“Of all the conditions which present themselves for treatment under hypnosis, the treatment of asthma, to my mind, yields the most gratifying results, particularly with children, and I believe that were hypnosis in general practice to be restricted to the treatment of the asthmatic patient alone, its use would be more than justified.” [No abstract included; first paragraph from the paper.]
1965
Agosti, E.; Camerota, G. (1965). Some effects of hypnotic suggestion on respiratory function. International Journal of Clinical and Experimental Hypnosis, 13 (3), 149-157.
Several respiratory indices were measured in 10 Ss in 3 states: at rest, with hypnotic suggestion of relaxation, and with hypnotic instructions to imagine muscular work. The same suggestions were given to 10 control Ss in the waking state. The suggestion of relaxation produced a decrease in pulmonary ventilation in both groups, although it was substantial only in the hypnotic group which started from a higher baseline level. The imagined work produced an increase in ventilation, especially in the hypnotic group. However, in both instances because of compensatory changes in respiratory efficiency the actual uptake of oxygen remained almost unaffected. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
1955
Dorcus, Roy M.; Kirkner, Frank J. (1955). The control of hiccoughs by hypnotic therapy. Journal of Clinical and Experimental Hypnosis, 3 (2), 104-108.
NOTES 1:
“The present paper is devoted to a discussion of 18 cases … of hiccoughs that were treated by hypnosis at the Long Beach Veterans Hospital during the course of the past five years. Aomost all of these cases had received some kind of medical therapy before hypnosis was employed. …
“The age range of the patients (27-75 years) indicates that age is not a factor either in the onset of the spasm or in the termination of it by hypnosis. … While there are some differences in the number of patients in the various [age] decile groups, these differences are in all probability due to sampling. The kinds of physical disorders fit into the table of causes abstracted from Samuels’ article and it is evident that hiccough may be associated with a wide variety of physical diseases. With respect to the onset of the hiccoughs, the major number of the spasms seem to be initiated after the central nervous system has been depressed by an anesthetic. When the diaphragm is set in reflex action by some other cause such as vomiting, hiccoughs may be initiated and continue. The hypnotic treatment stressed two points in procedure: (a) an attempt to obtain complete muscular relaxation, and (b) an attempt to relieve the patient of anxiety concerning the spasm and his physical disorder. The number of hypnotic sessions required varied from one session to as many as 8 or 10 sessions. The number of sessions required could not be predicted in advance. No criteria of whether hypnosis would be successful have been evolved other than whether the patient is, generally speaking, a good hypnotic subject. Of the eighteen patients treated by this method fourteen were permanently relieved of their symptoms; three received no benefit and one received temporary benefit. Since other therapies had been tried on most of these patients, it is quite apparent that this form of treatment is very useful and should be applied as soon as possible after the advent of the spasm. This statement is not based on the fact that hiccoughs of shorter duration respond more readily to hypnotic therapy. However, hypnosis should be utilized early to control hiccoughs so that the hiccoughs will not add to the distress of otherwise seriously ill patients” (pp. 107-108).
Burns
1997
Duhamel, Katherine N.; Difede, Joan; Foley, Frederick; Greenleaf, Marcia (1997, November). Hypnotizability and posttraumatic symptomatology after burn injury. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Washington, D. C..
NOTES 1:
Investigated the relationship between hypnotizability and post traumatic stress disorder (PTSD) symptoms following burn injury, in 43 hospitalized survivors. Authors found an association between these two variables and suggest that assessment of hypnotizability might help identify post-burn patients at risk for PTSD.
Hillig, Justine A.; Holroyd, Jean (1997-98). Consciousness, attention, and hypnoidal effects during firewalking. Imagination, Cognition and Personality.
Subjective experiences of individuals who walked on hot coals during a firewalking ceremony were investigated. This study extended and partially supported an investigation reported by Pekala and Ersek in this Journal [1]. Twenty-three participants completed retrospective questionnaire assessments concerning their subjective experiences while walking on hot coals. Results from twelve participants were compared with the participants’ own experiences during a baseline condition. The data suggested that attention during firewalking is significantly more “one-pointed” than during a baseline condition, and that consciousness may be characterized as more “hypnoidal” than during a baseline condition. Walking on hot coals was further characterized by trends toward reporting increased altered awareness, altered experience, and absorbed
attention. Participants who developed a grater degree of blistering reported significantly greater hypnoidal effects during the firewalk than those who developed a lesser degree of blistering.
Patterson, David R.; Adcock, Rebecca J.; Bombardier, Charles H. (1997). Factors predicting hypnotic analgesia in clinical burn pain. International Journal of Clinical and Experimental Hypnosis, 45 (4), 377-395.
The use of hypnosis for treating pain from severe burn injuries has received strong anecdotal support from case reports. Controlled studies provide less dramatic but empirically sound support for the use of hypnosis with this problem. The mechanisms behind hypnotic analgesia for burn pain are poorly understood with this patient population, as they are with pain in general. It is likely that, whatever the mechanisms are behind hypnotic pain analgesia, patients with burn injuries are more receptive to hypnosis than the general population. This article postulates some variables that may account for this enhanced receptivity, including motivation, hypnotizability, dissociation, and regression.
1996
Holroyd, Jean (1996). Hypnosis treatment of clinical pain: Understanding why hypnosis is useful. International Journal of Clinical and Experimental Hypnosis, 44 (1), 33-51.
