“At the present time it appears that there are several problems in which hpnosis is an acceptable and perhaps preferable method of anesthesia. Some of these problems include cases in which chemical analgesics and depressants are contraindicated or dangerous because of respiratory or cardiac disease. It may be indicated with patients who have demonstrated sensitivity to certain local anesthetics. Hypno-anesthesia may be used in cases in which repeated chemical anesthesia tends to have a debilitating effect on the patient with an already disturbed physiology, such as patients with thermal injuries who require multiple repeated debridements and dressings. Hypnosis may also obviate the debilitating effects of prolonged chemical anesthesia” (p. 156).
Behavior Therapy / Cognitive Therapy
1997
Kirsch, Irving (1996). Hypnosis in psychotherapy: Efficacy and mechanisms. Contemporary Hypnosis, 13 (2), 109-114.
Meta-analyses have established that different psychotherapies have different outcomes. Cognitive-behavioural therapies are significantly more effective than psychodynamic therapies, and their superiority increases when long-term follow-up is assessed. Hypnosis enhances the efficacy of both psychodynamic and cognitive- behavioural psychotherapy, and this effect is especially strong in long-term outcome of treatment for obesity. The paucity of procedural differences between hypnotic and non- hypnotic treatments in many of the studies demonstrating a substantial advantage for hypnosis suggests that the effect depends on the use of the word ‘hypnosis’. Hypnosis can be regarded as an empirically-validated, non-deceptive placebo, the effects of which are mediated by response expectancies.
1996
Kirsch, Irving (1996). Hypnotic enhancement of cognitive-behavioral weight loss treatments–Another meta-reanalysis. Journal of Consulting and Clinical Psychology, 64 (3), 517-519.
In a 3rd meta-analysis of the effect of adding hypnosis to cognitive- behavioral treatments for weight reduction, additional data were obtained from authors of 2 studies, and computational inaccuracies in both previous meta-analyses were corrected. Averaged across posttreatment and follow-up assessment periods, the mean weight loss was 6.00 lbs. (2.72 kg) without hypnosis and 11.83 lbs. (5.37 kg) with hypnosis. The mean effect size of this difference was 0.66 SD. At the last assessment period, the mean weight loss was 6.03 lbs. (2.74 kg) without hypnosis and 14.88 lbs. (6.75 kg) with hypnosis. The effect size for this difference was 0.98 SD. Correlational analyses indicated that the benefits of hypnosis increased substantially over time (r=.74).
1995
Kirsch, Irving; Montgomery, Guy; Sapirstein, Guy (1995). Hypnosis as an adjunct to cognitive behavioral psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 63 (2), 214-220.
A meta-analysis was performed on 18 studies in which a cognitive- behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.
A meta-analysis was performed on 18 studies in which a cognitive- behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.
Miller, Mary E.; Bowers, K. S. (1993). Hypnotic analgesia: Dissociated experience or dissociated control?. Journal of Abnormal Psychology, 102, 29-38
1994
Miller, Mary E.; Bowers, K. S. (1993). Hypnotic analgesia: Dissociated experience or dissociated control?. Journal of Abnormal Psychology, 102, 29-38
High-hypnotizable subjects were found superior to low-hypnotizable subjects in degree of pain reduction produced by hypnotic analgesia and by a stress- inoculation (cognitive-therapy) procedure. But, stress inoculation and not hypnotic analgesia impaired performance on a cognitively demanding task that competed with pain reduction for cognitive resources. This outcome implies that hypnotic analgesia occurs with little or no cognitive effort to reduce pain, challenging the social psychological theory of hypnotic response, at least in high-hypnotizable individuals. The findings are also incompatible with the concept of dissociated experience wherein the pain and cognitive efforts to reduce it are separated from consciousness by an amnesia-like barrier. But the results do support the concept of dissociated control, which proposes that suggestions for hypnotic analgesia directly activate pain reduction and thereby avert the need for cognitive strategies to reduce pain.
Saperstein, Guy; Montgomery, Guy; Kirsch, Irving (1993, August). Cognitive-behavioral hypnotherapy: A meta-analysis. [Paper] Presented at the annual meeting of the American Psychological Association, Toronto, Canada.
