Author notes that the Hilgards, in _Hypnosis in the Relief of Pain_ (1975), describe the use of hypnosis in treating patients with cancer pain. In all three–Butler (1954), Lea, Ware, and Monroe (1960), and a larger study by Cangello (1961), both success and failure are reported. As the Hilgards point out, about 50% of the patients studied were able to reduce their pain–a percentage the Hilgards remark is rather close to what successful clinicians tend to report.

McCue, Peter A. (1991). Key Paper Review: Prophylactic therapy for cancer and coronary heart disease. [Comment/Discussion] .

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.

Meares, Ainslie (1982-83). A form of intensive meditation associated with the regression of cancer. American Journal of Clinical Hypnosis, 25 (2-3), 114-121.

Elsewhere I have reported a number of cases of regression of cancer following intensive meditation. This type of meditation is characterized by extreme simplicity and stillness of the mind, and so differs from other forms using a mantra, awareness of breathing or visualization of the healing process. Any logical verbal communication by the therapist stimulates intellectual activity in the patient. So communication is by unverbalized phonation, reassuring words and phrases, and most important, by touch. There follows a profound reduction in the patient’s level of anxiety which flows on into his daily life. The non-verbal nature of the meditative experience initiates a non-verbal philosophical understanding of other areas of life.

Morrow, Gary R. (1984). Appropriateness of taped versus live relaxation in the systematic desensitization of anticipatory nausea and vomiting in cancer patients. Journal of Consulting and Clinical Psychology, 52 (6), 1098-1099.

Investigated the suggestion that the relaxation part of systematic desensitization–an effective treatment for the nausea and vomiting experienced by approximately 25% of cancer patients in anticipation of chemotherapeutic treatments– could be learned from a prerecorded audiotape prior to meeting a psychologist for treatment. 10 cancer patients who had developed anticipatory nausea or vomiting were assigned to either a live-relaxation or a tape-relaxation group. Results show that 4 of 5 Ss assigned to the tape-relaxation group experienced nausea while listening to the prerecorded audiotape, while none of the patients in the live-relaxation group reported nausea when subsequently listening to an audiotape made during the live presentation of relaxation.

Newton, Bernauer (1984, October). The use of imagery in the treatment of cancer patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Antonio, TX.

Several hundred cancer patients were treated with the Simonton visualization method, with the additional factor that they were hypnotized for the visualization. In a long term follow-up study, those patients who were treated for at least 6 months and are still alive had imagery that was vivid, persistent, positive, and passive (“passive” here meaning an underlying sense of calm). Those who died had the opposite kind of images, and retrospective review of clinical notes indicates their aggressive images reflected desperation. Of the patients who were treated less than six months, a few lived. Their images also were vivid, persistent, and positive.

Newton, Bernauer W. (1982-83). The use of hypnosis in the treatment of cancer patients. American Journal of Clinical Hypnosis, 25 (2-3), 104-113.

For nearly eight years, cancer patients have been treated at this outpatient facility using hypnosis and psychotherapy. Basic concepts, assumptions and procedures are presented and the issues and problems encountered are discussed. Results are given as they relate to the three goals of treatment.

Oliver, George W. (1982-83). A cancer patient and her family: A case study. American Journal of Clinical Hypnosis, 25 (2-3), 156-160.

In recent years, increasing numbers of mental health workers have been attempting to use techniques of psychotherapy to influence the course of malignant disease. This paper reviews in detail the course of treatment of one female patient with an inoperable malignancy and conveys a sense of the clinical experience of working intensively with a cancer patient and her family. It shows the complex levels of interaction within the patient herself, between the patient and her family, and between the therapist and her family and within the therapist himself during different phases of the therapeutic journey.