Clinical and experimental research literature indicates hypnosis is very useful for severe and persistent pain, yet reviews suggest hypnosis is not widely used. To encourage more widespread clinical application, the author reviews recent controlled clinical studies in which hypnosis compares favorably with other interventions; links advances in understanding endogenous pain modulation to a neurophysiologic view of hypnosis and hypnoanalgesia; relates the neurophysiology of hypnoanalgesia to management of chronic pain; challenges the view that hypnotic pain control is only for the highly hypnotizable patient; and raises issues about how people learn to control pain with hypnosis. Training in hypnotic analgesia may usefully enhance nervous system inhibitory processes that attenuate pain.
NOTES:
Hypnosis has been more effective for pain management than other cognitive behavioral interventions in studies of fibromyalgia (Haanen, Hoenderdos, Van Romunde, Hop, Malle, Terwiel, & Hekster, 1991); burn treatment (Patterson, Everett, Burns, & Marvin, 1992); and cancer bone marrow transplant procedures (Syrjala, Cummings, & Donaldson, 1992). Central nervous system gating or downward modulation of pain impulses may account for hypnotic pain control. “Hypnosis enables both amplification and attenuation of cortical response subsequent to sensory registration and prior to consciousness, depending on whether suggestions are for increasing or decreasing awareness (Blum & Barbour, 1979)” (p. 36). This type of inhibition may even be observed in the peripheral nervous system (see Hernandez-Peon, Dittborn, Borlone, & Davidovich, 1959/1960; Sharev & Tal, 1989; Kiernan, Dane, Phillips, & Price, 1995). Work by Helen Crawford (1994) suggests that frontal and limbic areas of the brain are involved in inhibitory patterns of brain activity, and that generation of theta EEG rhythms by lower centers is associated with the suppression of awareness of pain.
Some very low hypnotizable people have been able to learn to control pain with hypnosis, suggesting that it is a skill that can be learned. However, few investigations of improvement of hypnoanalgesia were located. Rather, one must generalize from the fact that other kinds of hypnosis skills have been improved using special training programs, such as the Carleton University program developed by Gorassini & Spanos, 1986). Although most research on improving hypnotic response has been based on operant learning principles, a model that incorporates respondent (classical conditioning) principles might be more useful when it comes to understanding the training of a neurophysiological response, such as inhibitory brain patterns associated with hypnoanalgesia. “Historical success with clinical pain, taken together with newer findings in the neurophysiology of hypnosis, indicate that we should be spending more energy investigating how learning may improve hypnotic analgesia” (p. 43). “We should acknowledge that there are advantages to hypnosis beyond those of relaxation, a good placebo, and psychotherapy. … Responsible care demands that we provide training or practice in hypnotic analgesia when treating pain, and especially whenever a chronic pain patient initially appears to be nonresponsive” (p. 43).
Patterson, David; Goldberg, Myron; Ehde, Dawn (1996). Hypnosis in the treatment of patients with severe burns. American Journal of Clinical Hypnosis, 38 (3), 200-213.
Burn injuries are a frequent form of trauma, the care for which typically involves repeated, intrusive procedures and acute, excruciating levels of pain. Although research in the use of hypnosis with burn patients is largely anecdotal there is emerging evidence that the burn unit may be one of the most useful arenas for the clinical application of this technique. The acute, identifiable nature of burn care procedures and the emotional state of patients in trauma care both provide an often receptive setting for the use of this intervention.
1995
Ptacek, J. T.; Patterson, D. R.; Montgomery, B. K. (1995, August). Hypnosis versus Lorazepamin in the treatment of burn pain. [Paper] Presented at the annual meeting of the American Psychological Association, New York.
The pain from burn dressing is substantial and is best treated with interventions that supplement opioid medication. This study compares the use of hypnosis with the benzodiazepine lorazepam (Ativan). Thirty-eight patients were randomly assigned to groups that received hypnosis or lorazepam as supplements to opioid (e.g., morphine) medication. The control group received opioid drug alone. The results indicated that relative to baseline levels with opioid drugs alone, the lorazepam group showed a significant reduction in pain ratings at post-test. The hypnosis group demonstrated a 10% reduction in pain ratings, although this change was not significant. The results suggest that hypnosis is useful, but not necessarily as powerful as a pharmacological anxiolytic. (ABSTRACT from Bulletin of Division 30, Psychological Hypnosis, Fall, 1995, Vol. 4, No. 3.)
1994
Holroyd, Jean (1994, January 27). Hypnosis and the mind-body relationship. [Lecture]
NOTES:
Historically, hypnosis has been associated with mental healing (e.g. Mesmer’s salon), and clinical literature has been well reviewed by T. X. Barber (1984); Di Piano & Salzberg (1979); E. Hilgard & J. Hilgard (1975); Mott (1979); Paul (1963); and Perry, Gelfand, & Marcovitch (1979). Recently psychoneuroimmunology research has provided some support for the clinical evidence of healing. Research in this area should provide for determining whether the results are due to relaxation, to suggestion (waking or hypnotic), to personality (high hypnotizability), and should lead to an understanding of the basic physiological processes.
Clinical studies are sometimes given more credence by basic laboratory studies in a closely related area. For example, irritable bowel syndrome responded better to hypnosis with direct suggestions than to a combination of psychotherapy and a placebo pill (Whorwell, Prior, and Faragher, 1984). In the laboratory, Klein and Spiegel (1989) showed that secretion of stomach acid could be controlled by hypnosis and suggestion. Chapman, Goodell, & Wolff (1959) demonstrated that hypnotic suggestions could not only decrease but could increase the inflammatory response to burns, and that the response probably was mediated by a histamine-type substance.