Meta-analysis was used to compare the effectiveness of cognitive-behavior therapy (CBT) to that of cognitive-behavior therapy with hypnosis (CBHT). A review of the literature revealed 18 studies in which 20 hypnotic treatments were compared to similar non-hypnotic treatments and in which sufficient data were presented for the calculation of effect sizes. Effect sizes were weighted for sample size and then averaged. This resulted in a mean effect size of 1.37 standard deviation units, indicating that the average client receiving cognitive-behavioral hypnotherapy is better off than 90 percent of clients who receive the same treatment in a nonhypnotic context. Substantial variance in effect sizes was found, indicating the presence of a moderator variable. Further analyses indicated that this variance was limited to treatments in which obesity was the presenting problem. The mean effect size for the addition of hypnosis to treatments of obesity was larger (M = 1.98) and more variable (variance = 4.10) than that for the addition of hypnosis to treatments for other presenting problems (M = .52; variance = .06). Also, studies of clinical samples yielded larger effects (M = 1.72) than analogue studies with college student samples (M = .07). The effect of hypnosis was independent of whether relaxation training was included in the nonhypnotic treatment or whether the hypnotic treatment included suggestions that were not included in the nonhypnotic treatment. Consistent with response expectancy theory, these data indicate that the substantial positive effect obtained was due to labeling the treatment ‘hypnosis,’ rather than to any substantive change in clinical procedure. (ABSTRACT from Bulletin of Division 30, Psychological Hypnosis, Fall 1993, Vol. 2, No. 3.)
Miller, Mary E.; Bowers, K. S. (1993). Hypnotic analgesia: Dissociated experience or dissociated control?. Journal of Abnormal Psychology, 102, 29-38.
High-hypnotizable subjects were found superior to low-hypnotizable subjects in degree of pain reduction produced by hypnotic analgesia and by a stress- inoculation (cognitive-therapy) procedure. But, stress inoculation and not hypnotic analgesia impaired performance on a cognitively demanding task that competed with pain reduction for cognitive resources. This outcome implies that hypnotic analgesia occurs with little or no cognitive effort to reduce pain, challenging the social psychological theory of hypnotic response, at least in high-hypnotizable individuals. The findings are also incompatible with the concept of dissociated experience wherein the pain and cognitive efforts to reduce it are separated from consciousness by an amnesia-like barrier. But the results do support the concept of dissociated control, which proposes that suggestions for hypnotic analgesia directly activate pain reduction and thereby avert the need for cognitive strategies to reduce pain.
1992
Kihlstrom, John F. (1992). Hypnosis: A sesquicentennial essay. International Journal of Clinical and Experimental Hypnosis, 40 (4), 301-314.
The present paper views Coe’s (1992) reflections on the socio-political interests in clinical and experimental hypnosis against the background of Braid’s Neurypnology of 1843. Topics considered are: the significance of the label “hypnosis”; the controversy over state; the tension between credulity and skepticism; the problem of dissociation and automaticity; current theoretical conflicts; and the relationships between practitioners and researchers.
Kirsch, Irving (1992, August). Cognitive-behavioral hypnotherapy. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, DC.
The use of hypnosis to augment cognitive behavior therapy was described. Hypnotic inductions establish a context in which the effects of therapeutic interventions can be potentiated for clients with positive attitudes and expectancies toward it. Hypnosis can also provide a disinhibiting context for both clients and therapists, allowing them to behave in ways that are therapeutic, but that might seem awkward in other contexts. A meta-analysis of outcome studies in which the effects of a cognitive-behavioral treatment were compared to the effects of the same treatments supplemented by hypnosis resulted in a mean effect size of 0.87 standard deviations, indicating the average client receiving cognitive-behavioral hypnotherapy is better off at the end of it than more than 80 percent of clients who receive the same treatment in a nonhypnotic context. (ABSTRACT from the Bulletin of Division 30, Psychological Hypnosis, Fall, 1992, Vol. 1, No. 3.)
Levitt, Eugine E. (1992, August). Hypnosis in the treatment of obesity. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, DC.
The literature dealing with the hypnotherapy of overweight and weight control is comprehensively reviewed. In general, the more recent reports are methodologically more sophisticated than earlier ones. Specific techniques employed include direct and aversive suggestions, imagery, ego-enhancement, self-hypnosis and a variety of behavior modification tactics. Most hypnotherapy is carried out in groups and most subjects/patients have been female. Twenty reports providing group data summarized. All but one report weight reduction at close and at follow-up. Of eight reports using control groups, six found that the group treated by hypnotherapy lost significantly more weight than some or all of the control groups. Hypnosis with behavior modification appears to be the most effective approach. Analysis suggests that hypnosis effectuates behavioral techniques after the close of treatment. Eleven reports presenting correlations between weight loss and hypnotic susceptibility differ sharply depending upon the year of publication. Only one of seven reports published prior to 1982 found a relationship between weight loss and susceptibility. Three of four reports since 1985 found a positive relationship. It is concluded that hypnotherapy for weight control can be effective and that it is probably maximally effective with high susceptibility persons. (ABSTRACT from the Bulletin of Division 30, Psychological Hypnosis, Fall, 1992, Vol. 1, No. 3.)
Reeves, John (1992). Hypnosis and pain control. [Lecture] UCLA Clinical Hypnosis Seminar, Psychiatry 207 (Holroyd).
