A brief review is presented of hemispheric specialization for different cognitive modes, and of the symptoms that follow disconnection of the two hemispheres by commissurotomy. Our present knowledge of the hemispheres’ cognitive specialization and potential for independent functioning provides a framework for thinking about the interaction of cognitive structures, defensive maneuvers, and variations in awareness. Parallels are noted between some aspects of the mental processes of the disconnected right hemisphere and some aspects of primary process thinking and repression. The hypothesis is proposed that in normal intact people mental events in the right hemisphere can become disconnected functionally from the left hemisphere (by inhibition of neuronal transmission across the cerebral commissures), and can continue a life of their own. This hypothesis suggests a neurophysiological mechanisms for at least some instances of repression and an anatomical locus for the unconscious mental contents.
1970
Crasilneck, Harold B.; Hall, James A. (1970). The use of hypnosis in the rehabilitation of complicated vascular and post-traumatic neurological patients. International Journal of Clinical and Experimental Hypnosis, 18 (3), 152-158.
Hypnotherapy has been found of value in rehabilitation of many patients experiencing difficulty in the usual procedures which follow cerebrovascular or traumatic brain injury. 3 cases are reported to illustrate the approach taken. Of 25 similar cases seen over a 9-year period, 4 were unresponsive to hypnosis. Although an increase in motivation for recovery seemed to be the major change elicited by hypnotherapy, other theoretical possibilities are mentioned. Hypnosis may be a useful way of approaching motivational problems in rehabilitating patients who manifest negativism toward conventional treatment.
1968
Bartlett, Esther E. (1968). A proposed definition of hypnosis with a theory of its mechanism of action. American Journal of Clinical Hypnosis, 11, 69-73.
A definition of hypnosis as a control of the normal control of input (information) for the purpose of controlling output (behavior) is proposed. A theory of the mechanism of action of hypnosis as an increasing integration of the neocortex and the subcortical areas of the brain, with the subcortical areas activated to a greater extent than normally, is postulated.
1964
Hammer, A. G.; Arkins, W. J. (1964). The role of photic stimulation in the induction of hypnotic trance. International Journal of Clinical and Experimental Hypnosis, 12, 81-87.
The relative effectiveness of the ordinary verbal method of trance induction is compared with 2 forms of induction utilizing mechanical photic stimulation, and with methods combining the personal and mechanical features. The criterion of trance adopted was the compulsive carrying out of a difficult suggestion. Results show that mechanical procedures alone are ineffective. On the other hand, the addition of a particular sort of photic driving probably improves trance induction, which suggests that induction is a complex matter involving both social interactions and relatively nonmeaningful impacts on the brain. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
1961
Levendula, Dezso (1961). Two case presentations: Treatment of central pain with reconstruction of the body-image — hypnoanalysis of a travel phobia. International Journal of Clinical and Experimental Hypnosis, 9, 283-289.
NOTES:
Uses analogy of phantom limb (hallucinated pain which is a central pain) with a multiple sclerosis patient who had ”excruciating” pain between her thighs despite paralysis from waist down due to multiple sclerosis. She valued her sex life though she couldn”t feel sexual response, and felt that she ”didn”t have any legs” and her husband ”had to carry her.”
In giving her history the patient noted an increasing numbness and weakness in her legs five years earlier. At that time she also entered menopause and developed severe vaginitis. She became depressed when she became increasingly unable control her excretory functions. As the pain in the genital region increased, her ability to feel pleasant vaginal sensations diminished. Ultimately the pain was continually present.
The therapist attributed her problem to a faulty body image because she “denied the existence of her legs which were actually physically present, although, she could neither feel, nor see, nor move them” (p. 285). Secondly, it was most necessary for her to hold on to the myth [sic], that her vagina existed, because it made her feel wanted and needed by her husband. She was unconsciously afraid that by giving up her vagina she would lose the most important bond between herself and her husband” (p. 285).
The therapist speculated that “the pain, which was the last sensation perceived before the total sensory loss occurred, was fixated centrally. This ”pain-image” served to maintain the pretense, unconsciously of course, that there was still feeling in the vagina even though it was only pain and not pleasure. The pain permitted her to avoid facing reality, just as in the case of an amputee who develops the fantasy of a phantom limb, because he cannot readjust his pre-existing body-image to the acceptance of mutilation” (p. 285). He offered the patient “the rather simple explanation… that because she really did not feel where her lower body ended or began, the pain served her need to know where the body halves were separated. If she could learn to imagine and to accept herself as a full, whole person, the pain probably would leave her. This theory seemed very logical and acceptable to the patient” (p. 285).
“Hypnosis was extensively utilized in the following sessions to regress the patient toward her youth. She went again for long walks with her boyfriend, now her husband. It was fun to re-experience the feeling of walking in her father”s apple orchard and stretch up for a red apple. Autohypnosis was taught and [he] told her to exercise ”walking” while hypnotized twice daily” (p. 285-286). He also tapped on the soles of her feet repeatedly, until she could localize the vibrations. “She finally learned that she did have legs and also that other sensations besides pain could originate below the waist…. Gradually with the acceptance of her ”wholeness and tallness” the pain became less and less. She was able to ”forget” the pain for a longer period of time. … Occasionally she does call. She tells [the therapist] that in a stressful situation, such as moving into a new house and not knowing where things are, the pain comes back temporarily, but it is much less and after [they] talk an hour she is relieved” (p. 287). The patient had a total of 20 visits. The author describes a second case, which is not described in these notes.