Warts have been removed not only by hypnotic suggestion but by waking suggestion (Spanos, Stenstrom, & Johnston, 1988; Spanos, Williams, & Gwynn, 1990), and the hypnosis was more effective than potent placebo comparison treatment conditions. The elimination of warts may be related to control of blood flow or to a change in the immunological response. Chaves, Whilden, & Roller, 1979 (and Chaves, 1980) showed that dental patients could reduce the blood loss associated with dental surgery, using hypnosis and imagery suggestions. Bennett, Benson, & Kuiken (1986) helped back surgery patients to reduce blood loss using waking suggestions. The immune response also can be modified using hypnotic suggestion (Zachariae, Bjerring, & Arendt-Nielsen, 1989).
In the research on mind-body healing, the following considerations also apply: 1. People’s psychosomatic reactivity may affect the results obtained with hypnosis. Research on the immune response has sometimes used patients with psychosomatic disorders as the research subjects, to assure reactive physiological systems. 2. Severity of the disease may affect outcome (e.g. in the Spanos studies, those with the most warts responded best to the hypnosis intervention). 3. Hypnotizability sometimes relates to outcome and sometimes does not, in these investigations. In general, among very highly hypnotizable people, some can perform one hypnotic task such as develop amnesia while others can perform other, different hypnotic tasks.
In summary, there is an extensive clinical literature on hypnosis and healing, and experimental laboratory studies can offer support and some understanding of hypnosis effects on blood flow, histamine release, acid release, immune cell function, etc. In order to establish the effect of hypnosis one needs to start with the best chances for finding an effect: use high hypnotizable subjects. But later you either need to see if results correlate with general hypnotizability or with some other ability or experience, and often waking suggestion is sufficient.
1993
Everett, John J.; Patterson, David R.; Burns, G. Leonard; Montgomery, Brenda; Heimbach, David (1993). Adjunctive interventions for burn pain control: Comparison of hypnosis and Ativan. Journal of Burn Care and Rehabilitation, 14, 676-683.
Thirty-two patients hospitalized for the care of major burns were randomly assigned to groups that received hypnosis, lorazepam, hypnosis with lorazepam, or placebo controls as adjuncts to opioids for the control of pain during dressing changes. Analysis of scores on the Visual Analogue Scale indicated that although pain during dressing changes decreased over consecutive days, assignment to the various treatment groups did not have a differential effect. This finding was in contrast to those of earlier studies and is likely attributable to the low baseline pain scores of subjects who participated. A larger number of subjects with low baseline pain ratings will likely be necessary to replicate earlier findings. The results are argued to support the analgesic advantages of early, aggressive opioid use via PCA or through careful staff monitoring and titration of pain drugs.
Patterson, David R. (1993, October). Managing burn pain through hypnosis. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
NOTES:
Since 1955 there were 13 published reports on managing burn pain through hypnosis, with generally positive results; but almost all were anecdotal, with a lack of standardized measures. Time, location, and duration of the hypnotic interventions were not specified, cost-effectiveness was hard to detect, and medications used were not reported. Publications don’t even report the type of hypnotic intervention used.
Hypnosis is indicated for procedural pain more than for during resting periods. Going through dressing changes is typically more painful than the burn itself. Opioid medications don’t control all the pain. In our research we use J. Barber’s Rapid Induction Analgesia, which entails suggestions for: 1. Slow breathing 2. Going down 20 steps 3. Confusion and amnesia 4. Anchoring post-hypnotic suggestions 5. Touching cue for reinstating the hypnosis 6. Relaxing scenario (Patterson added this to the Barber script) 7. Returning up the steps
This intervention is good because it’s replicable, and it’s easy to train students to use it. The hypnosis is done the morning before the dressing change.
Instructions for nurses are: 1. Read the card 2. Have patient lie down comfortably, etc. 3. Provide post hypnotic cue (usually a touch on the shoulder)
In the first study we used patients refractory to opioids, and also used a historical control group. This was published in the American Journal of Clinical Hypnosis. Our subsequent study was published in the Journal of Consulting and Clinical Psychology (1992). We stabilized administration of opioids; then patients had hypnosis or anxiolytics or were in the control condition. There was significant reduction in pain for hypnosis.
Patterson et al (current study). Compared Benzodiazapines to hypnosis using four groups: Hypnosis plus Lorazepam Hypnosis and placebo Lorazepam Hypnosis attention control and Lorazepam Placebo hypnosis and placebo pills
Analgesia stabilized on 2 days. There was not an effect, no significant drop in pain scores for either hypnosis or Lorazepam. Perhaps we didn’t get a significant drop in pain ratings because in this study we were taking all patients who applied and their initial pain ratings were not as high as in the other study. We have found no relationship or pain reduction with hypnotizability either.
Why did we not get the positive results found previously for hypnosis? There are several possibilities. There is always a trend toward a drop in pain ratings over time. People generally bottom out with a rating of 3 or 4, and it looks like a floor effect. Also, the efficacy of hypnosis may be partly contingent on baseline pain level, and motivation to cooperate with the intervention.
Could there be the same relation to baseline for benzodiazepines?
