1991
Madrid AD, Barnes SH. (1991, Oct). A hypnotic protocol for eliciting physical changes through suggestions [Abstract]. American Journal of Clinical Hypnosis, 34 (2), 122-128.
We employed brief hypnotherapy to effect physical changes in patients suffering from medical disorders including allergies, rectal bleeding, systemic lupus, hyperemesis, headache, asthma, and chronic pain. We present, in language appropriate to the individual patient, considerations and suggestions to effect the release of healing biochemicals. Ideomotor signals indicated the patient”s awareness of the healing. We hypothesize that the technique triggered novel state-dependent memory, learning and behavior.
Madrid, Antonio D.; Barnes, Susan v.d.H. (1991). A hypnotic protocol for eliciting physical changes through suggestions of biochemical responses. American Journal of Clinical Hypnosis, 122-128.
We employed brief hypnotherapy to effect physical changes in patients suffering from medical disorders including allergies, rectal bleeding, systemic lupus, hyperemesis, headache, asthma, and chronic pain. We present, in language appropriate to the individual patient, considerations and suggestions to effect the release of healing biochemicals. Ideomotor signals indicated the patient’s awareness of the healing. We hypothesize that the technique triggered novel state-dependent memory, learning, and behavior.
NOTES
They hypothesize that the technique they use triggers novel state-dependent memory, learning, and behavior (See for example Rossi, 1987, and Rossi & Cheek, 1988).
Hypnotic Protocol: “1. Tell the patient that he can heal himself by allowing his body to supply its own biochemicals needed to make him well. If a specific biochemical is known, such as cortisone or endorphins, name it. “2. Hypnotize the patient. Resistant or hard to hypnotize patients need not be deeply hypnotized because the patients, using this protocol, will automatically go into trance while accomplishing the next task of accessing and using ideomotor signals (Erickson, 1980; Rossi & Cheek, 1988). “3. Tell the patient that his index finger will automatically and involuntarily twitch and float when his body releases the biochemicals he needs. This ideomotor response (Rossi & Cheek, 1988) is the sole physical response required of the patient. Rossi hypothesizes that the ideomotor response correlates with biochemical changes (Rossi & Cheek, 1988). “4. Next, ask the patient to consider some things (as described below). Present the considerations one after another until one of them triggers the ideomotor response. “5. In some instances, ask the patient to practice on his own. Many patients who have dramatic emotional reactions during or at the completion of the task may not need to practice on their own” (p. 123).
They present several ‘considerations’ to the patient, one after the other, tailored to the patient’s specific case, until his finger twitches or floats, indicating a biochemical response. For example, the following ‘considerations’ have been used: “1. Psychodynamic: ‘Consider that you are not blamed for anything; that you are in fact perfect just the way you are; that you are loved by those you care about.’ ‘Consider that you can forgive whoever needs forgiving for hurting you.’ ‘Consider that there are no longer any threats; everything is better; everything is as it used to be.’ “2. Autosuggestion: ‘Tell your body to heal. It knows what to do; so ask it to do it.’ ‘Tell your adrenal glands to produce the steroids that your body needs.’ ‘Allow a glowing light to permeate that injured back, filling it with healing energy.’ “3. Incompatible responses: ‘Cover yourself with a cool breeze, cooling the injured leg.’ ‘Imagine your back getting slack and limp and relaxed.’ ‘Imagine your stomach lining becoming smooth and moving with easy, ocean-like waves.’ “4. Emotion calling: ‘Consider yourself feeling very happy with everything, for no reason at all.’ ‘Consider yourself getting angry at someone–your mother, your wife (husband), your boss, your lawyer.’ “5. Bargaining: ‘Tell yourself that you will heal if you agree to stay away from that job.’ ‘Tell yourself you will heal by allowing your right arm to begin to hurt when you are over- exerting yourself.’ ‘Tell yourself that you will heal in exchange for something else, not so serious, to replace this disease and to serve the same function'” (pp. 123-124).
They present seven cases involving, respectively, allergies, rectal bleeding, systemic lupus, hyperemesis of pregnancy, adult onset asthma, chronic pain, and cluster headaches. Two cases were particularly interesting because they represented patients who did not respond initially.
Their procedure involves reframing the state or emotion originally associated with the onset of disease using considerations, and then giving a suggestion that it is within the power of the person, rather than factors outside, to heal the body. First they instruct the patient that the body can heal itself; then they give the list of suggestions for the patient to consider, persisting with different considerations until they get an ideomotor response. Incorporation of the patient’s psychodynamic issues appears to be very important.
The authors regard it as unimportant if the patient cannot by hypnotized; “As Cheek (Cheek & LeCron, 1968; Rossi & Cheek, 1988) points out, the patient’s inability to be hypnotized may be synonymous with his disease. It is actually beneficial if the patient cannot achieve ideomotor responses at first because both he and the therapist then trust the validity of the response when it does occur after the appropriate consideration” (p. 127).
