The authors present six cases. They describe the act of swallowing as a complex neuromuscular activity involving a series of conditioned reflexes that get mingled with the voluntary act of swallowing, resulting in an automatic functioning of the mouth, pharynx, and the esophagus.

Pajntar, Marjan; Jeglic, Anton; Stefancic, Martin; Vodovnik, Lojze (1980). Improvements of motor response by means of hypnosis in patients with peripheral nerve lesions. International Journal of Clinical and Experimental Hypnosis, 28 (1), 16-26.

In order to accelerate rehabilitation of patients with peripheral nerve lesions, hypnosis was employed to encourage them voluntarily to move those muscles with weak re-innervation and to achieve the best possible activity of the affected muscle groups. By measuring muscle force and endurance and by observing the electrical activity of the affected muscles, it was found that the activity of the affected muscles was much better while patients were in hypnosis than when they were in the waking state. The patients were able to contract even paretic muscles having only weak re-innervation with such strength, that clinically perceptible contraction of the muscles and movement of paretic extremities occurred. Such early and improved activation is very important for prevention of much permanent damage.

Schubot, Errol David (1967). The influence of hypnotic and muscular relaxation in systematic desensitization of phobias (Dissertation). Dissertation Abstracts, 27 (n10-B), 3681-3682.

“15 snake phobic subjects had desensitization treatment and 15 matched subjects had desensitization treatment with a hypnotic and muscular relaxation induction. Rate of moving through the fear hierarchy was based on three variables fear report, report of body tension, and time of signaling anxiety. Analysis of results took into consideration initial approach (to snake) level of subjects. Both treatments were effective. However, hypnotic relaxation was significantly important in desensitization for the most phobic subjects (those who couldn’t approach closer than 5 feet, initially) though not for less fearful subjects. In fact, the most fearful subjects did not show improved approach behavior if they did not get the hypnosis relaxation treatment, though bodily tension and fear were reported as less while working on early items in the hierarchy. The Waking group, compared to the Relaxation hypnosis group, manifested significantly less improvement in approach and slower progress in desensitization. Hypnotizability was significantly correlated with improvement for the Relaxation subjects, as was vividness of imagery. In summary, hypnosis (a relaxation induction) facilitated desensitization treatment of highly anxiety snake-phobic subjects with the hypnotic relaxation induction, treatment outcome was related both to hypnotizability and to imagery vividness” (p. 3681- 3682).

Schneck, Jerome M. (1965). Hypnotherapy for vaginismus. International Journal of Clinical and Experimental Hypnosis, 13 (2), 92-95.

The literature on hypnotherapy contains few comments, usually generalizations, on vaginismus. 2 patients with this problem are presented here. Methods used and degrees of success are described. Major stress was on hypnotic relaxation with supporting, persuading, and graded, encouraging measures. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Moskowitz, Arnold E. (1964). A clinical and experimental approach to the evaluation and treatment of a conversion reaction with hypnosis. International Journal of Clinical and Experimental Hypnosis, 12 (4), 218-227.

A combination of hypnotherapeutic techniques within a clinical and experimental context provided a method of understanding, evaluating, and predicting the course of a conversion reaction. During waking and hypnotic conditions, 5 trials of dynamometer presses were obtained from a patient having primary symptoms of paralysis of his left arm. Difference scores between the left and right hands during waking and hypnotic conditions were evaluated. Findings were: (a) At the beginning of treatment, significant differences were found between the waking and hypnotic conditions (b) The largest differences between the waking and hypnotic conditions occurred during the early stages of treatment, while the smallest differences occurred on the final day of treatment. (c) With a complete remission of the patient”s symptoms, no significant differences between the waking and hypnotic conditions were found. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Cedercreutz, Claes (1961). Hypnosis in surgery. International Journal of Clinical and Experimental Hypnosis, 9, 93-95.

(Author”s Summary) “It is possible to treat painful conditions and spasms in the alimentary canal by hypnosis. In the rehabilitation of patients with limb injuries and fractures, hypnosis has also proved useful. There is seldom reason to resort to this method of inducing anaesthesia in surgery” (p. 95).


Blankfield, Robert; Scheurman, Kathleen; Bittel, Sue; Alemagno, Sonia; Flocke, Sue; Zyzanski, Stephen (1992, October). Taped therapeutic suggestions and taped music as adjuncts in the care of coronary artery bypass graft patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.