Petrucci, Ralph J.; Harwick, Robert D. (1984). Role of the psychologist on a radical head and neck surgical service team. Professional Psychology: Research and Practice, 15, 538-543.
Surgery for head and neck cancers often produces disfiguration and a sense of hopelessness in patients, and it may also results in a lack of self-acceptance, depression, and covert hostility. Psychologists are often called on to help such patients deal with drug abuse, suicidal behaviors, strong characterological disorders, noncompliance, and overall adjustment. Behavioral management and anxiety-reduction strategies, such as relaxation exercises and visual imagery, are often helpful. (17 ref).

Rapkin, David A.; Straubing, Marsha; Holroyd, Jean (1991). Guided imagery, hypnosis and recovery from head and neck cancer surgery. International Journal of Clinical and Experimental Hypnosis, 39, 215-226.

The value of a brief, preoperative hypnosis experience was explored with a sample of 36 head and neck cancer surgery patients. 15 patients volunteered for the experimental hypnosis intervention. 21 patients who received usual care (no hypnosis) were followed through their hospital charts and were used as a comparison group. Hypnotic intervention and usual care groups were comparable in terms of relevant demographic variables. Postoperative hospitalizations for the hypnotic intervention group were significantly shorter than for the usual care group. Within the hypnotic intervention group, hypnotizability was negatively correlated with surgical complications and there was a trend toward a negative correlation between hypnotizability and blood loss during surgery. Findings suggest that imagery-hypnosis may be prophylactic, benefitting patients by reducing the probability of postoperative complications and thereby keeping hospital stay within the expected range. Recommendations are presented for a controlled, randomized, clinical trial with a sufficiently large sample to provide the opportunity for statistical analysis with appropriate power.

