In an earlier study, DeBenedittis and Sironi (1986) demonstrated that during depth EEG studies, electrophysiological correlates of hypnotic behavior emphasize the role of the limbic system in mediating the trance experience. In the case of a young man who was affected by medically resistant temporal lobe epilepsy and who was a potential candidate for surgical treatment, diagnostic depth EEG in hypnotic and non- hypnotic conditions offered a unique opportunity to stimulate limbic structures. This permitted an evaluation of the subjective and behavioral responses, as well as of the electrophysiological correlates. During hypnosis, repeated stimulations of the left and the right amygdala produced arousal from the hypnotic state each time, whereas the stimulation of other cerebral structures (e.g., temporal neocortex, Ammon’s horn) or pseudostimulations were ineffective on the hypnotic state. These data represent the first experimental, controlled evidence of the amygdala’s effects on the arousal from the hypnotic state in man, thus suggesting that hypnotic behavior is mediated, at least in part, by a dynamic balance of antagonizing effects of discrete limbic structures–the amygdala and the hippocampus.
NOTES:
The patient was a 30-year-old man who had suffered from medically resistant psychomotor temporal lobe epilepsy since age 7; a diagnostic EEG showed right temporal seizure focus, concomitant with independent, contralateral, temporal spiking abnormalities. Hypnotizability was measured at 6 on the SHSS:C; the patient was given two training sessions in hypnosis, with suggestions for “dissociation, rehearsal and reframing of spontaneous seizure events, desensitization of their negative emotional impact, and amnesia” (p. 99).
Electrodes were implanted in deep cerebral structures (amygdala, Ammon’s horn) and corresponding superficial areas of temporal cortex, with confirmation of placement by X-ray. Two weeks later the patient’s brain was stimulated on two consecutive days, first in the waking state (Session 1) and then in hypnosis (Session 2). (Antiepileptic medication was discontinued three days before the stimulation sessions.) False (placebo) stimulations were randomly provided along with the true stimulations.
The false (placebo) stimulations did not result in subjective or behavioral changes in either the waking or the hypnosis condition.
In the waking condition, a psychomotor seizure was produced by stimulation of Right amygdala and Left Ammon’s horn; stimulation of Left amygdala evoked only the aura patient usually had before a seizure, or a brief lapse of consciousness. Stimulating the temporal neocortex did not evoke seizure activity.
In the hypnosis condition, arousal from hypnosis into the waking condition occurred with stimulation of amygdala (either Right or Left). Stimulation of the temporal neocortex or of the Right Ammon’s horn did not arouse the patient. Stimulation of Left Ammon’s horn led to abortive seizures, such that it could not be determined whether the hypnotic state had been interrupted. Stimulating the Right amygdala “triggered a psychomotor attack similar to that recorded during the waking stimulation, but with reduced emotional involvement” (p. 100). For the Left Ammon’s horn, “waking stimulation always induced clinical seizures with prolonged after-discharge, whereas hypnotic stimulation evoked only abortive seizures, without after-discharge” (p. 100).
In their Discussion, the authors note that animal experimental literature suggests that stimulation of the cortico-medial amygdala facilitates arousal functions, of the baso- lateral amygdala diminishes arousal and produces sleep, and lesions of the amygdala lead to ‘amygdala hangover’ (Weiskrantz, 1956). “The animal with amygdala destruction appears tame and placid, with reduced social reactivity, insensitive to environmental changes and reluctant to initiate new behavior, unless highly motivated (Isaacson, 1976)” (p. 101-102).
In contrast, the animal research on hippocampus suggests it is involved in inhibitory functions (Isaacson, 1976), and may be the ‘internal inhibitor’ theorized by Pavlov (1955) to be responsible for animal hypnosis. With lesions, animals are more willing to undertake new behaviors, less inactive, less distractible during goal-oriented behavior (Isaacson, 1976). “Moreover, normal hippocampograms show typical, slow (theta) synchronous activity opposed to the arousal desynchronized activity of the electroencephalogram. During hypnosis, desynchronization of the normal, slow activity of the hippocampal Ammon’s horn has been registered as compared with the waking hippocampogram, opposite to the slow synchronous activity of the amygdala” (p. 102).