18 studies have explored the issue with an experimental design; half used tapes, half didn’t; majority of studies found benefits; 2 were of heart surgery patients.
This study used taped suggestions with coronary bypass patients. Used tape recorder rather than person delivering suggestions because it was more convenient; used tape intra-surgery and post-operatively for more impact.
We hypothesized: shorter length of stay, less narcotic analgesia, less anxiety, faster recovery, more positive mental outlook, resume activities sooner, have less symptoms postoperatively, etc.
Used a prospective, randomized, single-blind trial in 2 community hospitals in Cleveland with coronary artery bypass graft surgery patients. Study was done between Dec 1989 – Feb 1992.
3 groups were involved: (1) Suggestion, (2) music, and (3) tape. Control subjects had a blank tape. Tapes were played continuously and repeatedly with headphones. Postoperatively, a different tape was played.
Excluded: Patients with emergent surgery, hearing impairment, poor comprehension of English, patients who died in hospital, patients whose hospital stay lasted longer than 14 days (3 of them). 5% of sample were eliminated for last 2 reasons.
Music: Herb Ernst, Dreamflight II. Suggestions: Music background, permissive, based on Evans & Richardson’s study.
Outcome Measures: Nurse assessment of anxiety and progress post operatively, Symptom scale, Depression scale.
Mean age 62, 3/4 men, 92% white, 75% married. The groups were same on a variety of preoperative variables (status of heart and arteries). Length of stay was 6.5 in all 3 groups. No difference in narcotics use, in nurse assessment of anxiety or of progress; of depression scale, or activities of daily living.
Recategorized data into patients who said the tapes were helpful (both music and suggestion) N = 33 vs the other patients N = 62. No difference in the variables evaluated.

Biasutti, M. (1990). Music ability and altered states of consciousness: An experimental study. International Journal of Psychosomatics, 37, 82-85.

The relationship between music and altered states of consciousness was studied with 30 subjects divided into hypnosis and control groups. The “Test di abilita musicale” was applied. The hypnosis group did the retest after posthypnotic suggestions and the second in waking conditions. The hypnosis group had better results than the control group, especially in the rhythm test (p < 0.0001). Clark, Duncan B.; Agras, W. Stewart (1990). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry, 148 (5), 598-605. 94 adults with a performance anxiety problem were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were questionnaires for all 94 ss, diagnostic interview of 50 ss, and laboratory performance of 34 ss. Treatment conditions were 6 weeks of buspirone, 6 weeks of placebo, a five-session group cognitive-behavior therapy program (CBTP) with buspirone, or the CBTP with placebo. All Ss fulfilled criteria for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) social phobia. Of the 15 full-time professional musicians, 10 had tried propranolol and 3 had stopped performing. Most Ss had substantial anxiety and heart rate increases during lab speech and musical performances. CBTP resulted in significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence. 1989 Snodgrass, M.; Lynn, Steven Jay (1989). Music absorption and hypnotizability. International Journal of Clinical and Experimental Hypnosis, 37, 41-54. The present study investigated differences between high (N = 15), medium (N = 20), and low (N = 16) hypnotizable Ss' involvement in imaginative versus nonimaginative music. Ss were first screened for hypnotizability with the Harvard Group Scale of Hypnotic Susceptibility, Form A (Shor & E. Orne, 1962). In a second session presented as a study of music appreciation, Ss listened to classical music of high- and low-rated music imaginativeness. Ss' involvement was indexed by absorption, imagery elaboration reported in open-ended essays, and reaction time to a pure tone. High hypnotizable Ss reported more absorption than low hypnotizable Ss, regardless of the imaginativeness level of the music. Ss reported more imagery elaboration in the imaginative than in the low-imaginative passages. High hypnotizable Ss tended to differ in their imagery elaboration in response to the imaginative passages but not in response to the nonimaginative passages. Reaction time results were nonsignificant. No sex differences were found. Medium hypnotizable Ss were indistinguishable from both high- and low-hypnotizable Ss. The findings are generally compatible with J. R. Hilgard's (1970, 1974) construct of imaginative involvement. 1983 Smith, Howard V.; Forrest, Derek W.; Sheehan, Eugene P. (1983). Suggested improvement, music, and the visual acuity of myopes: A reply. [Comment/Discussion] . This is a reply to Wagstaff, G.F. suggested improvement of visual acuity: A statistical reevaluation. IJCEH, 1983, 31, 239-240. Here, the authors suggest yet a third way of analysing the data initially presented by Sheehan, Smith, & Forrest in 1982 (A signal detection study of the effects of suggested improvement on the monocular visual acuity of myopes, IJCEH, 30, 138-146). Mysticism 1997 Court, John (1997). Hypnosis, healing and the Christian. Carlisle United Kingdom: Paternoster Press. Seeks to explore the interface between hypnotic phenomena and religious experiences. On the basis of clinical examples, and historical review, argues that the constraints expressed by some churches against hypnosis cannot be justified. Rather that there is a good deal of support for seeing religious experiences and clinical phenomena as similar. Challenges the use of the Old Testament to discount hypnosis in favor of more positive evaluations from the New Testament. 