1960
Diamant, J.; Dufek, M.; Hoskovec, J.; Kristof, M.; Pekarek, V.; Roth, B.; Velek, M. (1960). An electroencephalographic study of the waking state and hypnosis with particular reference to subclinical manifestations of sleep activity. International Journal of Clinical and Experimental Hypnosis, 8, 199-212.
(Author”s Conclusions) EEG records have been investigated in 10 patients in a waking state and under hypnosis. It was shown that no differences existed between these two states in terms of EEG. EEG signs of decreased wakefulness can be demonstrated in some of the patients, but these were also present without hypnosis. This latter effect appears to be subclinical sleep activity (Roth), frequently seen particularly in neurosis. Reactibility to external stimuli under hypnosis was also, in most cases, equivalent to reactions in the waking state. The authors incline to the view that EEG data does not support the concept that the nature of hypnosis and sleep is qualitatively the same.
Guinazu, S. (1960). Relajacion de Schultz e ionotoforesis calcica trans cerebral. Acta Hipnologia Latino-Americana, 1, 65-67. (Abstracted in American Journal of Clinical Hypnosis, 1962, 5, 75)
The author recommends the use of autogenic training in conjunction with transcerebral calcium iontoforesis for the treatment of neurotic and psychotic disorders. This combined therapy abbreviates treatment time and leads to greater percentage of recoveries. Four cases, taken from over two hundred, are presented and analyzed.
Hernandez-Peon, R.; Dittborn, J.; Borlone, M.; Davidovich, A. (1960). Changes of spinal excitability during hypnotically induced anesthesia and hyperesthesia. American Journal of Clinical Hypnosis, 3, 64. (From 21st International Congress of Physiology, Buenos Aires, 1959, pg. 124, Abstracts)
Although hypnosis is well established, the physiological mechanisms of the hypnotic state and their related sensory phenomena are far from clear. Hernandez-Peon and Donoso have found that the magnitude of photic evoked potentials in the optic radiations of awake human subjects changed in response to previous verbal suggestions concerning the intensity of the expected photic stimulus. This striking observation led the cited authors to propose that certain hypnotic sensory phenomena might be explained, at least partially, by changes occurring as far down as second-order sensory neurons by centrifugal mechanisms controlling the sensory input to the brain. In the intact subject it is impossible to record uncontaminated electrical indexes of afferent impulses from those lower sensory neurons. However, it is possible to gain indirect evidence of tactile sensory inflow to the spinal cord by recording cutaneous reflexes. In young males, a forearm skin reflex evoked by a single square pulse of 0-.1 msec. duration was recorded with cathode- ray oscilloscope. The amplitude of the evoked potentials was often reduced during the hypnotic state, and it was further reduced by verbally suggesting to the hypnotized subject complete anesthesia of the forearm. Reciprocally, during hypnotically suggested hyperesthesia the cutaneous reflex was enhanced. It is concluded that during hypnotic anesthesia and hyperesthesia excitability changes occur at the spinal level, and it is suggested that these changes probably involve the spinal internuncial system interposed between the dorsal root ganglion cells and the motoneurons. (From Abstracts, 21st Internat. Cong. Physiol., Buenos Aires, 1959, p. 124.
1959
NOTES
“[H]ypnosis is similar to sleep in that it usually begins with muscular relaxation and is accompanied by lack of spontaneous thinking, planning or talking. It is similar to deep concentration in that it excludes from attention everything that is irrelevant” (p. 110). The author summarizes research on brain functions associated with consciousness, especially those of the brain stem activating system, and research evidence of generalized cortical inhibition during sleep (possibly related to the diffuse thalamic system). She views hypnosis as having similar inhibitory effects because the hypnotized person inhibits irrelevant action impulses, “will literally neither act nor think except as the hypnotizer commands or implicitly permits” (p. 115). [Hypnotic] “analgesia can be explained as a depression of the somatosensory limbic cortex which results in appraising the organic sensation as indifferent rather than painful (i.e. as falling within the optimal range of sensitivity)” (p. 115). The author posits a mediating hippocampal action circuit that is associated with the diffuse thalamic system. “The latter mediates the reduction or intensification of neural conduction from sensory areas to limbic cortex and hippocampus, and thus is instrumental in the _exclusion_ of sensory impressions, resulting in _lack_ of pain or of sensory experience or, conversely, in the _production_ of pain and sensory hallucinations. Suggested action states (e.g. cataplexy) are mediated via the action circuit connecting with the premotor and motor cortex, and represent motor imagination transformed into action. Suggested sensations are mediated via the action circuit connecting with the association and sensory receiving areas, and represent projected memory images which are accepted as real because the impulse to appraise and evaluate has been excluded. Suggested goal-directed actions flow from the suggested situation and are mediated via the action circuit just like any action carried out without hypnosis” (pp. 117-118).
1953
Kline, Milton V. (1953). Hypnotic retrogression: A neuropsychological theory of age regression and progression. Journal of Clinical and Experimental Hypnosis, 1, 21-28.
