(From the cover) Focuses on structuring and delivering of hypnotic interventions for major depression, with a substantial use of concepts and techniques from cognitive-behavioral and strategic approaches as a foundation. Current research on depression is used to emphasize the still growing knowledge of depression. Hypnosis has shown itself to be effective in not only reducing symptoms, but in teaching the skills (such as rational thinking, effective problem-solving and coping strategies, and positive relationship skills) that can prevent recurrences. (PsycINFO Database Record (c) 2002 APA, all rights reserved).
Received the Arthur Shapiro Award for best book published in 2001, from the Society for Clinical and Experimental Hypnosis.
2000
Eimer, Bruce. N. (2000). Clinical applications of hypnosis for brief and efficient pain management psychotherapy. American Journal of Clinical Hypnosis, 43 (1), 17-40. (July)
This paper describes four specific clinical applications of hypnosis that can make psychotherapy for pain management briefer, more goal-oriented, and more efficient: (1) the assessment of hypnotizability; (2) the induction of hypnotic analgesia and development of individualized pain coping strategies;
(3) direct suggestion, cognitive reframing, hypnotic metaphors, and pain relief imagery; and (4) brief psychodynamic reprocessing during the trance state of emtoional factors in the patient”s experience of chonic pain. Important theoretical and clinical issues regarding the relationship between hypnotizability to the induction of hypnotic analgesia are presented, and attempts to individualize pain treatment strategies on the basis of assessed differences in hypnotizability and patients” preferred coping strategies are described. Some ways are also presented of integrating direct hypnotic suggestion, COGNITIVE-EVALUATIVE reframing, hypnotic metaphors, and imagery for alleviating the SENSORY and AFFECTIVE-MOTIVATIONAL components of pain, with an exploratory, insight-oriented, and brief psychodynamic reprocessing approach during trance for resolving unconscious sources of resistance to treatment, and reducing the emotional overlay associated with chronic pain. Some basic assumptions underlying the use of this approach are discussed, and a brief step-by-step protocol is outlined.
1999
Capafons, A. (1999). Applications of emotional self-regulation therapy. In Kirsch, I.; Capafons, A.; Cardeqa, E.; Amigs, S. (Ed.), Clinical hypnosis and self-regulation: Cognitive-behavioral perspectives (pp. 331-349). Washington, D.C.: American Psychological Association.
This chapter reviews the main applications of emotional self-regulation therapy, which have received empirical support: smoking reduction, obesity, fear of flying, drug addictions, and premenstrual distress and dysmenorrhea. The logic of each treatment and main empirical results are summarized.
1998
Alden, Phyllis; Heap, Michael (1998). Hypnotic pain control: Some theoretical and practical issues. International Journal of Clinical and Experimental Hypnosis, 46 (1), 62-76.
Pain management programs assist patients to use their behavioral and cognitive skills for the purpose of rendering their experience of pain as more tolerable in some way. Hypnotic procedures may be included in this perspective. Thus, hypnosis may be best conceived as a set of skills to be deployed by the individual rather than as a state. The authors contend that such an emphasis is more compatible with the approaches of some pain management practitioners who have been generally slow to acknowledge the value of hypnosis and to incorporate hypnosis in their range of treatment skills. In this article, the authors present a minimal and atheoretical definition of hypnosis, and they list the basic properties of hypnosis that may be used in the treatment of pain. For a number of reasons, it is suggested that undertaking hypnosis as though the individual were indeed being placed into a special trance state may in some cases promote an effective outcome. However, it should be acknowledged that there may be instances when the relevant skills may be more effectively engaged at the expense of a strict special trance state by targeting the specific skills that are to be used for therapeutic benefit.
Barber, Joseph (1998). The mysterious persistence of hypnotic analgesia. International Journal of Clinical and Experimental Hypnosis, 46 (1), 28-43.
Hypnotic treatment of pain has a long history and, among hypnotic phenomena, pain relief is a relatively commonplace focus for intervention, yet we lack a conceptual explanation for this treatment. Hilgard’s neodissociation theory accounts for the phenomenon of acute hypnotic analgesia, but not of persistent pain relief. Perhaps the enduring effect of hypnotic treatment can be explained at either of two levels: a neurophysiological model or a learning model. This explanation leads to the further question: How does hypnotic treatment of recurring pain achieve enduring relief? Clinical experience suggests a two-component model. First, the clnician communicates specific ideas that strengthen the patient’s ability to derive therapeutic support and to develop a sense of openness to the unexplored possibilities for pain relief within the security of a nurturing therapeutic relationship. Second, the clinician employs posthypnotic suggestions that capitalize on the patient’s particular pain experiences, which simultaneously ameliorate the pain experience, and which, in small, repetitive increments, tend to maintain persistent pain relief over increasing periods of time.
NOTES
Author’s Summary: “When a patient who suffers from recurring pain is treated with hypnotic methods and then reports substantial relief over time, what is significant is that the relief is so long-lasting, and that it endures through the patient’s various daily activities. Although I believe that the initial alteration of consciousness via the hypnotic experience greatly facilitates subsequent analgesia, it is not necessary to believe, nor is it even plausible, that subsequent analgesia is accomplished through re-creation of the hypnotic condition. Rather, it appears that the patient is able to generalize from these initial experiences to achieve this analgesia independent of a hypnotic intervention.
“Laboratory research and clinical experience suggest that the persistence of hypnotic analgesia is a function of learning, the therapeutic relationship that fosters that learning, and the neurophysiological changes that subserve that learning. The patient’s understandnig of the meaning and purpose of the clinician’s suggestions is a primary determiner of their efficacy” (pp. 39-40).
Capafons, A. (1998). Rapid self-hypnosis: A suggestion method for self-control.. Psychotema, 10 (3), 571-581.
A structured self-hypnosis method -rapid self-hypnosis- is described.This method has been created from a cognitive-behavioral perspective, and has received empirical validation. Some clinical applications of rapid self-hypnosis are shown from a coping skills and self-control orientation. From this perspective, the use of the method in everyday activities are emphasized. Clients can use suggestions while keeping their eyes open and being active. Mention of altered states of consciousness, trance or esoteric ideas is absolutely avoided.
Easterlin, Barbara L.; Cardena, Etzel (1998-99). Cognitive and emotional differences between short- and long-term Vipassana meditators. Imagination, Cognition and Personality, 18 (1), 69-81.
This study compared perceived stress and cognitive and emotional differences between two groups of Buddhist mindfulness [Vipassana] meditators. Nineteen beginning and twenty-four advanced meditators carried electronic pagers for five days and responded to daily random signals by completing an Experience Sampling form (ESF) containing items related to the dependent variables. As compared with beginners, advanced practitioners reported greater self-awareness, positive mood, and acceptance. Greater stress lowered mood and self-acceptance in both groups, but the deleterious effect of stress on acceptance was more marked for the beginners. These findings validate in a naturalistic setting some of the effects described in traditional Buddhist texts on mindfulness.
NOTES
“Meditation can be defined as the deliberate deployment of mental attention to obtain a particular patterning of consciousness. The aim of such control may be the stabilization of the stream of thought, greater relaxation, the attainment of an altered state, or the development of insights into the nature of mind [12]. Mindfulness meditation has sometimes been contrasted with concentration meditation as one of two main forms of meditation practice [13, 14]. The usual distinction is that mindfulness involves opening awareness to all contents and processes of mind, whereas concentrative forms of meditation involve shutting out all stimuli extraneous to a single object of attention” (p. 70). Long-term meditators averaged 103 months and 85 days of retreat training. They did not differ from short-term meditators on measures of absorption, neuroticism, trait anxiety, or cognitive style; however they evidenced greater self-awareness and acceptance. The short-term meditators actually had more than a year of meditation experience so that differences between groups are not likely to be due to self-selection. The authors conclude that “meditation brings about sustainable changes in people’s lives, above and beyond relaxation. … [and] that greater conscious awareness through mindfulness techniques such as Vipassana meditation, increases acceptance, positive mood, and the ability to dispassionately observe one’s mental states. These results have implications for clinical issues such as pain management and psychotherapy, in which acceptance and awarenss are necessary ingredients for therapeutic change” (p. 78). JH
Weisenberg, Matisyohu (1998). Cognitive aspects of pain and pain control. International Journal of Clinical and Experimental Hypnosis, 46 (1), 44-61.
The cognitive and cognitive-behavioral approaches have been shown to be very effective in controlling pain and its sequelae both in the laboratory and in the clinical setting. As used in most research and treatment, cognitive approaches are concerned with the way the person perceives, interprets, and relates to his or her pain rather than with the elimination of the pain per se. This article reviews some of the origins of cognitive theory and pain theory, as well as examples of the techniques used and the research support for the approach. Special emphasis is given to self-efficacy, perceived control, and stress inoculation therapy. There is also discussion of some of the limitations of the cognitive approach. The overall conclusion is that the cognitive approach is a powerful and effective one for pain control despite its limitations.
1996
Amigs, S.; Capafons, A. (1996). Emotional self-regulation therapy for treating primary dysmenorrhea and premenstrual distress.. In Lynn, S. J.; Kirsch, I.; Rhue, J. W. (Ed.), Casebook of clinical hypnosis. (pp. 153-171). Washington, D.C.: American Psychological Association.
A case study on dysmenorrhea and premenstrual distress is presented, using emotional self-regulation therapy. Authors show a step by step approach in how to treat this kind of problem, using suggestions in an awake, alert state. Follow-up data are included.
Kessler, Rodger; Dane, Joseph R. (1996). Psychological and hypnotic preparation for anesthesia and surgery: An individual differences perspective. International Journal of Clinical and Experimental Hypnosis, 44 (3), 189-207.
Multiple reviews indicate that psychological preparation for surgery can provide psychological, physiological, and economic benefit to the patient. Research demonstrating that hypnosis adds to this benefit is both limited and encouraging. The content and status of this literature, however, are confusing, with little coherent theoretical basis to account for the contradictions and inconsistencies across multiple studies whose methodologies often limit generalization. A model is presented regarding pertinent individual differences that include patient coping styles, prior medical experiences, and hypnotic ability, as well as differences in types of coping demanded by different surgical procedures. This model (a) helps explain some of the confusion, (b) offers a theoretical focus for patient assessment as well as development and selection of preparation strategies, and (c) clarifies future research goals.
1994
Wickramasekera, Ian (1994). Psychophysiological and clinical implications of the coincidence of high hypnotic ability and high neuroticism during threat perception in somatization disorders. American Journal of Clinical Hypnosis, 37, 22-33.
The electrodermal response to cognitive threat of unhypnotized female patients with somatic symptoms and high on both hypnotic ability and neuroticism (H-H) was found to be significantly higher (p<.01) than that of a matched group of female patients moderate on hypnotic ability and low on neuroticism (M-L). On verbal report the H-H and the M-L groups did not differ, but they were significantly different on a measure of self-deception (L scale) or repression. The above findings are consistent with predictions from the High Risk Model of Threat Perception (HRMTP), which states that people in the H-H group are both chronically and acutely more reactive to threat than the people in the M-L group. This finding may have important theoretical, clinical, and financial implications for the diagnosis, therapy, and prevention of somatization disorders seen in primary medical care. 1993 Bruehl, Stephen; Carlson, Charles R.; McCubbin, James A. (1993). Two brief interventions for acute pain. Pain, 54, 29-36. This study evaluated two brief (3-5 min) interventions for controlling responses to acute pain. Eighty male subjects were randomly assigned to 1 of 2 intervention groups (Positive Emotion Induction (PEI) or Brief Relaxation (BR)) or to 1 of 2 control groups (No-instruction or Social Demand). The PEI focused on re-creating a pleasant memory, while the BR procedure involved decreasing respiration rate and positioning the body in a relaxed posture. All subjects underwent a 60-sec finger pressure pain trial. Analyses indicated that the PEI subjects reported lower ratings of pain, fear, and anxiety, and experienced greater finger temperature recovery than controls. The BR procedure resulted in greater blood pressure recovery, but did not alter ratings of pain or emotion relative to controls. Further research is needed to explore the clinical use of the PEI for acute pain management. Kessler, Roger S. (1993, October). Suggestion and hypnosis in anesthesiology and surgery: A simple and complicated analysis. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL. NOTES Cites three reviews: Blankenfield; Rogers & Reich; and Mumford. These reviews leave us with several questions: - What does the addition of hypnosis add? - What is importance of hypnotic ability? - What techniques are most effective? - How useful are standardized tailored interventions? - What are psychological, physiological, and biochemical markers? We lack a general theoretical framework (see H. Bennett), and there are a broad variety of pre-surgical interventions, which may influence different aspects of functioning. Evans & Richardson found no differences between people with and without preparatory interventions. Bonke & colleagues found no differences in length of hospitalization for people with and without preparatory interventions (except for people 55 and over). Relaxation training for surgery finds mixed results. Blankenfield obtained negative findings in cardiac surgery. His recent IJCEH article reports those negative results. What does presurgical intervention influence? - Psychological dimensions - Biochemical & physiological dimensions - Time/cost dimensions Correspondence across these dimensions has not been consistently demonstrated, e.g. there is a lack of correlation between cortisol (physiological dimension) and anxiety (psychological dimension). Why are there conflicting findings? 1. Possibly patient's coping style is responded to inappropriately, e.g. people who deny vs those who sensitize seem to require different interventions. Must assess the patient's idiosyncratic coping style. 2. Four studies suggest hypnotic ability may be a factor in recovery. a. Disbrow, Bennett, & Owings (1993) b. Rondi et al. (high hypnotizables use less morphine via Patient Controlled Analgesia) c. Greenleaf et al. (hypnotizability predicts recovery independently) d. Rapkin, Straubing, & Holroyd (high hypnotizables had less blood loss during surgery) 3. Is hypnosis per se necessary? Comparative evaluation of strategies has been ignored. Enqist found hypnosis had a greater effect than non-hypnotic treatment in blood loss. Another study of bone marrow transplant patients found the hypnosis treatment superior. When it comes to clinical interventions, we need to assess the patient's historic and current beliefs, their experience with medical procedures, their coping style, and then form a brief tailored intervention. Page, Roger A.; Handley, George W. (1993). The use of hypnosis in cocaine addiction. American Journal of Clinical Hypnosis, 36, 120-123. An unusual case is presented in which hypnosis was successfully used to overcome a $50-0 (five grams) per day cocaine addiction. The subject was a female in her twenties. Six months into her addiction, she acquired a commercial weight-control tape that she used successfully to stop smoking cigarettes (mentally substituting the word "smoking"), as well as to bring her down from her cocaine high and allow her to fall asleep. After approximately 8 months of addiction, she decided to use the tape in an attempt to overcome the addiction itself. Over the next 4 months, she listened to the tape three times a day, mentally substituting the word "coke." At the end of this period, her addiction was broken, and she has been drug free for the past 9 years. Her withdrawal and recovery were extraordinary because hypnosis was the only intervention, and no support network of any kind was available. 1992 Lynn, Steven Jay; Sivec, Harry (1992). The hypnotizable subject as creative problem-solving agent. In Fromm, Erika; Nash, Michael R. (Ed.), Contemporary hypnosis research (pp. 292-333). Guilford Press. NOTES These notes are taken only from the section of this chapter that deals with Hypnotic Responding, Imaginative Activity, and Expectancies, and they treat of the concept of nonvoluntary responding (pp 315-316). Other topics covered in the chapter include: Imagination, Fantasy, and Hypnosis Theories; The Hypnotizable Subject as Creative Problem-Solving Agent; Hypnosis and Subjects' Capability for Imaginative Activity; Goal-Directed Fantasy: Patterns of Imaginative Activity during Hypnosis; Hypnosis and Creativity; and a Conclusion. Several studies manipulated expectancies re the relationship between imagination and involuntariness. When Ss were told that "good" hypnotic subjects could (or could not) resist suggestions, "this information affected their ability to resist the hypnotist and tended to affect subjects' report of suggestion-related involuntariness ... [Lynn, Nash, Rhue, Frauman, & Sweeney, 1984]. Furthermore, subjects who successfully resisted suggestions and subjects who failed to do so reported comparable levels of hypnotic depth and imaginative involvement in suggestions. "Spanos, Cobb, and Gorassini (1985) conducted a similar experiment in which they found that hypnotizable subjects who were instructed that they could become deeply involved in suggestions and yet resist them successfully resisted 95% of the suggestions and rated themselves as maintaining voluntary control over their behavior. Thus, subjects are able to resist nearly all of the suggestions when resistance is facilitated by situational demands. It is worth noting that subjects in this research who resisted hypnotic suggestions rated themselves as just as deeply involved in the suggestions as Ss who failed to resist suggestions after being informed that deeply hypnotized subjects were incapable of resisting suggestions" (pp. 315-316). Lynn, Snodgrass, et al. (1987). showed that hypnotizable Ss who were just "imagining" along with suggestions but instructed to resist responding to motoric suggestions acted the way hypnotized Ss did in their earlier countersuggestion research: imagining subjects tended to move in response to suggestion (that "good" Ss responded in certain ways), despite being instructed to resist. In this study, with instructions designed to increase the use of goal directed fantasies (GDFs), low and high hypnotizable subjects reported equivalent GDF absorption and frequency of GDFs. However, highs responded more and reported greater involuntariness than lows, even when their GDFs were equivalent. "A number of other studies have examined the effects of expectancies on imaginings and hypnotic behavior. Spanos, Weekes, and de Groh (1984) informed subjects that deeply hypnotized individuals could imagine an arm movement in one direction while their unconscious caused the arm to move in the opposite direction. Even though subjects so informed moved in the opposite direction, they imagined suggested effects and described their countersuggestion behavior as involuntary" (p. 317). Wickramasekera, Ian (1992, August). Hypnotic ability as a risk factor for psychopathology and pathophysiology. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, DC Eighty-three patients with psychophysiological disorders seen prior to therapy were tested on the seven risk factors of the High Risk Model. Thirty-two percent of these patients were high on hypnotic ability, and hypnotic ability was unrelated to all of the other six risk factors. Mean social support and coping skills were significantly below the norm. Mean catastrophizing, negative affect (neuroticism), major life change and minor hassles were significantly above the norm. There are positive and significant correlations between hassles, negative affect and catastrophizing. There are also positive and significant correlations between coping skills and number and level of satisfaction with social support. There are negative and significant correlations between coping skills, catastrophizing, negative affect and hassles. There are also negative and significant correlations between satisfaction with social support, catastrophizing, and hassles. (ABSTRACT from the Bulletin of Division 30, Psychological Hypnosis, Fall, 1992, Vol. 1, No. 3.) 1991 Burish, Thomas G.; Snyder, Susan L.; Jenkins, Richard A. (1991). Preparing patients for cancer chemotherapy: Effect of coping preparation and relaxation interventions. Journal of Consulting and Clinical Psychology, 59 (4), 518-525. 60 cancer chemotherapy patients were randomly assigned to 1 of 4 treatments: (a) relaxation training with guided relaxation imagery (RT), (b) general coping preparation package (PREP), (c) both RT and PREP, or (d) routine clinic treatment only. All patients were assessed on self-report, nurse observation, family observation, and physiological measures and were followed for 5 sequential chemotherapy treatments. Results indicate that the PREP intervention increased patients' knowledge of the disease and its treatment, reduced anticipatory side effects, reduced negative affect, and improved general coping. RT patients showed some decrease in negative affect and vomiting, but not as great as in past studies. The data suggest that relatively simple, 1-session coping preparation intervention can reduce many different types of distress associated with cancer chemotherapy and may be more effective than often-used behavioral relaxation procedures. 1990 Avants, S. Kelly; Margolin, Arthur; Salovey, Peter (1990-91). Stress management techniques: Anxiety reduction, appeal, and individual differences. Imagination, Cognition and Personality, 10, 3-23. NOTES Four stress management techniques were evaluated for their general appeal, their immediate benefits, and the subjective experiences they evoke. One hundred undergraduates were randomly assigned to one of five treatment groups: (1) progressive muscle relaxation (PMR); (2) distraction imagery; (3) focused imagery; (4) listening to music; (5) sitting quietly (control). Distraction imagery and listening to music were the only techniques found to reduce anxiety to a greater extent than simply sitting quietly. The techniques differed in the way they made subjects feel, but not in their general appeal. Individuals with a 'blunting' coping style were more likely to find all five techniques appealing. Tests used included the Miller Behavioral Style Scale, Cognitive-Somatic Anxiety Questionnaire of Schwartz, Davidson & Golman, Life Orientation Test of Scheier & Carver, Somatic Perception Questionnaire of Landy and Stern, Body Consciousness Questionnaire of L. C. Miller, Murphy, & Buss, Betts' Questionnaire Upon Mental Imagery, Shortened Form, State-Trait Anxiety Inventory, and Technique Evaluation Questionnaire of the authors. Progressive muscle relaxation was according to Bernstein & Borkovec. Distraction imagery involved successively imagining a walk along a beach, a stroll across a flower filled meadow, sitting by a stream, a walk into the woods, sitting in a cabin in the woods listening to the rain against the windowpane, all including images in a variety of sense modalities. Focused imagery involved creating an image of a stressor, then through symbolic imagery experiences Ss were guided through a typical day's events that might lead up to the stressor, reinterpreting cues associated with the stressor as signals that they are in control, visualizing encountering the stressor feeling strong and determined, and any physical sensations reinterpreted as 'energy' that would help them to cope, visualizing enjoying their success (from Crits-Cristoph & Singer. Music was a 20-min tape (10 min of music used in the distraction imagery tape--Natural Light by Steve Halpern & David Smith) and 10 min of music used in background of the focused imagery tape (Structures of Silence by Michael Lanz). A 5th group, Control, was instructed to sit quietly with eyes closed. This data can be used in support of imagery-suggestion types of hypnosis (as in surgery study) reducing anxiety. It shows particularly strong effects for people high in cognitive anxiety or low in optimism, pre-treatment. Discussion: "... we feel confident that our distraction techniques were more effective for the immediate relief of anxiety than was PMR. This conclusion is consistent with the Suls and Fletcher meta-analysis (29) that suggested that 'avoidance' is an effective short-term coping strategy. That distraction (positive) imagery may be a more useful clinical technique than focused (active involvement) imagery was concluded in a study comparing these two techniques in the treatment of phobias (24)" (p. 19. [Ref #24 is Crits-Cristoph & Singer (1983) in Imagination, Cognition, and Personality.] "Pessimism and cognitive anxiety emerged as the only individual difference variables to influence anxiety reduction. Pessimism as measured by the LOT is cognitive in nature, with most of the items relating to expectations of negative outcomes; similarly, cognitive anxiety is characterized by worry and an inability to control negative thoughts and images. That individuals who perceive their world somewhat negatively should have entered the study more anxious than individuals who do not is hardly surprising. What is surprising is that despite an inverse relation between cognitive anxiety and the ability to relax, these individuals were able to benefit from whatever technique they performed to a greater extent than were individuals with a more positive outlook. In fact, after performing the technique, pessimists had reduced their anxiety to the level of optimists" (p. 19). "The stress management techniques used in the current study did not differ in their appeal" (p. 20). "Our finding that PMR produced more somatic effects than did focused imagery and less cognitive effects than did distraction imagery, listening to music, or sitting quietly is consistent with the model of anxiety proposed by Davidson and Schwartz (17). Our findings are also generally consistent with a conclusion reached by Woolfolk and Lehrer (4): that although various techniques are generally stress reducing, they seem to have highly specific effects. However, we found no support for the hypothesis that individuals who express anxiety cognitively (or somatically) prefer and benefit most from techniques that produce cognitive (or somatic) effects. In fact, the extremely high correlation found between the cognitive and somatic anxiety subscales of the Schwartz et al. measure (5) casts some doubt on the usefulness of a cognitive-somatic distinction, as does the corr between the experience of physical symptoms under stress (the Somatic Perception Questionnaire) with the cognitive, as well as the somatic, anxiety subscale. "The finding that blunters experiences more 'somatic effects' regardless of the technique they were assigned may have been the result of a single response--'how much did mind-wandering interfere with performing the technique'--which was the only Factor 2 item that was highly inversely) related to blunting. Since blunters are more likely to perceive mind wandering as the essence of stress management rather than as 'interference,' we do not view this main effect as particularly illuminating" (p. 20). "However, our finding that blunters experienced all techniques as appealing is consistent with the results of Martelli et al. (1) who found that individuals with low information-preference benefitted from what the authors labeled an 'emotion-focused' intervention, but which, in fact, included many of the quite diverse stress management techniques that we compared in the current study. That 'avoiders' failed to benefit from any intervention in the Scott and Clum study (11) may be due to the nature of the stressor [postsurgical pain]. Our undergraduates may have been more like the Martelli dental patients in terms of their level of distress than were the Scott and Clum subjects who were patients undergoing major surgery (hysterectomy or cholecystectomy). Future research needs to examine possible three-way, technique by patient by stressor-type, interactions (cf. 19)" pp 20-21. Gil, Karen M.; Williams, David A.; Keefe, Francis J.; Beckham, Jean C. (1990). The relationship of negative thoughts to pain and psychological distress. Behavior Therapy, 21 (3), 349-362. Examined the degree to which negative thoughts during flare-ups of pain are related to pain and psychological distress in 3 pain populations: sickle cell disease, rheumatoid arthritis, and chronic pain. 185 adults completed the Inventory of Negative Thoughts in Response to Pain (INTRP), a pain rating scale, the SCL-90 (revised), and a coping strategies questionnaire. Factor analysis of the INTRP revealed 3 factors: Negative Self-Statements, Negative Social Cognitions, and Self-Blame. High scorers on Negative Self-Statement and Negative Social Cognitions reported more severe pain and psychological distress. Ss with chronic daily pain had more frequent negative thoughts during flare-ups than those having intermittent pain secondary to sickle cell disease or rheumatoid arthritis. The INTRP appears to have adequate internal consistency and construct validity. 1989 Soskis, D. A.; Orne, E. C.; Orne, M. T.; Dinges, D. F. (1989). Self-hypnosis and meditation for stress management: A brief communication. International Journal of Clinical and Experimental Hypnosis, 37, 285-289. In a 6-month follow-up study, telephone interviews were conducted with 31 male executives who were taught either a self-hypnosis or meditation exercise as part of a stress-management program. Use of and problems with the 2 exercises were similar, with the percentage of Ss using the techniques falling over 6 months from 90% to 42%. The exercises were used primarily for physical relaxation, refreshing mental interludes, aiding sleep onset, and stress-reduction. Problems with the exercises chiefly involved difficulty in scheduling even brief uninterrupted practice times and discomfort with the techniques. The incorporation of these issues into the clinical teaching of self-hypnosis may be useful. 1989 Goldmann, Les; Ogg, T. W.; Levey, A. B. (1988). Hypnosis and daycase anaesthesia. A study to reduce preoperative anxiety and intraoperative anesthesia requirements. Anesthesia, 43, 466-469. 52 female patients having gynecological surgery as day cases received either a short preoperative hypnotic induction or a brief discussion of equal length. Hypnotized patients who underwent vaginal termination of pregnancy required significantly less methohexitone for induction of anesthesia and were significantly more relaxed as judged by their visual analogue scores for anxiety. Less than half the patients were satisfied with their knowledge about the operative procedure even after discussions with the surgeon and anesthetist. A significant correlation was found between anxiety and perceived knowledge of procedures. Results suggest that preoperative hypnosis can provide a quick and effective way to reduce preoperative patient anxiety and anesthetic requirements for gynecological daycase surgery. 1988 Gudjonsson, Gisli (1988). Interrogative suggestibility: Its relationship with assertiveness, social-evaluative anxiety, state anxiety and method of coping. British Journal of Clinical Psychology, 27 (2), 159-166. Investigated in 30 adults some of the theoretical components related to individual differences thought by the present author and R. Clark (1986) to mediate interrogative suggestibility as measured by a scale developed by the present author (1984). The variables studied were assertiveness, social-evaluative anxiety, state anxiety, and the coping methods generated and implemented during interrogation. Low assertiveness and high evaluative anxiety correlated moderately with suggestibility, but no significant correlations emerged for social avoidance and distress. State anxiety correlated significantly with suggestibility, particularly after negative feedback had been administered. Coping methods (active-cognitive/behavioral vs. avoidance) significantly predicted suggestibility scores. The findings give strong support to the present author's theoretical model 1987 Bandura, A.; O'Leary, A.; Taylor, C. B.; Gauthier, J.; Gossard, D. (1987). Perceived self-efficacy and pain control: Opioid and non-opioid mechanisms. Journal of Personality and Social Psychology, 53, 563-571. NOTES Subjects who were trained to use psychological coping strategies (e.g. imagery, distraction, dissociation, sensation transformation) had both better pain tolerance on a cold pressor test and higher self efficacy ratings. Those subjects who were given naloxone (which blocks pain reduction effects of beta endorphins) showed more pain tolerance than subjects not given the cognitive training experiences. They attributed much of the pain tolerance increase associated with cognitive interventions to opiate release, suggesting that cognitive interventions may have physiological mediating effects on pain perception Chaves, John; Brown, Jude (1987). Spontaneous cognitive strategies for the control of clinical pain and stress. Journal of Behavioral Medicine, 10 (3), 263-276. The spontaneous cognitive strategies employed by 75 patients undergoing dental extractions or mandibular block injections were elicited using a structured interview. Interest focused on the relationship between these strategies and several personality variables, including state and trait anxiety, locus of control, and absorption. In addition, the effect of strategy utilization on perceived pain and stress was assessed. Fourty-four percent of the patients employed cognitive strategies designed to minimize pain and stress, while 37% catastrophized, engaging in cognitive activity which exaggerated the fearful aspects of their experience. Only 19% of the patients denied any cognitive activity during the clinical procedure, and many of these used noncognitive coping strategies. Discriminant analysis revealed that situational anxiety was associated with the use of cognitive coping strategies. Catastrophizing was associated with increasing age, past dental stress, and higher levels of stress vulnerability (high trait anxiety and external locus of control). Copers reported less stress than catastrophizers but not less pain. Katz, Ernest R.; Kellerman, Jonathan; Ellenberg, Leah (1987). Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology, 12, 379-394. Hypnosis has been used as a behavioral approach to help children tolerate aversive medical procedures more effectively, but empirical longitudinal research evaluating the outcome of such interventions has been limited. In the present study, 36 children with acute lymphoblastic leukemia between the ages of 6 and 12 years of age undergoing repeated bone marrow aspirations (BMAs) were randomized to hypnosis or play comparison groups. Subjects were selected on their behavioral performance on baseline procedures and received interventions prior to their next three BMA procedures. Major results indicated an improvement in self-reported distress over baseline with both interventions, with no differences between them. Girls exhibited more distress behavior than boys on three of four dependent measures used. Suggestions of an interaction effect between sex and treatment group were noted. The role of rapport between patient and therapist in therapeutic outcome was also evaluated. Results are discussed in terms of potential individual differences in responding to stress and intervention that warrant further research. 1986 Rogers, Malcolm; Reich, Peter (1986). Psychological intervention with surgical patients: Evaluation outcome. Advances in Psychosomatic Medicine, 15, 23-50. NOTES The Notes are a direct quotation of the authors' Conclusions. "There is well documented evidence that psychological and behavioral preparation prior to surgery can effect post-operative recovery. In almost all instances, except when patients are characterized by avoidance or denial defenses predominantly, the outcome results have been positive. The effect of interventions have been most consistently positive in reducing length of hospitalization and post-operative pain, but a variety of other improvements in affect and physiologic stability have been shown. As others such as Auerbach have pointed out [76], in all but a handful of studies different intervention approaches have been combined, making it impossible to sort out the specific effects of information, psychotherapeutic relationship, relaxation training, or suggestion given either with or without hypnosis. Indeed it is not only likely that each has had an effect, but there may also be synergistic effects. "More recent investigations have begun to include measurements of personality differences between patients so that the nature of the intervention can be more specific and appropriate to the individual's coping style. "The reduction in length of hospitalization alone (clearly shown to result from pre- operative psychologic preparation) argues forcefully on a cost benefit basis for the inclusions of careful pre-operative preparation. The reduction in pain is also of major importance, and may well reduce future avoidance behavior or post-traumatic disorders, although these latter potential outcomes have not been investigated. It should be kept in mind that there are also a number of studies which have failed to demonstrate the efficacy of psychological intervention on these outcome measures. Moreover, it is extremely difficult in studies of this nature to control adequately for the subtle effects on behavior of experimenter and subject expectation. "A few points can be made about future strategies in this field. The evidence accumulated to date suggests that all patients undergoing surgery or certain difficult procedures be given the option of pre-operative psychological preparation. The preparation should emphasize what the patient will experience and when, and how to cope with it, i.e., how to move, or breathe, or relax. Rapidly evolving audiovisual capabilities and hospital televisions connected by cable to health education channels will routinely offer such preparation in the future. Patients could choose or not choose to watch (thereby protecting mechanisms of denial). "Finally, future studies should focus on outcome measures uniquely important to a particular operation and also on longer term rehabilitation outcome measures. An example of the former might be post-operative sexual functioning after prostatectomy. A study by Zokar et al. [77] has shown that the likelihood of this post-operative function is correlated with not only the level of pre-operative anxiety and general 'life satisfaction', but also whether the patient received a pre-operative explanation of what to expect from the surgery" (pp. 45-46). Wickramasakera, Ian (1986). A model of people at high risk to develop chronic stress-related somatic symptoms: Some predictions. Professional Psychology: Research and Practice, 17, 437-447. Certain measurable high-risk factors that predispose people to develop functionally based somatic disorders are identified. These risk factors compose a multidimensional model that encompasses variables involved in the predisposition, the precipitation, and the buffering of stress-related symptoms. These high-risk factors are (a) high or low hypnotic ability, (b) habitual catastrophizing cognitions and pessimistic belief systems, (c) autonomic lability or neuroticism, (d) multiple major life changes or multiple minor hassles over a short period of time, and (e) a deficit in support systems or coping skills or both. 1985 Gottschalk, Louis A. (1985). Hope and other deterrents to illness. American Journal of Psychotherapy, 39, 515-524. Reviews animal and human research demonstrating that events during early development influence vulnerability to physical and mental illness. In addition, effectiveness of coping methods used to deal with problems of living can affect susceptibility to illness. The intervening mechanisms between stressful life experiences and illness appear to involve physiological homeostasis and immune competence. Spanos, Nicholas P.; Ollerhead, Virginia Gail; Gwynn, Maxwell I. (1985-86). The effects of three instructional treatments on pain magnitude and pain tolerance: Implications for theories of hypnotic analgesia. Imagination, Cognition and Personality, 5, 321-337. Between baseline and posttesting on the cold pressor test, subjects were assigned to four treatments: a) hypnotic analgesia, b) brief instructions to "Do whatever you can to reduce pain," c) stress inoculation, and d) no instruction control. Participants in the three instructional treatments showed significantly greater baseline to posttest decrements in pain magnitude and significantly greater increments in pain tolerance than controls. However, the instructional treatments did not differ significantly from one another in these regards. Pretested hypnotic susceptibility correlated significantly with degree of pain reduction in the hypnotic analgesia treatment but not in the "Do whatever" or stress inoculation treatments. Theoretical implications are discussed. 1984 D'Eon, Joyce Lillian (1984). Response to pressure pain as moderated by hypnotic susceptibility, type of suggestion strategy, and choice (Dissertation, Concordia University, Canada). Dissertation Abstracts International, 45 (n4-B), 1313-1314. The present study examined the relationship between hypnotic susceptibility and ability to control pain, by comparing high and low susceptible subjects' response to pressure pain when these subjects employed either an imagery or a distraction pain attenuating strategy. The effect of providing subjects with a choice of which strategy to employ was investigated. In addition, the subjects' imagery ability and the types of cognitive strategies they engaged in were assessed. Subjects who scored either 9 or above or 4 and below on the Harvard Group Scale of Hypnotic Susceptibility: Form A, were asked to participate in a pain study. All 84 subjects first received a baseline trial on a modified version of the Forgione-Barber Strain Gauge Pain Stimulator, within susceptibility levels. Subjects who were able to keep their finger in the apparatus for 60 seconds were randomly assigned to a Choice, a No Choice, or a Control condition. The 36 high and low susceptible subjects in the Choice condition were given the option of using either an imagery suggestion strategy or a low distraction strategy on the second trial. The 32 high and low susceptible subjects in the No Choice condition were told about both strategies but were assigned randomly to either the imagery or the distraction strategy group. The 16 subjects in the Control group did not receive a strategy. Both pain intensity and pain tolerance were measured. Results indicated that an equivalent number of high and low susceptible subjects, given a choice of strategy, chose the imagery and distraction strategies. There were no differences in either pain intensity or pain tolerance between high and low susceptible subjects in the Choice conditions. The Choice condition subjects exhibited significant pain reductions from the first to the second trial. No Choice and Control subjects did not reduce pain significantly. In addition, high and low susceptible subjects who chose the imagery strategy did not have higher imagery scores than those subjects who chose the distraction strategy. Subjects in the No Choice condition used fewer coping strategies than subjects in the Choice condition, on the second trial. The implication of these results and directions for future research are discussed" (p. ). 1983 Harris, Gina M.; Johnson, Suzanne Bennett (1983). Coping imagery and relaxation instructions in a covert modeling treatment for test anxiety. Behavior Therapy, 14, 144-157. The present study compared the efficacy of instructing test anxious subjects to use personalized coping imagery based on nonacademic experiences of competence with coping imagery based on academic experiences of competence. The effect of relaxation was also examined and the relationship of imagery elaborateness and content to treatment effectiveness was assessed. Sixty-three subjects were randomly assigned to one of four treatments or a waiting list control group. Test anxiety as measured by a self-report instrument significantly decreased in all treatment groups. Improvement in grade point average occurred for all treatment groups except for academic coping imagery without relaxation which was also the least efficient treatment. The waiting list control group significantly deteriorated in academic performance. Relaxation training did not appear to enhance treatment effectiveness or influence the elaborateness or content of the imagery used. Test anxiety scenes elicited highly response- oriented images by all subjects. However, the stimulus/response content of the subjects' images was not influenced by treatment outcome. In contrast, successful treatment was primarily associated with reduction in negative coping imagery descriptions, although an increase in positive coping statements cured as well. Myles, (1983, April). Cognition, hypnotic susceptibility, and laboratory induced pain (Dissertation, University of Waterloo). Dissertation Abstracts International, 43 (10), 3360-B. Individuals' experiences of pain, and responses to pain treatments vary greatly. This study attempted to relate two areas of research concerned with this variation: (a) cognitions and pain (thoughts, images, etc.), in particular, catastrophizing versus coping; and (b) hypnotic susceptibility and analgesia. "Subjects were preselected for high or low hypnotic susceptibility. Susceptibility assessment was divorced from the laboratory study to minimize the potential bias of expectancies concerning hypnosis. High hypnotic susceptibility was expected to potentiate therapeutic effects of hypnotic-like treatment that did not involve a hypnotic induction. "Ten high and ten low-susceptible subjects were assigned to each of three groups: (a) a cognitive treatment, encouraging subjects to reduce spontaneous catastrophizing and increase self-generated coping cognitions; (b) a dissociative imagery treatment, encouraging subjects to engage in self-generated engrossing images; (c) an attention- placebo manipulation. "Pre and post-treatment assessments involved tolerance and pain-report measures during the cold-pressor task, and interview and questionnaire information concerning cognitions. "No treatment effects were evident on measures of pain. Cognitive data indicated less catastrophizing and more coping during the post-treatment stressor across all groups. Subjects in the dissociative imagery group did report more imagery during the post- treatment assessment than subjects in the other groups, but this increased use of imagery was not associated with a decrease in pain. "Interview and questionnaire data supported prior reports that catastrophizing is related to increased pain. Low catastrophizing was associated with a high sense of control, high use of a variety of coping strategies, and lower pain reports. These relationships were altered following treatment, however, leading to a caution in generalizing about such variables. "High susceptibility did not potentiate therapeutic effects for either experimental treatment. Nor was susceptibility related in any other consistent way to pain, although high susceptibility was associated with more extensive use of post-treatment imagery. "Methodological inconsistencies and problems in laboratory pain research were discussed, and suggestions made for future work in the area" (p. 3360). 1981 Spanos, Nicholas P.; Brown, Jude M.; Jones, Bill; Horner, Donna (1981). Cognitive activity and suggestions for analgesia in the reduction of reported pain. Journal of Abnormal Psychology, 90, 554-556. Assessed 38 undergraduates' pain magnitude and pain tolerance for arm immersion in ice water during a baseline and posttest session. Before the posttest, half the Ss received an analgesia suggestion. On the basis of their written testimony, Ss were classified as having either predominately coped (e.g., imagined event inconsistent with pain or made positive self-statements) or predominantly exaggerated (e.g., worried about and exaggerated the noxious aspects of the situation) during each immersion. On both immersions, copers reported less pain and exhibited higher pain tolerance than exaggerators. Moreover, the suggestion was associated with reductions in reported pain only when it transformed baseline exaggerators into posttest copers. Wilson, John F. (1981). Behavioral preparation for surgery: Benefit or harm?. Journal of Behavioral Medicine, 4, 79-102. Elective surgery patients were prepared for surgery with training in muscle relaxation or with information about sensations they would experience. Relaxation reduced hospital stay, pain, and medication for pain and increased strength, energy, and postoperative epinephrine levels. Information reduced hospital stay. Personality variables (denial, fear, aggressiveness) were associated with recovery and influenced patients' responses to preparation. Less frightened patients benefitted more from relaxation than did very frightened patients. Nonaggressive patients reacted to information with decreased hospital stay along with increased pain, medication, and epinephrine. Aggressive patients responded to information with decreased hospital stay along with decreased pain, medication, and epinephrine. Patients using denial were not harmed by preparation. A catharsis/moderation model is proposed to explain how information benefits patients. An active coping model is proposed to explain the benefits of relaxation. This study suggests that behavioral preparation benefits even frightened, aggressive, or denying elective surgical patients. Worthington, Everett L.; Shumate, Michael (1981). Imagery and verbal counseling methods in stress inoculation training for pain control. Journal of Counseling Psychology, 28 (1), 1-6. Investigated 3 elements of stress inoculation training, a therapeutic package for helping clients control anxiety, anger or pain. 96 undergraduate females were tested twice for ice water tolerance. In a 3 design, the independent variables were the presence or absence of (a) pleasant imagery, (b) a conceptualization of pain as a multistage process, and (c) planned, explicit self-instructions. A multivariate analysis of covariance using the (transformed) pretest tolerance rating and 2 self-ratings of pain. Imagery users (Is) controlled their pain better than nonimagery users (NIs). There was a significant interaction of Imagery and Conceptualization. NIs had longer tolerance and less self- reported pain at withdrawal when they heard no conceptualization. The Is did not derive additional benefit from hearing the conceptualization. Self-instruction did not affect pain control. Results suggest that pleasant imagery effectively relieves pain and may account for much of the effectiveness of stress inoculation training. (23 ref) 1979 Beers, Thomas M.; Karoly, Paul (1979). Cognitive strategies, expectancy, and coping style in the control of pain. Journal of Consulting and Clinical Psychology, 47, 179-180.