1993 Kokoszka, Andrzej (1993). Occurrence of altered states of consciousness among students: Profoundly and superficially altered states in wakefulness. Imagination, Cognition and Personality, 12, 231-247. In a questionnaire survey waking altered states of consciousness (ASC) are found to be common among 174 Polish students. The experience of Superficially Altered States of Consciousness (SACS) was reported by 96 percent of subjects and more than half of them had such experiences often. Whereas an experience of Profoundly Altered States of Consciousness (PASC) was confirmed by 75 percent and about one-third of them had them often. The comparison of the experiences accompanying the ASC indicates that SASC are characterized by disturbances in experiencing the reality and oneself combined with positive, pleasant feelings and with quietness. On the other hand, PASC are accompanied by experiences related to an absolute, universal, eternal, and existential or religious matters. PASC are accompanied by extremely strong positive emotions of happiness, total love, etc. and are experienced as more rational than SASC, and with significantly less feelings of cognitive disturbances than in SASC. The comparison of circumstances of the ASC occurrence indicates that SASC occur in usual and common states and situation of everyday life, whereas PASC mainly in the context of religion and nature. The congruence of these findings with an integrated model of the main states of consciousness suggests a natural tendency for a cyclical occurrence of ASC, or more precisely, the differentiated waking states of consciousness. 1992 Richeport, Madeleine M. (1992). The interface between multiple personality, spirit mediumship, and hypnosis. American Journal of Clinical Hypnosis, 34, 168-177. The author draws parallels between multiple personality disorder (dissociative identity disorder), spirit mediumship, and hypnosis. She uses historical, anthropological, and clinical perspectives. According to the author, Milton Erickson's view of multiple personality disorder was that it was not necessarily pathological, and he employed hypnosis to gain access to personalities and to transform their behavior from involuntary to voluntary actions. "Natural trance therapies in other cultures offer a new perspective for viewing the normalcy or pathology of "other selves"" (p. 168). 1991 Nelson, Peter L. (1991-92). Personality attributes as discriminating factors in distinguishing religio-mystical from paranormal experients. Imagination, Cognition and Personality, 11, 389-406. In the first section of this article, an operationalized notion of preternatural experience is described which includes two general classes of experience: religio-mystical (Ontic) and paranormal (Perceptual). The exploratory study which follows uses the personality measures of the complete Tellegen Differential Personality Questionnaire taken from 120 subjects who reported having had spontaneous religio- mystical and/or paranormal experiences at some time in the past. The scores on all eleven primary dimensions, three higher order affect factors, and two validity scales were used individually, in univariate ANOVAs, and together, in a Direct Discriminant Function Analysis, to successfully separate two classes of preternatural experients from non- experients and from each other. 1984 Burnham, John C. (1984, October/1986). The fragmenting of the soul: Intellectual prerequisites for ideas of dissociation in the United States. In Quen, Jacques M. (Ed.), Split minds/split brains (pp. 63-84). New York: New York University Press. (Based on symposium in Bear Mt., N.Y., by Section on the History of Psychiatry of Cornell University Medical Center) "Reductionism was a relentless pursuit of the idea that knowledge of components led to knowledge of causes. In this context, I propose to show how, in the psychological-medical realm, the initial concept was the soul, and the final intellectual product was dissociative phenomena" p. 64. Decker, Hannah S. (1984, October/1986). The lure of nonmaterialism in materialist Europe: Investigations of dissociative phenomena, 1880-1915. In Quen, Jacques M. (Ed.), Split minds/split brains (pp. 31-62). New York: New York University Press. (Based on symposium in Bear Mt., N.Y., by Section on the History of Psychiatry of Cornell University Medical Center) Janet's career paralleled an increased interest in dissociation, because he had contact with scientists studying spiritism, used hypnosis, and insisted on a scientific approach. He coined the words "subconscious" and "dissociation." As his sphere of influence declined, so did scientific interest in dissociation--especially multiple personality disorder. Scientific study of dissociation began with investigations into religious exorcism and spirit possession. For example, at the behest of Prince Max Joseph of Bavaria, Mesmer duplicated the exorcisms of