Author’s Summary – In a review of the salient aspects of research in hypnotic age regression an evaluation of the data tended to indicate that under certain conditions valid age regression is discussed in the light of a neuropsychological theory of age regression. This theory based upon a concept of hypnotic retrogression views regression and progression phenomena in hypnosis as a form of psychological activity involving disorientation for the subject and a reorganization of his perceptual equilibrium and control mechanisms with particular reference to time-space perception. The term hypnotic retrogression is used to describe the centrally induced state which alters time-space perception and renders hypnotic regression and progression possible.
Brain Damage
1997
Karlin, Robert (1997). Illusory safeguards: Legitimizing distortion in recall with guidelines for forensic hypnosis – two case reports. International Journal of Clinical and Experimental Hypnosis, 45, 18-40.
Two amnesic automobile accident victims remembered the information needed for their ongoing lawsuits during hypnosis. Meeting the recording requirements of the Hurd safeguards led to the admission of hypnotically influenced testimony in court in one case, whereas failure to record led to exclusion in the other. In both cases, closed-head trauma almost certainly prevented long-term memory consolidation. Thus adherence to guidelines for forensic hypnosis legitimized distortions in recall instead of preventing them. Hypnosis used to facilitate hypermnesia alters expectations about what can be remembered, makes memory more vulnerable to postevent information, and increases confidence without a corresponding increase in accuracy. Distortion of recall is an inherent problem with the use of hypnosis and hypnotic-like procedures and cannot be adequately prevented by any set of guidelines.
1993
Laidlaw, Tannis M. (1993). Hypnosis and attention deficits after closed head injury. International Journal of Clinical and Experimental Hypnosis, 31, 97-111.
In a controlled study of patients attending a concussion clinic because of ongoing postconcussion symptoms, attention deficits were recorded in the head-injured group for the aspects of alertness, assessed by the Continuous Performance Test (CPT), and processing capacity, assessed by a version of the Paced Auditory Serial Addition Test (PASAT). Selective attention was intact. Hypnotizability was assessed by the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A), with normal means and standard deviations found in both the concussed and control groups. There was a significant correlation, however, between HGSHS:A scores and PASAT scores in the concussed group only. The results of this preliminary study suggest that slower processing capacity after a closed head injury may predict higher hypnotizability and that hypnosis could be an appropriate rehabilitation technique for these patients who present with postconcussion symptoms.
Litwin, R. G.; Cardena, E. (1993, August). Dissociation and reported trauma in organic and psychogenic seizure patients. [Paper] Presented at the annual meeting of the American Psychological Association, Toronto, Canada.
Early detection and differential diagnosis of non-epileptic seizures (NES) versus epileptic seizures (ES) is a major clinical issue in comprehensive epilepsy centers. Recent research suggests that differences in dissociative experiences between NES and ES patients may prove useful for diagnostic purposes. Non-epileptic seizures are frequently conceptualized as a dissociative response to past emotional trauma or abuse; dissociation in ES occurs as a result of electrophysiological abnormalities, most often associated with the temporal lobes. The purpose of this study was to evaluate the effectiveness for the differential diagnosis of NES from ES of several measures of dissociation and of a self- report measure for physical and sexual abuse. Four quantitative measures of dissociation were utilized in this study: the dissociative disorders interview schedule (DDIS), dissociative experience scale (DES), Tellegen absorption scale (TAS) and the Stanford Hypnotic Clinical Scale (SHCS). The incidence of sexual and physical abuse was obtained from structured questions in the DDIS. Forty-one patients being evaluated for intractable seizures participated in this study; 13 ES patients with non-temporal lobe involvement (ES/NTL), 18 ES patients with temporal lobe focus (ES/TLE) and 10 patients with NES spells of psychiatric origin. The main researcher was blind to these diagnoses until the study was completed. Results show a trend toward greater incidence of dissociative experiences in the NES versus ES group on the DDIS, TAS and DES, although these differences tended to be modest and not statistically significant, perhaps given the small N of the study. There were no significant trends or differences in dissociative experiences reported by ES/NTL patients versus ES/TLE patients. Contrary to the study’s hypothesis, ES patients were slightly more susceptible to being hypnotized than NES patients. As hypothesized, a significant difference was that NES patients reported physical and sexual abuse of higher incidence and longer duration than did ES patients. Logistic regression analysis for prediction of NES using the DES, TAS and SHCS instruments correctly predicted only 10% of NES patients. However, exploratory logistic regression analysis using the demographic variables of gender, months of sexual abuse and years of recurrent seizures suggest that these characteristics may be specific and sensitive in the prediction of NES. Being a female, having a higher incidence and longer duration of abuse and fewer years of recurrent seizures all predicted significantly the existence of non-epileptic seizure events, allowing for a 95% accuracy in diagnostic prediction. Our findings reinforce prior research indicating that dissociation is an important symptom component of both ES and NES events. The trend toward more prevalent dissociative experiences in the NES group suggests that in depth examination of these differences and of key demographic variables may help differentiate between these two groups. (ABSTRACT from Bulletin of Division 30, Psychological Hypnosis, Fall 1993, Vol. 2, No. 3.)
1992
Appel, Philip R. (1992). Performance enhancement in physical medicine and rehabilitation. American Journal of Clinical Hypnosis, 35, 11-19.
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.