NOTES:
Cancer patients have a high incidence of pain, as indicated by statistics from several different investigators. Pain is most common in tumors involving bone, oral cavity, genitourinary system, and breast. (Cites Fordyce (1988) Pain and suffering, _American Psychologist_)
No. of Incidence
Patients of Pain Wilkes 1974 300 58% Twycross 1974 500 80% Foley 1979 397 60% Pannuti 1979 290 64%
Spanos, Nicholas P.; Simulates, Ann; de Faye, Barbara; Mondoux, Thomas J.; Gabora, Natalie J. (1992-93). A comparison of hypnotic and nonhypnotic treatments for smoking. Imagination, Cognition and Personality, 12, 23-43.
Three experiments administered variants of Spiegel’s (1970) smoking cessation procedure to smokers in hypnotic and nonhypnotic treatments. Follow-up periods were from twelve to twenty-four weeks depending on the experiment. Complete abstinence was an infrequent outcome in all three experiments. Greater-than-control reductions in smoking for treated subjects were obtained in two of the experiments but, in both cases treatment and control subjects failed to differ significantly before the end of the follow-up period. Hypnotic and nonhypnotic treatments produced equivalent smoking reductions in all studies, and neither hypnotizability nor questionnaire assessments of motivation to quit correlated significantly with treatment outcome. Implications are discussed.
NOTES:
When the experimenters compared number of treatments they simply compared two sessions of Spiegel’s one-session treatment with four sessions of it. The authors make the point that perhaps they should vary the four sessions.
“In all three of the present experiments the abstinence rates associated with the Spiegel treatment were very low. Our abstinence rates were similar to those reported in one earlier study [4 – Perry et al.], but substantially lower than those reported in three other studies [2, 22, 25]. The reasons for these discrepancies between studies remains unclear, but experiment 3 suggests that these discrepancies cannot be accounted for simply in terms of whether the subjects were drawn from a university or nonuniversity population, and experiment 2 suggests that the discrepancies are unrelated to the number of treatment sessions administered to subjects.
“The finding that hypnotic and nonhypnotic subjects in all three experiments attained equivalent reductions in smoking is consistent with other comparison studies in this area which indicate that hypnotic treatments are no more effective than various nonhypnotic procedures at inducing reductions in smoking [22, 25, 30]. More generally, these findings are consistent with comparison studies on a wide variety of clinical disorders (headache pain, warts, phobias, obesity) which indicate that hypnotic treatments are no more effective than nonhypnotic ones at producing therapeutic change (see [3] for a review).
“The failure to find significant correlations between smoking reduction and hypnotizability among treated subjects is also consistent with the findings of most studies in this area [3], but the reasons why significant correlations between these variables are found in some studies and not others remains unclear. Spanos [3] suggested that significant correlations between these variables are particularly likely when hypnotizability testing is integrated into the treatment protocol. Under these circumstances subjects are likely to form strong expectations about treatment success on the basis of their self- observed responses to the hypnotizability scale. Such expectations may, in turn, influence subjects’ motivations to comply with the treatment regimen, the self-statements they make concerning their likelihood of quitting, etc. In all of the present experiments hypnotizability was assessed at the end of the follow-up period and, therefore, could not influence subjects’ expectations of treatment success” (pp. 40-41).
Syrjala, Karen L.; Cummings, Claudette; Donaldson, Gary W. (1992). Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: A controlled clinical trial. Pain, 48, 137-146.
Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post-chemotherapy nausea and emesis. In this study, 67 bone marrow transplant patients with hematological malignancies were randomly assigned to one of four groups prior to beginning transplantation conditioning: (1) hypnosis training (Hypnosis); (2) cognitive behavioral coping skills training (CB); (3) therapist contact control (TC); or (4) treatment as usual (TAU; no treatment control). Patients completed measures of physical functioning (Sickness Impact Profile; SIP) and psychological functioning (Brief Symptom Inventory; BSI), which were used as covariates in the analyses. Biodemographic variables included gender, age and a risk variable based on diagnosis and number of remissions or relapses. Patients in the Hypnosis, CB, and TC groups met with a clinical psychologist for two pre-transplant training sessions and ten in-hospital “booster” sessions during the course of transplantation. Forty-five patients completed the study and provided all covariate data, and 80% of the time series outcome data. Analyses of the principal study variables indicated that hypnosis was effective in reducing reported oral pain for patients undergoing marrow transplantation. Risk, SIP, and BSI pre-transplant were found to be effective predictors of inpatient physical symptoms. Nausea, emesis and opioid use did not differ significantly between the treatment groups. The cognitive behavioral intervention, as applied in this study, was not effective in reducing the symptoms measured.
NOTES:
Hypnotizability was not measured in this study.
