than females when trying to quit smoking (Green, Lynn, & Montgomery, 2006). By excluding studies that reported no gender differences, but failed to report final outcome-statistics-by-gender, our previous conclusion may have overestimated the role of gender in hypnosis-based smoking cessation treatment. In the present analysis, we included 12 additional studies that reported no gender differences, but failed to report final outcome-by-gender statistics. Across each of these studies, we calculated identical success rates for male and female participants and then added these results to our database. Among all 24 groups of participants who completed hypnosis-based treatment for smoking, we found a small but significant effect for male participants being more successful in quitting smoking relative to females. Specific suggestions for tailoring hypnosis smoking cessation programs to take gender differences into account are discussed.
"Intensive hypnotherapy for smoking cessation: a prospective study."
Elkins, G., J. Marcus, et al. (2006). International Journal of Clinical and Experimental Hypnosis 54(3): 303-15.
This study reports on a prospective pilot trial of intensive hypnotherapy for smoking cessation. The hypnotherapy involved multiple individual sessions (8 visits) over approximately 2 months, individualization of hypnotic suggestions, and a supportive therapeutic relationship. Twenty subjects were randomly assigned to either an intensive hypnotherapy condition or to a wait-list control condition. The target quitting date was 1 week after beginning treatment. Patients were evaluated for smoking cessation at the end of treatment and at Weeks 12 and 26. Self-reported abstinence was confirmed by a carbon-monoxide concentration in expired air of 8 ppm or less. The rates of point prevalence smoking cessation, as confirmed by carbon-monoxide measurements for the intensive hypnotherapy group, was 40% at the end of treatment; 60% at 12 weeks, and 40% at 26 weeks (p < .05).
"Clinical hypnosis for smoking cessation: preliminary results of a three-session intervention."
Elkins, G. R. and M. H. Rajab (2004). International Journal of Clinical and Experimental Hypnosis 52(1): 73-81.
This study presents preliminary data regarding hypnosis treatment for smoking cessation in a clinical setting. An individualized, 3-session hypnosis treatment is described. Thirty smokers enrolled in an HMO were referred by their primary physician for treatment. Twenty-one patients returned after an initial consultation and received hypnosis for smoking cessation. At the end of treatment, 81% of those patients reported that they had stopped smoking, and 48% reported abstinence at 12 months posttreatment. Most patients (95%) were satisfied with the treatment they received. Recommendations for future research to empirically evaluate this hypnosis treatment are discussed.
Stress
"Differences in relaxation by means of guided imagery in a healthy community sample."
Watanabe, E., S. Fukuda, et al. (2006). Alternative Therapies in Health and Medicine 12(2): 60-6.
OBJECTIVE: This study investigated differences in relaxation induced by guided imagery in healthy community samples. METHODS: One hundred forty-eight people took part in our investigation. The mean age of the 50 males and 98 females was 39.36 +/- 11.86 years. We took saliva samples to measure salivary cortisol (SC) before the first session, after the first session, and after the second session. Subjects were asked to complete the short form of the Multiple Mood Scale (MMS) questionnaire before the first session and after the second session. The shortened form of Betts' Questionnaire upon Mental Imagery (QMI) was collected once before the first session, and vividness of the imagery was measured using a visual analogue scale once after the second session. RESULTS: SC levels were significantly decreased after the first session and after the second session in all participants. We found, most significantly, that age and QMI scores were strongly related to changes in SC level throughout the relaxation sessions. CONCLUSIONS: Unpleasant information, a cause of mental stress, is replaced by a comfortable image, and this replacement affects a participant's SC level. The greater one's imagery ability is, the more successful the displacement of stress and the shift toward a comfortable mental and emotional state will be. This study provides a basis for explaining the mechanism through which relaxation by means of guided imagery is effective in reducing stress.
"A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health."
Gruzelier, J. H. (2002). Stress 5(2): 147-63.
This review considers psychological interventions involving relaxation and guided imagery targeting immune functions. The review provides evidence of immune control accompanied by reports of enhanced mood and well-being. Three recent investigations of the author and his colleagues with self-hypnosis training incorporating imagery of the immune system are outlined. In two studies, hypnosis buffered the effects of stress on immune functions in medical students at exam time, and the comparison of self-hypnosis with and without immune imagery confirmed advantages to targeted imagery for both immune function and mood, and importantly, fewer winter viral infections. The implications for health were investigated in a third study in patients with virulent and chronic herpes simplex virus-2 HSV-2). Six weeks of training almost halved recurrence, improved mood and reduced levels of clinical depression and anxiety. Immune functions were up-regulated, notably functional natural killer cell activity to HSV-1. Individual differences in hypnotic susceptibility and absorption have typically been found to predict efficacy. New replicable evidence is reviewed of the importance of cognitive activation, a personality difference whose neurophysiological underpinning is consistent with left hemispheric preferential influences over the immune system. Now that the validation of psychological interventions includes advantages for health, this field of enquiry, which has been characterised by modest, small scale, largely preliminary studies, warrants a greater investment in research.
"Psychological treatment for recurrent symptoms of colds and flu in children."
Hewson-Bower, B. and P. D. Drummond (2001). Journal of Psychosomatic Research 51(1): 369-77.
The effect of stress management and relaxation with guided imagery on upper respiratory tract infections (URTIs) was investigated in 45 children with a history of 10 or more infections in the past year. To investigate the influence of psychological treatment on mucosal immunity, secretory immunoglobulin A (sIgA) was measured before and during treatment. The number of symptomatic episodes during 13 weeks of monitoring was similar in treatment and waitlist conditions; however, episodes were shorter in stress management and guided imagery conditions than in the waitlist condition. Levels of sIgA increased toward the end of treatment. These findings were confirmed in a replication study. In addition, symptom reduction and improvements in psychological state persisted at 1-year follow-up. The findings suggest that psychological treatment interrupts a chronic illness cycle in children with symptoms of recurrent URTI.
"Hypnosis as a modulator of cellular immune dysregulation during acute stress."
Kiecolt-Glaser, J. K., P. T. Marucha, et al. (2001). Journal of Consulting and Clinical Psychology 69(4): 674-82.
To assess the influence of a hypnotic intervention on cellular immune function during a commonplace stressful event, the authors selected 33 medical and dental students on the basis of hypnotic susceptibility. Initial blood samples were obtained during a lower stress period, and a second sample was drawn 3 days before the first major exam of the term. Half of the participants were randomly assigned to hypnotic-relaxation training in the interval between samples. Participants in the hypnotic group were, on average, protected from the stress-related decrements that were observed in control participants' proliferative responses to 2 mitogens, percentages of CD3+ and CD4+ T-lymphocytes, and interleukin 1 production by peripheral blood leukocytes. More frequent hypnotic-relaxation practice was associated with higher percentages of CD3+ and CD4+ T-lymphocytes. These data provide encouraging evidence that interventions may reduce the immunological dysregulation associated with acute stressors.
"Cellular and humoral immunity, mood and exam stress: the influences of self-hypnosis and personality predictors."
Gruzelier, J., F. Smith, et al. (2001). International Journal of Psychophysiology 42(1): 55-71.
The effects of self-hypnosis training on immune function and mood were examined in medical students at exam time. Hypnosis involved relaxation and imagery directed at improved immune function and increased energy, alertness and concentration. Hypotheses were made about activated and withdrawn personality differences. Eight high and eight low hypnotically susceptible participants were given 10 sessions of hypnosis, one live and nine tape-recorded, and were compared with control subjects (N=12). CD3, CD4, CD8, CD19 and CD56 NK cells and blood cortisol were assayed. Life-style, activated vs. withdrawn temperament, arousal and anxiety questionnaires were administered. Self-hypnosis buffered the decline found in controls in NK (P<0.002) and CD8 cells (P<0.0.07) and CD8/CD4% (P<0.06) (45-35% order of magnitude differences) while there was an increase in cortisol (P<0.05). The change in NK cell counts correlated positively with changes in both CD8 cells and cortisol. Results were independent of changes in life-style. Energy ratings were higher after hypnosis (P<0.01), and increased calmness with hypnosis correlated with an increase in CD4 counts (P<0.01). The activated temperament, notably the cognitive subscale (speaking and thinking quickly), was predictive of exam levels of T and B lymphocytes (P&z.Lt;0.08-P<0.02), and reaching r=0.72 (P<0.001) in the non-intervention control group. The sizeable influences on cell-mediated immunity achieved by a relatively brief, low cost psychological intervention in the face of a compelling, but routine, stress in young, healthy adults have implications for illness prevention and for patients with compromised immunity.
"Psychoneuroimmunology: can psychological interventions modulate immunity?"
Kiecolt-Glaser, J. K. and R. Glaser (1992). Journal of Consulting and Clinical Psychology 60(4): 569-75.
There is ample evidence from human and animal studies demonstrating the downward modulation of immune function concomitant with a variety of stressors. As a consequence, the possible enhancement of immune function by behavioral strategies has generated considerable interest. Researchers have used a number of diverse strategies to modulate immune function, including relaxation, hypnosis, exercise, classical conditioning, self-disclosure, exposure to a phobic stressor to enhance perceived coping self-efficacy, and cognitive-behavioral interventions, and these interventions have generally produced positive changes. Although it is not yet clear to what extent these positive immunological changes translate into any concrete improvements in relevant aspects of health, that is, alterations in the incidence, severity, or duration of infectious or malignant disease, the preliminary evidence is promising.
Stroke
"Mental practice in chronic stroke: results of a randomized, placebo-controlled trial."
Page, S. J., P. Levine, et al. (2007). Stroke 38(4): 1293-7.
BACKGROUND AND PURPOSE: Mental practice (MP) of a particular motor skill has repeatedly been shown to activate the same musculature and neural areas as physical practice of the skill. Pilot study results suggest that a rehabilitation program incorporating MP of valued motor skills in chronic stroke patients provides sufficient repetitive practice to increase affected arm use and function. This Phase 2 study compared efficacy of a rehabilitation program incorporating MP of specific arm movements to a placebo condition using randomized controlled methods and an appropriate sample size. Method- Thirty-two chronic stroke patients (mean=3.6 years) with moderate motor deficits received 30-minute therapy sessions occurring 2 days/week for 6 weeks, and emphasizing activities of daily living. Subjects randomly assigned to the experimental condition also received 30-minute MP sessions provided directly after therapy requiring daily MP of the activities of daily living; subjects assigned to the control group received the same amount of therapist interaction as the experimental group, and a sham intervention directly after therapy, consisting of relaxation. Outcomes were evaluated by a blinded rater using the Action Research Arm test and the upper extremity section of the Fugl-Meyer Assessment. RESULTS: No pre-existing group differences were found on any demographic variable or movement scale. Subjects receiving MP showed significant reductions in affected arm impairment and significant increases in daily arm function (both at the P<0.0001 level). Only patients in the group receiving MP exhibited new ability to perform valued activities. CONCLUSIONS: The results support the efficacy of programs incorporating mental practice for rehabilitating affected arm motor function in patients with chronic stroke. These changes are clinically significant.
"A randomized efficacy and feasibility study of imagery in acute stroke."
Page, S. J., P. Levine, et al. (2001). Clinical Rehabilitation 15(3): 233-40.
OBJECTIVE: To compare the feasibility and efficacy of a programme combining imagery and occupational therapy with a programme of therapy only. DESIGN: Randomized, controlled case series. SETTING: Subacute outpatient clinic. SUBJECTS: Thirteen consecutively admitted patients between four weeks and one year post stroke exhibiting stable motor deficits in their affected upper limbs. INTERVENTION: All patients received an hour of therapy three times a week for six weeks administered by the same physical and occupational therapists. During the same period, eight patients participated in 10-minute guided imagery sessions after each therapy session, as well as practising imagery at home twice each week. Five patients participated in a control intervention consisting of exposure to stroke information. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer) and Action Research Arm Test (ARA). RESULTS: After intervention, Fugl-Meyer and ARA scores of patients in the therapy only group remained virtually the same; therapy plus imagery group scores improved by 13.8 and 16.4 points, respectively, on the Fugl-Meyer and ARA. CONCLUSIONS: Imagery is a clinically feasible, cost-effective complement to therapy that may improve outcomes more than participation in therapy only.
"Pushing the limits of recovery: hypnotherapy with a stroke patient."
Holroyd, J. and A. Hill (1989). Int J Clin Exp Hypn 37(2): 120-8.
Hypnotherapy was used to assist recovery of left arm function following stroke in a 66-year-old woman. Treatment protocol is described, and results are discussed in terms of how hypnosis may facilitate voluntary motor movement. Recent literature on cortical changes in hypnosis and motor improvement during hypnosis is discussed in relation to the present results.
"Hypnotherapy in the rehabilitation of a stroke victim: a case study."
Manganiello, A. J. (1986). Am J Clin Hypn 29(1): 64-8.
"Gene expression and brain plasticity in stroke rehabilitation: a personal memoir of mind-body healing dreams."
Rossi, E. L. (2004). Am J Clin Hypn 46(3): 215-27.
In this personal memoir the author describes the progress of his rehabilitation from a stroke and the dream manifestations of his mind-body healing. He also shares his reminiscences about Erickson's physical difficulties as well as Erickson's naturalistic or activity-dependent approach to therapeutic hypnosis and rehabilitation and emphasizes what he considers the least understood and most under appreciated aspect of Erickson's hypnotherapy--the fact that his patients frequently experienced intense emotional experiences as they accessed and replayed their traumas in a therapeutic manner. He also speculates about the neural mechanisms of his healing from the standpoint of his new neuroscience theory which includes the novelty-numinosum-neurogenesis effect.
Surgery
"Presurgical stress management improves postoperative immune function in men with prostate cancer undergoing radical prostatectomy."
Cohen, L., P. A. Parker, et al. Psychosomatic Medicine 73(3): 218-25.
OBJECTIVE: To assess whether stress management (SM) improved immune outcomes in men undergoing surgery for prostate cancer. METHODS: A total of 159 men were assigned randomly to a two-session presurgical SM intervention, a two-session supportive attention (SA) group, or a standard care (SC) group. Men in the SM group discussed their concerns about the upcoming surgery and were taught diaphragmatic breathing, guided imagery; they had an imaginal exposure to the day of surgery and learned adaptive coping skills. Men in the SA group discussed their concerns about the upcoming surgery and had a semistructured medical interview. Blood samples were collected at baseline (1 month before surgery) and 48 hours after surgery. Measures of mood (Profile of Mood States) were collected at baseline, 1 week pre surgery, and the morning of surgery. RESULTS: Men in the SM group had significantly higher levels of natural killer cell cytotoxicity (p = .04) and higher levels of circulating proinflammatory cytokines (interleukin [IL]-12p70, p = .02; IL-1beta, p = .02; tumor necrosis factor-alpha, p = .05) 48 hours post surgery than men in the SA group and higher levels of natural killer cell cytotoxicity (p = 0.02) and IL-1beta (p = .05) than men in the SC group. Immune parameters increased for the SM group and decreased or stayed the same for the SA and SC groups. The SM group had significantly lower Profile of Mood States scores than the SC group (p = .006), with no other group differences between SA and SC groups. Changes in mood were not associated with immune outcomes. CONCLUSIONS: The finding that SM leads to decreased presurgical mood-disturbance and increased immune parameters after surgery reveals the potential psychological and biological benefits of presurgical SM.
"Hypnosis as sole anesthesia for major surgeries: historical & contemporary perspectives."
Hammond, D. C. (2008). American Journal of Clinical Hypnosis 51(2): 101-21.
Hypnosis is a well validated treatment for acute and chronic pain (Montgomery, DuHamel, & Redd, 2000). It has been found capable of reducing inflammation, altering blood flow, and producing beneficial effects when hypnotic suggestions are provided during and prior to surgery (Frederick, 2001) and other painful medical procedures. This paper quotes extensively from historical examples of the use of hypnosis (mesmerism) as the sole anesthesia for major surgeries in the 1800's. These historic examples by themselves provide powerful documentation of the ability of the mind to influence the body, but they are then followed by a review of contemporary literature and controlled research on the use in hypnosis in relation to surgery and prior to medical procedures.
"Hypnosis decreases presurgical distress in excisional breast biopsy patients."
Schnur, J. B., D. H. Bovbjerg, et al. (2008). Anesthesia and Analgesia 106(2): 440-4, table of contents.
BACKGROUND: Excisional breast biopsy is associated with presurgical psychological distress. Such distress is emotionally taxing, and may have negative implications for postsurgical side effects and satisfaction with anesthesia. We investigated the ability of a brief hypnosis session to reduce presurgical psychological distress in excisional breast biopsy patients. METHODS: Ninety patients presenting for excisional breast biopsy were randomly assigned to receive either a 15-minute presurgery hypnosis session (n = 49, mean age: 46.4 (95% CI: 42.3-50.4)) or a 15-minute presurgery attention control session (n = 41, mean age: 45.0 (95% CI: 40.8-49.2)). The hypnosis session involved suggestions for increased relaxation and decreased distress. The attention control session involved nondirective empathic listening. Presurgery distress was measured using visual analog scales (VAS) and the short version of the Profile of Mood States (SV-POMS). Data were analyzed using analysis of variance and chi2 procedures. RESULTS: Groups did not differ in terms of the following: demographics (age, education, ethnicity, marital status, all P's > 0.28); medical variables (presurgery diagnosis, previous excisional biopsy, previous breast cancer, all P's > 0.11); or preintervention distress (SV-POMS P > 0.74) assessed on the day of surgery. Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS emotional upset (16.5 vs 38.2, P < 0.0001, d = .85), VAS depressed mood (6.6 vs 19.9, P < 0.02, d = .67), and SV-POMS anxiety (10.0 vs 5.0, P < 0.0001, d = 0.85); and significantly higher levels for VAS relaxation (75.7 vs 54.2, P < 0.001, d = -0.76) than attention controls. CONCLUSIONS: The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical distress in women awaiting diagnostic breast cancer surgery.
"Clinical hypnosis for reduction of atrial fibrillation after coronary artery bypass graft surgery."
Novoa, R. and T. Hammonds (2008). Cleveland Clinic Journal of Medicine 75 Suppl 2: S44-7.
The belief that postoperative atrial fibrillation (PAF) results from transient autonomic dysfunction suggests that interventions such as clinical hypnosis may reduce the incidence of PAF. To explore this hypothesis, we retrospectively compared outcomes between two groups of patients undergoing coronary artery bypass graft surgery: 50 consecutive patients who received preoperative hypnoidal explanation of the surgical procedure and 50 case-matched historical controls who received no clinical hypnosis. The patients who received hypnosis were significantly less likely to experience an episode of PAF (P = .003) and showed nonsignificant trends toward superior outcomes in terms of length of stay, narcotic use, and total hospital charges. Our findings indicate that prospective randomized trials are warranted to further delineate the potential benefit of clinical hypnosis for prevention of PAF.
"Hypnosis to alleviate perioperative anxiety and stress: a journey to challenge ideas."
Fern, P. A. (2008). J Perioper Pract 18(1): 14-6.
Mention the possibility of surgery to a patient and most will react with a feeling of apprehension at best. Some will be horrified at the mere thought of being 'cut open'. For others, it will be the suggestion of entering a hospital for anything longer than an out patient appointment. Newspaper reports of healthcare-acquired infections (HAIs) may spring to mind: 'Will I leave with more than I came in for?'; 'What if it goes wrong?'; 'Who will look after the family?'. All this worrying leads to increased anxiety and stress, and the patient has not even been put on the waiting list yet, let alone been admitted.
"Hypnosis and surgery: past, present, and future."
Wobst, A. H. (2007). Anesthesia and Analgesia 104(5): 1199-208.
Hypnosis has been defined as the induction of a subjective state in which alterations of perception or memory can be elicited by suggestion. Ever since the first public demonstrations of "animal magnetism" by Mesmer in the 18th century, the use of this psychological tool has fascinated the medical community and public alike. The application of hypnosis to alter pain perception and memory dates back centuries. Yet little progress has been made to fully comprehend or appreciate its potential compared to the pharmacologic advances in anesthesiology. Recently, hypnosis has aroused interest, as hypnosis seems to complement and possibly enhance conscious sedation. Contemporary clinical investigators claim that the combination of analgesia and hypnosis is superior to conventional pharmacologic anesthesia for minor surgical cases, with patients and surgeons responding favorably. Simultaneously, basic research of pain pathways involving the nociceptive flexion reflex and positron emission tomography has yielded objective data regarding the physiologic correlates of hypnosis. In this article I review the history, basic scientific and clinical studies, and modern practical considerations of one of the oldest therapeutical tools: the power of suggestion.
"A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients."
Montgomery, G. H., D. H. Bovbjerg, et al. (2007). Journal of the National Cancer Institute 99(17): 1304-12.
BACKGROUND: Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective. METHODS: We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control). Patients were not blinded to group assignment. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0-100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review. RESULTS: Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 microg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). No statistically significant differences were seen in the use of fentanyl, midazolam, or recovery room analgesics. Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time. CONCLUSIONS: Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.
"Hypnosis before breast cancer surgery eases pain, cuts costs."
(2007). Harvard Womens Health Watch 15(3): 6.
"Hypnosis reduces preoperative anxiety in adult patients."
Saadat, H., J. Drummond-Lewis, et al. (2006). Anesthesia and Analgesia 102(5): 1394-6.
In this study we examined the effect of hypnosis on preoperative anxiety. Subjects were randomized into 3 groups, a hypnosis group (n = 26) who received suggestions of well-being; an attention-control group (n = 26) who received attentive listening and support without any specific hypnotic suggestions and a "standard of care" control group (n = 24). Anxiety was measured pre- and postintervention as well as on entrance to the operating rooms. We found that patients in the hypnosis group were significantly less anxious postintervention as compared with patients in the attention-control group and the control group (31 +/- 8 versus 37 +/- 9 versus 41 +/- 11, analysis of variance, P = 0.008). Moreover, on entrance to the operating rooms, the hypnosis group reported a significant decrease of 56% in their anxiety level whereas the attention-control group reported an increase of 10% in anxiety and the control group reported an increase of 47% in their anxiety (P = 0.001). In conclusion, we found that hypnosis significantly alleviates preoperative anxiety. Future studies are indicated to examine the effects of preoperative hypnosis on postoperative outcomes.
"Premedication in children: hypnosis versus midazolam."
Calipel, S., M. M. Lucas-Polomeni, et al. (2005). Paediatric Anaesthesia 15(4): 275-81.
BACKGROUND: The main objectives of premedication in children are to facilitate the separation from the parents, to reduce preoperative anxiety, to smooth the induction of anesthesia and to lower the risk of postoperative behavioral disorders. The most common technique is sedative premedication with midazolam. Hypnosis enables a state of relaxation to be achieved and has never been evaluated as a premedication technique. The aim of the present study was to evaluate the efficacy of hypnosis on anxiety and perioperative behavioral disorders versus midazolam. METHODS: Fifty children from 2 to 11 years of age were randomized into two groups: group H received hypnosis as premedication; group M were given 0.5 mg x kg(-1) midazolam orally, 30 min before surgery. Preoperative anxiety was evaluated using the Modified Yale Preoperative Anxiety Scale (mYPAS) score when arriving in the department (T1), when entering the operating room (T2), and when fitting the facemask (T3). Postoperative behavioral disorders were evaluated using the Posthospitalization Behavioral Questionnaire (PHBQ) at days 1, 7 and 14. RESULTS: The two groups showed no significant difference preoperatively with the PHBQ: (M) 21 (17-25) vs (H) 20 (8-25) and mYPAS score: (M) 28 (23-75) vs (H) 23 (23-78). The number of anxious children was less during induction of anesthesia in the hypnosis group (T3: 39% vs 68%) (P < 0.05). Postoperatively, hypnosis reduced the frequency of behavior disorders approximately by half on day 1 (30% vs 62%) and day 7 (26% vs 59%). CONCLUSIONS: Hypnosis seems effective as premedication in children scheduled for surgery. It alleviates preoperative anxiety, especially during induction of anesthesia and reduces behavioral disorders during the first postoperative week.
"Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial."
Ginandes, C., P. Brooks, et al. (2003). American Journal of Clinical Hypnosis 45(4): 333-51.
Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing. The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants' group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants' subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36). Analysis of variance showed the hypnosis group's objectively observed wound healing to be significantly greater than the other two groups', p < .001, through 7 postoperative weeks; standard care controls showed the smallest degree of healing. In addition, at both the 1 and 7 week post-surgical observation intervals, one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls, p < 0.02. The mean scores of the subjective assessments of postoperative pain, incision healing and functional recovery trended similarly. Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.
"Guided imagery in cardiac surgery."
Halpin, L. S., A. M. Speir, et al. (2002). Outcomes Manag 6(3): 132-7.
Clinical research has demonstrated that guided imagery, a simple form of relaxation, can reduce preoperative anxiety and postoperative pain among patients undergoing surgical procedures. In 1998, the cardiac surgery team implemented a guided imagery program to compare cardiac surgical outcomes between two groups of patients: with and without guided imagery. Data from the hospital financial cost/accounting database and patient satisfaction data were collected and matched to the two groups of patients. A questionnaire was developed to assess the benefits of the guided imagery program to those who elected to participate in it. Patients who completed the guided imagery program had a shorter average length of stay, a decrease in average direct pharmacy costs, and a decrease in average direct pain medication costs while maintaining high overall patient satisfaction with the care and treatment provided. Guided imagery is now considered a complementary means to reduce anxiety, pain, and length of stay among our cardiac surgery patients.
"Empowering the patient: hypnosis in the management of cancer, surgical disease and chronic pain."
Lynch, D. F., Jr. (1999). American Journal of Clinical Hypnosis 42(2): 122-30.
In the past decade, the increasing acceptance of hypnosis as a therapeutic adjunct by physicians and health care professionals both within and outside of the mental health community has resulted in broader use of the technique with patients in both hospital and outpatient settings. In our recent experiences with urologic patients, our staff has found that many bring a surprisingly sophisticated knowledge of clinical hypnosis to the office and often have had experience with some form of therapeutic hypnosis prior to consulting us. Consequently, we find we often encounter a surprising openness to the use of hypnosis as a part of the treatment programs we employ. As a result we have been able to utilize clinical hypnosis successfully in several treatment areas to the benefit of our patients. This paper will describe several programs in place at our practice which utilize clinical hypnosis as an adjunct to treatment.
"Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts. A prospective, randomized and blinded study."
Enqvist, B., C. Bjorklund, et al. (1997). Acta Anaesthesiologica Scandinavica 41(8): 1028-32.
BACKGROUND: Postoperative nausea and vomiting (PONV) after general anesthesia and surgery may have an incidence as high as 70% irrespective of antiemetic drug therapy. The use of preoperative hypnosis and mental preparation by means of an audio tape was investigated in the prophylaxis of nausea and vomiting before elective breast reduction surgery. Similar interventions have not been found in the literature. METHODS: Fifty women were randomized to a control group or a hypnosis group; the latter listened to an audio tape daily 4-6 days prior to surgery. A hypnotic induction was followed by suggestions as to how to relax and experience states incompatible with nausea and vomiting postoperatively (e.g. thirst and hunger). There was a training part on the tape where the patients were asked to rehearse their own model for stress reduction. Premedication and anesthetic procedures were standardized. RESULTS: Patients in the hypnosis group had significantly less vomiting, 39% compared to 68% in the control group, less nausea and less need of analgesics postoperatively. CONCLUSIONS: Preoperative relaxation and/or hypnotic techniques in breast surgery contribute to a reduction of both PONV and postoperative analgesic requirements.
"Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial."
Ashton, C., Jr., G. C. Whitworth, et al. (1997). Journal of Cardiovascular Surgery 38(1): 69-75.
OBJECTIVE: The role of complementary medicine techniques has generated increasing interest in today's society. The purpose of our study was to evaluate the effects of one technique, self-hypnosis, and its role in coronary artery bypass surgery. We hypotesize that self-hypnosis relaxation techniques will have a positive effect on the patient's mental and physical condition following coronary artery bypass surgery. EXPERIMENTAL DESIGN: A prospective, randomized trial was conducted. Patients were followed beginning one day prior to surgery until the time of discharge from the hospital. SETTING: The study was conducted at Columbia Presbyterian Medical Center, a large tertiary care teaching institution. PATIENTS: All patients undergoing first-time elective coronary artery bypass surgery were eligible. A total of 32 patients were randomized into two groups. INTERVENTIONS: The study group was taught self-hypnosis relaxation techniques preoperatively, with no therapy in the control group. MEASURES: Outcome variables studied included anesthetic requirements, operative parameters, postoperative pain medication requirements, quality of life, hospital stay, major morbidity and mortality. RESULTS: Patients who were taught self-hypnosis relaxation techniques were significantly more relaxed postoperatively compared to the control group (p=0.032). Pain medication requirements were also significantly less in patients practising the self-hypnosis relaxation techniques that those who were noncompliant (p=0.046). No differences were noted in intraoperative parameters, morbidity or mortality. CONCLUSION: This study demonstrates the beneficial effects self-hypnosis relaxation techniques on patients undergoing coronary artery bypass surgery. It also provides a framework to study complementary techniques and the limitations encountered.
"Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery."
Tusek, D. L., J. M. Church, et al. (1997). Diseases of the Colon and Rectum 40(2): 172-8.
PURPOSE: Guided imagery uses the power of thought to influence psychologic and physiologic states. Some studies have shown that guided imagery can decrease anxiety, analgesic requirements, and length of stay for surgical patients. This study was designed to determine whether guided imagery in the perioperative period could improve the outcome of colorectal surgery patients. METHODS: We conducted a prospective, randomized trial of patients undergoing their first elective colorectal surgery at a tertiary care center. Patients were randomly assigned into one of two groups. Group 1 received standard perioperative care, and Group 2 listened to a guided imagery tape three days preoperatively; a music-only tape during induction, during surgery, and postoperatively in the recovery room; a guided imagery tape during each of the first six postoperative days. Both groups had postoperative patient-controlled analgesia. All patients rated their levels of pain and anxiety daily, on a linear analog scale of 0 to 100. Total narcotic consumption, time to first bowel movement, length of stay, and number of patients with complications were also recorded. RESULTS: Groups were similar in age and gender distribution, diagnoses, and surgery performed. Median baseline anxiety score was 75 in both groups. Before surgery, anxiety increased in the control group but decreased in the guided imagery group (median change, 30; P < 0.001). Postoperatively, median increase in the worst pain score was 72.5 for the control group and 42.5 for the imagery group (P < 0.001). Least pain was also significantly different (P < 0.001), with a median increase of 30 for controls and 12.5 for the imagery group. Total opioid requirements were significantly lower in the imagery group, with a median of 185 mg vs. 326 mg in the control group (P < 0.001). Time to first bowel movement was significantly less in the imagery group (median, 58 hours) than in the control group (median, 92 hours; P < 0.001). The number of patients experiencing postoperative complications (nausea, vomiting, pruritus, or ileus) did not differ in the two groups. CONCLUSION: Guided imagery significantly reduces postoperative anxiety, pain, and narcotic requirements of colorectal surgery and increases patient satisfaction. Guided imagery is a simple and low-cost adjunct in the care of patients undergoing elective colorectal surgery.
"Hypnosis as adjunct therapy in conscious sedation for plastic surgery."
Faymonville, M. E., J. Fissette, et al. (1995). Regional Anesthesia 20(2): 145-51.
BACKGROUND AND OBJECTIVES. Sedation is often requested during local and regional anesthesia. However, some surgical procedures, such as plastic surgery, require conscious sedation, which may be difficult to achieve. Hypnosis, used routinely to provide conscious sedation in the authors' Department of Plastic Surgery, results in high patient and surgeon satisfaction. The authors conducted a retrospective study to investigate the benefits of hypnosis in supplementing local anesthesia. METHODS. The study included 337 patients undergoing minor and major plastic surgical procedures under local anesthesia and conscious intravenous sedation. Patients were divided into three groups depending on the sedation technique: intravenous sedation (n = 137) using only midazolam and alfentanil; hypnosis (n = 172), during which patients achieved a hypnotic trance level with age regression; and relaxation (n = 28), comprising patients in whom hypnosis was induced without attaining a trance level. In all three groups, midazolam and alfentanil were titrated to achieve patient immobility, in response to patient complaints, and to maintain hemodynamic stability. Midazolam and alfentanil requirements; intra- and postoperative pain scores; as well as pre-, intra-, and postoperative anxiety score, reported on a 10-cm visual analog scale, were recorded and compared in the three groups. RESULTS. Intraoperative anxiety reported by patients in the hypnosis group (0.7 +/- 0.11) and in the relaxation group (2.08 +/- 0.4) was significantly (P < .001) less than in the intravenous sedation group (5.6 +/- 1.6). Pain scores during surgery were significantly greater in the intravenous sedation group (4.9 +/- 0.6) than in the hypnosis group (1.36 +/- 0.12; P < .001) and the relaxation group (1.82 +/- 0.6; P < .01). Furthermore, midazolam requirements were significantly lower in the hypnosis group (P < .001) and in the relaxation group (P < .01) as compared with the intravenous sedation group: respectively, 0.04 +/- 0.002, 0.07 +/- 0.005, and 0.11 +/- 0.01 mg/kg/h. Alfentanil requirements were significantly decreased in the hypnosis group, as compared with the intravenous sedation group: 10.2 +/- 0.6 microgram/kg/h versus 15.5 +/- 2.07 micrograms/kg/h; P < .002. In the relaxation group, alfentanil requirements were 14.3 +/- 1.5 micrograms/kg/h (ns). Postoperative nausea and vomiting were reported by 1.2% of patients in the hypnosis group, 12.8% in the relaxation group and 26.7% in the intravenous sedation group. Greater patient satisfaction with the anesthetic procedure and greater surgical comfort were also reported in the hypnosis group. CONCLUSIONS. Successful hypnosis as an adjunct sedation procedure to conscious intravenous sedation provided better pain and anxiety relief than conventional intravenous sedation and allowed for a significant reduction in midazolam and alfentanil requirements. Patient satisfaction was significantly improved.
"Effect of preoperative suggestion on postoperative gastrointestinal motility."
Disbrow, E. A., H. L. Bennett, et al. (1993). Western Journal of Medicine 158(5): 488-92.
Autonomic behavior is subject to direct suggestion. We found that patients undergoing major operations benefit more from instruction than from information and reassurance. We compared the return of intestinal function after intra-abdominal operations in 2 groups of patients: the suggestion group received specific instructions for the early return of gastrointestinal motility, and the control group received an equal-length interview offering reassurance and nonspecific instructions. The suggestion group had a significantly shorter average time to the return of intestinal motility, 2.6 versus 4.1 days. Time to discharge was 6.5 versus 8.1 days. Covariates including duration of operation, amount of intraoperative bowel manipulation, and amount of postoperative narcotics were also examined using the statistical model analysis of covariance. An average savings of $1,200 per patient resulted from this simple 5-minute intervention. In summary, the use of specific physiologically active suggestions given preoperatively in a beleivable manner can reduce the morbidity associated with an intra-abdominal operation by reducing the duration of ileus.
Test Anxiety
"Using hypnotherapy to overcome examination anxiety."
Stanton, H. E. (1993). American Journal of Clinical Hypnosis 35(3): 198-204.
Eleven medical practitioners who had previously failed their fellowship examinations sought assistance in combating the anxiety that they felt had been responsible for their lack of success. They were seen individually for two, 50-minute sessions of hypnotherapeutic training designed to engender an increased confidence in their ability to overcome examination anxiety. Two outcome measures were used: the actual examination result and a face-valid attitude scale, the Examination Anxiety Thermometer. On the first of these, 10 of the 11 practitioners recorded passes, whereas on the second, 9 indicated an attitude change toward lower levels of test anxiety. Attention is drawn to the minimal expenditure of time involved in the treatment and the generalizability of the hypnotherapeutic technique to other areas of the practitioners' lives.
"Effects of anxiety-reducing hypnotic training on learning and reading-comprehension tasks."
Johnson, R. L. and H. C. Johnson (1984). Journal of the National Medical Association 76(3): 233-5.
"A simple hypnotic approach to treat test anxiety in medical students and residents."
Hebert, S. W. (1984). Journal of Medical Education 59(10): 841-2.
"Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy [RSDH]."
Boutin, G. E. and D. J. Tosi (1983). Journal of Clinical Psychology 39(3): 382-91.
Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis and vivid-emotive-imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at post-treatment or at follow-up.
Tinnitus
"Ericksonian hypnosis in tinnitus therapy: effects of a 28-day inpatient multimodal treatment concept measured by Tinnitus-Questionnaire and Health Survey SF-36."
Ross, U. H., O. Lange, et al. (2007). European Archives of Oto-Rhino-Laryngology 264(5): 483-8.
For the first time, the therapeutic effects on subacute and chronic tinnitus of an inpatient multimodal treatment concept based on principles of Ericksonian hypnosis (EH) were examined by standardized criteria of the Tinnitus Questionnaire (TQ) and Health Survey (SF-36) within a controlled prospective, longitudinal study. A total of 393 patients were treated within an inpatient closed-group 28-day-setting based on a resource-oriented, hypnotherapeutic concept. The severity of tinnitus was assessed by TQ at times of admission, discharge and also at a 6- and 12-month follow-up. Health-related quality of life was evaluated before and after therapy using the SF-36. After therapy, a decrease in TQ score was seen in 90.5% of the patients with subacute tinnitus and in 88,3% of those with chronic tinnitus. Assessment of the TQ score at the end of therapy revealed highly significant improvements of 15.9/14.1 points in mean. Effect sizes in the treatment groups (0.94/0.80) were superior to those in the waiting-list controls (0.14/0.23). The TQ score remained stable in the follow-up controls. Significant improvement in health-related quality of life has been observed within the treatment groups depending on initial level of tinnitus serverity I-IV according to TQ. Using a multimodal treatment concept with emphasis on resource-activating approaches of EH the annoyance of tinnitus can be significantly reduced while health-related quality of life is enhanced within a comparatively short treatment period of 28 days.
"Ericksonian hypnosis in tinnitus therapy."
Maudoux, A., S. Bonnet, et al. (2007). B-ENT 3 Suppl 7: 75-7.