Weber, Alison Mary (1992, October). Hypnosis with brain-injured patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
NOTES: INTRODUCTION.
The purpose of this paper is a consciousness-raising one. The use of hypnosis with brain-injured people has been relatively neglected with respect to its potential benefit for the patients themselves and also for increasing our knowledge of hypnotic ability. Occasional reports concerning the use of hypnosis with brain-injured patients have appeared (e.g., Crasilneck & Hall, 1970 & 1975; LaClave & Blix, 1989; Manganiello, 1986). However, clinicians often assume that such patients are not able to utilise hypnotic techniques. This assumption appears to derive from three mistaken beliefs: 1. The belief that hypnotic trance ability requires an intact brain. Actually, a fully intact brain is not necessary for entering a hypnotic trance. 2. The belief that brain damage means that the person is totally mentally incompetent, a “vegetable.” In reality there are degrees of brain injury that vary from coma or vegetative state through to relatively mild changes in ability that may not be immediately obvious yet significantly impact the person’s functioning in everyday life. 3. The belief that brain-damaged individuals are identical with respect to their type of cognitive disability. In actual fact, the cognitive and other effects of brain injury vary according to location within the brain’s functional systems.
CASE EXAMPLES.
All four cases are people of apparently average or better ability prior to injury as judged from their educational and vocational history. Before discussing these examples, I should point out that the basic induction technique used has generally been the same one that I use with non-brain-injured people. This technique is one that encourages mental and physical relaxation and a mental attitude of passivity and dissociation (Weber, 1981). All were taught to use self-hypnosis as a means of making the benefits available as needed. No hypnotizability scales were used and the issue of using such scales with brain-injured people will be commented upon later.
CASE 1 is a 39 year-old man who fell hitting his head and sustaining a closed head injury. The main effect of that injury was severe slowing of information processing speed. This problem is a common one in cases of closed head injury , is thought to be related to diffuse microscopic axonal injury, and causes experiences of mental fatigue, overload, and stress. The mentally passive, relaxed dissociative state offered through hypnosis helps prevent and reduce these overload problems. In this patient’s case, his use of the hypnotic technique enabled him to increase his daily activity level from one of mainly sleeping and resting in darkened rooms to one that included a live-in relationship with his former wife and engaging in hobbies and social activities.
CASE 2 is a 22 year-old man who had a malformation of blood vessels in the left temporoparietal area of the brain. He was undergoing surgical correction of this malformation when it hemorrhaged and he was left aphasic and paralysed down the right side of his body. At the time of hypnotic treatment, he had switched to using his left hand for writing, was able to walk though with a limp, and was able to converse intelligibly but with some underlying language difficulties. He particularly complained of right-sided pain and general numbness of his body. Post-hypnotic suggestions about his body feeling normal and solid together with imagery related to swimming were effective in eliminating the pain and reducing the numbness so that he experienced his body as comfortable and “more normal.” He was so comfortable physically that he started earning a living by mowing lawns.
CASE 3 is a 40 year-old man who fell at work, sustained a closed head injury, was unconscious for 1.5 hours, and had no recall of events for 2.5 days after injury. Five years later he still showed a very disorganised and fragmented memory that was suggestive of frontal system dysfunction. He was also able to recall very little of his life prior to injury and this lack of autobiographical memory was very disconcerting to himself and to his family. He was able to benefit from post-hypnotic suggestions concerning his ability to form associations to pictures in the family photo album. These associations were then used as a basis for his making a written autobiographical outline to which he could refer as needed.
CASE 4 is a 47 year-old man who was showing subtle changes in personality over about 10 years, suddenly had a severe grand mal seizure during which he stopped breathing, and was found to have a large meningioma arising from the falx and extending bilaterally over the top of his brain. There was also evidence of recent hemorrhage within the tumor. The tumor was surgically removed but due to its previous pressure on the brain and to possible anoxia when he stopped breathing, he was left with cognitive problems of poor planning and organizing, slowed mental processing, and memory problems secondary to these other problems. He also showed emotional lability and disinhibition and physical problems that at first involved paralysis but later improved to leg weakness and spasticity and arm weakness and incoordination. Hypnotic techniques helped this patient in several ways: (a) Mental relaxation and dissociation resulted in better emotional control and some relief of the painful knotting of his leg muscles. (b) Age regression was successful in improving his manual coordination for the purpose of accordion playing, an activity of great emotional significance to this patient and his wife. During regression to age 15 years, he reported a twitching of his arm muscles (also observed by the therapist), a feeling that his arms and hands could “move more freely and flexibly as if a resistant force had been removed,” and a feeling like “electrical recharging and reconnecting.” His accordion playing noticeably improved from about 15 percent to about 90 percent competency and he was able to play again from memory for the first time since his surgery. (c) Post-hypnotic suggestions about his brain connecting to his leg muscles and these muscles working smoothly resulted in his being able to walk around the block without cramping for the first time since his surgery and a few weeks later he was able to walk for four or five hours in the mall instead of being limited to 30 minutes. (d) The patient also reported generally improved well-being as “having more energy, like another veil has been taken off so that things look sharper and more in focus.”
These four cases represent just a few of the ways brain-injured people can be helped by hypnosis. There are sure to be more ways just as there are for people with normal brains. In order to adapt hypnotic techniques to the needs of brain-injured people, some understanding of their particular brain-function problems is important.