Father Gassner (causing convulsions) using hypnosis. Following Mesmer, there were reports of multiple personalities (e.g. an "exchanged personality" in Germany, reported in 1791 by Eberhardt Gmelin). "Partly because of this growth of knowledge of multiple personality, a new model of the mind developed during the early 19th century: the mind was dual; there were conscious and unconscious mental states. Later, it was said that there was a dominant conscious personality with a group of underlying subpersonalities. Eventually it was declared that split fragments of personality could act autonomously" p. 37. The scientific study of these phenomena continued under the leadership of Frederic Myers of The Cambridge Society for Psychical Research. According to William James, Myers was the first to consider the phenomena of hallucination, hypnotism, automatism, double personality, and mediumship as connected parts of one whole subject. The Cambridge Society was involved in the transition from the use of automatic writing by mediums to its use for clinical purposes and experimental research in the 1880's and 1890's. Increasing numbers of multiple personalities reported in the literature in late 19th century led to increased interest in hypnosis and to the concept of dissociation. The author details the contributions of Janet, and then explains how interest declined in dissociation and in hypnosis due to the following: 1. Experimental psychologists in Germany (e.g. Wundt) refused to deal with anything that resembled the "unconscious," and neglected the point of view of the experiencing person. 2. Those few psychologists interested in the unconscious found projective tests (Rorschach, TAT) an easier avenue than hypnosis or automatic writing. 3. Many mediums were exposed as frauds, e.g. Flournoy's popular "From India to the Planet Mars". 4. Janet himself was very critical of parapsychology. 5. When Charcot died suddenly, it was discovered that some of his assistants had rehearsed the behavior of hypnotized patients. 6. Hypnotists' extravagant claims (e.g. past life age regression) led to a wave of reaction against them. 7. Questions were raised about the iatrogenic nature of multiple personality. 8. Conscientious hypnotists discovered drawbacks - not everyone could become good hypnotists (e.g. Freud) - not everyone could be hypnotized - some patients faked hypnosis - extreme sensitivity of hypnotized patients to the hypnotist's wishes led to biased results - hypnotist sometimes was conditioned to things in certain way by his first patient 9. Janet didn't have the personality of a leader, and he argued with the psychoanalysts about who should get credit for certain ideas 1980 Prince, Raymond (1980). Variations in psychotherapeutic procedures. In Triandis, Harry C.; Draguns, Juris G. (Ed.), Psychopathology (6, pp. 291-349). Boston: Allyn & Bacon. Prince points out that indigenous practitioners often capitalize on the organism's endogenous healing mechanisms which develop spontaneously when the individual is distressed. "healers around the world have learned to manipulate and build upon these endogenous mechanisms in a variety of ways to bring about resolution of life's problems and alleviation of suffering" (p. 292). Prince is referring here to altered states of consciousness such as dreams, trance states, dissociations, and mystical experiences of various sorts which are cultivated and elaborated by indigenous healers for therapeutic purposes. In general, Western type practitioners have denigrated these procedures...." (from Ann. Rev. of Psychol., 1982, pp 243-244). 1977 Sacerdote, Paul (1977). Application of hypnotically elicited mystical states to the treatment of physical and emotional pain. International Journal of Clinical and Experimental Hypnosis, 25, 309-324. Mystical states by-pass usual sensory perception and logical thinking. They often represent the ultimate goal of long apprenticeships in Eastern or Western monastic practices which stress self-discipline and meditation; or they correlate with sudden religious conversions. While interest has also been revived in mystical experiences stimulated by hallucinogens within the appropriate physical, intellectual, and emotional environment, less attention has been paid to those mystical experiences which appear spontaneously during hypnosis and Transcendental Meditation. The present author facilitates the unleashing of mystical experiences by using hypnotic approaches specifically aimed at altering space and time perceptions. Case presentations illustrate the methodologies for guiding receptive subjects to mystical states with the aim of relieving or correcting organic and functional painful syndromes unresponsive to other interventions. The probable biopsychological processes are discussed. 