The authors note that their results are at variance with the finding by Crasilneck et al. (1956) that their patient, during brain surgery for an epileptogenic focus, aroused from hypnosis each time they stimulated the hippocampus. They explain the discrepancy as due to the fact that the hippocampus was not simply stimulated, but in fact there was ‘coagulation’ of a hippocampal vessel each time. Quoting from Crasilneck et al. “‘The patient did not complain of pain during this [brain] excision [in hypnosis] except on one noteworthy occasion, when a blood vessel of the hippocampal region was being coagulated. The patient suddenly awoke from the hypnotic trance … She was immediately rehypnotized. … The surgeon then purposefully ‘restimulated’ the same region of the hippocampus. Once again, the patient abruptly awakened from trance… [p. 1607].’To the present authors, the description appears misleading and responsible for subsequent misinterpretation of the observation. Because on the first occasion the hypnotic arousal effect followed ‘coagulation’ of the hippocampal region, it may be assumed that ‘restimulation’ is a misnomer for repeated coagulation. From this it may be inferred that the arousal effect observed by Crasilneck et al. (1956) could probably be ascribed to a hippocampal microlesion rather than to hippocampal stimulation. This could explain the apparent discrepancy” (p. 104).
Hawkins, Russell; Le Page, Keith (1988). Hypnotic analgesia and reflex inhibition. Australian Journal of Clinical and Experimental Hypnosis, 16, 133-139.
The major change in thinking about models of analgesia over the last decade or so may be seen as a shift away from the earlier emphasis on a one-way afferent transmission sequence. Analgesia was effected, according to the older models, by a simple blocking of afferent impulses at some level (as achieved by local anaesthesia). Recent models suggest that there are at least two CNS analgesia control systems, each operating via an active mechanism for the inhibition of nociception which includes reciprocal _efferent_ impulses able to respond to input from lower centres by sending control signals which modify their output. One CNS analgesia system has now been quite well described. This “opiate” analgesia system has proved to be naloxone reversible and seems to be mediated by reciprocal pathways between brain stem structures and the dorsal horn and trigeminal caudalis. This is not likely to be the system responsible for all cases of hypnotic analgesia, since the common experience of continued awareness of some elements of a normally painful stimulus, in spite of a freedom from pain, implicates a higher level involvement such as input from the prefrontal cortex.
NOTES
The authors present a surgery case (of a cystoscopy and urethrotomy performed under hypnotic analgesia, with a highly hypnotizable patient) as an illustration of their position. The patient grimaced when the urethrotome was inserted into the urethra and dilated, but she denied discomfort and did not exhibit a reflex adduction of the thighs that is often observed even under standard general anaesthesia. She had spontaneous amnesia for the entire surgery. Later, under hypnosis, the patient could remember “discomfort and a sharp pain” which lasted for “seconds, if that” (p. 134).
The authors refer to Melzack and Wall’s (1965) gate control theory as well as Hilgard’s (1973) neodissociation interpretation of pain reduction in hypnosis. They review research by Hardy and Leichnetz (1981) with monkeys, in which they “traced the projections of the periaqueductal gray (PAG) to determine the extent of any possible cortical involvement in the endogenous analgesic system. Their work showed that the prefrontal cortex was the principal source of projections to the PAG” (p. 136). They quote the latter as writing that, “Patients who have had prefrontal lobotomies for relief of chronic pain report that while they still feel the pain they are no longer bothered by it … the prefrontal cortex by virtue of its projections to the PAG may play a role in modulating nociception at the spinal level” (Hardy & Leichnetz, 1981, p. 99).
“Hardy and Leichnetz have also suggested that there may be more than one analgesic system within the CNS. The first system is a naloxone-reversible mechanism which can be activated by opiates (presumably both endogenous and exogenous) and by acupuncture. Since hypnotic analgesia has shown itself not to be naloxone-reversible (Goldstein & Hilgard, 1975) it may have little to do with the opiate reception analgesia system. Instead the mechanism of hypnotic analgesia may lie in Hardy and Leichnetz’s second system which is sensitive to affective and cognitive influences” (pp. 136-137).
The authors include a review of the work by Mayer and Price (1976) which established the importance of brain stem structures in analgesia, especially for eliciting stimulation-produced analgesia. They cite Mayer and Price as drawing a distinction between “analgesia achieved by incapacitating a component in a pain transmission system or by activating a pain inhibition system” (p. 137). They also report that Mayer and Price conclude that stimulation-produced analgesia does not result from a “functional lesion” in the brain stem, but results from stimulation of a pain-inhibiting mechanism, suggesting the dorsal horn and trigeminal nucleus caudalis may be involved. This would be consistent with the inhibition of spinal reflexes (the adductor reflex) observed in their urethrotomy case, and the spinal reflex to nociception has also been reported by Finer (1974).
