Twenty normotensive subjects participated in a study of the effects of specific suggestions on blood pressure (BP). After an induction, the experimental group received suggestions presumed to be relatively nonactivating, although capable of lowering or raising BP. A control group was used to record the BP changes over time. All subjects met for one session. Eight subjects from the experimental group met for a second session. Both adaptation and induction resulted in significant BP decreases. A specific suggestion to increase BP gave a significant result when compared to the induction point. There was no significant change from induction to the BP-decrease suggestion. Both systolic and diastolic BP behaved in the same way. A second experimental session resulted in no significant change compared with the first session. Also, no significant difference was found in suggestibility scores from the first to the second session. The results are in line with previously published studies.
1989
DeBenedittis, Giuseppe; Panerai, Alberto A.; Villamira, Marco A. (1989). Effects of hypnotic analgesia and hypnotizability on experimental ischemic pain. International Journal of Clinical and Experimental Hypnosis, 37 (1), 55-69.
Mechanisms of hypnotic analgesia are still poorly understood and conflicting data are reported regarding the underlying neurochemical correlates. The present study was designed to investigate the effects of hypnotically induced analgesia and hypnotizability on experimental ischemic pain, taking into account pain and distress tolerance as well as the neurochemical correlates. 11 high hypnotizable Ss and 10 low hypnotizable Ss, as determined by scores on the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & E. R. Hilgard, 1962), were administered an ischemic pain test in both waking and hypnotic conditions. The following variables were measured: (a) pain and distress tolerance, (b) anxiety levels, and (c) plasma concentrations of beta-endorphin and adrenocorticotropic hormone (ACTH). Results confirmed significant increases of pain and distress tolerance during hypnosis as compared to the waking state, with positive correlations between pain and distress relief and hypnotizability. Moreover, a hypnotically induced dissociation between the sensory-discriminative and the affective-motivational dimensions of pain experience was found, but only in high hypnotizable Ss. Hypnotic analgesia was unrelated to anxiety reduction and was not mediated either by endorphins or by ACTH.
Meyer, H. K.; Diehl, B. J.; Ulrich, P. T.; Meinig, G. (1989). Changes in regional cortical blood flow in hypnosis. Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 35, 48-58.
NOTES:
Regional cerebral blood flow (rCBF) was measured by means of the 133-Xenon inhalation method in 12 healthy male volunteers who had several months of experience in doing self-hypnosis (autogenic training). During hypnotically suggested right arm levitation, as compared to resting conditions, they found an increase in cortical blood flow and an activation of temporal areas; the latter finding was considered to reflect acoustical attention. In addition, a so-far-unexplained deactivation of inferior temporal areas was observed during successful self hypnosis and hypnosis. While there was a global absolute increase of cortical blood flow bilaterally, they could not observe a relative increase of the right as compared to the left hemisphere during hypnosis. Several subjects successfully performed the levitation of the right arm, despite a relative left hemispheric activation, provided the absolute right hemispheric activation remained dominant.
1987
Jay, Susan M.; Elliott, Charles H.; Katz, Ernest; Siegel, Stuart E. (1987). Cognitive-behavioral and pharmacologic interventions for children’s’ distress during painful medical procedures. Journal of Consulting and Clinical Psychology, 55, 860-865.
This study evaluated the efficacy of a cognitive-behavioral intervention package and a low-risk pharmacologic intervention (oral Valium), as compared with a minimal treatment-attention control condition, in reducing children’s distress during bone marrow aspirations. The subjects were 56 leukemia patients who ranged in age from 3 years to 13 years. The three intervention conditions were delivered in a randomized sequence within a repeated-measures counterbalanced design. Dependent outcome measures included observed behavioral distress scores, self-reported pain scores, pulse rate, and blood pressure scores. Repeated-measures analyses of variance indicated that children in the cognitive-behavior therapy condition had significantly lower behavioral distress, lower pain ratings, and lower pulse rates than when they were in the attention- control condition. When children were in the Valium condition, they exhibited no significant differences from the attention control condition except that they had lower diastolic blood pressure scores.
Meyer, von H. K.; Diehl, B. J. M.; Ulrich, P.; Meinig, G. (1987). Kurz- und langfristige Anderungen der kortikalen Durchblutung bei Autogenem Training[Short and long-term changes in cortical circulation caused by autogenic training]. Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 33 (1), 52-62.