1963 King, C. D. (1963). The states of human consciousness. New York, NY: University Books. (Reviewed in American Journal of Clinical Hypnosis 7, 1964, 96.) From the book review by Stanley Abrams, AJCH: [The book] "is more philosophical and mystical than scientific. ... [and describes] the four states of consciousness: sleep, waking, awakeness, and objective consciousness. ... For man to attain completeness and normalcy he must achieve the state of awakeness. According to the author, however, only a relatively few have approached this stage of consciousness and his description of it is quite vague. When one has reached awakeness he is able to understand and actually perceive the world in a novel and unique manner. ... The final stage of awareness, objective consciousness, is characterized as the experiencing of cosmic phenomena in the same fashion as external reality is understood in the awakened state. The author indicated that this stage has not as yet been attained by man, but it does lie within his potential. ... The only treatment of hypnosis is the author's statement that the waking state is the same as the hypnotic state because suggestibility exists in both" (p. 96). N RESEARCH Nausea 2002 Edser, Stuart J (2002, March). Hypnotically-facilitated counter-conditioning of anticipatory nausea and vomiting associated with chemotherapy: A case study.. Australian Journal of Clinical Hypnotherapy and Hypnosis, 23 (1), 18-30. Presents an account of a cancer patient who suffers from severe anticipatory nausea and vomiting in the lead-up to chemotherapy treatment. The paper briefly contextualises the symptomatology of the presenting problem in the behavioural and hypnotic literature and recounts the rationale and methods that the writer used in assisting the patient to overcome the problem. Counter-conditioning was used to desensitise the patient to the aversive stimuli and hypnosis used to enhance this effect and to facilitate the final outcome. 1997 Faymonville, M. E.; Mambourg, P. H.; Joris, J.; Vrijens, B.; Fissette, J.; Albert, A.; Lamy, M. (1997). Psychological approaches during conscious sedation. Hypnosis versus stress reducing strategies: A prospective randomized study. Pain, 73 (3), 361-367. Stress reducing strategies are useful in patients undergoing surgery. Hypnosis is also known to alleviate acute and chronic pain. We therefore compared the effectiveness of these two psychological approaches for reducing perioperative discomfort during conscious sedation for plastic surgery. Sixty patients scheduled for elective plastic surgery under local anesthesia and intravenous sedation (midazolam and alfentanil upon request) were included in the study after providing informed consent. They were randomly allocated to either stress reducing strategies (control: CONT) or hypnosis (HYP) during the entire surgical procedure. Both techniques were performed by the same anesthesiologist (MEF). Patient behavior was noted during surgery by a psychologist, the patient noted anxiety, pain, perceived control before, during and after surgery, and postoperative nausea and vomiting (PONV). Patient satisfaction and surgical conditions were also recorded. Peri- and postoperative anxiety and pain were significantly lower in the HYP group. This reduction in anxiety and pain were achieved despite a significant reduction in intraoperative requirements for midazolam and alfentanil in the HYP group (alfentanil: 8.7 +/- 0.9 microg kg(-1)/h(-1) vs. 19.4 +/- 2 microg kg(-1)/h(-1), P < 0.001; midazolam: 0.04 +/- 0.003 mg kg(-1)/h(-1) vs. 0.09 +/- 0.01 mg kg(-1)/h(-1), P < 0.001). Patients in the HYP group reported an impression of more intraoperative control than those in the CONT group (P < 0.01). PONV were significantly reduced in the HYP group (6.5% vs. 30.8%, P < 0.001). Surgical conditions were better in the HYP group. Less signs of patient discomfort and pain were observed by the psychologist in the HYP group (P < 0.001). Vital signs were significantly more stable in the HYP group. Patient satisfaction score was significantly higher in the HYP group (P < 0.004). This study suggests that hypnosis provides better perioperative pain and anxiety relief, allows for significant reductions in alfentanil and midazolam requirements, and improves patient satisfaction and surgical conditions as compared with conventional stress reducing strategies support in patients receiving conscious sedation for plastic surgery. Abstract from National Library of Medicine, PubMed 1994 Brown, Gail W.; Riddell, Rodney; Summers, David; Coffman, Brent (1994, August). Use of hypnosis by practitioners in the school setting. [Paper] Presented at the annual meeting of the American Psychological Association, Los Angeles. Hypnosis is a therapeutic procedure that is appropriate for some school-age clients. Through the use of hypnosis that utilizes metaphors and imagery, children can be empowered to find unique solutions to their problems. Children enjoy the feeling of power and mastery that they have when able to perform hypnotic phenomena. They like to play magic and can be told that a finger or other body part will become numb. Because a major goal of hypnotherapy is to teach a child to be an active participant in his or her own behalf, the focus is on creating solutions and mastering the situation rather than enduring the problems. Four case studies demonstrate the utility of hypnosis in the treatment of phantom pain and nausea, sleep terror disorder, school phobia, and spider phobia. In each case, treatment goals were realized. Because the solutions were self- generated, the behavioral changes maintained over time and situation. Case #1: Hypnosis was used to help alleviate phantom limb pain and nausea during chemotherapy following amputation of the right leg at the knee due to cancer in a thirteen- year-old male. The client had indicated that he loved nature and enjoyed the mountains. The metaphor described a