Van Dyck, Richard; Zitman, Frans G.; Linssen, A. Corry G.; Spinhoven, Philip (1991). Autogenic training and future oriented hypnotic imagery in the treatment of tension headache: Outcome and process. International Journal of Clinical and Experimental Hypnosis, 39, 6-23.
The aim of the present study was (a) to investigate the relative efficacy of autogenic training and future oriented hypnotic imagery in the treatment of tension headache and (b) to explore the extent to which therapy factors such as relaxation, imagery skills, and hypnotizability mediate therapy outcome. Patients were randomly assigned to the 2 therapy conditions and therapists. 55 patients (28 in autogenic therapy and 27 in future oriented hypnotic imagery condition) completed the 4 therapy sessions and 2 assessment sessions. Patients were to practice at home. No significant main effect or interaction effects for treatment condition or therapist was revealed. A significant effect for time in analyzing scores for headache pain, pain medication usage, depression, and state anxiety was found. In the self-hypnosis condition, pain reduction proved to be associated with depth of relaxation during home practice (as assessed with diaries) and capacity to involve in imagery (as assessed with the Dutch version of the Creative Imagination Scale). After statistically controlling for relaxation and imagery, hypnotizability scores (assessed by Stanford Hypnotic Clinical Scale) were significantly correlated with ratings of pain reduction. Results are discussed in the context of the neo- dissociation and social-cognitive models of hypnoanalgesia. The clinical relevance and the methodological shortcomings of the present study are also critically assessed. NOTES 1:
NOTES
Unexpectedly, pain reduction occurring in AT [autogenic training] appears to be brought about by different means than in hypnotic treatment. Not only imagery skills and hypnotizability, but also level of relaxation were unrelated to pain reduction achieved during AT. Since the first two therapy sessions of AT and hypnosis were identical and in both treatment conditions patients are explicitly instructed to relax, the absence of a relationship between depth of relaxation and pain reduction in AT cannot be easily explained” (p. 19).
1988
Spinhoven, Philip (1988). Similarities and dissimilarities in hypnotic and nonhypnotic procedures for headache control: A review. American Journal of Clinical Hypnosis, 30 (3), 183-194.
Similarities and differences between hypnosis and similar psychological procedures in the treatment of headache are reviewed. A brief outline of various hypnotic and nonhypnotic interventions for headache reduction shows that none of these procedures has consistently proved to produce superior results. Possible common denominators such as control of physiological processes, placebo factors, and the alteration of cognitive factors are discussed. The positive relationship between hypnotic susceptibility and hypnotic pain reduction indicates that the value of hypnosis seems to be less a matter of therapeutic procedure per se than of which context activates a patient’s hypnotic potential for pain reduction. NOTES 1:
NOTES: The author summarizes literature on biofeedback and relaxation: “(a) biofeedback with home practice of relaxation is, at least in some cases, effective in reducing migraine and tension headache; (b) relaxation training alone has also produced some success in reducing migraine and tension headaches; and (c) there is not sufficient evidence that biofeedback in the treatment of these pain problems yields results superior to relaxation training” (p. 184). Hypnotherapy for headache is not reviewed in detail, but he provides a table showing various controlled studies and their results. “With the exception of the methodologically problematic study of Anderson, Basker, and Dalton (1975), no differences in effect are found between hypnosis and biofeedback (Andreychuck & Skriver, 1975; Schlutter, Golden, & Blume, 1980; Friedman & Taub, 1984) and hypnosis and relaxation (Friedman & Taub, 1984; Spinhoven, Van Dyck, Zitman, & Linnsen, 1985)” (p. 184). He notes that there are no studies that directly compare hypnosis and nonhypnotic relaxation interventions for headache.
“In all the studies in which hypnotizability was related to outcome, irrespective of patient selection method of measurement, and hypnotic procedure used, a significant positive relationship between hypnotizability and therapy results was found in more than 350 patients (Andreychuck & Skriver, 1975; Cedercreutz, Lahteenmaki, & Tulikoura, 1976; Cedercreutz, 1978; Friedman & Taub, 1984; Spinhoven et al., 1985). If we consider the level of hypnotizability rather than the details of the hypnotic procedure, it seems that headache patients who are highly hypnotizable benefit more from hypnosis in the reduction of headache.
“However, little reliable information is available concerning the underlying dimensions of hypnotic susceptibility relevant for pain reduction. In the neodissociation theory of Hilgard it is suggested that highly hypnotizable patients register pain covertly outside conscious awareness (Hilgard, 1977, 1979). In the social learning model of Spanos and his coworkers (Spanos, Radtke-Bodorik, Ferguson, & Jones, 1979; Spanos, Kennedy, & Gwynn, 1984), it is assumed that high susceptibles show a relatively greater preference for focusing attention on internal thoughts and images as a way of attenuating pain than low susceptibles.