Actual stay in hospital, post-surgery, was 8.7 days (SD = 3.7) for the Hypnosis group and 13.9 days (SD = 9.7) for the Usual Care group; the range was 3-17 days for the Hypnosis group and 5-42 days for the usual care group.
The hypnosis script included an indirect, permissive induction; positive suggestions for relaxation and healing imagery; images of calm situations that would lead to expectation for healing (e.g. a ‘healing pool’); suggestions for patients to develop their own images of pleasurable, comforting situations. The only direct suggestions were for minimal blood loss during surgery, modeled after those given in the waking situation by Bennett, Benson, and Kuiken (1986).
As measured by the Stanford Hypnotic Clinical Scale, there were five highly hypnotizable patients (scores 4-5), six mediums (scores 2-3), and four lows (scores 0-1). “Hypnotizability correlated negatively with complications (r = -.54, p<.04, two-tailed test). There was a trend toward a negative correlation with length-of-stay (r = -.37, p<.18, two-tailed test) and estimated blood loss (r = -.40, p<.15, two-tailed test). Note that these correlations represent moderate to large effects, and the significance levels are due in part to low power associated with a small N (Cohen, 1988). The means for blood lost during surgery for the three hypnotizability groups were: highs = 904 cc, mediums = 1465 cc, and lows = 2056 cc" (p. 222). Data on cost could not be published in this article but later was published in a letter to the Editor of the Newsletter of the Society of Clinical and Experimental Hypnosis (February 1994, Vol. 35, No. 1, p.8). "The average savings for the intervention group was $6,725. While this difference fell short of statistical significance on the Wilcoxon test (Z=- 1.5402, p < .10), it is rather striking on its face. The range actually was $7849 to $27,782 for Intervention Group patients and $9,390 to $53,627 for Usual Care group patients. "In 1990 a semi-private room at UCLA Center for the Health Sciences cost $405 to $529 per day, depending on quality; standard ICU care (one nurse for two patients) was $1236 per day, and more intensive care (one nurse for one patient) was $2471/day. Head and neck surgery patients may remain in the ICU, driving up costs, solely because they have not learned to suction their own tracheostomies, usually a motivational factor that might be affected by hypnosis. UCLA is a tertiary care hospital in a high-cost area (and is therefore reimbursed at higher rates than many other hospitals), and costs may be driven up by the many additional procedures required for long-stay patients. Therefore the cost savings could not be expected to be as great where expected length of stay is brief, ICU use is limited, and community costs are lower" (p. 8). Redd, William H.; Andresen, Graciela V.; Minagawa, Rahn Y. (1982). Hypnotic control of anticipatory emesis in patients receiving cancer chemotherapy. Journal of Consulting and Clinical Psychology, 50 (1), 14-19. NOTES Deep muscle relaxation hypnosis controlled nausea, gagging, retching in all cases. Anticipatory emesis recurred when hypnosis was not used. During subsequent sessions in which hypnosis was reinstated, anticipatory emesis was again controlled. Redd, William H.; Andrykowski, Michael A. (1982). Behavioral intervention in cancer treatment: Controlling aversion reactions to chemotherapy. Journal of Consulting and Clinical Psychology, 50 (6), 1018-1029. During the protracted course of cancer chemotherapy, approximately 25% of patients develop aversion reactions to treatment by becoming nauseated and/or vomiting before their chemotherapy treatments. This phenomenon has been conceptualized as a result of respondent conditioning. Since commonly used antiemetic drugs do not reliably control anticipatory nausea/emesis, behavioral techniques of control have been studied. They include hypnosis used in conjunction with guided-relaxation imagery, progressive muscle relaxation with guided imagery, and systematic desensitization. (67 ref) Redd, William H.; Rosenberger, Patricia H.; Hendler, Cobie S. (1982-83). Controlling chemotherapy side effects. American Journal of Clinical Hypnosis, 25 (2-3), 161-172. Severe nausea and vomiting are commonly experienced by cancer patients after receiving chemotherapy treatments. Moreover, approximately 25% of these patients develop conditioned aversions to treatment and become nauseated before they receive their chemotherapy injections. The use of deep muscle relaxation hypnosis in conjunction with guided imagery to control pre- and post-chemotherapy nausea and emesis is discussed. Theoretical and clinical issues raised by this application of hypnosis in cancer treatment arc also addressed. Rosenberg, Simon W. (1982-83). Hypnosis in cancer care: Imagery to enhance the control of the physiological and psychological 'side-effects' of cancer therapy. American Journal of Clinical Hypnosis, 25 (2-3), 122-127. The use of surgery, radiation, and chemotherapy has resulted in increased control of malignancy and prolonged survival for cancer patients. These modalities also carry significant morbidity. Normal