The authors hypothesized that “(1) patients receiving hypnosis training would report the least pain, but the cognitive behavioral group would report less pain than the untreated group; and (2) both treatment groups would report less nausea and emesis than the control groups” (p. 138). The adult patients were undergoing their first marrow transplant, had survived at least 19 days post-transplant, and had participated in at least the first 8 of 10 possible inpatient sessions; five additional patients completed the study but had missing data.
Each patient in the TC (therapist contact), CB (cognitive behavioral coping skills), and Hypnosis groups participated in two 90 minute training sessions with a psychologist, 2-4 days apart, on an outpatient basis. Once admitted to hospital, twice each week they participated in a total of ten 30-minute sessions designed to reinforce use of the interventions. The TAU (treatment as usual) group had no psychologist contact. For the TC control group, the psychologist simply talked with the patients about whatever was on their minds.
The CB group received multiple interventions: training in relaxation (2 techniques- -progressive muscle relaxation and abbreviated autogenic relaxation) with tapes provided; cognitive restructuring (Turk et al., 1983) which included training in attention redirection and restructuring self-defeating cognitions; preparing coping self-statements or affirmations, by focusing attention on neutral or pleasant events or objects, or by occupying their attention through mental repetition of affirmations, songs or prayer; encouragement to think of negative events as time limited; provision of information, especially the beneficial effects of reducing physiological arousal and attention to pain and nausea; assistance in setting short-term progress-related goals for self-care such as exercise, caloric intake, and mouth care; exploration of the meaning of their illness and of bone marrow transplant.
For the Hypnosis group, individually tailored Ericksonian inductions (Lankton & Lankton, 1983) with relaxation and multi-sensory imagery were taped and given to the patient to use in daily practice, in between sessions. The suggestions were directed at reducing pain, nausea, and the emotional reactions to those symptoms; there also were suggestions about health, well-being, self-control and enhanced coping capabilities.
The results were analyzed by ANCOVA (except where non-parametric analysis was required with the opioid data). Due to gender differences in reported pain (men experiencing more) and the fact that the TAU group had an over-representation of men, the TAU group could not be used in the pain analyses. However, there were no gender differences in nausea reports, so that all four groups could be used for nausea outcome analyses.
The Hypnosis group evidenced the lowest amount of post-transplant pain, and used (nonsignificantly) less opioids than the other groups. No significant treatment effects were observed for either nausea or emesis.
In their discussion, the authors noted that “The hypnosis group’s peak pain was lower and of a shorter duration than the other three groups. Opioid use closely followed the course of pain intensity. … The gender effect may be characteristic of this particular sample [since it was unexpected].
“Nausea and emesis followed a less predictable course than pain. … nausea fluctuated dramatically from day to day within treatment groups. As nausea moderated after completion of conditioning, the day to day fluctuations remained striking. This lack of symptom predictability may have contributed to the difficulty patients had in using the interventions effectively” (p. 143).
“The lack of significant differences between treatment groups in opioid use indicates that lower pain report in the hypnosis group cannot be explained by increased opioid use. Results do not support the second hypothesis that both hypnosis and cognitive behavioral training would reduce chemotherapy or radiation-induced nausea and emesis.
“In MT patients, several factors may limit the impact of either cognitive behavioral training or hypnosis on nausea and emesis. First, MT patients receive higher doses of emetogenic agents than are given to most other cancer patients. Second, patients in this study had only two sessions in which to learn relaxation techniques; this may not have provided adequate training. Third, the most severe emetic challenge began immediately with the first dose of chemotherapy rather than having a gradual onset. This did not permit patients to master the techniques with milder symptoms before applying training to intense symptoms. Fourth, for all patients, psychological interventions were provided as adjuncts to medications rather than as substitutes for antiemetics or opioids. Both antiemetics and opioids have substantial cognitive side effects which, in high doses, may impact patients’ abilities to implement interventions which are in essence cognitive. This combination of factors may have provided too severe a challenge to a newly learned skill. In contrast to nausea, oral pain developed over a number of days, permitting practice while symptoms were mild and before administration of opioids.
“Results suggest that the imagery component of the hypnosis intervention was central to its efficacy. Not only was the cognitive behavioral intervention without imagery not effective in reducing the symptoms measured, but we found in clinical practice that patients intermittently began to refuse sessions with relaxation alone. Even hypnosis patients, when under the physical stresses of treatment, had shortened attention spans that necessitated briefer inductions, less time spent on relaxation, and more active, engaging imagery.
“… Since, in clinical practice, imagery is frequently a component of cognitive behavioral treatment, these results would not generalize to those settings where imagery is combined with other skill training.
“Several other possible limitations of the cognitive behavioral intervention merit consideration. Our experience indicates that the number of components used in the two training sessions were more than patients could competently learn in a short time. … A further possibility is that maladaptive cognitions, which are the targets of cognitive restructuring, may be the exception rather than the rule among MT patients who tend to focus, with their families, on positive, hopeful attitudes toward their treatment” (pp. 144- 145).