English Summary. The well-known hyperfrontal pattern of hemispheric blood flow measured with 133-Xenon is not found in 12 healthy resting men who have been practicing Autogenic Training at least six months. This might indicate a long-term decrease in the level of activation. Successfully practiced exercises of Autogenic Training lead to an increased blood flow in the Rolandic area representing the body scem (sic) and to a decreased blood flow in regions related to acoustical attention and to autonomic functions. Left hemispheric cerebral blood flow is lower in rest. The relative activation of the left hemisphere during Autogenic Training is discussed.
Ulrich, P.; Meyer, H. J.; Diehl, B.; Meinig, G. (1987). Cerebral blood flow in autogenic training and hypnosis. Neurosurgery Review, 10, 305-307. (Abstracted in American Journal of Clinical Hypnosis, 1989)
In 12 healthy volunteers with at least an experience of 6 months in autogenic training (AT), the cerebral blood flow (CBF) was measured at rest, in AT, and in hypnosis (H). The results were correlated with individual test profiles. The cortical flow pattern at rest of our AT-trained volunteers did not show the hyperfrontality which is described in the literature. This may be interpreted as an effect of better and habitualized relaxation in long-trained AT practitioners. This flow pattern corresponds to the low grades of neuroticism and aggressivity found in the tests. Furthermore, an activation in central cortical areas and a deactivation in regions which are associated with acoustic and autonomous functions occur. Possible explanations for these phenomena as well as for the relatively low perfusion of the left hemisphere at rest and activation in AT are discussed. The global rise of CBF in Hypnosis may be an activation effect caused by resistance against the hypnotizer: the deeper the trance, the smaller the catalepsy of the right arm and in temporal cortical fields processing acoustic inputs.
1986
Suls, Jerry; Sanders, Glenn S.; Labrecque, Mark S. (1986). Attempting to control blood pressure without systematic instruction: When advice is counterproductive. Journal of Behavioral Medicine, 9 (6), 567-577.
Hypothesized that, without assistance, Ss’ attempts to keep their blood pressure low would produce increases in blood pressure, compared to Ss asked to respond naturally to an arousing stimulus. 50 male undergraduates watched a videotape containing a neutral (nonarousing) section and an erotic section while their blood pressure was recorded by an automated blood-pressure monitoring device. 22 Ss were asked to relax and keep their blood pressure low during the erotic parts of the videotape, and 28 Ss were asked to respond naturally. Results confirm the hypothesis, suggesting that urging people to relax can be counterproductive if they do not also receive systematic instruction on how to relax or control blood pressure.
1984
Bishay, Emil; Stevens, Grant; Lee, Chingmuh (1984). Hypnotic control of upper gastrointestinal hemorrhage: A case report. American Journal of Clinical Hypnosis, 27, 22-25.
The use of hypnosis for control of bleeding during and after surgical procedures is common practice. It has also been a useful tool for control of bleeding in hemophiliac children, especially during dental procedures, and in traffic accidents. This paper presents the successful treatment with hypnosis of a patient with upper gastrointestinal tract bleeding. After treatment, the patient was discharged from the hospital without the need for surgical intervention.
NOTES:
The physician explained to the patient that nothing would hurt her and that nobody would do anything against her will, that if she could “relax,” then her unconscious mind would help her control her bleeding. [Gives script used in the hypnosis.] Trance terminated after 20 minutes. “One hour later, endoscopy performed under local anesthesia revealed ‘non-bleeding gastritis, no ulcers seen.’ She had no bleeding following the hypnotherapy” (p. 23).
Conn, Lois; Mott, Thurman, Jr. (1984). Plethysmographic demonstration of rapid vasodilation by direct suggestions: A case of Raynaud’s Disease treated by hypnosis. American Journal of Clinical Hypnosis, 26, 166-170.
Raynaud’s Disease is a painful vasospastic disorder of the fingers and toes precipitated by cold or emotional stimuli. Treatment has usually included protection from cold stimuli and vasodilators. Biofeedback, imagery, relaxation, and hypnosis have also been used. The relationship between response to treatment and hypnotizability has been inconclusive. A case of Raynaud’s Disease was treated using hypnosis. The patient was highly hypnotizable and responded rapidly to direct suggestion with a fourfold increase in her blood volume. The implications of this rapid response and its relationship to hypnotizability are discussed with suggestions for further studies.
NOTES:
The authors review experimental literature on the usefulness of hypnosis in modifying peripheral circulation, finding both positive (Barabasz and McGeorge, 1978, Roberts, Kewman, and MacDonald, 1973) and negative (Peters, Lundy, and Stern, 1973; Black, Edholm, Fox, and Kidd, 1963) outcomes. Experiments relating outcome to hypnotizability also have positive (Block, Levitsky, Teitelbaum, and Valletta, 1977) and negative (Crosson, 1980; Roberts et al, 1973) results.