“A recent experimental study of Miller and Bowers (1986), which directly compared hypnotic analgesia, cognitive-behavior therapy, and cognitive-behavior therapy defined as hypnosis in high and low susceptibles, suggests that pain reduction achieved by highly hypnotizable subjects during hypnosis is not mediated by the deliberate use of cognitive strategies (such as imaginative inattention). Cognitive strategy use resulted in pain reduction only during behavior therapy. Clinical studies about the experiential aspects of high and low susceptible headache patients during hypnosis, biofeedback, relaxation training, and cognitive-behavior therapy are urgently needed. If process research in a clinical setting validates that hypnotic analgesia involves the activation of a subsystem of pain control temporarily dissociated from conscious executive control, a therapy component specific for hypnosis will have been identified” (pp. 189-190).
1987
Olness, Karen N.; Libbey, Patricia (1987). Unrecognized biologic bases of behavioral symptoms in patients referred for hypnotherapy. American Journal of Clinical Hypnosis, 30, 1-8.
Twenty patients referred for hypnotherapy had organic conditions which explained their symptoms. Each had been evaluated previously by physicians. Eleven had also been in psychotherapy; two of these had been hospitalized on child psychiatry inpatient units. Presenting symptoms included five with nocturnal enuresis, four each with headaches and recurrent abdominal pain, three with recurrent headaches, two with anxiety, and one each with sleep problems and tics. Diagnoses included hyperthyroidism, diabetes, diastometamyelia, partial oxalotranscarbamylase deficiency, sinusitis, carbon monoxide poisoning, vitamin overdose, food allergy, amebiasis, constipation, urinary tract infection, paroxysmal atrial tachycardia, and seizures. Each child had complete remission of symptoms with treatment of his/her underlying disease. Morbidity related to delayed diagnoses included parental anxiety and guilt, child anxiety, growth delays, family financial difficulties, loss of parental work time, loss of school days, and loss of confidence in child health professionals by families.
Miller, Mary E.; Bowers, Kennneth S. (1986). Hypnotic analgesia and stress inoculation in the reduction of pain. Journal of Abnormal Psychology, 95, 6-14.
Investigated the influence of hypnotic ability on 3 methods of reducing cold-pressor pain. Following a baseline immersion, 30 high- and 30 low-hypnotizable undergraduates were randomly assigned to 1 of 3 treatment groups: stress inoculation training, stress inoculation training defined as hypnosis, or hypnotic analgesia. Analysis of pain reports indicated a significant hypnotic ability x treatment interaction. Among Ss receiving hypnotic analgesia, high-hypnotizables reported significantly less intense pain than lows. There was no differential response for high- and low-hypnotizable Ss receiving stress inoculation training, whether or not it was defined as hypnotic. Moreover, Ss in the stress inoculation condition (whether or not defined as hypnosis) reported using cognitive strategies to reduce pain, whereas this was not the case for Ss in the hypnotic analgesia condition. The present findings seem inconsistent with the social psychological account of hypnosis and are discussed from a dissociation perspective, which views hypnosis as involving changes in the way information is processed.
1986
Sargent, Joseph; Solbach, Patricia; Coyne, Lolafaye; Spohn, Herbert; Segerson, John (1986). Results of a controlled, experimental, outcome study of nondrug treatments for the control of migraine headaches. Journal of Behavioral Medicine, 9, 291-323.
Headache variables were examined for 136 subjects who participated for 36 weeks in one of four groups: No Treatment, Autogenic Phrases, EMG Biofeedback, Thermal Biofeedback. All subjects kept daily records of headache activity and medication usage and participated in 22 laboratory sessions during which frontalis EMG and hand temperature measurements were taken; those in the 3 treatment groups practiced at home. There was a substantial reduction in headache variables in all groups. The No- Treatment Group differed significantly from the treatment groups combined, with the least reduction in headache variables. The thermal biofeedback group vs EMG biofeedback and autogenic phrases groups showed a suggestive trend toward improvement in the frequency and intensity of total headache.
1984
Fogel, Barry S. (1984). The ‘sympathetic ear’: Case reports of a self-hypnotic approach to chronic pain. American Journal of Clinical Hypnosis, 27 (2), 103-106.
Secondary gain issues may limit the success of hypnotherapeutic approaches to chronic pain. A self-hypnotic suggestion that promotes patients’ awareness of the interpersonal aspects of their pain complaints was used in the treatment of two patients with chronic headache. Hypnotic suggestions that help make secondary gains conscious may be a useful addition to hypnotic techniques of pain management.
1983
Bassman, S. (1983). The effects of indirect hypnosis, relaxation and homework on the primary and secondary psychological symptoms of women with muscle contraction headache (Dissertation). Dissertation Abstracts International, 44, 1950-B.