The authors note that the relatively small sample size may have provided inadequate statistical power to demonstrate effects with some of the outcome variables
Tosi, D. J.; Rudy, D. R.; Lewis, J.; Murphy, M. A. (1992). The psychobiological effects of cognitive experiential therapy, hypnosis, cognitive restructuring, and attention placebo control in the treatment of essential hypertension. Psychotherapy, 29, 274-284
Evaluated the effects of cognitive experiential hypnotherapy (CEH), which includes hypnosis, cognitive restructuring, and developmental staging, on essential hypertension. CEH, Hypnosis alone, cognitive restructuring, and attention-placebo control conditions were randomly assigned to 39 subjects. There was a significant interaction effect with the nine psychobiological outcome measures. Discriminant analysis found a stronger overall effect over time for CEH when compared with its components.
1991
Grossarth-Maticek, R.; Eysenck, H. J. (1991). Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II – Effects of treatment. Behaviour Research and Therapy, 29, 17-31.
NOTES:
Reports on what they call creative novation behavior therapy or “autonomy training” to prevent cancer and coronary heart disease in prone individuals. This individually tailored cognitive-behavioral program includes the use of hypnosis and of imagery. When administered individually (20-30 hours) in a group (6-15 sessions of up to several hours) or via bibliotherapy with 4-6 hours of individual therapy, the outcome was better than that of control subjects. After 13 years, 45 of 50 cancer-prone subjects in individual treatment were still alive (and none of the 5 deaths were from cancer), while among 50 control subjects, 31 died, 16 from cancer. This study along with Spiegel et al. (1989) article in Lancet have important implications for health care.
Mauer, D. R. (1991, October). A comparison of cognitive-behavioral and hypnotic techniques in the management of electromyography pain (Dissertation, University of Iowa). Dissertation Abstracts International, 53 (4), 1070-B. (Order No. DA 9217180)
“Compared a cognitive behavioral technique that included providing specific sensory and procedural information combined with relaxation with a hypnotic technique (relaxation with guided imagery) and a control group for management of acute EMG pain and anxiety. Pain and anxiety ratings were gathered from 45 EMG patients and observers for both nerve conduction and needle electrode components of the EMG exam. It was found that only the hypnosis group significantly reduced pain and anxiety during the needle electrode portion of the procedure. Patients with unexplained or functional symptoms reported more EMG pain and anxiety than patients who had an organically based disease. Because having had a prior EMG seemed to have an effect on the efficacy of treatment, the data were reexamined. Results determined that inexperienced EMG patients who were treated had less pain and anxiety than patients who experienced EMG before, but inexperienced control patients had an increase in pain and anxiety over experienced patients” (p. 1070).
Keywords: behavior therapy/cognitive therapy, cancer/oncology, cardiology/cardiovascular, hypnotherapy, personality, relaxation
NOTES :
This is a commentary on two papers by Grossarth-Maticek and Eysenck, in which they report on ‘creative novation behaviour therapy’ to prevent cancer and heart disease in people with prsonalities associated with the development of those diseases. Therapy may involve hypnosis and/or relaxation, with suggestions that facilitate modification of unhealthy expectancies. The papers are:
Grossarth-Maticek, R. & Eysenck, H.J. (1991). Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part I – Description of treatment. Behaviour Research and Therapy 29, 1-16.
Eysenck, H.J. & Grossarth-Maticek, R. (1991). Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II – Effects of treatment. Behaviour Research and Thearpy 29, 1, 17-31.
Oettingen, Gabriele; Wadden, Thomas A. (1991). Expectation, fantasy, and weight loss: Is the impact of positive thinking always positive?. Cognitive Therapy and Research, 15 (2), 167-175.
Investigated the impact of expectation and fantasy on the weight losses of 25 obese women participating in a behavioral weight reduction program. Both expectations of reaching one’s goal weight and spontaneous weight-related fantasies were measured at pretreatment before Ss began 1 year of weekly group treatment. Consistent with the hypothesis that expectation and fantasy are different in quality, these variables predicted weight change in opposite directions. Optimistic expectations but negative fantasies favored weight loss. Ss who displayed pessimistic expectations combined with positive fantasies had the poorest treatment outcome. Expectation but not fantasy predicted program attendance. The effects of fantasy are discussed with regard to their potential impact on weight reduction therapy.
Rapee, Ronald M. (1991). The conceptual overlap between cognition and conditioning in clinical psychology. Clinical Psychology Review, 11, 193-203.