OBJECTIVE: To evaluate the effect of Ericksonian therapy on tinnitus STUDY DESIGN: Non-randomised, prospective longitudinal study. SETTING: Tertiary referral centre. PATIENTS: A total of 49 patients underwent hypnosis therapy. Fourteen patients failed to finish the therapy (drop-out rate: 35%). Of the 35 patients who completed the therapy, 20 were male and 15 female. The average age was 46.3 years (range 17-78). INTERVENTION: The treatment is based on the principles and approaches of Ericksonian hypnosis. The first session was mainly dedicated to the evaluation of the impact of tinnitus on the patient's life and to an explanation of hypnosis therapy. The next sessions were "learning sessions" based on relaxation and mental imaging. Exercises were first based on all senses other than hearing. Then they focused on hearing, teaching patients how to modulate sound intensity, and finally how to modulate tinnitus intensity. Patients also learnt self-hypnosis. MAIN OUTCOME MEASURE(S): To evaluate the effect of the treatment, tinnitus was assessed with the Tinnitus Handicap Inventory questionnaire before and after the therapy. Results: After 5 to 10 sessions (mean: 8.09 + -1.92) of Ericksonian hypnosis therapy, the 35 patients were capable of self-hypnosis with the aim of modulating their tinnitus, and the measured THI score fell for all patients. The global score improved significantly from 60:23 before EH therapy to 16.9 at discharge. Within the group, the initial score was distributed as follows: 0% slight, 14% mild, 31% moderate, 31% severe and 23% catastrophic. The t-test for dependent variables revealed significant improvements in all subgroups (p < or = 0.005). CONCLUSIONS: The results of this clinical trial demonstrate that Ericksonian hypnosis, in particular using self-hypnosis, is a promising technique for treating patients with tinnitus.
"Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus."
Attias, J., Z. Shemesh, et al. (1993). Audiology 32(3): 205-12.
The efficacy of self-hypnosis (SH), masking (MA) and attentiveness to the patient's complaints (AT) in the alleviation of tinnitus was evaluated. Forty-five male patients close in age with chronic tinnitus related to acoustic trauma were assigned to three matched subgroups: SH, AT or MA. The therapeutic stimuli in the SH and MA sessions, recorded on audio cassettes, were given to the patients for use when needed. SH significantly reduced the tinnitus severity; AT partially relieved the tinnitus; MA did not have any significant effect.
Tourette Syndrome
"Nonpharmacological treatment of tics in Tourette syndrome adding videotape training to self-hypnosis."
Lazarus, J. E. and S. K. Klein. (2010) Journal of Developmental and Behavioral Pediatrics 31(6): 498-504.
OBJECTIVE: This case series examines the practicality of using a standardized method of training children in self-hypnosis (SH) methods to explore its efficiency and short-term efficacy in treating tics in patients with Tourette syndrome. METHODS: The files of 37 children and adolescents with Tourette syndrome referred for SH training were reviewed, yielding 33 patients for analysis. As part of a protocol for SH training, all viewed a videotape series of a boy undergoing SH training for tic control. Improvement in tic control was abstracted from subjective patient report. RESULTS: Seventy-nine percent of the patients trained in this technique experienced short-term clinical response, defined as control over the average 6-week follow-up period. Of the responders, 46% achieved tic control with SH after only 2 sessions and 96% after 3 visits. One patient required 4 visits. CONCLUSIONS: Instruction in SH, aided by the use of videotape training, augments a protocol and probably shortens the time of training in this technique. If SH is made more accessible in this way, it will be a valuable addition to multi-disciplinary management of tic disorders in Tourette syndrome.
"Elucidating Tourette's syndrome: perspectives from hypnosis, attention and self-regulation."
Raz, A., S. Keller, et al. (2007). American Journal of Clinical Hypnosis 49(4): 289-309.
Biological psychiatry favors drug treatment over non-pharmacological intervention and shapes the way clinicians both treat and understand Tourette's Syndrome (TS). However, drug treatments for TS involve side effects and are potentially toxic to the central nervous system. Moreover, current pharmacological treatments are largely ineffective and at best only provide a modest symptom reduction. In this paper, we describe how non-pharmacological treatments such as focused attention can modulate, reduce, or indeed entirely eliminate the symptoms of TS as well as elucidate the underlying neural mechanisms. Showing that the symptoms of TS are susceptible to self-regulatory interventions such as hypnosis, we propose that attentional training could be used to both treat the disorder and better understand it.
"A four-step hypnotherapy model for Gilles de la Tourette's syndrome."
Culbertson, F. M. (1989). American Journal of Clinical Hypnosis 31(4): 252-6.
Hypnotherapy may sometimes be helpful in ameliorating the behavioral characteristics of Tourette's Syndrome. This paper presents a case study of an adolescent male with Tourette's Syndrome who was referred by his physician for hypnotherapy for his disorder. A four-step treatment model involved progressive relaxation, finger-tip temperature feedback using a biotic finger band, Spiegel's eye-roll procedure, and imagery. The adolescent was in treatment for nine sessions, from October 1985 to March 1986, a period of 6 months. At the end of the nine sessions, his tics and vocalizations were minimal to nonexistent and he was discharged. A follow-up report 6 months later indicated that he had applied for the Air Force and had been accepted with no mention of Tourette's Syndrome as an issue during his Air Force examination.
Warts
"Hypnotherapy for warts (verruca vulgaris): 41 consecutive cases with 33 cures."
Ewin, D. M. (1992). American Journal of Clinical Hypnosis 35(1): 1-10.
Published, controlled studies of the use of hypnosis to cure warts are confined to using direct suggestion in hypnosis (DSIH), with cure rates of 27% to 55%. Prepubertal children respond to DSIH almost without exception, but adults often do not. Clinically, many adults who fail to respond to DSIH will heal with individual hypnoanalytic techniques that cannot be tested against controls. By using hypnoanalysis on those who failed to respond to DSIH, 33 of 41 (80%) consecutive patients were cured, two were lost to follow-up, and six did not respond to treatment. Self-hypnosis was not used. Several illustrative cases are presented.
"Hypnosis, placebo, and suggestion in the treatment of warts."
Spanos, N. P., R. J. Stenstrom, et al. (1988). Psychosomatic Medicine 50(3): 245-60.
Two experiments assessed the effects of psychological variables on wart regression. In Experiment 1, subjects given hypnotic suggestion exhibited more wart regression than those given either a placebo treatment or no treatment. In Experiment 2, hypnotic and nonhypnotic subjects given the same suggestions were equally likely to exhibit wart regression and more likely to show this effect than no treatment controls. In both experiments, treated subjects who lost warts reported more vivid suggested imagery than treated subjects who did not lose warts. However, hypnotizability and attribute measures of imagery propensity were unrelated to wart loss. Subjects given the suggestion that they would lose warts on only one side of the body did not show evidence of a side-specific treatment effect.
Weight Loss
"Weight loss for women: studies of smokers and nonsmokers using hypnosis and multicomponent treatments with and without overt aversion."
Johnson, D. L. (1997). Psychological Reports 80(3 Pt 1): 931-3.
Study 1 compared overweight adult women smokers (n = 50) and nonsmokers (n = 50) in an hypnosis-based, weight-loss program. Smokers and nonsmokers achieved significant weight losses and decreases in Body Mass Index. Study 2 treated 100 women either in an hypnosis only (n = 50) or an overt aversion and hypnosis (n = 50) program. This multicomponent follow-up study replicated significant weight losses and declines in Body Mass Index. The overt aversion and hypnosis program yielded significantly lower posttreatment weights and a greater average number of pounds lost.
"Hypnotic enhancement of cognitive-behavioral weight loss treatments--another meta-reanalysis."
Kirsch, I. (1996). Journal of Consulting and Clinical Psychology 64(3): 517-9.
In a 3rd meta-analysis of the effect of adding hypnosis to cognitive-behavioral treatments for weight reduction, additional data were obtained from authors of 2 studies, and computational inaccuracies in both previous meta-analyses were corrected. Averaged across posttreatment and follow-up assessment periods, the mean weight loss was 6.00 lbs. (2.72 kg) without hypnosis and 11.83 lbs. (5.37 kg) with hypnosis. The mean effect size of this difference was 0.66 SD. At the last assessment period, the mean weight loss was 6.03 lbs. (2.74 kg) without hypnosis and 14.88 lbs. (6.75 kg) with hypnosis. The effect size for this difference was 0.98 SD. Correlational analyses indicated that the benefits of hypnosis increased substantially over time (r = .74).
"Effectiveness of hypnosis as an adjunct to behavioral weight management."
Bolocofsky, D. N., D. Spinler, et al. (1985). Journal of Clinical Psychology 41(1): 35-41.
This study examined the effect of adding hypnosis to a behavioral weight-management program on short- and long-term weight change. One hundred nine subjects, who ranged in age from 17 to 67, completed a behavioral treatment either with or without the addition of hypnosis. At the end of the 9-week program, both interventions resulted in significant weight reduction. However, at the 8-month and 2-year follow-ups, the hypnosis clients showed significant additional weight loss, while those in the behavioral treatment exhibited little further change. More of the subjects who used hypnosis also achieved and maintained their personal weight goals. The utility of employing hypnosis as an adjunct to a behavioral weight-management program is discussed.
Wound Healing
"Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial."
Ginandes, C., P. Brooks, et al. (2003). American Journal of Clinical Hypnosis 45(4): 333-51.
Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing. The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants' group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants' subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36). Analysis of variance showed the hypnosis group's objectively observed wound healing to be significantly greater than the other two groups', p < .001, through 7 postoperative weeks; standard care controls showed the smallest degree of healing. In addition, at both the 1 and 7 week post-surgical observation intervals, one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls, p < 0.02. The mean scores of the subjective assessments of postoperative pain, incision healing and functional recovery trended similarly. Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.
"Using hypnosis to accelerate the healing of bone fractures: a randomized controlled pilot study."
Ginandes, C. S. and D. I. Rosenthal (1999). Alternative Therapies in Health and Medicine 5(2): 67-75.
CONTEXT: Hypnosis has been used in numerous medical applications for functional and psychological improvement, but has been inadequately tested for anatomical healing. OBJECTIVE: To determine whether a hypnotic intervention accelerates bodily tissue healing using bone fracture healing as a site-specific test. DESIGN: Randomized controlled pilot study. SETTING: Massachusetts General Hospital, Boston, Mass, and McLean Hospital, Belmont, Mass. PATIENTS: Twelve healthy adult subjects with the study fracture were recruited from an orthopedic emergency department and randomized to either a treatment (n = 6) or a control group (n = 6). One subject, randomized to the treatment group, withdrew prior to the intervention. INTERVENTION: All 11 subjects received standard orthopedic care including serial radiographs and clinical assessments through 12 weeks following injury. The treatment group received a hypnotic intervention (individual sessions, audiotapes) designed to augment fracture healing. MAIN OUTCOME MEASURES: Radiological and orthopedic assessments of fracture healing 12 weeks following injury and hypnotic subjects' final questionnaires and test scores on the Hypnotic Induction Scale. RESULTS: Results showed trends toward faster healing for the hypnosis group through week 9 following injury. Objective radiographic outcome data revealed a notable difference in fracture edge healing at 6 weeks. Orthopedic assessments showing trends toward better healing for hypnosis subjects through week 9 included improved ankle mobility; greater functional ability to descend stairs; lower use of analgesics in weeks 1, 3, and 9; and trends toward lower self-reported pain through 6 weeks. CONCLUSION: Despite a small sample size and limited statistical power, these data suggest that hypnosis may be capable of enhancing both anatomical and functional fracture healing, and that further investigation of hypnosis to accelerate healing is warranted.
"Hypnotically accelerated burn wound healing."
Moore, L. E. and J. Z. Kaplan (1983). American Journal of Clinical Hypnosis 26(1): 16-9.
"Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study."
Zylowska, L., D. L. Ackerman, et al. (2008). J Atten Disord 11(6): 737-46.
OBJECTIVE: ADHD is a childhood-onset psychiatric condition that often continues into adulthood. Stimulant medications are the mainstay of treatment; however, additional approaches are frequently desired. In recent years, mindfulness meditation has been proposed to improve attention, reduce stress, and improve mood. This study tests the feasibility of an 8-week mindfulness training program for adults and adolescents with ADHD. METHOD: Twenty-four adults and eight adolescents with ADHD enrolled in a feasibility study of an 8-week mindfulness training program. RESULTS: The majority of participants completed the training and reported high satisfaction with the training. Pre-post improvements in self-reported ADHD symptoms and test performance on tasks measuring attention and cognitive inhibition were noted. Improvements in anxiety and depressive symptoms were also observed. CONCLUSION: Mindfulness training is a feasible intervention in a subset of ADHD adults and adolescents and may improve behavioral and neurocognitive impairments. A controlled clinical study is warranted.
"Alternative and controversial treatments for attention-deficit/hyperactivity disorder."
Baumgaertel, A. (1999). Pediatric Clinics of North America 46(5): 977-92.
ADHD is a syndrome that can be treated effectively, safely, and economically with stimulant medications. There is no equal alternative to these agents in short-term treatment of ADHD symptoms. However, many families seek alternatives to stimulants and other drug treatments for a variety of reasons. Alternative approaches reflect the complexity and heterogeneity of the disorder by being equally manifold, complex, and often obscure in their modus operandi. Scientific evidence suggests that individualized dietary management may be effective in some children. Trace element supplementation also may be beneficial when specific deficiencies are present. At this point, nootropics, herbs, and homeopathy are being seriously researched regarding their role in neurologic functioning, but evidence to support their role in the specific treatment of ADHD is inconsistent or lacking. Self-regulatory techniques such as hypnotherapy and biofeedback do not alter the core symptoms of ADHD but may be helpful in controlling secondary symptoms. These methods are unique in ADHD treatment because children can become active agents of their own coping strategies. There is no scientific evidence to support the validity of vision therapy, oculovestibular treatment, or sound training (Tomatis method) as treatment modalities for ADHD. However, auditory stimulation with individualized music may help to improve situational performance in cognitive tasks. Regardless of the treatment approach, the diagnosis of ADHD and other comorbidities first must be established through a standard medical evaluation. The standard treatment options always should be presented and discussed carefully. If alternative approaches are sought, the merits of available options should be reiterated. If the primary care provider is not comfortable or knowledgeable about an acceptable method, referral to capable and responsible practitioners in the community who are experienced in these areas should be considered. The primary care provider, the alternative "specialist," and the family all should be willing to engage in "collaborative research," applying the same standards for treatment evaluation that one would apply in mainstream methods. Communication among all parties involved in a treatment strategy is the key to demystifying alternative approaches, creating strong therapeutic relationships, and optimizing management.
Allergy
"Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study."
Langewitz, W., J. Izakovic, et al. (2005). Psychotherapy and Psychosomatics 74(3): 165-72.
BACKGROUND: Many people suffer from hay fever symptoms. Hypnosis has proved to be a useful adjunct in the treatment of conditions where allergic phenomena have an important role. METHODS: Randomised parallel group study over an observation period of two consecutive pollen seasons. Outcome data include nasal flow under hypnosis, pollinosis symptoms from diaries and retrospective assessments, restrictions in well-being and use of anti-allergic medication. We investigated 79 patients with a mean age of 34 years (range 19-54 years; 41 males), with moderate to severe allergic rhinitis to grass or birch pollen of at least 2 years duration and mild allergic asthma. The intervention consisted of teaching self-hypnosis during a mean of 2.4 sessions (SD 1.7; range 2-5 sessions) and continuation of standard anti-allergic pharmacological treatment. RESULTS: Of 79 randomised patients, 66 completed one, and 52 completed two seasons. Retrospective VAS scores yielded significant improvements in year 1 in patients who had learned self-hypnosis: pollinosis symptoms -29.2 (VAS score, range 0-100; SD 25.4; p < 0.001), restriction of well-being -26.2 (VAS score, range 0-100; SD 28.7; p < 0.001. In year 2, the control group improved significantly having learned self-hypnosis as well: pollinosis symptoms -24.8 (SD 29.1; p < 0.001), restriction of well-being -23.7 (SD 30.0; p < 0.001). Daily self-reports of subjects who learnt self-hypnosis do not show a significant improvement. The hazard ratio of reaching a critical flow of 70% in nasal provocation tests was 0.333 (95% CI 0.157-0.741) after having learnt and applied self-hypnosis.
"Reduction in skin reactions to histamine after a hypnotic procedure."
Laidlaw, T. M., R. J. Booth, et al. (1996). Psychosomatic Medicine 58(3): 242-8.
This study sought to test whether a cognitive-hypnotic intervention could be used to decrease skin reactivity to histamine and whether hypnotizability, physiological variables, attitudes, and mood would influence the size of the skin weals. Thirty eight subjects undertook three individual laboratory sessions; a pretest session to determine sensitivity to histamine, a control session, and an intervention session during which the subject experienced a cognitive-hypnotic procedure involving imagination and visualization. Compared with the control session, most subjects (32 of 38) decreased the size of their weals measured during the intervention session, and the differences between the weal sizes produced in the two sessions were highly significant (N = 38; t = 4.90; p < .0001). Mood and physiological variables but not hypnotizability scores proved to be effective in explaining the skin test variance and in predicting weal size change. Feelings of irritability and tension and higher blood pressure readings were associated with less change in weal size (i.e., a continuation of reactivity similar to that found in the control session without the cognitive-hypnotic intervention), and peacefulness and a lower blood pressure were associated with less skin reactivity during the intervention. This study has shown highly significant results in reducing skin sensitivity to histamine using a cognitive-hypnotic technique, which indicates some promise for extending this work into the clinical area.
"Subjective assessment of allergy relief following group hypnosis and self-hypnosis: a preliminary study."
Madrid, A., G. Rostel, et al. (1995). American Journal of Clinical Hypnosis 38(2): 80-6.
Self-hypnosis was taught to 34 self-identified allergy patients who attended two training classes. They practiced on their own and were questioned two months later. Seventy-six percent of the subjects reported they felt an improvement in their symptoms; 86% of those who were medicated decreased their medicines. Practice was clearly related to reported improvement. "Feeling hypnotized" was not related to improvement.
Anxiety
"The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders."
Apostolo, J. L. and K. Kolcaba (2009). Archives of Psychiatric Nursing 23(6): 403-11.
This article describes the efficacy of a guided imagery intervention for decreasing depression, anxiety, and stress and increasing comfort in psychiatric inpatients with depressive disorders. A quasi-experimental design sampled 60 short-term hospitalized depressive patients selected consecutively. The experimental group listened to a guided imagery compact disk once a day for 10 days. The Psychiatric Inpatients Comfort Scale and the Depression, Anxiety, and Stress Scales (DASS-21) were self-administered at two time points: prior to the intervention (T1) and 10 days later (T2). Comfort and DASS-21 were also assessed in the usual care group at T1 and T2. Repeated measures revealed that the treatment group had significantly improved comfort and decreased depression, anxiety, and stress over time.
"Mind-body interventions in oncology."
Carlson, L. E. and B. D. Bultz (2008). Curr Treat Options Oncol 9(2-3): 127-34.
OPINION STATEMENT: A number of mind-body interventions have been studied for use with cancer patients, primarily measuring outcomes relating to pain control, anxiety reduction, and enhancing quality of life. This chapter defines the scope and characteristics of mind-body interventions, followed by a selective review of research indicating their appropriate use or cautions in cancer care. Mind-body interventions included are hypnosis, imagery/relaxation, meditation, yoga, and creative therapies. Current evidence supports the efficacy of hypnosis and imagery/relaxation for control of pain and anxiety during cancer treatments. Meditation is supported for reductions in stress and improvements in mood, quality of life, and sleep problems. There is a growing body of support for yoga from randomized controlled trials for improving quality of life, sleep, and mood. Creative therapies such as visual arts, dance, and music may help cancer patients express their feelings and cope with the demands of a cancer experience. Research on biological marker effects of mind-body therapies remains inconclusive. Study of mind-body interventions generally requires additional, methodologically rigorous investigation of how various interventions best assist patients during various phases of cancer survivorship, although a major benefit of these therapies lies in the opportunity for patients to self-select them.
"Hypnosis in the treatment of anxiety."
Smith, W. H. (1990). Bulletin of the Menninger Clinic 54(2): 209-16.
Hypnotherapy and training in self-hypnosis can help persons achieve remarkable success in alleviating anxiety, not only in anxiety disorders, but also in any problem involving anxiety. The author describes the role of hypnosis in the treatment of several disorders and provides clinical examples illustrating treatment of generalized anxiety, phobias, and posttraumatic stress disorders. He concludes that because hypnosis exploits the intimate connection between mind and body, it provides relief through improved self-regulation and also beneficially affects cognition and the experience of self-mastery.
"Rational self-directed hypnotherapy: a treatment for panic attacks."
Der, D. F. and P. Lewington (1990). American Journal of Clinical Hypnosis 32(3): 160-7.
A single-subject research design was employed to assess the efficacy of rational self-directed hypnotherapy in the treatment of panic attacks. Presenting symptoms were acute fear, dizziness, constricted throat, upset stomach, loss of appetite, loss of weight, insomnia, fear of doctors, and fear of returning to work. Treatment lasted 13 weeks plus a 2-week baseline and posttherapy period and a 6-month follow-up. Objective measurements (MMPI, TSCS, POMS) and self-report assessments (physiological symptoms and a subjective stress inventory) were implemented. Using hypnosis and guided imagery, the subject reviewed critical incidents identifying self-defeating components within a cognitive paradigm, revising and rehearsing these incidents. Results showed an increased sense of control, improved self-concept, elimination of pathological symptoms, and cessation of panic attacks.
"Managing desperate emotional behaviour with hypnosis."
Swartz, C. (1981). Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 26(8): 555-7.
When no other psychotherapy or pharmacotherapy could prevent debilitation or institutionalization consequent to longstanding frequent repeated maladaptive behaviour, hypnosis has been observed to be effective in suitable patients. A documentation, three cases of such chronic severe behaviour which have been encountered by the author are described; each had been regarded as hopelessly unmanageable by the primary physician at the time of referral for hypnotherapy. Relevant to their suitability for hypnosis, all three patients were able to understand normal speech with difficulty, were able to concentrate well, and were agreeable to using hypnosis.
Arthritis
"Efficacy of guided imagery with relaxation for osteoarthritis symptoms and medication intake."
Baird, C. L., M. M. Murawski, et al (2010). Pain Manag Nurs 11(1): 56-65.
Supporting safe self-management interventions for symptoms of osteoarthritis (OA) may reduce the personal and societal burden of this increasing health concern. Self-management interventions might be even more beneficial if symptom control were accompanied by decreased medication use, reducing cost and potential side effects. Guided imagery with relaxation (GIR) created especially for OA may be a useful self-management intervention, reducing both symptoms and medication use. A longitudinal randomized assignment experimental design was used to study the efficacy of GIR in reducing pain, improving mobility, and reducing medication use. Thirty older adults were randomly assigned to participate in the 4-month trial by using either GIR or a sham intervention, planned relaxation. Repeated-measures analysis of variance revealed that, compared with those who used the sham intervention, participants who used GIR had a significant reduction in pain from baseline to month 4 and significant improvement in mobility from baseline to month 2. Poisson technique indicated that, compared with those who used the sham intervention, participants who used GIR had a significant reduction in over-the-counter (OTC) medication use from baseline to month 4, prescribed analgesic use from baseline to month 4, and total medication (OTC, prescribed analgesic, and prescribed arthritis medication) use from baseline to month 2 and month 4. Results of this study support the efficacy of GIR in reducing symptoms, as well as in reducing medication use. Guided imagery with relaxation may be useful in the regimen of pain management for clinicians.
"Effect of guided imagery with relaxation on health-related quality of life in older women with osteoarthritis."
Baird, C. L. and L. P. Sands (2006). Research in Nursing and Health 29(5): 442-51.
Osteoarthritis (OA) is the most common cause of disability in older adults, which, in turn, leads to poor quality of life (QOL). Disability is caused primarily by the joint degeneration and pain associated with OA. A randomized pilot study was conducted to test the effectiveness of guided imagery with relaxation (GIR) to improve health-related QOL (HRQOL) in women with OA. A two-group (intervention versus control) longitudinal design was used to determine whether GIR leads to better HRQOL in these individuals and whether improvement in HRQOL could be attributed to intervention-associated improvements in pain and mobility. Twenty-eight women were randomized to either the GIR intervention or the control intervention group. Using GIR for 12 weeks significantly increased women's HRQOL in comparison to the women who used the control intervention, even after statistically adjusting for changes in pain and mobility. These findings suggest that the effects of GIR on HRQOL are not limited to improvements in pain and mobility. GIR may be an easy-to-use self-management intervention to improve the QOL of older adults with OA.
"A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis."
Baird, C. L. and L. Sands (2004). Pain Manag Nurs 5(3): 97-104.
Osteoarthritis (OA) is a common, chronic condition that affects most older adults. Adults with OA must deal with pain that leads to limited mobility and may lead to disability and difficulty maintaining independence. A longitudinal, randomized clinical trial pilot study was conducted to determine whether Guided Imagery (GI) with Progressive Muscle Relaxation (PMR) would reduce pain and mobility difficulties of women with OA. Twenty-eight older women with OA were randomly assigned to either the treatment or the control group. The treatment consisted of listening twice a day to a 10-to-15-minute audiotaped script that guided the women in GI with PMR. Repeated-measures ANOVA revealed a significant difference between the two groups in the amount of change in pain and mobility difficulties they experienced over 12 weeks. The treatment group reported a significant reduction in pain and mobility difficulties at week 12 compared to the control group. Members of the control group reported no differences in pain and non-significant increases in mobility difficulties. The results of this pilot study justify further investigation of the effectiveness of GI with PMR as a self-management intervention to reduce pain and mobility difficulties associated with OA.
"Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson [correction of Erickson] hypnosis and Jacobson relaxation."
Gay, M. C., P. Philippot, et al. (2002). Eur J Pain 6(1): 1-16.
The present study investigates the effectiveness of Erikson hypnosis and Jacobson relaxation for the reduction of osteoarthritis pain. Participants reporting pain from hip or knee osteoarthritis were randomly assigned to one of the following conditions: (a) hypnosis (i.e. standardized eight-session hypnosis treatment); (b) relaxation (i.e. standardized eight sessions of Jacobson's relaxation treatment); (c) control (i.e. waiting list). Overall, results show that the two experimental groups had a lower level of subjective pain than the control group and that the level of subjective pain decreased with time. An interaction effect between group treatment and time measurement was also observed in which beneficial effects of treatment appeared more rapidly for the hypnosis group. Results also show that hypnosis and relaxation are effective in reducing the amount of analgesic medication taken by participants. Finally, the present results suggest that individual differences in imagery moderate the effect of the psychological treatment at the 6 month follow-up but not at previous times of measurement (i.e. after 4 weeks of treatment, after 8 weeks of treatment and at the 3 month follow-up). The results are interpreted in terms of psychological processes underlying hypnosis, and their implications for the psychological treatment of pain are discussed.
"Biochemical correlates of hypnoanalgesia in arthritic pain patients."
Domangue, B. B., C. G. Margolis, et al. (1985). Journal of Clinical Psychiatry 46(6): 235-8.
Self-reported levels of pain, anxiety, and depression, and plasma levels of beta-endorphin, epinephrine, norepinephrine, dopamine, and serotonin were measured in 19 arthritic pain patients before and after hypnosis designed to produce pain reduction. Correlations were found between levels of pain, anxiety, and depression. Anxiety and depression were negatively related to plasma norepinephrine levels. Dopamine levels were positively correlated with both depression and epinephrine levels and negatively correlated with levels of serotonin. Serotonin levels were positively correlated with levels of beta-endorphin and negatively correlated to epinephrine. Following hypnotherapy, there were clinically and statistically significant decreases in pain, anxiety, and depression and increases in beta-endorphin-like immunoreactive material.
Asthma
"Functional relaxation and guided imagery as complementary therapy in asthma: a randomized controlled clinical trial."
Lahmann, C., M. Nickel, et al. (2009). Psychotherapy and Psychosomatics 78(4): 233-9.
BACKGROUND: Asthma is a frequently disabling and almost invariably distressing disease that has a high overall prevalence. Although relaxation techniques and hypnotherapeutic interventions have proven their effectiveness in numerous trials, relaxation therapies are still not recommended in treatment guidelines due to a lack of methodological quality in many of the trials. Therefore, this study aims to investigate the efficacy of the brief relaxation technique of functional relaxation (FR) and guided imagery (GI) in adult asthmatics in a randomized controlled trial. METHODS: 64 patients with extrinsic bronchial asthma were treated over a 4-week period and assessed at baseline, after treatment and after 4 months, for follow-up. 16 patients completed FR, 14 GI, 15 both FR and GI (FR/GI) and 13 received a placebo relaxation technique as the control intervention (CI). The forced expiratory volume in the first second (FEV(1)) as well as the specific airway resistance (sR(aw)) were employed as primary outcome measures. RESULTS: Participation in FR, GI and FR/GI led to increases in FEV(1) (% predicted) of 7.6 +/- 13.2, 3.3 +/- 9.8, and 8.3 +/- 21.0, respectively, as compared to -1.8 +/- 11.1 in the CI group at the end of the therapy. After follow-up, the increases in FEV(1) were 6.9 +/- 10.3 in the FR group, 4.4 +/- 7.3 in the GI and 4.5 +/- 8.1 in the FR/GI, compared to -2.8 +/- 9.2 in the CI. Improvements in sR(aw) (% predicted) were in keeping with the changes in FEV(1) in all groups. CONCLUSIONS: Our study confirms a positive effect of FR on respiratory parameters and suggests a clinically relevant long-term benefit from FR as a nonpharmacological and complementary therapy treatment option.
"Evidence-based hypnotherapy for asthma: a critical review."
Brown, D. (2007). International Journal of Clinical and Experimental Hypnosis 55(2): 220-49.
Asthma is a chronic disease with intermittent acute exacerbations, characterized by obstructed airways, hyper-responsiveness, and sometimes by chronic airway inflammation. Critically reviewing evidence primarily from controlled outcome studies on hypnosis for asthma shows that hypnosis is possibly efficacious for treatment of symptom severity and illness-related behaviors and is efficacious for managing emotional states that exacerbate airway obstruction. Hypnosis is also possibly efficacious for decreasing airway obstruction and stabilizing airway hyper-responsiveness in some individuals, but there is insufficient evidence that hypnosis affects asthma's inflammatory process. Promising research needs to be replicated with larger samples and better designs with careful attention paid to the types of hypnotic suggestions given. The critical issue is not so much whether it is used but how it is used. Future outcome research must address the relative contribution of expectancies, hypnotizability, hypnotic induction, and specific suggestions.
"Psychological aspects of asthma."
Lehrer, P., J. Feldman, et al. (2002). Journal of Consulting and Clinical Psychology 70(3): 691-711.
Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures.
"Hypnosis and asthma: a critical review."
Hackman, R. M., J. S. Stern, et al. (2000). Journal of Asthma 37(1): 1-15.
Asthma is among the most common chronic diseases of the western world and has significant effects on patients' health and quality of life. Asthma is typically treated with pharmaceutical products, but there is interest in finding nonpharmaceutical therapies for this condition. Hypnosis has been used clinically to treat a variety of disorders that are refractive to pharmaceutical-based therapies, including asthma, but relatively little attention has been given recently to the use of clinical hypnosis as a standard treatment for asthma. Significant data suggest that hypnosis may be an effective treatment for asthma, but it is premature to conclude that hypnosis is unequivocally effective. Studies conducted to date have consistently demonstrated an effect of hypnosis with asthma. More and larger randomized, controlled studies are needed. Existing data suggest that hypnosis efficacy is enhanced in subjects who are susceptible to the treatment modality, with experienced investigators, when administered over several sessions, and when reinforced by patient autohypnosis. Children in particular appear to respond well to hypnosis as a tool for improving asthma symptoms.
"Hypnosis for exercise-induced asthma."
Ben-Zvi, Z., W. A. Spohn, et al. (1982). American Review of Respiratory Disease 125(4): 392-5.
Hypnosis has been used for many years in the treatment of asthma, but studies of its usefulness have been controversial. We assessed the efficacy of hypnosis in attenuating exercise-induced asthma (EIA) in 10 stable asthmatics. The subjects ran on a treadmill while mouth breathing for 6 min on 5 different days. Pulmonary mechanics were measured before and after each challenge. Two control exercise challenges resulted in a reproducible decrease in forced expiratory volume in one second (FEV1). On 2 other days, saline or cromolyn by nebulization was given in a double-blind manner with the suggestion that these agents would prevent EIA. Hypnosis prior to exercise resulted in a 15.9% decrease in FEV1 compared with a 31.8% decrease on the control days (p less than 0.001). Pretreatment with cromolyn resulted in a 7.6% decrease in FEV1. We conclude that hypnosis can alter the magnitude of a pathophysiologic process, namely, the bronchospasm after exercise in patients with asthma.
Back Pain
"Chronic low-back pain modulation is enhanced by hypnotic analgesic suggestion by recruiting an emotional network: a PET imaging study."
Nusbaum, F., J. Redoute, et al. International Journal of Clinical and Experimental Hypnosis 59(1): 27-44.
This study aimed to characterize the neural networks involved in patients with chronic low-back pain during hypnoanalgesia. PET was performed in 2 states of consciousness, normal alertness and hypnosis. Two groups of patients received direct or indirect analgesic suggestion. The normal alertness state showed activations in a cognitive-sensory pain modulation network, including frontotemporal cortex, insula, somatosensory cortex, and cerebellum. The hypnotic state activated an emotional pain modulation network, including frontotemporal cortex, insula, caudate, accumbens, lenticular nuclei, and anterior cingulate cortex (ACC). Direct suggestion activated cognitive processes via frontal, prefrontal, and orbitofrontal cortices, while indirect suggestion activated a widespread and more emotional network including frontal cortex, anterior insula, inferior parietal lobule, lenticular nucleus, and ACC. Confirmed by visual analog scale data, these results suggest that chronic pain modulation is greater with hypnosis, which enhances both activated networks.
"Complementary and alternative medicine approaches to pain management."
Tan, G., J. A. Alvarez, et al. (2006). Journal of Clinical Psychology 62(11): 1419-31.
This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and self-hypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment.
"Hypnosis compared to relaxation in the outpatient management of chronic low back pain."
McCauley, J. D., M. H. Thelen, et al. (1983). Archives of Physical Medicine and Rehabilitation 64(11): 548-52.
Chronic low back pain (CLBP) presents a problem of massive dimensions. While inpatient approaches have been evaluated, outpatient treatment programs have received relatively little examination. Hypnosis and relaxation are two powerful techniques amenable to outpatient use. Seventeen outpatient subjects suffering from CLBP were assigned to either Self-Hypnosis (n = 9) or Relaxation (n = 8) treatments. Following pretreatment assessment, all subjects attended a single placebo session in which they received minimal EMG feedback. One week later the subjects began eight individual weekly treatment sessions. Subjects were assessed on a number of dependent variables at pretreatment, following the placebo phase, one week after the completion of treatment, and three months after treatment ended. Subjects in both groups showed significant decrements in such measures as average pain rating, pain as measured by derivations from the McGill Pain Questionnaire, level of depression, and length of pain analog line. Self-Hypnosis subjects reported less time to sleep onset, and physicians rated their use of medication as less problematic after treatment. While both treatments were effective, neither proved superior to the other. The placebo treatment produced nonsignificant improvement.
Bedwetting (Enuresis)
"Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy."
Banerjee, S., A. Srivastav, et al. (1993). American Journal of Clinical Hypnosis 36(2): 113-9.
Various therapeutic modalities have been used for treating enuresis due to the lack of a single identifiable cause. We carried out a comparative study of imipramine and direct hypnotic suggestions with imagery used for the management of functional nocturnal enuresis. Enuretic children, ranging in age from 5 to 16 years, underwent 3 months of therapy with imipramine (N = 25) or hypnosis (N = 25). After termination of the active treatment, the hypnosis group continued practicing self-hypnosis daily during the follow-up period of another 6 months. Of the patients treated with imipramine, 76% had a positive response (all dry beds); for patients treated with hypnotic strategies, 72% responded positively. At the 9-month follow-up, 68% of patients in the hypnosis group maintained a positive response, whereas only 24% of the imipramine group did. Hypnosis and self-hypnosis strategies were found to be less effective in younger children (5-7 years old) compared to imipramine treatment. The treatment response was not related to the hypnotic responsivity of the patient in either group.
"Hypnotherapy as a treatment for enuresis."
Edwards, S. D. and H. I. van der Spuy (1985). Journal of Child Psychology and Psychiatry and Allied Disciplines 26(1): 161-70.
The main objective of this study was to provide an adequately controlled experimental and clinical study to assess the efficacy of hypnotherapy in the treatment of nocturnal enuresis. Subjects were 48 nocturnal enuretic boys, aged 8-13 yr. Treatment consisted of six standardized sessions, one hourly session per subject per week. Results indicated that hypnotherapy was significantly effective over 6 months in decreasing nocturnal enuresis, compared with both pretreatment baseline enuresis frequency and no-treatment controls. It also suggested that trance induction was not a necessary prerequisite for success. Comparison with other methods of treatment provided evidence that hypnotherapy was an effective alternative or adjunctive form of treatment for enuresis.
"The use of relaxation-mental imagery (self-hypnosis) in the management of 505 pediatric behavioral encounters."
Kohen, D. P., K. N. Olness, et al. (1984). Journal of Developmental and Behavioral Pediatrics 5(1): 21-5.
This report assessed outcomes of hypnotherapeutic interventions for 505 children and adolescents seen by four pediatricians over a period of one year and followed from four months to two years. Presenting problems included enuresis, acute pain, chronic pain, asthma, habit disorders, obesity, encopresis, and anxiety. Using strict criteria for determination of problem resolution (e.g., all beds dry) and recognizing that some conditions were intrinsically chronic, the authors found that 51% of these children and adolescents achieved complete resolution of the presenting problem; an additional 32% achieved significant improvement, 9% showed initial or some improvement; and 7% demonstrated no apparent change or improvement. Children as young as three years of age effectively applied self-hypnosis techniques. In general, facility in self-hypnosis increased with age. There was an inverse correlation (p less than 0.001) between clinical success and number of visits, suggesting that prediction of responsivity is possible after four visits or less.
Cancer
"The effectiveness of hypnosis in reducing pain and suffering among women with metastatic breast cancer and among women with temporomandibular disorder."
Nash, M. R. and A. Tasso. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 497-504.
The authors describe two studies of special interest to clinicians and clinical researchers. Both are randomized controlled studies, exclusively focused on female patients. The first study tests whether a year-long weekly group intervention including hypnosis can reduce cancer pain among women with metastatic breast cancer. Findings suggest the intervention slowed the increase in reported pain over a 12-month period relative to controls. The second study examines the effect of hypnosis in women suffering from temporomandibular disorder (TMD), with a special focus on function as well as pain. Hypnosis reduced TMD pain as measured by a numerical-rating scale.