Clinical literature found that peripheral circulation could be influenced (Crasilneck & Hall, 1975; Norris & Huston, 1956; Jacobson et al., 1973) but none of those studies reported the hypnotizability of the patients. In the Crasilneck and Hall (1975) investigation, 60% of their 48 Raynaud’s patients experienced marked improvement in symptoms or remission.
Hypnotizability has been investigated with respect to biofeedback results, finding both no relationship (Holroyd et al., 1982) and a positive relationship (Andreychuk and Skriver, 1975).
In this investigation, the highly hypnotizable (Stanford Hypnotic Susceptibility Scale, Form A, score = 11) female patient was treated with hypnosis when the blood vessels in her hands were constricted. Either she had arrived at the office with poor circulation, or a Raynaud’s attack was induced with ice water. Hypnosis involved progressive relaxation followed by suggestions to visualize the blood vessels in her hand opening up, the blood warming and nourishing her hands. “With each beat of your pulse your hand becomes warmer as more blood reaches your fingers. It is as though you are lying in the warm sun. Try to visualize the blood vessels in your hand opening up….” (P. 168).
The patient was asked to use self hypnosis and a cassette of the office session twice a week between sessions, but in fact she either failed to practice or did the exercise once between weekly sessions.
With neutral hypnosis (no specific suggestions about circulation) there was little change in pulse volume; with suggestions to open up her blood vessels, there was an increase in blood volume that began within 20 seconds, reaching four times the baseline in 45 seconds. This increase was reproduced in later sessions, and a somewhat lesser degree of change could be produced with self hypnosis.
In their Discussion, the authors question whether the positive results depend on someone who is high in hypnotizability, and/or on someone with a labile vascular system. They refer to a model of biological information processing to explain how suggestions might have been incorporated by the patient. “Bowers (1977) has speculated that hypnotized patients process information in a way different from when they are not hypnotized. He presents a number of different studies which have shown a significant relationship between hypnotizability and treatment response in patients with illnesses with a clear cut physiological component, including asthma, warts, and icthyosis. He then speculates that ‘suggestions delivered to deeply hypnotized subjects can be transduced into information that is somatically encodable, thereby producing a selective and specific impact on body function and structure.’ This kind of processing of information could explain the very rapid response described in the patient presented here.
“In reviewing the cases in which blistering has been produced by hypnotic suggestion, Chertok (1981) states, ‘It therefore clearly emerges that these experiments have all been conducted with _highly hypnotizable_ subjects, including a very large proportion of true somnambulists. Inversely, there is not a single known case where a blister has been produced without the subject having been deeply hypnotized beforehand'” (p. 169).
Hall, Howard R. (1984, October). Hypnosis, imagery, and the immune system. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Antonio, TX.
NOTES:
Studied the relationship of hypnosis to immune functions, using imagery methods like the Simontons did with their cancer patients. Twenty normal volunteers were hypnotized and asked to imagine their white blood cells (WBCs) attacking weak germs like strong sharks would attack something, and they were told that the sharks would continue working after they came out of hypnosis (a post-hypnotic suggestion). They were asked to “feel it and experience it any way you can,” to avoid emphasizing visual imagery too much. Then they were taught self hypnosis and sent home to practice twice a day for a week.
Three blood measures increased after hypnosis: –B-cells increased with pokeweed stimuli (an allergen) for younger Ss, not older Ss –WBC’s increased for highly hypnotizable Ss who were young, not for poor hypnotizable Ss or for any older Ss (Age range was 22-80.) –Lymphocyte count increased, approaching significance for highly hypnotizable Ss who were young but not for poor hypnotizable Ss or for older Ss. A personality test administered before the hypnosis, the SLC-90, suggested that the higher the distress level, the lower the lymphocyte count before hypnosis training. Two scores that summed up the distress level correlated -.49 and -.53, respectively. The psychological distress measured by the personality test decreased after the week of self-hypnosis practice. Of the two scores that summed up distress, one decreased for everyone (General Severity Index) and the other decreased only for highly hypnotizable Ss (Positive Symptom Total). Thus, a week of self hypnosis with imagining one’s WBC’s eating up weak germs in the blood led to both an increase in immune response indicators and a decrease in psychological distress. Psychological distress decreased as lymphocytes increased.