Given the fact that contemporary theories of conditioning regularly utilize information processing concepts such as memory and expectancies, classifying clinical theories as either cognitive or conditioned appears to be outdated. Yet, this dichotomy is still upheld in many clinical writings. Such a false dichotomy seems to serve more of a political function than a theoretical one and thus is likely to interfere with a complete understanding of psychopathology. While the terms conditioning and cognition are often used to imply unconscious learning on the one hand versus conscious, rational learning on the other, this usage is not consistent. A more empirically useful way to describe pathological behavior may be in terms of the amount of attentional resources utilized.
Salkovskis, Paul M.; Clark, David M.; Hackmann, Ann (1991). Treatment of panic attacks using cognitive therapy without exposure or breathing retraining. Behaviour Research and Therapy, 29 (2), 161-166.
Used a multiple baseline design among 7 panic patients to determine whether a modified form of treatment involving cognitive procedures reduces panic attack frequency. Ss received both focal and nonfocal treatment. Focal therapy concentrated on bringing about reattribution of bodily sensations. Six of the 7 Ss showed a marked reduction in panic frequency following focal cognitive treatment, while nonfocal treatment did not reduce panic frequency. Results provide preliminary evidence that cognitive procedures that exclude breathing retraining and exposure to feared situations or sensations can reduce panic attack frequency, and that cognitive procedures that do not target misinterpretations of bodily sensations may not reduce panic.
Schwarz, Shirley P.; Blanchard, Edward B. (1991). Evaluation of a psychological treatment for inflammatory bowel disease. Behaviour Research and Therapy, 29 (2), 167-177.
Compared the effectiveness of a multicomponent behavioral treatment package, which included inflammatory bowel disease (IBD) education, progressive muscle relaxation, thermal biofeedback, and training in use of cognitive coping strategies, with the effectiveness of symptom-monitoring as a control condition. The treatment group consisted of 11 IBD patients (aged 25-62 yrs); 8 of 10 persons (aged 25-71 yrs) in the control group completed treatment. At posttreatment, the treatment group showed fewer reductions in symptoms (5) than the symptom-monitoring controls (8). However, treated Ss perceived themselves as coping better with IBD and as feeling less IBD-related stress. It is hypothesized that the differences in treatment responses may be related to differences between Ss with ulcerative colitis and Ss with Crohn’s disease.
1990
Clark, Duncan B.; Agras, W. Stewart (1990). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry, 148 (5), 598-605.
94 adults with a performance anxiety problem were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were questionnaires for all 94 ss, diagnostic interview of 50 ss, and laboratory performance of 34 ss. Treatment conditions were 6 weeks of buspirone, 6 weeks of placebo, a five-session group cognitive-behavior therapy program (CBTP) with buspirone, or the CBTP with placebo. All Ss fulfilled criteria for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) social phobia. Of the 15 full-time professional musicians, 10 had tried propranolol and 3 had stopped performing. Most Ss had substantial anxiety and heart rate increases during lab speech and musical performances. CBTP resulted in significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence.
Harmon, Teresa M.; Hynan, Michael T.; Tyre, Timothy E. (1990). Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Journal of Consulting and Clinical Psychology, 58, 525-530.
Studied the benefits of hypnotic analgesia as an adjunct to childbirth in 60 nulliparous women. Subjects were divided into high- and low-susceptibility groups before receiving six sessions of childbirth education and skill mastery using an ischemic pain task. Half of the subjects in each group received a hypnotic induction at the beginning of each session; the remaining control subjects received relaxation and breathing exercises typically used in childbirth education. Both hypnotic subjects and highly susceptible subjects reported reduced pain. Hypnotically prepared births had shorter Stage 1 labors, less medication, higher Apgar scores, and more frequent spontaneous deliveries than control subjects’ births. Highly susceptible, hypnotically treated women had lower depression scores after birth than women in the other three groups. The authors believe that repeated skill mastery facilitated the effectiveness of hypnosis in the study.
Kaye, J. M.; Schindler, B. A. (1990). Hypnosis on a consultation-liaison service. General Hospital Psychiatry, 12, 379-383.
Studied the use of hypnosis on a consultation-liaison service with a broad spectrum of medically hospitalized patients. Autohypnosis tapes were used for reinforcement. Twenty-nine women and eight men from 24-75 years of age were hypnotized for relief of depression, pain, anxiety, or side effects of chemotherapy. Results were excellent (total to almost total relief of symptoms) in 68%, fair in 22%, and poor in 11%, with no differences among the results with the various conditions. This demonstrates that hypnotherapy is an extremely useful tool in medical management of patients in consultation-liaison psychiatry.