We have noted that improved application of opioids early on means pain is lower. Marks & Sacher, Annals of Internal Medicine, 1973, indicate physicians under-prescribe opiates. Also Melzack in the Scientific American states this.
We feel that we should not push hypnotherapy so much that we feed in to opioidphobia. Hypnosis is a useful adjunct to opiates. We believe that you should stabilize the patient with opioids, and if they are not responding well, then use hypnosis.
In future research we want to find out which patients do best with hypnosis.
Pekala, Ronald J.; Ersek, Barrett (1993). Firewalking versus hypnosis: A preliminary study concerning consciousness, attention, and fire immunity. Imagination, Cognition and Personality, 12, 207-229.
This study assessed the subjective effects associated with firewalking, and compared them with the subjective effects associated with hypnosis and a baseline condition (eyes closed sitting quietly). Twenty-seven subjects, who walked over hot coals during a firewalk ceremony, completed questionnaires about what they subjectively experienced during the firewalk. Their experiences were subsequently compared with those of subjects (n – 246) who experienced hypnosis and a baseline condition. The data suggested that firewalking, as assessed across all subjects, is characterized by high levels of volitional control and rationality, and a very absorbed attentional style wherein the mind is one-pointed, and consciousness is characterized by strong feelings of joy and high levels of internal dialogue. Firewalking was also found to be associated with significantly more joy, one-pointedness of thought, absorption, and internal dialogue than hypnosis or the baseline condition. In addition, a cluster analysis suggested two subgroups of firewalkers based on their subjective experiences of the firewalk. Interestingly, analyzing the attentional experiences among these firewalkers who got slightly burned, versus those who did not, revealed significant differences. A one-pointed and absorbed attentional focus may be the critical variable for the fire immunity observed in firewalking.
NOTES:
About 500 people walked across coals, in 3-4 steps. At end of weekend, 71 said they would complete a questionnaire and it was mailed to them. Of those, 27 responded (25 of 26 in an average of 23 days). Hence, 5% of the population who walked responded to the questionnaire, and it was some time later. Three of 24 reported minor blisters. Those who didn’t get burned reported less detachment, less of a feeling of being out of their bodies, and more thoughts than the firewalkers who got slightly burned.
Pekala has defined an altered state of consciousness as associated with the perception of being in an altered state of awareness (the _subjective sense_ of _altered state_ –SSAS [30]), and a change in the patterning or configuration of the subsystems or dimensions of consciousness. A discrete state of consciousness, as defined by Pekala, is associated with a significant pattern change but no perceived alteration in state of consciousness (no SSAS). An identity state of consciousness, on the other hand, is defined as having neither a significantly perceived alteration in state of awareness nor a perceived pattern change among dimensions of consciousness in reference to another state of consciousness. Since the PCI can measure both intensity and pattern effects, it can be used to assess for altered, discrete, and identity states of consciousness.
Using a cluster analysis they found that one group of 16 subjects reported the firewalk experience to be characterized by a significant alteration in awareness and experience (body image, time sense, etc.), and significant intensities of internal dialogue, positive and negative affect, and arousal, while a second group of six subjects reported little alteration in consciousness or experience, little losses in rationality or control, and less internal dialogue, positive and negative affect or arousal than the larger group.
Whereas hypnosis is usually associated with a loss in control (the classic suggestion effect), firewalking was found to be associated with increased control, a more aroused state, and more fear! Firewalking appears to be a more absorbed and one-pointed state than even hypnosis.
The nature of attentional experience is similar across firewalkers (DAQ results).
Both firewalking and hypnosis meet the criteria for altered states of consciousness (different pattern and different subjective experience), but they are not altered states in reference to each other; they are _discrete states of consciousness_ in reference to each other, because there is a significantly different patterning of PCI dimensions between the two conditions, but no significant SSAS. This suggests that the firewalk state is qualitatively different from the hypnotic state (as induced by the induction procedure to the Harvard Scale) and probably represents a different type of state of consciousness than hypnosis. Firewalkers obtained a lower mean hypnoidal state score than hypnosis subjects, so it does not appear that the fire immunity is due to being in a “hypnotized” state.
The fact that there appears to be two groups of successful firewalkers, one of which did not report much alteration in consciousness, calls into question the theorizing concerning the importance of alteration in state of consciousness as being etiologically related to successful firewalking. Since about 25 percent of the firewalkers clustered into what appears to be a nonaltered state of awareness, this suggests a sizable percentage of subjects who did not report any significant alteration in consciousness and experience.
Hence, what may be important is not an alteration in consciousness, but rather an alteration in attention. The cluster analysis revealed a relatively unitary attentional state across all subjects suggesting that attention was deployed in a rather similar manner across all subjects, that is, with very high absorption and one-pointedness. it was also the DAQ dimensions, and not the PCI dimensions, that successfully discriminated a trend between the blistered and nonblistered firewalkers. Hence, high levels of one-pointedness and absorption, that is, how attention is deployed during firewalking may be more critical (than an alteration in consciousness in general) for the fire immunity observed during firewalking.
1992
Patterson, David R.; Everett, John J.; Burns, G. Leonard; Marvin, Janet A. (1992). Hypnosis for the treatment of burn pain. Journal of Consulting and Clinical Psychology, 60, 713-717.