Dr. Hall repeated these procedures with a small number of Ss who were told just to “lie down and rest” rather than being hypnotized and given instructions to imagine their WBC’s increasing. None of the above changes occurred. However, he cautions that his research doesn’t indicate whether the positive effects are due to relaxation, imagery, or hypnosis since all three were involved
Holmes, David S. (1984). Meditation and somatic arousal evidence. American Psychologist, 39 (1), 1-10.
The conceptual and methodological issues associated with research on the effects of meditation are reviewed. A summary of the research in which the somatic arousal of meditating subjects was compared to the somatic arousal of resting subjects did not reveal any consistent differences between meditating and resting subjects on measures of heart rate, electrodermal activity, respiration rate, systolic blood pressure, diastolic blood pressure, skin temperature, oxygen consumption, EMG activity, blood flow, or various biochemical factors. Similarly, a review of the research on the effects of meditation in controlling arousal in threatening situations did not reveal any consistent differences between meditating and nonmeditating (no-treatment, antimeditation, or relaxation) subjects. The implications of these findings for research and practice are discussed.
1983
Fung, E. H.; Lazar, B. S. (1983). Hypnosis as an adjunct in the treatment of von Willebrand’s disease. International Journal of Clinical and Experimental Hypnosis, 31 (4), 256-265.
Hypnosis ahs been used to control bleeding, both in normals and hemophiliacs. Case material is presented to demonstrate how hypnosis was used as an adjunct to standard medical treatment of a boy and his mother with von Willebrand’s disease, initially to reduce anxiety and improve self-esteem and the parent-child relationship, and later, to reduce bleeding. This use of hypnosis illustrates the relationship between hemostatic control and psychological adaptation
1981
Claghorn, James L.; Mathew, Roy J.; Largen, John W.; Meyer, John S. (1981). Directional effects of skin temperature self-regulation on regional cerebral blood flow in normal subjects and migraine patients. American Journal of Psychiatry, 138, 1182-1187.
Vascular headache of the migraine type is associated with vasomotor changes in cerebral arteries. The authors studied whether skin temperature training (biofeedback) reduced the frequency, severity, and duration of these headaches by measuring the regional cerebral blood flow (CBF) in 11 female migraine patients (27-52 years) and 9 female volunteers (22-37 years), using the noninvasive 133 Xe inhalation technique. Half of each group was randomly assigned to a hand-warming or a hand- cooling group. CBF increased in several regions of the left hemisphere to a significant degree only for the migraineurs who were in the hand-warming group. The pattern of vasomotor regulation apparently differed between migraine and normal Ss. The migraineurs” headache symptoms were affected by both warming and cooling, but warming produced more salutary effects.
1980
Case, David B.; Fogel, David H.; Pollack, Albert A. (1980). Intrahypnotic and long-term effects of self-hypnosis on blood pressure in mild hypertension. International Journal of Clinical and Experimental Hypnosis, 28, 27-38.
Self-hypnosis using the method of Spiegel (1974) was evaluated in 15 patients with labile or mild essential hypertension who were equally hypnotizable and adhered to a regimen of 6-10 daily exercises for a 4-month period. During the hypnotic state, there were consistent rises in both systolic and diastolic pressures in hypnotizable patients, but not in non-hypnotizable controls. Similar but smaller changes were also observed in normotensive subjects. Pressure rose immediately with hypnosis and subsided gradually over 15 minutes. However, the long-term effects of the daily practice of self- hypnosis were variable: ambulatory diastolic pressure fell in 5 patients, was unchanged in 7 patients, and rose in 3 patients. The changes in blood pressure could not be specifically attributed to the daily practice of self-hypnosis; however, all patients experienced improvement in well-being, mood, and behavior patterns during the 4-month period. The study indicates that self-hypnosis can produce changes in behavior and mood which may be beneficial to cardiovascular health, although paradoxically, the act of hypnosis by this technique is pressor. Aside from its therapeutic potential, self- hypnosis may provide useful information about central mechanisms of blood pressure regulation.
1978
Parker, Jerry C.; Gilbert, Gary S.; Thoreson, Richard W. (1978). Reduction of autonomic arousal in alcoholics: A comparison of relaxation and meditation techniques. Journal of Consulting and Clinical Psychology, 46 (5), 879-886.
To investigate and compare the effects of progressive relaxation training and meditation training on autonomic arousal in alcoholics, 30 subjects were selected from a population of alcoholics in a Veterans Administration hospital substance-abuse program. The subjects were randomly assigned to one of the following three experimental conditions: (a) progressive relaxation training group, (b) meditation training group, or (c) quiet rest control group. All groups met for 3 weeks during which state anxiety, blood pressure, heart rate, and spontaneous galvanic skin responses were measured. The measures were designed to assess the treatment effects following the first training session and at the end of the total training period. The results indicate that both progressive relaxation training and meditation training are useful for reducing blood pressure in alcoholics. In addition, significant differences between the groups in the effectiveness of the relaxation procedures were found. Meditation training induced blood pressure decreases at an earlier point in the 3-week training period and affected decreases in systolic blood pressure that progressive relaxation training did not. These results support the idea of considerable specificity of response to relaxation techniques.