HYPNOSIS AND BRAIN FUNCTION.
Because of time limits only a very quick and simplified overview of brain function can be provided but it should serve to give a general “feel” for a neuropsychological orientation to hypnosis with brain-injured people. It is based partly on Luria’s model of brain function (Luria, 1973).
1. Arousal and Some Physiological Functions. These functions involve the brain stem. Arousal functions include sleeping/waking, consciousness/coma, and level of general alertness. The brainstem also controls various physiological functions such as breathing, heart rate, and blood pressure.
2. Knowledge. Information from auditory, visual, and somesthetic path ways generally goes to the posterior half of the brain on the side opposite that of stimulus presentation. There are three levels of processing: (a) Primary processing involving initial registration and consciousness of stimuli; (b) Secondary perceptual elaboration of sensory input so that it makes perceptual sense. For example, in the visual modality the lines and colors registered in the primary area are organized into cohesive shapes in the secondary area. (c) Tertiary processing involves integration of input across modalities, for example, the ability to associate an auditorally heard word with the visually presented object it symbolizes.
3. Action. This aspect of brain function includes both motor and mental performance and embraces physical action, speech, and active thinking such as generating ideas and problem-solving. It is located in the anterior half of the brain and also has three levels: (a) Primary control of discrete muscle groups which mainly involves one side of the brain controlling the opposite side of the body; (b) Secondary areas underlie the ability to organize discrete muscle groups into a sequence such as brushing one’s teeth; (c) Tertiary executive areas which are critical to the generation of purposive behaviour, goals, plans, self-monitoring and adaptation.
4. Lateralization of Cognitive Function. The two cerebral hemispheres are usually specialized in the following way for most right- handed people: (a) Left Hemisphere language; symbolic, analytic, sequential type thinking; and
probably motor planning. (b) Right Hemisphere visuospatial, melodic, holistic, synthetic thinking.
5. Information Processing Speed. This aspect of mental function seems to depend on the axonal connections that form the white matter of the brain. Speed of information processing refers to the amount of information that can be attended to and processed within a given amount of time and includes both external stimuli like sights and sounds and also internal ones such as thoughts and memories.
6. New Learning and Memory. This feature of our abilities involves moving initially registered information into long term storage. The hippocampus is particularly critical in this process. The thalamus is thought to play a part in cued recall. General strategies for encoding and retrieval are probably influenced by frontal system function.
7. Emotional and Motivational Function. These functions appear to relate to the limbic system and basomedial frontal areas of the brain. These areas influence emotional intensity, emotional and social self-control, and motivation to initiate action.
8. Attention. Attentional function involves several brain areas. The brainstem is responsible for general arousal and level of alertness, white matter connections contribute to how much information a person can attend to and process within a given time, and the frontal cortex and its connections direct and organize the purposive focus of attention.
Any given mental or behavioral ability depends upon a complex system of brain areas and levels of processing. The effects of brain injury vary according to location and severity of damage, and also the person’s pre-injury condition and life style.
Obviously, the induction and suggestion techniques of hypnosis need to be based upon a neuropsychological understanding of the patient’s cognitive strengths and weaknesses. These factors also need to be considered when interpreting hypnotizability scores on standard scales and perhaps special scales need to be devised for work with such patients. The most common cognitive deficits encountered when working with brain- injured patients in the post-acute rehabilitation programs with which I have been associated have been those impacting memory, information processing speed, and executive function. Specific comments about these areas of deficit as they impact hypnosis are now given
Memory. A person with a defective ability to store new information (related to hippocampal dysfunction) is going to do well with post-hypnotic suggestions of amnesia but is probably not going to recall the items even when the amnestic suggestion is removed or if positive post-hypnotic suggestions are given. The patient with thalamic based memory difficulty may later be able to recall information but only provided a cuing structure of prompts or reminders is built into the suggestions. Whether or not memory ability in those with organically based memory deficit can be enhanced through hypnosis remains unclear. The patient presented earlier whose autobiographical memory difficulties were helped by hypnotic techniques did not have a storage problem per se but rather a very disorganized memory that probably stemmed from frontal type problems.
Information Processing Speed. Reduced speed of processing may necessitate giving instructions more slowly or in such a repetitive and redundant manner that some gaps in the patient’s registering what is said don’t matter. It is also important for such patients not to mentally overload them. For example, case #1 benefitted from the mental relaxation/ dissociation aspects of hypnosis and was able to mentally block out noise to which he was hypersensitive but the mental effort involved in such blocking-out resulted in his feeling mentally exhausted and stressed.
Executive Function. Patients with frontal system dysfunction show some deficits that are similar to hypnotic phenomena in people without brain dysfunction. From this point of view, they may be the most promising group to work with to clarify the nature of hypnosis. The hypnotized patient’s responses in conforming to suggestion resemble the stimulus-bound and concrete focus and time-distortive aspects of frontally dysfunctional behavior and perhaps also its confabulatory tendencies. The frontal patient may also show a dissociation between knowing and doing that is similar to the split reported by some people in being aware of and observing their own behavior at the same time as they respond to hypnotic suggestions. There is a sense in which the hypnotist acts as the “frontal lobes” of the hypnotized person, giving direction to their perceptions and behavior. The similarities between the two groups certainly invite further exploration and research.