young tree that has just begun to grow small silvery leaves. The spring floods tear the limbs and branches from the stump. The deep roots and stump of the tree are all that remain. The tree is not the same as before the flood. Its roots are stronger, its base more sturdy compared to the branches and limbs. The young tree has withstood the catastrophe of the torrent of waters and is even stronger than before. To counter the nausea and vomiting associated with chemotherapy a switch mechanism metaphor was used. The client was adroit with computers and had no difficulty picturing a switch located in his brain which could "turn off" the nausea from chemotherapy. A room contained all the unpleasant feelings that were being experienced. In this room is a light of a particular color that represents all the unpleasant sensations. Press the key on the computer that controls the switch to turn off the colored light in that room. Suggestions for healing were also given. Your body has known for years how to heal. Visualize the battle between good and bad cells and the victory of the good cells. Case #2: Hypnosis was used to alleviate sleep terror disorder in a ten-year-old female. The onset of the subject's parasomnic symptomatology appeared to coincide with her starting kindergarten and her family's relocation shortly before. The initial treatment consisted of progressive relaxation, deep breathing, and the visual image of her "secret safe place." An induction utilizing a variety of images was presented. Hiking barefoot on a cool moss covered mountain trial, sitting in a an alpine meadow on a warm summer afternoon, and flying proved most effective in facilitating trance. The participant was told to "Visualize all your anxiety and tension as hard grey rocks. Pick up these rocks and place them in your pockets. Go to the front porch of your "secret safe place and on the porch is a "magic hefty bag." Place your hard grey rocks that contain all your anxiety and tension in the magic bag. Once in the bag, the rocks will no longer weight you down, you will be free of any feelings of stress or tension. Your bed is magic; it is covered with a special glue which will keep you in a reclining position until you are fully rested and ready to awaken." Case #3: Hypnosis was used in the treatment of school phobia in a nine-year-old male. The student experienced intense anxiety whenever separation from the primary caretaker occurred. The teacher stated that this boy experienced frequent absences and crying spells that were only relieved by phone calls to his mother or the presence of his mother next to him in class. In preparation for the intervention, the student was asked to draw a picture of how he felt inside during a panic attack. He drew a fire. He also said that only his mother could put that fire out. This information was utilized in creating a metaphor that described a house in a small town. "The mother had left, and a young boy was left alone. While at home, the boy looked out the window and saw several boys trying to burn a neighbor's yard! Acting quickly, he called the fire department, grabbed the fire extinguisher and unraveled the garden hose. He was able to extinguish the fire. The neighbors and friends were very happy and praised the boy's performance. When his mother heard the good news, she quickly returned home and held a celebration in his honor." Following the metaphor, hypnotherapy continued with suggestions about fire extinguishers that the subject could use to put out emotional fires. Case #4: Hypnosis was used in the treatment of spider phobia. Diagnosis of phobia was made in this eleven-year-old female when the fear or avoidance behavior was distressing. The child's strained facial expressions occurred even at the thought of seeing what she described as "a creepy, crawly creature with 8 legs." Preparatory to her first induction the participant was read the story of Charlotte's Web (White, 1980) to facilitate the imagery for future hypnotic work. In the following session systematic desensitization was accomplished using characters from the story of Charlotte's Web. During the third session the subject was age regressed to the first time she remembered seeing a spider. She recalled playing in the woods outside her family home on an island and seeing a large web stretched between two trees with a very large spider in the center of its web. She was then asked to remain at that place to look closely at that spider as it was most likely Charlotte or one of Charlotte's family. Upon closer investigation she saw not only Charlotte but "teeny-tiny babies." The event was reconstructed as a happy experience. The imagery provided by Charlotte's Web permitted the subject to fantasize her previous frightful experience and reframe spiders as cute little "teeny-tiny" babies with admirable human qualities. 1993 LaGrone, Randy G. (1993). Hypnobehavioral therapy to reduce gag and emesis with a 10-year-old pill swallower. American Journal of Clinical Hypnosis, 36, 132-136. A 10-year-old child experienced severe nausea and psychogenic vomiting that resulted in refusal to take oral medication in pill form. The youngster was treated with hypnobehavioral therapy consisting of mental imagery, relaxation, direct suggestion, adaptive self-talk, self-monitoring, and self-reinforcement. The child's parents were instructed to reinforce approximations of successful pill swallowing while withdrawing attention for avoidance, whining, gagging, and vomiting. A one-year follow-up revealed successful pill swallowing without significant distress. 