1974
Redmond, Daniel P.; Gaylor, Michael S.; McDonald, Robert H.; Shapiro, Alvin P. (1974). Blood pressure and heart-rate response to verbal instruction and relaxation in hypertension. Psychosomatic Medicine, 36 (4), 285-297.
Recent data have suggested that instructional set and task awareness may play a substantial role in the achievement of directional changes in blood pressure associated with “operant conditioning” techniques. Six hypertensive patients were instructed alternately to raise (UP) and lower (DOWN) their blood pressure by concentrating on changing “heart rate, force of contraction, and blood vessel resistance to flow.” Paired 10 min periods were separated by the experimenter’s entry and exit. Five of the subjects were taught progressive muscular relaxation (PMR), and the protocol repeated, with PMR induced throughout this session. The immediate cardiovascular response to PMR, induced in both the presence and absence of the experimenter, was studied. Systolic (SBP) and diastolic (DBP) blood pressure and heart rate (HR) were measured every 30 sec in all sessions. Direction of changes in BP and HR for UP and DOWN periods was appropriate and significant in both instruction sessions, and these differences for BP frequently reached significant levels of magnitude. In general, interactions for HR did not reach significant levels. Comparison of the two sessions yielded little difference between them. PMR uniformly lowered BP and HR, but was of significant magnitude only when induction of PMR involved the active participation of the experimenter. Interview data revealed considerable dramatic mental imagery associated with directional shifts in BP. The results indicate that directional instruction may result in appropriate changes in BP and HR of a magnitude comparable to those reported in studies using “external biofeedback.” PMR did not alter the response. This study adds to other data which point to the potential for nonspecific or “placebo” effects to be operative in conditioning studies.
NOTES:
The authors reviewed literature suggesting that blood pressure changes have been brought about by hypnotic suggestions of attitudes, progressive muscular relaxation, autogenic training (a form of self hypnosis), yogi, transcendental meditation, and hypnotically suggested relaxation.
The instructions to raise and lower blood pressure by concentrating on changing heart rate, force of contraction, and blood vessel resistance to flow were a repetitive monologue with a monotonous emphasis on “rate and force of heart beat and resistance of vessels to flow.” Most subjects spontaneously introduced imagery appropriate to the desired change. The authors expressed the opinion that task awareness (to change the blood pressure) influenced the results, and the changes were accomplished more by associative imagery than by responding to the literal meaning of instructions.
1958
Duncan, Irma W.; Dressler, Robert L.; Lyon-James, Sara; Sears, Alden B. (1958). The search for an index of hypnosis. Journal of Clinical and Experimental Hypnosis, 6 (2), 95-108.
NOTES 1:
“Summary
“Blood and urine samples were obtained from 18 university students at the beginning and end of two experimental sessions, one with and one without hypnosis. Some of the subjects relaxed during the sessions; others imagined or hallucinated a traumatic experience.
“Of a variety of measurements made, urinary volumes and 17-ketosteroids, the eosinophil count and psychogalvanometer recordings appear to give useful information about any changes due to the hypnosis. The biochemical changes caused by the experimentally produced emotions seem to depend on the individual and his past experience rather than the hypnosis. The data suggest that if the experience hallucinated is known to the subject, the biochemical changes indicate a relaxed state during the hypnosis. The psycho-galvanometer recordings may indicate an agitated state while the biochemical indices suggest a relaxed state” (pp. 106-107).
C RESEARCH
CANCER
2002
Edser, Stuart J (2002, March). Hypnotically-facilitated counter-conditioning of anticipatory nausea and vomiting associated with chemotherapy: A case study.. Australian Journal of Clinical Hypnotherapy and Hypnosis, 23 (1), 18-30.
Presents an account of a cancer patient who suffers from severe anticipatory nausea and vomiting in the lead-up to chemotherapy treatment. The paper briefly contextualises the symptomatology of the presenting problem in the behavioural and hypnotic literature and recounts the rationale and methods that the writer used in assisting the patient to overcome the problem. Counter-conditioning was used to desensitise the patient to the aversive stimuli and hypnosis used to enhance this effect and to facilitate the final outcome.