The clinical utility of hypnosis for controlling pain during burn wound debridement was investigated. Thirty hospitalized burn patients and their nurses submitted visual analog scales (VAS) for pain during 2 consecutive daily wound debridements. On the 1st day, patients and nurses submitted baseline VAS ratings. Before the next day’s wound debridement, Subjects received hypnosis, attention and information, or no treatment. Only hypnotized Subjects reported significant pain reductions relative to pretreatment baseline. This result was corroborated by nurse VAS ratings. Findings indicate that hypnosis is a viable adjunct treatment for burn pain. Theoretical and practical implications and future research directions are discussed.
NOTES:
The treatment of burn patients involves a number of very painful procedures, including frequent removal of necrotic tissue, application of anticeptics, and bandaging. “Dressing changes often present pain so severe that the maximum dosages of opioids, even when supplemented by anxiolytics or inhalants, are often inadequate (Everett et al., 1990; Perry et al., 1981)” (p. 713). Previous research on the use of hypnosis with burn pain patients demonstrates many of the limitations found in the literature on clinical hypnosis and pain: nonrandomization of samples, nonstandardized hypnotic inductions, unreliable pain measures, inadequate control groups, unreported levels of analgesias used.
The present research controls for experimenter/therapist attention as well as ‘expectancy’ of both patient and hospital staff. (Both patients and their nurses were blind to group assignment.)
Patients who rated their most recent dressing change as 5 or greater (on a 1-10 scale) were invited to participate and then were randomly assigned to one of three groups: hypnosis, attention/information (pseudo hypnosis), or no treatment control. Interventions began within three days of admission to the acute burn care unit (though some had previously been on an intensive care unit). The patients were continued on opioid medication during the two days of the study, and an attempt was made to keep medication dosage constant. On Day 1 the patients received opioid medication before the dressing change, and on Day 2 they received the same medication plus their assigned treatment.
Hypnosis – Induction was administered by psychologist in patient’s room before the dressing change. It was based on Barber’s Rapid Induction Analgesia, modified specifically for burn wound debridement as described by Patterson, Questad, and deLateur (1989), and required 25 minutes
Attention and information (pseudo hypnosis) – The psychologist told patients they would get hypnosis, then spent 25 minutes with them, during which time the psychologist took a history of the accident and their emotional response; educated them about burn pain; encouraged them to differentiate sensations felt during dressing changes from signals of harm or danger; and informed them that their “sensation” indicated the presence of viable tissue and was a sign of healing. Toward the end of the session, patients were told “we have found that it is useful to close your eyes, count to 20, and imagine yourself in a relaxing place prior to dressing change” and were given 30 seconds to practice the “hypnosis.” They were told after that brief practice session that the nurse would prompt them to begin hypnosis before their next dressing change by giving them some instructions and touch them on the shoulder.
No-treatment control condition – Patients received only the opioid medication.
“A standard set of instructions for dressing changes was given to the nurse for each S in the hypnosis and attention and information groups … (a) having the subject sit comfortably in the tank (or lie on the table), (b) instructing the S to picture the staircase and count from 1 to 20, (c) touching the subject on the shoulder four times during wound care, and (d) telling the subject to let the area being worked on ‘become relaxed and numb'” (p. 714).
No treatment control condition – Subjects received only opioid medication for both Day 1 and Day 2 dressing changes.
A Visual Analog Scale (VAS) for rating pain was used by both the patients and the nurses, within three hours of the dressing change.
Of 87 patients who met the inclusion criteria (for age, psychiatric and language status, and length of hospital stay) only 30 were in the final group. (31 had pain rating scores below 5; 13 declined to participate; 5 were in other investigations; 5 were not able to participate because of hypnotherapist unavailability; and 3 who began the study did not complete it. Those in the final subject group averaged 34.1 years old; mean total burn surface area was 16%.
No subjects in the placebo group questioned whether they had actually been hypnotized. Nevertheless, Experimenters did a manipulation check to determine whether the pseudo hypnosis group thought they were hypnotized. Subjects rated on a scale of 1-5 the extent to which they believed the hypnotic intervention was ‘effective’; means were 4.0 for hypnosis and 3.4 for placebo, a non-significant difference.
Pain medication was converted to morphine equivalents (MD) and was equivalent across the three groups.
“The hypnosis group reported a significant reduction in pain from pre- to posttreatment, whereas the attention and information and the no-treatment control groups did not change significantly … In addition, the hypnosis group had a significantly lower posttreatment pain rating than both the attention and information and the no-treatment control groups, which did not differ significantly” (p. 715).
“Nurses’ ratings of subjects in the hypnosis group showed a significant reduction in pain from pretreatment to posttreatment, whereas there were no significant pain reductions for the attention and information and the no-treatment control groups … The three posttreatment means did not differ significantly … [and] correlations between patient baseline and posttreatment pain ratings and those submitted by nurses were r (27) = .16, p = .423, for baseline ratings and r(27) = .29, p = .127, for posttreatment ratings” (p. 716).
In their Discussion, the authors note that patients’ reports evidenced more treatment effect than that of nurses. Also, they observed that the treatment effects might have been stronger if they had not been following a research protocol very strictly. “We might also mention that hypnotized subjects reported lower pain scores in spite of problems that they may have had in remembering the actual amount of pain they experienced. There is an increasing body of evidence suggesting that subjects have difficulty remembering clinical pain (Carlsson, 1983). Considering these factors, we feel that the treatment effect was a robust one” (p. 716).