"Immuno-modulatory effects of relaxation training and guided imagery in women with locally advanced breast cancer undergoing multimodality therapy: a randomised controlled trial."
Eremin, O., M. B. Walker, et al. (2009). Breast 18(1): 17-25.
Eighty women undergoing multimodality treatment for large (>4cm) or locally advanced (T3, T4, Tx, N2), breast cancers participated in a randomised controlled trial (RCT) to evaluate the immuno-modulatory effects of relaxation training and guided imagery. Patients underwent chemotherapy followed by surgery, radiotherapy, and hormone therapy. Those in the intervention group were taught relaxation and guided imagery. Patients kept diaries of the frequency of relaxation practice and imagery vividness. On 10 occasions during the 37 weeks following the diagnosis, blood was taken for immunological assays CD phenotyping: T cell subsets (helper, cytotoxic), natural killer (NK) and lymphokine activated killer (LAK) cells, B lymphocytes and monocytes; cytotoxicity: NK and LAK cell activities; cytokines interleukin 1 beta (1beta), 2, 4 and 6 and tumour necrosis factor alpha. Significant between-group differences were found in the number of CD25+ (activated T cells) and CD56+ (LAK cell) subsets. The number of CD3+ (mature) T cells was significantly higher following chemotherapy and radiotherapy, in patients randomised to relaxation and guided imagery. Using a median split, women who rated their imagery ratings highly had elevated levels of NK cell activity at the end of chemotherapy and at follow-up. Significant correlations were obtained between imagery ratings and baseline corrected values for NK and LAK cell activity, and IL1beta. Relaxation frequency correlated with the number of CD4+ (T helper) cells, the CD4+:8+ (helper:cytotoxic) ratio, and IL1beta levels. Relaxation training and guided imagery beneficially altered putative anti-cancer host defences during and after multimodality therapy. Such changes, to the best of our knowledge, have not been previously documented in a RCT.
"Hypnosis for Postradiation Xerostomia in Head and Neck Cancer Patients: A Pilot Study."
Schiff, E., J. G. Mogilner, et al. (2009). Journal of Pain and Symptom Management 37(6):1086-1092.
Xerostomia, the sensation of dry mouth, affects almost all patients who undergo radiotherapy for cancer in the head and neck area. Current therapies for xerostomia are inadequate, and the condition negatively impacts the quality of life. This prospective observational pilot aimed to evaluate whether hypnosis could improve salivation and decrease xerostomia. Twelve patients with xerostomia after radiotherapy for head and neck cancer were assessed for severity of xerostomia symptoms and sialometry. They then received a single hypnosis session with specific suggestions to increase salivation. The session was recorded on a compact disk (CD), and the participants were instructed to listen to it twice a day for one month. Sialometry was repeated immediately after hypnosis. Validated xerostomia questionnaires were completed at one, four, and 12 weeks after hypnosis. A substantial overall improvement was reported by eight patients at 12 weeks (66%). The saliva flow rate increased on sialometry in nine patients following hypnosis (75%). There was no correlation between the magnitude of changes in the measured saliva flow rate and changes in subjective measures (Spearman's correlation coefficient r=0.134). Symptomatic improvement significantly correlated with the number of times the patients listened to the hypnosis CD (r=0.714, P=0.009). No adverse events were reported. The data from this small observational trial suggest that hypnosis may be an effective treatment for xerostomia. Confirmation in a larger randomized and controlled investigation is warranted.
"Cancer, cognitive impairment, and meditation."
Biegler, K. A., M. A. Chaoul, et al. (2009). Acta Oncologica 48(1): 18-26.
BACKGROUND AND OBJECTIVES: Cancer-related cognitive impairment has been acknowledged as a substantial limiting factor in quality of life among cancer patients and survivors. In addition to deficits on behavioral measures, abnormalities in neurologic structure and function have been reported. In this paper, we review findings from the literature on cognitive impairment and cancer, potential interventions, meditation and cognitive function, and meditation and cancer. In addition, we offer our hypotheses on how meditation practice may help to alleviate objective and subjective cognitive function, as well as the advantages of incorporating a meditation program into the treatment of cancer patients and survivors for cancer-related cognitive deficits. FINDINGS: Various factors have been hypothesized to play a role in cancer-related cognitive impairment including chemotherapy, reduced hormone levels, proinflammatory immune response, fatigue, and distress. Pharmacotherapies such as methylphenidate or modafinil have been suggested to alleviate cognitive deficits. While initial reports suggest they are effective, some pharmacotherapies have side effects and may not relieve other symptoms associated with multimodal cancer treatment including sleep disturbance, nausea and pain. Several recent studies investigating the effects of meditation programs have reported behavioral and corresponding neurophysiological modulations that may be particularly effective in alleviating cancer-related cognitive impairment. Such programs also have been shown to reduce stress, fatigue, nausea and pain, and improve mood and sleep quality. CONCLUSIONS: With the increasing success of cancer treatment and the ability to return to previous family, social, and work activities, symptom management and quality of life are an essential part of survivorship. We propose that meditation may help to improve cancer-related cognitive dysfunction, alleviate other cancer-related sequelae, and should be fully investigated as an adjuvant to cancer treatment.
"Mind-body interventions in oncology."
Carlson, L. E. and B. D. Bultz (2008). Curr Treat Options Oncol 9(2-3): 127-34.
OPINION STATEMENT: A number of mind-body interventions have been studied for use with cancer patients, primarily measuring outcomes relating to pain control, anxiety reduction, and enhancing quality of life. This chapter defines the scope and characteristics of mind-body interventions, followed by a selective review of research indicating their appropriate use or cautions in cancer care. Mind-body interventions included are hypnosis, imagery/relaxation, meditation, yoga, and creative therapies. Current evidence supports the efficacy of hypnosis and imagery/relaxation for control of pain and anxiety during cancer treatments. Meditation is supported for reductions in stress and improvements in mood, quality of life, and sleep problems. There is a growing body of support for yoga from randomized controlled trials for improving quality of life, sleep, and mood. Creative therapies such as visual arts, dance, and music may help cancer patients express their feelings and cope with the demands of a cancer experience. Research on biological marker effects of mind-body therapies remains inconclusive. Study of mind-body interventions generally requires additional, methodologically rigorous investigation of how various interventions best assist patients during various phases of cancer survivorship, although a major benefit of these therapies lies in the opportunity for patients to self-select them.
"Immune responses to guided imagery during breast cancer treatment."
Lengacher, C. A., M. P. Bennett, et al. (2008). Biol Res Nurs 9(3): 205-14.
BACKGROUND: The use of relaxation and guided imagery to reduce stress and improve immune function has great potential benefits for patients with breast cancer. METHODS: This pilot study used a pretest-posttest experimental design with 28 breast cancer patients, aged 25 to 75 years, with the diagnosis of stage 0, 1, or 2 breast cancer. The experimental group received a relaxation and guided imagery intervention and the control group received standard care. The effects of the intervention on immune function were measured by natural killer (NK) cell cytotoxicity and IL-2-activated NK cell activity prior to surgery and 4 weeks postsurgery. NK cell activity was measured using a 15-hr incubation chromium release assay. Cytotoxicity of NK cells was measured against chromium-labeled K-562 target cells. IL-2 was used to enhance reactivity of NK cells against tumor cells. After incubation for 15 hr, cytotoxicity was measured through the release of radioactive chromium. RESULTS: Significant differences between groups were found at 4 weeks postsurgery. T-tests showed increased NK cell cytotoxicity for the intervention group at 100:1, 50:1, and 25:1 effector cell: target cell ratios (E:T) (p < .01 to p < .05) and increased activation for IL-2 at 100:1, 50:1, 25:1, and 12.5:1 (E:T) (p < .01 to p < .05) for the intervention group as compared to the control group. DISCUSSION: These findings suggest that a relaxation intervention such as guided imagery could have an effect on NK cell cytotoxicity and NK cell cytotoxicity after activation with IL-2 in patients undergoing surgery for breast cancer.
"Potential role of mind-body therapies in cancer survivorship."
Monti, D. A., M. Sufian, et al. (2008). Cancer 112(11 Suppl): 2607-16.
The use of complementary and alternative medicine (CAM) by cancer survivors is high, particularly among those with psychosocial distress, poor quality of life, culturally based health beliefs, and those who experience health disparities in the mainstream healthcare system. As the number of cancer survivors continues to increase, so does the diversity of the survivorship population, making it increasingly important to understand and address the CAM culture in different survivor groups. Given the known communication barriers between cancer patients and their physicians regarding CAM, it would be useful for oncology providers to have a platform from which to discuss CAM-related issues. It is proposed that mind-body therapies with some basis in evidence could provide such a platform and also serve as a possible means of connecting cancer survivors to psychosocial supportive services. This article reviews a few mind-body therapies that may have particular relevance to cancer survivors, such as hypnosis and meditation practices. A theoretical foundation by which such therapies provide benefit is presented, with particular emphasis on self-regulation.
"Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors."
Elkins, G., J. Marcus, et al. (2008). Journal of Clinical Oncology 26(31): 5022-6.
PURPOSE: Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. PATIENTS AND METHODS: Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities. RESULTS: Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group. CONCLUSION: Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.
"Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice."
Lang, E. V., K. S. Berbaum, et al. (2008). Journal of Vascular and Interventional Radiology 19(6): 897-905.
PURPOSE: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events. MATERIALS AND METHODS: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (> or =50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment. RESULTS: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118). CONCLUSIONS: Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.
"Complementary and alternative medicine."
Filshie, J. and C. N. Rubens (2006). Anesthesiol Clin 24(1): 81-111, viii.
Thirty years ago, the integration of complementary medicine into cancer care almost was dismissed as quackery. Today, a whole range of complementary and alternative medicine (CAM) techniques have been integrated into the management of cancer, which are often of benefit to patients, when conventional treatment is deemed to have failed or caused intolerable side effects. Health care workers need to inquire about the use of CAM in their patients routinely in a sensitive and nonjudgmental way, and may need to advise patients to stop certain therapies. Yet in advanced cancer, a sensible balance needs to be struck between fear about adverse effects and interactions and the importance of making the remaining weeks/days/months as comfortable and enjoyable as possible.
"Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy."
Marchioro, G., G. Azzarello, et al. (2000). Oncology 59(2): 100-4.
AIMS AND BACKGROUND: In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies. PATIENTS AND METHODS: The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis. RESULTS: In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients. CONCLUSIONS: The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.
"Critical review of 5 nonpharmacologic strategies for managing cancer pain."
Sellick, S. M. and C. Zaza (1998). Cancer Prevention and Control 2(1): 7-14.
PURPOSE: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. METHODS: The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. RESULTS: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. CONCLUSION: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed.
"Imagery and hypnosis in the treatment of cancer patients."
Spiegel, D. and R. Moore (1997). Oncology (Williston Park) 11(8): 1179-89; discussion 1189-95.
Many patients with cancer often seek some means of connecting their mental activity with the unwelcome events occurring in their bodies, via techniques such as imagery and hypnosis. Hypnosis has been shown to be an effective method for controlling cancer pain. The techniques most often employed involve physical relaxation coupled with imagery that provides a substitute focus of attention for the painful sensation. Other related imagery techniques, such as guided imagery, involve attention to internally generated mental images without the formal use of hypnosis. The most well-known of these techniques involves the use of "positive mental images" of a strong army of white blood cells killing cancer cells. Despite claims to the contrary, no reliable evidence has shown that this technique affects disease progression or survival. Studies evaluating more broadly defined forms psychosocial support have come to conflicting conclusions about whether or not these interventions affect survival of cancer patients. However, 10-year follow-up of a randomized trial involving 86 women with cancer showed that a year of weekly "supportive/expressive" group therapy significantly increased survival duration and time from recurrence to death. This intervention encourages patients to express and deal with strong emotions and also focuses on clarifying doctor-patient communication. Numerous other studies suggest that suppression of negative affect, excessive conformity, severe stress, and lack of social support predict a poorer medical outcome from cancer. Thus, further investigation into the interaction between body and mind in coping with cancer is warranted.
"Hypnosis for children and adolescents with cancer: an annotated bibliography, 1985-1995."
Steggles, S., S. Damore-Petingola, et al. (1997). Journal of Pediatric Oncology Nursing 14(1): 27-32.
This annotated bibliography reviews the professional literature published in English, from 1985 to 1995 inclusive, on the subject of the use of hypnosis with pediatric cancer patients. Books, chapters, and journal articles are included; dissertation, theses, and unpublished material are not. This bibliography contains 37 items organized into three categories: (1) General Discussions; (2) Case Reports or Case Studies: and (3) Experimental and Nonexperimental Group Designs. The brief annotations provided are not intended to be reviews or to be evaluative, but, rather, to inform the reader about the content and focus of the publication. This is an update of a previously published annotated bibliography, also presented in this Journal, which explored the relationship between hypnosis and pediatric cancer in journal articles published from 1960 to 1985.
"Hypnotherapy: complementary support in cancer care."
Pattison, J. (1997). Nursing Standard 11(52): 44-6.
The psychological and physical consequences of cancer threaten patients' wellbeing and quality of life (Fallowfield 1991). Patients' needs are wide ranging and can include both personal and physical demands as well as support, relaxation and distraction. This article describes how many of these needs can be cared for by the skillful use of hypnotherapy.
"The use of hypnosis with cancer patients."
Levitan, A. A. (1992). Psychiatric Medicine 10(1): 119-31.
Hypnosis has proven to be extremely valuable in the treatment of cancer patients. Specific applications include: establishing rapport between the patient and members of the medical health team; control of pain with self-regulation of pain perception through the use of glove anesthesia, time distortion, amnesia, transference of pain to a different body part, or dissociation of the painful part from the rest of the body; controlling symptoms, such as, nausea, anticipatory emesis, learned food aversions, etc.; psychotherapy for anxiety, depression, guilt, anger, hostility, frustration, isolation, and a diminished sense of self-esteem; visualization for health improvement; and, dealing with death anxiety and other related issues. Hypnosis has unique advantages for patients including improvement of self-esteem, involvement in self-care, return of locus of control, lack of unpleasant side effects, and continued efficacy despite continued use.
Cardiovascular Disease
"Feasibility and effectiveness of a brief meditation-based stress management intervention for patients diagnosed with or at risk for coronary heart disease: a pilot study."
Olivo, E. L., B. Dodson-Lavelle, et al. (2009). Psychol Health Med 14(5): 513-23.
Extensive research has led to the development of a psychobiological model of cardiovascular disease. This model suggests that psychological factors such as depression, anxiety, hostility, and stress may affect the development and progression of coronary heart disease (CHD). Recent studies have also demonstrated that meditation-based stress reduction programs are useful interventions for patients with various medical and psychological symptoms. The objective of this pilot study was to gather preliminary information regarding the feasibility of implementing a brief meditation-based stress management (MBSM) program for patients with CHD, and those at high risk for CHD, at a major metropolitan hospital that serves a predominately non-local patient population. The secondary aim of this study was to investigate the possibility that such an intervention might reduce depression, as well as perceived stress, anxiety, and hostility, while improving general health scores. The overall feasibility results indicate that this MBSM intervention was highly feasible with regard to both recruitment and retention of participants. In fact, 40% of patients requested further training. In addition, after completion of the 4-week intervention, participants reported significant reductions in depression and perceived stress. In conclusion, the present study demonstrated that the brief meditation-based stress management program was well-received by patients and can successfully be used as a supportive program for patients at risk or diagnosed with CHD.
"Mind-body medicine: state of the science, implications for practice."
Astin, J. A., S. L. Shapiro, et al. (2003). Journal of the American Board of Family Practice 16(2): 131-47.
BACKGROUND: Although emerging evidence during the past several decades suggests that psychosocial factors can directly influence both physiologic function and health outcomes, medicine had failed to move beyond the biomedical model, in part because of lack of exposure to the evidence base supporting the biopsychosocial model. The literature was reviewed to examine the efficacy of representative psychosocial-mind-body interventions, including relaxation, (cognitive) behavioral therapies, meditation, imagery, biofeedback, and hypnosis for several common clinical conditions. METHODS: An electronic search was undertaken of the MEDLINE, PsycLIT, and the Cochrane Library databases and a manual search of the reference sections of relevant articles for related clinical trials and reviews of the literature. Studies examining mind-body interventions for psychological disorders were excluded. Owing to space limitations, studies examining more body-based therapies, such as yoga and tai chi chuan, were also not included. Data were extracted from relevant systematic reviews, meta-analyses, and randomized controlled trials. RESULTS: Drawing principally from systematic reviews and meta-analyses, there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. We found moderate evidence of efficacy for mind-body therapies in the areas of hypertension and arthritis. Additional research is required to clarify the relative efficacy of different mind-body therapies, factors (such as specific patient characteristics) that might predict more or less successful outcomes, and mechanisms of action. Research is also necessary to examine the cost offsets associated with mind-body therapies. CONCLUSIONS: There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions.
"Healing the heart: integrating complementary therapies and healing practices into the care of cardiovascular patients."
Kreitzer, M. J. and M. Snyder (2002). Progress in Cardiovascular Nursing 17(2): 73-80.
Complementary therapies and healing practices have been found to reduce stress, anxiety, and lifestyle patterns known to contribute to cardiovascular disease. Promising therapies include imagery and hypnosis, meditation, yoga, tai chi, prayer, music, exercise, diet, and use of dietary supplements. Many of these complementary approaches to healing have been within the domain of nursing for centuries and can readily be integrated into the care of patients with cardiovascular disease. While individual complimentary modalities hold considerable merit, it is critical that the philosophy underlying these therapies--caring, holism, and harmony--also be understood and honored.
Cerebral Palsy
"Can children with spastic cerebral palsy use self-hypnosis to reduce muscle tone? a preliminary study."
Mauersberger, K., K. Artz, et al. (2000). Integr Med 2(2): 93-96.
A few scattered reports suggest self-hypnosis may be helpful in reducing muscle tone in children with spastic cerebral palsy (CP). These reports are largely anecdotal and offer little objective evidence. This study used the Biocomp 2000 biofeedback electomyogram device to measure the degree of muscle tension in two muscle groups before, during, and after hypnosis in four children with spastic quadriplegic CP. Three of the four children were able to show a very significant decrease in muscle tension while under "trance" and were able to use self-relaxation techniques when confronted with stressful situations. Two of the children also had athetoid or involuntary movements and each was able to better control those movements with the aid of hypnosis. All four children demonstrated improved functional abilities.
Chemotherapy
"Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence."
Richardson, J., J. E. Smith, et al. (2007). European Journal of Cancer Care (English Language Edition) 16(5): 402-12.
To systematically review the research evidence on the effectiveness of hypnosis for cancer chemotherapy-induced nausea and vomiting (CINV). A comprehensive search of major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine databases were searched and efforts were made to identify unpublished and ongoing research. Citations were included from the databases' inception to March 2005. Randomized controlled trials (RCTs) were appraised and meta-analysis undertaken. Clinical commentaries were obtained. Six RCTs evaluating the effectiveness of hypnosis in CINV were found. In five of these studies the participants were children. Studies report positive results including statistically significant reductions in anticipatory and CINV. Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioural therapy. Meta-analysis has demonstrated that hypnosis could be a clinically valuable intervention for anticipatory and CINV in children with cancer. Further research into the effectiveness, acceptance and feasibility of hypnosis in CINV, particularly in adults, is suggested. Future studies should assess suggestibility and provide full details of the hypnotic intervention.
"Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy."
Marchioro, G., G. Azzarello, et al. (2000). Oncology 59(2): 100-4.
AIMS AND BACKGROUND: In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies. PATIENTS AND METHODS: The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis. RESULTS: In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients. CONCLUSIONS: The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.
Childbirth
"Hypnosis for childbirth: a retrospective comparative analysis of outcomes in one obstetrician's practice."
VandeVusse, L., J. Irland, et al. (2007). American Journal of Clinical Hypnosis 50(2): 109-19.
This exploratory, descriptive study, done retrospectively from perinatal medical records, compared childbirth outcomes in one obstetrician's caseload between 50 women who elected antepartal hypnosis preparation (usually a 5-class series) and 51 who did not. The groups were demographically similar. To achieve similar numbers to the hypnosis group, the control group was randomly selected from the women in the caseload who opted not to take hypnosis preparation, based on characteristics of parity and delivery mode. Prenatal hypnosis preparation resulted in significantly less use of sedatives, analgesia, and regional anesthesia during labor and in higher 1-minute neonatal Apgar scores. Other physiologic and outcome measures did not reveal statistical significance, although some trends were of clinical interest. Well-controlled studies are warranted for clinicians to offer hypnosis more frequently as a pain relief option for childbirth. Additional information provided includes pragmatic, clinical, and cost information about incorporating hypnosis into a physician's practice.
"Evidence-based clinical hypnosis for obstetrics, labor and delivery, and preterm labor."
Brown, D. C. and D. C. Hammond (2007). International Journal of Clinical and Experimental Hypnosis 55(3): 355-71.
This paper reviews the benefits and effectiveness of hypnosis in obstetrics and labor and delivery, demonstrating significant reductions in the use of analgesics and anesthesia and in shorter Stages 1 and 2 labors. It presents empirical and theoretical rationales for use of hypnosis in preterm labor (PTL) and labor and delivery at term. The benefits of hypnosis in relation to labor length, pain levels, and the enjoyment of labor, as well as its effectiveness in preterm labor are noted in randomized controlled trials and in a meta-analysis. Risk factors are reported for preterm delivery; hypnosis significantly prolongs pregnancy. Six cases are presented of hypnosis stopping PTL a number of times and when indicated at term. A case report of successful use of hypnosis in quadruplets is presented with some scripts. Suggestions are made for further research.
"Hypnosis: removing the labour from birth."
Mottershead, N. (2006). Practicing Midwife 9(3): 26-7, 29.
Hypnosis has been used in obstetrics for more than a century. However, with increasing numbers of women looking for alternative coping strategies for use during labour, the birth of a new discipline, HypnoBirthing, is gaining in popularity. HypnoBirthing is a hypnotherapy programme specifically designed for birth, employing the principles and techniques of hypnosis and self-relaxation. This article explains the philosophy and principles of HypnoBirthing, the evidence base and its physiological impact on labouring women, brought to life by real accounts.
"Self-hypnosis: alternative anesthesia for childbirth."
Ketterhagen, D., L. VandeVusse, et al. (2002). MCN; American Journal of Maternal Child Nursing 27(6): 335-40; quiz 341.
The purpose of this article is to inform nurses about the use of self-hypnosis in childbirth. Hypnosis is a focused form of concentration. Self-hypnosis is one form of hypnosis in which a certified practitioner or therapist teaches an individual to induce his or her own state of altered consciousness. When used for childbirth pain, the primary aim of self-hypnosis is to help the woman maintain control by managing anxiety and discomfort though inducing a focused state of relaxation. Before the widespread use of pharmaceuticals for pain, hypnosis was one of the few pain relief methods available for labor. However, as new technologies for pain relief emerged, hypnosis received less attention. Most nurses have little experience with hypnosis, and there is limited information available in the literature. However, because nurses are at laboring women's bedsides, it is important that nurses learn about self-hypnosis to be able to inform pregnant women fully about all pain control options and to maximize the benefits for the woman choosing hypnosis.
"Hypnosis and conversion of the breech to the vertex presentation."
Mehl, L. E. (1994). Archives of Family Medicine 3(10): 881-7.
OBJECTIVE: To evaluate the effectiveness of hypnosis to convert a breech presentation to a vertex presentation. DESIGN: Prospective case series compared with historical, matched comparison group. SUBJECTS: One hundred pregnant women whose fetuses were in breech position at 37 to 40 weeks' gestation and a matched comparison group of women with similar obstetrical and sociodemographic parameters derived from databases for other studies from the same time period and geographical areas. INTERVENTION: The intervention group received hypnosis with suggestions for general relaxation with release of fear and anxiety. While in the hypnotic state women were asked for the reasons why their baby was in the breech presentation. As much hypnosis was provided as was convenient and possible for the women until they were delivered of the baby or the baby converted to the vertex position. MAIN OUTCOME VARIABLES: A successful conversion for the intervention group was scored when the baby spontaneously converted to the vertex position before delivery or successful external cephalic version. The conversion rate of the intervention group was compared with the comparison group who received standard obstetrical care without the opportunity for hypnosis. DATA ANALYSIS: Parametric testing of statistically significant differences in the rate of conversion between the two groups. RESULTS: Eighty-one percent of the fetuses in the intervention group converted to vertex presentation compared with 48% of those in the comparison group. This difference was statistically significant. CONCLUSIONS: Motivated subjects can be influenced by a skilled hypnotherapist in such a manner that their fetuses have a higher incidence of conversion from breech to vertex presentation. Psychophysiological factors may influence the breech presentation and may explain this increased frequency of conversion to vertex presentation.
Compliance with Medical Advice
"Conscious hypnosis as a method for patient motivation in cervical headgear wear--a pilot study."
Trakyali, G., K. Sayinsu, et al. (2008). European Journal of Orthodontics 30(2): 147-52.
The aim of the present study was to assess the efficiency of conscious hypnosis on patient cooperation. The subjects were 30 patients (14 females and 16 males) with a skeletal Class II division 1 malocclusion, divided into two equal groups, a control and a study group. The mean age was 10.78 +/- 1.06 years for the hypnosis, and 10.07 +/- 1.09 years for the control group. Both groups were treated with cervical headgear containing a timer module. The patients were also asked to record their actual wear time on timetables. The hypnosis group patients were motivated with conscious hypnosis while the control group were given verbal motivation by their orthodontist. The timer modules were read at every visit and compared with the timetables. Analysis of variance was used to determine the differences in measurements at each time point. For comparison of the groups, an independent t-test was used. A statistically significant decrease (P < 0.05) in headgear wear was observed in the control group from the first to the sixth month; however, the difference in the hypnosis group was not significant. This result indicates that conscious hypnosis is an effective method for improving orthodontic patient cooperation. There was a low correlation between actual headgear wear indicated by the patient and that recorded by the timing modules, which showed that, timetables are not consistent tools for measuring patient cooperation.
"Psychological management of postsurgical pain and patient adherence."
Moskowitz, L. (1996). Hand Clinics 12(1): 129-37.
The advantages of proper management of postsurgical pain include fewer postoperative complications; increased early ambulation and mobilization; decreased opportunity for chronic pain syndromes to occur; shorter, less complicated rehabilitation; greater patient satisfaction; and increased patient adherence to prescribed regimens. In turn, greater adherence positively affects pain management and, therefore, patients, satisfaction with their surgeon. A variety of approaches may be used for the management of acute pain, and the "psychological preparation" of the patient prior to surgery plays a significant role. Specific approaches include (1) cognitive-behavioral (such as diaphragmatic breathing, positive visualization rehearsal, and autogenic training); (2) hypnosis; (3) biofeedback; and (4) microelectrostimulation. Some of these approaches to pain management apply during surgery and the recovery and rehabilitation periods. Many of the approaches can be carried out relatively easily by the physician and his or her staff; in some cases, specialists, such as psychologists trained in behavioral medicine, are needed. Variables that affect patient adherence, both positively and negatively, include patient motivations, the nature and chronicity of the disorder, treatment variables, and the quality of the patient-doctor relationship. Physician behaviors may encourage or discourage patient adherence.
"Use of hypnosis for improving medication compliance in psychiatric patients."
Forman, B. D. (1985). Southern Medical Journal 78(3): 242-4.
Factors involved in failure to comply with medication regimens may be divided into four categories: patient characteristics, physician-patient relationship, psychosocial environment, and treatment regimen features. Although several methods aimed at improving medication compliance have been described in the literature, hypnosis was not among them. Three cases in which hypnosis was effective for improving compliance are presented, suggesting that hypnotherapy for compliance problems has potential clinical applications.
Crohn's and Colitis
"Hypnosis and upper digestive function and disease."
Chiarioni, G., O. S. Palsson, et al. (2008). World J Gastroenterol 14(41): 6276-84.
Hypnosis is a therapeutic technique that primarily involves attentive receptive concentration. Even though a small number of health professionals are trained in hypnosis and lingering myths and misconceptions associated with this method have hampered its widespread use to treat medical conditions, hypnotherapy has gained relevance as an effective treatment for irritable bowel syndrome not responsive to standard care. More recently, a few studies have addressed the potential influence of hypnosis on upper digestive function and disease. This paper reviews the efficacy of hypnosis in the modulation of upper digestive motor and secretory function. The present evidence of the effectiveness of hypnotherapy as a treatment for functional and organic diseases of the upper bowel is also summarized, coupled with a discussion of potential mechanisms of its therapeutic action.
"Treatment of inflammatory bowel disease: a role for hypnotherapy?"
Miller, V. and P. J. Whorwell (2008). International Journal of Clinical and Experimental Hypnosis 56(3): 306-17.
Fifteen patients with severe or very severe inflammatory bowel disease on corticosteroids but not responding to medication received 12 sessions of "gut-focused hypnotherapy" and were followed up for a mean duration of 5.4 years with disease severity being graded as remission, mild, moderate, severe, or very severe. Two patients (13.4%) failed to respond and required surgery. At follow-up for the remaining 13 patients, 4 (26.6%) were in complete remission, 8 (53.3%) had mild severity, and 1 (6.7%) was moderately severe. Quality of life became good or excellent in 12 (79.9%). Corticosteroid requirements dramatically declined with 60% of patients stopping them completely and not requiring any during follow-up. Hypnotherapy appears to be a promising adjunctive treatment for inflammatory bowel disease and has steroid sparing effects. Controlled trials to clearly define its role in this disease area are justified.
"The effect of hypnosis on systemic and rectal mucosal measures of inflammation in ulcerative colitis."
Mawdsley, J. E., D. G. Jenkins, et al. (2008). American Journal of Gastroenterology 103(6): 1460-9.
OBJECTIVES: Hypnotherapy is effective in several diseases with a psychosomatic component. Our aim was to study the effects of one session of hypnosis on the systemic and rectal mucosal inflammatory responses in patients with active ulcerative colitis (UC). METHODS: In total, 17 patients with active UC underwent a 50-min session of gut-focused hypnotherapy. Before and after each procedure, the systemic inflammatory response was assessed by serum interleukin (IL)-6 and IL-13 concentrations, tumor necrosis factor-alpha (TNF-alpha) and IL-6 production by lipopolysaccharide (LPS)-stimulated whole blood, leukocyte count, natural killer (NK) cell number, platelet activation, and platelet-leukocyte aggregate formation. Rectal inflammation was assessed by mucosal release of substance P (SP), histamine, IL-13 and TNF-alpha, reactive oxygen metabolite production, and mucosal blood flow. Eight patients with active UC underwent a control procedure. RESULTS: Hypnosis decreased pulse by a median 7 beats per minute (bpm) (P= 0.0008); it also reduced the median serum IL-6 concentration by 53% (P= 0.001), but had no effect on the other systemic variables assessed. Hypnosis reduced rectal mucosal release of SP by a median 81% (P= 0.001), histamine by 35% (P= 0.002) and IL-13 by 53% (P= 0.003), and also, blood flow by 18% (P= 0.0004). The control protocol had no effect on any of the variables assessed. CONCLUSIONS: Hypnosis reduced several components of the systemic and mucosal inflammatory response in active ulcerative colitis toward levels found previously in the inactive disease. Some of these effects may contribute to the anecdotally reported benefits of hypnotherapy and provide a rationale for controlled trials of hypnotherapy in UC.
"Hypnotherapy for crohn's disease. A promising complementary/alternative therapy."
Abela, M. B. (2000). Integr Med 2(2): 127-131.
Crohn's disease is a nonspecific chronic syndrome of unknown origin for which, to date, no conventional (i.e., medical or surgical) cure exists. However, recent clinical case studies and anecdotal reports have shown that the use of different forms of hypnotherapy for the treatment of Crohn's have actually resulted in cures. This report reviews and compares the effectiveness of hypnotherapy in the treatment of Crohn's disease vis-a-vis current medical and surgical therapies, in addition to reviewing evidence of the modulation of immune function parameters by hypnosis, while providing support for current etiological hypotheses of Crohn's disease as an autoimmune disorder."
"Stress and mind-body impact on the course of inflammatory bowel diseases."
Anton, P. A. (1999). Seminars in Gastrointestinal Disease 10(1): 14-9.
At present, the medical management of inflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis, are focused on topical, locally active antiinflammatories and systemic immunosuppressives, which are thought to exert their targeted effects in the gastrointestinal mucosa. There is a paucity of controlled trials assessing the impact of mind, central nervous system (CNS), and neuromodulation on the overly active immune response in the intestinal mucosa. Patients and their physicians have long been aware of a strong association between attitude, stress, and flares of their IBD. Although reports to date remain mostly anecdotal, the degree to which mind-body influences and stress impact levels of local inflammation deserves closer attention with the aim of identifying contributing mechanisms, which may highlight new therapeutic interventions, as well as assist in identifying particular subsets of patients that may respond to novel forms of adjunctive treatments for IBD, including hypnosis, meditation, neuropeptide receptor modulation, and cortisol-releasing factor (CRF) modulation.
"Hypnosis and the treatment of ulcerative colitis and Crohn's disease."
Schafer, D. W. (1997). American Journal of Clinical Hypnosis 40(2): 111-7.
Ulcerative colitis and Crohn's Disease can be cured if they are treated as autoimmune diseases with a special understanding of the personality conflicts in the patient. The author hypothesizes that all autoimmune diseases are characterized by a high normal amount of the aggressive instinctual drives and ambivalence about their realization. Each patient's personality causes the ambivalence to be somaticized into specific autoimmune bodies that aggressively are overproduced and then attack specific tissues. Hypnosis helps in gaining insight, reinforcing interpretations, handling stress, visualizing normal intestinal areas, and controlling of the autoimmune antibodies to the normal level. This paper deals specifically with these 2 diseases.
Cystic Fibrosis
"Self-hypnosis for patients with cystic fibrosis."
Anbar, R. D. (2000). Pediatric Pulmonology 30(6): 461-5.
This report documents the utility of self-hypnosis in patients with cystic fibrosis (CF). Sixty-three patients 7 years of age or older were offered the opportunity to be taught self-hypnosis by their pulmonologist. Forty-nine agreed to learn it. Patients generally were taught hypnosis in one or two sessions. The outcome of hypnotherapy was determined by patients' answers to open-ended questions regarding their subjective evaluation of the efficacy of hypnosis. The average age of the 49 patients who were taught and used self-hypnosis was 18.1 years (range, 7-49 years). Many of the patients used hypnosis for more than one purpose, including relaxation (61% of patients), relief of pain associated with medical procedures (31%), headache relief (16%), changing the taste of medications to make the flavor more palatable (10%), and control of other symptoms associated with CF (18%). The patients successfully utilized self-hypnosis 86% of the time. No symptoms worsened following hypnotherapy. Sixteen patients chose to practice hypnosis on their own for a half year or longer. In conclusion, with the use of self-hypnosis, patients with CF can quickly learn to enhance their control over discomforts associated with therapy and their disease. Consideration should be given to making instruction in self-hypnosis available to patients with CF.
"The effects of self-hypnosis for children with cystic fibrosis: a pilot study."
Belsky, J. and P. Khanna (1994). American Journal of Clinical Hypnosis 36(4): 282-92.
This pilot study assessed the effects of self-hypnosis on psychological and physiological functioning of children ages 7 to 18 with Cystic Fibrosis (N = 12). The study used a pre- and posttest design, repeated measures, and control group. Control and experimental groups were matched for age and clinical severity. The experimental group demonstrated significant changes in locus of control, health locus of control, and self-concept. State anxiety scores did not differ significantly, but changes in trait anxiety distinguished the experimental group from the control group. The experimental group also demonstrated significant increase in peak expiratory flow rates using an air flow meter immediately after self-hypnosis when compared to the control group. Generalizability of the results is discussed in terms of the small sample size. Recommendations are offered for future studies with larger samples and variations in procedure.
Cystitis (Interstitial)
"Guided imagery for women with interstitial cystitis: results of a prospective, randomized controlled pilot study."
Carrico, D. J., K. M. Peters, et al. (2008). Journal of Alternative and Complementary Medicine 14(1): 53-60.
INTRODUCTION: In the United States, more than 1 million women and men are affected with interstitial cystititis (IC), which is a clinical syndrome involving urinary urgency, frequency, and pelvic pain. A review of the literature revealed that there are no studies showing the effect of guided imagery in women with IC. The purpose of this clinical investigation was to explore the effect of guided imagery on pelvic pain and urinary symptoms in women with IC symptoms. METHODOLOGY: Thirty (30) women with diagnosed IC were randomized into 2 equal groups. One group (treatment) listened to a 25-minute guided imagery compact disc (CD), that was created specifically for women with pelvic pain and IC, twice a day for 8 weeks. The control group rested for 25 minutes twice daily for 8 weeks. Because no guided imagery CDs specifically for women with IC were found on the commercial market, the authors created a script and recorded the CD specifically for women with IC and pelvic pain. The focus of this guided imagery CD was on healing the bladder, relaxing the pelvic-floor muscles, and quieting the nerves specifically involved in IC. Baseline and end-of-study assessment questionnaires (Interstitial Cystitis Symptom Index & Problem Index [IC-SIPI], IC Self-Efficacy Scale, a visual analogue [VAS] scale for pain, and a global response assessment [GRA]), 2-day voiding diaries, and 24-hour pain diaries were completed by the subjects and were evaluated using SPSS (Chicago, IL). RESULTS: More than 45% of the treatment group were responders to guided imagery therapy noting a moderate or marked improvement on the GRA. Pain scores and episodes of urgency significantly decreased in the treatment group. Responders had significant reductions in IC-SIPI scores (problem index, p = 0.006; symptom index, p = 0.004). In addition, responders on the GRA had significant (p = 0.039) improvements in mean pain scores from 5.50 to 2.57 at the end of the study in contrast to the nonresponders, whose pain levels remained the same (4.89 to 4.39). CONCLUSIONS: This is the first study providing preliminary data supporting the use of guided imagery as a potential therapy for IC. Guided imagery may be a useful tool to offer women with IC for pain and IC symptom management. It is an intervention without negative side-effects, is readily available, and shows a trend toward improvement of IC symptoms.
Dental Procedures
"Comparison of conventional therapies for dentin hypersensitivity versus medical hypnosis."
Eitner, S., C. Bittner, et al. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 457-75.