“The concomitant inhibition of reflexes in humans during hypnotic analgesia can be interpreted as evidence that nociception is probably not ascending to the cerebral cortex and that therefore the source of analgesia can be localized to the brain stem areas. It may be the case, however, that the locus of effect of hypnotic analgesia is not uniform across cases and may be identified by the overall pattern of subjective reports and physiological responses. Hypnotic analgesia may be experienced in more than one way subjectively and these differences may be attributable to differing underlying physiological mechanisms. On some occasions the relevant body part may be experienced as totally anaesthetised and all sensation (not only painful sensation) may be lost. This experience matches well with a brain stem involvement, which presumably inhibits any further afferent action. On other occasions, however, and more commonly, patients are still aware of a variety of sensations, which might include pressure in the case of childbirth or even cutting in the case of surgery, but these sensations are not described as painful. This is reminiscent of the effect of frontal lobotomy and it is tempting to focus on the frontal lobe as the locus of hypnotic analgesia effects in such instances” (p. 138).
Noll, Robert B. (1988). Hypnotherapy of a child with warts. Journal of Developmental and Behavioral Pediatrics, 9 (2), 89-91.
NOTES
Child with 82 warts was treated using hypnosis; suggestions for removal from face only resulted in 8 of 16 facial warts disappearing after one treatment and two weeks. (Child had previous experience with hypnosis for pain and anxiety associated with lumbar punctures and bone marrow aspirates.)
Pettinati, Helen M. (1988). Hypnosis and memory. New York and London: Guilford Press.
NOTES
From a review in British Journal of Experimental and Clinical Hypnosis, 7, 175- 178, by Vernon H. Gregg]:
Book has 5 sections: 1. method, theory 2. mechanisms of memory enhancement 3. hypnotic and other forms of reversible amnesia 4. clinical uses of hypnosis for increasing accessibility of memories and fantasies 5. Summary
The chapter by Martin Orne et al presents a comprehensive review. Perry, Lawrence, d’Eon and Tallant contribute a lively assessment of age regression procedures in the elicitation of inaccessible memories. They provide a description of procedures, a brief historical review, and discuss problems of confabulation and creation of pseudomemories. Their account is illustrated by clinical and forensic examples and gives an interesting account of belief in reincarnation in terms of source amnesia.
Section 3 has Hollander’s chapter on hysteria and memory, which illustrates the concept of reversibility of amnesia with two types of hysterical conditions: one of these types, the dissociative disorders, has the potential for amnesia to be reversed but the other, histrionic personality disorders, is characterized by no reversibility.
In the section on clinical studies of memory enhancement Frankel and Kolb both accept that uncovering repressed memories and fantasies is therapeutically beneficial and that the faithfulness of recovered memories is often not important for therapeutic success. Frankel illustrates the usefulness of hypnosis with several case studies. But he thinks that clinical issues are dealt with too briefly in this book. In her summary chapter Pettinati points to the dearth of systematic research into the effectiveness of hypnosis in clinical settings.
1987
Minichiello, William E. (1987). Treatment of hyperhidrosis of amputation site with hypnosis and suggestions involving classical conditioning. International Journal of Psychosomatics, 7-8.
Hyperhidrosis of an amputation site utilizing hypnosis and/or behavioral strategies has not been reported in the literature. This case report is on the successful use of hypnosis utilizing principles of classical conditioning in the treatment of a patient with hyperhidrosis of an amputated limb with two previous unsuccessful sympathectomies. The patient possessing moderate hypnotic ability as measured by the Stanford Hypnotic Clinical Scale (SHCS), reported a pre-treatment score of 10 on a 0-10 severity and intensity of sweating scale, and a post-treatment score of 0. All gains were maintained at the two-year follow-up.
NOTES
The patient was hypnotized while an electric fan was blowing on his stump and prosthesis. Direct suggestions were given according to procedures of thermal biofeedback. The suggestions were: 1. You will notice in days ahead that your stump feels increasingly cooler and drier. 2. You will feel throughout the day as if a cool breeze from a fan is blowing on your stump. 3. Whenever you pay attention to your leg during the day, particularly after the first few hours of the morning, you will associate that leg with a cool dry breeze from a fan blowing on it. 4. You will increasingly develop the power to cool and dry your stump.
The results were that 2 1/2 weeks later patient reported reduced frequency and intensity of sweating and significant healing of the stump ulcers; rating = 2. One month later, patient reported continued progress with almost normal skin color and stump condition; the patient discontinued disability, and returned to work. Patient returned one month later reporting, “It’s cured and my physician can’t believe it.” Rating = 0.
Author concludes that hypnosis should be tried prior to more invasive traditional procedures. In this case two previous sympathectomies failed to correct the condition and a third sympathectomy was being contemplated.
1986
Aronson, David M. (1986). The adolescent as hypnotist: Hypnosis and self-hypnosis with adolescent psychiatric inpatients. American Journal of Clinical Hypnosis, 28 (3), 163-169.