Kirsch, Irving (1990). Changing expectations: A key to effective psychotherapy. Pacific Grove, CA: Brooks/Cole. (Reviewed in American Journal of Clinical Hypnosis, 34, 138)
NOTES:
This is a clinical hypnosis textbook written from the perspective of a cognitive therapist, and based on response-expectancy theory. The author discusses how expectancy theory can account for results obtained with hypnosis, cognitive behavioral, and psychodynamic psychotherapy, as well as with psychopharmacology. The book draws heavily upon psychological research in psychotherapy as well as hypnosis, and discusses how therapists can mobilize patient positive expectations for change. Hypnotic responses are viewed as ‘genuine’ responses that subjectively are not perceived to be under voluntary control (similar to other classes of response behavior).
Newshan, Gayle; Balamuth, Ron (1990-91). Use of imagery in a chronic pain outpatient group. Imagination, Cognition and Personality, 10, 25-38.
Reports treatment of chronic pain, integrating relaxation, cognitive therapy, and imagery techniques for 3 groups of chronic pain patients. Imagery and visualization were the most important components of the treatment.
NOTES:
Chronic nonmalignant pain is defined as pain that exists beyond the normal and expected healing time, usually six months or more after the initial injury or trauma.
Patients used daily journal to monitor level of pain using a color scale 4 times/day (blue – little or no pain, green mild pain, yellow moderate, orange severe, and red pain so intense it could kill or render the patient unconscious.
Used two types of imagery: mental rehearsal of actually doing and reaching a goal, or symbolic representation of the pain as a creature, alive, within their bodies. They dialog with the creature, asking Why are you here? What do you need from me? What can I do to live with you? What is the message you have for me? patients are asked to listen very closely for the response.
Cognitive restructuring is introduced later to identify dysfunctional thought patterns and correct them. They are taught, 1) thoughts influence behavior and emotions, 2) thoughts can be changed, and therefore 3) behavior can be changed. However, not all patients benefit from cognitive restructuring (because resistant to self monitoring or frightened or critical of own negative thoughts.
Relaxation is especially beneficial in breaking the pain/anxiety cycle, reducing fear associated with pain, improving sleep patterns, promoting a general feeling of well-being and facilitating mental imagery. Mental imagery, on the other hand, provides a means of self-discovery. It is defined by Achterberg and Lawlis (1980) as the internal experience of a perceptual event in the absence of the actual external stimuli; although usually thought of as visual, it may well involve any other sensory modality associated with the image.
Imagery is a proverbial process, eliciting the rich symbolism of knowledge of a person’s unconscious and providing powerful insights indirectly. It provides an opportunity for one to reorganize a problem or experience, such as pain, towards a more positive resolution. Imagery can increase the patient’s self-esteem and self-control and seems to facilitate well behavior. It is also a vivid method of communication from the patient to the therapist and the rest of the group. The group members had a healthy respect for these images and were able to appreciate the impact they had in their recovery, even if the process is not completely understood.
In each of their cases, “it is important to emphasize that the pain was never ‘cured,’ the pain persisted throughout treatment. Again, the program does not take away the patients’ pain but changes the pain experience and enables patients to participate more fully in their lives despite the pain. As suggested by the ‘big person, small person’ concept, the pain would probably always be part of their lives, but through the program it could be a smaller, more manageable part. Imagery proved to be a valuable tool in helping clients achieve this goal.
Schwarz, Shirley P.; Taylor, Ann E.; Scharff, Lisa; Blanchard, Edward B. (1990). Behaviorally treated irritable bowel syndrome patients: A four-year follow-up. Behaviour Research and Therapy, 28 (4), 331-335.
A 4-yr longitudinal study evaluated 19 patients (aged 23-60 yrs) suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy, and IBS education at baseline. 17 Ss rated themselves as more than 50% improved. Six of the 12 Ss who submitted symptom monitoring diaries met the criteria for clinical improvement, (i.e., achieving at least a 50% reduction in primary IBS symptom scores). The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant reductions were obtained on abdominal pain/tenderness, diarrhea, nausea, and flatulence.
Stanton, Harry E. (1990). Using ego-enhancement to increase assertiveness. British Journal of Experimental and Clinical Hypnosis, 7, 133-137.
An ego-enhancement technique embodying three metaphors designed to help elderly people become more assertive is described. These metaphors: (1) the cloud – a symbol for ‘getting rid of things’; (2) the snowball – a symbol for determination; and (3) the pyramid – a symbol for confidence, are linked together to achieve both general ego- enhancement and increased assertiveness.
Turner, Judith A.; Clancy, Steve; McQuade, Kevin J.; Cardenas, Diana D. (1990). Effectiveness of behavioral therapy for chronic low back pain: A component analysis. Journal of Consulting and Clinical Psychology, 58 (5), 573-579.
The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments.
Vanderlindin, Johan; Vandereycken, Walter (1990). The use of hypnosis in the treatment of bulimia nervosa. International Journal of Clinical and Experimental Hypnosis, 38 (2), 101-111.