This study compared the efficacy of conventional treatments for dentin hypersensitivity (DHS) and hypnotherapy. During a 1-month period at an urban practice in a service area of approximately 22,000 inhabitants, all patients were examined. A total of 102 individuals were included in the evaluation. Values of 186 teeth were analyzed. The comparison of the different treatment methods (desensitizer, fluoridation, and hypnotherapy) did not show significant differences in success rates. However, a noticeable difference was observed in terms of onset and duration of effect. For both desensitizer and hypnotherapy treatments, onset of effect was very rapid. Compared to the other methods studied, hypnotherapy effects had the longest duration. In conclusion, hypnotherapy was as effective as other methods in the treatment of DHS.
"Psychological treatment of fearful and phobic special needs patients."
Peltier, B. (2009). Special Care in Dentistry 29(1): 51-7.
Dental fears and phobias trouble patients with and without special needs, and they are a problem for dentists, as well. This article reviews current research and literature related to methods used to alleviate dental fear and concludes that while some important psychological methods are available, much work is left to be done in this area. It is clear that there is an important role for psychological and behavioral input to the dentist-patient interaction. While dental phobia represents a class of special needs itself, patients with other important disabilities (e.g., physical or cognitive impairments) are sometimes comorbidly phobic, a condition often missed or misdiagnosed by treating practitioners. Office-based techniques that focus on relaxation, breathing, imagery, hypnosis, and effective use of operatory language are described. The methods advocated here can be used with patients having mild or moderate cognitive impairments. Readings are recommended for the dentist or auxiliary practitioner interested in learning these techniques.
"Conscious hypnosis as a method for patient motivation in cervical headgear wear--a pilot study."
Trakyali, G., K. Sayinsu, et al. (2008). European Journal of Orthodontics 30(2): 147-52.
The aim of the present study was to assess the efficiency of conscious hypnosis on patient cooperation. The subjects were 30 patients (14 females and 16 males) with a skeletal Class II division 1 malocclusion, divided into two equal groups, a control and a study group. The mean age was 10.78 +/- 1.06 years for the hypnosis, and 10.07 +/- 1.09 years for the control group. Both groups were treated with cervical headgear containing a timer module. The patients were also asked to record their actual wear time on timetables. The hypnosis group patients were motivated with conscious hypnosis while the control group were given verbal motivation by their orthodontist. The timer modules were read at every visit and compared with the timetables. Analysis of variance was used to determine the differences in measurements at each time point. For comparison of the groups, an independent t-test was used. A statistically significant decrease (P < 0.05) in headgear wear was observed in the control group from the first to the sixth month; however, the difference in the hypnosis group was not significant. This result indicates that conscious hypnosis is an effective method for improving orthodontic patient cooperation. There was a low correlation between actual headgear wear indicated by the patient and that recorded by the timing modules, which showed that, timetables are not consistent tools for measuring patient cooperation.
"Management of the anxious patient: what treatments are available?"
Mellor, A. (2007). Dental Update 34(2): 108-10, 113-4.
Fear of the dentist is a common phenomenon. There are many ways of dealing with anxious patients and this review aims to present the most common methods available to general dental practitioners. Clinical Relevance: An ability to deal with anxious patients successfully is undoubtedly a practice builder. Anxious patients can be stressful to manage but they often become the most vocal advocates of dentists that they trust.
"Hypnosis in dentistry."
Roberts, K. (2006). Dental Update 33(5): 312-4.
In this article, the nature of hypnosis will be discussed, together with its therapeutic/facilitator role in the control of the potential problems that occur in everyday dental practice. It is the vital relationship between a patient and therapist which produces the desired results of hypnotherapy. CLINICAL RELEVANCE: A holistic approach, in patient care, emphasizes the treatment of an individual who has a dental problem.
"Potential adjunctive applications of hypnosis in the management of periodontal diseases."
Wood, G. J. and H. H. Zadeh (1999). American Journal of Clinical Hypnosis 41(3): 212-25.
Many uses of hypnosis in dentistry have been described in the literature including anesthesia, analgesia, anxiety management, treatment for bruxism, to control gagging, and the alteration of salivary flow and bleeding control during treatment. However, very few references have been made specifically regarding the use of hypnosis with patients who have periodontal disease, a wide spread chronic inflammatory disease affecting the oral cavity of about 80% of the population. The purpose of this paper is to describe potential adjunctive applications of hypnosis in the treatment of patients with periodontal diseases. The supporting literature from two broad areas for potential application, health behaviors and psychoneuroimmunology is discussed, followed by proposed hypnotic strategies and suggestions for use with patients with periodontal diseases.
"Etiology and treatment of dental anxiety and phobia."
Rodolfa, E. R., W. Kraft, et al. (1990). American Journal of Clinical Hypnosis 33(1): 22-8.
Dental anxiety and phobia afflict millions of people. Dental patients who are anxious anticipate pain and feel vulnerable and out of control. Hypnotherapy to alleviate dental anxiety and phobias has received clinical and empirical support. Our purpose in this paper is to provide a body of objective data from American Society of Clinical Hypnosis members regarding incidence rates and the relative importance of various etiological and conceptual issues in the development and maintenance of dental anxiety and treatment interventions. From these data, we constructed a model of etiology, maintenance, and treatment of dental anxiety.
"Hypnosis in the treatment of dental fear and phobia."
Forgione, A. G. (1988). Dental Clinics of North America 32(4): 745-61.
The term hypnosis is currently used to define an area of research and treatment that employs suggestion. Within this area, suggestion refers to the induction of expectancies by implicit or explicit means, usually involving concentration and the expectancy that the suggested results are possible. This use of suggestion differs from the common use of the term suggestion, which is a logical offering for a change in behavior or thought. The long history of hypnosis is testimony to its effectiveness, although there has been controversy as to why it works. Patient selection is important. Further, fear must be distinguished from phobia. Combined with other treatment techniques, such as systematic desensitization, it is a powerful behavior modification method. To prevent accidental delivery of suggestions that may be counterproductive to treatment, the study of hypnosis is important even to those health care professionals who have no intention of employing it in their practice.
Depression
"A meta-analysis of hypnosis in the treatment of depressive symptoms: a brief communication."
Shih, M., Y. H. Yang, et al. (2009). International Journal of Clinical and Experimental Hypnosis 57(4): 431-42.
The efficacy of hypnosis in the treatment of depressive symptoms was subjected to a meta-analysis. Studies were identified using Google Scholar and 6 electronic databases: PubMed, Cochrane Library, PsiTri, PsychLit, Embase, and the Cochrane Depression, Anxiety and Neurosis Review Group (CCDAN). The keywords used were (a) hypnosis, (b) hypnotherapy, (c) mood disorder, (d) depression, and (e) dysthymia. Six studies qualified and were analyzed using the Comprehensive Meta-Analysis software package. The combined effect size of hypnosis for depressive symptoms was 0.57. Hypnosis appeared to significantly improve symptoms of depression (p < .001). Hypnosis appears to be a viable nonpharmacologic intervention for depression. Suggestions for future research are discussed.
"The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders."
Apostolo, J. L. and K. Kolcaba (2009). Archives of Psychiatric Nursing 23(6): 403-11.
This article describes the efficacy of a guided imagery intervention for decreasing depression, anxiety, and stress and increasing comfort in psychiatric inpatients with depressive disorders. A quasi-experimental design sampled 60 short-term hospitalized depressive patients selected consecutively. The experimental group listened to a guided imagery compact disk once a day for 10 days. The Psychiatric Inpatients Comfort Scale and the Depression, Anxiety, and Stress Scales (DASS-21) were self-administered at two time points: prior to the intervention (T1) and 10 days later (T2). Comfort and DASS-21 were also assessed in the usual care group at T1 and T2. Repeated measures revealed that the treatment group had significantly improved comfort and decreased depression, anxiety, and stress over time.
"A benchmarked feasibility study of a self-hypnosis treatment for depression in primary care."
Dobbin, A., M. Maxwell, et al. (2009). International Journal of Clinical and Experimental Hypnosis 57(3): 293-318.
This investigation assessed the effectiveness of a self-help, self-hypnosis treatment in a primary-care setting in Edinburgh, UK. A partially randomized preference (PRP) study design was used, with benchmarking results to trials of CBT and counseling. Patients seeing their general practitioner for depression were offered randomization to, or their treatment preference of, either self-help (self-hypnosis) or antidepressant medication. Evaluation measures were Becks Depression Inventory, Brief Symptom Inventory, and SF-36. Of the 58 patients recruited, 50 chose self-hypnosis, 4 chose antidepressants, and 4 were randomized. The preference groups demonstrated similar demography, baseline measurements, and outcome effects to benchmarked trials. This feasibility study of a self-help, self-hypnosis program for depression showed promise for its future use in primary care. Benchmarking improved validity and reliability. A PRP study design appeared useful in a primary-care setting, where past studies have experienced problems of recruitment, concordance, and compliance.
"Hypnosis in treating symptoms and risk factors of major depression."
Yapko, M. (2001). American Journal of Clinical Hypnosis 44(2): 97-108.
This article summarizes aspects of effective psychotherapy for major depression and describes how hypnosis can further enhance therapeutic effectiveness. Hypnosis is helpful in reducing common symptoms of major depression such as agitation and rumination and thereby may decrease a client' sense of helplessness and hopelessness. Hypnosis is also effective in facilitating the learning of new skills, a core component of all empirically supported treatments for major depression. The acquisition of such skills has also been shown to not only reduce depression, but also the likelihood of relapses, thus simultaneously addressing issues of risk factors and prevention.
Diabetes
"Hypnosis as an adjunct therapy in the management of diabetes."
Xu, Y. and E. Cardena (2008). International Journal of Clinical and Experimental Hypnosis 56(1): 63-72.
Although diabetes is one of the most serious global health problems, there is no real cure yet for it. The conventional insulin treatment programs aimed at life quality improvement do not take into account the psychological aspects of the disease. Because diabetes has important psychological components, it seems reasonable to consider hypnosis as an adjunct therapy for diabetes. This paper examines the empirical literature on the effectiveness of hypnosis in the management of diabetes, including regulation of blood sugar, increased compliance, and improvement of peripheral blood circulation. Despite some methodological limitations, the literature shows promising results that merit further exploration. Multimodal treatments seem especially promising, with hypnosis as an adjunct to insulin treatments in the management of both Type 1 and Type 2 diabetes for stabilization of blood glucose and decreased peripheral vascular complications.
"A hypnotherapeutic approach to the improvement of compliance in adolescent diabetics."
Ratner, H., L. Gross, et al. (1990). American Journal of Clinical Hypnosis 32(3): 154-9.
Adolescents with insulin-dependent diabetes mellitus (IDDM) have a rate of noncompliance in our clinic of approximately 20% despite all of the usual measures aimed at securing compliance. Seven IDDM patients ranging in age from 11 to 19 years were managed in our clinic with all of our usual modalities, but all remained in long-term poor control during the 6 months immediately prior to the study. To ensure that each patient would serve as his/her own control, no changes were made in his/her management other than the addition of hypnosis. Six of the seven patients were followed for more than 6 months. No changes were made in insulin, diet, or exercise as prescribed. Posttreatment, the average HgbA1C dropped from 13.2% to 9.7%, and the average fasting blood sugar from 426 mg/dl to 149 mg/dl, values which are consistent with good compliance.
Dry Mouth-Xerostomia
"Hypnosis for Postradiation Xerostomia in Head and Neck Cancer Patients: A Pilot Study."
Schiff, E., J. G. Mogilner, et al. (2009). Journal of Pain and Symptom Management.
Xerostomia, the sensation of dry mouth, affects almost all patients who undergo radiotherapy for cancer in the head and neck area. Current therapies for xerostomia are inadequate, and the condition negatively impacts the quality of life. This prospective observational pilot aimed to evaluate whether hypnosis could improve salivation and decrease xerostomia. Twelve patients with xerostomia after radiotherapy for head and neck cancer were assessed for severity of xerostomia symptoms and sialometry. They then received a single hypnosis session with specific suggestions to increase salivation. The session was recorded on a compact disk (CD), and the participants were instructed to listen to it twice a day for one month. Sialometry was repeated immediately after hypnosis. Validated xerostomia questionnaires were completed at one, four, and 12 weeks after hypnosis. A substantial overall improvement was reported by eight patients at 12 weeks (66%). The saliva flow rate increased on sialometry in nine patients following hypnosis (75%). There was no correlation between the magnitude of changes in the measured saliva flow rate and changes in subjective measures (Spearman's correlation coefficient r=0.134). Symptomatic improvement significantly correlated with the number of times the patients listened to the hypnosis CD (r=0.714, P=0.009). No adverse events were reported. The data from this small observational trial suggest that hypnosis may be an effective treatment for xerostomia. Confirmation in a larger randomized and controlled investigation is warranted.
Dyspepsia (Indigestion)
"Functional dyspepsia: At least recommend hypnotherapy."
Sharma, R. L. (2008). British Medical Journal 337: a1972.
"Dyspepsia in childhood and adolescence: insights and treatment considerations."
Perez, M. E. and N. N. Youssef (2007). Curr Gastroenterol Rep 9(6): 447-55.
Functional dyspepsia (FD) is common in children, with as many as 80% of those being evaluated for chronic abdominal pain reporting symptoms of epigastric discomfort, nausea, or fullness. It is known that patients with persistent complaints have increased comorbidities such as depression and anxiety. The interaction with psychopathologic variables has been found to mediate the association between upper abdominal pain and gastric hypersensitivity. These observations suggest that abnormal central nervous system processing of gastric stimuli may be a relevant pathophysiologic mechanism in FD. Despite increased understanding, no specific therapy has emerged; however, recent nonpharmacological-based options such as hypnosis may be effective. Novel approaches, including dietary manipulation and use of nutraceuticals such as ginger and Iberogast (Medical Futures Inc., Ontario, Canada), may also be considered.
"Long-term improvement in functional dyspepsia using hypnotherapy."
Calvert, E. L., L. A. Houghton, et al. (2002). Gastroenterology 123(6): 1778-85.
BACKGROUND & AIMS: We have shown hypnotherapy (HT) to be effective in irritable bowel syndrome, with long-term improvements in symptomatology and quality of life (QOL). This study aimed to assess the efficacy of HT in functional dyspepsia (FD). METHODS: A total of 126 FD patients were randomized to HT, supportive therapy plus placebo medication, or medical treatment for 16 weeks. Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase (short-term) and after 56 weeks (long-term) with 26 HT, 24 supportive therapy, and 29 medical treatment patients completing all phases of the study. QOL was measured as a secondary outcome. RESULTS: Short-term symptom scores improved more in the HT group (median, 59%) than in the supportive (41%; P = 0.01) or medical treatment (33%; P = 0.057) groups. HT also benefited QOL (42%) compared with either supportive therapy (10% [P < 0.001]) or medical treatment (11% [P < 0.001]). Long-term, HT significantly improved symptoms (73%) compared with supportive therapy (34% [P < 0.02]) or medical treatment (43% [P < 0.01]). QOL improved significantly more with HT (44%) than with medical treatment (20% [P < 0.001]). QOL did improve in the supportive therapy (43%) group, but 5 of these patients commenced taking antidepressants during follow-up. A total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the HT group did so (P < 0.001). Those in the HT group visited their general practitioner or gastroenterologist significantly less (median, 1) than did those in the supportive therapy (median, 4) and medical treatment (median, 4) groups during follow-up (P < 0.001). CONCLUSIONS: HT is highly effective in the long-term management of FD. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.
Eating Disorders
"Rapid remission of anorexia nervosa and unconscious communication."
Walsh, B. J. (2010) American Journal of Clinical Hypnosis 52(4): 319-33.
An alternate framework for thinking about anorexia treatment is presented with a treatment approach that results in prompt remission of anorexia symptoms. Prior treatment of eating disorders using hypnosis is reviewed. A case example illustrating the method is followed by a discussion. The process is described for teaching clients how to nullify the anorexia symptom complex when it is reactivated.
"Exploratory study to decrease postprandial anxiety: Just relax!"
Shapiro, J. R., E. M. Pisetsky, et al. (2008). International Journal of Eating Disorders 41(8): 728-33.
OBJECTIVE: Critical first steps in the treatment of anorexia nervosa (AN) include re-nutrition and weight restoration, both highly anxiety provoking for patients. We explored the impact of progressive muscle relaxation (PMR), guided imagery (GI), self-directed relaxation (SR), and control (C) on reducing postprandial anxiety in 64 females with AN. METHOD: Participants began the study upon hospital admission. They received relaxation training after lunch for 15 days. Pre- and post-session anxiety and treatment acceptability ratings were made daily. RESULTS: Although all conditions improved relaxation and decreased anxiety, feelings of fullness, and thoughts about weight, the three active conditions significantly reduced anxiety and increased relaxation more than C (p < .0001). Participants significantly enjoyed the three active treatments, were more likely to recommend them to a friend, and were more likely to use either PMR or GI again versus C (p < .0001). CONCLUSION: Relaxation may be a valuable component for reducing postprandial anxiety in AN.
"Efficacy of hypnotherapy in the treatment of eating disorders."
Barabasz, M. (2007). International Journal of Clinical and Experimental Hypnosis 55(3): 318-35.
Research on the efficacy of hypnosis in the treatment of eating disorders has produced mixed findings. This is due in part to the interplay between the characteristics of people with eating disorders and the phenomena of hypnosis. In addition, several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of the hypnotic intervention(s) to facilitate replication and clinical implementation. Therefore, this paper only reviews literature with replicable methodological descriptions. It focuses on the three primary disorders of interest to clinicians: bulimia nervosa, anorexia nervosa, and obesity. The implications for evaluating treatment efficacy are discussed.
"Hypnotizability, eating behaviors, attitudes, and concerns: a literature survey."
Hutchinson-Phillips, S., K. Gow, et al. (2007). International Journal of Clinical and Experimental Hypnosis 55(1): 84-113.
The literature suggests that aspects of hypnotizability may be involved in the etiology and maintenance of self-defeating eating. However, interpretation of the published research findings has been complicated by the use of instruments that appear to have measured different or, at best, only related facets of the underlying constructs. This article reports relationships between weight, shape, dietary concerns, hypnotizability, dissociative capacity, and fantasy proneness. Implications for a key role for hypnosis in the treatment of eating behaviors, attitudes, and concerns are discussed.
"The use of hypnosis with eating disorders."
Torem, M. S. (1992). Psychiatric Medicine 10(4): 105-18.
This paper reviews the literature on the use of hypnosis in the assessment and treatment of eating disorders. It proposes that patients with eating disorders ought to be investigated as to the underlying dynamics behind the eating disorders symptoms. Following a thorough assessment, a number of hypnotherapeutic techniques are explained and discussed, such as: general relaxation and calmness, guided imagery, teaching self-hypnosis, ego-strengthening, direct and indirect suggestions for healing and recovery, cognitive restructuring and reframing, symbolic guided imagery, age progression ("back from the future" technique), metaphorical prescriptions, age regression and abreactions, and ego state therapy. Verbatim examples of these techniques are given as illustrations of how to use them.
"Hypnotic alteration of body image in the eating disordered."
Walsh, B. J. (2008). American Journal of Clinical Hypnosis 50(4): 301-10.
A driving force in an eating disorder like anorexia nervosa has been a distorted body image. The psychobiological dynamics of eating disorders have demonstrated significant hypnotic phenomena such as forms of dissociation, hallucination, time distortion and catalepsy, and therefore, pose hypnosis as a good fit for particular parts of treatment. Presented here are four hypnotic approaches designed to inspire the establishment of a reality based body image in the eating disordered individual. Conditional prerequisites for application of these interventions are described and case examples illustrate each approach. A discussion on some of the rationale for formulating these strategies is offered.
Fertility
"Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization-embryo transfer: a case-control study."
Levitas, E., A. Parmet, et al. (2006). Fertility and Sterility 85(5): 1404-8.
OBJECTIVE: To investigate whether hypnosis during ET contributes to successful IVF/ET outcome. DESIGN: Case-control clinical study. SETTING: Academic Fertility and IVF Unit, Soroka Medical Center, Beer-Sheva, Israel. PATIENT(S): Infertile couples undergoing IVF. INTERVENTION(S): Ninety-eight IVF/ET cycles with hypnosis during the ET procedure were matched with 96 regular IVF/ET cycles. MAIN OUTCOME MEASURES: Comparison of clinical pregnancy and implantation rates between the two groups. RESULT(S): We obtained 52 clinical pregnancies out of 98 cycles (53.1%) with an implantation rate of 28% among hypnosis IVF/ET cycles, and 29 out of 96 (30.2%) clinical pregnancies and an implantation rate of 14.4% in the control cycles. Our overall IVF program pregnancy rate for the same period was 32.1%. Logistic regression analysis was performed emphasizing the positive contribution of hypnosis to the IVF/ET conception rates. CONCLUSION(S): This study suggests that the use of hypnosis during ET may significantly improve the IVF/ET cycle outcome in terms of increased implantation and clinical pregnancy rates. Furthermore, it seems that the patients' attitude to the treatment was more favorable.
"Hypnosis in the treatment of functional infertility."
Gravitz, M. A. (1995). American Journal of Clinical Hypnosis 38(1): 22-6.
The literature was reviewed and found to contain sparse information regarding the applicability of clinical hypnosis in the treatment of functional infertility. Two cases were then described in which hypnosis based on imagery and a relaxation strategy was successful in facilitating pregnancy in both instances. The treatment was considered to have resulted in beneficial modification of attitude, optimism, and mind-body interaction.
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Fibromyalgia
"Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: An fMRI analysis."
Derbyshire, S. W., M. G. Whalley, et al. (2008). Eur J Pain.
The neuropsychological status of pain conditions such as fibromyalgia, commonly categorized as 'psychosomatic' or 'functional' disorders, remains controversial. Activation of brain structures dependent upon subjective alterations of fibromyalgia pain experience could provide an insight into the underlying neuropsychological processes. Suggestion following a hypnotic induction can readily modulate the subjective experience of pain. It is unclear whether suggestion without hypnosis is equally effective. To explore these and related questions, suggestions following a hypnotic induction and the same suggestions without a hypnotic induction were used during functional magnetic resonance imaging to increase and decrease the subjective experience of fibromyalgia pain. Suggestion in both conditions resulted in significant changes in reported pain experience, although patients claimed significantly more control over their pain and reported greater pain reduction when hypnotised. Activation of the midbrain, cerebellum, thalamus, and midcingulate, primary and secondary sensory, inferior parietal, insula and prefrontal cortices correlated with reported changes in pain with hypnotic and non-hypnotic suggestion. These activations were of greater magnitude, however, when suggestions followed a hypnotic induction in the cerebellum, anterior midcingulate cortex, anterior and posterior insula and the inferior parietal cortex. Our results thus provide evidence for the greater efficacy of suggestion following a hypnotic induction. They also indicate direct involvement of a network of areas widely associated with the pain 'neuromatrix' in fibromyalgia pain experience. These findings extend beyond the general proposal of a neural network for pain by providing direct evidence that regions involved in pain experience are actively involved in the generation of fibromyalgia pain.
"Integrative therapy for fibromyalgia: possible strategies for an individualized treatment program."
Morris, C. R., L. Bowen, et al. (2005). Southern Medical Journal 98(2): 177-84.
One of the most complex patient treatment situations encountered by the clinician is the patient who presents with the cluster of signs and symptoms that lead to the diagnosis of fibromyalgia syndrome. While physicians focus primarily on pharmacologic treatment, a number of nonpharmacologic modalities have been shown to benefit patients as well. No one therapy is uniformly effective in every patient; treatment programs consisting of a combination of pharmacologic and nonpharmacologic therapies must be individualized to the patient, and the clinician may have to try several different modalities before reaching an optimal improvement in the patient's symptoms.
"Complementary medicine treatments for fibromyalgia syndrome."
Berman, B. M. and J. P. Swyers (1999). Baillieres Best Pract Res Clin Rheumatol 13(3): 487-92.
Fibromyalgia is a chronic-pain-related syndrome associated with high rates of complementary and alternative medicine (CAM) use. Among the many CAM therapies frequently used by fibromyalgia patients, empirical research data exist to support the use of only three: (1) mind-body, (2) acupuncture, and (3) manipulative therapies for treating fibromyalgia. The strongest data exist for the use of mind-body techniques (e.g. biofeedback, hypnosis, cognitive behavioural therapy), particularly when utilized as part of a multidisciplinary approach to treatment. The weakest data exist for manipulative techniques (e.g. chiropractic and massage). The data supporting the use of acupuncture for fibromyalgia are only moderately strong. Also, for some fibromyalgia patients, acupuncture can exacerbate symptoms, further complicating its application for this condition. Further research is needed not only in these three areas, but also for other treatments being frequently utilized by fibromyalgia patients.
"Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia."
Haanen, H. C., H. T. Hoenderdos, et al. (1991). Journal of Rheumatology 18(1): 72-5.
In a controlled study, 40 patients with refractory fibromyalgia were randomly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks. Compared with the patients in the physical therapy group, the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience, fatigue on awakening, sleep pattern and global assessment at 12 and 24 weeks, but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter. At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist. These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy, but they remained abnormally strong in many cases. We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.
Hair-Pulling
"Hypnosis as a vehicle for choice and self-agency in the treatment of children with Trichotillomania."
Iglesias, A. (2003). American Journal of Clinical Hypnosis 46(2): 129-37.
Three pediatric cases of Trichotillomania were treated with direct hypnotic suggestion with exclusive emphasis on sensitizing and alerting the patients to impending scalp hair pulling behaviors. These children had presented with total lack of awareness of their scalp hair pulling behaviors until they had actually twisted and pulled off clumps of hair. It was also suggested, under hypnosis, that upon learning to recognize impending scalp hair pulling behaviors, the patients would become free to choose to willfully pull their hair or to resist the impulse and not pull. At no point was the explicit suggestion given that they stop pulling their hair. A preliminary condition was agreed to by the parents that redefined the patients' hair as their own property and affirmed their sole responsibility for its care and maintenance. An element of secondary gain was identified in each of these cases. Scalp hair pulling was hypothesized to provide these particular patients with a vehicle with which to oppose their overbearing and over-involved parents. The technique of direct suggestion under hypnosis, aimed at alerting the patients to impending scalp hair pulling behaviors was combined with forming contracts with the parents to relinquish their authority over matters regarding the patients' hair. This combination provided an effective treatment that extinguished the scalp hair pulling in 7 visits or less. These cases received follow-up at intervals up to 6 months and no evidence of relapse was found.
"Acceptability of treatments for trichotillomania. Effects of age and severity."
Elliott, A. J. and W. R. Fuqua (2002). Behavior Modification 26(3): 378-99.
Based on the literature, trichotillomania (TTM, chronic hair pulling) in children and adults appears to be responsive to behavioral interventions such as habit reversal. However, some have questioned the generality and acceptability of such procedures. This study compared the acceptability ratings of four interventions targeting TTM (habit reversal, hypnosis, medication, and punishment). In the study, 233 college students read case vignettes in which the age of the analogue client and the severity of the hair pulling were manipulated. Results showed significant differences between the four treatment conditions, with hypnosis and habit reversal being rated most acceptable. Age of the analogue client and severity of TTM did not significantly influence acceptability ratings.
"The characterization and treatment of trichotillomania."
Christenson, G. A. and S. J. Crow (1996). Journal of Clinical Psychiatry 57 Suppl 8: 42-7; discussion 48-9.
Trichotillomania is an impulse control disorder characterized by chronic self-directed hair pulling. Trichotillomania has additionally been viewed as one of the obsessive-compulsive spectrum disorders. Any body hair may be targeted, and most patients pull from more than one site. In clinical settings the disorder predominantly affects females. Onset is generally in childhood or adolescence, and a chronic course is typical. Depression and anxiety frequently accompany the disorder. An increased incidence of comorbid obsessive-compulsive disorder (OCD) has been noted. Neurobiological investigations have paralleled etiologic studies of OCD and have demonstrated both similarities and differences between these two disorders. Current treatment options include a variety of medications, particularly the serotonin selective reuptake inhibitors, the behavioral technique of habit reversal, and hypnosis.
Headache
"Long-term follow-up of self-hypnosis training for recurrent headaches: what the children say."
Kohen, D. P. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 417-32.
The author sent surveys to 178 consecutive youths previously referred for hypnosis for headaches. The survey sought current status of headaches: treatment, application of self-hypnosis, headache intensity, frequency, duration after self-hypnosis, generalization of self-hypnosis to other problems, and attitudes regarding self-hypnosis and life stresses. Of 134 delivered surveys, 52 were returned complete. Years after treatment, 85% (44/52) reported continued relief with self-hypnosis, 44% (23/52) reported decreased headache frequency, 31% (16/52) noted decreased severity, and 56% (29/52) reported that self-hypnosis reduced headache intensity. Many (26/52) emphasized the value of self-hypnosis to life stresses. In children and adolescents, self-hypnosis is associated with significant improvement of headaches and with an enduring positive effect for many years following training. Results suggest common and spontaneous generalizability of self-hypnosis by young people to modulation of other problems in their lives.
"Relationship of headache-associated stressors and hypnosis therapy outcome in children: a retrospective chart review."
Anbar, R. D. and G. G. Zoughbi (2008). American Journal of Clinical Hypnosis 50(4): 335-41.
This study examined potential psychosocial stressors of 30 children with headaches (mean age, 15 years), and the role of insight generation in the outcome of hypnosis therapy. The mean duration of headache occurrence was 3 years. All of the patients were instructed in how to use hypnosis-induced relaxation and headache-related imagery to improve their symptoms. Thirty-seven percent reported their headaches were associated with fixed stressors, defined as caused by events over which patients had no control, while 63% reported variable stressors, defined as modifiable by the patients' actions. Four patients were lost to follow-up. Overall, 96% (25/26) reported a decrease in headache frequency and/or intensity following use of hypnosis. However, prior to insight generation patients reporting fixed stressors were significantly less likely to improve than those reporting variable stressors (p = 0.018). Thus, insight generation may be more important for achievement of improvement in children whose headaches are associated with fixed stressors.
"Review of the efficacy of clinical hypnosis with headaches and migraines."
Hammond, D. C. (2007). International Journal of Clinical and Experimental Hypnosis 55(2): 207-19.
The 12-member National Institute of Health Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996) reviewed outcome studies on hypnosis with cancer pain and concluded that research evidence was strong and that other evidence suggested hypnosis may be effective with some chronic pain, including tension headaches. This paper provides an updated review of the literature on the effectiveness of hypnosis in the treatment of headaches and migraines, concluding that it meets the clinical psychology research criteria for being a well-established and efficacious treatment and is virtually free of the side effects, risks of adverse reactions, and ongoing expense associated with medication treatments.
"Mind-body therapies for headache."
Sierpina, V., J. Astin, et al. (2007). American Family Physician 76(10): 1518-22.
Headache is one of the most common and enigmatic problems encountered by family physicians. Headache is not a singular entity, and different pathologic mechanisms are involved in distinct types of headache. Most types of headache involve dysfunction of peripheral or central nociceptive mechanisms. Mind-body therapies such as biofeedback, cognitive behavior therapy, hypnosis, meditation, and relaxation training can affect neural substrates and have been shown to be effective treatments for various types of headache. Meta-analyses of randomized controlled trials show that the use of mind-body therapies, alone or in combination, significantly reduces symptoms of migraine, tension, and mixed-type headaches. Side effects generally are minimal and transient.
"Effect of guided imagery on quality of life for patients with chronic tension-type headache."
Mannix, L. K., R. S. Chandurkar, et al. (1999). Headache 39(5): 326-34.
OBJECTIVE: To determine the effect of adjuvant guided imagery on patients with chronic tension-type headache. BACKGROUND: Management of chronic tension-type headache often requires a combination of pharmacological and nonpharmacological therapies. Guided imagery is a relaxation technique based on visualizing pleasant images and body awareness. METHODS: One hundred twenty-nine patients with chronic tension-type headache completed the Headache Disability Inventory and the Medical Outcomes Study Short Form (SF-36) at their initial visit to a specialty headache center and again 1 month after the visit. In addition to individualized headache therapy, patients listened to a guided imagery audiocassette tape daily for the month. One hundred thirty-one control subjects received individualized therapy without guided imagery. RESULTS: Controls and the patients who listened to the guided imagery tape improved in headache frequency, headache severity, patient global assessment, quality of life, and disability caused by headache. More guided imagery patients (21.7%) than controls (7.6%) reported that their headaches were much better (P = .004). The guided imagery patients had significantly more improvement than the controls in three of the SF-36 domains: bodily pain (95% CI; guided imagery patients 11.0, controls 0.2), vitality (95% CI; guided imagery patients 10.9, controls 1.7), and mental health (95% CI; guided imagery patients 7.8, controls 0.4). CONCLUSIONS: Guided imagery is an effective adjunct therapy for the management of chronic tension-type headache.
Hot Flashes
"Hypnosis helps reduce hot flashes in breast cancer survivors."
(2009). Harvard Womens Health Watch 16(6): 3.
"Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors."
Elkins, G., J. Marcus, et al. (2008). Journal of Clinical Oncology 26(31): 5022-6.
PURPOSE: Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. PATIENTS AND METHODS: Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities. RESULTS: Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group. CONCLUSION: Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.
"Mind control of menopause."
Younus, J., I. Simpson, et al. (2003). Womens Health Issues 13(2): 74-8.
The primary objective of this study was to observe the effect of hypnosis on hot flashes (HF) and overall quality of life in symptomatic patients. A secondary objective was to observe the effect of hypnosis on fatigue. Ten healthy volunteers and four breast cancer patients (total 14 patients) with symptoms of HF were treated with four, 1 h/wk sessions of hypnosis. The same physician, with the help of a nurse, conducted every session. All subjects recorded frequency, duration, and severity of HF in a HF diary. The QLQ-C30 and Brief Fatigue Inventory forms were used to assess the impact on quality of life and fatigue, respectively. The statistical evaluations were performed, including analysis of variance and nonparametric procedures. The frequency (p < 0.0001), duration (p < 0.0001), and severity (p < 0.0001) of HF were significantly reduced. The overall quality of life was also improved (p = 0.05). The subjects enjoyed better sleep and had less insomnia (p = 0.012). There was a significant improvement on current fatigue level (p = 0.017), but we did not find a statistically significant reduction in the total fatigue level. We conclude that hypnosis appears to be a feasible and promising intervention for HF, with a potential to improve quality of life and insomnia. Although improvement in current level of fatigue was observed in this pilot study, total fatigue improvement did not reach statistical significance.
Hypertension
"Effectiveness of hypnosis in reducing mild essential hypertension: a one-year follow-up."
Gay, M. C. (2007). International Journal of Clinical and Experimental Hypnosis 55(1): 67-83.
The present study investigates the effectiveness of hypnosis in reducing mild essential hypertension. Thirty participants were randomly assigned to hypnosis (standardized, individual 8-session hypnosis treatment) or to a control group (no treatment). Results show that hypnosis is effective in reducing blood pressure in the short term but also in the middle and long terms. We did not find any relationship between the practice of self-hypnosis and the evolution of blood pressure or between anxiety, personality factors, and therapeutic results. The implications of the results of the psychological treatment of hypertension are discussed.
Hypnosis Mechanisms
"The mysterious persistence of hypnotic analgesia."
Barber, J. (1998). International Journal of Clinical and Experimental Hypnosis 46(1): 28-43.
Hypnotic treatment of pain has a long history and, among hypnotic phenomena, pain relief is a relatively commonplace focus for intervention, yet we lack a conceptual explanation for this treatment. Hilgard's neodissociation theory accounts for the phenomenon of acute hypnotic analgesia, but not of persistent pain relief. Perhaps the enduring effect of hypnotic treatment can be explained at either of two levels: a neurophysiological model or a learning model. This explanation leads to the further question: How does hypnotic treatment of recurring pain achieve enduring relief? Clinical experience suggests a two-component model. First, the clinician communicates specific ideas that strengthen the patient's ability to derive therapeutic support and to develop a sense of openness to the unexplored possibilities for pain relief within the security of nurturing therapeutic relationship. Second, the clinician employs posthypnotic suggestions that capitalize on the patient's particular pain experiences, which simultaneously ameliorate the pain experience, and which, in small, repetitive increments, tend to maintain persistent pain relief over increasing periods of time.
"Evaluation of the efficacy and neural mechanism of a hypnotic analgesia procedure in experimental and clinical dental pain."
Barber, J. and D. Mayer (1977). Pain 4(1): 41-8.
Previous research implicates an endogenous central pain inhibitory mechanism in opiate analgesia, analgesia produced by focal electrical stimulation of the brain, and acupuncture analgesia. This investigation evaluates the possibility that analgesia produced by hypnosis is also mediated by such a mechanism. Results suggest that hypnotic analgesia is unlikely to involve this central pain inhibitory mechanism since hypnotic analgesia is not altered by naloxone hydrochloride, a specific narcotic antagonist. Results further demonstrate that the hypnotic procedure used produces an unusually effective and reliable increase in pain threshold. This finding generalizes to the control of clinical dental pain, and suggests that hypnotic pain control is a more widespread phenomenon in the population than has been thought.
"The neuroscience of observing consciousness & mirror neurons in therapeutic hypnosis."
Rossi, E. L. and K. L. Rossi (2006). American Journal of Clinical Hypnosis 48(4): 263-78.
Neuroscience documents the activity of "mirror neurons" in the human brain as a mechanism whereby we experience empathy and recognize the intentions of others by observing their behavior and automatically matching their brain activity. This neural basis of empathy finds support in research on dysfunctions in the mirror systems of humans with autism and fMRI research on normal subjects designed to assess intentionality, emotions, and complex cognition. Such empathy research now appears to be consistent with the historical and research literature on hypnotic induction, rapport, and many of the classical phenomena of suggestion. A preliminary outline of how mirror neurons may function as a rapport zone mediating between observing consciousness, the gene expression/protein synthesis cycle, and brain plasticity in therapeutic hypnosis and psychosomatic medicine is proposed. Brain plasticity is generalized in the theory, research, and practice of utilizing mirror neurons as an explanatory framework in developing and training new skill sets for facilitating an activity-dependent approach to creative problem solving, mind-body healing, and rehabilitation with therapeutic hypnosis.
"Clinical hypnosis modulates functional magnetic resonance imaging signal intensities and pain perception in a thermal stimulation paradigm."
Schulz-Stubner, S., T. Krings, et al. (2004). Regional Anesthesia and Pain Medicine 29(6): 549-56.