This paper describes the theoretical rationale, pragmatic implementation issues, and procedure for a particular technique of clinical hypnosis which is designed as an adjunctive therapy within a multidisciplinary adolescent inpatient treatment program. A model of combined auto- and heterohypnosis which features collaborative production of audiocassettes is presented. Advantages and indications for this technique are discussed, and a case study is presented. – Journal Abstract
DeBenedittis, Giuseppe; Sironi, Vittorio A. (1986). Depth cerebral electrical activity in man during hypnosis: A brief communication. International Journal of Clinical and Experimental Hypnosis, 34, 63-70.
To the authors’ knowledge, hypnosis has never been induced in epileptic patients during a depth EEG study. This neurosurgical diagnostic procedure has been routinely used in medically resistant epileptic patients for the preoperative exact delimitation of the epileptogenic lesion. It offers a unique opportunity to obtain fundamental information on the possible neurophysiological mechanisms implicated in hypnosis. Observations were carried out on 1 patient affected by medically resistant partial seizures with complex symptomatology. A chronic deep electrode study explored rhinencephalic structures as well as specific target areas of the cerebral cortex. Background electrical activity during hypnosis showed a significant decrease of slow waves and an increase of alpha and beta rhythms, with constant increase of amplitude, when compared to activity in the pre- and posthypnosis states. Focal interictal abnormalities were dramatically reduced during hypnosis.
NOTES:
Hypnotizability was assessed with the Barber Suggestibility Scale in order to test for suggestibility without a prior induction of hypnosis. The patient’s score was 7 out of 8 possible. Patient was hypnotized with a standard induction procedure (Barber & Calverley, 1963).
Experimental Protocol: 15 minutes resting baseline; 15 minute test of mental imagery (waking suggestions with imagination instructions); hypnosis with progressive relaxation; suggestions for dissociation; suggestions for amnesia; arousal from hypnosis (the patient was successful with positive hallucinations, catalepsy, total amnesia, and spontaneous analgesia); and posthypnosis awake and alert (5 minutes eyes open, 5 minutes eyes closed, then 15-minute recording of post-treatment waking baseline).
EEG background activity was scored for the number of sec/minute of delta (0-4), theta (4-7), alpha (8-12), and beta (13-30) rhythms, for each 5-min period. Score = percent as related to the 1-minute epoch. Number, amplitude, and diffusion of interictal spikes also were measured but ictal activity was not recorded during the periods considered. Experimenters also measured heart rate, respiratory rate, and mean blood pressure.
ANOVA for 4 conditions (resting, waking suggestion, hypnosis, and posthypnosis) was computed for background and for focal interictal activities, and the t-test used to evaluate significant differences. ANOVA indicated a significant effect across the four experimental conditions for theta and alpha in the temporal anterior cortex, temporal posterior cortex, and frontal convexity cortex. The effect was attributable only to changes in theta and alpha between baseline and hypnosis (theta decreasing, alpha increasing as the patient went into hypnosis). No other significant difference was found. Following arousal from hypnosis, EEG activity was similar to the EEG activity before the induction.
Interictal focal abnormalities were reduced during hypnosis, compared with before hypnosis. The effect was due to changes in the area of Ammon’s horn, the amygdala, the posterior temporal cortex, the mesial temporal cortex, and the inferior temporal cortex.
In their Discussion, the authors note that their data supports earlier work indicating that the limbic system is implicated in hypnosis. The cite the publications of Arnold (1959, International Journal of Clinical and Experimental Hypnosis) and Crasilneck, McCranie, and Jenkins (1956). The latter authors observed EEG records taken during brain surgery on one patient. Hypnosis terminated every time the hippocampus was stimulated, leading them to suggest that the hippocampus is part of the neural circuit involved in hypnosis.
“If it is assumed that a convulsion can be considered a result of both pathophysiological and emotional events operating in the individual, emotions being the most common precipitating factor in epilepsy, then any amelioration of one will raise the convulsive threshold or lower the seizure level (Goldie, 1979; MacCabe & Habovick, 1963). Although ‘voluntary control of the alpha rhythm’ was achieved over 40 years ago (jasper & Shagass, 1941), only since 1969 has such control been used for clinical purposes (Kamiya, 1969). One striking characteristic of the EEG pattern of many epileptics is the absence of a 12 to 14 c/s rhythm normally recorded from the anterior portions of the brain (sensorimotor rhythm) and the presence of a 4 to 7 c/s rhythm at the same location (Olton & Noonberg, 1980). Biofeedback may enable the individual to increase the amount of sensorimotor rhythm and to decrease the amount of 4 to 7 c/s activity. As a consequence, clinically significant decreases in seizure activity have been found after biofeedback training (Sterman, 1973, 1977).
“The present data demonstrate that in this female patient hypnosis induced a highly significant reduction of the interictal activity, concomitant with an increase of alpha and sensorimotor rhythm and a decrease of slow activity, similar to biofeedback but without prior training.