physiological homeostasis is often altered by both the neoplasm and its treatment. The diagnosis, treatment, and social stigma of cancer exact profound psychological impact. Hypnosis effectively can control the range of both physiological and psychological 'side-effects' of cancer and its therapy. This paper will delineate those effects of hypnosis of proven value to the cancer patient. Incorporation of images into each phase of a hypnosis session will be demonstrated with an actual case history and annotated transcript. Imagery as a therapeutic modality will be discussed in general, and specific suggestions and images will be given. Sacerdote, Paul (1970). Theory and practice of pain control in malignancy and other protracted or recurring painful illnesses. International Journal of Clinical and Experimental Hypnosis, 18 (3), 160-180. Recent neuroanatomical and neurophysiological experimental data suggest absence or presence of pain and changes in pain intensity as expressions of the balance between sensory (peripheral) and central (centrifugal) inputs at synaptic stations. Psychological activities by contributing to the centrifugal input influence conduction, transduction, and perception of pain stimuli. Hypnotically induced analgesia and anesthesia are therefore acceptable as neurophysiological realities. Methods for hypnotic alterations of pain based upon these premises are described utilizing neurophysiological mechanisms, psychodynamic changes, establishment of new behavioral patterns, or changes in time-space concepts and percepts. Case presentations illustrate some of these multiple psychological and physiological approaches to pain control. (Spanish & German summaries) (28 ref.) (PsycINFO Database Record (c) 2003 APA, all rights reserved) Shapiro, Arnold (1982-83). Psychotherapy as adjunct treatment for cancer patients. American Journal of Clinical Hypnosis, 25 (2-3), 150-155. During the past ten years psychotherapy as adjunct treatment for cancer patients has become increasingly common. The use of hypnosis as an integral part of that treatment has also burgeoned. This report will follow the progress of two cancer patients in psychotherapy. While each is highly individual, the commonalities which allow treatment to be systematic will be quite apparent. The ability to minimize pain and discomfort, the ability to keep the white cell count high despite ongoing chemotherapy, and augmenting the ability of the body's immune system to fight the disease are utilized by both of the patients. All of the above are accomplished through the use of visual imagery in the trance state. Visual imagery is also used to reach feelings which patients are often unable to verbalize, and of which they often claim to be unaware. Other aspects of therapy such as the gradual shift from despair to hope and even confidence, and the development of more assertive behavior are discussed. Slater, Roger C.; Flores, Louis S. (1963). Hypnosis in organic symptom removal: A temporary removal of an organic paralysis by hypnosis. American Journal of Clinical Hypnosis, 5 (4), 248-255. NOTES Summary and Conclusions. A detailed case study is reported on the use of hypnosis with beneficial results in an instance of eventually proved organic brain disease. Three other confirmatory case reports of organic disease definitely benefitted by the use of hypnosis are briefly cited. The first patient had been adequately studied repeatedly for organic brain disease. Because the studies led to an uncertain indefinite unconfirmed suspicion of psychogenic epilepsy, the patient was returned with a recommendation for continued treatment and observation by the author, a general practitioner. Hence, she was, after still further study for organic disease, treated symptomatically by hypnosis with beneficial results. This led to the erroneous conclusion that the patient's disability was probably functional. A sudden fatal outcome of the actual but unrecognized brain disease led to a correct but post- mortem diagnosis of astrocytoma of the brain, Grade IV. "This report and those given to supplement it raise significant questions about the importance and value of hypnosis in organic disease. These include the challenging question of the extent to which the use of hypnosis can potentiate the natural corrective forces of the body; the need to recognize the value of hypnosis in effecting beneficial results in organic disease; the need to qualify the reliability of hypnosis as a differential diagnostic procedure in relation to psychogenic and organic disability; and the possibility and extent of the amelioration or actual correction of known organic illness" (p. 254). 