Compared the effects of indirect hypnosis (e.g., metaphors, stories, vague suggestions, and implied directives) on muscle contraction headaches with a relaxation and a no-treatment control condition. Both hypnosis and relaxation conditions reduced symptoms more than did the no-treatment condition. Unlike relaxation, indirect hypnosis did not reduce the intensity and duration of headaches, although it did reduce the amount of medication and also benefitted sleep.
Classen, Wilhelm; Feingold, Ernest; Netter, Petra (1983). Influence of sensory suggestibility on treatment outcome in headache patients. Neuropsychobiology, 10, 44-47.
In 45 headache patients the relationship between sensory suggestibility and three measures of treatment effect-ratings on (1) intensity of headaches; (2) efficacy of drugs, and (3) physician’s competence – was investigated in a double-blind long-term crossover study. Subjects scoring high on sensory suggestibility clearly showed more relief of headaches upon the analgesic as well as upon the placebo. The physician’s competence was rated higher by high-suggestible patients, whereas ratings on drug efficacy were low in all patients. The seemingly controversial behavior of high-suggestible patients was interpreted as a call for continuation of the physician’s efforts in spite of the relief the patients already achieved.
1982
Howard, L.; Reardon, J. P.; Tosi, D. (1982). Modifying migraine headache through rational stage directed hypnotherapy: A cognitive-experiential perspective. International Journal of Clinical and Experimental Hypnosis, 30 (3), 257-269.
Recent techniques designed to modify migraine headache have emphasized physiological modification via hypnosis only or biofeedback. Psychological factors, however, have been identified as causal in many psychophysiological disorders such as migraine. The present case study describes the results of utilizing Rational Stage Directed Hypnotherapy (RSDH) of Tosi (1974), Tosi and Marzella (1975), and Tosi (1980a) in the treatment of an individual suffering from severe migraine headaches. RSDH, designed to attend to both physiological and psychological factors, is a cognitive-experientially based, stage directed, systematic psychotherapeutic regimen which utilizes hypnosis and hypnotic imagery to enhance the rational restructuring of negative cognitive/emotional/physiologicla/behavioral states.
In the present case study, RSDH demonstrated superior effects over the hypnosis only treatment and baseline in reducing migraine headaches. The client demonstrated improvement on both self-report measurement (frequency of migraine headaches) and objective test results (MPI, Hathaway & McKinley, 1951; Tennessee Self-Concept Scale, Fitts, 1979). In describing this case, particular attention was given to analyzing cognitive distortions via hypnotic imagery in a temporal framework. Analysis and restructuring of past traumatic events which were symbolically affecting the client’s current behavior were particularly significant aspects of the treatment process.
1981
Claghorn, James L.; Mathew, Roy J.; Largen, John W.; Meyer, John S. (1981). Directional effects of skin temperature self-regulation on regional cerebral blood flow in normal subjects and migraine patients. American Journal of Psychiatry, 138, 1182-1187.
Vascular headache of the migraine type is associated with vasomotor changes in cerebral arteries. The authors studied whether skin temperature training (biofeedback) reduced the frequency, severity, and duration of these headaches by measuring the regional cerebral blood flow (CBF) in 11 female migraine patients (27-52 years) and 9 female volunteers (22-37 years), using the noninvasive 133 Xe inhalation technique. Half of each group was randomly assigned to a hand-warming or a hand- cooling group. CBF increased in several regions of the left hemisphere to a significant degree only for the migraineurs who were in the hand-warming group. The pattern of vasomotor regulation apparently differed between migraine and normal Ss. The migraineurs” headache symptoms were affected by both warming and cooling, but warming produced more salutary effects.
Cott, A.; et al. (1981). The long-term therapeutic significance of the addition of electromyographic biofeedback to relaxation training in the treatment of tension headaches. Behavior Therapy, 12, 556-559.
Eight tension headache sufferers seeking traditional medical treatment from a neurologist participated in either a therapist-delivered relaxation training (RT) condition or an RT plus EMG feedback condition. Mean hours of pain/day, headache severity, and medication ingestion were significantly lower in both groups following treatment. Results were maintained at a 1-year follow-up for hours of pain/day and medication ingestion. Findings thus indicate no benefit of adding EMG feedback to relaxation training.
1980
Adams, Henry E.; Feuerstein, Michael; Fowler, Joanne L. (1980). Migraine headache: Review of parameters, etiology, and intervention. Psychological Bulletin, 87 (2), 217-237.
The migraine headache is a disorder of much interest to clinicians and researchers in the areas of psychology and medicine. Research that has investigated various characteristics of this disorder and the factors contributing to its etiology and a variety of treatment techniques have appeared in both the medical and the psychological literature. The present article provides a comprehensive critical appraisal of this literature, with particular emphasis on psychological intervention. Theoretical issues involving biological and psychological factors in migraine etiology are discussed, and a psychobiological model for the migraine disorder is proposed. Areas requiring further basic and clinical research are identified. Major conclusions include (a) that etiological factors of migraine remain unclear; (b) that pharmacological intervention does not constitute an adequate treatment method in terms of headache elimination; (c) that although a number of psychological treatment approaches have been reported in the literature, there are few well-controlled evaluations, and definitive conclusions regarding differential effectiveness of the various techniques are difficult; and (d) that a biofeedback approach directed at modifying the peripheral pain mechanism in migraine appears to be a promising treatment technique for this disorder.