” In conclusion, a depth EEG study in one epileptic patient comparing EEG activity during hypnosis and pre- and posthypnosis suggests the following conclusions: (a) hypnosis may be associated with significant decrease of slow activity and an increase of alpha and relatively high frequency, beta activity; (b) electrophysiological correlates of hypnotic behavior support the possible role of the limbic system in mediating the trance experience; and (c) hypnosis is effective in reducing focal interictal abnormalities in this patient and so it can be considered a promising technique to prevent and/or reduce emotional precipitating factors and the tendency to develop seizure activity” (p. 69).
The article referenced regarding biofeedback training to reduce ictal activity is: Sterman, M. B. (1973). Neurophysiologic and clinical studies of sensorimotor EEG biofeedback training: some effects on epilepsy. In L. Birk (Ed.), _Biofeedback: Behavioral medicine._ New York: Grune & Stratton, Pp. 147-165.
Sterman, M. B. (1977). Effects of sensorimotor EEG feedback training on sleep and clinical manifestations of epilepsy. In J. Beatty & H. Legewie (Eds.), _Biofeedback: Behavioral medicine._ New York: Plenum, 1977, Pp. 167-200.
1986
Sands, Steven (1986, August). The use of hypnosis in establishing a holding environment to facilitate affect tolerance and integration in impulsive patients. Psychiatry, 49.
This paper is concerned with the use of hypnosis in establishing a facilitating and holding environment in the treatment of impulsive behavior across a range of diagnoses. The reason for this cross-diagnostic viewpoint is to underscore the common sources of such action and the needs to be met in its treatment. Illustrations from work with two patients are presented: One was a hypomanic and bulimic woman who was successful in her profession; the other was an underemployed and sometimes unemployed schizophrenic man. Both were inclined to self-defeating impulsive action—bulimia in the woman, assault in the man.
1985
Morris, Don M.; Nathan, Ronald G.; Goebel, Ronald A.; Blass, Norman H. (1985). Hypnoanesthesia in the morbidly obese. Journal of the American Medical Association, 253 (22), 3292-3294.
The advent of chemical anesthesia relegated hypnosis to an adjunctive role in patients requiring major operations. Anesthesia can be utilized with acceptable risk in the great majority of patients encountered in modern practice. But an occasional patient will present–such as one with morbid obesity–who needs a surgical procedure and who cannot be safely managed by conventional anesthetic techniques. This report describes our experience with such a patient and illustrates some of the advantages and disadvantages of hypnoanesthesia. The greatest disadvantage is that it is unpredictable. Close cooperation between the patient, hypnotist, anesthesiologist, and surgeon is critical. However, the technique may be utilized to remove very large lesions in selected patients. Hypnoanesthesia is an important alternative for some patients who cannot and should not be managed with conventional anesthetic techniques
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).
Brown, Erick L.; Kinsman, Robert A. (1984). Resolving intractable medical problems through psychological intervention: A clinical report. Psychotherapy, 21, 452-455.
Treatment of chronic physical illness is often complicated by psychological factors that maintain and exacerbate the illness. Hypnotic techniques, coupled with insight-oriented psychotherapy comprised an effective strategy for favorably influencing medical outcome. A clinical report illustrates how psychological intervention initiated the resolution of severe medical problems in an asthmatic patient.
Cocores, James A.; Bender, Andrew L.; McBride, Eugene (1984). Multiple personality, seizure disorder, and the electroencephalogram. Journal of Nervous and Mental Disease, 172, 436-438.
Used the EEG to study multiple personality in a 48-yr-old ambidextrous male admitted for alcohol detoxification and individual psychotherapy. Despite conflicting reports in the literature, no changes in the EEG were found that could not be ascribed to the normal changes seen in transitions from various states of alertness. The problems of differentiating multiple personality as a psychiatric entity in itself from those cases arising as a result of chronic partial or partial-complex epilepsy are discussed.
Elkins, Gary R. (1984). Hypnosis in the treatment of myofibrositis and anxiety: A case report. American Journal of Clinical Hypnosis, 27, 26-30.
A 38-year-old woman with chronic myofibrositis pain was treated by the se of hypnosis and psychotherapy. Hypnotherapeutic techniques, including symptom alteration, relaxation, and insight, are described. This regimen resulted in reduction in pain and emotional distress. which was maintained at three months and one year after treatment.
Fogel, Barry S. (1984). The ‘sympathetic ear’: Case reports of a self-hypnotic approach to chronic pain. American Journal of Clinical Hypnosis, 27 (2), 103-106.
Secondary gain issues may limit the success of hypnotherapeutic approaches to chronic pain. A self-hypnotic suggestion that promotes patients’ awareness of the interpersonal aspects of their pain complaints was used in the treatment of two patients with chronic headache. Hypnotic suggestions that help make secondary gains conscious may be a useful addition to hypnotic techniques of pain management.