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. Spiegel, David; Bloom, J. R.; Kraemer, H. C.; Gottheil, E. (1989, October 14). The beneficial effect of psychosocial treatment on survival of metastatic breast cancer patients: A randomized prospective outcome study. Lancet, 888-891. The effect of psychosocial intervention on time of survival of 86 metastatic breast cancer patients was studied using randomized prospective design. The one-year treatment consisted of weekly supportive group therapy with training in self-hypnosis for pain management, and resulted in significant reductions in mood disturbance and pain. Both the treatment and control groups had routine oncologic care. At ten-year follow-up, only three of the original 86 patients were still alive, and death records were obtained for the other 83. Survival from the time of randomization and onset of intervention was 36.6 (sd = 37.6) months for the treatment group, compared with 18.9 (sd = 10.8) months for the control group, and this difference was highly significant (Z = 3.94, p <.0001) using the Cox life table regression model. Kaplan-Meier survival analysis indicated that the divergence in survival began at 20 months after entry into the study, or 8 months after the treatment intervention ended. These unexpected findings suggest that intensive psychosocial support affects the course of the illness, although the mechanism by which it does so is not clear. 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. Stokvis, B. (1956). The appliction of hypnosis in organic diseases. Journal of Clinical and Experimental Hypnosis, 4 (2), 79-82. SUMMARY. Hypnotherapy, applied as a symptomatic treatment, is especially indicted in those cases of organic diseases in which the patient has neurotically elaborated his physical suffering. In cases presenting neither etiological nor secondary psychic factors one may try to improve the patient's condition by hypnotic treatment. Description of a case (hypnotherapy in a woman with carcinoma mammae)[sic]. The writer's lack of appreciation of hypnotherapy in organic diseases does not include the treatment of diseases which are definitely psychosomatically determined" (pp. 81-82). 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 1: 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. Walker, Leslie G. (1992). Hypnosis with cancer patients. American Journal of Preventative Psychiatry & Neurology, 3, 42-49. Overviews the uses of hypnosis with cancer, for example to ameliorate side effects of treatment, help patients adjust to having cancer and its symptoms, reduce the distress caused by painful procedures, and to attempt to alter mechanisms of immunity with a view to improving prognosis. Studies in these areas are reviewed. Wall, Valerie J.; Womack, William (1989). Hypnotic versus active cognitive strategies for alleviation of procedural distress in pediatric oncology patients. American Journal of Clinical Hypnosis, 31 (3), 181-191. NOTES The authors compared the effectiveness of a standardized hypnosis instruction vs and active cognitive strategy. Zeltzer, Lonnie K.; Dolgin, M. J.; LeBaron, Samuel; LeBaron, C. (1991). A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics, 88, 34-42. Subjects were randomly assigned to hypnosis, nonhypnotic distraction/relaxation, or attention placebo control. children in the hypnosis group reported the greatest reduction in both anticipatory and postchemotherapy symptoms. Distraction/relaxation kept symptoms from getting worse, but they did not get better, and the control children's symptoms became much worse. CARDIOLOGY/CARDIOVASCULAR 2000 Lang, E. V.; Benotsch, E. G.; Fick, L. J.; Lutgendorf, S.; Berbaum, M. L.; Berbaum, K. S.; Logan, H.; Spiegel, D. (2000, Apr 29). Adjunctive non-pharmacological analgesia for invasive medical procedures: A randomised trial. Lancet, 355 (9214), 1486-90. BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. METHODS 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. FINDINGS Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability. Abstract from National Library of Medicine, PubMed 1999 Rainville, P.; Hofbauer, R. K.; Paus, T.; Duncan, G. H.; Bushnell, M. C.; Price, D. D. (1999). Cerebral mechanisms of hypnotic induction and suggestion. Journal of Cognitive Neuroscience, 11 (1), 110-125. The neural mechanisms underlying hypnotic states and responses to hypnotic suggestions remain largely unknown and, to date, have been studied only with indirect methods. Here, the effects of hypnosis and suggestions to alter pain perception were investigated in hypnotizable subjects by using positron emission tomography (PET) measures of regional cerebral blood flow (rCBF) and electroencephalographic (EEG) measures of brain electrical activity. The experimental conditions included a restful state (Baseline) followed by hypnotic relaxation alone (Hypnosis) and by hypnotic relaxation with suggestions for altered pain unpleasantness (Hypnosis-with-Suggestion). During each scan, the left hand was immersed in neutral (35 degree C) or painfully hot (47 degrees C) water in the first two conditions and in painfully hot water in the last condition. Hypnosis was accompanied by significant increases in both occipital rCBF and delta EEG activity, which were highly correlated with each other (r = 0.70, p < 0.0001). Peak increases in rCBF were also observed in the caudal part of the right anterior cingulate sulcus and bilaterally in the inferior frontal gyri. Hypnosis-related decreases in rCBF were found in the right inferior parietal lobule, the left precuneus, and the posterior cingulate gyrus. Hypnosis-with-suggestions produced additional