1992 Levitan, Alexander A. (1992). The use of hypnosis with cancer patients. Psychiatric Medicine, 10, 119-131. Hypnosis has proven to be extremely valuable in the treatment of cancer patients. Specific applications include: establishing rapport between the patient and members of the medical health team; control of pain with self-regulation of pain perception through the use of glove anesthesia, time distortion, amnesia, transference of pain to a different body part, or dissociation of the painful part form the rest of the body; controlling symptoms, such as, nausea, anticipatory emesis, learned food aversions, etc.; psychotherapy for anxiety, depression, guilt, anger, hostility, frustration, isolation, and a diminished sense of self-esteem; visualization for health improvement; and, dealing with death anxiety and other related issues. Hypnosis has unique advantages for patients including improvement of self-esteem, involvement in self-care, return of locus of control, lack of unpleasant side effects, and continued efficacy despite continued use. Syrjala, Karen L.; Cummings, Claudette; Donaldson, Gary W. (1992). Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: A controlled clinical trial. Pain, 48, 137-146. Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post-chemotherapy nausea and emesis. In this study, 67 bone marrow transplant patients with hematological malignancies were randomly assigned to one of four groups prior to beginning transplantation conditioning: (1) hypnosis training (Hypnosis); (2) cognitive behavioral coping skills training (CB); (3) therapist contact control (TC); or (4) treatment as usual (TAU; no treatment control). Patients completed measures of physical functioning (Sickness Impact Profile; SIP) and psychological functioning (Brief Symptom Inventory; BSI), which were used as covariates in the analyses. Biodemographic variables included gender, age and a risk variable based on diagnosis and number of remissions or relapses. Patients in the Hypnosis, CB, and TC groups met with a clinical psychologist for two pre-transplant training sessions and ten in-hospital "booster" sessions during the course of transplantation. Forty-five patients completed the study and provided all covariate data, and 80% of the time series outcome data. Analyses of the principal study variables indicated that hypnosis was effective in reducing reported oral pain for patients undergoing marrow transplantation. Risk, SIP, and BSI pre-transplant were found to be effective predictors of inpatient physical symptoms. Nausea, emesis and opioid use did not differ significantly between the treatment groups. The cognitive behavioral intervention, as applied in this study, was not effective in reducing the symptoms measured. Hypnotizability was not measured in this study. The authors hypothesized that "(1) patients receiving hypnosis training would report the least pain, but the cognitive behavioral group would report less pain than the untreated group; and (2) both treatment groups would report less nausea and emesis than the control groups" (p. 138). The adult patients were undergoing their first marrow transplant, had survived at least 19 days post-transplant, and had participated in at least the first 8 of 10 possible inpatient sessions; five additional patients completed the study but had missing data. Each patient in the TC (therapist contact), CB (cognitive behavioral coping skills), and Hypnosis groups participated in two 90 minute training sessions with a psychologist, 2-4 days apart, on an outpatient basis. Once admitted to hospital, twice each week they participated in a total of ten 30-minute sessions designed to reinforce use of the interventions. The TAU (treatment as usual) group had no psychologist contact. For the TC control group, the psychologist simply talked with the patients about whatever was on their minds. The CB group received multiple interventions: training in relaxation (2 techniques- -progressive muscle relaxation and abbreviated autogenic relaxation) with tapes provided; cognitive restructuring (Turk et al., 1983) which included training in attention redirection and restructuring self-defeating cognitions; preparing coping self-statements or affirmations, by focusing attention on neutral or pleasant events or objects, or by occupying their attention through mental repetition of affirmations, songs or prayer; encouragement to think of negative events as time limited; provision of information, especially the beneficial vision of information, especially the beneficial effects of reducing physiological arousal and attention to pain and nausea; assistance in setting short-term progress-related goals for self-care such as exercise, caloric intake, and mouth care; exploration of the meaning of their illness and of bone marrow transplant. For the Hypnosis group, individually tailored Ericksonian inductions (Lankton & Lankton, 1983) with relaxation and multi-sensory imagery were taped and given to the patient to use in daily practice, in between sessions. The suggestions were directed at reducing pain, nausea, and the emotional reactions to those symptoms; there