Harper, Gary W. (1999). A developmentally sensitive approach to clinical hypnosis for chronically and terminally ill adolescents. American Journal of Clinical Hypnosis, 42 (1), 50-60.
Adolescents who suffer from terminal and/or chronic medical illnesses must face difficult developmental issues coupled with increased burdens of physical discomfort and uncertainty about survival. Clinical hypnosis is one technique that can be used to help these individuals gain a sense of comfort and control over their lives. I describe the use of a developmentally sensitive hypnotherapeutic intervention for chronically and terminally ill adolescents. I have used the technique for the reduction of various types of physical and psychological discomfort secondary to a range of medical problems such as cancer, end-stage renal disease, organ transplant, and HIV disease. The treatment focuses on the use of personalized procedures that attempt to increase perceptions of control through interactive formats. Movement through a personally intriguing journey is used as a metaphor for controlling and moving away from discomfort. I also present three case examples as well as general treatment recommendations for clinical use.
Liossi, Christina; Hatira, Popi (1999). Clinical hypnosis versus cognitive behavioural training for pain management with pediatric patients undergoing bone marrow aspirations. International Journal of Clinical and Experimental Hypnosis, 47 (2), 104-116.
A randomized controlled trial was conducted to compare the efficacy of clinical hypnosis versus cognitive behavioral (CB) coping skills training in alleviating the pain and distress of 30 pediatric cancer patients (age 5 to 15 years) undergoing bone marrow aspirations. Patients were randomized to one of three groups: hypnosis, a package of CB coping skills, and no intervention. Patients who received either hypnosis or CB reported less pain and pain-related anxiety than did control patients and less pain and anxiety than at their own baseline. Hypnosis and CB were similarly effective in the relief of pain. Results also indicated that children reported more anxiety and exhibited more behavioral distress in the CB group than in the hypnosis group. It is concluded that hypnosis and CB coping skills are effective in preparing pediatric oncology patients for bone marrow aspiration.
Eimer, Bruce; Freeman, Arthur (1998). Pain management psychotherapy: A practical guide. New York NY: John Wiley & Sons, Inc..
NOTES
“Pain Management Psychotherapy” (PMP) provides a clear and methodical look at pain management psychotherapy beginning with the initial consultation and work-up of the patient and continuing through termination of treatment. It is a thoughtful and thorough presentation that covers methods for psychologically assessing the chronic pain patient (structured interviews, pain assessment tests and rating scales, instruments for evaluating beliefs, attitudes, pain behavior, disability, depression, anxiety, anger and alienation), treatment planning, cognitive-behavioral therapy techniques, and a range of hypnotic approaches to pain management. The book covers both traditional (cognitive and behavior therapy, biofeedback, assessing hypnotizability, choice of inductions, designing an individualized self-hypnosis exercise) as well as newer innovative techniques (e.g., EMDR, pain-relief imagery, hypno-projective methods, hypno-analytic reprocessing of pain-related negative experiences). An extensive appendix reproduces in their entirety numerous forms, rating scale, inventories, assessment instruments, and scripts.
The senior author, Bruce Eimer, states in his online comments on Amazon.com that “most therapists hold the belief that ‘real’ chronic pain patients are quite impossible to help. This book attempts to dispel these misguided beliefs by providing a body of knowledge, theory, and techniques that have proven value in understanding and relieving chronic physical pain.” He also states that “the challenge for the therapist is to persuade the would-ne patient/client that he or she has something to offer that can help take way pain and bring back more pleasure. This challenge is negotiated through the therapeutic relationship. However, the therapist just can’t be ‘warm, accepting, non-judgmental and empathic’. The therapist must also have knowledge and skills relevant to relieving pain. Only then can the therapist impart such knowledge, and in teaching these skills to the pain patient, help the patient become something of a ‘self-therapist’. . . I dedicate this book to everyone who wants to find ways to make living with pain more comfortable, and to the ongoing search for better ways to relieve pain.”
Bayot, A.; Capafons, A.; Cardeqa, E. (1997). Emotional self-regulation therapy: A new and efficacious treatment for smoking.. American Journal of Clinical Hypnosis, 40 (2), 146-156.
We described emotional self-regulation therapy, a recently-developed suggestion technique for the treatment of smoking, and present data attesting to its efficacy. Of the 38 individuals who completed treatment, 82% (47% of the initial sample)stopped smoking altogether and 13% (8% of the initial sample) reduced their smoking. A follow-up at 6 months showed that 66% (38% of the initial sample) of those who had completed the treatment remained abstinent and reported minimal withdrawal symptoms or weight gain. In a no-treatment comparison group, only 8% reduced their smoking or became abstinent.