Gould, Sol S.; Tissler, Doreen M. (1984). The use of hypnosis in the treatment of herpes simplex II. American Journal of Clinical Hypnosis, 26, 171-174.
Hypnosis training was used to treat the painful lesions and emotional symptoms associated with Herpes Simplex II in two females, ages 32 and 26. Three weekly sessions of hypnosis and daily practice sessions were initiated in the first case. During this time, the patient experienced a decline in the subjective level of pain and severity of the lesions, as well as an elevation in mood level. On three-month followup, she reported no pain or skin eruptions and significantly less feelings of stress and anxiety. The second case utilized two sessions of hypnosis and daily practice sessions, and similar results were obtained. A traumatic event caused a relapse in the latter patient, but she was again able to use hypnosis to bring the virus back under control and to experience an elevation in mood level as well. A seven-month follow-up indicated no eruptions and an improvement in self-esteem.
NOTES
In the first case the tape included ego-strengthening suggestions (Hartland, 1971); another tape used the patient’s fantasy of water and snow skiing. The patient felt that hypnosis helped her acquire a more positive attitude toward herself and relief of guilt and blame, as well as an improved ability to cope with the unpleasant sensations.
In treatment session, ego strengthening suggestions were followed by 2 minutes of quiet for integration of suggestions, then visualization used in cancer therapy (Simonton): suggestions of a strong cell structure, perfect skin, hormonal balance, cleanliness, and a cooling refreshed feeling in the area of the vagina and perineum; imagery of internally controlled friendly white sharks was used to “devour” the virus; of water and snow skiing, imagery of cool breezes, white refreshing snow, clean fresh water; visualized herself forgiving and releasing her previous boyfriend of guilt, thereby allowing her anger to abate.
For second patient it was similar, plus visualization of being bathed in white lights and traveling through concentric circles radiating peace and protection, being purified as she traveled through the circles until she emerged as flawless as a diamond, reflecting only clarity and light. Both patients scored 4 on Spiegel’s Hypnotic Induction Profile (HIP).
Handelsman, Mitchell M. (1984). Self-hypnosis as a facilitator of self-efficacy: A case example. Psychotherapy, 21 (4), 550-553.
This article presents the four-session treatment of Elaine, using self- hypnosis to facilitate the mourning process. It is argued that self-hypnosis– rather than enhancing imagery– increases self-efficacy, a person’s feeling that he/she can perform behaviors that lead to desired outcomes. Elaine’s sense of self-efficacy was increased by allowing her to choose scenes from her life to be explored in the context of the use of imagery. Elaine imagined events surrounding her father’s death, and “rewrote history” in an attempt to permit herself the direct expression of emotions.
Margolis, Clorinda G. (1984). Hypnosis and cancer: An overview of the field. [Unpublished manuscript]
NOTES:
This paper apparently was presented either at American Psychological Association or the Society for Clinical and Experimental Hypnosis. The author has two tables summarizing types of cancer associated with pain, and pain syndromes in patients with cancer.
Table 3 is a list of Erickson’s procedures for Controlling Pain: –Direct hypnotic suggestion for total abolition of pain –Permissive indirect hypnotic abolition of pain –Amnesia –Hypnotic analgesia –Hypnotic anesthesia –Hypnotic replacement or substitution of sensations –Hypnotic displacement of pain –Hypnotic dissociation
Time and body disorientation –Hypnotic reinterpretation of pain experience –Hypnotic time distortion –Hypnotic suggestions effecting a diminution of pain
(from Rossi, Ed., _Innovative Hypnotherapy_, Vol. IV of the Collected Papers of Milton H. Erickson on Hypnosis, 1980
Table 4 is a list of Sacerdote’s Procedures for Controlling Pain: –Teleological approach –Reinterpretation of signals –Associating and conditioning –Dissociation –Simile of electric wiring –Development of amnesia –Positive and negative hallucinations –Induction of dreams –Time and space distortion, and elicitation of mystical states –Relaxation techniques –Glove anesthesia and analgesia –Pain management through control of autonomic functions
(from Barber & Adrian, Eds., _Psychological Approaches to the Management of Pain_, 1982)
The author describes cases treated by Erickson (one in which he used 12 hours of training, in one session, reported in Rossi’s 1980 edited writings of Milton Erickson, Vol. IV) and by Sacerdote.
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.
Nugent, William R.; Carden, Nick A.; Montgomery, Daniel J. (1984). Utilizing the creative unconscious in the treatment of hypodermic phobias and sleep disturbance. American Journal of Clinical Hypnosis, 26 (3), 201-205.
An Ericksonian hypnotherapeutic procedure is designed to access and direct creative unconscious processes toward the creation and implementation of satisfactory solutions to recurrent problem behaviors. The use of the procedure is described in 3 cases. Two of the cases involve treatment of severe hypodermic needle phobias. The third case involves use of the procedure in treatment of a somnambulistic sleep disturbance. Possible curative forces tapped by the procedure, suggestions for its continued use, and suggestions for further investigation of the procedure are also discussed.
NOTES
The procedure involved: 1. Pretrance discussion of unconscious mental processes 2. Hypnosis, followed by “Now your unconscious mind can do what is necessary, in a manner fully meeting all your needs as a person, to insure that [desired therapeutic outcome], and as soon as your unconscious knows that you will [desired therapeutic outcome] it can signal by [appropriate ideomotor signal]” 3. Post-ratification.
Example: “‘Now your unconscious mind can do what is necessary, in a manner fully meeting all your needs as a person, to insure that you remain comfortably awake and alert anytime you receive an injection in the future, and as soon as your unconscious knows you will remain comfortably awake and alert when receiving an injection it can signal by lifting your right hand into the air off the chair.’ This suggestion was [their] communicative effort to access and direct unconscious processes to the creation and implementation of altered behavioral responses to injections. Three minutes after the suggestion, B’s right hand lifted jerkily into the air. She was then awakened and experienced a complete amnesia for the trance period” (p. 203).
“[They] then carried out a procedure to ratify the therapeutic change. This process presumably further develops expectancy of change, confirms change at the unconscious level, and puts doubt into any conscious beliefs contrary to positive change. This step is standardly carried out as was done with B. [They] had B sit with her hands resting on the arms of the chair. [They] told her they would ask her unconscious mind a question that only it would know the answer to. It could answer ‘yes’ to the question by lifting her left hand, ‘no’ by lifting her right hand, and ‘I don’t know’ or ‘I don’t want to answer’ by lifting both hands. Then the question was asked, ‘In the future, will B remain comfortably awake and alert anytime she receives an injection or a blood test?’ After a few minutes her left hand jerked momentarily into the air. After some discussion about the ideomotor response and her trance experience they dismissed her with the prescription to ‘await the surprising results'” (p. 203).
The authors cite as a source for their work two books: Erickson, Rossi, and Rossi, Hypnotic Realities, 1976, pp. 226-230; also Erickson & Rossi, Hypnotherapy, 1979.
1981
Baker, Elgan L. (1981). An hypnotherapeutic approach to enhance object relatedness in psychotic patients. International Journal of Clinical and Experimental Hypnosis, 29 (2), 136-147.
The present paper develops a conceptual rationale for utilizing hypnosis in the intensive psychotherapy of acutely psychotic patients which emphasizes deficits in object relatedness and associated ego pathology stemming from impaired internalized object representations. From this perspective, specific hypnotherapeutic techniques are suggested to enhance the positive aspects of the emerging transference in psychotherapy and to support the patient’s capacity to establish and maintain real connections with the external environment. Special attention is directed toward the hypnotherapeutic management of various aspects of psychotic ambivalence and “primitive splitting” as significant sources of dynamic and structural resistance in work with these patients. Case material is presented to illustrate aspects of this conceptual and technical approach.
Fromm, Erika (1981). How to write a clinical paper: A brief communication. International Journal of Clinical and Experimental Hypnosis, 29, 5-9.
The standards for publishing clinical papers are in some ways the same and in some ways different from those applying to experimental articles. The present paper, written by the Clinical Editor of the International Journal of Clinical and Experimental Hypnosis, is meant to be a guide to clinicians on how to write publishable papers and to reviewers and readers on how to evaluate them.
NOTES 1:
“An outline could follow this sample:
a) Statement of problem.
b) Review of literature — and not only the literature of the last 5 years.
c) Clinical material — number of patients, descriptions of cases.
d) Description of method of treatment. If it is a new technique, give a verbatim account.
3) Results.
f) Discussion. (Evaluate your own results and, if appropriate, compare them to those in the literature.)
g) Conclusion.
h) Tables and Figures (if appropriate).
i) Footnotes.
j) List of references.
k) Abstract” (pp. 6-7).
“In closing, here is a short reviewers’ and editors’ guide — a set of questions editors and referees ask. It might be helpful to be aware of these questions as you write a paper.
1. Is the article appropriate for our journal? Does it deal with hypnosis?
2. Has the hypothesis been made explicit?
3. Has the reason for or the origin of the hypothesis been made clear?
4. Does the paper describe something new or describe the approach to an old field in a new way?
5. Are references missing? Are all the citations correct and necessary? Or, is there padding?
6. Has the author been careful to cite prior reports dealing with the same topic? Prior theories about the same topic?
7. What was the “set” given to subjects? Was there control for experimenter influence and demand characteristics?
8. Were patients led to believe they were receiving treatment or not?
9. How was the diagnosis arrived at? Is it correct? Or, does the material given remain unclear as to the correctness or incorrectness of the diagnosis?
10. Was administration and scoring of tests and evaluation of the results done correctly?
11. If statistics were used, were they used corerctly?
12. Are the figures, graphs, and tables used necessary and sufficient? Do they correspond logically to the textual argument of the article?
13. Is the discussion properly confined to the findings or is it digressive? Does it include new post-hoc speculations?
14. Has the author explicitly considered and discussed viable alternative explanations?” (p. 9).
Gross, Meir, M. D. (1981). Hypnosis for dissociation — diagnostic and therapeutic. Journal of the American Society of Psychosomatic Dentistry and Medicine, 28 (2), 49-56
NOTES:
Dissociative disorders might be at times very difficult to diagnose and treat, especially since they are very similar to epilepsy in general and to temporal lobe epilepsy in particular. Amnesia, fugue, changing personality and depersonalization are part of both disorders. Patients who suffer from dissociative disorders might be diagnosed and treated for epilepsy with anticonvulsive medications without any beneficial results. These patients are labeled as epileptics and have to face the social stigmata associated with being epileptic. The wrong label could even reinforce the sick role and make it become fixed and chronic.
Hypnosis was used to diagnose the dissociative disorder by using the hand levitation technique for the differential diagnosis. It was found by the author that patients who suffer from dissociative disorders would get into spontaneous hypnotic trance during the hand levitation. Hypnosis was used also for successful therapy of these patients.
Seven cases are presented in which the hand levitation technique was used to diagnose the dissociative disorder. They were also treated by hypnotherapy. Their treatment by hypnosis is discussed. The purpose of this paper is to introduce the hand levitation technique for the differential diagnosis of dissociative disorder and to emphasize the effectiveness of hypnotherapy in the treatment of this disorder. Sorting out the cases of dissociative disorders from the epileptics is very important clinically, since it can save many patients from the anguish of having to take anti-convulsants unnecessarily and having to face the social stigmata of being labeled as epileptic.
1979
Kleinhauz, Moris; Dreyfuss, Daniel A.; Beran, Barbara; Goldberg, Tova; Azikri, David (1979). Some after-effects of stage hypnosis: A case study of psychopathological manifestations. International Journal of Clinical and Experimental Hypnosis, 27, 219-226.
Some deleterious effects of stage hypnosis are described through a case report. A middle-aged respected member of a kibbutz who became the subject of an evening’s entertainment by a stage hypnotist suffered a posttraumatic neurosis. The stage hypnotist, unaware of her traumatic childhood during World War II when she and her sister were hidden by Gentiles, requested her to regress to that age. This reactivated a former successfully repressed trauma and acted as a precipitating factor to the development of a traumatic neurosis which was left untreated. She was self-referred for adequate psychiatric treatment 11 years ater. This treatment successfully restored her to an adequate level of functioning.
1978
Gruenewald, Doris (1978). Analogues of multiple personality in psychosis. International Journal of Clinical and Experimental Hypnosis, 26, 1-8.
A brief discussion of taxonomic and diagnostic problems in the multiple-personailty syndrome precedes presentation of theoretical considerations. The disorder is conceptualized as a category sui generis on a continuum from neurosis to psychosis. Attenuated forms are considered as pertaining to the syndrome with supporting case material.
Sanders, Shirley (1978). Creative problem-solving and psychotherapy. International Journal of Clinical and Experimental Hypnosis, 26, 15-21.
The techniques described comprise a creative problem-solving approach to short-term individual psychotherapy which appears effective in conjunction with hypnosis. The techniques include describing and visualizing the client’s problem, imagining alternative reactions, dreaming about new solutions, and trying the solutions in real life. The method is illustrated by 2 clinical examples. The discussion focuses on a comparison of the techniques used with individuals versus with small groups, the fostering of regression in the service of the ego, and the redirection of attention from the physically out of control to the recognition of the possibility of obtaining control. This shift of attention fosters active coping on the part of the client.
1977
Anderson, J. W. (1977). Defensive maneuvers in two incidents involving the Chevreul pendulum: A clinical note. International Journal of Clinical and Experimental Hypnosis, 25, 4-6.
NOTES
“Hypnosis frequently facilitates increased access to the unconscious. In both of these cases, the hypnotized subject gained contact with a thought which otherwise would likely have remained out of awareness. Then the ego quickly resorted to defensive maneuvers in order to deny the thought” (p. 6).
Chertok, Leon; Michaux, D.; Droin, M. C. (1977). Dynamics of hypnotic analgesia: Some new data. Journal of Nervous and Mental Disease, 164, 88-96.