1979
Di Piano, Frank A.; Salzberg, H. C. (1979). Clinical applications of hypnosis to three psychosomatic disorders. Psychological Bulletin, 86, 1223-1235.
Studies of hypnosis in the treatment of skin disorders, headaches, and asthma were reviewed in terms of outcomes and methodological soundness. Some studies focused on changing physiological functions, others on increasing insight in their patients, and still others on altering patients’ perceptions of their symptoms. Methodological weaknesses included lack of control groups, nonrandom assignment of patients to treatment conditions, and confounding of treatment effects or lack of control for placebo effects. Additional weaknesses centered around the use of single outcome measures and the failure to assess the specific roles of mediating variables. Most of the studies reviewed showed positive treatment effects. However, there is equivocal evidence that hypnosis can directly influence autonomic functioning. Hypnosis may be valuable in facilitating one’s capacity to gain insight into how one’s symptoms developed and are maintained. In addition, hypnotic procedures have resulted in some success when used to indirectly alleviate symptoms by altering how individuals perceive their disorders and how these disorders affect their lives.
Turk, Dennis C.; Meichenbaum, Donald H.; Berman, William H. (1979). Application of biofeedback for the regulation of pain: A critical review. Psychological Bulletin, 86 (6), 1322-1338.
The biofeedback literature for the regulation of pain is reviewed and found wanting on both conceptual and methodological grounds. In particular, studies on the use of biofeedback for the treatment of tension and migraine headaches and chronic pain indicate that biofeedback was not found to be superior to less expensive, less instrument- oriented treatments such as relaxation and coping skills training. The relative absence of needed control comparisons was noted, and the need for caution in promoting biofeedback was stressed. Suggestions for future research are offered.
1978
Acosta, Frank X.; Yamamoto, Joe; Wilcox, Stuart A. (1978). Application of electromyographic biofeedback to the relaxation training of schizophrenic, neurotic, and tension headache patients. Journal of Consulting and Clinical Psychology, 46 (2), 383-384.
This study examined the effects of electromyographic (EMG) biofeedback on tension reduction by schizophrenic, neurotic, and tension headache patients. Fourteen patients participated voluntarily in at least 10 weekly EMG biofeedback sessions at a public outpatient clinic. All had complained of chronic tension. Patients showed significant decreases in their muscle tension levels with successive biofeedback training sessions. No significant differences were found between the schizophrenic, neurotic, and tension headache groups. A further contribution was the finding that patients with diverse socioeconomic and educational levels benefitted similarly from EMG biofeedback training.
1977
Ansel, Edward Leslie (1977). A simple exercise to enhance response to hypnotherapy for migraine headache. International Journal of Clinical and Experimental Hypnosis, 25 (2), 68-71.
A common method of hypnotherapy for migraine headache utilizes suggestions of warmth for the hands and coldness for the head. This procedure reverses the abnormal pattern of vasodilation and excess supply of blood in the head and decreased supply in the extremities associated with this type of headache, threby relieving the pain. A simple exercise, utilizing centrifugal force to dramatically increase blood flow to the hands, is described. It promotes relief in itself and provides a vivid background experience to enhance productino of this effect in hypnosis. It appears to be especially useful in patients exhibiting lesser degrees of trance capacity.
Wickramasekera, Ian (1977). The placebo effect and biofeedback for headache pain. [Paper]
NOTES 1:
“The strength of the placebo response is hypothesized to be primarily a function of the following variables:
1. Credibility of the therapist.
2. The credibility of the placebo per se.
3. The credibility of the setting in which the placebo is administered.
4. The credibility of the administration ritual.
5. The level of emotional arousal of the patient.
6. The patient’s level of attention to the placebo elements.
7. The baseline suggestibility of the patient” (P. 197).
“I suggest that more careful attention to the placebo and hypnosis literatures and to the isolation of the conditions which potentiate the context of treatment, the rituals of treatment, the instructions that accompany treatment, and the relationship within the therapeutic unit, will significantly increase the reliability and the power of biofeedback effects. It will do this by a more systematic arrangement of conditions for motivated patient behavior” (p. 198).
1976
Cedercrentz, C.; Lahteenmaki, R.; Tulikoura, J. (1976). Hypnotic treatment of headache and vertigo in skull injured patients. International Journal of Clinical and Experimental Hypnosis, 24, 195-201.