OBJECTIVE: This study was designed to describe regional changes in blood oxygenation level dependent signals in functional magnetic resonance images (fMRI) elicited by thermal pain in hypnotized subjects. These signals approximately identify the neural correlates of the applied stimulation to identify neuroanatomic structures involved in the putative effects of clinical hypnosis on pain perception. METHODS: After determination of the heat pain threshold of 12 healthy volunteers, fMRI scans were performed at 1.5 Tesla by using echoplanar imaging technique during repeated painful heat stimuli. Activation of brain regions in response to thermal pain during hypnosis (using a fixation and command technique of hypnosis) was compared with responses without hypnosis. RESULTS: With hypnosis, less activation in the primary sensory cortex, the middle cingulate gyrus, precuneus, and the visual cortex was found. An increased activation was seen in the anterior basal ganglia and the left anterior cingulate cortex. There was no difference in activation within the right anterior cingulate gyrus in our fMRI studies. No activation was seen within the brainstem and thalamus under either condition. CONCLUSION: Our observations indicate that clinical hypnosis may prevent nociceptive inputs from reaching the higher cortical structures responsible for pain perception. Whether the effects of hypnosis can be explained by increased activation of the left anterior cingulate cortex and the basal ganglia as part of a possible inhibitory pathway on pain perception remains speculative given the limitations of our study design.
"Naloxone fails to reverse hypnotic alleviation of chronic pain."
Spiegel, D. and L. H. Albert (1983). Psychopharmacology 81(2): 140-3.
The hypothesis that the alleviation of chronic pain with hypnosis is mediated by endorphins was tested. Six patients with chronic pain secondary to peripheral nerve irritation were taught to control the pain utilizing self-hypnosis. Each subject was tested at 5-min intervals during four 1-h sessions for the amount of reduction of pain sensation and suffering associated with hypnosis while being given, in a random double-blind crossover fashion, an IV injection of either 10 mg naloxone or a saline placebo through an indwelling catheter. The patients demonstrated significant alleviation of the pain with hypnosis, but this effect was not significantly diminished in the naloxone condition. These findings contradict the hypothesis that endorphins are involved in hypnotic analgesia.
Immunity
"Efficacy of hypnosis in the treatment of human papillomavirus (HPV) in women: rural and urban samples."
Barabasz, A., L. Higley, et al. (2010) International Journal of Clinical and Experimental Hypnosis 58(1): 102-21.
This article investigates the effect of hypnosis on immunity and whether this is the key mechanism in the hypnotic treatment of the genital infection caused by human papillomavirus (HPV). HPV is the most common sexually transmitted disease and can lead to cervical and other cancers. Current medical treatments are aimed at tissue assault (acids, freezing, surgery). Medical wart clearance rates are only 30% to 70% and recurrence is common. Our research contrasted hypnosis-only with medical-only therapies, using both urban hospital and rural community samples. Both hypnosis and medical therapy resulted in a statistically significant (p < .04) reduction in areas and numbers of lesions. Yet, at the 12-week follow-up, complete clearance rates were 5 to 1 in favor of hypnosis.
"A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health."
Gruzelier, J. H. (2002). Stress 5(2): 147-63.
This review considers psychological interventions involving relaxation and guided imagery targeting immune functions. The review provides evidence of immune control accompanied by reports of enhanced mood and well-being. Three recent investigations of the author and his colleagues with self-hypnosis training incorporating imagery of the immune system are outlined. In two studies, hypnosis buffered the effects of stress on immune functions in medical students at exam time, and the comparison of self-hypnosis with and without immune imagery confirmed advantages to targeted imagery for both immune function and mood, and importantly, fewer winter viral infections. The implications for health were investigated in a third study in patients with virulent and chronic herpes simplex virus-2 HSV-2). Six weeks of training almost halved recurrence, improved mood and reduced levels of clinical depression and anxiety. Immune functions were up-regulated, notably functional natural killer cell activity to HSV-1. Individual differences in hypnotic susceptibility and absorption have typically been found to predict efficacy. New replicable evidence is reviewed of the importance of cognitive activation, a personality difference whose neurophysiological underpinning is consistent with left hemispheric preferential influences over the immune system. Now that the validation of psychological interventions includes advantages for health, this field of enquiry, which has been characterised by modest, small scale, largely preliminary studies, warrants a greater investment in research.
"Psychological treatment for recurrent symptoms of colds and flu in children."
Hewson-Bower, B. and P. D. Drummond (2001). Journal of Psychosomatic Research 51(1): 369-77.
The effect of stress management and relaxation with guided imagery on upper respiratory tract infections (URTIs) was investigated in 45 children with a history of 10 or more infections in the past year. To investigate the influence of psychological treatment on mucosal immunity, secretory immunoglobulin A (sIgA) was measured before and during treatment. The number of symptomatic episodes during 13 weeks of monitoring was similar in treatment and waitlist conditions; however, episodes were shorter in stress management and guided imagery conditions than in the waitlist condition. Levels of sIgA increased toward the end of treatment. These findings were confirmed in a replication study. In addition, symptom reduction and improvements in psychological state persisted at 1-year follow-up. The findings suggest that psychological treatment interrupts a chronic illness cycle in children with symptoms of recurrent URTI.
"Hypnosis as a modulator of cellular immune dysregulation during acute stress."
Kiecolt-Glaser, J. K., P. T. Marucha, et al. (2001). Journal of Consulting and Clinical Psychology 69(4): 674-82.
To assess the influence of a hypnotic intervention on cellular immune function during a commonplace stressful event, the authors selected 33 medical and dental students on the basis of hypnotic susceptibility. Initial blood samples were obtained during a lower stress period, and a second sample was drawn 3 days before the first major exam of the term. Half of the participants were randomly assigned to hypnotic-relaxation training in the interval between samples. Participants in the hypnotic group were, on average, protected from the stress-related decrements that were observed in control participants' proliferative responses to 2 mitogens, percentages of CD3+ and CD4+ T-lymphocytes, and interleukin 1 production by peripheral blood leukocytes. More frequent hypnotic-relaxation practice was associated with higher percentages of CD3+ and CD4+ T-lymphocytes. These data provide encouraging evidence that interventions may reduce the immunological dysregulation associated with acute stressors.
"Cellular and humoral immunity, mood and exam stress: the influences of self-hypnosis and personality predictors."
Gruzelier, J., F. Smith, et al. (2001). International Journal of Psychophysiology 42(1): 55-71.
The effects of self-hypnosis training on immune function and mood were examined in medical students at exam time. Hypnosis involved relaxation and imagery directed at improved immune function and increased energy, alertness and concentration. Hypotheses were made about activated and withdrawn personality differences. Eight high and eight low hypnotically susceptible participants were given 10 sessions of hypnosis, one live and nine tape-recorded, and were compared with control subjects (N=12). CD3, CD4, CD8, CD19 and CD56 NK cells and blood cortisol were assayed. Life-style, activated vs. withdrawn temperament, arousal and anxiety questionnaires were administered. Self-hypnosis buffered the decline found in controls in NK (P<0.002) and CD8 cells (P<0.0.07) and CD8/CD4% (P<0.06) (45-35% order of magnitude differences) while there was an increase in cortisol (P<0.05). The change in NK cell counts correlated positively with changes in both CD8 cells and cortisol. Results were independent of changes in life-style. Energy ratings were higher after hypnosis (P<0.01), and increased calmness with hypnosis correlated with an increase in CD4 counts (P<0.01). The activated temperament, notably the cognitive subscale (speaking and thinking quickly), was predictive of exam levels of T and B lymphocytes (P&z.Lt;0.08-P<0.02), and reaching r=0.72 (P<0.001) in the non-intervention control group. The sizeable influences on cell-mediated immunity achieved by a relatively brief, low cost psychological intervention in the face of a compelling, but routine, stress in young, healthy adults have implications for illness prevention and for patients with compromised immunity.
"Psychoneuroimmunology: can psychological interventions modulate immunity?"
Kiecolt-Glaser, J. K. and R. Glaser (1992). Journal of Consulting and Clinical Psychology 60(4): 569-75.
There is ample evidence from human and animal studies demonstrating the downward modulation of immune function concomitant with a variety of stressors. As a consequence, the possible enhancement of immune function by behavioral strategies has generated considerable interest. Researchers have used a number of diverse strategies to modulate immune function, including relaxation, hypnosis, exercise, classical conditioning, self-disclosure, exposure to a phobic stressor to enhance perceived coping self-efficacy, and cognitive-behavioral interventions, and these interventions have generally produced positive changes. Although it is not yet clear to what extent these positive immunological changes translate into any concrete improvements in relevant aspects of health, that is, alterations in the incidence, severity, or duration of infectious or malignant disease, the preliminary evidence is promising.
Impotence
"Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction."
Aydin, S., M. Ercan, et al. (1997). Scandinavian Journal of Urology and Nephrology 31(3): 271-4.
We have examined the effects of acupuncture and hypnotic suggestions, and compared them with placebo in the treatment of male sexual dysfunction with no detectable organic cause. The study comprised 15 men (mean age 36.7 +/- 10.43 years) who received acupuncture treatment, 16 men (mean age 38.4 +/- 10.75 years) who underwent hypnosis (mean age 35.3 +/- 11.52 years) and 29 men (mean age 36.2 +/- 11.38 years) who served as controls. They were interviewed periodically; the patients' reports were verified by interviewing their partners. Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be used as an adjuvant therapy in non-organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.
"The use of hypnosis in the treatment of impotence."
Crasilneck, H. B. (1992). Psychiatric Medicine 10(1): 67-75.
This chapter describes the use of hypnotherapy in the treatment of psychogenic impotency. A listing of etiological factors common to this problem are described. Appropriate case histories are presented.
Insomnia
"Hypnotherapy in the treatment of chronic combat-related PTSD patients suffering from insomnia: a randomized, zolpidem-controlled clinical trial."
Abramowitz, E. G., Y. Barak, et al. (2008). International Journal of Clinical and Experimental Hypnosis 56(3): 270-80.
This study evaluated the benefits of add-on hypnotherapy in patients with chronic PTSD. Thirty-two PTSD patients treated by SSRI antidepressants and supportive psychotherapy were randomized to 2 groups: 15 patients in the first group received Zolpidem 10 mg nightly for 14 nights, and 17 patients in the hypnotherapy group were treated by symptom-oriented hypnotherapy, twice-a-week 1.5-hour sessions for 2 weeks. All patients completed the Stanford Hypnotic Susceptibility Scale, Form C, Beck Depression Inventory, Impact of Event Scale, and Visual Subjective Sleep Quality Questionnaire before and after treatment. There was a significant main effect of the hypnotherapy treatment with PTSD symptoms as measured by the Posttraumatic Disorder Scale. This effect was preserved at follow-up 1 month later. Additional benefits for the hypnotherapy group were decreases in intrusion and avoidance reactions and improvement in all sleep variables assessed.
"Hypnosis for treatment of insomnia in school-age children: a retrospective chart review."
Anbar, R. D. and M. P. Slothower (2006). BMC Pediatr 6: 23.
BACKGROUND: The purposes of this study are to document psychosocial stressors and medical conditions associated with development of insomnia in school-age children and to report use of hypnosis for this condition. METHODS: A retrospective chart review was performed for 84 children and adolescents with insomnia, excluding those with central or obstructive sleep apnea. All patients were offered and accepted instruction in self-hypnosis for treatment of insomnia, and for other symptoms if it was felt that these were amenable to therapy with hypnosis. Seventy-five patients returned for follow-up after the first hypnosis session. Their mean age was 12 years (range, 7-17). When insomnia did not resolve after the first instruction session, patients were offered the opportunity to use hypnosis to gain insight into the cause. RESULTS: Younger children were more likely to report that the insomnia was related to fears. Two or fewer hypnosis sessions were provided to 68% of the patients. Of the 70 patients reporting a delay in sleep onset of more than 30 minutes, 90% reported a reduction in sleep onset time following hypnosis. Of the 21 patients reporting nighttime awakenings more than once a week, 52% reported resolution of the awakenings and 38% reported improvement. Somatic complaints amenable to hypnosis were reported by 41%, including chest pain, dyspnea, functional abdominal pain, habit cough, headaches, and vocal cord dysfunction. Among these patients, 87% reported improvement or resolution of the somatic complaints following hypnosis. CONCLUSION: Use of hypnosis appears to facilitate efficient therapy for insomnia in school-age children.
"Hypnotic relaxation and the reduction of sleep onset insomnia."
Stanton, H. E. (1989). International Journal of Psychosomatics 36(1-4): 64-8.
In the present study, a hypnotic relaxation technique was compared to stimulus control and placebo conditions as a means of reducing sleep onset latency (SOL). Forty-five subjects (Ss) were matched on their baseline SOL as measured through sleep diaries. They were randomly assigned to one of three groups: hypnotic relaxation; stimulus control; and placebo. These groups experienced four weekly sessions of 30-minutes duration with demand effects being controlled through the use of counter-demand instructions. Data generated by the study suggested that the particular hypnotic relaxation treatment used was effective in helping Ss go to sleep more quickly. Neither stimulus control nor placebo groups recorded similar improvement.
Irritable Bowel Syndrome
"Hypnotherapy for irritable bowel syndrome: the response of colonic and noncolonic symptoms."
Whorwell, P. J. (2008). Journal of Psychosomatic Research 64(6): 621-3.
There is now good evidence that hypnotherapy benefits a substantial proportion of patients with irritable bowel syndrome and that improvement is maintained for many years. Most patients seen in secondary care with this condition also suffer from a wide range of noncolonic symptoms such as backache and lethargy, as well as a number of musculoskeletal, urological, and gynaecological problems. These features do not typically respond well to conventional medical treatment approaches, but fortunately, their intensity is often reduced by hypnosis. The mechanisms by which hypnosis mediates its benefit are not entirely clear, but there is evidence that, in addition to its psychological effects, it can modulate gastrointestinal physiology, alter the central processing of noxious stimuli, and even influence immune function.
"Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial."
Vlieger, A. M., C. Menko-Frankenhuis, et al. (2007). Gastroenterology 133(5): 1430-6.
BACKGROUND & AIMS: Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and compared clinical effectiveness of HT with standard medical therapy (SMT) in children with FAP or IBS. METHODS: Fifty-three pediatric patients, age 8-18 years, with FAP (n = 31) or IBS (n = 22), were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions over a 3-month period. Patients in the SMT group received standard medical care and 6 sessions of supportive therapy. Pain intensity, pain frequency, and associated symptoms were scored in weekly standardized abdominal pain diaries at baseline, during therapy, and 6 and 12 months after therapy. RESULTS: Pain scores decreased significantly in both groups: from baseline to 1 year follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0. Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group. Hypnotherapy was highly superior, with a significantly greater reduction in pain scores compared with SMT (P < .001). At 1 year follow-up, successful treatment was accomplished in 85% of the HT group and 25% of the SMT group (P < .001). CONCLUSIONS: Gut-directed HT is highly effective in the treatment of children with longstanding FAP or IBS.
"Standardized hypnosis treatment for irritable bowel syndrome: the North Carolina protocol."
Palsson, O. S. (2006). International Journal of Clinical and Experimental Hypnosis 54(1): 51-64.
The North Carolina protocol is a seven-session hypnosis-treatment approach for irritable bowel syndrome that is unique in that the entire course of treatment is designed for verbatim delivery. The protocol has been tested in two published research studies and found to benefit more than 80% of patients. This article describes the development, content, and testing of the protocol, and how it is used in clinical practice.
"Long term benefits of hypnotherapy for irritable bowel syndrome."
Gonsalkorale, W. M., V. Miller, et al. (2003). Gut 52(11): 1623-9.
BACKGROUND AND AIMS: There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question. PATIENTS AND METHODS: 204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status". RESULTS: 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy. CONCLUSION: This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.
"Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms."
Palsson, O. S., M. J. Turner, et al. (2002). Digestive Diseases and Sciences 47(11): 2605-14.
Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.
Itch (Pruritis)
"A practical review and update on the management of pruritus sine materia."
Tuerk, M. J. and J. Koo (2008). Cutis 82(3): 187-94.
Pruritus can be divided into several categories: pruritoceptive, neurogenic, neuropathic, and psychogenic. Neuropathic itch is caused by lesions of afferent neural pathways. Psychogenic itch is secondary to primary psychiatric disorders. Both of these types of pruritus present with no evidence of primary cutaneous lesions. The presentation of both conditions can be confusing and patients with no primary cutaneous lesions can be prematurely diagnosed as having a psychiatric disorder. Treatment of neuropathic and psychogenic pruritus can be divided into pharmacologic and nonpharmacologic therapies. Medications used include topical capsaicin and anesthetic agents, antiepileptic agents, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and atypical antipsychotic agents. Nonpharmacologic therapies such as psychotherapy and hypnosis have been beneficial. Further studies are needed, as most reports of efficacy are not evidence based.
"The efficacy of hypnosis in the treatment of pruritus in people with HIV/AIDS: a time-series analysis."
Rucklidge, J. J. and D. Saunders (2002). International Journal of Clinical and Experimental Hypnosis 50(2): 149-69.
Pruritus, or generalized itch, is a source of serious discomfort and distress in a significant minority of people living with AIDS. Anecdotal reports suggest hypnosis might be a useful treatment, leading to reductions in distress and improvements in the condition. But empirical examination of the question is notably lacking. This time-series study reports results of a 6-session self-hypnosis treatment (relaxation, deepening, imagery, and home practice) for 3 HIV-positive men suffering from pruritus, related to disease progression and/or HIV medications. Posttreatment, all 3 patients reported significant reductions in daily itch severity and extent of sleep disturbance due to itch. One patient also evidenced significantly less itch distress. Another also experienced significantly less time bothered by itch. For the 2 patients on which 4-month follow-up data were available, treatment benefit across variables was stable or further improved.
"Hypnosis in a case of long-standing idiopathic itch."
Rucklidge, J. J. and D. Saunders (1999). Psychosomatic Medicine 61(3): 355-8.
OBJECTIVE: This article presents the results of a brief hypnosis treatment of a woman with chronic, idiopathic vaginal and anal itch. METHODS: The patient was referred after 3 years of unsuccessful outcomes with standard topical and oral treatments prescribed by her family physician and three dermatologists. Treatment consisted of five sessions of self-hypnosis training in techniques of relaxation, deepening, and imagery, and home practice with an individualized instructional tape. RESULTS: After treatment, the patient reported substantial tissue healing, confirmed by her treating physician, that coincided with significant reductions in her scores of itch intensity, itch-related sleep disruption, and distress from pre- to posttreatment. These improvements continued at 4 months of follow-up, and the patient reported complete resolution of physical symptoms. CONCLUSIONS: The fact that these changes coincided with only minor improvements in general anxiety scores suggests that the resolution of the patient's itch condition was treatment-specific rather than the result of methodological artifact, participant reporting bias, or a general sense of feeling better. These findings suggest that hypnosis is a cost-effective treatment for idiopathic itch conditions, especially those that are unresponsive to standard medical treatments.
Learning
"Teaching college students better learning skills using self-hypnosis."
Wark, D. M. (1996). American Journal of Clinical Hypnosis 38(4): 277-87.
This paper reports the effects of self-hypnosis used by 51 college students enrolled in a 10-week course on efficient learning skills. All students were administered the Creative Imagination Scale. Subsequently, they learned to enter and deepen alert self-hypnosis. They gave themselves personal suggestions and then studied in hypnosis. They reported their depth of hypnosis and satisfaction with each session. Grades were collected the quarter before, during and after the course. Satisfaction and depth data indicated the students were involved all through the course. Statistical testing showed that students who scored highest on the CIS had the lowest initial GPA, improved most during the course, and significantly increased their GPA in the quarter after.
Medical Procedures
"Practical hypnotic interventions during invasive cancer diagnosis and treatment."
Flory, N. and E. Lang (2008). Hematology/Oncology Clinics of North America 22(4): 709-25, ix.
Novel advances in biotechnology and medical imaging techniques have enabled an evolution toward earlier diagnosis and treatment by way of "minimally invasive" surgical techniques performed on the conscious patient without the use of general anesthesia. Although the risks of diagnostic and therapeutic interventions have been reduced with these approaches, patients still face many physical and psychologic challenges. Several randomized controlled trials have shown that hypnotic techniques are effective in reducing pain, anxiety, and other symptoms; in reducing procedure time; and in stabilizing vital signs. The benefits of adjunctive hypnotic treatments come at no additional cost. Patients, health care providers, hospitals, and insurance companies are advised to take advantage of hypnotic techniques.
"Methods of reducing discomfort during colonoscopy."
Leung, F. W. (2008). Digestive Diseases and Sciences 53(6): 1462-7.
In the United States sedation for colonoscopy is usual practice. Unsedated colonoscopy is limited to a small proportion of unescorted patients and those with a personal preference for no sedation. Over 80% of patients who accept the option of as-needed sedation can complete colonoscopy without sedation. Colonoscopy in these unsedated patients is performed with techniques similar to those used in the sedated patients. Uncontrolled observations indicate willingness to repeat colonoscopy amongst these patients was correlated significantly with low discomfort score during the examination. Methods reported to minimize patient discomfort or enhance cecal intubation during sedated or unsedated colonoscopy included use of pediatric colonoscope, variable stiffness colonoscope, gastroscope, and inhalation of nitrous oxide or insufflation of carbon dioxide, hypnosis, music, audio distraction, or simply allowing the patients to participate in administration of the medication. Research focusing on confirming the efficacy of a simple inexpensive nonmedication dependent method for minimizing discomfort will likely improve the outcome of care and more importantly will ensure compliance with future surveillance in patients accepting the unsedated option.
"Hypnosis for acute distress management during medical procedures."
Flory, N., G. M. Salazar, et al. (2007). International Journal of Clinical and Experimental Hypnosis 55(3): 303-17.
The use of hypnosis during medical procedures has a long-standing tradition but has been struggling for acceptance into the mainstream. In recent years, several randomized-controlled trials with sufficient participant numbers have demonstrated the efficacy of hypnosis in the perioperative domain. With the advancements of minimally invasive high-tech procedures during which the patient remains conscious, hypnotic adjuncts have found many applications. This article describes the procedural environment as well as pharmacologic and nonpharmacologic interventions to reduce distress. Current research findings, controversies in the literature, and safety considerations are reviewed. Implications for clinical practice and training as well as directions for future research are discussed. Obstacles and possible reasons for the slow acceptance of nonpharmacologic interventions, mind-body therapies, and patient-centered approaches are addressed.
"Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy."
Lang, E. V., K. S. Berbaum, et al. (2006). Pain 126(1-3): 155-64.
Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical center were prospectively randomized to receive standard care (n=76), structured empathic attention (n=82), or self-hypnotic relaxation (n=78) during their procedures. Patients' self-ratings at 1 min-intervals of pain and anxiety on 0-10 verbal analog scales with 0=no pain/anxiety at all, 10=worst pain/anxiety possible, were compared in an ordinal logistic regression model. Women's anxiety increased significantly in the standard group (logit slope=0.18, p<0.001), did not change in the empathy group (slope=-0.04, p=0.45), and decreased significantly in the hypnosis group (slope=-0.27, p<0.001). Pain increased significantly in all three groups (logit slopes: standard care=0.53, empathy=0.37, hypnosis=0.34; all p<0.001) though less steeply with hypnosis and empathy than standard care (p=0.024 and p=0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46 min/161 dollars for standard care, 43 min/163 dollars for empathy, and 39 min/152 dollars for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.
"Effect of hypnotic sedation during percutaneous transluminal coronary angioplasty on myocardial ischemia and cardiac sympathetic drive."
Baglini, R., M. Sesana, et al. (2004). American Journal of Cardiology 93(8): 1035-8.
Forty-six patients were randomized to receive drug (group 1) or hypnotic sedation (group 2) during percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery. Intracoronary and standard electrocardiograms were continuously registered, and heart rate spectral variability was studied. Normalized units of low- and high-frequency components and the ratio of low to high frequency were measured during balloon inflations. The ST segment shifted at the first balloon inflation from 0.02 +/- 0.01 to 0.09 +/- 0.6 mm in group 1 and from 0.02 +/- 0.08 to 0.1 +/- 0.6 in group 2 mm (p <0.05). In group 1, the low-frequency band and the ratio of low to high frequency increased significantly during the first balloon inflation (from 59 +/- 10 to 75 +/- 10 normalized units and from 2.4 +/- 1.4 to 7.3 +/- 4.7, respectively; p <0.001). The increase of the ratio of low to high frequency was significantly related to ST shift (r = 0.706; p <0.01). In contrast, no significant variation of spectral parameters was found in group 2. The increase in cardiac sympathetic activity associated with balloon inflation and myocardial ischemia during percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery was selectively eliminated by hypnosis but not by drug sedation.
"Clinical management of stressors perceived by patients on mechanical ventilation."
Thomas, L. A. (2003). AACN Clinical Issues 14(1): 73-81.
Psychological and psychosocial stressors perceived by the mechanically ventilated patient include intensive care unit environmental factors, communication factors, stressful symptoms, and the effectiveness of interventions. The studies reviewed in this article showed four stressors commonly identified by mechanically ventilated patients including dyspnea, anxiety, fear, and pain. Few interventional studies to reduce these stressors are available in the literature. Four interventions including hypnosis and relaxation, patient education and information sharing, music therapy, and supportive touch have been investigated in the literature and may be helpful in reducing patient stress. The advanced practice nurse is instrumental in the assessment of patient-perceived stressors while on the ventilator, and in the planning and implementation of appropriate interventions to reduce stressors and facilitate optimal ventilation, weaning, or both.
"Use of hypnosis in controlling lumbar puncture distress in an adult needle-phobic dementia patient."
Simon, E. P. and M. M. Canonico (2001). International Journal of Clinical and Experimental Hypnosis 49(1): 56-67.
Lumbar punctures are often vital to the medical management of patients with suspected organic pathology, yet they are commonly met with such distress that medical risk is significantly increased, and patient rapport is significantly decreased, further compromising medical treatment. Although the use of hypnosis for lumbar punctures is well established in pediatric patients, no literature exists for adult patients. Similarly, there is no extant research regarding hypnosis for dementia patients, likely due to the limiting factors of impaired attention and concentration. With these factors in mind, a method for incorporating hypnosis into a lumbar puncture procedure is described for a needle-phobic adult patient suffering from dementia.
"Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial."
Lang, E. V., E. G. Benotsch, et al. (2000). Lancet 355(9214): 1486-90.
BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. METHODS: 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. FINDINGS: Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
"Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use."
Lang, E. V., J. S. Joyce, et al. (1996). International Journal of Clinical and Experimental Hypnosis 44(2): 106-19.
The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.
"Liver biopsy under hypnosis."
Adams, P. C. and P. G. Stenn (1992). Journal of Clinical Gastroenterology 15(2): 122-4.
Two patients underwent outpatient percutaneous liver biopsy under hypnosis without complications. One patient had severe anxiety about the procedure because of a previous adverse experience with liver biopsy and the other had a history of severe allergy to local anesthesia. Both patients had undergone a session of hypnosis at least once prior to the biopsy. One received no local anesthetic and the other received 1% lidocaine as a local anesthetic. Both patients were completely cooperative during the procedure with the required respiratory maneuvers. Both patients stated that they were aware of the procedure under hypnosis but described no pain and would be most willing to have the procedure done under hypnosis in the future. Hypnosis can be a useful method of preparing carefully selected patients for percutaneous liver biopsy.
Meditation
"Effect of meditation on stress-induced changes in cognitive functions."
Mohan, A., R. Sharma, et al. Journal of Alternative and Complementary Medicine 17(3): 207-12.
OBJECTIVES: The objective of this study was to study the effects of meditation on stress-induced changes in cognitive functions. METHODS: The study was conducted on 32 healthy adult male student volunteers who had never practiced meditation before the study. The study consisted of practicing 20 minutes of guided meditation and administration of psychologic stress to the subjects. The psychologic stress was administered to the subjects by asking them to play a (preselected) stressful computer game. The subjects were asked to meditate either before or after the administration of psychologic stress. For the control group measurements, the subjects were asked to wait quietly for an equivalent period of meditation time. OUTCOME MEASURES: The outcome measures were galvanic skin response (GSR), heart rate (HR), electromyography (EMG), sympathetic reactivity (QTc/QS2 ratio), cortisol, and acute psychologic stress scores. The central nervous system functions were assessed using Wechsler memory scale and visual-choice reaction time (VCRT). These parameters were measured both at the beginning and at the end of the intervention, using a pre-post experimental test design. RESULTS: Computer game stress was associated with a significant increase in physiologic (GSR, EMG, HR, QTc/QS2) and psychologic (acute stress questionnaire scores) markers of stress. Meditation was associated with relaxation (significant decrease in GSR, EMG, QTc/QS2, and acute stress questionnaire scores). Meditation, if practiced before the stressful event, reduced the adverse effects of stress. Memory quotient significantly increased, whereas cortisol level decreased after both stress and meditation. VCRT showed no significant change. CONCLUSIONS: Practice of meditation produced a relaxation response even in the young adult subjects who had never practiced meditation before. The practice of meditation reduced the physiologic stress responses without taking away the beneficial effect of stress, namely, improved memory scores.
"Feasibility and effectiveness of a brief meditation-based stress management intervention for patients diagnosed with or at risk for coronary heart disease: a pilot study."
Olivo, E. L., B. Dodson-Lavelle, et al. (2009). Psychol Health Med 14(5): 513-23.
Extensive research has led to the development of a psychobiological model of cardiovascular disease. This model suggests that psychological factors such as depression, anxiety, hostility, and stress may affect the development and progression of coronary heart disease (CHD). Recent studies have also demonstrated that meditation-based stress reduction programs are useful interventions for patients with various medical and psychological symptoms. The objective of this pilot study was to gather preliminary information regarding the feasibility of implementing a brief meditation-based stress management (MBSM) program for patients with CHD, and those at high risk for CHD, at a major metropolitan hospital that serves a predominately non-local patient population. The secondary aim of this study was to investigate the possibility that such an intervention might reduce depression, as well as perceived stress, anxiety, and hostility, while improving general health scores. The overall feasibility results indicate that this MBSM intervention was highly feasible with regard to both recruitment and retention of participants. In fact, 40% of patients requested further training. In addition, after completion of the 4-week intervention, participants reported significant reductions in depression and perceived stress. In conclusion, the present study demonstrated that the brief meditation-based stress management program was well-received by patients and can successfully be used as a supportive program for patients at risk or diagnosed with CHD.
"Cancer, cognitive impairment, and meditation."
Biegler, K. A., M. A. Chaoul, et al. (2009). Acta Oncologica 48(1): 18-26.
BACKGROUND AND OBJECTIVES: Cancer-related cognitive impairment has been acknowledged as a substantial limiting factor in quality of life among cancer patients and survivors. In addition to deficits on behavioral measures, abnormalities in neurologic structure and function have been reported. In this paper, we review findings from the literature on cognitive impairment and cancer, potential interventions, meditation and cognitive function, and meditation and cancer. In addition, we offer our hypotheses on how meditation practice may help to alleviate objective and subjective cognitive function, as well as the advantages of incorporating a meditation program into the treatment of cancer patients and survivors for cancer-related cognitive deficits. FINDINGS: Various factors have been hypothesized to play a role in cancer-related cognitive impairment including chemotherapy, reduced hormone levels, proinflammatory immune response, fatigue, and distress. Pharmacotherapies such as methylphenidate or modafinil have been suggested to alleviate cognitive deficits. While initial reports suggest they are effective, some pharmacotherapies have side effects and may not relieve other symptoms associated with multimodal cancer treatment including sleep disturbance, nausea and pain. Several recent studies investigating the effects of meditation programs have reported behavioral and corresponding neurophysiological modulations that may be particularly effective in alleviating cancer-related cognitive impairment. Such programs also have been shown to reduce stress, fatigue, nausea and pain, and improve mood and sleep quality. CONCLUSIONS: With the increasing success of cancer treatment and the ability to return to previous family, social, and work activities, symptom management and quality of life are an essential part of survivorship. We propose that meditation may help to improve cancer-related cognitive dysfunction, alleviate other cancer-related sequelae, and should be fully investigated as an adjuvant to cancer treatment.
"Potential role of mind-body therapies in cancer survivorship."
Monti, D. A., M. Sufian, et al. (2008). Cancer 112(11 Suppl): 2607-16.
The use of complementary and alternative medicine (CAM) by cancer survivors is high, particularly among those with psychosocial distress, poor quality of life, culturally based health beliefs, and those who experience health disparities in the mainstream healthcare system. As the number of cancer survivors continues to increase, so does the diversity of the survivorship population, making it increasingly important to understand and address the CAM culture in different survivor groups. Given the known communication barriers between cancer patients and their physicians regarding CAM, it would be useful for oncology providers to have a platform from which to discuss CAM-related issues. It is proposed that mind-body therapies with some basis in evidence could provide such a platform and also serve as a possible means of connecting cancer survivors to psychosocial supportive services. This article reviews a few mind-body therapies that may have particular relevance to cancer survivors, such as hypnosis and meditation practices. A theoretical foundation by which such therapies provide benefit is presented, with particular emphasis on self-regulation.
"Migraines and meditation: does spirituality matter?"
Wachholtz, A. B. and K. I. Pargament (2008). Journal of Behavioral Medicine 31(4): 351-66.
Migraine headaches are associated with symptoms of depression and anxiety (Waldie and Poulton Journal of Neurology, Neurosurgery, and Psychiatry 72: 86-92, 2002) and feelings of low self-efficacy (French et al. Headache, 40: 647-656, 2000). Previous research suggests that spiritual meditation may ameliorate some of the negative traits associated with migraine headaches (Wachholtz and Pargament Journal of behavioral Medicine, 30: 311-318, 2005). This study examined two primary questions: (1) Is spiritual meditation more effective in enhancing pain tolerance and reducing migraine headache related symptoms than secular meditation and relaxation? and, (2) Does spiritual meditation create better mental, physical, and spiritual health outcomes than secular meditation and relaxation techniques? Eighty-three meditation naive, frequent migraineurs were taught Spiritual Meditation, Internally Focused Secular Meditation, Externally Focused Secular Meditation, or Muscle Relaxation which participants practiced for 20 min a day for one month. Pre-post tests measured pain tolerance (with a cold pressor task), headache frequency, and mental and spiritual health variables. Compared to the other three groups, those who practiced spiritual meditation had greater decreases in the frequency of migraine headaches, anxiety, and negative affect, as well as greater increases in pain tolerance, headache-related self-efficacy, daily spiritual experiences, and existential well being.
"Hypnosis and meditation: similar experiential changes and shared brain mechanisms."
Grant, J. A. and P. Rainville (2005). Medical Hypotheses 65(3): 625-6.
"Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes."
Wachholtz, A. B. and K. I. Pargament (2005). Journal of Behavioral Medicine 28(4): 369-84.
This study compared secular and spiritual forms of meditation to assess the benefits of a spiritual intervention. Participants were taught a meditation or relaxation technique to practice for 20 min a day for two weeks. After two weeks, participants returned to the lab, practiced their technique for 20 min, and placed their hand in a cold-water bath of 2 degrees C for as long as they could endure it. The length of time that individuals kept their hand in the water bath was measured. Pain, anxiety, mood, and the spiritual health were assessed following the two-week intervention. Significant interactions occurred (time x group); the Spiritual Meditation group had greater decreases in anxiety and more positive mood, spiritual health, and spiritual experiences than the other two groups. They also tolerated pain almost twice as long as the other two groups.
"Alterations in brain and immune function produced by mindfulness meditation."
Davidson, R. J., J. Kabat-Zinn, et al. (2003). Psychosomatic Medicine 65(4): 564-70.
OBJECTIVE: The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees. METHODS: We measured brain electrical activity before and immediately after, and then 4 months after an 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group. A wait-list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8-week period, subjects in both groups were vaccinated with influenza vaccine. RESULTS: We report for the first time significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Finally, the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine. CONCLUSIONS: These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.
"The science of meditation and the state of hypnosis."
Holroyd, J. (2003). American Journal of Clinical Hypnosis 46(2): 109-28.
Two aspects of Buddhist meditation--concentration and mindfulness--are discussed in relationship to hypnosis. Mindfulness training facilitates the investigation of subjective responses to hypnosis. Concentration practice leads to altered states similar to those in hypnosis, both phenomenologically and neurologically. The similarities and differences between hypnosis and meditation are used to shed light on perennial questions: (1) Does hypnosis involve an altered state of consciousness? (2) Does a hypnotic induction increase suggestibility? I conclude that a model for hypnosis should include altered states as well as capacity for imaginative involvement and expectations.
"Eastern meditative techniques and hypnosis: a new synthesis."
Otani, A. (2003). American Journal of Clinical Hypnosis 46(2): 97-108.
In this article major ancient Buddhist meditation techniques, samatha, vipassana, Zen, and ton-len, will be described in reference to contemporary clinical hypnosis. In so doing, the Eastern healing framework out of which these techniques emerged is examined in comparison with and in contrast to its Western counterpart. A growing body of empirical literature shows that meditation and hypnosis have many resemblances despite the distinct differences in underlying philosophy and technical methodologies. Although not all meditation techniques "fit" the Western culture, each has much to offer to clinicians who are familiar with hypnosis.
"Effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in HIV positive men."
Taylor, D. N. (1995). Psychological Reports 76(2): 451-7.
This study evaluated the effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in a group of HIV-positive men who were asymptomatic except for T-cell counts below 400. The program consisted of 20 biweekly sessions of progressive muscle relaxation and electromyograph biofeedback-assisted relaxation training, meditation, and hypnosis. Ten subjects were randomly assigned to either a treatment group of a no-treatment control group, and the 2 groups were compared on pre- to posttreatment changes in the dependent measures. Analysis showed that, compared with the no-treatment group, the treatment group showed significant improvement on all the dependent measures, which was maintained at a 1-mo. follow-up. Since stress is known to compromise the immune system, these results suggest that stress management to reduce arousal of the nervous system and anxiety would be an appropriate component of a treatment regimen for HIV infection.
Migraine
"Mind-body therapies for headache."
Sierpina, V., J. Astin, et al. (2007). American Family Physician 76(10): 1518-22.
Headache is one of the most common and enigmatic problems encountered by family physicians. Headache is not a singular entity, and different pathologic mechanisms are involved in distinct types of headache. Most types of headache involve dysfunction of peripheral or central nociceptive mechanisms. Mind-body therapies such as biofeedback, cognitive behavior therapy, hypnosis, meditation, and relaxation training can affect neural substrates and have been shown to be effective treatments for various types of headache. Meta-analyses of randomized controlled trials show that the use of mind-body therapies, alone or in combination, significantly reduces symptoms of migraine, tension, and mixed-type headaches. Side effects generally are minimal and transient.
"Review of the efficacy of clinical hypnosis with headaches and migraines."
Hammond, D. C. (2007). International Journal of Clinical and Experimental Hypnosis 55(2): 207-19.