References:
Crasilneck, H. B., & Hall, J. A. (1970) The use of hypnosis in the rehabilitation of complicated vascular and post-traumatic neurological patients. International Journal of Clinical and Experimental Hypnosis, 18, 145-159.
Crasilneck, H. B., & Hall, J. A. (1975) Hypnosis in neurological problems and rehabilitation. In H. B. Crasilneck & J. A. Hall, Clinical hypnosis: Principles and applications. New York: Grune & Stratton, pp. 203-222.
LaClave, L. J., & Blix, S. (1989) Hypnosis in the management of symptoms in a young girl with malignant astrocytoma: A challenge to the therapist. International Journal of Clinical and Experimental Hypnosis, 37, 6-14.
Luria, A. R. (1973) The Working Brain: An introduction to neuropsychology. Harmondsworth (UK): Penguin.
Manganiello, A. J. Hypnotherapy in the rehabilitation of a stroke victim. A case study. American Journal of Clinical Hypnosis, 29, 64-68.
Weber, A.M. (1981) Facilitation of dissociation in relation to mental relaxation and hypnosis. Australian Journal of Clinical and Experimental Hypnosis, 9, 101-102.
1991
Sapp, Marty (1991, August). The effects of hypnosis in reducing anxiety and stress in adults with neurogenic impairment. [Paper] Presented at the annual meeting of the American Psychological Association, San Francisco.
A repeated measures design was utilized to investigate the effects of hypnosis in reducing anxiety and stress in 16 adults with neurogenic impairment. Seven sessions were used to measure the efficacy of hypnosis. Session one was used to obtain a baseline level of anxiety and stress and to initiate hypnosis. Sessions three and six were used to obtain repeated measures of these emotions. Sessions two, four, and five were the treatment sessions. Session seven was used to conduct a four week follow-up on the effects of hypnosis. Levels of anxiety were measured by the State-Trait Anxiety Inventory, while stress was measured by the State-Trait Anger Expression Inventory. The results indicated a statistically significant decrease in anxiety and stress. Hypnosis also significantly increased levels of self-esteem. Finally, follow-up data demonstrated that the treatment gains were maintained.
1989
Holroyd, Jean; Hill, Alexis (1989). Pushing the limits of recovery: HypnoHypnotherapy 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.
NOTES:
The patient was 6 months post-stroke and physicians did not expect much additional improvement. She improved despite the fact that she measured as a low hypnotizable on the Stanford Scale, Form C. However, she appeared very absorbed in the hypnotic imagery, and she was highly motivated and exhibited much hope or positive expectation. Also, the author notes that “remarkable improvements in brain functioning have been reported through the use of sophisticated behavioral technology,” (p. 124), as in the use of EEG biofeedback to treat untractable seizures (Sterman & Lanz, 1981).
In rehabilitation cases, hypnotic dissociation may enhance pain control during the performance of exercises; more vivid hypnotic imagery may facilitate mental rehearsal of movements; attitudes may be reframed using hypnotic suggestion; and focusing attention on bodily sensations may be enhanced with hypnosis. Hypnosis also may improve expectancy, reduce anxiety, increase hope, provide general relaxation (reducing involuntary spasticity), increase cerebral blood flow, or in other ways promote healing.
Research by Pajntar, Roskar, & Vodovnik (1985) has demonstrated improved motor response during hypnosis for patients with hemiparesis. They attributed EMG changes under hypnosis “to a facilitory influx from supraspinal motor centers. They hypothesized that new motor units of paretic muscles were being activated or that there was an increased recruitment of the motor units already active, and they suggested that relaxation of the spastic antagonist muscle permits the paralyzed muscle to move” (p. 125).
LaClave, Linda J.; Blix, Susanne (1989). Hypnosis in the management of symptoms in a young girl with malignant astrocytoma: A challenge to the therapist. International Journal of Clinical and Experimental Hypnosis, 37 (1), 6-14.
This paper presents the case of a 6.5-year-old girl with malignant astrocytoma of the left brain hemisphere. During the course of her chemotherapy treatment, severe vomiting developed to the degree that on several occasions she became dehydrated. Discontinuation of chemotherapy was being considered when she was referred for hypnotherapy. Despite severe neurological impairments which excluded many traditional techniques, hypnosis was successful in eliminating emesis. Hypnosis was also utilized to decrease pain and to improve sleep patterns. Drawings are presented to help show how this child resolved anxiety associated with treatment and fears surrounding the knowledge of her impending death.
1988
Borgens, Richard B. (1988). Stimulation of neuronal regeneration and development by steady electrical fields. In Waxman, S. G. (Ed.), Functional recovery in neurological disease (47, pp. 547-564). New York: Raven Press.
NOTES:
At the end of the review, author notes that a combination of electromyography and computer modeling of agonist-antagonist, flexor-extensor muscle contraction patterns in the functional body parts of hemiparetic patients, artificially imposed on the paralyzed portions of the body using repetitive electrical stimulation to effect more normal movement, sometimes leads to functional recovery. Such recovery has been observed in some chronic cases of paralysis associated with head injury, stroke, and cerebral palsy. These clinical observations challenge the way we should view paralysis in general. Perhaps there are many redundant pathways in the CNS that will support certain kinds of functional return in the absence of the original pathways destroyed by trauma. Perhaps CNS-associated paralysis is a problem, at least in part, of too much competing signal in spared pathways, not one of impoverished signal. Can use of these neuronal pathways be entrained or retrained? Is the return of function in patients who experience repetitive functional electrical stimulation due to a reorganization within the CNS? These are exciting questions whose answers will possibly lead to our ability to further modify the plasticity of the brain and spinal cord.