Symptoms of headache and vertigo were treated using direct hypnotic suggestions of symptom relief in 155 consecutive skull injured patients. Posttraumatic headache and vertigo were completely relieved after an average observation period of 1 year 10 months in 50% and 58% of the patients, and partially relieved in 20% and 16% respectively. Most of the relief was achieved after about 4 weekly sessions and, particularly with the headaches, only if treatment began within a few weeks of the injury. Therapeutic outcome was correlated with depth of hypnosis achieved for both headache (r = .44, p < .0001) and vertigo (r = .47, p < .0001) symptoms. Patients who could not even achieve light hypnosis obtained no therapeutic improvement, but patients who experienced only light hypnosis were as clinically responsive as those achieving deep hypnosis. NOTES 1: Outcome of hypnosis treatment was studied in relationship to hypnotizability 1975 Anderson, J. A. D.; Basker, M. A.; Dalton, R. (1975). Migraine and hypnotherapy. International Journal of Clinical and Experimental Hypnosis, 23 (1), 48-58. Therapeutic measures for migraine are largely ineffective. Prophylaxis by hypnosis (including autohypnosis) and prochlorperazine is difficult to assess because of the intermittency of the disease and the subjective nature of the disabling symptoms. A method of studying this problem is described in this article. Random allocation of 47 patients was made to one or other prophylactic measure. This was followed by monthly assessments and independent evaluation of 1 year of continuous care. Criteria of improvement were the number of attacks per month, number who had Grade 4 attacks, and complete remission. Results showed that the number of attacks and the number who suffered blinding attacks were significantly lower for the group receiving hypnotherapy than for the group receiving prochlorperazine. For the group on hypnotherapy, these 2 measures were significantly lower when on hypnotherapy than when on previous treatment. Prochlorperazine seemed about as effective as previous treatment. 10 out of 23 patients on hypnotherapy achieved "complete remission" during the last 3 months of the trial as opposed to only 3 out of 24 on prochlorperazine. It is concluded that further trials of hypnotherapy are justified against some other treatment not solely associated with the ingestion of tablets. Andreychuk, Theodore; Skriver, Christian (1975). Hypnosis and biofeedback in the treatment of migraine headache. International Journal of Clinical and Experimental Hypnosis, 23 (3), 172-183. A study was made to explore the effects of subject hypnotizability in response to 3 treatment procedures applied to 33 migraine headache sufferers. These treatment procedures included biofeedback training for hand-warming, biofeedback training for alpha enhancement and training for self-hypnosis. The Hypnotic Induction Profile (HIP) of Spiegel & Bridger (1970) was given to each S to determine degree of hypnotizability and the MMPI was administered to all Ss. All 3 treatment groups showed significant reductions in headache rates and there were no significant differences between groups. Cutting across treatment groups, high hypnotizable Ss (N - 15) showed significant reductions in headache rates when compared with low hypnotizable Ss (N - 13). There was no correlation between HIP scores and the hysteria scale of the MMPI. NOTES 1: NOTES This research investigated the relationship between hypnotizability and treatment outcome. Graham, George W. (1975). Hypnotic treatment for migraine headaches. International Journal of Clinical and Experimental Hypnosis, 23, 165-171. 2 patients with a long clinical history of migraine headaches were treated with hypnosis coupled with the hand-warming technique of Sargent, Green, and Walters (1973). Both patients were followed up (1 for 12 months and 1 for 9), and the treatment was extremely effective in reducing the intensity, frequency, and duration of their migraine headaches. 1972 Cedercrentz, C. (1972). The big mistakes: A note. International Journal of Clinical and Experimental Hypnosis, 20, 15-16. In his book, A System of Medical Hypnosis, Ainslie Meares writes, "Most books on hypnosis, from Bernheim to the present time, devote a great deal of space to the description of successful and dramatic cures. These accounts may be of prestige value to the author, and may do something to inform the profession of the potential value of hypnosis in medicine, but these success stories are really of little help to those who would learn the technique of hypnotherapy because the emphasis is always on the success of the treatment rather than on anlysis of the psychodynamic mechanisms which brought it abauot. As in everything else, we learn most from a study of our failures [p. 3]." These comments remain as true today as they were ten years ago. With the notable exception of Meares, few colleagues have been willing to share their errors, allowing us to profit from their experience. Thus, when Dr. Cedercreutz sent along a note describing his experience with one of his patients, I was struck by his generosity, and it seemed most appropriate for all of us to share his experience by way of the Journal. Hopefully, this may encourage other colleagues to share their failures as well as their successes so that all of us may learn to be more effective therapists and better scientists. M.T.O. [Martin Orne] NOTES 1: The case reported involves a patient who had migraine headache removed with hypnosis, but later developed gastrointestinal symptoms that were operated surgically with absence of positive (physical) pathology noted. Subsequent investigation of the psychological component of the problem with hypnosis revealed an early