also were suggestions about health, well-being, self-control and enhanced coping capabilities. The results were analyzed by ANCOVA (except where non-parametric analysis was required with the opioid data). Due to gender differences in reported pain (men experiencing more) and the fact that the TAU group had an over-representation of men, the TAU group could not be used in the pain analyses. However, there were no gender differences in nausea reports, so that all four groups could be used for nausea outcome analyses. The Hypnosis group evidenced the lowest amount of post-transplant pain, and used (nonsignificantly) less opioids than the other groups. No significant treatment effects were observed for either nausea or emesis. In their discussion, the authors noted that "The hypnosis group's peak pain was lower and of a shorter duration than the other three groups. Opioid use closely followed the course of pain intensity. ... The gender effect may be characteristic of this particular sample [since it was unexpected]. "Nausea and emesis followed a less predictable course than pain. ... nausea fluctuated dramatically from day to day within treatment groups. As nausea moderated after completion of conditioning, the day to day fluctuations remained striking. This lack of symptom predictability may have contributed to the difficulty patients had in using the interventions effectively" (p. 143). "The lack of significant differences between treatment groups in opioid use indicates that lower pain report in the hypnosis group cannot be explained by increased opioid use. Results do not support the second hypothesis that both hypnosis and cognitive behavioral training would reduce chemotherapy or radiation-induced nausea and emesis "In MT patients, several factors may limit the impact of either cognitive behavioral training or hypnosis on nausea and emesis. First, MT patients receive higher doses of emetogenic agents than are given to most other cancer patients. Second, patients in this study had only two sessions in which to learn relaxation techniques; this may not have provided adequate training. Third, the most severe emetic challenge began immediately with the first dose of chemotherapy rather than having a gradual onset. This did not permit patients to master the techniques with milder symptoms before applying training to intense symptoms. Fourth, for all patients, psychological interventions were provided as adjuncts to medications rather than as substitutes for antiemetics or opioids. Both antiemetics and opioids have substantial cognitive side effects which, in high doses, may impact patients' abilities to implement interventions which are in essence cognitive. This combination of factors may have provided too severe a challenge to a newly learned skill. In contrast to nausea, oral pain developed over a number of days, permitting practice while symptoms were mild and before administration of opioids. "Results suggest that the imagery component of the hypnosis intervention was central to its efficacy. Not only was the cognitive behavioral intervention without imagery not effective in reducing the symptoms measured, but we found in clinical practice that patients intermittently began to refuse sessions with relaxation alone. Even hypnosis patients, when under the physical stresses of treatment, had shortened attention spans that necessitated briefer inductions, less time spent on relaxation, and more active, engaging imagery. "... Since, in clinical practice, imagery is frequently a component of cognitive behavioral treatment, these results would not generalize to those settings where imagery is combined with other skill training. "Several other possible limitations of the cognitive behavioral intervention merit consideration. Our experience indicates that the number of components used in the two training sessions were more than patients could competently learn in a short time. ... A further possibility is that maladaptive cognitions, which are the targets of cognitive restructuring, may be the exception rather than the rule among MT patients who tend to focus, with their families, on positive, hopeful attitudes toward their treatment" (pp. 144- 145). The authors note that the relatively small sample size may have provided inadequate statistical power to demonstrate effects with some of the outcome variables. Walker, Leslie G. (1992). Hypnosis with cancer patients. American Journal of Preventative Psychiatry & Neurology, 3, 42-49. Overviews the uses of hypnosis with cancer, for example to ameliorate side effects of treatment, help patients adjust to having cancer and its symptoms, reduce the distress caused by painful procedures, and to attempt to alter mechanisms of immunity with a view to improving prognosis. Studies in these areas are reviewed. 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. Zeltzer, Lonnie K.; Dolgin, M. J.; LeBaron, Samuel; LeBaron, C. (1991). A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics, 88, 34-42. Subjects were randomly assigned to hypnosis, nonhypnotic distraction/relaxation, or attention placebo control. children in the hypnosis group reported the greatest reduction in both anticipatory and postchemotherapy symptoms. Distraction/relaxation kept symptoms from getting worse, but they did not get better, and the control children's symptoms became much worse.