[This would fit with the inhibition model of hypnosis, and with the high theta power findings during hypnosis, the implication being that hypnosis facilitates filtering out non-essential competing stimuli.]
1986
Thompson, Cynthia K.; Hall, Howard R.; Sison, Cecile E. (1986). Effects of hypnosis and imagery training on naming behavior in aphasia. Brain and Language, 28, 141-153.
The effects of hypnosis and imagery training on the naming behavior of three subjects with Broca’s aphasia were investigated using a multiple baseline design across subjects. Treatment consisted of the induction of hypnosis, followed by guided imagery focused on the physical and functional attributes of stimulus objects. Measures of naming ability on both trained and untrained items were taken at baseline, after every training session, and a few hours after training each day. Measures were also taken of imagery ability, hypnotic susceptibility, and psychological state. Results indicated that treatment facilitated improvement in naming ability, over baseline level, for two subjects. In the case of the third subject, the verbal label was incorporated into the imagery procedure following 10 training sessions. Subsequently, this subject’s naming behavior improved over baseline level. The results are discussed in terms of current theory and research in neuropsychology and cognitive psychology.
1985
Tranel, Daniel; Damasio, Antonio R. (1985, June). Knowledge without awareness: An autonomic index of facial recognition by prosopagnosics. Science, 208 (4706), 1453-1454.
Prosopagnosia, the inability to recognize visually the faces of familiar persons who continue to be normally recognized through other sensory channels, is caused by bilateral cerebral lesions involving the visual system. Two patients with prosopagnosia generated frequent and large electrodermal skin conductance responses to faces of persons they had previously known but were now unable to recognize. They did not generate such responses to unfamiliar faces. The results suggest that an early step of the physiological process of recognition is still taking place in these patients, without their awareness but with an autonomic index.
1984
Smith, Mark Scott; Kamitsuka, Michael (1984). Self-hypnosis misinterpreted as CNS deterioration in an adolescent with leukemia and Vincristine toxicity. American Journal of Clinical Hypnosis, 26 (4), 280-282.
A thirteen year-old girl with leukemia was taught self-hypnosis techniques for symptom control. She was hospitalized with probable vincristine toxicity and a superimposed hyperventilation syndrome. Her spontaneous use of the self- hypnosis technique was misinterpreted as central nervous system deterioration until her apparently comatose state resolved with suggestions from the therapist.
1981
Gravitz, Melvin A. (1981). Non-verbal hypnotic techniques in a centrally deaf brain-damaged patient. International Journal of Clinical and Experimental Hypnosis, 29, 110-116.
Non-verbal techniques across several sensory dimensions were utilized with a brain-damaged centrally deaf 36-year-old female patient who had been referred for hypnotherapeutic relaxation. These included optical fixation on the therapist’s hand with gradual thumb and fore-finger closure, vibratory stimuli, light shoulder pressures, arm stroking, manually facilitated air currents, and reinforcing homework assignments. With hypnotherapy, the patient’s physical and emotional behavior was reported by her to have improved to a significant degree.
1977
Lazar, Billie S. (1977). Hypnotic imagery as a tool in working with a cerebral palsied child. International Journal of Clinical and Experimental Hypnosis, 25 (2), 78-87.
Hypnotic imagery ws used with a moderately severe athetoid cerebral palsied 12-year-old boy who was mildly retarded and a poor hypnotic subject. Techniques included imagery, observation of the self, revivification of relaxing experiences, proprioceptive feedback about the athetoid movements, and dealing with feelings and motivation. Athetoid movements were reduced, results extended beyond the treatment situation, and improvement was made in practical skills.
1976
Cedercrentz, C.; Lahteenmaki, R.; Tulikoura, J. (1976). Hypnotic treatment of headache and vertigo in skull injured patients. International Journal of Clinical and Experimental Hypnosis, 24, 195-201.