NOTES:
25 people who were highly hypnotizable were treated. Treatment consisted of three phases: introduction to hypnosis, addressing core issues, and ensuring long term results. The induction included focus on breathing, relaxation, and arm levitation. Subject was told to imagine that she is eating a meal, while concentrating and tasting her food. She is then told to imagine a recent binge and to exaggerate all the negative consequences of binging (weight gain, low self-esteem) and all the positive consequences of binge-free life.
To address Subject’s core issues of why binging started, the Subject is told to separate her ego from her bulimic past, and the therapist then tries to find out why the bulimic past entered the patients’ life. The therapist then tries to ‘negotiate’ with the bulimic past and tries to help the patient find other ways to deal with the problems. Cognitive restructuring and hypnosis techniques are used.
The final phase, which entails a year of followup care, involves helping the patients to become independent from their past. Many bulimic patients are still dependent on their parents, and this may have caused their dependency on food. Therefore, the goal of hypnosis is to allow herself to become emotionally independent and to control her life.
It was estimated that 50% of patients completely recovered and 30% showed great improvement but 20% did not change at all.
Wells, Adrian (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21 (3), 273-280.
Trained a 40-yr-old woman with panic disorder without agoraphobic avoidance in the use of an attentional training procedure that was effective in eliminating panic and facilitated tension reduction without producing anxiety. A 2-treatment design revealed that a procedure evoking external attentional focus eliminated panic attacks, whereas autogenic training increased the frequency of panic attacks and the intensity of anxiety. Possible roles of self-focus in mediating panic and the effects of relaxation are discussed.
1989
Cooper, Nancy A.; Clum, George A. (1989). Imaginal flooding as a supplementary treatment for PTSD in combat veterans: A controlled study. Behavior Therapy, 20 (3), 381-391.
14 Vietnam veterans suffering from posttraumatic stress disorder (PTSD) were assigned either to standard treatment (control group), or standard treatment plus imaginal flooding (experimental group). The 2 groups were closely matched on medications and combat roles and tours of duty were comparable. Experimental Ss received up to 14 sessions of flooding for a maximum of one and one-half hours per session. Self-report measures were administered at pre-treatment, post-treatment, and at 3-mo follow-up. These measures included the Behavioral Avoidance Test, the Beck Depression Inventory, and a Modified Vietnam Experiences Questionnaire. Results indicate that flooding increased the effectiveness of usual treatment, particularly in such areas as re-experiencing symptoms and sleep disturbances. However, flooding had no effect on level of depression, trait anxiety, and violence-proneness.
Edelson, Jeffrey; Fitzpatrick, Jody L. (1989). A comparison of cognitive-behavioral and hypnotic treatments of chronic pain. Journal of Clinical Psychology, 45, 316-323.
27 male chronic pain patients were assigned to 1 of 3 treatment groups: hypnosis, cognitive-behavioral, and attention control. Hypnosis and cognitive-behavioral treatments were identical, with the exception of the hypnotic induction. Scores on the McGill Pain Questionnaire (MPQ) and a measure of the overt motor behavior element of chronic pain were collected at pretreatment, posttreatment, and follow-up intervals. Analyses showed significant increases in activity and decreases in pain intensity for the cognitive-behavioral treatment. Changes for the hypnosis treatment were noted only on the MPQ. Changes for both groups were sustained on the 1-mo follow-up. Findings generally support the superiority of the cognitive-behavioral treatment on behavior measures and its equivalence to hypnosis on subjective measures.
Heap, Michael (1989). Antecedent imagery in a case of Gilles de la Tourette syndrome. British Journal of Experimental and Clinical Hypnosis, 6 (1), 55-56.
NOTES 1:
Author presents a male teenager diagnosed with Gilles de la Tourette syndrome, who was treated without noticeable success using a variety of techniques (relaxation, suggestion, hypnoanalysis, video-feedback, paradoxical injunction).
Stanton, Harry E. (1989). Hypnotic relaxation and the reduction of sleep onset insomnia. International Journal of Psychosomatics, 36, 64-68.
A hypnotic relaxation technique was compared to stimulus control and placebo conditions as a means of reducing sleep onset latency (SOL). Forty-five subjects were matched on their baseline SOL as measured through sleep diaries. They were randomly assigned to one of the three groups and experienced four weekly sessions of 30- minutes’ duration, with demand effects being controlled through the use of counter- demand instructions. Data generated by the study suggested that the particular hypnotic relaxation treatment used was effective in helping Ss sleep more quickly. Neither stimulus control nor placebo groups recorded similar improvement.
Tosi, D. J.; Judah, S. M.; Murphy, M. A. (1989). The effects of a cognitive experiential therapy utilizing hypnosis, cognitive restructuring, and developmental staging in psychological factors associated with duodenal ulcer disease: A multivariate experimental study. Journal of Cognitive Psychotherapy, 3, 273-290.