The low correlation between nurses’ ratings and patients’ ratings is consistent with earlier reports that nurses are often unable to assess patients’ pain accurately (Choiniere et al., 1990; Iafrati, 1986; Walkenstein, 1982). The authors discuss why this might be, giving references. “Yet in this study, nurses [blind to group assignment] still reported a significant pain reduction for the hypnosis group” (p. 716).
“Our findings were consistent with theoretical approaches that argue that hypnotized subjects undergo an altered state–or at least a different form of cognitive processing–as opposed to a placebo effect” (p. 716).
“The question of whether hypnosis is superior to opioid pain medication, or can be used in its stead, was never addressed in this study. All subjects received opioids throughout hospitalization, including the study period. Our bias is that opioid drugs are the primary treatment of choice for burn pain. Attempting to replace opioids with hypnosis for the purpose of satisfying the hypnotist’s curiosity or convictions, while occasionally successful, may often result in unnecessary patient suffering” (p. 716).
1990
Gauld, Alan (1990). The early history of hypnotic skin marking and blistering. British Journal of Experimental and Clinical Hypnosis, 7, 139-152.
NOTES:
Reviews the history of alleged hypnotic skin marking and blistering from 1785 to 1917. Various early studies are described and brought to bear upon certain long- standing and recurrent controversies. The conclusion is drawn that, even by the end of the period surveyed, the available evidence warranted the belief that such phenomena sometimes occur. However, there were also occasional examples of their occurrence through suggestion without hypnosis, and it remained unclear to what extent hypnosis had played a special role in their production.
1989
Patterson, David R.; Questad, Kent A.; deLateur, B. J. (1989). Hypnotherapy as an adjunct to narcotic analgesia for the treatment of pain for burn debridement. American Journal of Clinical Hypnosis, 31, 156-163.
This paper presents a hypnotherapeutic intervention for controlling pain in severely burned patients while they go through dressing changes and wound debridement. The technique is based on Barber’s (1977) Rapid Induction Analgesia (RIA) and involves hypnotizing patients in their rooms and having their nurses provide posthypnotic cues for analgesia during wound cleaning. Five subjects who underwent hypnotherapy showed reductions on their pain rating scores (Visual Analogue Scale) relative to their own baselines and to the pain curves of a historical control group (N – 8) matched for initial pain rating scores. Although the lack of randomized assignment to experimental and control groups limited the validity of the results, the findings provide encouraging preliminary evidence that RIA offers an efficient and effective method for controlling severe pain from burns.
Van der Does, A. J.; Van Dyck, R. (1989). Does hypnosis contribute to the care of burn patients? Review of the evidence. General Hospital Psychiatry, 11, 119-124.
In burn treatment, hypnosis has been used for alleviation of pain, prevention and treatment of anxiety and depression, and acceleration of wound healing. Successful application of hypnosis decreases the extensive medication needed. Furthermore, it provides a tool to patients with which they may experience more control in situations that are often experienced as overwhelming. Notwithstanding these important applications and the very positive terms with which the results of studies are generally described, hypnosis has mostly been neglected as a tool to help burn patients. This article reviews the clinical and experimental evidence of the usefulness of hypnosis in the management of burns. Pain reduction and crisis intervention are promising applications. However, due to a lack of systematic and controlled research, more specific conclusions are precluded. In the controversial area of wound healing, claims for the effectiveness of hypnosis have been made on the basis of slim evidence and inconclusive studies. This hypothesis needs to be addressed in controlled experiments. In summary, systematic investigations are needed to confirm and supplement available clinical evidence. Recommendations for future research are given.
1988
Van der Does, A. J.; Van Dyck, R.; Spijker, R. E. (1988). Hypnosis and pain in patients with severe burns: A pilot study. Burns Including Thermal Injuries, 14, 399-404.
Presents a pilot study on the effectiveness of hypnosis in the control of pain during dressing changes of burn patients. Eight patients were treated, and all evaluated the interventions as beneficial. The treatment of four patients was more closely analyzed by obtaining pain and anxiety ratings daily. Results show a 50%-64% decrease in reported pain level for three patients and a 52% increase of pain for one patient. The mean decrease for these four patients was 30% (for overall as well as worst pain during dressing changes). A 30% reduction of anxiety level and a modest reduction of medication use were achieved concurrently. It is concluded that hypnosis is of potential value during dressing changes of burn patients. Comparison of global evaluations and daily pain ratings shows that systematic research in some cases leads to conclusions opposite from clinical observations. Follow-up recommendations for future studies are given.
Wakeman, R. J. (1988). Hypnotic desensitization of job-related heat intolerance in recovered burn victims. American Journal of Clinical Hypnosis, 31, 28-32.
The thermally injured patient who suffers extensive third-degree burns usually finds the adaptation to high temperature environments quite difficult. A 7-year study of 50 thermally injured patients with greater than 45% total body surface second- and third-degree burns was conducted to assess the usefulness of hypnosis for improved heat adaptation at the work site. There were 25 subjects in the experimental group who received hypnotic training and 25 in a matched control group. The experimental group achieved a mean of 6.25 hours worked over 16 weeks and 63.5 days worked out of 80. They worked 4.5 to 6.5 hours per day for an average of 221 days per year for up to 3 years from baseline. The control group achieved a mean of 4.5 hours worked over 16 weeks and 54.33 days worked out of 80. The efficacy of hypnosis in heat desensitization is discussed.
NOTES:
Mean age was 38 for the hypnosis group, 33 for the control group; both groups had mean educational level of 8 grades. Mean percentage of total body surface burn was 50% for hypnosis and 54% for control groups.