widespread increases in rCBF in the frontal cortices predominantly on the left side. Moreover, the medial and lateral posterior parietal cortices showed suggestion-related increases overlapping partly with regions of hypnosis-related decreases. Results support a state theory of hypnosis in which occipital increases in rCBF and delta activity reflect the alteration of consciousness associated with decreased arousal and possible facilitation of visual imagery. Frontal increases in rCBF associated with suggestions for altered perception might reflect the verbal mediation of the suggestions, working memory, and top-down processes involved in the reinterpretation of the perceptual experience. These results provide a new description of the neurobiological basis of hypnosis, demonstrating specific patterns of cerebral activation associated with the hypnotic state and with the processing of hypnotic suggestions. Abstract from National Library of Medicine, PubMed 1998 Wickramasekera, Ian E.; Kolm, Paul; Pope, Alan; Turner, Marsha (1998). Observation of a paradoxical temperature increase during cognitive stress in some chronic pain patients. Applied Psychophysiology and Biofeedback, 23 (4), 233-241. A total of 224 chronic pain somatoform disorder patients without obvious pathophysiology or psychopathology were found to have colder hands than nonpatients. A paradoxical temperature increase (PTI) in response to a cognitive stressor (mental arithmetic) was noted in a subset of these chronic pain patients. Patients were defined as "PTI" responders if, during cognitive stress, an increase in digital temperature occurred over a prior eyes closed resting condition. It was found that 49.4% of males and 42.6% of females in a total sample of 224 patients demonstrated PTI. The PTI patients had significantly colder hands than non-PTI patients prior to stress. A concurrent SCL measure of sympathetic activation found no difference between the PTI and non-PTI groups either at baseline or during cognitive stress. It appears from this data that PTI is specific to the peripheral vascular system of these patients and may be a marker of psychophysiological dissociation or trauma blocked from consciousness. 1997 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. 1996 Lang, Elvira V.; Joyce, Janet S.; Spiegel, David; Hamilton, Donna; Lee, Kelvin K. (1996). Self-hypnotic relaxation during interventional radiological procedures: Effects on pain perception and intravenous drug use. International Journal of Clinical and Experimental Hypnosis, 44 (2), 106-119. The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety. 1995 Enqvist, Bjorn; von Konow, L.; Bystedt, H. (1995). Pre- and perioperative suggestion in maxillofacial surgery: Effects on blood loss and recovery. International Journal of Clinical and Experimental Hypnosis, 43 (3), 284-294. The basic assumption underlying the present study was that emotional factors may influence not only recovery but also blood loss and blood pressure in maxillofacial surgery patients, where the surgery was performed under general anesthesia. Eighteen patients were administered a hypnosis tape containing preoperative therapeutic suggestions, 18 patients were administered hypnosis tapes containing pre- and perioperative suggestions, and 24 patients were administered a hypnosis tape containing perioperative suggestions only. The patients who received taped suggestions were compared to a group of matched control patients. The patients who received preoperative suggestions exhibited a 30% reduction in blood loss. A 26% reduction in blood loss was shown in the group of patients receiving pre- and perioperative suggestions, and the group of patients receiving perioperative suggestions only showed a 9% reduction in blood loss. Lower blood pressure was found in the groups that received pre- and perioperative and perioperative suggestions only. Rehabilitation was facilitated in the group of patients receiving perioperative suggestions only. 1993 Blankfield, Robert P. (1993, October). Suggestion, hypnosis, and relaxation as adjuncts for surgery patients: Lessons from studies involving cardiac surgery patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL. NOTES The author stated that his research and the few other studies of cardiac surgery patients do not support idea that cardiac surgery patients benefit from hypnosis and suggestion. Types of intervention have varied: hypnosis, suggestion, relaxation; pre-op, during, or post-op; with many different outcome variables. Aiken & Henrichs (1971) study was nonrandomized, nonblinded, for 30 patients getting open heart surgery. Treated patients had benefits. Surman, Hackett, Silverberg, & Behrendt (1974) had a randomized, single-blind design for 40 patients taught Self Hypnosis (S-H), for elective mitral valve surgery. No difference in benefits. But 45% of patients taught S-H reported a subjective sense of benefit (though objective indicators didn't support that). [He says the difference between subjective/objective outcome ratings is important.] Hart (1980) used randomized, single-blind design for 40 patients who had open heart surgery. No