trauma (seeing a soldier killed with a bayonette) that led to migraine-like pain in the head and vomiting. Meares, Ainslie (1972). Group relaxing hypnosis. Journal of the American Society of Psychosomatic Dentistry and Medicine, 19, 137-141. NOTES 1: The paper is reprinted from Med. J. Aust., 1971, 2, 675-676 with permission of Editor. The author discusses theoretical concepts, techniques and patient selection for this method. "I avoid all logical communication, as this would only keep the patient alert, and so prevent the atavistic regression which is the essential factor in hypnosis" (p. 139). He moves from patient to patient, saying little except "Good--easy--natural" etc. and he uses touch to reinforce their development of hypnotic state. To ratify the trance and make sure they are hypnotized, not just relaxed, he places a clip on forearm skin for a few moments. "This potentially painful stimulus has the effect of further deepening hypnosis" (p. 139). After about 35-40 minutes he alerts the group. Patients are taught self hypnosis to extend the results into daily life. 1967 Elkind, Arthur H.; Friedman, Arnold P. (1967). Recent advances in medicine and surgery: Review of headache, Part III. New York Journal of Medicine, 552-559. NOTES 1: This article mentions only three papers dealing with hypnotherapy used with migraine headache and none used with tension headache or headaches of other etiologies. The papers are: Hanley, F. W. (1964). Hypnotherapy of migraine, Canad. Psychiat. Ass. J., 9, 254 (June). Krogen, W. S. [Kroger?] (1963). Hypnotherapeutic management of headache, Headache, 3, 50. Blumenthal, L. S. (1963). Hypnotherapy of headache, Headache, 2, 197. 1953 Erickson, Milton H. (1953). The therapy of a psychosomatic headache. Journal of Clinical and Experimental Hypnosis, 1 (4), 2-6. The author presents a case in which the patient complained of headaches to illustrate a theoretical position, described as follows in the Introduction: "For example, many psychotherapists regard as almost axiomatic that therapy is contingent upon making the unconscious conscious. When thought is given to the unmeasurable role that the unconscious plays in the total experiential life of a person from infancy on, whether awake or asleep, there can be little expectation of doing more than making some small parts of it conscious. Furthermore, the unconscious as such, not as transformed into the conscious, constitutes an essential part of psychological functioning. Hence, it seems more reasonable to assume that a legitimate goal in therapy lies in promoting an integrated functioning, both singly and together, and in complementary and supplementary relationships, as occurs daily in well-adjusted living in contrast to the inadequate, disordered and contradictory manifestations in neurotic behavior" (p. 2). Horan, John S. (1953). Hypnosis and recorded suggestions in the treatment of migraine: Case report. Journal of Clinical and Experimental Hypnosis, 1 (4), 7-10. (Abstracted in Psychological Abstracts 54: 6399) NOTES 1: Author's Discussion: "The case above is presented because of its rather bizarre features. It is notable in that in the hypnotic sessions no attempt was made to explore the dynamics of the patient's resentment or her illness, no insight was given into psychic mechanisms conected with the migraine. This had been done before, in conventional psychiatric interviewing, without much result. Under hypnosis, the only suggestions given were concerned with direct symptomatic relief of headache, insomnia and anorexia. For the patient's purposes, these were sufficient. Just how the pathological physiological state causing the migraine attacks was altered by direct and recorded suggestion is a mystery to this writer. It may be that hypnotic states can cause a dissociation of the subject from the emotional stress related to the attacks. Or perhaps the strangeness and the mystery of hypnosis was sufficient. It would be absurd to make any claims about the efficacy of hypnosis in migraine patients in general on the basis of this one case. In a disease which causes as much disability and suffering as migraine, however, it is profitable to report any safe means that gives a satisfactory result" (pp. 9-10). HEADACHE Haddock CK. Rowan AB. Andrasik F. Wilson PG. Talcott GW. Stein RJ. Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials. Cephalalgia 1997;17(2):113-8 Controlled clinical trials have consistently demonstrated that behavioral treatments for chronic benign headache produce clinically beneficial outcomes both post-treatment and at follow-up. Given these results there is interest in cost-reduction and redesign of these treatments to improve their accessibility. One promising approach in this regard is home-based headache treatment. These treatments seek to provide the same amount of treatment as clinic-based treatments; however, some of the material typically presented to the patient by a clinician is presented through home-study materials (e.g., manuals, audiotapes). To date, the published literature contains 20 controlled clinical trials which have examined the outcomes produced by home-based treatments. This article presents the first comprehensive meta-analysis of these clinical outcome studies. Results of the quantitative analyses suggest that home-based treatments produce comparable, or with certain outcome measures, superior results to clinic-based treatments. Moreover, costeffectiveness scores of home-based treatments were found to be more than five times larger than those of clinic-based therapies. Methodological analyses are also presented along with suggestions for future research. Johnson PR. Thorn BE. Cognitive behavioral treatment of chronic headache: group versus individual treatment