Each patient was seen for 16 weeks, for 2 hours/week. The hypnosis group received hypnosis, were taught self hypnosis, and were given cassette tapes for use at home. The hypnosis training included a variety of techniques (e.g. progressive deep muscle relaxation, eye-fixation, eye-roll, and visual imagery techniques). They were given suggestions for lower skin temperature, lower ‘inner body’ temperature, less itching, gradual improvement of time spent on the job, as well as ego strengthening suggestions. The control patients received supportive psychotherapy, family consultation, and cognitive behavior therapy for the same amount of contact time with the same therapist.
The hypnosis group was to do self hypnosis every two hours at the worksite, in addition to home practice. Visual imagery suggestions were things like imagery of a cool waterfall flowing over the skin, having a tall cold glass of beer or soft drink, etc. They also had biofeedback of skin temperature during office visits, to reinforce decreases in skin temperature near the burned sites. They had exposure to heat (in a 95 degree sauna) for in gradually increased periods of time (15 to 120 minutes) before returning to the worksite.
Three years after treatment 20 of 25 control patients had quit their jobs or transferred to a cooler worksite, and all 25 had resigned from their original jobs or applied for further disability benefits. In contrast, only 2 of 25 experimental Ss were working in controlled-temperature settings, and none had applied for permanent disability benefits.
The authors note that family support was essential for the hypnosis patients to carry out their treatment program, and family consultations were essential for every patient. They also found the ‘fade-in’ technique using the sauna in the hospital occupational therapy area very useful for bridging the gap between practice in the office and going back to the work setting. “This procedure enabled the subject to practice self- hypnosis under controlled physical conditions while performing a work task that was more realistic than ‘imagined heat’ in the office setting” (p. 31).
1987
Dobkin de Rios, Marlene; Friedmann, Joyce K. (1987). Hypnotherapy with Hispanic burn patients. International Journal of Clinical and Experimental Hypnosis, 35 (2), 87-94.
This paper examines a culturally sensitive hypnotherapeutic intervention for Hispanic burn patients who suffer symptoms of the post-traumatic stress disorder and discusses the outcome of 27 patients seen by the authors (a medical anthropologist and a clinical psychologist), over a 3.5-year period. Given the difficulties of recent monolingual, Mexican migrants in responding to psychological interventions that are not culturally sensitive, the hypnotherapeutic interventions and procedurs developed by the authors provide a plan for systematic desensitization and cultural concordance to make rehabilitation of Hispanic burn patients more effective.
Patterson, David R.; Questad, Kent A.; Boltwood, Michael D. (1987). Hypnotherapy as a treatment for pain in patients with burns: Research and clinical considerations. Journal of Burn Care and Rehabilitation, 8 (3), 263-268.
Hypnotherapy has increasingly been included in the management of burn patients, particularly in the area of acute pain. To better understand such issues as (1) overall efficacy of hypnotherapy to alleviate acute burn pain, (2) instances in which hypnotherapy is contraindicated, (3) interaction of hypnotherapy with medication, (4) standard induction techniques to use with various age groups, (5) role of nursing and other staff in facilitating hypnotic effects, and (6) future methodological directions, they examined the clinical and methodological merits of recent studies of hypnoanalgesia. A literature search found 17 studies in which hypnotherapy was applied to the management of burns. The literature generally supports the efficacy of this approach to reduce burn pain; however, little else can be concluded from these studies. Several recent studies have applied hypnotherapy to aspects of burn care other than pain using excellent experimental designs. It is suggested that future studies of acute pain management follow suit.
1983
Spiegel, David (1983). Hypnosis with medical/surgical patients. General Hospital Psychiatry, 5, 265-277.
The role of hypnosis as a tool in the treatment of problems commonly encountered among medical and surgical patients is examined. Hypnosis is defined as a change in state of mind far more akin to intense concentration than sleep. Diagnostic implications of differences in hypnotic responsivity are explored, and scales suitable for use in the clinic are examined. Uses of hypnosis in treating anxiety, pain, childbirth, psychosomatic symptoms, seizure disorders, neuromuscular dysfunction, and habits are described and evaluated. The phenomenon of hypnosis is presented as a means of exploring the mind-body relationship in a controlled fashion, providing information of diagnostic importance while at the same time allowing hypnotizable patients to intensify their concentration and interpersonal receptivity in the service of a therapeutic goal.
1982
Spanos, Nicholas P.; McNeil, Conrad; Stam, Henderikus J. (1982). Hypnotically ‘reliving’ a prior burn: Effects on blister formation and localized skin temperature. Journal of Abnormal Psychology, 91 (4), 303-305.
60 Ss who had previously been burned were “hypnotically age regressed” and given both suggestions to “relive” the burn experience and suggestions that a blister was forming. Although 17 Ss reported vividly imagining the burn events, none showed localized skin-coloration changes or evidence of blister formation. Moreover, skin temperature measured before, during, and after age regression indicated no overall suggestion effects. Nevertheless, 1 S did show differential skin-temperature response to the suggestion. This S had showed only moderate hypnotic susceptibility on the Harvard Group Scale of Hypnotic Susceptibility. (10 ref)
NOTES:
The male subject who appeared to show changes in response to the suggestion increased temperature differences between the burn site and the contralateral site from .3 degrees C before the imagining period to a maximum of 2.7 degrees C during the imagining period and decreased to 0 degrees C after the imagining period. However, temperature differences between the adjacent sites remained very small (never more than .1 degree C) throughout the session. This subject answered “no” to all seven items on the skin-sensitivity questionnaire. He testified postexperimentally to being only “slightly hypnotized” (score 1), “not at all age regressed” (score 0), and to have experienced imagery that was only 50% as vivid as the real experience. (His HGSHS:A score was 8.)