differences found except initial 3 days post surgery. Greenleaf et al (1992) - see her paper presentation of this date. Blankfield et al (presented at Society of Clinical and Experimental Hypnosis meeting in 1992) used a randomized, single-blind design for 95 patients, who were randomly assigned to taped suggestions, music, or controls. No differences were found in benefits. Our data were re-analyzed: patients who felt tape was helpful were compared to the remaining 62 patients, but there again were no differences in amount of narcotics used for pain, though there was a trend in the right direction; nursing assessments failed to identify less anxiety. The point is, whereas the bulk of publications suggest benefits, there is little evidence with this population. Could these patients be different in personality, ability to respond to intervention, amount of external stimuli? They should be studied because there are a lot of these patients with only a few surgeons and you don't have to gain the cooperation of a lot of different surgeons to do this kind of research. Also, there is uniformity in cardiac surgery whereas standard operating surgery is in a state of flux in other areas (e.g. movement from generous incisions to micro procedures, and patients receiving this type of surgery remain in hospital for a week whereas this opportunity to study them during inpatient post-surgical period is disappearing in other areas). It is my opinion that cardiac patients may not be highly receptive to suggestion. Curiously, according to Surman and my research, 1/2 the subjects report benefits. Either some benefits are subtle, or they are reporting a placebo effect. Future studies need more patients, and the investigators must stratify on personality inventory variables such as Type A personality, hypnotizability, motivation, anxiety, depression, family support, social support systems. This is labor intensive, to determine which characteristics determine differing outcomes. The patients used in this type of research require more presurgery evaluation than previously has occurred. The MMPI can be self administered and is widely acceptable, but is cumbersome, not well suited to people who are acutely ill. Assessment of Type A personality is important because Type A's might be less receptive to suggestion. Structured interview is time consuming, but a 52-item questionnaire can be self administered. Other factors listed above are important. Crawford, Helen J.; Gur, Ruben C.; Skolnick, Brett; Gur, Raquel E.; Benson, Deborah M. (1993). Effects of hypnosis on regional cerebral blood flow during ischemic pain with and without suggested hypnotic analgesia. International Journal of Psychophysiology, 15, 181-195. Using 133Xe regional cerebral blood flow (CBF) imaging, two male groups having high and low hypnotic susceptibility were compared in waking and after hypnotic induction, while at rest and while experiencing ischemic pain to both arms under two conditions: attend to pain and suggested analgesia. Differences between low and highly-hypnotizable persons were observed during all hypnosis conditions: only highly-hypnotizable persons showed a significant increase in overall CBF, suggesting that hypnosis requires cognitive effort. As anticipated, ischemic pain produced CBF increases in the somatosensory region. Of major theoretical interest is a highly-significant bilateral CBF activation of the orbito-frontal cortex in the highly-hypnotizable group only during hypnotic analgesia. During hypnotic analgesia, highly-hypnotizable persons showed CBF increase over the somatosensory cortex, while low-hypnotizable persons showed decreases. Research is supportive of a neuropsychophysiological model of hypnosis (Crawford, 1991; Crawford and Gruzelier, 1992) and suggests that hypnotic analgesia involves the supervisory, attentional control system of the far-frontal cortex in a topographically specific inhibitory feedback circuit that cooperates in the regulation of thalamocortical activities. Greenleaf, Marcia; Fisher, Stanley; Miaskowski, Christine; Du Hamel, Katherine (1993). Hypnotizability and recovery from cardiac surgery. American Journal of Clinical Hypnosis, 35, 119-128. NOTES: Notes were taken from author's presentation of this material at the Annual Meeting of the Society of Clinical and Experimental Hypnosis, Arlington Heights, Illinois. The paper presentation was part of a Symposium: Towards a Theory of Surgery: Hypnosis, Suggestion, Anesthesiology and Surgery, Methodological and Theoretical Issues and Dilemmas. Authors outlined the reported advantages of using hypnosis. Their review found problems in much of the research on this topic published to date: many single subject studies, subjects were often selected and trained by the investigator, hypnotizability wasn't evaluated. Used the Hypnotic Induction Profile (HIP) before assignment of patients to groups, and also equated groups for age. Groups 1 & 2 had formal hypnosis and then either relaxation-imagery (Jancks' autogenic training) or specific outcome suggestions (e.g. to have a clean dry wound, and to look forward to being able to function well); Group 3 were controls.