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).
Jones, M. M. (1994). Apnea in postsurgical hypnotherapy of an esophageal cancer patient: A brief communication. International Journal of Clinical and Experimental Hypnosis, 42 (3), 179-183.
Use of clinical hypnosis in the postsurgical psychotherapy of an esophageal cancer patient who could not swallow involved reenactment of the successful surgery and producing hallucinations of taste and smell, as well as working through emotions relating to the surgery and her disease. An apnea that occurred in a late phase of the treatment was addressed with the familiar arm pumping technique that had been used as a deepening technique, resulting in the patient’s resuming normal breathing. The experience reminds the practitioner of the possible unexpected professional demands when working in a medical environment. It also provides clues as to the underlying psychological mechanisms and their role in successful symptom removal. A 6-year follow-up confirmed the lasting effect of this brief psychotherapy.
Kraft, Tom (1993). Using hypnosis with cancer patients: Six case studies. Contemporary Hypnosis, 10, 43-48.
Hypnosis can be used in a number of different ways for helping patients suffering from cancer. As well as pain relief, hypnosis may be used to correct insomnia that does not respond to sleeping tablets; for the reduction in skin irritation and dyspnoea when these are due to organic causes, and for treatment-related over-eating. Some patients will use hypnosis in a symbolic way. When this occurs, just as in dream interpretation, it is important to ask the patient for associations, so that these symbols can be understood. Hypnosis can be an extremely useful addition to the medical armamentarium, and should be employed as an adjunct to standard forms of cancer treatment. This paper reports six case studies in which hypnosis was used to help cancer patients.
Barinaga, Marcia (1992). Giving personal magnetism a whole new meaning. Science, 256, 967.
NOTES:
Cited in Noetic Sciences Review, Autumn, 1992. This geobiologist has discovered that the human brain contains billions of tiny magnets–some 7 billion of them, each so small that their total weight is only one/millionth of an ounce. In magnetite- containing bacteria, the crystals are used as a compass needle which orients the bacteria with respect to the Earth’s magnetic field. In birds, bees, and fish, where concentration of the mineral is a few orders of magnitude higher than he found in the human brain, it is used as a navigational aid. He plays down the possible connection to weak electromagnetic fields that supposedly cause cancer (unless fields could induce very weak electrical fields inside the cells, disrupting cellular function). Other possible interpretations: a means for cells to store excess iron, or part of a magnetic sensing system, or a vestigial system left over in evolution from when we were more directly connected with the earth’s magnetic field and may have relied on it for navigation or migratory movement.
Kraft, Tom (1992). Counteracting pain in malignant disease by hypnotic techniques: Five case studies. Contemporary Hypnosis, 9, 123-129.
Five cases of patients suffering from cancer are described in which hypnotic visualization techniques were successfully employed to relieve pain and anxiety. This study supports the view that hypnosis can be an effective tool for pain relief in malignant disease, particularly when traditional methods have been exhausted.
Levitan, Alexander A. (1992). The use of hypnosis with cancer patients. Psychiatric Medicine, 10, 119-131.
Hypnosis has proven to be extremely valuable in the treatment of cancer patients. Specific applications include: establishing rapport between the patient and members of the medical health team; control of pain with self-regulation of pain perception through the use of glove anesthesia, time distortion, amnesia, transference of pain to a different body part, or dissociation of the painful part form the rest of the body; controlling symptoms, such as, nausea, anticipatory emesis, learned food aversions, etc.; psychotherapy for anxiety, depression, guilt, anger, hostility, frustration, isolation, and a diminished sense of self-esteem; visualization for health improvement; and, dealing with death anxiety and other related issues. Hypnosis has unique advantages for patients including improvement of self-esteem, involvement in self-care, return of locus of control, lack of unpleasant side effects, and continued efficacy despite continued use.
Spiegel, David (1992, October). Hypnotizability. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
NOTES
Dr. Spiegel announced that this was a last minute substitution for Fred Frankel’s presentation on Hypnotizability.
We have ongoing a major replication of the study that we published on group therapy with terminally ill breast cancer patients. The matched control patients get educational materials but not psychotherapy. We are looking at NKC cytotoxicity and delayed hypersensitivity.
Tasks: spend 15 minutes discussing list of problems; 15 minutes discussing things like, “What is your spouse doing that doesn’t help; what can we do to help it?” We get drop in NKC cytotoxicity immediately afterward, returning after 24 hrs to usual levels. Controls don’t drop in NKC cytotoxicity. This measure of stress may be a predictor of survival time.