format. Headache 1989;29(6):358-65 Two hypotheses were tested in this study: (1) that a short course of cognitive behavioral therapy (CBT) is effective in the treatment of chronic headache; and (2) that group CT is as effective as individually administered CBT. Twenty-two chronic headache sufferers were randomly assigned to one of three treatment conditions: group administered CBT, individually administered CBT, or no treatment (wait list) control. Wait list subjects ultimately received treatment identical to that offered to subjects in the group treatment condition. Treatment outcome measures included the Brief Symptom Inventory, the McGill Pain Questionnaire, and several measures calculated from self-monitoring data. Tentative support was found for the hypothesis that CBT as provided in this study is effective in the treatment of chronic headache. There was no evidence that group versus individually treated subjects differed significantly on any of the measures used, although the small N and large variance among subjects limit us to preliminary conclusions for our findings. Clinical implications and suggestions for future research are discussed. Llaneza-Ramos ML. Hypnotherapy in the treatment of chronic headaches. Philippine Journal of Psychology 1989;22:17-25. 35 chronic headache patients were assessed on frequency, duration, intensity, amount of medication, and number of difficulties associated with headaches. 25 Subjects were randomly assigned to 2 psychotherapists who administered Ericksonian hypnotherapy; 10 Subjects became the comparison group. Prior to treatment, all 25 Subjects were nonsignificantly different on their baseline measures. Posttreatment measures showed all Subjects with complete relief from headaches. Two months later, 20 Subjects experienced complete recovery while 5 had a single attack of headache. For the 2 experimental groups, there were no significant differences in symptomatic manifestations before and after treatment. At the delayed posttreatment period, post hoc test analysis evidenced a shared pattern of significant differences between each of the 2 treatment groups and the comparison group. Melis PM. Rooimans W. Spierings EL. Hoogduin CA. Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study. Headache 1991;31(10):686-9 We investigated the effectiveness of a special hypnotherapy technique in the treatment of chronic tension-type headache. A waitinglist control group was used to control for the changes in headache activity due to the passage of time. The results showed significant reductions in the number of headache days (p less than 0.05), the number of headache hours (p less than 0.05) and headache intensity (p less than 0.05). The improvement was confirmed by the subjective evaluation data gathered with the use of a questionnaire and by a significant reduction in anxiety scores (p less than 0.01). Passchier J. Hunfeld JA. Jelicic M. Verhage F. Suggestibility and headache reports in schoolchildren: a problem in epidemiology. Headache 1993;33(2):73-5 In a sample from the general population of school children of 15 years of age, we studied whether receiving information about the prevalence of headaches had any effect on their subsequent headache report. Sixty children in the fourth year at four secondary schools were allocated at random to two conditions: a biased condition emphasizing the high prevalence of headaches and a neutral condition. Subjects in the biased condition reported more headaches but they did not report more other physical symptoms than the subjects in the neutral condition. The results are discussed. Reich BA. Non-invasive treatment of vascular and muscle contraction headache: a comparative longitudinal clinical study. Headache 1989;29(1):34-41 The purpose of this investigation was to evaluate the long-term course of non-invasively treated chronic headache. A total of 1015 adult patients with primary diagnosis of vascular/migraine or muscle contraction headache participated in the study investigating symptom frequency and severity over a 36 month period after receiving treatment. Treatment consisted of either: relaxation training (stepwise relaxation/hypnosis/autogenic training/cognitive behavior therapy); biofeedback (thermal/photoplethysmograph/EMG); micro-electrical therapy (TENS/Neurotransmitter Modulation) or multimodal treatment (combination of any of the above two treatments). Seven hundred and ninety-three patients returned sufficient data to be included in the analysis. Patients were randomly assigned to treatment groups and received either short term intervention (15 or less treatments) or long term intervention (greater than 15 treatments). Results indicate that all treatment conditions significantly reduced frequency and intensity of cephalalgia. Repeated measure analysis of variance indicated that grouping variables of Biofeedback treatment, symptoms being evidenced less than 2 years and receiving over 15 treatment sessions best predicted successful intervention. I RESEARCH IDEPMOTOR 2001 Fredericks, Lillian E. (2001). The use of hypnosis in surgery and anesthesiology. Springfield IL USA: Charles C Thomas. NOTES 1: Preface: Definition of Hypnosis History of Hypnosis in Surgery Theories of Hypnosis Chapter: 1. An Introduction to Hypnosis 2. Hypnosis in the Management of Chronic Pain 3. Hypnosis in Conjunction with Chemical Anesthesia 4. Hypnosis in Conjunction with Regional Anesthesia 5. Hypnosis as the Sole Anesthetic 6. Hypnosis in the Intensive Care Unit 7. Hypnosis in the Emergency Unit 8. Hypnosis in Pediatric Surgery 9. Hypnosis in Obstetrics and Gynecology 10. Perspectives from Physician-Patients 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. 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.