1978
Kaplan, Jerold Z.; Wakeman, John (1978). An experimental study of hypnosis in painful burns. American Journal of Clinical Hypnosis, 21, 3-12.
The present study examines the usefulness of hypnosis in the control of acute pain in thermal and electrically burned patients as an adjunctive analgesic during the routine care of burn wounds. It was hypothesized that the use of hypnosis would lead to significant reductions in the amount of drugs needed as compared to patients using medication only. Anxiety and discomfort associated with daily tanking, debridement, and dressing changes were expected to be reduced because of the introduction of hypnotic procedures. The experimental study also examined the variables of age and percent of burns. Two studies were conducted including patients with 0-20% total body burns and 31-60% burns. A variety of hypnotic techniques were used. Both studies revealed significantly lower percentages of medication used (p <.01) by the hypnotic groups than control groups. The 7-18-year-old patients used significantly less medication (p < .05) than the adult groups. The implications of the findings, and usefulness of hypnosis and ego strengthening techniques for improvement of self-confidence and improved body image were considered. 1967 Dahinterova, Jeanette (1967). Some experiences with the use of hypnosis in the treatment of burns. International Journal of Clinical and Experimental Hypnosis, 2, 49-53. EXPERIENCE WITH HYPNOSIS AS A MEANS OF ELIMINATING PAIN DURING SURGICAL PROCEDURES FOR THE TREATMENT OF SEVERE BURNS HAS BEEN FAVORABLE IN 3 OUT OF THE 4 CASES DISCUSSED. THESE INCLUDE PATIENTS WHO HAD RELATIVELY CHRONIC, SERIOUS, AND SEVERE BURNS. IT IS CONCLUDED THAT HYPNOSIS CAN BE AN IMPORTANT AND USEFUL ADJUNCT IN PSYCHOTHERAPEUTIC TREATMENT OF BURNS. (GERMAN + SPANISH SUMMARIES) (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1965 Bernstein, Norman R. (1965). Observations on the use of hypnosis with burned children on a pediatric ward. International Journal of Clinical and Experimental Hypnosis, 13 (1), 1-10. Several cases are described and observations made about the interplay of forces between staff, patient, and therapist, as well as the expectations of the patients to assess how these factors influenced the use of hypnosis. Hypnosis appears to be a particularly useful means for reaching isolated and depressed children with burns and for improving the morale of the staff team working with these children. The results may be along specific lines in terms of pain tolerance and improved eating, or in general improvement of cooperativeness and mood on the part of the child. (PsycINFO Database Record (c) 2002 APA, all rights reserved) Vasiliev, L. (1965). Mysterious phenomena of the human psyche. New York NY: University Books. (Reviewed by Leo Wollman in American Journal of Clinical Hypnosis, 1965, 8 (2), 146-147) NOTES 1: AJCH Abstract by Leo Wollman: Many interesting theories about hypnosis are aired in this book. The opinions Pavlov propounded many years ago, about cortical inhibition are assiduously asserted, yet some statements made bear investigation. The mere sight of the experimenter in B.N. Birman's experiments with dogs put the dog into a hypnotic state. The appearance in the room of other people, who had not participated in the experiments, had no sleep-inducing effect. For the experimental animal, therefore, the experimenter himself had been transformed into a conditioned hypnogenous stimulus. Similarly, in group hypnotherapy, the entrance of the physician-hypnotist into the room often effects a hypnotic state in some of the subjects. The doctor has become the stimulus for the conditioned response, that of hypnotic trance state induction. An interesting and perhaps little known fact elicited from Chapter III (Hypnotism and Suggestion) is the high percentage (12%) of those replies to questionnaires during the First International Congress on Experimental Psychology held in Paris in 1899, which indicated that 3,000 respondents had hallucinations while in a normal state of health. The majority were visual; auditory and tactile hallucinations were less frequent. Dr. P. P. Podyapolsky, in 1905, wrote 'I tried unsuccessfully to induce in a peasant a reddening of the skin from a mock mustard plaster not only was there no reddening, there wasn't even any appropriate sensation of burning or smarting. I surmised that this simple man had probably never experienced a mustard plaster; therefore, his mind lacked the corresponding images and the ability to reproduce them with all their consequences... And so it turned out--he had never experienced a mustard plaster. It happened that he later had occasion to put a mustard plaster on his chest, and when I hypnotized him thereafter, suggestion quickly created not only the appropriate burning sensation but also reddening of the skin where the mock mustard plaster was applied.' This phenomenon is explained by the fact that the connection between the skin and cerebral cortex by means of neural conductors may, under certain circumstances, alter the activity of different organs. The alteration operates, apparently, in the category of conditioned-reflex formation. This book is interesting reading and from a historic point of view is worth having in one's library. 1958 Crasilneck, Harold B.; Jenkins, M. T. (1958). Further studies in the use of hypnosis as a method of anesthesia. Journal of Clinical and Experimental Hypnosis, 6 (3), 152-158. NOTES 1: