6. Although the Ss stated that they did not ‘remember’ the ‘post’-hypnotic suggestion (or anything else about the experiment), they usually showed a GSR when the E made the _preliminary_ movements to give the signal for the ‘post’-hypnotic behavior. (They also showed a GSR when E gave the signal for the ‘post’hypnotic behavior.)
“Since skin conductance is an index of the S’s level of ‘activation,’ ‘arousal,’ or ‘excitation,’ these results indicate the following:
1. Ss do not necessarily become more ‘passive’ or ‘relaxed’ during the ‘hypnotic induction procedure.’
2. Ss often become more and more ‘excited’ and ‘aroused’ when they are given a series of ‘active’ suggestions such as ‘sensory hallucinations,’ ‘age-regression,’ etc.
3. Ss often show momentary ‘excitement’ when they are ‘hallucinating.’
4. A pinprick can ‘arouse’ a S to the same extent during ‘hypnotic analgesia’ as it can during ‘normal waking.’ In addition, ‘hypnotic analgesic’ Ss are often just as much ‘aroused’ by the threat of a pinprick as they are by an actual pinprick.
5. Many Ss become momentarily ‘excited’ when they are asked to look directly at an object (or person) which they have been told they will not be able to see. However, _some_ Ss do _not_ show this momentary ‘excitement.’
6. Although Ss may state that they do not ‘remember’ the ‘post’-hypnotic suggestion, they often become momentarily ‘excited’ when the E makes _preliminary_ motions to give the signal for the ‘post’-hypnotic act” (pp. 90-92).
Crasilneck, Harold B.; Hall, James A. (1959). Physiological changes associated with hypnosis: A review of the literature since 1948. International Journal of Clinical and Experimental Hypnosis, 7 (1), 9-50. ( Abstracted in Psychological Abstracts, 61: 6626)
NOTES
Topic headings include:
Experimental Techniques (Depth, Type of suggestion, Other variables)
Cardiovascular Effects (Clinical reports, Blister formation, Bleeding, Peripheral vasomotion, Heart rate, EKG changes, Blood pressure, Hematological changes)
Respiration
Urogenital System
Gastrointestinal System
Metabolism and Temperature
Endocrine System
Central Nervous System (Electroencephalography, Epilepsy, Age regression, Galvanic skin response, Muscle control, Electromotive changes, Multiple sclerosis, Cold adaptation, Exocrine glands, Reflexes, Russian reports)
Special Senses (Hearing, Taste)
1958
Duncan, Irma W.; Dressler, Robert L.; Lyon-James, Sara; Sears, Alden B. (1958). The search for an index of hypnosis. Journal of Clinical and Experimental Hypnosis, 6 (2), 95-108.
Summary
“Blood and urine samples were obtained from 18 university students at the beginning and end of two experimental sessions, one with and one without hypnosis. Some of the subjects relaxed during the sessions; others imagined or hallucinated a traumatic experience.
“Of a variety of measurements made, urinary volumes and 17-ketosteroids, the eosinophil count and psychogalvanometer recordings appear to give useful information about any changes due to the hypnosis. The biochemical changes caused by the experimentally produced emotions seem to depend on the individual and his past experience rather than the hypnosis. The data suggest that if the experience hallucinated is known to the subject, the biochemical changes indicate a relaxed state during the hypnosis. The psycho-galvanometer recordings may indicate an agitated state while the biochemical indices suggest a relaxed state” (pp. 106-107).
1956
Sears, Alden B.; Beatty, Jeanne M. (1956). A comparison of galvanic skin response in the hypnotic and waking state. Journal of Clinical and Experimental Hypnosis, 4 (2), 49-60.
Summary.
In this experiment an attempt was made to determine whether or not there was a difference in the galvanic skin response between waking and hypnotic questioning. The 24 subjects were randomly assigned to one of four groups, each group following a different sequence of experimental conditions. During the first session, each subject observed a table top setup for 30 seconds and then wrote out what he could remember in both the waking and hypnotic states. During the second session, which followed seven or eight days after the first, each subject was asked a series of 14 questions concerning the table top setup. Half of the subjects answered the questions first in the waking and then in the hypnotic state; for the remaining 12 subjects hypnotic questioning preceeded waking questioning. The galvanic skin response was recorded for both the waking and hypnotic questioning of all subjects, and the amount of deviation was measured in millimeters. Because the subjects tended to respond more slowly during the hypnotic questioning than during the waking questioning, a direct comparison of the amount of deviation in the two states could not be made. Consequently, two indicators of amount of deviation were considered necessary: mean deviation per second (D/T) and the mean average deviation (D/ND). No significant differences were found between the waking and hypnotic questioning in a comparison of the mean deviation per second for the group and for the males alone. However, there was a difference between waking and hypnotic questioning in the mean deviation per second for females, significant at the .01 level of confidence. The difference between the waking and hypnotic measures of the mean average deviation were also not significant for either the total group or for the males. For females, this difference was significant at the .001 level of confidence. No attempt was made to explain this apparent sex difference in the behavior of the galvanic skin response. It was suggested that further research be done to confirm and account for these results. The differences between the results of male and female subjects in this experiment, where procedures were the same for both, may account for the conflicting reports found in the literature. In many of the reported experiments the sex of the subjects has not been noted” (pp. 57-58).
The questions were factual in nature, e.g. “What object is in the lower right hand corner.”
1952
West, Louis Jolyon; Niell, Karleen C.; Hardy, James D. (1952). Effects of hypnotic suggestion on pain perception and galvanic skin response. A. M. A. Archives of Neurology and Psychiatry, 68, 549-560.
A study is reported in which pain perception and galvanic skin responses of seven subjects were measured before and during hypnosis. The depths of hypnotic trance varied from light to deep. Stimuli of measured intensity were administered, and changes in pain threshold were measured. Quantitative estimates of pain intensity were made by the subjects. Alterations in ability to discriminate between pains of differing intensities were noted. Quantitative records of galvanic skin responses were utilized, permitting statistical analysis of data from matched pairs. Data were collected at 45 experimental sessions, during which a total of 478 painful stimuli were administered, the stimuli varying in intensity from threshold to blister- producing levels. At each session, the subject’s sensations from and responses to stimuli during a control period were compared with sensations from and responses to identical stimuli administered after hypnotic suggestions of anesthesia. The following observations were made: 1. Hypnotic suggestions of anesthesia influence pain perception by causing elevation of pain threshold, hypalgesia, and analgesia. 2. When hypnotic suggestions of anesthesia caused hypalgesia and elevation of pain threshold, ability to discriminate among stimuli of different intensities was impaired. 3. There was a general correlation between the depth of hypnotic trance and the degree to which pain perception was altered by hypnotic suggestion. 4. The galvanic skin response to noxious stimulation was diminished, and it sometimes disappeared, as a result of hypnotic suggestions of anesthesia. The galvanic skin response was affected even when there was no alteration in pain perception, according to subjective reports. NOTES 1:
NOTES: The authors review literature on the effects of analgesia suggestions on the galvanic skin response and other autonomic nervous system responses. The present study differs from previous studies in the following ways: “1. The subjects were studied in various stages of hypnosis. 2. Quantitatively determined noxious stimuli were used instead of pinching or pinprick. 3. Changes in pain threshold were measured. 4. Quantitative estimates of pain intensity were made by the subject in the hypnotized and the unhypnotized state. 5. Changes in ability to discriminate between pains of differing intensity were noted. 6. Quantitative records of galvanic skin responses in the control and in the hypnotized state were utilized” (p. 552).
Analgesia was defined as “that state in which none of the noxious stimuli administered were reported as painful;” hypalgesia was defined as “a state in which noxious stimuli were reported as less painful than would be expected on the basis of reports of the same subject regarding the same stimuli in control situations” (p. 554).
In their Discussion, the authors state, “As a result of hypnotic suggestions of anesthesia, the following effects on sensation were observed: (1) no alteration in reports of pain intensity; (2) hypalgesia for higher-intensity stimuli without elevation of the pain threshold; (3) definite elevation of pain threshold with hypalgesia; (4) analgesia; (5) disturbances in pain discrimination.
” The third effect was observed in the majority of trials. The threshold elevation in light trances may be similar to that which can be produced by suggestion in the unhypnotized subject, but in deeper trances the effectiveness of hypnotic suggestion is much greater. The progression of effects 1 through 4 appears to be directly related to the depth of trance. The fifth effect was variable and was seen only in conjunction with the third effect. It is described as a separate phenomenon because the disturbance of ability to discriminate relatively between stimuli of differing intensities was only clearly observed when we were remeasuring pain thresholds. In actuality, it may merely represent a facet of altered pain perception, and the variability of its appearance may be related to the variable psychological state of the subject. It must be kept in mind that the hypnotic trance is not a static state” (p. 558). For one Subject, analgesia decreased in successive hypnotic sessions, while for four Subjects analgesia increased; a sixth Subject exhibited overall variability in hypnotic depth and analgesia from session to session.
The authors indicate that their review of the literature found no evidence that hypnosis, absent suggestions for analgesia, affects the galvanic skin response. In the present study, diminishment of the GSR is related to, though not dependent on, the effectiveness of the suggestion of anesthesia. “Thus, in Subject 2, with only moderate hypalgesia, the GSR to noxious stimuli was diminished by 64%; in S 6, with analgesia on nearly all trials, only 57%. It is particularly interesting that S 1 had a reduction in GSR of 26% after hypnotic suggestions which apparently had no effect upon his pain perception, and which seemed even to make him anxious. S 5 showed a direct correlation between depth of trance and decrease of GSR while Subjects 6 and 7 showed no such correlation” (p. 559).
“It is important to realize that on some occasions hypnotic anesthesia apparently led to complete disappearance of the GSR to all stimuli during a given session, such stimuli evoking pain of 6 or 7 dols in the control period. This phenomenon was seen twice with Subject 3, twice with Subject 5, and once with Subject 6. In several trials there was only a very slight GSR to the higher stimuli during hypnosis. In all the control periods there was only one occasion on which a stimulus evoking pain of 6 or 7 dols failed to produce a GSR, while equally intense stimulation failed to produce a GSR on 14 occasions after hypnotic suggestions of anesthesia. This observation is stressed because it suggests a need for caution in the clinical use of the GSR to distinguish organic from hysterical anesthesias” (pp. 559-560).
GASTROENTEROLOGY
1996
Spiegel, Sharon B. (1996). Uses of hypnosis in the treatment of uncontrollable belching: A case report. American Journal of Clinical Hypnosis, 38 (4), 263-270.
Uncontrollable belching is frequently benign in origin, but can be distressing in its psychosocial consequences. Physicians have little to offer in the way of medical treatment. This is a case report of a 71-year-old woman with incessant eructation of four months duration treated with brief psychotherapy utilizing hypnosis. The patient was symptom-free at termination, and this improvement was sustained at six month follow-up. This paper includes a detailed description of some of the hypnotic suggestions as well as a discussion of the factors that may have contributed to change.
1992
Chantler, Lisa J. (1992). The treatment of irritable bowel syndrome using hypnosis. Australian Journal of Clinical and Experimental Hypnosis, 20, 39-47.
A single case is reported of the hypnobehavioural treatment of a patient with chronic irritable bowel syndrome. The success of this treatment suggests that it has potential over and above relaxation and other behavioural techniques alone.
Whorwell, P. J.; Houghton, L. A.; Taylor, E. E.; Maxton, D. G. (1992). Physiological effects of emotion: Assessment via hypnosis. Lancet, 340, 69-72.
Studied the effects of distal colonic motility of three hypnotically induced emotions (excitement, anger, and happiness) in 18 patients, aged 20-48, with irritable bowel syndrome. Colonic motility index was reduced by hypnosis on its own (p<.05), and this change was accompanied by decreases in both pulse and respiration rates (p<.001 for both). Anger and excitement increased the clonic motility index (p<.01 for both), pulse rate and respiration rate (p<.001 for both). Happiness further reduced colonic motility although not significantly from that observed during hypnosis alone. Changes in motility were mainly due to alterations in rate in amplitude of contractions. The results indicate that hypnosis may help in the investigation of the effects of emotions on physiological functions. The finding that neutral hypnosis strikingly reduces fasting colonic motility may partly explain the beneficial effects of hypnotherapy with functional bowel disorders. 1991 Schwarz, Shirley P.; Blanchard, Edward B. (1991). Evaluation of a psychological treatment for inflammatory bowel disease. Behaviour Research and Therapy, 29 (2), 167-177. Compared the effectiveness of a multicomponent behavioral treatment package, which included inflammatory bowel disease (IBD) education, progressive muscle relaxation, thermal biofeedback, and training in use of cognitive coping strategies, with the effectiveness of symptom-monitoring as a control condition. The treatment group consisted of 11 IBD patients (aged 25-62 yrs); 8 of 10 persons (aged 25-71 yrs) in the control group completed treatment. At posttreatment, the treatment group showed fewer reductions in symptoms (5) than the symptom-monitoring controls (8). However, treated Ss perceived themselves as coping better with IBD and as feeling less IBD-related stress. It is hypothesized that the differences in treatment responses may be related to differences between Ss with ulcerative colitis and Ss with Crohn's disease. Whorwell, P. J. (1991). Use of hypnotherapy in gastrointestinal disease. British Journal of Hospital Medicine, 45, 27-29. Recent controlled studies in the field of gastroenterology have shown that hypnotherapy is unequivocally beneficial in conditions such as irritable bowel syndrome and peptic ulceration. There is also some evidence for influence on certain physiological functions. Further research should help to define more clearly the role of this controversial form of therapy. NOTES 1: NOTES This is a summary of work the authors are doing in gastroenterology. The authors are doing pilot work with inflammatory bowel disease and also ulcerative colitis. Patients are given an idea of the pathophysiology. "First subjects are asked to place a hand on their abdomen and feel warmth and then to relate this sensation to the relief of pain, spasm, bloating etc. Second they are asked to visualize a river and imagine that it is their gut. They are then told to modify the flow in order to achieve a more satisfactory bowel habit. For instance it would be suggested to a subject with loose bowels that a fast- flowing river with broken water is changed into a much more slow, smoothly flowing one. To the trainee therapist these suggestions sound very unconvincing but they do seem to work. "Patients often take many weeks to respond and this can be very testing for the resolve of both patient and doctor alike. Some patients seem to adopt a very passive approach to treatment, expecting the therapy to work rather akin to taking a tablet--they attend once a week and wait for something to happen." (p. 29). [They have to be taught that they must make the treatment work for themselves.] 1990 Prior, A.; Colgan, S. M.; Whorwell, P. J. (1990). Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut, 31, 896-898. Fifteen patients with irritable bowel syndrome were studied to assess the effect of hypnotherapy on anorectal physiology. In comparison with a control group who received no hypnotherapy, significant changes in rectal sensitivity were found in patients with diarrhoea-predominant irritable bowel syndrome both after a course of hypnotherapy and during a session of hypnosis (p<.05). Although patient numbers were small, a trend towards normalization of rectal sensitivity was also observed in patients with constipation- predominant syndrome. No changes in rectal compliance or distension-induced motor activity occurred in either subgroup nor were any changes in somatic pain thresholds observed. The results suggest that symptomatic improvement in irritable bowel syndrome after hypnotherapy may in part be due to changes in visceral sensitivity. NOTES 1: NOTES This research involved 15 patients diagnosed with irritable bowel syndrome (IBS), which was defined as abdominal pain with abdominal distension and 'an altered bowel habit'--10 had diarrhea mostly and 5 had constipation mostly. Patients with this disease usually have an exaggerated colon sensitivity to many different stimuli, as well as lower threshold to a balloon inflated in the bowel for diagnostic purposes. The patients were treated with ten sessions of hypnosis, 30 minutes each, over a three month period. Dependent variables included self ratings of abdominal pain, abdominal distention, and 'bowel habit disturbance.' Each of the three variables received a score of 0-10; the total score therefore could range from 0-30. Other ratings were obtained using the inflation of a rectal balloon as stimulus. "After a basal period of at least 15 minutes the rectal balloon was serially inflated with air at intervals of 1 min in 20 ml increments up to 100 ml and then in 50 ml increments up to the sensation of discomfort. The study was repeated after a rest period of 15 minutes. After hypnotherapy the S was restudied first in the waking state and then, after 15 min, following induction of hypnosis" During this procedure they measured balloon volume, rectal compliance (a function of volume and pressure), and presence or absence of repetitive rectal contractions. In order to learn whether the analgesia being experienced in the rectal or bowel area transferred to other areas, patients experienced cold water immersion induced pain on one hand, for a measure of time until discomfort was felt (pain threshold, essentially). The control group of 15 patients diagnosed with IBS received the same measures of balloon volume, rectal compliance, and presence or absence of repetitive rectal contractions. The total symptom score (which might have ranged 0-30) dropped from 23.5 to 9.6, and 13 of the 15 patients rated their symptoms as much improved. The two Ss who did not experience improvement also did not return for the assessment using the balloon. Therefore, the physiological assessment included only 13 Subjects, the ones who rated themselves as 'improved.' "In patients with diarrhoea-predominant irritable bowel syndrome a decreased rectal sensitivity occurred after hypnotherapy which was significant for the sensations of gas and urgency. This was most pronounced in patients who could initially tolerate only small rectal balloon volumes (Fig 1). During hypnosis the results for rectal sensitivity in the diarrhoea-predominant group were similar to those noted after the course of hypnotherapy but were of a greater magnitude, reaching significance for all sensations (Fig 2). "In the constipation-predominant Subjects there was a tendency for rectal sensitivity to move towards normal values both after the course of hypnotherapy and during hypnosis. Patient numbers in this subgroup were small, however, and the changes were not significant (Figs 1 and 2). Rectal compliance and distension induced motor activity were unaffected by hypnotherapy in both the diarrhoea and constipation- predominant patients" (p. 897). It was noted that of patients who had manifested depression and/or anxiety (8 of 13), most showed psychological improvement--3 of them to a great degree--but there was no correlation between psychological improvement and the degree that visceral sensitivity was diminished. Also, the ten sessions of hypnotherapy did not affect length of time subjects could tolerate hand immersion in cold water. "In the control group of 15 patients with the irritable bowel syndrome who did not receive hypnotherapy no changes in rectal sensory or motor parameters occurred when manometry was repeated on the same day or on a second study day nine to 12 weeks later (Table II)" (p. 897). In their Discussion, the authors remark that "hypnotherapy seemed to produce a trend towards normalization of visceral sensitivity (Figs 1 and 2). This was most pronounced in the patients with diarrhoea-predominant irritable bowel syndrome who initially had particularly low sensation thresholds" (p. 898). They continue, "The pathophysiological abnormalities which lead to the symptoms of the irritable bowel syndrome remain unclear. The increased visceral sensitivity found in the large [7-9] and small intestine [18, 19] in some patients with the irritable bowel syndrome may contribute to their perception of pain. In addition, an increase in rectal sensitivity might also contribute to the symptoms of urgency and frequency of defecation seen in many patients with diarrhoea-predominant irritable bowel syndrome. ... Hypnotherapy also induces an improvement in well being by increasing coping capacities, and may therefore decrease perceived stress" (p. 898). "The present study suggests therefore that hypnotherapy might operate by a variety of mechanisms in patients with the irritable bowel syndrome. In those with visceral hypersensitivity it seems to alter the perception of rectal sensation, although the mechanism by which this is achieved is unknown. Modification at a cortical level or more locally along afferent pathways are possibilities. This does not, however, explain the symptomatic improvement in all subjects and hypnotherapy is probably also acting in a non-specific psychotherapeutic sense" (p. 898). Schwarz, Shirley P.; Taylor, Ann E.; Scharff, Lisa; Blanchard, Edward B. (1990). Behaviorally treated irritable bowel syndrome patients: A four-year follow-up. Behaviour Research and Therapy, 28 (4), 331-335. A 4-yr longitudinal study evaluated 19 patients (aged 23-60 yrs) suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy, and IBS education at baseline. 17 Ss rated themselves as more than 50% improved. Six of the 12 Ss who submitted symptom monitoring diaries met the criteria for clinical improvement, (i.e., achieving at least a 50% reduction in primary IBS symptom scores). The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant reductions were obtained on abdominal pain/tenderness, diarrhea, nausea, and flatulence. 1989 Harvey, R. F.; Hinton, R. A.; Gunary, R. M.; Barry, R. E. (1989). Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, 1 (8635), 424-425. Thirty-three patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks. Twenty improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to eight patients was as effective as individual therapy. NOTES 1: NOTES: DISCUSSION: The mechanisms by which hypnotherapy improves symptoms of IBS remain unclear. A placebo effect alone is unlikely, because few patients who improved on hypnotherapy suffered a relapse after formal treatment ended at 7 weeks; many patients continued to improve after the end of formal treatment. There was no disproportionate improvement in the feeling of wellbeing of patients who improved, and most of the patients who became nearly symptom-free had no initial tension or anxiety, as judged by GHQ scores. This suggests that the treatment is not just producing a psychological effect. The effects... were less striking than those reported by Whorwell and colleagues. Nevertheless, the results were encouraging because all 33 had been refractory to conventional medical treatment." Klein, Kenneth B.; Spiegel, David (1989). Modulation of gastric acid secretion by hypnosis. Gastroenterology, 96, 1383-1387. NOTES "The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 to 6.80 ... with hypnosis, an increase of 89% ( = .0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output ... and an 11% reduction in pentagastrin-stimulated peak acid output ... p<.05. We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control." Tosi, D. J.; Judah, S. M.; Murphy, M. A. (1989). The effects of a cognitive experiential therapy utilizing hypnosis, cognitive restructuring, and developmental staging in psychological factors associated with duodenal ulcer disease: A multivariate experimental study. Journal of Cognitive Psychotherapy, 3, 273-290. This study evaluated the effects of a Cognitive Experiential Therapy (CET)--in the past referred to as Rational Stage Directed Hypnotherapy--Cognitive Restructuring (CR), Hypnosis Only (HO), and a no-treatment control condition on the duodenal ulcer syndrome. CET is a systematic, stage-directed therapy that employs hypnosis and the cognitive restructuring of self-defeating cognitive, emotional, physiological, and behavioral tendencies. Seven criterion variables were assessed using two standardized instruments and questionnaire data. The standardized instruments included the Millon Behavioral Health Inventory (MBHI) and the Common Beliefs Survey III (CBS). Twenty-five volunteer duodenal ulcer patients were subjects in a 4 x 3 factorial design with repeated measures consisting of the four treatments and pretest, posttest, and follow-up. There was a significant treatment effect, and effects were observed on personality coping styles, beliefs and locus of control scales, and on gastrointestinal disturbance. CET appeared to have an ameliorative effect on psychological factors associated with duodenal ulcer. 1988 Colgan, S. M.; Faragher, E. B.; Whorwell, P. J. (1988, June 11). Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration. Lancet, 1299-1300. 30 patients with rapidly relapsing duodenal ulceration were studied to assess the possible benefit of hypnotherapy in relapse prevention. After the ulcer had healed on treatment with ranitidine, the drug was continued for a further 10 weeks during which time patients received either hypnotherapy or no hypnotherapy. The two randomly selected groups were comparable in terms of age, sex, smoking habits, and alcohol consumption. Follow-up of both groups of patients was continued for 12 months after the cessation of ranitidine. After 1 year, 8 (53%) of the hypnotherapy patients and 15 (100%) of the control subjects had relapsed. The results of this study suggest that hypnotherapy may be a useful therapeutic adjunct for some patients with chronic recurrent duodenal ulceration. NOTES: "The aetiology of duodenal ulceration is poorly understood but it is probably multifactorial. ... Stress, both psychological and physical, has since been shown to affect gastric emptying and the secretion of acid and pepsin, but attempts to causally link stress and peptic ulcer disease have produced conflicting results. "Hypnotherapy can modify the response to betazole-stimulated gastric acid secretion, although the mechanism by which this is mediated remains unclear" (p. 1299). "The active [treatment] group received 7 sessions of hypnotherapy and were given an audio tape for daily autohypnosis; the other group were seen as often, but did not receive any hypnotherapy. The ranitidine was then stopped and both groups were reviewed every 3 months for a further year, with the active group receiving hypnotherapy at their follow-up visits. All subjects had an endoscopy at the end of the study, or sooner if a symptomatic relapse occurred. "Hypnosis was induced as previously described, with attention focused on the abdomen by the use of the patient's hand. They were asked to imagine warmth beneath the hand and to relate this to the control of gastric secretion. Reinforcement by visualization was used if the patient had this ability" (p. 1299). At the end of a year, on follow up, the patient relapse rate was 53% and controls relapse was 100%, a difference significant at p = 0.01. In their Discussion, the authors state, "This study shows that hypnotherapy is helpful in maintaining remission in those patients with duodenal ulceration who are particularly prone to relapse. ... In this model, hypnotherapy might operate at a variety of levels in the disease process: it could act in a nonspecific psychotherapeutic sense increasing 'coping' capacities and decreasing perceived stress. Alternatively, hypnotically induced relaxation may affect gastric acid secretion, and there is some experimental evidence for this. "The early relapse rate in the hypnotherapy subjects was similar to that of controls, but subsequently the curves showed a much greater separation. This finding could indicate that there is a subgroup of subjects who are particularly response to therapy. However, a detailed review of psychological and clinical parameters did not reveal any specific feature that could be used to predict a response to this form of treatment" (pp. 1299-1300). NOTES 2: Current etiology of duodenal ulcers includes the presence of bacteria Helicobacter pylori which is important in relapse. In order to compare treatments we must know what is the status of each group regarding the presence of this bacteria. Current treatment of duodenal ulcer includes metronidazole, amoxicillin and tetraciclin to kill it. [Editor's Note: This appears to be a critique of the research methodology rather than notes on the article itself.] 1984 Whorwell, P. J.; Prior, Alison; Faragher, E. B. (1984, December 1). Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet, 1232-1234. 30 patients with severe refractory irritable-bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed. 1977 Schneck, Jerome M. (1977). Hypnotherapy for ptyalism. International Journal of Clinical and Experimental Hypnosis, 25, 1-3. This paper furnishes a description of brief hypnotherapy with a comment on theory in the case of a 56-year-old man suffering from ptyalism (excessive salivation). He was able to obtain considerable, but not complete relief. 1966 Zane, M. D. (1966). The hypnotic situation and changes in ulcer pain. International Journal of Clinical and Experimental Hypnosis, 14 (4), 292-304. This is a study of internal and external hypnotic conditions associated with changes in pain developed during 5 hypnosis sessions in a patient with an acute duodenal ulcer. The 12 increases and 8 decreases in pain studied were found to be related to the interaction of coexisting reactions directed toward shifting social and private goals. Pain was associated with conflict among these reactions; intensification of pain occurred as a train of self-propagating internal events increased the conflict; relief of pain accompanied a reduction in the conflict. Increasing bodily disorganization resulted as shifts in focus of attention among social and private goals resulted in the rapid growth of conflicting mental and physical processes. An external stimulus, in the form of a highly individualized hypnotic suggestion, was often required to stop the disorganizing processes. Dorcus, Roy M.; Goodwin, Phillip (1955). The treatment of patients with the dumping syndrome by hypnosis. Journal of Clinical and Experimental Hypnosis, 3 (4), 200-202. NOTES Psychological tests (MMPI and Manifest Anxiety Scale) were administered to 20 duodenal ulcer patients with successful outcome following subtotal gastrectomy and 20 with an outcome characterized by "one or more of the following symptoms: lack of appetite, aversion to food, aversion to particular kinds of food, nausea, vomiting, dizziness, sweating, cardiac palpitation, weakness, and weight loss" (p. 200). Since the symptoms are supposedly due to food passing more rapidly through the digestive tract the syndrome is called "dumping." In the unsuccessful outcome group, four patients with symptoms persisting 8-26 months, received hypnosis (2 to 9 sessions). "The suggestions were directed towards reducing tension (production of relaxation), removal of fear of this condition, enhancing the olfactory qualities of food, and the feeling of comfort with food or liquid intake" (p. 201). All four patients responded with remission of symptoms. 1954 Kline, Milton V. (1954). Stimulus transformation and learning theory in the production and treatment of an acute attack of benign paroxysmal peritonitis. Journal of Clinical and Experimental Hypnosis, 2 (1), 93-98. Summary A case episode from the hypnoanalysis of a patient with benigh paroxysmal peritonitis has been presented to illustrate the nature of stimulus transformation in symptom formation and maintenance. Perceptual distortion and the role of the perceptual system in facilitating stimulus transformation has been discussed. Hypnotherapeutic intervention was based upon the awareness of the role of perceptual alteration in facilitating differential response and was effective in terminating the attack in its original form and in experimental revivification. The autonomous factor in learning has been discussed in relationship to the drive for activity and reenforcement and resistance to all possible forms of spontaneous or planned retroactive inhibition. Resistance in neurosis possesses the essentials of all well established learned responses -- strength against extinction. Psychotherapy as a new learning experience will be resisted on a Gestalt basis -- dynamically and neurally. The recognition of the role of involuntary neuropsychological mechanisms in the development and maintenance of neurotic learning is essential in the planning and study of those remedial efforts which we term psychotherapy" (pp. 97-98). NOTES Patient was 30 year old male who had experienced pain attacks since age 10, usually running a course of 3-4 days and requiring bed rest and sedation. With hypnoanalysis attacks were reduced to 3/year. In the therapy excerpt presented, in age regression it was established that an (unconsciously) significant event occurred at a different time than was consciously remembered, and accounted thereby for the onset of an attack. 1953 Kroger, William S. (1953). Hypnotherapy in obstetrics and gynecology. Journal of Clinical and Experimental Hypnosis, 1 (2), 61-70. Author's Summary "A high percentage of gynecologic complains [sic] are due to psychic factors. Therapeutic efforts, therefore, must be directed primarily toward the psychologic component. Until recently, the principal weapon of the dynamically oriented physician was orthodox psychoanalysis. However, the increased interest for a relatively rapid approach has demonstrated the diagnostic and therapeutic value of hypnoanalysis. This development has been concomitant with the psychoanalysist's [sic] interest in 'brief psychotherapy' and narcosynthesis. "In many functional gynecologic disorders, hypnoanalysis has supplanted the parent therapy even though this form of treatment utilizes the concepts of dynamic psychiatry. "The relevant literature on the use of hypnotherapy in functional obstetrical and gynecological disorders has been reviewed. "Significant areas for research have been pointed out. "This review emphasizes that hypnosis _per se_ is only of value in obtaining symptomatic relief. On the other hand, hypnoanalysis elicits the responsible dynamics behind the symptom, and is effective in reaching all aspects of the personality. "Hypnoanalysis will be more applicable in obstetrics and gynecology when there is a wider acceptance of its techniques" (p. 68). GENDER 2000 Lichtenberg, P.; Bachner-Melman, R.; Gritsenko, I.; Ebstein, R. P. (2000). Exploratory association study between catechol-O-methyltransferase (COMT) high/low enzyme activity polymorphism and hypnotizability. American Journal of Medical Genetics , 96, 771-774. Only recently have studies of electrocortical activity, event-related potentials, and regional cerebral blood flow begun to shed light on the anatomical and neurobiological underpinnings of hypnosis. Since twin studies show a significant heritable component for hypnotizability, we were prompted to examine the role of a common, functional polymorphism in contributing to individual differences in hypnotizability. A group of 109 subjects (51 male, 58 female) were administered three psychological instruments and tested for the high/low enzyme activity COMT val.met polymorphism. We observed a significant correlation between hypnotizability measured by the Stanford Hypnotic Susceptibility Scale (SHSS:C), ability to partition attention (Differential Attentional Processes Inventory or DAPI), and absorptive capacities (Tellegen Absorption Scale or TAS). The effect of COMT on the various dependent variables was initially examined by multivariate analysis that corrects for multiple testing. The dependent variables were SHSS:C hypnotizability scores, four attentional subscales of the DAPI, and TAS total score grouped by the COMT genotype (val/val, val/met, met/met) as the independent variable. Hotelling''s Trace statistic was significant when scores were grouped by the COMT genotype (Hotelling''s T2 = 1.88, P = 0.04). Post-hoc testing using the Bonferroni correction shows that the only significant difference is between the val/met vs. the val/val COMT genotypes on hypnotizability. This association was significant for men but not for women. As for all case-control studies, these results need to be interpreted cautiously and require replication. 1999 Daniel, Sheryll (1999). The healthy patient: Empowering women in their encounters with the health care system. American Journal of Clinical Hypnosis, 42 (2), 108-114. Many women's expectancies when they assume the role of patient include the experiences of regression, helplessness, passivity and fear. This paper describes techniques for interrupting this negative set and for facilitating the development of a self-efficacious state in which the woman experiences herself as an active and informed participant in her encounters with medical personnel. 1992 Kvaal, Steven; Lynn, Steven Jay; Myers, Brian (1992, October). The Gulf war: Effects on hypnotizability. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA. NOTES We did a study that follows the line that volunteers may differ from nonvolunteers for hypnosis experiments (Authors cite 3 studies, including one with Hilgard as later author; Brodsky; Zamansky). Also, Ss who volunteer early in the quarter at the university are motivated for hypnosis; later volunteers want course credit. The former want to experience hypnosis. Previously we did a study on authoritative vs permissive suggestions with Ss who volunteered early or late in the quarter; Ss were tested twice. For Ss who volunteered in first 2 weeks of the quarter, scores decreased across testing; for Ss volunteering late, scores remained stable across testing. This implies that if an experiment were conducted late in a quarter we would conclude that repeated testing has no effect; if done earlier, we would have concluded repeated testing decreases scores.