The 12-member National Institute of Health Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996) reviewed outcome studies on hypnosis with cancer pain and concluded that research evidence was strong and that other evidence suggested hypnosis may be effective with some chronic pain, including tension headaches. This paper provides an updated review of the literature on the effectiveness of hypnosis in the treatment of headaches and migraines, concluding that it meets the clinical psychology research criteria for being a well-established and efficacious treatment and is virtually free of the side effects, risks of adverse reactions, and ongoing expense associated with medication treatments.
"The efficacy of hypnotherapy in the treatment of migraine."
Matthews, M. and S. Flatt (1999). Nursing Standard 14(7): 33-6.
The pain of migraine is notoriously difficult to manage. This article describes hypnotherapy as an effective intervention in a group of self-diagnosed migraine sufferers.
Morning Sickness
"Medical hypnosis for hyperemesis gravidarum."
Simon, E. P. and J. Schwartz (1999). Birth 26(4): 248-54.
Hyperemesis gravidarum in pregnancy is a serious condition that is often resistant to conservative treatments. Medical hypnosis is a well-documented alternative treatment. This article reviews the empirical studies of medical hypnosis for treating hyperemesis gravidarum, explains basic concepts, and details the treatment mechanisms. The importance of a thorough differential diagnosis and appropriate referrals is stressed. The article presents three case studies to illustrate the efficacy of this treatment approach. It is suggested that medical hypnosis should be considered as an adjunctive treatment option for those women with hyperemesis gravidarum. It is also stressed that medical hypnosis can be used to treat common morning sickness that is experienced by up to 80 percent of pregnant women. Its use could allow a more comfortable pregnancy and healthier fetal development, and could prevent cases that might otherwise proceed to full-blown hyperemesis gravidarum.
Multiple Sclerosis
"Effects of self-hypnosis training and cognitive restructuring on daily pain intensity and catastrophizing in individuals with multiple sclerosis and chronic pain."
Jensen, M. P., D. M. Ehde, et al. International Journal of Clinical and Experimental Hypnosis 59(1): 45-63.
Fifteen adults with multiple sclerosis were given 16 sessions of treatment for chronic pain that included 4 sessions each of 4 different treatment modules: (a) an education control intervention; (b) self-hypnosis training (HYP); (c) cognitive restructuring (CR); and (d) a combined hypnosis-cognitive restructuring intervention (CR-HYP). The findings supported the greater beneficial effects of HYP, relative to CR, on average pain intensity. The CR-HYP treatment appeared to have beneficial effects greater than the effects of CR and HYP alone. Future research examining the efficacy of an intervention that combines CR and HYP is warranted.
"A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain."
Jensen, M. P., J. Barber, et al. (2009). International Journal of Clinical and Experimental Hypnosis 57(2): 198-221.
Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS.
"Hypnosis as adjunctive therapy for multiple sclerosis: a progress report."
Sutcher, H. (1997). American Journal of Clinical Hypnosis 39(4): 283-90.
Several reports suggest that hypnosis can facilitate healing in various physical pathologies. This is a preliminary report, supported by three cases. They demonstrate that suggestion by a hypnotist of symptom improvement can be used beneficially in the treatment of the physical impairment caused by Multiple Sclerosis. The first patient, severely affected, had Multiple Sclerosis for over 35 years. He had been wheelchair bound for many years. The second, recently diagnosed and minimally affected, had difficulty with balance and walked with the aid of a cane. The third, also minimally affected, reported pain in her right leg. All three showed improvement either immediately or within several weeks when the hypnotist suggested improvement or displacement of symptoms with the patients in hypnosis. No attempt was made to deal with psychodynamics or to suggest alternative symptoms to the patients. Symptom substitution did not occur. When symptoms improved, even slightly, these patients exhibited increased hopefulness.
"Hypnosis for pain and neuromuscular rehabilitation with multiple sclerosis: case summary, literature review, and analysis of outcomes."
Dane, J. R. (1996). International Journal of Clinical and Experimental Hypnosis 44(3): 208-31.
Videotaped treatment sessions in conjunction with 1-month, 1-year, and 8-year follow-up allow a unique level of analysis in a case study of hypnotic treatment for pain and neuromuscular rehabilitation with multiple sclerosis (MS). Preparatory psychotherapy was necessary to reduce the patient's massive denial before she could actively participate in hypnosis. Subsequent hypnotic imagery and posthypnotic suggestion were accompanied by significantly improved control of pain, sitting balance, and diplopia (double vision), and a return to ambulatory capacity within 2 weeks of beginning treatment with hypnosis. Evidence regarding efficacy of hypnotic strategies included (a) direct temporal correlations between varying levels of pain relief and ambulatory capacity and the use versus nonuse of hypnotic strategies, (b) the absence of pharmacological explanations, and (c) the ongoing presence of other MS-related symptoms that remained unaltered. In conjunction with existing literature on hypnosis and neuromuscular conditions, results of this case study strongly suggest the need for more detailed and more physiologically based studies of the phenomena involved.
"The effects of imagery on attitudes and moods in multiple sclerosis patients."
Maguire, B. L. (1996). Alternative Therapies in Health and Medicine 2(5): 75-9.
OBJECTIVE: To determine the efficacy of imagery for influencing attitudes and moods in multiple sclerosis patients. DESIGN: Experimental pretest-posttest, control-group. SETTING: Outpatient group in Central Pennsylvania. PATIENTS: 33 patients with mean ages of 43.93 years in the imagery group and 46.33 years in the control group. All subjects previously were identified with multiple sclerosis. INTERVENTION: Control group subjects followed their typical medical protocol and completed pretest and posttest measures. Imagery group subjects completed pretest and posttest measures and participated in a six-session group process that included brief exposure to relaxation training and ongoing work with biologically oriented imagery. Relaxation training and imagery were practiced on a daily basis. Imagery group subjects also produced imagery drawings, which were assessed after the third and sixth sessions. MAIN OUTCOME MEASURES: Profile of Mood States, State-Trait Anxiety Inventory, Health Attribution Test, Imagery Assessment Tool, and Multiple Sclerosis Symptom Checklist. MAIN RESULTS: Imagery group subjects demonstrated significant reductions in state anxiety and significant alteration in their illness imagery because of feedback obtained during the study. CONCLUSION: Use of the relaxation/imagery protocol led to clinically significant reductions in state anxiety. Imagery may be assessed through drawings that allow for positive modification of the imagery material to increase its utility and power.
Nausea and Vomiting
"Preoperative hypnotherapy in the management of a child with anticipatory nausea and vomiting."
Mackenzie, A. and G. P. Frawley (2007). Anaesthesia and Intensive Care 35(5): 784-7.
A six-year-old boy with oesophageal strictures secondary to neonatal repair of oesophageal atresia and requiring six to eight weekly oesophageal dilatations by bouginage developed anticipatory nausea and vomiting. This was effectively managed by a course of preoperative hypnotherapy over four sessions. Resolution of anticipatory nausea and vomiting occurred along with cessation of postoperative nausea and vomiting. This case supports early intervention with preoperative hypnotherapy in children with anticipatory nausea and vomiting that has not responded to other measures.
"Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence."
Richardson, J., J. E. Smith, et al. (2007). European Journal of Cancer Care (English Language Edition) 16(5): 402-12.
To systematically review the research evidence on the effectiveness of hypnosis for cancer chemotherapy-induced nausea and vomiting (CINV). A comprehensive search of major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine databases were searched and efforts were made to identify unpublished and ongoing research. Citations were included from the databases' inception to March 2005. Randomized controlled trials (RCTs) were appraised and meta-analysis undertaken. Clinical commentaries were obtained. Six RCTs evaluating the effectiveness of hypnosis in CINV were found. In five of these studies the participants were children. Studies report positive results including statistically significant reductions in anticipatory and CINV. Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioural therapy. Meta-analysis has demonstrated that hypnosis could be a clinically valuable intervention for anticipatory and CINV in children with cancer. Further research into the effectiveness, acceptance and feasibility of hypnosis in CINV, particularly in adults, is suggested. Future studies should assess suggestibility and provide full details of the hypnotic intervention.
"Behavioral interventions in treating anticipatory nausea and vomiting."
Figueroa-Moseley, C., P. Jean-Pierre, et al. (2007). J Natl Compr Canc Netw 5(1): 44-50.
Anticipatory nausea and vomiting (ANV) is associated with a significant reduction in the quality of life for many chemotherapy patients. The use of 5-hydroxytryptamine type 3 receptor antagonists provides some relief for chemotherapy-induced nausea and vomiting, but does not seem to control ANV. Nonpharmacologic approaches, which include behavioral interventions, may provide the greatest promise in relieving symptoms. Little evidence supports the use of complementary and alternative methods, such as acupuncture and acupressure, in relieving ANV. Behavioral interventions, especially progressive muscle relaxation training and systematic desensitization, should be considered important methods for preventing and treating ANV.
"Psychological factors in the etiology and treatment of severe nausea and vomiting in pregnancy."
Buckwalter, J. G. and S. W. Simpson (2002). American Journal of Obstetrics and Gynecology 186(5 Suppl Understanding): S210-4.
The assumption is frequently made that women with severe nausea and vomiting during pregnancy are transforming psychological distress into physical symptoms. Psychoanalytic theory supporting this assumption is reviewed, along with the few methodologically flawed empirical studies that have been conducted. Little support can be found for the hypothesis that nausea and vomiting during pregnancy is such a conversion disorder, but there are suggestions that psychological responses to the physiologic condition(s) underlying this problem may become entrenched, or conditioned. This possibility is supported by findings that psychological treatments, such as hypnosis, can be effective. This implies that psychological responses can interact with the physiology of nausea and vomiting during pregnancy to exacerbate the condition. As such, psychological treatments for the symptoms of this disorder need to be further explored.
"Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy."
Marchioro, G., G. Azzarello, et al. (2000). Oncology 59(2): 100-4.
AIMS AND BACKGROUND: In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies. PATIENTS AND METHODS: The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis. RESULTS: In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients. CONCLUSIONS: The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.
Nervous Habits
"Elucidating Tourette's syndrome: perspectives from hypnosis, attention and self-regulation."
Raz, A., S. Keller, et al. (2007). American Journal of Clinical Hypnosis 49(4): 289-309.
Biological psychiatry favors drug treatment over non-pharmacological intervention and shapes the way clinicians both treat and understand Tourette's Syndrome (TS). However, drug treatments for TS involve side effects and are potentially toxic to the central nervous system. Moreover, current pharmacological treatments are largely ineffective and at best only provide a modest symptom reduction. In this paper, we describe how non-pharmacological treatments such as focused attention can modulate, reduce, or indeed entirely eliminate the symptoms of TS as well as elucidate the underlying neural mechanisms. Showing that the symptoms of TS are susceptible to self-regulatory interventions such as hypnosis, we propose that attentional training could be used to both treat the disorder and better understand it.
"User friendly hypnosis as an adjunct for treatment of habit cough: a case report."
Anbar, R. D. (2007). American Journal of Clinical Hypnosis 50(2): 171-5.
The more user friendly medical hypnosis can be, the more readily it will be accepted by patients and the medical community. Hypnosis is user friendly when it is simple to employ, and yields rapid, effective, and clinically significant results. Thus, we should define reasons for the effectiveness of such successful hypnosis methods, and provide this information to students of hypnosis. Some of the elements that may permit hypnosis to be user friendly are establishment of rapport, a belief that a symptom often has a functional role, and a flexible approach to the hypnosis encounter. This case report of a child with habit cough, illustrates the importance of these elements.
"Using hypnosis to facilitate resolution of psychogenic excoriations in acne excoriee."
Shenefelt, P. D. (2004). American Journal of Clinical Hypnosis 46(3): 239-45.
Hypnotic suggestion successfully alleviated the behavioral picking aspect of acne excoriee des juenes filles in a pregnant woman who had been picking at the acne lesions on her face for 15 years. Acne excoriee is a subset of psychogenic or neurotic excoriation. Conventional topical antibiotic treatment was used to treat the acne. Compared with other treatments for uncomplicated acne excoriee, hypnosis is relatively brief and cost-effective and is non-toxic in pregnancy.
"Childhood habit cough treated with self-hypnosis."
Anbar, R. D. and H. R. Hall (2004). Journal of Pediatrics 144(2): 213-7.
OBJECTIVES: To better understand factors associated with the development and persistence of habit cough and to report use of self-hypnosis for this condition. STUDY DESIGN: A retrospective chart review was performed for 56 children and adolescents with habit cough. Interested patients were instructed in self-hypnosis for relaxation and to help ignore the cough-triggering sensation. RESULTS: The patients' mean age was 10.7 years. The cough was triggered by upper respiratory infections in 59%, asthma in 13%, exercise in 5%, and eating in 4%. Onset of the cough occurred as early as 2 years, and its average duration was 13 months (range, 2 weeks to 7 years). There was a high incidence of abdominal pain and irritable bowel syndrome in the 50% of the patients who missed more than 1 week of school because of their cough. Among the 51 patients who used hypnosis, the cough resolved during or immediately after the initial hypnosis instruction session in 78% and within 1 month in an additional 12%. CONCLUSIONS: Habit cough is triggered by various physiologic conditions, related frequently to other diagnoses, and it is associated with significant school absence. Self-hypnosis offers a safe efficient treatment.
"Hypnosis as a vehicle for choice and self-agency in the treatment of children with Trichotillomania."
Iglesias, A. (2003). American Journal of Clinical Hypnosis 46(2): 129-37.
Three pediatric cases of Trichotillomania were treated with direct hypnotic suggestion with exclusive emphasis on sensitizing and alerting the patients to impending scalp hair pulling behaviors. These children had presented with total lack of awareness of their scalp hair pulling behaviors until they had actually twisted and pulled off clumps of hair. It was also suggested, under hypnosis, that upon learning to recognize impending scalp hair pulling behaviors, the patients would become free to choose to willfully pull their hair or to resist the impulse and not pull. At no point was the explicit suggestion given that they stop pulling their hair. A preliminary condition was agreed to by the parents that redefined the patients' hair as their own property and affirmed their sole responsibility for its care and maintenance. An element of secondary gain was identified in each of these cases. Scalp hair pulling was hypothesized to provide these particular patients with a vehicle with which to oppose their overbearing and over-involved parents. The technique of direct suggestion under hypnosis, aimed at alerting the patients to impending scalp hair pulling behaviors was combined with forming contracts with the parents to relinquish their authority over matters regarding the patients' hair. This combination provided an effective treatment that extinguished the scalp hair pulling in 7 visits or less. These cases received follow-up at intervals up to 6 months and no evidence of relapse was found.
"Acceptability of treatments for trichotillomania. Effects of age and severity."
Elliott, A. J. and W. R. Fuqua (2002). Behavior Modification 26(3): 378-99.
Based on the literature, trichotillomania (TTM, chronic hair pulling) in children and adults appears to be responsive to behavioral interventions such as habit reversal. However, some have questioned the generality and acceptability of such procedures. This study compared the acceptability ratings of four interventions targeting TTM (habit reversal, hypnosis, medication, and punishment). In the study, 233 college students read case vignettes in which the age of the analogue client and the severity of the hair pulling were manipulated. Results showed significant differences between the four treatment conditions, with hypnosis and habit reversal being rated most acceptable. Age of the analogue client and severity of TTM did not significantly influence acceptability ratings.
"Hypnosis for habit disorders. Helping children help themselves."
Thomson, L. (2002). Advance for Nurse Practitioners 10(7): 59-62.
"The characterization and treatment of trichotillomania."
Christenson, G. A. and S. J. Crow (1996). Journal of Clinical Psychiatry 57 Suppl 8: 42-7; discussion 48-9.
Trichotillomania is an impulse control disorder characterized by chronic self-directed hair pulling. Trichotillomania has additionally been viewed as one of the obsessive-compulsive spectrum disorders. Any body hair may be targeted, and most patients pull from more than one site. In clinical settings the disorder predominantly affects females. Onset is generally in childhood or adolescence, and a chronic course is typical. Depression and anxiety frequently accompany the disorder. An increased incidence of comorbid obsessive-compulsive disorder (OCD) has been noted. Neurobiological investigations have paralleled etiologic studies of OCD and have demonstrated both similarities and differences between these two disorders. Current treatment options include a variety of medications, particularly the serotonin selective reuptake inhibitors, the behavioral technique of habit reversal, and hypnosis.
"Outcome of habit cough in children treated with a brief session of suggestion therapy."
Lokshin, B., S. Lindgren, et al. (1991). Annals of Allergy 67(6): 579-82.
Nine patients with habit cough, initially misdiagnosed as asthma, were treated during a period of sustained repetitive symptoms with a brief session of suggestion therapy. Symptoms had previously been present for up to 2 years (median = 2 months). Five had been hospitalized for the cough. Evaluation revealed no physiologic or radiologic abnormality. All patients became symptom free during a 15-minute session of suggestion therapy. During the subsequent week, one remained completely asymptomatic and 8 had transient minor relapses that were readily self-controlled. Seven of the 9 could be contacted for determination of long-term outcome at periods up to 9 years (median 2.2 years) after the session. Six were totally asymptomatic; one had occasional minor self-controlled symptoms. A standardized questionnaire assessing psychologic symptoms at the time of follow-up revealed no somatization nor emotional distress. In contrast to this apparent cure, others have reported extended periods of continued symptoms in the absence of a uniform treatment plan for suggestion therapy even though the correct diagnosis was made. We conclude that the classical habit cough syndrome is amenable to immediate relief and long-term cure in most cases with a single session of appropriate suggestion therapy.
"Hypnobehavioral treatment of chronic nailbiting: a multiple baseline analysis."
Bornstein, P. H., R. G. Rychtarik, et al. (1980). International Journal of Clinical and Experimental Hypnosis 28(3): 208-17.
Pain
"Psychosocial Issues in Cancer Pain."
Porter, L. S. and F. J. Keefe (2011) Curr Pain Headache Rep.
Cancer pain is a complex and multidimensional experience that affects and is affected by psychological and social factors. This article reviews recent research that points to a number of key psychosocial factors associated with pain, including psychological distress, coping, and social support, as well as the impact of socioeconomic factors on barriers to pain management. We also review recent research suggesting that psychosocial interventions, including education, coping-skills training, and hypnosis, may be useful adjuncts to medical management of pain. Clinical implications and recommendations for future research are discussed.
"The effectiveness of hypnosis in reducing pain and suffering among women with metastatic breast cancer and among women with temporomandibular disorder."
Nash, M. R. and A. Tasso. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 497-504.
The authors describe two studies of special interest to clinicians and clinical researchers. Both are randomized controlled studies, exclusively focused on female patients. The first study tests whether a year-long weekly group intervention including hypnosis can reduce cancer pain among women with metastatic breast cancer. Findings suggest the intervention slowed the increase in reported pain over a 12-month period relative to controls. The second study examines the effect of hypnosis in women suffering from temporomandibular disorder (TMD), with a special focus on function as well as pain. Hypnosis reduced TMD pain as measured by a numerical-rating scale.
"Treatment of chronic recurrent abdominal pain: laparoscopy or hypnosis?"
Galili, O., R. Shaoul, et al. (2009). Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A 19(1): 93-6.
OBJECTIVE: Functional chronic recurrent abdominal pain (FCRAP) is long lasting, intermittent, or constant pain affecting 15-30% of children ages 4-18 and presents a diagnostic and treatment challenge to the physician. The predictive value of diagnostic tests is questionable, and studies of the treatment of chronic abdominal pain show inconclusive evidence regarding diet regimens as well as medical and surgical treatments. However, there is evidence that cognitive-behavioral therapy may be useful in improving pain and disability outcome. Increasing the understanding of the neural-pain pathways and research in cognitive modulation of pain led to the application of behavioral strategies in children with FCRAP with variable success. However, the use of hypnotherapy in children with recurrent abdominal pain is not common. During the last 3 years, we have implemented hypnosis as the preferred treatment for patients with FCRAP. In the current study, we aimed to summarize our experience with hypnosis for the treatment of FCRAP in children. PATIENTS AND METHODS: Twenty patients who met the criteria for FCRAP were candidates for hypnosis. Hypnosis or imagery was offered to the families, of whom 3 refused. Seventeen patients underwent just one single session of hypnosis. RESULTS: A possible nonorganic etiology for the abdominal pain was revealed in all cases. In 14 adolescents, all clinical symptoms resolved. Hypnosis was not effective in 3 cases, in whom secondary gain was probably responsible for their symptoms. No side effects have been noted during and after the study. Follow-up was available for a period of 4-24 months. CONCLUSIONS: Although effective in the management of acute pain and distress in pediatric cancer patients, the use of hypnotherapy in children with FCRAP is not a common practice. The current study highly supports the use of hypnosis as a part of the biobehavioral approach for this dilemma.
"Hypnotherapy in management of pain and reexperiencing of trauma in burn patients."
Shakibaei, F., A. A. Harandi, et al. (2008). International Journal of Clinical and Experimental Hypnosis 56(2): 185-97.
This study examined the effects of hypnosis on both pain and reexperiencing of trauma in burn patients. Forty-four patients hospitalized for burn care were randomly assigned to either hypnotherapy or a control group. Direct and indirect hypnotic suggestions were used to reduce pain and reexperiencing of trauma. All patients received routine burn care. Pain reports were quantified by using a self-report numeric rating scale ranging from 0 to 5. The number of recalled vivid, troubling events of the trauma in 24-hour intervals was used for rating the reexperiencing of trauma. The hypnotherapy group showed significantly lower pain ratings than the control group and reported a significant reduction in pain from baseline. There was a significant reduction in trauma reexperience scores in the hypnotherapy group but not the control group. The findings support the efficacy of hypnotherapy in the management of both pain and reexperiencing of trauma in burn patients.
"Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice."
Lang, E. V., K. S. Berbaum, et al. (2008). Journal of Vascular and Interventional Radiology 19(6): 897-905.
PURPOSE: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events. MATERIALS AND METHODS: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (> or =50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment. RESULTS: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118). CONCLUSIONS: Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.
"Long-term outcome of hypnotic-analgesia treatment for chronic pain in persons with disabilities."
Jensen, M. P., J. Barber, et al. (2008). International Journal of Clinical and Experimental Hypnosis 56(2): 156-69.
Data from 26 participants in a case series of hypnotic analgesia for chronic pain were examined to determine the long-term effects of hypnosis treatment. Statistically significant decreases in average daily pain intensity, relative to pretreatment values, were observed at posttreatment and at 3- and 9-month follow-up but not at 6- or 12-month follow-up. The percent of participants who reported clinically meaningful decreases in pain were 27%, 19%, 19%, and 23%, at the 3-, 6-, 9-, and 12-month follow-up points, respectively. Moreover, at 12-months posttreatment, 81% of the sample reported that they still used the self-hypnosis skills learned in treatment. Overall, the results indicate that about 20% of the sample obtained substantial and lasting long-term reductions in average daily pain following hypnosis treatment and that many more continue to use self-hypnosis up to 12 months following treatment.
"Relationship of headache-associated stressors and hypnosis therapy outcome in children: a retrospective chart review."
Anbar, R. D. and G. G. Zoughbi (2008). American Journal of Clinical Hypnosis 50(4): 335-41.
This study examined potential psychosocial stressors of 30 children with headaches (mean age, 15 years), and the role of insight generation in the outcome of hypnosis therapy. The mean duration of headache occurrence was 3 years. All of the patients were instructed in how to use hypnosis-induced relaxation and headache-related imagery to improve their symptoms. Thirty-seven percent reported their headaches were associated with fixed stressors, defined as caused by events over which patients had no control, while 63% reported variable stressors, defined as modifiable by the patients' actions. Four patients were lost to follow-up. Overall, 96% (25/26) reported a decrease in headache frequency and/or intensity following use of hypnosis. However, prior to insight generation patients reporting fixed stressors were significantly less likely to improve than those reporting variable stressors (p = 0.018). Thus, insight generation may be more important for achievement of improvement in children whose headaches are associated with fixed stressors.
"Hypnosis for treatment of pain in children."
Rogovik, A. L. and R. D. Goldman (2007). Canadian Family Physician 53(5): 823-5.
QUESTION: Many children suffer from chronic and painful illnesses. Hypnosis was found to be effective for analgesia in adults. Is it effective for managing pain in children? ANSWER: Children can be easier to hypnotize than adults. Studies have shown clinical hypnosis and self-hypnosis to be effective as adjunct treatments for children in pain. Examples include painful medical procedures, such as bone marrow aspiration and lumbar puncture in pediatric cancer patients, postoperative pain and anxiety in children undergoing surgery, and chronic headache.
"Self-hypnosis training for headaches in children and adolescents."
Kohen, D. P. and R. Zajac (2007). Journal of Pediatrics 150(6): 635-9.
OBJECTIVE: To describe the effect of treatment with self-hypnosis for youth with recurrent headaches. STUDY DESIGN: A retrospective review was conducted of outpatient clinical records of 178 consecutive youths referred to the Behavioral Pediatrics Program (University of Minnesota) from 1988 to 2001 for recurrent headaches. All patients were taught self-hypnosis for self-regulation. Intensity, frequency, and duration of headaches before, during, and after treatment were measured. Outcomes included number and frequency of visits, types of medication, and nature of self-hypnosis practice. RESULTS: Data were available for 144 patients in this patient self-selected and uncontrolled observation. Compared with self-reports before learning self-hypnosis, children and youths who learned self-hypnosis for recurrent headaches reported reduction in frequency of headache from an average of 4.5 per week to 1.4 per week (P < .01), reduction in intensity (on a self-rating scale of 0 to 12) from an average of 10.3 to 4.7, P < .01, and reduction in average duration from 23.6 hours to 3.0 hours, (P < .01). There were no adverse side effects of self-hypnosis. CONCLUSIONS: Training in self-hypnosis is associated with significant improvement of chronic recurrent headaches in children and adolescents.
"Hypnotherapy for the management of chronic pain."
Elkins, G., M. P. Jensen, et al. (2007). International Journal of Clinical and Experimental Hypnosis 55(3): 275-87.
This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than nonhypnotic interventions such as attention, physical therapy, and education. Most of the hypnosis interventions for chronic pain include instructions in self-hypnosis. However, there is a lack of standardization of the hypnotic interventions examined in clinical trials, and the number of patients enrolled in the studies has tended to be low and lacking long-term follow-up. Implications of the findings for future clinical research and applications are discussed.
"Painful menstruation."
Tzafettas, J. (2006). Pediatr Endocrinol Rev 3 Suppl 1: 160-3.
Painful menstruation is a cyclic painful condition that adversely affects the woman's wellbeing for a large part of her life. Its pathogenesis is not always understood. Prostaglandins seem to be intimately involved in primary dysmenorrhoea although it is difficult to understand the underlying cause for their excessive secretion. Abnormalities in plasma steroid levels could account for the disturbance, especially significantly elevated plasma levels of estradiol in the luteal phase. Plasma levels of vasopressin appear to be higher in women with dysmenorrhea suggesting a possible aetiological role in the uterine prostaglandin synthesis. The main aim of diagnosis is to distinguish those cases with secondary dysmenorrhoea due to endometriosis and chronic pelvic inflammatory disease and treat them accordingly although the exact role of endometriosis remains unclear. The development of sonographic and magnetic resonance imaging techniques (MRI) allow pre-operative diagnosis of adenomyosis, a difficult to diagnose cause of dysmenorrhea and pelvic pain. Medication is usually required for all cases of moderate to severe painful menstruation. Apart from pharmacological agents, several techniques have been used including relaxation therapy, hypnosis, manipulation, psychotherapy, acupuncture, biofeedback techniques, surgery e.g. Despite the high prevalence of painful menstruation, its frequency and severity is very often underestimated.
"Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy."
Jones, H., P. Cooper, et al. (2006). Gut 55(10): 1403-8.
BACKGROUND: Non-cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting. AIMS: This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina-like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory. PATIENTS AND METHODS: Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication. RESULTS: Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores. CONCLUSION: Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.
"Satisfaction with, and the beneficial side effects of, hypnotic analgesia."
Jensen, M. P., K. D. McArthur, et al. (2006). International Journal of Clinical and Experimental Hypnosis 54(4): 432-47.
Case study research suggests that hypnosis treatment may provide benefits that are not necessarily the target of specific suggestions. To better understand satisfaction with and the beneficial "side effects" of hypnosis treatment, questions inquiring about treatment satisfaction and treatment benefits were administered to a group of 30 patients with chronic pain who had participated in a case series of hypnotic analgesia treatment. The results confirmed the authors' clinical experience and showed that most participants reported satisfaction with hypnosis treatment even when the targeted symptom (in this case, pain intensity) did not decrease substantially. Study participants also reported a variety of both symptom-related and nonsymptom-related benefits from hypnosis treatment, including decreased pain, increased perceived control over pain, increased sense of relaxation and well-being, and decreased perceived stress, although no single benefit was noted by a majority of participants.
"Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial."
Weydert, J. A., D. E. Shapiro, et al. (2006). BMC Pediatr 6: 29.
BACKGROUND: Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. METHODS: 22 children, aged 5-18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with < or = 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. RESULTS: At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P < 0.01) months and significantly greater decrease in days with missed activities at one (85% vs. 15%, P = 0.02) and two (95% vs. 77%. P = 0.05) months. During the two months of follow-up, more children who had learned guided imagery met the threshold of < or = 4 day of pain each month and no missed activities (RR = 7.3, 95%CI [1.1,48.6]) than children who learned only the breathing exercises. CONCLUSION: The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.
"Changes in the meaning of pain with the use of guided imagery."
Lewandowski, W., M. Good, et al. (2005). Pain Manag Nurs 6(2): 58-67.
The purpose of this study is to determine how verbal descriptions of pain change with the use of a guided imagery technique. A mixed method, concurrent nested design was used. Participants in the treatment group used the guided imagery technique over a consecutive 4-day period, and those in the control group were monitored. Verbal descriptions of pain were obtained before randomization and at four daily intervals. A total of 210 pain descriptions were obtained across the five time points. Data were analyzed using content analysis. Six categories emerged from the data: pain is never-ending, pain is relative, pain is explainable, pain is torment, pain is restrictive, and pain is changeable. For participants in the treatment group, pain became changeable. The meaning of pain as never-ending was a prominent theme for participants before randomization to treatment and control groups. It remained a strong theme for participants in the control group throughout the 4-day study period; however, pain as never-ending did not resurface for participants in the treatment group.
"Hypnosis and clinical pain."
Patterson, D. R. and M. P. Jensen (2003). Psychological Bulletin 129(4): 495-521.
Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.
"Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison."
Lu, D. P., G. P. Lu, et al. (2001). American Journal of Clinical Hypnosis 44(2): 141-8.
Despite their long histories, acupuncture and hypnosis have only recently been acknowledged as valuable by the medical establishment in the U.S. Few studies have used rigorous prospective measurement to evaluate the individual or relative merits of hypnosis and acupuncture in specific clinical settings. In this study, 25 patients with various head and neck pain were studied. Each had an initial assessment of their pain, as well as of their attitudes and expectations. All patients received acupuncture, followed by a reassessment of their pain. After a washout period they received another assessment of pain before and after hypnosis therapy. Preferences for therapy were sought following the hypnotic intervention. Both acupuncture and hypnosis were effective at relieving pain under these conditions. The average relief in pain reported was 4.2 units on a ten point scale, with hypnosis reducing pain by a mean of 4.8 units, compared to 3.7 for acupuncture (p = 0.26). Patient characteristics appeared to impact the effectiveness of treatment: patients with acute pain benefited most from acupuncture treatment, whereas patients with psychogenic pain were more likely to benefit from hypnosis. Patients with chronic pain had more variation in their results. Patients who received healing suggestions from a tape during a hypnotic trance benefited more than those who received no such suggestion, and acupuncture patients who were needle phobic benefited less than those who were not fearful of needles. This study demonstrates the benefits of well designed studies of the effectiveness of these alternative modalities. More work is needed to help practitioners identify which patients are most likely to benefit from these complementary therapies.
"Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial."
Lang, E. V., E. G. Benotsch, et al. (2000). Lancet 355(9214): 1486-90.
BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. METHODS: 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. FINDINGS: Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
"Critical review of 5 nonpharmacologic strategies for managing cancer pain."
Sellick, S. M. and C. Zaza (1998). Cancer Prevention and Control 2(1): 7-14.
PURPOSE: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. METHODS: The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. RESULTS: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. CONCLUSION: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed.
"Evaluation of the efficacy and neural mechanism of a hypnotic analgesia procedure in experimental and clinical dental pain."
Barber, J. and D. Mayer (1977). Pain 4(1): 41-8.
Previous research implicates an endogenous central pain inhibitory mechanism in opiate analgesia, analgesia produced by focal electrical stimulation of the brain, and acupuncture analgesia. This investigation evaluates the possibility that analgesia produced by hypnosis is also mediated by such a mechanism. Results suggest that hypnotic analgesia is unlikely to involve this central pain inhibitory mechanism since hypnotic analgesia is not altered by naloxone hydrochloride, a specific narcotic antagonist. Results further demonstrate that the hypnotic procedure used produces an unusually effective and reliable increase in pain threshold. This finding generalizes to the control of clinical dental pain, and suggests that hypnotic pain control is a more widespread phenomenon in the population than has been thought.
Palliative Care
"Efficacy of guided imagery with theta music for advanced cancer patients with dyspnea: a pilot study."
Lai, W. S., C. S. Chao, et al. (2010) Biological Research for Nursing 12(2): 188-97.
BACKGROUND: Dyspnea is a frequent and devastating symptom among advanced cancer patients for which improved and low-cost palliative techniques are needed. METHODS: A one-group repeated measures research design investigated the efficacy of guided imagery (GI) with theta music (M) on dyspnea in advanced cancer patients. The intervention consisted of four periods: (a) pretest; (b) intervention with peaceful non-M; (c) intervention with 10 min of GI with M (GI/M), with the first and last 3 min being M only (i.e., the middle 4 min was GI/M); and (d) posttest. Dyspnea outcome was measured with the Modified Borg Scale (MBS) for self-reported evaluation of dyspneic symptoms. Physiological parameters measured were pulse oxygen saturation (SpO(2)), end-tidal CO( 2) (EtCO(2)), heart rate (HR), and respiratory rate (RR). Posttest qualitative data were obtained via interview for subjective patient experience. RESULTS: Participants included 53 patients, 33% with lung cancer. GI/M produced a significant decrease in MBS scores; 90% of the subjects gave positive qualitative reviews of GI/M. SpO(2) did not change significantly over time. GI/M significantly increased EtCO(2), decreased RR, and decreased HR. DISCUSSION: This study demonstrates that GI/M is a useful intervention for palliative care of patients with dyspnea. M alone was demonstrated to be effective, while soothing non-M was not effective. GI/M was more effective than M alone. GI/M should be considered low-cost end-of-life palliative care for dyspnea.
"Complementary medicine in palliative care and cancer symptom management."
Mansky, P. J. and D. B. Wallerstedt (2006). Cancer J 12(5): 425-31.
Complementary and alternative medicine (CAM) use among cancer patients varies according to geographical area, gender, and disease diagnosis. The prevalence of CAM use among cancer patients in the United States has been estimated to be between 7% and 54%. Most cancer patients use CAM with the hope of boosting the immune system, relieving pain, and controlling side effects related to disease or treatment. Only a minority of patients include CAM in the treatment plan with curative intent. This review article focuses on practices belonging to the CAM domains of mind-body medicine, CAM botanicals, manipulative practices, and energy medicine, because they are widely used as complementary approaches to palliative cancer care and cancer symptom management. In the area of cancer symptom management, auricular acupuncture, therapeutic touch, and hypnosis may help to manage cancer pain. Music therapy, massage, and hypnosis may have an effect on anxiety, and both acupuncture and massage may have a therapeutic role in cancer fatigue. Acupuncture and selected botanicals may reduce chemotherapy-induced nausea and emesis, and hypnosis and guided imagery may be beneficial in anticipatory nausea and vomiting. Transcendental meditation and the mindfulness-based stress reduction can play a role in the management of depressed mood and anxiety. Black cohosh and phytoestrogen-rich foods may reduce vasomotor symptoms in postmenopausal women. Most CAM approaches to the treatment of cancer are safe when used by a CAM practitioner experienced in the treatment of cancer patients. The potential for many commonly used botanical to interact with prescription drugs continues to be a concern. Botanicals should be used with caution by cancer patients and only under the guidance of an oncologist knowledgeable in their use.
"The integration of hypnosis into a model of palliative care."
Marcus, J., G. Elkins, et al. (2003). Integr Cancer Ther 2(4): 365-70.
There exists a need for a broad and inclusive model of integration of mind-body interventions for palliative care. Symptoms relating to psychological distress and existential concerns are even more prevalent than pain and other physical symptoms among those with life-limiting conditions. The hypnotic model's purpose is to improve the patient's total psychological, social, and spiritual well-being. A 4-stage model of interventions is offered to assist the clinician in developing and implementing appropriate hypnotherapeutic treatment for noncurative patients. The focus of the hypnotherapy is to ameliorate the effects of pain and dyspnea to restore a level of psychological and physical wellbeing. Within this model of therapy for patients with active, progressive, far-advanced disease and a short life expectancy, the goals of the hypnotic intervention are to provide relief from pain and shortness of breath. Other focuses include assisting the patient with the psychological adjustment to their noncurative and ultimately final state.
"Hypnosis: useful, neglected, available."
Douglas, D. B. (1999). American Journal of Hospice and Palliative Care 16(5): 665-70.
Hypnosis is presented as a valuable and frequently neglected resource for many patients with chronic and terminal illness. Particular attention is given herein to the use of hypnosis in attaining relaxation, overcoming insomnia, helping the patient achieve pain relief, and, most particularly, teaching the patient to work with relatives and other persons close to them, as caregivers in a special relationship that can be a very important source of relief to the patient. A brief overview of indications, contraindications, errors, and safeguards is given. Sources of education and training are briefly reviewed and a bibliography is included to identify the nature of professional societies, three in the United States and one international, together with some standard publications. The purpose of this article is to affirm the value of hypnosis as a complementary or alternative therapy for hospice patients, to summarize its clinical applications, and to list the most standard and best known professional societies and publications.
Parkinson's Tremor
"Parkinson's disease tremor is diminished with relaxation guided imagery."
Schlesinger, I., O. Benyakov, et al. (2009). Movement Disorders.
Patients with Parkinson's disease (PD) may have pronounced tremor that exacerbates during stress. To determine whether PD tremor improves with relaxation guided imagery (RGI) and relaxing music. Twenty patients with PD with moderate to severe tremor participated in sessions where relaxation techniques were implemented. Tremor was objectively monitored using an accelerometer. RGI dramatically decreased tremor in all 20 patients (baseline 270.38 +/- 85.82 vs. RGI 35.57 +/- 43.90 movements per minute P < 0.0001). In 15 patients, RGI completely abolished tremor for 1-13 min. Average tremor activity remained significantly bellow baseline both 15 min and 30 min after RGI was discontinued (P < 0.001). Patients reported improvement lasting 2-14 hours (mean 6.8 +/- 3.8). Relaxing music significantly reduced tremor but to a lesser degree than RGI (220.04 +/- 106.53 movements per minute P = 0.01). Self-relaxation had no significant effect on tremor. RGI can supplement conventional medical treatments for tremor in patients with PD on best medical treatment. (c) 2009 Movement Disorder Society.
"The effects of hypnosis on a parkinsonian tremor: case report with polygraph/EEG recordings."
Wain, H. J., D. Amen, et al. (1990). American Journal of Clinical Hypnosis 33(2): 94-8.
Although Parkinsonian tremors typically disappear during sleep and are reduced during relaxation periods, the effects of hypnosis on this type of movement disorder have been generally ignored. We observed a patient's severe Parkinsonian tremor under hypnosis and monitored it with EEG and EMG studies. The patient was taught self-hypnosis and performed it three to four times daily in conjunction with taking medication. The results suggest that daily sessions of self-hypnosis can be a useful therapeutic adjunct in the treatment of Parkinsonian tremors.
Phobias
"Brief hypnosis for severe needle phobia using switch-wire imagery in a 5-year old."
Cyna, A. M., D. Tomkins, et al. (2007). Paediatric Anaesthesia 17(8): 800-4.
We present a case of severe needle phobia in a 5-year-old boy who learned to utilize a self-hypnosis technique to facilitate intravenous (i.v.) cannula placement. He was diagnosed with Bruton's disease at 5 months of age and required monthly intravenous infusions. The boy had received inhalational general anesthesia for i.v. cannulation on 58 occasions. Initially, this was because of difficult venous access but more recently because of severe distress and agitation when approached with a cannula. Oral premedication with midazolam or ketamine proved unsatisfactory and hypnotherapy was therefore considered. Following a 10-min conversational hypnotic induction, he was able to use switch--wire imagery to dissociate sensation and movement in all four limbs in turn. Two days later the boy experienced painless venepuncture without the use of topical local anesthetic cream. There was no movement in the 'switched-off' arm during i.v. cannula placement. This report adds to the increasing body of evidence that hypnosis represents a useful, additional tool that anesthetists may find valuable in everyday practice.
"Accessing state-bound memories in the treatment of phobias: two case studies."
Bodden, J. L. (1991). American Journal of Clinical Hypnosis 34(1): 24-8.
Two cases of simple phobia demonstrate the inadequacies of both behavioral and psychodynamic theories. These cases and their treatment outcomes provide support for the state-dependent memory and learning theory. Hypnosis and ideomotor signaling proved to be not only effective treatments but also useful means of illuminating the role and nature of symptom function. Issues of symptom removal and substitution are also discussed in relation to these cases.
"Hypnotic regression and reframing in the treatment of insect phobias."
Domangue, B. B. (1985). American Journal of Psychotherapy 39(2): 206-14.
Two cases of insect phobia are presented in which constructs and strategies from psychodynamic, cognitive, and behavioral approaches were combined with hypnotic interventions. Flexibility and integration of approaches may be advantageous and hypnosis, including regression and reframing, may be especially powerful in the treatment of phobics.
Physical Rehabilitation
"Effect of motor imagery in the rehabilitation of burn patients."
Guillot, A., F. Lebon, et al. (2009). J Burn Care Res 30(4): 686-93.
Although there is ample evidence that motor imagery (MI) improves motor performance after CNS injury, it is still unknown whether MI may enhance motor recovery after peripheral injury and most especially in the rehabilitation of burn patients. This study aimed to investigate the effects of a 2-week MI training program combined with conventional rehabilitation on the recovery of motor functions in handed burn patients. Fourteen patients admitted to the Medical Burn Center were requested to take part in the study and were randomly assigned to the imagery or the control group. Behavioral data related to the ability to perform each successive step of three manual motor sequences were collected at five intervals during the medical procedure. The results provided evidence that MI may facilitate motor recovery, and the belief in the effectiveness of MI was strong in all patients. MI may substantially contribute to improve the efficacy of conventional rehabilitation programs. Hence, this technique should be considered as a reliable alternative method to help burn patients to recover motor functions.
"Clinical applications of hypnosis in the physical medicine and rehabilitation setting: three case reports."
Appel, P. R. (1990). American Journal of Clinical Hypnosis 33(2): 85-93.
Hypnosis is useful in the rehabilitation setting to help patients master skills, to increase their sense of self-efficacy and self-esteem and, in general, to facilitate and accelerate their rehabilitation program. I used hypnosis with three patients where patient behaviors and beliefs were interfering with the rehabilitation treatment goals set by the patient and the health care team. Collectively, these cases demonstrate the use of hypnotic techniques in diagnosing and treating problems with patient compliance and assisting patients to gain greater benefit from their rehabilitation regimen.
"The use of hypnosis in physical medicine and rehabilitation."
Appel, P. R. (1992). Psychiatric Medicine 10(1): 133-48.
Hypnosis and hypnotic strategies has been used for over 30 years in the field of Physical Medicine and Rehabilitation by psychiatrists and psychologists to effectively intervene in and influence: the enhancement of the patient's attainment of rehabilitation goals; adjustment and grief reactions to disability and handicap; and pre-existing psychiatric conditions exacerbated by the disability or handicap. In this article I will focus on how hypnosis has been effectively utilized to enhance performance of functional ability, increase self-esteem, and potentiate brief psychotherapy for adjustment difficulties to injuries and disabilities through the use of case examples.
"Performance enhancement in physical medicine and rehabilitation."
Appel, P. R. (1992). American Journal of Clinical Hypnosis 35(1): 11-9.
Performance enhancement or mental practice is the "symbolic rehearsal of a physical activity without any gross muscular movements" to facilitate skill acquisition and to increase performance in the production of that physical activity. Performance-enhancement interventions have been well known in the area of sports psychology and medicine. However, clinical applications in physical medicine and rehabilitation have not flourished to the same extent, though the demand for improved physical performance and the acquisition of various motor skills are as important. In this paper I will describe how hypnosis can potentiate mental practice, present a model of mental practice to enhance performance, and describe how to help patients access an ideal performance state of consciousness.
"Hypnosis also useful in rehabilitation therapy."
Martin, J. (1983). JAMA 249(12): 1536.
"Attempts to influence movement disorders in hemiparetics."
Radil, T., I. Snydrova, et al. (1988). Scandinavian Journal of Rehabilitation Medicine. Supplement 17: 157-61.
Step duration, measured in hemiparetic patients walking on a circular path, showed that step duration of the affected foot is usually longer. Functional electrical stimulation of the peroneal nerve in the swing phase of the step (eliminating foot drop) shortened step duration in the majority of cases. Hypnosis induced by the verbal fixation technique was used in hemiparetic patients (a) to ascertain whether the patient's mobility would increase during hypnosis and to determine (in positive cases) whether this approach might be used to predicting the effect of rehabilitation performed by classical methods; (b) to use hypnosis as a method of auxiliary treatment. The general finding was that the extent of movements of the hemiparetic upper extremity considerably improved during and immediately after hypnosis. This effect could be observed both at the level of severe impairment (at the beginning of treatment) and during the later stages when mobility greatly improved due to rehabilitation and recovery.
Post-Traumatic Stress Disorder
"Hypnotherapy in the treatment of chronic combat-related PTSD patients suffering from insomnia: a randomized, zolpidem-controlled clinical trial."
Abramowitz, E. G., Y. Barak, et al. (2008). International Journal of Clinical and Experimental Hypnosis 56(3): 270-80.
This study evaluated the benefits of add-on hypnotherapy in patients with chronic PTSD. Thirty-two PTSD patients treated by SSRI antidepressants and supportive psychotherapy were randomized to 2 groups: 15 patients in the first group received Zolpidem 10 mg nightly for 14 nights, and 17 patients in the hypnotherapy group were treated by symptom-oriented hypnotherapy, twice-a-week 1.5-hour sessions for 2 weeks. All patients completed the Stanford Hypnotic Susceptibility Scale, Form C, Beck Depression Inventory, Impact of Event Scale, and Visual Subjective Sleep Quality Questionnaire before and after treatment. There was a significant main effect of the hypnotherapy treatment with PTSD symptoms as measured by the Posttraumatic Disorder Scale. This effect was preserved at follow-up 1 month later. Additional benefits for the hypnotherapy group were decreases in intrusion and avoidance reactions and improvement in all sleep variables assessed.
"Hypnosis in the treatment of trauma: a promising, but not fully supported, efficacious intervention."
Cardena, E. (2000). International Journal of Clinical and Experimental Hypnosis 48(2): 225-38.
Hypnotic techniques for the treatment of posttraumatic conditions were often used by the clinical pioneers of the end of the 19th century and by military therapists treating soldiers during the 20th century's conflagrations. More recently, hypnosis has also been used with survivors of sexual assault, accidents, and other traumas, and with various groups, including children and ethnic minorities. Nonetheless, there have been almost no systematic studies on the efficacy of hypnosis for posttraumatic disorders. This state of affairs is especially disappointing considering that: hypnosis can be easily integrated into therapies that are commonly used with traumatized clients; a number of PTSD individuals have shown high hypnotizability in various studies; hypnosis can be used for symptoms associated with PTSD; and hypnosis may help modulate and integrate memories of trauma. Hypnotic techniques may indeed be efficacious for posttraumatic conditions, but systematic group or single-case studies need to be conducted before reaching that conclusion.
"New uses of hypnosis in the treatment of posttraumatic stress disorder."
Spiegel, D. and E. Cardena (1990). Journal of Clinical Psychiatry 51 Suppl: 39-43; discussion 44-6.
Hypnosis is associated with the treatment of posttraumatic stress disorder (PTSD) for two reasons: (1) the similarity between hypnotic phenomena and the symptoms of PTSD, and (2) the utility of hypnosis as a tool in treatment. Physical trauma produces a sudden discontinuity in cognitive and emotional experience that often persists after the trauma is over. This results in symptoms such as psychogenic amnesia, intrusive reliving of the event as if it were recurring, numbing of responsiveness, and hypersensitivity to stimuli. Two studies have shown that Vietnam veterans with PTSD have higher than normal hypnotizability scores on standardized tests. Likewise, a history of physical abuse in childhood has been shown to be strongly associated with dissociative symptoms later in life. Furthermore, dissociative symptoms during and soon after traumatic experience predict later PTSD. Formal hypnotic procedures are especially helpful because this population is highly hypnotizable. Hypnosis provides controlled access to memories that may otherwise be kept out of consciousness. New uses of hypnosis in the psychotherapy of PTSD victims involve coupling access to the dissociated traumatic memories with positive restructuring of those memories. Hypnosis can be used to help patients face and bear a traumatic experience by embedding it in a new context, acknowledging helplessness during the event, and yet linking that experience with remoralizing memories such as efforts at self-protection, shared affection with friends who were killed, or the ability to control the environment at other times. In this way, hypnosis can be used to provide controlled access to memories that are then placed into a broader perspective. Patients can be taught self-hypnosis techniques that allow them to work through traumatic memories and thereby reduce spontaneous unbidden intrusive recollections.
Self-Hypnosis
"Hypnosis in the treatment of anxiety- and stress-related disorders."
Hammond, D. C. (2010) Expert Review of Neurotherapeutics 10(2): 263-73.
Self-hypnosis training represents a rapid, cost-effective, nonaddictive and safe alternative to medication for the treatment of anxiety-related conditions. Here we provide a review of the experimental literature on the use of self-hypnosis in the treatment of anxiety and stress-related disorders, including anxiety associated with cancer, surgery, burns and medical/dental procedures. An overview of research is also provided with regard to self-hypnotic treatment of anxiety-related disorders, such as tension headaches, migraines and irritable bowel syndrome. The tremendous volume of research provides compelling evidence that hypnosis is an efficacious treatment for state anxiety (e.g., prior to tests, surgery and medical procedures) and anxiety-related disorders, such as headaches and irritable bowel syndrome. Although six studies demonstrate changes in trait anxiety, this review recommends that further randomized controlled outcome studies are needed on the hypnotic treatment of generalized anxiety disorder and in documenting changes in trait anxiety. Recommendations are made for selecting clinical referral sources.
"Long-term follow-up of self-hypnosis training for recurrent headaches: what the children say."
Kohen, D. P. (2010) International Journal of Clinical and Experimental Hypnosis 58(4): 417-32.
The author sent surveys to 178 consecutive youths previously referred for hypnosis for headaches. The survey sought current status of headaches: treatment, application of self-hypnosis, headache intensity, frequency, duration after self-hypnosis, generalization of self-hypnosis to other problems, and attitudes regarding self-hypnosis and life stresses. Of 134 delivered surveys, 52 were returned complete. Years after treatment, 85% (44/52) reported continued relief with self-hypnosis, 44% (23/52) reported decreased headache frequency, 31% (16/52) noted decreased severity, and 56% (29/52) reported that self-hypnosis reduced headache intensity. Many (26/52) emphasized the value of self-hypnosis to life stresses. In children and adolescents, self-hypnosis is associated with significant improvement of headaches and with an enduring positive effect for many years following training. Results suggest common and spontaneous generalizability of self-hypnosis by young people to modulation of other problems in their lives.
"Identification of children who may benefit from self-hypnosis at a pediatric pulmonary center."
Anbar, R. D. and S. C. Geisler (2005). BMC Pediatr 5(1): 6.
BACKGROUND: Emotional difficulties can trigger respiratory symptoms. Thus, children presenting with respiratory complaints may benefit from a psychological intervention. The purpose of this study was to define the proportion of patients referred to a Pediatric Pulmonary Center who may benefit from instruction in self-hypnosis, as a psychological intervention. METHODS: A retrospective chart review was conducted for all newly referred patients to the SUNY Upstate Medical University Pediatric Pulmonary Center during an 18 month period beginning January 1, 2000. Patients were offered hypnosis if they presented with symptoms or signs suggestive of psychological difficulties. Hypnosis was taught in one or two 15-45 minute sessions by a pediatric pulmonologist. RESULTS: Of 725 new referrals, 424 were 0-5 years old, 193 were 6-11 years old, and 108 were 12-18 years old. Diagnoses of anxiety, habit cough, or vocal cord dysfunction accounted for 1% of the 0-5 year olds, 20% of the 6-11 year olds, and 31% of the 12-18 year olds. Hypnotherapy was offered to 1% of 0-5 year olds, 36% of 6-11 year olds, and 55% of 12-18 year olds. Of 81 patients who received instruction in self-hypnosis for anxiety, cough, chest pain, dyspnea, or inspiratory difficulties, 75% returned for follow-up, and among the returning patients 95% reported improvement or resolution of their symptoms. CONCLUSION: A large number of patients referred to a Pediatric Pulmonary Center appeared to benefit from instruction in self-hypnosis, which can be taught easily as a psychological intervention.
"Self-hypnosis training as an adjunctive treatment in the management of pain associated with sickle cell disease."
Dinges, D. F., W. G. Whitehouse, et al. (1997). International Journal of Clinical and Experimental Hypnosis 45(4): 417-32.
A cohort of patients with sickle cell disease, consisting of children, adolescents, and adults, who reported experiencing three or more episodes of vaso-occlusive pain the preceding year, were enrolled in a prospective two-period treatment protocol. Following a 4-month conventional treatment baseline phase, a supplemental cognitive-behavioral pain management program that centered on self-hypnosis was implemented over the next 18 months. Frequency of self-hypnosis group straining sessions began at once per week for the first 6 months, became biweekly for the next 6 months, and finally occurred once every third week for the remaining 6 months. Results indicate that the self-hypnosis intervention was associated with a significant reduction in pain days. Both the proportion of "bad sleep" nights and the use of pain medications also decreased significantly during the self-hypnosis treatment phase. However, participants continued to report disturbed sleep and to require medications on those days during which they did experience pain. Findings further suggest that the overall reduction in pain frequency was due to the elimination of less severe episodes of pain. Non-specific factors may have contributed to the efficacy of treatment. Nevertheless, the program clearly demonstrates that an adjunctive behavioral treatment for sickle cell pain, involving patient self-management and regular contact with a medical self-hypnosis team, can be beneficial in reducing recurrent, unpredictable episodes of pain in a patient population for whom few safe, cost-effective medical alternatives exist.
"The effects of self-hypnosis on quality of life following coronary artery bypass surgery: preliminary results of a prospective, randomized trial."
Ashton, R. C., Jr., G. C. Whitworth, et al. (1995). Journal of Alternative and Complementary Medicine 1(3): 285-90.
The effects of complementary techniques and alternative medicine on allopathic therapies is generating much interest and research. To properly evaluate these techniques, well controlled studies are needed to corroborate the findings espoused by individuals practicing complementary medicine therapies. To this end, we evaluated the role of one of these therapies, self-hypnosis relaxation techniques, in a prospective, randomized trial to study its effects on quality of life after coronary artery bypass surgery. Subjects were randomized to a control group or a study group. Study group patients were taught self-hypnosis relaxation techniques the night prior to surgery. The control group received no such treatment. Patients then underwent routine cardiac management and care. The main endpoint of our study was quality of life, assessed by the Profile of Moods Scale. Results demonstrated that patients undergoing self-hypnosis the night prior to coronary artery bypass surgery were significantly more relaxed than the control group (p = 0.0317). Trends toward improvement were also noted in depression, anger, and fatigue. This study demonstrates the beneficial effects of self-hypnosis relaxation techniques on coronary surgery. This study also identifies endpoints and a study design that can be used to assess complementary medicine therapies. Results of this preliminary investigation are encouraging and demonstrate a need for further well-controlled studies.
"Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study."
Langewitz, W., J. Izakovic, et al. (2005). Psychotherapy and Psychosomatics 74(3): 165-72.
BACKGROUND: Many people suffer from hay fever symptoms. Hypnosis has proved to be a useful adjunct in the treatment of conditions where allergic phenomena have an important role. METHODS: Randomised parallel group study over an observation period of two consecutive pollen seasons. Outcome data include nasal flow under hypnosis, pollinosis symptoms from diaries and retrospective assessments, restrictions in well-being and use of anti-allergic medication. We investigated 79 patients with a mean age of 34 years (range 19-54 years; 41 males), with moderate to severe allergic rhinitis to grass or birch pollen of at least 2 years duration and mild allergic asthma. The intervention consisted of teaching self-hypnosis during a mean of 2.4 sessions (SD 1.7; range 2-5 sessions) and continuation of standard anti-allergic pharmacological treatment. RESULTS: Of 79 randomised patients, 66 completed one, and 52 completed two seasons. Retrospective VAS scores yielded significant improvements in year 1 in patients who had learned self-hypnosis: pollinosis symptoms -29.2 (VAS score, range 0-100; SD 25.4; p < 0.001), restriction of well-being -26.2 (VAS score, range 0-100; SD 28.7; p < 0.001. In year 2, the control group improved significantly having learned self-hypnosis as well: pollinosis symptoms -24.8 (SD 29.1; p < 0.001), restriction of well-being -23.7 (SD 30.0; p < 0.001). Daily self-reports of subjects who learnt self-hypnosis do not show a significant improvement. The hazard ratio of reaching a critical flow of 70% in nasal provocation tests was 0.333 (95% CI 0.157-0.741) after having learnt and applied self-hypnosis.
"Complementary and alternative medicine approaches to pain management."
Tan, G., J. A. Alvarez, et al. (2006). Journal of Clinical Psychology 62(11): 1419-31.
This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and self-hypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment.
"Psychosocial and immune effects of self-hypnosis training for stress management throughout the first semester of medical school."
Whitehouse, W. G., D. F. Dinges, et al. (1996). Psychosomatic Medicine 58(3): 249-63.
This study was a 19-week prospective conducted to determine the effectiveness of a self-hypnosis/relaxation intervention to relieve symptoms of psychological distress and moderate immune system reactivity to examination stress in 35 first-year medical students. Twenty-one subjects were randomly selected for training in the use of self-hypnosis as a coping skill and were encouraged to practice regularly and to maintain daily diary records related to mood, sleep, physical symptoms, and frequency of relaxation practice. An additional 14 subjects received no explicit training in stress-reduction strategies, but completed similar daily diaries. Self-report psychosocial and symptom measures, as well as blood draws, were obtained at four time points: orientation, late semester, examination period, and postsemester recovery. It was found that significant increases in stress and fatigue occurred during the examination period, paralleled by increases in counts of B lymphocytes and activated T lymphocytes, PHA-induced and PWM-induced blastogenesis, and natural killer cell (NK) cytotoxicity. No immune decreases were observed. Subjects in the self-hypnosis condition reported significantly less distress and anxiety than their nonintervention counterparts, but the two groups did not differ with respect to immune function. Nevertheless, within the self-hypnosis group, the quality of the exercises (ie, relaxation ratings) predicted both the number of NK cells and NK activity. It was concluded that stress associated with academic demands affects immune function, but immune suppression is not inevitable. Practice of self-hypnosis reduces distress, without differential immune effects. However, individual responses to the self-hypnosis intervention appear to predict immune outcomes.
Skin Diseases
"Therapeutic management of psychodermatological disorders."
Shenefelt, P. D. (2008). Expert Opin Pharmacother 9(6): 973-85.
BACKGROUND: The skin and the brain interact through psychoneuroimmunoendocrine mechanisms and through behaviors that can strongly influence the initiation or flaring of skin disorders. OBJECTIVE: To obtain knowledge of these factors to assist in designing treatment plans for specific skin disorders. METHODS: Psychocutaneous disease literature for the past 80 years was reviewed. RESULTS/CONCLUSION: Therapeutic options include standard psychotropic drugs and alternative herbs and supplements, the placebo effect, suggestion, cognitive-behavioral methods, biofeedback, and hypnosis. When simple measures fail to produce the desired results, combinations of drugs or addition of nonpharmacological therapies may produce better results. Psychophysiological skin disorders may respond well to nonpharmacological therapies that counteract stress, supplemented when indicated by anxiolytic or antidepressant drugs. Treatment of primary psychiatric disorders that affect the skin often results in improvement of the associated skin disorders. Psychiatric disorders secondary to skin disorders may also require treatment.
"Nonpharmacologic management of common skin and psychocutaneous disorders."
Fried, R. G. and S. H. Hussain (2008). Dermatol Ther 21(1): 60-8.
Data supporting the effectiveness of nonpharmacologic psychocutaneous techniques continues to accumulate. These interventions are used for the treatment of common and psychocutaneous skin conditions. They are most commonly used as adjuncts to traditional therapies. This article will review the data on the effectiveness of hypnosis, biofeedback, psychotherapy, meditation, support groups, guided imagery and progressive muscle relaxation, and psychotherapy.
"Biofeedback, cognitive-behavioral methods, and hypnosis in dermatology: is it all in your mind?"
Shenefelt, P. D. (2003). Dermatol Ther 16(2): 114-22.
Biofeedback can improve cutaneous problems that have an autonomic nervous system component. Examples include biofeedback of galvanic skin resistance (GSR) for hyperhidrosis and biofeedback of skin temperature for Raynaud's disease. Hypnosis may enhance the effects obtained by biofeedback. Cognitive-behavioral methods may resolve dysfunctional thought patterns (cognitive) or actions (behavioral) that damage the skin or interfere with dermatologic therapy. Responsive diseases include acne excoriee, atopic dermatitis, factitious cheilitis, hyperhidrosis, lichen simplex chronicus, needle phobia, neurodermatitis, onychotillomania, prurigo nodularis, trichotillomania, and urticaria. Hypnosis can facilitate aversive therapy and enhance desensitization and other cognitive-behavioral methods. Hypnosis may improve or resolve numerous dermatoses. Examples include acne excoriee, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Hypnosis can also reduce the anxiety and pain associated with dermatologic procedures.
"Hypnosis in dermatology."
Shenefelt, P. D. (2000). Archives of Dermatology 136(3): 393-9.
BACKGROUND: Hypnosis is an alternative or complementary therapy that has been used since ancient times to treat medical and dermatologic problems. OBJECTIVE: To describe the various uses for hypnosis as an alternative or complementary therapy in dermatologic practice. METHODS: A MEDLINE search was conducted from January 1966 through December 1998 on key words related to hypnosis and skin disorders. RESULTS: A wide spectrum of dermatologic disorders may be improved or cured using hypnosis as an alternative or complementary therapy, including acne excoriee, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. CONCLUSION: Appropriately trained clinicians may successfully use hypnosis in selected patients as alternative or complementary therapy for many dermatologic disorders.
"Hypnotherapy as a treatment for atopic dermatitis in adults and children."
Stewart, A. C. and S. E. Thomas (1995). British Journal of Dermatology 132(5): 778-83.
Eighteen adults with extensive atopic dermatitis, resistant to conventional treatment, were treated by hypnotherapy, with statistically significant benefit (P < 0.01) measured both subjectively and objectively, which was maintained at up to 2 years where results were available. Twenty children with severe, resistant atopic dermatitis were treated by hypnosis. All but one showed immediate improvement, which was maintained at the following two clinic appointments. In 12 children, replies to a questionnaire at up to 18 months after treatment, showed that 10 had maintained improvement in itching and scratching, nine in sleep disturbance, and seven maintained improvement in mood.
Smoking Cessation
"Hypnosis for smoking cessation: a randomized trial."
Carmody, T. P., C. Duncan, et al. (2008). Nicotine Tob Res 10(5): 811-8.
The purpose of this study was to determine whether hypnosis would be more effective in helping smokers quit than standard behavioral counseling when both interventions are combined with nicotine patches (NP). A total of 286 current smokers were enrolled in a randomized controlled smoking cessation trial at the San Francisco Veterans Affairs Medical Center. Participants in both treatment conditions were seen for two 60-min sessions, and received three follow-up phone calls and 2 months of NP. At 6 months, 29% of the hypnosis group reported 7-day point-prevalence abstinence compared with 23% of the behavioral counseling group (relative risk [RR] = 1.27; 95% confidence interval, CI 0.84-1.92). Based on biochemical or proxy confirmation, 26% of the participants in the hypnosis group were abstinent at 6 months compared with 18% of the behavioral group (RR = 1.44; 95% CI 0.91-2.30). At 12 months, the self-reported 7-day point-prevalence quit rate was 24% for the hypnosis group and 16% for the behavioral group (RR = 1.47; 95% CI 0.90-2.40). Based on biochemical or proxy confirmation, 20% of the participants in the hypnosis group were abstinent at 12 months compared with 14% of the behavioral group (RR = 1.40; 95% CI 0.81-2.42). Among participants with a history of depression, hypnosis yielded significantly higher validated point-prevalence quit rates at 6 and 12 months than standard treatment. It was concluded that hypnosis combined with NP compares favorably with standard behavioral counseling in generating long-term quit rates.
"Gender-related differences in hypnosis-based treatments for smoking: a follow-up meta-analysis."
Green, J. P., S. J. Lynn, et al. (2008). American Journal of Clinical Hypnosis 50(3): 259-71.
In an earlier meta-analysis of 12 studies using hypnosis-based treatments for smoking cessation, we provided preliminary evidence that males fare better than females when trying to quit smoking (Green, Lynn, & Montgomery, 2006). By excluding studies that reported no gender differences, but failed to report final outcome-statistics-by-gender, our previous conclusion may have overestimated the role of gender in hypnosis-based smoking cessation treatment. In the present analysis, we included 12 additional studies that reported no gender differences, but failed to report final outcome-by-gender statistics. Across each of these studies, we calculated identical success rates for male and female participants and then added these results to our database. Among all 24 groups of participants who completed hypnosis-based treatment for smoking, we found a small but significant effect for male participants being more successful in quitting smoking relative to females. Specific suggestions for tailoring hypnosis smoking cessation programs to take gender differences into account are discussed.
"Intensive hypnotherapy for smoking cessation: a prospective study."
Elkins, G., J. Marcus, et al. (2006). International Journal of Clinical and Experimental Hypnosis 54(3): 303-15.
This study reports on a prospective pilot trial of intensive hypnotherapy for smoking cessation. The hypnotherapy involved multiple individual sessions (8 visits) over approximately 2 months, individualization of hypnotic suggestions, and a supportive therapeutic relationship. Twenty subjects were randomly assigned to either an intensive hypnotherapy condition or to a wait-list control condition. The target quitting date was 1 week after beginning treatment. Patients were evaluated for smoking cessation at the end of treatment and at Weeks 12 and 26. Self-reported abstinence was confirmed by a carbon-monoxide concentration in expired air of 8 ppm or less. The rates of point prevalence smoking cessation, as confirmed by carbon-monoxide measurements for the intensive hypnotherapy group, was 40% at the end of treatment; 60% at 12 weeks, and 40% at 26 weeks (p < .05).
"Clinical hypnosis for smoking cessation: preliminary results of a three-session intervention."
Elkins, G. R. and M. H. Rajab (2004). International Journal of Clinical and Experimental Hypnosis 52(1): 73-81.
This study presents preliminary data regarding hypnosis treatment for smoking cessation in a clinical setting. An individualized, 3-session hypnosis treatment is described. Thirty smokers enrolled in an HMO were referred by their primary physician for treatment. Twenty-one patients returned after an initial consultation and received hypnosis for smoking cessation. At the end of treatment, 81% of those patients reported that they had stopped smoking, and 48% reported abstinence at 12 months posttreatment. Most patients (95%) were satisfied with the treatment they received. Recommendations for future research to empirically evaluate this hypnosis treatment are discussed.
Stress
"Differences in relaxation by means of guided imagery in a healthy community sample."
Watanabe, E., S. Fukuda, et al. (2006). Alternative Therapies in Health and Medicine 12(2): 60-6.
OBJECTIVE: This study investigated differences in relaxation induced by guided imagery in healthy community samples. METHODS: One hundred forty-eight people took part in our investigation. The mean age of the 50 males and 98 females was 39.36 +/- 11.86 years. We took saliva samples to measure salivary cortisol (SC) before the first session, after the first session, and after the second session. Subjects were asked to complete the short form of the Multiple Mood Scale (MMS) questionnaire before the first session and after the second session. The shortened form of Betts' Questionnaire upon Mental Imagery (QMI) was collected once before the first session, and vividness of the imagery was measured using a visual analogue scale once after the second session. RESULTS: SC levels were significantly decreased after the first session and after the second session in all participants. We found, most significantly, that age and QMI scores were strongly related to changes in SC level throughout the relaxation sessions. CONCLUSIONS: Unpleasant information, a cause of mental stress, is replaced by a comfortable image, and this replacement affects a participant's SC level. The greater one's imagery ability is, the more successful the displacement of stress and the shift toward a comfortable mental and emotional state will be. This study provides a basis for explaining the mechanism through which relaxation by means of guided imagery is effective in reducing stress.
"A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health."
Gruzelier, J. H. (2002). Stress 5(2): 147-63.
This review considers psychological interventions involving relaxation and guided imagery targeting immune functions. The review provides evidence of immune control accompanied by reports of enhanced mood and well-being. Three recent investigations of the author and his colleagues with self-hypnosis training incorporating imagery of the immune system are outlined. In two studies, hypnosis buffered the effects of stress on immune functions in medical students at exam time, and the comparison of self-hypnosis with and without immune imagery confirmed advantages to targeted imagery for both immune function and mood, and importantly, fewer winter viral infections. The implications for health were investigated in a third study in patients with virulent and chronic herpes simplex virus-2 HSV-2). Six weeks of training almost halved recurrence, improved mood and reduced levels of clinical depression and anxiety. Immune functions were up-regulated, notably functional natural killer cell activity to HSV-1. Individual differences in hypnotic susceptibility and absorption have typically been found to predict efficacy. New replicable evidence is reviewed of the importance of cognitive activation, a personality difference whose neurophysiological underpinning is consistent with left hemispheric preferential influences over the immune system. Now that the validation of psychological interventions includes advantages for health, this field of enquiry, which has been characterised by modest, small scale, largely preliminary studies, warrants a greater investment in research.
"Psychological treatment for recurrent symptoms of colds and flu in children."
Hewson-Bower, B. and P. D. Drummond (2001). Journal of Psychosomatic Research 51(1): 369-77.
The effect of stress management and relaxation with guided imagery on upper respiratory tract infections (URTIs) was investigated in 45 children with a history of 10 or more infections in the past year. To investigate the influence of psychological treatment on mucosal immunity, secretory immunoglobulin A (sIgA) was measured before and during treatment. The number of symptomatic episodes during 13 weeks of monitoring was similar in treatment and waitlist conditions; however, episodes were shorter in stress management and guided imagery conditions than in the waitlist condition. Levels of sIgA increased toward the end of treatment. These findings were confirmed in a replication study. In addition, symptom reduction and improvements in psychological state persisted at 1-year follow-up. The findings suggest that psychological treatment interrupts a chronic illness cycle in children with symptoms of recurrent URTI.
"Hypnosis as a modulator of cellular immune dysregulation during acute stress."
Kiecolt-Glaser, J. K., P. T. Marucha, et al. (2001). Journal of Consulting and Clinical Psychology 69(4): 674-82.
To assess the influence of a hypnotic intervention on cellular immune function during a commonplace stressful event, the authors selected 33 medical and dental students on the basis of hypnotic susceptibility. Initial blood samples were obtained during a lower stress period, and a second sample was drawn 3 days before the first major exam of the term. Half of the participants were randomly assigned to hypnotic-relaxation training in the interval between samples. Participants in the hypnotic group were, on average, protected from the stress-related decrements that were observed in control participants' proliferative responses to 2 mitogens, percentages of CD3+ and CD4+ T-lymphocytes, and interleukin 1 production by peripheral blood leukocytes. More frequent hypnotic-relaxation practice was associated with higher percentages of CD3+ and CD4+ T-lymphocytes. These data provide encouraging evidence that interventions may reduce the immunological dysregulation associated with acute stressors.
"Cellular and humoral immunity, mood and exam stress: the influences of self-hypnosis and personality predictors."
Gruzelier, J., F. Smith, et al. (2001). International Journal of Psychophysiology 42(1): 55-71.
The effects of self-hypnosis training on immune function and mood were examined in medical students at exam time. Hypnosis involved relaxation and imagery directed at improved immune function and increased energy, alertness and concentration. Hypotheses were made about activated and withdrawn personality differences. Eight high and eight low hypnotically susceptible participants were given 10 sessions of hypnosis, one live and nine tape-recorded, and were compared with control subjects (N=12). CD3, CD4, CD8, CD19 and CD56 NK cells and blood cortisol were assayed. Life-style, activated vs. withdrawn temperament, arousal and anxiety questionnaires were administered. Self-hypnosis buffered the decline found in controls in NK (P<0.002) and CD8 cells (P<0.0.07) and CD8/CD4% (P<0.06) (45-35% order of magnitude differences) while there was an increase in cortisol (P<0.05). The change in NK cell counts correlated positively with changes in both CD8 cells and cortisol. Results were independent of changes in life-style. Energy ratings were higher after hypnosis (P<0.01), and increased calmness with hypnosis correlated with an increase in CD4 counts (P<0.01). The activated temperament, notably the cognitive subscale (speaking and thinking quickly), was predictive of exam levels of T and B lymphocytes (P&z.Lt;0.08-P<0.02), and reaching r=0.72 (P<0.001) in the non-intervention control group. The sizeable influences on cell-mediated immunity achieved by a relatively brief, low cost psychological intervention in the face of a compelling, but routine, stress in young, healthy adults have implications for illness prevention and for patients with compromised immunity.
"Psychoneuroimmunology: can psychological interventions modulate immunity?"
Kiecolt-Glaser, J. K. and R. Glaser (1992). Journal of Consulting and Clinical Psychology 60(4): 569-75.
There is ample evidence from human and animal studies demonstrating the downward modulation of immune function concomitant with a variety of stressors. As a consequence, the possible enhancement of immune function by behavioral strategies has generated considerable interest. Researchers have used a number of diverse strategies to modulate immune function, including relaxation, hypnosis, exercise, classical conditioning, self-disclosure, exposure to a phobic stressor to enhance perceived coping self-efficacy, and cognitive-behavioral interventions, and these interventions have generally produced positive changes. Although it is not yet clear to what extent these positive immunological changes translate into any concrete improvements in relevant aspects of health, that is, alterations in the incidence, severity, or duration of infectious or malignant disease, the preliminary evidence is promising.
Stroke
"Mental practice in chronic stroke: results of a randomized, placebo-controlled trial."
Page, S. J., P. Levine, et al. (2007). Stroke 38(4): 1293-7.
BACKGROUND AND PURPOSE: Mental practice (MP) of a particular motor skill has repeatedly been shown to activate the same musculature and neural areas as physical practice of the skill. Pilot study results suggest that a rehabilitation program incorporating MP of valued motor skills in chronic stroke patients provides sufficient repetitive practice to increase affected arm use and function. This Phase 2 study compared efficacy of a rehabilitation program incorporating MP of specific arm movements to a placebo condition using randomized controlled methods and an appropriate sample size. Method- Thirty-two chronic stroke patients (mean=3.6 years) with moderate motor deficits received 30-minute therapy sessions occurring 2 days/week for 6 weeks, and emphasizing activities of daily living. Subjects randomly assigned to the experimental condition also received 30-minute MP sessions provided directly after therapy requiring daily MP of the activities of daily living; subjects assigned to the control group received the same amount of therapist interaction as the experimental group, and a sham intervention directly after therapy, consisting of relaxation. Outcomes were evaluated by a blinded rater using the Action Research Arm test and the upper extremity section of the Fugl-Meyer Assessment. RESULTS: No pre-existing group differences were found on any demographic variable or movement scale. Subjects receiving MP showed significant reductions in affected arm impairment and significant increases in daily arm function (both at the P<0.0001 level). Only patients in the group receiving MP exhibited new ability to perform valued activities. CONCLUSIONS: The results support the efficacy of programs incorporating mental practice for rehabilitating affected arm motor function in patients with chronic stroke. These changes are clinically significant.
"A randomized efficacy and feasibility study of imagery in acute stroke."
Page, S. J., P. Levine, et al. (2001). Clinical Rehabilitation 15(3): 233-40.