Symptoms of headache and vertigo were treated using direct hypnotic suggestions of symptom relief in 155 consecutive skull injured patients. Posttraumatic headache and vertigo were completely relieved after an average observation period of 1 year 10 months in 50% and 58% of the patients, and partially relieved in 20% and 16% respectively. Most of the relief was achieved after about 4 weekly sessions and, particularly with the headaches, only if treatment began within a few weeks of the injury. Therapeutic outcome was correlated with depth of hypnosis achieved for both headache (r = .44, p < .0001) and vertigo (r = .47, p < .0001) symptoms. Patients who could not even achieve light hypnosis obtained no therapeutic improvement, but patients who experienced only light hypnosis were as clinically responsive as those achieving deep hypnosis. 1970 Crasilneck, Harold B.; Hall, James A. (1970). The use of hypnosis in the rehabilitation of complicated vascular and post-traumatic neurological patients. International Journal of Clinical and Experimental Hypnosis, 18 (3), 152-158. Hypnotherapy has been found of value in rehabilitation of many patients experiencing difficulty in the usual procedures which follow cerebrovascular or traumatic brain injury. 3 cases are reported to illustrate the approach taken. Of 25 similar cases seen over a 9-year period, 4 were unresponsive to hypnosis. Although an increase in motivation for recovery seemed to be the major change elicited by hypnotherapy, other theoretical possibilities are mentioned. Hypnosis may be a useful way of approaching motivational problems in rehabilitating patients who manifest negativism toward conventional treatment. 1964 Webb, Robert A.; Nesmith, C. C. (1964). A normative study of suggestibility in a mental patient population. International Journal of Clinical and Experimental Hypnosis, 12 (3), 181-183. The postural sway technique was used to make suggestibility measurements on a total of 490 Ss of which 279 were hospitalized psychiatric patients. The remaining Ss were "normal" college students. The "normal" Ss were significantly more suggestible than the psychiatric group. Within the psychiatric group, the psychotics, nonpsychotics, and organics differed significantly, with the nonpsychotics being least suggestible, the psychotics most suggestible, and the organics intermediate. The hospital group was further reduced into diagnostic subcategories and postural sway parameters were shown. The sample distributions were essentially normal although the sample drawn from a psychiatric population showed positive skewness. (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1960 McCord, Hallack (1960). A note on a change in mental age accompanying hypnosis of a teen-age-girl. International Journal of Clinical and Experimental Hypnosis, 8 (4), 259-262. NOTES 1: An adolescent with questionable diagnosis (mental retardation due to organic brain damage or functional psychological disorder) was given the E-G-Y test for an estimate of verbal intelligence. After initial testing, in which attention span was limited and she was very negativistic, she was re-tested in light hypnosis. Her mental age "more than doubled -- went up by six years -- "in the intervening 24 hours. The author ascribes improvement to relaxation from light hypnosis and opined that the 10 year level achieved under hypnosis was closr to her "true" level of functioning. Subsequent attempts to hypnotize her were not successful, possibly due to short attention span and negativistic tendencies. 1953 Kirkner, Frank J.; Dorcus, R. M.; Seacat, Gloria (1953). Hypnotic motivation of vocalization in an organic motor aphasic case. Journal of Clinical and Experimental Hypnosis, 1 (3), 47-49. Authors' Summary - A 41 year old male patient with a history of mutism on an organic basis for a year and a half failed to respond to speech retraining efforts. Comprehension was good and motivation poor. With the aid of hypnosis, he was induced to vocalize. Following vocalization, oral speech retraining progress was steady. Retraining efforts in writing met with repeated failure. Breathing & Respiration 2002 Anbar, Ron (2002, Dec 3). Hypnosis in pediatrics: applications at a pediatric pulmonary center.. BMC Pediatrics, 2 (1), 11-18. This report describes the utility of hypnosis for patients who presented to a Pediatric Pulmonary Center over a 30 month period. METHODS: Hypnotherapy was offered to 303 patients from May 1, 1998 - October 31, 2000. Patients offered hypnotherapy included those thought to have pulmonary symptoms due to psychological issues, discomfort due to medications, or fear of procedures. Improvement in symptoms following hypnosis was observed by the pulmonologist for most patients with habit cough and conversion reaction. Improvement of other conditions for which hypnosis was used was gauged based on patients'''' subjective evaluations. RESULTS: Hypnotherapy was associated with improvement in 80% of patients with persistent asthma, chest pain/pressure, habit cough, hyperventilation, shortness of breath, sighing, and vocal cord dysfunction. When improvement was reported, in some cases symptoms resolved immediately after hypnotherapy was first employed. For the others improvement was achieved after hypnosis was used for a few weeks. No patients'''' symptoms worsened and no new symptoms emerged following hypnotherapy. CONCLUSIONS: Patients described in this report were unlikely to have achieved rapid improvement in their symptoms without the use of hypnotherapy. Therefore, hypnotherapy can be an important complementary therapy for patients in a pediatric practice. 2001 Anbar, R. D. (2001). Self-hypnosis for management of chronic dyspnea in pediatric patients. Pediatrics, 107 (2), E21. " ... instruction in self-hypnosis was offered to 17 children and adolescents with chronic dyspnea, which had not resolved despite medical therapy, and who were documented to have normal lung function at rest. ... Chronic dyspnea was defined as recurrent difficulty breathing or shortness of breath at rest or with exertion, which had existed for at least 1 month in patients who had not suffered within a month from an acute pulmonary illness. ... Additionally, imagery relating to dyspnea was developed by coaching patients to change their imagined lung appearance from a dyspneic to a healthy state. ... The mean duration of their dyspnea before learning self-hypnosis was 2 years (range: 1 month to 5 years). ... A patient with a history of psychogenic cough declined to learn self-hypnosis. ... Thirteen of the 16 patients reported their dyspnea and any associated symptoms had resolved within 1 month of their final hypnosis instruction session. ... There was no recurrence of dyspnea, associated symptoms, or onset of new symptoms in patients in whom the dyspnea resolved." PMID: 11158495 [PubMed - indexed for MEDLINE 1996 Kohen, Daniel (1996). Relaxation/mental imagery (self-hypnosis) for childhood asthma: Behavioural outcomes in a prospective, controlled study. Australian Journal of Clinical and Experimental Hypnosis, 24 (1), 12-28.