In Fawzy’s study of group therapy with melanoma patients, they noted a significant difference at 6 months in interferon augmented activity of NK, which didn’t hold up at a year. But at 6 years there were 10 of 40 deaths in control group vs 3 of 40 deaths in treated group. This is a vigorous effect.
Cohen’s study of colds in New England J. of Med is another good clinical study.
There are two broad areas of relevance of hypnotizability to healing: 1. Hypnotizability as a trait: do highs differ in way they regulate body or mind? 2. Is there something you do when in hypnotized state that is different? Studies of treatment of warts with hypnosis are important 3. Transition between states, e.g. circadian rhythms; is there a shift in wakefulness between trance and nontrance states that affects health?
Psychiatric Diagnosis and self regulation. High hypnotizability is associated with certain psychiatric disorders (dissociative reaction, PTSD, MPD, etc.). Schizophrenics score much lower than normals (av. = 4 vs 7; replicated with the Hypnotic Induction Profile (HIP). Stanford Hypnotizability Scales show no difference in means, but do show a difference in range). I don’t know what this means. But schizophrenics can falsely pass some Stanford Scale items, e.g. amnesia which they don’t however reverse; so schizophrenics’ hypnotizability scores may be inflated on Stanford scales. We don’t see extremely high scores in schizophrenics.
Psychoactive medication doesn’t affect scores of schizophrenics, but improves scores of anxiety neurotics (by reducing anxiety). Frischholz has an article coming out in a psychiatry journal that confirms this.
There is a lot of evidence that patients with dissociative disorders are more hypnotizable than other groups. Frischholz et al couldn’t replicate Frankel’s finding of higher scores in phobics. Pettinati et al found higher scores in bulimia and I haven’t seen anything to counter that. Another idea is that high hypnotizables are very good at internal regulation
Spiegel & Ken Kline selected Ss who could regulate gastric activity. They got an 80% increase in gastric acid output while imagining eating; got 40% decrease in output when imagining something pleasant that wasn’t imagining eating. Injected with pentagastrin, which induces gastric output, they still got a decrease in gastric acid output in the relaxation condition.
This suggests that hypnotizability should be a selection criterion for some research. See also Katz et al. 1974 (?) with acupuncture; and McGlashan, Evans & Orne on the placebo response.
Herbert Spiegel found that 2/3 of highs but 1/3 of lows were cured of phobia. Eye roll sign on the HIP, living with spouse/lover, rating self as hypnotizable, and giving a postcard follow-up response at one week post treatment were associated with 89% rate abstinence at 2 years follow-up, when only 23% overall of 223 were abstinent. Absence of those positive predictors was associated with only a 4% rate of abstinence.
Spira, James L.; Spiegel, David (1992). Hypnosis and related techniques in pain management. Hospice Journal, 8, 89-119.
Hypnosis has been used successfully in treating cancer patients at all stages of disease and for degrees of pain. The experience of pain is influenced not only by physiological factors stemming from disease progression and oncological treatment, but also from psychosocial factors including social support and mood. Each of these influences must be considered in the successful treatment of pain. The successful use of hypnosis also depends upon the hypnotizability of patients, their particular cognitive style, their specific motivation, and level of cognitive functioning. While most patients can benefit from the use of hypnosis, less hypnotizable patients or patients with low cognitive functioning need to receive special consideration. The exercises described in this chapter can be successfully used in groups, individual sessions, and for hospice patients confined to bed. Both self-hypnosis and therapist guided hypnosis exercises are offered.
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.
Burish, Thomas G.; Snyder, Susan L.; Jenkins, Richard A. (1991). Preparing patients for cancer chemotherapy: Effect of coping preparation and relaxation interventions. Journal of Consulting and Clinical Psychology, 59 (4), 518-525.
60 cancer chemotherapy patients were randomly assigned to 1 of 4 treatments: (a) relaxation training with guided relaxation imagery (RT), (b) general coping preparation package (PREP), (c) both RT and PREP, or (d) routine clinic treatment only. All patients were assessed on self-report, nurse observation, family observation, and physiological measures and were followed for 5 sequential chemotherapy treatments. Results indicate that the PREP intervention increased patients’ knowledge of the disease and its treatment, reduced anticipatory side effects, reduced negative affect, and improved general coping. RT patients showed some decrease in negative affect and vomiting, but not as great as in past studies. The data suggest that relatively simple, 1-session coping preparation intervention can reduce many different types of distress associated with cancer chemotherapy and may be more effective than often-used behavioral relaxation procedures.