OBJECTIVE: To compare the feasibility and efficacy of a programme combining imagery and occupational therapy with a programme of therapy only. DESIGN: Randomized, controlled case series. SETTING: Subacute outpatient clinic. SUBJECTS: Thirteen consecutively admitted patients between four weeks and one year post stroke exhibiting stable motor deficits in their affected upper limbs. INTERVENTION: All patients received an hour of therapy three times a week for six weeks administered by the same physical and occupational therapists. During the same period, eight patients participated in 10-minute guided imagery sessions after each therapy session, as well as practising imagery at home twice each week. Five patients participated in a control intervention consisting of exposure to stroke information. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer) and Action Research Arm Test (ARA). RESULTS: After intervention, Fugl-Meyer and ARA scores of patients in the therapy only group remained virtually the same; therapy plus imagery group scores improved by 13.8 and 16.4 points, respectively, on the Fugl-Meyer and ARA. CONCLUSIONS: Imagery is a clinically feasible, cost-effective complement to therapy that may improve outcomes more than participation in therapy only.
"Pushing the limits of recovery: hypnotherapy with a stroke patient."
Holroyd, J. and A. Hill (1989). Int J Clin Exp Hypn 37(2): 120-8.
Hypnotherapy was used to assist recovery of left arm function following stroke in a 66-year-old woman. Treatment protocol is described, and results are discussed in terms of how hypnosis may facilitate voluntary motor movement. Recent literature on cortical changes in hypnosis and motor improvement during hypnosis is discussed in relation to the present results.
"Hypnotherapy in the rehabilitation of a stroke victim: a case study."
Manganiello, A. J. (1986). Am J Clin Hypn 29(1): 64-8.
"Gene expression and brain plasticity in stroke rehabilitation: a personal memoir of mind-body healing dreams."
Rossi, E. L. (2004). Am J Clin Hypn 46(3): 215-27.
In this personal memoir the author describes the progress of his rehabilitation from a stroke and the dream manifestations of his mind-body healing. He also shares his reminiscences about Erickson's physical difficulties as well as Erickson's naturalistic or activity-dependent approach to therapeutic hypnosis and rehabilitation and emphasizes what he considers the least understood and most under appreciated aspect of Erickson's hypnotherapy--the fact that his patients frequently experienced intense emotional experiences as they accessed and replayed their traumas in a therapeutic manner. He also speculates about the neural mechanisms of his healing from the standpoint of his new neuroscience theory which includes the novelty-numinosum-neurogenesis effect.
Surgery
"Presurgical stress management improves postoperative immune function in men with prostate cancer undergoing radical prostatectomy."
Cohen, L., P. A. Parker, et al. Psychosomatic Medicine 73(3): 218-25.
OBJECTIVE: To assess whether stress management (SM) improved immune outcomes in men undergoing surgery for prostate cancer. METHODS: A total of 159 men were assigned randomly to a two-session presurgical SM intervention, a two-session supportive attention (SA) group, or a standard care (SC) group. Men in the SM group discussed their concerns about the upcoming surgery and were taught diaphragmatic breathing, guided imagery; they had an imaginal exposure to the day of surgery and learned adaptive coping skills. Men in the SA group discussed their concerns about the upcoming surgery and had a semistructured medical interview. Blood samples were collected at baseline (1 month before surgery) and 48 hours after surgery. Measures of mood (Profile of Mood States) were collected at baseline, 1 week pre surgery, and the morning of surgery. RESULTS: Men in the SM group had significantly higher levels of natural killer cell cytotoxicity (p = .04) and higher levels of circulating proinflammatory cytokines (interleukin [IL]-12p70, p = .02; IL-1beta, p = .02; tumor necrosis factor-alpha, p = .05) 48 hours post surgery than men in the SA group and higher levels of natural killer cell cytotoxicity (p = 0.02) and IL-1beta (p = .05) than men in the SC group. Immune parameters increased for the SM group and decreased or stayed the same for the SA and SC groups. The SM group had significantly lower Profile of Mood States scores than the SC group (p = .006), with no other group differences between SA and SC groups. Changes in mood were not associated with immune outcomes. CONCLUSIONS: The finding that SM leads to decreased presurgical mood-disturbance and increased immune parameters after surgery reveals the potential psychological and biological benefits of presurgical SM.
"Hypnosis as sole anesthesia for major surgeries: historical & contemporary perspectives."
Hammond, D. C. (2008). American Journal of Clinical Hypnosis 51(2): 101-21.
Hypnosis is a well validated treatment for acute and chronic pain (Montgomery, DuHamel, & Redd, 2000). It has been found capable of reducing inflammation, altering blood flow, and producing beneficial effects when hypnotic suggestions are provided during and prior to surgery (Frederick, 2001) and other painful medical procedures. This paper quotes extensively from historical examples of the use of hypnosis (mesmerism) as the sole anesthesia for major surgeries in the 1800's. These historic examples by themselves provide powerful documentation of the ability of the mind to influence the body, but they are then followed by a review of contemporary literature and controlled research on the use in hypnosis in relation to surgery and prior to medical procedures.
"Hypnosis decreases presurgical distress in excisional breast biopsy patients."
Schnur, J. B., D. H. Bovbjerg, et al. (2008). Anesthesia and Analgesia 106(2): 440-4, table of contents.
BACKGROUND: Excisional breast biopsy is associated with presurgical psychological distress. Such distress is emotionally taxing, and may have negative implications for postsurgical side effects and satisfaction with anesthesia. We investigated the ability of a brief hypnosis session to reduce presurgical psychological distress in excisional breast biopsy patients. METHODS: Ninety patients presenting for excisional breast biopsy were randomly assigned to receive either a 15-minute presurgery hypnosis session (n = 49, mean age: 46.4 (95% CI: 42.3-50.4)) or a 15-minute presurgery attention control session (n = 41, mean age: 45.0 (95% CI: 40.8-49.2)). The hypnosis session involved suggestions for increased relaxation and decreased distress. The attention control session involved nondirective empathic listening. Presurgery distress was measured using visual analog scales (VAS) and the short version of the Profile of Mood States (SV-POMS). Data were analyzed using analysis of variance and chi2 procedures. RESULTS: Groups did not differ in terms of the following: demographics (age, education, ethnicity, marital status, all P's > 0.28); medical variables (presurgery diagnosis, previous excisional biopsy, previous breast cancer, all P's > 0.11); or preintervention distress (SV-POMS P > 0.74) assessed on the day of surgery. Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS emotional upset (16.5 vs 38.2, P < 0.0001, d = .85), VAS depressed mood (6.6 vs 19.9, P < 0.02, d = .67), and SV-POMS anxiety (10.0 vs 5.0, P < 0.0001, d = 0.85); and significantly higher levels for VAS relaxation (75.7 vs 54.2, P < 0.001, d = -0.76) than attention controls. CONCLUSIONS: The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical distress in women awaiting diagnostic breast cancer surgery.
"Clinical hypnosis for reduction of atrial fibrillation after coronary artery bypass graft surgery."
Novoa, R. and T. Hammonds (2008). Cleveland Clinic Journal of Medicine 75 Suppl 2: S44-7.
The belief that postoperative atrial fibrillation (PAF) results from transient autonomic dysfunction suggests that interventions such as clinical hypnosis may reduce the incidence of PAF. To explore this hypothesis, we retrospectively compared outcomes between two groups of patients undergoing coronary artery bypass graft surgery: 50 consecutive patients who received preoperative hypnoidal explanation of the surgical procedure and 50 case-matched historical controls who received no clinical hypnosis. The patients who received hypnosis were significantly less likely to experience an episode of PAF (P = .003) and showed nonsignificant trends toward superior outcomes in terms of length of stay, narcotic use, and total hospital charges. Our findings indicate that prospective randomized trials are warranted to further delineate the potential benefit of clinical hypnosis for prevention of PAF.
"Hypnosis to alleviate perioperative anxiety and stress: a journey to challenge ideas."
Fern, P. A. (2008). J Perioper Pract 18(1): 14-6.
Mention the possibility of surgery to a patient and most will react with a feeling of apprehension at best. Some will be horrified at the mere thought of being 'cut open'. For others, it will be the suggestion of entering a hospital for anything longer than an out patient appointment. Newspaper reports of healthcare-acquired infections (HAIs) may spring to mind: 'Will I leave with more than I came in for?'; 'What if it goes wrong?'; 'Who will look after the family?'. All this worrying leads to increased anxiety and stress, and the patient has not even been put on the waiting list yet, let alone been admitted.
"Hypnosis and surgery: past, present, and future."
Wobst, A. H. (2007). Anesthesia and Analgesia 104(5): 1199-208.
Hypnosis has been defined as the induction of a subjective state in which alterations of perception or memory can be elicited by suggestion. Ever since the first public demonstrations of "animal magnetism" by Mesmer in the 18th century, the use of this psychological tool has fascinated the medical community and public alike. The application of hypnosis to alter pain perception and memory dates back centuries. Yet little progress has been made to fully comprehend or appreciate its potential compared to the pharmacologic advances in anesthesiology. Recently, hypnosis has aroused interest, as hypnosis seems to complement and possibly enhance conscious sedation. Contemporary clinical investigators claim that the combination of analgesia and hypnosis is superior to conventional pharmacologic anesthesia for minor surgical cases, with patients and surgeons responding favorably. Simultaneously, basic research of pain pathways involving the nociceptive flexion reflex and positron emission tomography has yielded objective data regarding the physiologic correlates of hypnosis. In this article I review the history, basic scientific and clinical studies, and modern practical considerations of one of the oldest therapeutical tools: the power of suggestion.
"A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients."
Montgomery, G. H., D. H. Bovbjerg, et al. (2007). Journal of the National Cancer Institute 99(17): 1304-12.
BACKGROUND: Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective. METHODS: We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control). Patients were not blinded to group assignment. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0-100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review. RESULTS: Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 microg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). No statistically significant differences were seen in the use of fentanyl, midazolam, or recovery room analgesics. Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time. CONCLUSIONS: Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.
"Hypnosis before breast cancer surgery eases pain, cuts costs."
(2007). Harvard Womens Health Watch 15(3): 6.
"Hypnosis reduces preoperative anxiety in adult patients."
Saadat, H., J. Drummond-Lewis, et al. (2006). Anesthesia and Analgesia 102(5): 1394-6.
In this study we examined the effect of hypnosis on preoperative anxiety. Subjects were randomized into 3 groups, a hypnosis group (n = 26) who received suggestions of well-being; an attention-control group (n = 26) who received attentive listening and support without any specific hypnotic suggestions and a "standard of care" control group (n = 24). Anxiety was measured pre- and postintervention as well as on entrance to the operating rooms. We found that patients in the hypnosis group were significantly less anxious postintervention as compared with patients in the attention-control group and the control group (31 +/- 8 versus 37 +/- 9 versus 41 +/- 11, analysis of variance, P = 0.008). Moreover, on entrance to the operating rooms, the hypnosis group reported a significant decrease of 56% in their anxiety level whereas the attention-control group reported an increase of 10% in anxiety and the control group reported an increase of 47% in their anxiety (P = 0.001). In conclusion, we found that hypnosis significantly alleviates preoperative anxiety. Future studies are indicated to examine the effects of preoperative hypnosis on postoperative outcomes.
"Premedication in children: hypnosis versus midazolam."
Calipel, S., M. M. Lucas-Polomeni, et al. (2005). Paediatric Anaesthesia 15(4): 275-81.
BACKGROUND: The main objectives of premedication in children are to facilitate the separation from the parents, to reduce preoperative anxiety, to smooth the induction of anesthesia and to lower the risk of postoperative behavioral disorders. The most common technique is sedative premedication with midazolam. Hypnosis enables a state of relaxation to be achieved and has never been evaluated as a premedication technique. The aim of the present study was to evaluate the efficacy of hypnosis on anxiety and perioperative behavioral disorders versus midazolam. METHODS: Fifty children from 2 to 11 years of age were randomized into two groups: group H received hypnosis as premedication; group M were given 0.5 mg x kg(-1) midazolam orally, 30 min before surgery. Preoperative anxiety was evaluated using the Modified Yale Preoperative Anxiety Scale (mYPAS) score when arriving in the department (T1), when entering the operating room (T2), and when fitting the facemask (T3). Postoperative behavioral disorders were evaluated using the Posthospitalization Behavioral Questionnaire (PHBQ) at days 1, 7 and 14. RESULTS: The two groups showed no significant difference preoperatively with the PHBQ: (M) 21 (17-25) vs (H) 20 (8-25) and mYPAS score: (M) 28 (23-75) vs (H) 23 (23-78). The number of anxious children was less during induction of anesthesia in the hypnosis group (T3: 39% vs 68%) (P < 0.05). Postoperatively, hypnosis reduced the frequency of behavior disorders approximately by half on day 1 (30% vs 62%) and day 7 (26% vs 59%). CONCLUSIONS: Hypnosis seems effective as premedication in children scheduled for surgery. It alleviates preoperative anxiety, especially during induction of anesthesia and reduces behavioral disorders during the first postoperative week.
"Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial."
Ginandes, C., P. Brooks, et al. (2003). American Journal of Clinical Hypnosis 45(4): 333-51.
Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing. The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants' group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants' subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36). Analysis of variance showed the hypnosis group's objectively observed wound healing to be significantly greater than the other two groups', p < .001, through 7 postoperative weeks; standard care controls showed the smallest degree of healing. In addition, at both the 1 and 7 week post-surgical observation intervals, one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls, p < 0.02. The mean scores of the subjective assessments of postoperative pain, incision healing and functional recovery trended similarly. Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.
"Guided imagery in cardiac surgery."
Halpin, L. S., A. M. Speir, et al. (2002). Outcomes Manag 6(3): 132-7.
Clinical research has demonstrated that guided imagery, a simple form of relaxation, can reduce preoperative anxiety and postoperative pain among patients undergoing surgical procedures. In 1998, the cardiac surgery team implemented a guided imagery program to compare cardiac surgical outcomes between two groups of patients: with and without guided imagery. Data from the hospital financial cost/accounting database and patient satisfaction data were collected and matched to the two groups of patients. A questionnaire was developed to assess the benefits of the guided imagery program to those who elected to participate in it. Patients who completed the guided imagery program had a shorter average length of stay, a decrease in average direct pharmacy costs, and a decrease in average direct pain medication costs while maintaining high overall patient satisfaction with the care and treatment provided. Guided imagery is now considered a complementary means to reduce anxiety, pain, and length of stay among our cardiac surgery patients.
"Empowering the patient: hypnosis in the management of cancer, surgical disease and chronic pain."
Lynch, D. F., Jr. (1999). American Journal of Clinical Hypnosis 42(2): 122-30.
In the past decade, the increasing acceptance of hypnosis as a therapeutic adjunct by physicians and health care professionals both within and outside of the mental health community has resulted in broader use of the technique with patients in both hospital and outpatient settings. In our recent experiences with urologic patients, our staff has found that many bring a surprisingly sophisticated knowledge of clinical hypnosis to the office and often have had experience with some form of therapeutic hypnosis prior to consulting us. Consequently, we find we often encounter a surprising openness to the use of hypnosis as a part of the treatment programs we employ. As a result we have been able to utilize clinical hypnosis successfully in several treatment areas to the benefit of our patients. This paper will describe several programs in place at our practice which utilize clinical hypnosis as an adjunct to treatment.
"Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts. A prospective, randomized and blinded study."
Enqvist, B., C. Bjorklund, et al. (1997). Acta Anaesthesiologica Scandinavica 41(8): 1028-32.
BACKGROUND: Postoperative nausea and vomiting (PONV) after general anesthesia and surgery may have an incidence as high as 70% irrespective of antiemetic drug therapy. The use of preoperative hypnosis and mental preparation by means of an audio tape was investigated in the prophylaxis of nausea and vomiting before elective breast reduction surgery. Similar interventions have not been found in the literature. METHODS: Fifty women were randomized to a control group or a hypnosis group; the latter listened to an audio tape daily 4-6 days prior to surgery. A hypnotic induction was followed by suggestions as to how to relax and experience states incompatible with nausea and vomiting postoperatively (e.g. thirst and hunger). There was a training part on the tape where the patients were asked to rehearse their own model for stress reduction. Premedication and anesthetic procedures were standardized. RESULTS: Patients in the hypnosis group had significantly less vomiting, 39% compared to 68% in the control group, less nausea and less need of analgesics postoperatively. CONCLUSIONS: Preoperative relaxation and/or hypnotic techniques in breast surgery contribute to a reduction of both PONV and postoperative analgesic requirements.
"Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial."
Ashton, C., Jr., G. C. Whitworth, et al. (1997). Journal of Cardiovascular Surgery 38(1): 69-75.
OBJECTIVE: The role of complementary medicine techniques has generated increasing interest in today's society. The purpose of our study was to evaluate the effects of one technique, self-hypnosis, and its role in coronary artery bypass surgery. We hypotesize that self-hypnosis relaxation techniques will have a positive effect on the patient's mental and physical condition following coronary artery bypass surgery. EXPERIMENTAL DESIGN: A prospective, randomized trial was conducted. Patients were followed beginning one day prior to surgery until the time of discharge from the hospital. SETTING: The study was conducted at Columbia Presbyterian Medical Center, a large tertiary care teaching institution. PATIENTS: All patients undergoing first-time elective coronary artery bypass surgery were eligible. A total of 32 patients were randomized into two groups. INTERVENTIONS: The study group was taught self-hypnosis relaxation techniques preoperatively, with no therapy in the control group. MEASURES: Outcome variables studied included anesthetic requirements, operative parameters, postoperative pain medication requirements, quality of life, hospital stay, major morbidity and mortality. RESULTS: Patients who were taught self-hypnosis relaxation techniques were significantly more relaxed postoperatively compared to the control group (p=0.032). Pain medication requirements were also significantly less in patients practising the self-hypnosis relaxation techniques that those who were noncompliant (p=0.046). No differences were noted in intraoperative parameters, morbidity or mortality. CONCLUSION: This study demonstrates the beneficial effects self-hypnosis relaxation techniques on patients undergoing coronary artery bypass surgery. It also provides a framework to study complementary techniques and the limitations encountered.
"Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery."
Tusek, D. L., J. M. Church, et al. (1997). Diseases of the Colon and Rectum 40(2): 172-8.
PURPOSE: Guided imagery uses the power of thought to influence psychologic and physiologic states. Some studies have shown that guided imagery can decrease anxiety, analgesic requirements, and length of stay for surgical patients. This study was designed to determine whether guided imagery in the perioperative period could improve the outcome of colorectal surgery patients. METHODS: We conducted a prospective, randomized trial of patients undergoing their first elective colorectal surgery at a tertiary care center. Patients were randomly assigned into one of two groups. Group 1 received standard perioperative care, and Group 2 listened to a guided imagery tape three days preoperatively; a music-only tape during induction, during surgery, and postoperatively in the recovery room; a guided imagery tape during each of the first six postoperative days. Both groups had postoperative patient-controlled analgesia. All patients rated their levels of pain and anxiety daily, on a linear analog scale of 0 to 100. Total narcotic consumption, time to first bowel movement, length of stay, and number of patients with complications were also recorded. RESULTS: Groups were similar in age and gender distribution, diagnoses, and surgery performed. Median baseline anxiety score was 75 in both groups. Before surgery, anxiety increased in the control group but decreased in the guided imagery group (median change, 30; P < 0.001). Postoperatively, median increase in the worst pain score was 72.5 for the control group and 42.5 for the imagery group (P < 0.001). Least pain was also significantly different (P < 0.001), with a median increase of 30 for controls and 12.5 for the imagery group. Total opioid requirements were significantly lower in the imagery group, with a median of 185 mg vs. 326 mg in the control group (P < 0.001). Time to first bowel movement was significantly less in the imagery group (median, 58 hours) than in the control group (median, 92 hours; P < 0.001). The number of patients experiencing postoperative complications (nausea, vomiting, pruritus, or ileus) did not differ in the two groups. CONCLUSION: Guided imagery significantly reduces postoperative anxiety, pain, and narcotic requirements of colorectal surgery and increases patient satisfaction. Guided imagery is a simple and low-cost adjunct in the care of patients undergoing elective colorectal surgery.
"Hypnosis as adjunct therapy in conscious sedation for plastic surgery."
Faymonville, M. E., J. Fissette, et al. (1995). Regional Anesthesia 20(2): 145-51.
BACKGROUND AND OBJECTIVES. Sedation is often requested during local and regional anesthesia. However, some surgical procedures, such as plastic surgery, require conscious sedation, which may be difficult to achieve. Hypnosis, used routinely to provide conscious sedation in the authors' Department of Plastic Surgery, results in high patient and surgeon satisfaction. The authors conducted a retrospective study to investigate the benefits of hypnosis in supplementing local anesthesia. METHODS. The study included 337 patients undergoing minor and major plastic surgical procedures under local anesthesia and conscious intravenous sedation. Patients were divided into three groups depending on the sedation technique: intravenous sedation (n = 137) using only midazolam and alfentanil; hypnosis (n = 172), during which patients achieved a hypnotic trance level with age regression; and relaxation (n = 28), comprising patients in whom hypnosis was induced without attaining a trance level. In all three groups, midazolam and alfentanil were titrated to achieve patient immobility, in response to patient complaints, and to maintain hemodynamic stability. Midazolam and alfentanil requirements; intra- and postoperative pain scores; as well as pre-, intra-, and postoperative anxiety score, reported on a 10-cm visual analog scale, were recorded and compared in the three groups. RESULTS. Intraoperative anxiety reported by patients in the hypnosis group (0.7 +/- 0.11) and in the relaxation group (2.08 +/- 0.4) was significantly (P < .001) less than in the intravenous sedation group (5.6 +/- 1.6). Pain scores during surgery were significantly greater in the intravenous sedation group (4.9 +/- 0.6) than in the hypnosis group (1.36 +/- 0.12; P < .001) and the relaxation group (1.82 +/- 0.6; P < .01). Furthermore, midazolam requirements were significantly lower in the hypnosis group (P < .001) and in the relaxation group (P < .01) as compared with the intravenous sedation group: respectively, 0.04 +/- 0.002, 0.07 +/- 0.005, and 0.11 +/- 0.01 mg/kg/h. Alfentanil requirements were significantly decreased in the hypnosis group, as compared with the intravenous sedation group: 10.2 +/- 0.6 microgram/kg/h versus 15.5 +/- 2.07 micrograms/kg/h; P < .002. In the relaxation group, alfentanil requirements were 14.3 +/- 1.5 micrograms/kg/h (ns). Postoperative nausea and vomiting were reported by 1.2% of patients in the hypnosis group, 12.8% in the relaxation group and 26.7% in the intravenous sedation group. Greater patient satisfaction with the anesthetic procedure and greater surgical comfort were also reported in the hypnosis group. CONCLUSIONS. Successful hypnosis as an adjunct sedation procedure to conscious intravenous sedation provided better pain and anxiety relief than conventional intravenous sedation and allowed for a significant reduction in midazolam and alfentanil requirements. Patient satisfaction was significantly improved.
"Effect of preoperative suggestion on postoperative gastrointestinal motility."
Disbrow, E. A., H. L. Bennett, et al. (1993). Western Journal of Medicine 158(5): 488-92.
Autonomic behavior is subject to direct suggestion. We found that patients undergoing major operations benefit more from instruction than from information and reassurance. We compared the return of intestinal function after intra-abdominal operations in 2 groups of patients: the suggestion group received specific instructions for the early return of gastrointestinal motility, and the control group received an equal-length interview offering reassurance and nonspecific instructions. The suggestion group had a significantly shorter average time to the return of intestinal motility, 2.6 versus 4.1 days. Time to discharge was 6.5 versus 8.1 days. Covariates including duration of operation, amount of intraoperative bowel manipulation, and amount of postoperative narcotics were also examined using the statistical model analysis of covariance. An average savings of $1,200 per patient resulted from this simple 5-minute intervention. In summary, the use of specific physiologically active suggestions given preoperatively in a beleivable manner can reduce the morbidity associated with an intra-abdominal operation by reducing the duration of ileus.
Test Anxiety
"Using hypnotherapy to overcome examination anxiety."
Stanton, H. E. (1993). American Journal of Clinical Hypnosis 35(3): 198-204.
Eleven medical practitioners who had previously failed their fellowship examinations sought assistance in combating the anxiety that they felt had been responsible for their lack of success. They were seen individually for two, 50-minute sessions of hypnotherapeutic training designed to engender an increased confidence in their ability to overcome examination anxiety. Two outcome measures were used: the actual examination result and a face-valid attitude scale, the Examination Anxiety Thermometer. On the first of these, 10 of the 11 practitioners recorded passes, whereas on the second, 9 indicated an attitude change toward lower levels of test anxiety. Attention is drawn to the minimal expenditure of time involved in the treatment and the generalizability of the hypnotherapeutic technique to other areas of the practitioners' lives.
"Effects of anxiety-reducing hypnotic training on learning and reading-comprehension tasks."
Johnson, R. L. and H. C. Johnson (1984). Journal of the National Medical Association 76(3): 233-5.
"A simple hypnotic approach to treat test anxiety in medical students and residents."
Hebert, S. W. (1984). Journal of Medical Education 59(10): 841-2.
"Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy [RSDH]."
Boutin, G. E. and D. J. Tosi (1983). Journal of Clinical Psychology 39(3): 382-91.
Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis and vivid-emotive-imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at post-treatment or at follow-up.
Tinnitus
"Ericksonian hypnosis in tinnitus therapy: effects of a 28-day inpatient multimodal treatment concept measured by Tinnitus-Questionnaire and Health Survey SF-36."
Ross, U. H., O. Lange, et al. (2007). European Archives of Oto-Rhino-Laryngology 264(5): 483-8.
For the first time, the therapeutic effects on subacute and chronic tinnitus of an inpatient multimodal treatment concept based on principles of Ericksonian hypnosis (EH) were examined by standardized criteria of the Tinnitus Questionnaire (TQ) and Health Survey (SF-36) within a controlled prospective, longitudinal study. A total of 393 patients were treated within an inpatient closed-group 28-day-setting based on a resource-oriented, hypnotherapeutic concept. The severity of tinnitus was assessed by TQ at times of admission, discharge and also at a 6- and 12-month follow-up. Health-related quality of life was evaluated before and after therapy using the SF-36. After therapy, a decrease in TQ score was seen in 90.5% of the patients with subacute tinnitus and in 88,3% of those with chronic tinnitus. Assessment of the TQ score at the end of therapy revealed highly significant improvements of 15.9/14.1 points in mean. Effect sizes in the treatment groups (0.94/0.80) were superior to those in the waiting-list controls (0.14/0.23). The TQ score remained stable in the follow-up controls. Significant improvement in health-related quality of life has been observed within the treatment groups depending on initial level of tinnitus serverity I-IV according to TQ. Using a multimodal treatment concept with emphasis on resource-activating approaches of EH the annoyance of tinnitus can be significantly reduced while health-related quality of life is enhanced within a comparatively short treatment period of 28 days.
"Ericksonian hypnosis in tinnitus therapy."
Maudoux, A., S. Bonnet, et al. (2007). B-ENT 3 Suppl 7: 75-7.
OBJECTIVE: To evaluate the effect of Ericksonian therapy on tinnitus STUDY DESIGN: Non-randomised, prospective longitudinal study. SETTING: Tertiary referral centre. PATIENTS: A total of 49 patients underwent hypnosis therapy. Fourteen patients failed to finish the therapy (drop-out rate: 35%). Of the 35 patients who completed the therapy, 20 were male and 15 female. The average age was 46.3 years (range 17-78). INTERVENTION: The treatment is based on the principles and approaches of Ericksonian hypnosis. The first session was mainly dedicated to the evaluation of the impact of tinnitus on the patient's life and to an explanation of hypnosis therapy. The next sessions were "learning sessions" based on relaxation and mental imaging. Exercises were first based on all senses other than hearing. Then they focused on hearing, teaching patients how to modulate sound intensity, and finally how to modulate tinnitus intensity. Patients also learnt self-hypnosis. MAIN OUTCOME MEASURE(S): To evaluate the effect of the treatment, tinnitus was assessed with the Tinnitus Handicap Inventory questionnaire before and after the therapy. Results: After 5 to 10 sessions (mean: 8.09 + -1.92) of Ericksonian hypnosis therapy, the 35 patients were capable of self-hypnosis with the aim of modulating their tinnitus, and the measured THI score fell for all patients. The global score improved significantly from 60:23 before EH therapy to 16.9 at discharge. Within the group, the initial score was distributed as follows: 0% slight, 14% mild, 31% moderate, 31% severe and 23% catastrophic. The t-test for dependent variables revealed significant improvements in all subgroups (p < or = 0.005). CONCLUSIONS: The results of this clinical trial demonstrate that Ericksonian hypnosis, in particular using self-hypnosis, is a promising technique for treating patients with tinnitus.
"Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus."
Attias, J., Z. Shemesh, et al. (1993). Audiology 32(3): 205-12.
The efficacy of self-hypnosis (SH), masking (MA) and attentiveness to the patient's complaints (AT) in the alleviation of tinnitus was evaluated. Forty-five male patients close in age with chronic tinnitus related to acoustic trauma were assigned to three matched subgroups: SH, AT or MA. The therapeutic stimuli in the SH and MA sessions, recorded on audio cassettes, were given to the patients for use when needed. SH significantly reduced the tinnitus severity; AT partially relieved the tinnitus; MA did not have any significant effect.
Tourette Syndrome
"Nonpharmacological treatment of tics in Tourette syndrome adding videotape training to self-hypnosis."
Lazarus, J. E. and S. K. Klein. (2010) Journal of Developmental and Behavioral Pediatrics 31(6): 498-504.
OBJECTIVE: This case series examines the practicality of using a standardized method of training children in self-hypnosis (SH) methods to explore its efficiency and short-term efficacy in treating tics in patients with Tourette syndrome. METHODS: The files of 37 children and adolescents with Tourette syndrome referred for SH training were reviewed, yielding 33 patients for analysis. As part of a protocol for SH training, all viewed a videotape series of a boy undergoing SH training for tic control. Improvement in tic control was abstracted from subjective patient report. RESULTS: Seventy-nine percent of the patients trained in this technique experienced short-term clinical response, defined as control over the average 6-week follow-up period. Of the responders, 46% achieved tic control with SH after only 2 sessions and 96% after 3 visits. One patient required 4 visits. CONCLUSIONS: Instruction in SH, aided by the use of videotape training, augments a protocol and probably shortens the time of training in this technique. If SH is made more accessible in this way, it will be a valuable addition to multi-disciplinary management of tic disorders in Tourette syndrome.
"Elucidating Tourette's syndrome: perspectives from hypnosis, attention and self-regulation."
Raz, A., S. Keller, et al. (2007). American Journal of Clinical Hypnosis 49(4): 289-309.
Biological psychiatry favors drug treatment over non-pharmacological intervention and shapes the way clinicians both treat and understand Tourette's Syndrome (TS). However, drug treatments for TS involve side effects and are potentially toxic to the central nervous system. Moreover, current pharmacological treatments are largely ineffective and at best only provide a modest symptom reduction. In this paper, we describe how non-pharmacological treatments such as focused attention can modulate, reduce, or indeed entirely eliminate the symptoms of TS as well as elucidate the underlying neural mechanisms. Showing that the symptoms of TS are susceptible to self-regulatory interventions such as hypnosis, we propose that attentional training could be used to both treat the disorder and better understand it.
"A four-step hypnotherapy model for Gilles de la Tourette's syndrome."
Culbertson, F. M. (1989). American Journal of Clinical Hypnosis 31(4): 252-6.
Hypnotherapy may sometimes be helpful in ameliorating the behavioral characteristics of Tourette's Syndrome. This paper presents a case study of an adolescent male with Tourette's Syndrome who was referred by his physician for hypnotherapy for his disorder. A four-step treatment model involved progressive relaxation, finger-tip temperature feedback using a biotic finger band, Spiegel's eye-roll procedure, and imagery. The adolescent was in treatment for nine sessions, from October 1985 to March 1986, a period of 6 months. At the end of the nine sessions, his tics and vocalizations were minimal to nonexistent and he was discharged. A follow-up report 6 months later indicated that he had applied for the Air Force and had been accepted with no mention of Tourette's Syndrome as an issue during his Air Force examination.
Warts
"Hypnotherapy for warts (verruca vulgaris): 41 consecutive cases with 33 cures."
Ewin, D. M. (1992). American Journal of Clinical Hypnosis 35(1): 1-10.
Published, controlled studies of the use of hypnosis to cure warts are confined to using direct suggestion in hypnosis (DSIH), with cure rates of 27% to 55%. Prepubertal children respond to DSIH almost without exception, but adults often do not. Clinically, many adults who fail to respond to DSIH will heal with individual hypnoanalytic techniques that cannot be tested against controls. By using hypnoanalysis on those who failed to respond to DSIH, 33 of 41 (80%) consecutive patients were cured, two were lost to follow-up, and six did not respond to treatment. Self-hypnosis was not used. Several illustrative cases are presented.
"Hypnosis, placebo, and suggestion in the treatment of warts."
Spanos, N. P., R. J. Stenstrom, et al. (1988). Psychosomatic Medicine 50(3): 245-60.
Two experiments assessed the effects of psychological variables on wart regression. In Experiment 1, subjects given hypnotic suggestion exhibited more wart regression than those given either a placebo treatment or no treatment. In Experiment 2, hypnotic and nonhypnotic subjects given the same suggestions were equally likely to exhibit wart regression and more likely to show this effect than no treatment controls. In both experiments, treated subjects who lost warts reported more vivid suggested imagery than treated subjects who did not lose warts. However, hypnotizability and attribute measures of imagery propensity were unrelated to wart loss. Subjects given the suggestion that they would lose warts on only one side of the body did not show evidence of a side-specific treatment effect.
Weight Loss
"Weight loss for women: studies of smokers and nonsmokers using hypnosis and multicomponent treatments with and without overt aversion."
Johnson, D. L. (1997). Psychological Reports 80(3 Pt 1): 931-3.
Study 1 compared overweight adult women smokers (n = 50) and nonsmokers (n = 50) in an hypnosis-based, weight-loss program. Smokers and nonsmokers achieved significant weight losses and decreases in Body Mass Index. Study 2 treated 100 women either in an hypnosis only (n = 50) or an overt aversion and hypnosis (n = 50) program. This multicomponent follow-up study replicated significant weight losses and declines in Body Mass Index. The overt aversion and hypnosis program yielded significantly lower posttreatment weights and a greater average number of pounds lost.
"Hypnotic enhancement of cognitive-behavioral weight loss treatments--another meta-reanalysis."
Kirsch, I. (1996). Journal of Consulting and Clinical Psychology 64(3): 517-9.
In a 3rd meta-analysis of the effect of adding hypnosis to cognitive-behavioral treatments for weight reduction, additional data were obtained from authors of 2 studies, and computational inaccuracies in both previous meta-analyses were corrected. Averaged across posttreatment and follow-up assessment periods, the mean weight loss was 6.00 lbs. (2.72 kg) without hypnosis and 11.83 lbs. (5.37 kg) with hypnosis. The mean effect size of this difference was 0.66 SD. At the last assessment period, the mean weight loss was 6.03 lbs. (2.74 kg) without hypnosis and 14.88 lbs. (6.75 kg) with hypnosis. The effect size for this difference was 0.98 SD. Correlational analyses indicated that the benefits of hypnosis increased substantially over time (r = .74).
"Effectiveness of hypnosis as an adjunct to behavioral weight management."
Bolocofsky, D. N., D. Spinler, et al. (1985). Journal of Clinical Psychology 41(1): 35-41.
This study examined the effect of adding hypnosis to a behavioral weight-management program on short- and long-term weight change. One hundred nine subjects, who ranged in age from 17 to 67, completed a behavioral treatment either with or without the addition of hypnosis. At the end of the 9-week program, both interventions resulted in significant weight reduction. However, at the 8-month and 2-year follow-ups, the hypnosis clients showed significant additional weight loss, while those in the behavioral treatment exhibited little further change. More of the subjects who used hypnosis also achieved and maintained their personal weight goals. The utility of employing hypnosis as an adjunct to a behavioral weight-management program is discussed.
Wound Healing
"Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial."
Ginandes, C., P. Brooks, et al. (2003). American Journal of Clinical Hypnosis 45(4): 333-51.
Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing. The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants' group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants' subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36). Analysis of variance showed the hypnosis group's objectively observed wound healing to be significantly greater than the other two groups', p < .001, through 7 postoperative weeks; standard care controls showed the smallest degree of healing. In addition, at both the 1 and 7 week post-surgical observation intervals, one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls, p < 0.02. The mean scores of the subjective assessments of postoperative pain, incision healing and functional recovery trended similarly. Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.
"Using hypnosis to accelerate the healing of bone fractures: a randomized controlled pilot study."
Ginandes, C. S. and D. I. Rosenthal (1999). Alternative Therapies in Health and Medicine 5(2): 67-75.
CONTEXT: Hypnosis has been used in numerous medical applications for functional and psychological improvement, but has been inadequately tested for anatomical healing. OBJECTIVE: To determine whether a hypnotic intervention accelerates bodily tissue healing using bone fracture healing as a site-specific test. DESIGN: Randomized controlled pilot study. SETTING: Massachusetts General Hospital, Boston, Mass, and McLean Hospital, Belmont, Mass. PATIENTS: Twelve healthy adult subjects with the study fracture were recruited from an orthopedic emergency department and randomized to either a treatment (n = 6) or a control group (n = 6). One subject, randomized to the treatment group, withdrew prior to the intervention. INTERVENTION: All 11 subjects received standard orthopedic care including serial radiographs and clinical assessments through 12 weeks following injury. The treatment group received a hypnotic intervention (individual sessions, audiotapes) designed to augment fracture healing. MAIN OUTCOME MEASURES: Radiological and orthopedic assessments of fracture healing 12 weeks following injury and hypnotic subjects' final questionnaires and test scores on the Hypnotic Induction Scale. RESULTS: Results showed trends toward faster healing for the hypnosis group through week 9 following injury. Objective radiographic outcome data revealed a notable difference in fracture edge healing at 6 weeks. Orthopedic assessments showing trends toward better healing for hypnosis subjects through week 9 included improved ankle mobility; greater functional ability to descend stairs; lower use of analgesics in weeks 1, 3, and 9; and trends toward lower self-reported pain through 6 weeks. CONCLUSION: Despite a small sample size and limited statistical power, these data suggest that hypnosis may be capable of enhancing both anatomical and functional fracture healing, and that further investigation of hypnosis to accelerate healing is warranted.
"Hypnotically accelerated burn wound healing."
Moore, L. E. and J. Z. Kaplan (1983). American Journal of Clinical Hypnosis 26(1): 16-9.
